A client and a professional employer organization licensed under this chapter shall each be considered an employer for purposes of sponsoring a retirement or welfare benefit plan for a covered employee.
Administrator: means the same as that term is defined in Subsection (182). See Utah Code 31A-1-301
Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
authorized insurer: means an insurer:
(i)
holding a valid certificate of authority to do an insurance business in this state; and
(ii)
transacting business as authorized by a valid certificate. See Utah Code 31A-1-301
Client: means a person who enters into a professional employer agreement with a professional employer organization. See Utah Code 31A-40-102
Covered employee: means an individual who has a coemployment relationship with a client and a professional employer organization if the conditions of Section 31A-40-203 are met. See Utah Code 31A-40-102
Employee: means :
(a)
an individual employed by an employer; or
(b)
an individual who meets the requirements of Subsection (53)(b). 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
a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
(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
(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
Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
Participating: means a plan of insurance under which the insured is entitled to receive a dividend representing a share of the surplus of the insurer. See Utah Code 31A-1-301
professional employer organization: means a person engaged in the business of providing a professional employer service. See Utah Code 31A-40-102
Qualified actuary: means an individual who:
(a)
is a member in good standing of a professional actuarial accreditation organization designated by the department by rule;
(b)
is qualified to sign a statement of actuarial opinion or annual statement for a professional employer organization in accordance with the qualification standards for an actuary signing an opinion or annual statement as provided by the professional actuarial accreditation organization designated under Subsection (19)(a);
(c)
is familiar with the valuation requirements applicable to a professional employer organization;
(d)
has not been found by the commissioner, or if so found has subsequently been reinstated as a qualified actuary, following appropriate notice and hearing to have:
(i)
violated a provision of, or an obligation imposed by, statute or other law in the course of the actuary's dealings as a qualified actuary;
(ii)
been found guilty of a fraudulent or dishonest practice;
(iii)
demonstrated the actuary's incompetency, lack of cooperation, or untrustworthiness to act as a qualified actuary;
(iv)
submitted to the commissioner during the past five years, pursuant to this rule, an actuarial opinion or memorandum that the commissioner rejected because it did not meet the provisions of rule; or
(v)
resigned or been removed as an actuary within the past five years as a result of an act or omission indicated in an adverse report on examination or as a result of failure to adhere to a generally acceptable actuarial standard; and
(e)
has not failed to notify the commissioner of an action taken by any commissioner of another state similar to that under Subsection (19)(d). See Utah Code 31A-40-102
Small employer: means , in connection with a health benefit plan and with respect to a calendar year and to a plan year, an employer who:
(i)
(A)
employed at least one but not more than 50 eligible employees on business days during the preceding calendar year; or
(B)
if the employer did not exist for the entirety of the preceding calendar year, reasonably expects to employ an average of at least one but not more than 50 eligible employees on business days during the current calendar year;
(ii)
employs at least one employee on the first day of the plan year; and
(iii)
for an employer who has common ownership with one or more other employers, is treated as a single employer under 26 U. 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
Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. Source: OCC
(2)
(a)
A fully insured welfare benefit plan offered to a covered employee of a single professional employer organization licensed under this chapter is to be treated as a single employer welfare benefit plan for purposes of this title and rules made under this title.
(b)
The single professional employer organization that sponsors the fully insured welfare plan is exempt from the registration requirements under this title for:
a professional employer organization licensed under this chapter is considered the employer of a covered employee; and
(b)
all covered employees of one or more clients participating in a health benefit plan sponsored by a single professional employer organization licensed under this chapter are considered employees of that professional employer organization.
(4)
A professional employer organization licensed under this chapter may offer to a covered employee a health benefit plan that is not fully insured by an authorized insurer, only if:
(a)
the professional employer organization has operated as a professional employer organization for at least one year before the day on which the professional employer organization offers the health benefit plan; and
(b)
the health benefit plan:
(i)
is administered by a third-party administrator licensed to do business in this state;
(ii)
holds all assets of the health benefit plan, including participant contributions, in a trust account;
(iii)
has and maintains reserves that are sound for the health benefit plan as determined by an actuary who:
(A)
uses generally accepted actuarial standards of practice; and
(B)
is an independent qualified actuary, including not being an employee or covered employee of the professional employer organization;
(iv)
provides written notice to a covered employee participating in the health benefit plan that the health benefit plan is self-insured or is not fully insured;
(v)
consents to an audit:
(A)
on a random basis; or
(B)
upon a finding of a reasonable need by the commissioner; and
(vi)
provides for continuation of coverage in compliance with Section 31A-22-722.
(5)
The cost of an audit described in Subsection (4)(b)(v) shall be paid by the sponsoring professional employer organization.
(6)
A plan of a professional employer organization described in Subsection (4) that is not fully insured:
(a)
is subject to the requirements of this section; and
(b)
is not subject to another licensure or approval requirement of this title.
