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

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