Title 41 — INSURANCE

41-5210. Application to become a risk-assuming carrier. (1) An individual carrier may apply to become a risk-assuming carrier by filing an application with the director in a form and manner prescribed by the director. (2) The director shall consider the following factors in evalu…

41-5211. Administrative procedures. The director shall promulgate rules in accordance with the provisions of chapter 52, title 67, Idaho Code, for the implementation and administration of the individual health coverage reform act.

41-5212. Standards to assure fair marketing. (1) Each individual carrier shall actively market health benefit plan coverage, including the individual basic, standard, catastrophic A, catastrophic B, and HSA compatible health benefit plans, to eligible individuals in the state. If…

41-5214. enhanced short-term PLANS. The director shall adopt reasonable rules to establish specific standards for enhanced short-term plans. The standards shall be in addition to and in accordance with applicable laws of this state, including this chapter. The standards: (1) Shal…

41-5401. Definitions. As used in this chapter, these terms shall have the following meanings: (1) "Adjusted RBC report" means an RBC report which has been adjusted by the director in accordance with section 41-5402(5), Idaho Code. (2) "Corrective order" means an order issued by t…

41-5402. RBC Reports. (1) Every domestic insurer shall, on or prior to each March 1 (the "filing date"), prepare and submit to the director a report of its RBC levels as of the end of the calendar year just ended, in a form and containing such information as is required by the RB…

41-5403. Company action level event. (1) "Company action level event" means any of the following events: (a) The filing of an RBC report by an insurer which indicates that: (i) The insurer’s total adjusted capital is greater than or equal to its regulatory action level RBC but le…

41-5404. Regulatory action level event. (1) "Regulatory action level event" means, with respect to any insurer, any of the following events: (a) The filing of an RBC report by the insurer which indicates that the insurer’s total adjusted capital is greater than or equal to its au…

41-5405. Authorized control level event. (1) "Authorized control level event" means any of the following events: (a) The filing of an RBC report by the insurer which indicates that the insurer’s total adjusted capital is greater than or equal to its mandatory control level RBC bu…

41-5406. Mandatory control level event. (1) "Mandatory control level event" means any of the following events: (a) The filing of an RBC report that indicates that the insurer’s total adjusted capital is less than its mandatory control level RBC; (b) Notification by the director t…

41-5407. Hearings. Upon any of the following the insurer shall have the right to a confidential departmental hearing, on a record, at which the insurer may challenge any determination or action by the director. The insurer shall notify the director of its request for a hearing wi…

41-5408. Confidentiality — Prohibition on announcements, prohibition on use in ratemaking. (1) All RBC reports, to the extent the information therein is not required to be set forth in a publicly available annual statement schedule, and RBC plans, including the results or report …

41-5409. Supplemental provisions — Rules — Exemption. (1) The provisions of this chapter are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the director under such laws, including, but not limited to, …

41-5410. Foreign insurers. (1) Any foreign insurer shall, upon the written request of the director, submit to the director an RBC report as of the end of the calendar year just ended the later of: (a) The date an RBC report would be required to be filed by a domestic insurer unde…

41-5411. Immunity. There shall be no liability on the part of, and no cause of action shall arise against, the director or the insurance department or its employees or agents for any action taken by them in the performance of their powers and duties under this chapter.

41-5412. Notices. All notices by the director to an insurer which may result in regulatory action hereunder shall be effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission shall be effective upon the insurer’s receipt of s…

41-5413. 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…

41-5501. Definitions. As used in this chapter: (1) "Agent" means a producer as defined in section 41-1003(8), Idaho Code. (2) "Board" means the board of directors of the Idaho individual high risk reinsurance pool established in this chapter. (3) "Carrier" means any entity that p…

41-5502. Creation of the individual high risk reinsurance pool — Board. (1) There is hereby created an independent public body corporate and politic to be known as the Idaho individual high risk reinsurance pool. The pool will perform an essential governmental function in the exe…

41-5503. Plan of operation. (1) The board shall submit to the director a plan of operation and thereafter any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the pool. The director may, after notice and hearing, approve the …

41-5504. Powers and authority. (1) The pool shall have the general powers and authority granted under the laws of this state to insurance companies and managed care organizations licensed to transact business, except the power to issue health benefit plans directly to individuals…

41-5505. Reinsurance. (1) Any individual carrier issuing a health benefit plan shall be liable to the pool for the reinsurance premium and shall be reinsured by the pool for each eligible individual ceded in accordance with section 41-5509, Idaho Code, and the plan of operation. …

41-5506. Reinsurance premium rates. (1) The board, as part of the plan of operation, shall establish a methodology for determining reinsurance premium rates to be charged reinsuring carriers to reinsure individuals under this chapter. The methodology shall include a system for cl…

41-5507. Premium rates for high risk pool plan coverage. (1) For high risk pool plans issued prior to April 1, 2017, the board shall establish premium rates for coverage under the individual basic, standard, catastrophic A, catastrophic B, and HSA compatible high risk pool plans.…

41-5508. Assessments. (1) Prior to March 1 of each year, the board shall determine and report to the director the pool’s net loss for the previous calendar year, including administrative expenses and incurred losses for the year, taking into account investment income and other ap…

41-5509. ceding Eligibility. (1) The pool shall provide reinsurance to any eligible individual who qualifies for reinsurance pursuant to this chapter if evidence is provided that such person has a qualifying high risk medical condition as defined by section 41-5501(8), Idaho Code…

41-5601. Definitions. As used in this chapter: (1) "Beneficiary" means a policyholder, subscriber, member, employer or other person who is eligible for benefits under a contract providing hospital, surgical, or medical expense coverage or a managed care organization policy or agr…

41-5602. Prompt payment of claims. (1) Except as otherwise specifically provided in this chapter, an insurer shall process a claim for payment for health care services rendered by a practitioner or facility to a beneficiary in accordance with this section. (2) If a beneficiary, p…

41-5603. Interest payments. An insurer that fails to pay, request additional information or documentation or deny a claim from a beneficiary, practitioner or facility within the time periods established in this chapter shall pay interest at the contract statutory rate pursuant to…

41-5604. Assignment. Nothing in this chapter requires an insurer to accept an assignment of payment by the beneficiary to the practitioner or facility.

41-5605. Exceptions. (1) The time periods set forth in section 41-5602, Idaho Code, shall not apply to claims that the insurer reasonably believes involve fraud or misrepresentation by the practitioner or facility or the beneficiary or to instances where the insurer has not been …

41-5606. Penalties. (1) The director shall enforce the provisions of this chapter and shall review and, if appropriate, investigate complaints received by the department related to noncompliance with the provisions of this chapter. (2) If the director determines an insurer has vi…

41-5701. Preamble. Pursuant to terms and conditions of this chapter, the state of Idaho seeks to join with other states and establish the interstate insurance product regulation compact, and thus become a member of the interstate insurance product regulation commission. The direc…

41-5702. Interstate insurance product regulation compact. The "Interstate Insurance Product Regulation Compact" is hereby enacted into law and entered into by this state with any other states legally joining therein in the form substantially as follows: INTERSTATE INSURANCE PRODU…

41-5801. Purpose and scope. This chapter governs the qualifications and procedures for the licensing of public adjusters. It specifies the duties of and restrictions on public adjusters, which include limiting their licensure to assisting insureds in first party claims.

41-5802. Definitions. As used in this chapter: (1) "Business entity" means a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity. (2) "Fingerprints" means an impression of the lines on the finger taken for purpose …

41-5803. License required. (1) A person shall not act or hold himself out as a public adjuster in this state unless the person is licensed as a public adjuster in accordance with this chapter. (2) A person licensed as a public adjuster shall not misrepresent to a claimant that he…

41-5804. Exceptions to licensing. Notwithstanding section 41-5803, Idaho Code, a license as a public adjuster shall not be required of the following: (1) An attorney admitted to practice in this state, when acting in his or her professional capacity as an attorney; (2) A producer…

41-5805. Application for license. [EFFECTIVE UPON A STATE’S PARTICIPATION IN NAIC’S CENTRAL REPOSITORY FOR CRIMINAL BACKGROUND INFORMATION] (1) A person applying for a public adjuster license shall make application to the department on an application form prescribed by the depart…

41-5806. License qualifications. (1) Before issuing a public adjuster license to an applicant under this section, the department shall find that the applicant: (a) Is at least eighteen (18) years of age; (b) Is eligible to designate this state as his or her home state or is a non…

41-5807. Examination. (1) An individual applying for a public adjuster license under this chapter shall pass a written examination unless exempt pursuant to section 41-5808, Idaho Code. The examination shall test the knowledge of the individual concerning the duties and responsib…

41-5808. Exemptions from examination. (1) An individual who applies for a public adjuster license in this state who was previously licensed as a public adjuster in another state based on a public adjuster examination shall not be required to complete any prelicensing examination.…

41-5809. Nonresident license reciprocity. (1) Unless denied licensure pursuant to sections 41-5810 or 41-5811, Idaho Code, a nonresident person shall receive a nonresident public adjuster license if: (a) The person is currently licensed as a resident public adjuster and in good s…

41-5810. License. (1) Unless denied licensure under this chapter, persons who have met the requirements of this chapter shall be issued a public adjuster license. (2) A public adjuster license shall remain in effect unless revoked, terminated or suspended as long as the request f…

41-5811. License denial, nonrenewal or revocation. (1) The department may place on probation, suspend, revoke or refuse to issue or renew a public adjuster’s license or may levy a civil penalty in accordance with section 41-1016, Idaho Code, or any combination of actions, for any…

41-5812. Bond or letter of credit. Prior to issuance of a license as a public adjuster and for the duration of the license, the applicant shall secure evidence of financial responsibility in a format prescribed by the department through a security bond or irrevocable letter of cr…

41-5813. Continuing education. (1) An individual, who holds a public adjuster license and who is not exempt under subsection (2) of this section, shall satisfactorily complete a minimum of twenty-four (24) hours of continuing education courses, including three (3) hours of law or…

41-5814. Public adjuster fees. (1) A public adjuster shall not pay a commission, service fee or other valuable consideration to a person for investigating or settling claims in this state if that person is required to be licensed under this chapter and is not so licensed. (2) A p…

41-5815. Contract between public adjuster and insured. (1) Public adjusters shall ensure that all contracts for their services are in writing and contain the following terms: (a) Legible full name of the adjuster signing the contract, as specified in department records; (b) Perma…

41-5816. Escrow or trust accounts. A public adjuster who receives, accepts or holds any funds on behalf of an insured, towards the settlement of a claim for loss or damage, shall deposit the funds in a noninterest bearing escrow or trust account in a financial institution that is…