2010 Idaho Code
TITLE 41 INSURANCE
CHAPTER 55 IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL
41-5511 DESIGN OF PRODUCTS.

TITLE 41

INSURANCE

CHAPTER 55

IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL

41-5511. Design of products. (1) The board shall design the individual basic, standard, catastrophic A, catastrophic B, and HSA compatible health benefit plans, with an emphasis on making coverage available for preventive care, and subject to the deductibles and maximum benefits provided in subsection (2) of this section.

(2) (a) The basic health benefit plan shall provide a deductible of five hundred dollars ($500), with a lifetime maximum benefit of five hundred thousand dollars ($500,000) per carrier;

(b) The standard health benefit plan shall provide a deductible of one thousand dollars ($1,000), with a lifetime maximum benefit of one million dollars ($1,000,000) per carrier;

(c) The catastrophic A health benefit plan shall offer a deductible of two thousand dollars ($2,000) and a lifetime maximum benefit of one million dollars ($1,000,000) per carrier;

(d) The catastrophic B health benefit plan shall offer a deductible of five thousand dollars ($5,000) and a lifetime maximum benefit of one million dollars ($1,000,000) per carrier; and

(e) The HSA compatible health benefit plan shall provide a lifetime maximum benefit of one million dollars ($1,000,000) per carrier with a deductible and other cost-sharing features that meet federal high deductible health plan qualifications as defined in public law 108-173, title XII, section 1201(a), 117 stat. 2469.

(3) The board shall establish all other benefit levels, as well as cost sharing arrangements, exclusions and limitations for each health benefit plan. The plan designs for the small employer market shall not necessarily be the same as the plan designs for the individual market.

(4) The board shall also design an individual basic, standard, catastrophic A, catastrophic B, and HSA compatible health benefit plan which each contain benefit and cost-sharing arrangements that are consistent with the basic method of operation and the benefit plans of managed care organizations, including any restrictions imposed by federal law, which may include cost containment features such as the following:

(a) Utilization review of health care services, including review of medical necessity of hospital and physician services;

(b) Case management;

(c) Selective contracting with hospitals, physicians and other health care providers;

(d) Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and

(e) Other managed care provisions.

(5) The board shall submit the health benefit plans or changes described in this section to the director for approval. The director shall promulgate the approved plans in accordance with the provisions of chapter 52, title 67, Idaho Code.

(6) The board may appoint an advisory committee to assist it in developing the health benefit plans prescribed by this section.