Idaho Code 41-5509 – Ceding Eligibility
Current as of: 2023 | Check for updates
|
Other versions
(1) The pool shall provide reinsurance to any eligible individual who qualifies for reinsurance pursuant to this chapter if evidence is provided that such person has a qualifying high risk medical condition as defined by section 41-5501(8), Idaho Code.
(2) Notwithstanding any other provision of this chapter, eligibility for continuation of coverage under COBRA shall not render a person ineligible for reinsurance coverage under this chapter.
Terms Used In Idaho Code 41-5509
- 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
- Eligible individual: means an Idaho resident individual or dependent of an Idaho resident who is:
Idaho Code 41-5501Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other. Health benefit plan: means any hospital or medical policy or certificate, any subscriber contract provided by a hospital or professional service corporation, or health maintenance organization subscriber contract. See Idaho Code 41-5501 High risk medical condition: means a medical condition or diagnosis identified by the board in its plan of operation as making an individual eligible for reinsurance through the pool. See Idaho Code 41-5501 Month: means a calendar month, unless otherwise expressed. See Idaho Code 73-114 person: includes a corporation as well as a natural person;
Idaho Code 73-114Pool: means the Idaho [individual] high risk reinsurance 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) Reinsurance through the pool shall cease:
(a) On the first day of the month following the date a person is no longer a resident of this state;
(b) On the date coverage under the individual health benefit plan ends;
(c) Upon the death of the covered person;
(d) At the option of the board, thirty (30) days after the plan makes any inquiry concerning the person’s eligibility or place of residence to which the person does not reply.
(4) Reinsurance for a person who ceases to meet the eligibility requirements of this chapter may be terminated on the first day of the month following the date when the individual becomes ineligible.