Title 41 — INSURANCE

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…

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 sharehol…

41-3802. definitions. As used in this chapter, the following terms shall have the following meanings: (1) "Affiliate" of, or a person "affiliated" with, a specific person, means a person who directly or indirectly through one (1) or more intermediaries controls or is controlled b…

41-3803. Subsidiaries of insurers. (1) A domestic insurer, either by itself or in cooperation with one (1) or more persons, may organize or acquire one (1) or more subsidiaries. The subsidiaries may conduct any kind of business or businesses and their authority to do so shall not…

41-3804. Acquisition of control of controlling interest with domestic insurer — acquisition of merger or divestiture of controlling interest with domestic insurer. (1) The following filing requirements shall apply: (a) No person other than the issuer shall make a tender offer for…

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…

41-3806. Approval by director — Hearings. (1) The director shall approve any purchase, exchange, merger or other acquisition of control referred to in section 41-3804(1), Idaho Code, or in section 41-3824, Idaho Code, unless, after a public hearing, the director finds that: (a) A…

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 shal…

41-3808. Acquisitions involving insurers not otherwise covered. (1) The following definitions shall apply for the purposes of this section only: (a) "Acquisition" means any agreement, arrangement or activity, the consummation of which results in a person acquiring directly or ind…

41-3809. Registration of holding company system insurers. (1)(a) Every insurer authorized to do business in this state and that is a member of an insurance holding company system shall register with the director, except a foreign insurer subject to registration requirements and s…

41-3809A. group capital calculation reporting. (1) If an insurance holding company system under section 41-3809(13), Idaho Code, has previously filed the annual group capital calculation at least once, the lead state director may exempt the ultimate controlling person from filing…

41-3810. Standards and management of an insurer within an insurance holding company system. (1) Transactions within an insurance holding company system to which an insurer subject to registration is a party shall be subject to the following standards: (a) The terms shall be fair …

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 …

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 th…

41-3813. Management of domestic insurers subject to registration. (1) Notwithstanding the control of a domestic insurer by any person, the officers and directors of the insurer shall not thereby be relieved of any obligation or liability to which they would otherwise be subject b…

41-3814. Examination. (1) Power of director. Subject to the limitation contained in this section and in addition to the authority the director has under chapter 2, title 41, Idaho Code, relating to the examination of insurers, the director shall have the power to examine any insu…

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 insur…

41-3815A. group-wide supervision of internationally active insurance groups. (1) The director is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with the provisions of this section. However, the director may otherwise ac…

41-3816. Confidential treatment. (1) Documents, materials or other information in the possession or control of the department that are obtained by or disclosed to the director or any other person in the course of an examination or investigation made pursuant to section 41-3814, I…

41-3817. Rules. The director may promulgate rules and issue orders as shall be necessary to carry out the provisions of this chapter.

41-3818. Injunctions, prohibitions against voting securities, sequestration of voting securities. (1) Whenever it appears to the director that any insurer or any director, officer, employee or agent thereof has committed or is about to commit a violation of the provisions of this…

41-3819. Sanctions. (1) Any insurer failing, without just cause, to file any registration statement as required in this chapter shall be required, after notice and the opportunity for a hearing, to pay a penalty of two hundred dollars ($200) for each day of delay, to be recovered…

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 …

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 w…

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 p…

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 accord…

41-3824. Mutual insurance holding companies. (1) (a) A domestic mutual insurer, upon approval of the director, may reorganize by forming an insurance holding company system, which shall be designated as "a mutual insurance holding company," based upon a mutual insurance company p…

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 …

41-3901. Short title. This chapter may be cited as the Idaho "Managed Care Reform Act."

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, ac…

41-3903. Definitions. (1) "Basic health care services" means the following services: preventive care, emergency care, inpatient and outpatient hospital and physician care, hospital-based rehabilitation treatment, diagnostic laboratory and diagnostic and therapeutic radiological s…

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 offer…

41-3905. Qualifications for certificate of authority. The director shall not issue or permit to remain in force a certificate of authority authorizing the transaction of managed care plans unless the organization offering the managed care plan is qualified therefor as follows: (1…

41-3906. Application for certificate of authority. (1) The application for a certificate of authority shall be in writing in the form prescribed by the director. It shall be verified by an officer of an applicant corporation or association, or member of an applicant firm, or by t…

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…

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 l…

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.…

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 t…

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 disb…

41-3915. Health care contracts. (1) All health care contracts or other marketing documents describing health care services offered by any managed care organization shall contain: (a) A complete description of the health care services and other benefits to which the member is enti…

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 t…

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 organiza…

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 appe…

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 …

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 associati…

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 …

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 f…

41-3923. Coverage of adopted newborn children — Coverage of maternity and complications of pregnancy. (1) Any contract delivered or issued for delivery in this state by an organization offering a managed care plan for which a certificate of authority is required, which provides c…

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 f…

41-3925. Services provided by governmental entities. (1) From and after July 1, 1990, no contract shall be issued in Idaho by an organization offering a managed care plan for which a certificate of authority is required which excludes from coverage services rendered the member wh…