reglab/statecodes huggingface dataset:
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3612 - EXHAUSTION OF OTHER COVERAGE.

41-3612. EXHAUSTION OF OTHER COVERAGE. (1) Any person having a claim against an insurer, whether or not the insurer is a member insurer, under any provision in an insurance policy other than a policy of an insolvent insurer which is also a covered claim, shall be required to exhaust first his right under such policy. Any amount payable on a covered claim under this act shall be reduced by the amount of any recovery under such insurance policy.
(2) Any person having a claim which may be recovered under more than one insurance guaranty association or its equivalent shall seek recovery first from the association of the place of residence of the insured except that if it is a first party claim for damage to property with a permanent location, he shall seek recovery first from the association of the location of the property, and if it is a worker’s compensation claim, he shall seek recovery first from the association of the residence of the claimant. Any recovery under this act shall be reduced by the amount of recovery from any other insurance guaranty association or its equivalent.
History:
[41-3612, added 1970, ch. 152, sec. 12, p. 462; am. 1997, ch. 109, sec. 10, p. 264.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3613 - PREVENTION OF INSOLVENCIES.

41-3613. PREVENTION OF INSOLVENCIES. To aid in the detection and prevention of insurer insolvencies:
(1) The board of directors, upon majority vote, may make recommendations to the director for the detection and prevention of insurer insolvencies. Such recommendations shall not be considered public documents.
(2) The board of directors may, upon majority vote, make recommendations on matters generally relating to improving or enhancing regulation for solvency.
(3) The board of directors may, at the conclusion of any domestic insurer insolvency in which the association was obligated to pay covered claims, prepare a report on the history and causes of such insolvency, based on the information available to the association and submit such report to the director.
(4) All domestic insurance companies subject to the coverage of this chapter must maintain the paid-up capital stock or basic surplus and the additional surplus set forth in section 41-313, Idaho Code.
(5) Domestic reciprocal insurance companies issuing only fully assessable worker’s compensation policies are not subject to coverage of this chapter but must meet the requirements of section 41-313A, Idaho Code.
History:
[41-3613, added 1970, ch. 152, sec. 13, p. 462; am. 1992, ch. 316, sec. 4, p. 946; am. 1993, ch. 279, sec. 2, p. 946; am. 1997, ch. 109, sec. 11, p. 264.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3614 - REGULATION BY DIRECTOR — ANNUAL REPORTS TO DIRECTOR.

41-3614. REGULATION BY DIRECTOR — ANNUAL REPORTS TO DIRECTOR. The association shall be subject to examination and regulation by the director. The board of directors shall submit, not later than March 30 of each year, a financial report for the preceding calendar year in a form approved by the director.
History:
[41-3614, added 1970, ch. 152, sec. 14, p. 462.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3615 - EXEMPTION FROM TAXES — EXCEPTION.

41-3615. EXEMPTION FROM TAXES — EXCEPTION. The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions except taxes levied on real or personal property.
History:
[41-3615, added 1970, ch. 152, sec. 15, p. 462.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3616 - CREDITS FOR ASSESSMENTS PAID.

41-3616. CREDITS FOR ASSESSMENTS PAID. (1) A member insurer may offset against its premium tax liability to this state under section 41-402, Idaho Code, an assessment described in subsection (1)(d) of section 41-3608, Idaho Code. An offset is allowable to the extent of twenty percent (20%) of the amount of such assessment for each of five (5) calendar years beginning with the premium tax due under section 41-402(4), Idaho Code, with respect to the year of payment of the assessment and thereafter with the premium tax due under section 41-402(4), Idaho Code, during each of the four (4) succeeding years. An allowable offset, or portion thereof, not used in any calendar year cannot be carried over or back to any other year. An insurer that is exempt from the premium tax imposed by section 41-402, Idaho Code, may offset against its premium tax liability to the industrial administration fund in the same manner as an offset to the premium tax imposed by section 41-402(4).
(2) Notwithstanding any provision to the contrary in section 41-3608(2)(f), Idaho Code, any sums acquired by refund from insurance company receiverships by the association which have heretofore been written off by contributing insurers and offset against premium taxes as provided in subsection (1) of this section, and which, in the opinion of the board of directors, will not be needed for the purposes of this chapter within two (2) years from the date the association receives the refund from the receivership, shall be paid by the association to the director and by him deposited with the state treasurer for credit to the state general fund.
History:
[41-3616, added 1970, ch. 152, sec. 16, p. 462; am. 2004, ch. 241, sec. 1, p. 704; am. 2005, ch. 268, sec. 2, p. 831; am. 2013, ch. 265, sec. 1, p. 650.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3617 - NO LIABILITY FOR ACTIONS TAKEN PURSUANT TO ACT.

41-3617. NO LIABILITY FOR ACTIONS TAKEN PURSUANT TO ACT. There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer, the association or its agents or employees, the board of directors, or any person serving as a representative of any board director, or the director or his representatives for any action taken or any failure to act by them in the performance of their powers and duties under this act.
History:
[41-3617, added 1970, ch. 152, sec. 17, p. 462; am. 1997, ch. 109, sec. 12, p. 265.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3618 - STAY OF COURT PROCEEDINGS FOR INSOLVENCY — SETTING ASIDE JUDGMENT AGAINST INSOLVENT INSURER.

41-3618. STAY OF COURT PROCEEDINGS FOR INSOLVENCY — SETTING ASIDE JUDGMENT AGAINST INSOLVENT INSURER. All proceedings in which the insolvent insurer is a party or is obligated to defend a party in any court in this state shall, subject to written waiver by the association in specific cases involving covered claims, be stayed until the last day fixed by the court for the filing of claims and such additional time thereafter as may be determined by the court from the date the insolvency is determined or an ancillary proceeding is instituted in the state, whichever is later, to permit proper defense by the association of all pending causes of action. As to any covered claims arising from a judgment under any decision, verdict or findings based on the default of the insolvent insurer or its failure to defend an insured, the association either on its own behalf or on behalf of such insured may apply to have such judgment, order, decision, verdict or finding set aside by the same court or administrator that made such judgment, order, decision, verdict or finding and shall be permitted to defend against such claim on the merits. The liquidator, receiver, or statutory successor of an insolvent insurer covered by this act shall permit access by the board or its authorized representative to such of the insolvent insurer’s records which are necessary for the board in carrying out its functions under this act with regard to covered claims. In addition, the liquidator, receiver, or statutory successor shall provide the board or its representative with copies of such records upon the request by the board and at the expense of the board.
History:
[41-3618, added 1970, ch. 152, sec. 18, p. 462; am. 1981, ch. 54, sec. 2, p. 84; am. 1997, ch. 109, sec. 13, p. 265.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3619 - PROTECTION OF ACT NOT USED TO SELL INSURANCE.

41-3619. PROTECTION OF ACT NOT USED TO SELL INSURANCE. It is an unfair trade practice for any insurer or agent to in any manner make use of the protection given policyholders by this chapter as a reason for buying insurance from him.
History:
[41-3619, added 1970, ch. 152, sec. 19, p. 462.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3620 - TERMINATION OF OPERATION OF ASSOCIATION AS TO INSURANCE COVERED BY OTHER PLAN — DISSOLUTION OF ASSOCIATION AND DISTRIBUTION OF ASSETS — EXPIRATION OF ACT.

41-3620. TERMINATION OF OPERATION OF ASSOCIATION AS TO INSURANCE COVERED BY OTHER PLAN — DISSOLUTION OF ASSOCIATION AND DISTRIBUTION OF ASSETS — EXPIRATION OF ACT. (1) The director shall by order terminate the operation of the Idaho insurance guaranty association as to any kind of insurance covered by this act with respect to which he has found, after hearing, that there is in effect a statutory or voluntary plan which:
(a) Is a permanent plan which is adequately funded or for which adequate funding is provided.
(b) Extends, or will extend to the Idaho policyholders and residents protection and benefits with respect to insolvent insurers not substantially less favorable and effective to such policyholders and residents than the protection and benefits provided with respect to such kinds of insurance under this act.
(2) The director shall by the same such order authorize discontinuance of future payments by insurers to the Idaho insurance guaranty association with respect to the same kinds of insurance; provided, the assessments and payments shall continue, as necessary, to liquidate covered claims of insurers adjudged insolvent prior to said order and the related expenses not covered by such other plan.
(3) In the event the operation of the Idaho insurance guaranty association shall be so terminated as to all kinds of insurance otherwise within its scope, the association as soon as possible thereafter shall distribute the balance of moneys and assets remaining (after discharge of the functions of the association with respect to prior insurer insolvencies not covered by such other plan, together with related expenses) to the insurers which are then writing in this state policies of the kinds of insurance covered by this act and which had made payments to the association, pro rata upon the basis of the aggregate of such payments made by the respective insurers during the period of five (5) years next preceding the date of such order. Upon completion of such distribution with respect to all of the kinds of insurance covered by this act, this act shall be deemed to have expired.
History:
[41-3620, added 1970, ch. 152, sec. 20, p. 462.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 36 - INSURANCE GUARANTY ASSOCIATION › Section 41-3621 - COOPERATION OF LIQUIDATOR, RECEIVER, OR STATUTORY SUCCESSOR OF AN INSOLVENT INSURER.

41-3621. COOPERATION OF LIQUIDATOR, RECEIVER, OR STATUTORY SUCCESSOR OF AN INSOLVENT INSURER. The liquidator, receiver, or statutory successor of an insolvent insurer covered by this act shall permit access by the board of directors or its authorized representative to such of the insolvent insurer’s records which are necessary for the board in carrying out its functions under this act with regard to covered claims. In addition, the liquidator, receiver, or statutory successor shall provide the board of directors or its authorized representative with copies of such records upon the request by the board of directors and at the expense of the board of directors.
History:
[41-3621, added 1981, ch. 54, sec. 3, p. 84.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3801 - PURPOSE.

41-3801. PURPOSE. The purpose of this chapter is to prevent acquisition or divestiture of control of an insurer or a holding company system of which an insurer is a part where such acquisition would be adverse to the public interest and the interests of policyholders and shareholders. A further purpose of this chapter is to promote the public interest and the interests of policyholders and shareholders by facilitating, consistent with those interests, better use of management skills and services, diversification through acquisitions, free access to capital markets, sound tax planning and open competition. An additional purpose is to monitor and regulate insurance holding company systems.
History:
[41-3801, added 2013, ch. 266, sec. 2, p. 652.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3805 - TENDER OFFER MATERIAL.

41-3805. TENDER OFFER MATERIAL. All requests or invitations for tenders or advertisements making a tender offer or requesting or inviting tenders of such voting securities for control of a domestic insurer made by or on behalf of any person shall contain the information specified in section 41-3804, Idaho Code, as the director may prescribe and shall be filed with the director at least ten (10) days prior to the time such material is first published or sent or provided to security holders. Copies of any additional material soliciting or requesting such tender offers subsequent to the initial solicitation or request shall contain information as the director may prescribe as necessary or appropriate in the public interest or for the protection of policyholders and stockholders and shall be filed with the director at least ten (10) days prior to the time copies of the material are first published or sent or provided to security holders.
History:
[41-3805, added 2013, ch. 266, sec. 2, p. 657.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3807 - MAILING — PAYMENT OF EXPENSES.

41-3807. MAILING — PAYMENT OF EXPENSES. (1) All notices of public hearings held pursuant to section 41-3806, Idaho Code, shall be mailed by the insurer to its shareholders within five (5) business days after the insurer has received such notices. The expenses of such mailing shall be borne by the person making the filing. As security for the payment of such expenses, such person shall file with the director a bond or other deposit deemed acceptable and in an amount determined by the director.
(2) The provisions of this section shall not apply to any offers, requests, invitations, agreements or acquisitions by the person referred to in section 41-3804, Idaho Code, of any voting security referred to in section 41-3804, Idaho Code, which, immediately prior to the consummation of such offer, request, invitation, agreement or acquisition, was not issued and outstanding.
History:
[41-3807, added 2013, ch. 266, sec. 2, p. 659.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3811 - ADEQUACY OF SURPLUS.

41-3811. ADEQUACY OF SURPLUS. For purposes of this chapter, in determining whether an insurer’s surplus regarding policyholders is reasonable in relation to the insurer’s outstanding liabilities and adequate to meet its financial needs, the following factors, among others, shall be considered:
(1) The size of the insurer as measured by its assets, capital and surplus, reserves, premium writings, insurance in force and other appropriate criteria;
(2) The extent to which the insurer’s business is diversified among several lines of insurance;
(3) The number and size of risks insured in each line of business;
(4) The extent of the geographical dispersion of the insurer’s insured risks;
(5) The nature and extent of the insurer’s reinsurance program;
(6) The quality, diversification and liquidity of the insurer’s investment portfolio;
(7) The recent past and projected future trend in the size of the insurer’s investment portfolio;
(8) The surplus regarding policyholders maintained by other comparable insurers;
(9) The adequacy of the insurer’s reserves;
(10) The quality and liquidity of investments in affiliates; the director may treat any investment in an affiliate as a disallowed asset for purposes of determining the adequacy of surplus regarding policyholders whenever in the judgment of the director the investment so warrants; and
(11) The quality of the insurer’s earnings and the extent to which the reported earnings include extraordinary items.
History:
[41-3811, added 2013, ch. 266, sec. 2, p. 668.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3812 - DIVIDENDS AND OTHER DISTRIBUTIONS.

41-3812. DIVIDENDS AND OTHER DISTRIBUTIONS. (1) No domestic insurer shall pay any extraordinary dividend or make any other extraordinary distribution to its shareholders until thirty (30) days after the director has received notice of the declaration thereof and has not within that period disapproved the payment, or until the director has approved the payment within the thirty (30) day period. For purposes of this section, an extraordinary dividend or distribution includes any dividend or distribution of cash or other property, whose fair market value together with that of other dividends or distributions made within the preceding twelve (12) months exceeds the greater of:
(a) Ten percent (10%) of the insurer’s surplus regarding policyholders as of December 31 of the year immediately preceding; or
(b) The net gain from operations of the insurer, if the insurer is a life insurer, or the net income, if the insurer is not a life insurer, not including net realized capital gains or losses, for the twelve (12) month period ending December 31 of the year immediately preceding, but shall not include pro rata distributions of any class of the insurer’s own securities.
Notwithstanding any other provision of law, an insurer may declare an extraordinary dividend or distribution that is conditional upon the director’s approval, and the declaration shall confer no rights upon shareholders until the director has approved the payment of the dividend or distribution or until the director has not disapproved payment within the thirty (30) day period referred to in this subsection.
(2) Except as provided in this subsection, a domestic insurer shall not make any dividends except from earned surplus. A domestic insurer may declare and distribute a dividend from other than earned surplus if:
(a) The director has given approval for the dividend prior to payment; and
(b) Following payment of the dividend, the insurer’s surplus regarding policyholders is:
(i) Reasonable in relation to its outstanding liabilities; and
(ii) Adequate to meet its financial needs.
(3) For purposes of subsection (2) of this section, "earned surplus" means unassigned funds as required to be reported on the insurer’s annual statement.
(4) A domestic insurer that is a member of a holding company system shall notify the director in writing of any nonextraordinary dividends to be paid or other distributions to be made to shareholders within five (5) business days following the declaration of the dividend or distribution, and shall notify the director in writing at least ten (10) days, commencing from the date of receipt by the director, prior to the payment of any dividends or the making of any other distribution.
History:
[41-3812, added 2013, ch. 266, sec. 2, p. 668; am. 2017, ch. 95, sec. 1, p. 244; am. 2018, ch. 89, sec. 1, p. 194.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3815 - SUPERVISORY COLLEGES.

41-3815. SUPERVISORY COLLEGES. (1) With respect to any insurer registered under section 41-3809, Idaho Code, and in accordance with subsection (3) of this section, the director is authorized to participate in a supervisory college for any domestic insurer that is part of an insurance holding company system with international operations in order to determine compliance by the insurer with this chapter. The powers of the director with respect to supervisory colleges include, but are not limited to, the following:
(a) Initiating the establishment of a supervisory college;
(b) Clarifying the membership and participation of other supervisors in the supervisory college;
(c) Clarifying the functions of the supervisory college and the role of other regulators, including the establishment of a group-wide supervisor;
(d) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities and processes for information sharing; and
(e) Establishing a crisis management plan.
(2) Each registered insurer subject to this section shall be liable for and shall pay the reasonable expenses of the director’s participation in a supervisory college in accordance with subsection (3) of this section, including reasonable travel expenses. For purposes of this section, a supervisory college may be convened as either a temporary or permanent forum for communication and cooperation between the regulators charged with the supervision of the insurer or its affiliates and the director may establish a regular assessment to the insurer for the payment of these expenses.
(3) In order to assess the business strategy, financial position, legal and regulatory position, risk exposure, risk management and governance processes, and as part of the examination of individual insurers in accordance with section 41-3813, Idaho Code, the director may participate in a supervisory college with other regulators charged with supervision of the insurer or its affiliates, including other state, federal and international regulatory agencies. The director may enter into agreements in accordance with section 41-3816(3), Idaho Code, providing the basis for cooperation among the director and the other regulatory agencies, and the activities of the supervisory college. Nothing in this section shall delegate to the supervisory college the authority of the director to regulate or supervise the insurer or its affiliates within its jurisdiction.
History:
[41-3815, added 2013, ch. 266, sec. 2, p. 670.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3817 - RULES.

41-3817. RULES. The director may promulgate rules and issue orders as shall be necessary to carry out the provisions of this chapter.
History:
[41-3817, added 2013, ch. 266, sec. 2, p. 673.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3820 - RECEIVERSHIP.

41-3820. RECEIVERSHIP. Whenever it appears to the director that any person has committed a violation of the provisions of this chapter that so impairs the financial condition of a domestic insurer as to threaten insolvency or make its further transaction of business hazardous to its policyholders, creditors, shareholders or the public, the director may proceed as provided in chapter 33, title 41, Idaho Code, to take possession of the property of the domestic insurer and to conduct its business in the capacity of a receiver.
History:
[41-3820, added 2013, ch. 266, sec. 2, p. 674.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3821 - RECOVERY.

41-3821. RECOVERY. (1) If an order for liquidation or rehabilitation of a domestic insurer has been entered, the receiver appointed under the order shall be authorized to recover on behalf of the insurer:
(a) From any parent corporation or holding company or person or affiliate who otherwise controlled the insurer, the amount of distributions, other than distributions of shares of the same class of stock, paid by the insurer on its capital stock; or
(b) Any payment in the form of a bonus, termination settlement or extraordinary lump sum salary adjustment made by the insurer or its subsidiary to a director, officer or employee, where the distribution or payment pursuant to this subsection is made at any time during the one (1) year period preceding the petition for liquidation, conservation or rehabilitation, as the case may be, subject to the limitations of subsections (2), (3) and (4) of this section.
(2) No distribution shall be recoverable if the parent or affiliate of such domestic insurer shows that when paid the distribution was lawful and reasonable, and that the insurer did not know and could not reasonably have known that the distribution might adversely affect the ability of the insurer to fulfill its contractual obligations.
(3) Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or affiliate at the time the distributions were paid shall be liable up to the amount of distributions or payments under subsection (1) of this section, that the person received. Any person who otherwise controlled the insurer at the time the distributions were declared shall be liable up to the amount of distributions that would have been received if they had been paid immediately. If two (2) or more persons are liable with respect to the same distributions, they shall be jointly and severally liable.
(4) The maximum amount recoverable pursuant to this section shall be the amount needed in excess of all other available assets of the impaired or insolvent insurer to pay the contractual obligations of the impaired or insolvent insurer and to reimburse any guaranty funds.
(5) To the extent that any person liable under subsection (3) of this section is insolvent or otherwise fails to pay claims due pursuant to subsection (3) of this section, its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid shall be jointly and severally liable for any resulting deficiency in the amount recovered from the parent corporation or holding company or person who otherwise controlled it.
History:
[41-3821, added 2013, ch. 266, sec. 2, p. 675.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3822 - REVOCATION, SUSPENSION OR NONRENEWAL OF INSURER’S LICENSE.

41-3822. REVOCATION, SUSPENSION OR NONRENEWAL OF INSURER’S LICENSE. Whenever it appears to the director that any person has committed a violation of the provisions of this chapter that makes the continued operation of an insurer contrary to the interests of policyholders or the public, the director may, after giving notice and the opportunity for a hearing, suspend, revoke or refuse to renew the insurer’s license or certificate of authority to do business in this state for such period as the director finds is required for the protection of policyholders or the public. Any such determination shall be accompanied by specific findings of fact and conclusions of law.
History:
[41-3822, added 2013, ch. 266, sec. 2, p. 675.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3823 - JUDICIAL REVIEW — MANDAMUS.

41-3823. JUDICIAL REVIEW — MANDAMUS. (1) Any person aggrieved by any act, determination, rule or order or any other action of the director pursuant to this chapter may appeal to the fourth judicial district court for Ada county, Idaho. The court shall conduct its review in accordance with the provisions of chapter 52, title 67, Idaho Code, or other applicable provisions of law.
(2) The filing of an appeal pursuant to this section shall stay the application of any rule, order or other action of the director to the party pursuing such appeal, unless the court, after providing the party with notice and the opportunity for a hearing, determines that a stay would be detrimental to the interest of policyholders, shareholders, creditors or the public.
(3) Any person aggrieved by any failure of the director to act or make a determination required by this chapter may petition the fourth judicial district court for Ada county for a writ in the nature of a mandamus or a peremptory mandamus directing the director to act or make a determination.
History:
[41-3823, added 2013, ch. 266, sec. 2, p. 675.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS › Section 41-3825 - SEVERABILITY.

41-3825. SEVERABILITY. The provisions of this chapter are hereby declared to be severable and if any provision of this chapter 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 chapter.
History:
[41-3825, added 2013, ch. 266, sec. 2, p. 679.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3901 - SHORT TITLE.

41-3901. SHORT TITLE. This chapter may be cited as the Idaho "Managed Care Reform Act."
History:
[41-3901, added 1974, ch. 177, sec. 1, p. 1444; am. 1997, ch. 204, sec. 2, p. 582.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3902 - INTENT AND PURPOSE.

41-3902. INTENT AND PURPOSE. As a guide to the interpretation and application of this chapter, the public policy of this state is declared as follows: The legislature wishes to eliminate legal barriers to the establishment of managed care plans which provide readily available, accessible and quality health care to their members and to encourage their development as an optional method of health care delivery. The state of Idaho must have reasonable assurance that organizations offering managed care plans within this state are financially and administratively sound and responsive to the needs of their members, and that such organizations are, in fact, able to deliver the benefits which they offer.
History:
[41-3902, added 1974, ch. 177, sec. 2, p. 1444; am. 1997, ch. 204, sec. 3, p. 582.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3904 - CERTIFICATE OF AUTHORITY REQUIRED — EXCEPTIONS — APPLICATION OF CERTAIN PROVISIONS.

41-3904. CERTIFICATE OF AUTHORITY REQUIRED — EXCEPTIONS — APPLICATION OF CERTAIN PROVISIONS. (1) No person shall in this state offer a managed care plan on a predetermined and prepaid basis, unless authorized under a certificate of authority issued by the director. A person offering a managed care plan on a predetermined and prepaid basis is deemed to be transacting the business of insurance.
(2) An organization proposing to offer a managed care plan on a predetermined and prepaid basis, after it has filed its application for a certificate of authority as provided in section 41-3906, Idaho Code, and while its application is pending, if permitted by and in accordance with rules promulgated by the director, may inform the public concerning its proposed health care services.
(3) Entities not offering a managed care plan shall not be subject to the provisions of this chapter.
(4) An entity not required to obtain a certificate of authority which holds itself out to the public or markets itself as an organization rendering basic health care services to a specified population through a managed care plan shall be subject to and must comply with the following sections of this chapter but shall not be subject to regulation by the department: 41-3902; 41-3903; 41-3904; 41-3909(1) and (2); 41-3914(1) and (2); 41-3915(1), (2), (3), (4), (5), (6) and (8); 41-3916; 41-3917; 41-3918(1), (2) and (4); 41-3919(1) and (2); 41-3920; 41-3921(2), (3) and (4); 41-3922(2); 41-3926; 41-3927; 41-3928; 41-3930 and 41-3932, Idaho Code.
History:
[41-3904, added 1974, ch. 177, sec. 4, p. 1444; am. 1997, ch. 204, sec. 6, p. 584; am. 2003, ch. 304, sec. 14, p. 839.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3909 - RECORDS.

41-3909. RECORDS. (1) Every managed care organization shall establish and at all times maintain adequate records of its financial and business transactions.
(2) The managed care organization shall retain its general records with respect to a particular transaction for a period of not less than seven (7) years after termination of the transaction, and health records shall be retained for a period of seven (7) years after the termination of the member’s contract.
(3) The managed care organization shall make all records available to the director or his designee for review at all reasonable times upon the director’s request; provided, however, that the availability of health records shall be subject to any Idaho law limiting or defining such availability.
History:
[41-3909, added 1974, ch. 177, sec. 9, p. 1444; am. 1997, ch. 204, sec. 10, p. 588.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3910 - REPORTS TO THE DIRECTOR.

41-3910. REPORTS TO THE DIRECTOR. (1) Every managed care organization offering a managed care plan for which a certificate of authority is required shall annually, on or before the first day of June, file a report with the director showing its audited financial condition on the last day of the preceding December. The report shall be on forms prescribed by the director and shall be verified by an appropriate officer of the organization.
(2) Such report shall include:
(a) A financial statement of the organization, including its balance sheet and statement of income and expenditures for the preceding year certified by an independent public accountant;
(b) Any changes in the information submitted in connection with its application for certificate of authority;
(c) Such other information as is available to the managed care organization relating to the operations of the organization as the director may require by rule to enable him to carry out his duties under this chapter.
History:
[41-3910, added 1974, ch. 177, sec. 10, p. 1444; am. 1997, ch. 204, sec. 11, p. 589; am. 2008, ch. 203, sec. 2, p. 653.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3911 - EXAMINATIONS.

41-3911. EXAMINATIONS. (1) The director shall make an examination of the affairs and operations of any organization offering a managed care plan for which a certificate of authority is required as often as he deems necessary but not less frequently than once every five (5) years.
(2) Every such organization shall upon the director’s request submit its books and records relating to its affairs and operations to such examination and shall facilitate the examination.
(3) Health records of individuals and records of providers providing services under a contract with the managed care organization shall not be subject to such examination, except as provided in section 41-3909(3), Idaho Code.
(4) At the direction of the director, the expenses of examination shall be borne by the organization being examined in accordance with section 41-228, Idaho Code.
History:
[41-3911, added 1974, ch. 177, sec. 11, p. 1444; am. 1997, ch. 204, sec. 12, p. 589; am. 2001, ch. 85, sec. 11, p. 219.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3912 - SUSPENSION OR REVOCATION OF CERTIFICATE OF AUTHORITY.

41-3912. SUSPENSION OR REVOCATION OF CERTIFICATE OF AUTHORITY. The director may initiate proceedings to suspend or revoke a certificate of authority to offer a managed care plan for the reasons and in the manner provided in title 41, Idaho Code, for mutual insurers. In addition to any other penalties, the director may impose a penalty upon the managed care organization of up to fifteen thousand dollars ($15,000) for each and every unlawful act committed.
History:
[41-3912, added 1997, ch. 204, sec. 14, p. 590.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3914 - ANNUAL DISCLOSURES.

41-3914. ANNUAL DISCLOSURES. (1) Every managed care organization shall provide to its enrollees and make available for inspection by the general public on an annual basis:
(a) an audited statement of financial condition including a balance sheet and a summary of receipts and disbursements;
(b) a description of the accessibility and availability of services, including a list of the providers currently participating in the managed care plan and of the providers who are accepting new patients, the addresses of primary care physicians and participating hospitals and the specialty of each physician and category of the other participating providers;
(c) a statement as to whether the plan includes a limited formulary of medications, and a statement that the formulary will be made available to any prospective member or member upon request;
(d) a clear and understandable description of the managed care organization’s method of resolving member grievances;
(e) a description of how the qualifications of participating providers may be obtained;
(f) such other information as the director may by rule prescribe.
(2) In addition to matters specified in subsection (1) of this section, each managed care organization shall make available for public inspection a description of the benefit package or packages offered to each class of members and their rates. Such information shall be presented in clear, readable, and concise form and shall include, at a minimum, a description of all of the material elements required of health care contracts.
(3) A managed care organization for which a certificate of authority is required shall furnish a copy of the information required by this section to the department upon request of the director.
History:
[41-3914, added 1974, ch. 177, sec. 14, p. 1444; am. 1978, ch. 360, sec. 1, p. 947; am. 1997, ch. 204, sec. 16, p. 590; am. 2008, ch. 203, sec. 3, p. 653.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3916 - ADVISORY PANELS.

41-3916. ADVISORY PANELS. Every managed care organization shall establish a mechanism to provide members an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other reasonable mechanisms. As a minimum, such an advisory panel shall be required to review and comment upon any proposed changes to: (a) the managed care plan’s grievance procedures, and (b) nongroup member benefit packages and prepayments, prior to implementation of such policy. The substance of such comments shall be distributed to the affected members at the time notification of such policy changes are made.
History:
[41-3916, added 1974, ch. 177, sec. 16, p. 1444; am. 1978, ch. 361, sec. 1, p. 948; am. 1997, ch. 204, sec. 18, p. 593.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3917 - CERTAIN WORDS PROHIBITED IN NAME OF ORGANIZATION.

41-3917. CERTAIN WORDS PROHIBITED IN NAME OF ORGANIZATION. No person or organization offering a health care plan not qualified as a managed care plan under the provisions of this chapter shall use in its name, logo, contracts or literature the phrase, "health maintenance organization," "managed care organization," "general managed care organization" or "limited managed care organization" or the initials "HMO," "MCO," "GMCO," or "LMCO."
History:
[41-3917, added 1974, ch. 177, sec. 17, p. 1444; am. 1997, ch. 204, sec. 19, p. 593.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3918 - GRIEVANCE SYSTEM.

41-3918. GRIEVANCE SYSTEM. (1) Every managed care organization shall establish a grievance system to resolve grievances initiated by members concerning health care services. The system shall provide reasonable procedures for the resolution of grievances, and shall include an appeals process which affords the member the right to a prompt review by a grievance panel before whom the member has the right either to appear or be heard, or both. A managed care organization offering a managed care plan for which a certificate of authority is required shall have its grievance system approved by the director and shall submit to the director an annual report in a form prescribed by the director which shall include:
(a) A description of the procedures of the grievance system; and
(b) The total number of grievances handled through the grievance system and a compilation of causes underlying the grievances filed.
(2) Every managed care organization shall maintain records of grievances filed with it concerning health care services and each managed care organization for which a certificate of authority is required shall submit to the director a summary report at such times and in such form as the director may require. Grievances involving other persons shall be referred to such persons with a copy to the director.
(3) The director may examine a grievance system of a managed care organization for which a certificate of authority is required, subject to the limitations concerning health records of individuals set forth in section 41-3909(3), Idaho Code.
(4) Every managed care organization must show evidence that such grievance procedures have been reviewed and approved by the member representatives through their participation on advisory panels or other reasonable mechanisms as set forth in section 41-3916, Idaho Code.
History:
[41-3918, added 1974, ch. 177, sec. 18, p. 1444; am. 1997, ch. 204, sec. 20, p. 593; am. 2008, ch. 203, sec. 4, p. 654.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3919 - OPEN ENROLLMENT.

41-3919. OPEN ENROLLMENT. (1) Requirement of an open enrollment period is intended to provide the benefits of managed care to the general public or to all members of the class of persons the managed care organization serves. Such requirement is not intended to prohibit a managed care organization from establishing administrative procedures that protect the quality of service to its members or the financial condition of the organization. However, during periods of open enrollment the organization shall not establish any administrative procedure that arbitrarily and unreasonably restricts enrollment.
(2) After the initial twenty-four (24) months of operation every managed care organization shall have an annual open enrollment period of at least one (1) month during which it accepts members, without restrictions up to the limits of its capacity except as provided in subsection (3) of this section, as determined by the managed care organization, in the order in which they apply for enrollment. Managed care organizations organized to provide services exclusively to a specified group or groups of individuals may limit such open enrollment to all members of such group(s).
(3) A managed care organization may apply to the director for authorization to impose underwriting restrictions upon enrollment. The director shall, within thirty (30) days, approve the application if he determines that such restrictions will:
(a) Preserve the financial stability of the managed care organization; or
(b) Prevent excessive adverse selection of prospective members; or
(c) Avoid unreasonably high or unmarketable charges for member coverage for health care services.
If the application cannot be approved the director must deny it within the thirty (30) day period.
History:
[41-3919, added 1974, ch. 177, sec. 19, p. 1444; am. 1997, ch. 204, sec. 21, p. 594.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3920 - DISCRIMINATION AGAINST HEALTH PROFESSIONALS ASSOCIATED WITH MANAGED CARE ORGANIZATIONS.

41-3920. DISCRIMINATION AGAINST HEALTH PROFESSIONALS ASSOCIATED WITH MANAGED CARE ORGANIZATIONS. It shall be unlawful for any health service institution or associations of health professionals to exclude other health professionals from working privileges, membership, or association solely on the basis that such other person is employed by or contracts with a managed care organization pursuant to this chapter.
History:
[41-3920, added 1974, ch. 177, sec. 20, p. 1444; am. 1997, ch. 204, sec. 22, p. 595.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3921 - STATUTORY CONSTRUCTION AND RELATIONSHIP TO OTHER LAWS.

41-3921. STATUTORY CONSTRUCTION AND RELATIONSHIP TO OTHER LAWS. (1) Except as stated in this chapter, provisions of title 41, Idaho Code, applicable to disability insurers shall be applicable to the lawful transactions and business of an organization offering a managed care plan for which a certificate of authority is required pursuant to this chapter.
(2) With respect to all managed care organizations, the provision of factually accurate information regarding coverage, rates, locations and hours of service, names of affiliated institutions, and credentials of participating providers by the organization or its personnel to potential members shall not constitute a violation of any law relating to solicitation or advertising by health care professionals.
(3) Any managed care organization which contracts with a health care facility or enters into arrangements with one (1) or more groups of providers organized on a group practice or individual practice basis shall not by virtue of such contracts or arrangements be deemed to have entered into a "conspiracy in restraint of trade".
(4) Except as expressly and specifically stated in this chapter, the provisions of chapter 34, title 41, Idaho Code, are not amended, repealed or otherwise affected by this chapter.
History:
[41-3921, added 1974, ch. 177, sec. 21, p. 1444; am. 1988, ch. 265, sec. 573, p. 871; am. 1997, ch. 204, sec. 23, p. 595; am. 2015, ch. 251, sec. 5, p. 1047.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3922 - TAXATION — PENALTY FOR FAILURE TO FILE.

41-3922. TAXATION — PENALTY FOR FAILURE TO FILE. (1) Each organization offering a managed care plan for which a certificate of authority is required under this chapter shall be subject to taxation as provided in chapter 4, title 41, Idaho Code.
(2) Any managed care organization failing to file any documents required to be filed with the director by this chapter shall be liable to a fine of twenty-five dollars ($25.00) for each day of delinquency. As applicable, the director shall suspend or revoke the certificate of authority of a delinquent managed care organization until the document is filed and the fine, if any, is fully paid.
History:
[(41-3922), added 1974, ch. 177, sec. 28, p. 1444; am. 1978, ch. 9, sec. 2, p. 17; am. 1982, ch. 252, sec. 2, p. 644; am. and redesig. 1997, ch. 204, sec. 25, p. 596.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 39 - MANAGED CARE REFORM › Section 41-3924 - LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS.

41-3924. LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS. All policies, contracts, plans or certificates delivered, issued for delivery or renewed in this state by an organization offering a managed care plan for which a certificate of authority is required shall exclude coverage for elective abortions. Such exclusion may be waived by endorsement and the payment of a premium therefor. Availability of such coverage shall be at the option of the contractor. For purposes of this section, an "elective abortion" means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.
History:
[(41-3924), added 1983, ch. 94, sec. 4, p. 207; am. and redesig. 1997, ch. 204, sec. 27, p. 598.]