Utah Admin. Code R590-146-15 - Filing Policies, Certificates, and Premium Rates

(1) For the purpose of this subsection, "type" means:

(a) an individual policy;

(b) a group policy;

(c) an individual Medicare Select policy; or

(d) a group Medicare Select policy.

(2) An issuer may not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed in accordance with filing requirements and procedures prescribed by the commissioner.

(3) An issuer may not use or change premium rates unless the rates, rating schedule, and supporting documentation have been filed in accordance with the filing requirements and procedures prescribed by the commissioner.

(4)

(a) Except as provided in Subsection (4)(b), an issuer may not file more than one policy form or certificate form of each standardized plan type for each standardized plan.

(b) An issuer may offer, with the approval of the commissioner, up to four additional policy forms or certificate forms of the same standardized plan type, one for:

(i) the inclusion of new or innovative benefits;

(ii) the addition of either direct response or producer marketing methods;

(iii) the addition of either guaranteed issue or underwritten coverage; and

(iv) the offering of coverage to individuals eligible for Medicare by reason of disability.

(c) A policy form issued under Section R590-146-9b is not considered a new policy form, and is not a permissible separate rating class.

(5)

(a) Except as provided in Subsection (5)(b), an issuer shall continue to make available for purchase each policy form or certificate form that has been filed with the commissioner. A policy form or certificate form is not considered available for purchase unless the issuer has actively offered it for sale in the previous 12 months.

(b) An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the commissioner, in writing, its decision at least 30 days before discontinuing the availability of the policy form or certificate form. After receipt of the notice by the commissioner, the issuer may no longer offer for sale the policy form or certificate form in this state.

(i) An issuer that discontinues the availability of a policy form or certificate form under this subsection may not file a new policy form or certificate form of the same standardized plan type for the same standardized plan as the discontinued form for a period of five years after the issuer provides notice to the commissioner of the discontinuance. The period of discontinuance may be reduced if the commissioner determines that a shorter period is appropriate.

(ii) The sale or other transfer of Medicare supplement insurance business to another issuer is considered a discontinuance.

(iii)

(A) A change in the rating structure or methodology shall be considered a discontinuance unless the issuer:

(I) provides an actuarial memorandum, in a form and manner prescribed by the commissioner, describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates; and

(II) does not subsequently put into effect a change of rates or rating factors that causes the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change.

(B) The commissioner may approve a change to the differential that is in the public interest.

(C) A revised rating methodology may only apply to a policy or certificate issued after the effective date of the revision.

(6)

(a) Except as provided in Subsection (6)(b), the experience of all policy forms or certificate forms of the same type in a standardized plan shall be combined for purposes of the refund or credit calculation prescribed in Section R590-146-14.

(b) Policy forms assumed under an assumption reinsurance agreement may not be combined with the experience of other forms for purposes of the refund or credit calculation.

Notes

Utah Admin. Code R590-146-15

Amended by Utah State Bulletin Number 2019-13, effective 6/7/2019 Adopted by Utah State Bulletin Number 2024-16, effective 8/7/2024