Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.13 - THE INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT › Section 18.04.13.046 - REQUIREMENT TO INSURE INDIVIDUALS

Current through August 31, 2023
01.
Offer of
			 Coverage
. An individual carrier that offers coverage to an individual
			 will offer to provide coverage to each eligible individual and to each eligible
			 dependent of an eligible individual. (3-31-22)
02.
Risk Characteristics
.
			 Individuals are accepted for coverage by the individual carrier without any
			 restrictions or limitations on coverage related to the risk characteristics of
			 the Individual or their dependents, except that a carrier may exclude or limit
			 coverage for pre-existing medical conditions, consistent with the provisions
			 provided in Section
			 41-5208(3), Idaho
			 Code. (3-31-22)
03.
Risk
			 Load
. An individual carrier may assess a risk load to the premium rate
			 associated with a new entrant, consistent with the requirements of Section
			 41-5206, Idaho Code. The risk load
			 is the same risk load charged to the Individual immediately prior to acceptance
			 of the new entrant into the health benefit plan. (3-31-22)
04.
Rescission
. When material
			 application misstatements are found, rescission action by the carrier may be
			 taken at the carrier's option. When rescission action is taken, premiums are
			 refunded less any claims which had been paid prior to the date the rescission
			 was initiated. At the carrier's option, the carrier may seek to recover any
			 amounts of claims paid in excess of premiums paid. The applicable contract or
			 coverage is considered null and void. (3-31-22)
05.
Coverage Rescinded for Fraud or
			 Misrepresentation
. Any individual whose coverage is subsequently
			 rescinded for fraud or misrepresentation will not be an "eligible individual"
			 for a period of twelve (12) months from the effective date of the termination
			 of the individual coverage and cannot be deemed to have "qualifying previous
			 coverage" under Title 41, Chapter 22, 47, 52, or 55, Idaho Code; provided such
			 limitations are not in conflict with the Health Insurance Portability and
			 Accountability Act of 1996. (3-31-22)
06.
Certification of Creditable
			 Coverage
. (3-31-22)
a. Individual
			 carriers will provide written certification of creditable coverage to
			 individuals in accordance with this Subsection. (3-31-22)
b. The certification of creditable coverage
			 is provided: (3-31-22)
i. At the time an
			 individual ceases to be covered under the health benefit plan or otherwise
			 becomes covered under a COBRA continuation provision; (3-31-22)
ii. In the case of an individual who becomes
			 covered under a COBRA continuation provision, at the time the individual ceases
			 to be covered under that provision; and (3-31-22)
iii. Such certification is automatically
			 provided by the individual carrier or at the time a request is made on behalf
			 of an individual if the request is made not later than twenty-four (24) months
			 after the date of cessation of coverage described in Paragraphs 046.06.b.i. and
			 046.06.b.ii., whichever is later. (3-31-22)
c. The certificate of creditable coverage
			 contains: (3-31-22)
i. Written certification
			 of the period of creditable coverage of the individual under the health benefit
			 plan; and (3-31-22)
ii. The waiting
			 period, if any, and if applicable, affiliation period imposed with respect to
			 the individual for any coverage under the health benefit plan.
			 (3-31-22)