Insurance, Administration

Rule R590-176

Health Benefit Plan Enrollment

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 35557
Filed: 12/19/2011 04:12:17 PM

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 Insurance Code, Section 31A. The rule provides enrollment standards as required by Section 31A-30-108 for carriers who provide health benefit plan coverage to individuals and small employers as stated in Section 31A-30-104. Subsection 31A-2-202(2) allows the commissioner to prescribe forms for the collection of information by the department. The rule requires the insurer to file a certificate with the department with information about the individuals covered, the qualifying conditions, and uninsurable count at the end of an enrollment.

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

This rule was amended twice in the past five years, effective 09/09/2008 and 11/18/2008. Due to two comments received during the first comment period, further changes were made to the rule adding the full name and date of the uninsurable underwriting standard specified in the rule along with how the standard is to be used by the health insurance industry. No comments were received during the second comment period that took effect 11/18/2008.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule provides clarification for Title 31A, Chapter 30, with regards to the federal Health Insurance Portability and Accountability Act (HIPAA) and HIPUtah. The rule provides standards that must be met for an insurer to be waived from the requirements of Chapter 30 and defines what constitutes meeting the enrollment cap. It also addresses general requirements to make sure insurers treat health benefit plan applicants fairly. 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:

12/19/2011