DAR File No. 40182

Insurance, Administration

Section R590-167-11

Actuarial Certification and Additional Filing Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 40182
Filed: 02/01/2016 02:38:12 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The change is being made to avoid conflicts with Sections 31A-30-106, 31A-30-106.1, and 31A-30-105, as well as "Actuarial Standard of Practice 26".

Summary of the rule or change:

The changes being made to the rule require that a carrier's actuarial certification only applies to grandfathered plans, require only identification of the carrier's classes rather than a description for rate manual filings, and eliminate the index premium rate requirement.

State statutory or constitutional authorization for this rule:

• Subsection 31A-2-201(3)(a)
• Subsection 31A-30-106(1)(k)
• Subsection 31A-30-106.1(10)

Anticipated cost or savings to:

the state budget:

There is no anticipated cost or savings to the state budget. The changes being made to the rule bring it into alignment with current industry practices.

local governments:

There is no anticipated cost or savings to local government. The changes being made to the rule bring it into alignment with current industry practices.

small businesses:

There is no anticipated cost or savings to small businesses. The changes being made to the rule bring it into alignment with current industry practices.

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

There is no anticipated cost or savings to any other persons. The changes being made to the rule bring it into alignment with current industry practices.

Compliance costs for affected persons:

There is no compliance costs for any affected persons. The changes being made bring the rule into alignment with current industry practices.

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

This rule change will result in no fiscal impact to any businesses. Insurers are already acting according to the new criteria as a matter of course. The Department is amending the rule so it aligns with current industry practices.

Todd E. Kiser, Commissioner

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

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY, UT 84114-1201

Direct questions regarding this rule to:

• Steve Gooch at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at sgooch@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:

03/16/2016

This rule may become effective on:

03/23/2016

Authorized by:

Steve Gooch, Information Specialist

R590. Insurance, Administration.

R590-167. Individual, Small Employer, and Group Health Benefit Plan Rule.

R590-167-11. Actuarial Certification and Additional Filing Requirements.

(1) Actuarial Certification.

(a) An actuarial certification shall be filed annually and meet the requirements of Subsections 31A-30-106(4)(b) or 31A-30-106.1(9)(b), or both, as applicable, and the following:

(i) the actuarial certification shall be a written statement that meets the requirements of Title 31A Chapter 30, R590-167, and the applicable standards of practice as promulgated by the Actuarial Standards Board;

(ii) the actuary must state that he or she meets the qualifications of Subsection 31A-30-103(1);

(iii) the actuarial certification shall:

(A) contain the following statement: "I, (name), certify that (name of covered carrier) is in compliance with the provisions of Title 31A Chapter 30, and 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;"

(B) list and describe each written demonstration used by the actuary to establish compliance with Title 31A Chapter 30 and R590-167; and

(C) include a list of all affiliated insurers, define each class of business which includes the commissioner's approval date if more than one class of business exists, and the SERFF filing number for each applicable rate manual filing.

(b) The actuarial certification shall be filed no later than April 1 of each year.

(c) The actuarial certification required by Subsections 31A-30-106(4)(b) and 31A-30-106.1(13)(b) and this subsection, applies only to an individual or small employer health benefit plan issued prior to March 23, 2010, and has maintained grandfathered status.

(2) Rating Manual.

(a) For every health benefit plan subject to the Act and this rule, the carrier shall file with the commissioner a copy of the applicable rating manual, for both new business and renewal rates, which includes:

(i) signed certification by an actuary that to the best of the actuary's knowledge and judgment the rate filing is in compliance with the applicable laws and rules of the State of Utah;

(ii) a complete and detailed description of how the final premium, including any fees, is calculated from the rating manual;

(iii) all changes and updates, which includes a complete and detailed description of how the final premium, including any fees, is calculated from the rating manual;

(iv) [a description ]an identification of the carrier's classes of business as described in Subsection R590-167-4(1);

(v) all information required by 45 CFR 154.215(b)(1);

(vi) for a rate increase subject to review as required by 45 CFR 154.200(a)(1), all information required by 45 CFR 154.215(b)(2); and

(vii) all information required by the Utah Accident and Health Comprehensive Health Insurance Rate Filing Checklist.

(b) The rate manual shall be filed:

(i) with an initial product filing; or

(ii) within 30 days prior to use for an existing health benefit plan.

[(3) Index Premium Rates.

(a) A small employer carrier shall file annually the index premium rate information required by Subsection 31A-29-117(2). The report shall include:

(i) the small employer index premium rate as of January 1 of the previous year;

(ii) the small employer index premium rate as of January 1 of the current year; and

(iii) the average percentage change in the index premium rate as of January 1 of the current and preceding year.

(b) The information described in Subsection R590-167-11(3)(a) shall be filed no later than February 1 of each year. ]

 

KEY: health insurance

Date of Enactment or Last Substantive Amendment: [October 16, 2012]2016

Notice of Continuation: August 20, 2014

Authorizing, Implemented, or Interpreted Law: 31A-30-106; 31A-30-106.1