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The following questions have been received by the Idaho Department of Insurance regarding the Idaho Health Insurance Exchange and SHOP (Idaho Exchange), the filing process, Qualified Health Plan standards, and other related topics. The answers are intended to offer guidance on current issues based on the DOI’s current understanding of applicable federal and state law requirements. If you have any concerns regarding the accuracy of any of the guidance, please contact Wes Trexler at the DOI by phone at 208-334-4315 or email. The DOI will continue to release additional information and revise these responses as needed.


Check out our other ACA FAQ pages: 2013, 2014, 2015, 2016/2017
Will the Idaho DOI continue to allow transitional or “grandmothered” plans in the individual and small group market for 2015, for 2016, and beyond?


Mid-size group plans (51-100), currently considered part of the large group market, will be redefined as small group plans for plan years beginning on or after January 1, 2016. Are these mid-size groups eligible for the transitional or “grandmothered” option, and if so, may they retain their current benefit design?


According to DOI’s 2013 Frequently Asked Questions, the federal method of counting employees, provided by the IRS at 26 USC 4980H will be used beginning January 1, 2016, replacing the method found in Idaho Code section 41-4703(28). Does this mean that current small employer groups must be recalculated using the federal method to determine whether they retain small group status?


When a grandfathered mid-size group is redefined as a small group (for plan years beginning on or after January 1, 2016), will they lose grandfathered status?


Two or more businesses may be affiliated (under control of a single entity, per Idaho Code section 41-4703(2)). In situations where each business has fewer than 50 (or 100 beginning 1/1/2016) employees, but the total number of employees exceeds 50 (or 100 beginning 1/1/2016), are the affiliated businesses considered one large employer? If so, may each employer be issued a separate policy?


Has DOI established a filing timeline for large groups?


The final 2016 Benefit and Payment Parameters rule modified the 2016 open enrollment period to November 1, 2015 through January 31, 2016. Does this change any of the dates in the DOI’s February 3, 2015 QHP Standards timeline?


What date can a carrier begin marketing 2016 QHPs?


Are there any Essential Health Benefit corrections needed for the 2016 QHP templates?


Regarding rate development, how should the age calibration and the age curve be applied to the plan adjusted index rate?


Regarding rate development, can consumer adjusted premium rates by rounded to the nearest dollar or some other rounding other than nearest penny?


Can a carrier apply an open enrollment period that is broader than the federally mandated open enrollment period?


The 2016 Benefit and Payment Parameters clarified that the self-only maximum out-of-pocket applies even for policies that are not self-only. Does this apply for High Deductible Health Plans as well as PPO plans?


In order to exclude pediatric dental coverage from a QHP, as explained in Idaho DOI Bulletin 14-02, there must be at least one Exchange-certified stand-alone dental plan available in the market. Is this the case for 2016 plans?


Regarding the Plans and Benefits template, what expectations does the DOI have around SBC and Plan Brochure URLs?


What method of counting employees will be used for the purpose of determining whether a group is defined as a small employer group?



If your question is not answered above, please submit your question directly to the DOI.


Check out our other ACA FAQ pages: 2013, 2014, 2015, 2016/2017

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