Insurance, Administration

Section R590-247-3

General Instructions

Notice of 120-Day (Emergency) Rule

DAR File No.: 33505
Filed: 03/24/2010 04:31:21 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 294 was passed by the Utah Legislature in the 2010 General Session and was effective 03/22/2010. The bill includes a change to Section 31A-22-635, Development of Uniform Health Insurance Application--Uniform waiver of coverage. The changes deal with what can be required for employees waiving coverage. New wording requires the use of a uniform waiver of coverage form that limits what can be asked. The Department is in the process of working with the insurance industry to develop this form but until it is completed, guidelines need to be provided to the health care industry. The changes to this rule will implement similar requirements that be in the waiver when developed. (DAR NOTE: H.B. 294 (2010) is found at Chapter 68, Laws of Utah 2010, and was effective 03/22/2010.)

Summary of the rule or change:

Changes to the rule require health insurers to limit the questions in their uniform health insurance application waivers as now required in Subsection 31A-22-635(2)(a)(ii).

Emergency rule reason and justification:

Regular rulemaking procedures would place the agency in violation of federal or state law.

H.B. 294 (2010) passed and was effective 03/22/2010, and requires the Department to put into effect the same date, a waiver to be used with all universal health insurance applications. The waiver is to limit the questions an employee can be asked. The emergency rule instructs health insurers how this is to be complied with in the interim until the waiver is developed and put into effect by rule.

State statutory or constitutional authorization for this rule:

• Section 31A-22-635
• Section 31A-30-102

Anticipated cost or savings to:

the state budget:

The change to this rule will create no additional work or revenues nor will there be a cost savings for the Department. The rule simply limits the questions that can be asked on a waiver when an employee waives coverage.

local governments:

This rule deals solely with the relationship between the Department and their health insurance licensees. It will have no impact on local government.

small businesses:

This change affects health insurance policies sold to small employers with less than 50 employees. It will affect the questions an employee will have to answer in relation to an insurance waiver they fill out. The change in the questions to be asked will have no fiscal impact on the employer or the employee except that there will be fewer questions to answer. The waiver applies to employees that waive health insurance coverage which means there is no coverage, no benefits, and no premium for the employee.

persons other than small businesses, businesses, or local governmental entities:

This rule does not apply to large employers. It applies to employees waiving health coverage so there is no cost to them. Depending on how the insurer makes the changes to their waiver form there may be some minor cost.

Compliance costs for affected persons:

Small employers and insureds will not be impacted financially. The insured will have fewer questions to answer. The insurer may have minor costs associated with changing their waiver to conform to the rule.

Comments by the department head on the fiscal impact the rule may have on businesses:

The changes to this rule will have no fiscal impact on small employers. It may have a minor fiscal impact on health insurers doing business in Utah.

Neal T. Gooch, Acting Commissioner

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

Insurance
Administration
450 N MAIN ST
SALT LAKE CITY, UT 84114-1201

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

This rule is effective on:

03/24/2010

Authorized by:

Jilene Whitby, Information Specialist

R590. Insurance, Administration.

R590-247. Universal Health Insurance Application Rule.

R590-247-3. General Instructions.

(1) Use of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application by insurers or by health insurance producers is mandatory.

(2) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application must be used without insurer identifying logos or addresses to facilitate multiple insurer submissions using a single application.

(3) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application can be downloaded from the Department's website at www.insurance.utah.gov.

(4) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application may only be altered for:

(a) purposes of electronic application and submission, including electronic signature disclaimers;

(b) languages other than English; and

(c) reasons specifically approved by the commissioner.

(5) The use of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application does not limit the ability of an insurer to obtain additional information for underwriting purposes.

(6) Section L, Producer Agreement and Compensation Disclosure section on the Utah Individual Health Insurance Application must include all information to be disclosed as required by Section 31A-23a-501.

(7) Question number 40 on the Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application may not be used for purposes of Sections 31A-8-402.3, 31A-8-402.5, 31A-21-105, 31A-22-721, 31A-30-107, 31A-30-107.1, or R590-247-3(5), unless the information was disclosed or should have been disclosed in another question on the application.

(8)(a) Starting July 1, 2009, insurers shall accept the Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application.

(b) An insurer may accept an application other than the Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application until December 31, 2009.

(9) No later than July 1, 2010, all insurers shall offer compatible systems for electronic submission of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application.

(10) Effective March 24, 2010, if an employee chooses to waive coverage, an insurer shall not require such employee to complete any section of the Utah Small Employer Health Insurance Application other than sections A, B, D, E, questions 1 and 2 of section G, and J.

 

KEY: universal health insurance application

Date of Enactment or Last Substantive Amendment: March 24, 2010

Authorizing, and Implemented or Interpreted Law: 31A-30-102; 31A-22-635