2011 Utah Code
Title 31A Insurance Code
Chapter 30 Individual, Small Employer, and Group Health Insurance Act
Section 110 Individual enrollment cap.

31A-30-110. Individual enrollment cap.
(1) The commissioner shall set the individual enrollment cap at .5% on July 1, 1997.
(2) The commissioner shall raise the individual enrollment cap by .5% at the later of the following dates:
(a) six months from the last increase in the individual enrollment cap; or
(b) the date when CCI/TI is greater than .90, where:
(i) "CCI" is the total individual coverage count for all carriers certifying that their uninsurable percentage has reached the individual enrollment cap; and
(ii) "TI" is the total individual coverage count for all carriers.
(3) The commissioner may establish a minimum number of uninsurable individuals that a carrier entering the market who is subject to this chapter shall accept under the individual enrollment provisions of this chapter.
(4) Beginning July 1, 1997, an individual carrier may decline to accept individuals applying for individual enrollment under Subsection 31A-30-108(3), other than individuals applying for coverage as set forth in P.L. 104-191, 110 Stat. 1979, Sec. 2741 (a)-(b), if:
(a) the uninsurable percentage for that carrier equals or exceeds the cap established in Subsection (1); and
(b) the covered carrier has certified on forms provided by the commissioner that its uninsurable percentage equals or exceeds the individual enrollment cap.
(5) The department may audit a carrier's records to verify whether the carrier's uninsurable classification meets industry standards for underwriting criteria as established by the commissioner in accordance with Subsection 31A-30-106(1)(h).
(6) (a) If the commissioner determines that individual enrollment is causing a substantial adverse effect on premiums, enrollment, or experience, the commissioner may suspend, limit, or delay further individual enrollment for up to 12 months.
(b) The commissioner shall adopt rules to establish a uniform methodology for calculating and reporting loss ratios for individual policies for determining whether the individual enrollment provisions of Section 31A-30-108 should be waived for an individual carrier experiencing significant and adverse financial impact as a result of complying with those provisions.