DAR File No. 42366

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.: 42366
Filed: 12/08/2017 01:24:21 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)(c) authorizes the Insurance Commissioner to write rules to implement the provisions of the Utah Insurance Code, Title 31A. The Department of Labor, Pension and Welfare Benefits Administration Rules and Regulations for Administration and Enforcement: Claims Procedure, 29 CPR 2560.503-1 effective July1, 2002 and excluding 2560.503-1(a), requires the state to write rules to recognize arbitration as an acceptable method of alternative dispute resolution with regards to health benefit plans. This rule is required to define "permissible arbitration provisions," and to provide guidelines upon which disclosure of a contract arbitration provision is to be made. This rule fulfills that 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 of Insurance has received no written comments regarding this rule during 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 that set 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. This rule ensures that the arbitration process is the same in all U.S. 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 Office 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

Effective:

12/08/2017

Authorized by:

Steve Gooch, Information Specialist