Title 41 — INSURANCE

41-4119. Liquidation of trust fund. (1) Upon termination of registration the trust fund of a joint public agency self-funded plan shall be liquidated. (2) Liquidation of a solvent joint public agency self-funded plan shall be conducted by its trustee under a plan of liquidation i…

41-4120. Rules. (1) The director may make reasonable rules necessary for or as an aid to effectuation of any provision of this chapter. No such rule shall extend, modify, or conflict with any provision of this chapter and the reasonable implications thereof nor any of the adminis…

41-4121. Other provisions applicable. Chapter 2, title 41, Idaho Code (the director of the department of insurance), chapter 13, title 41, Idaho Code (trade practices and frauds), and sections 41-2141(1) and 41-2216(1), Idaho Code (coordination of benefits, except to the extent t…

41-4122. Penalties. (1) Any person who violates or causes or induces violation of any provision of this chapter or any lawful rule of the director issued hereunder, shall be subject to an administrative penalty for each violation of not more than one thousand dollars ($1,000) for…

41-4123. Coverage from moment of birth — Complications of pregnancy. (1) Every joint public agency self-funded plan issued in this state or providing coverage to any covered family residing within this state, shall contain a provision granting immediate accident and sickness cove…

41-4124. Services provided by governmental entities. (1) From and after July 1, 2006, no joint public agency self-funded plan shall be issued in Idaho which excludes from coverage services rendered the subscriber while a resident in an Idaho state institution, provided the servic…

41-4125. Mammography coverage. (1) From and after July 1, 2006, all joint public agency self-funded plans 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 mam…

41-4201. Purpose. The purpose of this act shall be to provide reasonable standardization and simplification of terms and coverages of individual disability insurance policies, group supplemental disability insurance policies, nongroup subscriber contracts of nonprofit hospitals, …

41-4202. Definitions. (1) "Form" includes but is not limited to policies, contracts, certificates, riders, endorsements, and applications as provided in sections 41-1812, 41-3419 and 41-3915, Idaho Code. (2) "Disability Insurance" means insurance written under chapter 21, title 4…

41-4203. Standards for policy provisions. (1) The director shall issue rules, subject to chapter 52, title 67, Idaho Code, to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content, and required disclosure for the sale of…

41-4204. Minimum standards for benefits. (1) The director shall issue rules, subject to chapter 52, title 67, Idaho Code, to establish minimum standards for benefits under each of the following categories of coverage in individual policies, group supplemental policies, nongroup s…

41-4205. Outline of coverage. (1) In order to provide for full and fair disclosure in the sale of individual disability insurance policies, group supplemental disability insurance policies, nongroup subscriber contracts of a nonprofit hospital, medical or dental service associati…

41-4207. Administrative procedure. Rules and regulations promulgated pursuant to this act shall be subject to notice and hearing pursuant to section 41-211, Idaho Code, and chapter 52, title 67, Idaho Code.

41-4301. short title. This chapter shall be known and may be cited as the "Idaho Life and Health Insurance Guaranty Association Act."

41-4302. purpose. (1) The purpose of this chapter is to protect, subject to certain limitations, the persons specified in section 41-4303(1), Idaho Code, against failure in the performance of contractual obligations under life and health insurance policies and annuity contracts s…

41-4303. coverage and limitations. (1) This chapter shall provide coverage for the policies and contracts specified in subsection (2) of this section: (a) To persons, except for nonresident certificate holders under group policies or contracts who, regardless of where they reside…

41-4304. construction. The provisions of this chapter shall be construed to effect the purpose under section 41-4302, Idaho Code.

41-4305. definitions. As used in this chapter: (1) "Account" means any of the three (3) accounts maintained pursuant to section 41-4306, Idaho Code. (2) "Association" means the Idaho life and health insurance guaranty association. (3) "Authorized assessment" or "authorized," when…

41-4306. creation of the association. (1) This chapter continues the existence of the nonprofit legal entity known as the Idaho life and health insurance guaranty association. All member insurers shall be and remain members of the association as a condition of their authority to …

41-4307. board of directors. (1) The board of directors of the association shall consist of not fewer than five (5) nor more than nine (9) member insurers serving terms as established in the plan of operation. The members of the board of directors shall be selected by member insu…

41-4308. powers and duties of the association. (1) If a member insurer is an impaired insurer, the association may, in its discretion, and subject to any conditions imposed by the association that do not impair the contractual obligations of the impaired insurer and that are appr…

41-4309. assessments. (1) For the purpose of providing the funds necessary to carry out the powers and duties of the association, the board of directors shall assess the member insurers, separately for each account, at such time and for such amounts as the board of directors find…

41-4310. plan of operation. (1) The association shall submit to the director a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto shall…

41-4311. duties and powers of the director. In addition to the duties and powers enumerated elsewhere in this chapter: (1) The director shall: (a) Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate st…

41-4312. prevention of insolvencies. (1) To aid in the detection and prevention of insurer insolvencies or impairments, it shall be the duty of the director to: (a) Notify the insurance directors or commissioners of all the other states, territories of the United States and the D…

41-4313. credits for assessments paid. (1) A member insurer may offset against its premium tax liability to this state an assessment described in section 41-4309(8), Idaho Code, to the extent of twenty percent (20%) of the amount of the assessment for each of five (5) calendar ye…

41-4314. miscellaneous provisions. (1) This chapter shall not be construed to reduce the liability for unpaid assessments of the insureds of an impaired or insolvent insurer operating under a plan with assessment liability. (2) Records shall be kept of all meetings of the board o…

41-4315. examination of the association –- annual report. The association shall be subject to examination and regulation by the director. The board of directors shall submit to the director each year, not later than May 1 of each year, a financial report in a form approved by the…

41-4316. tax exemptions. The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.

41-4317. immunity. There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer or its agents or employees, the association or its agents or employees, members of the board of directors or the director or the director’s re…

41-4318. stay of proceeding –- reopening default judgments. All proceedings in which the insolvent insurer is a party in any court in this state shall be stayed one hundred eighty (180) days from the date an order of liquidation, rehabilitation or conservation is final to permit …

41-4319. prohibited advertisement of insurance guaranty association act in commercial sales. No person, including an insurer, agent or affiliate of an insurer shall make, publish, disseminate, circulate or place before the public, or cause directly or indirectly, to be made, publ…

41-4320. application. This chapter shall apply to coverage the guaranty association provides in connection with any member insurer that was first placed under an order of liquidation on or after January 1, 2011.

41-4401. Purpose. The purpose of this chapter shall be to provide reasonable standardization and simplification of terms and coverages of medicare supplement disability insurance policies and enrollee contracts of managed care organizations, to facilitate public understanding and…

41-4402. Definitions. (1) "Applicant" means: (a) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits; and (b) In the case of a group medicare supplement policy, the proposed certificate holder. (2) "Certificate" means, …

41-4403. Applicability and scope. (1) Except as otherwise specifically provided this chapter shall apply to: (a) All medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this act; and (b) All certificates issued under group…

41-4404. Standards for policy provisions and authority to promulgate rules. (1) No medicare supplement policy or certificate in force in this state shall contain benefits that duplicate benefits provided by medicare. (2) Notwithstanding any other provision of law of this state, a…

41-4405. Loss ratio standards. Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director may issue reasonable rules to establish minimum standards for loss ratios of medicare supplement policies on th…

41-4406. Disclosure standards. (1) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time a…

41-4407. Notice of free examination. Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certi…

41-4408. Filing requirements for advertising. Every issuer of medicare supplement insurance policies or certificates in this state shall provide a copy of any medicare supplement advertisement intended for use in this state whether through written, radio or television medium to t…

41-4409. Administrative procedures. Rules adopted pursuant to this chapter shall be subject to the provisions of chapter 52, title 67, Idaho Code.

41-4410. Penalties. In addition to any other applicable penalties for violations of the insurance code, the director may require issuers violating any provision of this chapter or rules promulgated pursuant to this chapter to cease marketing any medicare supplement policy or cert…

41-4411. Separability. If any provision of this act or the application of it to any person or circumstances is for any reason held to be invalid, the remainder of the act and the application of the provision to other persons or circumstances shall not be affected.

41-4601. Purpose. The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to establish …

41-4602. Scope. The requirements of this chapter shall apply to policies delivered or issued for delivery in this state on or after the effective date of this chapter. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the…

41-4603. Definitions. Unless the context requires otherwise, the definitions in this section apply throughout this chapter. (1) "Applicant" means: (a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (b) In the case …

41-4604. Extraterritorial jurisdiction — Group long-term care insurance. No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in section 41-4603(4)(d), Idaho Code, unless this state…

41-4605. Disclosure and performance standards for long-term care insurance. (1) The director may adopt rules that include standards for full and fair disclosure setting forth the manner, content and required disclosures for the sale of long-term care insurance policies, terms of …

41-4606. Incontestability period. (1) For a policy or certificate that has been in force for less than six (6) months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentat…