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

  (1) A filer submitting a group accident and health filing is advised to review:

  (a) Title 31A, Chapter 8, Health Maintenance Organizations and Limited Health Plans;

  (b) Title 31A, Chapter 22, Parts 6 and 7;

  (c) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act; and

  (d)(i) Rules R590-76, R590-85, R590-122, R590-126, R590-131, R590-146, R590-148, R590-192, R590-203, and R590-215.

  (ii) Filers submitting group health benefit plans should also review Rules R590-167, R590-176, R590-194, R590-200, R590-218, R590-233, R590-237, R590-247, R590-259, R590-261, R590-266, R590-271 and Section R590-220-10.

  (2) A filer must determine if the group is an allowable group. An allowable group must meet the parameters of an eligible group or a discretionary group. All groups, except a group formed under a Taft Hartley trust in accordance with Section 302(c)(5) of the Federal Labor Management Relations Act, must be formed and maintained for purposes other than obtaining insurance.

  (a) Eligible Group.

  (i) A filing for an eligible group must include a signed and fully completed Utah Accident and Health Insurance Group Questionnaire.

  (A) A questionnaire must be completed for each eligible group under Sections 31A-22-503 through 507, and Subsection 31A-22-701(2).

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

  (ii) A filing for an eligible Bona Fide Employer Association must include a signed and fully completed Utah Bona Fide Employer Association Group Questionnaire.

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

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

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

  (A) the existence of a verifiable group;

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

  (C) the proposed group would be actuarially sound;

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

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

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

  (iv) 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.

  (v) Adding additional types of insurance products to be offered, requires that the discretionary group be reauthorized. The discretionary group authorization will specify the types of products that a discretionary group may offer.

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

  (vii) 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.

  (3) A filer submitting a long-term care filing, including a long-term care endorsement or rider attached to a life insurance policy, is advised to review Title 31A, Chapter 22, Part 14, Long Term Care Insurance Standards, Rule R590-148, and Sections R590-220-12 and 13.

  (4) A filer submitting a Medicare supplement filing is advised to review Section 31A-22-620, Rule R590-146, and Section R590-220-11.