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

(1) An insurer filing a group accident and health insurance filing shall comply with:

(a) Title 31A, Chapter 22, Part 6, Accident and Health Insurance;

(b) Title 31A, Chapter 22, Part 7, Group Accident and Health Insurance;

(c) Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards;

(d) Title 31A, Chapter 22, Part 20, Limited Long-Term Care Insurance Act;

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

(f) Title 31A, Chapter 45, Managed Care Organizations;

(g) Rule R590-85;

(h) Rule R590-122;

(i) Rule R590-126;

(j) Rule R590-131;

(k) Rule R590-146;

(l) Rule R590-148;

(m) Rule R590-192;

(n) Rule R590-203;

(o) Rule R590-215;

(p) Rule R590-277;

(q) Rule R590-283; and

(r) Rule R590-285.

(2) An insurer filing a group health benefit plan filing shall comply with:

(a) Rule R590-167;

(b) Rule R590-176;

(c) Rule R590-194;

(d) Rule R590-200;

(e) Rule R590-233;

(f) Rule R590-237;

(g) Rule R590-247;

(h) Rule R590-259;

(i) Rule R590-261;

(j) Rule R590-266;

(k) Rule R590-271;

(l) Rule R590-277; and

(m) Section R590-220-10.

(3) An insurer shall determine if a group is an eligible group or a discretionary group.

(a) Eligible Group.

(i) A filing for an eligible group shall include a compliant Utah Accident and Health Insurance Group Questionnaire.

(ii) A questionnaire shall be completed for each eligible group under Section 31A-22-701.

(iii) When a filing applies to more than one employer or employee group, only one questionnaire is required.

(iv) A filing for a bona fide employer association shall include a compliant Utah Bona Fide Employer Association Group Authorization Questionnaire.

(v) A filing for a non-employer group shall comply with Rule R590-126.

(b) Discretionary Group.

(i) If a group is not an eligible group, specific discretionary group authorization shall be obtained.

(ii) If a form filing is submitted without discretionary group authorization, the filing shall be rejected.

(A) A filing may not include a rate or form filing before receiving discretionary group authorization.

(B) If a rate or form filing is submitted without discretionary group authorization, the filing shall be rejected.

(C) A discretionary group authorization filing may include a copy of the policy or certificate for informational purposes only, and such an inclusion does not satisfy a form filing requirement.

(iii) To obtain discretionary group authorization, a compliant Utah Accident and Health Insurance Request for Discretionary Group Authorization shall be submitted.

(iv) A change to an authorized discretionary group shall be submitted to the department within 30 days of the change.

(v) The commissioner may periodically re-evaluate a group's authorization.

(vi)

(A) An insurer shall file a separate discretionary group authorization to add another TOI to a previously authorized group.

(B) The discretionary group authorization shall specify the TOI products that a discretionary group may offer.

Notes

Utah Admin. Code R590-220-9

Amended by Utah State Bulletin Number 2015-20, effective 9/23/2015 Adopted by Utah State Bulletin Number 2023-12, effective 3/23/2016 Adopted by Utah State Bulletin Number 2023-13, effective 6/9/2023