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Insurance Code | |
Professional Employer Organization Licensing Act | |
Section 208 | Benefit plan. |
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31A-40-208. Benefit plan. (1) A client and a professional employer organization licensed under this chapter shall each be considered an employer for purposes of sponsoring a retirement or welfare benefit plan for a covered employee. (2) A fully insured welfare benefit plan offered to a covered employee of a single professional employer organization licensed under this chapter: (a) is to be treated as a single employer welfare benefit plan for purposes of this title and rules made under this title; (b) may not be considered an employer welfare fund or plan, as described in Section 31A-13-101; and (c) the single professional employer organization that sponsors the fully insured welfare plan is exempt from the registration requirements under this title for: (i) an insurance provider; or (ii) an employer welfare fund or plan. (3) For purposes of Chapter 30, Individual, Small Employer, and Group Health Insurance Act: (a) a professional employer organization licensed under this chapter is considered the employer of a covered employee; and (b) all covered employees of one or more clients participating in a health benefit plan sponsored by a single professional employer organization licensed under this chapter are considered employees of that professional employer organization. (4) A professional employer organization licensed under this chapter may offer to a covered employee a health benefit plan that is not fully insured by an authorized insurer, only if: (a) the professional employer organization has operated as a professional employer organization for at least one year before the day on which the professional employer organization offers the health benefit plan; and (b) the health benefit plan: (i) is administered by a third-party administrator licensed to do business in this state; (ii) holds all assets of the health benefit plan, including participant contributions, in a trust account; (iii) has and maintains reserves that are sound for the health benefit plan as determined by an actuary who: (A) uses generally accepted actuarial standards of practice; and (B) is an independent qualified actuary, including not being an employee or covered employee of the professional employer organization; (iv) provides written notice to a covered employee participating in the health benefit plan that the health benefit plan is self-insured or is not fully insured; and (v) consents to an audit: (A) on a random basis; or (B) upon a finding of a reasonable need by the commissioner. (5) The cost of an audit described in Subsection (4)(b)(v) shall be paid by the sponsoring professional employer organization. (6) A plan of a professional employer organization described in Subsection (4) that is not fully insured: (a) is subject to the requirements of this section; and (b) is not subject to another licensure or approval requirement of this title.
Enacted by Chapter 318, 2008 General Session |
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