Utah Admin. Code R590-167-4 - Establishment of Classes of Business
(1) A covered carrier with more than one
class of business under Section
31A-30-105 shall maintain, for
inspection by the commissioner, the following information with respect to each
class of business:
(a) a description of all
criteria used by the covered carrier or its agents to determine membership in
the class of business;
(b) a
statement justifying the establishment of each separate class of business and
documentation that the establishment of each class of business reflects
substantial differences in expected claims experience or administrative costs;
and
(c) a statement disclosing each
health benefit plan currently available for purchase in the class and any
significant limitations related to the purchase of such plans.
(2) For policies issued or renewed
on or after January 1, 2011, a covered carrier may not establish a separate
class of business without the commissioner's prior approval.
(3) To establish a separate class of business
under Subsection (2), a covered carrier shall submit a filing in compliance
with Rule R590-220 that includes:
(a) a
written request to establish a separate class of business;
(b) a description of all criteria used by the
covered carrier, or its agents, to determine membership in the class of
business;
(c) a disclosure of each
health benefit plan that will be available for purchase in the class and any
significant limitations related to the purchase of such plans;
(d) a statement demonstrating that the use of
a separate class of business is necessary due to substantial differences in
either expected claims experience or administrative costs related to the
covered carrier:
(i) using more than one
system for the marketing and sale of a health benefit plan to covered
insureds;
(ii) acquiring a class of
business from another covered carrier; or
(iii) providing coverage to one or more
association groups;
(e)
a list of previously approved classes of business; and
(f) for each class of business used before
January 1, 2011, a certification that the continued use of the class of
business is necessary under Subsection (3)(d).
(4) A covered carrier may not, directly or
indirectly, use group size as a criterion for establishing eligibility for a
class of business.
Notes
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