a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
(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
(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
PPACA: means the Patient Protection and Affordable Care Act, Pub. 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
(a)
The commissioner may adopt administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, that change the rating and underwriting requirements of this chapter as necessary to transition the insurance market to meet federal qualified health plan standards and rating practices under PPACA.
(b)
Administrative rules adopted by the commissioner under this section may include:
(i)
the regulation of health benefit plans as described in Subsection 31A-2-212(5); and
(ii)
disclosure of records and information required by PPACA and state law.
(c)
(i)
The commissioner shall establish by administrative rule one statewide open enrollment period that applies to the individual insurance market that is not on the PPACA certified individual exchange.
(ii)
The statewide open enrollment period:
(A)
may be shorter, but no longer than the open enrollment period established for the individual insurance market offered in the PPACA certified exchange; and
(B)
may not be extended beyond the dates of the open enrollment period established for the individual insurance market offered in the PPACA certified exchange.
(2)
A carrier that offers health benefit plans in the individual market that is not part of the individual PPACA certified exchange:
(a)
shall open enrollment:
(i)
during the statewide open enrollment period established in Subsection (1)(c); and
(ii)
at other times, for qualifying events, as determined by administrative rule adopted by the commissioner; and
(b)
may open enrollment at any time.
(3)
To the extent permitted by the Centers for Medicare and Medicaid Services policy, or federal regulation, the commissioner shall allow a health insurer to choose to continue coverage and individuals and small employers to choose to re-enroll in coverage in nongrandfathered health coverage that is not in compliance with market reforms required by PPACA.
Amended by Chapter 32, 2020 General Session Amended by Chapter 354, 2020 General Session
