Utah Code 31A-22-647. Insurer shared savings program
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(1) As used in this section:
Terms Used In Utah Code 31A-22-647
- Enrollee: includes an insured. 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 care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. 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- 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
(1)(a) “Insurer” means a person who offers health care insurance, including a health maintenance organization as that term is defined in Section 31A-8-101.(1)(b) “PEHP” means the Public Employees’ Benefit and Insurance Program created in Section 49-20-103.(1)(c) “Savings reward program” means a program to reward a health insurance enrollee if the enrollee receives services:(1)(c)(i) covered by the enrollee’s health plan; and(1)(c)(ii) from a provider whose costs for services are lower than the average costs for the services.(2) An insurer may, in accordance with Subsection (4), establish a savings reward program for a health benefit plan that is:(2)(a) offered by the insurer; and(2)(b) entered into or renewed on or after January 1, 2019.(3) PEHP shall, in accordance with Subsection (4), establish a savings reward program for a health plan that is:(3)(a) offered to state employees under Title 49, Chapter 20, Public Employees’ Benefit and Insurance Program Act; and(3)(b) entered into or renewed on or after July 1, 2019.(4) A savings reward program described in Subsection (2) or (3) may include, in accordance with federal and state law, rewards to the enrollee through:(4)(a) premium discounts;(4)(b) rebates;(4)(c) reduction of out-of-pocket costs; or(4)(d) other rewards or incentives developed by the insurer. - health insurance: means insurance providing: