(1) The board, as part of the plan of operation, shall establish a methodology for determining reinsurance premium rates to be charged reinsuring carriers to reinsure individuals under this chapter. The methodology shall include a system for classification of individuals that reflects the types of case characteristics commonly used by individual carriers in the state. The methodology shall provide for the development of base reinsurance premium rates, subject to the approval of the director, which shall be set at levels which reasonably approximate gross premiums charged to individuals by individual carriers for health benefit plans. Rate adjustments under the provisions of this subsection shall not be subject to the provisions of section 41-5206, Idaho Code.
(2)  The board periodically shall review the methodology established under the provisions of subsection (1) of this section, including the system of classification and any rating factors, to assure that it reasonably reflects the claims experience of the pool. The board may propose changes to the methodology which shall be subject to the approval of the director.
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Terms Used In Idaho Code 41-5506

  • 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
  • Director: means the director of the department of insurance of the state of Idaho. See Idaho Code 41-5501
  • 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
  • Reinsurance premium: means the premium set by the board pursuant to section 41-5506, Idaho Code, to be paid by a reinsuring carrier for eligible individuals ceded to the pool. See Idaho Code 41-5501
  • 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 board may consider adjustments to the reinsurance premium rates charged by the pool to reflect the use of effective cost containment and managed care arrangements.