Idaho § 41-5501 - Definitions

§ 41-5501. Definitions

As used in this chapter:

(1) "Agent" means a producer as defined in section 41-1003 (8), Idaho Code.

(2) "Board" means the board of directors of the Idaho individual high risk reinsurance pool established in this chapter.

(3) "Carrier" means any entity that provides, or is authorized to provide, health insurance in this state. For purposes of this chapter, carrier includes an insurance company, any other entity providing reinsurance including excess or stop loss coverage, a hospital or professional service corporation, a fraternal benefit society, a managed care organization, any entity providing health insurance coverage or benefits to residents of this state as certificate holders under a group policy issued or delivered outside of this state, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.

(4) "Dependent" means a spouse, a child or any other individual listed as having coverage under the primary policyholder’s or subscriber’s health benefit plan.

(5) "Director" means the director of the department of insurance of the state of Idaho.

(6) "Eligible individual" means an Idaho resident individual or dependent of an Idaho resident who is:

(a) Not eligible for coverage under a group health benefit plan, part A or part B of title XVIII of the social security act (medicare), or a state plan under title XIX (medicaid) or any successor program, and who does not have other health insurance coverage; and

(b) Enrolled in an individual health benefit plan.

(7) "Health benefit plan" means any hospital or medical policy or certificate, any subscriber contract provided by a hospital or professional service corporation, or health maintenance organization subscriber contract. Health benefit plan does not include policies or certificates of insurance for specific disease, hospital confinement indemnity, accident-only, credit, dental, vision, medicare supplement, long-term care, or disability income insurance, student health benefits only, coverage issued as a supplement to liability insurance, worker’s compensation or similar insurance, automobile medical payment insurance, or nonrenewable short-term coverage issued for a period of twelve (12) months or less.

(8) "High risk medical condition" means a medical condition or diagnosis identified by the board in its plan of operation as making an individual eligible for reinsurance through the pool.

(9) "High risk pool plan" means an individual basic, standard, catastrophic A, catastrophic B, or HSA compatible health benefit plan issued pursuant to this chapter prior to April 1, 2017.

(10) "High risk pool plan premium" means all moneys paid by an individual or a dependent as a condition of receiving coverage from a carrier, including any fees or other contributions associated with the health benefit plan.

(11) "Individual carrier" means a carrier that offers individual health benefit plans.

(12) "Plan of operation" means the plan of operation of the individual high risk reinsurance pool established pursuant to this chapter.

(13) "Pool" means the Idaho individual high risk reinsurance pool.

(14) "Reinsurance premium" means the premium set by the board pursuant to section 41-5506 , Idaho Code, to be paid by a reinsuring carrier for eligible individuals ceded to the pool.

(15) "Reinsuring carrier" means a carrier participating in the individual high risk reinsurance pool established by this chapter.

[41-5501, added 2000, ch. 472, sec. 17, p. 1633; am. 2001, ch. 296, sec. 11, p. 1071; am. 2003, ch. 267, sec. 3, p. 715; am. 2004, ch. 285, sec. 3, p. 806; am. 2004, ch. 332, sec. 2, p. 990; am. 2005, ch. 25, sec. 96, p. 121; am. 2005, ch. 353, sec. 4, p. 1117; am. 2007, ch. 148, sec. 6, p. 439; am. 2008, ch. 297, sec. 1, p. 831; am. 2009, ch. 125, sec. 10, p. 403; am. 2017, ch. 281, sec. 1, p. 733; am. 2025, ch. 49, sec. 13, p. 253.]