31A-42a-202 (Effective 01/01/13) - Contents of plan. - Utah Statutes

31A-42a-202 (Effective 01/01/13). Contents of plan.
(1) The Utah Statewide Risk Adjuster Board shall submit to the commissioner aproposed plan of operation for the Utah Statewide Risk Adjuster. The proposed plan ofoperation shall:
(a) specify how the Utah Statewide Risk Adjuster shall adjust risk for:
(i) the defined contribution arrangement market established under Chapter 30, Part 2,Defined Contribution Arrangements; and
(ii) any health benefit plan offered to a small employer group on or after January 1, 2013,including a plan offered to a small employer group not participating in a defined contributionarrangement;
(b) establish regular times and places for meetings of the board;
(c) establish procedures for keeping records of all financial transactions and for sendingannual fiscal reports to the commissioner;
(d) contain additional provisions necessary and proper for the execution of the powersand duties of the Utah Statewide Risk Adjuster; and
(e) establish procedures in compliance with Title 63A, Utah Administrative ServicesCode, to pay for administrative expenses incurred.
(2) The proposed plan of operation under Subsection (1) shall include:
(a) for the defined contribution arrangement market:
(i) parameters an employer may use to designate eligible employees for the definedcontribution arrangement market;
(ii) employer eligibility guidelines that protect carriers from adverse selection in thedefined contribution market; and
(iii) (A) how premium contributions for qualified individuals shall be submitted to theInternet portal in the amount determined under Subsection (2)(b); and
(B) how the Internet portal shall distribute premiums to the carriers selected by qualifiedindividuals within an employer group based on each individual's health risk factor determined inaccordance with the plan;
(b) for the defined contribution arrangement market and for any health benefit planoffered to a small employer group on or after January 1, 2013, including a plan offered to a smallemployer group not participating in a defined contribution arrangement:
(i) underwriting mechanisms:
(A) consistent with the federal Health Insurance Portability and Accountability Act; and
(B) necessary to protect carriers from adverse selection;
(ii) how premium rates for an enrollee are calculated, including:
(A) calculation of an initial rate for an enrollee based on:
(I) standardized age bands submitted by carriers; and
(II) wellness incentives for the individual as permitted by federal law; and
(B) calculation of a group risk factor to be applied to the initial age rate based on thehealth conditions of all qualified individuals in the same employer group, and for small employergroups, in accordance with Sections 31A-30-105 and 31A-30-106; and
(iii) a mechanism for adjusting risk among carriers that:
(A) identifies health conditions subject to risk adjustment;
(B) establishes an adjustment amount for each identified health condition;
(C) determines the extent to which a carrier has more or fewer individuals with an

identified health condition than would be expected; and
(D) calculates all risk adjustments.

Enacted by Chapter 68, 2010 General Session