Idaho Admin. Code r. 18.04.13.075

Current through September 2, 2024

Section 18.04.13.075 - RULES RELATED TO FAIR MARKETING

01.Individual Carrier to Actively Market. An individual carrier actively markets each of its health benefit plans to individuals in this state.

02.Offer. An individual carrier offers all health benefit plans to any individual that applies for or makes an inquiry regarding health insurance coverage from the individual carrier. The offer may be provided directly to the individual or delivered through a producer. The offer is in writing and includes at least the following information:

a. A general description of the benefits contained in the all actively marketed health benefit plans; and

b. Information describing how the individual may enroll in the plans.

04.Timeliness of Price Quote. An individual carrier provides a price quote to an individual (directly or through an authorized producer) within fifteen (15) working days of receiving a request for a quote and such information as is necessary to provide the quote. An individual carrier notifies an individual (directly or through an authorized producer) within ten (10) working days of receiving a request for a price quote of any additional information needed by the individual carrier to provide the quote.

05.Restrictions as to Application Process. An individual carrier will not apply more stringent or detailed requirements related to the application process for the mandated health benefit plans than are applied for other health benefit plans offered by the carrier.

06.Denial of Coverage. If an individual carrier denies coverage under a health benefit plan to an individual on the basis of a risk characteristic, the denial is in writing and maintained in the individual carrier's office. This written denial states with specificity the risk characteristic(s) of the individual that made it ineligible for the health benefit plan it requested (for example, health status). The denial is accompanied by a written explanation of the availability of any mandated health benefit plans from the individual carrier. The explanation includes at least the following:

a. A general description of the benefits contained in each such plan;

b. A price quote for each such plan; and

c. Information describing how the individual may enroll in such plans.

d. The written information described in this paragraph may be provided within the time periods provided in Subsection 075.04 directly to the individual or delivered through an authorized producer.

07.Premium Rate Charged. The price quote prescribed under Paragraph 075.06.b. is for the lowest premium rate charged under the rating system for a health benefit plan for which the individual is eligible.

08.Toll-Free Telephone Service. An individual carrier establishes and maintains a toll-free telephone service to provide information to individuals regarding the availability of individual health benefit plans in this state. The service provides information to callers on how to apply for coverage from the carrier. The information may include the names and phone numbers of producers located geographically proximate to the caller or such other information reasonably designed to assist the caller to locate an authorized producer or to apply for coverage.

09.No Requirement to Qualify for Other Insurance Product. An individual carrier will not require, as a condition to the offer of sale of a health benefit plan to an individual, that the individual purchase or qualify for any other insurance product or service.

10.Plans Subject to Requirements. Carriers offering individual health benefit plans in this state are responsible for determining whether the plans are subject to the requirements of the Act and this chapter.

11.Annual Filing Requirement. An individual carrier files annually the following information with the Director related to health benefit plans issued by the individual carrier to individuals in this state on forms prescribed by the Director:

a. The number of individuals that were covered under health benefit plans in the previous calendar year (separated as to newly issued plans and renewals);

b. The number of individuals that were covered under each mandated health benefit plan in the previous calendar year (separated as to newly issued plans and renewals).

c. The number of individual health benefit plans in force in each county (or by five (5) digit zip code) of the state as of December 31 of the previous calendar year;

d. The number of individual health benefit plans that were voluntarily not renewed by Individuals in the previous calendar year;

e. The number of individual health benefit plans that were terminated or non renewed (for reasons other than nonpayment of premium) by the carrier in the previous calendar year; and

f. The number of health benefit plans that were issued to residents that were uninsured for at least the sixty-three (63) days prior to issue.

12.Total Number of Residents. All carriers file annually with the Director, on forms prescribed by the Director, the total number of residents, including spouses and dependents, covered during the previous calendar year under all health benefit plans issued in this state. This includes residents covered under reinsurance by way of excess loss and stop loss plans.

13.Filing Date. The information described in Subsections 075.11 and 075.12 is filed no later than March 15, each year.

14.Specific Data. For purposes of this section, health benefit plan information includes policies or certificates of insurance for specific disease, hospital confinement indemnity, reinsurance by way of excess loss, and stop loss coverages.

Idaho Admin. Code r. 18.04.13.075

Effective March 31, 2022