Utah Admin. Code R590-262-3 - Definitions
Terms used in this rule are defined in Sections 31A-1-301 and 26B-8-501. Additional terms are defined as follows:
(1) "Data" means
information consisting of, or derived directly from, enrollment, medical
claims, dental claims, and pharmacy claims that this rule requires an insurer
to report.
(2) "Insurer," for
purposes of this rule, means:
(a) a person
engaged in the business of offering health insurance;
(b) a third-party administrator that settles
claims for:
(i) health insurance policies;
or
(ii) a self-funded employee
health plan if the employer of the self-funded employee health plan opts-in
under Section R590-262-7;
(c) a governmental plan as defined in Section
414(d), Internal Revenue Code;
(d)
a non-electing church plan as described in Section 410(d), Internal Revenue
Code; or
(e) a licensed
professional employer organization that is acting as an administrator of a
health insurance policy.
(3) "Office" means the Healthcare Information
and Analysis Program within the Utah Department of Health and Human Services
Division of Data, Systems, and Evaluation.
(4) "Reporting period" means a calendar
year.
(5)
(a) "Self-funded employee health plan" means:
(i) an employee welfare benefit plan as
defined in 29 U.S.C. Section
1002(1) whose health
coverage is provided other than through an insurance policy; and
(ii) the plan has opted-in under Section
R590-262-7.
(b) Self-funded employee health plan does not
include:
(i) a governmental plan as defined
in Section 414(d), Internal Revenue Code;
(ii) a non-electing church plan as described
in Section 410(d), Internal Revenue Code; or
(iii) the Public Employees' Benefit and
Insurance Program created in Section
49-20-103.
(6) "Technical specifications" means the
technical specifications document published by the Health Data Committee
describing the variables and formats of the data that are to be submitted as
well as submission directions and guidelines.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.