2005 Idaho Code - 41-5505 — REINSURANCE

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 55
                 IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL
    41-5505.  REINSURANCE. (1) Any individual carrier issuing an individual
basic, standard, catastrophic A, catastrophic B, or HSA compatible health
benefit plan as provided in this chapter shall be reinsured by the pool to the
level of coverage provided in the plan and shall be liable to the pool for the
reinsurance premium.
    (2)  (a) The pool shall not reimburse a reinsuring carrier with respect to
    the claims of a reinsured individual or dependent until the carrier has
    incurred an initial level of claims for such individual or dependent of
    five thousand dollars ($5,000) in a calendar year for benefits covered by
    the pool. In addition, the reinsuring carrier shall be responsible for ten
    percent (10%) of the next twenty-five thousand dollars ($25,000) of
    benefit payments during a calendar year and the pool shall reinsure the
    remainder.
    (b)  The board annually may adjust the initial level of claims and the
    maximum limit to be retained by the carrier to reflect increases in costs
    and utilization within the standard market for health benefit plans within
    the state. The adjustment shall not be less than the annual change in the
    medical component of the "Consumer Price Index for All Urban Consumers" of
    the department of labor, bureau of labor statistics, unless the board
    proposes and the director approves a lower adjustment factor.
    (3)  A reinsuring carrier shall apply all managed care and claims handling
techniques, including utilization review, individual case management,
preferred provider provisions, and other managed care provisions or methods of
operation consistently with respect to reinsured and nonreinsured business.
    (4)  Each carrier shall make a filing with the director containing the
carrier's earned health insurance premium derived from health benefit plans
delivered or issued for delivery in this state in the previous calendar year.
    (5)  Each carrier shall file with the director, in a form and manner to be
prescribed by the director, an annual report. The report shall state the
number of resident persons insured under the carrier's health benefit plan, or
through excess or stop loss coverage.