Individual Idaho Health Insurance Regulations

Medical insurance policies sold to individuals or families in Idaho may be medically underwritten, in order to establish eligibility. Applicants may be denied coverage if they do not meet the medical requirements of the insurance company with whom they are applying. Guidelines for underwriting may differ from one insurance company to another. If the insurance company decides to insure you and you have a pre-existing medical condition, they can require that an elimination rider be put on your policy and that excludes them from covering benefits on that pre-existing medical condition. Idaho health insurance regulations allow for an exclusionary period of 12 months for pre-existing conditions; however, credit for prior coverage is necessary. Insurance premium rates can vary and they are based upon the type of plan, gender, age, and if the applicant is a smoker. Also, if the insurance company believes your insurance risk is greater than their standard risk, they have the right to offer you a higher coverage rate. The maximum rate they are allowed to increase on a new member with an individual health plan in Idaho is 50% above the standard rate.

Idaho Small Group Health Insurance Regulations

In Idaho, any employer with 2-50 employees is considered a small group. Any person that is qualified to enroll in an Idaho group medical insurance plan is protected by non-discrimination laws. These laws prevent the health insurance company from denying an employee's application for medical insurance based on their health status.

For a period of sixty days, children that have just been adopted and newborn babies are covered automatically under their parent's group health insurance plan in Idaho.. Furthermore, Idaho group health insurance coverage is guaranteed-issue, which means that the group coverage application cannot be declined as a result of the health status of the group's employees. If it is determined that there is a pre-existing medical condition, and the employee does not have creditable coverage, the insurance company has the right to put a waiting period of 12 months on treatment for that condition. Also, employers have the right to elect a waiting period for health coverage for new hires under the group plan. This waiting period is kept uniform for all new employees. In Idaho, there are additional medical insurance laws that require a minimum employer contribution and minimum participation value. Although a small group cannot have coverage refused, the insurance companies are permitted to charge a rate up to 50% for groups that have a history of excessive claims.

Idaho COBRA and Continuation Coverage

Groups that have 20 or more employees must follow federal COBRA regulations. For groups with less than 20 employees, Idaho does not have applicable mini-COBRA laws. Some health insurance companies have an available conversion option that allows anyone under a group plan to move their coverage over to an individual policy. Any insurance company that offers individual health insurance or major medical insurance in Idaho has to agree to offer at least 3 of their plans to every applicant. If the applicant is eligible for HIPAA, the plans must be offered no matter what the applicant's health status is. This process is performed through pools of those that are at high-risk for reinsurance.

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