No. 38969 (5-year Review): Rule R590-232. Authorization for a Health Maintenance Organization to Provide Services as Third Party Administrator of Health Care Benefits

DAR File No.: 38969
Filed: 11/21/2014 10:45:15 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-8-103(2) allows the commissioner to waive provisions of Title 31A that may be considered inapplicable to health maintenance organizations. Section 31A-2-201 gives the commissioner authority to write rules to implement the provisions of Title 31A. The rule authorizes a health maintenance organization to provide services as a third party administrator of health care benefits without a license.

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 has not received any written comments regarding 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:

It is important that this rule remain in effect since it authorizes heath maintenance organizations (HMOs) to provide services as a third party administrator of health care benefits. As a third party administrator, an HMO would provide administrative services to employers and other associations having group insurance policies. They process claims, certify eligibility, etc. 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:

• Steve Gooch at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at [e-mail]

Effective:

11/21/2014

Authorized by:

Todd Kiser, Commissioner

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