DAR File No. 40321

Insurance, Administration

Rule R590-247

Universal Health Insurance Application Rule

Notice of Proposed Rule

(Amendment)

DAR File No.: 40321
Filed: 04/15/2016 02:03:23 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to remove the reference to the "Producer Agreement and Compensation Disclosure" due to changes made during the 2015 General Session in H.B. 23, and to remove the last page of the application, which is where the disclosure was incorporated into the application.

Summary of the rule or change:

The change removes the reference to the "Producer Agreement and Compensation Disclosure" due to changes made to Subsection 31A-23a-501(4) during the 2015 General Session in H.B. 23. The change also removes the last page of the application, which is where the disclosure was incorporated into the application.

State statutory or constitutional authorization for this rule:

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

Anticipated cost or savings to:

the state budget:

There is no anticipated cost or savings to state budget because the change results in a form no longer being required.

local governments:

There is no anticipated cost or savings to local governments because the change results in a form no longer being required.

small businesses:

There is no anticipated cost or savings to small businesses because the change results in a form no longer being required.

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

Large employers, specifically insurers, may incur minimal programming costs to remove the last page of the Utah Individual Health Insurance Application.

Compliance costs for affected persons:

There are no compliance costs for any affected persons because the change merely results in a form no longer being required.

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

This rule change is required due to actions taken by the Utah Legislature.

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:

• Steve Gooch at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at sgooch@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:

05/31/2016

This rule may become effective on:

06/07/2016

Authorized by:

Steve Gooch, Information Specialist

R590. Insurance, Administration.

R590-247. Universal Health Insurance Application Rule.

R590-247-1. Authority.

This rule is promulgated pursuant to S[ubs]ections 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 individual 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 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) [Section F, Producer Agreement and Compensation Disclosure section of the Utah Individual Health Insurance Application, must include all information to be disclosed as required by Section 31A-23a-501.

(6) ]All insurers shall offer compatible systems for electronic submission of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application.

[(7)](6) 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 the Waiver of Coverage section.

[(8)](7)(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]June 2016 for coverage outside of the Federally Facilitated Marketplace.

(b)(i) 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. 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: [September 10, 2013]2016

Notice of Continuation: June 26, 2013

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