DAR File No. 29947

Insurance, Administration

R590-220

Submission of Accident and Health Insurance Filings

NOTICE OF PROPOSED RULE

DAR File No.: 29947
Filed: 05/15/2007, 04:42
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

Based on a need to store filings electronically and an increasing number of electronic filings, a policy change was made to require only electronic filings.

Summary of the rule or change:

The rule changes set standards for electronic filing. While reviewing the rule, numerous format and grammatical changes were made to enhance clarity.

State statutory or constitutional authorization for this rule:

Sections 31A-2-201.1, 31A-2-201, 31A-2-202, 31A-22-605, 31A-22-620, and 31A-30-106

This rule or change incorporates by reference the following material:

"NAIC Life, Accident and Health, Annuity, Credit Transmittal Document," dated March 1, 2007; "NAIC Life, Accident and Health, Annuity, Credit Transmittal Document (Instructions)," dated March 1, 2007; "NAIC Uniform Life, Accident and Health, Annuity and Credit Coding Matrix," dated March 1, 2007; "Utah Accident and Health Insurance Filing Certification," dated July 1, 2007; "Utah Accident and Health Insurance Group Questionnaire," dated July 1, 2007; and "Utah Accident and Health Insurance Request for Discretionary Group Authorization," dated July 1, 2007

Anticipated cost or savings to:

the state budget:

There will be a mid-term savings due to reducing need to store paper and an immediate savings in time due to reduced mail and handling of paper filings. There will be no change in the fees coming into the department.

local governments:

The changes to this rule will have no effect on local governments since the rule deals solely with the relationship between the department and their licensees.

other persons:

For those insurers not already filing electronically there will be a transaction fee of $6 to $15 per filing. Some of this will be offset by the elimination of printing and mailing costs. There will be a minimal, if any, fiscal impact on consumers.

Compliance costs for affected persons:

For those insurers not already filing electronically there will be a transaction fee of $6 to $15 per filing. Some of this will be offset by the elimination of printing and mailing costs. There will be minimal, if any, fiscal impact on consumers.

Comments by the department head on the fiscal impact the rule may have on businesses:

The fiscal impact of these changes will be minimal on businesses and will vary according to the size and number of filings they send to the department. Kent Michie, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY UT 84114-1201

Direct questions regarding this rule to:

Jilene Whitby at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at jwhitby@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/02/2007

This rule may become effective on:

07/09/2007

Authorized by:

Jilene Whitby, Information Specialist

R590. Insurance, Administration.

R590-220. Submission of Accident and Health Insurance Filings.

R590-220-1. Authority.

This rule is promulgated by the insurance commissioner pursuant to Section 31A-2-201.1 and Subsections 31A-2-201(3), 31A-2-202(2), 31A-22-605(4), 31A-22-620(3)(f), and 31A-30-106(1)(i) and (k).

 

R590-220-2. Purpose and Scope.

(1) The purpose of this rule is to set forth procedures for submitting:

(a) accident and health filings required by Section 31A-21-201;

(b) individual accident and health filings in accordance with Section 31A-22-605 and Rule R590-85;

(c) [individual and group ]Medicare supplement filings in accordance with Sections 31A-22-605 and 31A-22-620, and Rules R590-85 and R590-146;

(d) long term care filings required by Section 31A-22-1404 and Rule R590-148;

(e) basic health care plan filings required by Section 31A-22-613.5 and Rule R590-175; and

(f) health benefit plan filings required by Chapter 31A-30 and Rule R590-167.

(2) This rule applies to:

(a) all types of accident and health insurance products; and

(b) group accident and health contracts issued to nonresident policyholders, including trusts, when Utah residents are provided coverage by certificates of insurance.

 

R590-220-3. Documents Incorporated by Reference.

(1) The department requires that the documents described in this rule shall be used for all filings. Actual copies may be used or you may adapt them to your word processing system. If adapted, the content, size, font, and format must be similar.

(2) The following filing documents are hereby incorporated by reference and are available on the department's web site, www.insurance.utah.gov:

(a) "NAIC Life, Accident and Health, Annuity, Credit Transmittal Document," dated March 1, 2007[effective January 1, 2006];

(b) "NAIC [Instruction Sheet for ]Life, Accident and Health, Annuity, Credit Transmittal Document (Instructions)," dated March 1, 2007[effective January 1, 2006;

(c) "NAIC Instruction Sheet for Life, Accident and Health, Annuity, Credit Transmittal Document Form Filing Attachment and Rate Filing Attachment," effective January 1, 2006];

(c)[(d)] "NAIC Uniform Life, Accident and Health, Annuity and Credit Coding Matrix," dated March 1, 2007[effective January 1, 2006];

(d)[(e)] "Utah Accident and Health Insurance Filing Certification," dated July 1, 2007[version September 1, 2006];

(e)[(f)] "Utah Accident and Health Insurance Group Questionnaire," dated July 1, 2007[version September 1, 2006]; and

(f)[(g)] "Utah Accident and Health Insurance Request for Discretionary Group Authorization," dated July 1, 2007[version September 1, 2006].

 

R590-220-4. Definitions.

In addition to the definitions in Sections 31A-1-301 and 31A-30-103, the following definitions shall apply for the purposes of this rule.

(1) "Certification" means a statement that the filing being submitted is in compliance with Utah laws and rules.

(2) "Discretionary group" means a group that has been specifically authorized by the commissioner under Subsection 31A-22-701(1)(b).

(3) "Electronic filing" means a:

(a) filing submitted via the Internet by using the System for Electronic Rate and Form Filings, SERFF, system; or

(b) filing submitted via the Internet by using the Sircon system.

(4) "Eligible group" means a group that meets the definition in Subsection 31A-22-701(1)(a).

(5)[(4)] "File And Use" means a filing can be used, sold, or offered for sale after it has been filed with the department.

(6)[(5)] "File Before Use" means a filing can be used, sold, or offered for sale after it has been filed with the department and a stated period of time has elapsed from the date filed.

(7)[(6)] "File For Acceptance" means a filing can be used, sold, or offered for sale after it has been filed and the filer has received written confirmation that the filing was accepted.

(8)[(7)] "File for Approval" means a filing can be used, sold, or offered for sale after it has been filed and the filer has received written confirmation that the filing was approved.

(9)[(8)] "Filer" means a person or entity who submits a filing.

(10)[(9)] "Filing," when used as a noun, means an item required to be filed with the department including:

(a) a policy;

(b) a rate, rate manual, or rate methodologies;

(c) a form;

(d) a document;

(e) a plan;

(f) a manual;

(g) an application;

(h) a report;

(i) a certificate;

(j) an endorsement;

(k) an actuarial memorandum, demonstration, and certification;

(l) a licensee annual statement;

(m) a licensee renewal application; or

(n) an advertisement.

(11)[(10)] "Filing Objection Letter" means a letter issued by the commissioner when a review has determined the filing fails to comply with Utah law and rules. The filing objection letter, in addition to requiring correction of non-compliant items, may request clarification or additional information pertaining to the filing.

(12) "Filing status information" means a list of the states to which the filing was submitted, the date submitted, and the states' actions, including their responses.

(13)[(11)] "Letter of authorization" means a letter signed by an officer of the insurer on whose behalf the filing is submitted that designates filing authority to the filer.

(14)[(12)] "Market type" means the type of policy that indicates the targeted market such as individual or group.

(15)[(13)] "Order to Prohibit Use" means an order issued by the commissioner that [forbids ]prohibits the use of a filing.

(16)[(14)] "Rating methodology change" for the purpose of a health benefit plan means a:

(a) [a ]change in the number of case characteristics used by a covered carrier to determine premium rates for health benefit plans in a class of business;

(b) [a ]change in the manner or procedures by which insureds are assigned into categories for the purpose of applying a case characteristic to determine premium rates for health benefit plans in a class of business;

(c) [a ]change in the method of allocating expenses among health benefit plans in a class of business; or

(d) [a ]change in a rating factor, with respect to any case characteristic, if the change would produce a change in premium for any individual or small employer that exceeds 10%. A change in a rating factor shall mean the cumulative change with respect to such factor considered over a 12-month period. If a covered carrier changes rating factors with respect to more than one case characteristic in a 12-month period, the carrier shall consider the cumulative effect of all such changes in applying the 10% test.

(17)[(15)] "Rejected" means a filing is:

(a) not submitted in accordance with Utah laws and rules;

(b) returned to the filer by the department with the reasons for rejection; and

(c) not considered filed with the department.

(18)[(16)] "Type of insurance" means a specific accident and health product including dental, health benefit plan, long-term care, Medicare supplement, income replacement, specified disease, or vision.

(19) "Utah Filed Date" means the date provided to a filer by the Utah Insurance Department, that indicates a filing has been accepted pursuant to Subsections 4, 5, 6 or 7.

 

R590-220-5. General Filing Information.

(1) Each filing submitted must be accurate, consistent, complete and contain all required documents in order for the filing to be processed in a timely and efficient manner. The commissioner may request any additional information deemed necessary.

(2) An insurer and filer are responsible for assuring that a filing is in compliance with Utah laws and rules. A filing not in compliance with Utah laws and rules is subject to regulatory action under Section 31A-2-308.

(3) A filing that does not comply with this rule will be rejected and returned to the filer. A rejected filing:

(a) is not considered filed with the department[.];

(b) must be submitted as a new filing; and

(c) will not be reopened for purposes of resubmission.

(4) A prior filing[Prior filings] will not be researched to determine the purpose of the current filing.

(5) The department does not review or proofread every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) as a result of a complaint;

(iii) during a regulatory examination or investigation; or

(iv) at any other time the department deems necessary.

(b) If a filing is reviewed and is not in compliance with Utah laws and rules, a Filing Objection Letter or an Order To Prohibit Use will be issued to the filer. The commissioner may require the filer[insurer] to disclose deficiencies in forms or rating practices to affected insureds.

(6) Filing correction.

(a) [No transmittal is required when making a correction to misspelled words and punctuation in a filing. This]Filing corrections are[ filing will be] considered informational.

(b) [No transmittal is required when a clerical correction is made to a previous filing if]Filing corrections must be submitted within 15 days of the date ["Filed" with]the original filing was submitted to the department. The filer must reference the original filing[ or include a copy of the original transmittal].

(c) A new filing is required if a [clerical]filing correction is made more than 15 days after the date ["Filed" with]the original filing was submitted to the department. The filer must reference the original filing[ or include a copy of the original transmittal].

(7) If responding to a Filing Objection Letter or an Order to Prohibit Use, refer to R590-220-15 for instructions.

(8) Filing withdrawal. A filer must notify the department when withdrawing a previously filed form, rate, or supplementary information.

 

R590-220-6. Filing Submission Requirements.

(1) All filings must be submitted as an electronic filing.

(2) A filing must be submitted by market type and type of insurance.

(3) A filing may not include more than one type of insurance, or request filing for more than one insurer.[ A complete filing consists of the following documents submitted in the following order:]

(4) SERFF Filings.

(a) Filing Description. Do not submit a cover letter. On the general information tab, complete the Filing Description section with the following information, presented in the order shown below.

(i) Provide a description of the filing.

(ii) Indicate if the filing:

(A) is new;

(B) is replacing or modifying a previous submission; if so, describe the changes made, if previously rejected the reasons for rejection, and the previous filing's Utah Filed Date;

(C) includes forms for informational purposes; if so, provide the Utah Filed Date; or

(D) does not include the base policy; if so, provide the Utah Filed Date of the base policy and describe the effect on the base policy.

(iii) Identify if any of the provisions are unusual, controversial, or have been previously objected to, or prohibited, and explain why the provision is included in the filing.

(iv) Explain any change in benefits or premiums that may occur while the contract is in force.

(v) List the issue ages, which means the range of minimum and maximum ages for which a policy will be issued.

(b) Certification. The filer must certify that a filing has been properly completed AND is in compliance with Utah laws and rules. The Utah Accident and Health Insurance Filing Certification must be properly completed, signed, and attached to the supporting documentation tab. A false certification may subject the insurer or filer to administrative action.

(c) Domiciliary Approval and Filing Status Information. All filings for a foreign insurer must include on the supporting documentation tab:

(i) copy of domicile approval for the exact same filing;

(ii) filing status information which includes:

(A) a list of the states to which the filing was submitted;

(B) the date submitted; and

(C) summary of the states' actions and their responses; or

(iii) if the filing is specific to Utah and only filed in Utah, then state, "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE."

(d) Group Questionnaire or Discretionary Group Authorization Letter. A group filing must attach to the supporting documentation tab either a:

(i) signed and fully completed Utah Accident and Health Insurance Group Questionnaire; or

(ii) copy of the Utah Accident and Health Insurance Discretionary Group Authorization letter.

(e) Letter of Authorization.

(i) When the filer is not the insurer, a letter of authorization from the insurer must be attached to the supplementary documentation tab.

(ii) The insurer remains responsible for the filing being in compliance with Utah laws and rules.

(f) Items being submitted for filing.

(i) Any forms must be attached to the form schedule tab.

(ii) Any rating documentation, including actuarial memorandums and rate schedules, must be attached to the rate/rule schedule.

(5) Sircon Filings.

(a)[(1)] Transmittal. The NAIC Life, Accident and Health, Annuity, Credit Transmittal Document, as provided in R590-220-3[(2)], must be [on the top of the filing. The transmittal form must be ]properly completed.

(i)[(a)] Complete the transmittal by using the following:

(A)[(i)] NAIC [Instruction Sheet for ]Life, Accident and Health, Annuity, Credit Transmittal Document (Instructions); and

(B)[(ii) NAIC Instruction Sheet for Life, Accident and Health, Annuity, Credit Transmittal Document Form Filing Attachment and Rate Filing Attachment; and

(iii)] NAIC Uniform Life, Accident and Health, Annuity and Credit Coding Matrix.

(ii)[(b)] Do not submit the document described in sections (a)(i)(A) and (B)[, (ii), and (iii)] with the filing.

(b)[(2)] Filing Description. [A cover letter]Do not submit a cover letter[ should not be submitted]. [Instead, the]In Section 15 of the transmittal, complete the Filing Description with the following information [must be included in the Filing Description on the transmittal and ]presented in the order shown below.

(i) Provide a description of the filing.

(ii)[(i)] Indicate if the filing:

(A) is new[,];

(B) is replacing or modifying a previous[ filing, or contains forms] submission; if so, describe the changes made, if previously rejected the reasons for rejection, and the previous filing's Utah Filed Date;

(C) includes forms [that have been previously filed and are included ]for informational purposes[.]; if so, provide the Utah Filed Date; or

(D) does not include the base policy; if so, provide the Utah Filed Date of the base policy and describe the effect on the base policy.

[ (ii) Provide a brief description of each component's purpose, benefits and provisions.

] (iii) Identify if any of the provisions are[any new,]unusual, [or ]controversial,[ provision.

(iv) Identify] or have been [any unresolved ]previously objected to, or prohibited, and explain why the provision is included in the filing.[ provision and explain why the provision is included in the filing.]

(iv)[(v)] Explain any change in benefits or premiums that may occur while the contract is in force.

[ (vi) If the filing is replacing or modifying a previous submission, provide information that identifies the filing being replaced or modified, the Utah filed date, and a detailed description of the changes made.

(vii) If the filing includes forms for informational purposes, provide the dates the forms were filed.

(viii) If filing a certificate, outline of coverage, application, or endorsements, and the filing does not contain a policy, identify the affected policy form number, the Utah filed date, and describe the effect of the submitted forms on the base policy.

(b) Marketing Facts.]

(v)[(i)] List the issue ages, which means the range of minimum and maximum ages for which a policy will be issued.[;]

[ (ii) Identify the intended market, such as senior citizens, nonprofit organizations, association members, etc; and

(iii) Describe marketing and advertising in detail, i.e., through a marketing association, mass solicitation, electronic media, financial institutions, internet, telemarketing, or individually through licensed producers.

] (c) [Underwriting Methods. Provide a general explanation of the underwriting applicable to the filing.

(3) ]Certification. The filer must certify that a filing has been properly completed AND is in compliance with Utah laws and rules. The Utah Accident and Health Insurance Filing Certification must be properly completed and signed. [A filing will be rejected if the certification is missing or incomplete. ]A false certification[ that is inaccurate] may subject the insurer or filer to administrative action.

(d)[(4)] Domiciliary Approval and Filing Status Information. All filings for a foreign insurer must include:

(i)[(a) a stamped copy of the approval letter from the domicile state for the exact same filing;]copy of domicile approval for the exact same filing;

(ii)[(b)] filing status information which includes:

(A)[(i)] a list of the states to which the filing was submitted;

(B)[(ii)] the date submitted; and

(C)[(iii)] summary of the states' actions and their responses; or

(iii)[(c)] if the filing is specific to Utah and only filed in Utah, then section 14 of the transmittal must be completed stating, "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE."

(e)[(5)] Group Questionnaire or Discretionary Group Authorization Letter. A group filing must attach either a:[identify the type of group, and include either a]

(i) signed and fully completed ["]Utah Accident and Health Insurance Group Questionnaire;[,"] or[ a]

(ii) copy of the ["]Utah Accident and Health Insurance Discretionary Group Authorization["] letter.

(f)[(6)] Letter of Authorization.

(i) When the filer is not the insurer, a letter of authorization from the insurer must be included.

(ii) The insurer remains responsible for the filing being in compliance with Utah laws and rules.

(g)[(7)] Items being submitted for filing. [Refer to each applicable subsection of this rule for general procedures and additional procedures on how to submit]Any form or rate items submitted for filing must be attached to the product forms[, rates, and reports] tab.

[ (8) Return Notification Materials.

(a) Return notification materials are limited to:

(i) a copy of the transmittal; and

(ii) a self addressed, stamped envelope.

(b) Any additional documents submitted for return will be discarded.

(c) Notice of filing will not be provided unless return notification materials are submitted.

] (6) Refer to each applicable section of this rule for additional procedures on how to submit forms, rates, and reports.

 

R590-220-7. Procedures for Form Filings.

(1) Forms in General.

(a) Forms are ["]File and Use["] filings.

(b) Each form must be identified by a unique form number. The form number may not be variable.

(c) A form must be in final printed form or printer's proof format. A draft may not be submitted.

(d) Specific sections may be filed with variable data by placing brackets around affected information. Variable data must be identified within the specific section, or on a separate sheet included with the submission.

(e) Blank spaces within the forms must be completed in John Doe fashion to accurately represent the intended market, purpose, and use.

(2) Application Filing.

(a) Each application or enrollment form may be submitted as a separate filing or may be filed with its related policy or certificate filing.

(b) If an application has been previously filed or is filed separately, an informational copy of the application must be included with the policy or certificate filing.

(3) Policy Filing.

(a) Each type of insurance must be filed separately.

(b) A policy filing consists of one policy form, including its related forms, such as outline of coverage, certificate, or endorsement, and an actuarial memorandum.

(c)[(a)] Only one policy filing for a single type of insurance may be filed, except as stated in subsection [(b)](d).

(d)[(b)] A Medicare supplement filing may include more than one policy filing but each filing is limited to only one of each of the Medicare supplement plans A through [J]L.

(4) Endorsement Only Filing.

(a) Up to three related endorsements may be filed together.

(b) A single endorsement that affects multiple forms may be filed if the Filing Description references all affected forms.

(c) The filing must include:

(i) A listing of all base policy form numbers, title and [dates filed with the department]Utah Filed Dates; and

(ii) a description of how each filed endorsement affects the base policy.

(d) Unrelated endorsements may not be filed together.

(5) Outline of Coverage. If an outline of coverage is required to be issued with a policy or an endorsement, the outline of coverage must be filed when the policy or endorsement is filed.

 

R590-220-8. Additional Procedures for Individual Accident and Health Market Filings.

(1) This section does not apply to filings for individual health benefit plans that are subject to 31A-30 and Rule R590-167. Individual health[Health] benefit plan filings are discussed in R590-220-10.

(2) Rate and rate documentation filings.

(a) Rates and rate documentation submitted with a new form filing are a ["]File and Use["] filing.

(b) A rate revision filing is a ["]File for Acceptance["] filing.

(3) A filer submitting an individual accident and health filing is advised to review Chapter 31A-22[,] Part 6[VI], and Rules R590-85, R590-126, and R590-131.

(4) Every individual accident and health policy, or endorsement affecting benefits shall be accompanied by a rate filing with an actuarial memorandum signed by a qualified actuary.

(a) A rate filing need not be submitted if the filing does not require a change in premiums, however the reason why there is not a change in premium must be explained in the Filing Description.

(b) Rates must be filed in accordance with the requirements of Section 31A-22-602, Rule R590-85, and this rule.

(5) A filer submitting a long term care filing, including an endorsement attached to a life insurance policy, is advised to review Chapter 31A-22 Part 1401-1414,[XIV and] Rule R590-148, and Rule R590-220-12 and 13.

(6) A filer submitting a Medicare supplement filing is advised to review Section 31A-22-620, [and ]Rule R590-146, and R590-220-11.

 

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

A filer submitting a group accident and health filing is advised to review 31A-8, 31A-22 Parts VI and VII, 31A-30, Rules R590-76, R590-126, R590-131, R590-146, [and ]R590-148, and R590-233. A filer submitting a group health benefit plan filing should also review R590-220-10 in addition to this section.

(1) Determine whether the group is an eligible group or a discretionary group.

(2) Eligible Group. A filing for an eligible group must include a completed ["]Utah Accident and Health Insurance Group Questionnaire.["]

(a) A questionnaire must be completed for each eligible group under Sections 31A-22-503 through 507.

(b) When a filing applies to multiple employee-employer groups under Section 31A-22-502, only one questionnaire is required to be completed.

(3) Discretionary Group. If the group is not an eligible group, then specific discretionary group authorization must be obtained prior to filing.

(a) To obtain discretionary group authorization a Utah Accident and Health Insurance Request for Discretionary Group Authorization must be submitted and include all required information.

(b) Evidence or proof of the following items are some factors considered in determining acceptability of a discretionary group:

(i) the existence of a verifiable group;

(ii) that granting permission is not contrary to public policy;

(iii) the proposed group would be actuarially sound;

(iv) the group would result in economies of acquisition and administration which justify a group rate; and

(v) the group would not present hazards of adverse selection.

(c) A discretionary group filing that does not provide authorization documentation will be rejected.

(d) A change to an authorized discretionary group, such as change of name, trustee or domicile state, must be submitted to the department within 30 days of the change.

(e) Adding additional types of insurance products to be offered, requires that the discretionary group be reauthorized. The discretionary group authorization will specify the types of products that a discretionary group may offer.

(f) The commissioner may periodically re-evaluate the group's authorization.

(4) A filer may not submit a rate or form filing prior to receiving discretionary group authorization. If a rate or form filing is submitted without discretionary group authorization, the filing will be rejected.

(5) A filer submitting a long-term care filing, including a long-term care endorsement attached to a life insurance policy, is advised to review Chapter 31A-22 Part 1401-1414[XIV], Rule R590-148, and [section]Sections 12 and 13 of this rule.

(6) A filer submitting a Medicare supplement filing is advised to review Section 31A-22-620, Rule R590-146, and [section]R590-220-11[ of this rule].

 

R590-220-10. Additional Procedures for Individual, Small Employer, and Group Health Benefit Plan Filings.

This section contains instructions for filings subject to 31A-30. A filer submitting health benefit plan filings that are subject to 31A-30 is advised to review 31A-8, Chapter 31A-22 Parts 6[VI] and 7[VII], Chapter 31A-30, Rules R590-76, R590-131, R590-167, R590-175, [and ]R590-176, and R590-233.

(1) General requirements.

(a) Letter of Intent. A filing must include a copy of the letter filed with the commissioner declaring the carrier's intention as required by R590-167-10.

(b) Class of Business. The Filing Description must describe the class of business, as provided in Section 31A-30-105.

(c) Rate Manual. A health benefit plan form filing must include a rate manual. If the rate manual was previously filed, provide [a copy of the transmittal and ]documentation indicating the department's receipt.

(2) Rate Manual Filing.

(a) A rate manual that does not request a change in rating methodology is a ["]File Before Use["] filing.

(b) A change in rating methodology filing is a ["]File for Approval["] filing.

(c) A new and revised rate manual must:[.]

(i) [A filing must ]include an actuarial certification signed by a qualified actuary[.];

(ii) [A rate manual and subsequent change must ]be filed 30 days prior to use[.];

(iii) [A rate manual must ]list the case characteristics and rate factors to be used[.];

(iv) [A rating manual must ]be applied in the same manner for all health benefit plans in a class;[.]

(v) contain specific [ The ]area factor and industry factors [must contain the specific schedules ]applicable in Utah;[.]

[ Any case characteristic not listed in Subsection 31A-30-106(1)(h) requires prior approval of the commissioner.

(iv)]vi [The rating manual shall describe ]the method of calculating the risk load, including the method used to determine any experience factors[.]; and

(vii) [The rating manual must clearly describe ]how the overall rate is reviewed for compliance with the rate restrictions.

(d) Any case characteristic not listed in Subsection 31A-30-106(1)(h) requires prior approval of the commissioner.

(3) Health Benefit Plan Reports.

(a) [Reports due April 1 each year:

(i) "]Actuarial Certification.["]

(i) All individual and small employer carriers must file an [An ]actuarial certification as described in Section 31A-30-106 and Rule R590-167-11(1)(a)[.A].

(ii) The report is due April 1 each year.

(b)[(ii) "]Small Employer Index Rates Report.["]

All small employer carriers must file their index rates as of January[March] 1 of the current year and preceding year, as required by Subsection 31A-29-117(2).

(i) The report must include:

(A) the actual index rates[,]; and

(B) calculate the percentage change in these rates between the two years.

(ii) The report is due February 1 each year.

(c)[(b)] [A]Each report must be filed separately and be properly identified.

 

R590-220-11. Additional Procedures for Medicare Supplement Filings.

A filer submitting Medicare supplement filings is advised to review Section 31A-22-620 and Rule R590-146. A Medicare supplement form filing that affects rates must be filed with all required rating documentation.

(1) An insurer must file its Medicare Supplement Buyers Guide.

(2) Rates.

(a) Rates and rate documentation submitted with a new form filing are a ["]File and Use["] filing.

(b) A rate revision filing is a ["]File for Acceptance["] filing.

(c)[(b)] Medicare supplement rates must comply with Section 31A-22-602, Rules R590-146 and R590-85.

(d)[(c)] An insurer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been filed.

(e)[(d)] A rate revision request may not be used to satisfy the annual filing requirements of Rule R590-146-14.C.

(3) Annual Medicare Supplement Reports.

(a) Medicare supplement reports are ["]File and Use["] filings.

(b) Reports are due May 31[March 1] each year.[,]

(c) ["]Report of Multiple Policies.["]

(i) As required by R590-146-22, an issuer of Medicare supplement policies shall annually submit a report of multiple policies the insurer has issued to a single insured.

(ii) The report is required each year listing each insured with multiple policies or stating that no multiple policies were issued.

[ (c) Reports due May 31 each year.

(i)](d) ["]Annual Filing of Rates and Supporting Documentation.["]

(i) An issuer of Medicare supplement policies and certificates shall file annually its rates, rating schedule and supporting documentation, including ratios of incurred losses to earned premiums by policy duration, in accordance with R590-146-14.C.

(ii) The NAIC Medicare Supplement Insurance Model Regulations Manual details what should be included in the annual rate filing.

(iii) Annual reports submitted with a request or any type of reference to a rate revision will be rejected.

(e)[(ii)] ["]Refund Calculation and Benchmark Ratio.["] An issuer shall file the ["]Medicare Supplement Refund Calculation Form["] and ["]Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies["] reports according to R590-146-14.B.

(f)[(d)] [A]Each report must be filed separately and be properly identified.

 

R590-220-12. Additional Procedures for Combination Policies or Endorsements Providing Life and Accident and Health Benefits.

A filer submitting health and life combination policies, or health endorsements to life policies, is advised to review Rule R590-226.

(1) A combination filing is a policy or endorsement, which creates a product that provides both life and accident and health insurance benefits.

(a) The two types of acceptable combination filings are an endorsement or an integrated policy.

(b) Combination filings take considerable time to process, and will be processed by both the [Life Insurance Division and the ]Health Insurance Division, and the Life Section of the Life, Property and Casualty Insurance Division.

(2) [A combination filing submitted via paper must include transmittals and certifications for both the Life and Property and casualty Insurance Division and the Health Insurance Division. ]A combination filing [submitted electronically ]must be submitted separately to both the Health Insurance Division and the Life Section of the Life, [and ]Property and Casualty Insurance Division.

(3)(a) For an integrated policy, the filing must be submitted to the appropriate division based on benefits provided in the base policy.

(b) For an endorsement, the filing must be submitted to the appropriate division based on benefits provided in the endorsement.

(4) The Filing Description must identify the filing as having a combination of insurance types, such as:

(a) term life policy with a long-term care benefit rider; or

(b) major medical health policy that includes a life insurance benefit.

 

R590-220-13. Additional Procedures for Long Term Care Products.

A filer submitting long-term care product filings is advised to review Section 31A-22-1400, Rule R590-148, and section 12 of this rule. A long-term care form filing that affects rates must be filed with all required rating documentation.

(1) Rates.

(a) Rates and rate documentation submitted with a new form filing are a ["]File and Use["] filing.

(b) A rate revision filing is a ["]File for Acceptance["] filing.

(c)[(b)] Long-term care rates must comply with Rules R590-148 and R590-85.

(d)[(c)] An insurer shall not use or change premium rates for a long-term care policy or certificate unless the rates, rating schedule and supporting documentation have been filed.

(2) Annual Long-term Care Reports.

(a) All four long-term care reports required by Rule R590-148-25 must be submitted together as one filing[filed separately, with a transmittal, and be properly identified].

(b) If all four reports are not submitted as one filing, the filing is considered incomplete and will be rejected.

(c) If there is no information to report, the reporting form must indicate "NONE."

(d) Reports are due June 30 each year.

(e) The four reports shown below are required by R590-148-25.

(i) Replacement and Lapse Reporting Form.

(ii) Claims Denial Reporting Form.

(iii) Rescission Reporting Form.

(iv) Suitability Report Form.

 

R590-220-14. [Electronic Filings.

A filer submitting an electronic filing must follow the requirements for both the electronic system and this rule, as applicable.

 

R590-220-15. ]Correspondence and[,] Status Checks[, and Responses].

(1) Correspondence. When corresponding with the department, a filer must provide sufficient information to identify the original filing:

(a) type of insurance;

(b) date of filing;

(c) form numbers;[ and]

(d) submission method, SERFF or Sircon; and[copy of the original transmittal.]

(e) tracking number.

(2) Status Checks.

(a) A complete filing is usually processed within 45 days of receipt.

[(a)](b) A filer can request the status of its filing by telephone or email 60 days after the date of submission.

[ (b) A complete filing is usually processed within 45 days of receipt. If a filing includes all return notification materials, a response should be received within that time.

(3) Response to an Order. A response to an order must include:

(a) a response cover letter identifying the changes made;

(b) a copy of the Protected Correspondence that was included with the Order to Prohibit Use;

(c) one copy of the revised documents with all changes highlighted;

(d) one copy of the revised documents incorporating all changes without highlights; and

(e) return notification materials, which consist of a copy of the response cover letter and a self-addressed stamped envelope.

(4) Rejected Filing.

(a) A rejected filing is NOT considered filed. If resubmitted it is considered a new filing.

(b) If resubmitting a previously rejected filing, the new filing must include a copy of the rejection notice.

]

R590-220-15. Responses.

(1) Response to a Filing Objection Letter. A response to a Filing Objection Letter must include:

(a) a cover letter identifying all changes made;

(b) revised documents with all changes highlighted; and

(c) revised documents incorporating all changes without highlights.

(2) Response to an Order to Prohibit Use.

(a) An Order to Prohibit Use becomes final 15 days after the date of the Order.

(b) Use of the filing must be discontinued not later than the date specified in the Order.

(c) To contest an Order to Prohibit Use, the commissioner must receive a written request for a hearing not later than 15 days after the date of the Order.

(d) A new filing is required if the company chooses to make the requested change addressed in the Filing Objection Letter. The new filing must reference the previously prohibited filing.

 

R590-220-16. Penalties.

A person found, after a hearing or other regulatory process, to be in violation of this rule shall be subject to penalties as provided under Section 31A-2-308.

 

R590-220-17. Enforcement Date.

The commissioner will begin enforcing the revised provisions of this rule 30 days from the effective date of this rule.

 

R590-220-18. Severability.

If any provision of this rule or the application of it to any person or circumstance is for any reason held to be invalid, the remainder of the rule and the application of the provision to other persons or circumstances shall not be affected by it.

 

KEY: health insurance filings

Date of Enactment or Last Substantive Amendment: [January 22,] 2007

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A-30-106