R590. Insurance, Administration.R590-176. Health Benefit Plan Enrollment.
R590-176-1. Authority.
This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-202.
R590-176-2. Purpose and Scope.
(1) The purpose of this rule is to provide enrollment requirements under Section 31A-30-108.
(2) This rule applies to a carrier that provides health benefit plan coverage to individuals and small employers under Section 31A-30-104.
R590-176-3. Definitions.
Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows.
(1) "Time period" means the period such as daily, weekly, or monthly, as determined by the carrier, in which applications are grouped.
R590-176-4. General Provisions.
(1) Any attempt to selectively or unfairly delay, obstruct, or hinder any person from obtaining coverage under Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act, is a violation of Section 31A-30-108.
(2) Enrollment shall be equally available through all distribution systems.
(3) A carrier may not market or encourage producers to market individual or small employer health benefit plans to lessen the incentive to insure business with greater health risks.
(4) Each record regarding an enrollment application or underwriting determination shall:
(a) be retrievable for examination by the time period the application was received;
(b) include any document pertaining to the application and its underwriting; and
(c) be retained for the current year plus three years.
(5) A document described in Subsection (4)(b) includes:
(a) an application and date received;
(b) any notification to the applicant and date of notification;
(c) any record used in underwriting and date received; and
(d) an underwriting decision and date of decision.
R590-176-5. Application and Enrollment.
(1) A carrier shall keep a record of each application for coverage that includes the time period the application is received by the carrier.
(2) All applications shall be treated consistently.
(3)(a) A complete application shall be processed and the applicant shall be given written notice of the decision within 30 days of the decision.
(b) A carrier may not require that an application be complete to qualify as an application for coverage.
(c) If an application is incomplete, the carrier shall notify the applicant of the incomplete areas and the information required to complete the application within 15 days of receipt of the application.
(d) Before an application can be rejected as incomplete, an applicant shall have at least 30 days to provide the required information.
R590-176-6. Severability.
If any provision of this rule, Rule R590-176, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.
KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202
