No. 29430 (Amendment): R590-236. HIPAA Eligibility Following Receipt of a Certificate of Insurability or Denial by an Individual Carrier

DAR File No.: 29430
Filed: 01/22/2007, 04:51
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Centers for Medicaid and Medicare Services, who approve our Health Insurance Portability and Accountability Act (HIPPA) alternative mechanism, required the change for clarification that the Utah Health Insurance (HIPUtah) Pool cannot deny a HIPPA eligible individual.

Summary of the rule or change:

The change clarifies that the HIPUtah cannot deny a HIPPA eligible individual.

State statutory or constitutional authorization for this rule:

Sections 31A-29-106, 31A-30-104, and 31A-2-201

Anticipated cost or savings to:

the state budget:

HIPUtah is already complying with the intent of the clarification. As a result, no filings will need to be made to the department and revenue to the department will not be affected.

local governments:

The changes to this rule do not affect local governments since the rule only deals with the department and its relationship with its licensees.

other persons:

HIPUtah is already complying with the intent of the clarifying change being made to the rule. As a result, it will not be required to make any additional filings with the department and those using the Pool will not be affected in any way.

Compliance costs for affected persons:

HIPUtah is already complying with the intent of the clarifying change being made to the rule. As a result, it will not be required to make any additional filings with the department and those using the Pool will not be affected in any way.

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

The change to this rule will not create a fiscal impact on Utah businesses. D. Kent Michie, Insurance 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 [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:

03/19/2007

This rule may become effective on:

03/26/2007

Authorized by:

Jilene Whitby, Information Specialist

RULE TEXT

R590. Insurance, Administration.

R590-236. HIPAA Eligibility Following Receipt of a Certificate of Insurability or Denial by an Individual Carrier.

R590-236-6. HIPAA and Subsection 31A-30-108(3)(e)(i), 30-Day Provision.

(1) This section applies to a HIPAA eligible who meets HIPUtah's eligibility requirements but does not meet HIPUtah's health underwriting criteria, having been previously denied by an individual carrier, and is issued a certificate of insurability under Section 31A-29-111.

(2)(a) A HIPAA eligible [must]may reapply with the individual carrier who denied coverage immediately prior to HIPUtah's issuance of a certificate of insurability to preserve HIPAA rights, no later than:

(i) the remainder of the 63 consecutive day time period under HIPAA; or

(ii) 30 consecutive days after the date of issuance of a certificate of insurability.

(b) R590-236-6(2)(a) applies only to a HIPAA eligible that has:

(i) submitted a substantially completed application to an individual carrier within the HIPAA 63-day time period;

(ii) is denied coverage by an individual carrier; and

(iii) makes application to HIPUtah no later than:

(I) the remainder of the 63 consecutive day time period under HIPAA; or

(II) 30 consecutive days after denial by the individual carrier.

(3) Effective Dates.

(a) A HIPAA eligible applying within the time period in R590-236-6(2)(a)(i), shall have an effective date with the individual carrier on the first day of the month following the submission of a substantially completed application, if the required premium is paid.

(b) A HIPAA eligible applying within the time period in R590-236-6(2)(a)(ii), shall have an effective date with the individual carrier on the first day of the month following the original submission of a substantially completed application to the individual carrier who denied coverage immediately prior to the application to HIPUtah, if the required premium is paid.

(c) When a HIPAA eligible applies within both time periods in R590-236-6(2)(a)(i) and (ii), the HIPAA eligible shall choose the effective date provided in R590-236-6(3)(a) or (b).

 

R590-236-7. HIPAA and Subsection 31A-30-108(3)(e)(ii)(B), 45-Day Provision.

(1) This section applies to a HIPAA eligible who applies first with HIPUtah, meets HIPUtah's eligibility requirements, but does not meet HIPUtah's health underwriting criteria and is issued a certificate of insurability under Section 31A-29-111.

(2) When a HIPAA eligible submits a substantially completed application to HIPUtah within the HIPAA 63-day time period and is issued a certificate of insurability, [to preserve HIPAA rights, ]the HIPAA eligible [must]may make application to an individual carrier no later than:

(a) the remainder of the 63 consecutive day time period under HIPAA; or

(b) 45 consecutive days after the date of issuance of a certificate of insurability by HIPUtah.

(3) Effective Dates.

(a) A HIPAA eligible qualifying under option R590-236-7(2)(a) shall have an effective date of the first of the month following the submission of the substantially completed application to an individual carrier, if the required premium is paid.

(b) A HIPAA eligible qualifying under R590-236-7(2)(b) shall have an effective date of the day following the submission of the substantially completed application to HIPUtah, if the required premium is paid.

(c) When a HIPAA eligible applies within both time periods in R590-236-7(2)(a) and (b), the HIPAA eligible shall choose the effective date provided in R590-236-7(3)(a) or (b).

 

KEY: HIPAA eligibility

Date of Enactment or Last Substantive Amendment: [November 1, 2006]2007

Authorizing, and Implemented or Interpreted Law: 31A-29-106; 31A-30-104; 31A-2-201