Utah Department of Administrative Services Division of Administrative Rules

File No. 33297

This rule was published in the January 15, 2010, issue (Vol. 2010, No. 2) of the Utah State Bulletin.


Insurance, Administration

Rule R590-220

Submission of Accident and Health Insurance Filings

Notice of Proposed Rule

(Amendment)

DAR File No.: 33297
Filed: 12/30/2009 04:16:36 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of these changes is to update the rule to comply with rate and form filing procedures used throughout the United States and to clarify language.

Summary of the rule or change:

The changes update the rule to comply with rate and form filing procedures; update incorporated documents; eliminate the reference to SIRCON; change the time required to make filing corrections from 30 to 15 days; and require that the intent of the filing and purpose of each document be included with each filing.

State statutory or constitutional authorization for this rule:

  • Subsection 31A-2-202(2)
  • Section 31A-2-201.1
  • Subsection 31A-22-620(3)(f)
  • Subsection 31A-2-201(3)
  • Subsections 31A-30-106(1)(i) and (k)
  • Subsection 31A-22-605(4)

This rule or change incorporates by reference the following material:

  • Removes: NAIC Life, Accident and Health, Annuity, Credit Transmittal Document (Instructions), 03/01/2007
  • Adds: NAIC Life, Accident and Health, Annuity, Credit Trasnmittal Document (Instructions), 03/01/2007
  • Removes: NAIC Uniform Life, Accident and Health, Annuity and Credit Coding Matrix, 03/01/2007
  • Removes: Utah Accident and Health Insurance Filing Certification, 07/01/2007
  • Adds: NAIC Uniform Life, Accident and Health, Annuity, and Credit Coding Matrix, 07/01/2009
  • Removes: Utah Accident and Health Insurance Group Questionnaire, 07/01/2007

Anticipated cost or savings to:

the state budget:

These changes will have no fiscal impact on the department. The changes will not create a change in the filings or fees coming into the department and will in no way create a change to employee work load.

local governments:

The changes to this rule will have no impact on local governments since the rule deals with the relationship between the department and its licensees, which in this case includes around 550 health insurance companies.

small businesses:

This rule affects health insurance companies, few; if any, would be considered small businesses. The changes to this rule update the filing procedures of the department to comply with national standards being used by most states. The only fiscal impact may be the reduction in rejected filings, as a result of language clarifications. This would result in reduced filing fees paid by insurers to the contracted organization processing these filings, not the department.

persons other than small businesses, businesses, or local governmental entities:

This rule affects health insurance companies, most are large businesses. The changes to this rule update the filing procedures of the department to comply with national standards being used by most states. The only fiscal impact may be the reduction in rejected filings, as a result of language clarifications. This would result in reduced filing fees paid by insurers to the contracted organization processing these filings, not the department. Consumers will likely not be impacted financially by these changes since health insurers will have little, if any, fiscal impact on them.

Compliance costs for affected persons:

This rule affects health insurance companies. The changes update the procedures of the department to comply with national standards being used by most states. The only fiscal impact may be the reduction in rejected filings resulting from clarified language. This would reduce filing fees paid by insurers to the contracted organization processing these filings, not the department.

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

The changes to this rule will have little, if any, fiscal impact on businesses in Utah.

D. Kent Michie, Insurance Commissioner

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

Insurance
Administration
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:

02/15/2010

Interested persons may attend a public hearing regarding this rule:

  • 02/09/2010 09:00 AM, Room 3112, State Office Building (behind the Capitol), Salt Lake City, UT 84114

This rule may become effective on:

02/22/2010

Authorized by:

Jilene Whitby, Information Specialist

RULE TEXT

R590. Insurance, Administration.

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

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) 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 Title[Chapter] 31A , Chapter [-]30 , Individual, Small Employer, and Group Health Insurance Act, 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.

(a) Actual copies may be used or you may adapt them to your word processing system.

(b) If adapted, the content, size, font, and format must be similar.

(2) The "NAIC Uniform Life, Accident and Health, Annuity, and Credit Coding Matrix," effective July 1, 2009, is[following filing documents are] hereby incorporated by reference and is[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;

(b) "NAIC Life, Accident and Health, Annuity, Credit Transmittal Document (Instructions)," dated March 1, 2007;

(c) "NAIC Uniform Life, Accident and Health, Annuity and Credit Coding Matrix," dated March 1, 2007;

(d) "Utah Accident and Health Insurance Filing Certification," dated July 1, 2007;

(e) "Utah Accident and Health Insurance Group Questionnaire," dated July 1, 2007; and

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

 

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

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

(10) "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 or rider;

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

(l) a licensee annual statement;

(m) a licensee renewal application; or

(n) an advertisement.

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

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

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

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

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

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

(d) 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 licensee[carrier] changes rating factors with respect to more than one case characteristic in a 12-month period, the licensee[carrier] shall consider the cumulative effect of all such changes in applying the 10% test.

(17) "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) "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) A Licensee[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 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[To] Prohibit Use will be issued to the filer. The commissioner may require the licensee[filer] to disclose deficiencies in forms or rating practices to affected insureds.

(6) Filing correction.

(a) Filing corrections are considered informational.

(b) Filing corrections must be submitted within 15 days of the date the original filing was submitted to the department.[ The filer must reference the original filing.] The filer shall include a description of the filing corrections.

(c) A new filing is required if a filing correction is made more than 15 days after the date the original filing was submitted to the department. The filer must reference the original filing in the filing description and include a description of the filing corrections.

(7) If responding to a Filing Objection Letter or an Order to Prohibit Use, refer to Section R590-220-16[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]licensee.

(4) (a)[ SERFF Filings.

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

(i) Provide a description of the filing including:

(A) the intent of the filing; and

(B) the purpose of each document within 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 documents[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[supporting] Documentation[documentation] tab. A false certification may subject the licensee[insurer or filer] to administrative action.

(c) Domiciliary Approval and Filing Status Information. All filings for a foreign licensee[insurer] must include on the Supporting[supporting] Documentation[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[supporting] Documentation[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]licensee, a letter of authorization from the [insurer]licensee must be attached to the Supporting[supplementary] Documentation[documentation] tab.

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

(f) Variable data.

(i) A statement of variability must be attached to the Supporting Documentation tab and certify:

(A) the final form will not contain brackets denoting variable data;

(B) the use of variable data will be administered in a uniform and non-discriminatory manner and will not result in unfair discrimination;

(C) the variable data included in this statement will be used on the referenced forms;

(D) any changes to variable data will be submitted prior to implementation.

(ii) Variable data are denoted in brackets and are defined, either by imbedding in the form, or by a separate form identified by its own form number and edition date. Variable data submitted as a separate form must be in a manner that follows the construction of the form, by page and paragraph, or page and footnote.

(iii) Variable data must be reasonable, appropriate and compliant.

(iv) Use of unauthorized variable data is prohibited.

(g) Utah Accident and Health Insurance Intake Survey.

(i) The intake survey must be properly completed, signed and attached to the Supporting Documentation tab for filings submitted with the type of insurance of "H15G," "H15I," "H16G," "H16I," "HOrg02G," or "HOrg02I."

(ii) If the intake survey is incomplete or not attached, the filing will be rejected.

(h)[(f)] Items being submitted for filing.

(i) [Any]All forms must be attached to the Form[form] Schedule[schedule] tab.

(ii) [Any]All rating documentation, including actuarial memorandums and rate schedules, must be attached to the Rate/Rule[rate/rule] Schedule[schedule].

(i) Reports are exempt from the filing submission requirement listed in Subsections R590-220-6(4)(c), (d), (f) and (g).

(5)[ Sircon Filings.

(a) Transmittal. The NAIC Life, Accident and Health, Annuity, Credit Transmittal Document, as provided in R590-220-3, must be properly completed.

(i) Complete the transmittal by using the following:

(A) NAIC Life, Accident and Health, Annuity, Credit Transmittal Document (Instructions); and

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

(ii) Do not submit the document described in sections (a)(i)(A) and (B) with the filing.

(b) Filing Description. Do not submit a cover letter. In Section 15 of the transmittal, complete the Filing Description 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.

(c) 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 false certification may subject the insurer or filer to administrative action.

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

(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 section 14 of the transmittal must be completed stating, "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE."

(e) Group Questionnaire or Discretionary Group Authorization Letter. A group filing must attach 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.

(f) 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) Items being submitted for filing. Any form or rate items submitted for filing must be attached to the product forms tab.

(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 the application, outline of coverage, certificate, rider,[or] endorsement, and [an] actuarial memorandum.

(c) Only one policy filing for a single type of insurance may be filed, except as stated in Subsection[subsection] R590-220-7(3)(d).

(d) 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 [L]N.

(4) Rider or Endorsement Only Filing.

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

(b) A single rider or 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 Utah Filed Dates; and

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

(d) Unrelated riders or endorsements may not be filed together.

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

 

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

(1) A filer submitting an individual accident and health filing is advised to review:

(a) Title 31A, Chapter 8, Health Maintenance Organizations and Limited Health Plans;

(b) Title 31A, Chapter 22, Part 6, Accident and Health Insurance; and

(c) Rules R590-85, R590-126, R590-131, and R590-192.

(2) This section does not apply to filings for individual health benefit plans that are subject to Title 31A , Chapter [-]30 , Individual, Small Employer, and Group Health Insurance Act, and Rule R590-167. Individual health benefit plan filings are discussed in Section R590-220-10.

(3)[(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.

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

(4)] Every individual accident and health policy, rider, 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, Rules[Rule] R590-85, and R590-220[this rule].

(5) A filer submitting a long term care filing, including an endorsement or rider attached to a life insurance policy, is advised to review Title[Chapter] 31A , Chapter [-]22 , Part 14 , Long Term Care Insurance Standards[01- 1414], Rule R590-148, and Sections[Rule] R590-220-12 and 13.

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

 

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

(1) A filer submitting a group accident and health filing is advised to review :

(a) Title 31A , Chapter [-]8, Health Maintenance Organizations and Limited Health Plans;

(b) Title 31A , Chapter [-]22 , Parts 6[VI] and 7[VII,];

(c) Title 31A , Chapter [-]30, Individual, Small Employer, and Group Health Insurance Act; and

(d) Rules R590-76, R590-126, R590-131, R590-146, R590-148, R590-192,[and] R590-233 , and Section R590-220-10.[ A filer submitting a group health benefit plan filing should also review R590-220-10 in addition to this section.]

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

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

(i)[(a)] A questionnaire must be completed for each eligible group under Sections 31A-22-503 through 507 , and Subsection 31A-22-701(2).

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

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

(i)[(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.

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

(A)[(i)] the existence of a verifiable group;

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

(C)[(iii)] the proposed group would be actuarially sound;

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

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

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

(iv)[(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.

(v)[(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.

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

(vii)[(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.

(3)[(5)] A filer submitting a long-term care filing, including a long-term care endorsement or rider attached to a life insurance policy, is advised to review Title[Chapter] 31A , Chapter [-]22 , Part 14, Long Term Care Insurance Standards[1401-1414], Rule R590-148, and Sections R590-220-12 and 13[ of this rule].

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

 

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

This section contains instructions for filings subject to Title 31A , Chapter [-]30 , Individual, Small Employer, and Group Health Insurance Act.

(1) A filer submitting health benefit plan filings that are subject to Title 31A , Chapter [-]30 , is advised to review :

(a) Title 31A , Chapter [-]8, Health Maintenance Organization and Limited Health Plans;

(b) Title 31A, Chapter [31A-]22 , Parts 6 and 7[,];

(c) Title 31A, Chapter [31A-]30[,]; and

(d) Rules R590-76, R590-131, R590-167, R590-175, R590-176,[ and] R590-233 , and R590-247.

(2)(a)[(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)] Form Filing[Rate Manual]. (i) A health benefit plan form filing must include a rate manual.

(ii) If the rate manual was previously filed, provide documentation indicating the department's receipt.

(b)[(2)] Rate Manual Filing.

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

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

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

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

(B)[(ii)] be filed 30 days prior to use;

(C)[(iii)] list the case characteristics and rate factors to be used;

(D)[(iv)] be applied in the same manner for all health benefit plans in a class;

(E)[(v)] contain specific area factor and industry factors applicable in Utah;

(F)[(vi)] include the method of calculating the risk load, including the method used to determine any experience factors;[ and]

(G)[(vii)] include how the overall rate is reviewed for compliance with the rate restrictions ; and

(H) include detailed description of all classes of business, as provided in Section 31A-30-105.

(iv)[(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) Actuarial Certification.

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

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

(b) Small Employer Index Rates Report.

All small employer licensees[carriers] must file their index rates as of January 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) Each report must be filed separately and be properly identified.

(d)(i) All health benefit plan reports must be filed with SERFF using a type of insurance of "H16I" or "H16G," and a filing type of "Report."

(ii) A Health Maintenance Organization must use "HOrg02I" or "HOrg02G" as the type of insurance and the filing type of "Report."

 

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) (a) A licensee[An insurer] must file its Medicare Supplement Buyers Guide.

(b) If previously filed, indicate the filed date in the filing description.

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

(d) A licensee[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) A rate revision request may not be used to satisfy the annual filing requirements of Subsection[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 each year.

(c) Report of Multiple Policies.

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

(ii) The report is required each year listing each insured with multiple policies or must state "NO MULTIPLE POLICIES WERE ISSUED."[stating that no multiple policies were issued.]

(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 Subsection 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) 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 Subsection R590-146-14.B.

(f) [Each report must be filed separately and be properly identified]Reports for Pre-Standardized Medicare supplement benefit plans and 1990 Standardized Medicare supplement benefit plans must be submitted together as one filing with SERFF using a type of insurance of "MS06," and a filing type of "Report."

(g) Reports for 2010 Standardized Medicare supplement benefit plans must be submitted together as one filing with SERFF using a type of insurance of "MS09," and a filing type of "Report."

(h) If Medicare supplement reports are not submitted as one filing, the filing is considered incomplete and will be rejected.

 

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

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

(1) A combination filing is a policy , rider, 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 rider, or an integrated policy.

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

(2) A combination filing must be submitted separately to both the Health Insurance Division and the Life Section of the Life, 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 or rider, the filing must be submitted to the appropriate division based on benefits provided in the endorsement or rider.

(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.

(1) A filer submitting long-term care product filings is advised to review :

(a) Title[Section] 31A , Chapter [-]22 , Part [-]14[00], Long Term Care Insurance Standards;

(b) Rule R590-148[,]; and

(c) Section R590-220-12[section 12 of this rule].

(2) A long-term care form filing that affects rates must be filed with all required rating documentation.

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

(d) A licensee[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.

(4)[(2)] Annual Long-term Care Reports.

(a) All four long-term care reports required by Section[Rule] R590-148-25 must be submitted together as one filing.

(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 state[indicate] "NONE."

(d) Reports are due June 30 each year.

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

(i) Replacement and Lapse Reporting Form.

(ii) Claims Denial Reporting Form.

(iii) Rescission Reporting Form.

(iv) Suitability Report Form.

(f) All long term care reports must be filed with SERFF using a type of insurance of "LTC06," and a filing type of "Report."

 

R590-220-14. Criteria for Adding or Terminating Participating Providers.

(1) Criteria for adding or terminating participating providers must be submitted electronically via SERFF using a type of insurance of "H21" and a filing type of "Report."

(2) The Filing Description must state "Preferred Provider Agreement," as required by Subsection 31A-22-617.1(1)(c).

 

R590-220-15 [14]. Correspondence and Status Checks.

(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

(e)] tracking number.

(2) Status Checks.

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

(b) A filer can request the status of its filing [by telephone or email] 60 days after the date of submission. A response will not be provided to a status request prior to 60 days.

 

R590-220-16 [15]. Responses.

(1) Response to a Filing Objection Letter. When responding to a[A response to a] Filing Objection Letter a filer must[include]:

(a) provide an explanation[a cover letter] identifying all changes made;

(b) include an underline and strikeout version for each revised document;[revised documents with all changes highlighted; and]

(c) a final version of revised documents that incorporates all changes; and[revised documents incorporating all changes without highlights.]

(d) attach the documents in Subsections R590-220-16(1)(b) and (c) to the appropriate Form Schedule or Rate/Rule Schedule tabs.

(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 licensee[company] chooses to make the requested changes[change] addressed in the Filing Objection Letter. The new filing must reference the previously prohibited filing.

 

R590-220-17 [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.

 

R590-220-18 [17]. Enforcement Date.

The commissioner will begin enforcing the revised provisions of this rule [30 days]15 days from the effective date of this rule.

 

R590-220-19 [18]. Severability.

If any provision of this rule or its[the] application[ of it] to any person or situation[circumstance] is [for any reason] held to be invalid, that invalidity shall not affect any other provision or application of this rule which can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable[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: [July 12, 2007]2010

Notice of Continuation: March 12, 2009

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

 


Additional Information

The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at http://www.rules.utah.gov/publicat/bull-pdf/2010/b20100115.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.

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For questions regarding the content or application of this rule, please contact 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.