No joint public agency self-funded plan shall register, and the director shall not register a joint public agency self-funded plan, which is not qualified as provided in this section.
(1)  The joint powers agreement must require all contributions to be paid in advance and to be deposited in and disbursed from a trust fund duly created and existing under an adequate written irrevocable trust agreement between the employer or employers and the board.
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Terms Used In Idaho Code 41-4104

  • Administrator: means a person, other than a board member, employed by the board to administer a joint public agency self-funded plan. See Idaho Code 41-4102
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Director: means the director of the department of insurance of this state. See Idaho Code 41-4102
  • Irrevocable trust: A trust arrangement that cannot be revoked, rescinded, or repealed by the grantor.
  • Joint powers agreement: means an agreement entered into between public agencies pursuant to chapter 23, title 67, Idaho Code. See Idaho Code 41-4102
  • plan: means any public agency plan established by a joint powers agreement and under which payment for any disability benefits not otherwise provided for under title 72, Idaho Code (worker’s compensation and related laws — industrial commission), medical, surgical, hospital, and other services for prevention, diagnosis, or treatment of any disease, injury, or bodily condition of an employee is, or is to be, regularly provided for or promised from funds created or maintained in whole or in part by contributions or payments thereto by a public agency employer, or by a public agency employer and the employees of the public agency, and not otherwise covered by insurance or contract with a health care service corporation, health maintenance organization, or similar other third party prepayment plan. See Idaho Code 41-4102
  • Public agency: means any city, county or political subdivision of this state, including, but not limited to: counties; school districts; highway districts; port authorities; instrumentalities of counties, county hospitals, cities or any political subdivision created under the laws of the state of Idaho; and the state of Idaho and any agency of the state government. See Idaho Code 41-4102
  • State: when applied to the different parts of the United States, includes the District of Columbia and the territories; and the words "United States" may include the District of Columbia and territories. See Idaho Code 73-114
  • Trust fund: means a fund established under a joint public agency self-funded plan for receipt of contributions of employers and employees and payment of or with respect to health care service costs of beneficiaries. See Idaho Code 41-4102
(2)  The plan must:
(a)  Have, or provide for, a board of trustees in accordance with this chapter for the administration of the plan;
(b)  Require that all members of the joint powers agreement comply with the provisions of the joint powers agreement;
(c)  Provide that the administrator or board on behalf of the plan, as the case may be, shall furnish to each employee-beneficiary of the plan a written statement or schedule adequately and clearly stating all benefits currently allowable under the plan, together with all applicable restrictions, limitations, and exclusions, and the procedure for filing a claim for benefits; and
(d)  Otherwise be in compliance with the provisions of this chapter.
(3)  The allocated trust fund must be actuarially sound; that is, assets and income of the fund must be adequate under reasonable estimates for payment of all benefits promised to beneficiaries by the plan. In determining actuarial soundness the director shall also give due consideration to:
(a)  Applicable stop-loss insurance provided or to be provided the plan by an insurer duly authorized to transact disability insurance in this state;
(b)  Contracts with health care service corporations or health maintenance organizations authorized to conduct such operations in this state and covering certain of the promised benefits;
(c)  Other applicable insurance or guarantys; and
(d)  The nature of the participating entities and other plan factors or provisions for prevention or reduction of adverse selection against the plan by those otherwise eligible to become beneficiaries.
(4)  The plan shall maintain aggregate stop-loss coverage and specific stop-loss coverage provided by an insurance company authorized to transact insurance in this state in accordance with the annual actuarial opinion of the plan, unless waived pursuant to section 41-4110(3), Idaho Code.