(1) The board, in addition to its other powers and duties, shall establish the form and level of coverages, including benefit levels, cost-sharing levels, exclusions and limitations for the small employer basic, standard and catastrophic health benefit plans to be made available by small employer carriers pursuant to section 41-4708, Idaho Code, with an emphasis on making coverage available for preventive care.
(2)  The board shall also design a small employer basic, standard and catastrophic health benefit plan which each contain benefit and cost-sharing levels that are consistent with the basic method of operation and the benefit plans of managed care organizations, including any restrictions imposed by federal law. The plans or changes established by the board may include cost containment features such as:
(a)  Utilization review of health care services, including review of medical necessity of hospital and physician services;
(b)  Case management;
(c)  Selective contracting with hospitals, physicians and other health care providers;
(d)  Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and
(e)  Other managed care provisions.
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Terms Used In Idaho Code 41-4712

  • Board: means the board of directors of the small employer reinsurance program and the individual high risk reinsurance pool as provided for in section 41-5502, Idaho Code. See Idaho Code 41-4703
  • Catastrophic health benefit plan: means a higher limit health benefit plan developed pursuant to section 41-4712, Idaho Code. See Idaho Code 41-4703
  • Director: means the director of the department of insurance of the state of Idaho. 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
  • 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
(3)  The board shall submit the plans or changes approved by the board to the director for approval not later than March 1 of each year. The director shall promulgate the approved plans pursuant to the provisions of section 41-4715, Idaho Code.
(4)  Small employer carriers desiring to issue a small employer basic, standard or catastrophic health benefit plan differing from the form and level of coverage approved by the board and the director shall submit such plan to the board for review to insure that such proposed plan is commensurate with the benefit levels, cost-sharing levels, exclusions, and limitations for the plan developed and approved pursuant to the provisions of this section.
(5)  The board may appoint an advisory committee to assist in the development of and any changes to the small employer basic, standard and catastrophic health benefit plans.