Title 41 — INSURANCE
62 chapters · 1,376 sections in this title.
Idaho Code § 41-5901 short title
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41-5901. short title. This chapter shall be known and may be cited as the "Idaho Health Carrier External Review Act."
Idaho Code § 41-5902 purpose and intent
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41-5902. purpose and intent. The purpose of this chapter is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of a final adverse benefit determination, as …
Idaho Code § 41-5903 definitions
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41-5903. definitions. For purposes of this chapter: (1) "Administrative record" means all nonprivileged documents, records or other health information which was submitted, considered, generated or relied upon by the health carrier in the course of making the adverse benefit deter…
Idaho Code § 41-5904 applicability and scope
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41-5904. applicability and scope. (1) Except as provided in subsection (2) of this section, this chapter shall apply to all health carriers. (2) The provisions of this chapter shall not apply to a plan, policy or certificate that provides coverage only for a specified disease, sp…
Idaho Code § 41-5905 notice of right to external review
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41-5905. notice of right to external review. (1) When a final adverse benefit determination is made, the health carrier shall notify the covered person in writing of the covered person’s right to request an external review to be conducted pursuant to section 41-5908, 41-5909 or 4…
Idaho Code § 41-5906 request for external review
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41-5906. request for external review. A covered person may make a request for an external review of a final adverse benefit determination. Except for a request for an expedited external review as set forth in section 41-5909, Idaho Code, all requests for external review shall be …
Idaho Code § 41-5907 Exhaustion of internal grievance process
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41-5907. Exhaustion of internal grievance process. (1) Except as provided in subsection (2) of this section, a request for an external review pursuant to section 41-5908, 41-5909 or 41-5910, Idaho Code, shall not be made until the covered person has exhausted the health carrier’s…
Idaho Code § 41-5908 standard external review
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41-5908. standard external review. (1) Within four (4) months after the date of issuance of a notice of a final adverse benefit determination pursuant to section 41-5905, Idaho Code, a covered person may file a request for an external review with the director. The request shall b…
Idaho Code § 41-5909 expedited external review
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41-5909. expedited external review. (1) A covered person may make a request for an expedited external review of a pre-service or concurrent service adverse benefit determination where the requested service meets the definition of an urgent care request and the covered person has …
Idaho Code § 41-5910 binding nature of external review decision
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41-5910. binding nature of external review decision. (1) For a health care benefit plan not subject to the employee retirement income security act of 1974 (ERISA), the external review decision is final and binding on the health carrier and on the covered person. No judicial actio…
Idaho Code § 41-5911 approval of independent review organizations
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41-5911. approval of independent review organizations. (1) The director shall approve independent review organizations eligible to be assigned on a random basis to conduct external reviews under this chapter. (2) In order to be eligible for approval by the director under this sec…
Idaho Code § 41-5912 minimum qualifications for independent review organizations
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41-5912. minimum qualifications for independent review organizations. (1) To be approved to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external review process an…
Idaho Code § 41-5913 hold harmless for independent review organizations
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41-5913. hold harmless for independent review organizations. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable in damages or oth…
Idaho Code § 41-5914 external review reporting requirements
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41-5914. external review reporting requirements. (1) An independent review organization assigned pursuant to this chapter to conduct an external review shall maintain written records in the aggregate for Idaho by health carrier on all requests for external review for which it con…
Idaho Code § 41-5915 funding of external review
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41-5915. funding of external review. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the reasonable cost of the independent review organization for conducting the external review.
Idaho Code § 41-5916 disclosure requirements
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41-5916. disclosure requirements. (1) Each health carrier shall include a summary description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons. The dis…
Idaho Code § 41-5917 SEVERABILITY
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41-5917. SEVERABILITY. The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the rema…