id-18-0406-2501: Governmental Self-Funded Employee Health Care Plans Rule (ZBR Chapter Rewrite)
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2,056 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 18.04.06 - Governmental Self-Funded Employee Health Care Plans Rule (ZBR Chapter Rewrite)-Proposed Rule (Docket No. 18-0406-2501). 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 18.04.06 - Governmental Self-Funded Employee Health Care Plans Rule (ZBR Chapter Rewrite)- Proposed Rule (Docket No. 18-0406-2501) Summary and Stated Reasons for the Rule The Department of Insurance submits notice of proposed rulemaking for the governmental self-funded employee health care plans rule, IDAPA 18.04.06. The Department states that the purpose of the chapter is to supplement the provisions of Title 41, Chapter 41, Idaho Code, by providing application requirements, rules, dates, and definitions. 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 states that there will be no impact to the general fund. Statutory Authority The Department appears to have the authority to promulgate this rule pursuant to section 41-211, 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, Manager April 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 18.04.06 – GOVERNMENTAL SELF-FUNDED EMPLOYEE HEALTH CARE PLANS RULE DOCKET NO. 18-0406-2501 (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 Section 41-211, 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 is to supplement the provisions of Title 41, Chapter 41, Idaho Code, Joint Public Agency Self-Funded Health Care Plans by providing application requirements, rules, dates, and definitions. 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 TECHNICAL QUESTIONS, SUBMISSION OF WRITTEN COMMENTS: For assistance on technical questions concerning the proposed rule, contact Weston Trexler, (208) 334-4214, weston.trexler@doi.idaho.gov. IdahoAdministrative Bulletin Page 61 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0406-2501 Governmental Self-Funded Employee 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 or beforeAugust 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. 18-0406-2501 (ZBR Chapter Rewrite.) 18.04.06 – GOVERNMENTAL SELF-FUNDED EMPLOYEE HEALTH CARE PLANS RULE 000. LEGALAUTHORITY. Title 41, Chapter 2,Sections 41-211 and 41-4120 Idaho Code. (3-31-22)( ) 001. TITLE AND SCOPE.
02. Scope. The purpose of tThis rule is to chapter supplements the provisions of Title 41, Chapter 41,
Idaho Code, Joint Public Agency Self-Funded Health Care Plans by providing: (3-31-22)( ) a. Dates of, and requirements for, application for registration; (3-31-22)( ) b. Requirements for application for registration; (3-31-22) cb. Rules regarding investigation of applications; and (3-31-22)( ) dc. Definition of needed liabilities; and establishment of reserve bases; and. (3-31-22)( ) e. To provide an effective date. (3-31-22) 002. -- 0202. (RESERVED) 021. QUALIFICATION OF PLAN. In order to qualify under Title 41, Chapter 41, Idaho Code, the plan's trust needs to be established by agreement between the public agency employers or joint powers entity and the trustee of the trust, for the sole purpose of providing health care benefits to employees of the public agency employer or employers. (3-31-22) 022. REGISTRATION. IdahoAdministrative Bulletin Page 62 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0406-2501 Governmental Self-Funded Employee Health Care Plans Rule ZBR Proposed Rulemaking
01. Registration Requisite. No joint public agency self-funded plan, unless exempted from
registration by Section 41-4103, Idaho Code, will be organized and permitted to operate in the state of Idaho without securing a certificate of registration from the Director of insurance. (3-31-22)
02. Beneficiary Within State. Registration is mandatory of plans that cover any beneficiary working
or residing within this state, unless the plans are exempted by Section 41-4103, Idaho Code. (3-31-22) 023. APPLICATION FOR REGISTRATION.
01. Application. The application needs to include each of the requirements set out in Section 41-4105,
Idaho Code. The projected income and disbursement statement referenced in Section 41-4105(2)(d), Idaho Code, needs to be certified by an actuary meeting the qualifications of Section 41-4105(2)(d), Idaho Code, and accompanied by a description of assumptions used in projecting income and disbursements together with bases used to estimate amounts reserved for claims. (3-31-22)
02. Joint Powers Agreement. The joint powers agreement needs to comply with Title 41, Chapter 41
and, to the extent not in conflict with Title 41, the joint powers agreement needs to also comply with Title 67, Chapter 23, Idaho Code. The joint powers agreement needs to contain, at a minimum, the conditions set forth in Section 41- 4104, Idaho Code. (3-31-22) 031. TrustAgreement. (3-31-22) a. The trust agreement will comply with Title 41, Chapter 41, Idaho Code, and, to the extent not in conflict with Title 41, the trust agreement needs to also comply with Title 68, Idaho Code, and Title 15, Chapter 7, Idaho Code. The trust agreement will contain, at a minimum, the conditions set forth in Section 41-4104, Idaho Code. (3-31-22) b. The term irrevocable as used in Section 41-4104(1), Idaho Code, means that the plan sponsor cannot retain a power to alter, amend, revoke or terminate the transfer in trust. The trustee may, pursuant to the terms of the trust agreement, amend the terms of the trust agreement for the purpose of complying with applicable law. (3-31-22)( ) 042. Biographical Affidavit. The application needs to be accompanied by a biographical affidavit for each trustee on a form acceptable to Director. (3-31-22) 024. INVESTIGATION OF PROPOSEDAPPLICATION FOR REGISTRATION. The Director may make an investigation of matters accompanying the application for registration as deemed necessary including an examination specified in Section 41-4113, Idaho Code. (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.
01. Reserve Requirements. The trust fund of a plan needs to continuously maintain reserves, pursuant
to Section 41-4110, Idaho Code, from inception of the plan, sufficient to fully fund payment of all benefits 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 reserves determined by the Minimum Reserve Standards for Group Health Insurance Contracts set forth the in the NAIC’sAccounting 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 an actuary who meets the
IdahoAdministrative Bulletin Page 63 August 6, 2025 – Vol. 25-8 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0406-2501 Governmental Self-Funded Employee Health Care Plans Rule ZBR Proposed Rulemaking requirements of Section 41-4105(2)(d), Idaho Code, and 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. (3-31-22)
a. Insolvency means that the plan is unable to pay its obligations when they are due, or when its admitted assets do not exceed its liabilities, including needed reserves. (3-31-22) b. If the determination of reserves reveals an insolvent condition, the Director may allow the plan a period of time not exceeding ninety (90) days to accumulate needed reserves. (3-31-22) 027. BONDING OR DISHONESTY INSURANCE.
01. Certified Copy of Bond. The plan will furnishAa certified copy of the fidelity bond or dishonesty
policy, as prescribed under Section 41-4114(3), Idaho Code, will be furnished to the Director by the plan. (3-31-22)( )
02. Cancellation of Bond Requirements. The bond or dishonesty policy will contain language stating
that the bond or policy is noncancellable except upon not less than thirty (30) days advance notice in writing to the trustee and the Director. A The surety or policy provider is to forward a copy of any notice cancelling a bond or dishonesty policy prescribed under Chapter 41 is to be forwarded to the Director by the surety or policy provider to the Director at the same time it is forwarded to the board. (3-31-22)( ) 028. ANNUAL QUARTERLY STATEMENT. The trustee will file an annual statement within ninety (90) days after the close of each fiscal year of the plan and at such other time as may be determined by the Director. A quarterly statement, per Idaho Code 41-4111(4), 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)( ) 029. -- 999. (RESERVED) IdahoAdministrative Bulletin Page 64 August 6, 2025 – Vol. 25-8
Documents
- Full text (state register) · May 07, 2025
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