R590. Insurance,
Administration. (Effective 9-30-05)
R590-172. Notice to Uninsurable Applicants for Health Insurance.
R590-172-1. Authority.
This rule is adopted pursuant to the provisions of Section 31A-29-116.
R590-172-2. Scope.
This rule applies to all health insurers doing business in the State of
Utah.
R590-172-3.
Definitions.
For the purpose of this rule the commissioner adopts the definitions as
particularly set forth in Section 31A-1-301 and in addition, the following:
The term, "health insurance," is defined in Subsection 31A-29-103(5)(a) as
any hospital and medical expense-incurred policy; nonprofit health care service
plan contract, and health maintenance organization subscriber contract. It does
not include workers' compensation insurance, automobile medical payment
insurance, or insurance under which benefits are payable with or without regard
to fault and which is required by law to be contained in any liability insurance
policy.
R590-172-4. Rule.
Every health insurer writing health insurance in the State of Utah will
provide a written notice containing the requirements in R590-176-5(3)(a), Health
Benefit Plan Enrollment, and the following language to each applicant for health
insurance coverage that is denied coverage by the insurer for reasons relating
to health:
"You have been denied health insurance coverage due to a health condition
which is uninsurable. The Utah Comprehensive Health Insurance Pool (HIPUtah) was
created to provide health insurance to residents of Utah who are denied health
insurance and who are considered uninsurable. If you have lived in the State of
Utah for 12 consecutive months prior to applying for insurance with this company
you may be eligible for health insurance coverage with HIPUtah.
"However, if you have not lived in the state of Utah for 12 consecutive
months, but you are a Utah resident and you are coming from another State's high
risk pool or have had 18 months of continuous coverage with the most recent
coverage being through a group health plan, you may still be eligible for health
insurance coverage with the Utah Comprehensive Insurance Pool.
"Part or all of the preexisting waiting period will be waived if you are an
eligible individual according to the Health Insurance Portability and
Accountability Act (HIPAA) or your previous coverage was involuntarily
terminated for reasons other than for nonpayment of premium or fraud, and
application for HIPUtah is made within 63 days of that termination. The amount
of credit given will depend on the length of time an applicant was previously
covered under that health insurance.
"If application for coverage with HIPUtah is made within 30 days of this
denial letter and you are declined coverage with
the pool, HIPUtah will issue a certificate of insurability and you may reapply
for coverage with this company within 30 days of the certificate date.
"To find out whether you qualify for pool coverage or to make application
for pool coverage, Salt Lake City area residents should call 442-6660. Residents
of other areas in Utah should call 1-800-638-5038, ext. 6660, toll free. The
HIPUtah's mailing address is P.O. Box 30192, Salt Lake City, Utah 84130-0192."
R590-172-5.
Enforcement Date.
The commissioner will begin enforcing the revised provisions of this rule
45 days from the effective date of the rule
R590-172-6.
Severability.
If a provision of this rule or its application to any person or
circumstance is for any reason held to be invalid, the remainder of the rule and
the application of such provisions are not affected.
KEY:
health insurance
Notice of Continuation June 15, 2000
31A-29-116
[Back to Top]
|