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Individual Health Insurance Availability Act

Idaho Code, Title 41, Chapter 52, is the Individual Health Insurance Availability Act. The purpose of this act is to make health insurance coverage available to Idaho “eligible individuals” not covered by employment-based insurance. Idaho residents may be eligible for coverage regardless of their health status or claims experience.

An “eligible individual” means an Idaho resident individual or dependent of an Idaho resident:

  • Who is under the age of 65, is not eligible for coverage under a group health plan, for Part A or Part B of Medicare or for Medicaid, and who does not have other health insurance coverage; or
  • Who is a federally eligible individual under the federal law known as HIPAA (1996 Public Law 104-191).

Every insurance company that is approved to market individual health benefit plans* in Idaho must actively offer health benefit plans to individuals. Companies must follow fair marketing standards set by the act.

Insurance companies may offer individual health benefit plans through Idaho’s insurance marketplace, Your Health Idaho or off the marketplace, or both. However, premium subsidies (advanced premium tax credit or APTC) are available to individuals only if the health benefit plan is purchased through Your Health Idaho.

A company or agent may not encourage an individual to refrain from applying or to apply with another company due to the health status, claims experience, industry, occupation, or geographic location of the individual.

The act and the Department’s Rule, IDAPA 18.01.72, require a company to disclose its rating practices to an individual purchasing a health benefit plan. The act and rule give the Department oversight to prevent abusive rating practices. On and after January 1, 2014, the only rate variables an insurance company may use are:

  • An individual’s age
  • Geography
  • Tobacco use
  • Family composition

An insurance company may not refuse to insure or charge higher premiums to individuals with medical problems or charge different premiums for men and women.

Idaho Code, Title 41, Chapter 55, enacted the Idaho Individual High Risk Reinsurance Pool effective January 1, 2001. There are five High Risk Reinsurance Pool Plans (HRP Plans): Basic, Standard, Catastrophic A, Catastrophic B and the HSA Compatible Plan. Insurance companies are not required to offer HRP Plans to individuals for effective dates on and after January 1, 2014. HRP Plans are considered “minimum essential coverage” through plan years beginning in December 2014. The five HRP Plan designs are included in the Department’s Rule, IDAPA 18.01.73, and in the sample policy of insurance.

On and after January 1, 2014, health benefit plans for individuals may no longer apply Idaho’s laws regarding preexisting conditions and portability. (§ 41-5208)

ALL health benefit plans are renewable at the insured’s option, except due to circumstances such as: nonpayment of premium; fraud or misrepresentation; or the insured ceases to be an “eligible individual.” (§ 41-5207)

The Idaho Department of Insurance maintains a list of the health insurance companies approved to offer individual health benefit plans. Please also see our Health Care Reform Q&A for individuals and families.

*”Health benefit plan” means a hospital or medical policy or certificate.
“Health benefit plan” does not include a policy or certificate for specific disease, hospital confinement indemnity, accident-only, credit, dental, vision, Medicare supplement, long-term care, disability income insurance, student health benefits-only coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, automobile medical payment insurance, or nonrenewable short-term coverage issued for a period of 12 months or less. (§ 41-5203)