Idaho Health Insurance Guide
Idaho Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As an Idaho resident you have a variety of health insurance plans to choose from including plans for individuals and groups provided by private insurance carriers, as well as Idaho State-funded affordable health insurance for eligible individuals and families, and federal programs such as Medicaid and COBRA.
Idaho is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, the insurer has the right to impose a 12-month exclusionary period for any pre-existing conditions, which includes a 6-month look-back discovery period. However, this only applies if you have been uninsured for more than 63 days, prior to applying for the policy. Pregnancy can be counted as a pre-existing condition.
Idaho does not cap what a private insurance company can charge an individual. Premiums are based on the type of plan you apply for, your health, age, sex and lifestyle habits including tobacco use. If you represent a higher risk, you will be offered a policy with a correspondingly higher premium.
Idaho is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Idaho is a guarantee issue state for group health plans. If your Idaho health insurance is provided through your employer’s group plan, your coverage cannot be denied, limited or subject to higher premiums because of your health. However, the 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of creditable coverage. Furthermore, an employer can specify a waiting period before new hires become eligible for group coverage, although it must be applied equally. In addition, Idaho laws mandate a minimum participation and minimum employer premium contribution. Finally, while small groups can’t be refused coverage, the insurer can charge up to 50% more for groups with a history of excessive claims.
Idaho Mandated Health Benefits
Idaho laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Breast Reconstruction
- Cleft Palate
- Contraceptives
- Emergency Services
- Mammography
- Maternity Stays
- Mental Health Parity
- Coverage for newborn and adopted children under parent's policy
- Coverage for dependent students and handicapped dependents under their parent’s policy
- Coverage is also mandated for continuation/employees and conversion to non-groups.
Types Health Insurance Plans Available in Idaho
The following major medical health insurance plans are generally available in Idaho. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Idaho
Idaho has High Risk Reinsurance Pool Plans (HRP Plans) to provide health insurance for eligible Idaho residents who are not covered by employment-related plans because of pre-existing conditions. Plan benefits include basic, standard, catastrophic A, catastrophic B and HSA Compatible plans. Deductibles, co-insurance and out-of-pocket expense vary by plan. Eligibility is restricted to individuals whose most recent coverage was from a group plan, who had a minimum of 12 months’ coverage, have exhausted COBRA benefits, who haven’t been terminated because of nonpayment or fraud, have no other health coverage and aren’t eligible for Medicaid or Medicare.
Children’s Access Card
Idaho CHIP provides health coverage to resident children under 19 whose families earn too much to be eligible for Medicaid. Two plans are available and eligibility is based on family income. Depending on plan, coverage is provided through Medicaid or a private health insurance provider. Comprehensive coverage includes doctor’s visits, preventive services, lab and x-rays, vision, dental and mental health care, and emergency room services. Depending on family income, CHIP coverage is free or costs up to $15.00 per child per month. Waiting periods and renewability vary.
Regulating Agency
The State of Idaho Department of Insurance is responsible for regulating Idaho’s health insurance industry.
News – Idaho and Federal Health Care Reform
On March 17, 2010, Idaho signed into law the Idaho Health Freedom Act (HB 391) a bill blocking any individual mandate to secure health insurance currently under consideration in the U.S. Congress. The bill gives the state the right to sue to protect that freedom.
Get access to Idaho health insurance quotes from http://www.einsurance.com/health-insurance/.
Idaho Department of Insurance
700 West State Street
PO Box 83720
Boise, ID 83720-0043
(208) 334-4250
http://www.doi.idaho.gov/
Idaho Department of Health and Welfare
http://www.healthandwelfare.idaho.gov/Home/tabid/55/Default.aspx
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/