reglab/statecodes huggingface dataset:
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3418 - SERVICE AGREEMENTS AND SUBSCRIBER’S CONTRACTS MUST PROVIDE SUBSTANTIAL SERVICE BENEFITS.

41-3418. SERVICE AGREEMENTS AND SUBSCRIBER’S CONTRACTS MUST PROVIDE SUBSTANTIAL SERVICE BENEFITS. (1) Service agreements and subscriber’s contracts entered into or issued by a service corporation on a service basis shall provide for health care services of a substantial and broad character to be rendered to subscribers on a service basis by participant licensees or participant hospitals, as the case may be and, as to participant licensees, within the scope of health care services which may otherwise lawfully be provided by the respective categories of participant licensees under the laws of Idaho.
(2) The director may, after a hearing thereon, by rules and regulations establish certain reasonable minimums of service benefits to be so provided consistent with subsection (1) above.
(3) If any group for whom a master contract is to be issued desires to enter into such contract providing either greater or lesser benefits either by way of indemnity or service to the members of such group than the issuing service corporation usually issues to similar groups, the service corporation may enter into such contract, providing, however, (a) that the request of such deviation from usual benefits and/or rates be in writing signed by the proper person representing such group setting forth the benefits desired and (b) that the master contract shall, as clearly as possible, describe in detail the benefits and rates charged, and (c) that the provisions of section 41-3417(5), Idaho Code, shall apply to such transaction. Should such group desire benefits less than those that may have been established under subsection (2) of this section a true copy of the executed request therefor and the master contract issued shall be filed with the director.
History:
[41-3418, added 1961, ch. 330, sec. 776, p. 645; am. 1967, ch. 399, sec. 10, p. 1194; am. 1971, ch. 252, sec. 12, p. 1008.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3419 - FILING AND APPROVAL OF AGREEMENTS AND CONTRACTS.

41-3419. FILING AND APPROVAL OF AGREEMENTS AND CONTRACTS. (1) No service corporation shall issue or use any basic form of service agreement or subscriber’s contract, or application, identification, supplement, or endorsement to be connected with any such agreement or contract, until such form has been filed with the director and approved by him. This provision shall not apply to agreements, contracts, applications, identification, supplements, endorsements or other forms of unique character designed for and used with relation to a particular set of circumstances.
(2) The director shall approve any such form unless disapproved by him on one or more of the grounds set forth in subsection (3) below. If not so approved or disapproved by order transmitted to the filing service corporation within sixty (60) days after the date filed, the form shall be deemed to have been approved, provided, however, that the director may extend by not more than an additional sixty (60) days the period within which he may so affirmatively approve or disapprove any such form, by giving notice to the service corporation of such extension before expiration of the initial sixty (60) day period. At the expiration of any such period as so extended, and in the absence of such prior affirmative approval or disapproval, any such form shall be deemed approved. The director may at any time, after notice and for cause shown, withdraw any such approval.
(3) The director shall disapprove any proposed form referred to in subsection (1) above which:
(a) Is in any respect not in compliance with or in violation of law; or
(b) Contains any inconsistent, ambiguous, or misleading clauses, or exceptions and conditions which deceptively affect the services or benefits purported to be provided for in the general terms of the agreement or contract; or
(c) Has any indication of its provisions which is misleading; or
(d) Is printed or otherwise reproduced in such manner as to render any provision of the form substantially illegible.
(4) In any order of disapproval the director shall state the particulars of the grounds for disapproval.
History:
[41-3419, added 1961, ch. 330, sec. 777, p. 645; am. 1989, ch. 141, sec. 1, p. 331.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3420 - CHARGES AND RATES.

41-3420. CHARGES AND RATES. (1) Subscription rates, fees, and payments to be charged by a service corporation to or on account of its subscribers shall not be excessive, inadequate, or unfairly discriminatory; and rates of payments to be made to participant physicians, participant hospitals, and participant pharmacists for services rendered under a subscriber’s contract, shall be fair and reasonable.
(2) The service corporation shall, before use, file with the director a schedule of subscription rates, fees, or payments of any kind to be charged subscribers; and shall likewise so file before use every proposed change or modification in such rates, fees, or payments.
(3) If the subscriber’s contracts to be issued by the service corporation provide for indemnity benefits, where permitted under this chapter, the service corporation shall include in the rate, fee, or payment required of the subscriber an adequate additional charge for such indemnity benefit, and shall separately set forth the amount of such additional charge in the schedule filed with the director.
History:
[41-3420, added 1961, ch. 330, sec. 778, p. 645; am. 1967, ch. 399, sec. 11, p. 1194.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3421 - RESERVES.

41-3421. RESERVES. (1) In addition to the surplus fund provided for in section 41-3422, every service corporation shall establish and maintain unimpaired reserves as follows:
(a) Due obligations. A reserve in an amount not less than all legal obligations of the corporation, other than claims originating under subscriber’s contracts, due but unpaid;
(b) Incurred losses. A reserve equal to not less than the amount necessary by reasonable estimate to pay all claims incurred under subscriber’s contracts but currently unpaid, and including a reasonable additional amount to cover claims incurred but not reported to the corporation at the time of determination of the corporation’s financial condition; but subject, as to amounts payable to participant physicians, participant hospitals, or participant pharmacists, to the right of the service corporation to prorate such amounts in accordance with the provisions of the service agreement;
(c) Unearned indemnity charges. A reserve equal to fifty percent of all sums charged and received by the corporation during the calendar period covered by the financial statement, on account of indemnity benefits provided in subscriber’s contracts for terms for which premium was last paid and unexpired at the date of the financial statement; and
(d) Deferred service benefits. A reserve in an amount reasonably adequate to offset the additional cost thereafter to be incurred on account of deferred maternity benefits and similar deferred service benefits, such reserve to be set aside out of charges currently received on account of subscriber’s contracts providing for such deferred benefits.
(2) The reserves required under subsection (1) above, shall constitute a liability of the corporation in any determination of its financial condition.
History:
[41-3421, added 1961, ch. 330, sec. 779, p. 645; am. 1967, ch. 399, sec. 12, p. 1194.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3422 - SURPLUS FUND.

41-3422. SURPLUS FUND. (1) Every service corporation shall set aside into a "surplus fund" an amount of money equal to not less than two per cent (2%) of all sums hereafter received by it on account of subscriber’s contracts, until such surplus fund amounts to not less than fifty thousand dollars ($50,000) if a professional service corporation or hospital service corporation or one hundred thousand dollars ($100,000) if a combination professional-hospital service corporation.
(2) After such minimum surplus fund is established the service corporation may in like manner increase it to an amount not to exceed the total gross collections from subscribers during the seven (7) months next preceding.
(3) That portion of the surplus fund referred to in subsection (1) above, may be used by the service corporation, by express appropriation therefrom by action of its board of directors, solely if necessary to pay the additional health care costs and expenses under its contracts, resulting from disease, epidemic or catastrophic occurrences in which numerous persons were injured in the same such occurrence.
(4) If at any time depleted below the minimum amount required under subsection (1) above, the service corporation shall replenish the fund by a resumption or continuance of allocations thereto from subscribers’ payments, as provided for original accumulation of the fund under subsection (1), or by such other reasonable means as may be approved by the director.
History:
[41-3422, added 1961, ch. 330, sec. 780, p. 645; am. 1967, ch. 399, sec. 13, p. 1194; am. 1971, ch. 252, sec. 13, p. 1008.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3423 - INVESTMENTS.

41-3423. INVESTMENTS. The investable funds of a service corporation may be invested in securities and other investments permitted by and pursuant to the provisions of chapter 7, title 41, Idaho Code, and for the purposes of chapter 7, title 41, Idaho Code, a service corporation shall be deemed to be an "insurer."
History:
[41-3423, added 1961, ch. 330, sec. 781, p. 645; am. 1980, ch. 215, sec. 1, p. 487; am. 1984, ch. 98, sec. 1, p. 226; am. 1997, ch. 369, sec. 1, p. 1175; am. 2021, ch. 42, sec. 5, p. 126.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3424 - RECORDS AND ACCOUNTS.

41-3424. RECORDS AND ACCOUNTS. (1) Every service corporation shall establish and maintain complete and accurate records and accounts covering its transactions and affairs, in accordance with common and accepted principles and practices of insurance accounting and recordkeeping as applied to the business of the corporation.
(2) Among other records, the corporation shall establish a separate record of each claim received for benefits under a subscriber’s contract, whether such claim is for service or for indemnity. Such claim record shall contain such information as is reasonably necessary for determination of:
(a) The identity of the claimant;
(b) The nature of the claim;
(c) The probable amount to be paid by the corporation on account of the claim;
(d) Amounts actually paid by the corporation on account of the claim.
History:
[41-3424, added 1961, ch. 330, sec. 782, p. 645.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3425 - ANNUAL STATEMENT.

41-3425. ANNUAL STATEMENT. (1) Each service corporation shall annually on or before the first day of March file with the director a statement of its financial condition as at the December 31 next preceding. The statement shall be in form, and provide for such information relative to the corporation’s affairs, as the director shall prescribe consistent with this chapter. The statement shall be verified under oath by at least two (2) of the corporation’s principal administrative officers.
(2) At time of filing the statement, the corporation shall pay the fee therefor as specified in section 41-3433 (fee schedule).
History:
[41-3425, added 1961, ch. 330, sec. 783, p. 645.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3426 - EXAMINATION.

41-3426. EXAMINATION. Every service corporation shall be subject to examination by the director, with the same rights and powers and in the same manner as is provided in this code for the examination of insurers; and for the purposes thereof the following sections of this code shall, to the extent so applicable, apply as to such a corporation, which, for the purpose of such application shall be deemed to be an "insurer":
(1) Section 41-219 (examination of insurers);
(2) Section 41-220 (examination of agents, managers, adjusters, promoters);
(3) Section 41-221 (place of examination);
(4) Section 41-223 (conduct of examination–access to records–correction of accounts–removal of records);
(5) Section 41-224 (examination–appraisal of assets);
(6) Section 41-225 (obstruction of examination–penalty);
(7) Section 41-226 (examiners–qualifications);
(8) Section 41-227 (examination report);
(9) Section 41-228 (examination expense);
(10) Section 41-229 (witnesses and evidence); and
(11) Section 41-230 (testimony compelled–immunity from prosecution).
History:
[41-3426, added 1961, ch. 330, sec. 784, p. 645.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3427 - TAXATION AND ANNUAL REPORT.

41-3427. TAXATION AND ANNUAL REPORT. (1) Each service corporation shall annually on or before the first day of March, file with the director a report in addition to the statement required under section 41-3425, Idaho Code, (on forms as approved by the director) under oath, showing the number of subscribers’ contracts, as defined under section 41-3403(6), Idaho Code, in effect during the preceding year. A tax is hereby imposed upon each such subscriber’s contract, at the rate of four cents ($.04) per subscriber’s contract, per month, such amount to be computed each month. The tax imposed hereby shall be due and payable by each service corporation to the director annually on or before the first day of March of the succeeding year.
The tax imposed hereby shall be in lieu of and in place of the premium tax provided in section 41-402, Idaho Code, and except as to the tax imposed hereby, and as to the fees provided for in section 41-3433, Idaho Code, the subscription income, funds and assets of every service corporation are exempt from all state, county and municipal taxes, other than payroll taxes and taxes on real estate and office furniture and equipment.
The director shall transmit and account for all taxes received by him hereunder as provided in section 41-3433, Idaho Code.
(2) Any service corporation failing to render the annual statement or pay the fee required by section 41-3425, Idaho Code, or to render the report or pay the tax required under subsection (1) of this section on or before the date due or within any extension of time thereof, not to exceed thirty (30) days, which the director for good cause may have granted, shall be liable to a fine of twenty-five dollars ($25.00) for each additional day of delinquency; and the taxes shall be collected by distraint and recovered by an action to be instituted by the attorney general in the name of the state in any court of competent jurisdiction. The director shall suspend or revoke the certificate of authority of the delinquent service corporation until the statement is filed and the taxes and fine, if any, are fully paid.
History:
[41-3427, added 1961, ch. 330, sec. 785, p. 645; am. 1973, ch. 283, sec. 1, p. 599; am. 1978, ch. 9, sec. 1, p. 16; am. 1982, ch. 252, sec. 1, p. 643.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3428 - JOINT OPERATIONS.

41-3428. JOINT OPERATIONS. (1) A hospital service corporation and a professional service corporation may operate under joint management for the purpose of reducing operating costs.
(2) Separate records and accounts shall be kept for each such corporation, and the funds and assets of one shall not be commingled with those of the other; except that funds received from a joint billing to subscribers may be deposited in a common bank account for purposes of collection, if the records of each corporation at all times show the amount of such funds belonging to each and if final distribution of the funds is made to each corporation within thirty (30) days from receipt of payment of such joint billing.
History:
[41-3428, added 1961, ch. 330, sec. 786, p. 645; am. 1971, ch. 252, sec. 14, p. 1008.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3429 - COMBINED CORPORATION.

41-3429. COMBINED CORPORATION. (1) A service corporation may be formed as, or may by suitable amendment of its articles of incorporation become, a combined professional service and hospital service corporation. As to its professional services each such combined service corporation shall fully comply with those provisions of this chapter especially applicable as to professional service corporations; and as to its hospital services the corporation shall fully comply with those provisions of this chapter especially applicable as to hospital service corporations.
(2) Subject to subsection (1) above, nothing in this chapter shall be deemed to prohibit such a combined service corporation from issuing subscriber’s contracts providing for both professional services and hospital services.
History:
[41-3429, added 1961, ch. 330, sec. 787, p. 645; am. 1971, ch. 252, sec. 15, p. 1008.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3430 - CONTRACTS COVERING WORKMEN’S COMPENSATION RISKS.

41-3430. CONTRACTS COVERING WORKMEN’S COMPENSATION RISKS. (1) No service corporation shall issue any subscriber’s contract covering, or otherwise insure, any industrial injury or illness with respect to which health care service or indemnity benefits are provided by either federal or state law, or covered under the provisions of the Idaho workmen’s compensation act.
(2) The restriction set forth in subsection (1) above, shall not be construed as prohibiting hospitals or licensees, either as individuals, partnerships, or as a separate corporation, from contracting directly with employers, in their own right, with respect to such health care services as are provided for in the Idaho workmen’s compensation act.
(3) A service corporation may act as agent for such hospitals or licensees as may so contract, as referred to in subsection (2) above, for the purpose and to the extent only of the collection of moneys from the employers, the payment of claims therefrom to the hospitals or licensees, the keeping of such records as may be necessarily related thereto, and the rendering of reports to the hospitals or licensees and the Idaho industrial commission. The service corporation shall charge and receive payment of reasonable compensation for such services.
(4) The service corporation acting as agent as provided in subsection (3) above, shall not at any time be liable as to any claim arising against any employer, except to disburse on behalf of the contracting hospitals or licensees responsible as to such liability, such sums, out of the funds available, as may be awarded or payable under the workmen’s compensation act. The service corporation shall keep all such funds in separate accounts in the names of the respective hospitals or licensees, and shall not commingle them with the funds of the service corporation.
History:
[41-3430, added 1961, ch. 330, sec. 788, p. 645; am. 1971, ch. 252, sec. 16, p. 1008.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3431 - ANNUAL ADJUSTMENT OF SERVICE PAYMENTS — DISPOSITION OF EXCESS FUNDS.

41-3431. ANNUAL ADJUSTMENT OF SERVICE PAYMENTS — DISPOSITION OF EXCESS FUNDS. (1) Annually on or before March 1 every service corporation shall make a special accounting, at which time any prorated settlements for any bills submitted by participant licensees or hospitals, for services rendered during the preceding calendar year shall be adjusted, and any deficits thereon made up on a uniform basis as to all such participants to the extent of funds available therefor.
(2) Any funds of the service corporation remaining after such annual accounting, and after adequate provision for all its liabilities and reserves, and for the surplus fund required under section 41-3422, Idaho Code, may be used by the corporation, upon express authorization by its board of directors, for any of the following purposes:
(a) To liquidate on a uniform and prorata basis any charges for services by participant licensees or participant hospitals not paid in full upon the settlement of bills in previous years;
(b) To pay off any part or the whole of any outstanding contribution of working capital to the corporation, any such payment to be prorated on a uniform basis among all such outstanding contributions; or
(c) To reduce the rates thereafter to be charged subscribers, or to expand the services or benefits thereafter to be provided under subscription contracts.
History:
[41-3431, added 1961, ch. 330, sec. 789, p. 645; am. 1967, ch. 399, sec. 14, p. 1194; am. 1971, ch. 252, sec. 17, p. 1008.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3432 - FIDELITY BOND.

41-3432. FIDELITY BOND. Every service corporation shall procure and maintain in force a fidelity bond or bonds, with authorized corporate surety, covering every officer or employee entrusted with the handling of its funds, in such amount, but not less than five thousand dollars ($5,000), as may be fixed by its board of directors.
History:
[41-3432, added 1961, ch. 330, sec. 790, p. 645.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3433 - SERVICE CORPORATION FEES.

41-3433. SERVICE CORPORATION FEES. (1) Every service corporation shall pay to the director fees in advance as provided for by regulation.
(2) The director shall transmit and account for all fees received by him hereunder, as provided in section 41-406, Idaho Code[.]
History:
[41-3433, added 1984, ch. 23, sec. 7, p. 41.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3434 - OTHER PROVISIONS APPLICABLE.

41-3434. OTHER PROVISIONS APPLICABLE. In addition to those contained or referred to heretofore in this chapter, the following chapters and provisions of title 41, Idaho Code, shall also apply with respect to service corporations to the extent applicable and not in conflict with the express provisions of this chapter and the reasonable implications of such express provisions and, for the purposes of such application, such corporations shall be deemed to be mutual "insurers":
(1) Chapter 1, Idaho Code (scope of insurance code);
(2) Chapter 2, Idaho Code (the department of insurance);
(3) Section 41-308(2), Idaho Code (general eligibility for certificate of authority — competence, affiliations of management);
(4) Sections 41-345 through 41-347, Idaho Code (disclosure of material transactions);
(5) Section 41-601, Idaho Code ("assets" defined);
(6) Section 41-603, Idaho Code (assets not allowed);
(7) Section 41-604, Idaho Code (disallowance of "wash" transactions);
(8) Section 41-613, Idaho Code (valuation of bonds);
(9) Section 41-731, Idaho Code (prohibited investments and investment underwriting);
(10) Chapter 13, Idaho Code (trade practices and frauds);
(11) Section 41-2840, Idaho Code (vouchers for expenditures);
(12) Section 41-2841, Idaho Code (borrowed surplus);
(13) Sections 41-2857, Idaho Code (mergers and consolidations of mutual insurers), 41-2858, Idaho Code (bulk reinsurance, mutual insurers), and 41-2859, Idaho Code (mutual member’s share of assets on liquidation);
(14) Chapter 33, Idaho Code (supervision, rehabilitation and liquidation);
(15) Sections 799 through 809, chapter 330, laws of 1961 (transitory provisions);
(16) Section 41-2106(3), Idaho Code (health history application for disability insurance);
(17) Section 41-2141, Idaho Code (coordination of benefits — coordination with social security benefits);
(18) Section 41-1839, Idaho Code (attorney’s fees);
(19) Chapter 46, Idaho Code (long-term care insurance act);
(20) Section 41-1844, Idaho Code (prescription drug benefit restrictions prohibited);
(21) Section 41-2216, Idaho Code (coordination of benefits — coordination with social security benefits);
(22) Chapter 54, Idaho Code (risk-based capital);
(23) Chapter 64, Idaho Code (corporate governance); and
(24) Chapter 63, Idaho Code (own risk and solvency assessment).
History:
[41-3434, added 1961, ch. 330, sec. 792, p. 645; am. 1976, ch. 135, sec. 2, p. 508; am. 1978, ch. 10, sec. 4, p. 21; am. 1988, ch. 8, sec. 1, p. 10; am. 1990, ch. 285, sec. 4, p. 802; am. 1991, ch. 123, sec. 2, p. 268; am. 1994, ch. 404, sec. 3, p. 1271; am. 1995, ch. 68, sec. 4, p. 177; am. 1997, ch. 319, sec. 3, p. 943; am. 2003, ch. 304, sec. 13, p. 838; am. 2014, ch. 319, sec. 8, p. 792; am. 2017, ch. 75, sec. 2, p. 192; am. 2017, ch. 77, sec. 2, p. 213; am. 2018, ch. 169, sec. 11, p. 359.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3435 - PRODUCER LICENSING.

41-3435. PRODUCER LICENSING. (1) Producers or persons representing a service corporation in the solicitation and negotiation of subscriber’s contracts shall qualify for and be licensed as producers of the service corporation in the same manner and in compliance with the same applicable qualifications, licensing procedures and fees as apply under this code as to producers of disability insurers except that:
(a) Any such person who holds a valid license as a producer for a disability insurer issued under chapter 10, title 41, Idaho Code, may be appointed as the agent for such service corporation without further examination or other compliance with chapter 10, title 41, Idaho Code; and
(b) Nothing in this section shall prevent such person from being licensed as a producer and appointed as an agent for a life insurer or insurers under chapter 10, title 41, Idaho Code, and concurrently being licensed as a producer for such a service corporation.
(2) Service corporations may file appointment of agents or representatives in the same manner as provided in section 41-1018, Idaho Code, with respect to producers of insurers.
(3) The exceptions to license requirements set forth in chapter 10, title 41, Idaho Code, shall also apply as to service corporations.
History:
[I.C., sec. 41-3435, as added by 1969, ch. 214, sec. 71, p. 625; am. 1977. ch. 142, sec. 14, p. 314; am. 2001, ch. 296, sec. 7, p. 1064.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3436 - DEPENDENT’S COVERAGE — DEPENDENT’S TERMINATION OF COVERAGE, DISABILITY AND DEPENDENCY PROOF AND APPLICATION.

41-3436. DEPENDENT’S COVERAGE — DEPENDENT’S TERMINATION OF COVERAGE, DISABILITY AND DEPENDENCY PROOF AND APPLICATION. (1) Any new or renewing subscriber contract delivered or issued for delivery in this state shall provide that an unmarried child under the age of twenty-five (25) years and who receives more than one-half (1/2) of his financial support from the parent shall be permitted to remain on the parent’s or parents’ contract. Further, any unmarried child of any age who is medically certified as disabled and financially dependent upon the parent is permitted to remain on the parent’s or parents’ contract.
(2) There shall be a provision that a subscriber’s contract delivered or issued for delivery in this state more than one hundred twenty (120) days after the effective date of this act under which coverage of a dependent of a subscriber terminates at a specified age shall, with respect to an unmarried child who is incapable of self-sustaining employment by reason of intellectual disability or physical disability and who became so incapable prior to attainment of the limiting age and who is chiefly dependent upon such member for support and maintenance, not to terminate while the contract remains in force and the dependent remains in such condition, if the member has within thirty-one (31) days of such dependent’s attainment of the limiting age submitted proof of such dependent’s incapacity as described herein. The service corporation may require at reasonable intervals during the two (2) years following the child’s attainment of the limiting age subsequent proof of the child’s disability and dependency. After the two (2) year period, such subsequent proof may not be required more than once each year.
History:
[41-3436, added 1972, ch. 348, sec. 4, p. 1030; am. 2008, ch. 296, sec. 3, p. 828; am. 2009, ch. 125, sec. 4, p. 394; am. 2010, ch. 235, sec. 34, p. 569.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3437 - REQUIRED PROVISIONS — INFANTS.

41-3437. REQUIRED PROVISIONS — INFANTS. (a) A subscriber’s contract, delivered or issued for delivery in this state which provides coverage for injury or sickness for newborn dependent children of subscribers or other members of the covered group, shall provide coverage for such newborn children, including adopted newborn children that are placed with the adoptive subscriber or other member of the covered group within sixty (60) days of the adopted child’s date of birth, from and after the moment of birth. Coverage under the contract for an adopted newborn child placed with the adoptive subscriber or other member of the covered group more than sixty (60) days after the birth of the adopted child shall be from and after the date the child is so placed. Coverage provided in accord with this section shall include, but not be limited to, coverage for congenital anomalies. For the purposes of this section, "child" means an individual who has not attained age eighteen (18) years as of the date of the adoption or placement for adoption. For the purposes of this section, "placed" shall mean physical placement in the care of the adoptive subscriber or other member of the covered group, or in those circumstances in which such physical placement is prevented due to the medical needs of the child requiring placement in a medical facility, it shall mean when the adoptive subscriber or other member of the covered group signs an agreement for adoption of such child and signs an agreement assuming financial responsibility for such child. Prior to legal finalization of adoption, the coverage required under the provisions of this subsection as to a child placed for adoption with a subscriber or other member of the covered group continues in the same manner as it would with respect to a naturally born child of the subscriber or other member of the covered group until the first to occur of the following events:
(1) Date the child is removed permanently from that placement and the legal obligation terminates; or
(2) The date the subscriber or other member of the covered group rescinds, in writing, the agreement of adoption or agreement assuming financial responsibility.
(b) A service corporation shall not restrict coverage under a subscriber’s contract of any dependent child adopted by a participant or beneficiary, or placed with a participant or beneficiary for adoption, solely on the basis of a preexisting condition of the child at the time the child would otherwise become eligible for coverage under the plan, if the adoption or placement for adoption occurs while the participant or beneficiary is eligible for coverage under the plan.
History:
[I.C., sec. 41-3437, as added by 1974, ch. 66, sec. 4, p. 1146; am. 1993, ch. 305, sec. 3, p. 1132; am. 1994, ch. 365, sec. 6, p. 1156.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3438 - COMPLICATIONS OF PREGNANCY.

41-3438. COMPLICATIONS OF PREGNANCY. No hospital or medical service corporation contract which provides maternity benefits for a person covered continuously from conception shall be issued, amended, delivered, or renewed in this state on or after January 1, 1977, if it contains any exclusion, reduction, or other limitations as to coverage, deductibles, or coinsurance provisions as to involuntary complications of pregnancy, unless such provisions apply generally to all benefits paid under the contract. If a fixed amount is specified in such contract for surgery, the fixed amounts for surgical procedures involving involuntary complications of pregnancy shall be commensurate with other fixed amounts payable for procedures of comparable difficulty and severity. In a case where a fixed amount is payable for maternity benefits, involuntary complications of pregnancy shall be deemed an illness and entitled to benefits otherwise provided by the contract. Where the contract contains a maternity deductible, the maternity deductible shall apply only to expenses resulting from normal delivery and cesarean section delivery; however, expenses for cesarean section delivery in excess of the deductible shall be treated as expenses for any other illness under the contract. This section shall apply to all hospital or medical service corporation contracts except any group hospital or medical service corporation contract made subject to an applicable collective-bargaining agreement in effect before January 1, 1977.
For purposes of this section, involuntary complications of pregnancy shall include, but not be limited to, puerperal infection, eclampsia, cesarean section delivery, ectopic pregnancy, and toxemia.
All contracts subject to this section and issued, amended, delivered, or renewed in this state on or after January 1, 1977, shall be construed to be in compliance with this section, and any provision in any such contract which is in conflict with this section shall be of no force or effect.
History:
[41-3438, added 1976, ch. 113, sec. 3, p. 445.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3439 - LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS.

41-3439. LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS. All individual nongroup or subscriber’s policies, contracts, plans or certificates delivered, issued for delivery or renewed in this state after the effective date of this section shall exclude coverage for elective abortions except. Such exclusion may be waived by endorsement and the payment of a premium therefor. Availability of such coverage shall be at the option of the service corporation. For purposes of this section, an "elective abortion" means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.
History:
[41-3439, added 1983, ch. 94, sec. 3, p. 207.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3440 - SERVICES PROVIDED BY GOVERNMENTAL ENTITIES.

41-3440. SERVICES PROVIDED BY GOVERNMENTAL ENTITIES. (1) From and after July 1, 1990, no hospital or professional service corporation subscriber’s contract shall be issued in Idaho which excludes from coverage services rendered the subscriber while a resident in an Idaho state institution, provided the services to the subscriber would be covered by the contract if rendered to him outside an Idaho state institution.
(2) From and after July 1, 1990, no hospital or professional service corporation subscriber’s contract may contain any provision denying or reducing benefits otherwise provided under the policy for the reason that the person insured is receiving health or mental health care or developmental services provided by the department of health and welfare, whether or not the department of health and welfare bases its charges for such services on the recipient’s ability to pay. Provided, nothing in this section shall prevent the issuance of a contract which excludes or reduces benefits where the charge level or amount of the charge levied by a governmental entity for such services would vary or be affected in any way by the existence of coverage under a hospital or professional service corporation subscriber contract.
History:
[41-3440, added 1990, ch. 300, sec. 3, p. 829.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3441 - MAMMOGRAPHY COVERAGE.

41-3441. MAMMOGRAPHY COVERAGE. (1) From and after July 1, 1992, all group subscriber’s contracts which provide coverage for the surgical procedure known as a mastectomy which are delivered, issued for delivery, continued or renewed in this state shall provide minimum mammography examination or equivalent examination coverage. Such coverage shall include at least the following benefits:
(a) One (1) baseline mammogram for any woman who is thirty-five (35) through thirty-nine (39) years of age.
(b) A mammogram every two (2) years for any woman who is forty (40) through forty-nine (49) years of age, or more frequently if recommended by the woman’s physician.
(c) A mammogram every year for any woman who is fifty (50) years of age or older.
(d) A mammogram for any woman desiring a mammogram for medical cause.
Such coverage shall not exceed the cost of the examination.
(2) As used in this section, "mastectomy" means the removal of all or part of the breast for medically necessary reasons as determined by a licensed physician.
(3) Nothing in this section shall apply to specified accident, specified disease, hospital indemnity, medicare supplement, long-term care or other limited benefit health insurance policies.
History:
[41-3441, added 1992, ch. 132, sec. 3, p. 415; am. 1993, ch. 113, sec. 3, p. 289.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS › Section 41-3443 - BEST PRICE — MOST FAVORED NATIONS CLAUSE PROHIBITED.

41-3443. BEST PRICE — MOST FAVORED NATIONS CLAUSE PROHIBITED. No service corporation may require, as an element of any service agreement, that any licensee or hospital agree:
(1) To the unnegotiated adjustment by the service corporation of the licensee’s or hospital’s contractual reimbursement rate to equal the lowest reimbursement rate the licensee or hospital has agreed to charge any other payor;
(2) To a requirement that the licensee or hospital adjust, or enter into negotiations to adjust, their charges to the service corporation if the licensee or hospital agrees to charge another payor lower rates; or
(3) To a requirement that the licensee or hospital disclose his, her or its contractual reimbursement rates from other payors.
History:
[41-3443, added 1998, ch. 422, sec. 3, p. 1334.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3603 - APPLICATION OF ACT.

41-3603. APPLICATION OF ACT. This act shall apply to all kinds of direct insurance, but shall not be applicable to the following:
(1) Life, annuity, health or disability insurance;
(2) Residual value, mortgage guaranty, financial guaranty or other forms of insurance offering protection against investment risks;
(3) Fidelity or surety bonds, or any other bonding obligations;
(4) Credit insurance, vendors’ single interest insurance, or collateral protection insurance or any similar insurance protecting the interests of a creditor arising out of a creditor-debtor transaction;
(5) Insurance of warranties or service contracts, including insurance that provides for the repair, replacement or service of goods or property, indemnification for repair, replacement or service for the operational or structural failure of the goods or property due to a defect in materials, workmanship, or normal wear and tear, or provides reimbursement for the liability incurred by the issuer of agreements or service contracts that provide such benefits;
(6) Title insurance;
(7) Ocean marine insurance;
(8) Any transaction or combination of transactions between a person (including affiliates of such person) and an insurer (including affiliates of such insurer) which involves the transfer of investment or credit risk unaccompanied by transfer of insurance risk;
(9) Any insurance provided by or guaranteed by government including, but not limited to the state insurance fund, created pursuant to chapter 9, title 72, Idaho Code, and the Idaho petroleum clean water trust fund, created pursuant to chapter 49, title 41, Idaho Code;
(10) Any insurance provided by or through any reciprocal insurer which exclusively insures members who are governmental entities;
(11) Insurance written on a retroactive basis to cover known losses for which a claim has already been made and the claim is known to the insurer at the time the insurance is bound; or
(12) Domestic reciprocal insurers with fewer than seven (7) subscribers which insure only worker’s compensation risks and which only issue fully assessable policies.
History:
[41-3603, added 1970, ch. 152, sec. 3, p. 462; am. 1991, ch. 121, sec. 1, p. 264; am. 1991, ch. 252, sec. 2, p. 620; am. 1992, ch. 316, sec. 1, p. 942; am. 1993, ch. 279, sec. 4, p. 947; am. 1997, ch. 109, sec. 2, p. 256.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3606 - INSURANCE GUARANTY ASSOCIATION — INSURERS REQUIRED TO BE MEMBERS — PURPOSES.

41-3606. INSURANCE GUARANTY ASSOCIATION — INSURERS REQUIRED TO BE MEMBERS — PURPOSES. There is created a nonprofit unincorporated legal entity to be known as the Idaho insurance guaranty association. All insurers defined as member insurers shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under a plan of operation established and approved under section 41-3609, Idaho Code, and shall exercise its powers through a board of directors established under section 41-3607, Idaho Code. For purposes of administration and assessment, the association shall maintain one (1) account. Any accounts in existence on June 30, 2001, shall be consolidated into one (1) account.
History:
[41-3606, added 1970, ch. 152, sec. 6, p. 462; am. 2001, ch. 155, sec. 2, p. 560.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3607 - BOARD OF DIRECTORS — NUMBER — ELECTION OR APPOINTMENT — REIMBURSEMENT FOR EXPENSES.

41-3607. BOARD OF DIRECTORS — NUMBER — ELECTION OR APPOINTMENT — REIMBURSEMENT FOR EXPENSES. (1) The board of directors of the association shall consist of not less than five (5) nor more than nine (9) persons serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the director. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining board members subject to the approval of the director. If no members are selected within sixty (60) days after May 6, 1970, the director may appoint the initial members of the board of directors.
(2) In approving selections to the board, the director shall consider among other things whether all member insurers are fairly represented.
(3) Members of the board may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors.
History:
[41-3607, added 1970, ch. 152, sec. 7, p. 462; am. 1997, ch. 109, sec. 5, p. 258.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3610 - DUTIES AND POWERS OF DIRECTOR — JUDICIAL REVIEW.

41-3610. DUTIES AND POWERS OF DIRECTOR — JUDICIAL REVIEW. (1) The director shall:
(a) Notify the association of the existence of an insolvent insurer not later than three (3) days after he receives notice of the determination of the insolvency. The association shall be entitled to a copy of any complaint seeking an order of liquidation with a finding of insolvency against a member company at the same time that such complaint is filed with a court of competent jurisdiction.
(b) Upon request of the board of directors, provide the association with a statement of the net direct written premiums of each member insurer.
(2) The director may:
(a) Suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the director may levy a fine on any member insurer which fails to pay an assessment when due. Such fine shall not exceed five per cent (5%) of the unpaid assessment per month, except that no fine shall be less than one hundred dollars ($100) per month.
(b) Revoke the designation of any servicing facility if he finds claims are being handled unsatisfactorily.
(3) Any final action or order of the director under this act shall be subject to judicial review in a court of competent jurisdiction.
History:
[41-3610, added 1970, ch. 152, sec. 10, p. 462; am. 1997, ch. 109, sec. 8, p. 262.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3611 - SUBROGATION OF ASSOCIATION TO RIGHTS OF CLAIMANTS — RECEIVER, LIQUIDATOR, OR SUCCESSOR BOUND BY ASSOCIATION CLAIM SETTLEMENTS — PERIODIC FILING OF STATEMENTS OF PAID CLAIMS WITH RECEIVER OR LIQUIDATOR.

41-3611. SUBROGATION OF ASSOCIATION TO RIGHTS OF CLAIMANTS — RECEIVER, LIQUIDATOR, OR SUCCESSOR BOUND BY ASSOCIATION CLAIM SETTLEMENTS — PERIODIC FILING OF STATEMENTS OF PAID CLAIMS WITH RECEIVER OR LIQUIDATOR. (1) Any person recovering under this act shall be deemed to have assigned his rights under the policy to the association to the extent of his recovery from the association. Every insured or claimant seeking the protection of this act shall cooperate with the association to the same extent as such person would have been required to cooperate with the insolvent insurer. The association shall have no cause of action against the insured of the insolvent insurer for any sums it has paid out except such causes of action as the insolvent insurer would have had if such sums had been paid by the insolvent insurer. In the case of an insolvent insurer operating on a plan with assessment liability, payments of claims of the association shall not operate to reduce the liability of insureds to the receiver, liquidator, or statutory successor for unpaid assessments.
(2) The receiver, liquidator, or statutory successor of an insolvent insurer shall be bound by settlements of claims made by the association or a similar organization in another state to the extent such determinations or settlements satisfy obligations of the association. The receiver shall not be bound in any way by such determinations or settlements to the extent there remains a claim against the insolvent insurer. The court having jurisdiction shall grant such claims priority equal to that which the claimant would have been entitled in the absence of this act against the assets of the insolvent insurer. The expenses of the association or similar organization in handling claims shall be accorded the same priority as the liquidator’s expenses.
(3) The association shall periodically file with the receiver or liquidator of the insolvent insurer statements of the covered claims paid by the association and estimates of anticipated claims on the association which shall preserve the rights of the association against the assets of the insolvent insurer.
History:
[41-3611, added 1970, ch. 152, sec. 11, p. 462; am. 1997, ch. 109, sec. 9, p. 263.]