DAR File No. 37101

Insurance, Administration

Rule R590-215

Permissible Arbitration Provisions for Individual and Group Health Insurance

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 37101
Filed: 12/12/2012 11:43:04 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)(c) authorizes the commissioner to write rules to implement the provisions of the insurance code. The Department of Labor, Pension and Welfare Benefits Administration Rules and Regulations for Administration and Enforcement: Claims Procedure, 29 CPR 2560.503-1 effective 07/01/2002, and excluding 2560.503-1(a), requires the state write rules to recognize arbitration as an acceptable method of alternative dispute resolution with regards to health benefit plans. The rule is required to define "permissible arbitration provisions" and provide guidelines upon which disclosure of a contract arbitration provision is to be made. This rule fulfills this requirement.

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 no written requests to make changes to this rule in the past five years.

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

Federal law requires states to establish rules setting guidelines for the use of arbitration in the claims process. This rule provides those guidelines. Once an insured has exhausted the insurer's internal appeals process, then they have the right to arbitration. This rule defines arbitration in its several forms, as well as the process itself. By having this rule the arbitration process is the same in all states, which reduces confusion and misunderstanding. 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:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
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

Authorized by:

Neal Gooch, Commissioner

Effective:

12/12/2012