A covered carrier shall make the information described in Subsection (2) available:
Terms Used In Utah Code 31A-30-114
Carrier: means a person that provides health insurance in this state including:
(a)
an insurance company;
(b)
a prepaid hospital or medical care plan;
(c)
a health maintenance organization;
(d)
a multiple employer welfare arrangement; and
(e)
another person providing a health insurance plan under this title. See Utah Code 31A-30-103
Covered carrier: means an individual carrier or small employer carrier subject to this chapter. See Utah Code 31A-30-103
Exclusion: means for the purposes of accident and health insurance that an insurer does not provide insurance coverage, for whatever reason, for one of the following:
(a)
a specific physical condition;
(b)
a specific medical procedure;
(c)
a specific disease or disorder; or
(d)
a specific prescription drug or class of prescription drugs. See Utah Code 31A-1-301
Premium: means money paid by covered insureds and covered individuals as a condition of receiving coverage from a covered carrier, including fees or other contributions associated with the health benefit plan. See Utah Code 31A-30-103
Small employer: means , in connection with a health benefit plan and with respect to a calendar year and to a plan year, an employer who:
(i)
(A)
employed at least one but not more than 50 eligible employees on business days during the preceding calendar year; or
(B)
if the employer did not exist for the entirety of the preceding calendar year, reasonably expects to employ an average of at least one but not more than 50 eligible employees on business days during the current calendar year;
(ii)
employs at least one employee on the first day of the plan year; and
(iii)
for an employer who has common ownership with one or more other employers, is treated as a single employer under 26 U. See Utah Code 31A-1-301
(a)
to:
(i)
a small employer; or
(ii)
an individual; and
(b)
(i)
at the time of solicitation; or
(ii)
upon the request of:
(A)
a small employer; or
(B)
an individual;
(c)
as part of the covered carrier‘s solicitation and sales materials.
(2)
The following information is required to be disclosed or made available under Subsection (1):
(a)
the provisions of the coverage concerning the covered carrier’s right to change premium rates; and
(b)
the factors that may effect changes in premium rates;
(c)
the provisions of the coverage relating to renewability of coverage; and
(d)
the provisions of the coverage relating to any preexisting condition exclusion.
