No. 28767: R590-220. Submission of Accident and Health Insurance Filings

DAR File No.: 28767
Filed: 07/31/2006, 05:11
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is being changed to make corrections suggested by the insurance industry during the comment period and hearing.

 

Summary of the rule or change:

Subsection R590-220-5(6)(c) adds back in the word "correction" after the word "clerical". Subsection R590-220-6(1)(a)(i) corrected the reference for the NAIC Instruction Sheet. Technical corrections were made in Sections R590-220-9, R590-220-12, and R590-220-13. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed amendment that was published in the June 15, 2006, issue of the Utah State Bulletin, on page 27. 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:

Sections 31A-2-201.1, 31A-2-201, 31A-2-202, 31A-22-605, 31A-22-620, and 31A-30-106

 

Anticipated cost or savings to:

the state budget:

The changes to this rule will not change the work load on department personnel nor will they require a change in filings. The changes are basically technical and grammatical.

 

local governments:

The changes to this rule will have no fiscal impact on local governments since they deal solely with the relationship between the licensee and the department.

 

other persons:

The changes to this rule are of a technical and grammatical nature. They do not change policies or procedures of the department or the requirements of health insurance licensees.

 

Compliance costs for affected persons:

The changes to this rule are of a technical and grammatical nature. They do not change policies or procedures of the department or the requirements of health insurance licensees.

 

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

The changes to this rule will have no fiscal impact on businesses 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:

09/14/2006

 

This rule may become effective on:

09/21/2006

 

Authorized by:

Jilene Whitby, Information Specialist

 

 

RULE TEXT

R590. Insurance, Administration.

R590-220. Submission of Accident and Health Insurance Filings.

 

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R590-220-5. General Filing Information.

(1) Each filing submitted must be accurate, consistent, complete and contain all required documents in order for the filing to be processed in a timely and efficient manner. The commissioner may request any additional information deemed necessary.

(2) An insurer and filer are responsible for assuring compliance with Utah laws and rules. A filing not in compliance with Utah laws and rules is subject to regulatory action under Section 31A-2-308.

(3) A filing that does not comply with this rule will be rejected and returned to the filer. A rejected filing is not considered filed with the department.

(4) Prior filings will not be researched to determine the purpose of the current filing.

(5) The department does not review or proofread every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) as a result of a complaint;

(iii) during a regulatory examination or investigation; or

(iv) at any other time the department deems necessary.

(b) If a filing is reviewed and is not in compliance with Utah laws and rules, an Order To Prohibit Use will be issued to the filer. The commissioner may require the insurer to disclose deficiencies in forms or rating practices to affected insureds.

(6) Filing correction.

(a) No transmittal is required when making a correction to misspelled words and punctuation in a filing. This filing will be considered informational.

(b) No transmittal is required when a clerical correction is made to a previous filing if submitted within 15 days of the date "Filed" with the department. The filer must reference the original filing or include a copy of the original transmittal.

(c) A new filing is required if a clerical correction is made more than 15 days after the date "Filed" with the department. The filer must reference the original filing or include a copy of the original transmittal.

(7) Filing withdrawal. A filer must notify the department when withdrawing a previously filed form, rate, or supplementary information.

 

R590-220-6. Filing Submission Requirements.

A filing must be submitted by market type and type of insurance. A filing may not include more than one type of insurance, or request filing for more than one insurer. A complete filing consists of the following documents submitted in the following order:

(1) Transmittal. The NAIC Life, Accident and Health, Annuity, Credit Transmittal Document, as provided in R590-220-3(2), must be on the top of the filing. The transmittal form must be properly completed.

(a) Complete the transmittal by using the following:

(i) NAIC Instruction Sheet for Life, Accident and Health, Annuity, Credit Transmittal Document[ Form Filing Attachment and Rate Filing Attachment];

(ii) NAIC Instruction Sheet for Life, Accident and Health, Annuity, Credit Transmittal Document Form Filing Attachment and Rate Filing Attachment; and

(iii) NAIC Uniform Life, Accident and Health, Annuity and Credit Coding Matrix.

(b) Do not submit the document described in sections (a)(i),(ii), and (iii) with the filing.

(2) Filing Description. A cover letter should not be submitted. Instead, the following information must be included in the Filing Description on the transmittal and presented in the order shown below.[ Description of Filing.]

(i) Indicate if the filing is new, replacing a previous filing, or contains forms that have been previously filed and are included for informational purposes.

(ii) Provide a brief description of each component's purpose, benefits and provisions.

(iii) Identify any new, unusual, or controversial provision.

(iv) Identify any unresolved previously prohibited provision and explain why the provision is included in the filing.

(v) Explain any change in benefits or premiums that may occur while the contract is in force.

(vi) If the filing is replacing or modifying a previous submission, provide information that identifies the filing being replaced or modified, the Utah filed date, and a detailed description of the changes made.

(vii) If the filing includes forms for informational purposes, provide the dates the forms were filed.

(viii) If filing a certificate, outline of coverage, application, or endorsements, and the filing does not contain a policy, identify the affected policy form number, the Utah filed date, and describe the effect of the submitted forms on the base policy.

(b) Marketing Facts.

(i) List the issue ages, which means the range of minimum and maximum ages for which a policy will be issued;

(ii) Identify the intended market, such as senior citizens, nonprofit organizations, association members, etc; and

(iii) Describe marketing and advertising in detail, i.e., through a marketing association, mass solicitation, electronic media, financial institutions, internet, telemarketing, or individually through licensed producers.

(c) Underwriting Methods. Provide a general explanation of the underwriting applicable to the filing.

(3) Certification. The Utah Accident and Health Insurance Filing Certification must be properly completed and signed. A filing will be rejected if the certification is missing or incomplete. A certification that is inaccurate may subject the filer to administrative action.

(4) Domicile Approval and Filing Status Information. A foreign insurer and filer must first submit filings to their domicile state. All filings must include domicile status and filing status information:

(a) Provide a stamped copy of the approval letter from the domicile state for the exact same filing and;

(b) Filing status information which includes;

(i) a list of the states to which the filing was submitted,

(ii) the date submitted, and

(iii) the states' actions and their responses,.

(c) If the filing is specific to Utah and only filed in Utah, then section 14 of the transmittal must be completed stating, "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE."

(5) Group Questionnaire or Discretionary Group Authorization Letter. A group filing must identify the type of group, and include either a signed and fully completed "Utah Accident and Health Insurance Group Questionnaire," or a copy of the "Utah Accident and Health Insurance Discretionary Group Authorization" letter.

(6) Letter of Authorization. When the filer is not the insurer, a letter of authorization from the insurer must be included. The insurer remains responsible for the filing being in compliance with Utah laws and rules.

(7) Items being submitted for filing. Refer to each applicable subsection of this rule for general procedures and additional procedures on how to submit forms, rates, and reports.

(8) Return Notification Materials.

(a) Return notification materials are limited to:

(i) a copy of the transmittal; and

(ii) a self addressed, stamped envelope.

(b) Any additional documents submitted for return will be discarded.

(c) Notice of filing will not be provided unless return notification materials are submitted.

 

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R590-220-9. Additional Procedures for Group Market Form Filings.

A filer submitting a group accident and health filing is advised to review 31A-8, 31A-22 Parts VI and VII, 31A-30, Rules R590-76, R590-131, R590-146 and R590-148. A filer submitting a group health benefit plan filing should also review R590-220-10 in addition to this section.

(1) Determine whether the group is an eligible group or a discretionary group.

(2) Eligible Group. A filing for an eligible group must include a completed "Utah Accident and Health Insurance Group Questionnaire."

(a) A questionnaire must be completed for each eligible group under Section 31A-22-503 through 507.

(b) When a filing applies to multiple employee-employer groups under Section 31A-22-502, only one questionnaire is required to be completed.

(3) Discretionary Group. If the group is not an eligible group, then specific discretionary group authorization must be obtained prior to filing.

(a) To obtain discretionary group authorization a Utah Accident and Health Insurance Request for Discretionary Group Authorization must be submitted and include all required information.

(b) Evidence or proof of the following items are some factors considered in determining acceptability of a discretionary group:

(i) the existence of a verifiable group;

(ii) that granting permission is not contrary to public policy;

(iii) the proposed group would be actuarially sound;

(iv) the group would result in economies of acquisition and administration which justify a group rate; and

(v) the group would not present hazards of adverse selection.

(c) A discretionary group filing that does not provide authorization documentation will be rejected.

(d) A change to an authorized discretionary group, such as change of name, trustee or domicile state, must be submitted to the department within 30 days of the change.

(e) [To add]Adding additional types of insurance products to be offered, requires that the discretionary group [to ]be re[-]authorized. The discretionary group authorization will specify the types of products that a discretionary group may offer.

(f) The commissioner may periodically re-evaluate the group's authorization.

(4) A filer may not submit a rate or form filing prior to receiving discretionary group authorization. If a rate or form filing is submitted without discretionary group authorization, the filing will be rejected.

(5) A filer submitting a long-term care filing, including a long-term care endorsement attached to a life insurance policy, is advised to review 31A-22 Part XIV, Rule R590-148, and section 13 of this rule.

(6) A filer submitting a Medicare supplement filing is advised to review Section 31A-22-620, Rule R590-146, and section 11 of this rule.

 

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R590-220-12. Additional Procedures for Combination Policies or Endorsements Providing Life and Accident and Health Benefits.

A filer submitting health and life combination policies, or health endorsements to life policies, [are]is advised to review Rule R590-226.

(1) A combination filing is a policy or endorsement, which creates a product that provides both life and accident and health insurance benefits. The two types of acceptable filings are an endorsement or an integrated policy. Combination filings take considerable time to process, and will be processed by both the Life Insurance Division and the Health Insurance Division.

(2) A combination filing submitted via paper must include transmittals and certifications for both the Life and Property and casualty Insurance Division and the Health Insurance Division. A combination filing submitted electronically must be submitted separately to both the Health Insurance Division and the Life and Property and Casualty Division.

(3)(a) For an integrated policy, the filing must be submitted to the appropriate division based on benefits provided in the base policy.

(b) For an endorsement, the filing must be submitted to the appropriate division based on benefits provided in the endorsement.

(4) The Filing Description must identify the filing as having a combination of insurance types, such as:

(a) term policy with a long-term care benefit rider; or

(b) major medical policy that includes a life insurance benefit.

 

R590-220-13. Additional Procedures for Long Term Care Products.

A filer submitting long-term care product filings is advised to review Section 31A-22-1400, Rule R590-148, and section 12 of this rule. A long-term care form filing that affects rates must be filed with all required rating documentation.

(1) Rates.

(a) Rates and rate documentation submitted with a new form filing are a "File and Use" filing. A rate revision filing is a "File for Acceptance" filing.

(b) Long-term care rates must comply with Rules R590-148 and R590-85.

(c) An insurer shall not use or change premium rates for a long-term care policy or certificate unless the rates, rating schedule and supporting documentation have been filed.

[(3)](2) Reports. All reports required by Rule R590-148-25 must be filed separately, with a transmittal, and be properly identified.

 

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R590-220-17. Enforcement Date.

The commissioner will begin enforcing the revised provisions of this rule [September 1, 2006]30 days from the effective date of this rule.

 

KEY: health insurance filings

Date of Enactment or Last Substantive Amendment: 2006

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A-30-106