(1) An individual 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 individuals;
(c)  The carrier’s commitment to market fairly to all individuals in the state or its established geographic service area, as applicable;
(d)  The carrier’s experience with managing the risk of individuals; and
(e)  The extent to which a carrier has and will be able to maintain reinsurance pursuant to the provisions of subsection (3) of section 41-5204, Idaho Code.
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Terms Used In Idaho Code 41-5210

  • Carrier: means any entity that provides health insurance in this state. See Idaho Code 41-5203
  • Director: means the director of the department of insurance of the state of Idaho. See Idaho Code 41-5203
  • 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 41-5203
  • Individual carrier: means a carrier that offers health benefit plans covering eligible individuals and their dependents. See Idaho Code 41-5203
  • Risk-assuming carrier: means a carrier whose application is approved by the director pursuant to section 41-5210, Idaho Code. See Idaho Code 41-5203
  • 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 an individual 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 individuals in compliance with the provisions of section 41-5208, Idaho Code, without the protection afforded by the program;
(b)  The carrier has failed to market fairly to all individuals in the state or its established geographic service area, as applicable; or
(c)  The carrier has failed to provide coverage to eligible individuals as required in section 41-5208, Idaho Code.
(5)  An individual 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 individual carrier is subject to assessment for additional funding pursuant to the provisions of subsection (12)(c) of section 41-4711, Idaho Code.