| << Previous Section (31A-30-104) | Next Section (31A-30-106) >> |
Insurance Code | |
Individual, Small Employer, and Group Health Insurance Act | |
Section 105 | Establishment of classes of business. |
|
31A-30-105. Establishment of classes of business. (1) For a policy that takes effect on or after January 1, 2011, a covered carrier may not establish a separate class of business unless: (a) the covered carrier submits an application to the commissioner to establish a separate class of business; (b) the covered carrier demonstrates to the satisfaction of the commissioner that a separate class of business is justified under the provisions of this section; and (c) the commissioner approves the carrier's application for the use of a separate class of business. (2) (a) The commissioner shall have a presumption against the use of a separate class of business by a covered insured, except when the covered carrier demonstrates that this Subsection (2) applies. (b) The commissioner may approve the use of a separate class of business only if the covered carrier can demonstrate that the use of a separate class of business is necessary due to substantial differences in either expected claims experience or administrative costs related to the following reasons: (i) the covered carrier uses more than one type of system for the marketing and sale of health benefit plans to covered insureds; (ii) the covered carrier has acquired a class of business from another covered carrier; or (iii) the covered carrier provides coverage to one or more association groups. (3) The commissioner may establish regulations to provide for a period of transition in order for a covered carrier to come into compliance with Subsection (2) in the instance of acquisition of an additional class of business from another covered carrier. (4) The commissioner may approve the establishment of up to five classes of business per covered carrier upon application to the commissioner and a finding by the commissioner that such action would substantially enhance the efficiency and fairness of the health insurance marketplace subject to this chapter. (5) A covered carrier may not establish a class of business based solely on the marketing or sale of a health benefit plan as a defined contribution arrangement health benefit plan, or through the Health Insurance Exchange.
Amended by Chapter 284, 2011 General Session |
| << Previous Section (31A-30-104) | Next Section (31A-30-106) >> |