Utah Admin. Code R590-277-7 - Restrictions Relating to Premium Rates
(1) The premium charged may not be adjusted
more frequently than annually, except the premium rate may be changed:
(a) to reflect a change in
enrollment;
(b) to reflect a change
to the contract; or
(c) as
expressly permitted by federal or state law.
(2) Premium rates may vary based only on the
following:
(a) whether the plan covers an
individual or a family, as follows:
(i) the
total family premium shall only include premiums for covered family members
over the age of 21 and the three oldest children under the age of 21;
and
(ii) a rating variation based
on age or tobacco use shall be applied separately to the portion of the premium
attributable to each covered family member;
(b) geographic rating area, determined by the
policyholder's primary address, as follows:
(i) Area 1, Cache and Rich
counties;
(ii) Area 2, Box Elder,
Morgan, and Weber counties;
(iii)
Area 3, Davis, Salt Lake, Summit, Tooele, and Wasatch counties;
(iv) Area 4, Utah County;
(v) Area 5, Iron and Washington counties; and
(vi) Area 6, Beaver, Carbon,
Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San
Juan, Sanpete, Sevier, Uintah, and Wayne counties;
(c) age of each enrollee, as of the date of
the contract issuance or renewal, in accordance with the Utah Individual and
Small Employer Health Benefit Plan Age Curve; and
(d) tobacco rate factor not greater than 1.5.
(3) Subsection (2) does
not apply to:
(a) a large employer contract;
or
(b) an individual or small
employer contract issued before January 1, 2014, if the contract rating
complies with:
(i) Title 31A, Chapter 30,
Individual, Small Employer, and Group Health Insurance Act; and
(ii) Rule R590-167.
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.
(1) The premium charged shall not be adjusted more frequently than annually, except that the premium rates may be changed:
(a) to reflect changes to the enrollment;
(b) to reflect changes to the health benefit plan; or
(c) as expressly permitted by federal or state law.
(2) Premium rates may vary only with respect to the particular coverage involved on the basis of the following:
(a) whether the plan covers an individual or family:
(i) the total family premium shall include only the premiums for all covered family members over the age of twenty-one and the three oldest children under the age of twenty one; and
(ii) any rating variation on the basis of age or tobacco use must be applied separately to the portion of the premium attributable to each covered family member;
(b) geographic rating area, determined by the policyholder's primary address, as follows:
(i) Area 1, comprised of Cache and Rich counties;
(ii) Area 2, comprised of Box Elder, Morgan, and Weber counties;
(iii) Area 3, comprised of Davis, Salt Lake, Summit, Tooele, and Wasatch counties;
(iv) Area 4, comprised of Utah county;
(v) Area 5, comprised of Iron and Washington counties; and
(vi) Area 6, comprised of Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, and Wayne counties;
(c) age of each enrollee, as of the date of the policy issuance or renewal, in accordance with the Utah Individual and Small Employer Health Benefit Plan Age Curve; and
(d) tobacco rate factor, not greater than 1.5.
(3) R590-277-7(2) does not apply to:
(a) a large employer health benefit plan; or
(b) an individual or small employer health benefit plan issued prior to January 1, 2014 in which the policy rating complies with:
(i) Title 31A-30, Individual, Small Employer, and Group Health Insurance Act; and
(ii) Rule R590-167, Individual, Small Employer, and Group Health Benefit Plan Rule.