Current through Bulletin 2024-06, March 15, 2024
(1)
(a) An
insurer providing claim administration services for a self-funded plan shall
provide the employer for the self-funded plan a copy of the APCD Self-funded
Employee Health Plan Opt-In form, available on the department's website,
https://insurance.utah.gov, to
determine if the employer agrees to opt-in to submission of its self-funded
plan's data as described in this rule.
(b) An insurer may use a form the insurer has
developed for multi-state use instead of the form referenced in Subsection
(1)(a) if the form is substantially similar and is approved in advance by the
office.
(c) An insurer shall
provide the APCD Self-funded Employee Health Plan Opt-In form within 15 days
after claims administration services are retained and it is determined the
employer meets the requirements of this section.
(2)
(a)
Except as provided in Subsection (c), an opt-in is effective for the reporting
period in which it is signed and all future reporting periods.
(b) An employer may not opt-in for a partial
reporting period.
(c) An employer
that has opted-in may opt-out for subsequent reporting periods by notifying the
insurer in writing at least 30 days before the beginning of the next reporting
period.
(3) For a
self-funded plan whose employer has made an affirmative election for the
submission of data, the insurer shall include the self-funded plan data as part
of the insurer's data submission otherwise required by this rule.
(4) An insurer shall file with the office,
annually by January 31 of each year, the following for the prior calendar year:
(a) a list of self-funded plans whose
employer made an affirmative election for the submission of data;
(b) a list of employers who previously filed
an opt-in request and have elected to opt-out for future reporting periods as
provided under Subsection (2)(c);
(c) a certification from an officer of the
insurer that the insurer has taken reasonable efforts to provide the form to
all known required employers; and
(d) a list identifying the employers to whom
the form was provided and their contact information.
(5) The APCD Self-funded Employee Health Plan
Opt-In form is for use only with self-funded plans and does not affect the
mandatory reporting otherwise required by this rule.
(6) Nothing in this section requires an
insurer to submit data for claims processed before the insurer was contracted
to provide services.
