No. 27845 (Amendment): R590-172-4. Rule

DAR File No.: 27845
Filed: 04/29/2005, 09:25
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

The changes are being made to clarify another rule and federal law that must be followed and to correct contact information in the rule.

 

Summary of the rule or change:

The first paragraph of Section R590-172-4 adds a cross reference to Rule R590-176, Health Benefit Plan Enrollment, that insurers must follow when providing notice to applicants denied coverage for health insurance. The second paragraph eliminates a "the" in the last line to make it more grammatically correct. The fourth paragraph adds wording that preexisting conditions will be waived if the applicant is eligible for the Health Insurance Portability and Accountability Act (HIPAA). The last paragraph makes corrections in the contact information.

 

State statutory or constitutional authorization for this rule:

Section 31A-29-116

 

Anticipated cost or savings to:

the state budget:

The changes to this rule will have no fiscal impact on the state's budget. It will create no change in the amount of fees coming into the state nor the work load on employees.

 

local governments:

The changes to this rule only deals with the relationship between licensed health insurers and the Insurance Department. It will have no fiscal impact on local governments.

 

other persons:

The changes to this rule are for clarification purposes only and to update contact information in the rule. They will create no fiscal impact on insurers or consumers. Insurers are already required to comply with Rule R590-176 and preexisting conditions are already being waived if an insured is eligible for HIPAA.

 

Compliance costs for affected persons:

The changes to this rule are for clarification purposes only and to update contact information in the rule. They will create no fiscal impact on insurers or consumers. Insurers are already required to comply with Rule R590-176 and preexisting conditions are already being waived if an insured is eligible for HIPAA.

 

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

The changes being proposed to this rule will have no fiscal impact on the department's licensees doing business in Utah. D. Kent Michie, 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:

06/14/2005

 

This rule may become effective on:

06/15/2005

 

Authorized by:

Jilene Whitby, Information Specialist

 

 

RULE TEXT

R590. Insurance, Administration.

R590-172. Notice to Uninsurable Applicants for Health Insurance.

R590-172-4. Rule.

Every health insurer writing health insurance in the State of Utah will provide a written notice containing the requirements in R590-176-5(3)(a), Health Benefit Plan Enrollment, and the following language to each applicant for health insurance coverage that is denied coverage by the insurer for reasons relating to health:

"You have been denied health insurance coverage due to a health condition which is uninsurable. The Utah Comprehensive Health Insurance Pool (HIPUtah) was created to provide health insurance to residents of Utah who are denied health insurance and who are considered uninsurable. If you have lived in the State of Utah for 12 consecutive months prior to applying for insurance with this company you may be eligible for health insurance coverage with [the ]HIPUtah.

"However, if you have not lived in the state of Utah for 12 consecutive months, but you are a Utah resident and you are coming from another State's high risk pool or have had 18 months of continuous coverage with the most recent coverage being through a group health plan, you may still be eligible for health insurance coverage with the Utah Comprehensive Insurance Pool.

"The preexisting waiting period will be waived if you are eligible for the Health Insurance Portability and Accountability Act (HIPAA) or your previous coverage was involuntarily terminated for reasons other than for nonpayment of premium or fraud, and application for HIPUtah is made within 63 days of that termination. The amount of credit given will depend on the length of time an applicant was previously covered under that health insurance.

"If application for coverage with HIPUtah is made within 30 days of this denial letter and you are declined coverage with the pool, HIPUtah will issue a certificate of insurability and you may reapply for coverage with this company within 30 days of the certificate date.

"To find out whether you qualify for pool coverage or to make application for pool coverage, Salt Lake City area residents should call [333-5573]442-6660. Residents of other areas in Utah should call 1-800-[662-3398]638-5038, ext. [5573]6660, toll free. The HIPUtah's mailing address is P.O. Box [27797]30192, Salt Lake City, Utah [84127-0797]84130-0192."

 

KEY: health insurance

[November 21, 2003]2005

Notice of Continuation June 15, 2000

31A-29-116