Utah Admin. Code R590-246-3 - Definitions
(1) The definitions
in Sections
31A-1-301 and
31A-40-102 apply to
this rule.
(2) "Fully insured" as
used in
31A-40-208 means a
health benefit plan for which 100% of the liability has been assumed by an
insurance company or health maintenance organization authorized to conduct
business in Utah.
(a) The health benefit plan
may include a layer of financial responsibility for claims assumed by the PEO
as long as the insurance company or health maintenance organization is
responsible for 100% of the PEO's liability in the event of non-payment by the
PEO.
(b) The covered individual
must be entitled to make a claim for payment directly to the insurance company
or health maintenance organization.
(c) A fully insured plan may have co-pay or
deductible requirements as required by contract.
Notes
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