(1) A health benefit plan subject to the provisions of this chapter shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases:
(a)  Nonpayment of the required premiums;
(b)  Fraud or intentional misrepresentation of material fact by the small employer;
(c)  Noncompliance with the carrier’s minimum participation requirements;
(d)  Noncompliance with the carrier’s employer contribution requirements;
(e)  In the case of health benefit plans that are made available in the small employer market only through one (1) or more associations as defined in section 41-2202, Idaho Code, the membership of an employer in the association, on the basis of which the coverage is provided ceases, but only if the coverage is terminated under this paragraph uniformly without regard to any health status-related factor relating to any covered individual;
(f)  The small employer no longer meets the requirements of section 41-4703(28), Idaho Code;
(g)  The small employer carrier elects, at the time of coverage renewal, to discontinue offering a particular health benefit plan delivered or issued for delivery to small employers in this state. Unless otherwise authorized in advance by the department of insurance, a carrier may discontinue a product only after the product has been in use for at least thirty-six (36) consecutive months, provided the carrier may not discontinue more than fifteen percent (15%) of its total number of employees and dependents in all lines of business regulated by this chapter in a twelve (12) month period. The carrier shall:
(i)   Provide advance written or electronic notice of its decision under this paragraph to the director;
(ii)  Provide notice of the discontinuation to all affected employers and employees or dependents at least ninety (90) calendar days prior to the date the particular health benefit plan will be discontinued by the carrier, provided that notice to the director under the provisions of this paragraph shall be provided at least fourteen (14) calendar days prior to the notice to the affected employers;
(iii) Offer to each affected employer, on a guaranteed issue basis, the option to purchase all other health benefit plans currently being offered by the carrier to small employers in this state;
(iv)  In exercising the option to discontinue the health benefit plan and in offering the option to purchase all other health benefit plans under the provisions of this paragraph, act uniformly without regard to:
1.  The claims experience of an affected employer;
2.  Any health status-related factor relating to any affected employee or dependent; or
3.  Any health status-related factor relating to any new employee or dependent who may become eligible for the coverage; and
(v)  Offer the new products at rates that comply with section 41-4706(1)(c), Idaho Code.
(h)  The small employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to small employers in this state. In such a case the carrier shall:
(i)   Provide advance notice of its decision under this paragraph to the director in each state in which it is licensed; and
(ii)  Provide notice of the decision not to renew coverage to all affected small employers and to the director at least one hundred eighty (180) calendar days prior to the nonrenewal of any health benefit plans by the carrier. Notice to the director under the provisions of this paragraph shall be provided at least three (3) working days prior to the notice to the affected small employers; or
(i)  The director finds that the continuation of the coverage would:
(i)   Not be in the best interests of the policyholders or certificate holders; or
(ii)  Impair the carrier’s ability to meet its contractual obligations.
In such instance the director shall assist affected small employers in finding replacement coverage.
(2)  A small employer carrier that elects not to renew a health benefit plan under the provisions of subsection (1)(h) of this section shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the director.
lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Idaho Code 41-4707

  • Carrier: means any entity that provides, or is authorized to provide, health insurance in this state. See Idaho Code 41-4703
  • Dependent: A person dependent for support upon another.
  • Director: means the director of the department of insurance of the state of Idaho. See Idaho Code 41-4703
  • Established geographic service area: means a geographic area, as approved by the director and based on the carrier’s certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage. See Idaho Code 41-4703
  • Health benefit plan: means any hospital or medical policy or certificate, any subscriber contract provided by a hospital or professional service corporation, or managed care organization subscriber contract. See Idaho Code 41-4703
  • Month: means a calendar month, unless otherwise expressed. See Idaho Code 73-114
  • Small employer: means any person, firm, corporation, partnership or association that is actively engaged in business that employed an average of at least two (2) but no more than fifty (50) eligible employees on business days during the preceding calendar year and that employs at least two (2) but no more than fifty (50) eligible employees on the first day of the plan year, the majority of whom were and are employed within this state. See Idaho Code 41-4703
  • Small employer carrier: means a carrier that offers health benefit plans covering eligible employees of one (1) or more small employers in this state. See Idaho Code 41-4703
  • 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
(3)  In the case of a small employer carrier doing business in one (1) established geographic service area of the state, the rules set forth in this subsection shall apply only to the carrier’s operations in that service area.