Insurance, Administration

Rule R590-232

Authorization for a Health Maintenance Organization to Provide Services as Third Party Administrator of Health Care Benefits

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 33291
Filed: 12/24/2009 10:44:02 AM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Subsection 31A-8-103(2) allows the commissioner to waive provisions of Title 31A that he considers inapplicable to health maintenance organizations, and Section 31A-2-201 gives the commissioner authority to implement the provisions of Title 31A.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

The department has not received any written comments within the past five years regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

It is important that this rule remain in effect since it authorizes health maintenance organizations (HMOs) to provide services as a third party administrator of health care benefits. As a third party administrator, an HMO would provide administrative services to employers and other associations having group insurance policies. They process claims, certify eligibility, etc. Therefore, this rule should be continued.

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

• Jilene Whitby at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at jwhitby@utah.gov

Effective:

12/24/2009

Authorized by:

Jilene Whitby, Information Specialist