Insurance, Administration

Rule R590-257

Standardized Health Benefit Plan Information Card

Notice of Proposed Rule

(New Rule)

DAR File No.: 33525
Filed: 03/31/2010 02:44:34 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule is to adopt standards for a health benefit plan information card. This rule is the result of H.B. 188, Health System Reform - Insurance Market, passed in 2009 and developed by the Health System Reform Task Force. (DAR NOTE: H.B. 188 (2009) is found at Chapter 12, Laws of Utah 2009, and was effective 03/1//2009.)

Summary of the rule or change:

The rule adopts a uniform standardized health benefit plan information card. Health insurers, third party administrators, and Public Employees Health Plan (PEHP) will be required to adopt and distribute the new cards to their new insureds and current insureds at renewal.

State statutory or constitutional authorization for this rule:

• Section 31A-22-636

This rule or change incorporates by reference the following material:

• Adds: UHIN Standard #6 Health Identification Card Version 1.1, 10/25/2006

Anticipated cost or savings to:

the state budget:

The department will not be affected financially by these changes. Public Employees Health Plan (PEHP) will be required to make changes to their health benefit plan card and distribute to new insureds and current insureds at renewal.

local governments:

This rule will have no effect on local government since it deals solely with the relationship between the department and its licensees.

small businesses:

The cost to insurers to produce the health benefit plan cards will filter down to the insureds, of which will be small and large businesses, as well as individuals. This cost will be minor.

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

The cost to insurers to produce the health benefit plan cards will filter down to the insureds, of which will be small and large businesses, as well as individuals. This cost will be minor.

Compliance costs for affected persons:

Minimal costs associated with insurers making changes to and reprinting health benefit plan cards and sending them to insureds at issue and renewal will filter down to their insureds, which will include small and large businesses and individual consumers.

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

Minimal costs associated with insurers making changes to and reprinting health benefit plan cards and sending them to insureds at renewal will filter down to insureds which will include small and large businesses and individual consumers.

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

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/17/2010

Interested persons may attend a public hearing regarding this rule:

• 05/10/2010 02:00 PM, State Office Building, 450 N State Street, Room B110, Salt Lake City, UT

This rule may become effective on:

05/24/2010

Authorized by:

Jilene Whitby, Information Specialist

R590. Insurance, Administration.

R590-257. Standardized Health Benefit Plan Information Card.

R590-257-1. Authority.

(1) This rule is promulgated pursuant to Section 31A-22-636 which authorizes the commissioner to adopt standardized electronic interchange technology.

 

R590-257-2. Purpose and Scope.

(1) The purpose of this rule is to adopt standards for a health benefit plan information card.

(2) This rule applies to:

(a) an accident and health insurer;

(b) a health maintenance organizations governed by Chapter 8, Health Maintenance Organizations and Limited Health Benefit Plans;

(c) a third party administrator; and

(d) notwithstanding Subsection 31A-1-103(3)(f) and Section 31A-22-600, a health, medical, or conversion policy offered under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act.

 

R590-257-3. Health Benefit Plan Information Card.

(1) Within 30 days, an entity described in R590-257-2(2) shall issue to an enrollee a health benefit plan information card upon the purchase or renewal of, or enrollment in, a health benefit plan.

(2) The health benefit plan information card must include:

(a) the required information described in Subsection 31A-22-636(3); and

(b) comply with Utah Health Information Network Standard number 6, Health Identification Card, version 1.1, hereby incorporated by reference and available on the department's website, www.insurance.utah.gov.

 

R590-257-4. Enforcement Date.

The commissioner will begin enforcing this rule July 1, 2010.

 

R590-257-5. Penalties.

A person found to be in violation of this rule shall be subject to penalties as provided under 31A-2-308.

 

R590-257-6. Severability.

If any provision of this rule or its application to any person or situation is held to be invalid, that invalidity shall not affect any other provision or application of this rule which can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable.

 

KEY: health benefit plan card

Date of Enactment or Last Substantive Amendment: 2010

Authorizing, and Implemented or Interpreted Law: 31A-22-636