No. 38376 (Amendment): Section R590-269-4. Open and Special Enrollment Periods

(Amendment)

DAR File No.: 38376
Filed: 03/19/2014 10:20:02 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The change is being made to correct the open-enrollment period for 2015 and the following years to match that required by the federal Department of Health and Human Services.

Summary of the rule or change:

The change in the open-enrollment period will comply with that of the federal government and will lengthen the open-enrollment period for 2015.

State statutory or constitutional authorization for this rule:

• Subsection 31A-30-117(1)(c)

Anticipated cost or savings to:

the state budget:

Changing the date of the open-enrollment period will have no fiscal impact on the department or state's budgets. It simply puts Utah in compliance with federal laws and provides more time for people to enroll for an individual health benefit plan outside the Federally Facilitated Marketplace. It will not make a change in fees coming into the department or costs to the department.

local governments:

The changes to this rule will have no fiscal impact on local governments. It simply correlates the open enrollment dates with those required by the federal government and provides more time for individuals to enroll in individual health benefit plans provided by health insurers.

small businesses:

The changes to this rule will have no impact on small businesses. The change will lengthen the open enrollment period for individuals to enroll in individual health benefit plans, which may allow more people to apply for the coverage.

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

The changes to this rule will have the greatest impact on insurers selling individual health benefit plans and on those individuals seeking coverage in the market place. The change will lengthen the open enrollment period for individuals to enroll in individual health benefit plans, which may cause more people to purchase coverage they have not had before and insurance companies to sell more policies. The fiscal impact would vary from one individual and insurer to another.

Compliance costs for affected persons:

The changes to this rule will have the greatest impact on insurers selling individual health benefit plans and on those individuals seeking coverage in the market place. The change will lengthen the open enrollment period for individuals to enroll in individual health benefit plans, which may cause more people to purchase coverage they have not had before and insurance companies to sell more policies. The fiscal impact would vary from one individual and insurer to another.

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

The impact of the length of the open-enrollment period may increase health insurers sales of individual health benefit plans. The impact, if any, would vary from insurer to insurer. It cannot be determined at this time.

Todd E. Kiser, 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:

05/15/2014

This rule may become effective on:

05/22/2014

Authorized by:

Todd Kiser, Commissioner

RULE TEXT

R590. Insurance, Administration.

R590-269. Individual Open Enrollment Period.

R590-269-4. Open and Special Enrollment Periods.

(1)(a)(i) Except as otherwise provided herein, the initial open enrollment period for an individual health benefit plan outside the Federally Facilitated Marketplace is October 1, 2013 through March 31, 2014.

(ii) The open enrollment period in Subsection (a)(i) shall be extended to be consistent with the open enrollment period for the Federally Facilitated Marketplace if the United States Department of Health and Human Services extends the open enrollment period for the Federally Facilitated Marketplace beyond March 31, 2014.

(iii)(A) Coverage begins on January 1, 2014 for individuals who enroll on or before December 15, 2013.

(B) After December 15, 2013, if an individual enrollment occurs between the first and the fifteenth of the month, coverage is effective the first day of the following month. If enrollment occurs between the sixteen and the last day of the month, then coverage is effective the first day of the second following month.

(b) The open enrollment period for 2015 is November 15, 2014 through February 15, 2015.

(c)  [After the initial enrollment period in Subsection (a), t]The open enrollment period [is annually from October 15 through December 7 for a coverage effective date of January 1 the immediately following year]for subsequent years will be the open enrollment period as established by the United States Department of Health and Human Services.

(2)(a) An individual carrier shall offer to an individual experiencing a qualifying life event, a special enrollment period for at least 60 days.

(b) In the case of birth, adoption or placement for adoption, the coverage is effective on the date of:

(i) birth;

(ii) adoption; or

(iii) placement for adoption

(c) Coverage is effective the first day of the month following the date the insurer receives the request for special enrollment in the case of:

(i) marriage;

(ii) an individual or dependent loses minimum essential coverage;

(iii) an individual or dependent's enrollment or non-enrollment is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee or agent of an exchange or the United States Department of Health and Human Services, or its instrumentalities as evaluated and determined by an exchange ;

(iv) an individual adequately demonstrates to the individual carrier that the health benefit plan in which he or she is previously enrolled substantially violated a material provision of its contract in relation to the enrollee; or

(v) an individual permanently moves into a new service area.

(3) Nothing in this rule prohibits an insurer from offering open or special enrollment periods in addition to the open and special enrollment periods required by this rule.

 

KEY: individual open enrollment period

Date of Enactment or Last Substantive Amendment: [January 13, ]2014

31A-30-117(1)(c)

 

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