View Bill Status
View Bill Text
View Amendment
View Engrossed Bill (Original Bill with Amendment(s) Incorporated)
View Statement of Purpose / Fiscal Impact
H0655aaS........................................................by BUSINESS
INSURANCE - Amends existing law relating to insurance to provide that large
employer carriers, small employer carriers and individual carriers may
discontinue offering particular health benefit plans at the time of
coverage renewal under certain conditions.
02/10 House intro - 1st rdg - to printing
02/13 Rpt prt - to Bus
03/02 Rpt out - rec d/p - to 2nd rdg
03/03 2nd rdg - to 3rd rdg
03/06 3rd rdg - PASSED - 62-1-7
AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer,
Bedke, Bell, Bilbao, Black, Block, Bolz, Bradford, Cannon,
Chadderdon, Clark, Collins, Crow, Deal, Denney, Edmunson, Ellsworth,
Eskridge, Field(18), Field(23), Garrett, Hart, Harwood, Henbest,
Henderson, Jaquet, Kemp, Lake, Loertscher, Martinez, Mathews,
McGeachin, McKague, Miller, Mitchell, Moyle, Nielsen, Nonini,
Pasley-Stuart, Pence, Raybould, Ringo, Roberts, Rusche, Rydalch,
Sali, Schaefer, Shepherd(2), Shepherd(8), Shirley, Skippen,
Smith(30), Smith(24), Smylie, Snodgrass, Wood, Mr. Speaker
NAYS -- LeFavour
Absent and excused -- Boe, Brackett, Ring, Sayler, Stevenson, Trail,
Wills
Floor Sponsors - Deal & Black
Title apvd - to Senate
03/07 Senate intro - 1st rdg - to Com/HuRes
03/24 Rpt out - to 14th Ord
03/28 Rpt out amen - to 1st rdg as amen
03/29 1st rdg - to 2nd rdg as amen
03/30 2nd rdg - to 3rd rdg as amen
Rls susp - PASSED - 34-0-1
AYES -- Andreason, Brandt, Broadsword, Bunderson, Burkett,
Burtenshaw, Cameron, Coiner, Compton, Corder, Darrington, Davis,
Fulcher, Gannon, Geddes, Goedde, Hill, Jorgenson, Kelly, Keough,
Langhorst, Little, Lodge, Malepeai, Marley, McGee, McKenzie, Pearce,
Richardson, Schroeder, Stegner, Stennett, Werk, Williams
NAYS -- None
Absent and excused -- Sweet
Floor Sponsor - Goedde
Title apvd - to House
04/03 House concurred in Senate amens - to engros
04/04 Rpt engros - 1st rdg - to 2nd rdg as amen
Rls susp - PASSED - 66-0-4
AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer,
Bilbao, Black, Block, Boe, Bolz, Brackett, Bradford, Cannon,
Chadderdon, Clark, Collins, Deal, Denney, Edmunson, Ellsworth,
Eskridge, Field(18), Field(23), Garrett, Hart, Harwood, Henbest,
Henderson, Jaquet, Kemp, Lake, LeFavour, Loertscher, Martinez,
Mathews, McGeachin, McKague, Miller, Mitchell, Moyle, Nielsen,
Nonini, Pasley-Stuart, Pence, Raybould, Ring, Ringo, Roberts, Rusche,
Rydalch, Sali, Sayler, Schaefer, Shepherd(8), Shirley, Skippen,
Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Trail, Wills,
Wood, Mr. Speaker
NAYS -- None
Absent and excused -- Bedke, Bell, Crow, Shepherd(2)
Floor Sponsor - Deal
Title apvd - To enrol - Rpt enrol - Sp signed
04/05 Pres signed - To Governor
04/07 Governor signed
Session Law Chapter 353
Effective: 07/01/06
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 655
BY BUSINESS COMMITTEE
1 AN ACT
2 RELATING TO INSURANCE; AMENDING SECTION 41-2223, IDAHO CODE, TO PROVIDE THAT
3 LARGE EMPLOYER CARRIERS MAY DISCONTINUE OFFERING PARTICULAR HEALTH BENEFIT
4 PLANS AT THE TIME OF COVERAGE RENEWAL UNDER CERTAIN CONDITIONS; AMENDING
5 SECTION 41-4707, IDAHO CODE, TO PROVIDE THAT SMALL EMPLOYER CARRIERS MAY
6 DISCONTINUE OFFERING PARTICULAR HEALTH BENEFIT PLANS AT THE TIME OF COVER-
7 AGE RENEWAL UNDER CERTAIN CONDITIONS; AND AMENDING SECTION 41-5207, IDAHO
8 CODE, TO PROVIDE THAT INDIVIDUAL CARRIERS MAY DISCONTINUE OFFERING PARTIC-
9 ULAR HEALTH BENEFIT PLANS AT THE TIME OF COVERAGE RENEWAL UNDER CERTAIN
10 CONDITIONS.
11 Be It Enacted by the Legislature of the State of Idaho:
12 SECTION 1. That Section 41-2223, Idaho Code, be, and the same is hereby
13 amended to read as follows:
14 41-2223. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
15 the provisions of this chapter shall be renewable with respect to all eligible
16 employees or dependents, at the option of the employer, except in any of the
17 following cases:
18 (a) Nonpayment of the required premiums;
19 (b) Fraud or intentional misrepresentation of material fact by the
20 employer;
21 (c) Noncompliance with the carrier's minimum participation requirements;
22 (d) Noncompliance with the carrier's employer contribution requirements;
23 (e) In the case of health benefit plans that are made available in the
24 employer market only through one (1) or more associations, as defined in
25 section 41-2202, Idaho Code, the membership of an employer in the associa-
26 tion, on the basis of which the coverage is provided ceases, but only if
27 the coverage is terminated under this paragraph uniformly without regard
28 to any health status-related factor relating to any covered individual;
29 (f) The employer no longer meets the requirements of section
30 41-2221(2)(b), Idaho Code;
31 (g) The carrier elects, at the time of coverage renewal, to discontinue
32 offering a particular health benefit plan delivered or issued for delivery
33 to large employers in this state. Unless otherwise authorized in advance
34 by the department of insurance, a carrier may discontinue a product only
35 after the product has been in use for at least thirty-six (36) consecutive
36 months, provided the carrier may not discontinue more than twenty percent
37 (20%) of its total number of employees and dependents in all lines of
38 business in a twelve (12) month period. The carrier shall:
39 (i) Provide advance written or electronic notice of its decision
40 under this paragraph to the director;
41 (ii) Provide notice of the discontinuation to all affected employers
42 and employees or dependents at least ninety (90) calendar days prior
43 to the date the particular health benefit plan will be discontinued
2
1 by the carrier, provided that notice to the director under the provi-
2 sions of this paragraph shall be provided at least fourteen (14) cal-
3 endar days prior to the notice to the affected employers;
4 (iii) Offer to each affected employer, on a guaranteed issue basis,
5 the option to purchase all other health benefit plans currently being
6 offered by the carrier to large employers in this state; and
7 (iv) In exercising the option to discontinue the health benefit plan
8 and in offering the option to purchase all other health benefit plans
9 under the provisions of this paragraph, act uniformly without regard
10 to:
11 1. The claims experience of an affected employer;
12 2. Any health status-related factor relating to any affected
13 employee or dependent; or
14 3. Any health status-related factor relating to any new
15 employee or dependent who may become eligible for the coverage.
16 (h) The carrier elects to nonrenew all of its health benefit plans deliv-
17 ered or issued for delivery to large employers in this state. In such a
18 case the carrier shall:
19 (i) Provide advance notice of its decision under this paragraph to
20 the director in each state in which it is licensed; and
21 (ii) Provide notice of the decision not to renew coverage to all
22 affected employers and to the director at least one hundred eighty
23 (180) calendar days prior to the nonrenewal of any health benefit
24 plans by the carrier. Notice to the director under the provisions of
25 this paragraph shall be provided at least three (3) working days
26 prior to the notice to the affected employers; or
27 (hi) The director finds that the continuation of the coverage would:
28 (i) Not be in the best interests of the policyholders or certifi-
29 cate holders; or
30 (ii) Impair the carrier's ability to meet its contractual obliga-
31 tions.
32 In such instance the director shall assist affected employers in finding
33 replacement coverage.
34 (2) A carrier that elects not to renew a health benefit plan under the
35 provisions of subsection (1)(gh) of this section shall be prohibited from
36 writing new business in the large employer market in this state for a period
37 of five (5) years from the date of notice to the director.
38 (3) In the case of a carrier doing business in one (1) established geo-
39 graphic service area of the state, the provisions set forth in this section
40 shall apply only to the carrier's operations in that service area.
41 SECTION 2. That Section 41-4707, Idaho Code, be, and the same is hereby
42 amended to read as follows:
43 41-4707. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
44 the provisions of this chapter shall be renewable with respect to all eligible
45 employees or dependents, at the option of the small employer, except in any of
46 the following cases:
47 (a) Nonpayment of the required premiums;
48 (b) Fraud or intentional misrepresentation of material fact by the small
49 employer;
50 (c) Noncompliance with the carrier's minimum participation requirements;
51 (d) Noncompliance with the carrier's employer contribution requirements;
52 (e) In the case of health benefit plans that are made available in the
53 small employer market only through one (1) or more associations as defined
3
1 in section 41-2202, Idaho Code, the membership of an employer in the asso-
2 ciation, on the basis of which the coverage is provided ceases, but only
3 if the coverage is terminated under this paragraph uniformly without
4 regard to any health status-related factor relating to any covered indi-
5 vidual;
6 (f) The small employer no longer meets the requirements of section
7 41-4703(28), Idaho Code;
8 (g) The small employer carrier elects, at the time of coverage renewal,
9 to discontinue offering a particular health benefit plan delivered or
10 issued for delivery to small employers in this state. Unless otherwise
11 authorized in advance by the department of insurance, a carrier may dis-
12 continue a product only after the product has been in use for at least
13 thirty-six (36) consecutive months, provided the carrier may not discon-
14 tinue more than twenty percent (20%) of its total number of employees and
15 dependents in all lines of business in a twelve (12) month period. The
16 carrier shall:
17 (i) Provide advance written or electronic notice of its decision
18 under this paragraph to the director;
19 (ii) Provide notice of the discontinuation to all affected employers
20 and employees or dependents at least ninety (90) calendar days prior
21 to the date the particular health benefit plan will be discontinued
22 by the carrier, provided that notice to the director under the provi-
23 sions of this paragraph shall be provided at least fourteen (14) cal-
24 endar days prior to the notice to the affected employers;
25 (iii) Offer to each affected employer, on a guaranteed issue basis,
26 the option to purchase all other health benefit plans currently being
27 offered by the carrier to small employers in this state; and
28 (iv) In exercising the option to discontinue the health benefit plan
29 and in offering the option to purchase all other health benefit plans
30 under the provisions of this paragraph, act uniformly without regard
31 to:
32 1. The claims experience of an affected employer;
33 2. Any health status-related factor relating to any affected
34 employee or dependent; or
35 3. Any health status-related factor relating to any new
36 employee or dependent who may become eligible for the coverage.
37 (h) The small employer carrier elects to nonrenew all of its health bene-
38 fit plans delivered or issued for delivery to small employers in this
39 state. In such a case the carrier shall:
40 (i) Provide advance notice of its decision under this paragraph to
41 the director in each state in which it is licensed; and
42 (ii) Provide notice of the decision not to renew coverage to all
43 affected small employers and to the director at least one hundred
44 eighty (180) calendar days prior to the nonrenewal of any health ben-
45 efit plans by the carrier. Notice to the director under the provi-
46 sions of this paragraph shall be provided at least three (3) working
47 days prior to the notice to the affected small employers; or
48 (hi) The director finds that the continuation of the coverage would:
49 (i) Not be in the best interests of the policyholders or certifi-
50 cate holders; or
51 (ii) Impair the carrier's ability to meet its contractual obliga-
52 tions.
53 In such instance the director shall assist affected small employers in
54 finding replacement coverage.
55 (2) A small employer carrier that elects not to renew a health benefit
4
1 plan under the provisions of subsection (1)(gh) of this section shall be pro-
2 hibited from writing new business in the small employer market in this state
3 for a period of five (5) years from the date of notice to the director.
4 (3) In the case of a small employer carrier doing business in one (1)
5 established geographic service area of the state, the rules set forth in this
6 subsection shall apply only to the carrier's operations in that service area.
7 SECTION 3. That Section 41-5207, Idaho Code, be, and the same is hereby
8 amended to read as follows:
9 41-5207. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
10 the provisions of this chapter shall be renewable with respect to the individ-
11 ual or dependents, at the option of the individual, except in any of the fol-
12 lowing cases:
13 (a) Nonpayment of the required premiums;
14 (b) Fraud or intentional misrepresentation of material fact by the indi-
15 vidual insured or his representatives. An individual whose coverage is
16 terminated for fraud or misrepresentation shall not be deemed to be an
17 "eligible individual" for a period of twelve (12) months from the effec-
18 tive date of the termination of the individual's coverage and shall not be
19 deemed to have "qualifying previous coverage" under chapter 22, 47 or 52,
20 title 41, Idaho Code;
21 (c) The individual ceases to be an eligible individual as defined in sec-
22 tion 41-5203(10), Idaho Code;
23 (d) In the case of health benefit plans that are made available in the
24 individual market only through one (1) or more associations, as defined in
25 section 41-2202, Idaho Code, the membership of an individual in the asso-
26 ciation, on the basis of which the coverage is provided ceases, but only
27 if the coverage is terminated under this paragraph uniformly without
28 regard to any health status-related factor relating to any covered indi-
29 vidual;
30 (e) The individual carrier elects, at the time of coverage renewal, to
31 discontinue offering a particular health benefit plan delivered or issued
32 for delivery to individuals in this state. Unless otherwise authorized in
33 advance by the department of insurance, a carrier may discontinue a prod-
34 uct only after the product has been in use for at least thirty-six (36)
35 consecutive months, provided the carrier may not discontinue more than
36 twenty percent (20%) of its total number of individuals and dependents in
37 all lines of business in a twelve (12) month period. The carrier shall:
38 (i) Provide advance written or electronic notice of its decision
39 under this paragraph to the director;
40 (ii) Provide notice of the discontinuation to all affected individu-
41 als at least ninety (90) calendar days prior to the date the particu-
42 lar health benefit plan will be discontinued by the carrier, provided
43 that notice to the director under the provisions of this paragraph
44 shall be provided at least fourteen (14) calendar days prior to the
45 notice to the affected individuals;
46 (iii) Offer to each affected individual, on a guaranteed issue basis,
47 the option to purchase all other health benefit plans currently being
48 offered by the carrier to individuals in this state; and
49 (iv) Act uniformly without regard to any health status-related fac-
50 tor of an affected individual or dependent of an affected individual
51 who may become eligible for the coverage.
52 (f) The individual carrier elects to nonrenew all of its health benefit
53 plans delivered or issued for delivery to individuals in this state. In
5
1 such a case the carrier shall:
2 (i) Provide advance notice of its decision under this paragraph to
3 the director; and
4 (ii) Provide notice of the decision not to renew coverage to all
5 affected individuals and to the director at least one hundred eighty
6 (180) calendar days prior to the nonrenewal of any health benefit
7 plans by the carrier. Notice to the director under the provisions of
8 this paragraph shall be provided at least three (3) working days
9 prior to the notice to the affected individuals; or
10 (fg) The director finds that the continuation of the coverage would:
11 (i) Not be in the best interests of the policyholders or certifi-
12 cate holders; or
13 (ii) Impair the carrier's ability to meet its contractual obliga-
14 tions.
15 In such instance, the director shall assist affected individuals in find-
16 ing replacement coverage.
17 (2) An individual carrier that elects not to renew a health benefit plan
18 under the provisions of subsection (1)(ef) of this section shall be prohibited
19 from writing new business in the individual market in this state for a period
20 of five (5) years from the date of notice to the director.
21 (3) In the case of an individual carrier doing business in one (1) estab-
22 lished geographic service area of the state, the rules set forth in this sub-
23 section shall apply only to the carrier's operations in that service area.
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
Moved by Goedde
Seconded by Broadsword
IN THE SENATE
SENATE AMENDMENTS TO H.B. NO. 655
1 AMENDMENTS TO SECTION 2
2 On page 3 of the printed bill, in line 14, delete "twenty percent (20%)"
3 and insert: "fifteen percent (15%)"; in line 15, following "business" insert:
4 "regulated by this chapter"; in line 27, delete "and"; and in line 36, delete
5 "coverage." and insert: "coverage; and
6 (v) Offer the new products at rates that comply with section
7 41-4706(1)(c), Idaho Code.".
8 AMENDMENTS TO SECTION 3
9 On page 4, in line 36, delete "twenty percent (20%)" and insert: "fifteen
10 percent (15%)"; in line 37, following "business" insert: "regulated by this
11 chapter"; in line 48, delete "and"; and in line 51, delete "coverage." and
12 insert: "coverage; and
13 (v) Offer the new products at rates that comply with section
14 41-5206(1)(b), Idaho Code.".
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 655, As Amended in the Senate
BY BUSINESS COMMITTEE
1 AN ACT
2 RELATING TO INSURANCE; AMENDING SECTION 41-2223, IDAHO CODE, TO PROVIDE THAT
3 LARGE EMPLOYER CARRIERS MAY DISCONTINUE OFFERING PARTICULAR HEALTH BENEFIT
4 PLANS AT THE TIME OF COVERAGE RENEWAL UNDER CERTAIN CONDITIONS; AMENDING
5 SECTION 41-4707, IDAHO CODE, TO PROVIDE THAT SMALL EMPLOYER CARRIERS MAY
6 DISCONTINUE OFFERING PARTICULAR HEALTH BENEFIT PLANS AT THE TIME OF COVER-
7 AGE RENEWAL UNDER CERTAIN CONDITIONS; AND AMENDING SECTION 41-5207, IDAHO
8 CODE, TO PROVIDE THAT INDIVIDUAL CARRIERS MAY DISCONTINUE OFFERING PARTIC-
9 ULAR HEALTH BENEFIT PLANS AT THE TIME OF COVERAGE RENEWAL UNDER CERTAIN
10 CONDITIONS.
11 Be It Enacted by the Legislature of the State of Idaho:
12 SECTION 1. That Section 41-2223, Idaho Code, be, and the same is hereby
13 amended to read as follows:
14 41-2223. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
15 the provisions of this chapter shall be renewable with respect to all eligible
16 employees or dependents, at the option of the employer, except in any of the
17 following cases:
18 (a) Nonpayment of the required premiums;
19 (b) Fraud or intentional misrepresentation of material fact by the
20 employer;
21 (c) Noncompliance with the carrier's minimum participation requirements;
22 (d) Noncompliance with the carrier's employer contribution requirements;
23 (e) In the case of health benefit plans that are made available in the
24 employer market only through one (1) or more associations, as defined in
25 section 41-2202, Idaho Code, the membership of an employer in the associa-
26 tion, on the basis of which the coverage is provided ceases, but only if
27 the coverage is terminated under this paragraph uniformly without regard
28 to any health status-related factor relating to any covered individual;
29 (f) The employer no longer meets the requirements of section
30 41-2221(2)(b), Idaho Code;
31 (g) The carrier elects, at the time of coverage renewal, to discontinue
32 offering a particular health benefit plan delivered or issued for delivery
33 to large employers in this state. Unless otherwise authorized in advance
34 by the department of insurance, a carrier may discontinue a product only
35 after the product has been in use for at least thirty-six (36) consecutive
36 months, provided the carrier may not discontinue more than twenty percent
37 (20%) of its total number of employees and dependents in all lines of
38 business in a twelve (12) month period. The carrier shall:
39 (i) Provide advance written or electronic notice of its decision
40 under this paragraph to the director;
41 (ii) Provide notice of the discontinuation to all affected employers
42 and employees or dependents at least ninety (90) calendar days prior
43 to the date the particular health benefit plan will be discontinued
2
1 by the carrier, provided that notice to the director under the provi-
2 sions of this paragraph shall be provided at least fourteen (14) cal-
3 endar days prior to the notice to the affected employers;
4 (iii) Offer to each affected employer, on a guaranteed issue basis,
5 the option to purchase all other health benefit plans currently being
6 offered by the carrier to large employers in this state; and
7 (iv) In exercising the option to discontinue the health benefit plan
8 and in offering the option to purchase all other health benefit plans
9 under the provisions of this paragraph, act uniformly without regard
10 to:
11 1. The claims experience of an affected employer;
12 2. Any health status-related factor relating to any affected
13 employee or dependent; or
14 3. Any health status-related factor relating to any new
15 employee or dependent who may become eligible for the coverage.
16 (h) The carrier elects to nonrenew all of its health benefit plans deliv-
17 ered or issued for delivery to large employers in this state. In such a
18 case the carrier shall:
19 (i) Provide advance notice of its decision under this paragraph to
20 the director in each state in which it is licensed; and
21 (ii) Provide notice of the decision not to renew coverage to all
22 affected employers and to the director at least one hundred eighty
23 (180) calendar days prior to the nonrenewal of any health benefit
24 plans by the carrier. Notice to the director under the provisions of
25 this paragraph shall be provided at least three (3) working days
26 prior to the notice to the affected employers; or
27 (hi) The director finds that the continuation of the coverage would:
28 (i) Not be in the best interests of the policyholders or certifi-
29 cate holders; or
30 (ii) Impair the carrier's ability to meet its contractual obliga-
31 tions.
32 In such instance the director shall assist affected employers in finding
33 replacement coverage.
34 (2) A carrier that elects not to renew a health benefit plan under the
35 provisions of subsection (1)(gh) of this section shall be prohibited from
36 writing new business in the large employer market in this state for a period
37 of five (5) years from the date of notice to the director.
38 (3) In the case of a carrier doing business in one (1) established geo-
39 graphic service area of the state, the provisions set forth in this section
40 shall apply only to the carrier's operations in that service area.
41 SECTION 2. That Section 41-4707, Idaho Code, be, and the same is hereby
42 amended to read as follows:
43 41-4707. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
44 the provisions of this chapter shall be renewable with respect to all eligible
45 employees or dependents, at the option of the small employer, except in any of
46 the following cases:
47 (a) Nonpayment of the required premiums;
48 (b) Fraud or intentional misrepresentation of material fact by the small
49 employer;
50 (c) Noncompliance with the carrier's minimum participation requirements;
51 (d) Noncompliance with the carrier's employer contribution requirements;
52 (e) In the case of health benefit plans that are made available in the
53 small employer market only through one (1) or more associations as defined
3
1 in section 41-2202, Idaho Code, the membership of an employer in the asso-
2 ciation, on the basis of which the coverage is provided ceases, but only
3 if the coverage is terminated under this paragraph uniformly without
4 regard to any health status-related factor relating to any covered indi-
5 vidual;
6 (f) The small employer no longer meets the requirements of section
7 41-4703(28), Idaho Code;
8 (g) The small employer carrier elects, at the time of coverage renewal,
9 to discontinue offering a particular health benefit plan delivered or
10 issued for delivery to small employers in this state. Unless otherwise
11 authorized in advance by the department of insurance, a carrier may dis-
12 continue a product only after the product has been in use for at least
13 thirty-six (36) consecutive months, provided the carrier may not discon-
14 tinue more than fifteen percent (15%) of its total number of employees and
15 dependents in all lines of business regulated by this chapter in a twelve
16 (12) month period. The carrier shall:
17 (i) Provide advance written or electronic notice of its decision
18 under this paragraph to the director;
19 (ii) Provide notice of the discontinuation to all affected employers
20 and employees or dependents at least ninety (90) calendar days prior
21 to the date the particular health benefit plan will be discontinued
22 by the carrier, provided that notice to the director under the provi-
23 sions of this paragraph shall be provided at least fourteen (14) cal-
24 endar days prior to the notice to the affected employers;
25 (iii) Offer to each affected employer, on a guaranteed issue basis,
26 the option to purchase all other health benefit plans currently being
27 offered by the carrier to small employers in this state;
28 (iv) In exercising the option to discontinue the health benefit plan
29 and in offering the option to purchase all other health benefit plans
30 under the provisions of this paragraph, act uniformly without regard
31 to:
32 1. The claims experience of an affected employer;
33 2. Any health status-related factor relating to any affected
34 employee or dependent; or
35 3. Any health status-related factor relating to any new
36 employee or dependent who may become eligible for the coverage;
37 and
38 (v) Offer the new products at rates that comply with section
39 41-4706(1)(c), Idaho Code.
40 (h) The small employer carrier elects to nonrenew all of its health bene-
41 fit plans delivered or issued for delivery to small employers in this
42 state. In such a case the carrier shall:
43 (i) Provide advance notice of its decision under this paragraph to
44 the director in each state in which it is licensed; and
45 (ii) Provide notice of the decision not to renew coverage to all
46 affected small employers and to the director at least one hundred
47 eighty (180) calendar days prior to the nonrenewal of any health ben-
48 efit plans by the carrier. Notice to the director under the provi-
49 sions of this paragraph shall be provided at least three (3) working
50 days prior to the notice to the affected small employers; or
51 (hi) The director finds that the continuation of the coverage would:
52 (i) Not be in the best interests of the policyholders or certifi-
53 cate holders; or
54 (ii) Impair the carrier's ability to meet its contractual obliga-
55 tions.
4
1 In such instance the director shall assist affected small employers in
2 finding replacement coverage.
3 (2) A small employer carrier that elects not to renew a health benefit
4 plan under the provisions of subsection (1)(gh) of this section shall be pro-
5 hibited from writing new business in the small employer market in this state
6 for a period of five (5) years from the date of notice to the director.
7 (3) In the case of a small employer carrier doing business in one (1)
8 established geographic service area of the state, the rules set forth in this
9 subsection shall apply only to the carrier's operations in that service area.
10 SECTION 3. That Section 41-5207, Idaho Code, be, and the same is hereby
11 amended to read as follows:
12 41-5207. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
13 the provisions of this chapter shall be renewable with respect to the individ-
14 ual or dependents, at the option of the individual, except in any of the fol-
15 lowing cases:
16 (a) Nonpayment of the required premiums;
17 (b) Fraud or intentional misrepresentation of material fact by the indi-
18 vidual insured or his representatives. An individual whose coverage is
19 terminated for fraud or misrepresentation shall not be deemed to be an
20 "eligible individual" for a period of twelve (12) months from the effec-
21 tive date of the termination of the individual's coverage and shall not be
22 deemed to have "qualifying previous coverage" under chapter 22, 47 or 52,
23 title 41, Idaho Code;
24 (c) The individual ceases to be an eligible individual as defined in sec-
25 tion 41-5203(10), Idaho Code;
26 (d) In the case of health benefit plans that are made available in the
27 individual market only through one (1) or more associations, as defined in
28 section 41-2202, Idaho Code, the membership of an individual in the asso-
29 ciation, on the basis of which the coverage is provided ceases, but only
30 if the coverage is terminated under this paragraph uniformly without
31 regard to any health status-related factor relating to any covered indi-
32 vidual;
33 (e) The individual carrier elects, at the time of coverage renewal, to
34 discontinue offering a particular health benefit plan delivered or issued
35 for delivery to individuals in this state. Unless otherwise authorized in
36 advance by the department of insurance, a carrier may discontinue a prod-
37 uct only after the product has been in use for at least thirty-six (36)
38 consecutive months, provided the carrier may not discontinue more than
39 fifteen percent (15%) of its total number of individuals and dependents in
40 all lines of business regulated by this chapter in a twelve (12) month
41 period. The carrier shall:
42 (i) Provide advance written or electronic notice of its decision
43 under this paragraph to the director;
44 (ii) Provide notice of the discontinuation to all affected individu-
45 als at least ninety (90) calendar days prior to the date the particu-
46 lar health benefit plan will be discontinued by the carrier, provided
47 that notice to the director under the provisions of this paragraph
48 shall be provided at least fourteen (14) calendar days prior to the
49 notice to the affected individuals;
50 (iii) Offer to each affected individual, on a guaranteed issue basis,
51 the option to purchase all other health benefit plans currently being
52 offered by the carrier to individuals in this state;
53 (iv) Act uniformly without regard to any health status-related fac-
5
1 tor of an affected individual or dependent of an affected individual
2 who may become eligible for the coverage; and
3 (v) Offer the new products at rates that comply with section
4 41-5206(1)(b), Idaho Code.
5 (f) The individual carrier elects to nonrenew all of its health benefit
6 plans delivered or issued for delivery to individuals in this state. In
7 such a case the carrier shall:
8 (i) Provide advance notice of its decision under this paragraph to
9 the director; and
10 (ii) Provide notice of the decision not to renew coverage to all
11 affected individuals and to the director at least one hundred eighty
12 (180) calendar days prior to the nonrenewal of any health benefit
13 plans by the carrier. Notice to the director under the provisions of
14 this paragraph shall be provided at least three (3) working days
15 prior to the notice to the affected individuals; or
16 (fg) The director finds that the continuation of the coverage would:
17 (i) Not be in the best interests of the policyholders or certifi-
18 cate holders; or
19 (ii) Impair the carrier's ability to meet its contractual obliga-
20 tions.
21 In such instance, the director shall assist affected individuals in find-
22 ing replacement coverage.
23 (2) An individual carrier that elects not to renew a health benefit plan
24 under the provisions of subsection (1)(ef) of this section shall be prohibited
25 from writing new business in the individual market in this state for a period
26 of five (5) years from the date of notice to the director.
27 (3) In the case of an individual carrier doing business in one (1) estab-
28 lished geographic service area of the state, the rules set forth in this sub-
29 section shall apply only to the carrier's operations in that service area.
STATEMENT OF PURPOSE
RS15984
This proposed HIPAA-compliant legislation will allow carriers to
discontinue obsolete health insurance products while continuing to
guarantee coverage to members through new and existing product
lines, thereby enabling health insurers to better respond to market
needs. Similar legislation has been enacted in 44 other states.
FISCAL NOTE
None.
Contact: Rep. Max Black, 332-1000
Rep. Bill Deal, 332-1000
Regence BlueShield of Idaho
Lyn Darrington, 336-1986
Tim Olson, 333-7838
STATEMENT OF PURPOSE/FISCAL NOTE H 655