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IDAPA 18.04.06 — Governmental Self-Funded Employee Health Care Plans Rule

Idaho Administrative Code IDAPA 18.04.06: Governmental Self-Funded Employee Health Care Plans Rule (8 codified sections)

Sections 41-211 and 41-4120 Idaho Code. (7-1-26)

IDAPA 18.04.06.001 - Scope

This chapter supplements the provisions of Title 41, Chapter 41, Idaho Code, Joint Public Agency Self-Funded Health Care Plans by providing: (7-1-26)

  a. Dates of, and requirements for, application for registration; (7-1-26)

  b. Rules regarding investigation of applications; and (7-1-26)

  c. Definition of needed liabilities; and establishment of reserve bases. (7-1-26)

IDAPA 18.04.06.023 - Application For Registration

01. Trust Agreement. The term irrevocable as used in Section 41-4104(1), Idaho Code, means that the plan sponsor cannot retain a power to alter, amend, revoke or terminate the transfer in trust. The trustee may, pursuant to the terms of the trust agreement, amend the terms of the trust agreement for the purpose of complying with applicable law. (7-1-26)

02. Biographical Affidavit. The application needs to be accompanied by a biographical affidavit for each trustee on a form acceptable to Director. (3-31-22)

IDAPA 18.04.06.024 - Investigation Of Proposed Application For Registration

The Director may make an investigation of matters accompanying the application for registration as deemed necessary including an examination specified in Section 41-4113, Idaho Code. (3-31-22)

IDAPA 18.04.06.025 - Contributions Receivable

The trust fund may take credit in any financial statement for contributions receivable which are not in excess of ninety (90) days past due. (3-31-22)

IDAPA 18.04.06.026 - Trust Fund Reserves

01. Reserve Requirements. The trust fund of a plan needs to continuously maintain reserves, pursuant to Section 41-4110, Idaho Code, from inception of the plan, sufficient to fully fund payment of all benefits at the time a claim arises. This reserve needs to adequately provide for all reasonably estimated future claim payments, adjustment expenses, and litigation expenses on claims which have arisen, including claims incurred but not reported, extended benefits and maternity benefits, if any. (3-31-22)

02. Reserves for Disability Income Benefits. Reserves established for disability income benefits cannot be less than reserves determined by the Minimum Reserve Standards for Group Health Insurance Contracts set forth the in the NAIC's Accounting Practices and Procedures Manual unless it can be proven to the satisfaction of the Director that a lower reserve can be actuarially justified. (3-31-22)

03. Certification by Actuary. Reserves needs to be certified annually by an actuary who meets the requirements of Section 41-4105(2)(d), Idaho Code, and such certification needs to be accompanied by a statement describing bases used in reserve determination. The certification will be in a form acceptable to the Director. (3-31-22)

04. Insolvent Condition. (3-31-22)

  a. Insolvency means that the plan is unable to pay its obligations when they are due, or when its admitted assets do not exceed its liabilities, including needed reserves. (3-31-22)

  b. If the determination of reserves reveals an insolvent condition, the Director may allow the plan a period of time not exceeding ninety (90) days to accumulate needed reserves. (3-31-22)

IDAPA 18.04.06.027 - Bonding Or Dishonesty Insurance

01. Certified Copy of Bond. The plan will furnish a certified copy of the fidelity bond or dishonesty policy, as prescribed under Section 41-4114(3), Idaho Code, to the Director. (7-1-26)

02. Cancellation of Bond Requirements. The bond or dishonesty policy will contain language stating that the bond or policy is noncancellable except upon not less than thirty (30) days advance notice in writing to the trustee and the Director. The surety or policy provider is to forward a copy of any notice cancelling a bond or dishonesty policy prescribed under Chapter 41 to the Director at the same time it is forwarded to the board. (7-1-26)

IDAPA 18.04.06.028 - Quarterly Statement

A quarterly statement, per Idaho Code 41-4111(4), will be filed with the Director within sixty (60) days of the end of each quarter in a form acceptable to the Director. (7-1-26)