No. 26806: R590-220. Submission of Accident and Health Insurance Filings

DAR File No.: 26806
Filed: 01/29/2004, 10:45
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is being changed to implement suggestions made by the insurance industry during the recently completed comment period.

 

Summary of the rule or change:

The proposed changes to this rule correct grammar; add a new definition for the term "issue age;" remove a requirement for endorsements; and adds a rule reference for clarification purposes. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed new rule that was published in the December 15, 2003, issue of the Utah State Bulletin, on page 33. Underlining in the rule below indicates text that has been added since the publication of the proposed rule mentioned above; strike-out indicates text that has been deleted. You must view the change in proposed rule and the proposed new rule together to understand all of the changes that will be enforceable should the agency make this rule effective.)

 

State statutory or constitutional authorization for this rule:

Sections 31A-2-201, 31A-2-201.1, 31A-2-202, 31A-22-605, 31A-22-620, and 31A-30-106

 

Anticipated cost or savings to:

the state budget:

The proposed changes to this rule will not create nor reduce the departments workload nor will it impact the revenues of the department.

 

local governments:

This rule only affects the relationship between the department and its licensees. It will have no affect on cities, counties, or any other local government.

 

other persons:

The proposed changes to this rule will have no fiscal impact on Utah's health insurance industry nor the public. It will not create nor reduce the industries workload nor the cost of doing business.

 

Compliance costs for affected persons:

The proposed changes to this rule will have no fiscal impact on Utah's health insurance industry nor the public. It will not create nor reduce the industries workload nor the cost of doing business.

 

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

The proposed changes to this rule will have no fiscal impact on Utah businesses.

 

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 [e-mail]

 

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:

03/16/2004

 

This rule may become effective on:

03/17/2004

 

Authorized by:

Jilene Whitby, Information Specialist

 

 

RULE TEXT

R590. Insurance, Administration.

R590-220. Submission of Accident and Health Insurance Filings.

 

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R590-220-5. General Filing Information.

(1) Each filing submitted must be accurate, consistent, complete and contain all required documents in order for the filing to be processed in a timely and efficient manner. The commissioner may request any additional information deemed necessary.

(2) An insurer and filer [is]are responsible for assuring compliance with Utah laws and rules. A filing not in compliance with Utah laws and rules is subject to regulatory action under Section 31A-2-308.

(3) A filing that does not comply with this rule will be rejected and returned to the filer. A rejected filing is not considered filed with the department.

(4) Prior filings will not be researched to determine the purpose of the current filing.

(5) The department does not review or proofread every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) as a result of a complaint;

(iii) during a regulatory examination or investigation; or

(iv) at any other time the department deems necessary.

(b) If a filing is reviewed and is not in compliance with Utah laws and rules, an Order To Prohibit Use will be issued to the filer. The commissioner may require the insurer to disclose deficiencies in forms or rating practices to affected insureds.

(6) Filing correction.

(a) No filing transmittal is required when clerical or typographical corrections are made to a filing previously filed if the corrected filing is submitted within 30 days of the date "Fled" with the department. The filer will need to reference the original filing.

(b) A new filing is required if the clerical or typographical corrections are made more than 30 days after the filed date of the original filing. The filer will need to reference the original filing.

(7) Filing withdrawal. A filer must notify the department when the filer withdraws a previously filed form, rate, or supplementary information.

 

R590-220-6. Filing Submission Requirements.

A filing must be submitted by market type and type of insurance. A filing may not include more than one type of insurance, or request filing for more than one insurer. A complete filing consists of the following documents submitted in the following order:

(1) Transmittal. A transmittal, as provided in R590-220-3(2), must be on the top of the filing. The transmittal form must be properly completed.

(2) Filing Description. The following information must be included in a cover letter or in the Filing Description on the NAIC transmittal and presented in the order shown below. If using a cover letter, the letter must be on company letterhead and properly identify the insurer.

(a) List of Forms. All form numbers being filed or affected by the filing must be listed in the "Regarding" line of the cover letter, or on an attached list, which includes the form number, and title or name. This information does not need to be included if submitting the NAIC transmittal form.

(b) Description of Filing.

(i) Indicate if the filing is new, replacing a previous filing, or contains forms that have been previously filed and are included for informational purposes.

(ii) Provide a brief description of each component's purpose, benefits and provisions.

(iii) Identify any new, unusual, or controversial provision.

(iv) Identify any unresolved previously prohibited provision and explain why the provision is included in the filing.

(v) Explain any change in benefits or premiums that may occur while the contract is in force.

(vi) If the filing is replacing or modifying a previous submission, provide information that identifies the filing being replaced or modified, the Utah filed date, and a detailed description of the changes made.

(vii) If the filing includes forms for informational purposes, provide the dates the forms were filed.

(viii) If filing a certificate, outline of coverage, application, or endorsements, and the filing does not contain a policy, identify the affected policy form number, the Utah filed date, and describe the effect of the submitted forms on the base policy.

(c) Marketing Facts. If the NAIC transmittal is used, the company must:

(i) list the issue ages, which means the range of minimum and maximum ages for which a policy will be issued;

(ii) identify the intended market, such as senior citizens, nonprofit organizations, association members, etc; and

(iii) describe marketing and advertising in detail, i.e., through a marketing association, mass solicitation, electronic media, financial institutions, internet, telemarketing, or individually through licensed producers.

(d) Underwriting Methods. Provide a general explanation of the underwriting applicable to the filing.

(3) Certification. The Utah Accident and Health Insurance Filing Certification must be properly completed and signed. A filing will be rejected if the certification is missing or incomplete. A certification that is inaccurate may subject the filer to administrative action. If the NAIC transmittal is being submitted, the Utah Accident and Health Insurance Filing Certification must also be included.

(4) Domicile Approval. A foreign insurer and filer must first submit filings to their domicile state.

(i) If a filing was submitted to the domicile state, provide a stamped copy of the approval letter from the domicile state for the exact same filing.

(ii) If a filing was not submitted to the domicile state, or the domicile state did not provide specific approval for the filing, then alternate information must be provided.

(5) Group Questionnaire or Discretionary Group Authorization Letter. A group filing must identify the type of group, and include either a completed "Utah Accident and Health Insurance Group Questionnaire," or a copy of the "Utah Accident and Health Insurance Discretionary Group Authorization" letter.

(6) Letter of Authorization. When the filer is not the insurer, a letter of authorization from the insurer must be included. The insurer remains responsible for the filing being in compliance with Utah laws and rules.

(7) Items being submitted for filing. Refer to each applicable subsection of this rule for general procedures and additional procedures on how to submit forms, rates, and reports.

(8) Return Notification Materials.

(a) Return notification materials are limited to:

(i) a copy of the cover letter if submitted;

(ii) a copy of the transmittal; and

(iii) a self addressed, stamped envelope.

(b) Any additional documents submitted for return will be discarded.

(c) Notice of filing will not be provided unless return notification materials are submitted.

 

R590-220-7. Procedures for Form Filings.

(1) Forms in General.

(a) Forms are "File and Use" filings.

(b) Each form must be identified by a unique form number. The form number may not be variable.

(c) A form must be in final printed form or printer's proof format. A draft may not be submitted.

(d) Specific sections may be filed with variable data by placing brackets around affected information. Variable data must be identified within the specific section, or on a separate sheet included with the submission.

(e) Blank spaces within the forms must be completed in John Doe fashion to accurately represent the intended market, purpose, and use.

(2) Application Filing. Each application or enrollment form may be submitted as a separate filing or may be filed with its related policy or certificate filing. If an application has been previously filed or is filed separately, an informational copy of the application must be included with the policy or certificate filing.

(3) Policy Filing. Each type of insurance must be filed separately. A policy filing consists of one policy form, including its related forms, such as outline of coverage, certificate or endorsement, and an actuarial memorandum.

(a) Only one policy filing for a single type of insurance may be filed, except as stated in subsection (b).

(b) A Medicare supplement filing may include more than one policy filing but each filing is limited to only one of each of the Medicare supplement plans A through J.

(4) Endorsement Only Filing.

(a) Up to three related endorsements may be filed together.

(b) A single endorsement that affects multiple forms may be filed if the Filing Description references all affected forms.

(c) The filing must include:

(i) A listing of all base policy form numbers, title and dates filed with the department; and

(ii) a description of how each filed endorsement affects the base policy.

(d) [An endorsement may not be used to change a basic feature of the policy form.

(e) ]Unrelated endorsements may not be filed together.

(5) Outline of Coverage. If an outline of coverage is required to be issued with a policy, the outline of coverage must be filed when the policy is filed.

 

R590-220-8. Additional Procedures for Individual Market Filings.

(1) This section does not apply to filings for individual health benefit plans that are subject to 31A-30 and Rule R590-167. Health benefit plan filings are discussed in R590-220-10.

(2) A rate filing addressed in this section is a "File for Acceptance" filing.

(3) A filer submitting an individual accident and health filing is advised to review 31A-22, Part VI, and Rules R590-85, R590-126, and R590-131.

(4) Every individual accident and health policy, or endorsement [effecting]affecting benefits shall be accompanied by a rate filing with an actuarial memorandum signed by a qualified actuary. A rate filing need not be submitted if the filing does not require a change in premiums, however the reason why there is not a change in premium must be explained in the Filing Description. Rates must be filed in accordance with the requirements of Section 31A-22-602, Rule R590-85, and this rule.

(5) A filer submitting a long term care filing, including an endorsement attached to a life insurance policy, is advised to review 31A-22 Part XIV and Rule R590-148.

(6) A filer submitting a Medicare supplement filing is advised to review Section 31A-22-620 and Rule R590-146.

 

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R590-220-10. Additional Procedures for Individual, Small Employer, and Group Health Benefit Plan Filings.

This section contains instructions for filings subject to 31A-30. A filer submitting health benefit plan filings that are subject to 31A-30 [are]is advised to review 31A-8, 31A-22 Parts VI and VII, 31A-30, Rules R590-76, R590-131, R590-167, [and ]R590-175 and R590-176.

(1) General requirements.

(a) Letter of Intent. A filing must include a copy of the letter filed with the commissioner declaring the carrier's intention as required by R590-167-10.

(b) Class of Business. The Filing Description must describe the class of business, as provided in Section 31A-30-105.

(c) Rate Manual. A health benefit plan form filing must include a rate manual. If the rate manual was previously filed, provide a copy of the transmittal and documentation indicating the department's receipt.

(2) Rate Manual Filing.

(a) A rate manual that does not request a change in rating methodology is a "File Before Use" filing.

(b) A change in rating methodology filing is a "File for Approval" filing.

(c) A new and revised rate manual.

(i) A filing must include an actuarial certification signed by a qualified actuary.

(ii) A rate manual and subsequent change must be filed 30 days prior to use.

(iii) A rate manual must list the case characteristics and rate factors to be used. A rating manual must be applied in the same manner for all health benefit plans in a class. The area factor and industry factor must contain the specific schedules applicable in Utah. Any case characteristic not listed in Subsection 31A-30-106(1)(h) requires prior approval of the commissioner.

(iv) The rating manual shall describe the method of calculating the risk load, including the method used to determine any experience factors. The rating manual must clearly describe how the overall rate is reviewed for compliance with the rate restrictions.

(3) Health Benefit Plan Report. A report must be filed separately and be properly identified.

(a) Reports due April 1 each year:

(i) "Actuarial Certification" An actuarial certification as described in Section 31A-30-106 and Rule R590-167-11.A.

(ii) "List of Health Benefit Plan Policy Forms." A list of every health benefit plan policy form to which 31A-30 applies and a description of how to find each form in the rating manual, as required by R590-167-11.C.

(iii) "Statistical Report." The statistical report, as required by R590-167-11.D, in the required format provided in Appendix I of that rule.

(iv) "Small Employer Index Rates." All small employer carriers must file their index rates as of March 1 of the current year and preceding year, as required by Subsection 31A-29-117(2). The report must include the actual index rates and calculate the percentage change in these rates between the two years.

(b) Report due August 15 each year, "Covered Lives Counts as of June 30." Carriers must submit the number of natural lives covered under individual market health benefit plans and small employer market health benefit plans, as required by R590-167-11.E.

 

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R590-220-12. Additional Procedures for Combination Policies or Endorsements Providing Life and Accident and Health Benefits.

(1) A combination filing is a policy or endorsement, which [create]creates a product that provides both life and accident and health insurance benefits. The two types of acceptable filings [is]are an endorsement or an integrated policy. Combination filings take considerable time to process, and will be processed by both the Life Insurance Division and the Health Insurance Division.

(2) A combination filing must include transmittals for both the Life Insurance Division and the Health Insurance Division[s].

(3) (a) For an integrated policy, the filing must be submitted to the appropriate division based on benefits provided in the base policy.

(b) For an endorsement, the filing must be submitted to the appropriate division based on benefits provided in the endorsement.

(4) The Filing Description must identify the filing as having a combination of insurance types, such as:

(a) term policy with a long-term care benefit rider; or

(b) major medical policy that includes a life insurance benefit.

 

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KEY: health insurance filings

2004

l31A-2-201

31A-2-201.1

31A-2-202

31A-22-605

31A-22-620

31A-30-106