Utah Admin. Code R590-283-3 - Definitions
Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103, and Rule R590-266. Additional terms are defined as follows:
(1) "Defrayal payment" means the amount
payable to a carrier from the state for expenses incurred for a state-required
benefit under:
(a)
45 C.F.R.
155.170(b);
(b) Section
31A-30-118;
and
(c) this
rule.
(2) "EHB" means
essential health benefits.
(3)
"Exchange" means exchange as defined in
45
CFR 155.20.
(4) "Member month" means a count of one for
each month during a calendar year during which an individual has coverage under
a plan subject to this rule where coverage is evaluated on the first of the
month.
(5) "Qualified health plan"
means a qualified health plan as defined in
45
CFR 155.20.
(6) "State-required benefit" means a benefit
required by the state:
(a) on or after January
1, 2012;
(b) for a purpose other
than compliance with a federal requirement;
(c) that is in excess of the Utah Essential
Health Benefits Package; and
(d)
that is eligible for a defrayal payment.
Notes
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