Idaho Code > Title 41 > Chapter 52 – Individual Health Insurance Availability Act
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Terms Used In Idaho Code > Title 41 > Chapter 52 - Individual Health Insurance Availability Act
- Actuarial certification: means a written statement by a member of the American academy of actuaries or other individual acceptable to the director that an individual carrier is in compliance with the provisions of section 41-5206, Idaho Code, based upon the person’s examination and including a review of the appropriate records and the actuarial assumptions and methods used by the individual carrier in establishing premium rates for applicable health benefit plans. See Idaho Code 41-5203
- affiliated: means any entity or person who directly or indirectly through one (1) or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person. See Idaho Code 41-5203
- Agent: means a producer as defined in section 41-1003(8), Idaho Code. See Idaho Code 41-5203
- Base premium rate: means , as to a rating period, the lowest premium rate charged or that could have been charged under a rating system by the individual carrier to individuals with similar case characteristics for health benefit plans with the same or similar coverage. See Idaho Code 41-5203
- Carrier: means any entity that provides health insurance in this state. See Idaho Code 41-5203
- Case characteristics: means demographic or other objective characteristics of an individual that are considered by the individual carrier in the determination of premium rates for the individual, provided that claim experience, health status and duration of coverage shall not be case characteristics for the purposes of this chapter. See Idaho Code 41-5203
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Dependent: A person dependent for support upon another.
- Director: means the director of the department of insurance of the state of Idaho. See Idaho Code 41-5203
- Eligible individual: means an Idaho resident individual or dependent of an Idaho resident:
Idaho Code 41-5203Enhanced short-term plan: means an individual health benefit plan that:
Idaho Code 41-5203Established 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 Fraud: Intentional deception resulting in injury to another. 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 and includes enhanced short-term plans. See Idaho Code 41-5203 Index rate: means , as to a rating period for individuals with similar case characteristics, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate. 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 Individual standard health benefit plan: means a health benefit plan developed pursuant to chapter 55, title 41, Idaho Code, prior to April 1, 2017. See Idaho Code 41-5203 Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases. Month: means a calendar month, unless otherwise expressed. See Idaho Code 73-114 New business premium rate: means , as to a rating period, the lowest premium rate charged or offered or which could have been charged or offered by the individual carrier to individuals with similar case characteristics for newly issued health benefit plans with the same or similar coverage. See Idaho Code 41-5203 Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period. person: includes a corporation as well as a natural person;
Idaho Code 73-114Premium: means all moneys paid by an individual and eligible dependents as a condition of receiving coverage from a carrier, including any fees or other contributions associated with the health benefit plan. See Idaho Code 41-5203 Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide. Rating period: means the calendar period for which premium rates established by a carrier are assumed to be in effect. See Idaho Code 41-5203 Reinsuring carrier: means a carrier participating in the Idaho individual high-risk reinsurance pool established in chapter 55, title 41, Idaho Code. See Idaho Code 41-5203 Restricted network provision: means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into a contractual arrangement with the carrier to provide health care services to covered individuals. 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