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H.B. 2003

This document includes House Floor Amendments incorporated into the bill on Wed, Jul 20, 2011 at 3:42 PM by jeyring. --> PLEASE NOTE:
THIS DOCUMENT INCLUDES BOTH THE BILL AND ALSO A TRANSMITTAL LETTER THAT CONTAINS PASSED AMENDMENTS BUT NOT INCORPORATED INTO THE BILL.






        July 20, 2011 (3:35pm)



Mr. President:

    The House passed H.B. 2003, INSURANCE AMENDMENTS, by Representative J. Dunnigan, with the following amendments:

1.    Page 7, Lines 206 through 213 :    

             206          (6) The small employer carrier may not use case characteristics other than the
             207      following:
             208          (a) age of the employee, [as determined at the beginning of the plan year, limited to:] in
             209      accordance with Subsection (7);
             210          (b) geographic area;
             211          (c) family composition in accordance with Subsection (9);   and  
             212          (d) for plans renewed or effective on or after July 1, 2011, gender of the employee and
             213      spouse   ; and
    (e) for an individual age 65 and older, whether the employer policy is primary or secondary to Medicare  
.


2.    Page 8, Line 214 :    

             214          (7) Age   shall be determined at the beginning of the plan year   , limited to:

3.    Page 14, Lines 404 through 407 :    

             404          (b) the Health Insurance Exchange shall provide [an employer who is participating in
             405      the defined contribution arrangement market of the Health Insurance Exchange and the] an
             406      employer and the employer's producer with premium renewal rates at least 60 days prior to [a]
             407      the group's renewal date for a plan offered under Part 2, Defined Contribution Arrangements.  
    (3) An insurer does not have to provide additional notice of premium renewal

rates to the employer or the employer's producer if the Health Insurance Exchange provides notice in accordance with Subsection (2)(b).  


and it is transmitted to the Senate for consideration.


        Respectfully,




        Sandy D. Tenney
        Chief Clerk

35 hb2003.wpd 3:35 pm CJD/jeyring


             1     
INSURANCE AMENDMENTS

             2     
2011 SECOND SPECIAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: James A. Dunnigan

             5     
Senate Sponsor: J. Stuart Adams

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill amends the provisions related to health benefit plans in the Insurance Code.
             10      Highlighted Provisions:
             11          This bill:
             12          .    amends provisions related to unfair marketing practices by insurance producers;
             13          .    amends the case characteristics a small employer carrier may use when establishing
             14      health insurance premium rates for a small employer group;
             15          .    amends the calculation of premium cost for family coverage in the small employer
             16      group market by:
             17              .    allowing a carrier to use either four, five, or six rate tiers based on family size
             18      for plans offered outside of the Health Insurance Exchange; and
             19              .    limiting a carrier to four rate tiers based on family size for plans offered in the
             20      defined contribution market on the Health Insurance Exchange;
             21          .    authorizes the Insurance Department actuary to allow different rating practices
             22      related to family tiering in and out of the Health Insurance Exchange;
             23          .    amends provisions that require notice to a small employer group of the risk factor
             24      used to calculate a group's health insurance premium; and
             25          .    makes technical amendments.
             26      Money Appropriated in this Bill:
             27          This bill appropriates:


             28          .    $35,000 from the General Fund, One-time, for fiscal year 2011-12 only, to the
             29      Insurance Department - Risk Adjuster.
             30      Other Special Clauses:
             31          This bill provides an immediate effective date.
             32      Utah Code Sections Affected:
             33      AMENDS:
             34          31A-23a-402, as last amended by Laws of Utah 2011, Chapters 62 and 289
             35          31A-30-106.1, as last amended by Laws of Utah 2011, Chapters 284 and 400
             36          31A-30-115, as enacted by Laws of Utah 2011, Chapter 400
             37          31A-30-202.5, as enacted by Laws of Utah 2010, Chapter 68
             38          31A-30-207, as last amended by Laws of Utah 2011, Chapter 400
             39          31A-30-211, as enacted by Laws of Utah 2011, Chapter 400
             40     
             41      Be it enacted by the Legislature of the state of Utah:
             42          Section 1. Section 31A-23a-402 is amended to read:
             43           31A-23a-402. Unfair marketing practices -- Communication -- Unfair
             44      discrimination -- Coercion or intimidation -- Restriction on choice.
             45          (1) (a) (i) Any of the following may not make or cause to be made any communication
             46      that contains false or misleading information, relating to an insurance product or contract, any
             47      insurer, or any licensee under this title, including information that is false or misleading
             48      because it is incomplete:
             49          (A) a person who is or should be licensed under this title;
             50          (B) an employee or producer of a person described in Subsection (1)(a)(i)(A);
             51          (C) a person whose primary interest is as a competitor of a person licensed under this
             52      title; and
             53          (D) a person on behalf of any of the persons listed in this Subsection (1)(a)(i).
             54          (ii) As used in this Subsection (1), "false or misleading information" includes:
             55          (A) assuring the nonobligatory payment of future dividends or refunds of unused
             56      premiums in any specific or approximate amounts, but reporting fully and accurately past
             57      experience is not false or misleading information; and
             58          (B) with intent to deceive a person examining it:


             59          (I) filing a report;
             60          (II) making a false entry in a record; or
             61          (III) wilfully refraining from making a proper entry in a record.
             62          (iii) A licensee under this title may not:
             63          (A) use any business name, slogan, emblem, or related device that is misleading or
             64      likely to cause the insurer or other licensee to be mistaken for another insurer or other licensee
             65      already in business; or
             66          (B) use any advertisement or other insurance promotional material that would cause a
             67      reasonable person to mistakenly believe that a state or federal government agency, including
             68      the Health Insurance Exchange, also called the "Utah Health Exchange," created in Section
             69      63M-1-2504 , the Comprehensive Health Insurance Pool created in Chapter 29, Comprehensive
             70      Health Insurance Pool Act, and the Children's Health Insurance Program created in Title 26,
             71      Chapter 40, Utah Children's Health Insurance Act:
             72          (I) is responsible for the insurance sales activities of the person;
             73          (II) stands behind the credit of the person;
             74          (III) guarantees any returns on insurance products of or sold by the person; or
             75          (IV) is a source of payment of any insurance obligation of or sold by the person.
             76          (iv) A person who is not an insurer may not assume or use any name that deceptively
             77      implies or suggests that person is an insurer.
             78          (v) A person other than persons licensed as health maintenance organizations under
             79      Chapter 8 may not use the term "Health Maintenance Organization" or "HMO" in referring to
             80      itself.
             81          (b) A licensee's violation creates a rebuttable presumption that the violation was also
             82      committed by the insurer if:
             83          (i) the licensee under this title distributes cards or documents, exhibits a sign, or
             84      publishes an advertisement that violates Subsection (1)(a), with reference to a particular
             85      insurer:
             86          (A) that the licensee represents; or
             87          (B) for whom the licensee processes claims; and
             88          (ii) the cards, documents, signs, or advertisements are supplied or approved by that
             89      insurer.


             90          (2) (a) A title insurer or producer or any officer or employee of either may not pay,
             91      allow, give, or offer to pay, allow, or give, directly or indirectly, as an inducement to obtaining
             92      any title insurance business:
             93          (i) any rebate, reduction, or abatement of any rate or charge made incident to the
             94      issuance of the title insurance;
             95          (ii) any special favor or advantage not generally available to others; or
             96          (iii) any money or other consideration, except if approved under Section 31A-2-405 ; or
             97          (iv) material inducement.
             98          (b) "Charge made incident to the issuance of the title insurance" includes escrow
             99      charges, and any other services that are prescribed in rule by the Title and Escrow Commission
             100      after consultation with the commissioner and subject to Section 31A-2-404 .
             101          (c) An insured or any other person connected, directly or indirectly, with the
             102      transaction may not knowingly receive or accept, directly or indirectly, any benefit referred to
             103      in Subsection (2)(a), including:
             104          [(A)] (i) a person licensed under Title 61, Chapter 2c, Utah Residential Mortgage
             105      Practices and Licensing Act;
             106          [(B)] (ii) a person licensed under Title 61, Chapter 2f, Real Estate Licensing and
             107      Practices Act;
             108          [(C)] (iii) a builder;
             109          [(D)] (iv) an attorney; or
             110          [(E)] (v) an officer, employee, or agent of a person listed in this Subsection (2)(c)(iii).
             111          (3) (a) An insurer may not unfairly discriminate among policyholders by charging
             112      different premiums or by offering different terms of coverage, except on the basis of
             113      classifications related to the nature and the degree of the risk covered or the expenses involved.
             114          (b) Rates are not unfairly discriminatory if they are averaged broadly among persons
             115      insured under a group, blanket, or franchise policy, and the terms of those policies are not
             116      unfairly discriminatory merely because they are more favorable than in similar individual
             117      policies.
             118          (4) (a) This Subsection (4) applies to:
             119          (i) a person who is or should be licensed under this title;
             120          (ii) an employee of that licensee or person who should be licensed;


             121          (iii) a person whose primary interest is as a competitor of a person licensed under this
             122      title; and
             123          (iv) one acting on behalf of any person described in Subsections (4)(a)(i) through (iii).
             124          (b) A person described in Subsection (4)(a) may not commit or enter into any
             125      agreement to participate in any act of boycott, coercion, or intimidation that:
             126          (i) tends to produce:
             127          (A) an unreasonable restraint of the business of insurance; or
             128          (B) a monopoly in that business; or
             129          (ii) results in an applicant purchasing or replacing an insurance contract.
             130          (5) (a) (i) Subject to Subsection (5)(a)(ii), a person may not restrict in the choice of an
             131      insurer or licensee under this chapter, another person who is required to pay for insurance as a
             132      condition for the conclusion of a contract or other transaction or for the exercise of any right
             133      under a contract.
             134          (ii) A person requiring coverage may reserve the right to disapprove the insurer or the
             135      coverage selected on reasonable grounds.
             136          (b) The form of corporate organization of an insurer authorized to do business in this
             137      state is not a reasonable ground for disapproval, and the commissioner may by rule specify
             138      additional grounds that are not reasonable. This Subsection (5) does not bar an insurer from
             139      declining an application for insurance.
             140          (6) A person may not make any charge other than insurance premiums and premium
             141      financing charges for the protection of property or of a security interest in property, as a
             142      condition for obtaining, renewing, or continuing the financing of a purchase of the property or
             143      the lending of money on the security of an interest in the property.
             144          (7) (a) A licensee under this title may not refuse or fail to return promptly all indicia of
             145      agency to the principal on demand.
             146          (b) A licensee whose license is suspended, limited, or revoked under Section
             147      31A-2-308 , 31A-23a-111 , or 31A-23a-112 may not refuse or fail to return the license to the
             148      commissioner on demand.
             149          (8) (a) A person may not engage in an unfair method of competition or any other unfair
             150      or deceptive act or practice in the business of insurance, as defined by the commissioner by
             151      rule, after a finding that the method of competition, the act, or the practice:


             152          (i) is misleading;
             153          (ii) is deceptive;
             154          (iii) is unfairly discriminatory;
             155          (iv) provides an unfair inducement; or
             156          (v) unreasonably restrains competition.
             157          (b) Notwithstanding Subsection (8)(a), for purpose of the title insurance industry, the
             158      Title and Escrow Commission shall make rules, subject to Section 31A-2-404 , that define an
             159      unfair method of competition or unfair or deceptive act or practice after a finding that the
             160      method of competition, the act, or the practice:
             161          (i) is misleading;
             162          (ii) is deceptive;
             163          (iii) is unfairly discriminatory;
             164          (iv) provides an unfair inducement; or
             165          (v) unreasonably restrains competition.
             166          Section 2. Section 31A-30-106.1 is amended to read:
             167           31A-30-106.1. Small employer premiums -- Rating restrictions -- Disclosure.
             168          (1) Premium rates for small employer health benefit plans under this chapter are
             169      subject to this section [for a health benefit plan that is issued or renewed, on or after July 1,
             170      2011].
             171          (2) (a) The index rate for a rating period for any class of business may not exceed the
             172      index rate for any other class of business by more than 20%.
             173          (b) For a class of business, the premium rates charged during a rating period to covered
             174      insureds with similar case characteristics for the same or similar coverage, or the rates that
             175      could be charged to an employer group under the rating system for that class of business, may
             176      not vary from the index rate by more than 30% of the index rate, except when catastrophic
             177      mental health coverage is selected as provided in Subsection 31A-22-625 (2)(d).
             178          (3) The percentage increase in the premium rate charged to a covered insured for a new
             179      rating period, adjusted pro rata for rating periods less than a year, may not exceed the sum of
             180      the following:
             181          (a) the percentage change in the new business premium rate measured from the first
             182      day of the prior rating period to the first day of the new rating period;


             183          (b) any adjustment, not to exceed 15% annually and adjusted pro rata for rating periods
             184      of less than one year, due to the claim experience, health status, or duration of coverage of the
             185      covered individuals as determined from the small employer carrier's rate manual for the class of
             186      business, except when catastrophic mental health coverage is selected as provided in
             187      Subsection 31A-22-625 (2)(d); and
             188          (c) any adjustment due to change in coverage or change in the case characteristics of
             189      the covered insured as determined for the class of business from the small employer carrier's
             190      rate manual.
             191          (4) (a) Adjustments in rates for claims experience, health status, and duration from
             192      issue may not be charged to individual employees or dependents.
             193          (b) Rating adjustments and factors, including case characteristics, shall be applied
             194      uniformly and consistently to the rates charged for all employees and dependents of the small
             195      employer.
             196          (c) Rating factors shall produce premiums for identical groups that:
             197          (i) differ only by the amounts attributable to plan design; and
             198          (ii) do not reflect differences due to the nature of the groups assumed to select
             199      particular health benefit products.
             200          (d) A small employer carrier shall treat all health benefit plans issued or renewed in the
             201      same calendar month as having the same rating period.
             202          (5) A health benefit plan that uses a restricted network provision may not be considered
             203      similar coverage to a health benefit plan that does not use a restricted network provision,
             204      provided that use of the restricted network provision results in substantial difference in claims
             205      costs.
             206          (6) The small employer carrier may not use case characteristics other than the
             207      following:
             208          (a) age of the employee, [as determined at the beginning of the plan year, limited to:] in
             209      accordance with Subsection (7);
             210          (b) geographic area;
             211          (c) family composition in accordance with Subsection (9); and
             212          (d) for plans renewed or effective on or after July 1, 2011, gender of the employee and
             213      spouse.


             214          (7) Age shall be determined at the beginning of the plan year, limited to:
             215          [(i)] (a) the following age bands:
             216          [(A)] (i) less than 20;
             217          [(B)] (ii) 20-24;
             218          [(C)] (iii) 25-29;
             219          [(D)] (iv) 30-34;
             220          [(E)] (v) 35-39;
             221          [(F)] (vi) 40-44;
             222          [(G)] (vii) 45-49;
             223          [(H)] (viii) 50-54;
             224          [(I)] (ix) 55-59;
             225          [(J)] (x) 60-64; and
             226          [(K)] (xi) 65 and above; and
             227          [(ii)] (b) a standard slope ratio range for each age band, applied to each family
             228      composition tier rating structure under Subsection [(6)(c)] (9)(b):
             229          [(A)] (i) as developed by the commissioner by administrative rule; and
             230          [(B)] (ii) not to exceed an overall ratio [of 5:1; and] as provided in Subsection (8).
             231          (8) (a) The overall ratio permitted in Subsection (7)(b)(ii) may not exceed:
             232          (i) 5:1 for plans renewed or effective before January 1, 2012; and
             233          (ii) 6:1 for plans renewed or effective on or after January 1, 2012; and
             234          [(C)] (b) the age slope ratios for each age band may not overlap[;].
             235          [(b) geographic area;]
             236          [(c) family] (9) Except as provided in Subsection 31A-30-207 (2), family
             237      composition[,] is limited to:
             238          [(i)] (a) an overall ratio of [5:1 or less; and]:
             239          [(ii) a four]
             240          (i) 5:1 or less for plans renewed or effective before January 1, 2012; and
             241          (ii) 6:1 or less for plans renewed or effective on or after January 1, 2012; and
             242          (b) a tier rating structure that includes:
             243          (i) four tiers that include:
             244          (A) employee only;


             245          (B) employee plus spouse;
             246          (C) employee plus a [dependent or dependents] child or children; and
             247          (D) a family, consisting of an employee plus spouse, and a [dependent or dependents]
             248      child or children; [and]
             249          [(d) gender of the employee or spouse.]
             250          (ii) for plans renewed or effective on or after January 1, 2012, five tiers that include:
             251          (A) employee only;
             252          (B) employee plus spouse;
             253          (C) employee plus one child;
             254          (D) employee plus two or more children; and
             255          (E) employee plus spouse plus one or more children; or
             256          (iii) for plans renewed or effective on or after January 1, 2012, six tiers that include:
             257          (A) employee only;
             258          (B) employee plus spouse;
             259          (C) employee plus one child;
             260          (D) employee plus two or more children;
             261          (E) employee plus spouse plus one child; and
             262          (F) employee plus spouse plus two or more children.
             263          [(7)] (10) If a health benefit plan is a health benefit plan into which the small employer
             264      carrier is no longer enrolling new covered insureds, the small employer carrier shall use the
             265      percentage change in the base premium rate, provided that the change does not exceed, on a
             266      percentage basis, the change in the new business premium rate for the most similar health
             267      benefit product into which the small employer carrier is actively enrolling new covered
             268      insureds.
             269          [(8)] (11) (a) A covered carrier may not transfer a covered insured involuntarily into or
             270      out of a class of business.
             271          (b) A covered carrier may not offer to transfer a covered insured into or out of a class
             272      of business unless the offer is made to transfer all covered insureds in the class of business
             273      without regard to:
             274          (i) case characteristics;
             275          (ii) claim experience;


             276          (iii) health status; or
             277          (iv) duration of coverage since issue.
             278          [(9)] (12) (a) Each small employer carrier shall maintain at the small employer carrier's
             279      principal place of business a complete and detailed description of its rating practices and
             280      renewal underwriting practices, including information and documentation that demonstrate that
             281      the small employer carrier's rating methods and practices are:
             282          (i) based upon commonly accepted actuarial assumptions; and
             283          (ii) in accordance with sound actuarial principles.
             284          (b) (i) Each small employer carrier shall file with the commissioner on or before April
             285      1 of each year, in a form and manner and containing information as prescribed by the
             286      commissioner, an actuarial certification certifying that:
             287          (A) the small employer carrier is in compliance with this chapter; and
             288          (B) the rating methods of the small employer carrier are actuarially sound.
             289          (ii) A copy of the certification required by Subsection [(9)] (12)(b)(i) shall be retained
             290      by the small employer carrier at the small employer carrier's principal place of business.
             291          (c) A small employer carrier shall make the information and documentation described
             292      in this Subsection [(9)] (12) available to the commissioner upon request.
             293          [(10)] (13) (a) The commissioner shall[, by July 1, 2010,] establish rules in accordance
             294      with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to:
             295          (i) implement this chapter; and
             296          (ii) assure that rating practices used by small employer carriers under this section and
             297      carriers for individual plans under Section 31A-30-106 [, in effect on January 1, 2011,] are
             298      consistent with the purposes of this chapter.
             299          (b) The rules may:
             300          (i) assure that differences in rates charged for health benefit plans by carriers are
             301      reasonable and reflect objective differences in plan design, not including differences due to the
             302      nature of the groups or individuals assumed to select particular health benefit plans; and
             303          (ii) prescribe the manner in which case characteristics may be used by small employer
             304      and individual carriers.
             305          [(11)] (14) Records submitted to the commissioner under this section shall be
             306      maintained by the commissioner as protected records under Title 63G, Chapter 2, Government


             307      Records Access and Management Act.
             308          Section 3. Section 31A-30-115 is amended to read:
             309           31A-30-115. Actuarial review of health benefit plans.
             310          (1) (a) The department shall conduct an actuarial review of rates submitted by small
             311      employer carriers:
             312          (i) prior to the publication of the premium rates on the Health Insurance Exchange;
             313          (ii) except as permitted by Subsection 31A-30-207 (2), to determine if the [rates are]
             314      carrier is using the same rating and underwriting practices in both the defined contribution
             315      arrangement market in the Health Insurance Exchange and the defined benefit market offered
             316      outside the Health Insurance Exchange, in compliance with Subsection 31A-30-202.5 (1)(b);
             317          (iii) to verify the validity of the rates, underwriting and risk factors, and premiums of
             318      plans both in and outside of the Health Insurance Exchange;
             319          (iv) to verify that insurers are pricing similar health benefit plans and groups the same
             320      in and out of the exchange, except as permitted by Subsection 31A-30-207 (2); and
             321          (v) as the department determines is necessary to oversee market conduct.
             322          (b) The actuarial review by the department shall be funded from a fee:
             323          (i) established by the department in accordance with Section 63J-1-504 ; and
             324          (ii) paid by all small employer carriers participating in the defined contribution
             325      arrangement market and small employer carriers offering health benefit plans under [Chapter
             326      30,] Part 1, Individual and Small Employer Group.
             327          (c) The department shall:
             328          (i) report aggregate data from the actuarial review to the risk adjuster board created in
             329      Section 31A-42-201 ; and
             330          (ii) contact carriers, if the department determines it is appropriate, to:
             331          (A) inform a carrier of the department's findings regarding the rates of a particular
             332      carrier; and
             333          (B) request a carrier to recalculate or verify base rates, rating factors, and premiums.
             334          (d) A carrier shall comply with the department's request under Subsection (1)(c)(ii).
             335          (2) (a) There is created in the General Fund a restricted account known as the "Health
             336      Insurance Actuarial Review Restricted Account."
             337          (b) The Health Insurance Actuarial Review Restricted Account shall consist of money


             338      received by the commissioner under this section.
             339          (c) The commissioner shall administer the Health Insurance Actuarial Review
             340      Restricted Account. Subject to appropriations by the Legislature, the commissioner shall use
             341      money deposited into the Health Insurance Actuarial Review Restricted Account to pay for the
             342      actuarial review conducted by the department under this section.
             343          Section 4. Section 31A-30-202.5 is amended to read:
             344           31A-30-202.5. Insurer participation in defined contribution arrangement market.
             345          (1) A small employer carrier who chooses to participate in the defined contribution
             346      arrangement market:
             347          (a) shall offer the defined contribution arrangement health benefit plans required by
             348      Section 31A-30-205 ;
             349          (b) may:
             350          (i) offer additional defined contribution arrangement health benefit plans in the Health
             351      Insurance Exchange as permitted by Section 31A-30-205 ;
             352          (ii) offer a defined benefit plan in the Health Insurance Exchange if the small employer
             353      carrier offers a defined contribution arrangement health benefit plan that is actuarially
             354      equivalent to the defined benefit plan that is offered in the Health Insurance Exchange; and
             355          (iii) continue to offer defined benefit plans outside of the Health Insurance Exchange
             356      and the defined contribution arrangement market, if, except as provided in Subsection
             357      31A-30-207 (2), the carrier uses the same rating and underwriting practices in both the defined
             358      contribution arrangement market in the Health Insurance Exchange and the defined benefit
             359      market outside the Health Insurance Exchange.
             360          (2) A carrier that does not elect to participate in the defined contribution arrangement
             361      market by January 1, 2011, may not participate in the defined contribution arrangement market
             362      in the Health Insurance Exchange until January 1, 2013.
             363          Section 5. Section 31A-30-207 is amended to read:
             364           31A-30-207. Rating and underwriting restrictions for health plans in the defined
             365      contribution arrangement market.
             366          (1) [The] Except as provided in Subsection (2), rating and underwriting restrictions for
             367      [defined benefit plans and for the] defined contribution arrangement health benefit plans
             368      offered in the Health Insurance Exchange [defined contribution arrangement market] shall be in


             369      accordance with Section 31A-30-106.1 , and the plan adopted under Chapter 42, Defined
             370      Contribution Risk Adjuster Act.
             371          (2) Notwithstanding the provisions of Subsections 31A-30-106.1 (9)(b)(ii) and (iii), a
             372      carrier offering a defined contribution arrangement in the Health Insurance Exchange under
             373      this part:
             374          (a) shall calculate rates based on a family tier rating structure that includes four tiers in
             375      compliance with Subsection 31A-30-106.1 (9)(b)(i); and
             376          (b) may not calculate rates based on a family tier rating structure that includes five or
             377      six tiers as described in Subsection 31A-30-106 (9)(b)(ii) or (iii).
             378          [(2)] (3) All insurers who participate in the defined contribution market shall:
             379          (a) participate in the risk adjuster mechanism developed under Chapter 42, Defined
             380      Contribution Risk Adjuster Act for all defined contribution arrangement health benefit plans;
             381          (b) provide the risk adjuster board with:
             382          (i) an employer group's risk factor; and
             383          (ii) carrier enrollment data; and
             384          (c) submit rates to the exchange that are net of commissions.
             385          [(3)] (4) When an employer group enters the defined contribution arrangement market
             386      [for either a defined contribution arrangement health benefit plan, or a defined benefit plan,]
             387      and the employer group has a health plan with an insurer who is participating in the defined
             388      contribution arrangement market, the risk factor applied to the employer group when it enters
             389      the defined contribution arrangement market may not be greater than the employer group's
             390      renewal risk factor for the same group of covered employees and the same effective date, as
             391      determined by the employer group's insurer.
             392          Section 6. Section 31A-30-211 is amended to read:
             393           31A-30-211. Insurer disclosure.
             394          (1) The Health Insurance Exchange shall provide an [employer and an] employer's
             395      producer with the group's risk factor used to calculate the employer group's premium at the
             396      time of:
             397          (a) the initial offering of a health benefit plan; and
             398          (b) the renewal of a health benefit plan.
             399          (2) For health benefit plans that renew on or after March 1, 2012:


             400          (a) a carrier [in the small employer market under Part 1, Individual and Small
             401      Employer Group,] shall provide an employer and the employer's producer with premium
             402      renewal rates at least 60 days prior to the group's renewal date for a plan offered under Part 1,
             403      Individual and Small Employer Group; and
             404          (b) the Health Insurance Exchange shall provide [an employer who is participating in
             405      the defined contribution arrangement market of the Health Insurance Exchange and the] an
             406      employer and the employer's producer with premium renewal rates at least 60 days prior to [a]
             407      the group's renewal date for a plan offered under Part 2, Defined Contribution Arrangements.
             408          Section 7. Appropriation.
             409          Under the terms and conditions of Utah Code Title 63J, Chapter 1, Budgetary
             410      Procedures Act, the following sums of money are appropriated one-time only from the funds or
             411      fund accounts indicated for the use and support of the government of the state for the fiscal
             412      year beginning July 1, 2011, and ending June 30, 2012.
             413          To the Insurance Department - Risk Adjuster
             414              From General Fund, One-time                    $35,000
             415          Schedule of Programs:
             416              Risk Adjuster                        $35,000
             417          Section 8. Effective date.
             418          If approved by two-thirds of all the members elected to each house, this bill takes effect
             419      upon approval by the governor, or the day following the constitutional time limit of Utah
             420      Constitution Article VII, Section 8, without the governor's signature, or in the case of a veto,
             421      the date of veto override.




Legislative Review Note
    as of 7-19-11 10:23 AM


Office of Legislative Research and General Counsel


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