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Blue Cross of Idaho files 5 state-based plans at odds with ACA rules


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Blue Cross of Idaho files 5 state-based plans at odds with ACA rules

Blue Cross of Idaho Care Plus Inc. has applied to offer health insurance plans in the state that do not conform to Affordable Care Act coverage requirements.

The company, if approved by the Idaho Department of Insurance, will offer five plans in the state with varying coverage and cost options. The company can base its underwriting criteria on a health questionnaire with 20 questions approved by the department detailing a consumer's health history.

The form requires applicants to fill a non-comprehensive form asking if they have been diagnosed with more than 100 conditions, have had surgery or been hospitalized, or have been advised to undergo future surgery. In addition, the form asks applicants if the consumer or his or her family members suffer from chronic or recurring ailments, have taken prescription medicine in the last year, have been denied or refused coverage, or have filed a $5,000 or more claim.

According to the ACA, an insurance company cannot refuse to cover a consumer or charge more for a plan if he or she has a pre-existing condition.

The plans offered comply with a set of guidelines Idaho regulators created after the state's governor directed them to bring the state’s rising health insurance premiums under control.

Blue Cross of Idaho President and CEO Charlene Maher wrote in a statement Feb. 14 that the company's plans "begin to solve the issues that have kept middle-class Idahoans from buying health insurance." The company did not respond to requests for comment Feb. 16.

The plans are meant to give consumers less coverage than the minimum required by the ACA in order to lower costs and offer more choices for consumers, especially those who do not need comprehensive coverage, the department has argued.

Weston Trexler, a bureau chief for Idaho's insurance department, said companies were given guidance allowing them to ask about consumers' health histories on the application for underwriting purposes. The guidance states, however, that premiums must not be more than 50% above or below the insurer’s filed plan adjusted index rate after "applying all allowable case characteristics."

Trexler reiterated in a statement to S&P Global Market Intelligence that the state's alternative plans offer "similarly comprehensive coverage" as ACA plans at more affordable prices.

He also maintained that the Idaho Department of Insurance will continue to fully enforce federal protections for separate ACA plans offered in the state.