Title 41 — INSURANCE

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…

41-3601. Short title. This act shall be known and may be cited as the "Idaho insurance guaranty association act."

41-3603. Application of act. This act shall apply to all kinds of direct insurance, but shall not be applicable to the following: (1) Life, annuity, health or disability insurance; (2) Residual value, mortgage guaranty, financial guaranty or other forms of insurance offering prot…

41-3605. Definitions. As used in this act: (1) "Account" means the account created by section 41-3606, Idaho Code. (2) "Affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries controls, is controlled by, or is under common control with an ins…

41-3606. Insurance guaranty association — Insurers required to be members — Purposes. There is created a nonprofit unincorporated legal entity to be known as the Idaho insurance guaranty association. All insurers defined as member insurers shall be and remain members of the assoc…

41-3607. Board of directors — Number — Election or appointment — Reimbursement for expenses. (1) The board of directors of the association shall consist of not less than five (5) nor more than nine (9) persons serving terms as established in the plan of operation. The members of …

41-3608. Obligations and powers of association. (1) The association shall: (a) Be obligated to pay covered claims existing prior to the order of liquidation arising within thirty (30) days after the order of liquidation, or before the policy expiration date if less than thirty (3…

41-3609. Plan of operation — Approval — Adoption of interim rules by director — Contents of plan — Delegation of powers and duties — Reimbursement of delegate corporation or organization. (1) (a) The association shall submit to the director a plan of operation and any amendments …

41-3610. Duties and powers of director — Judicial review. (1) The director shall: (a) Notify the association of the existence of an insolvent insurer not later than three (3) days after he receives notice of the determination of the insolvency. The association shall be entitled t…

41-3611. Subrogation of association to rights of claimants — Receiver, liquidator, or successor bound by association claim settlements — Periodic filing of statements of paid claims with receiver or liquidator. (1) Any person recovering under this act shall be deemed to have assi…

41-3612. Exhaustion of other coverage. (1) Any person having a claim against an insurer, whether or not the insurer is a member insurer, under any provision in an insurance policy other than a policy of an insolvent insurer which is also a covered claim, shall be required to exha…

41-3613. Prevention of insolvencies. To aid in the detection and prevention of insurer insolvencies: (1) The board of directors, upon majority vote, may make recommendations to the director for the detection and prevention of insurer insolvencies. Such recommendations shall not b…

41-3614. Regulation by director — Annual reports to director. The association shall be subject to examination and regulation by the director. The board of directors shall submit, not later than March 30 of each year, a financial report for the preceding calendar year in a form ap…

41-3615. Exemption from taxes — Exception. 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 or personal property.

41-3616. Credits for assessments paid. (1) A member insurer may offset against its premium tax liability to this state under section 41-402, Idaho Code, an assessment described in subsection (1)(d) of section 41-3608, Idaho Code. An offset is allowable to the extent of twenty per…

41-3617. No liability for actions taken pursuant to act. There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer, the association or its agents or employees, the board of directors, or any person serving as a represen…

41-3618. Stay of court proceedings for insolvency — Setting aside judgment against insolvent insurer. All proceedings in which the insolvent insurer is a party or is obligated to defend a party in any court in this state shall, subject to written waiver by the association in spec…

41-3619. Protection of act not used to sell insurance. It is an unfair trade practice for any insurer or agent to in any manner make use of the protection given policyholders by this chapter as a reason for buying insurance from him.

41-3620. Termination of operation of association as to insurance covered by other plan — Dissolution of association and distribution of assets — Expiration of act. (1) The director shall by order terminate the operation of the Idaho insurance guaranty association as to any kind o…