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Group Health Insurance

Idaho Code, Title 41, Chapter 47, the Small Employer Health Insurance Availability Act, provides that every health insurance company must, as a condition of transacting small employer business in Idaho, actively offer the company’s health benefit plans* to Idaho small employers.

“Small employer” means a business that employs at least two but no more than 50 eligible employees, the majority of whom are employed within Idaho. “Eligible employee” means an employee who works on a full-time basis and has a normal work week of 30 or more hours (or down to 20 hours by agreement between the employer and insurance company).

The act applies to any health benefit plan that provides coverage to the employees of a small employer if:

  • Any portion of the premium or benefits is paid by or on behalf of the small employer;
  • An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium; or
  • The health benefit plan is treated by the employer, employee, or dependent as a part of a plan or program under certain IRS rules.

All insurance companies writing coverage in the small employer market must actively market all health benefit plans to small employers regardless of the health condition of the eligible employees. These companies may not use medical underwriting to deny coverage. The companies must follow fair marketing standards as set by the act. Insurance companies may offer small employer health benefit plans through Idaho’s insurance marketplace, Your Health Idaho or off the marketplace, or both.

A company or agent may not encourage an eligible group to refrain from applying or to apply with another company due to the health status, claims experience, industry, occupation, or geographic location of the small employer. No company or agent may induce or otherwise encourage a small employer to separate or exclude an employee or eligible dependent from coverage. The insurance company may impose minimum participation or contribution levels, and must apply these levels uniformly to all small employers.

The act and the Department’s Rule, IDAPA 18.04.12, require a company to disclose its rating practices to a small employer 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
  • Geography
  • 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.

On and after January 1, 2014, health benefit plans for small employers may no longer apply Idaho’s laws regarding preexisting conditions and portability. (§41-4708)

The act provides that a health benefit plan is renewable at the small employer’s option, except due to circumstances such as: nonpayment of premium; fraud or misrepresentation by the small employer; or the small employer did not comply with the company’s minimum participation or contribution requirements. (§41-4707)

The Idaho Department of Insurance maintains a list of the health insurance companies approved to offer small employer 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. (§ 41-4703)

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