2005 Idaho Code - 41-5212 — STANDARDS TO ASSURE FAIR MARKETING

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 52
                 INDIVIDUAL HEALTH INSURANCE AVAILABILITY ACT
    41-5212.  STANDARDS TO ASSURE FAIR MARKETING. (1) Each individual carrier
shall actively market health benefit plan coverage, including the individual
basic, standard, catastrophic A, catastrophic B, and HSA compatible health
benefit plans, to eligible individuals in the state. If an individual carrier
denies coverage to an individual on the basis of the health status or claims
experience of the individual or dependents, the individual carrier shall offer
the individual the opportunity  to purchase an individual basic, standard,
catastrophic A, catastrophic B, or HSA compatible health benefit plan.
    (2)  (a) Except as provided in subsection (2)(b) of this section, no
    individual carrier or agent shall, directly or indirectly, engage in the
    following activities:
         (i)   Encouraging or directing individuals to refrain from filing an
         application for coverage with the individual carrier because of the
         health status, claims experience, industry, occupation or geographic
         location of the individual or dependents.
         (ii)  Encouraging or directing individuals to seek coverage from
         another carrier because of the health status, claims experience,
         industry, occupation or geographic location of the individual.
    (b)  The provisions of subsection (2)(a) of this section shall not apply
    with respect to information provided by an individual carrier or agent to
    an individual regarding the established geographic service area or a
    restricted network provision of an individual carrier.
    (3)  (a) Except as provided in subsection (2)(b) of this section, no
    individual 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
    carried because of the health status, claims experience, industry,
    occupation or geographic location of the individual.
    (b)  The provisions of paragraph (a) of this subsection 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 individual.
    (4)  An individual carrier shall provide reasonable compensation, as
provided under the plan of operation of the individual high risk reinsurance
pool, to an agent, if any, for the sale of an individual basic, standard,
catastrophic A, catastrophic B, or HSA compatible health benefit plan.
    (5)  No individual 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 individuals placed by the agent with the individual carrier.
    (6)  Denial by an individual carrier of an application for coverage from
an individual shall be in writing and shall state the reason or reasons for
the denial.
    (7)  The director may establish rules setting forth additional standards
to provide for the fair marketing and broad availability of health benefit
plans to individuals in this state.
    (8)  (a) A violation of the provisions of this section by an individual
    carrier or an agent shall be an unfair trade practice pursuant to the
    provisions of section 41-1302, Idaho Code.
    (b)  If an individual 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 individuals in this state, the third party administrator shall be
    subject to the provisions of this section as if it were an individual
    carrier.