No. 27845: R590-172-4. Rule

DAR File No.: 27845
Filed: 07/28/2005, 07:40
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

Further changes are being made to this rule as a result of comments received during the previous comment period.

 

Summary of the rule or change:

The changes clarify that either part or all of the waiting period will be waived based on an insured's prior coverage. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed amendment that was published in the May 15, 2005, issue of the Utah State Bulletin, on page 28. 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 amendment 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:

Section 31A-29-116

 

Anticipated cost or savings to:

the state budget:

The changes to this rule will require no changes in filing fees or personnel. No additional work will be required of department personnel.

 

local governments:

This rule only applies to the relationship between the Insurance Department and their licensees. It does not affect local government laws or procedures.

 

other persons:

Health insurers licensed to do business in Utah will need to update and reprint their "Notice to Uninsurable Applicants." There should be no fiscal impact on their consumers.

 

Compliance costs for affected persons:

Health insurers licensed to do business in Utah will need to update and reprint their "Notice to Uninsurable Applicants." There should be no fiscal impact on their consumers.

 

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

The changes being made to this rule will have minimal fiscal impact on Utah businesses. 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:

09/14/2005

 

This rule may become effective on:

09/15/2005

 

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 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]Part or all of the preexisting waiting period will be waived if you are an eligible individual according to[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 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."

 

KEY: health insurance

2005

Notice of Continuation June 15, 2000

31A-29-116