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Compliance Corner

State Updates

COVID-19 Exchange Special Enrollment Period

February 17, 2021

On February 12, 2021, Director Cameron released Bulletin No. 21-01, providing a special enrollment period (SEP) on the state exchange as a part of Idaho’s ongoing response to the COVID-19 pandemic. The SEP will be in effect from March 1, 2021, through March 31, 2021. Normally, individuals can only elect coverage through the state exchange (Your Health Idaho) during open enrollment or special enrollment periods.

During this SEP, individuals can apply for coverage through the exchange or directly through carriers. The state also requests that carriers allow the SEP in off-exchange individual health benefit plans. The SEP does not allow currently enrolled individuals to change carriers or metal levels unless they have another qualifying event. The coverage will be effective on April 1, 2021.

Although this change affects the individual market, employers should keep this in mind as it would likely create a qualifying event that would allow for an employee to potentially drop employer coverage (for themselves or their dependents) to go on the Idaho exchange.

Bulletin No. 21-01 »

COVID-19 Testing Coverage Expectations

July 21, 2020

On July 10, 2020, Director Cameron released Bulletin 20-13, which recommends that insurance carriers take a number of steps to effectively remove the barriers to testing and treatment of the COVID-19 virus. Specifically, the Department of Insurance recommends that carriers:

  • Establish and publicize how insured individuals can correspond directly with the carriers about prevention and testing of COVID-19
  • Relax prior approval requirements and procedures for receiving COVID-19 testing and treatment
  • Ease out-of-network requirements and procedures when access to urgent testing or treatment is unavailable from in-network providers
  • Forgo any cost sharing for COVID-19 testing

The guidance also recommends that carriers cover both diagnostic and antibody testing. Further, they suggest that any carriers that serve as the plan administrator for self-funded plans should also follow this guidance. Plan sponsors should be aware that the state of Idaho is suggesting these measures to insurers.

Bulletin 20-13 »

Extension of Transitional Health Insurance Plans

May 12, 2020

On April 22, 2020, Insurance Director Cameron released Bulletin 20-07, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans through December 31, 2021.

As background, on January 31, 2020, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Idaho and allows the issuer to renew these non-ACA-compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 20-07 »

Temporary Waiver of Pharmacy Benefit Requirements

April 14, 2020

On April 6, 2020, Director Cameron issued Bulletin No. 20-02, providing flexibility in pharmacy benefits requirements in the hopes of maximizing healthcare access and minimizing in-person pharmacy transactions. As such, for as long as the governor’s emergency proclamation is in place, the Department of Insurance is waiving:

  • Policy limitations on the number of pharmaceutical refills and early refills
  • Restrictions that would disallow coverage of a 90-day refill at a retail (as opposed to mail-order) setting, unless doing so would be inconsistent with an applicable prescription safety limits of the Social Security Act
  • Requirements for in-person pharmacy signature logs as well as the associated signature audits by insurers or pharmacy benefit managers

While this guidance is aimed at pharmacies, insurers and pharmacy benefits managers, employers should review this guidance so that they are aware of the relaxed pharmacy rules.

Bulletin No. 20-02 »

Temporary Waiver of Telehealth Restrictions

April 14, 2020

On April 6, 2020, Director Cameron issued Bulletin No. 20-03, providing flexibility in telehealth services provided in the state. Specifically, as long as the governor’s emergency proclamation is in place, the Department of Insurance is authorizing insurers to:

  • Immediately allow for provider-patient relationships to be established over two-way audio or audio-visual interaction
  • Provide coverage of telehealth visits for all in-network providers, if the visit would be reimbursable telehealth under the Secretary of the Department of Health and Human Services 1135 waiver published March 13, 2020
  • Allow in-network providers to use non-HIPAA compliant communication platforms (such as Skype, Facebook Messenger, or Apple FaceTime) to provide patient care, to the extent that the provider does not already have access to a HIPAA compliant platform
  • Allow health care service providers to waive or pay all or part of a claimant’s deductible or cost-sharing for COVID-19 related testing, diagnosis and treatment

While this guidance is aimed at insurers and providers, employers should review this guidance so that they are aware of the relaxed rules on telehealth services.

Bulletin No. 20-03 »

Conditional Renewal for Non-ACA-Compliant Plans Extended

May 14, 2019

On April 4, 2019, Idaho Department of Insurance Director Cameron released Bulletin No. 19-02 related to the extension of non-ACA compliant small group and individual policies and plans. As background, on March 25, 2019, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions, and the annual out-of-pocket maximum limit.

Transitional relief for these “grandmothered” plans has been extended several times before, and this bulletin applies the most recent federal extension to ID and allows insurers to renew policies in the individual market and the small group market according to the extended transitional policy through December 31, 2020. Please note, however, that such carriers must continue to abide by requirements outlined in Bulletin 16-03 (meaning that all grandmothered plans will be on a calendar-year renewal schedule).

Additionally, carriers are required to provide a notice at renewal which informs the individual or small employer of the option to renew the existing coverage or to enroll in a new plan on or off the ID marketplace. The notice must also inform them that some ACA market reforms are not included in their current plans. There is a model notice available on the department’s website that must be used without modification, and must be mailed without any other materials except for a cover letter, which may include the renewal premium.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 19-02 »

Rule Amended to Allow Medicare Supplemental Coverage Regardless of Age

May 16, 2017

On May 1, 2017, the Idaho Department of Insurance issued a news release announcing an amendment to its rule regarding Medicare Supplement insurance (often referred to as Medigap). The amendment now allows Medicare-eligible individuals under age 65 with disabilities or end-stage renal disease to be eligible for the supplemental coverage. Previously, Medicare Supplement policies were only available to individuals age 65 and older.

Carriers will be developing and submitting Medicare Supplemental plans incorporating this rule for 2018. This news release has little applicability to employers, but employers should be aware of the change as a resource for employees in case any questions arise.

News Release »

Abortifacient Drugs No Longer Prohibited From Being Prescribed Through Telemedicine

May 02, 2017

On April 4, 2017, Gov. Otter signed H.B. 250 into law, amending existing abortion law by no longer requiring that a physician must have examined a woman in person to determine the medical appropriateness of the administration of an abortifacient. Specific to telemedicine, the law removes language providing that no drug for purposes of causing an abortion may be prescribed through telehealth services.

The amendments were effective upon passage.

H.B. 250 »

Conditional Extension of Renewal for Non-PPACA-Compliant Plans

April 04, 2017

On March 8, 2017, Idaho Department of Insurance Director Cameron released Bulletin No. 17-01 related to the extension of non-PPACA-compliant small group and individual policies and plans. As background, on Feb. 23, 2017, the federal government announced an additional transition policy that allows insurers (if allowed by the state) to renew non-grandfathered non-PPACA-compliant plans (this transitional relief has been extended twice before). Such policies are not required to be in compliance with certain PPACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit.The Bulletin states that Idaho will allow insurers to renew policies in the individual market and the small group market according to the extended transitional policy. Please note, however, that such carriers must continue to abide by requirements outlined in Bulletin 16-03 (meaning that all grandmothered plans will be on a calendar-year renewal schedule).Carriers are required to provide a notice at renewal which informs the individual or small employer of the option to renew the existing coverage. The notice must also inform them that some PPACA market reforms are not included in their current plans. It must be mailed without any other materials except for a cover letter, which may include the renewal premium.

Small employers that are interested in renewing their non-PPACA-compliant plan should work with their advisors and insurers. Bulletin No. 17-01 »

ID State Updates - 2015 Jan 20 No.01

October 20, 2015

On Oct. 15, 2015, the Idaho Department of Insurance issued a news release on their decision on small employer group size. Idaho will retain its existing definition of ‘small employer’ as groups of up to 50 employees.

As background, PPACA included a provision to change the definition of small employer from 1-50 to 1-100 employees effective Jan. 1, 2016. On Oct. 1, 2015, the US Congress passed HR 1624, called the PACE Act. The PACE Act repeals the mandated small-group expansion from groups of up to 50 employees to groups of up to 100 employees. Thus, unless a state has expanded its definition of small employer, PPACA’s insurance mandates would not apply to employers in the 51-100 group in that state.

News Release »


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