reglab/statecodes huggingface dataset:
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4313 - CREDITS FOR ASSESSMENTS PAID.

41-4313. CREDITS FOR ASSESSMENTS PAID. (1) A member insurer may offset against its premium tax liability to this state an assessment described in section 41-4309(8), Idaho Code, to the extent of twenty percent (20%) of the amount of the assessment for each of five (5) calendar years beginning with the premium tax due under section 41-402(4), Idaho Code, with respect to the year of payment of the assessment and thereafter with the premium tax due under section 41-402(4), Idaho Code, during each of the four (4) succeeding years. An allowable offset, or portion thereof, not used in any calendar year cannot be carried over or back to any other year.
(2) Any sums acquired by refund, pursuant to section 41-4309(6), Idaho Code, from the association which have theretofore been written off by contributing insurers and offset against premium taxes as provided in subsection (1) of this section, and are not then needed for purposes of this chapter, shall be paid by the association to the director and by him deposited with the state treasurer for credit to the general account of the state operating fund.
History:
[41-4313, added 2011, ch. 196, sec. 2, p. 575; am. 2013, ch. 265, sec. 2, p. 650.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4315 - EXAMINATION OF THE ASSOCIATION –- ANNUAL REPORT.

41-4315. EXAMINATION OF THE ASSOCIATION –- ANNUAL REPORT. The association shall be subject to examination and regulation by the director. The board of directors shall submit to the director each year, not later than May 1 of each year, a financial report in a form approved by the director and a report of its activities during the preceding fiscal year. Upon the request of a member insurer, the association shall provide the member insurer with a copy of the report.
History:
[41-4315, added 2011, ch. 196, sec. 2, p. 577.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4316 - TAX EXEMPTIONS.

41-4316. TAX EXEMPTIONS. The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.
History:
[41-4316, added 2011, ch. 196, sec. 2, p. 577.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4317 - IMMUNITY.

41-4317. IMMUNITY. There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer or its agents or employees, the association or its agents or employees, members of the board of directors or the director or the director’s representatives, for any action or omission by them in the performance of their powers and duties under this chapter. This immunity shall extend to the participation in any organization of one (1) or more other state associations of similar purposes and to any such organization and its agents or employees.
History:
[41-4317, added 2011, ch. 196, sec. 2, p. 577.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4318 - STAY OF PROCEEDING –- REOPENING DEFAULT JUDGMENTS.

41-4318. STAY OF PROCEEDING –- REOPENING DEFAULT JUDGMENTS. All proceedings in which the insolvent insurer is a party in any court in this state shall be stayed one hundred eighty (180) days from the date an order of liquidation, rehabilitation or conservation is final to permit proper legal action by the association on any matters germane to its powers or duties. As to judgment under any decision, order, verdict or finding based on default, the association may apply to have such judgment set aside by the same court that made such judgment and shall be permitted to defend against such suit on the merits.
History:
[41-4318, added 2011, ch. 196, sec. 2, p. 577.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4319 - PROHIBITED ADVERTISEMENT OF INSURANCE GUARANTY ASSOCIATION ACT IN COMMERCIAL SALES.

41-4319. PROHIBITED ADVERTISEMENT OF INSURANCE GUARANTY ASSOCIATION ACT IN COMMERCIAL SALES. No person, including an insurer, agent or affiliate of an insurer shall make, publish, disseminate, circulate or place before the public, or cause directly or indirectly, to be made, published, disseminated, circulated or placed before the public, in any newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio station or television station, or in any other way, any advertisement, announcement or statement, written or oral, which uses the existence of the insurance guaranty association of this state for the purpose of sales, solicitation or inducement to purchase any form of insurance covered by the Idaho life and health insurance guaranty association act. Provided however, that this section shall not apply to the Idaho life and health insurance guaranty association or any other entity which does not sell or solicit insurance. This section shall also not prohibit the furnishing of written information that is in a form prepared by the association and approved by the director upon request of the policy owner.
History:
[41-4319, added 2011, ch. 196, sec. 2, p. 577.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4320 - APPLICATION.

41-4320. APPLICATION. This chapter shall apply to coverage the guaranty association provides in connection with any member insurer that was first placed under an order of liquidation on or after January 1, 2011.
History:
[41-4320, added 2011, ch. 196, sec. 2, p. 578.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4401 - PURPOSE.

41-4401. PURPOSE. The purpose of this chapter shall be to provide reasonable standardization and simplification of terms and coverages of medicare supplement disability insurance policies and enrollee contracts of managed care organizations, to facilitate public understanding and comparison, to eliminate provisions contained in disability insurance policies and enrollee contracts of managed care organizations which may be misleading or unreasonably confusing in connection either with the purchase of such coverages or with the settlement of claims, and to provide for full disclosure in the sale of such coverages.
History:
[41-4401, added 1999, ch. 102, sec. 2, p. 323.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4402 - DEFINITIONS.

41-4402. DEFINITIONS. (1) "Applicant" means:
(a) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits; and
(b) In the case of a group medicare supplement policy, the proposed certificate holder.
(2) "Certificate" means, for the purposes of this chapter, any certificate delivered or issued for delivery in this state under a group medicare supplement policy.
(3) "Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer.
(4) "Issuer" includes insurance companies, fraternal benefit societies, managed care organizations, and any other entity delivering or issuing for delivery in this state medicare supplement policies or certificates.
(5) "Medicare" means the "Health Insurance for the Aged Act," title XVIII of the social security amendments of 1965, as then constituted or later amended.
(6) "Medicare supplement policy" means a group or individual policy of accident and sickness insurance or an enrollee contract under a managed care organization, other than a policy issued pursuant to a contract under section 1876 of the federal social security act (42 U.S.C. section 1395 et seq.), or an issued policy under a demonstration project specified in 42 U.S.C. section 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under medicare for the hospital, medical or surgical expenses of persons eligible for medicare.
(7) "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer.
History:
[41-4402, added 1999, ch. 102, sec. 2, p. 323.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4403 - APPLICABILITY AND SCOPE.

41-4403. APPLICABILITY AND SCOPE. (1) Except as otherwise specifically provided this chapter shall apply to:
(a) All medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this act; and
(b) All certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this state.
(2) This chapter shall not apply to a policy of one (1) or more employers or labor organizations, or of the trustees of a fund established by one (1) or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.
(3) Except as otherwise specifically provided in section 41-4406(4), Idaho Code, the provisions of this chapter are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons when the policies are not marketed or held to be medicare supplement policies or benefit plans.
History:
[41-4403, added 1999, ch. 102, sec. 2, p. 324.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4405 - LOSS RATIO STANDARDS.

41-4405. LOSS RATIO STANDARDS. Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director may issue reasonable rules to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a managed care organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
History:
[41-4405, added 1999, ch. 102, sec. 2, p. 325.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4406 - DISCLOSURE STANDARDS.

41-4406. DISCLOSURE STANDARDS. (1) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.
(2) The director may prescribe the format and content of the outline of coverage required by this section. For purposes of this section, "format" means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include:
(a) A description of the principal benefits and coverage provided in the policy;
(b) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums;
(c) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(3) The director may prescribe by rule a standard form and the contents of an informational brochure for persons eligible for medicare, which is intended to improve the buyer’s ability to select the most appropriate coverage and improve the buyer’s understanding of medicare. Except in the case of direct response insurance policies, the director may require by rule that the informational brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the director may require by rule that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare, but in no event later than the time of policy delivery.
(4) The director may adopt rules for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all accident and sickness insurance policies sold to persons eligible for medicare, other than:
(a) Medicare supplement policies; or
(b) Disability income policies.
(5) The director may adopt reasonable rules to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, or certificates by persons eligible for medicare.
History:
[41-4406, added 1999, ch. 102, sec. 2, p. 325.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4407 - NOTICE OF FREE EXAMINATION.

41-4407. NOTICE OF FREE EXAMINATION. Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. A refund made pursuant to this section shall be paid directly to the applicant by the issuer in a timely manner.
History:
[41-4407, added 1999, ch. 102, sec. 2, p. 326.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4408 - FILING REQUIREMENTS FOR ADVERTISING.

41-4408. FILING REQUIREMENTS FOR ADVERTISING. Every issuer of medicare supplement insurance policies or certificates in this state shall provide a copy of any medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the director of the Idaho department of insurance for review or approval by the director to the extent it may be required under state law.
History:
[41-4408, added 1999, ch. 102, sec. 2, p. 326.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4409 - ADMINISTRATIVE PROCEDURES.

41-4409. ADMINISTRATIVE PROCEDURES. Rules adopted pursuant to this chapter shall be subject to the provisions of chapter 52, title 67, Idaho Code.
History:
[41-4409, added 1999, ch. 102, sec. 2, p. 327.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4410 - PENALTIES.

41-4410. PENALTIES. In addition to any other applicable penalties for violations of the insurance code, the director may require issuers violating any provision of this chapter or rules promulgated pursuant to this chapter to cease marketing any medicare supplement policy or certificate in this state which is related directly or indirectly to a violation or may require the issuer to take actions necessary to comply with the provisions of this chapter, or both.
History:
[41-4410, added 1999, ch. 102, sec. 2, p. 327.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 44 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 41-4411 - SEPARABILITY.

41-4411. SEPARABILITY. If any provision of this act or the application of it to any person or circumstances is for any reason held to be invalid, the remainder of the act and the application of the provision to other persons or circumstances shall not be affected.
History:
[41-4411, added 1999, ch. 102, sec. 2, p. 327.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4601 - PURPOSE.

41-4601. PURPOSE. The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage.
History:
[41-4601, added 1999, ch. 98, sec. 2, p. 304.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4602 - SCOPE.

41-4602. SCOPE. The requirements of this chapter shall apply to policies delivered or issued for delivery in this state on or after the effective date of this chapter. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws insofar as they do not conflict with this chapter, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance.
History:
[41-4602, added 1999, ch. 98, sec. 2, p. 304.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4604 - EXTRATERRITORIAL JURISDICTION — GROUP LONG-TERM CARE INSURANCE.

41-4604. EXTRATERRITORIAL JURISDICTION — GROUP LONG-TERM CARE INSURANCE. No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in section 41-4603(4)(d), Idaho Code, unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
History:
[41-4604, added 1999, ch. 98, sec. 2, p. 306.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4606 - INCONTESTABILITY PERIOD.

41-4606. INCONTESTABILITY PERIOD. (1) For a policy or certificate that has been in force for less than six (6) months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
(2) For a policy or certificate that has been in force for at least six (6) months but less than two (2) years an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.
(3) After a policy or certificate has been in force for two (2) years it is not contestable upon the grounds of misrepresentation alone; such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health.
(4) (a) No long-term care insurance policy or certificate may be field issued based on medical or health status.
(b) For purposes of this section, "field issued" means a policy or certificate issued by an agent or a third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer.
(5) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(6) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by section 41-1905, Idaho Code, as it pertains to incontestability. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
History:
[41-4606, added 1999, ch. 98, sec. 2, p. 309.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4607 - NONFORFEITURE BENEFITS.

41-4607. NONFORFEITURE BENEFITS. (1) Except as provided in subsection (2) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. In the event the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates.
(2) When a group long-term care insurance policy is issued, the offer required in subsection (1) of this section shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance as defined in section 41-4603(4)(d), Idaho Code, other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificate holder.
(3) The director shall promulgate rules specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding a contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection (1) of this section.
History:
[41-4607, added 1999, ch. 98, sec. 2, p. 310.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4608 - AUTHORITY TO PROMULGATE RULES.

41-4608. AUTHORITY TO PROMULGATE RULES. The director shall issue reasonable rules to promote premium adequacy and to protect the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, agent compensation, agent testing, penalties and reporting practices for long-term care insurance.
History:
[41-4608, added 1999, ch. 98, sec. 2, p. 311.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4609 - ADMINISTRATIVE PROCEDURES.

41-4609. ADMINISTRATIVE PROCEDURES. Rules adopted for the implementation and administration of this chapter shall be in accordance with the provisions of chapter 52, title 67, Idaho Code.
History:
[41-4609, added 1999, ch. 98, sec. 2, p. 311.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4610 - SEVERABILITY.

41-4610. SEVERABILITY. If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby.
History:
[41-4610, added 1999, ch. 98, sec. 2, p. 311.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE ACT › Section 41-4611 - PENALTIES.

41-4611. PENALTIES. In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three (3) times the amount of any commissions paid for each policy involved in the violation or up to ten thousand dollars ($10,000), whichever is greater.
History:
[41-4611, added 1999, ch. 98, sec. 2, p. 311.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4701 - SHORT TITLE.

41-4701. SHORT TITLE. This chapter shall be known and may be cited as the "Small Employer Health Insurance Availability Act."
History:
[41-4701, added 1993, ch. 176, sec. 1, p. 435.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4702 - PURPOSE.

41-4702. PURPOSE. The purpose and intent of this chapter is to promote the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules regarding renewability of coverage, to establish limitations on the use of preexisting condition exclusions, to provide for establishment of a reinsurance program, and to improve the overall fairness and efficiency of the small group health insurance market.
This chapter is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.
History:
[41-4702, added 1993, ch. 176, sec. 1, p. 435; am. 2000, ch. 472, sec. 1, p. 1603.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4704 - APPLICABILITY AND SCOPE.

41-4704. APPLICABILITY AND SCOPE. With the exception of a health benefit plan subject to regulation under chapter 52, title 41, Idaho Code, and to the extent permitted by federal law, the provisions of this chapter shall apply to any health benefit plan delivered or issued for delivery in the state of Idaho that provides coverage to the employees of a small employer in this state if any of the following conditions are met:
(1) Any portion of the premium or benefits is paid by or on behalf of the small employer;
(2) An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium;
(3) The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of section 162, section 125 or section 106 of the United States internal revenue code.
(4) (a) Except as provided in subsection (b) of this section, for the purposes of this chapter, carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one (1) carrier and any restrictions or limitations imposed in this chapter shall apply as if all health benefit plans delivered or issued for delivery to small employers in this state by such affiliated carriers were issued by one (1) carrier.
(b) An affiliated carrier that is a health maintenance organization having a certificate of authority pursuant to the provisions of chapter 39, title 41, Idaho Code, may be considered to be a separate carrier for the purposes of this chapter.
(c) Unless otherwise authorized by the director, a small employer carrier shall not enter into one (1) or more ceding arrangements with respect to health benefit plans delivered or issued for delivery to small employers in this state if such arrangements would result in less than fifty percent (50%) of the insurance obligation or risk for such health benefit plans being retained by the ceding carrier. The provisions of sections 41-510 and 41-511, Idaho Code, shall apply if a small employer carrier cedes or assumes all of the insurance obligation or risk with respect to one (1) or more health benefit plans delivered or issued for delivery to small employers in this state.
History:
[41-4704, added 1993, ch. 176, sec. 1, p. 438; am. 1994, ch. 427, sec. 3, p. 1352; am. 1995, ch. 360, sec. 3, p. 1240.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4705 - ESTABLISHMENT OF CLASSES OF BUSINESS.

41-4705. ESTABLISHMENT OF CLASSES OF BUSINESS. (1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:
(a) The small employer carrier uses more than one (1) type of system for the marketing and sale of health benefit plans to small employers;
(b) The small employer carrier has acquired a class of business from another small employer carrier; or
(c) The small employer carrier provides coverage to one (1) or more association groups that meet the requirements of section 41-2202, Idaho Code.
(2) A small employer carrier may establish up to nine (9) separate classes of business under the provisions of subsection (1) of this section.
(3) The director may establish regulations to provide for a period of transition in order for a small employer carrier to come into compliance with the provisions of subsection (2) of this section in the instance of acquisition of an additional class of business from another small employer carrier.
(4) The director may approve the establishment of additional classes of business upon application to the director and a finding by the director that such action would enhance the efficiency and fairness of the small employer marketplace.
History:
[41-4705, added 1993, ch. 176, sec. 1, p. 439.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4708B - CONVERSION PLAN — WHEN REQUIRED.

41-4708B. CONVERSION PLAN — WHEN REQUIRED. Any group carrier doing business in the state of Idaho that does not have an individual product on file with the department of insurance shall provide a conversion plan to all group insureds. The conversion plan shall provide benefits at least equal to the standard health benefit plan developed pursuant to section 41-4712, Idaho Code. The premium under the plan shall not exceed one hundred twenty-five percent (125%) of the index rate for groups.
History:
[41-4708B, added 1996, ch. 124, sec. 2, p. 439.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4709 - NOTICE OF INTENT TO OPERATE AS A RISK-ASSUMING CARRIER OR A REINSURING CARRIER.

41-4709. NOTICE OF INTENT TO OPERATE AS A RISK-ASSUMING CARRIER OR A REINSURING CARRIER. (1) (a) Each small employer carrier shall notify the director within thirty (30) days of the effective date of this chapter of the carrier’s intention to operate as a risk-assuming carrier or a reinsuring carrier. A small employer carrier seeking to operate as a risk-assuming carrier shall make an application pursuant to the provisions of section 41-4710, Idaho Code.
(b) The decision shall be binding for a five (5) year period except that the initial decision shall be binding for two (2) years. The director may permit a carrier to modify its decision at any time for good cause shown.
(c) The director shall establish an application process for small employer carriers seeking to change their status under the provisions of this subsection.
(2) A reinsuring carrier that applies and is approved to operate as a risk-assuming carrier shall not be permitted to continue to reinsure any health benefit plan with the program. Such a carrier shall pay a prorated assessment based upon business issued as a reinsuring carrier for any portion of the year that the business was reinsured.
History:
[41-4709, added 1993, ch. 176, sec. 1, p. 446.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4710 - APPLICATION TO BECOME A RISK-ASSUMING CARRIER.

41-4710. APPLICATION TO BECOME A RISK-ASSUMING CARRIER. (1) A small employer carrier may apply to become a risk-assuming carrier by filing an application with the director in a form and manner prescribed by the director.
(2) The director shall consider the following factors in evaluating an application filed under the provisions of subsection (1) of this section:
(a) The carrier’s financial condition;
(b) The carrier’s history of rating and underwriting small employer groups;
(c) The carrier’s commitment to market fairly to all small employers in the state or its established geographic service area, as applicable;
(d) The carrier’s experience with managing the risk of small employer groups; and
(e) The extent to which a carrier has and will be able to maintain reinsurance pursuant to the provisions of subsection (4)(c) of section 41-4704, Idaho Code.
(3) The director shall provide public notice of an application by a small employer carrier to be a risk-assuming carrier and shall provide at least a sixty (60) day period for public comment prior to making a decision on the application. If the application is not acted upon within ninety (90) days of the receipt of the application by the director, the carrier may request a hearing.
(4) The director may rescind the approval granted to a risk-assuming carrier under the provisions of this section if the director finds that:
(a) The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with the provisions of section 41-4708, Idaho Code, without the protection afforded by the program;
(b) The carrier has failed to market fairly to all small employers in the state or its established geographic service area, as applicable; or
(c) The carrier has failed to provide coverage to eligible small employers as required in section 41-4708, Idaho Code.
(5) A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of section 41-4711, Idaho Code, except to the extent such small employer carrier is subject to assessment for additional funding pursuant to the provisions of subsection (12)(c) of section 41-4711, Idaho Code.
History:
[41-4710, added 1993, ch. 176, sec. 1, p. 447.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4712 - SMALL EMPLOYER HEALTH BENEFIT PLANS.

41-4712. SMALL EMPLOYER HEALTH BENEFIT PLANS. (1) The board, in addition to its other powers and duties, shall establish the form and level of coverages, including benefit levels, cost-sharing levels, exclusions and limitations for the small employer basic, standard and catastrophic health benefit plans to be made available by small employer carriers pursuant to section 41-4708, Idaho Code, with an emphasis on making coverage available for preventive care.
(2) The board shall also design a small employer basic, standard and catastrophic health benefit plan which each contain benefit and cost-sharing levels that are consistent with the basic method of operation and the benefit plans of managed care organizations, including any restrictions imposed by federal law. The plans or changes established by the board may include cost containment features such as:
(a) Utilization review of health care services, including review of medical necessity of hospital and physician services;
(b) Case management;
(c) Selective contracting with hospitals, physicians and other health care providers;
(d) Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and
(e) Other managed care provisions.
(3) The board shall submit the plans or changes approved by the board to the director for approval not later than March 1 of each year. The director shall promulgate the approved plans pursuant to the provisions of section 41-4715, Idaho Code.
(4) Small employer carriers desiring to issue a small employer basic, standard or catastrophic health benefit plan differing from the form and level of coverage approved by the board and the director shall submit such plan to the board for review to insure that such proposed plan is commensurate with the benefit levels, cost-sharing levels, exclusions, and limitations for the plan developed and approved pursuant to the provisions of this section.
(5) The board may appoint an advisory committee to assist in the development of and any changes to the small employer basic, standard and catastrophic health benefit plans.
History:
[41-4712, added 1993, ch. 176, sec. 1, p. 453; am. 1994, ch. 427, sec. 8, p. 1365; am. 1995, ch. 360, sec. 7, p. 1253; am. 1997, ch. 321, sec. 16, p. 977; am. 2000, ch. 472, sec. 7, p. 1620.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4713 - PERIODIC MARKET EVALUATION.

41-4713. PERIODIC MARKET EVALUATION. The board, in consultation with members of the committee, shall study and report at least every three (3) years to the director on the effectiveness of chapters 47 and 52, title 41, Idaho Code. The report shall analyze the effectiveness of the chapters in promoting rate stability, product availability, and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency and fairness of the small group and individual health insurance marketplace. The report shall address whether carriers and agents are fairly and actively marketing or issuing health benefit plans to small employers and individuals in fulfillment of the purposes of the chapters. The report may contain recommendations for market conduct or other regulatory standards or action.
History:
[41-4713, added 1993, ch. 176, sec. 1, p. 454; am. 1994, ch. 427, sec. 9, p. 1366.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 47 - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 41-4715 - ADMINISTRATIVE PROCEDURES.

41-4715. ADMINISTRATIVE PROCEDURES. The director shall promulgate rules and regulations in accordance with the provisions of chapter 52, title 67, Idaho Code, for the implementation and administration of the small employer health coverage reform act.
History:
[41-4715, added 1993, ch. 176, sec. 1, p. 454.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4802 - PURPOSE.

41-4802. PURPOSE. The purpose of this chapter is to regulate the formation and operation of risk retention groups in Idaho formed pursuant to the provisions of the federal liability risk retention act of 1986.
History:
[41-4802, added 1987, ch. 140, sec. 1, p. 275.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4804 - RISK RETENTION GROUPS CHARTERED IN THIS STATE.

41-4804. RISK RETENTION GROUPS CHARTERED IN THIS STATE. (1) A risk retention group seeking to be chartered in this state must be chartered and licensed as a liability insurance company authorized by the insurance laws of this state and, except as provided elsewhere in this chapter, must comply with:
(a) All of the laws, rules, regulations and requirements applicable to such insurers chartered and licensed in this state;
(b) Section 41-4805, Idaho Code, to the extent such requirements are not a limitation on laws, rules, regulations or requirements of this state.
(2) Before it may offer insurance in any state, each risk retention group shall also submit for approval to the director of this state a plan of operation or feasibility study and revisions of such plan or study if the group intends to offer any additional lines of liability insurance. Immediately upon receipt of an application for charter, this state shall provide:
(a) Summary information concerning the filing to the national association of insurance commissioners, including the name of the risk retention group, the identity of the initial members of the group, the identity of those individuals who organized the group or who will provide administrative services or otherwise influence or control the activities of the group;
(b) The amount and nature of initial capitalization;
(c) The coverages to be afforded; and
(d) The states in which the group intends to operate.
Providing notification to the national association of insurance commissioners is in addition to and shall not be sufficient to satisfy the requirements of section 41-4805, Idaho Code, or any other sections of this chapter.
History:
[41-4804, added 1987, ch. 140, sec. 1, p. 277.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4806 - COMPULSORY ASSOCIATIONS.

41-4806. COMPULSORY ASSOCIATIONS. No risk retention group shall be permitted to join or contribute financially to any insurance insolvency guaranty fund or similar mechanism in this state, nor shall any risk retention group, or its insureds, receive any benefit from any such fund for claims arising out of the operations of such risk retention group.
History:
[41-4806, added 1987, ch. 140, sec. 1, p. 280.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4807 - COUNTER SIGNATURES NOT REQUIRED.

41-4807. COUNTER SIGNATURES NOT REQUIRED. A policy of insurance issued to a risk retention group or any member of that group shall not be required to be countersigned as otherwise provided in sections 41-337 and 41-338, Idaho Code.
History:
[41-4807, added 1987, ch. 140, sec. 1, p. 280; am. 2005, ch. 75, sec. 3, p. 255.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4808 - PURCHASING GROUPS — EXEMPTION FROM CERTAIN LAWS RELATING TO THE GROUP PURCHASE OF INSURANCE.

41-4808. PURCHASING GROUPS — EXEMPTION FROM CERTAIN LAWS RELATING TO THE GROUP PURCHASE OF INSURANCE. Any purchasing group meeting the criteria established under the provisions of the federal liability risk retention act of 1986 shall be exempt from any law of this state relating to the creation of groups for the purchase of insurance, prohibition of group purchasing, or any law that would discriminate against a purchasing group or its members. In addition, an insurer shall be exempt from any law of this state which prohibits providing, or offering to provide to a purchasing group or its members advantages based on their loss and expense experience not afforded to other persons with respect to rates, policy forms, coverages or other matters. A purchasing group shall be subject to all other applicable laws of this state.
History:
[41-4808, added 1987, ch. 140, sec. 1, p. 280.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4809 - NOTICE AND REGISTRATION REQUIREMENTS OF PURCHASING GROUPS.

41-4809. NOTICE AND REGISTRATION REQUIREMENTS OF PURCHASING GROUPS. (1) A purchasing group which intends to do business in this state shall furnish notice to the director which shall:
(a) Identify the state in which the group is domiciled;
(b) Specify the lines and classifications of liability insurance which the purchasing group intends to purchase;
(c) Identify the insurance company from which the group intends to purchase its insurance and the domicile of such company;
(d) Identify the principal place of business of the group; and
(e) Provide such other information as may be required by the director to verify that the purchasing group is qualified as defined in subsection (10) of section 41-4803, Idaho Code.
(2) The purchasing group shall register with and designate the director as its agent for the purpose of receiving service of legal documents or process, except that such requirements shall not apply in the case of a purchasing group:
(a) Which was domiciled before April 1, 1986, and is domiciled on and after October 27, 1986, in any state of the United States;
(b) Which before October 27, 1986, purchased insurance from an insurance carrier licensed in any state and since October 27, 1986, purchased its insurance from an insurance carrier licensed in any state;
(c) Which was a purchasing group under the requirements of the product liability risk retention act of 1981 before October 27, 1986; and
(d) Which does not purchase insurance that was not authorized for purposes of an exemption under that act, as in effect before October 27, 1986.
History:
[41-4809, added 1987, ch. 140, sec. 1, p. 280.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4810 - RESTRICTIONS ON INSURANCE PURCHASED BY PURCHASING GROUPS.

41-4810. RESTRICTIONS ON INSURANCE PURCHASED BY PURCHASING GROUPS. A purchasing group may not purchase insurance from a risk retention group that is not chartered in a state, nor from an insurer not admitted in the state in which the purchasing group is located, unless the purchase is effected through a licensed agent or broker acting pursuant to the surplus lines laws and regulations of such state.
History:
[41-4810, added 1987, ch. 140, sec. 1, p. 281.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4811 - ADMINISTRATIVE AND PROCEDURAL AUTHORITY REGARDING RISK RETENTION GROUPS AND PURCHASING GROUPS.

41-4811. ADMINISTRATIVE AND PROCEDURAL AUTHORITY REGARDING RISK RETENTION GROUPS AND PURCHASING GROUPS. The director is authorized to make use of any of the powers established under this code to enforce the laws of this state so long as those powers are not specifically preempted by the product liability risk retention act of 1981, as amended by the risk retention amendments of 1986. This includes, but is not limited to, the director’s administrative authority to investigate, issue subpoenas, conduct depositions and hearings, issue orders and impose penalties. With regard to any investigation, administrative proceedings, or litigation, the director may rely on the procedural law and regulations of the state. The injunctive authority of the director in regard to risk retention groups is restricted by the requirement that any injunction be issued by a court of competent jurisdiction.
History:
[41-4811, added 1987, ch. 140, sec. 1, p. 281.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4812 - PENALTIES.

41-4812. PENALTIES. A risk retention group which violates any provision of this chapter will be subject to fines and penalties applicable to licensed insurers generally, including revocation of its license and/or the right to do business in this state.
History:
[41-4812, added 1987, ch. 140, sec. 1, p. 281.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4813 - DUTY OF AGENTS OR BROKERS TO OBTAIN LICENSE.

41-4813. DUTY OF AGENTS OR BROKERS TO OBTAIN LICENSE. Any person acting, or offering to act, as an agent or broker for a risk retention group or purchasing group, which solicits members, sells insurance coverage, purchases coverage for its members located within the state or otherwise does business in this state shall, before commencing any such activity, obtain a license from the director.
History:
[41-4813, added 1987, ch. 140, sec. 1, p. 281.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4814 - BINDING EFFECT OF ORDERS ISSUED IN U.S. DISTRICT COURTS.

41-4814. BINDING EFFECT OF ORDERS ISSUED IN U.S. DISTRICT COURTS. An order issued by any district court of the United States enjoining a risk retention group from soliciting or selling insurance, or operating in any state, or in all states or in any territory or possession of the United States, upon a finding that such a group is in a hazardous financial condition shall be enforceable in the courts of the state.
History:
[41-4814, added 1987, ch. 140, sec. 1, p. 282.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4815 - RULES AND REGULATIONS.

41-4815. RULES AND REGULATIONS. The director may establish and from time to time amend such rules relating to risk retention groups as may be necessary or desirable to carry out the provisions of this chapter.
History:
[41-4815, added 1987, ch. 140, sec. 1, p. 282.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 48 - RISK RETENTION GROUPS › Section 41-4816 - PURCHASING GROUP TAXATION.

41-4816. PURCHASING GROUP TAXATION. Premium taxes and taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing group shall be:
(1) Imposed at the same rate and subject to the same interest, fines and penalties as that applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insureds; and
(2) Paid first by such insurance source, and if not by such source by the agent or broker for the purchasing group, and if not by such agent or broker then by the purchasing group, and if not by such purchasing group then by each of its members.
History:
[41-4816, added 1990, ch. 348, sec. 1, p. 937.]