id-18-0405-2501: Self-Funded Health Care Plans Rule (ZBR Chapter Rewrite)
Get alerted when the next rule lands
New rules open for comment on their own schedule. Pick how you want to hear about them — we email you when one appears.
Publishing to members? Embed a live rule tracker on your own site — the proposed rules in your area and the comment deadlines closing on them, updating themselves. Free, one line of HTML.
Create a free account & build one →The rule, in full
2,387 words as published, May 07, 2025. View the original →
Dear Senators FOREMAN, Lenney, Ward-Engelking, and Representatives CLOW, Redman, Berch: The Legislative Services Office, Research and Legislation, has received the enclosed rules of the Department of Insurance: IDAPA 18.04.05 - Self-Funded Health Care Plans Rule (ZBR Chapter Rewrite)-Proposed Rule (Docket No. 18-0405-2501). Pursuant to Section 67-454, Idaho Code, a meeting on the enclosed rules may be called by the cochairmen or by two (2) or more members of the subcommittee giving oral or written notice to Research and Legislation no later than fourteen (14) days after receipt of the rules' analysis from Legislative Services. The final date to call a meeting on the enclosed rules is no later than 10/23/2025. If a meeting is called, the subcommittee must hold the meeting within forty-two (42) days of receipt of the rules' analysis from Legislative Services. The final date to hold a meeting on the enclosed rules is 11/20/2025. The germane joint subcommittee may request a statement of economic impact with respect to a proposed rule by notifying Research and Legislation. There is no time limit on requesting this statement, and it may be requested whether or not a meeting on the proposed rule is called or after a meeting has been held. To notify Research and Legislation, call 334-4854, or send a written request to the address on the memorandum attached below. Page 1 of 1 Terri Kondeff Director MEMORANDUM TO: Rules Review Subcommittee of the Senate Commerce & Human Resources Committee and the House Business Committee FROM: Legislative Drafter - Kyle Slominski DATE: October 06, 2025 SUBJECT: Department of Insurance IDAPA 18.04.05 - Self-Funded Health Care Plans Rule (ZBR Chapter Rewrite)-Proposed Rule (Docket No. 18-0405-2501) Summary and Stated Reasons for the Rule The Department of Insurance submits notice of proposed rulemaking for the self-funded health care plans rule, IDAPA 18.04.05. The Department states that the purpose of the rule is to supplement the provisions of Title 41, Chapter 40, Idaho Code, by providing application requirements, dates, definitions, effective dates, and requirements for contribution rates, contracts, services, and records. Negotiated Rulemaking / Fiscal Impact The Department states that negotiated rulemaking was conducted and that notice was published in the May 7, 2025, Administrative Bulletin, Volume 25-5, pages 52-53. The Department also states that there will not be an impact to the general fund. Statutory Authority The Department appears to have the authority to promulgate this rule pursuant to sections 41-211 and 41-4020, Idaho Code. cc: Department of Insurance Weston Trexler *** PLEASE NOTE *** Per the Idaho Constitution, all administrative rules may be reviewed by the Legislature during the next legisla- tive session. The Legislature has 3 options with this rulemaking docket: 1) Approve the docket in its entirety; 2) Reject the docket in its entirety; or 3) Reject the docket in part. Paul Headlee, Deputy DirectMatt Drake, Manager Keith Bybee, ManagerApril Renfro, Manager Norma Clark, Manager Legislative Services OffResearch & Legislation Budget & Policy AnalysLegislative AuditsInformation Technology Statehouse, P.O. Box 83720 Tel: 208–334–2475 Boise, Idaho 83720–0054 legislature.idaho.gov IDAPA 18 – IDAHO DEPARTMENT OF INSURANCE 18.04.05 – SELF-FUNDED HEALTH CARE PLANS RULE DOCKET NO. 18-0405-2501 (ZBR CHAPTER REWRITE) NOTICE OF RULEMAKING – PROPOSED RULE AUTHORITY: In compliance with Section 67-5221(1), Idaho Code, notice is hereby given that this agency has initiated proposed rulemaking procedures. The action is authorized pursuant to Sections 41-211 and 41-4020, Idaho Code. PUBLIC HEARING SCHEDULE: A public hearing concerning this rulemaking will be held as follows: Thursday, August 7, 2025 2:00 p.m. – 4:00 p.m. In-person participation is available at: Department of Insurance 700 W. State St. 3rd Floor Boise, ID 83702 Web meeting link: Click here to join the meeting Meeting ID: 237 139 719 159 3 Passcode: jk3o9Ur2 Download Teams | Join on the web The hearing site(s) will be accessible to persons with disabilities. Requests for accommodation must be made not later than five (5) days prior to the hearing, to the agency address below. DESCRIPTIVE SUMMARY: The following is a nontechnical explanation of the substance and purpose of the proposed rulemaking: The purpose of this chapter supplements the provisions of Title 41, Chapter 40, Idaho Code, Self-Funded Health Care Plans by providing application requirements, dates, definitions, effective dates; and requirements for contribution rates, contracts, services, and records. FEE SUMMARY: The following is a specific description of the fee or charge imposed or increased: No fee or charge imposed or increased. FISCAL IMPACT: The following is a specific description, if applicable, of any negative fiscal impact on the state general fund greater than ten thousand dollars ($10,000) during the fiscal year as a result of this rulemaking: None. NEGOTIATED RULEMAKING: Pursuant to Section 67-5220(1), Idaho Code, negotiated rulemaking was conducted. The Notice of Intent to Promulgate Rules - Negotiated Rulemaking was published in the May 7, 2025, IdahoAdministrative Bulletin, Volume 25-5, pages 52-53 under docket number 18-ZBRR-2501. INCORPORATION BY REFERENCE: Pursuant to Section 67-5229(2)(a), Idaho Code, the following is a brief synopsis of why the materials cited are being incorporated by reference into this rule: None. ASSISTANCE ON TECHNICALQUESTIONS, SUBMISSION OFWRITTEN COMMENTS: For assistance on technical questions concerning the proposed rule, contact Weston Trexler, (208) 334-4214, weston.trexler@doi.idaho.gov. IdahoAdministrative Bulletin Page 56 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0405-2501 Self-Funded Health Care Plans Rule ZBR Proposed Rulemaking Anyone may submit written comments regarding this proposed rulemaking. All written comments must be directed to the undersigned and must be delivered on orAugust 27, 2025. DATED this 2nd day of July, 2025. Dean L. Cameron, Director Idaho Department of Insurance 700 W. State Street, 3rd Floor P.O. Box 83720 Boise, ID 83720-0043 Phone: (208) 334-4250 Fax: (208) 334-4398 THE FOLLOWING IS THE PROPOSED TEXT OF DOCKET NO. 18-0405-2501 (ZBR Chapter Rewrite.) 18.04.05 – SELF-FUNDED HEALTH CARE PLANS RULE 000. LEGALAUTHORITY. Title 41, Chapter 2,Sections 41-244 and 41-4020, Idaho Code. (3-31-22)( ) 001. TITLE AND SCOPE.
02. Scope. This rule chapter supplements the provisions of Title 41, Chapter 40, Idaho Code, Self-
Funded Health Care Plans. (3-31-22)( ) 002. -- 00923. (RESERVED) 010. DEFINITIONS.
01. “All Contributions to Be Paid in Advance.” All contributions are to be paid in advance of the
period of time for which the contribution is made. (3-31-22)
02. “Deposited in and Disbursed from a Trust Fund.” All contributions based on calculated rates in
accordance with Section 028 of this rule are deposited into the trust fund and all expenses are paid out of the trust fund. (3-31-22) 011. -- 020. (RESERVED) 021. QUALIFICATION OF PLAN. In order for a plan to qualify under Title 41, Chapter 40, Idaho Code, the plan's trust will be established by agreement between the employer or employers or a postsecondary education institution and the trustee of the trust, for the sole purpose of providing health care benefits to employees of the employer or employers or to students of the postsecondary educational institution. (3-31-22) IdahoAdministrative Bulletin Page 57 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0405-2501 Self-Funded Health Care Plans Rule ZBR Proposed Rulemaking 022. REGISTRATION.
01. Registration Requisite. No self-funded plan, unless exempted from registration by Section 41-
4003, Idaho Code, will be organized and permitted to operate in the state of Idaho without securing a Certificate of Registration from the Director. (3-31-22)
02. Specific Plans. Any plans covering the employees of a common employer are a single plan in
respect to the exemption for registration allowed in Section 41-4003, Idaho Code. Any combinations of plans under the effective control of a single administrator, trustee, and/or employer, or group of administrators, trustees and/or employers utilizing or attempting to utilize the exempt dollar amounts permitted under Section 41-4003, Idaho Code in order to avoid registration of any such plans are deemed to be contrary to the intent of Title 41, Chapter 40, Idaho Code, and are expressly banned by this rule. (3-31-22)
03. Beneficiary Within State. Registration is mandatory of plans that cover any beneficiary working
or residing within this state, unless the plans are otherwise exempted by Section 41-4003(2), Idaho Code. (3-31-22) 023. (RESERVED) 024. INVESTIGATION OF PROPOSEDAPPLICATION FOR REGISTRATION. The Director may make an investigation of investigate matters accompanying the application for registration including an examination specified in Section 41-4013, Idaho Code. Costs of any investigation or examination, or both, will be borne by the trust fund of the plan. (3-31-22)( ) 025. CONTRIBUTIONS RECEIVABLE. The trust fund may take credit in any financial statement for contributions receivable which are not in excess of ninety (90) days past due. (3-31-22) 026. TRUST FUND RESERVES AND SURPLUS.
01. Reserve Requirements. The trust fund of the plan is to continuously maintain reserves sufficient,
as certified by a qualified actuary as being necessary, to fully fund payment of all benefits in effect at the time a claim arises. This reserve needs to adequately provide for all reasonably estimated future claim payments, adjustment expenses, and litigation expenses on claims which have arisen, including claims incurred but not reported, extended benefits and maternity benefits, if any. (3-31-22)
02. Reserves for Disability Income Benefits. Reserves established for disability income benefits
cannot be less than the Minimum Reserve Standards for Group Health Insurance Contracts set forth the in the NAIC’s Accounting Practices and Procedures Manual unless it can be proven to the satisfaction of the Director that a lower reserve can be actuarially justified. (3-31-22)
03. Certification by Actuary. Reserves needs to be certified annually by a qualified actuary. Such
certification needs to be accompanied by a statement describing bases used in reserve determination. The certification will be in a form acceptable to the Director. (3-31-22)( )
04. Insolvent Condition. If determination of surplus reveals a deficiency in surplus, the Director may
allow the plan up to ninety (90) days to accumulate prescribed surplus. The plan is deemed insolvent when it is either unable to pay its obligations or its assets do not exceed all its liabilities, including prescribed reserves(3-31-22) 027. BONDING.
01. Certified Copy of Bond. The plan will submit to the Director a certified copy of the fidelity bond
or equivalent coverage, as prescribed under pursuant to Section 41-4014(3), Idaho Code. (3-31-22)( )
02. Scope of Coverage. The fidelity bond or equivalent coverage will cover every trustee, officer,
director, and employee of the plan. (3-31-22)
03. Cancellation of Bond Requirements. The fidelity bond or equivalent coverage needs to contain
IdahoAdministrative Bulletin Page 58 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0405-2501 Self-Funded Health Care Plans Rule ZBR Proposed Rulemaking language stating that it is noncancellable except upon not less than thirty (30) days advance notice in writing to the trustee and the Director. AThe surety is to forward a copy of any notice cancelling a bond prescribed under Title 41, Chapter 40, Idaho Code, is to be forwarded such bond to the Director by the surety at the same time it is forwarded to the trustee. (3-31-22)( )
04. Third Party Administrator. Any party that provides any one of the following services to the plan
needs to be licensed as a third party administrator: (3-31-22) a. Directly or indirectly underwrites; (3-31-22) b. Collects or handles charges or contributions; or (3-31-22) c. Adjusts or settles claims on members or beneficiaries of the plan. (3-31-22) 028. CONTRIBUTION RATES.
01. Contribution Rate Calculation. Contribution rates will be calculated at least annually by a
qualified actuary. The contribution rate calculations should break down and designate the rate for the employer and the rate per employee, or the rate for the postsecondary educational institution and the rate per student. (3-31-22)
02. Employer Contributions. Employer contributions will be based on filed rates, paid in advance on
a periodic basis during the period of coverage or at the beginning of the period of coverage. (3-31-22)
03. Annual Filing of Rates. The annual filing of rates with the Director will include a breakdown as
prescribed under Subsection 028.01. (3-31-22) 029. CONTRACTS AND SERVICES.
01. Affiliated Contracts.All contracts for goods or services provided to the plan by any plan sponsor,
employer, third party administrator, or other affiliated entity or employee or agent thereof, will be in writing, setting forth in detail the rights and duties of each party to the writing; regardless of whether compensation, fees, or other consideration is paid or exchanged directly or indirectly. (3-31-22)
02. Contracts for Services. All contracts for services directly affecting the plan including, but not
limited to, accounting services, legal services, custodial agreements, and agreements for lease, rent, or insurance coverage to be performed or entered into on behalf of the plan will be agreed to by the board of trustees and the other party. (3-31-22)
03. Recordkeeping and Writing. Contracts and agreements valued at greater than five hundred
dollars ($500.00) entered into by the plan, will be in writing and approved by resolution of the board of trustees, and placed in the minutes and records of the plan. (3-31-22)
04. Fiduciary Duty. By entering into contracts and agreements, t The trustees are not permitted to
transfer or avoid their statutory fiduciary responsibilities. (3-31-22)( ) 030. RECORDS.
01. Board Actions. Any and all acts, resolutions, appointments, or delegations, or other decisions of
the board of trustees will be in writing and placed in the minutes and records of the plan. (3-31-22)
02. Complete Records. The full and accurate records and accounts of the plan include, but are not
limited to, minutes of the meetings of the board of trustees that document the acts, resolutions, appointments or delegations of the trustees; any and all correspondence between the board of trustees and contractors; accounting and actuarial records; and any and all records, correspondence, minutes, or statements as prescribed by law or the trust agreement. (3-31-22) 031. ANNUAL STATEMENT. IdahoAdministrative Bulletin Page 59 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0405-2501 Self-Funded Health Care Plans Rule ZBR Proposed Rulemaking The trustee will file an annual statement within ninety (90) days after the close of each fiscal year of the Pand at such other time as may be determined by the Director. A quarterly statement will be filed with the Director within sixty (60) days of the end of each quarter in a form acceptable to the Director. (3-31-22)( ) 032. -- 999. (RESERVED) IdahoAdministrative Bulletin Page 60 August 6, 2025 – Vol. 25-8
Documents
- Full text (state register) · May 07, 2025
Don't miss the comment window
One Click Politics alerts you on every deadline, hearing, and rule change.
See all rules with comments due soon →