2011 Utah Code
Title 31A Insurance Code
Chapter 30 Individual, Small Employer, and Group Health Insurance Act
Section 115 Actuarial review of health benefit plans.

31A-30-115. Actuarial review of health benefit plans.
(1) (a) The department shall conduct an actuarial review of rates submitted by small employer carriers:
(i) prior to the publication of the premium rates on the Health Insurance Exchange;
(ii) to determine if the rates are in compliance with Subsection 31A-30-202.5(1)(b);
(iii) to verify the validity of the rates, underwriting and risk factors, and premiums of plans both in and outside of the Health Insurance Exchange;
(iv) to verify that insurers are pricing similar health benefit plans and groups the same in and out of the exchange; and
(v) as the department determines is necessary to oversee market conduct.
(b) The actuarial review by the department shall be funded from a fee:
(i) established by the department in accordance with Section 63J-1-504; and
(ii) paid by all small employer carriers participating in the defined contribution arrangement market and small employer carriers offering health benefit plans under Chapter 30, Part 1, Individual and Small Employer Group.
(c) The department shall:
(i) report aggregate data from the actuarial review to the risk adjuster board created in Section 31A-42-201; and
(ii) contact carriers, if the department determines it is appropriate, to:
(A) inform a carrier of the department's findings regarding the rates of a particular carrier; and
(B) request a carrier to recalculate or verify base rates, rating factors, and premiums.
(d) A carrier shall comply with the department's request under Subsection (1)(c)(ii).
(2) (a) There is created in the General Fund a restricted account known as the "Health Insurance Actuarial Review Restricted Account."
(b) The Health Insurance Actuarial Review Restricted Account shall consist of money received by the commissioner under this section.
(c) The commissioner shall administer the Health Insurance Actuarial Review Restricted Account. Subject to appropriations by the Legislature, the commissioner shall use money deposited into the Health Insurance Actuarial Review Restricted Account to pay for the actuarial review conducted by the department under this section.