(1) The board shall submit to the director a plan of operation and thereafter any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the pool. The director may, after notice and hearing, approve the plan of operation if the director determines it to be suitable to assure the fair, reasonable and equitable administration of the pool, and to provide for the sharing of pool gains or losses on an equitable and proportionate basis in accordance with the provisions of this chapter. The plan of operation shall become effective upon written approval by the director.
(2)  If the board fails to submit a suitable plan of operation, the director shall, after notice and hearing, adopt and promulgate a temporary plan of operation. The director shall approve the plan of operation submitted by the board, or adopt a temporary plan of operation if the board fails to submit a suitable plan. The director shall amend or rescind any plan adopted under the provisions of this section at the time a plan of operation is submitted by the board and approved by the director.
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Terms Used In Idaho Code 41-5503

  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Board: means the board of directors of the Idaho individual high risk reinsurance pool established in this chapter and the Idaho small employer health reinsurance program established in section 41-4711, Idaho Code. See Idaho Code 41-5501
  • Carrier: means any entity that provides, or is authorized to provide, health insurance in this state. See Idaho Code 41-5501
  • Director: means the director of the department of insurance of the state of Idaho. See Idaho Code 41-5501
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Plan of operation: means the plan of operation of the individual high risk reinsurance pool established pursuant to this chapter. See Idaho Code 41-5501
  • Pool: means the Idaho [individual] high risk reinsurance pool. See Idaho Code 41-5501
  • Reinsuring carrier: means a carrier participating in the individual high risk reinsurance pool established by this chapter. See Idaho Code 41-5501
(3)  The plan of operation shall:
(a)  Establish procedures for handling and accounting of pool assets and moneys and for an annual fiscal reporting to the director;
(b)  Establish procedures for selecting an administrator, and setting forth the powers and duties of the administrator;
(c)  Establish procedures for reinsuring risks in accordance with the provisions of this chapter;
(d)  Establish procedures and conditions for a carrier to cede individuals with certain high risk medical conditions;
(e)  Define the high risk medical conditions for which carriers are allowed to cede for reinsurance;
(f)  Set forth the reinsurance parameters including, but not limited to, the initial level of claims for which the reinsuring carrier is responsible, the coinsurance percentage at which claims above the initial level are reinsured by the pool, and the maximum claims limit above which the pool no longer reimburses;
(g)  Establish procedures for collecting assessments from carriers to fund claims and administrative expenses incurred or estimated to be incurred by the pool; and
(h)  Provide for any additional matters necessary for the implementation and administration of the pool.