Insurance, Administration

Section R590-247-3

General Instructions

Notice of Proposed Rule

(Amendment)

DAR File No.: 33644
Filed: 05/13/2010 03:09:27 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 294, Health System Reform Amendments, was passed by the Utah Legislature and put into effect 03/22/2010. The bill includes a change to Section 31A-22-635. 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 has developed this waiver form with the health insurance industry. The rule will provide needed guidelines to the health care industry in Utah. The new wording also requires the department to shorten the application. (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 shorten the uniform health insurance application and create a uniform waiver as now required in Subsection 31A-22-635(2)(a)(ii).

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 revenue, nor will there be a cost savings for the department. The rule simply revises the application and creates a waiver form when an employee waives coverage.

local governments:

This rule deals solely with the relationship between the department and its health insurance licensees. It will have no impact on local governments.

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. The changes also simplify the application for persons applying for coverage.

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 will not be impacted financially. The insured will have fewer questions to answer. The insurer will have costs associated with the changes that will need to be made to their applications to comply with the new law.

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

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:

07/01/2010

Interested persons may attend a public hearing regarding this rule:

• 06/21/2010 01:00 PM, Senate Bldg, 420 N State St, The Copper Room, Salt Lake City, UT

This rule may become effective on:

07/08/2010

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.

(9) Effective March 22, 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.

(10) Starting October 1, 2010, small employer insurers shall use the Utah Small Employer Health Insurance Application dated October 2010.

 

KEY: universal health insurance application

Date of Enactment or Last Substantive Amendment: [July 1, 2009]2010

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