Utah Admin. Code R590-268-7 - Annual Certification

(1) An insurer shall, on or before April 1, submit the following using SERFF:

(a) stop-loss experience as described in Subsections (2) and (3) for the previous two years;

(b) an actuarial certification of compliance with Title 31A, Chapter 43, Small Employer Stop-Loss Insurance Act; and

(c) an actuarial memorandum, describing the review done to prepare the actuarial certification.

(2)

(a) An insurer's stop-loss experience shall be presented by:

(i) small employer; and

(ii) experience year.

(b) An insurer's stop-loss experience shall include:

(i) a group identifier that uniquely identifies the employer group and is consistent from year to year for the same employer group;

(ii) the effective date of coverage for each policy year;

(iii) the contract term;

(iv) the employer size, including number of covered lives and employees, at the beginning of the contract;

(v) the number of covered lives and employee exposure years for the period of the experience;

(vi) the specific attachment point;

(vii) expected claims absent stop-loss insurance;

(viii) expected claims under the specific attachment point;

(ix) the aggregate attachment point;

(x) earned premium; and

(xi) claims paid by the stop-loss insurance separated by specific losses and aggregate losses.

(c) An insurer's stop-loss experience shall:

(i) be aggregated over the entire contract period, rather than aggregated by month; and

(ii) only include stop-loss contracts where the final claim date is contained within the two calendar years before the submission date.

(d) Runout claims that are paid after the submission date shall be updated in the following years' experience submission.

(3) An insurer's stop-loss experience shall be submitted using the Utah Stop-Loss Experience Report dated July 1, 2019, available on the department's website, https://insurance.utah.gov.

Notes

Utah Admin. Code R590-268-7

Amended by Utah State Bulletin Number 2016-1, effective 12/9/2015 Amended by Utah State Bulletin Number 2019-14, effective 6/21/2019 Amended by Utah State Bulletin Number 2023-10, effective 5/9/2023