Idaho State Statutes - Idaho Attorney Directory

Unless the context requires otherwise, the
definitions in this section apply throughout this chapter.
(1) "Applicant" means:
(a) In the case of an individual long-term care insurance policy, the
person who seeks to contract for benefits; and
(b) In the case of a group long-term care insurance policy, the proposed
certificate holder.
(2) "Certificate" means, for the purposes of this chapter, any
certificate issued under a group long-term care insurance policy, which policy
has been delivered or issued for delivery in this state.
(3) "Director" means the director of the department of insurance of this
state.
(4) "Group long-term care insurance" means a long-term care insurance
policy which is delivered or issued for delivery in this state and issued to:
(a) One (1) or more employers or labor organizations, or to a trust or to
the trustees of a fund established by one (1) or more employers or labor
organizations, or a combination thereof, for employees or former employees
or a combination thereof, or for members or former members or a
combination thereof, of the labor organizations; or
(b) Any professional, trade or occupational association for its members
or former or retired members, or combination thereof, if such association:
(i) Is composed of individuals all of whom are or were actively
engaged in the same profession, trade or occupation; and
(ii) Has been maintained in good faith for purposes other than
obtaining insurance; or
(c) An association or a trust or the trustee(s) of a fund established,
created or maintained for the benefit of members of one (1) or more
associations. Prior to advertising, marketing or offering such policy
within this state, the association or associations, or the insurer of the
association or associations, shall file evidence with the director that
the association or associations have at the outset a minimum of one
hundred (100) persons and have been organized and maintained in good faith
for purposes other than that of obtaining insurance; have been in active
existence for at least one (1) year; and have a constitution and bylaws
which provide that:
(i) The association or associations hold regular meetings not less
than annually to further purposes of the members;
(ii) Except for credit unions, the association or associations
collect dues or solicit contributions from members; and
(iii) The members have voting privileges and representation on the
governing board and committees.
Sixty (60) days after such filing the association or associations will be
deemed to satisfy such organizational requirements, unless the director
makes a finding that the association or associations do not satisfy those
organizational requirements.
(d) A group other than as described in paragraphs (a), (b) and (c) of
this subsection, subject to a finding by the director that:
(i) The issuance of the group policy is not contrary to the best
interest of the public;
(ii) The issuance of the group policy would result in economies of
acquisition or administration; and
(iii) The benefits are reasonable in relation to the premiums
charged.
(5) "Long-term care insurance" means any insurance policy or rider
advertised, marketed, offered or designed to provide coverage for not less
than twelve (12) consecutive months for each covered person on an expense
incurred, indemnity, prepaid or other basis; for one (1) or more necessary or
medically necessary diagnostic, preventive, therapeutic, rehabilitative,
maintenance or personal care services, provided in a setting other than an
acute care unit of a hospital. Such term includes group and individual
annuities and life insurance policies or riders which provide directly or
which supplement long-term care insurance. Such term also includes a policy or
rider which provides for payment of benefits based upon cognitive impairment
or the loss of functional capacity. The term shall also include qualified
long-term care insurance contracts. Long-term care insurance may be issued by
insurers, fraternal benefit societies, managed care organizations, or any
similar organization to the extent they are otherwise authorized to issue life
or health insurance. Long-term care insurance shall not include any insurance
policy which is offered primarily to provide basic medicare supplement
coverage, basic hospital expense coverage, basic medical-surgical expense
coverage, hospital confinement indemnity coverage, major medical expense
coverage, disability income or related asset-protection coverage, accident
only coverage, specified disease or specified accident coverage, or limited
benefit health coverage. With regard to life insurance, this term does not
include life insurance policies which accelerate the death benefit
specifically for one (1) or more of the qualifying events of terminal illness,
medical conditions requiring extraordinary medical intervention, or permanent
institutional confinement, and which provide the option of a lump-sum payment
for those benefits and in which neither the benefits nor the eligibility for
the benefits is conditioned upon the receipt of long-term care.
Notwithstanding any other provision contained herein, any product advertised,
marketed or offered as long-term care insurance shall be subject to the
provisions of this chapter.
(6) "Policy" means, for the purposes of this chapter, any policy,
contract, enrolled member agreement, rider or endorsement delivered or issued
for delivery in this state by an insurer, fraternal benefit society, managed
care organization, or any similar organization.

Click here to visit the Official Idaho State Statutes