(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.
(2)   The pool shall reimburse a reinsuring carrier with respect to the claims of a ceded eligible individual incurred during the calendar year and paid by the reinsuring carrier for benefits covered by the health benefit plan, in accordance with the reinsurance parameters set forth in the plan of operation.
(a)  The board may annually adjust the reinsurance parameters by submitting an amendment to the plan of operation in accordance with section 41-5503(1), Idaho Code. The adjustments may reflect increases in costs and utilization within the individual market for health benefit plans but must consider the availability of pool funding and the stability of the individual health insurance market, as well as any objectives stated in the plan of operation.
(b)  The board shall not submit for approval by the director a plan of operation or an amendment thereto with an initial level of less than twenty-five thousand dollars ($25,000) or a reinsuring carrier coinsurance percentage of less than twenty percent (20%).

Terms Used In Idaho Code 41-5505

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Board: means the board of directors of the Idaho individual high risk reinsurance pool established in this chapter and the Idaho small employer health reinsurance program established in section 41-4711, Idaho Code. See Idaho Code 41-5501
  • Carrier: means any entity that provides, or is authorized to provide, health insurance in this state. See Idaho Code 41-5501
  • Director: means the director of the department of insurance of the state of Idaho. See Idaho Code 41-5501
  • Eligible individual: means an Idaho resident individual or dependent of an Idaho resident who is:
Idaho Code 41-5501
  • Health benefit plan: means any hospital or medical policy or certificate, any subscriber contract provided by a hospital or professional service corporation, or health maintenance organization subscriber contract. See Idaho Code 41-5501
  • High risk pool plan: means an individual basic, standard, catastrophic A, catastrophic B, or HSA compatible health benefit plan issued pursuant to this chapter prior to April 1, 2017. See Idaho Code 41-5501
  • Plan of operation: means the plan of operation of the individual high risk reinsurance pool established pursuant to this chapter. See Idaho Code 41-5501
  • Pool: means the Idaho [individual] high risk reinsurance pool. See Idaho Code 41-5501
  • Reinsurance premium: means the premium set by the board pursuant to section 41-5506, Idaho Code, to be paid by a reinsuring carrier for eligible individuals ceded to the pool. See Idaho Code 41-5501
  • Reinsuring carrier: means a carrier participating in the individual high risk reinsurance pool established by this chapter. See Idaho Code 41-5501
  • State: when applied to the different parts of the United States, includes the District of Columbia and the territories; and the words "United States" may include the District of Columbia and territories. See Idaho Code 73-114
    • (3)  A reinsuring carrier shall apply all managed care and claims handling techniques, including utilization review, individual case management, preferred provider provisions, and other managed care provisions or methods of operation consistently with respect to reinsured and nonreinsured business.
    (4)  Each carrier shall make a filing with the director containing the carrier’s earned health insurance premium derived from health benefit plans delivered or issued for delivery in this state in the previous calendar year.
    (5)  Each carrier shall file with the director, in a form and manner to be prescribed by the director, an annual report. The report shall state the number of resident persons insured under the carrier’s health benefit plan, or through excess or stop loss coverage.
    (6)  Carriers shall permit individuals and their dependents covered by a high risk pool plan to remain on the high risk pool plan as long as the individual continues to meet the conditions of section 41-5501(6)(a), Idaho Code.