R590. Insurance, Administration.R590-235. Medicare Prescription Drug Plan.
R590-235-1. Authority.
This rule is promulgated by the commissioner pursuant to Section 31A-2-201.
R590-235-2. Purpose and Scope.
(1) The purpose of this rule is to establish licensing and regulatory requirements for a stand-alone Medicare PDP.
(2) This rule applies to a person that offers a stand-alone Medicare PDP.
R590-235-3. Definitions.
Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-620, and Rule R590-146. Additional terms are defined as follows:
(1) "Medicare Advantage company" means a company selling a Medicare Advantage plan.
(2)(a) "Stand-alone Medicare PDP" means a Medicare prescription drug plan offered by an insurer or a private company to provide Medicare Part D benefits.
(b) "Stand-alone Medicare PDP" does not mean a Medicare prescription drug plan included in the benefit package offered by a Medicare Advantage company.
R590-235-4. Licensure and Regulatory Requirements.
(1) A stand-alone Medicare PDP sponsor shall be licensed as a risk-bearing entity in the jurisdiction where the sponsor proposes to serve Medicare Part D beneficiaries.
(2) A stand-alone Medicare PDP may be licensed and regulated as either a Utah domiciled health maintenance organization (HMO), a limited health plan, or a Utah domiciled or foreign indemnity insurer.
(a) Regulatory requirements for a Utah domiciled stand-alone Medicare PDP organized as an HMO or limited health plan are established by Title 31A, Chapter 8, Health Maintenance Organizations and Limited Health Plans.
(b) Regulatory requirements for a Utah domiciled stand-alone Medicare PDP organized as an indemnity insurer are established by Title 31A, Chapter 5, Domestic Stock and Mutual Insurance Corporations.
(c) Regulatory requirements for a foreign indemnity insurer are established by Title 31A, Chapter 14, Foreign Insurers.
(3) A stand-alone Medicare PDP shall file Quarterly and Annual Statement Blanks pursuant to the instructions provided by the NAIC and in accordance with statutory accounting principles.
(4) A stand-alone Medicare PDP applicant shall apply for licensure using the appropriate NAIC Uniform Certificate of Authority Application form:
(a) Primary Application Form, for a Utah domiciled insurer stand-alone Medicare PDP; or
(b) Expansion Application Form, for a foreign indemnity insurer stand-alone Medicare PDP.
R590-235-5. Severability.
If any provision of this rule, Rule R590-235, 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: prescription drug plans
Date of Last Change: December 8, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201
