Insurance, Administration

Rule R590-236

HIPAA Eligibility Following Receipt of a Certificate of Insurability or Denial by an Individual Carrier

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 35374
Filed: 10/25/2011 09:04:46 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-2-201(3) authorizes the commissioner to write rules to implement the provisions of Title 31A. Subsection 31A-29-106(1)(f) gives the HIPUtah Pool authority to write rules, conditions, and procedures for reinsuring risks. Subsection 31A-30-104(7) authorizes the commissioner to make rules that require marketing practices to be consistent with Title 31A, Chapter 30, for small employer carriers, their agents, insurance producers, and consultants. These citations provide the department and HIPUtah Pool with authority to write rules that state how the HIPAA laws are to be applied to HIPUtah applicants and the HIPUtah board and insurance carriers.

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

There have been no substantive changes in the past five years and no written comments have been sent to the department 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:

This rule is necessary in that it provides interpretation of interplay between federal and state statutes that affect protections provided by federal Health Insurance Portability and Accountability Act (HIPAA) to those that apply for coverage with HIPUtah and receive a certificate of insurability from HIPUtah, or denial of coverage by an individual carrier. The rule addresses effective dates of coverage for HIPAA eligible applicants applying for coverage with an individual carrier or HIPUtah. The rule also provides guidance for actual and potential interplay between HIPAA code sections and individual carriers, the HIPUtah pool administrator and HIPUtah applicants. 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

Authorized by:

Jilene Whitby, Information Specialist

Effective:

10/25/2011