T41CH61

Title 41 > T41CH61

Sections (9)

41-6101

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6101. short title. This chapter shall be known and may be cited as the Idaho Health Insurance Exchange Act. History: [41-6101, added 2013, ch. 170, sec. 1, p. 390.]

41-6102

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6102. purpose and intent. It is the public policy of the state of Idaho to actively resist federal actions that would limit or override state sovereignty under the 10th amendment of the United States constitution. Through this legislation, the state of Idaho asserts its sovereignty by refusing to surrender decision-making authority over health care issues, which are matters appropriately left to states and individual citizens. The purpose of this chapter is to establish a state-created, market-driven health insurance exchange that will facilitate the selection and purchase of individual and employer health benefit plans. The creation of a state-based health insurance exchange will provide an Idaho-specific solution that fits the unique needs of the state of Idaho. Participation in the exchange is voluntary in that no person or employer shall be required by this chapter to purchase a health benefit plan through the exchange. Creation of the exchange and its operation is deemed a public purpose intended to enhance Idaho residents’ choice regarding options and access to health insurance. History: [41-6102, added 2013, ch. 170, sec. 1, p. 390.]

41-6103

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6103. definitions. For the purposes of this chapter: (1) Board means those individuals who, acting as a board of directors of the exchange, govern and act for the exchange pursuant to section 41-6104 , Idaho Code. (2) Conflict of interest means that by taking any action or making any decision or recommendation on a matter within the authority of the board, a member of the board, or a person within the member’s household, or any entity with which the member, or a person within the member’s household is associated, would receive a pecuniary benefit or detriment, unless the pecuniary benefit or detriment would apply to the same degree to a class consisting of all persons within the particular class in this state. (3) Director means the director of the department of insurance of the state of Idaho. (4) Exchange means the Idaho health insurance exchange established pursuant to this chapter. (5) Health carrier has the same meaning as carrier as set forth in section 41-5203 (5), Idaho Code. (6) Person has the same meaning as set forth in section 41-104 , Idaho Code. (7) Producer has the same meaning as set forth in section 41-1003 (8), Idaho Code. (8) Stand-alone dental plan means a policy, certificate of insurance or subscriber contract that provides only dental health plan benefits, which may include adult, pediatric or both, and is approved by the department of insurance as being in compliance with the requirements of state law and departmental rules relating to such policy, certificate of insurance or subscriber contract. History: [41-6103, added 2013, ch. 170, sec. 1, p. 391; am. 2015, ch. 193, sec. 1, p. 602.]

41-6104

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6104. establishment of the exchange and the board. (1) There is hereby created an independent body corporate and politic to be known as the Idaho Health Insurance Exchange. Said exchange may exercise the authority and powers conferred by this chapter and such exercise shall be deemed and held to be the performance of an essential public function. (2) The exchange created by this chapter is not a state agency, shall not be subject to the purchasing statutes and rules of the state of Idaho or subdivisions of the state including, but not limited to, chapters 28 and 57, title 67 , Idaho Code, and shall operate subject to the supervision and control of its board. (3) The board shall consist of nineteen (19) total members, with seventeen (17) voting members. Subject to the provisions of this section, members of the board shall collectively offer expertise, knowledge and experience in health benefits administration, health care finance, health plan purchasing, health care delivery system administration, public health and health policy issues related to small employer and individual markets and the uninsured. A majority of the board shall not collectively represent health carriers and producers. The fourteen (14) voting members who are not members of the legislature shall be appointed to the board by, and serve at the pleasure of, the governor. The members appointed to the board by the governor shall be subject to confirmation by the senate, provided that, upon appointment, board members shall have full authority to exercise all the rights and duties and participate in all decisions required of the position. The seventeen (17) voting members of the board shall be appointed as follows: (a) Three (3) members representing different health carriers appointed by the governor; (b) Two (2) members representing producers appointed by the governor; (c) Three (3) members representing individual consumer interests appointed by the governor; (d) Four (4) members representing small employer business interests appointed by the governor with, at the time of appointment: (i) One (1) member representing small employer business interests employing between one (1) and ten (10) employees; (ii) One (1) member representing small employer business interests employing between eleven (11) and twenty-five (25) employees; (iii) One (1) member representing small employer business interests employing twenty-six (26) or more employees; and (iv) One (1) at-large member; (e) Two (2) members representing health care providers appointed by the governor; (f) One (1) member of the house of representatives appointed by the speaker of the house; (g) One (1) member of the senate appointed by the president pro tempore; and (h) One (1) member of the legislature representing the minority party in the legislature appointed by minority leadership. The director or his designee and the director of the state department of health and

41-6105

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6105. powers and authority of the exchange. (1) Unless otherwise required by this chapter, in the discretion of the board, the exchange shall have the powers and authority to: (a) Perform all duties that are necessary and appropriate to implement a health insurance exchange and the provisions of this chapter; (b) Adopt bylaws for the regulation of its affairs and the conduct of its business, subject to the review and approval by the director. The director’s consent shall be required for any amendment to the bylaws; (c) Assess and collect fees from participating health carriers, exchange users and receive funds from any other source, that shall be used solely for the purposes of this chapter. The exchange shall not be subject to income tax imposed by the state of Idaho under chapter 30, title 63 , Idaho Code; (d) Appoint any advisory committees as deemed necessary by the board; (e) Take any legal action to recover any amounts lawfully owed to the exchange or otherwise consistent with this chapter; (f) Enter into contracts to effectuate and implement a health insurance exchange and shall accept requests for proposal to bid on such contracts; and (g) Develop, adopt and implement a plan of operation and other governing documents to fulfill the requirements of this chapter. (2) The exchange powers and authority shall be subject to the following limitations: (a) The exchange shall not have the power to alter its own legal structure; (b) The exchange shall be financially self-supporting and shall not request any financial support from the state and shall not have the power to tax or encumber state assets; (c) (i) The exchange shall be a voluntary marketplace with the purpose of preserving individual choice and facilitating the informed selection and purchase of health benefit plans by eligible individuals, eligible employers and eligible employees. To that end the exchange portal shall be constructed to permit health insurance shoppers to anonymously input information to comparison shop, and only upon submission of an application require login names, passwords and identifying information. (ii) Neither the exchange nor any agency of the state of Idaho shall require any person to use or participate in the exchange, nor have the authority to impose upon or collect from a person any penalty for failure or refusal to participate in the exchange or to purchase a health benefit plan or stand-alone dental plan. (iii) The exchange shall provide as part of the application process for any person qualifying for premium assistance through the exchange a prominent warning advising purchasers to estimate income for the year carefully, that underestimating income can result in an overpayment of premium assistance and that an overpayment of premium assistance will likely result in owing the overpayment back to the internal revenue service. (d) The exchange shall not prohibit a health carrier from parti

41-6106

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6106. report. (1) The exchange shall submit a written report of its activities and the condition of the exchange to the director, the governor and the director of the legislative services office for distribution to all legislators on or before January 31, 2014, and annually on or before each January 31 thereafter. The exchange shall also report to the appropriate senate and house of representatives germane committees on any changes to its bylaws or policies and any changes or updates from the federal department of health and human services (HHS) regarding essential health benefits or operation or conditions of the exchange on or before January 31, 2014, and annually on or before each January 31 thereafter. (2) For any changes by the board to the fee schedule charged to exchange users or participants, the exchange shall, at the next legislative session, report to the appropriate senate and house of representatives germane committees on or before January 31. History: [41-6106, added 2013, ch. 170, sec. 1, p. 394.]

41-6107

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6107. relation to other laws. The board and the exchange are entitled to rely upon work performed by the director and the director of the Idaho department of health and welfare in furtherance of the purpose of this chapter that are not otherwise inconsistent with their respective statutory duties and authority. Nothing in this chapter, and no action taken by the exchange pursuant to this chapter, shall be construed to preempt or supersede the authority of the director to regulate the business of insurance within this state pursuant to title 41 , Idaho Code, and administer and enforce rules adopted in accordance therewith. History: [41-6107, added 2013, ch. 170, sec. 1, p. 394.]

41-6108

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6108. IDAHO CONTRACTORS IN A HEALTH INSURANCE EXCHANGE. Pursuant to sections 41-6104 and 41-6105 , Idaho Code, the board shall, to the fullest extent practicable, enter into contracts with businesses conducting business in Idaho and employing citizens of this state to staff and provide support for the exchange. History: [41-6108, added 2013, ch. 170, sec. 1, p. 394.]

41-6109

TITLE 41 INSURANCE CHAPTER 61 IDAHO HEALTH INSURANCE EXCHANGE ACT 41-6109. severability. The provisions of this act are hereby declared to be severable, and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act. History: [41-6109, added 2013, ch. 170, sec. 1, p. 394.]