Insurance, Administration

Rule R590-131

Accident and Health Coordination of Benefits Rule

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 36913
Filed: 10/03/2012 02:25:40 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 provisions of Title 31A. Section 31A-22-619 allows the commissioner to adopt rules concerning the coordination of benefits between accident and health insurance policies. The rule establishes a uniform order of benefit determination under which plans pay coordination of benefit claims; reduce duplication of benefits; and provide greater efficiency in the processing of claims when a person is covered under more than one plan.

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

The department received written comments during a comment period held 11/15/2007. The department made changes to the rule as requested and did not receive any written comments during the second comment period. Comments were in regards to: 1) adding "prescription drug" reference to allowable expense definition; 2) adding a definition of "Group-type contract;" 3) correcting code references; 4) adding a definition for "Policyholder;" 5) adding a definition of "Retiree employee benefit plan based on" to allow for coordination based on the EEOC; 6) clarifying benefits paid by another plan; 7) clarifying wording in Subsection R590-131-6(D.2); 8) removing redundancy in Subsection R590-131-9(D.1); and 9) making corrections in grammar.

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

This rule brings consistency and order when considering which health policy covers a claim when there is more than one health carrier covering the same individual or group. It eliminates law suits and expedites the payment of health claims. 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:

10/03/2012