2005 Idaho Code - 41-5207 — RENEWABILITY OF COVERAGE

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 52
                 INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT
    41-5207.  RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to
the provisions of this chapter shall be renewable with respect to the
individual or dependents, at the option of the individual, except in any of
the following cases:
    (a)  Nonpayment of the required premiums;
    (b)  Fraud or intentional misrepresentation of material fact by the
    individual insured or his representatives. An individual whose coverage is
    terminated for fraud or misrepresentation shall not be deemed to be an
    "eligible individual" for a period of twelve (12) months from the
    effective date of the termination of the individual's coverage and shall
    not be deemed to have "qualifying previous coverage" under chapter 22, 47
    or 52, title 41, Idaho Code;
    (c)  The individual ceases to be an eligible individual as defined in
    section 41-5203(10), Idaho Code;
    (d)  In the case of health benefit plans that are made available in the
    individual market only through one (1) or more associations, as defined in
    section 41-2202, Idaho Code, the membership of an individual 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;
    (e)  The individual carrier elects, at the time of coverage renewal, to
    discontinue offering a particular health benefit plan delivered or issued
    for delivery to individuals 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 individuals 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
         individuals 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 individuals;
         (iii) Offer to each affected individual, on a guaranteed issue basis,
         the option to purchase all other health benefit plans currently being
         offered by the carrier to individuals in this state;
         (iv)  Act uniformly without regard to any health status-related
         factor of an affected individual or dependent of an affected
         individual who may become eligible for the coverage; and
         (v)  Offer the new products at rates that comply with section
         41-5206(1)(b), Idaho Code.
    (f)  The individual carrier elects to nonrenew all of its health benefit
    plans delivered or issued for delivery to individuals in this state. In
    such a case the carrier shall:
         (i)   Provide advance notice of its decision under this paragraph to
         the director; and
         (ii)  Provide notice of the decision not to renew coverage to all
         affected individuals 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 individuals; or
    (g)  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 individuals in
    finding replacement coverage.
    (2)  An individual carrier that elects not to renew a health benefit plan
under the provisions of subsection (1)(f) of this section shall be prohibited
from writing new business in the individual market in this state for a period
of five (5) years from the date of notice to the director.
    (3)  In the case of an individual 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.