R590. Insurance, Administration.R590-152. Health Discount Programs and Value-Added Benefit Rule.
R590-152-1. Authority.
This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-8a-210.
R590-152-2. Purpose and Scope.
(1) The purpose of this rule is to establish standards for:
(a) a health discount program; and
(b) a value-added benefit.
(2) This rule applies to:
(a) a person offering, operating, or marketing a health discount program; and
(b) a value-added benefit provided by a person licensed under:
(i) Title 31A, Chapter 7, Nonprofit Health Service Insurance Corporations; or
(ii) Title 31A, Chapter 8, Health Maintenance Organizations and Limited Health Plans.
R590-152-3. Definitions.
Terms used in this rule are defined in Sections 31A-1-301 and 31A-8a-102. Additional terms are defined as follows:
(1) "Private label entity" means an entity that purchases a health discount program from a health discount program operator and issues or markets the health discount program under the entity's name or logo.
R590-152-4. Licensing (Application, Initial, Renewal).
(1) An application for a health discount program operator or a health discount program marketer shall be complete and submitted with the appropriate fee.
(2) An application may be denied if the applicant, in any jurisdiction:
(a) is under investigation; or
(b) has been found in violation of a statute or regulation.
R590-152-5. Fees and Other Authorized Charges.
(1) A health discount program operator may provide a discount or free service through a contracted provider to a member purchaser in exchange for a periodic payment to the program or as a benefit in connection with a membership.
(2) A health discount program operator may charge:
(a) a non-refundable one-time membership charge; and
(b) a refundable periodic fee.
(3) If a membership is cancelled by a health discount program operator that charges a fee in excess of one month, the health discount program operator shall make a pro rata refund of the excess fees paid by the purchaser.
R590-152-6. Required Practices.
(1) A health discount program operator shall have an active toll-free telephone number for an enrollee to call.
(2) Any communication with a purchaser, a member, or a potential purchaser shall state that the health discount program is a discount plan and not insurance.
(3) When a health discount program operator or a health discount program marketer markets or sells a health discount program with any other product that can be purchased separately, including insured benefits, an itemized list including each fee and premium for each individual product must be provided in writing to the potential purchaser at the time of solicitation.
(4) Information available online to a member must be updated within 30 days from the date of the change.
R590-152-7. Value-Added Benefit.
(1) Evidence of a value-added benefit shall be available to the commissioner upon request.
(2) Before offering a value-added benefit, a licensee shall:
(a) file with the commissioner a value-added benefit list that includes the following:
(i) the insurer's name and address;
(ii) each form to which the value-added benefit applies; and
(iii) a description of each benefit offered; and
(b) comply with Sections R590-152-10 and R590-152-11, if providing a discount card to a member.
R590-152-8. Prohibited Practices.
(1) A health discount program operator may not make any payment to a provider for:
(a) participation in the health discount program;
(b) a capitation arrangement;
(c) a signing fee;
(d) a bonus; or
(e) any other form of compensation.
