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

(1) An insurer filing a group accident and health insurance filing shall comply with: (a) Title 31A, Chapter 22, Part 6, Accident and Health Insurance; (b) Title 31A, Chapter 22, Part 7, Group Accident and Health Insurance; (c) Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards; (d) Title 31A, Chapter 22, Part 20, Limited Long-Term Care Insurance Act; (e) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act; (f) Title 31A, Chapter 45, Managed Care Organizations; (g) Rule R590-85; (h) Rule R590-122; (i) Rule R590-126; (j) Rule R590-131; (k) Rule R590-146; (l) Rule R590-148; (m) Rule R590-192; (n) Rule R590-203; (o) Rule R590-215; (p) Rule R590-277; (q) Rule R590-283; and (r) Rule R590-285. (2) An insurer filing a group health benefit plan filing shall comply with: (a) Rule R590-167; (b) Rule R590-176; (c) Rule R590-194; (d) Rule R590-200; (e) Rule R590-233; (f) Rule R590-237; (g) Rule R590-247; (h) Rule R590-259; (i) Rule R590-261; (j) Rule R590-266; (k) Rule R590-271; (l) Rule R590-277; and (m) Section R590-220-10. (3) An insurer shall determine if a group is an eligible group or a discretionary group. (a) Eligible Group. (i) A filing for an eligible group shall include a compliant Utah Accident and Health Insurance Group Questionnaire. (ii) A questionnaire shall be completed for each eligible group under Section 31A-22-701. (iii) When a filing applies to more than one employer or employee group, only one questionnaire is required. (iv) A filing for a bona fide employer association shall include a compliant Utah Bona Fide Employer Association Group Authorization Questionnaire. (v) A filing for a non-employer group shall comply with Rule R590-126. (b) Discretionary Group. (i) If a group is not an eligible group, specific discretionary group authorization shall be obtained. (ii) If a form filing is submitted without discretionary group authorization, the filing shall be rejected. (A) A filing may not include a rate or form filing before receiving discretionary group authorization. (B) If a rate or form filing is submitted without discretionary group authorization, the filing shall be rejected. (C) A discretionary group authorization filing may include a copy of the policy or certificate for informational purposes only, and such an inclusion does not satisfy a form filing requirement. (iii) To obtain discretionary group authorization, a compliant Utah Accident and Health Insurance Request for Discretionary Group Authorization shall be submitted. (iv) A change to an authorized discretionary group shall be submitted to the department within 30 days of the change. (v) The commissioner may periodically re-evaluate a group's authorization. (vi)(A) An insurer shall file a separate discretionary group authorization to add another TOI to a previously authorized group. (B) The discretionary group authorization shall specify the TOI products that a discretionary group may offer.