Self-Funded Employee Health Care Plans
The forms and procedures of the application process are designed to facilitate our review of the application. Therefore, it is extremely important that your application conforms fully with the instructions and requirements set forth below. This may not provide all the information or requirements that you need based upon your particular situation. You will be advised of any additional registration information that is required. Please submit the following:
- The attached signed by at least one (1) of the employers and one (1) of the trustees. If employer or trustee is a corporation, the verification shall be by a duly authorized corporate officer.
- A verified copy of the trust agreement under which the trust fund is to exist and operate. The trust agreement should comply with Idaho Code Title 41, Chapter 40 and contains, at a minimum, the conditions set forth in .
- A copy of the proposed written statement of benefits referred to in Idaho Code §41-4004(5) and §41-4004(4). This should include a table of the rates charged.
- Copies of all materials used in marketing or the solicitation of business.
- A certified Financial Statement. If a self-funded plan (hereinafter plan) is in existence and operating on the date of the application, the application for registration must be accompanied by a financial statement certified by an independent accountant. The statement must be as of the most recent year-end of the plan. The statement should be accompanied by an actuarial opinion certifying the reserve liabilities, prepared in accordance with and . The actuarial statement should be prepared in accordance with Actuarial Standards of Practice, in particular, ASOP #8 and ASOP #41.
- If a plan has not been in existence and does not have audited financial statements to submit to the Department, we will accept a balance sheet for the plan as of the effective date of the plan. In order to verify compliance with Idaho Code and Rules, the balance sheet should include: 1) detailed list of the type and amount of investments of the plan; 2) reserves for claims and other items, per Idaho Rule IDAPA 18.01.026, which have been certified by an actuary; and 3) other liabilities. The actuarial statement should be prepared in accordance with Actuarial Standards of Practice, in particular, ASOP #8 and ASOP #41.
- A certified Statement of Income and Disbursement. A written statement of monthly projected income and disbursements of the Fund for the twelve (12) month period commencing with the date of application. This statement must show the amount reserved as of the beginning and end of each month for claims incurred and not paid and incurred and not reported. An actuary who is a member of the American Academy of Actuaries must certify the statement. The certification must be accompanied by a description of assumptions used in projecting membership, income, disbursements including claim costs and administrative expenses together with bases used to estimate amounts reserved for claims. The actuarial statement should be prepared in accordance with Actuarial Standards of Practice, in particular, ASOP #8 and ASOP #41.
- A certified statement attesting to actuarial soundness of contribution rates. Include an explanation of how contribution rates were determined, the employer and employee contribution percentages, and the period of time for which rates may be deemed valid. An actuary who is a member of the American Academy of Actuaries must certify the statement. The actuarial statement should be prepared in accordance with Actuarial Standards of Practice, in particular, ASOP #8 and ASOP #41.
- A copy of any study made of the proposed self-funded plan by a consultant for the information or guidance or employer or employees.
- A certified copy of the fidelity bond or an original properly executed
(This bond is required of the self-funded plan regardless of any other TPA (third party administrator) or bond requirements of an affiliated TPA.
- A copy of every contract between the plan and any administrator or service company.
- A biographical affidavit for each of the Plan’s trustees with original signatures and notarizations.
- If the plan is domiciled out of state, a letter or other written evidence of good standing from the plan’s regulator in its state of domicile.
- A copy of all stop loss agreements.
- If the applicant is a multiple employer welfare arrangement, the application shall be signed under oath by the plan sponsor or the trustee of the plan, and the application shall also include: (a) A copy of any articles of incorporation and bylaws or other organizational documents of any entity acting as a plan sponsor; (b) A list of the names, addresses and official capacities with the plan of the individuals who will be responsible for the management and conduct of the affairs of the plan including all trustees, officers and directors. Such individuals shall fully disclose the extent and nature of any contracts or arrangements between them and the plan, including any possible conflicts of interest; and (c) A copy of the articles of incorporation, bylaws, trust agreement and any other document that governs the operation of the plan.
- Completion of the .