TITLE 41

INSURANCE

CHAPTER 52

INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT

41-5210.  Application to become a risk-assuming carrier. (1) An individual carrier may apply to become a risk-assuming carrier by filing an application with the director in a form and manner prescribed by the director.

(2)  The director shall consider the following factors in evaluating an application filed under the provisions of subsection (1) of this section:

(a)  The carrier’s financial condition;

(b)  The carrier’s history of rating and underwriting individuals;

(c)  The carrier’s commitment to market fairly to all individuals in the state or its established geographic service area, as applicable;

(d)  The carrier’s experience with managing the risk of individuals; and

(e)  The extent to which a carrier has and will be able to maintain reinsurance pursuant to the provisions of subsection (3) of section 41-5204, Idaho Code.

(3)  The director shall provide public notice of an application by an individual carrier to be a risk-assuming carrier and shall provide at least a sixty (60) day period for public comment prior to making a decision on the application. If the application is not acted upon within ninety (90) days of the receipt of the application by the director, the carrier may request a hearing.

(4)  The director may rescind the approval granted to a risk-assuming carrier under the provisions of this section if the director finds that:

(a)  The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to individuals in compliance with the provisions of section 41-5208, Idaho Code, without the protection afforded by the program;

(b)  The carrier has failed to market fairly to all individuals in the state or its established geographic service area, as applicable; or

(c)  The carrier has failed to provide coverage to eligible individuals as required in section 41-5208, Idaho Code.

(5)  An individual carrier electing to be a risk-assuming carrier shall not be subject to the provisions of section 41-4711, Idaho Code, except to the extent such individual carrier is subject to assessment for additional funding pursuant to the provisions of subsection (12)(c) of section 41-4711, Idaho Code.

History:

[41-5210, added 1994, ch. 427, sec. 1, p. 1347.]