TITLE 41

INSURANCE

CHAPTER 47

SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT

41-4707.  Renewability of coverage. (1) A health benefit plan subject to the provisions of this chapter shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases:

(a)  Nonpayment of the required premiums;

(b)  Fraud or intentional misrepresentation of material fact by the small employer;

(c)  Noncompliance with the carrier’s minimum participation requirements;

(d)  Noncompliance with the carrier’s employer contribution requirements;

(e)  In the case of health benefit plans that are made available in the small employer market only through one (1) or more associations as defined in section 41-2202, Idaho Code, the membership of an employer in the association, on the basis of which the coverage is provided ceases, but only if the coverage is terminated under this paragraph uniformly without regard to any health status-related factor relating to any covered individual;

(f)  The small employer no longer meets the requirements of section 41-4703(28), Idaho Code;

(g)  The small employer carrier elects, at the time of coverage renewal, to discontinue offering a particular health benefit plan delivered or issued for delivery to small employers in this state. Unless otherwise authorized in advance by the department of insurance, a carrier may discontinue a product only after the product has been in use for at least thirty-six (36) consecutive months, provided the carrier may not discontinue more than fifteen percent (15%) of its total number of employees and dependents in all lines of business regulated by this chapter in a twelve (12) month period. The carrier shall:

(i)   Provide advance written or electronic notice of its decision under this paragraph to the director;

(ii)  Provide notice of the discontinuation to all affected employers and employees or dependents at least ninety (90) calendar days prior to the date the particular health benefit plan will be discontinued by the carrier, provided that notice to the director under the provisions of this paragraph shall be provided at least fourteen (14) calendar days prior to the notice to the affected employers;

(iii) Offer to each affected employer, on a guaranteed issue basis, the option to purchase all other health benefit plans currently being offered by the carrier to small employers in this state;

(iv)  In exercising the option to discontinue the health benefit plan and in offering the option to purchase all other health benefit plans under the provisions of this paragraph, act uniformly without regard to:

1.  The claims experience of an affected employer;

2.  Any health status-related factor relating to any affected employee or dependent; or

3.  Any health status-related factor relating to any new employee or dependent who may become eligible for the coverage; and

(v)  Offer the new products at rates that comply with section 41-4706(1)(c), Idaho Code.

(h)  The small employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to small employers in this state. In such a case the carrier shall:

(i)   Provide advance notice of its decision under this paragraph to the director in each state in which it is licensed; and

(ii)  Provide notice of the decision not to renew coverage to all affected small employers and to the director at least one hundred eighty (180) calendar days prior to the nonrenewal of any health benefit plans by the carrier. Notice to the director under the provisions of this paragraph shall be provided at least three (3) working days prior to the notice to the affected small employers; or

(i)  The director finds that the continuation of the coverage would:

(i)   Not be in the best interests of the policyholders or certificate holders; or

(ii)  Impair the carrier’s ability to meet its contractual obligations.

In such instance the director shall assist affected small employers in finding replacement coverage.

(2)  A small employer carrier that elects not to renew a health benefit plan under the provisions of subsection (1)(h) of this section shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the director.

(3)  In the case of a small employer carrier doing business in one (1) established geographic service area of the state, the rules set forth in this subsection shall apply only to the carrier’s operations in that service area.

History:

[41-4707, added 1993, ch. 176, sec. 1, p. 443; am. 1994, ch. 427, sec. 5, p. 1356; am. 1995, ch. 360, sec. 12, p. 1262; am. 1997, ch. 321, sec. 13, p. 968; am. 1998, ch. 143, sec. 2, p. 511; am. 2000, ch. 472, sec. 4, p. 1611; am. 2006, ch. 353, sec. 2, p. 1080.]