In order to complete all filing requirements you must submit the electronic form even though you may not have incurred any new or renewal disability premium in 2012.  The information required is as follows:

1. Idaho Small Employer Health Reinsurance Program - Idaho total health benefit premium as reported in the annual statement for all disability coverages including specific disease and hospital confinement indemnity;
2. Idaho Individual High Risk Reinsurance Pool - Idaho total health benefit premium as reported in the annual statement for all disability coverages including specific disease and hospital confinement indemnity AND including reinsurance by way of excess loss and stop loss coverage;
3. Pursuant to Idaho Code Sections 41-4711(16) and 41-5505(5) and the director's inquiry power under Section 41-247, each carrier is required to file with the director in a form and manner as prescribed by the director the total number of resident persons covered (enrollment counts) under the carrier's disability coverages including excess loss or stop loss coverage.

Please note that the statute creating this program does not provide for an offset of this contribution against your premium tax liability to the State of Idaho. Questions should be referred to the Idaho Department of Insurance (208-334-4277).

Due March 1, 2013

• Do not use dollar signs, commas, decimal points, any negative numbers or spaces in the numeric fields.
• Round money amounts to the next whole dollar. No cents please.
• To move through the form use the "Tab" key or your mouse.
• Please do not use the "Enter" key to move through the form.  The "Enter" key will submit the form.
• You must submit the electronic form, even though you may not have incurred any new or renewal disability premium in 2012.
• Only one submission is allowed. If you have a problem or questions email Scott Frost or telephone (208)334-4277.