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Instructions for Completing the Small Group Health Plan Standards Checklist

In an effort to provide better service and faster review of small group health 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, regulations 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 small group health products that have been a recurring source of returned filings. Beginning March 1, 2005, the company representative certifying the filing will be expected to initial each item in 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 March 1, 2005, a filing will be considered incomplete without the submission of the initialed checklist.

Expand Section Filing Requirements

The Small Group Checklist applies to small group policies providing disability coverage. Idaho Code §41-503 defines “disability insurance” as:

(a) 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

(b) A managed care plan for which a certificate of authority is required pursuant to chapter 39, title 41, Idaho Code.

Small Group Health Plans are subject to the provisions of Chapter 22 and Chapter 47, Idaho Code and IDAPA 18.01.69 and IDAPA 18.01.70 also apply. Small group managed care plans are also subject to Title 41, Chapter 39, Idaho Code. The Idaho Code and the Department’s Administrative Rules (IDAPA) can be accessed through this website under “Laws/Rules/Bulletins.”

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