Revised Instructions for Completing the Individual Health/Disability and Group
Supplemental Plans Standards Checklist
In an effort to provide better service and faster review of health/disability
policy filings, the Idaho Department of Insurance has prepared the following
checklist and filing instructions. Idaho is a “file and use” state. This means
that it is the company’s responsibility to review all statutes, rules and
bulletins, which may be pertinent to its filings prior to submission of a
filing. A company representative must sign the Idaho Submission
Documentation Form, which certifies the filing is in compliance with all Idaho
laws and administrative rules. Forms that are submitted that do not meet
Idaho’s legal requirements will be disapproved and returned to the company,
which results in significant delays in the filing process.
To assist companies in determining that a filing meets the requirements of
Idaho’s laws and rules, the Department has created a checklist of specific
legal requirements applicable to health/disability products that have been a
recurring source of returned filings. Beginning October 1, 2004, the company
representative certifying the filing will be expected to complete the checklist
below to certify that he or she has reviewed the filing for compliance with the
listed requirement. If a listed requirement is not applicable to the filing,
the representative should designate by inserting “N/A” instead of an
initial. After October 1, 2004, a filing will be considered incomplete
without the required checklist.
Filing Requirements
- As of April 9, 2009, there will be a $20.00 fee for each rate or form filed in excess of ten (10) per calendar year.
- Idaho Code Section 41-1812 requires
the filing of all policy forms for health insurance.
- Each filing must include:
(1) A cover letter describing the filing and explaining the purpose of the filing.
(2) A detailed forms list, including the name of the form, the form number and the form number of the form the filing
replaces, if applicable.
(3) The
ID-FF Certification form, signed by a company representative. Filings
will be returned disapproved if the signed certification form is not included
in the filing along with the initialed Individual Health/Disability and Group
Supplemental Checklist.
(4) Either a duplicate set of the forms or a copy of the cover letter to be
returned to the company notifying it of the status of the filing.
Once you have reviewed the appropriate department checklist, you can download
from the Department’s website the required ID-FF Certification form that must
be submitted with all filings.
Health/Disability
The Health/Disability and Group Supplemental Checklist apply to individual
policies and group supplemental policies providing disability coverage. Idaho
Code §41-503 defines “disability insurance” as:
- Insurance of human beings against bodily injury, disablement, or death by
accident or accidental means, or the expense thereof, or against disablement or
expense resulting from sickness, and every insurance appertaining thereto.
Disability insurance does not include worker's compensation coverages; and
- A managed care plan for which a certificate of authority is required
pursuant to chapter 39, title 41, Idaho Code.
Health/disability plans are subject to the provisions of Chapter 21 and Chapter
42, Idaho Code and IDAPA 18.01.30. If the plan is an individual health benefit
plan, as defined in Title 41, Chapter 52, Idaho Code, then Chapter 52 and IDAPA
18.01.72 and 18.01.73 also apply. Title 41, Chapter 55, Idaho Code applies to
Idaho individual high-risk pool contracts. Individual managed care plans are
also subject to Title 41, Chapter 39, Idaho Code. If the plan is a group
supplemental plan, Chapter 22, of Title 41, Idaho Code and IDAPA 18.01.30
apply. The Idaho Code and the Department’s Administrative Rules (IDAPA) can be
accessed through this website under “Laws/Rules/Bulletins.”
Types of Contracts
IDAPA 18.01.30 (Rule 30) defines the guidelines for the following types of
contracts
| Accident Only Policies |
Major Medical Plans |
| Dental |
Disability Income |
| Home Health Care Only |
Indemnity |
| Short Term Coverages |
Vision |
| Basic Medical Surgical Expense Coverage |
Basic Hospital Medical Surgical Expense |
| Hospital Confinement Indemnity Coverage |
Specified Disease |
| Hospice Care |
Non-Cancer Coverage |
| Cancer Only or Combination Policies |
Basic Hospital Expense Coverage
|
| Per Diem Cancer Coverages |
Lump Sum Indemnity Coverage |
| Specified Accident |
Limited Benefit Health Coverage |
| Group Supplemental Plans |
|
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