Utah Admin. Code R590-167-11 - Actuarial Certification and Additional Filing Requirements

(1)

(a) An actuarial certification filing under Subsection 31A-30-106(4)(b) or 31A-30-106.1(13)(b) shall:

(i) include a written statement that meets the requirements of the act, this rule, and the applicable standards of practice promulgated by the Actuarial Standards Board;

(ii) be signed by the actuary and state that the actuary meets the qualifications of Subsection 31A-30-103(1);

(iii) contain the following statement: "I, (name), certify that (name of covered carrier) is in compliance with Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act, and Rule R590-167, based upon the examination of (name of covered carrier), including review of the appropriate records and of the actuarial assumptions and methods utilized by (name of covered carrier) in establishing premium rates for applicable health benefit plans";

(iv) list and describe each written demonstration used by the actuary to establish compliance with the act and this rule;

(v) list all affiliated insurers, defining each class of business that includes the commissioner's approval date if more than one class of business exists; and

(vi) include the System for Electronic Rates and Forms Filing, SERFF, filing number for each applicable rate manual filing.

(b) The actuarial certification applies to an individual or a small employer health benefit plan issued before March 23, 2010, and maintains grandfathered status.

(2)

(a) A covered carrier shall file with the commissioner a copy of the applicable rate manual for a health benefit plan that is subject to the act and this rule, for both new business and renewal rates, and shall include:

(i) a signed certification by an actuary that, to the best of the actuary's knowledge and judgment, the rate filing complies with the applicable laws and rules of Utah;

(ii) a complete and detailed description of how the final premium, including any fees, is calculated from the rate manual;

(iii) all changes and updates, including a complete and detailed description of how the final premium, including any fees, is calculated from the rate manual;

(iv) an identification of the covered carrier's classes of business under Subsection R590-167-4(1);

(v) all information required by 45 CFR 154.215(b)(1); and

(vi) for a rate increase subject to review by 45 CFR 154.200(a)(1), all information required by 45 CFR 154.215(b)(2).

(b) The rate manual shall be filed:

(i) with an initial product filing; or

(ii) 30 days before use, for an existing health benefit plan.

Notes

Utah Admin. Code R590-167-11

Amended by Utah State Bulletin Number 2016-8, effective 3/23/2016 Adopted by Utah State Bulletin Number 2024-05, effective 2/21/2024