The national guide covers the general group concepts: group underwriting, master contract and certificates, contributory plans, COBRA and coordination of benefits. Idaho's group disability (health) rules are in Idaho Code chapter 41-22. The small employer rules are in chapter 41-47.

National concepts in brief

• The employer holds the master contract. Members get certificates.
• Federal COBRA lets eligible people continue group coverage for a limited time at their own cost.
• Experience rating prices a group on its own claims history.

Idaho group disability rules

• Who can be the policyholder: an employer, or trustees of an employer fund (Idaho Code 41-2202).
• Extension of benefits: when a group policy is discontinued, people totally disabled on that date get a reasonable extension of benefits (Idaho Code 41-2213).
• Pregnancy: benefits for a pregnancy underway when the policy ends continue as if it hadn't ended, for up to 12 months (Idaho Code 41-2214).
• Newborns: newborns and adopted children placed within 60 days of birth are covered from birth (Idaho Code 41-2210).
• Large group nonrenewal: allowed only for listed reasons (Idaho Code 41-2223):
  • nonpayment;
  • employer fraud or intentional misrepresentation;
  • failing participation or contribution rules;
  • similar listed grounds.

Small employer rules (chapter 41-47)

• A small employer averaged 2 to 50 eligible employees in the prior year (Idaho Code 41-4703).
• An eligible employee normally works 30+ hours a week. By agreement, employees working 20–30 hours may also be eligible.
• A late enrollee asks to join after the initial enrollment period, which must be at least 30 days.
• Fair marketing: carriers and agents may not steer employers away from applying because of health, claims, industry, occupation or location (Idaho Code 41-4716).

Common exam traps

• A small employer has 2–50 employees, not 1–50.
• Group maternity extension lasts up to 12 months.
• Adopted newborns placed within 60 days are covered from birth.