id-18-0415-2501: Rules Governing Short-Term Health Insurance Coverage
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Terri Kondeff Director MEMORANDUM TO: Senators FOREMAN, Lenney, Ward-Engelking and, Representatives CLOW, Redman, Berch FROM: Kyle Slominski - Legislative Drafting Attorney DATE: November 06, 2025 SUBJECT: Temporary Rule IDAPA18.04.15-RulesGoverningShort-TermHealthInsuranceCoverage-AdoptionofPendingRule and Temporary Rule - Docket No. 18-0415-2501 We are forwarding this temporary rule to you for your information only. No analysis was done by LSO. This rule is posted on our web site. If you have any questions, please call Kyle Slominski at the Legislative Services Office at (208) 334-4845. Thank you. Attachment: Temporary Rule PaulHeadlee,DeputyDirectoratt Drake, Manager Keith Bybee, Manager April Renfro, Manager Norma Clark, Manager Legislative Services OfResearch & Legislation Budget & Policy AnaLegislative AuditsInformation Technology Statehouse, P.O. Box 83720 Tel: 208–334–2475 Boise, Idaho 83720–0054 legislature.idaho.gov IDAPA 18 – IDAHO DEPARTMENT OF INSURANCE 18.04.15 – RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE DOCKET NO. 18-0415-2501 (ZBR CHAPTER REWRITE) NOTICE OF RULEMAKING – ADOPTION OF PENDING RULE AND TEMPORARY RULE
Effective Date
The effective date of this temporary rule is October 15, 2025. The pending rule has been adopted by the agency and is now pending review by the 2026 Idaho State Legislature and must be approved by concurrent resolution to go into effect, in accordance with Section 67-5224(2)(c), Idaho Code. If the Legislature approves the pending rule, it will become final and effective on July 1, 2026, unless the concurrent resolution states a different effective date. AUTHORITY: In compliance with Sections 67-5224 and 67-5226, Idaho Code, notice is hereby given this agency has adopted a temporary rule and a pending rule. The action is authorized pursuant to Sections 67-5226, 41-211, 41- 4207, and 41-5214, Idaho Code. DESCRIPTIVE SUMMARY: The following is the required finding and concise statement of its supporting reasons for adopting a temporary rule and a pending rule: This pending rule was presented as part of the Department of Insurance’s plan to review each rule according to the Governor’s Executive Order 2020-01: Zero-Based Regulation, and pursuant to Section 67-5220(1), Idaho Code, negotiated rulemaking was conducted. This chapter implements Title 41, Chapter 21, 42, and 52, Idaho Code regarding short-term limited-duration insurance by defining requirements for enhanced short-term plans and nonrenewable short-term coverage, including minimum standards for benefits, rating rules, enrollment, renewability, and required disclosure provisions. Due to recent events, the Department of Insurance (DOI) determined that a temporary rule is necessary to (A) protect public health and safety and (B) to reduce a regulatory burden. Further, on August 7, 2025, the U.S. Departments of Labor, HHS, and Treasury (hereinafter, the “Federal Departments”) issued a statement that the Federal Departments do not intend to prioritize enforcement actions for violations related to failing to meet the definition of Short-Term Limited Duration Insurance (STLDI) related to the 2024 rules. Acting on this guidance, the DOI is authorizing carriers and producers that sell STLDI to follow the durations set forth under this temporary rule. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/ for-employers-and-advisers/short-term-limited-duration-insurance/stldi-statement-08-07-2025. There are no changes to the pending rule, and it is being adopted as originally proposed. The complete text of the proposed rule was published in theAugust 6, 2025, IdahoAdministrative Bulletin, Vol. 25-8, pages 145-151. TEMPORARY RULE JUSTIFICATION: Pursuant to Sections 67-5226(1)(a) and (c), Idaho Code, the Governor has found that temporary adoption of the rule is appropriate for the following reasons: Due to recent increases in the cost of health insurance and the expiration of the enhanced tax credit, Idaho consumers are faced with a significant impact on their ability to obtain coverage. This temporary rule is necessary to protect public health and safety by ensuring that Idahoans have the ability to access Short-Term Limited Duration Insurance (STLDI) during open enrollment which commences on October 15. Additionally, the DOI sought to eliminate burdensome requirements or regulations that were costly or harmful to consumers. For example, the DOI removed the 6-month duration maximum on traditional STLDI, instead allowing such plans to continue until the end of the calendar year. FEE SUMMARY: Pursuant to Section 67-5224(2)(d), Idaho Code, a pending fee rule shall not become final and effective unless affirmatively approved by concurrent resolution of the Legislature. The following is a description of the fee or charge imposed or increased in this rulemaking: N/A. 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: No fiscal impact. IdahoAdministrative Bulletin Page 94 November 5, 2025 – Vol. 25-11 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0415-2501 Rules Governing Short-Term Health Insurance Coverage ZBR Pending & Temporary Rule ASSISTANCE ON TECHNICAL QUESTIONS: For assistance on technical questions concerning the temporary and pending rule, contact Weston Trexler, (208) 334-4214, weston.trexler@doi.idaho.gov. DATED this 20th day of October, 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 DOCKET NO. 18-0415-2501 -ADOPTION OF PENDING RULEAND TEMPORARY RULE No substantive changes have been made to the pending rule. The complete text of the proposed rule was published in the IdahoAdministrative Bulletin, Volume 25-8,August 6, 2025, pages 145 through 151. This rule has been adopted as a pending rule by the Agency and is now awaiting review and final approval by the 2026 Idaho State Legislature. Pursuant to Section 67-5226, Idaho Code, the full text of the temporary rule is being published in this Bulletin. THE FOLLOWING IS THE TEXT OFTHE TEMPORARY RULE FOR DOCKET NO. 18-0415-2501 (Entire ZBR Chapter Rewrite Printed) 18.04.15 – RULES GOVERNING SHORT-TERM HEALTH INSURANCE COVERAGE 000. LEGALAUTHORITY. Title 41, Chapters 2, 21, 42, and 52Section 41-211, Section 41-4203, Section 41-4204, and Section 41-5211, Idaho Code. (3-31-22)(10-15-25)T 001. TITLE AND SCOPE.
02. Purpose and Scope. IThis chapter implements Title 41, Chapters 21, 42, and 52, Idaho Code,
regarding short-term, limited-duration insurance by defining rules for enhanced short-term plans and nonrenewable short-term coverage, including minimum standards for benefits, rating rules, enrollment, renewability, and disclosure provisions. (3-31-22)(10-15-25)T IdahoAdministrative Bulletin Page 95 November 5, 2025 – Vol. 25-11 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0415-2501 Rules Governing Short-Term Health Insurance Coverage ZBR Pending & Temporary Rule
03. Applicability. This rule applies to all enhanced short-term plans and nonrenewable short-term
coverage that provide medical expense coverage. (3-31-22) 002. -- 009. (RESERVED) 010. DEFINITIONS. In addition to the applicable definitions in Chapters 21, 42, and 52, Idaho Code, the following definitions apply: (3-31-22)
01. Benchmark Medical Plan. The health benefit plan identified by the U.S. Department of Health
and Human Services to be applicable in establishing minimum benefit coverages by Qualified Health Plans within Idaho, excluding any supplements for pediatric dental or vision. (3-31-22)
03. Nonrenewable Short-term Coverage. Short-term, limited-duration insurance that is not
renewable, has a total duration of six (6) months or less in total not to exceed twelve (12) months, and does not extend past the end of the current calendar year, and is not an Enhanced Short-term Plan under Section 41-5203(11), Idaho Code, and this rule. (3-31-22)(10-15-25)T
04. Preexisting Condition. (3-31-22)
a. A condition for which an ordinarily prudent person would seek medical advice, diagnosis, care or treatment during the six (6) months immediately preceding the effective date of coverage; (3-31-22) b. A condition for which medical advice, diagnosis, care or treatment was recommended or received during the six (6) months immediately preceding the effective date of coverage; or (3-31-22) c. Apregnancy existing on the effective date of coverage. (3-31-22) 054. Qualified Health Plan or QHP. Ahealth plan certified as such by the Exchange. (3-31-22) 065. Reissuance or Replace. The practice of issuing a short-term, limited-duration insurance policy covering at least one individual having short-term, limited-duration insurance coverage within sixty-three (63) days of the policy’s effective date. (3-31-22) 076. Short-term, Limited-duration Insurance. Health insurance coverage pursuant to a contract that has a specified expiration date less than twelve (12) months after the original effective date of the contract and, including renewals or extensions, has a total duration of no longer than thirty-six (36) months. (3-31-22) 011. GENERAL RULES FOR ENHANCED SHORT-TERM PLANS, LIMITED-DURATION INSURANCE. Short-term, Limited-duration Insurance is subject to the provisions of IDAPA18.04.13, Sections 081, 082, and 101. (10-15-25)T 012. GENERAL RULES FOR ENHANCED SHORT-TERM PLANS.
01. Application of Requirements. Any short-term, limited-duration insurance that, including
renewals, reissuance or extensions, has a total duration of longer than six (6) twelve (12) months or longer is subject to the requirements applicable to enhanced short-term plans. (3-31-22)(10-15-25)T
03. Portability. Enhanced short-term plan coverage is qualifying previous coverage under Title 41,
Chapter 52, Idaho Code. Preexisting condition exclusions are to be waived for the period of time an individual was previously covered by an enhanced short-term plan or other qualifying previous coverage. (3-31-22)(10-15-25)T IdahoAdministrative Bulletin Page 96 November 5, 2025 – Vol. 25-11 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0415-2501 Rules Governing Short-Term Health Insurance Coverage ZBR Pending & Temporary Rule
04. Requirement to Offer Exchange Plans. To offer an enhanced short-term plan, a carrier is to offer
individual QHPs through the Exchange in the same service area. (3-31-22) 012. GENERAL RULES FOR NONRENEWABLE SHORT-TERM COVERAGE. Nonrenewable short-term coverage is subject to the provisions of IDAPA18.04.13, Sections 081, 082, and 101. (3-31-22) 013. -- 019. (RESERVED) 020. ENROLLMENT.
01. Enhanced Short-term Plans. There are two exclusive options for enhanced short-term plan
enrollment. (3-31-22) a01. Year-round Enrollment. If a A carrier will allows year-round enrollment in enhanced short-term plans, the following provisions apply:. (3-31-22)(10-15-25)T i02. Preexisting Conditions. A preexisting condition exclusion period, as defined at Subsection 010.04, may be applied, subject to Section 41-5208, Idaho Code. (3-31-22)(10-15-25)T ii. The policy is to be offered on a plan year basis, not a calendar year basis. (3-31-22) b. Annual Open Enrollment Period. If a carrier restricts enrollment in enhanced short-term plans to an annual open enrollment period, the following apply: (3-31-22) i. No preexisting condition exclusion period may be applied. (3-31-22) ii. The beginning and ending dates of the open enrollment period are identical to those for enrollment in QHPs, unless the Director allows an extension of the open enrollment period for enhanced short-term plans after determining it is in the public interest. (3-31-22) iii. Special enrollment periods are to be allowed to the same extent as QHP enrollment. (3-31-22)
02. Nonrenewable Short-term Coverage. Nonrenewable short-term coverage is to be offered on a
year-round basis. (3-31-22) 021. RENEWALAND REISSUANCE.
01. Enhanced Short-term Plans Renewals. (3-31-22)
a. A policy is to be renewable at the option of the enrollee, consistent with Section 41-5207, Idaho Code. (3-31-22) b. No new application or questions concerning the health or medical condition of the covered individuals may be requested to effectuate the renewal. (3-31-22) c. Apolicy is not to be renewable beyond thirty-six (36) consecutive months. (3-31-22) dc. Upon exhaustion of a policy’s renewability due to duration or age, the policyholder is eligible for enrollment into fully renewable coverage, including all of the current carrier’s QHPs, when an enhanced short-term policy has been in effect for at least eleven (11) months. The carrier will provide to the policyholder Ttimely notification of eligibility is to be provided to the policyholder plus the notification of any offer of reissuance. (3-31-22)(10-15-25)T
02. Enhanced Short-term Plans Reissuances. Upon exhausting renewability due to duration or age,
the following provisions apply to reissuance: (3-31-22) IdahoAdministrative Bulletin Page 97 November 5, 2025 – Vol. 25-11 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0415-2501 Rules Governing Short-Term Health Insurance Coverage ZBR Pending & Temporary Rule a. No new application or questions concerning the health or medical condition of the covered individuals may be requested for reissuance. (3-31-22) b. The reissuance premium rate is a change in premium rate subject to IDAPA 18.04.13.036.17 Section 41-5206, Idaho Code. (3-31-22)(10-15-25)T
03. Nonrenewable Coverage. Carriers are not to renew nonrenewable short-term coverage and are not
to reissue or replace nonrenewable short-term coverage issued by the same or another carrier. (3-31-22) 022. RATING REQUIREMENTS.
01. Enhanced Short-term Plans. In addition to the requirements applicable to individual health
benefit plans, the following rating requirements apply: (3-31-22) a. Premium rates do not vary by gender. (3-31-22) b. Geographic rating areas are identical to those used for Exchange-offered QHPs. (3-31-22) c. Medical underwriting criteria may be used to ascertain the risk characteristics of an applicant, if the criteria are limited to those in the Universal Health Statement Addendum and available claims data. (3-31-22) d. Enhanced short-term plans comprise a single risk pool with the carrier’s other actively marketed individual health benefit plans subject to Title 41, Chapter 52, Idaho Code. (3-31-22) ed. The rating period is on a calendar year basis, whereby the rates filed apply to all enrollees uniformly during a given calendar year and premium rate changes occur at the start of a new calendar year. (3-31-22)
02. Nonrenewable Short-term Coverage. The following rating requirements apply: (3-31-22)
a. The rates cannot utilize case characteristics other than age, individual tobacco use, and geography but may vary by the duration of coverage requested. (3-31-22) b. Case characteristics are applied uniformly, without regard to the risk characteristics of an eligible individual. (3-31-22) c. The premium rate is not affected by an applicant’s risk characteristics or health status. (3-31-22) d. The premium rate remains the same for the duration of the policy. (3-31-22) 023. -- 029. (RESERVED) 030. MINIMUM STANDARDS FOR BENEFITS.
01. Minimum Covered Benefits. (3-31-22)
a. Daily hospital room and board expenses subject only to limitations based on average daily cost of the semiprivate room rate in the area where the insured resides; (3-31-22) b. Miscellaneous hospital services; (3-31-22) c. Surgical services; (3-31-22) d. Anesthesia services; (3-31-22) e. In-hospital medical services; and (3-31-22) IdahoAdministrative Bulletin Page 98 November 5, 2025 – Vol. 25-11 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0415-2501 Rules Governing Short-Term Health Insurance Coverage ZBR Pending & Temporary Rule f. Out-of-hospital care, consisting of physicians’ services rendered on an ambulatory basis where coverage is not provided elsewhere in the policy for diagnosis and treatment of sickness or injury, diagnostic x-ray, laboratory services, radiation therapy, and hemodialysis ordered by a physician. (3-31-22)
02. Minimum Additional Benefits. A separate premium corresponding to additional benefits offered
through a rider is to be filed and actuarially justified. A policy is to provide not fewer than three (3) of the following additional benefits: (3-31-22) a. In-hospital private duty registered nurse services; (3-31-22) b. Convalescent nursing home care; (3-31-22) c. Diagnosis and treatment by a radiologist or physiotherapist; (3-31-22) d. Rental of special medical equipment, as defined by the insurer in the policy; (3-31-22) e. Artificial limbs or eyes, casts, splints, trusses or braces; (3-31-22) f. Treatment for functional nervous disorders, and mental and emotional disorders; or (3-31-22) g. Out-of-hospital prescription drugs and medications. (3-31-22)
03. Enhanced Short-term Plans Covered Benefits. The following covered benefits and limitations
are to be provided, consistent with the Benchmark Medical Plan, including:. (3-31-22)(10-15-25)T a. Ambulatory (outpatient) patient services; (3-31-22) b. Emergency services; (3-31-22) c. Hospitalization; (3-31-22) d. Maternity and newborn care; (3-31-22) e. Mental health and substance use disorder services, including behavioral health treatment; (3-31-22) fd. Generic Pprescription drugs; (3-31-22)(10-15-25)T ge. Rehabilitative and habilitative services and devices; and (3-31-22)(10-15-25)T hf. Laboratory services; and. (3-31-22)(10-15-25)T i. Preventive and wellness services and chronic disease management. (3-31-22) 042. Prescription Drug Formulary. If a prescription drug coverage formulary is applied, the applicable formulary drug list is to: (3-31-22) a. Include at least one drug in every United States Pharmacopeia (USP) category and class; (3-31-22) b. Cover a range of drugs across a broad distribution of therapeutic categories and classes and recommended drug treatment regimens that treat all covered disease states, and does not discourage enrollment by any group of enrollees; and (3-31-22) c. Provide appropriate access to drugs included in broadly accepted treatment guidelines and indicative of then-current general best practices. (3-31-22) 053. Cost Sharing. (3-31-22) IdahoAdministrative Bulletin Page 99 November 5, 2025 – Vol. 25-11 IDAHO DEPARTMENT OF INSURANCE Docket No. 18-0415-2501 Rules Governing Short-Term Health Insurance Coverage ZBR Pending & Temporary Rule a. Except for out-of-network benefits offered as part of a managed care plan, a coinsurance percentage is not to exceed fifty percent (50%) of covered charges. A coinsurance percentage for out-of-network benefits offered as part of a managed care plan is not to exceed sixty percent (60%) of covered charges. (3-31-22) b. The maximum out-of-pocket is to be stated in the policy and in aggregate is not to exceed four percent (4%) of the aggregate annual limit under the policy for each covered person the limits for QHPs. All deductibles, copayments, coinsurance and any other cost-sharing are applicable to the maximum out-of-pocket. Within the aggregate maximum, the policy may include separate out-of-pocket limits applicable to particular services. (3-31-22)(10-15-25)T c. The annual limit is no less than one million dollars ($1,000,000) for each covered person insured. (3-31-22)(10-15-25)T d. Enhanced short-term plans are to provide coverage for and not impose any cost sharing requirements for preventive and wellness services consistent with QHP requirements. (3-31-22) 06. Applicability of Mental Health Parity. Enhanced short-term plans are to meet the requirements of Section 2726 of the Public Health Service Act (Mental Health Parity and Addiction Equity Act) in the same manner and extent as QHPs. (3-31-22) 074. Benefit Requirements. The minimum benefits imposed by Subsections 030.01, 030.02, and 030.03 may be subject to all applicable deductibles, coinsurance and general policy exceptions and limitations. Except as disallowed by Subsections 030.03, 030.05, and 030.06, a policy may also have special or internal limitations for nursing facilities, transplants, experimental treatments, services covered under Subsection 030.02, and other special or internal limitations authorized by the Director. Except as authorized by this Subsection through the application of special or internal limitations, a policy will cover, after any deductibles or coinsurance provisions are met, the usual, customary and reasonable charges, as determined consistently by the carrier and as subject to prior written approval by the Director or another rate agreed to between the insurer and provider, for covered services up to the annual limit. (3-31-22)(10-15-25)T 031. -- 039. (RESERVED) 040. DISCLOSURE PROVISIONS. Polices subject to this chapter will include in the application for coverage, any application materials, and the insurance contract, the following language in at least 14-point type: “This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.” (3-31-22) 041. -- 999. (RESERVED) IdahoAdministrative Bulletin Page 100 November 5, 2025 – Vol. 25-11
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