Insurance, Administration

Rule R590-260

Utah Defined Contribution Risk Adjuster Plan of Operation

Notice of Proposed Rule

(New Rule)

DAR File No.: 34362
Filed: 01/13/2011 04:42:27 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of the rule is to adopt the Utah Defined Contribution Risk Adjuster Plan of Operation (Plan) as required by Section 31A-42-204. The Plan sets forth operating procedures for insurers who offer insurance plans through the Utah Health Exchange (Exchange) and sets standards and requirements for employers and their employees who purchase insurance through the Exchange.

Summary of the rule or change:

This rule adopts the Utah Defined Contribution Risk Adjuster Plan of Operation and sets the date of enforcement at 45 days after the rule becomes effective.

State statutory or constitutional authorization for this rule:

• Section 31A-42-204

Anticipated cost or savings to:

the state budget:

This rule will create no fiscal impact or increased work load for the department or the state budget. The rule sets forth procedures for health insurers to follow if they decide to participate in the Exchange.

local governments:

This rule will have no effect on local governments since it deals with the relationship between the department and health insurers licensed through the department to do business in Utah.

small businesses:

The rule sets qualifying requirements and standards for small businesses who want to participate in the Exchange. It provides small employers with additional insurance plans for their employees to choose from. For employers who were unable to afford coverage for their employees, the Exchange makes it possible for them to give each employee a choice of health coverage and contribute money to them to pay for their premium.

persons other than small businesses, businesses, or local governmental entities:

Health insurers who offer insurance on the Utah Health Exchange will be required to follow the procedures in the Plan. It is the insurer's choice if they participate. Those participating in the Plan have already incurred cost to have computer technicians put five of their more popular plans onto the Exchange and pay actuaries to determine the cost of these plans. The Plan sets qualifying requirements and standards for small and large businesses who want to participate in the Exchange. It provides employers with an additional option to present to their employees to choose from. For employers who were unable to afford coverage for their employees, the Exchange makes it possible for them to give each employee a choice of health plans to fit their needs and with the money contributed by their employer, they have a little help to pay for the insurance premium.

Compliance costs for affected persons:

Health insurers who offer insurance on the Utah Health Exchange will be required to follow procedures in the Plan. It is the insurer's choice if they participate. Those participating in the Plan have already incurred cost to have computer technicians put five of their more popular plans onto the Exchange and pay actuaries to determine the cost of these plans. The Plan sets qualifying requirements and standards for small and large businesses who want to participate in the Exchange. It provides employers with an additional option to present to their employees to choose from. For employers who were unable to afford coverage for their employees, the Exchange makes it possible for them to give each employee a choice of health plans to fit their needs and with the money contributed by their employer, they have a little help to pay for the insurance premium. What the exact cost is for each affected person varies.

Comments by the department head on the fiscal impact the rule may have on businesses:

The fiscal impact on employers and health insurers who are on the Exchange and following the Defined Contribution plan varies. It should be noted that this participation is not mandated. It is completely voluntary on the part of the employer and insurer.

Neal T. Gooch, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
450 N MAIN ST
SALT LAKE CITY, UT 84114-1201

Direct questions regarding this rule to:

• Jilene Whitby at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at jwhitby@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/03/2011

This rule may become effective on:

03/10/2011

Authorized by:

Jilene Whitby, Information Specialist

R590. Insurance, Administration.

R590-260. Utah Defined Contribution Risk Adjuster Plan of Operation.

R590-260-1. Authority.

This rule is promulgated by the insurance commissioner pursuant to Section 31A-42-204, wherein the commissioner shall adopt the Utah Defined Contribution Risk Adjuster Plan of Operation.

 

R590-260-2. Purpose.

The purpose of this rule is to adopt the Utah Defined Contribution Risk Adjuster Plan of Operation as required by Section 31A-42-204.

 

R590-260-3. Plan of Operation.

The commissioner adopts the Utah Defined Contribution Risk Adjuster Plan of Operation that is available at the department and on line at http://www.insurance.utah.gov/legalresources/currentrules.html.

 

R590-260-4. Enforcement Date.

The commissioner will begin enforcing this rule 45 days from the rule's effective date.

 

R590-260-5. Penalties.

A person found, after a hearing or other regulatory process, to be in violation of this rule shall be subject to penalties as provided under Section 31A-2-308.

 

R590-260-6. Severability.

If any provision of this rule or its application to any person or situation is held to be invalid, that invalidity shall not affect any other provision or application of this rule which can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable.

 

KEY: risk adjuster plan operation

Date of Enactment or Last Substantive Amendment: 2011

Authorizing, and Implemented or Interpreted Law: 31A-42-204