Utah Code 31A-2-218.1. Section 1332 Waiver Study
Current as of: 2024 | Check for updates
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(1) As used in this section:
Terms Used In Utah Code 31A-2-218.1
- Application: means a document:(10)(a)(10)(a)(i) completed by an applicant to provide information about the risk to be insured; and(10)(a)(ii) that contains information that is used by the insurer to evaluate risk and decide whether to:(10)(a)(ii)(A) insure the risk under:(10)(a)(ii)(A)(I) the coverage as originally offered; or(10)(a)(ii)(A)(II) a modification of the coverage as originally offered; or(10)(a)(ii)(B) decline to insure the risk; or(10)(b) used by the insurer to gather information from the applicant before issuance of an annuity contract. See Utah Code 31A-1-301
- Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the Insurance Department. See Utah Code 31A-1-301
- Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
- health insurance: means insurance providing:
(84)(a)(i) a health care benefit; or(84)(a)(ii) payment of an incurred health care expense. See Utah Code 31A-1-301- Insurance: includes :
(96)(b)(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;(96)(b)(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and(96)(b)(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301- Person: includes :
(146)(a) an individual;(146)(b) a partnership;(146)(c) a corporation;(146)(d) an incorporated or unincorporated association;(146)(e) a joint stock company;(146)(f) a trust;(146)(g) a limited liability company;(146)(h) a reciprocal;(146)(i) a syndicate; or(146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301- Premium: includes , however designated:
(156)(b)(i) an assessment;(156)(b)(ii) a membership fee;(156)(b)(iii) a required contribution; or(156)(b)(iv) monetary consideration. See Utah Code 31A-1-301- Reinsurance: means an insurance transaction where an insurer, for consideration, transfers any portion of the risk it has assumed to another insurer. See Utah Code 31A-1-301
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
- United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
(1)(a) “Secretary” means the secretary of the United States Department of Health and Human Services.(1)(b) “Section 1332 waiver” means a waiver for state innovation under 45 C.F.R. part 155, Subpart N.(2) The commissioner shall conduct a study to determine the feasibility of a state-based program designed to:(2)(a) lower health benefit plan insurance premiums; and(2)(b) increase stabilization in the market.(3) The commissioner, in the study described in Subsection (2), shall create a proposal for a Section 1332 waiver that includes:(3)(a) a list of provisions the state should seek to waive and the rationale for waiving each provision;(3)(b) data, assumptions, targets, and other information sufficient to determine that the proposed waiver will provide coverage at least as comprehensive as coverage that would be provided absent the waiver;(3)(c) coverage and cost sharing protections that keep premiums at least as affordable as would be provided absent the Section 1332 waiver;(3)(d) actuarial analyses, actuarial certifications, and financial modeling that:(3)(d)(i) support the estimates that the proposal will comply with the comprehensive coverage requirements, the affordability requirement, the scope of coverage requirement, and the federal deficit requirement; and(3)(d)(ii) include:(3)(d)(ii)(A) a detailed 10-year budget plan that is deficit-neutral to the federal government;(3)(d)(ii)(B) all costs to the state, including administrative costs, and other costs to the federal government; and(3)(d)(ii)(C) a detailed analysis regarding the estimated impact of the Section 1332 waiver on health insurance coverage in the state;(3)(e) proposed legislative changes to provide the state authority to implement the proposed waiver;(3)(f) implementation plans with a timeline;(3)(g) categories of covered individuals with high-cost medical conditions who may be reinsured through the proposed waiver, including a recommendation for a multi-year phased-in approach;(3)(h) reinsurance parameters, including co-insurance, attachment points, or limits;(3)(i) set premium reduction targets;(3)(j) a detailed plan for a budget and program implementation; and(3)(k) a complete application for submission to the secretary.(4) To carry out the requirements in Subsections (2) and (3) the commissioner may partner or contract with a person that the commissioner determines is appropriate, subject to Title 63G, Chapter 6a, Utah Procurement Code.(5) On or before November 1, 2024, the commissioner shall submit to the Business and Labor Interim Committee a final written report describing the study described in this section.