TITLE 41

INSURANCE

CHAPTER 41

JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS

41-4104.  Qualifications for registration. No joint public agency self-funded plan shall register, and the director shall not register a joint public agency self-funded plan, which is not qualified as provided in this section.

(1)  The joint powers agreement must require all contributions to be paid in advance and to be deposited in and disbursed from a trust fund duly created and existing under an adequate written irrevocable trust agreement between the employer or employers and the board.

(2)  The plan must:

(a)  Have, or provide for, a board of trustees in accordance with this chapter for the administration of the plan;

(b)  Require that all members of the joint powers agreement comply with the provisions of the joint powers agreement;

(c)  Provide that the administrator or board on behalf of the plan, as the case may be, shall furnish to each employee-beneficiary of the plan a written statement or schedule adequately and clearly stating all benefits currently allowable under the plan, together with all applicable restrictions, limitations, and exclusions, and the procedure for filing a claim for benefits; and

(d)  Otherwise be in compliance with the provisions of this chapter.

(3)  The allocated trust fund must be actuarially sound; that is, assets and income of the fund must be adequate under reasonable estimates for payment of all benefits promised to beneficiaries by the plan. In determining actuarial soundness the director shall also give due consideration to:

(a)  Applicable stop-loss insurance provided or to be provided the plan by an insurer duly authorized to transact disability insurance in this state;

(b)  Contracts with health care service corporations or health maintenance organizations authorized to conduct such operations in this state and covering certain of the promised benefits;

(c)  Other applicable insurance or guarantys; and

(d)  The nature of the participating entities and other plan factors or provisions for prevention or reduction of adverse selection against the plan by those otherwise eligible to become beneficiaries.

(4)  The plan shall maintain aggregate stop-loss coverage and specific stop-loss coverage provided by an insurance company authorized to transact insurance in this state in accordance with the annual actuarial opinion of the plan, unless waived pursuant to section 41-4110(3), Idaho Code.

History:

[41-4104, added 2006, ch. 415, sec. 1, p. 1273; am. 2018, ch. 61, sec. 2, p. 152.]