(1) A joint public agency self-funded plan shall establish and maintain in its trust fund the following reserves:
(a)  A reserve in an amount as certified by a member of the American academy of actuaries as being necessary for payment of claims against the trust fund for benefits, including both claims reported and not yet paid and claims incurred but not yet reported. Any joint public agency self-funded plan in existence as of July 1, 2006, shall also have three (3) years from the effective date of this act to fund the applicable reserves.
(b)  If under the plan periodic contributions of either the employer or employees to the trust fund are payable less frequently than monthly, there shall be a reserve for unearned contributions as computed pro rata on the basis of the unexpired portion of the period for which the contribution has been paid.
(2)  In any determination of the financial condition of the trust fund, the claims reserve and reserve for unearned contributions shall constitute liabilities.
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Terms Used In Idaho Code 41-4110

  • Contribution: means the amount paid or payable by the employer or employee into the trust fund. See Idaho Code 41-4102
  • Director: means the director of the department of insurance of this state. See Idaho Code 41-4102
  • Joint powers agreement: means an agreement entered into between public agencies pursuant to chapter 23, title 67, Idaho Code. See Idaho Code 41-4102
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • 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
  • Surplus: means the excess of the assets of a self-funded plan minus the liabilities of the plan, provided the liabilities of a self-funded plan shall include the claims liability of the plan. See Idaho Code 41-4102
  • 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
(3)  Upon request of a plan, the director shall have the authority to annually waive the requirement that the plan maintain aggregate stop-loss coverage if:
(a)  The joint public agency self-funded plan established by a joint powers agreement is governed by a board of trustees and is operating as a public agency;
(b)  Enrollment under the plan averages a minimum of one thousand (1,000) covered persons in each of the preceding twelve (12) months;
(c)  The plan establishes and maintains, in its trust fund, reserves as set forth in subsection (1)(a) of this section; and
(d)  The plan establishes and maintains, in its trust fund, surplus of at least the amount certified annually by a member of the American academy of actuaries as sufficient without aggregate stop-loss coverage, but no less than three (3) months of contributions.