41-4303 APPLICATION OF CHAPTER.
INSURANCE
CHAPTER 43
IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT
41-4303. Application of chapter. (1) This chapter shall apply to direct life insurance policies, contractual obligations of managed care plans to members of such plans only, disability insurance policies, annuity contracts, and contracts supplemental to life and disability insurance policies, annuity contracts, and contracts supplemental to life and disability insurance policies and annuity contracts issued by persons licensed to transact insurance in this state at any time. Covered policies shall include annuities owned by a trust for a money purchase pension plan, profit sharing plan, 401(k) thrift plan or any other defined contribution plan, annuities owned by a custodian of an individual retirement account and structured settlement annuities.
(2) This chapter shall not apply to:
(a) That portion or part of a variable life insurance or variable annuity contract not guaranteed by an insurer;
(b) That portion or part of any policy or contract under which the risk is borne by the policyholder;
(c) Any policy or contract or part thereof assumed by the impaired or insolvent insurer under a contract of reinsurance, other than reinsurance for which assumption certificates have been issued;
(d) Any such policy or contract issued by a reciprocal insurer, mutual benefit association, fraternal benefit society, hospital and medical service corporation, limited managed care plan, or self-funded health care plan;
(e) Any unallocated annuity contract, including an annuity owned by a defined benefit pension plan or trust;
(f) A portion of a policy or contract to the extent that the rate of interest on which it is based, or the interest rate, crediting rate or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or exchanges in value:
(i) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moody's Corporate Bond Yield Average averaged for that same four (4) year period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier;
(ii) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moody's Corporate Bond Yield Average as most recently available; and
(iii) For purposes of this section, "Moody's Corporate Bond Yield Average" means the monthly average corporates as published by Moody's Investors Service, Inc., or any successor thereto;
(g) An obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the contract owner or policyowner, including without limitation:
(i) Claims based on marketing materials;
(ii) Claims based on side letters, riders or other documents that were issued by the insurer without meeting applicable policy form filing or approval requirements;
(iii) Misrepresentations of or regarding policy benefits;
(iv) Extra-contractual claims; or
(v) A claim for penalties or consequential or incidental damages; or
(h) A policy or contract providing any hospital, medical, prescription drug or other health care benefits pursuant to 42 U.S.C. chapter 7, subchapter XVIII, parts C and D, commonly known as medicare part C and D, or any regulations issued pursuant thereto.
(3) This chapter shall not provide coverage to a person who is a payee or beneficiary of a contract owner resident of this state if the payee or beneficiary receives any coverage by the association of another state.
(4) In order to avoid duplicate coverage, a person who is eligible for coverage under the provisions of this chapter and is currently provided coverage under the laws of any other state shall not be provided coverage under this chapter. This chapter shall be construed in conjunction with other states' laws in order to ensure coverage by only one (1) association.