2005 Idaho Code - 41-4712 — SMALL EMPLOYER HEALTH BENEFIT PLANS

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 47
                            SMALL EMPLOYER HEALTH
                          INSURANCE AVAILABILITY ACT
    41-4712.  SMALL EMPLOYER HEALTH BENEFIT PLANS. (1) The board, in addition
to its other powers and duties, shall establish the form and level of
coverages, including benefit levels, cost-sharing levels, exclusions and
limitations for the small employer basic, standard and catastrophic health
benefit plans to be made available by small employer carriers pursuant to
section 41-4708, Idaho Code, with an emphasis on making coverage available for
preventive care.
    (2)  The board shall also design a small employer basic, standard and
catastrophic health benefit plan which each contain benefit and cost-sharing
levels that are consistent with the basic method of operation and the benefit
plans of managed care organizations, including any restrictions imposed by
federal law. The plans or changes established by the board may include cost
containment features such as:
    (a)  Utilization review of health care services, including review of
    medical necessity of hospital and physician services;
    (b)  Case management;
    (c)  Selective contracting with hospitals, physicians and other health
    care providers;
    (d)  Reasonable benefit differentials applicable to providers that
    participate or do not participate in arrangements using restricted network
    provisions; and
    (e)  Other managed care provisions.
    (3)  The board shall submit the plans or changes approved by the board to
the director for approval not later than March 1 of each year. The director
shall promulgate the approved plans pursuant to the provisions of section
41-4715, Idaho Code.
    (4)  Small employer carriers desiring to issue a small employer basic,
standard or catastrophic health benefit plan differing from the form and level
of coverage approved by the board and the director shall submit such plan to
the board for review to insure that such proposed plan is commensurate with
the benefit levels, cost-sharing levels, exclusions, and limitations for the
plan developed and approved pursuant to the provisions of this section.
    (5)  The board may appoint an advisory committee to assist in the
development of and any changes to the small employer basic, standard and
catastrophic health benefit plans.