View Daily Data Tracking History
View Bill Text
View Amendment
View Engrossed Bill (Original Bill with Amendment(s) Incorporated)
View Statement of Purpose / Fiscal Impact
S1073aaH..............................................by HEALTH AND WELFARE
CHILDREN - HEALTH INSURANCE - Repeals, adds to and amends existing law to
adopt requirements for medical support notice; to provide for enforcement
by the Department of Health and Welfare; to require notice to the parent
ordered to provide health insurance benefits; to provide notice to
employers; to provide enrollment by employers and to provide conditions
when termination of coverage may occur.
02/06 Senate intro - 1st rdg - to printing
02/07 Rpt prt - to Health/Wel
02/13 Rpt out - rec d/p - to 2nd rdg
02/14 2nd rdg - to 3rd rdg
02/18 3rd rdg - PASSED - 19-16-0
AYES -- Andreason, Brandt, Burkett, Calabretta, Compton, Darrington,
Gannon, Geddes, Ingram, Kennedy, Little, Malepeai, Marley,
McWilliams, Noh, Schroeder, Stegner, Stennett, Werk
NAYS -- Bailey, Bunderson, Burtenshaw, Cameron, Davis, Goedde, Hill,
Keough, Lodge, McKenzie, Noble, Pearce, Richardson, Sorensen, Sweet,
Williams
Absent and excused -- None
Floor Sponsor - Compton
Title apvd - to House
02/19 House intro - 1st rdg - to Health/Wel
03/11 Ref'd to Bus
03/28 Rpt out - to Gen Ord
04/01 Rpt out amen - to 1st rdg as amen
04/02 1st rdg - to 2nd rdg as amen
04/03 2nd rdg - to 3rd rdg as amen
04/04 3rd rdg as amen - PASSED - 61-6-3
AYES -- Andersen, Barraclough, Bauer, Bedke, Bell, Bieter, Black,
Block, Boe, Bolz, Bradford, Campbell, Cannon, Collins, Crow, Cuddy,
Deal, Denney, Douglas, Edmunson, Ellsworth, Eskridge, Field(18),
Field(23), Gagner, Garrett, Henbest, Jaquet, Jones, Kellogg,
Langford, Langhorst, Martinez, McGeachin, Meyer, Miller, Mitchell,
Naccarato, Raybould, Ridinger, Ring, Ringo, Roberts, Robison,
Rydalch, Sali, Sayler, Schaefer, Shepherd, Shirley, Skippen,
Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Tilman,
Trail(Young), Wills, Wood, Mr. Speaker
NAYS -- Barrett, Harwood, Kulczyk, McKague, Moyle, Nielsen
Absent and excused -- Clark, Eberle, Lake
Floor Sponsor - Cannon
Title apvd - to Senate
04/07 Senate concurred in House amens - to engros
04/08 Rpt engros - 1st rdg - to 2nd rdg as amen
04/09 2nd rdg - to 3rd rdg as amen
04/10 3rd rdg as amen - PASSED - 25-9-1
AYES -- Andreason, Brandt, Bunderson, Burkett, Calabretta, Cameron,
Compton, Darrington, Davis, Gannon, Geddes, Goedde, Ingram, Kennedy,
Little, Lodge, Malepeai(Kumm), Marley, McWilliams, Noh, Schroeder,
Sorensen, Stegner, Stennett, Werk
NAYS -- Bailey, Burtenshaw, Hill, McKenzie, Noble, Pearce,
Richardson, Sweet, Williams
Absent and excused -- Keough
Floor Sponsor - Compton
Title apvd - to enrol
04/11 Rpt enrol - Pres signed
04/14 Sp signed
04/15 To Governor
04/21 Governor signed
Session Law Chapter 304
Effective: 07/01/03
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE SENATE
SENATE BILL NO. 1073
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO HEALTH INSURANCE COVERAGE PURSUANT TO A CHILD SUPPORT ORDER;
3 REPEALING SECTIONS 32-1214, 41-2145, 41-2219, 41-3442, 41-3929, 41-4026
4 AND 41-4717, IDAHO CODE; AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE
5 ADDITION OF A NEW SECTION 32-1214A, IDAHO CODE, TO STATE THE PURPOSE;
6 AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SEC-
7 TION 32-1214B, IDAHO CODE, TO DEFINE TERMS; AMENDING CHAPTER 12, TITLE 32,
8 IDAHO CODE, BY THE ADDITION OF A NEW SECTION 32-1214C, IDAHO CODE, TO
9 AUTHORIZE A MEDICAL SUPPORT ORDER; AMENDING CHAPTER 12, TITLE 32, IDAHO
10 CODE, BY THE ADDITION OF A NEW SECTION 32-1214D, IDAHO CODE, TO SPECIFY
11 EXCEPTIONS TO THE REQUIREMENT FOR IMMEDIATE ENROLLMENT; AMENDING CHAPTER
12 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 32-1214E, IDAHO
13 CODE, TO PROHIBIT DENIAL OF ENROLLMENT UNDER CONDITIONS SPECIFIED; AMEND-
14 ING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
15 32-1214F, IDAHO CODE, TO REQUIRE NOTICE OF THE REQUIREMENT FOR A MEDICAL
16 SUPPORT ORDER; AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION
17 OF A NEW SECTION 32-1214G, IDAHO CODE, TO DEFINE AUTHORITY OF THE DEPART-
18 MENT FOR ENFORCEMENT OF THE MEDICAL SUPPORT ORDER PROVISIONS; AMENDING
19 CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
20 32-1214H, IDAHO CODE, TO REQUIRE NOTICE OF INTENT TO ENFORCE AN ORDER;
21 AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SEC-
22 TION 32-1214I, IDAHO CODE, TO PROVIDE CONDITIONS FOR DISENROLLMENT; AMEND-
23 ING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
24 32-1214J, IDAHO CODE, TO REQUIRE NOTICE OF INTENT TO TERMINATE COVERAGE;
25 AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SEC-
26 TION 32-1214K, IDAHO CODE, TO PROVIDE PENALTIES FOR NONCOMPLIANCE; AMEND-
27 ING CHAPTER 13, TITLE 41, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
28 41-1336, IDAHO CODE, TO REQUIRE COMPLIANCE BY INSURERS; AND AMENDING SEC-
29 TIONS 41-3434 AND 41-3904, IDAHO CODE, TO DELETE CODE REFERENCES.
30 Be It Enacted by the Legislature of the State of Idaho:
31 SECTION 1. That Sections 32-1214, 41-2145, 41-2219, 41-3442, 41-3929,
32 41-4026 and 41-4717, Idaho Code, be, and the same are hereby repealed.
33 SECTION 2. That Chapter 12, Title 32, Idaho Code, be, and the same is
34 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
35 ignated as Section 32-1214A, Idaho Code, and to read as follows:
36 32-1214A. PURPOSE. The state of Idaho has an interest in ensuring that
37 its children receive health insurance benefits through private means when
38 available. Therefore, the legislature hereby adopts the national medical sup-
39 port notice required by 42 U.S.C. section 666(a)(19) and the employee retire-
40 ment income security act, 29 U.S.C. section 1169(a), to allow the department
41 of health and welfare or an obligee to enforce an order for medical support.
2
1 SECTION 3. That Chapter 12, Title 32, Idaho Code, be, and the same is
2 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
3 ignated as Section 32-1214B, Idaho Code, and to read as follows:
4 32-1214B. DEFINITIONS. For the purposes of this chapter, the following
5 definitions apply:
6 (1) "Child" means any child including an adopted minor child, of a par-
7 ticipant in a health benefit plan, recognized under a medical child support
8 order as having a right to enrollment under a health benefit plan.
9 (2) "Department" means the department of health and welfare.
10 (3) "Health benefit plan" means a group or individual health benefit plan
11 or combination of plans, other than public assistance programs, that provides
12 medical care or benefits for a child.
13 (4) "Insurer" means every person engaged as indemnitor, surety or con-
14 tractor in the business of entering into contracts of insurance or annuity.
15 (5) "Medical child support order" means any order, including those that
16 meet the requirements of 29 U.S.C. section 1169, or notice issued by either a
17 court or administrative agency that requires a plan administrator, or if none,
18 the employer, to enroll an eligible child in a health benefit plan.
19 (6) "Obligee" means a party or parent other than the parent ordered to
20 carry or provide a health benefit plan for the parties' minor child.
21 (7) "Obligor" means the parent ordered by the court to carry or provide
22 health insurance benefits for the parties' minor child.
23 (8) "Party" means the department, grandparent or any person who is the
24 custodian, other than the parent who owes a duty of medical support.
25 (9) "Plan administrator" means a person or entity, including a state or
26 local government agency or church, that assesses and collects premiums,
27 accepts and processes claims, and pays benefits for medical care.
28 SECTION 4. That Chapter 12, Title 32, Idaho Code, be, and the same is
29 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
30 ignated as Section 32-1214C, Idaho Code, and to read as follows:
31 32-1214C. MEDICAL SUPPORT ORDER. (1) A medical support notice issued to
32 an employer or plan administrator is a qualified medical support order as
33 defined by 29 U.S.C. section 1169(a) through (c).
34 (2) Upon receipt of a national medical support notice, if the employer
35 has one (1) health benefit plan, the employer shall respond within twenty (20)
36 days and confirm that the child will be enrolled or explain that one (1) of
37 the conditions identified in section 32-1214D, Idaho Code, exists. The
38 employer shall provide the national medical support notice to the plan admin-
39 istrator within twenty (20) days.
40 (3) Upon receipt of a national medical support notice from an employer,
41 the plan administrator shall notify the department or other obligee within
42 forty (40) days that a health benefit plan will become available for the
43 child, or explain that one (1) of the conditions identified in section
44 32-1214D, Idaho Code, exists. The plan administrator shall also notify the
45 department or other obligee of any additional steps that need to be taken to
46 complete enrollment. The plan administrator shall notify the department or
47 other obligee when the notice has not been properly filled out, listing the
48 specific deficiencies.
49 (4) If more than one (1) plan is available, the child shall be enrolled
50 in the obligor's plan. If the obligor has not chosen a health benefit plan,
51 the plan administrator or employer shall provide plan descriptions to the
52 department or other obligee within twenty (20) days. If the department is
3
1 enforcing the medical support order, the department shall notify the other
2 obligee of the opportunity to choose the health benefit plan within twenty
3 (20) days. If for any reason the other obligee does not or is not available
4 to choose, the department shall choose the least expensive health benefit plan
5 available to the obligor.
6 (5) The employer shall withhold any required premium from the obligor's
7 income or wages. The amount to be withheld from the income of the obligor
8 shall not exceed the amount specified in section 11-207, Idaho Code. The
9 employer shall forward the premium withheld to the insurer. If the amount of
10 income taken for child support along with the amount taken for medical support
11 exceeds the amount specified in section 11-207, Idaho Code, child support
12 shall be paid first.
13 (6) The plan administrator or employer shall provide the department or
14 other obligee with the name of the insurer, the extent of coverage available
15 and other necessary information, and shall make available any necessary claim
16 forms or enrollment membership cards.
17 (7) An insurer shall not impose requirements on a state agency, which has
18 been assigned the rights of an individual who is eligible for medical assis-
19 tance, that are different than the requirements that apply to an agent or
20 assignee of any other covered individual.
21 (8) The department or other obligee shall be allowed to submit claims for
22 covered services without the approval of the obligor. The plan administrator
23 or employer shall pay on such claims directly to the party who submitted the
24 claim.
25 (9) An insurer shall not consider the availability or eligibility for
26 medical assistance under medicaid, 42 U.S.C. section 1396a., in this or any
27 other state when considering eligibility for health benefits or making pay-
28 ments under its plan. To the extent that payment has been made by medicaid,
29 the department is subrogated to the rights of the individual to payment by any
30 other third party for covered health care items or services.
31 SECTION 5. That Chapter 12, Title 32, Idaho Code, be, and the same is
32 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
33 ignated as Section 32-1214D, Idaho Code, and to read as follows:
34 32-1214D. EXCEPTIONS TO REQUIREMENT FOR IMMEDIATE ENROLLMENT. The plan
35 administrator or employer shall enroll the child unless the employer or
36 insurer does not offer insurance, the obligor would not qualify for any plan,
37 or the obligor has separated from employment. If insurance is not available
38 because a probationary period exceeds ninety (90) days, the plan administrator
39 or employer shall return the notice to the employer and the department without
40 enrolling the child. If insurance is not available during a probationary
41 period that is ninety (90) days or less, or if ninety (90) days or less
42 remains from a longer waiting period, the plan administrator shall process the
43 enrollment, and notify the employer, the department or other obligee, of the
44 effective date of coverage.
45 SECTION 6. That Chapter 12, Title 32, Idaho Code, be, and the same is
46 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
47 ignated as Section 32-1214E, Idaho Code, and to read as follows:
48 32-1214E. PROHIBITION ON DENIAL OF ENROLLMENT. A child shall not be
49 denied enrollment in a health benefit plan because:
50 (1) The child was born out of wedlock;
51 (2) The child is not claimed as a dependent on the obligor's federal
4
1 income tax return;
2 (3) The child does not reside with the obligor or in the insurer's ser-
3 vice area; or
4 (4) There is no current enrollment season.
5 SECTION 7. That Chapter 12, Title 32, Idaho Code, be, and the same is
6 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
7 ignated as Section 32-1214F, Idaho Code, and to read as follows:
8 32-1214F. NOTICE OF MEDICAL SUPPORT ORDER. Any support order or decree
9 that requires a child to be covered by a health benefit plan issued after July
10 1, 2003, shall include a statement in substantially the following form:
11 "Failure to provide medical insurance coverage may result in the
12 direct enforcement of a medical support order by either the obligee
13 or the Department of Health and Welfare. A national medical support
14 notice will be sent to your employer, requiring your employer to
15 enroll the child in a health benefit plan as provided by Sections
16 32-1214A through 32-1214K, Idaho Code, and applicable rules of the
17 department.".
18 SECTION 8. That Chapter 12, Title 32, Idaho Code, be, and the same is
19 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
20 ignated as Section 32-1214G, Idaho Code, and to read as follows:
21 32-1214G. AUTHORITY OF THE DEPARTMENT. The department of health and wel-
22 fare shall have the authority to promulgate rules necessary to implement and
23 enforce orders for medical insurance. The rules shall provide the obligor an
24 opportunity to protest the issuance of the national medical support notice
25 based on mistake of fact.
26 SECTION 9. That Chapter 12, Title 32, Idaho Code, be, and the same is
27 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
28 ignated as Section 32-1214H, Idaho Code, and to read as follows:
29 32-1214H. NOTICE OF INTENT TO ENFORCE. If the order for health benefits
30 fails to provide for direct enforcement, the department or other obligee may
31 serve a written notice of intent to enforce the order on the obligor by mail
32 or personal service. If the obligor fails to provide written proof that health
33 benefits have been obtained or applied for within twenty (20) days of service
34 of the notice, or within twenty (20) days of health benefits becoming avail-
35 able, the department or other obligee may proceed to enforce the order
36 directly by sending the notice prescribed by section 32-1214C, Idaho Code.
37 SECTION 10. That Chapter 12, Title 32, Idaho Code, be, and the same is
38 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
39 ignated as Section 32-1214I, Idaho Code, and to read as follows:
40 32-1214I. DISENROLLMENT. The plan administrator or employer shall not
41 disenroll or eliminate health benefits of any such child unless:
42 (1) A certified copy of an order terminating the obligation to provide
43 health benefits is provided to a plan administrator or employer;
44 (2) Confirmation has been received by the plan administrator or employer
45 that the child is enrolled in another comparable health benefit plan;
46 (3) The employer has eliminated family health benefit plans for all of
47 its employees; or
5
1 (4) The obligor has separated from employment.
2 SECTION 11. That Chapter 12, Title 32, Idaho Code, be, and the same is
3 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
4 ignated as Section 32-1214J, Idaho Code, and to read as follows:
5 32-1214J. NOTICE OF TERMINATION OF COVERAGE. The plan administrator or
6 employer shall notify the department or other obligee within twenty (20) days
7 when health benefits are no longer available and state the reason why.
8 SECTION 12. That Chapter 12, Title 32, Idaho Code, be, and the same is
9 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
10 ignated as Section 32-1214K, Idaho Code, and to read as follows:
11 32-1214K. PENALTIES FOR NONCOMPLIANCE. The employer and plan administra-
12 tor shall be subject to a civil penalty of up to three hundred dollars ($300)
13 and other civil remedies, plus costs and attorney's fees if:
14 (1) The employer fails to forward the national medical support notice to
15 the plan administrator;
16 (2) The plan administrator fails to take action in response to the
17 national medical support order as required by section 32-1214C, Idaho Code;
18 (3) The employer fails to withhold or remit health benefit plan premiums
19 in compliance with section 32-1214C, Idaho Code; or
20 (4) Any other failure to comply with the obligations created by sections
21 32-1214A through 32-1214J, Idaho Code.
22 SECTION 13. That Chapter 13, Title 41, Idaho Code, be, and the same is
23 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
24 ignated as Section 41-1336, Idaho Code, and to read as follows:
25 41-1336. REQUIREMENTS FOR COMPLIANCE. It shall be a violation of this
26 chapter for an insurer to fail to comply with the requirements applicable to
27 insurers under chapter 12, title 32, Idaho Code.
28 SECTION 14. That Section 41-3434, Idaho Code, be, and the same is hereby
29 amended to read as follows:
30 41-3434. OTHER PROVISIONS APPLICABLE. In addition to those contained or
31 referred to heretofore in this chapter, the following chapters and provisions
32 of this code shall also apply with respect to service corporations to the
33 extent applicable and not in conflict with the express provisions of this
34 chapter and the reasonable implications of such express provisions, and for
35 the purposes of such application such corporations shall be deemed to be
36 mutual "insurers":
37 (1) Chapter 1 (scope of code);
38 (2) Chapter 2 (the director of insurance);
39 (3) Section 41-308(2) (general eligibility for certificate of authority
40 -- competence, affiliations of management);
41 (4) Sections 41-345 through 41-347 (disclosure of material transactions);
42 (5) Section 41-601 ("assets" defined);
43 (6) Section 41-603 (assets not allowed);
44 (7) Section 41-604 (disallowance of "wash" transactions);
45 (8) Section 41-613 (valuation of bonds);
46 (9) Section 41-731 (prohibited investments and investment underwriting);
47 (10) Chapter 13 (trade practices and frauds);
6
1 (11) Section 41-2840 (vouchers for expenditures);
2 (12) Section 41-2841 (borrowed surplus);
3 (13) Sections 41-2857 (mergers and consolidations, mutual insurers),
4 41-2858 (bulk reinsurance, mutual insurers), and 41-2859 (mutual member's
5 share of assets on liquidation);
6 (14) Chapter 33 (supervision, rehabilitation and liquidation);
7 (15) Sections 799 to 809 of chapter 330 of Session Laws of 1961
8 (transitory provisions);
9 (16) Section 41-2106(3) (health history application for disability insur-
10 ance);
11 (17) Section 41-2141 (coordination of benefits -- coordination with social
12 security benefits);
13 (18) Section 41-1839 (attorney fees);
14 (19) Chapter 46 (long-term care insurance);
15 (20) Section 41-1844 (prescription drug benefit restrictions prohibited);
16 and
17 (21) Section 41-2145 (coverage provided to person having insurance);
18 (22) Section 41-2216, (coordination of benefits -- coordination with
19 social security benefits); and
20 (23) Section 41-2219 (coverage provided to person having insurance).
21 SECTION 15. That Section 41-3904, Idaho Code, be, and the same is hereby
22 amended to read as follows:
23 41-3904. CERTIFICATE OF AUTHORITY REQUIRED -- EXCEPTIONS -- APPLICATION
24 OF CERTAIN PROVISIONS. (1) No person shall in this state offer a managed care
25 plan on a predetermined and prepaid basis, unless authorized under a certifi-
26 cate of authority issued by the director. A person offering a managed care
27 plan on a predetermined and prepaid basis is deemed to be transacting the
28 business of insurance.
29 (2) An organization proposing to offer a managed care plan on a predeter-
30 mined and prepaid basis, after it has filed its application for a certificate
31 of authority as provided in section 41-3906, Idaho Code, and while its appli-
32 cation is pending, if permitted by and in accordance with rules promulgated by
33 the director, may inform the public concerning its proposed health care ser-
34 vices.
35 (3) Entities not offering a managed care plan shall not be subject to the
36 provisions of this chapter.
37 (4) An entity not required to obtain a certificate of authority which
38 holds itself out to the public or markets itself as an organization rendering
39 basic health care services to a specified population through a managed care
40 plan shall be subject to and must comply with the following sections of this
41 chapter but shall not be subject to regulation by the department: 41-3902;
42 41-3903; 41-3904; 41-3909(1) and (2); 41-3914(1) and (2); 41-3915(1), (2),
43 (3), (4), (5), (6) and (8); 41-3916; 41-3917; 41-3918(1), (2) and (4);
44 41-3919(1) and (2); 41-3920; 41-3921(2), (3) and (4); 41-3922(2); 41-3926;
45 41-3927; 41-3928; 41-3929; 41-3930 and 41-3932, Idaho Code.
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
Moved by Cannon
Seconded by Block
IN THE HOUSE OF REPRESENTATIVES
HOUSE AMENDMENTS TO S.B. NO. 1073
1 AMENDMENTS TO SECTION 4
2 On page 2 of the printed bill, in line 35, following "(20)" insert:
3 "business"; in line 39, following "(20)" insert: "business"; in line 42, fol-
4 lowing "(40)" insert: "business"; in line 52, following "(20)" insert:
5 "business"; on page 3, in line 3, following "(20)" insert: "business"; and in
6 line 21, following "(8)" delete the remainder of the line, delete lines 22, 23
7 and 24 and insert: "A child covered by a qualified medical child support
8 order, or the child's custodial parent, legal guardian, or the provider of
9 services to the child, or a state agency to the extent assigned the child's
10 rights, may file claims and the plan shall make payment for covered benefits
11 or reimbursement directly to such party.".
12 AMENDMENT TO SECTION 7
13 On page 4, in line 16, delete "32-1214K" and insert: "32-1214J".
14 AMENDMENTS TO SECTION 9
15 On page 4, in line 33, following "(20)" insert: "business"; and in line
16 34, following "(20)" insert: "business".
17 AMENDMENTS TO SECTION 10
18 On page 4, in line 47, delete "or"; on page 5, in line 1, delete "." and
19 insert: ";"; and following line 1, insert:
20 "(5) The child is no longer eligible for coverage under the terms of the
21 plan; or
22 (6) The required premium has not been paid by or on behalf of the
23 child.".
24 AMENDMENTS TO THE BILL
25 On page 5, delete lines 8 through 21, and renumber subsequent sections of
26 the bill accordingly.
27 CORRECTION TO TITLE
28 On page 1, delete lines 25 and 26 and insert: "AMEND-".
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE SENATE
SENATE BILL NO. 1073, As Amended in the House
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO HEALTH INSURANCE COVERAGE PURSUANT TO A CHILD SUPPORT ORDER;
3 REPEALING SECTIONS 32-1214, 41-2145, 41-2219, 41-3442, 41-3929, 41-4026
4 AND 41-4717, IDAHO CODE; AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE
5 ADDITION OF A NEW SECTION 32-1214A, IDAHO CODE, TO STATE THE PURPOSE;
6 AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SEC-
7 TION 32-1214B, IDAHO CODE, TO DEFINE TERMS; AMENDING CHAPTER 12, TITLE 32,
8 IDAHO CODE, BY THE ADDITION OF A NEW SECTION 32-1214C, IDAHO CODE, TO
9 AUTHORIZE A MEDICAL SUPPORT ORDER; AMENDING CHAPTER 12, TITLE 32, IDAHO
10 CODE, BY THE ADDITION OF A NEW SECTION 32-1214D, IDAHO CODE, TO SPECIFY
11 EXCEPTIONS TO THE REQUIREMENT FOR IMMEDIATE ENROLLMENT; AMENDING CHAPTER
12 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 32-1214E, IDAHO
13 CODE, TO PROHIBIT DENIAL OF ENROLLMENT UNDER CONDITIONS SPECIFIED; AMEND-
14 ING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
15 32-1214F, IDAHO CODE, TO REQUIRE NOTICE OF THE REQUIREMENT FOR A MEDICAL
16 SUPPORT ORDER; AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION
17 OF A NEW SECTION 32-1214G, IDAHO CODE, TO DEFINE AUTHORITY OF THE DEPART-
18 MENT FOR ENFORCEMENT OF THE MEDICAL SUPPORT ORDER PROVISIONS; AMENDING
19 CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
20 32-1214H, IDAHO CODE, TO REQUIRE NOTICE OF INTENT TO ENFORCE AN ORDER;
21 AMENDING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SEC-
22 TION 32-1214I, IDAHO CODE, TO PROVIDE CONDITIONS FOR DISENROLLMENT; AMEND-
23 ING CHAPTER 12, TITLE 32, IDAHO CODE, BY THE ADDITION OF A NEW SECTION
24 32-1214J, IDAHO CODE, TO REQUIRE NOTICE OF INTENT TO TERMINATE COVERAGE;
25 AMENDING CHAPTER 13, TITLE 41, IDAHO CODE, BY THE ADDITION OF A NEW SEC-
26 TION 41-1336, IDAHO CODE, TO REQUIRE COMPLIANCE BY INSURERS; AND AMENDING
27 SECTIONS 41-3434 AND 41-3904, IDAHO CODE, TO DELETE CODE REFERENCES.
28 Be It Enacted by the Legislature of the State of Idaho:
29 SECTION 1. That Sections 32-1214, 41-2145, 41-2219, 41-3442, 41-3929,
30 41-4026 and 41-4717, Idaho Code, be, and the same are hereby repealed.
31 SECTION 2. That Chapter 12, Title 32, Idaho Code, be, and the same is
32 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
33 ignated as Section 32-1214A, Idaho Code, and to read as follows:
34 32-1214A. PURPOSE. The state of Idaho has an interest in ensuring that
35 its children receive health insurance benefits through private means when
36 available. Therefore, the legislature hereby adopts the national medical sup-
37 port notice required by 42 U.S.C. section 666(a)(19) and the employee retire-
38 ment income security act, 29 U.S.C. section 1169(a), to allow the department
39 of health and welfare or an obligee to enforce an order for medical support.
40 SECTION 3. That Chapter 12, Title 32, Idaho Code, be, and the same is
41 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
2
1 ignated as Section 32-1214B, Idaho Code, and to read as follows:
2 32-1214B. DEFINITIONS. For the purposes of this chapter, the following
3 definitions apply:
4 (1) "Child" means any child including an adopted minor child, of a par-
5 ticipant in a health benefit plan, recognized under a medical child support
6 order as having a right to enrollment under a health benefit plan.
7 (2) "Department" means the department of health and welfare.
8 (3) "Health benefit plan" means a group or individual health benefit plan
9 or combination of plans, other than public assistance programs, that provides
10 medical care or benefits for a child.
11 (4) "Insurer" means every person engaged as indemnitor, surety or con-
12 tractor in the business of entering into contracts of insurance or annuity.
13 (5) "Medical child support order" means any order, including those that
14 meet the requirements of 29 U.S.C. section 1169, or notice issued by either a
15 court or administrative agency that requires a plan administrator, or if none,
16 the employer, to enroll an eligible child in a health benefit plan.
17 (6) "Obligee" means a party or parent other than the parent ordered to
18 carry or provide a health benefit plan for the parties' minor child.
19 (7) "Obligor" means the parent ordered by the court to carry or provide
20 health insurance benefits for the parties' minor child.
21 (8) "Party" means the department, grandparent or any person who is the
22 custodian, other than the parent who owes a duty of medical support.
23 (9) "Plan administrator" means a person or entity, including a state or
24 local government agency or church, that assesses and collects premiums,
25 accepts and processes claims, and pays benefits for medical care.
26 SECTION 4. That Chapter 12, Title 32, Idaho Code, be, and the same is
27 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
28 ignated as Section 32-1214C, Idaho Code, and to read as follows:
29 32-1214C. MEDICAL SUPPORT ORDER. (1) A medical support notice issued to
30 an employer or plan administrator is a qualified medical support order as
31 defined by 29 U.S.C. section 1169(a) through (c).
32 (2) Upon receipt of a national medical support notice, if the employer
33 has one (1) health benefit plan, the employer shall respond within twenty (20)
34 business days and confirm that the child will be enrolled or explain that one
35 (1) of the conditions identified in section 32-1214D, Idaho Code, exists. The
36 employer shall provide the national medical support notice to the plan admin-
37 istrator within twenty (20) business days.
38 (3) Upon receipt of a national medical support notice from an employer,
39 the plan administrator shall notify the department or other obligee within
40 forty (40) business days that a health benefit plan will become available for
41 the child, or explain that one (1) of the conditions identified in section
42 32-1214D, Idaho Code, exists. The plan administrator shall also notify the
43 department or other obligee of any additional steps that need to be taken to
44 complete enrollment. The plan administrator shall notify the department or
45 other obligee when the notice has not been properly filled out, listing the
46 specific deficiencies.
47 (4) If more than one (1) plan is available, the child shall be enrolled
48 in the obligor's plan. If the obligor has not chosen a health benefit plan,
49 the plan administrator or employer shall provide plan descriptions to the
50 department or other obligee within twenty (20) business days. If the depart-
51 ment is enforcing the medical support order, the department shall notify the
52 other obligee of the opportunity to choose the health benefit plan within
3
1 twenty (20) business days. If for any reason the other obligee does not or is
2 not available to choose, the department shall choose the least expensive
3 health benefit plan available to the obligor.
4 (5) The employer shall withhold any required premium from the obligor's
5 income or wages. The amount to be withheld from the income of the obligor
6 shall not exceed the amount specified in section 11-207, Idaho Code. The
7 employer shall forward the premium withheld to the insurer. If the amount of
8 income taken for child support along with the amount taken for medical support
9 exceeds the amount specified in section 11-207, Idaho Code, child support
10 shall be paid first.
11 (6) The plan administrator or employer shall provide the department or
12 other obligee with the name of the insurer, the extent of coverage available
13 and other necessary information, and shall make available any necessary claim
14 forms or enrollment membership cards.
15 (7) An insurer shall not impose requirements on a state agency, which has
16 been assigned the rights of an individual who is eligible for medical assis-
17 tance, that are different than the requirements that apply to an agent or
18 assignee of any other covered individual.
19 (8) A child covered by a qualified medical child support order, or the
20 child's custodial parent, legal guardian, or the provider of services to the
21 child, or a state agency to the extent assigned the child's rights, may file
22 claims and the plan shall make payment for covered benefits or reimbursement
23 directly to such party.
24 (9) An insurer shall not consider the availability or eligibility for
25 medical assistance under medicaid, 42 U.S.C. section 1396a., in this or any
26 other state when considering eligibility for health benefits or making pay-
27 ments under its plan. To the extent that payment has been made by medicaid,
28 the department is subrogated to the rights of the individual to payment by any
29 other third party for covered health care items or services.
30 SECTION 5. That Chapter 12, Title 32, Idaho Code, be, and the same is
31 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
32 ignated as Section 32-1214D, Idaho Code, and to read as follows:
33 32-1214D. EXCEPTIONS TO REQUIREMENT FOR IMMEDIATE ENROLLMENT. The plan
34 administrator or employer shall enroll the child unless the employer or
35 insurer does not offer insurance, the obligor would not qualify for any plan,
36 or the obligor has separated from employment. If insurance is not available
37 because a probationary period exceeds ninety (90) days, the plan administrator
38 or employer shall return the notice to the employer and the department without
39 enrolling the child. If insurance is not available during a probationary
40 period that is ninety (90) days or less, or if ninety (90) days or less
41 remains from a longer waiting period, the plan administrator shall process the
42 enrollment, and notify the employer, the department or other obligee, of the
43 effective date of coverage.
44 SECTION 6. That Chapter 12, Title 32, Idaho Code, be, and the same is
45 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
46 ignated as Section 32-1214E, Idaho Code, and to read as follows:
47 32-1214E. PROHIBITION ON DENIAL OF ENROLLMENT. A child shall not be
48 denied enrollment in a health benefit plan because:
49 (1) The child was born out of wedlock;
50 (2) The child is not claimed as a dependent on the obligor's federal
51 income tax return;
4
1 (3) The child does not reside with the obligor or in the insurer's ser-
2 vice area; or
3 (4) There is no current enrollment season.
4 SECTION 7. That Chapter 12, Title 32, Idaho Code, be, and the same is
5 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
6 ignated as Section 32-1214F, Idaho Code, and to read as follows:
7 32-1214F. NOTICE OF MEDICAL SUPPORT ORDER. Any support order or decree
8 that requires a child to be covered by a health benefit plan issued after July
9 1, 2003, shall include a statement in substantially the following form:
10 "Failure to provide medical insurance coverage may result in the
11 direct enforcement of a medical support order by either the obligee
12 or the Department of Health and Welfare. A national medical support
13 notice will be sent to your employer, requiring your employer to
14 enroll the child in a health benefit plan as provided by Sections
15 32-1214A through 32-1214J, Idaho Code, and applicable rules of the
16 department.".
17 SECTION 8. That Chapter 12, Title 32, Idaho Code, be, and the same is
18 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
19 ignated as Section 32-1214G, Idaho Code, and to read as follows:
20 32-1214G. AUTHORITY OF THE DEPARTMENT. The department of health and wel-
21 fare shall have the authority to promulgate rules necessary to implement and
22 enforce orders for medical insurance. The rules shall provide the obligor an
23 opportunity to protest the issuance of the national medical support notice
24 based on mistake of fact.
25 SECTION 9. That Chapter 12, Title 32, Idaho Code, be, and the same is
26 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
27 ignated as Section 32-1214H, Idaho Code, and to read as follows:
28 32-1214H. NOTICE OF INTENT TO ENFORCE. If the order for health benefits
29 fails to provide for direct enforcement, the department or other obligee may
30 serve a written notice of intent to enforce the order on the obligor by mail
31 or personal service. If the obligor fails to provide written proof that health
32 benefits have been obtained or applied for within twenty (20) business days of
33 service of the notice, or within twenty (20) business days of health benefits
34 becoming available, the department or other obligee may proceed to enforce the
35 order directly by sending the notice prescribed by section 32-1214C, Idaho
36 Code.
37 SECTION 10. That Chapter 12, Title 32, Idaho Code, be, and the same is
38 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
39 ignated as Section 32-1214I, Idaho Code, and to read as follows:
40 32-1214I. DISENROLLMENT. The plan administrator or employer shall not
41 disenroll or eliminate health benefits of any such child unless:
42 (1) A certified copy of an order terminating the obligation to provide
43 health benefits is provided to a plan administrator or employer;
44 (2) Confirmation has been received by the plan administrator or employer
45 that the child is enrolled in another comparable health benefit plan;
46 (3) The employer has eliminated family health benefit plans for all of
47 its employees;
5
1 (4) The obligor has separated from employment;
2 (5) The child is no longer eligible for coverage under the terms of the
3 plan; or
4 (6) The required premium has not been paid by or on behalf of the child.
5 SECTION 11. That Chapter 12, Title 32, Idaho Code, be, and the same is
6 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
7 ignated as Section 32-1214J, Idaho Code, and to read as follows:
8 32-1214J. NOTICE OF TERMINATION OF COVERAGE. The plan administrator or
9 employer shall notify the department or other obligee within twenty (20) days
10 when health benefits are no longer available and state the reason why.
11 SECTION 12. That Chapter 13, Title 41, Idaho Code, be, and the same is
12 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
13 ignated as Section 41-1336, Idaho Code, and to read as follows:
14 41-1336. REQUIREMENTS FOR COMPLIANCE. It shall be a violation of this
15 chapter for an insurer to fail to comply with the requirements applicable to
16 insurers under chapter 12, title 32, Idaho Code.
17 SECTION 13. That Section 41-3434, Idaho Code, be, and the same is hereby
18 amended to read as follows:
19 41-3434. OTHER PROVISIONS APPLICABLE. In addition to those contained or
20 referred to heretofore in this chapter, the following chapters and provisions
21 of this code shall also apply with respect to service corporations to the
22 extent applicable and not in conflict with the express provisions of this
23 chapter and the reasonable implications of such express provisions, and for
24 the purposes of such application such corporations shall be deemed to be
25 mutual "insurers":
26 (1) Chapter 1 (scope of code);
27 (2) Chapter 2 (the director of insurance);
28 (3) Section 41-308(2) (general eligibility for certificate of authority
29 -- competence, affiliations of management);
30 (4) Sections 41-345 through 41-347 (disclosure of material transactions);
31 (5) Section 41-601 ("assets" defined);
32 (6) Section 41-603 (assets not allowed);
33 (7) Section 41-604 (disallowance of "wash" transactions);
34 (8) Section 41-613 (valuation of bonds);
35 (9) Section 41-731 (prohibited investments and investment underwriting);
36 (10) Chapter 13 (trade practices and frauds);
37 (11) Section 41-2840 (vouchers for expenditures);
38 (12) Section 41-2841 (borrowed surplus);
39 (13) Sections 41-2857 (mergers and consolidations, mutual insurers),
40 41-2858 (bulk reinsurance, mutual insurers), and 41-2859 (mutual member's
41 share of assets on liquidation);
42 (14) Chapter 33 (supervision, rehabilitation and liquidation);
43 (15) Sections 799 to 809 of chapter 330 of Session Laws of 1961
44 (transitory provisions);
45 (16) Section 41-2106(3) (health history application for disability insur-
46 ance);
47 (17) Section 41-2141 (coordination of benefits -- coordination with social
48 security benefits);
49 (18) Section 41-1839 (attorney fees);
6
1 (19) Chapter 46 (long-term care insurance);
2 (20) Section 41-1844 (prescription drug benefit restrictions prohibited);
3 and
4 (21) Section 41-2145 (coverage provided to person having insurance);
5 (22) Section 41-2216, (coordination of benefits -- coordination with
6 social security benefits); and
7 (23) Section 41-2219 (coverage provided to person having insurance).
8 SECTION 14. That Section 41-3904, Idaho Code, be, and the same is hereby
9 amended to read as follows:
10 41-3904. CERTIFICATE OF AUTHORITY REQUIRED -- EXCEPTIONS -- APPLICATION
11 OF CERTAIN PROVISIONS. (1) No person shall in this state offer a managed care
12 plan on a predetermined and prepaid basis, unless authorized under a certifi-
13 cate of authority issued by the director. A person offering a managed care
14 plan on a predetermined and prepaid basis is deemed to be transacting the
15 business of insurance.
16 (2) An organization proposing to offer a managed care plan on a predeter-
17 mined and prepaid basis, after it has filed its application for a certificate
18 of authority as provided in section 41-3906, Idaho Code, and while its appli-
19 cation is pending, if permitted by and in accordance with rules promulgated by
20 the director, may inform the public concerning its proposed health care ser-
21 vices.
22 (3) Entities not offering a managed care plan shall not be subject to the
23 provisions of this chapter.
24 (4) An entity not required to obtain a certificate of authority which
25 holds itself out to the public or markets itself as an organization rendering
26 basic health care services to a specified population through a managed care
27 plan shall be subject to and must comply with the following sections of this
28 chapter but shall not be subject to regulation by the department: 41-3902;
29 41-3903; 41-3904; 41-3909(1) and (2); 41-3914(1) and (2); 41-3915(1), (2),
30 (3), (4), (5), (6) and (8); 41-3916; 41-3917; 41-3918(1), (2) and (4);
31 41-3919(1) and (2); 41-3920; 41-3921(2), (3) and (4); 41-3922(2); 41-3926;
32 41-3927; 41-3928; 41-3929; 41-3930 and 41-3932, Idaho Code.
STATEMENT OF PURPOSE
RS 12689C1
Federal law requires that the State of Idaho begin using the
National Medical Support Notice (NMSN) by October 1, 2001, or the
first legislative session after October 1, 2001. The NT4SN is a
standardized federal form that will provide information and a
standardized procedure to employers and administrators of group
health plans in obtaining medical support for Idaho~s children.
Idaho Code 32-1214 is substantially impacted by the changes needed
to implement the National Medical Support Notice. This section will
be rewritten to bring Idaho Code into compliance with the
requirements of the NMSN process. This will include an outline of
the procedures notifying employers and group health plan
administrators of their duties and obligations that are required by
the NMSN.
FISCAL IMPACT
The first year the estimated cost is $60,400 and $45,400
thereafter.
CONTACT
Name: Tern Meyer
Agency: Health and Welfare
Phone: 334-6673
Statement of Purpose/Fiscal Impact S 1073