Utah Admin. Code R590-220-10 - Additional Procedures for Individual, Small Employer, and Group Health Benefit Plan Filings

This section contains instructions for health benefit plan filings subject to Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act.

(1) Form Filing.

(a) A health benefit plan form filing must include in the Filing Description the SERFF tracking number for the form's applicable rate manual.

(b) Grandfathered and transitional plans must be filed separate from 2014 PPACA compliant health benefit plans.

(c) Provide documentation for the department's receipt of the form filing's corresponding rate filing.

(2) Rate Manual Filing for non-2014 PPACA Compliant Health Benefit Plans.

(a) A rate manual that does not request a change in rating methodology is a File Before Use filing.

(b) A change in rating methodology filing is a File for Approval filing.

(c) A new and revised rate manual must:

(i) include an actuarial certification signed by a qualified actuary;

(ii) be filed 30 days prior to use;

(iii) list the case characteristics and rate factors to be used;

(iv) be applied in the same manner for all health benefit plans in a class;

(v) contain specific area factors applicable in Utah;

(vi) include the method of calculating the risk load, including the method used to determine any experience factors;

(vii) include how the overall rate is reviewed for compliance with the rate restrictions;

(viii) include detailed description of all classes of business, as provided in Section 31A-30-105;

(ix) fully complete the Company Rate Information on the Rate/Rule Schedule tab; and

(x) comply with all information required by Section R590-167-6.

(3) Rate Filing for 2014 PPACA Compliant Health Benefit Plans.

(a) Rate filings shall be filed in accordance with the department's annual Bulletin to insurance carriers.

(b) Quarterly changes to a rate filing shall be filed in accordance with Bulletin 2015-3.

(c) Fully complete the Company Rate Information on the Rate/Rule Schedule tab.

(4) Actuarial Certification Report.

(a) All individual and small employer licensees who maintain a non-2014 PPACA compliant health benefit plan must file an actuarial certification as described in Sections 31A-30-106, 31A-30-106.1, and Subsection R590-167-11(1)(a).

(b) The report is due April 1 each year.

(c) Each report must be filed separately and be properly identified.

(d)

(i) Except as provided in R590-220-10(4)(d)(ii), a health benefit plan report must be filed using a type of insurance of "H16I" or "H16G," and a filing type of "Report."

(ii) A Health Maintenance Organization must use "HOrg02I" or "HOrg02G" as the type of insurance and the filing type of "Report."

Notes

Utah Admin. Code R590-220-10

Amended by Utah State Bulletin Number 2015-20, effective 9/23/2015