2005 Idaho Code - 41-4707 — RENEWABILITY OF COVERAGE

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 47
                            SMALL EMPLOYER HEALTH
                          INSURANCE AVAILABILITY ACT
    41-4707.  RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
the provisions of this chapter shall be renewable with respect to all eligible
employees or dependents, at the option of the small employer, except in any of
the following cases:
    (a)  Nonpayment of the required premiums;
    (b)  Fraud or intentional misrepresentation of material fact by the small
    employer;
    (c)  Noncompliance with the carrier's minimum participation requirements;
    (d)  Noncompliance with the carrier's employer contribution requirements;
    (e)  In the case of health benefit plans that are made available in the
    small employer market only through one (1) or more associations as defined
    in section 41-2202, Idaho Code, the membership of an employer in the
    association, on the basis of which the coverage is provided ceases, but
    only if the coverage is terminated under this paragraph uniformly without
    regard to any health status-related factor relating to any covered
    individual;
    (f)  The small employer no longer meets the requirements of section
    41-4703(28), Idaho Code;
    (g)  The small employer carrier elects, at the time of coverage renewal,
    to discontinue offering a particular health benefit plan delivered or
    issued for delivery to small employers in this state. Unless otherwise
    authorized in advance by the department of insurance, a carrier may
    discontinue a product only after the product has been in use for at least
    thirty-six (36) consecutive months, provided the carrier may not
    discontinue more than fifteen percent (15%) of its total number of
    employees and dependents in all lines of business regulated by this
    chapter in a twelve (12) month period. The carrier shall:
         (i)   Provide advance written or electronic notice of its decision
         under this paragraph to the director;
         (ii)  Provide notice of the discontinuation to all affected employers
         and employees or dependents at least ninety (90) calendar days prior
         to the date the particular health benefit plan will be discontinued
         by the carrier, provided that notice to the director under the
         provisions of this paragraph shall be provided at least fourteen (14)
         calendar days prior to the notice to the affected employers;
         (iii) Offer to each affected employer, on a guaranteed issue basis,
         the option to purchase all other health benefit plans currently being
         offered by the carrier to small employers in this state;
         (iv)  In exercising the option to discontinue the health benefit plan
         and in offering the option to purchase all other health benefit plans
         under the provisions of this paragraph, act uniformly without regard
         to:
              1.  The claims experience of an affected employer;
              2.  Any health status-related factor relating to any affected
              employee or dependent; or
              3.  Any health status-related factor relating to any new
              employee or dependent who may become eligible for the coverage;
              and
         (v)  Offer the new products at rates that comply with section
         41-4706(1)(c), Idaho Code.
    (h)  The small employer carrier elects to nonrenew all of its health
    benefit plans delivered or issued for delivery to small employers in this
    state. In such a case the carrier shall:
         (i)   Provide advance notice of its decision under this paragraph to
         the director in each state in which it is licensed; and
         (ii)  Provide notice of the decision not to renew coverage to all
         affected small employers and to the director at least one hundred
         eighty (180) calendar days prior to the nonrenewal of any health
         benefit plans by the carrier. Notice to the director under the
         provisions of this paragraph shall be provided at least three (3)
         working days prior to the notice to the affected small employers; or
    (i)  The director finds that the continuation of the coverage would:
         (i)   Not be in the best interests of the policyholders or
         certificate holders; or
         (ii)  Impair the carrier's ability to meet its contractual
         obligations.
    In such instance the director shall assist affected small employers in
    finding replacement coverage.
    (2)  A small employer carrier that elects not to renew a health benefit
plan under the provisions of subsection (1)(h) of this section shall be
prohibited from writing new business in the small employer market in this
state for a period of five (5) years from the date of notice to the director.
    (3)  In the case of a small employer carrier doing business in one (1)
established geographic service area of the state, the rules set forth in this
subsection shall apply only to the carrier's operations in that service area.