Utah Administrative Code
Topic - Insurance
Title R590 - Administration
Rule R590-167 - Individual, Small Employer, and Group Health Benefit Plan Rule
Section R590-167-11 - Actuarial Certification and Additional Filing Requirements
Universal Citation: UT Admin Code R 590-167-11
Current through Bulletin 2024-06, March 15, 2024
(1)
(a) An actuarial certification filing under
Subsection 31A-30-106(4)(b) or 31A-30-106.1(13)(b) shall:
(i) include a written statement that meets
the requirements of the act, this rule, and the applicable standards of
practice promulgated by the Actuarial Standards Board;
(ii) be signed by the actuary and state that
the actuary meets the qualifications of Subsection 31A-30-103(1);
(iii) contain the following statement: "I,
(name), certify that (name of covered carrier) is in compliance with Title 31A,
Chapter 30, Individual, Small Employer, and Group Health Insurance Act, and
Rule R590-167, based upon the examination of (name of covered carrier),
including review of the appropriate records and of the actuarial assumptions
and methods utilized by (name of covered carrier) in establishing premium rates
for applicable health benefit plans";
(iv) list and describe each written
demonstration used by the actuary to establish compliance with the act and this
rule;
(v) list all affiliated
insurers, defining each class of business that includes the commissioner's
approval date if more than one class of business exists; and
(vi) include the System for Electronic Rates
and Forms Filing, SERFF, filing number for each applicable rate manual
filing.
(b) The
actuarial certification applies to an individual or a small employer health
benefit plan issued before March 23, 2010, and maintains grandfathered
status.
(2)
(a) A covered carrier shall file with the
commissioner a copy of the applicable rate manual for a health benefit plan
that is subject to the act and this rule, for both new business and renewal
rates, and shall include:
(i) a signed
certification by an actuary that, to the best of the actuary's knowledge and
judgment, the rate filing complies with the applicable laws and rules of
Utah;
(ii) a complete and detailed
description of how the final premium, including any fees, is calculated from
the rate manual;
(iii) all changes
and updates, including a complete and detailed description of how the final
premium, including any fees, is calculated from the rate manual;
(iv) an identification of the covered
carrier's classes of business under Subsection R590-167-4(1);
(v) all information required by 45 CFR 154.215(b)(1); and
(vi) for a rate
increase subject to review by 45 CFR 154.200(a)(1), all information required by
45 CFR 154.215(b)(2).
(b) The rate manual shall be filed:
(i) with an initial product filing;
or
(ii) 30 days before use, for an
existing health benefit plan.
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