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Terms Used In Utah Code 31A-30-106.7

  • 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
  • Carrier: means a person that provides health insurance in this state including:
         (5)(a) an insurance company;
         (5)(b) a prepaid hospital or medical care plan;
         (5)(c) a health maintenance organization;
         (5)(d) a multiple employer welfare arrangement; and
         (5)(e) another person providing a health insurance plan under this title. See Utah Code 31A-30-103
  • Covered carrier: means an individual carrier or small employer carrier subject to this chapter. See Utah Code 31A-30-103
  • Form: means one of the following prepared for general use:
              (74)(a)(i) a policy;
              (74)(a)(ii) a certificate;
              (74)(a)(iii) an application;
              (74)(a)(iv) an outline of coverage; or
              (74)(a)(v) an endorsement. See Utah Code 31A-1-301
  • Plan year: means :
         (149)(a) the year that is designated as the plan year in:
              (149)(a)(i) the plan document of a group health plan; or
              (149)(a)(ii) a summary plan description of a group health plan;
         (149)(b) if the plan document or summary plan description does not designate a plan year or there is no plan document or summary plan description:
              (149)(b)(i) the year used to determine deductibles or limits;
              (149)(b)(ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or
              (149)(b)(iii) the employer's taxable year if:
                   (149)(b)(iii)(A) the plan does not impose deductibles or limits on a yearly basis; and
                   (149)(b)(iii)(B)
                        (149)(b)(iii)(B)(I) the plan is not insured; or
                        (149)(b)(iii)(B)(II) the insurance policy is not renewed on an annual basis; or
         (149)(c) in a case not described in Subsection (149)(a) or (b), the calendar year. See Utah Code 31A-1-301
  • Premium: means money paid by covered insureds and covered individuals as a condition of receiving coverage from a covered carrier, including fees or other contributions associated with the health benefit plan. See Utah Code 31A-30-103
  • producer: means a person licensed or required to be licensed under the laws of this state to sell, solicit, or negotiate insurance. See Utah Code 31A-1-301
     (1)(a) Except as provided in Subsection (1)(b), if prior notice is given, a covered carrier may impose upon a small group that changes coverage to that carrier from another carrier a one-time surcharge of up to 25% of the annualized premium that the carrier could otherwise charge under Section 31A-30-106.1.
     (1)(b) A covered carrier may not impose the surcharge described in Subsection (1)(a) if:

          (1)(b)(i) the change in carriers occurs on the anniversary of the plan year, as defined in Section 31A-1-301;
          (1)(b)(ii) the previous coverage was terminated under Subsection 31A-22-618.6(5);
          (1)(b)(iii) employees from an existing group form a new business; and
          (1)(b)(iv) the surcharge is not applied uniformly to all similarly situated small groups.
(2) A covered carrier may not impose the surcharge described in Subsection (1) if the offer to cover the group occurs at a time other than the anniversary of the plan year because:

     (2)(a)

          (2)(a)(i) the application for coverage is made prior to the anniversary date in accordance with the covered carrier’s published policies; and
          (2)(a)(ii) the offer to cover the group is not issued until after the anniversary date; or
     (2)(b)

          (2)(b)(i) the application for coverage is made prior to the anniversary date in accordance with the covered carrier’s published policies; and
          (2)(b)(ii) additional underwriting or rating information requested by the covered carrier is not received until after the anniversary date.
(3) If a covered carrier chooses to apply a surcharge under Subsection (1), the application of the surcharge and the criteria for incurring or avoiding the surcharge shall be clearly stated in the:

     (3)(a) written application materials provided to the applicant at the time of application; and
     (3)(b) written producer guidelines.
(4) The commissioner shall adopt rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to ensure compliance with this section.