No. 35006 (Amendment): Section R590-172-4. Rule

(Amendment)

DAR File No.: 35006
Filed: 07/05/2011 02:13:02 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule currently requires health insurers to notify Utah Comprehensive Health Insurance Pool (HIPUtah) on the 1st and 15th of the month of applicants who have been denied health insurance coverage. HIPUtah has asked that reporting be done only on the 1st of the month in an attempt to alleviate duplication in the reporting of these denied applicants.

Summary of the rule or change:

Subsection R590-172-4(2)(c) changes the requirement of health insurers to report to HIPUtah on the 1st and 15th of the month those individuals without health insurance who have been denied coverage by them.

State statutory or constitutional authorization for this rule:

• Section 31A-29-116

Anticipated cost or savings to:

the state budget:

This change will have no impact on the budget or workload of the department since the reports referred to in the change are submitted to HIPUtah and not the department.

local governments:

The change to this rule will have no impact on local governments since it deals solely with the relationship between HIPUtah and licensed health insurers doing business in Utah.

small businesses:

This rule applies only to individuals applying for health insurance coverage from health insurers that are large businesses.

persons other than small businesses, businesses, or local governmental entities:

The change to this rule will eliminate the requirement for health insurers to report to HIPUtah on the 15th of the month, uninsured applicants that they have denied coverage to. Currently the requirement is to provide this information on the 1st and 15th of the month. Reporting is done electronically so there will be no cost savings. The savings will be in time and effort of health insurance company staff.

Compliance costs for affected persons:

The change to this rule will eliminate the requirement for health insurers to report to HIPUtah on the 15th of the month, uninsured applicants that they have denied coverage to. Currently the requirement is to provide this information on the 1st and 15th of the month. Reporting is done electronically so there will be no cost savings. The savings will be in time and effort of health insurance company staff.

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

This rule will have no fiscal impact on businesses in Utah. The elimination of one required report will reduce an insurers workload.

Neal Gooch, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
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:

08/31/2011

This rule may become effective on:

09/07/2011

Authorized by:

Jilene Whitby, Information Specialist

RULE TEXT

R590. Insurance, Administration.

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

R590-172-4. Rule.

(1) Notification of Denial to Applicants.

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 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.

"Part or all of the preexisting waiting period will be waived if you are an eligible individual according to 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 442-6660. Residents of other areas in Utah should call 1-800-638-5038, ext. 6660, toll free. The HIPUtah's mailing address is P.O. Box 30192, Salt Lake City, Utah 84130-0192."

(2) Notification of Denial to HIPUtah.

(a) Every health insurer writing health insurance in the State of Utah shall provide written notice to HIPUtah for each application in which applicant does not have current individual coverage, for insurance the insurer has denied.

(b) The notice to HIPUtah shall contain the name and address of the applicant who was denied insurance, and no other personal information. If the applicant applied for the insurance through an insurance producer, the written notice shall provide the name and the address of the insurance producer. The information must be presented in an excel spreadsheet in the format; Applicant, Last Name, First Name, Mailing Address, Producer, Last Name, First Name, Mailing Address.

(c) The notice shall be submitted to HIPUtah on the 1st [and 15th] of each month. The notice shall be transmitted electronically to HIPUtah through a secure email address at [e-mail].

 

KEY: health insurance

Date of Enactment or Last Substantive Amendments: [July 15, 2010]2011

Notice of Continuation: April 29, 2010

Authorizing, and Implemented or Interpreted Law: 31A-29-116

 

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