reglab/statecodes huggingface dataset:
2023 Idaho Code › Title 41 - INSURANCE › Chapter 55 - IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL › Section 41-5503 - PLAN OF OPERATION.

41-5503. PLAN OF OPERATION. (1) The board shall submit to the director a plan of operation and thereafter any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the pool. The director may, after notice and hearing, approve the plan of operation if the director determines it to be suitable to assure the fair, reasonable and equitable administration of the pool, and to provide for the sharing of pool gains or losses on an equitable and proportionate basis in accordance with the provisions of this chapter. The plan of operation shall become effective upon written approval by the director.
(2) If the board fails to submit a suitable plan of operation, the director shall, after notice and hearing, adopt and promulgate a temporary plan of operation. The director shall approve the plan of operation submitted by the board, or adopt a temporary plan of operation if the board fails to submit a suitable plan. The director shall amend or rescind any plan adopted under the provisions of this section at the time a plan of operation is submitted by the board and approved by the director.
(3) The plan of operation shall:
(a) Establish procedures for handling and accounting of pool assets and moneys and for an annual fiscal reporting to the director;
(b) Establish procedures for selecting an administrator, and setting forth the powers and duties of the administrator;
(c) Establish procedures for reinsuring risks in accordance with the provisions of this chapter;
(d) Establish procedures and conditions for a carrier to cede individuals with certain high risk medical conditions;
(e) Define the high risk medical conditions for which carriers are allowed to cede for reinsurance;
(f) Set forth the reinsurance parameters including, but not limited to, the initial level of claims for which the reinsuring carrier is responsible, the coinsurance percentage at which claims above the initial level are reinsured by the pool, and the maximum claims limit above which the pool no longer reimburses;
(g) Establish procedures for collecting assessments from carriers to fund claims and administrative expenses incurred or estimated to be incurred by the pool; and
(h) Provide for any additional matters necessary for the implementation and administration of the pool.
History:
[41-5503, added 2000, ch. 472, sec. 17, p. 1636; am. 2017, ch. 281, sec. 2, p. 735.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 55 - IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL › Section 41-5505 - REINSURANCE.

41-5505. REINSURANCE. (1) Any individual carrier issuing a health benefit plan shall be liable to the pool for the reinsurance premium and shall be reinsured by the pool for each eligible individual ceded in accordance with section 41-5509, Idaho Code, and the plan of operation.
(2) The pool shall reimburse a reinsuring carrier with respect to the claims of a ceded eligible individual incurred during the calendar year and paid by the reinsuring carrier for benefits covered by the health benefit plan, in accordance with the reinsurance parameters set forth in the plan of operation.
(a) The board may annually adjust the reinsurance parameters by submitting an amendment to the plan of operation in accordance with section 41-5503(1), Idaho Code. The adjustments may reflect increases in costs and utilization within the individual market for health benefit plans but must consider the availability of pool funding and the stability of the individual health insurance market, as well as any objectives stated in the plan of operation.
(b) The board shall not submit for approval by the director a plan of operation or an amendment thereto with an initial level of less than twenty-five thousand dollars ($25,000) or a reinsuring carrier coinsurance percentage of less than twenty percent (20%).
(3) A reinsuring carrier shall apply all managed care and claims handling techniques, including utilization review, individual case management, preferred provider provisions, and other managed care provisions or methods of operation consistently with respect to reinsured and nonreinsured business.
(4) Each carrier shall make a filing with the director containing the carrier’s earned health insurance premium derived from health benefit plans delivered or issued for delivery in this state in the previous calendar year.
(5) Each carrier shall file with the director, in a form and manner to be prescribed by the director, an annual report. The report shall state the number of resident persons insured under the carrier’s health benefit plan, or through excess or stop loss coverage.
(6) Carriers shall permit individuals and their dependents covered by a high risk pool plan to remain on the high risk pool plan as long as the individual continues to meet the conditions of section 41-5501(6)(a), Idaho Code.
History:
[41-5505, added 2000, ch. 472, sec. 17, p. 1637; am. 2003, ch. 267, sec. 4, p. 717; am. 2005, ch. 353, sec. 5, p. 1119; am. 2017, ch. 281, sec. 4, p. 737.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 55 - IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL › Section 41-5506 - REINSURANCE PREMIUM RATES.

41-5506. REINSURANCE PREMIUM RATES. (1) The board, as part of the plan of operation, shall establish a methodology for determining reinsurance premium rates to be charged reinsuring carriers to reinsure individuals under this chapter. The methodology shall include a system for classification of individuals that reflects the types of case characteristics commonly used by individual carriers in the state. The methodology shall provide for the development of base reinsurance premium rates, subject to the approval of the director, which shall be set at levels which reasonably approximate gross premiums charged to individuals by individual carriers for health benefit plans. Rate adjustments under the provisions of this subsection shall not be subject to the provisions of section 41-5206, Idaho Code.
(2) The board periodically shall review the methodology established under the provisions of subsection (1) of this section, including the system of classification and any rating factors, to assure that it reasonably reflects the claims experience of the pool. The board may propose changes to the methodology which shall be subject to the approval of the director.
(3) The board may consider adjustments to the reinsurance premium rates charged by the pool to reflect the use of effective cost containment and managed care arrangements.
History:
[41-5506, added 2000, ch. 472, sec. 17, p. 1638; am. 2017, ch. 281, sec. 5, p. 738.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 55 - IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL › Section 41-5507 - PREMIUM RATES FOR HIGH RISK POOL PLAN COVERAGE.

41-5507. PREMIUM RATES FOR HIGH RISK POOL PLAN COVERAGE. (1) For high risk pool plans issued prior to April 1, 2017, the board shall establish premium rates for coverage under the individual basic, standard, catastrophic A, catastrophic B, and HSA compatible high risk pool plans.
(2) Separate schedules of premium rates based on age, individual tobacco use, geography as defined by rule of the director, gender and benefit plan design shall apply for individual risks.
(3) The board, with the assistance of the director and in accordance with appropriate actuarial principles, shall determine a standard risk rate by using the average rates that individual standard risks in this state are charged by at least five (5) of the largest health insurance carriers providing individual health insurance coverage to residents of Idaho that is substantially similar to the coverage offered by each high risk pool plan. In determining the average rate or charges of those health insurance carriers, the rates charged by those carriers shall be actuarially adjusted to determine the rate that would have been charged for benefits similar to those provided by each plan. The standard risk rates shall be established using reasonable actuarial techniques and shall reflect anticipated claims experience, expenses, and other appropriate risk factors for such coverage.
(4) Rates for plan coverage shall not be less than one hundred twenty-five percent (125%) nor more than one hundred fifty percent (150%) of rates established as applicable for individual standard risks pursuant to subsection (3) of this section.
(5) Carriers shall not issue high risk pool plans as defined in section 41-5501(9), Idaho Code, after April 1, 2017.
History:
[41-5507, added 2000, ch. 472, sec. 17, p. 1638; am. 2005, ch. 353, sec. 6, p. 1119; am. 2017, ch. 281, sec. 6, p. 738.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 55 - IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL › Section 41-5508 - ASSESSMENTS.

41-5508. ASSESSMENTS. (1) Prior to March 1 of each year, the board shall determine and report to the director the pool’s net loss for the previous calendar year, including administrative expenses and incurred losses for the year, taking into account investment income and other appropriate gains and losses, and any premium tax funds appropriated to the pool pursuant to section 41-406, Idaho Code.
(2) Any net loss for the year may be recouped by assessments of carriers.
(3) (a) For the assessment of March 1, 2001, and prior to March 1 of each succeeding year, the board shall determine and file with the director an estimate of the assessments needed to fund the losses incurred by the pool in the previous calendar year.
(b) The individual assessments shall be determined by multiplying net losses, if net earnings are negative, as defined by subsection (1) of this section, by a fraction, the numerator of which shall be the carrier’s total premiums earned in the preceding calendar year from all health benefit plans and policies or certificates of insurance for specific disease, and hospital confinement indemnity in this state as reported in the carrier’s reports filed pursuant to section 41-5505(4) and (5), Idaho Code, including reinsurance by way of excess or stop loss coverage, and the denominator of which shall be the total premiums earned in the preceding calendar year from all health benefit plans and policies or certificates of insurance for specific disease and hospital confinement indemnity in this state, including reinsurance by way of excess or stop loss coverage.
(4) If assessments exceed net losses of the pool, the excess shall be held at interest and used by the board to offset future losses or to reduce pool premiums. As used in this paragraph, "future losses" includes reserves for incurred but not reported claims.
(5) Each carrier’s proportion of the assessment shall be determined annually by the board based on annual statements and other reports deemed necessary by the board and filed by the carriers with the director.
(6) The plan of operation shall provide for the imposition of an interest penalty for late payment of assessments.
(7) A carrier may seek from the director a deferment from all or part of an assessment imposed by the board. The director may defer all or part of the assessment if the director determines that the payment of the assessment would place the carrier in a financially impaired condition. If all or part of an assessment against a carrier is deferred the amount deferred shall be assessed against the other carriers in a manner consistent with the basis for assessment set forth in this section. The carrier receiving the deferment shall remain liable to the pool for the amount deferred and shall be prohibited from reinsuring any individuals with the pool until such time as it pays the assessments.
History:
[41-5508, added 2000, ch. 472, sec. 17, p. 1639; am. 2017, ch. 281, sec. 7, p. 739.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 55 - IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL › Section 41-5509 - CEDING ELIGIBILITY.

41-5509. CEDING ELIGIBILITY. (1) The pool shall provide reinsurance to any eligible individual who qualifies for reinsurance pursuant to this chapter if evidence is provided that such person has a qualifying high risk medical condition as defined by section 41-5501(8), Idaho Code.
(2) Notwithstanding any other provision of this chapter, eligibility for continuation of coverage under COBRA shall not render a person ineligible for reinsurance coverage under this chapter.
(3) Reinsurance through the pool shall cease:
(a) On the first day of the month following the date a person is no longer a resident of this state;
(b) On the date coverage under the individual health benefit plan ends;
(c) Upon the death of the covered person;
(d) At the option of the board, thirty (30) days after the plan makes any inquiry concerning the person’s eligibility or place of residence to which the person does not reply.
(4) Reinsurance for a person who ceases to meet the eligibility requirements of this chapter may be terminated on the first day of the month following the date when the individual becomes ineligible.
History:
[(41-5509) 41-5510, added 2000, ch. 472, sec. 17, p. 1640; am. 2004, ch. 285, sec. 4, p. 808; am. 2004, ch. 332, sec. 3, p. 992; am. 2005, ch. 71, sec. 1, p. 247; am. 2005, ch. 353, sec. 8, p. 1120; am. 2008, ch. 297, sec. 2, p. 832; am. and redesig. 2017, ch. 281, sec. 9, p. 740.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 56 - PROMPT PAYMENT OF CLAIMS › Section 41-5601 - DEFINITIONS.

41-5601. DEFINITIONS. As used in this chapter:
(1) "Beneficiary" means a policyholder, subscriber, member, employer or other person who is eligible for benefits under a contract providing hospital, surgical, or medical expense coverage or a managed care organization policy or agreement under which a third party payer agrees to reimburse for covered health care services rendered to beneficiaries in accordance with the benefits contract.
(2) "Date of payment" means the date the payment is sent as indicated by the mail stamp on the envelope, by the insurer to the practitioner or facility or to the beneficiary in the event there is not a contract for direct payment by the insurer to the practitioner or facility, or, in the event of a wire or other electronic funds transfer, upon acceptance by the insurer’s bank of a payment order.
(3) "Department" means the department of insurance.
(4) "Director" means the director of the department of insurance.
(5) "Electronic claim" means a claim that is transmitted through the use of electronic media, which includes the internet, extranet, leased lines, dial-up lines, private networks, and those transmissions that are physically moved from one (1) location to another using magnetic tape, disk or compact disk media. The claim shall contain the proper format and code sets in accordance with the applicable implementation specifications under 45 CFR 160 et seq., and 45 CFR 162 et seq.
(6) "Insurer" means any insurer that sells hospital, medical, long-term care, or vision insurance policies or certificates and managed care organizations. For the purpose of this chapter only, "insurer" also includes a third party administrator who makes payments to beneficiaries, practitioners or facilities on behalf of an insurer and a hospital or professional service corporation that provides hospital, medical, long-term care or vision health care services.
(7) "Practitioner or facility" means any physician, hospital or other person or facility licensed or otherwise authorized to furnish health care services.
(8) "Receipt of claim" means the date the claim is actually received by the insurer from the practitioner or facility or the beneficiary.
(9) "Submission of claim" means the date the claim is sent as indicated by the mail stamp on the envelope, by the beneficiary, practitioner or facility, to the insurer or the date an electronic claim is transmitted to an insurer.
History:
[41-5601, added 2004, ch. 290, sec. 1, p. 812.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 56 - PROMPT PAYMENT OF CLAIMS › Section 41-5602 - PROMPT PAYMENT OF CLAIMS.

41-5602. PROMPT PAYMENT OF CLAIMS. (1) Except as otherwise specifically provided in this chapter, an insurer shall process a claim for payment for health care services rendered by a practitioner or facility to a beneficiary in accordance with this section.
(2) If a beneficiary, practitioner or facility submits an electronic claim to an insurer within thirty (30) days of the date on which service was delivered, an insurer shall pay or deny the claim not later than thirty (30) days after receipt of the claim.
(3) If a beneficiary, practitioner or facility submits a paper claim for payment to an insurer within forty-five (45) days of the date on which service was delivered, an insurer shall pay or deny the claim not later than forty-five (45) days after receipt of the claim.
(4) If an insurer denies the claim or needs additional information to process the claim, the insurer shall notify the practitioner or facility and the beneficiary in writing within thirty (30) days of receipt of an electronic claim or within forty-five (45) days of receipt of a paper claim. The notice shall state why the insurer denied the claim.
(5) If the claim was denied because more information was required to process the claim, the notice shall specifically describe all information and supporting documentation needed to evaluate the claim for processing. If the practitioner or facility submits the information and documentation identified by the insurer within thirty (30) days of receipt of the written notice, the insurer shall process and pay the claim within thirty (30) days of receipt of the additional information or, if appropriate, deny the claim.
(6) Any claim submitted pursuant to this chapter shall use the current procedural terminology (CPT) code in effect, as published by the American medical association, the international classification of disease (ICD) code in effect, as published by the United States department of health and human services, or the healthcare common procedural coding system (HCPCS) code in effect, as published by the United States centers for medicaid and medicare services (CMS).
(7) This chapter shall not apply to claims submitted under policies or certificates of insurance for specific disease, hospital confinement indemnity, accident-only, credit, medicare supplement, disability income insurance, student health benefits only coverage issued as a supplement to liability insurance, worker’s compensation or similar insurance, automobile medical payment insurance or nonrenewable short-term coverage issued for a period of twelve (12) months or less.
History:
[41-5602, added 2004, ch. 290, sec. 1, p. 813; am. 2005, ch. 66, sec. 1, p. 231.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 56 - PROMPT PAYMENT OF CLAIMS › Section 41-5603 - INTEREST PAYMENTS.

41-5603. INTEREST PAYMENTS. An insurer that fails to pay, request additional information or documentation or deny a claim from a beneficiary, practitioner or facility within the time periods established in this chapter shall pay interest at the contract statutory rate pursuant to section 28-22-104, Idaho Code, on the unpaid amount of a claim that is determined to be due and owing. The interest shall accrue from the date payment was due, pursuant to the provisions of this chapter, until the claim is paid. Payment of any interest amount of less than four dollars ($4.00) shall not be required. Insurers may add any interest due to a future payment to the beneficiary, practitioner or facility.
History:
[41-5603, added 2004, ch. 290, sec. 1, p. 814.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 56 - PROMPT PAYMENT OF CLAIMS › Section 41-5604 - ASSIGNMENT.

41-5604. ASSIGNMENT. Nothing in this chapter requires an insurer to accept an assignment of payment by the beneficiary to the practitioner or facility.
History:
[41-5604, added 2004, ch. 290, sec. 1, p. 814.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 56 - PROMPT PAYMENT OF CLAIMS › Section 41-5605 - EXCEPTIONS.

41-5605. EXCEPTIONS. (1) The time periods set forth in section 41-5602, Idaho Code, shall not apply to claims that the insurer reasonably believes involve fraud or misrepresentation by the practitioner or facility or the beneficiary or to instances where the insurer has not been provided the information necessary to evaluate the claim after notice has been given requesting additional information by the insurer as required by section 41-5602(5), Idaho Code.
(2) The time periods set forth in section 41-5602, Idaho Code, shall not apply to claims that the insurer reasonably believes require medical records, including accident reports, for the purpose of investigating whether a claim is valid for subrogation, or the coordination of benefits payable by the insurer with benefits payable by another insurer or payable under federal or state law.
(3) An insurer is not required to comply with the time periods set forth in section 41-5602, Idaho Code, if the insurer is in compliance with a contract with the practitioner or facility which specifies different payment requirements. Payments made within the time periods set forth in section 41-5602, Idaho Code, for the purpose of this chapter, shall be deemed to be made in a reasonable and timely manner.
(4) An insurer is not required to comply with the periods set forth in section 41-5602, Idaho Code, if the fee or premium entitling a beneficiary to insurance benefits has not been paid in full.
(5) An insurer is not required to comply with the time periods set forth in section 41-5602, Idaho Code, if failure to comply is due to an act of God, bankruptcy, an act of a governmental authority responding to an act of God or emergency or the result of a strike, walkout or other labor dispute, or act of terrorism.
History:
[41-5605, added 2004, ch. 290, sec. 1, p. 814.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 56 - PROMPT PAYMENT OF CLAIMS › Section 41-5606 - PENALTIES.

41-5606. PENALTIES. (1) The director shall enforce the provisions of this chapter and shall review and, if appropriate, investigate complaints received by the department related to noncompliance with the provisions of this chapter.
(2) If the director determines an insurer has violated the provisions of this chapter, the director may impose an administrative fine not to exceed five thousand dollars ($5,000) based upon an enforcement action.
(3) The director shall not suspend or revoke an insurer’s certificate of authority for violation of this chapter.
(4) No administrative penalty shall be imposed against an insurer under this chapter or any other provision of law for failure to comply with this chapter if, in the calendar year it has paid ninety-five percent (95%) or more of all claims subject to this chapter to or on behalf of beneficiaries within the time periods set forth in section 41-5602, Idaho Code.
(5) This section shall not create a private cause of action by or on behalf of a beneficiary or practitioner or facility against an insurer.
History:
[41-5606, added 2004, ch. 290, sec. 1, p. 815.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 57 - INTERSTATE INSURANCE PRODUCT REGULATION COMPACT › Section 41-5701 - PREAMBLE.

41-5701. PREAMBLE. Pursuant to terms and conditions of this chapter, the state of Idaho seeks to join with other states and establish the interstate insurance product regulation compact, and thus become a member of the interstate insurance product regulation commission. The director of the department of insurance is hereby designated to serve as the representative of this state to the interstate insurance product regulation commission.
History:
[41-5701, added 2005, ch. 79, sec. 1, p. 275.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5801 - PURPOSE AND SCOPE.

41-5801. PURPOSE AND SCOPE. This chapter governs the qualifications and procedures for the licensing of public adjusters. It specifies the duties of and restrictions on public adjusters, which include limiting their licensure to assisting insureds in first party claims.
History:
[41-5801, added 2008, ch. 179, sec. 1, p. 532.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5802 - DEFINITIONS.

41-5802. DEFINITIONS. As used in this chapter:
(1) "Business entity" means a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity.
(2) "Fingerprints" means an impression of the lines on the finger taken for purpose of identification. The impression may be electronic or in ink converted to electronic format.
(3) "Home state" means the District of Columbia or any state or territory of the United States in which the public adjuster’s principal place of residence or principal place of business is located. If neither the state in which the public adjuster maintains the principal place of residence nor the state in which the public adjuster maintains the principal place of business has a substantially similar law governing public adjusters, the public adjuster may declare another state in which it becomes licensed and acts as a public adjuster to be the home state.
(4) "Individual" means a natural person.
(5) "Person" means an individual or a business entity.
(6) "Public adjuster" means any person who, for compensation or any other thing of value on behalf of the insured:
(a) Acts or aids, solely in relation to first party claims arising under insurance contracts that insure the real or personal property of the insured, on behalf of an insured in negotiating for, or effecting the settlement of, a claim for loss or damage covered by an insurance contract;
(b) Advertises for employment as a public adjuster of insurance claims or solicits business or represents himself or herself to the public as a public adjuster of first party insurance claims for losses or damages arising out of policies of insurance that insure real or personal property; or
(c) Directly or indirectly solicits business, investigates or adjusts losses, or advises an insured about first party claims for losses or damages arising out of policies of insurance that insure real or personal property for another person engaged in the business of adjusting losses or damages covered by an insurance policy, for the insured.
History:
[41-5802, added 2008, ch. 179, sec. 1, p. 532.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5803 - LICENSE REQUIRED.

41-5803. LICENSE REQUIRED. (1) A person shall not act or hold himself out as a public adjuster in this state unless the person is licensed as a public adjuster in accordance with this chapter.
(2) A person licensed as a public adjuster shall not misrepresent to a claimant that he or she is an adjuster representing an insurer in any capacity, including acting as an employee of the insurer or acting as an independent adjuster unless so appointed by an insurer in writing to act on the insurer’s behalf for that specific claim or purpose. A licensed public adjuster is prohibited from charging that specific claimant a fee when appointed by the insurer and the appointment is accepted by the public adjuster.
History:
[41-5803, added 2008, ch. 179, sec. 1, p. 533.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5804 - EXCEPTIONS TO LICENSING.

41-5804. EXCEPTIONS TO LICENSING. Notwithstanding section 41-5803, Idaho Code, a license as a public adjuster shall not be required of the following:
(1) An attorney admitted to practice in this state, when acting in his or her professional capacity as an attorney;
(2) A producer licensed in Idaho who acts only on behalf of his or her own insured and does not hold himself or herself out to the public as a public adjuster;
(3) A person who negotiates or settles claims arising under a life or health insurance policy or an annuity contract;
(4) A person employed only for the purpose of obtaining facts surrounding a loss or furnishing technical assistance to a licensed public adjuster including, but not limited to, photographers, estimators, private investigators, engineers and handwriting experts;
(5) A licensed health care provider, or employee of a licensed health care provider, who prepares or files a health claim form on behalf of a patient; or
(6) A person who settles subrogation claims between insurers.
History:
[41-5804, added 2008, ch. 179, sec. 1, p. 533.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5805 - APPLICATION FOR LICENSE.

41-5805. APPLICATION FOR LICENSE. [EFFECTIVE UPON A STATE’S PARTICIPATION IN NAIC’S CENTRAL REPOSITORY FOR CRIMINAL BACKGROUND INFORMATION] (1) A person applying for a public adjuster license shall make application to the department on an application form prescribed by the department.
(2) The applicant shall declare under penalty of perjury and under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the applicant’s knowledge and belief.
(3) In order to make a determination of license eligibility, the department is authorized to require fingerprints of applicants and submit the fingerprints and the fee required to perform the criminal history record checks to the Idaho state police and the federal bureau of investigation (FBI) for state and national criminal history record checks; the department shall require a criminal history record check on each applicant in accordance with this chapter. The department shall require each applicant to submit a full set of fingerprints in order for the department to obtain and receive national criminal history records from the FBI criminal justice information services division.
(a) The department may contract for the collection, transmission and resubmission of fingerprints required under this section. If the department does so, the fee for collecting, transmitting and retaining fingerprints shall be payable directly to the contractor by the person. The department may agree to a reasonable fingerprinting fee to be charged by the contractor.
(b) The department is authorized to receive criminal history record information in lieu of the Idaho state police that submitted the fingerprints to the FBI.
History:
[41-5805, added 2008, ch. 179, sec. 1, p. 533.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5806 - LICENSE QUALIFICATIONS.

41-5806. LICENSE QUALIFICATIONS. (1) Before issuing a public adjuster license to an applicant under this section, the department shall find that the applicant:
(a) Is at least eighteen (18) years of age;
(b) Is eligible to designate this state as his or her home state or is a nonresident who is eligible for a license under section 41-5809, Idaho Code;
(c) Has successfully passed the public adjuster examination;
(d) Has not committed any act that is a ground for denial, suspension or revocation of a license as set forth in section 41-5811, Idaho Code;
(e) Is trustworthy, reliable, and of good reputation, evidence of which may be determined by the department;
(f) Is financially responsible to exercise the license and has provided proof of financial responsibility as required in section 41-5812, Idaho Code;
(g) Has paid the fees set forth by rule adopted pursuant to section 41-401, Idaho Code; and
(h) Maintains an office in the home state of residence with public access by reasonable appointment and/or regular business hours. This includes a designated office within a home state of residence.
(2) In addition to satisfying the requirements of subsection (1), when applicable, a business entity shall:
(a) Designate a licensed individual public adjuster responsible for the business entity’s compliance with the insurance laws and rules of this state;
(b) Designate only licensed individual public adjusters to exercise the business entity’s license; and
(c) The department may require any documents reasonably necessary to verify the information contained in the application.
History:
[41-5806, added 2008, ch. 179, sec. 1, p. 534.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5807 - EXAMINATION.

41-5807. EXAMINATION. (1) An individual applying for a public adjuster license under this chapter shall pass a written examination unless exempt pursuant to section 41-5808, Idaho Code. The examination shall test the knowledge of the individual concerning the duties and responsibilities of a public adjuster and the insurance laws and rules of this state. Examinations required by this section shall be developed and conducted under rules prescribed by the department.
(2) The department may make arrangements, including contracting with an outside testing service, for administering examinations and collecting the nonrefundable fee set forth by rule of the department.
(3) Each individual applying for an examination shall remit a nonrefundable fee as prescribed by the department in an amount set by rule of the department adopted pursuant to section 41-401, Idaho Code.
(4) An individual who fails to appear for the examination as scheduled or fails to pass the examination shall reapply for an examination and remit all required fees and forms before being rescheduled for another examination.
History:
[41-5807, added 2008, ch. 179, sec. 1, p. 534.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5808 - EXEMPTIONS FROM EXAMINATION.

41-5808. EXEMPTIONS FROM EXAMINATION. (1) An individual who applies for a public adjuster license in this state who was previously licensed as a public adjuster in another state based on a public adjuster examination shall not be required to complete any prelicensing examination. This exemption is only available if the person is currently licensed in that state or if the person applies for a license in this state within ninety (90) days of cancellation of the applicant’s previous license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state’s producer database records or records maintained by the national association of insurance commissioners (NAIC), its affiliates, or subsidiaries, indicate that the public adjuster is or was licensed and in good standing.
(2) A person licensed as a public adjuster in another state based on a public adjuster examination who moves to this state shall make application within ninety (90) days of establishing legal residence to become a resident licensee pursuant to section 41-5805, Idaho Code. No prelicensing examination shall be required of that person to obtain a public adjuster license.
(3) An individual who applies for a public adjuster license in this state who was previously licensed as a public adjuster in this state shall not be required to complete any prelicensing examination. This exemption is only available if the application is received within twelve (12) months of the cancellation of the applicant’s previous license in this state and if, at the time of cancellation, the applicant was in good standing in this state.
(4) A licensed individual who moves and establishes residency in this state must apply for a resident license within ninety (90) days of establishing residency here and must relinquish his or her resident license in the former home state.
History:
[41-5808, added 2008, ch. 179, sec. 1, p. 535.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5809 - NONRESIDENT LICENSE RECIPROCITY.

41-5809. NONRESIDENT LICENSE RECIPROCITY. (1) Unless denied licensure pursuant to sections 41-5810 or 41-5811, Idaho Code, a nonresident person shall receive a nonresident public adjuster license if:
(a) The person is currently licensed as a resident public adjuster and in good standing in his or her home state;
(b) The person has submitted the proper request for licensure, has paid the fees required by rule of the department adopted pursuant to section 41-5806(1)(g), Idaho Code, and has provided proof of financial responsibility as required in section 41-5812, Idaho Code;
(c) The person has submitted or transmitted to the department the appropriate completed application for licensure; and
(d) The person’s home state awards nonresident public adjuster licenses to residents of this state on the same basis.
(2) The department may verify the public adjuster’s licensing status through the producer database maintained by the NAIC, its affiliates, or subsidiaries.
(3) As a condition to continuation of a public adjuster license issued under this section, the licensee shall maintain a resident public adjuster license in his or her home state. The nonresident public adjuster license issued under this section shall terminate and be surrendered immediately to the department if the home state public adjuster license terminates for any reason, unless the public adjuster has been issued a license as a resident public adjuster in his or her new home state. Notification to the state or states where a nonresident license is issued must be made as soon as possible, within thirty (30) days of the change in new state resident license. The licensee shall include new and old addresses. A new state resident license is required for nonresident licenses to remain valid. The new state resident license must have reciprocity with the licensing nonresident state(s) for the nonresident license not to terminate.
History:
[41-5809, added 2008, ch. 179, sec. 1, p. 535.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5810 - LICENSE.

41-5810. LICENSE. (1) Unless denied licensure under this chapter, persons who have met the requirements of this chapter shall be issued a public adjuster license.
(2) A public adjuster license shall remain in effect unless revoked, terminated or suspended as long as the request for renewal and the fee set forth in the rule promulgated under section 41-5806(1)(g), Idaho Code, is paid and any other requirements for license renewal are met by the due date.
(3) The licensee shall inform the department by any means acceptable to the department of a change of address, change of legal name, or change of information submitted on the application within thirty (30) days of the change.
(4) A public adjuster who allows his or her license to lapse may, within twelve (12) months from the due date of the renewal, reinstate his or her public adjuster license upon the department’s receipt of the request for renewal, payment of a penalty in the amount of double the unpaid renewal fee and certification that all continuing education requirements have been met. The new public adjuster license shall be effective the date the department receives all of the above stated items required for reinstatement.
(5) A licensed public adjuster who is unable to comply with license renewal procedures due to military service, a long-term medical disability or some other extenuating circumstance, may request a waiver of those procedures. The public adjuster may also request a waiver of any examination requirement, fine or other sanction imposed for failure to comply with renewal procedures.
(6) The license shall contain the licensee’s name, city and state of business address, license number, the date of issuance, the expiration date and any other information the department deems necessary.
(7) In order to assist in the performance of the department’s duties, the department may contract with nongovernmental entities, including the NAIC or any affiliates or subsidiaries that the NAIC oversees, to perform any ministerial functions, including the collection of fees and data, related to licensing that the department may deem appropriate.
History:
[41-5810, added 2008, ch. 179, sec. 1, p. 536.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5812 - BOND OR LETTER OF CREDIT.

41-5812. BOND OR LETTER OF CREDIT. Prior to issuance of a license as a public adjuster and for the duration of the license, the applicant shall secure evidence of financial responsibility in a format prescribed by the department through a security bond or irrevocable letter of credit.
(1) A surety bond executed and issued by an insurer authorized to issue surety bonds in this state, which bond:
(a) Shall be in the minimum amount of twenty thousand dollars ($20,000);
(b) Shall be in favor of this state and shall specifically authorize recovery by the department on behalf of any person in this state who sustained damages as the result of erroneous acts, a failure to act, conviction of fraud, or conviction of unfair practices in his or her capacity as a public adjuster; and
(c) Shall not be terminated unless at least thirty (30) days’ prior written notice will have been filed with the department and given to the licensee.
(2) An irrevocable letter of credit issued by a qualified financial institution, which letter of credit:
(a) Shall be in the minimum amount of twenty thousand dollars ($20,000);
(b) Shall be to an account within the department and subject to lawful levy of execution on behalf of any person to whom the public adjuster has been found to be legally liable as the result of erroneous acts, a failure to act, fraudulent acts, or unfair practices in his or her capacity as a public adjuster; and
(c) Shall not be terminated unless at least thirty (30) days’ prior written notice will have been filed with the department and given to the licensee.
(3) The issuer of the evidence of financial responsibility shall notify the department upon termination of the bond or letter of credit, unless otherwise directed by the department.
(4) The department may ask for the evidence of financial responsibility at any time deemed relevant.
(5) The authority to act as a public adjuster shall automatically terminate if the evidence of financial responsibility terminates or becomes impaired.
History:
[41-5812, added 2008, ch. 179, sec. 1, p. 537.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5813 - CONTINUING EDUCATION.

41-5813. CONTINUING EDUCATION. (1) An individual, who holds a public adjuster license and who is not exempt under subsection (2) of this section, shall satisfactorily complete a minimum of twenty-four (24) hours of continuing education courses, including three (3) hours of law or ethics, reported on a biennial basis in conjunction with the license renewal cycle.
(2) This section shall not apply to:
(a) Licensees not licensed for one (1) full year prior to the end of the applicable continuing education biennium; or
(b) Licensees holding nonresident public adjuster licenses who have met the continuing education requirements of their home state and whose home state gives credit to residents of this state on the same basis.
(3) Only continuing education courses approved by the department shall be used to satisfy the continuing education requirement of subsection (1) of this section.
(4) Failure of the licensee to comply with the applicable education requirement by the expiration date of the license shall be grounds for the director to refuse to continue any such license. The licensee may reinstate his or her license by submitting proof of all education requirements within ninety (90) days from the date of expiration of the license and by submitting an additional administrative penalty of one hundred dollars ($100) for a delinquency of one (1) day to thirty (30) days, two hundred dollars ($200) for a delinquency of thirty-one (31) days to sixty (60) days, and three hundred dollars ($300) for a delinquency of sixty-one (61) days to ninety (90) days. Following the ninetieth day from the date of nonrenewal of the license and up to one (1) year from the nonrenewal date, the licensee must complete all requirements for licensure including retesting, submission of a new application and payment of all new licensing fees. In addition, the individual must submit proof of completion of the required education requirements from the licensing period in which the license was terminated. After the license has been expired for one (1) year or more, the individual must reapply and retest as a new applicant.
History:
[41-5813, added 2008, ch. 179, sec. 1, p. 538.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5814 - PUBLIC ADJUSTER FEES.

41-5814. PUBLIC ADJUSTER FEES. (1) A public adjuster shall not pay a commission, service fee or other valuable consideration to a person for investigating or settling claims in this state if that person is required to be licensed under this chapter and is not so licensed.
(2) A person shall not accept a commission, service fee or other valuable consideration for investigating or settling claims in this state if that person is required to be licensed under this chapter and is not so licensed.
(3) A public adjuster may pay or assign commission, service fees or other valuable consideration to persons who do not investigate or settle claims in this state, unless the payment would violate section 41-1314, Idaho Code.
History:
[41-5814, added 2008, ch. 179, sec. 1, p. 539.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5816 - ESCROW OR TRUST ACCOUNTS.

41-5816. ESCROW OR TRUST ACCOUNTS. A public adjuster who receives, accepts or holds any funds on behalf of an insured, towards the settlement of a claim for loss or damage, shall deposit the funds in a noninterest bearing escrow or trust account in a financial institution that is insured by an agency of the federal government in the public adjuster’s home state or where the loss occurred.
History:
[41-5816, added 2008, ch. 179, sec. 1, p. 541.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5817 - RECORD RETENTION.

41-5817. RECORD RETENTION. (1) A public adjuster shall maintain a complete record of each transaction as a public adjuster. The records required by this section shall include the following:
(a) Name of the insured;
(b) Date, location and amount of the loss;
(c) Copy of the contract between the public adjuster and insured;
(d) Name of the insurer, amount, expiration date and number of each policy carried with respect to the loss;
(e) Itemized statement of the insured’s recoveries;
(f) Itemized statement of all compensation received by the public adjuster, from any source whatsoever, in connection with the loss;
(g) A register of all moneys received, deposited, disbursed or withdrawn in connection with a transaction with an insured, including fees, transfers and disbursements from a trust account and all transactions concerning all interest bearing accounts;
(h) Name of public adjuster who executed the contract;
(i) Name of the attorney representing the insured, if applicable, and the name of the claims representatives of the insurance company; and
(j) Evidence of financial responsibility in a format prescribed by the department.
(2) Records shall be maintained for at least five (5) years after the termination of the transaction with an insured and shall be open to examination by the department at all times.
(3) Records submitted to the department in accordance with this section that contain information identified in writing as proprietary by the public adjuster shall be treated as confidential by the department pursuant to section 74-107, Idaho Code.
History:
[41-5817, added 2008, ch. 179, sec. 1, p. 541; am. 2015, ch. 141, sec. 117, p. 466.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5819 - REPORTING OF ACTIONS.

41-5819. REPORTING OF ACTIONS. (1) The public adjuster shall report to the department any administrative action taken against the public adjuster in another jurisdiction or by another governmental agency in this state within thirty (30) days of the final disposition of the matter. This report shall include a copy of the order, consent to order, or other relevant legal documents.
(2) Within thirty (30) days of the initial pretrial hearing date, the public adjuster shall report to the department any criminal prosecution of the public adjuster taken in any jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing, and any other relevant legal documents.
History:
[41-5819, added 2008, ch. 179, sec. 1, p. 543.]