reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.011 - POLICY DEFINITIONS

Current through August 31, 2023
An insurance policy subject to this chapter will not apply
				definitions more restrictive than the following: (3-31-22)
01.
Accident
. "Accident,"
			 "accidental injury," and "accidental" is to employ "result" language and does
			 not include words that establish an accidental means test or use words such as
			 "external, violent, visible wounds" or similar words of description or
			 characterization. (3-31-22)
a. "Injury" or
			 "injuries" means accidental bodily injury sustained by the insured person that
			 is the direct cause of the condition for which benefits are provided,
			 independent of disease or bodily infirmity or any other cause, and that occurs
			 while the insurance is in force. (3-31-22)
b. It may exclude injuries for which benefits
			 are provided: (3-31-22)
i. Under workers'
			 compensation, employers' liability, or similar law; or (3-31-22)
ii. Under a motor vehicle no-fault plan,
			 unless the motor vehicle no-fault plan provides for coordination of benefits;
			 or (3-31-22)
iii. For injuries
			 occurring while the insured person is engaged in any activity pertaining to a
			 trade, business, employment or occupation for wage or profit.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.012 - ASSESSMENTS

Current through August 31, 2023
The Board, prior to March 1st of each year, determines and
				files with the Director an estimate of the assessments needed to fund the
				losses incurred by the Idaho Small Employer and Individual Health Reinsurance
				Program. The March 1, 2001 assessment anticipated by Section
				41-4711, Idaho Code, will consist
				of the amounts needed to cover the claims cost of the individual policies
				issued on or before June 30, 2000. This interim assessment is based on the
				assessment formula set forth in Section
				41-4711(12)(c),
				Idaho Code. Initial or interim assessments paid, on behalf of the Idaho
				Individual High Risk Reinsurance Pool, will be credited to each carrier's
				account when the amounts needed to fund losses and pay program expenses are
				known. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.028 - TRANSITION FOR ASSUMPTIONS OF BUSINESS FROM ANOTHER CARRIER

Current through August 31, 2023
01.
Conditions for Transfer or
			 Assumption of Entire Insurance Obligation
. An individual carrier will
			 not transfer or assume the entire insurance obligation and/or risk of a health
			 benefit plan covering an individual in this state unless: (3-31-22)
a. The transaction received any necessary
			 approval of the insurance supervisory official of the state of domicile of the
			 assuming carrier; (3-31-22)
b. The
			 transaction received any necessary approval of the insurance supervisory
			 official of the state of domicile of the ceding carrier; and,
			 (3-31-22)
c. The transaction meets
			 the other requirements of this Section. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.036 - RESTRICTIONS RELATING TO PREMIUM RATES

Current through August 31, 2023
The following provisions are applicable for all individual
				health benefit plans. (3-31-22)
01.
Rate Manual
. An individual carrier develops a rate manual for all
			 individual business. Base premium rates and new business premium rates charged
			 to eligible individuals by the individual carrier are computed solely from the
			 applicable rate manual developed pursuant to this Section. To the extent that a
			 portion of the premium rates charged by an individual carrier is based on the
			 carrier's discretion, the manual specifies the criteria and factors considered
			 by the carrier in exercising such discretion. (3-31-22)
02.
Requirements for Adjustments to
			 Rating Method
. An individual carrier will not modify the rating method
			 used in the rate manual for its individual business until the change has been
			 approved as provided in this Section. The Director may approve a change to a
			 rating method if the Director finds that the change is reasonable, actuarially
			 appropriate, and consistent with the purposes of the Act and this chapter.
			 (3-31-22)
03.
Information for
			 Review of Modification of Rating Method
. A carrier may modify the rating
			 method for its individual business only with prior approval of the Director. A
			 carrier requesting to change the rating method for its individual business
			 makes a filing with the Director at least thirty (30) days prior to the
			 proposed date of the change. The filing contains at least the following
			 information: (3-31-22)
a. The reasons the
			 change in rating method is being requested; (3-31-22)
b. A complete description of each of the
			 proposed modifications to the rating method; (3-31-22)
c. A description of how the change in rating
			 method would affect the premium rates currently charged to eligible individuals
			 in the health benefit plan, including an estimate from a qualified actuary of
			 the number of individuals (and a description of the types of individuals) whose
			 premium rates may change by more than ten percent (10%) due to the proposed
			 change in rating method (not generally including increases in premium rates
			 applicable to all individuals in a health benefit plan); (3-31-22)
d. A certification from a qualified actuary
			 that the new rating method would be based on objective and credible data and
			 would be actuarially sound and appropriate; and (3-31-22)
e. A certification from a qualified actuary
			 that the proposed change in rating method would not produce premium rates for
			 eligible individuals that would be in violation of Section
			 41-5206, Idaho Code.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.055 - APPLICATION TO REENTER STATE

Current through August 31, 2023
01.
Restrictions on Offering Individual Health Insurance
. An
			 individual carrier that has been banned from writing coverage for individuals
			 in this state pursuant to Section
			 41-5207(2), Idaho
			 Code, will not resume offering health benefit plans to individuals in this
			 state until the carrier has made a petition to the Director to be reinstated as
			 an individual carrier and the petition has been approved by the Director. In
			 reviewing a petition, the Director may ask for such information and assurances
			 as the Director finds reasonable and appropriate. (3-31-22)
02.
Geographic Service Areas
. In
			 the case of an individual carrier doing business in an established geographic
			 service area of the state, if the individual carrier elects to non-renew a
			 health benefit plan under Section
			 41-5207(3), Idaho
			 Code, the individual carrier is banned from offering health benefit plans to
			 individuals in that service area for a period of five (5) years.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.060 - QUALIFYING PREVIOUS AND QUALIFYING EXISTING COVERAGES

Current through August 31, 2023
01.
Previous Coverage or Existing
			 Coverage
. In determining whether a health benefit plan or other health
			 benefit arrangement (whether public or private) is considered qualifying
			 previous coverage or qualifying existing coverage for the purposes of Sections
			 41-5203(20), and
			 41-5208(3), Idaho
			 Code, an individual carrier interprets the Act no less favorably to an insured
			 individual than the following: (3-31-22)
a.
			 An individual carrier ascertains the source of previous or existing coverage of
			 each eligible individual and each dependent of an eligible individual at the
			 time such individual or dependent initially enrolls into the health benefit
			 plan provided by the individual carrier. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.067 - RESTRICTIVE RIDERS

Current through August 31, 2023
Except as permitted in Section
				41-5208(3), Idaho
				Code, an individual carrier will not modify or restrict any health benefit plan
				with respect to any eligible individual or dependent of an eligible individual,
				through riders, endorsements or otherwise, for the purpose of restricting or
				excluding the coverage or benefits provided to such individual or dependent for
				specific diseases, medical conditions or services otherwise covered by the
				plan. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.075 - RULES RELATED TO FAIR MARKETING

Current through August 31, 2023
01.
Individual Carrier to Actively Market
. An individual carrier
			 actively markets each of its health benefit plans to individuals in this state.
			 (3-31-22)
02.
Offer
.
			 An individual carrier offers all health benefit plans to any individual that
			 applies for or makes an inquiry regarding health insurance coverage from the
			 individual carrier. The offer may be provided directly to the individual or
			 delivered through a producer. The offer is in writing and includes at least the
			 following information: (3-31-22)
a. A general
			 description of the benefits contained in the all actively marketed health
			 benefit plans; and (3-31-22)
b.
			 Information describing how the individual may enroll in the plans.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.081 - BANNED POLICY PROVISIONS

Current through August 31, 2023
01.
Probationary or Waiting Period
. Except as provided in Subsection
			 081.02 for a pre-existing
			 condition, a policy cannot contain provisions establishing a probationary or
			 waiting period during which no coverage is provided under the policy.
			 (3-31-22)
02.
Pre-existing
			 Conditions
. A policy will not deny, exclude or limit benefits for
			 covered expenses incurred more than twelve (12) months following the effective
			 date of the coverage due to a pre-existing condition. (3-31-22)
a. A policy waives any time period applicable
			 to a pre-existing condition exclusion or limitation period with respect to
			 particular services for the period of time an individual was previously covered
			 by qualifying previous coverage to the extent such previous coverage provided
			 benefits with respect to such services, provided that the qualifying previous
			 coverage was continuous to a date not more than sixty-three (63) days prior to
			 the effective date of the new coverage. (3-31-22)
b. A carrier will not modify a policy with
			 respect to an individual or dependent through riders, endorsements, or
			 otherwise, to restrict or exclude coverage for specifically named pre-existing
			 conditions otherwise covered by the policy. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.082 - GENERAL MINIMUM STANDARDS

Current through August 31, 2023
An insurance policy subject to this chapter cannot be offered,
				delivered or issued for delivery, continued or renewed in this state unless it
				meets the following minimum standards. (3-31-22)
01.
Outline of Coverage
. An
			 insurer will deliver an outline of coverage to an applicant or enrollee with
			 the sale, which complies with the model outline of coverage established by the
			 National Association of Insurance Commissioners ("NAIC"), incorporated herein
			 in Section 002. (3-31-22)
a. If an outline of coverage was delivered at
			 the time of application or enrollment and the policy is issued on a basis which
			 would require revision of the outline, a substitute outline of coverage
			 properly describing the policy will accompany the policy when it is delivered
			 and contain the following statement in no less than twelve (12) point type,
			 immediately above the company name: "NOTICE: Read this outline of coverage
			 carefully. It is not identical to the outline of coverage provided upon
			 (application) (enrollment), and the coverage originally applied for has not
			 been issued." (3-31-22)
b. In any
			 case where the prescribed outline of coverage is inappropriate for the coverage
			 provided by the policy, an alternate outline of coverage is to be submitted to
			 the Director for prior written approval. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.101 - DISCLOSURE PROVISIONS

Current through August 31, 2023
01.
Requisite
			 Provisions.
Each policy will include a renewal, continuation or
			 nonrenewal provision. The language or specification of the provision will be
			 consistent with the type of contract to be issued. The provision will be
			 appropriately captioned, will appear on the first page of the policy, and will
			 clearly state the duration, where limited, of renewability and the duration of
			 the term of coverage for which the policy is issued and for which it may be
			 renewed. (3-31-22)
02.
Added
			 Riders or Endorsements
. Riders or endorsements added to a policy after
			 date of issue or at reinstatement or renewal that reduce or eliminate benefits
			 or coverage in the policy require signed acceptance by the policyholder. After
			 date of policy issue, any rider or endorsement that increases benefits or
			 coverage with a concomitant increase in premium during the policy term will be
			 agreed to in writing and signed by the policyholder, except if the increased
			 benefits or coverage is prescribed by law. (3-31-22)
03.
Separate Additional Premium
.
			 Where a separate additional premium is charged for benefits provided in
			 connection with riders or endorsements, the premium charge is set forth in the
			 policy. (3-31-22)
04.
Requisite Definition of Terms.
A policy that provides for the
			 payment of benefits based on standards described as "usual and customary,"
			 "reasonable and customary," or words of similar import will include a
			 definition of the terms and an explanation of the terms in its accompanying
			 outline of coverage. (3-31-22)
05.
Pre-existing Conditions Limitations
. If a policy contains any
			 limitations with respect to preexisting conditions, the limitations will appear
			 as a separate paragraph of the policy and be labeled as "Pre-existing Condition
			 Limitations." (3-31-22)
06.
Requisite Notice
. All policies will have a notice prominently
			 printed on the first page of the policy stating in substance that the
			 policyholder has the right to return the policy within ten (10) days of its
			 delivery and have the premium refunded if, after examination of the policy, the
			 policyholder holder is not satisfied for any reason. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.001 - TITLE AND SCOPE

Current through August 31, 2023
01.
Title
. IDAPA 18.04.14, "Coordination of Benefits."
			 (3-31-22)
02.
Scope
.
			 This chapter applies to all plans, as defined. It allows plans to include a
			 coordination of benefits (COB) provision unless banned by federal law;
			 establish a uniform order of benefit determination under which plans pay
			 claims; provide authority for the orderly transfer of necessary information and
			 funds between plans; reduce duplication of benefits by permitting a reduction
			 of the benefits to be paid by plans that, pursuant to these rules, do not pay
			 their benefits first; reduce claims payment delays; and require that COB
			 provisions be consistent with this rule; and provide greater efficiency in the
			 processing of claims when a person is covered under more than one (1) plan.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.002 - INCORPORATION BY REFERENCE

Current through August 31, 2023
This rule incorporates by reference the full text of the
				National Association of Insurance Commissioners (NAIC) Model Coordination of
				Benefits Contract Provisions (Appendix A) and the NAIC Consumer Explanatory
				Booklet (Appendix B), published as part of the NAIC 2013 Coordination of
				Benefits model regulation and available on the Idaho Department of Insurance
				website. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.021 - USE OF MODEL COB CONTRACT PROVISION

Current through August 31, 2023
01.
Coordination of Benefits.
The incorporated by reference Appendix A
			 contains a model COB provision for use in contracts. The use of this model COB
			 provision is subject to the provisions of Subsections
			 021.02 through
			 021.04 and the provisions of
			 Section 022.
			 (3-31-22)
02.
Coordination of
			 Benefits Attachment.
The incorporated by reference Appendix B is a plain
			 language description of the COB process that explains to the covered person how
			 health plans will implement coordination of benefits. It is not intended to
			 replace or change the provisions that are set forth in the contract. Its
			 purpose is to explain the process by which two (2) or more plans will pay for
			 or provide benefits. (3-31-22)
03.
Application of Requirements
. The COB provision contained in the
			 incorporated by reference Appendix A and the plain language explanation in the
			 incorporated by reference Appendix B do not have to use the specific words and
			 format as shown. Changes may be made to fit the language and style of the rest
			 of the contract or to reflect differences among plans that provide services,
			 that pay benefits for expenses incurred and that indemnify. No substantive
			 changes are permitted. (3-31-22)
04.
Limits on COB Provisions
. A
			 COB provision will not be used that permits a plan to reduce benefits on the
			 basis that: (3-31-22)
a. Another plan exists
			 and the covered person did not enroll in that plan; (3-31-22)
b. A person is or could have been covered
			 under another plan, except with respect to Part B of Medicare; or
			 (3-31-22)
c. A person has elected
			 an option under another plan providing a lower level of benefits than another
			 option that could have been elected. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.022 - RULES FOR COORDINATION OF BENEFITS

Current through August 31, 2023
01.
Order of
			 Benefit Payments
. When a person is covered by two (2) or more plans, the
			 rules for determining the order of benefit payments are as follows: (3-31-22)
a. The primary plan pays or provides its
			 benefits as if the secondary plan or plans did not exist. (3-31-22)
b. If the primary plan is a closed panel plan
			 and the secondary plan is not a closed panel plan, the secondary plan pays or
			 provides benefits as if it were the primary plan when a covered person uses a
			 non-panel provider, except for emergency services or authorized referrals that
			 are paid or provided by the primary plan. (3-31-22)
c. When multiple contracts providing
			 coordinated coverage are treated as a single plan under this rule, Section
			 022 of this chapter applies only to
			 the plan as a whole, and coordination among the component contracts is governed
			 by the terms of the contracts. If more than one (1) carrier pays or provides
			 benefits under the plan, the carrier designated as primary within the plan is
			 responsible for the plan's compliance with this rule. (3-31-22)
d. If a person is covered by more than one
			 (1) secondary plan, the order of benefit determination requirements of this
			 rule decide the order in which secondary plan benefits are determined in
			 relation to each other. Each secondary plan takes into consideration the
			 benefits of the primary plan or plans and the benefits of any other plan,
			 which, under the requirements of this rule, has its benefits determined before
			 those of that secondary plan. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.023 - PROCEDURE TO BE FOLLOWED BY SECONDARY PLAN

Current through August 31, 2023
In determining the amount to be paid by the secondary plan on a
				claim, should the plan wish to coordinate benefits, the secondary plan
				calculates the benefits it would have paid on the claim in the absence of other
				health care coverage and apply that calculated amount to any allowable expense
				under its plan that is unpaid by the primary plan. The secondary plan may
				reduce its payment by the amount so that, when combined with the amount paid by
				the primary plan, the total benefits paid or provided by all plans for the
				claim do not exceed one hundred percent (100%) of the total allowable expense
				for that claim. In addition, the secondary plan credits to its plan deductible
				any amounts it would have credited to its deductible in the absence of other
				benefit care coverage. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.024 - NOTICE TO COVERED PERSONS

Current through August 31, 2023
A plan, in its explanation of benefits provided to covered
				persons, includes the following language: "If you are covered by more than one
				(1) health benefit plan, you should file all your claims with each plan."
				(3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.14 - COORDINATION OF BENEFITS › Section 18.04.14.025 - MISCELLANEOUS PROVISIONS

Current through August 31, 2023
01.
Benefits
			 in the Form of Services
. A secondary plan that provides benefits in the
			 form of services may recover the reasonable cash value of the services from the
			 primary plan, to the extent that benefits for the services are covered by the
			 primary plan and have not already been paid or provided by the primary plan.
			 Nothing in this provision requires a plan to reimburse a covered person in cash
			 for the value of services provided by a plan which provides benefits in the
			 form of services. (3-31-22)
02.
Complying Plan Versus Noncomplying Plan
. A plan with order of
			 benefit determination rules that comply with this rule (complying plan) may
			 coordinate its benefits with a plan that is "excess" or "always secondary" or
			 that uses order of benefit determination rules that are inconsistent with those
			 contained in this rule (noncomplying plan) on the following basis: (3-31-22)
a. If the complying plan is the primary plan,
			 it pays or provides its benefits first; (3-31-22)
b. If the complying plan is the secondary
			 plan, it pays or provides its benefits first, but the amount of the benefits
			 payable is determined as if the complying plan were the secondary plan. In such
			 a situation, the payment is the limit of the complying plan's liability; and
			 (3-31-22)
c. If the noncomplying
			 plan does not provide the information needed by the complying plan to determine
			 its benefits within a reasonable time after it is requested to do so, the
			 complying plan assumes that the benefits of the noncomplying plan are identical
			 to its own and pays its benefits accordingly. If, within two (2) years of
			 payment, the complying plan receives information as the actual benefits of the
			 noncomplying plan, it adjusts payments accordingly. (3-31-22)
i. If the noncomplying plan reduces its
			 benefits so that the covered person receives less in benefits than the covered
			 person would have received had the complying plan paid or provided its benefits
			 as the secondary plan and the noncomplying plan paid or provided its benefits
			 as the primary plan, and governing state law allows the right of subrogation
			 set forth below, then the complying plan advances to the covered person or on
			 behalf of the covered person an amount equal to the difference.
			 (3-31-22)
ii. In no event does the
			 complying plan advance more than the complying plan would have paid had it been
			 the primary plan less any amount it previously paid for the same expense or
			 services. In consideration of the advance, the complying plan is subrogated to
			 all rights of the covered person against the noncomplying plan. The advance by
			 the complying plan is to be without prejudice to any claim it may have against
			 the noncomplying plan in the absence of such subrogation.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.001 - TITLE AND SCOPE

Current through August 31, 2023
01.
Title
. IDAPA 18.04.15, "Rules Governing Short-Term Health
			 Insurance Coverage." (3-31-22)
02.
Purpose and Scope
. Implement Title 41, Chapters 21, 42, and 52,
			 Idaho Code, regarding short term, limited-duration insurance by defining rules
			 for enhanced short-term plans and nonrenewable short-term coverage, including
			 minimum standards for benefits, rating rules, enrollment, renewability, and
			 disclosure provisions. (3-31-22)
03.
Applicability
. This rule
			 applies to all enhanced short-term plans and nonrenewable short-term coverage
			 that provide medical expense coverage. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.010 - DEFINITIONS

Current through August 31, 2023
In addition to the applicable definitions in Chapters 21, 42,
				and 52, Idaho Code, the following definitions apply: (3-31-22)
01.
Benchmark Medical Plan
. The
			 health benefit plan identified by the U.S. Department of Health and Human
			 Services to be applicable in establishing minimum benefit coverages by
			 Qualified Health Plans within Idaho, excluding any supplements for pediatric
			 dental or vision. (3-31-22)
02.
Exchange
. Has the meaning set forth in Section
			 41-6103, Idaho Code.
			 (3-31-22)
03.
Nonrenewable
			 Short-term Coverage
. Short-term, limited-duration insurance that is not
			 renewable, has a duration of six (6) months or less in total, and is not an
			 Enhanced Short-term Plan under Section
			 41-5203(11),
			 Idaho Code, and this rule. (3-31-22)
04.
Preexisting Condition
.
			 (3-31-22)
a. A condition for which an
			 ordinarily prudent person would seek medical advice, diagnosis, care or
			 treatment during the six (6) months immediately preceding the effective date of
			 coverage; (3-31-22)
b. A condition
			 for which medical advice, diagnosis, care or treatment was recommended or
			 received during the six (6) months immediately preceding the effective date of
			 coverage; or (3-31-22)
c. A
			 pregnancy existing on the effective date of coverage.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.011 - GENERAL RULES FOR ENHANCED SHORT-TERM PLANS

Current through August 31, 2023
01.
Application of Requirements
. Any short-term, limited-duration
			 insurance that, including renewals, reissuance or extensions, has a total
			 duration of longer than six (6) months is subject to the requirements
			 applicable to enhanced short-term plans. (3-31-22)
02.
Guaranteed Issue
. Enhanced
			 short-term plans are only to be offered on a guaranteed issue basis.
			 (3-31-22)
03.
Portability
. Enhanced short-term plan coverage is qualifying
			 previous coverage under Title 41, Chapter 52, Idaho Code. Preexisting condition
			 exclusions are to be waived for the period of time an individual was previously
			 covered by an enhanced short-term plan or other qualifying previous coverage.
			 (3-31-22)
04.
Requirement to
			 Offer Exchange Plans
. To offer an enhanced short-term plan, a carrier is
			 to offer individual QHPs through the Exchange in the same service area.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.012 - GENERAL RULES FOR NONRENEWABLE SHORT-TERM COVERAGE

Current through August 31, 2023
Nonrenewable short-term coverage is subject to the provisions
				of IDAPA 18.04.13, Sections
				081,
				082, and
				101. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.020 - ENROLLMENT

Current through August 31, 2023
01.
Enhanced Short-term Plans
.
			 There are two exclusive options for enhanced short-term plan enrollment.
			 (3-31-22)
a. Year-round Enrollment. If a
			 carrier allows year-round enrollment in enhanced short-term plans, the
			 following provisions apply: (3-31-22)
i. A
			 preexisting condition exclusion period, as defined at Subsection
			 010.04, may be applied, subject
			 to Section
			 41-5208, Idaho Code.
			 (3-31-22)
ii. The policy is to be
			 offered on a plan year basis, not a calendar year basis.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.021 - RENEWAL AND REISSUANCE

Current through August 31, 2023
01.
Enhanced
			 Short-term Plans Renewals
. (3-31-22)
a.
			 A policy is to be renewable at the option of the enrollee, consistent with
			 Section 41-5207, Idaho Code.
			 (3-31-22)
b. No new application or
			 questions concerning the health or medical condition of the covered individuals
			 may be requested to effectuate the renewal. (3-31-22)
c. A policy is not to be renewable beyond
			 thirty-six (36) consecutive months. (3-31-22)
d. Upon exhaustion of a policy's renewability
			 due to duration or age, the policyholder is eligible for enrollment into fully
			 renewable coverage, including all of the current carrier's QHPs, when an
			 enhanced short-term policy has been in effect for at least eleven (11) months.
			 Timely notification of eligibility is to be provided to the policyholder plus
			 the notification of any offer of reissuance. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.022 - RATING REQUIREMENTS

Current through August 31, 2023
01.
Enhanced
			 Short-term Plans
. In addition to the requirements applicable to
			 individual health benefit plans, the following rating requirements apply:
			 (3-31-22)
a. Premium rates do not vary by
			 gender. (3-31-22)
b. Geographic
			 rating areas are identical to those used for Exchange-offered QHPs.
			 (3-31-22)
c. Medical underwriting
			 criteria may be used to ascertain the risk characteristics of an applicant, if
			 the criteria are limited to those in the Universal Health Statement Addendum
			 and available claims data. (3-31-22)
d. Enhanced short-term plans comprise a
			 single risk pool with the carrier's other actively marketed individual health
			 benefit plans subject to Title 41, Chapter 52, Idaho Code. (3-31-22)
e. The rating period is on a calendar year
			 basis, whereby the rates filed apply to all enrollees uniformly during a given
			 calendar year and premium rate changes occur at the start of a new calendar
			 year. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.030 - MINIMUM STANDARDS FOR BENEFITS

Current through August 31, 2023
01.
Minimum
			 Covered Benefits
. (3-31-22)
a. Daily
			 hospital room and board expenses subject only to limitations based on average
			 daily cost of the semiprivate room rate in the area where the insured resides;
			 (3-31-22)
b. Miscellaneous hospital
			 services; (3-31-22)
c. Surgical
			 services; (3-31-22)
d. Anesthesia
			 services; (3-31-22)
e. In-hospital
			 medical services; and (3-31-22)
f.
			 Out-of-hospital care, consisting of physicians' services rendered on an
			 ambulatory basis where coverage is not provided elsewhere in the policy for
			 diagnosis and treatment of sickness or injury, diagnostic x-ray, laboratory
			 services, radiation therapy, and hemodialysis ordered by a physician.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.15 - RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE › Section 18.04.15.040 - DISCLOSURE PROVISIONS

Current through August 31, 2023
Polices subject to this chapter will include in the application
				for coverage, any application materials, and the insurance contract, the
				following language in at least 14-point type:
"This coverage is not required to comply with certain federal
				market requirements for health insurance, principally those contained in the
				Affordable Care Act. Be sure to check your policy carefully to make sure you
				are aware of any exclusions or limitations regarding coverage of preexisting
				conditions or health benefits (such as hospitalization, emergency services,
				maternity care, preventive care, prescription drugs, and mental health and
				substance use disorder services). Your policy might also have lifetime and/or
				annual dollar limits on health benefits. If this coverage expires or you lose
				eligibility for this coverage, you might have to wait until an open enrollment
				period to get other health insurance coverage." (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.000 - LEGAL AUTHORITY

Current through August 31, 2023
Title 41, Section
				41-211, Idaho Code, to aid in the
				effectuation of Title 41, Chapter 27 and Section
				41-1314, Idaho Code.
				(3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.001 - TITLE AND SCOPE

Current through August 31, 2023
01.
Title
. IDAPA 18.05.01, "Rules for Title Insurance Regulation."
			 (3-31-22)
02.
Purpose
.
			 This rule applies to all title insurers and title insurance agents and:
			 (3-31-22)
a. Defines and clarifies the meaning
			 of "a complete set of tract indexes or abstract records" as used in Section
			 41-2702, Idaho Code.
			 (3-31-22)
b. Provides procedural
			 rules as to the way title insurers, title insurance agents and escrow officers
			 are to perform certain actions, charge rates for various services, and provide
			 insurability on certain matters. (3-31-22)
c. Clarifies consumer protection on title
			 insurance products. (3-31-22)
d.
			 Preserves the financial stability of title insurers and title insurance agents.
			 (3-31-22)
e. Defines certain fair
			 trade practice standards for title insurance, the violation of which will
			 constitute rebates and/or illegal inducements by Sections
			 41-2708(3)  and
			 41-1314, Idaho Code. This rule
			 does not limit the Director's authority to determine that other title insurance
			 trade practices constitute violations of Title 41, Chapter 27 and 41-1314,
			 Idaho Code. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.010 - DEFINITIONS

Current through August 31, 2023
All terms defined in Title 41, Chapters 1, 13, and 27, Idaho
				Code, which are used in this rule will have the same meaning as used in those
				chapters. (3-31-22)
01.
Applicant.
A party to a real estate transaction who may be the
			 buyer, seller and/or a proposed or named insured on a title commitment, policy,
			 guaranty or other title insurance product. (3-31-22)
02.
Financial Interest
. Any
			 interest that entitles the holder in any manner to two and one-half percent
			 (2.5%) or more of the profits or net worth of the title entity in which the
			 interest is held. (3-31-22)
03.
Policy
. Any contract or form of title insurance which prior to its
			 issuance has been filed with the Director of Insurance. (3-31-22)
04.
Preliminary Report
. A binder
			 of insurance, a commitment to insure, a preliminary report of title, and
			 litigation reports including quiet title action, foreclosure actions of
			 contracts of sale, deeds of trust or mortgages where a policy of title
			 insurance will be issued on the successful completion thereof. Excluded are
			 miscellaneous reports which do not insure title, such as judgment reports, lot
			 book reports or property search reports which are governed by Subsection
			 012.01. (3-31-22)
05.
Producer of Title Business
.
			 Includes any person engaged in this state in the trade, business, occupation or
			 profession of: (3-31-22)
a. Buying or selling
			 interest in real property; or (3-31-22)
b. Making loans secured by interest in real
			 property; and (3-31-22)
c. May
			 include but not be limited to real estate agents, real estate brokers, mortgage
			 brokers, lending or financial institutions, builders, attorneys, developers,
			 sub-dividers, auctioneers engaged in the sale of real property, consumers, and
			 the employees, agents, representatives, or solicitors of any of the foregoing;
			 and (3-31-22)
d. Will include any
			 legal entity whose ownership is, directly or indirectly, comprised fifty-one
			 percent (51%) or more by entities or individuals described in Paragraph
			 010.05.c of this rule. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.011 - TRACT INDEXES OR ABSTRACT RECORDS

Current through August 31, 2023
For clarification and guidance, the following is considered to
				be the correct definition or meaning of "a complete set of tract indexes or
				abstract records" as used in Section
				41-2702, Idaho Code: A set of
				indexes from which the record ownership and condition of title to all land
				within a particular county can be traced and ascertained. Tract indexes and
				abstract records will be maintained and posted to current date and will include
				adequate maps that will enable a person working the title plant to locate a
				tract of land that is the subject of the title examination. The basic component
				parts of such a set of indexes are: (3-31-22)
01.
Basic Component Parts
. An
			 index or indexes, to be complete from the inception of title from the United
			 States of America, in which the reference is to geographic subdivisions of
			 land, classified according to legal description, (as distinguished from an
			 index or indexes in which the reference is to the name of the title holder,
			 commonly called a grantor-grantee index) wherein notations of or references to:
			 (3-31-22)
a. All filed or recorded instruments
			 legally affecting title to particularly described parcels of real property and
			 which impart constructive notice under the recording laws; and
			 (3-31-22)
b. All judicial
			 proceedings in the particular county legally affecting title to particularly
			 described parcels of real property are posted, filed, entered or otherwise
			 included in that part of the indexing system which designates the particular
			 parcel of real property; provided, no reference need be made in such index to
			 any judicial proceeding which is referred to or noted in the name index defined
			 in Subsection 011.02 of
			 these rules. (3-31-22)
c. No
			 requirement is made for taxes and assessments, water or otherwise, or for water
			 and mineral rights, land use regulations, and zoning ordinances to be made a
			 part of the plant records. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.014 - DISCLOSURE BY PRODUCER OF TITLE BUSINESS

Current through August 31, 2023
01.
Disclosure of Financial Interest
. No title entity may accept any
			 order to issue a title commitment, guarantee, title insurance policy for, or
			 provide services including, but not limited to, escrow closing and foreclosure
			 services, to an applicant if it knows or has reason to believe that the
			 applicant was referred by a producer of title business, where the producer of
			 title business has a financial interest in the title entity to which the
			 business is referred unless the producer of title business has disclosed to the
			 applicant the financial interest of the producer of title business. The
			 disclosure will be made in writing and contain the items prescribed in
			 Subsection 014.02 of this rule.
			 (3-31-22)
02.
Disclosure
			 Provided to Applicant
. The disclosure will be provided to the applicant
			 at the time the sale and/or purchase contract is entered into. A signed copy of
			 the disclosure will be maintained by the producer of title business and
			 provided to the title entity prior to, or simultaneously with, the placing or
			 the order for a title insurance commitment or guarantee or escrow closing
			 services. The title entity will maintain a copy of said disclosure for a
			 minimum period of five (5) years. The disclosure will contain the following:
			 (3-31-22)
a. A heading, in bold face, all
			 caps, type font 14 or higher that states: "NOTICE OF FINANCIAL INTEREST IN
			 TITLE ENTITY BY PRODUCER OF TITLE BUSINESS." (3-31-22)
b. A statement in type 12 font or higher: "We
			 call this interest to your attention for disclosure purposes. (Provide name of
			 Producer of Title Business) has a financial interest in this title entity
			 (provide title entity name). This financial interest may result in a conflict
			 of interest in our representation of you. Accordingly, you are free to choose
			 any other title entity which is licensed by the Idaho Department of Insurance
			 in the county in which the property is located. A list of title insurers and
			 title agents licensed in the county in which the property is located may be
			 found by contacting the Idaho Department of Insurance." (3-31-22)
c. A statement that the Applicant has read
			 the aforementioned disclosure and chooses to have their transaction served by
			 the Title Entity referred by the Producer of Title Business. The disclosure
			 will contain the signature of all applicants along with the date the
			 signature(s) was accomplished. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.015 - FINANCIAL INTEREST NOTICE

Current through August 31, 2023
01.
Financial
			 Interest Notice to Director
. A title entity will notify the Director of
			 the Department the names and addresses of all producers of title business that
			 have a financial interest in the title entity, including the financial interest
			 held by the producer of title business and the date the financial interest was
			 acquired. (3-31-22)
02.
Notice Filing
. The title entity will provide the financial
			 interest notice to the Director of the Department prior to the granting of a
			 title agent license and upon request for renewal of a title agent license.
			 (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.022 - ESCROW FEES

Current through August 31, 2023
Title insurers and title insurance agents will not charge less
				than the fees filed with the Department of Insurance for a specified escrow
				service, as such service is defined in the title insurer's or title insurance
				agent's filed schedule of fees. Each title insurer and title insurance agent
				will file its schedule of escrow fees charged for all escrow and closing
				services rendered on a yearly basis due March 15 reflecting experience from the
				previous calendar year. Fees should include a title entity's basic rate,
				minimum rate and negotiable rate with respect to different types of closings
				and should not reflect credits of any kind with regard to different
				classifications of customers. The fee will be based upon the full sales price
				in the event of a sale, or the amount of the loan in the event of a mortgage
				and will not be less than the title entity's cost for providing that service.
				Fees for escrow and closing services will not include preparation of
				instruments. Property in different ownerships always, and noncontiguous
				properties generally, are rated separately. Additional fees will be charged
				where the minimum fee is inadequate because of the unusual complications of the
				transactions. Fees may also be filed throughout the year as often as necessary
				as determined by the title entity. Fee filings in these instances will be filed
				at least thirty (30) days prior to implementation of the fees. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.031 - REBATES AND ILLEGAL INDUCEMENTS

Current through August 31, 2023
01.
Items of
			 Value
. A title entity will not provide items of value to a producer of
			 title business, consumer or member of the general public except as permitted in
			 Sections 031.02,
			 031.03,
			 031.04 and
			 031.05 of this chapter. If a
			 providing of things of value does not clearly fit into the rules in Sections
			 031.02,
			 031.03,
			 031.04, and
			 031.05, then it is not allowed.
			 Exhibit 1, located on our website at
https://doi.idaho.gov/
, is a partial, but
			 not all-inclusive, list of acts and practices that are considered illegal
			 inducements disallowed by Title 41, Idaho Code. (3-31-22)
02.
Permitted Consumer
			 Information
. To facilitate the listing and sale of Idaho property,
			 certain consumer information may be provided without charge to licensed real
			 estate agents and brokers or to a person who owns the property for which the
			 request is made, but is limited to the following information: (3-31-22)
a. Listing Package is a single copy of a
			 listing package, property profile, or similarly named packet of information and
			 will consist of information relating to the ownership and status of title to
			 real property, and may include a single copy of only the following seven (7)
			 items: (3-31-22)
i. The last deed appearing of
			 record; (3-31-22)
ii. Deeds of
			 trust or mortgages which appear to be in full force and effect;
			 (3-31-22)
iii. A plat map
			 reproduction and/or a locater map; (3-31-22)
iv. A copy of applicable restrictive
			 covenants; (3-31-22)
v. Tax
			 information; (3-31-22)
vi. Property
			 characteristics such as number of rooms, square footage and year built; and
			 (3-31-22)
vii. Photographs,
			 including aerial, of the property. (3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.05.01 - RULES FOR TITLE INSURANCE REGULATION › Section 18.05.01.032 - DISSEMINATION

Current through August 31, 2023
All title entities are instructed to distribute a copy of this
				rule to every employee that may be engaged in activities requiring knowledge of
				its contents, and to instruct all employees in its scope and operation.
				(3-31-22)
Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.06.01 - RULES PERTAINING TO BAIL AGENTS › Section 18.06.01.000 - LEGAL AUTHORITY

Current through August 31, 2023
Title 41, Sections
				41-211 and
				41-1037 through
				41-1045, Idaho Code.
				(3-31-22)