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Idaho - Compensation & Benefit Legislation

IDAHO - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

IDAHO - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

If policy covers newborns it must do so from birth. Adopted children must also be covered.

 

Preventive care for children: No.

 

(Idaho Code Sections 41-2203,41-2210)

 

IDAHO - ALCOHOLISM & DRUG ABUSE

State reports no statutory requirements.

 

IDAHO - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: No. Follows FUTA.

 

IDAHO - CONTINUATION OF COVERAGE CONVERSIONS

State reports no statutory requirements.

 

IDAHO - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. (Idaho Code Section 41-2121, -2122, 41-2216)

 

IDAHO - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

IDAHO - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

State has no statutory requirements.

 

IDAHO - GROUP HEALTH CODE ADDITIONS (MANDATED)

Continuation Coverage: Group policies covering hospital, medical, or surgical expenses must provide continuation rights to employees or dependents who become totally disabled. (Idaho Code Section 41-2213.) Group policies covering pregnancy, childbirth, or miscarriage must provide continuation rights for employees or dependents whose coverage is discontinued for up to 12 months. (Idaho Code Section 41-2214.)

 

Dependents: A court order or an administrative order issued requiring that a dependent child be covered under an individual's health insurance plan may be enforced by the Department of Health and Welfare or authorized body. Enforcement of these orders may take place if an individual required to provide dependent coverage is eligible for family health benefits through an employer but fails to secure the coverage or if provisions made by an individual for dependent benefits have lapsed. (H413, 1996) (Idaho Code Sections 32-1216, 41-3929.)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a child is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Idaho Code Sections 2139, 2203.)

 

Long Term Care: Coverage under long term health insurance plans may provide benefits only for in home care. Plans which cover nursing home care must cover costs for all levels of care including, but not limited to, custodial, immediate, and skilled. Services which may be provided under long term care plans include personal care, adult foster care, adult day care, in home services, and home delivered meals. (H472, 1996) (Idaho Code Sections 41-4605, 4603(4)(a).)

 

Mammography Screening: All disability contracts, group or blanket disability insurance policies, group subscriber's contracts, health maintenance organization policies, contracts, plans, certificates, and self funded plans which provide mastectomy coverage shall provide minimum mammography coverage equivalent to one baseline mammogram for women 35 through 40 years of age; one mammogram every two years for women 40 through 49 years of age - more frequently if recommended by her physician; one mammogram every year for women 50 years of age or older; and one mammogram for any woman desiring a mammogram for medical cause. Such coverage shall not exceed the cost of the examination. (Idaho Code Sections 41-2144, 41-2218, 41-3441, 41-3926, 41-4025.)

 

Managed Care Organizations: Under managed care provisions, health care benefits must be provided on a prepaid basis, and coverage must include benefits for out-of-area, out-of-network, and emergency services. Out-of-network non emergency services may be accessed in instances where a managed care organization has determined that an individual needs care from a category of providers not available through a plan. (S1150, 1997) (Idaho Code Section 41-3905.) Grievance procedures, including appeals provisions, must be established by managed care organizations in order to resolve members' complaints. (S1150, 1997) (Idaho Code Section 41-3918.) Adopted Newborn Children and Maternity Care: Managed care plans must provide coverage for newborn children who are placed with a member within 60 days of the adopted child's date of birth. Managed care coverage for adopted children must not be restricted solely on the basis of pre-existing conditions. Coverage for maternity care must provide benefits for involuntary complications of pregnancy without exclusions, reductions, or other limitations or coverage, unless the restrictions also apply to coverage for other conditions. (S1150, 1997) (Idaho Code Section 41-3932.) HMO Disclosure: Managed care organizations must provide to individuals enrolled in a plan and make available to the general public annual disclosures of financial standings, provider information, details of formularies, grievance procedures and descriptions of available benefits packages. (S1150, 1997) (Idaho Code Section 41-3914.) Incentives: Managed care organizations must not offer to providers incentives and must not contract with providers on incentives as inducements to deny, reduce, limit, or delay specific, medically necessary, and appropriate services covered by a health care plan to specific members of group of members with similar medical conditions. (S1150, 1997) (Idaho Code Section 41-3928.)

 

Maternity: Health care contracts and disability policies that provide maternity benefits for persons covered continuously from conception may not limit coverage for involuntary complications of pregnancy unless such provisions apply generally to all benefits. (Idaho Code Sections 41-2140(2), 41-2210(2), 41-3923.)

 

Newborns: Health care contracts and disability policies that cover injury or sickness of newborn dependents must provide such coverage from the moment of birth and include coverage for congenital anomalies. (Idaho Code Sections 41-2140(1), 41-2210(1), 41-3923.)

 

Policies for Small Employers: A small employer carrier shall offer to any eligible small employer that applies, a basic and a standard health benefit plan. (Idaho Code Section 41-4708(1)(a), (b)( i).) A standard health benefit plan is one approved by the Health Benefit Plan Committee and the State Director of the Department of Insurance. (Idaho Code Sections 41-4703(30< 41-4712( c).) A basic health benefit plan is a lower cost health benefit plan. (Idaho Code Sections 41-4703(5), 41-4712( c). A small employer is one that is actively engaged in business on at least 50 percent of its working days during the preceding calendar quarter and employed no more than 49 eligible employees, the majority of whom were employed in Idaho. (Idaho Code Section 41-4703(28).) An employer is eligible for small employer coverage if it employed at least 2 or more eligible employees within the state at least 50 percent of its working days during the preceding calendar quarter. (Idaho Code Section 41-4708( c).)

 

Pre-existing Conditions: Health plans, including HMOs, covering large employers (employers with not less than 50 workers must not deny, exclude or limit benefits for an individual for covered expenses incurred more than 12 months following the effective date of the individual's coverage due to a pre-existing condition. In addition, plans must waive time periods during which benefits for individuals under new coverage are limited or excluded due to pre-existing conditions in instances in which these persons had been covered continuously under another plan which expired not more than 30 days prior to the effective date of the new coverage. (S1322, 19967) (Idaho Code Section 41-2221.)

 

Prescription Drugs: A group policy or contract providing for third party payment or pre-payment for prescription drugs may designate an affiliated mail order pharmacy or other pharmacy, but it may not require a participant to obtain prescription drugs from any such pharmacy nor shall it require the payment of additional fees or deductibles if the participant obtains prescription drugs from a registered pharmacy not designated by the policy or contract. (Idaho Code Section 41-1844.)

 

IDAHO - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

Eligibility Criteria: 2 - 50 full-time employees; the majority must be employed within the state.

 

Restrictions on premiums: Yes.

 

Restrictions on cancellation: Yes.

 

Pre-existing Conditions: Provision may not exclude benefits for more than 12 months after the effective date of coverage.

 

Other: Basic coverage for inpatient and outpatient minimum coverage shall be offered according to Health Benefit Plan Committee guidelines. No other law mandating particular coverage shall apply to plans offered pursuant to this act.

 

(Idaho Code Sections 41-4703, 41-4706, 41-4707, 41- 4708)

 

IDAHO - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%

 

Percent of employees who must be covered if employer pays all of premium: 100%

 

Minimum number of employees in group plan: 5.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(Idaho Code Sections 41-2003, 4102011, 41-2018)

 

IDAHO - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Thanksgiving, Sunday. Other: Any day appointed by the Governor or President. If any holiday falls on Sunday, following Monday is a holiday; if holiday falls on Saturday, preceding Friday is a holiday. (Idaho Code Section 73-108)

 

IDAHO - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

IDAHO - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of criminal contempt punishable by a fine of not more than $300. Employee can bring civil action within 60 days of discharge for lost wages, reinstatement and reasonable attorney fees. Damages recovered shall not exceed 6 weeks' lost wages.

 

Other Requirements: None reported. (Idaho Code 2-218.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

IDAHO - LEAVES OF ABSENCE

State reports no statutory requirements.

 

See U.S. Federal Family and Medical Leave Act

 

IDAHO - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

IDAHO - MANDATED PROVIDERS

State reports no statutory requirements.

 

IDAHO - MENTAL HEALTH CARE

State reports no statutory requirements.

 

IDAHO - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain professionals, agriculture workers , domestics, and outside sales. Students, apprentices, and handicapped in special environments may be exempt by special license. (Idaho Code Sections 44-1502, 44-1504, 44-1506)

 

See U.S. Minimum Wage

 

IDAHO - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 form or by any other means authorized by the State.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, federal tax identification number, and state unemployment insurance account number.

 

Employee information to be included: Name, address, SSN, and date of hire.

 

Penalty for failure to report: -

 

(Idaho Code Sections 72-1601 through 7-2-1607)

 

IDAHO - NEWBORN CARE MANDATE

If policy covers newborns it must do so from birth. Adopted children must also be covered. Preventive care for children: no. (Idaho Code Sections 41-2203,41-2210)

 

IDAHO - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

IDAHO - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, benefits shall not be denied for covered expenses incurred over 12 months following effective date of coverage due to a pre-existing condition. (Idaho Code Sections 41-4703, 41-4706, 41-4707, 41-4708)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

IDAHO - PROTECTED CLASSIFICATIONS

Age:  Yes.

Race:  Yes.

Color:  Yes.

National Origin: Yes.

Ancestry:  No specific law. State has expressed policy against discrimination.

Religion:  Yes.

Sex:  Yes.

Pregnancy: No specific law. State has expressed policy against discrimination.

Sexual Harassment:  No specific law. State has expressed policy against discrimination.

 

(Idaho Code Sections 67-5901, 67-5902, 67-5909.)

 

IDAHO - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

IDAHO - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

IDAHO - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Earlier of payday or 10 days, or 48 hours after written request.

 

Date due if employee resigns: Earlier of payday or 10 days, or 48 hours after written request.

 

Wages: Yes.

 

Vacation Pay: No.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

(Idaho Code Section 45-606)

 

IDAHO - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: No. State reports no statutory requirements.

 

(Idaho Code Sections 72-1347A, 72-1350.)

 

IDAHO - VACATION PAY

State reports no statutory requirements.

 

IDAHO - VOTING TIME OFF

State reports no statutory requirements.

 

IDAHO - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Elective as to corporate officers who are 10% shareholders, sole proprietors and working members of partnership.

 

Public Employers: Mandatory as to all public employments except officials at secondary school athletic contests. Members of Idaho National Guard are covered under state law, if not covered under federal law.

 

Exceptions: Agricultural pursuits, domestic servants, casual labor indwelling members of employer's family, outworkers (Note: Outworker is person to whom articles are given for cleaning, repairing, etc., at home.), employment not for money, airmen, and commission real estate salespersons and brokers.

 

Special Coverage Provisions: Employees within state who work for employers domiciled in another state are covered. Credit is provided for benefits paid to employees under the law of other states.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)