2005 Idaho Code - 41-2140 — REQUIRED PROVISIONS

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 21
                        DISABILITY INSURANCE POLICIES
    41-2140.  REQUIRED PROVISIONS. (1) Any disability insurance contract
delivered or issued for delivery in this state which provides coverage for
injury or sickness for newborn dependent children of the insured, shall
provide such coverage for such newborn children,  including adopted newborn
children that are placed with the adoptive insured 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 insured 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
insured, 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 insured 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 an insured continues in the same manner as it would
with respect to a naturally born child of the insured 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 insured rescinds, in writing, the agreement of adoption
    or agreement assuming financial responsibility.
    (2)  An insurer shall not restrict coverage under a disability insurance
policy 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 the child at the time the child would otherwise
become eligible for coverage under the plan, if the adoption or placement for
adoption occurs which 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 individual noncancelable or guaranteed renewable policies,
issued or delivered before January 1, 1977.
    With respect to such individual noncancelable or guaranteed renewable
policies issued or delivered before January 1, 1977, the insurer shall
communicate the availability of coverage of involuntary complications of
pregnancy when negotiating any changes in such policies.
    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.