S.B. 56

1

OFFICE OF CONSUMER HEALTH
2 ASSISTANCE
3 1999 GENERAL SESSION
4 STATE OF UTAH
5 Sponsor: Peter C. Knudson
6 AN ACT RELATING TO INSURANCE; ESTABLISHING THE OFFICE OF CONSUMER
7 HEALTH ASSISTANCE AND ADVISORY COMMITTEE; ESTABLISHING THE DUTIES OF
8 THE OFFICE IN EDUCATING AND ASSISTING HEALTH CARE CONSUMERS;
9 CLARIFYING THE ROLE OF THE COMMISSIONER IN CONSUMER EDUCATION
10 GENERALLY; REQUIRING INSURERS TO ESTABLISH A GRIEVANCE PROCEDURE
11 AND INCLUDE A CONSUMER REPRESENTATIVE ON APPEAL BOARDS; EXTENDING
12 RULEMAKING AUTHORITY; AND MAKING CONFORMING AMENDMENTS.
13 This act affects sections of Utah Code Annotated 1953 as follows:
14 AMENDS:
15 31A-8-401, as enacted by Chapter 204, Laws of Utah 1986
16 ENACTS:
17 31A-2-215, Utah Code Annotated 1953
18 31A-2-216, Utah Code Annotated 1953
19 31A-4-116, Utah Code Annotated 1953
20 Be it enacted by the Legislature of the state of Utah:
21 Section 1. Section 31A-2-215 is enacted to read:
22 31A-2-215. Consumer education.
23 (1) In furtherance of the purposes in Section 31A-1-102 , the commissioner may educate
24 consumers about insurance and provide consumer assistance.
25 (2) Consumer education may include:
26 (a) outreach activities; and
27 (b) the production or collection and dissemination of educational materials.

28 (3) (a) Consumer assistance may include explaining:
29 (i) the terms of a policy;
30 (ii) a policy's complaint and grievance procedure; and
31 (iii) the fundamentals of self-advocacy.
32 (b) Notwithstanding Subsection (3)(a), consumer assistance may not include testifying or
33 representing a consumer in any grievance, arbitration, judicial, or related proceeding, unless the
34 proceeding is in connection with an enforcement action brought under Section 31A-2-308 .
35 (4) The commissioner may adopt rules necessary to implement the requirements of this
36 section.
37 Section 2. Section 31A-2-216 is enacted to read:
38 31A-2-216. Office of Consumer Health Assistance.
39 (1) The commissioner shall establish:
40 (a) an Office of Consumer Health Assistance before July 1, 1999; and
41 (b) a committee to advise the commissioner on consumer assistance rendered under this
42 section.
43 (2) The office shall:
44 (a) be a resource for health care consumers concerning health care coverage or the need
45 for such coverage;
46 (b) help health care consumers understand:
47 (i) contractual rights and responsibilities;
48 (ii) statutory protections; and
49 (iii) available remedies;
50 (c) educate health care consumers:
51 (i) by producing or collecting and disseminating educational materials to consumers, health
52 insurers, and health benefit plans; and
53 (ii) through outreach and other educational activities;
54 (d) for health care consumers that have difficulty in accessing their health insurance
55 policies because of language, disability, age, or ethnicity, provide services, directly or through
56 referral, such as:
57 (i) information and referral; and
58 (ii) grievance process initiation;

59 (e) analyze and monitor federal and state consumer health-related statutes, rules, and
60 regulations; and
61 (f) summarize information gathered under this section and make the summaries available
62 to the public, government agencies, and the Legislature.
63 (3) The office may:
64 (a) obtain data from health care consumers as necessary to further the office's duties under
65 this section;
66 (b) investigate complaints and attempt to resolve complaints at the lowest possible level;
67 and
68 (c) assist, but not testify or represent, a consumer in a grievance, arbitration, judicial, or
69 related, unless the proceeding is in connection with an enforcement action brought under Section
70 31A-2-308 .
71 (4) The commissioner may adopt rules necessary to implement the requirements of this
72 section.
73 Section 3. Section 31A-4-116 is enacted to read:
74 31A-4-116. Grievance procedures.
75 (1) An insurer shall establish grievance procedures under which an insured may challenge
76 an adverse insurance-related decision of the insurer.
77 (2) Grievance procedures established under Subsection (1) shall include a complaint
78 resolution body or grievance appeal board that hears appeals and includes at least one consumer
79 representative.
80 Section 4. Section 31A-8-401 is amended to read:
81 31A-8-401. Enrollee participation.
82 Every organization shall provide a reasonable procedure, consistent with Section
83 31A-4-116 , for allowing enrollees to participate in matters of policy of the organization and for
84 resolving complaints and grievances initiated by enrollees or providers.

Legislative Review Note
as of 2-2-99 10:43 AM

A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel