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Transferring Between Major Medical Plans

Idaho Code, Title 41*, permits an insured individual or an insured dependent with an existing “major medical” plan to request a transfer to another “major medical” plan with the same insurance carrier. This right to request a transfer applies to individual and group policies. For group policies, this right must be made available after the insured’s declination or expiration of COBRA continuation coverage, if applicable, otherwise upon termination of group coverage.

“Major medical” means policies, contracts or certificates that are issued to provide hospital and medical-surgical coverage, including Medicare supplement coverage.

When an insurance carrier receives a transfer request from an insured, the carrier must offer equal or lesser benefits than the insured has under the existing policy with the carrier. The carrier may not use underwriting criteria where coverage is denied or subject to cancellation or nonrenewal, in whole or in part, due to the insured’s:

  • Age;
  • Health;
  • Medical history;
  • Employment status; or
  • If employed, industry or job classification.

However, if the insured requests Medicare supplement benefits in excess of the insured’s current Medicare supplement policy, the carrier may use health underwriting criteria in its determination to accept the request.

“Benefits in excess of the current policy” may include, but are not limited to, lower deductibles, lower coinsurance or copayments, and lower maximum out-of-pocket limits. Excess benefits do not include the addition of pharmacy cards to replace existing prescription drug benefits, supplemental accident insurance, chiropractic services or vision services.

Insurance carriers must provide a simplified application to an insured who makes a transfer request. That application may not exceed one page in length and six medical questions.

*Idaho Code § 41-2146 for individual insurance; § 41-2220 for group insurance.