Idaho Regulations

The news release announces that non-grandfathered transitional plans (also known as “grandmothered” plans) will be extended through December 31, 2019. A renewal for these plans must be offered by carriers for the 12 month period beginning on January 1, 2019. Transitional policies must continue to comply with ACA provisions with respect to essential health benefits, pre-existing condition exclusions, waiting periods, and mental health parity rules.

This bulletin to carriers in the employer and individual health insurance markets provides guidance regarding the extension of non-grandfathered transitional plans (also known as “grandmothered” plans) through December 31, 2019. The transitional plans must continue to comply with the mental health parity rules (individual plans upon renewal July 1, 2014 or later; not applicable to small group plans).

Treatments for autism spectrum disorder by Idaho health plans cannot be excluded from coverage if rehabilitative or habilitative services are covered. All health benefit plans that are subject to the Mental Health Parity and Addiction Equity Act of 2008 must follow the guidance in this bulletin for plan years starting on or after January 1, 2019. If a group health plan or health insurance coverage includes medical/surgical benefits and mental health/substance use disorder benefits, under the MHPAEA an applicable health plan cannot impose limitations on a numerical basis, e.g. financial, visit limits or day limits (quantitative); or other basis, e.g., medical management, (non-quantitative); unless, under the terms of the plan any such limitation of MH/SUD benefits such as treatments for autism is comparable to, and is applied no more stringently than, the standards and factors used in applying the limitation with respect to medical surgical/benefits under the plan. Exclusion of treatments for autism spectrum disorder are discriminatory and prohibited when a plan includes coverage of rehabilitative or habilitative services, such as coverage of occupational therapy or speech therapy. Treatments for autism spectrum disorder are to be considered part of Idaho’s Essential Health Benefits (EHB) package under mental health services including behavioral health treatment; and therefore the coverage of such treatments must be: consistent with other mental health services (including applicable deductibles, copayments, or coinsurance), not subject to any separate dollar limits or visit limits, and in parity with medical and surgical benefits.

Outlines the provisions that will be required for new health products to comply with Idaho Code, Title 41, Chapter 52. The “state-based health benefit plans” or “state-based plans” will not be subject to the federal restrictions applied to “grandfathered” or “transitional” plans. The plans must be in accordance with mental health and substance use disorder parity rules.

This bulletin to carriers in the employer and individual health insurance markets provides guidance regarding the extension of non-grandfathered transitional plans (also known as “grandmothered” plans) through December 31, 2018. The grandmothered plans (not applicable to small group plans) must continue to comply with mental health parity rules.