63M-1-2506 - Health benefit plan information on Health Insurance Exchange -- Insurer transparency. - Utah Statutes

63M-1-2506. Health benefit plan information on Health Insurance Exchange --Insurer transparency.
(1) (a) The office shall adopt administrative rules in accordance with Title 63G, Chapter3, Utah Administrative Rulemaking Act, that:
(i) establish uniform electronic standards for:
(A) a health insurer to use when:
(I) transmitting information to:
(Aa) the Insurance Department under Subsection 31A-22-613.5(2)(a)(ii); and
(Bb) the Health Insurance Exchange as required by this section;
(II) receiving information from the Health Insurance Exchange;
(III) receiving or transmitting the universal health application to or from the HealthInsurance Exchange;
(B) facilitating the transmission and receipt of premium payments from multiple sourcesin the defined contribution arrangement market; and
(C) the use of the uniform health insurance application required by Section 31A-22-635on the Health Insurance Exchange;
(ii) designate the level of detail that would be helpful for a concise consumer comparisonof the items described in Subsections (4) and (5) on the Health Insurance Exchange;
(iii) assist the risk adjuster board created under Title 31A, Chapter 42, DefinedContribution Risk Adjuster Act, and carriers participating in the defined contribution market onthe Health Insurance Exchange with the determination of when an employer is eligible toparticipate in the Health Insurance Exchange under Title 31A, Chapter 30, Part 2, DefinedContribution Arrangements; and
(iv) create an advisory board to advise the exchange concerning the operation of theexchange and transparency issues with the following members:
(A) two health producers who are registered with the Health Insurance Exchange;
(B) two consumers;
(C) one representative from a large insurer who participates on the exchange;
(D) one representative from a small insurer who participates on the exchange;
(E) one representative from the Insurance Department; and
(F) one representative from the Department of Health.
(b) The office shall post or facilitate the posting of:
(i) the information required by this section on the Health Insurance Exchange created bythis part; and
(ii) links to websites that provide cost and quality information from the Department ofHealth Data Committee or neutral entities with a broad base of support from the provider andpayer communities.
(2) A health insurer shall use the uniform electronic standards when transmittinginformation to the Health Insurance Exchange or receiving information from the HealthInsurance Exchange.
(3) (a) (i) An insurer who participates in the defined contribution arrangement marketunder Title 31A, Chapter 30, Part 2, Defined Contribution Arrangements, shall post all plansoffered in the defined contribution arrangement market on the Health Insurance Exchange andshall comply with the provisions of this section.
(ii) Beginning January 1, 2013, an insurer who offers a health benefit plan to a small

employer group in the state shall:
(A) post the health benefit plans in which the insurer is enrolling new groups on theHealth Insurance Exchange; and
(B) comply with the provisions of this section.
(b) An insurer who offers individual health benefit plans under Title 31A, Chapter 30,Part 1, Individual and Small Employer Group:
(i) shall post on the Health Insurance Exchange the basic benefit plan required by Section31A-22-613.5; and
(ii) may publish on the Health Insurance Exchange any other health benefit plans that itoffers in the individual market.
(c) An insurer who posts a health benefit plan on the Health Insurance Exchange:
(i) shall comply with the provisions of this section for every health benefit plan it postson the Health Insurance Exchange; and
(ii) may not offer products on the Health Insurance Exchange that are not health benefitplans.
(4) A health insurer shall provide the Health Insurance Exchange with the followinginformation for each health benefit plan submitted to the Health Insurance Exchange:
(a) plan design, benefits, and options offered by the health benefit plan including statemandates the plan does not cover;
(b) provider networks;
(c) wellness programs and incentives; and
(d) descriptions of prescription drug benefits, exclusions, or limitations.
(5) (a) An insurer offering any health benefit plan in the state shall submit theinformation described in Subsection (5)(b) to the Insurance Department in the electronic formatrequired by Subsection (1).
(b) An insurer who offers a health benefit plan in the state shall submit to the HealthInsurance Exchange the following operational measures:
(i) the percentage of claims paid by the insurer within 30 days of the date a claim issubmitted to the insurer for the prior year; and
(ii) for all health benefit plans offered by the insurer in the state, the claims denial andinsurer transparency information developed in accordance with Subsection 31A-22-613.5(5).
(c) The Insurance Department shall forward to the Health Insurance Exchange theinformation submitted by an insurer in accordance with this section and Section 31A-22-613.5.
(6) The Insurance Department shall post on the Health Insurance Exchange the InsuranceDepartment's solvency rating for each insurer who posts a health benefit plan on the HealthInsurance Exchange. The solvency rating for each carrier shall be based on methodologyestablished by the Insurance Department by administrative rule and shall be updated eachcalendar year.
(7) The commissioner may request information from an insurer under Section31A-22-613.5 to verify the data submitted to the Insurance Department and to the HealthInsurance Exchange under this section.
(8) A health insurer shall accept and process an application for a health benefit plan fromthe Health Insurance Exchange in accordance with this section and Section 31A-22-635.

Amended by Chapter 68, 2010 General Session