Utah Code 31A-2-201.2. Evaluation of health insurance market
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Terms Used In Utah Code 31A-2-201.2
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Department: means the Insurance Department. See Utah Code 31A-1-301
- health insurance: means insurance providing:(84)(a)(i) a health care benefit; or(84)(a)(ii) payment of an incurred health care expense. See Utah Code 31A-1-301
- Individual: means a natural person. See Utah Code 31A-1-301
- Insurance: includes :
(96)(b)(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;(96)(b)(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and(96)(b)(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301- insurance company: means a person doing an insurance business as a principal including:
(104)(a)(i) a fraternal benefit society;(104)(a)(ii) an issuer of a gift annuity other than an annuity specified in Subsections31A-22-1305 (2) and (3);(104)(a)(iii) a motor club;(104)(a)(iv) an employee welfare plan;(104)(a)(v) a person purporting or intending to do an insurance business as a principal on that person's own account; and(104)(a)(vi) a health maintenance organization. See Utah Code 31A-1-301- Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
(103)(a)(i) a policyholder;(103)(a)(ii) a subscriber;(103)(a)(iii) a member; and(103)(a)(iv) a beneficiary. See Utah Code 31A-1-301- Member: means a person having membership rights in an insurance corporation. See Utah Code 31A-1-301
- Rate: means :
(163)(a)(i) the cost of a given unit of insurance; or(163)(a)(ii) for property or casualty insurance, that cost of insurance per exposure unit either expressed as:(163)(a)(ii)(A) a single number; or(163)(a)(ii)(B) a pure premium rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:(163)(a)(ii)(B)(I) expenses;(163)(a)(ii)(B)(II) profit; and(163)(a)(ii)(B)(III) individual insurer variation in loss experience. 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
(1)(a) Each year the commissioner shall:(1)(a)(i) conduct an evaluation of the state‘s health insurance market;(1)(a)(ii) report the findings of the evaluation to the Office of Legislative Research and General Counsel before February 1 of each year; and(1)(a)(iii) publish the findings of the evaluation on the department website.(1)(b) After the president of the Senate and the speaker of the House of Representatives appoint members to the Health and Human Services Interim Committee for the year in which the Office of Legislative Research and General Counsel receives a report under this subsection, the Office of Legislative Research and General Counsel shall provide a copy of the report to each member of the committee.(2) The evaluation required by this section shall:(2)(a) analyze the effectiveness of the insurance regulations and statutes in promoting a healthy, competitive health insurance market that meets the needs of the state, and includes an analysis of:(2)(a)(i) the availability and marketing of individual and group products;(2)(a)(ii) rate changes;(2)(a)(iii) coverage and demographic changes;(2)(a)(iv) benefit trends;(2)(a)(v) market share changes; and(2)(a)(vi) accessibility;(2)(b) assess complaint ratios and trends within the health insurance market, which assessment shall include complaint data from the Office of Consumer Health Assistance within the department;(2)(c) contain recommendations for action to improve the overall effectiveness of the health insurance market, administrative rules, and statutes;(2)(d) include claims loss ratio data for each health insurance company doing business in the state;(2)(e) include information about pharmacy benefit managers collected under Section31A-46-301 ; and(2)(f) include information, for each health insurance company doing business in the state, regarding:(2)(f)(i) preauthorization determinations; and(2)(f)(ii) adverse benefit determinations.(3) When preparing the evaluation and report required by this section, the commissioner may seek the input of insurers, employers, insured persons, providers, and others with an interest in the health insurance market.(4) The commissioner may adopt administrative rules for the purpose of collecting the data required by this section, taking into account the business confidentiality of the insurers.(5) Records submitted to the commissioner under this section shall be maintained by the commissioner as protected records under Title 63G, Chapter 2, Government Records Access and Management Act.