It is the public policy of the state of Idaho to actively resist federal actions that would limit or override state sovereignty under the 10th amendment of the United States constitution. Through this legislation, the state of Idaho asserts its sovereignty by refusing to surrender decision-making authority over health care issues, which are matters appropriately left to states and individual citizens. The purpose of this chapter is to establish a state-created, market-driven health insurance exchange that will facilitate the selection and purchase of individual and employer health benefit plans.

The managed care organization shall make all records available to the director or his designee for review at all reasonable times upon the director’s request; provided, however, that the availability of health records shall be subject to any Idaho law limiting or defining such availability.

Every managed care organization offering a managed care plan for which a certificate of authority is required shall annually, on or before the first day of June, file a report with the director showing its audited financial condition on the last day of the preceding December. The report shall be on forms prescribed by the director and shall be verified by an appropriate officer of the organization.

The director shall make an examination of the affairs and operations of any organization offering a managed care plan for which a certificate of authority is required as often as he deems necessary but not less frequently than once every five (5) years.

Health care contracts must disclose predetermined and prepaid payment rates for health care services and other benefits, and anything else the member is obliged to pay, such as deductibles, copayments, and coinsurance; and whether the plan includes a limited formulary of medications and a statement that the formulary will be made available to any member on request.

Every managed care organization shall provide to its enrollees and make available for inspection by the general public on an annual basis the following.

Every managed care organization shall establish a mechanism to provide members an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other reasonable mechanisms.

Every managed care organization shall establish a grievance system to resolve grievances initiated by members concerning health care services.

Requirement of an open enrollment period is intended to provide the benefits of managed care to the general public or to all members of the class of persons the managed care organization serves

It shall be unlawful for any health service institution or associations of health professionals to exclude other health professionals from working privileges, membership, or association solely on the basis that such other person is employed by or contracts with a managed care organization pursuant to this chapter.