Utah Admin. Code 590-220-3

Current through Bulletin 2024-24, December 15, 2024

Section R590-220-3 - Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1) "Certification" means a statement that a submitted filing is compliant.

(2) "Compliant" means a filing that is complete and that complies with Title 31A, Insurance Code, and this rule.

(3) "Discretionary group" means a group that is authorized by the commissioner under Subsection 31A-22-701(1)(b).

(4) "Electronic filing" means a filing submitted using SERFF.

(5) "Eligible group" means a group that meets the requirements in Section 31A-22-701.

(6) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(7) "File before use" means a filing is used, sold, or offered for sale after it is filed with the department and a stated period of time elapses from the date filed.

(8) "File for acceptance" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is accepted.

(9) "File for approval" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is approved.

(10) "Filing objection letter" means a letter issued by the commissioner when a review of the filing determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(c) additional information related to the filing.

(11) "Filing status information" means a list of states a similar filing was submitted to, the date submitted, and the action taken by each state, including their responses.

(12) "Letter of authorization" means a letter signed by an officer of the insurer giving authority to a third party to submit a filing on behalf of the insurer.

(13) "Market type" means a policy that specifies a targeted market.

(14) "NAIC Product Coding Matrix" means a numerical coding system developed by the NAIC that provides uniform naming convention, uniform terminology, and uniform description for a type of insurance product in a filing.

(15) "Non-2014 PPACA compliant health benefit plan" means a health benefit plan that is:

(a) a grandfathered health plan under 45 CFR 147.140(a); or

(b) a transitional health benefit plan, also known as a grandmothered plan, under:

(i) the letter from the Centers for Medicare and Medicaid Services dated November 14, 2013; and

(ii) Subsection 31A-30-117(3).

(16) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(17) "Change in rating methodology," for the purposes of a non-2014 PPACA compliant health benefit plan, means a change in:

(a) the number of case characteristics used by an insurer to determine premium rates in a class of business;

(b) the manner or procedures used to assign an insured into categories for the purpose of applying a case characteristic to determine premium rates in a class of business;

(c) the method of allocating expenses in a class of business; or

(d) a rating factor, with respect to any case characteristic, if the change would produce a change in premium that exceeds 10% for an individual or small employer.

(18) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the insurer stating the reason for rejection; and

(c) not considered filed with the department.

(19) "Resubmission" means a correction, modification, or replacement of a previously rejected, withdrawn, or prohibited filing.

(20) "SERFF" means the System for Electronic Rates and Form Filings.

(21) "Stop-loss insurance" means insurance purchased by an employer for which the stop-loss insurer assumes all loss amounts of the employer's plan in excess of a stated amount, subject to the policy limit.

(22) "Type of insurance" or "TOI" means a specific accident and health insurance product identified by the NAIC Product Coding Matrix that can be selected in SERFF when submitting a filing in Utah.

(23) "Utah filed date" means the date the department indicates a paper filing is accepted.

Utah Admin. Code R590-220-3

Amended by Utah State Bulletin Number 2015-20, effective 9/23/2015

Adopted by Utah State Bulletin Number 2023-12, effective 3/23/2016

Adopted by Utah State Bulletin Number 2023-13, effective 6/9/2023