Insurance, Administration

Rule R590-259

Dependent Coverage to Age 26

Notice of Proposed Rule

(Amendment)

DAR File No.: 34727
Filed: 04/28/2011 10:04:49 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Suggested changes for this rule have come from a member of the health insurance industry as well as the Insurance Department. The changes are for clarification purposes and to correct grammar and add a new code citation to the Authority Section.

Summary of the rule or change:

A new code reference has been added to Section R590-259-1, Authority. The code citation was changed during the 2011 General Session in H.B. 128, Health Reform Amendments. The new wording requires insurers to comply with specific requirements of the federal Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act of 2010. These requirements specifically relate to the requirements already in this rule. Subsection R590-259-8(1)(a) makes a grammatical correction and clarifies that health insurers shall offer continuous enrollment for individuals applying for a new policy unless Section R590-259-9 applies and the individual is under the age of 19. The changes to Subsection R590-259-9(1) are just for clarification purposes only. Words and phrases have been moved around to bring greater clarity to the topic but the meaning remains the same. (DAR NOTE: H.B. 128 is effective as of 05/10/2011.)

State statutory or constitutional authorization for this rule:

• Section 31A-22-605
• Section 31A-2-201

Anticipated cost or savings to:

the state budget:

The changes made to this rule are for clarification purposes only and will create no change to the budget or work of the department or the state.

local governments:

The changes to this rule will have no fiscal impact on local governments since it deals solely with the relationship of the department and its licensees. The changes will not affect an insurer's relationship with their insureds.

small businesses:

The changes to this rule will have no fiscal impact on small or large businesses or consumers since the changes are grammatical and for clarification purposes only.

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

The changes to this rule will have no fiscal impact on small or large businesses or consumers since the changes are grammatical and for clarification purposes only.

Compliance costs for affected persons:

The changes to this rule will have no fiscal impact on small or large businesses or consumers since the changes are grammatical and for clarification purposes only.

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

This rule will create no fiscal impact on businesses since the changes are for clarification purposes only.

Neat T. Gooch, 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:

06/14/2011

This rule may become effective on:

06/21/2011

Authorized by:

Jilene Whitby, Information Specialist

R590. Insurance, Administration.

R590-259. Dependent Coverage to Age 26.

R590-259-1. Authority.

This rule is promulgated by the insurance commissioner pursuant to Subsections 31A-2-201(3) , 31A-2-212(5) and 31A-22-605(4).

 

R590-259-8. Enrollment Periods.

(1) An individual carrier shall offer:

(a) continuously enrollment for individuals applying for a new policy[;]unless R590-259-9 applies; and

(b) for a dependent to be added to an existing policy:

(i) beginning May 1, 2011 and extending through June 15, 2011 for coverage effective July 1, 2011; and

(ii) at least once a year beginning 45 days prior to the policy renewal; or

(iii) continuously.

(2) During an enrollment period in R590-259-8(1), a dependent under the age of 19 shall be offered coverage on a guaranteed issue basis and without any limitations, pre-existing exclusions or riders based on health status.

(3) A health insurer shall provide prior written notice to each of its policyholders annually of the enrollment rights in R590-259-8(1)(b) that includes information as to the enrollment dates and how a dependent eligible for enrollment may apply for coverage with the insurer.

 

R590-259-9. Utah Alternative Mechanism Enrollment.

(1) An individual carrier shall only be required to offer [a continuous enrollment]coverage to an individual under age 19 [with]if the individual first obtains a certificate of insurability[:] from the Comprehensive High Risk Pool pursuant to Subsection 31A-30-108(3) and 31A-30-109(1), in which case, the coverage shall be offered by the carrier:

(a) [as required by Subsection 31A-30-108(3) and 31A-30-109(1); and]on a continuous open enrollment basis; and

(b) on an underwritten basis without any limitations, pre-existing exclusions or riders based on health status.

(2) An individual carrier shall not:

(a) require a health benefit plan offered under the requirements of this section to cover more than one individual;

(b) deny or unreasonably delay the issuance of a policy; or

(c) refuse to issue a policy.

 

KEY: health insurance open enrollment

Date of Enactment or Last Substantive Amendment: [January 25, ]2011

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605