Idaho Administrative Code
Title IDAPA 18 - Insurance, Department of
Rule 18.04.04 - THE MANAGED CARE REFORM ACT RULE
Section 18.04.04.012 - SOLICITATION PRIOR TO ISSUANCE OF CERTIFICATE OF AUTHORITY

Universal Citation: ID Admin Code 18.04.04.012

Current through August 31, 2023

01. Permission for Solicitation Requisite. In accordance with Section 41-3904, Idaho Code, a proposed MCO, after filing its application for a Certificate of Authority, may request permission from the Director to inform potential enrollees concerning its proposed managed care services. (3-31-22)

02. Solicitation Materials. Before contacting potential enrollees or subscribers, the proposed MCO will submit its request for permission to the Director in writing, with copies of brochures, advertising or solicitation materials, sales talks or any other procedures or methods to be used. (3-31-22)

03. Methods of Solicitation. Advertising and solicitation materials used by a proposed MCO need to meet the following minimum requirements: (3-31-22)

a. The prospective enrollee will clearly be advised that: (3-31-22)
i. The proposed MCO is not as yet authorized to offer health care services in this state; (3-31-22)

ii. Coverage for health care services is not being provided at the time of the solicitation; (3-31-22)

iii. The solicitation is not a guarantee that any services will be provided at a future date. (3-31-22)

b. The format and content of any material offered will conform with the MCO Act. Such material will contain but not be limited to the following information: (3-31-22)
i. Complete description of the proposed MCO services and other benefits to which the enrollee would be entitled; (3-31-22)

ii. The location of all facilities, the hours of operation, and the services which would be provided in each facility; (3-31-22)

iii. The predetermined periodic rate of payment for the proposed services; (3-31-22)

iv. All exclusions and limitations on the proposed services, including any copayment feature, and all restrictions relating to pre-existing conditions. (3-31-22)

c. No person will solicit enrollment or inform prospective enrollees concerning proposed MCO services unless compensated solely as a salaried employee of the proposed MCO. (3-31-22)

Disclaimer: These regulations may not be the most recent version. Idaho may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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