S.B. 56 Enrolled

OFFICE OF CONSUMER HEALTH ASSISTANCE
1999 GENERAL SESSION
STATE OF UTAH
Sponsor: Peter C. Knudson
AN ACT RELATING TO INSURANCE; ESTABLISHING THE OFFICE OF CONSUMER
HEALTH ASSISTANCE AND ADVISORY COMMITTEE; ESTABLISHING THE DUTIES OF
THE OFFICE IN EDUCATING AND ASSISTING HEALTH CARE CONSUMERS;
CLARIFYING THE ROLE OF THE COMMISSIONER IN CONSUMER EDUCATION
GENERALLY; REQUIRING INSURERS TO INCLUDE A CONSUMER REPRESENTATIVE
ON APPEAL BOARDS; EXTENDING RULEMAKING AUTHORITY; AND MAKING
CONFORMING AMENDMENTS.
This act affects sections of Utah Code Annotated 1953 as follows:
AMENDS:
31A-8-401, as enacted by Chapter 204, Laws of Utah 1986
ENACTS:
31A-2-215, Utah Code Annotated 1953
31A-2-216, Utah Code Annotated 1953
31A-4-116, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 31A-2-215 is enacted to read:
31A-2-215. Consumer education.
(1) In furtherance of the purposes in Section 31A-1-102 , the commissioner may educate
consumers about insurance and provide consumer assistance.
(2) Consumer education may include:
(a) outreach activities; and
(b) the production or collection and dissemination of educational materials.
(3) (a) Consumer assistance may include explaining:
(i) the terms of a policy;
(ii) a policy's complaint and grievance procedure; and

(iii) the fundamentals of self-advocacy.
(b) Notwithstanding Subsection (3)(a), consumer assistance may not include testifying or
representing a consumer in any grievance, arbitration, judicial, or related proceeding, unless the
proceeding is in connection with an enforcement action brought under Section 31A-2-308 .
(4) The commissioner may adopt rules necessary to implement the requirements of this
section.
Section 2. Section 31A-2-216 is enacted to read:
31A-2-216. Office of Consumer Health Assistance.
(1) The commissioner shall establish:
(a) an Office of Consumer Health Assistance before July 1, 1999; and
(b) a committee to advise the commissioner on consumer assistance rendered under this
section.
(2) The office shall:
(a) be a resource for health care consumers concerning health care coverage or the need for
such coverage;
(b) help health care consumers understand:
(i) contractual rights and responsibilities;
(ii) statutory protections; and
(iii) available remedies;
(c) educate health care consumers:
(i) by producing or collecting and disseminating educational materials to consumers, health
insurers, and health benefit plans; and
(ii) through outreach and other educational activities;
(d) for health care consumers that have difficulty in accessing their health insurance policies
because of language, disability, age, or ethnicity, provide services, directly or through referral, such
as:
(i) information and referral; and
(ii) grievance process initiation;

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(e) analyze and monitor federal and state consumer health-related statutes, rules, and
regulations; and
(f) summarize information gathered under this section and make the summaries available
to the public, government agencies, and the Legislature.
(3) The office may:
(a) obtain data from health care consumers as necessary to further the office's duties under
this section;
(b) investigate complaints and attempt to resolve complaints at the lowest possible level; and
(c) assist, but not testify or represent, a consumer in a grievance, arbitration, judicial, or
related proceeding, unless the proceeding is in connection with an enforcement action brought under
Section 31A-2-308 .
(4) The commissioner may adopt rules necessary to implement the requirements of this
section.
Section 3. Section 31A-4-116 is enacted to read:
31A-4-116. Grievance procedures.
If an insurer has established a complaint resolution body or grievance appeal board, the body
or board shall include at least one consumer representative.
Section 4. Section 31A-8-401 is amended to read:
31A-8-401. Enrollee participation.
Every organization shall provide a reasonable procedure, consistent with Section 31A-4-116 ,
for allowing enrollees to participate in matters of policy of the organization and for resolving
complaints and grievances initiated by enrollees or providers.

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