reglab/statecodes huggingface dataset:
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5820 - RULES.

41-5820. RULES. The department may, in accordance with section 41-211, Idaho Code, promulgate reasonable rules as are necessary or proper to carry out the purposes of this chapter.
History:
[41-5820, added 2008, ch. 179, sec. 1, p. 543.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 58 - PUBLIC ADJUSTER LICENSING ACT › Section 41-5821 - SEVERABILITY.

41-5821. SEVERABILITY. If any provisions of this chapter, or the application of a provision to any persons or circumstances, shall be held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.
History:
[41-5821, added 2008, ch. 179, sec. 1, p. 543.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5901 - SHORT TITLE.

41-5901. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Health Carrier External Review Act."
History:
[41-5901, added 2009, ch. 87, sec. 1, p. 240.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5902 - PURPOSE AND INTENT.

41-5902. PURPOSE AND INTENT. The purpose of this chapter is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of a final adverse benefit determination, as defined in this chapter.
History:
[41-5902, added 2009, ch. 87, sec. 1, p. 240.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5904 - APPLICABILITY AND SCOPE.

41-5904. APPLICABILITY AND SCOPE. (1) Except as provided in subsection (2) of this section, this chapter shall apply to all health carriers.
(2) The provisions of this chapter shall not apply to a plan, policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage; nor shall this chapter apply to a credit, dental, disability income, hospital indemnity, long-term care insurance, vision care, limited benefit health plans or any other limited supplemental benefit; nor shall this chapter apply to a medicare advantage plan or medicare supplemental policy of insurance, as defined by the director by rule, coverage under a plan through medicare, medicaid, or the federal employees health benefits program, any coverage issued under chapter 55, title 10, of the United States Code and any coverage issued as supplemental to that coverage; nor shall this chapter apply to any coverage issued as supplemental to liability insurance, worker’s compensation or similar insurance, automobile medical payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis; nor shall this chapter apply to a single employer self-funded employee benefit plan subject to and operated in compliance with the employee retirement income security act of 1974 (ERISA); provided however, the single employer self-funded ERISA employee benefit plan administrator or designee may, by timely and appropriate written notice to the director, voluntarily elect to comply with the provisions of this chapter either for a single plan beneficiary or for a specific period of time. The director may promulgate rules establishing the procedure for an employee benefit plan administrator or designee, to voluntarily comply with the provisions of this chapter and to provide for an administrative fee to be paid by the employee benefit plan administrator for each voluntary external review request submitted to the department pursuant to this chapter.
(3) The availability or use of external review pursuant to this chapter shall not alter the standard of review used by a court of competent jurisdiction when adjudicating the health carrier’s final adverse benefit determination.
History:
[41-5904, added 2009, ch. 87, sec. 1, p. 245; am. 2011, ch. 122, sec. 2, p. 337; am. 2011, ch. 258, sec. 1, p. 703.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5905 - NOTICE OF RIGHT TO EXTERNAL REVIEW.

41-5905. NOTICE OF RIGHT TO EXTERNAL REVIEW. (1) When a final adverse benefit determination is made, the health carrier shall notify the covered person in writing of the covered person’s right to request an external review to be conducted pursuant to section 41-5908, 41-5909 or 41-5910, Idaho Code, and include the appropriate statements and information set forth in subsection (2) of this section at the same time the health carrier sends written notice of the final adverse benefit determination.
(2) The director may prescribe by rule the form and content of the notice required under this section, which shall include:
(a) The following, or substantially equivalent, language:
"We have denied your request for the provision of or payment for a health care service or course of treatment. You may have the right to have our decision reviewed by health care professionals who have no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, health care setting, level of care or effectiveness of your health care service or supply, or your health care service or supply was denied based upon a determination that it was investigational. You may request an external review by submitting a written request to the department of insurance."
The notice shall include contact information for the department of insurance, including the website, address and telephone number.
(b) If the adverse benefit determination is for a pre-service or concurrent service, the health carrier shall notify the covered person of the right to an expedited external review if the request is an urgent care request. The notification shall include the definition of urgent care request.
(c) The health carrier shall include a copy of the description of both the standard and expedited external review procedures the health carrier is required to provide pursuant to section 41-5916, Idaho Code, highlighting the provisions in the external review procedures that give the covered person the opportunity to submit additional information, and include any forms used to process an external review.
(d) The health carrier shall include an authorization form, or other document approved by the director, that complies with the requirements of 45 CFR section 164.508, by which the covered person, for purposes of conducting an external review pursuant to this chapter, authorizes the health carrier and the covered person’s treating health care providers to disclose protected health information, including medical records, concerning the covered person that are pertinent to the external review. Until the director receives this form from the covered person, duly executed, the external review process is stayed and the health carrier has no obligations under this chapter.
History:
[41-5905, added 2009, ch. 87, sec. 1, p. 245; am. 2011, ch. 122, sec. 3, p. 338.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5906 - REQUEST FOR EXTERNAL REVIEW.

41-5906. REQUEST FOR EXTERNAL REVIEW. A covered person may make a request for an external review of a final adverse benefit determination. Except for a request for an expedited external review as set forth in section 41-5909, Idaho Code, all requests for external review shall be made in writing to the director. The director may prescribe by rule the form and content of external review requests required to be submitted under this section.
History:
[41-5906, added 2009, ch. 87, sec. 1, p. 246; am. 2011, ch. 122, sec. 4, p. 339.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5907 - EXHAUSTION OF INTERNAL GRIEVANCE PROCESS.

41-5907. EXHAUSTION OF INTERNAL GRIEVANCE PROCESS. (1) Except as provided in subsection (2) of this section, a request for an external review pursuant to section 41-5908, 41-5909 or 41-5910, Idaho Code, shall not be made until the covered person has exhausted the health carrier’s internal grievance process. A covered person shall be considered to have exhausted the health carrier’s internal grievance process for purposes of this section, if the covered person:
(a) Has filed and completed a grievance, involving an adverse benefit determination, according to the terms and conditions of the covered person’s health benefit plan; or
(b) Except to the extent the covered person requested or agreed to a delay, has not received a written decision on the grievance from the health carrier within thirty-five (35) days following the date the covered person filed the grievance with the health carrier, or the covered person filed a grievance on an urgent care request on a pre-service or concurrent care adverse benefit determination and has not received a determination from the health carrier within three (3) business days after filing.
(2) A request for an external review of an adverse benefit determination may be made before the covered person has exhausted the health carrier’s internal grievance procedures as set forth in the health carrier’s grievance appeal process whenever:
(a) The health carrier agrees to waive the exhaustion requirement;
(b) The health carrier has failed to strictly follow its duties in affording a timely, full and fair opportunity for the covered person to take advantage of the internal grievance procedures; or
(c) The urgent care request involves a medical condition for which the time frame for completion of the carrier’s internal grievance process pursuant to this section would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function, and the covered person has applied for expedited external review at the same time as applying for an expedited internal review.
History:
[41-5907, added 2009, ch. 87, sec. 1, p. 246; am. 2011, ch. 122, sec. 5, p. 339.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5910 - BINDING NATURE OF EXTERNAL REVIEW DECISION.

41-5910. BINDING NATURE OF EXTERNAL REVIEW DECISION. (1) For a health care benefit plan not subject to the employee retirement income security act of 1974 (ERISA), the external review decision is final and binding on the health carrier and on the covered person. No judicial action or proceeding arising out of the external review decision or the issues determined by the external review decision shall be permitted. For a health care benefit plan subject to ERISA, the external review decision is final and binding on the health carrier; however, should the covered person seek judicial review of the external review decision, then the external review record and decision shall be included as a part of the administrative record for the purpose of review by any court of competent jurisdiction.
(2) A covered person may not file a subsequent request for external review involving the same adverse benefit determination or final adverse benefit determination for which the covered person has already received an external review decision pursuant to this chapter.
History:
[41-5910, added 2009, ch. 87, sec. 1, p. 252.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5913 - HOLD HARMLESS FOR INDEPENDENT REVIEW ORGANIZATIONS.

41-5913. HOLD HARMLESS FOR INDEPENDENT REVIEW ORGANIZATIONS. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable in damages or otherwise to any person for any opinions rendered or acts or omissions performed within the scope of the organization’s or person’s duties under the law during or upon completion of an external review conducted pursuant to this chapter unless the opinion was rendered or act or omission performed in bad faith or involved gross negligence; provided that the health carrier shall not be liable in damages or otherwise to any person for any opinions rendered or acts or omissions performed by the independent review organization, its employees, agents or contractors within the scope of the organization’s or person’s duties under the law during or upon completion of an external review conducted pursuant to this chapter.
History:
[41-5913, added 2009, ch. 87, sec. 1, p. 255.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5914 - EXTERNAL REVIEW REPORTING REQUIREMENTS.

41-5914. EXTERNAL REVIEW REPORTING REQUIREMENTS. (1) An independent review organization assigned pursuant to this chapter to conduct an external review shall maintain written records in the aggregate for Idaho by health carrier on all requests for external review for which it conducted an external review during a calendar year and, upon request, submit a report to the director, as required under this section. Each independent review organization required to maintain written records on all requests for external review pursuant to this section for which it was assigned to conduct an external review shall submit to the director, upon request or at specified intervals, a report in the format specified by the director.
(2) The report shall include in the aggregate for Idaho for each health carrier:
(a) The total number of requests for external review;
(b) The number of requests for external review resolved and, of those resolved, the number resolved upholding the final adverse benefit determinations and the number resolved reversing the final adverse benefit determinations;
(c) The average length of time for resolution;
(d) A summary of the types of coverages or cases for which an external review was sought;
(e) The number of external reviews pursuant to section 41-5908(18), Idaho Code, that were terminated as the result of a reconsideration by the health carrier of its final adverse benefit determination after the receipt of additional information from the covered person; and
(f) Any other information the director may reasonably request or require.
(3) The independent review organization shall retain the written records required pursuant to this section for at least five (5) years.
(4) Each health carrier shall maintain written records in the aggregate for Idaho for each type of health benefit plan offered by the health carrier on all requests for external review that the health carrier receives notice of from the director pursuant to this chapter.
(5) Each health carrier is required to maintain written records on all requests for external review pursuant to subsection (1) of this section and shall submit to the director, upon request or at specified intervals, a report in the format specified by the director. The report shall include in the aggregate for Idaho and by type of health benefit plan:
(a) The total number of requests for external review;
(b) From the total number of requests for external review reported, the number of requests determined eligible for a full external review; and
(c) Any other information the director may reasonably request or require.
(6) The health carrier shall retain the written records required pursuant to this section for at least five (5) years.
History:
[41-5914, added 2009, ch. 87, sec. 1, p. 255.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5915 - FUNDING OF EXTERNAL REVIEW.

41-5915. FUNDING OF EXTERNAL REVIEW. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the reasonable cost of the independent review organization for conducting the external review.
History:
[41-5915, added 2009, ch. 87, sec. 1, p. 256; am. 2011, ch. 122, sec. 8, p. 345.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5916 - DISCLOSURE REQUIREMENTS.

41-5916. DISCLOSURE REQUIREMENTS. (1) Each health carrier shall include a summary description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons. The disclosure shall be in a format prescribed by the director.
(2) The description required under subsection (1) of this section shall include:
(a) A statement that informs the covered person of the right of the covered person to file a request for an external review of a final adverse benefit determination with the director;
(b) An explanation that external review and, in certain circumstances, expedited external review are available when the final adverse benefit determination involves an issue of medical necessity, appropriateness, health care setting, level of care, effectiveness or investigational service or supply;
(c) The website, telephone number and address of the director; and
(d) A statement informing the covered person that, when filing a request for an external review, the covered person will be required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the external review including any judicial review of the external review decision pursuant to ERISA, if applicable.
(e) If the health plan is not subject to ERISA, a statement informing the covered person that the plan is not subject to ERISA and that if the covered person elects to request external review, the external review decision of the independent review organization shall be final and binding on both the covered person and the health carrier, as provided in section 41-5910, Idaho Code. If the health plan is subject to ERISA, the statement shall inform the covered person that the plan is subject to ERISA and that if the covered person elects to request external review, the external review decision of the independent review organization shall be final and binding on the health carrier but not the covered person, as provided in section 41-5910, Idaho Code, and that the covered person may have the right to judicial review under ERISA in a court of competent jurisdiction.
History:
[41-5916, added 2009, ch. 87, sec. 1, p. 256; am. 2011, ch. 122, sec. 9, p. 345.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT › Section 41-5917 - SEVERABILITY.

41-5917. SEVERABILITY. The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act.
History:
[41-5917, added 2009, ch. 87, sec. 1, p. 257.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6001 - LEGISLATIVE INTENT.

41-6001. LEGISLATIVE INTENT. [EFFECTIVE UNTIL JULY 1, 2024] The intent of the legislature is to provide a supplemental funding mechanism for the Idaho immunization program administered by the Idaho department of health and welfare, by creating a dedicated vaccine fund and an independent board, which board is empowered to assess fees from all carriers. The chapter’s goal is to ensure access to childhood vaccinations in Idaho, by decreasing costs and enabling the maintenance of a single distribution of vaccines available to health care providers in Idaho who administer the vaccines to program eligible children.
History:
[41-6001, added 2010, ch. 32, sec. 1, p. 60.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6002 - DEFINITIONS.

41-6002. DEFINITIONS. [EFFECTIVE UNTIL JULY 1, 2024] As used in this chapter:
(1) "Board" means the Idaho immunization assessment board created by section 41-6003, Idaho Code.
(2) "Carrier" means: any entity subject to regulation by the department that provides or is authorized to provide health insurance or health benefit plans, or that administers health insurance or health benefit coverage or that otherwise provides a plan of health insurance or health benefits; or a foreign insurer who provides health insurance coverage or benefits to residents of this state as certificate holders under a group policy issued or delivered outside of this state. For purposes of this chapter, the term "carrier" includes an insurance company, a hospital or professional service corporation, a fraternal benefit society, a managed care organization, entities that provide excess or stop-loss insurance, and persons or entities required to be registered with the director under chapter 9, title 41, Idaho Code. For the purposes of this chapter, the term "carrier" does not include an entity that only issues policies, certificates or subscriber contracts within the state of Idaho that are limited to a specific disease, hospital confinement indemnity, accident-only, credit, dental, vision, medicare supplement, long-term care, 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.
(3) "Director" means the director of the department of insurance of the state of Idaho.
(4) "Fund" means the Idaho immunization dedicated vaccine fund created in section 41-6007, Idaho Code.
(5) "Idaho immunization program" means that program administered by the Idaho department of health and welfare to provide vaccinations against diseases to Idaho children consistent with Idaho and federal law.
(6) "Plan of operation" means the plan of operation of the fund as established by the board.
(7) "Program-eligible child" means any child, natural or adopted, who is under nineteen (19) years of age, whose custodial parent or legal guardian resides in Idaho and who is not eligible for the federal vaccines for children program.
(8) "Vaccine" means any preparations of killed microorganisms, living attenuated organisms or living fully virulent organisms that are approved by the federal food and drug administration and recommended by the federal advisory committee on immunization practices of the centers for disease control and prevention.
(9) "Vaccines for children" program is that federally funded program that provides vaccines at no cost to eligible children pursuant to section 1928 of the social security act.
History:
[41-6002, added 2010, ch. 32, sec. 1, p. 60; am. 2010, ch. 187, sec. 1, p. 399.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6003 - IDAHO IMMUNIZATION ASSESSMENT BOARD.

41-6003. IDAHO IMMUNIZATION ASSESSMENT BOARD. [EFFECTIVE UNTIL JULY 1, 2024] (1) There is hereby created in the Idaho department of insurance the Idaho immunization assessment board. The board will perform an essential governmental function in the exercise of powers conferred upon it by this chapter and shall be a governmental entity within the meaning of chapter 9, title 6, Idaho Code.
(2) The board shall consist of ten (10) members and one (1) ex officio member:
(a) Seven (7) members shall be appointed by the director and serve at the pleasure of the director. In selecting the members of the board, the director shall appoint:
(i) Three (3) members representing carriers, one (1) of whom shall represent administrators or third-party administrators;
(ii) One (1) primary care physician licensed and practicing in Idaho; and
(iii) Three (3) members representing the Idaho business community, one (1) of whom shall represent a private self-funded insurance plan;
(b) One (1) member appointed by the director of the department of health and welfare;
(c) One (1) member shall be a member of the senate, appointed by the president pro tempore of the senate;
(d) One (1) member shall be a member of the house of representatives, appointed by the speaker of the house of representatives; and
(e) The director or the director’s designated representative shall serve as an ex officio eleventh member of the board.
(3) The initial board members appointed by the director pursuant to subsection (2)(a) of this section shall be appointed as follows: Legislative members of the board shall serve for a term of two (2) years.
(a) Two (2) members, as determined by the director, shall serve an initial term of two (2) years;
(b) Two (2) members, as determined by the director, shall serve an initial term of three (3) years; and
(c) One (1) member, as determined by the director, shall serve an initial term of four (4) years.
Subsequent board members appointed by the director pursuant to subsection (2)(a) of this section shall serve for terms of three (3) years.
(4) A vacancy on the board appointed by the director pursuant to subsection (2)(a) of this section shall be filled by the director. A vacancy in a legislative member’s position on the board shall be filled in the same manner as the original appointment.
(5) Except for employees of the state of Idaho, members of the board shall not receive compensation or reimbursement for expenses for their service on the board. Employees of the state of Idaho serving on the board shall be reimbursed for their vouched expenses associated with their service on the board in a manner consistent with policy for other state employees.
History:
[41-6003, added 2010, ch. 32, sec. 1, p. 61; am. 2018, ch. 32, sec. 1, p. 59.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6004 - PLAN OF OPERATION.

41-6004. PLAN OF OPERATION. [EFFECTIVE UNTIL JULY 1, 2024] (1) The board shall submit to the director a plan of operation and thereafter any amendments thereto. The plan of operation, and any amendments thereto, shall become effective upon written approval by the director. If the board fails to submit a suitable plan of operation, the director shall adopt and promulgate a temporary plan of operation.
(2) The plan of operation shall:
(a) Identify methodology and procedures for determining assessments to the carriers that are fair and equitable;
(b) Establish procedures for the director to collect assessments from carriers to fund vaccine purchases by the state of Idaho; and
(c) Provide for any additional matters necessary for the implementation and administration of the fund.
(3) Administrative cost associated with the creation and amending the plan of operation shall be paid out of the fund.
History:
[41-6004, added 2010, ch. 32, sec. 1, p. 61.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6005 - POWER AND LIABILITY OF THE BOARD.

41-6005. POWER AND LIABILITY OF THE BOARD. [EFFECTIVE UNTIL JULY 1, 2024] (1) The board shall have the power to:
(a) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this chapter, including contracts for administrative services;
(b) Determine the method of assessment and assess carriers in accordance with the provisions of section 41-6006, Idaho Code;
(c) Require carriers to provide to the board such statements and reports the board deems necessary to fulfill its duties under this chapter;
(d) Establish policies and procedures as may be necessary or convenient for the implementation of this chapter and the operation of the assessments authorized by this chapter; and
(e) Consult with the Idaho department of health and welfare and other experts as the board may deem appropriate as necessary or proper to carry out the provisions and purposes of this chapter.
(2) Neither the board nor its members shall be liable for any obligations of the vaccine assessments. No member or employee of the board shall be liable, and no cause of action of any nature may arise against them, for any act or omission related to the performance of their powers and duties under this chapter, unless such act or omission constitutes willful or wanton misconduct. Participation by a carrier in the assessments authorized by this chapter or on the board under the provisions of this chapter shall not be grounds for any legal action, criminal or civil liability, or penalty against the fund or any of its carriers or board members, either jointly or separately.
History:
[41-6005, added 2010, ch. 32, sec. 1, p. 62; am. 2011, ch. 121, sec. 1, p. 331.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6007 - IDAHO IMMUNIZATION DEDICATED VACCINE FUND.

41-6007. IDAHO IMMUNIZATION DEDICATED VACCINE FUND. [EFFECTIVE UNTIL JULY 1, 2024] There is hereby created in the state treasury the Idaho immunization dedicated vaccine fund. Moneys in the fund shall be appropriated solely for purposes established by this chapter. All funds in excess to the cost required to perform the administrative functions required under this chapter shall be paid to the Idaho department of health and welfare for the sole purposes of purchasing vaccine for use in the Idaho immunization program. Any moneys in excess of the amount needed to fund the Idaho immunization program for a given period shall be retained by the Idaho department of health and welfare to be used to fund the program in subsequent periods, including a subsequent period after the date this chapter is no longer in effect. The fund and any assessments imposed or collected pursuant to the operation of the fund shall at all times be free from taxation of every kind.
History:
[41-6007, added 2010, ch. 32, sec. 1, p. 63; am. 2011, ch. 121, sec. 3, p. 332.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024] › Section 41-6008 - RULEMAKING AUTHORITY.

41-6008. RULEMAKING AUTHORITY. [EFFECTIVE UNTIL JULY 1, 2024] Upon consultation with the board, the director shall have the authority to promulgate rules necessary to implement this chapter.
History:
[41-6008, added 2010, ch. 32, sec. 1, p. 63.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6101 - SHORT TITLE.

41-6101. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Health Insurance Exchange Act."
History:
[41-6101, added 2013, ch. 170, sec. 1, p. 390.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6102 - PURPOSE AND INTENT.

41-6102. PURPOSE AND INTENT. It is the public policy of the state of Idaho to actively resist federal actions that would limit or override state sovereignty under the 10th amendment of the United States constitution. Through this legislation, the state of Idaho asserts its sovereignty by refusing to surrender decision-making authority over health care issues, which are matters appropriately left to states and individual citizens. The purpose of this chapter is to establish a state-created, market-driven health insurance exchange that will facilitate the selection and purchase of individual and employer health benefit plans. The creation of a state-based health insurance exchange will provide an Idaho-specific solution that fits the unique needs of the state of Idaho. Participation in the exchange is voluntary in that no person or employer shall be required by this chapter to purchase a health benefit plan through the exchange. Creation of the exchange and its operation is deemed a public purpose intended to enhance Idaho residents’ choice regarding options and access to health insurance.
History:
[41-6102, added 2013, ch. 170, sec. 1, p. 390.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6103 - DEFINITIONS.

41-6103. DEFINITIONS. For the purposes of this chapter:
(1) "Board" means those individuals who, acting as a board of directors of the exchange, govern and act for the exchange pursuant to section 41-6104, Idaho Code.
(2) "Conflict of interest" means that by taking any action or making any decision or recommendation on a matter within the authority of the board, a member of the board, or a person within the member’s household, or any entity with which the member, or a person within the member’s household is associated, would receive a pecuniary benefit or detriment, unless the pecuniary benefit or detriment would apply to the same degree to a class consisting of all persons within the particular class in this state.
(3) "Director" means the director of the department of insurance of the state of Idaho.
(4) "Exchange" means the Idaho health insurance exchange established pursuant to this chapter.
(5) "Health carrier" has the same meaning as "carrier" as set forth in section 41-5203(5), Idaho Code.
(6) "Person" has the same meaning as set forth in section 41-104, Idaho Code.
(7) "Producer" has the same meaning as set forth in section 41-1003(8), Idaho Code.
(8) "Stand-alone dental plan" means a policy, certificate of insurance or subscriber contract that provides only dental health plan benefits, which may include adult, pediatric or both, and is approved by the department of insurance as being in compliance with the requirements of state law and departmental rules relating to such policy, certificate of insurance or subscriber contract.
History:
[41-6103, added 2013, ch. 170, sec. 1, p. 391; am. 2015, ch. 193, sec. 1, p. 602.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6106 - REPORT.

41-6106. REPORT. (1) The exchange shall submit a written report of its activities and the condition of the exchange to the director, the governor and the director of the legislative services office for distribution to all legislators on or before January 31, 2014, and annually on or before each January 31 thereafter. The exchange shall also report to the appropriate senate and house of representatives germane committees on any changes to its bylaws or policies and any changes or updates from the federal department of health and human services (HHS) regarding essential health benefits or operation or conditions of the exchange on or before January 31, 2014, and annually on or before each January 31 thereafter.
(2) For any changes by the board to the fee schedule charged to exchange users or participants, the exchange shall, at the next legislative session, report to the appropriate senate and house of representatives germane committees on or before January 31.
History:
[41-6106, added 2013, ch. 170, sec. 1, p. 394.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6107 - RELATION TO OTHER LAWS.

41-6107. RELATION TO OTHER LAWS. The board and the exchange are entitled to rely upon work performed by the director and the director of the Idaho department of health and welfare in furtherance of the purpose of this chapter that are not otherwise inconsistent with their respective statutory duties and authority. Nothing in this chapter, and no action taken by the exchange pursuant to this chapter, shall be construed to preempt or supersede the authority of the director to regulate the business of insurance within this state pursuant to title 41, Idaho Code, and administer and enforce rules adopted in accordance therewith.
History:
[41-6107, added 2013, ch. 170, sec. 1, p. 394.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6108 - IDAHO CONTRACTORS IN A HEALTH INSURANCE EXCHANGE.

41-6108. IDAHO CONTRACTORS IN A HEALTH INSURANCE EXCHANGE. Pursuant to sections 41-6104 and 41-6105, Idaho Code, the board shall, to the fullest extent practicable, enter into contracts with businesses conducting business in Idaho and employing citizens of this state to staff and provide support for the exchange.
History:
[41-6108, added 2013, ch. 170, sec. 1, p. 394.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 61 - IDAHO HEALTH INSURANCE EXCHANGE ACT › Section 41-6109 - SEVERABILITY.

41-6109. SEVERABILITY. The provisions of this act are hereby declared to be severable, and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act.
History:
[41-6109, added 2013, ch. 170, sec. 1, p. 394.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6201 - SHORT TITLE.

41-6201. SHORT TITLE. The provisions of this chapter shall be known and may be cited as the "Idaho Motor Vehicle Service Contract Act."
History:
[41-6201, added 2018, ch. 116, sec. 2, p. 241.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6202 - LEGISLATIVE INTENT.

41-6202. LEGISLATIVE INTENT. (1) The legislature finds and declares that a considerable number of Idaho citizens use contracts to provide necessary services for the repair and servicing of motor vehicles purchased and used within the state.
(2) It is the intent of the legislature that this act provides for state of Idaho regulation of motor vehicle service contracts offered for sale in the state by any person other than the motor vehicle manufacturer or its affiliates and subsidiaries.
(3) It is also the intent of the legislature that this act shall not apply to:
(a) The customary and usual performance guarantees or warranties offered at no additional charge by motor vehicle manufacturers, or their affiliates and subsidiaries, regarding the sale of motor vehicles;
(b) Maintenance agreements; or
(c) Theft protection programs or theft protection program warranties.
Such products identified in this subsection shall not be subject to the provisions of title 41, Idaho Code, unless expressly made applicable.
History:
[41-6202, added 2018, ch. 116, sec. 2, p. 241.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6206 - MOTOR VEHICLE SERVICE CONTRACT REQUIREMENTS.

41-6206. MOTOR VEHICLE SERVICE CONTRACT REQUIREMENTS. Before the sale of any motor vehicle service contract, the motor vehicle service contract provider shall give written notice to the customer clearly disclosing that the purchase of the contract is not required either to purchase or to obtain financing for a motor vehicle. No motor vehicle service contract may be used in this state by any motor vehicle service contract provider if the contract:
(1) In any respect violates, or does not comply with, the laws of this state;
(2) Contains or incorporates by reference any inconsistent, ambiguous or misleading clauses or any exceptions and conditions that affect the risk assumed or to be assumed in the general coverage of the contract;
(3) Has any title, heading or other indication of its provisions that is misleading; or
(4) Is printed or otherwise reproduced in any manner that renders any material provision of the contract substantially illegible.
History:
[41-6206, added 2018, ch. 116, sec. 2, p. 245.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6207 - PROHIBITED ACTS.

41-6207. PROHIBITED ACTS. (1) A motor vehicle service contract provider may not use in its name, contracts or literature:
(a) Any of the words "insurance," "casualty," "surety," "mutual" or any other words descriptive of the insurance, casualty or surety business; or
(b) A name deceptively similar to the name or description of any insurance or surety corporation, or any other motor vehicle service contract provider.
(2) A motor vehicle service contract provider, its representative or any other person may not make, permit or allow to be made any false, deceptive or misleading statement, or may not deliberately omit any material statement that would be considered misleading if omitted, in connection with the sale, offer to sell or advertisement of a motor vehicle service contract.
(3) It shall be unlawful for any company to directly or indirectly represent in any manner, whether by written solicitation, advertisement or telemarketing, a false, deceptive or misleading statement with regard to:
(a) Such company’s affiliation with a motor vehicle manufacturer, recreational vehicle manufacturer or dealer;
(b) Such company’s possession of information regarding a motor vehicle owner’s current motor vehicle manufacturer’s or recreational vehicle manufacturer’s original equipment warranty;
(c) All indications that such company’s records show that a motor vehicle or recreational vehicle owner’s current motor vehicle manufacturer’s or recreational vehicle manufacturer’s original equipment warranty is nearing or past expiration;
(d) A requirement that such motor vehicle or recreational vehicle owner register for a new motor vehicle service contract with such company to maintain coverage under the motor vehicle or recreational vehicle owner’s current service contract or manufacturer’s original equipment warranty.
History:
[41-6207, added 2018, ch. 116, sec. 2, p. 245.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6208 - RECORDKEEPING REQUIREMENTS.

41-6208. RECORDKEEPING REQUIREMENTS. (1) All motor vehicle service contract providers shall keep accurate accounts, books and records concerning transactions regulated under the provisions of this act. A motor vehicle service contract provider’s accounts, books and records shall include:
(a) Copies of all motor vehicle service contracts issued;
(b) The name and address of each motor vehicle service contract holder; and
(c) Claim files.
(2) All motor vehicle service contract providers shall retain all records pertaining to each motor vehicle service contract holder for at least three (3) years after the specified period of coverage has expired. It shall be the responsibility of the insurer issuing the liability policy to make an examination at least every two (2) years of each motor vehicle service contract provider that they insure to assure that each provider is in compliance with the recordkeeping requirements.
History:
[41-6208, added 2018, ch. 116, sec. 2, p. 246.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6209 - LICENSING.

41-6209. LICENSING. Motor vehicle service contract providers, and persons marketing, administering, selling or offering to sell motor vehicle service contracts for motor vehicle service contract providers, are not required to obtain a license under title 41, Idaho Code. A motor vehicle service contract provider shall not be subject to regulation under any provision of title 41, Idaho Code, not made expressly applicable to it.
History:
[41-6209, added 2018, ch. 116, sec. 2, p. 246.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6210 - GUARANTY.

41-6210. GUARANTY. The provisions of the Idaho insurance guaranty association act, chapter 36, title 41, Idaho Code, shall not apply to any motor vehicle service contract, mechanical breakdown insurance or motor vehicle service contract liability insurance policy, as defined in this chapter, and no claim under any motor vehicle service contract, mechanical breakdown insurance or motor vehicle service contract liability insurance policy shall be deemed to be a "covered claim" within the scope of section 41-3605(7), Idaho Code, as to which the Idaho insurance guaranty association has any obligation under section 41-3608, Idaho Code, or other provisions of chapter 36, title 41, Idaho Code.
History:
[41-6210, added 2018, ch. 116, sec. 2, p. 246.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 62 - IDAHO MOTOR VEHICLE SERVICE CONTRACT ACT › Section 41-6211 - ENFORCEMENT AND PENALTIES.

41-6211. ENFORCEMENT AND PENALTIES. (1) The director may conduct examinations of motor vehicle service contract providers, administrators, insurers or other persons to enforce the provisions of this chapter and to protect motor vehicle service contract holders in this state. Upon request of the director, the provider shall make available to the director all accounts, books and records concerning motor vehicle service contracts sold or issued by the provider that are necessary to enable the director to reasonably determine compliance or noncompliance with this chapter.
(2) The following provisions of chapter 2, title 41, Idaho Code, generally addressing the director’s inquiry powers, orders and conduct of administrative proceedings apply to persons subject to this chapter:
(a) Sections 41-210 through 41-215, Idaho Code;
(b) Sections 41-220 through 41-223, 41-225, and 41-227, Idaho Code; and
(c) Sections 41-229 through 41-240, and section 41-247, Idaho Code.
(3) Any company that violates any provisions of this act may, in the director’s discretion, be subject to a civil penalty of one thousand dollars ($1,000) per violation, limited to a total of twenty-five thousand dollars ($25,000) in the aggregate for all like violations.
(4) This act does not create a separate civil cause of action, but does not preclude a cause of action under the Idaho consumer protection act, chapter 6, title 48, Idaho Code, or any applicable common law or statutory causes of action.
History:
[41-6211, added 2018, ch. 116, sec. 2, p. 246.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 63 - OWN RISK AND SOLVENCY ASSESSMENT › Section 41-6301 - PURPOSE AND SCOPE.

41-6301. PURPOSE AND SCOPE. (1) The purpose of this chapter is to provide the requirements for maintaining a risk management framework and completing an own risk and solvency assessment (ORSA) and provide guidance and instructions for filing an ORSA summary report with the director of the state department of insurance.
(2) The requirements of this chapter shall apply to all insurers domiciled in this state unless exempt pursuant to section 41-6306, Idaho Code.
(3) The legislature finds and declares that the ORSA summary report will contain confidential and sensitive information related to an insurer’s or an insurance group’s identification of risks material and relevant to the insurer or insurance group filing the report. This information will include proprietary and trade secret information that has the potential for harm and competitive disadvantage to the insurer or insurance group if the information is made public. It is the intent of the legislature that the ORSA summary report shall be a confidential document filed with the director, that the ORSA summary report will be shared only as stated herein and to assist in the performance of the director’s duties, and that in no event shall the ORSA summary report be subject to public disclosure.
History:
[41-6301, added 2017, ch. 75, sec. 1, p. 188.]