Idaho Health Study Guide

Idaho calls this line Disability in statute, Accident Health and Sickness on the license, and Accident & Health or Sickness on the exam. Whatever it is called, twenty-five of its seventy-five scored questions are Idaho law, graded as their own portion — and Idaho’s health chapter is unusually number-dense. Chapter 21 alone supplies six different day-counts, and the state’s Medicare supplement rules contain one genuinely distinctive feature that no neighbouring state matches.

The uniform policy provisions — six numbers from one chapter

Idaho Code Chapter 21 sets the required provisions for individual disability policies, and the exam mines it hard:

• Free look: 10 days (§ 41-2138) — the purchaser may return the policy within ten days of delivery for a refund.
• Grace period: tiered by premium mode (§ 41-2107) — not less than 7 days on weekly-premium policies, 10 days on monthly-premium policies, and 31 days on all others.
• Notice of claim: 20 days after the occurrence or commencement of loss (§ 41-2109).
• Claim forms: 15 days — if the insurer fails to furnish proof-of-loss forms within fifteen days of notice, the claimant may submit written proof in any form (§ 41-2110).
• Proof of loss: 90 days after the end of the period for which the insurer is liable (§ 41-2111).
• Legal actions: 60 days and 3 years (§ 41-2115) — no suit before sixty days after proof of loss is furnished, and none after three years.

Add time limit on certain defenses: 2 years (§ 41-2106), after which no misstatement except a fraudulent one may void the policy.

Prompt payment — thirty and forty-five, with the interest hidden elsewhere

Title 41, Chapter 56 — “Prompt Payment of Claims” — gives an insurer 30 days to pay or deny an electronic claim and 45 days for a paper one (§ 41-5602). Both are counted from receipt.

The penalty structure has two features worth knowing. § 41-5603 requires interest on overdue amounts “at the contract statutory rate pursuant to section 28-22-104” — Title 41 never prints the number, and § 28-22-104 supplies it as “twelve cents (12¢) on the hundred by the year,” i.e. 12% per year. And § 41-5606 caps the administrative fine at $5,000, subject to a 95% safe harbour — no penalty where the insurer timely paid 95% or more of covered claims for the year — and expressly denies the Director power to suspend or revoke a certificate of authority for chapter 56 violations.

What Idaho does not have: a mini-COBRA

This is one of the more consequential absences in the state’s health law. Idaho has no general state continuation right. A full reading of Title 41 Chapter 22 turns up no continuation and no conversion section at all.

What exists instead are two narrow extensions of benefits, and the distinction matters:

• § 41-2213 continues hospital, medical and surgical benefits for not less than 12 months where an employee or dependent is totally disabled when the group policy is discontinued and remains so.
• § 41-2214 continues maternity benefits for not beyond 12 months where the person is pregnant at discontinuance and is not eligible for replacement group coverage within 60 days.

Both attach to an ongoing condition. Neither is an elective right an employee can buy into, and neither has an employer-size trigger. An Idahoan leaving a job at an employer below the federal COBRA threshold of twenty employees has no state fallback.

Medicare supplement — Idaho’s birthday rule

Every state gives a Medicare supplement buyer a six-month open enrollment window beginning “the first day of the first month in which an individual is both sixty-five (65) years of age or older and is enrolled for benefits under Medicare Part B” (IDAPA 18.04.10 § 036.01). Idaho gives something more.

Since March 1, 2022, Idaho has run an annual birthday rule: a guaranteed-issue period that “begins on the individual’s birthday and ends sixty-three (63) days thereafter,” during which a policyholder may change insurance company or plan regardless of health conditions. It came in with Senate Bill 1143, signed April 22, 2021, which also imposed community rating — new Medicare supplement premiums are no longer based on the applicant’s age — and ended payment-frequency discounts on new policies.

Two boundaries: the birthday rule governs changing coverage, not initial enrollment at 65, and preexisting conditions may not be excluded beyond six months from the effective date (§ 022.01.a).

Long-term care, and the training that comes with it

LTC policies carry a 30-day free look with the notice “prominently printed on the first page” (§ 41-4605(6)), and preexisting conditions may only be excluded where they last beyond six months from the coverage start date. Selling LTC also requires 8 hours of producer training before you start and 4 hours every 24 months thereafter — measured, the Department stresses, between course completion dates, not licence renewal dates.