Idaho Code, Title 41, Chapter 52, is the Individual Health Insurance Availability Act. The purpose of this act is
to make health insurance coverage available to Idaho “eligible individuals” not covered by employment-based insurance.
Idaho residents may be eligible for coverage regardless of their health status or claims experience.
An “eligible individual” means an Idaho resident individual or dependent of an Idaho resident:
- Who is under the age of 65, is not eligible for coverage under a group health plan, for Part A or Part B of
Medicare or for Medicaid, and who does not have other health insurance coverage; or
- Who is a federally eligible individual under the federal law known as HIPAA (1996 Public Law 104-191).
Every insurance company that is approved to market individual health benefit plans* in Idaho must actively offer health
benefit plans to individuals. Companies must follow fair marketing standards set by the act.
Insurance companies may offer individual health benefit plans through Idaho’s insurance marketplace,
Your Health Idaho or off the marketplace, or both.
However, premium subsidies (advanced premium tax credit or APTC) are available to individuals only if the health
benefit plan is purchased through Your Health Idaho.
A company or agent may not encourage an individual to refrain from applying or to apply with another company due
to the health status, claims experience, industry, occupation, or geographic location of the individual.
The act and the Department’s Rule, IDAPA 18.01.72, require a company to disclose its rating practices to an
individual purchasing a health benefit plan. The act and rule give the Department oversight to prevent abusive
rating practices. On and after January 1, 2014, the only rate variables an insurance company may use are:
- An individual’s age
- Tobacco use
- Family composition
An insurance company may not refuse to insure or charge higher premiums to individuals with medical problems or charge
different premiums for men and women.
Idaho Code, Title 41, Chapter 55, enacted the Idaho Individual High Risk Reinsurance Pool effective January 1, 2001.
There are five High Risk Reinsurance Pool Plans (HRP Plans): Basic, Standard, Catastrophic A, Catastrophic B and the
HSA Compatible Plan. Insurance companies are not required to offer HRP Plans to individuals for effective dates on
and after January 1, 2014. HRP Plans are considered “minimum essential coverage” through plan years beginning in
December 2014. The five HRP Plan designs are included in the Department’s Rule, IDAPA 18.01.73, and in the
sample policy of insurance.
On and after January 1, 2014, health benefit plans for individuals may no longer apply Idaho’s laws regarding
preexisting conditions and portability. (§ 41-5208)
ALL health benefit plans are renewable at the insured’s option, except due to circumstances such as: nonpayment of
premium; fraud or misrepresentation; or the insured ceases to be an “eligible individual.” (§ 41-5207)
The Idaho Department of Insurance maintains a list of the health insurance companies approved to offer
individual health benefit plans.
*”Health benefit plan” means a hospital or medical policy or certificate.
“Health benefit plan” does not include a policy or certificate for specific disease, hospital confinement indemnity,
accident-only, credit, dental, vision, Medicare supplement, long-term care, disability income insurance, student health
benefits-only coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance,
automobile medical payment insurance, or nonrenewable short-term coverage issued for a period of 12 months or less.
Need more info? Contact us at 208 334-4319 or email us .
Consumer Affairs Officers are available to answer your questions 8-5 M-F MST