Utah Admin. Code 590-262-3

Current through Bulletin 2024-20, October 15, 2024

Section R590-262-3 - Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 26-33a-102. Additional terms are defined as follows:

(1) "Data" means information consisting of, or derived directly from, enrollment, medical claims, dental claims, and pharmacy claims that this rule requires an insurer to report.

(2) "Insurer," for purposes of this rule, means:

(a) a person engaged in the business of offering health insurance;

(b) a third-party administrator that settles claims for:

(i) health insurance policies; or

(ii) a self-funded employee welfare benefit plan if the self-funded plan opts-in under Section R590-262-7;

(c) a governmental plan as defined in Section 414(d), Internal Revenue Code;

(d) a non-electing church plan as described in Section 410(d), Internal Revenue Code; or

(e) a licensed professional employer organization that is acting as an administrator of a health insurance policy.

(3) "Office" means the Healthcare Information and Analysis Programs within the Department of Health and Human Services Division of Data, Systems, and Evaluation.

(4) "Reporting period" means a calendar year.

(5)

(a) "Self-funded plan" means:

(i) an employee welfare benefit plan as defined in 29 U.S.C. Section 1002(1) whose health coverage is provided other than through an insurance policy; and

(ii) the plan has opted-in under Section R590-262-7.

(b) Self-funded plan does not include:

(i) a governmental plan as defined in Section 414(d), Internal Revenue Code;

(ii) a non-electing church plan as described in Section 410(d), Internal Revenue Code; or

(iii) the Public Employees' Benefit and Insurance Program created in Section 49-20-103.

(6) "Technical specifications" means the technical specifications document published by the Health Data Committee describing the variables and formats of the data that are to be submitted as well as submission directions and guidelines.

Utah Admin. Code R590-262-3

Amended by Utah State Bulletin Number 2016-12, effective 5/23/2016

Amended by Utah State Bulletin Number 2017-1, effective 12/12/2016

Amended by Utah State Bulletin Number 2023-13, effective 6/21/2023