(1) Except as provided in Subsection (2), each health maintenance organization authorized in this state shall maintain a deposit with the commissioner under Section 31A-2-206 in an amount equal to the sum of:

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Terms Used In Utah Code 31A-8-211

  • Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
  • Filed: means that a filing is:
              (69)(a)(i) submitted to the department as required by and in accordance with applicable statute, rule, or filing order;
              (69)(a)(ii) received by the department within the time period provided in applicable statute, rule, or filing order; and
              (69)(a)(iii) accompanied by the appropriate fee in accordance with:
                   (69)(a)(iii)(A) Section 31A-3-103; or
                   (69)(a)(iii)(B) rule. See Utah Code 31A-1-301
  • Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
         (83)(a) a professional service;
         (83)(b) a personal service;
         (83)(c) a facility;
         (83)(d) equipment;
         (83)(e) a device;
         (83)(f) supplies; or
         (83)(g) medicine. See Utah Code 31A-1-301
  • minimum required capital: means the capital that must be constantly maintained by a stock insurance corporation as required by statute. See Utah Code 31A-1-301
  • Permanent surplus: means the surplus of an insurer or organization that is designated by the insurer or organization as permanent. See Utah Code 31A-1-301
  • Premium: includes , however designated:
              (156)(b)(i) an assessment;
              (156)(b)(ii) a membership fee;
              (156)(b)(iii) a required contribution; or
              (156)(b)(iv) monetary consideration. See Utah Code 31A-1-301
  • State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
  • Surplus: means the excess of assets over the sum of paid-in capital and liabilities. See Utah Code 31A-1-301
     (1)(a) $100,000; and
     (1)(b) 50% of the greater of:

          (1)(b)(i) $900,000;
          (1)(b)(ii) 2% of the annual premium revenues as reported on the most recent annual financial statement filed with the commissioner; or
          (1)(b)(iii) an amount equal to the sum of three months uncovered health care expenditures as reported on the most recent financial statement filed with the commissioner.
(2)

     (2)(a) The commissioner may exempt a health maintenance organization from the deposit requirement of Subsection (1) if:

          (2)(a)(i) the commissioner determines that the enrollees’ interests are adequately protected;
          (2)(a)(ii) the health maintenance organization has been continuously authorized to do business in this state for at least five years; and
          (2)(a)(iii) the health maintenance organization has $5,000,000 surplus in excess of the health maintenance organization’s company action level RBC as defined in Subsection 31A-17-601(8)(b).
     (2)(b) The commissioner may rescind an exemption given under Subsection (2)(a).
(3)

     (3)(a) Each limited health plan authorized in this state shall maintain a deposit with the commissioner under Section 31A-2-206 in an amount equal to the minimum capital or permanent surplus plus 50% of the greater of:

          (3)(a)(i) .5 times minimum required capital or minimum permanent surplus; or
          (3)(a)(ii)

               (3)(a)(ii)(A) during the first year of operation, 10% of the limited health plan’s projected uncovered expenditures for the first year of operation;
               (3)(a)(ii)(B) during the second year of operation, 12% of the limited health plan’s projected uncovered expenditures for the second year of operation;
               (3)(a)(ii)(C) during the third year of operation, 14% of the limited health plan’s projected uncovered expenditures for the third year of operation;
               (3)(a)(ii)(D) during the fourth year of operation, 18% of the limited health plan’s projected uncovered expenditures during the fourth year of operation; or
               (3)(a)(ii)(E) during the fifth year of operation, and during all subsequent years, 20% of the limited health plan’s projected uncovered expenditures for the previous 12 months.
     (3)(b) Projections of future uncovered expenditures shall be established in a manner that is approved by the commissioner.
(4) A deposit required by this section may be counted toward the minimum capital or minimum permanent surplus required under Section 31A-8-209.