Utah Admin. Code R590-283-5 - Unified Rate Review Template, Rate Data Template, and Plans and Benefits Template Modifications
(1) A carrier
that expects to be eligible to receive a defrayal payment shall modify a
federal rate filing template as follows:
(a)
exclude the expected defrayal payment from the rates submitted on both the
Unified Rate Review Template and the Rate Data Template;
(b) indicate in the rate filing's actuarial
memorandum:
(i) whether the carrier
anticipates a defrayal payment from the state for the cost of an eligible
state-required benefit;
(ii) that
the cost of the state-required benefit is not included in the premiums;
and
(iii) the defrayal payment
amount the carrier expects to receive; and
(c) indicate in the "Benefits Information"
field on the Plans and Benefits Template that the carrier covers the
state-required benefits, selecting the state-required benefit of "Not EHB" for
the "EHB Variance Reason" field.
(2)
(a) A
carrier may not factor a state-required benefit into the calculation for the
"EHB Percent of Total Premium" field on the Plans and Benefits
Template.
(b) A state-required
benefit may not be included in the total premium from which the "EHB Percent of
Total Premium" field is calculated.
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.