DAR File No. 37849

Insurance, Administration

Rule R590-247

Universal Health Insurance Application Rule

Notice of Proposed Rule

(Amendment)

DAR File No.: 37849
Filed: 07/15/2013 03:59:58 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is being amended to provide the health insurance industry with the application to be used for individual health insurance outside of the Federally Facilitated Marketplace (FFM) and for small employer health insurance. These changes comply with the Affordable Care Act (ACA).

Summary of the rule or change:

Changes limit the individual application to use outside of the FFM; delete the questions applicable to the health risk; and specify when the current application is to be replaced with the new one.

State statutory or constitutional authorization for this rule:

• Section 31A-30-102
• Section 31A-22-635

Anticipated cost or savings to:

the state budget:

The changes to this rule will have no fiscal impact on the department or state's costs or savings. The rule notes the date when health insurers are to start using the new application form as required by ACA.

local governments:

This rule does not affect local governments since the rule relates solely to the relationship between the department and its health insurance licensees.

small businesses:

This rule will have no fiscal impact on small businesses, or in this case, insurance agencies. Insurers, or large businesses, will implement the new application and pass it on to insurance agencies associated with them. The agencies will then use the new form for coverage effective on or after 01/01/2014.

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

Health insurers will insert their name onto the new application form provided by the department. They will then transfer it electronically to their agencies to use in place of the current form. This should not require any additional expense on the part of insurers or their agencies.

Compliance costs for affected persons:

Health insurers will have no costs associated with the changes being made to this rule. They will insert their name onto the new application form provided by the department, then transfer it electronically to their agencies to use in place of the current form.

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

There will be no fiscal impact on businesses as a result of changes being made to this rule.

Todd E. Kiser, Commissioner

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

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:

09/03/2013

This rule may become effective on:

09/10/2013

Authorized by:

Todd Kiser, Commissioner

R590. Insurance, Administration.

R590-247. Universal Health Insurance Application Rule.

R590-247-1. Authority.

This rule is promulgated pursuant to Subsections 31A-22-635 and 31A-30-102 which direct the commissioner to create a universal health insurance application.

 

R590-247-2. Purpose and Scope.

(1) The purpose of this rule is to establish universal applications for all insurers offering a health benefit plan in Utah outside the Federally Facilitated Marketplace.

(2) This rule applies to :

(a) all [insurers offering an ]individual [or small employer ]health benefit plans in Utah outside the Federally Facilitated Marketplace; and

(b) all small employer health benefit plans.

 

R590-247-3. General Instructions.

(1) Use of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application by insurers or by health insurance producers is mandatory.

(2) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application must be used without insurer identifying logos or addresses to facilitate multiple insurer submissions using a single application.

(3) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application can be downloaded from the Department's website at www.insurance.utah.gov.

(4) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application may [only] be altered for:

(a) purposes of electronic application and submission, including electronic signature disclaimers;

(b) languages other than English; and

(c) reasons specifically approved by the commissioner.

(5)[ The use of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application does not limit the ability of an insurer to obtain additional information for underwriting purposes.

(6)] Section [L]F, Producer Agreement and Compensation Disclosure section o[n]f the Utah Individual Health Insurance Application, must include all information to be disclosed as required by Section 31A-23a-501.

[(7) Question number 40 on the Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application may not be used for purposes of Sections 31A-8-402.3, 31A-8-402.5, 31A-21-105, 31A-22-721, 31A-30-107, 31A-30-107.1, or R590-247-3(5), unless the information was disclosed or should have been disclosed in another question on the application.

(8) No later than July 1, 2010,] (6) [a]All insurers shall offer compatible systems for electronic submission of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application.

([9]7) [Effective March 22, 2010, i]If an employee chooses to waive coverage, an insurer shall not require such employee to complete any section of the Utah Small Employer Health Insurance Application other than [sections A, B, D, E, questions 1 and 2 of section G, and J]the Waiver of Coverage section.

([10]8) (a)(i) Individual health insurers shall use the Utah Individual Insurance Application dated October 2010 for all applications with coverage effective dates prior to January 1, 2014.

(ii) Individual health insurers shall use the Utah Individual Health Insurance Application dated January 2014 for all applications with coverage effective dates on or after January 1, 2014 for coverage outside of the Federally Facilitated Marketplace.

(b)(i) [Starting October 1, 2010, s]Small employer insurers shall use the Utah Small Employer Health Insurance Application dated October 2010 for all applications with coverage effective dates prior to January 1, 2014.

(ii) Small employer insurers shall use the Utah Small Employer Health Insurance Application dated January 2014 for all applications with coverage effective dates on or after January 1, 2014.

 

R590-247-4. Penalties.

A person found to be in violation of this rule shall be subject to penalties as provided under 31A-2-308.

 

R590-247-5. [Enforcement Date.

The commissioner will begin enforcing this rule 45 days from the rule's effective date.

 

R590-247-6.] Severability.

If any provision of this rule or its application to any person or situation is held to be invalid, that invalidity shall not affect any other provision or application of this rule which can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable.

 

KEY: universal health insurance application

Date of Enactment or Last Substantive Amendment: [July 15, 2010]2013

Authorizing, and Implemented or Interpreted Law: 31A-30-102