2005 Idaho Code - 41-4123 — COVERAGE FROM MOMENT OF BIRTH -- COMPLICATIONS OF PREGNANCY

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 41
              JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS
    41-4123.  COVERAGE FROM MOMENT OF BIRTH -- COMPLICATIONS OF PREGNANCY. (1)
Every joint public agency self-funded plan issued in this state or providing
coverage to any covered family residing within this state, shall contain a
provision granting immediate accident and sickness coverage, from and after
the moment of birth, to each newborn child or infant of any covered family,
including a newborn child placed with the adoptive covered family within sixty
(60) days of the adopted child's date of birth. Coverage under the joint
public agency self-funded plan for an adopted newborn child placed with the
adoptive covered family 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 accordance 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 reached eighteen (18) years
of age 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 covered family, 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
covered family 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 covered family
continues in the same manner as it would with respect to a naturally born
child of the covered family until the first to occur of the following events:
    (a)  The date the child is removed permanently from that placement and the
    legal obligation terminates; or
    (b)  The date the covered family rescinds, in writing, the agreement of
    adoption or agreement assuming financial responsibility.
    No such plan may be issued or amended if it contains any disclaimer,
waiver, or other limitation of coverage relative to the coverage or
insurability of newborn or adopted children or infants of a covered family
covered from and after the moment of birth that is inconsistent with the
provisions of this section.
    (2)  An insurer shall not restrict coverage under a joint public agency
self-funded plan 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 while the participant or beneficiary is
eligible for coverage under the plan.
    (3)  No joint public agency self-funded plan which provides maternity
benefits for a person covered continuously from conception shall be issued,
amended, delivered, or renewed in this state 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 plan. If a fixed
amount is specified in such plan 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 plan. Where the
plan 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 plan.
    For purposes of this subsection (3), involuntary complications of
pregnancy shall include, but not be limited to, puerperal infection,
eclampsia, cesarean section delivery, ectopic pregnancy, and toxemia.
    All plans subject to this subsection (3) and issued, amended, delivered,
or renewed in this state shall be construed to be in compliance with this
section, and any provision in any such plan which is in conflict with this
section shall be of no force or effect.