2005 Idaho Code - 41-2210 — REQUIRED PROVISION IN GROUP AND BLANKET POLICIES

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 22
                         GROUP AND BLANKET DISABILITY
                                  INSURANCE
    41-2210.  REQUIRED PROVISION IN GROUP AND BLANKET POLICIES. (1) Any group
disability insurance contract or blanket disability insurance contract,
delivered or issued for delivery in this state which provides coverage for
injury or sickness for newborn dependent children of subscribers or other
members of the covered group, shall provide coverage for such newborn
children, including adopted newborn children that are placed with the adoptive
subscriber or other member of the covered group within sixty (60) days of the
adopted child's date of birth, from and after the moment of birth. Coverage
under the contract for an adopted newborn child placed with the adoptive
subscriber or other member of the covered group more than sixty (60) days
after the birth of the adopted child shall be from and after the date the
child is so placed. Coverage provided in accord with this section shall
include, but not be limited to, coverage for congenital anomalies. For the
purposes of this section, "child" means an individual who has not attained age
eighteen (18) years as of the date of the adoption or placement for adoption.
For the purposes of this section, "placed" shall mean physical placement in
the care of the adoptive subscriber or other member of the covered group, or
in those circumstances in which such physical placement is prevented due to
the medical needs of the child requiring placement in a medical facility, it
shall mean when the adoptive subscriber or other member of the covered group
signs an agreement for adoption of such child and signs an agreement assuming
financial responsibility for such child. Prior to legal finalization of
adoption, the coverage required under the provisions of this subsection (1) as
to a child placed for adoption with a subscriber or other member of the
covered group continues in the same manner as it would with respect to a
naturally born child of the subscriber or other member of the covered group
until the first to occur of the following events:
    (a)  Date the child is removed permanently from that placement and the
    legal obligation terminates; or
    (b)  The date the subscriber or other member of the covered group
    rescinds, in writing, the agreement of adoption or agreement assuming
    financial responsibility.
    (2)  An insurer shall not restrict coverage under a group disability
insurance contract or a blanket disability insurance contract of any dependent
child adopted by a participant or beneficiary, or placed with a participant or
beneficiary for adoption, solely on the basis of a preexisting condition of a
child at the time the child would otherwise become eligible for coverage under
the plan, if the adoption or placement for adoption occurs while the
participant or beneficiary is eligible for coverage under the plan.
    (3)  No policy of disability insurance which provides maternity benefits
for  a person covered continuously from conception shall be issued, amended,
delivered, or renewed in this state on or after January 1, 1977, if it
contains any exclusion, reduction, or other limitations as to coverage,
deductibles, or coinsurance provisions, as to involuntary complications of
pregnancy, unless such provisions apply generally to all benefits paid under
the policy. If a fixed amount is specified in such policy for surgery, the
fixed amounts for surgical procedures involving involuntary complications of
pregnancy shall be commensurate with other fixed amounts payable for
procedures of comparable difficulty and severity. In a case where a fixed
amount is payable for maternity benefits, involuntary complications of
pregnancy shall be deemed an illness and entitled to benefits otherwise
provided by the policy. Where the policy contains a maternity deductible, the
maternity deductible shall apply only to expenses resulting from normal
delivery and cesarean section delivery; however, expenses for cesarean section
delivery in excess of the deductible shall be treated as expenses for any
other illness under the policy. This section shall apply to all disability
policies except any group disability policy made subject to an applicable
collective-bargaining agreement in effect before January 1, 1977.
    For purposes of this section, involuntary complications of pregnancy shall
include, but not be limited to, puerperal infection, eclampsia, cesarean
section delivery, ectopic pregnancy, and toxemia.
    All policies subject to this section and issued, amended, delivered, or
renewed in this state on or after January 1, 1977, shall be construed to be in
compliance with this section, and any provision in any such policy which is in
conflict with this section shall be of no force or effect.
    (4)  From and after January 1, 1998, no policy of disability insurance
which provides medical expense maternity benefits, shall restrict benefits for
any hospital length of stay in connection with childbirth for the mother or
newborn child in a manner that would be in conflict with the newborns' and
mothers' health protection act of 1996.