(1) A small employer carrier may apply to become a risk-assuming carrier by filing an application with the director in a form and manner prescribed by the director.
(2)  The director shall consider the following factors in evaluating an application filed under the provisions of subsection (1) of this section:
(a)  The carrier’s financial condition;
(b)  The carrier’s history of rating and underwriting small employer groups;
(c)  The carrier’s commitment to market fairly to all small employers in the state or its established geographic service area, as applicable;
(d)  The carrier’s experience with managing the risk of small employer groups; and
(e)  The extent to which a carrier has and will be able to maintain reinsurance pursuant to the provisions of subsection (4)(c) of section 41-4704, Idaho Code.
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Terms Used In Idaho Code 41-4710

  • Carrier: means any entity that provides, or is authorized to provide, health insurance in this state. See Idaho Code 41-4703
  • 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
  • Program: means the Idaho small employer reinsurance program created in section 41-4711, Idaho Code. See Idaho Code 41-4703
  • Risk-assuming carrier: means a small employer carrier whose application is approved by the director pursuant to section 41-4710, Idaho Code. See Idaho Code 41-4703
  • 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)  The director shall provide public notice of an application by a small employer carrier to be a risk-assuming carrier and shall provide at least a sixty (60) day period for public comment prior to making a decision on the application. If the application is not acted upon within ninety (90) days of the receipt of the application by the director, the carrier may request a hearing.
(4)  The director may rescind the approval granted to a risk-assuming carrier under the provisions of this section if the director finds that:
(a)  The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with the provisions of section 41-4708, Idaho Code, without the protection afforded by the program;
(b)  The carrier has failed to market fairly to all small employers in the state or its established geographic service area, as applicable; or
(c)  The carrier has failed to provide coverage to eligible small employers as required in section 41-4708, Idaho Code.
(5)  A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of section 41-4711, Idaho Code, except to the extent such small employer carrier is subject to assessment for additional funding pursuant to the provisions of subsection (12)(c) of section 41-4711, Idaho Code.