US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 47
                            SMALL EMPLOYER HEALTH
                          INSURANCE AVAILABILITY ACT
    41-4716.  STANDARDS TO ASSURE FAIR MARKETING. (1) Each small employer
carrier shall actively market health benefit plan coverage, including the
small employer basic, standard and catastrophic health benefit plans, to
eligible small employers in the state.
    (2)  (a) Except as provided in subsection (2)(b) of this section, no small
    employer carrier or agent shall, directly or indirectly, engage in the
    following activities:
         (i)   Encouraging or directing small employers to refrain from filing
         an  application for coverage with the small employer carrier because
         of the health status, claims experience, industry, occupation or
         geographic location of the small employer;
         (ii)  Encouraging or directing small employers to seek coverage from
         another carrier because of the health status, claims experience,
         industry, occupation or geographic location of the small employer.
    (b)  The provisions of subsection (2)(a) of this section shall not apply
    with respect to information provided by a small employer carrier or agent
    to a small employer regarding the established geographic service area or a
    restricted network provision of a small employer carrier.
    (3)  (a) Except as provided in subsection (2)(b) of this section, no small
    employer carrier shall, directly or indirectly, enter into any contract,
    agreement or arrangement with an agent that provides for or results in the
    compensation paid to an agent for the sale of a health benefit plan to be
    varied because of the health status, claims experience, industry,
    occupation or geographic location of the small employer.
    (b)  The provisions of subsection (a) of this section shall not apply with
    respect to a compensation arrangement that provides compensation to an
    agent on the basis of percentage of premium, provided that the percentage
    shall not vary because of the health status, claims experience, industry,
    occupation or geographic area of the small employer.
    (4)  A small employer carrier shall provide reasonable compensation, as
provided under the plan of operation of the program, to an agent, if any, for
the sale of a small employer basic, standard or catastrophic health benefit
plan.
    (5)  No small employer carrier may terminate, fail to renew or limit its
contract or agreement of representation with an agent for any reason related
to the health status, claims experience, occupation or geographic location of
the small employers placed by the agent with the small employer carrier.
    (6)  No small employer carrier or agent may induce or otherwise encourage
a small employer to separate or otherwise exclude an employee from health
coverage or benefits provided in connection with the employee's employment.
    (7)  Denial by a small employer carrier of an application for coverage
from a small employer shall be in writing and shall state the reason or
reasons for the denial.
    (8)  The director may establish rules setting forth additional standards
to provide for the fair marketing and broad availability of health benefit
plans to small employers in this state.
    (9)  (a) A violation of the provisions of this section by a small employer
    carrier or an agent shall be an unfair trade practice pursuant to the
    provisions of section 41-1302, Idaho Code.
    (b)  If a small employer carrier enters into a contract, agreement or
    other arrangement with a third-party administrator to provide
    administrative, marketing or other services related to the offering of
    health benefit plans to small employers in this state, the third-party
    administrator shall be subject to the provisions of this section as if it
    were a small employer carrier.