31A-22-635 - Development of uniform health insurance application -- Uniform waiver of coverage.
31A-22-635. Development of uniform health insurance application -- Uniformwaiver of coverage.
(1) For purposes of this section, "insurer":
(a) is defined in Subsection 31A-22-634(1); and
(b) includes the state employee's risk pool under Section 49-20-202.
(2) (a) Insurers offering a health benefit plan to an individual or small employer shall:
(i) except as provided in Subsection (6), use a uniform application form, which,beginning October 1, 2010:
(A) except for cancer and transplants, may not include questions about an applicant'shealth history prior to the previous 10 years; and
(B) shall be shortened and simplified in accordance with rules adopted by thedepartment; and
(ii) use a uniform waiver of coverage form, which:
(A) may not include health status related questions other than pregnancy; and
(B) is limited to:
(I) information that identifies the employee;
(II) proof of the employee's insurance coverage; and
(III) a statement that the employee declines coverage with a particular employer group.
(b) Notwithstanding the requirements of Subsection (2)(a), the uniform application anduniform waiver of coverage forms may be combined or modified to facilitate:
(i) the electronic submission and processing of an application through the HealthInsurance Exchange created pursuant to Section 63M-1-2504 or directly to all carriers; and
(ii) a more efficient and understandable experience for a consumer submitting anapplication in the Health Insurance Exchange or directly to all carriers.
(3) An insurer offering a defined contribution arrangement health benefit plan in theHealth Insurance Exchange to a large group shall use a large group uniform application, anduniform waiver of coverage form, that is adopted by the department by administrative rule.
(4) (a) (i) The uniform application form, and uniform waiver form, shall be adopted andapproved by the commissioner in accordance with Title 63G, Chapter 3, Utah AdministrativeRulemaking Act.
(ii) Modifications to the uniform application necessary to facilitate the electronicsubmission and processing of an application through the Health Insurance Exchange shall beadopted by administrative rule adopted by the Office of Consumer Health Services in accordancewith Section 63M-1-2506.
(b) The commissioner shall convene the health insurance industry, the Office ofConsumer Health Services, and consumers to review the uniform application for the individualand small group market, and the large group market, and make recommendations regarding theuniform applications. The department shall report the findings of the group convened pursuantto this Subsection (4)(b) to the Legislature no later than July 1, 2010.
(5) (a) Beginning October 1, 2010, an insurer who offers a health benefit plan on theHealth Insurance Exchange created in Section 63M-1-2504, shall:
(i) accept and process an electronic submission of the uniform application or uniformwaiver from the Health Insurance Exchange using the electronic standards adopted pursuant toSection 63M-1-2506; and
(ii) if requested, provide the applicant with a copy of the completed application either by
mail or electronically.
(b) The commissioner shall regulate any fees charged by insurers to an enrollee for auniform application form or electronic submission of the application forms.
(6) An insurer offering a health benefit plan outside the Health Insurance Exchange mayuse the uniform application in effect prior to May 15, 2010, until January 1, 2011.
Amended by Chapter 68, 2010 General Session