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Insurance Code | |
Individual, Small Employer, and Group Health Insurance Act | |
Section 205 | Health benefit plans offered in the defined contribution market. |
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31A-30-205. Health benefit plans offered in the defined contribution market. (1) An insurer who offers a defined contribution arrangement health benefit plan in the small group market shall offer the following health benefit plans as defined contribution arrangements: (a) one health benefit plan that: (i) is a federally qualified high deductible health plan; (ii) has a deductible that is within $250 of the lowest deductible that qualifies as a federally qualified high deductible health plan as adjusted by federal law; and (iii) has an annual out-of-pocket maximum that does not exceed three times the amount of the deductible; (b) one health benefit plan that: (i) is a federally qualified high deductible health plan that is within $250 of an individual deductible of $2,500 and a deductible of $5,000 for coverage including two or more individuals; and (ii) does not exceed an annual out-of-pocket maximum equal to three times the amount of the annual deductible; (c) one health benefit plan that: (i) is a federally qualified high deductible health plan; (ii) has a deductible that is within $1,000 of the highest deductible that qualifies as a federally qualified high deductible health plan, as adjusted by federal law; and (iii) has an out-of-pocket maximum that qualifies as a federally qualified high deductible health plan; (d) the insurer's four most commonly selected small group health benefit plans that: (i) include: (A) the provider panel; (B) the deductible; (C) co-payments; (D) co-insurance; and (E) pharmacy benefits; (ii) are currently being marketed by the carrier to new groups for enrollment; and (iii) meet the standard for most commonly selected plan as determined by administrative rule adopted by the commissioner; and (e) alternative coverage required by Section 31A-22-724. (2) (a) The provisions of Subsection (1) do not limit the number of defined contribution arrangement health benefit plans an insurer may offer in the defined contribution arrangement market. (b) An insurer who offers the health benefit plans required by Subsection (1) may also offer any other health benefit plan as a defined contribution arrangement if the health benefit plan provides benefits with an aggregate actuarial value that is no lower than the actuarial value of the plan required in Subsection (1)(c). (3) An employee who has the right to extend employer coverage under Subsection 31A-22-722(1) or federal COBRA, may: (a) continue coverage under the employee's current plan under state mini-COBRA or federal COBRA; or (b) enroll in alternative coverage under Section 31A-22-724.
Amended by Chapter 400, 2011 General Session |
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