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Idaho insurance law and regulation
The Idaho Department of Insurance Web site contains the complete text of the state’s insurance statutes as well as a section that announces and summarizes changes to legislation and administrative rules. Your Health Idaho state exchange opened in 2013.
Idaho also operates a Catastrophic Health Care program that acts as a loan program to pay the expenses of individuals without insurance but then the state places a lien on all assets and collects the money upon sale of the asset or death of the individual.
News that affects your health insurance and planning
March 9, 2020 – About a third of the individuals who purchased health coverage in Idaho did so through health sharing ministries, not health insurance. It is important to understand that the latter can be quite helpful, but are different than insurance. One healthcare ministry in Idaho writes: “We are NOT an insurance company nor is the membership offered through an insurance company, and our organization is not subject to the regulatory requirements or consumer protections of any state insurance code.” Stories of claim denies are not commonplace but do surface in the news more often lately. Consumers in those cases seem to be unaware of the risks of health sharing ministry coverage. Insurance agents who sell health sharing ministries plans alongside insurance may be adding to the lack of public clarity.
May 26, 2019 – Status of alternative non-ACA health plans: Idaho does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
March 20, 2019 – Some Idaho residents believe that their future health benefits depend on the ability of ordinary citizens, and not just rich corporations, to put important issues on the ballot as voter referendums. Protection of the state’s referendum process would preserve the right of citizens to vote for their own interests on issues like Medicaid, prescription drug benefits and Medicare expansion. We expect more discussion of this issue to follow.
The history of health care planning in Idaho (Information is outdated and links may be expired)
2/11/ 2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Idaho residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
12/14/2012 Idaho is one of a minority of states that will run a health insurance exchange for individuals and small businesses that is not managed by the federal government. Consumer advocates who once viewed a state-run exchange as a positive are growing concerned that the state may not be fully committed to implementing all of the funding and features expected to be part of the federal health insurance exchanges that are expected to open in the fall of 2013.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross of Idaho Health Service, Regence Blue Shield of Idaho and PacificSource Health Plans are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
10/17/2011 Idaho became the first state in 2011 to adapt a resolution to urgently request that the U.S. Department of Health and Human Services remove health insurance agent and broker commissions from the medical loss ratio (MLR) calculation; also strongly encouraging Congress to amend the Affordable Care Act to remove agent and broker commissions from the MLR calculation. The stare recognizes that insurance agents, advisers and navigators are more important now than ever before. Freedom Benefits believes that independent professional insurance advice is the single most important professional financial service that an individual can obtain.
10/10/2011 We received notice from Chartis (The Insurance Company of the State of Pennsylvania) the state of Idaho is no longer eligible for any of their international travel insurance plans, in any direction, to or from the US or any other country. Retail plans to be included in this restriction: Liaison Majestic, Liaison Silver, Wander Frequent Traveler, and Disciple Missionary. Other international travel insurance plansremain available and we do not believe that Idaho consumers will be adversely affected by this singular change. We are concerned however, that if the recent trend of state legislative and interpretive enforcement actions continues to pull Idaho too far from the mainstream of U.S. consumer health insurance trends that the state’s residents will have fewer low cost health insurance choices and they will ultimately pay more for their health insurance.
7/10/2011 The U.S. Center for Consumer Information and Insurance Oversight announced that Idaho lacks proper resources or authority in the individual or small-group health insurance market to effectively review large rate increases as required by federal law. The federal government will temporarily take over the task of reviewing both individual and small business health insurance rate increases that are greater than 10%.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
Plan/Age Band
0-18
19-34
35-44
45-54
55+
Standard
$133
$199
$239
$305
$424
Extended
$179
$268
$321
$410
$571
HSA
$138
$207
$248
$317
$441
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
12/16/2010 Idaho Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, the Department of Insurance said that it would: 1) Conduct background research to establish scope and citizen impact, 2) Engage stakeholders and create strategies for continued engagement, 3) Evaluate existing government and non-government structures for opportunities to integrate these structures to support an Exchange, 4) Assess current and future resource needs and capabilities, 5) Create recommendations for governance structures, 6) Analyze accounting systems and methods to build on those systems, 7) Analyze existing technology, capacity and needed expansion, 8) Identify changes needed to existing technology and programs to accommodate the implementation of State Exchange, 9) Develop methods and resources needed to manage business operations for an Exchange, and 10) Identify needed enabling State legislation and regulations.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Idaho is now available at Freedom Benefits.