No. 29826: R590-203. Health Grievance Review Process and Disability Claims

DAR File No.: 29826
Filed: 04/17/2007, 10:14
Received by: NL

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:

Section 31A-2-201 authorizes the commissioner to write rules to implement Title 31A. Section 31A-2-203 gives the commissioner the authority to examine insurer records files and documentations. Section 31A-4-116 and Subsection 31A-22-629(4) require the commissioner to establish minimum standards for grievance review procedures. The rule is to ensure that insurer grievance review procedures for individual and group health insurance and income replacement plans comply with the Department of Labor, Pension and Welfare Benefits Administration Rules and Regulations for Administration, and Enforcement: Claims Procedures.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

In November 2005, changes were made to this rule resulting in one comment requesting that insurers providing individual and group disability income insurance policies implement claims review procedures consistent with the Department of Labor's regulations. During the comment period in November of 2004, the department received comments requesting clarification that the rule is not retroactive; requested that its claims review process more closely follow that set by the Pension and Welfare Benefit Association Rules; and clarify language in Section R590-203-10 regarding exemptions and who is exempted and under what conditions.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule clarifies statute and explains the difference from the federal law and the state statutes. Removing this rule will confuse insurance companies and what is required in our state regarding consumer protections. 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:

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]

Authorized by:

Jilene Whitby, Information Specialist