BOND OF SELF-FUNDED HEALTH CARE PLANS
Bond #____________
KNOW ALL BY THESE PRESENTS THAT _________________________________________________________________________
________________________________________________________________________________________________________of
____________________________________________________________________________________________, as Principal and
_______________________________________________________________________________________________________ of
_______________________________________________________________ a corporation organized and existing under the laws
of the State of _____________________, and authorized to transact surety business in the State of Idaho, as Surety, are held and
firmly bound unto the Director of the Department of Insurance, State of Idaho, as Obligee, for the benefit and protection of insureds,
insurers
and
claimants
whose
monies
the
Self-Funded
Plan
handles,
in
the
amount
of
_________________________________________ dollars ($_________________ ), lawful money of the United States of America,
for the payment of which sum, well and truly to be made, the Principal and Surety obligate and bind ourselves, our heirs, executors,
administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THE OBLIGATION OF THIS BOND IS SUCH THAT, WHEREAS, the above bounden Principal has made application
to the Department of Insurance of the State of Idaho for registration to act as a Self-Funded Health Care Plan, in accordance with
the provisions of Title 41, Section 4014, of the Idaho Insurance Code and is required by Title 41, Section 4014, of the Idaho
Insurance Code to post bond to secure performance of the Self-Funded Health Care Plan in conformity with the insurance laws of the
State of Idaho for the benefit of parties injured by the actions of the Self-Funded Health Care Plan, as allowed by law.
NOW, THEREFORE, if the said Department of Insurance shall grant the application and issue the registration above referred to and
the said Principal shall faithfully and lawfully comply with all the requirements of the insurance laws of the State of Idaho, and any
regulations promulgated thereunder, then this obligation shall be null and void; otherwise, it shall remain in full force and effect.
It IS FURTHER AGREED THAT the bond shall be continuous in nature and that in no event shall the surety be obligated to an amount
exceeding ____________________________________________________________ dollars ($______________) bond penalty
which is the maximum aggregate liability of the surety regardless of the number of successive renewal periods the bond has been in
effect or the number of claimants that might have a right of action against the bond.
PROVIDED, HOWEVER, that this bond and the obligation under this bond shall become effective______________________________
______________________________________ 20____ , and shall remain in full force and effect until or unless terminated by thirty
(30) days’ advance written notice of termination mailed to the Principal and the Director of the Department of Insurance, State of
Idaho, by the Surety at which time the liability of the Surety on this bond shall cease upon the effective date of such termination.
Such termination shall not affect any liability or obligation of the Surety incurred or accrued prior to the effective date of the
termination.
IN WITNESS, WHEREOF, the said Principal and Surety have caused this bond to be executed at _____________________________
_____________________________________________ and signed and sealed this instrument this _________________________
day of ________________________________________, 20____.
WITNESS
______________________________________
PRINCIPAL
_______________________________________
BY:____________________________________
(as to Principal)
_______________________________________
SURETY
_______________________________________
BY:____________________________________
(as to Surety)