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Utah Accident & Health Survey
(ASO Supplment)

The Utah Accident & Health Survey (ASO Supplemenet) is a follow-up survey fort he Utah Accident & Health Survey. The purpose of this follow-up survey is to provide more detailed information on the administrative services business reported on the Utah Accident & Health Survey.

The completed survey is due June 13, 2014. Failure to file by the deadline may subject your company to the enforcement penalties under Utah Code Annotated ยง 31A-2-308.

Status of the survey for data year 2013

Please review the instructions and survey form carefully so that you will understand how to report your data. This will save your time and ours, and reduce the number of corrections after the survey is filed. However, as always we will work with you to understand and file the survey form.

Please note that the Utah Insurance Department will only accept electronic submissions of the Utah Accident & Health Survey (ASO Supplement) via an MS Excel spreadsheet electronic data file submitted through email. Hard copy (paper) or Adobe PDF submissions are NOT acceptable. Also, do not make any changes to the formatting of the Excel survey form. This file is designed to allow us to import your data directly into a software database, while attempting to remain “user friendly”. Any changes to the line numbers, columns, or other parts of the survey form (other than simple data entry) may cause errors when we import your survey form.

Please remember each insurer is required to file a complete survey. In cases where your company has nothing to report, answer with a “0” rather than leaving a section blank. To make this easier, we have pre-populated the survey with sample data, so that you can change just the sections that are applicable to your company. This includes providing a contact person, with correct contact information, including a valid telephone number and email address.

Please note that all data in the survey form should be whole numbers. Use of decimals creates rounding errors when the data is processed.

Also, please only submit one company per Excel form. Filings with multiple companies in multiple Excel sheets will not import correctly.

How to get the survey

Please download the instructions, the signature form, and the survey form using the links available below. Right click on each link and select “Save Target As” to download each file to your computer.

The survey instructions and signature form are available in Adobe PDF format. The survey form is available as a data entry form in Microsoft Excel format.

Insurers are expected to read the instructions before completing the form. Questions regarding the survey should be directed to Kris Buckler, Research Assistant at uid.healthresearch@utah.gov.

Survey Instructions in Adobe PDF format:

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Signature Form in Adobe PDF format:

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(Please note that the Signature Form should be submitted along with the Survey Form.)

Survey Form in Microsoft Excel format:

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