(b) The filing shall state if the carrier intends to market to individuals, small employers, or both, and shall be signed by an officer of the company.(2) Except as provided by Subsection (3), a carrier may not offer a health benefit plan to an individual or a small employer in Utah, or continue to provide coverage under a health benefit plan previously issued to an individual or a small employer in Utah, unless the filing under Subsection (1) indicates that the carrier intends to operate as a covered carrier in Utah.
(3)(a) If a carrier does not intend to operate as a covered carrier in Utah, the carrier may continue to provide coverage under a health benefit plan previously issued to an individual or a small employer in Utah if:
(i) the carrier complies with the act with respect to each health benefit plan previously issued to an individual or a small employer;
(ii) the carrier provides coverage to each new entrant to a health benefit plan previously issued to an individual or a small employer;
(iii) the carrier complies with Sections 31A-30-106 and 31A-30-106.1 and this rule as they apply to an individual or a small employer whose coverage was terminated, limited, or restricted by the carrier; and
(iv) the carrier files a letter of intent indicating the carrier does not intend to operate as a covered carrier in Utah and will maintain the business in compliance with the act and this rule.
(b)(i) If a filing made under Subsection (3) indicates that a carrier does not intend to operate as a covered carrier in Utah, the carrier is precluded from operating as a covered carrier in Utah, except as provided for in Subsection (3), for a period of five years from the date of the filing.
(ii) Upon written request from the carrier, the commissioner may reduce the five-year period if the commissioner finds that permitting the carrier to operate as a covered carrier would be in the best interests of the individuals and small employers in Utah.
R590-167-11. Actuarial Certification and Additional Filing Requirements.
(1)(a) An actuarial certification filing under Subsection 31A-30-106(4)(b) or 31A-30-106.1(13)(b) shall:
(i) include a written statement that meets the requirements of the act, this rule, and the applicable standards of practice promulgated by the Actuarial Standards Board;
(ii) be signed by the actuary and state that the actuary meets the qualifications of Subsection 31A-30-103(1);
(iii) contain the following statement: "I, (name), certify that (name of covered carrier) is in compliance with Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act, and Rule R590-167, based upon the examination of (name of covered carrier), including review of the appropriate records and of the actuarial assumptions and methods utilized by (name of covered carrier) in establishing premium rates for applicable health benefit plans";
(iv) list and describe each written demonstration used by the actuary to establish compliance with the act and this rule;
(v) list all affiliated insurers, defining each class of business that includes the commissioner's approval date if more than one class of business exists; and
(vi) include the System for Electronic Rates and Forms Filing, SERFF, filing number for each applicable rate manual filing.
(b) The actuarial certification applies to an individual or a small employer health benefit plan issued before March 23, 2010, and maintains grandfathered status.
(2)(a) A covered carrier shall file with the commissioner a copy of the applicable rate manual for a health benefit plan that is subject to the act and this rule, for both new business and renewal rates, and shall include:
(i) a signed certification by an actuary that, to the best of the actuary's knowledge and judgment, the rate filing complies with the applicable laws and rules of Utah;
(ii) a complete and detailed description of how the final premium, including any fees, is calculated from the rate manual;
(iii) all changes and updates, including a complete and detailed description of how the final premium, including any fees, is calculated from the rate manual;
(iv) an identification of the covered carrier's classes of business under Subsection R590-167-4(1);
(v) all information required by 45 CFR 154.215(b)(1); and
(vi) for a rate increase subject to review by 45 CFR 154.200(a)(1), all information required by 45 CFR 154.215(b)(2).
(b) The rate manual shall be filed:
(i) with an initial product filing; or
(ii) 30 days before use, for an existing health benefit plan.
R590-167-12. Records.
(1) Except as provided in Subsection (2), a record submitted to the commissioner under this rule shall be maintained as a protected record under Title 63G, Chapter 2, Government Records Access and Management Act.
(2) The commissioner classifies the following records as public:
(a) the status of a filing; and
(b) information submitted under Subsections R590-167-11(2)(a)(v) and R590-167-11(2)(a)(vi).
R590-167-13. Severability.
