Title 41 — INSURANCE

41-3401. Scope of chapter. (1) This chapter shall apply to every individual, person, firm, corporation, association, or organization of any kind hereafter engaging or purporting to engage in the provision of all or part of any health care service, as hereinafter defined, for its …

41-3402. Purpose and interpretation. (1) It is the purpose of this chapter to regulate in the public interest the formation and operation of prepaid health care service organizations, in order that such services may be made available upon a basis of fair and equitable contracts t…

41-3403. Definitions. For the purposes of this chapter: (1) "Health care service" means any service rendered to an individual for diagnosis, relief, or treatment of any injury, ailment or bodily condition. (2) "Service corporation" means a corporation providing all or part of one…

41-3404. Provisions exclusive. No provision of this code shall apply to any such health care service corporation unless contained or referred to in this chapter.

41-3405. Incorporation — Certificate of authority required. No person otherwise subject to this chapter shall engage or purport to engage in the provision of any part or all of any health care service for its subscribers in exchange for periodic prepayments in identifiable amount…

41-3406. Incorporation — Laws applicable — Approval of articles of incorporation — Amendment. (1) A service corporation shall be formed as a nonprofit, nonstock professional service corporation consistent with the applicable requirements of this chapter under the statutes of Idah…

41-3407. Name of corporation. No service corporation shall have or use a corporate or business name which includes the words "insurance", "casualty", "surety", "health and accident", "mutual", or other terms descriptive of an insurer or insurance business. No service corporation …

41-3408. Qualifications for certificate of authority. The director shall not issue or permit to exist a certificate of authority to be or act as a service corporation, as to any corporation not fulfilling the following qualifications: (1) Must be incorporated as provided in secti…

41-3409. Application for certificate of authority. (1) Application for a certificate of authority to transact business as a service corporation shall be made to the director, on forms as prepared and furnished by the director and requiring such information relative to the applica…

41-3410. Issuance or refusal of certificate of authority. (1) If after the application for certificate of authority is completed the director finds that the applicant is fully qualified for a certificate of authority in accordance with the provisions of this chapter, and that the…

41-3411. Continuance or expiration of certificate of authority. (1) A certificate of authority issued to a service corporation shall continue in force as long as the corporation is entitled thereto under this chapter, and until suspended or revoked by the director or terminated a…

41-3412. Suspension or revocation of certificate of authority. (1) The director shall suspend or revoke the certificate of authority of any service corporation which he finds, after a hearing thereon, is no longer qualified therefor under the provisions of this chapter. (2) The d…

41-3413. Services and benefits which may be provided professional service corporations. (1) A professional service corporation shall have the right to provide to its subscribers part or all of the following services and benefits only: (a) Professional services furnished to the su…

41-3414. Services and benefits which may be provided — Hospital service corporations. (1) A hospital service corporation shall have the right to provide to its subscribers part or all of the following services and benefits only: (a) Hospital services furnished to the subscriber b…

41-3415. Professional service agreements. (1) A professional service corporation shall enter into service agreements with only licensees duly licensed by the state of Idaho. (2) Each such service agreement shall require the participant licensees to furnish to subscribers of the s…

41-3415A. Pharmacists’ service agreements. (1) With respect to services of participant licensee pharmacists, the service agreement shall require the participant pharmacist to furnish to subscribers the pharmaceutical services and drugs which are, under the subscriber’s contract, …

41-3416. Hospital service agreements. (1) A hospital service corporation shall enter into service agreements with only hospitals duly approved or licensed by the state of Idaho. (2) Each such service agreement shall require the participant hospital to furnish to subscribers of th…

41-3417. Subscriber’s contracts. (1) Each subscriber’s contract hereafter issued by a service corporation shall constitute a direct obligation of the participant licensees and/or participant hospitals to render the professional or hospital services, as the case may be, as agreed …

41-3418. Service agreements and subscriber’s contracts must provide substantial service benefits. (1) Service agreements and subscriber’s contracts entered into or issued by a service corporation on a service basis shall provide for health care services of a substantial and broad…

41-3419. Filing and approval of agreements and contracts. (1) No service corporation shall issue or use any basic form of service agreement or subscriber’s contract, or application, identification, supplement, or endorsement to be connected with any such agreement or contract, un…

41-3420. Charges and rates. (1) Subscription rates, fees, and payments to be charged by a service corporation to or on account of its subscribers shall not be excessive, inadequate, or unfairly discriminatory; and rates of payments to be made to participant physicians, participan…

41-3421. Reserves. (1) In addition to the surplus fund provided for in section 41-3422, every service corporation shall establish and maintain unimpaired reserves as follows: (a) Due obligations. A reserve in an amount not less than all legal obligations of the corporation, other…

41-3422. Surplus fund. (1) Every service corporation shall set aside into a "surplus fund" an amount of money equal to not less than two per cent (2%) of all sums hereafter received by it on account of subscriber’s contracts, until such surplus fund amounts to not less than fifty…

41-3423. Investments. The investable funds of a service corporation may be invested in securities and other investments permitted by and pursuant to the provisions of chapter 7, title 41, Idaho Code, and for the purposes of chapter 7, title 41, Idaho Code, a service corporation s…

41-3424. Records and accounts. (1) Every service corporation shall establish and maintain complete and accurate records and accounts covering its transactions and affairs, in accordance with common and accepted principles and practices of insurance accounting and recordkeeping as…

41-3425. Annual statement. (1) Each service corporation shall annually on or before the first day of March file with the director a statement of its financial condition as at the December 31 next preceding. The statement shall be in form, and provide for such information relative…

41-3426. Examination. Every service corporation shall be subject to examination by the director, with the same rights and powers and in the same manner as is provided in this code for the examination of insurers; and for the purposes thereof the following sections of this code sh…

41-3427. Taxation and annual report. (1) Each service corporation shall annually on or before the first day of March, file with the director a report in addition to the statement required under section 41-3425, Idaho Code, (on forms as approved by the director) under oath, showin…

41-3428. Joint operations. (1) A hospital service corporation and a professional service corporation may operate under joint management for the purpose of reducing operating costs. (2) Separate records and accounts shall be kept for each such corporation, and the funds and assets…

41-3429. Combined corporation. (1) A service corporation may be formed as, or may by suitable amendment of its articles of incorporation become, a combined professional service and hospital service corporation. As to its professional services each such combined service corporatio…

41-3430. Contracts covering workmen’s compensation risks. (1) No service corporation shall issue any subscriber’s contract covering, or otherwise insure, any industrial injury or illness with respect to which health care service or indemnity benefits are provided by either federa…

41-3431. Annual adjustment of service payments — Disposition of excess funds. (1) Annually on or before March 1 every service corporation shall make a special accounting, at which time any prorated settlements for any bills submitted by participant licensees or hospitals, for ser…

41-3432. Fidelity bond. Every service corporation shall procure and maintain in force a fidelity bond or bonds, with authorized corporate surety, covering every officer or employee entrusted with the handling of its funds, in such amount, but not less than five thousand dollars (…

41-3433. Service corporation fees. (1) Every service corporation shall pay to the director fees in advance as provided for by regulation. (2) The director shall transmit and account for all fees received by him hereunder, as provided in section 41-406, Idaho Code

41-3434. Other provisions applicable. In addition to those contained or referred to heretofore in this chapter, the following chapters and provisions of title 41, Idaho Code, shall also apply with respect to service corporations to the extent applicable and not in conflict with t…

41-3435. Producer licensing. (1) Producers or persons representing a service corporation in the solicitation and negotiation of subscriber’s contracts shall qualify for and be licensed as producers of the service corporation in the same manner and in compliance with the same appl…

41-3436. Dependent’s coverage — Dependent’s termination of coverage, disability and dependency proof and application. (1) Any new or renewing subscriber contract delivered or issued for delivery in this state shall provide that an unmarried child under the age of twenty-five (25)…

41-3437. Required provisions — Infants. (a) A subscriber’s contract, delivered or issued for delivery in this state which provides coverage for injury or sickness for newborn dependent children of subscribers or other members of the covered group, shall provide coverage for such …

41-3438. Complications of pregnancy. No hospital or medical service corporation contract which provides maternity benefits for a person covered continuously from conception shall be issued, amended, delivered, or renewed in this state on or after January 1, 1977, if it contains a…

41-3439. Limitation of benefits for elective abortions. All individual nongroup or subscriber’s policies, contracts, plans or certificates delivered, issued for delivery or renewed in this state after the effective date of this section shall exclude coverage for elective abortion…

41-3440. Services provided by governmental entities. (1) From and after July 1, 1990, no hospital or professional service corporation subscriber’s contract shall be issued in Idaho which excludes from coverage services rendered the subscriber while a resident in an Idaho state in…

41-3441. Mammography coverage. (1) From and after July 1, 1992, all group subscriber’s contracts which provide coverage for the surgical procedure known as a mastectomy which are delivered, issued for delivery, continued or renewed in this state shall provide minimum mammography …

41-3443. Best price — Most favored nations clause prohibited. No service corporation may require, as an element of any service agreement, that any licensee or hospital agree: (1) To the unnegotiated adjustment by the service corporation of the licensee’s or hospital’s contractual…

41-3444. contracts with providers of dental services. (1) No person contracting with dentists to provide coverage or reimbursement for dental services may require, as an element of any dental care provider participation contract, that the provider agree to adopt fees set by the p…