Utah Admin. Code R590-167-3 - Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1) "Act" means Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act.

(2) "Change in a rating factor" means the cumulative change of a rating factor over a 12-month period.

(3) "Change in rating method" means:

(a) a change in the number of case characteristics used to determine health benefit plan premium rates in a class of business;

(b) a change in the manner or procedure by which an insured is assigned into a category for applying a case characteristic to determine health benefit plan premium rates in a class of business;

(c) a change in the method of allocating expenses among health benefit plans in a class of business; or

(d) a change in one or more rating factors for any case characteristic if the change produces a change in premium for an individual or small employer that exceeds 10%.

(4) "New entrant" means an eligible employee, or a dependent of an eligible employee, who becomes part of a small employer group after the initial period for enrollment in a health benefit plan.

(5) "Risk characteristic" means a rating factor related to the demographics, health status, or experience of an individual, a small employer, or a member of a small employer group, other than a case characteristic under Section 31A-30-106 or 31A-30-106.1, as applicable, including:

(a) exact age;

(b) gender;

(c) family composition;

(d) health status;

(e) claims experience;

(f) duration of coverage; or

(g) any similar characteristic.

(6) "Risk load" means the percentage above the base premium rate charged by a covered carrier to a covered insured reflecting the risk characteristics of the covered individual.

Notes

Utah Admin. Code R590-167-3

Adopted by Utah State Bulletin Number 2024-05, effective 2/21/2024