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Utah Accident & Health Survey
Instructions & Form

The Utah Accident & Health Survey is a required state specific annual filing. The purpose of this survey is to provide more detailed information on Utah accident and health business than is currently reported on the Utah State page of the NAIC Annual Statement.

Who is required to file?

Fraternal, Health, Life and Property & Casualty insurers who report accident & health business in Utah on the Utah State page of the NAIC Annual Statement are required to file this survey. All other insurers are exempt. The completed survey is due April 1, 2015. Failure to file by the deadline may subject your company to the enforcement penalties under Utah Code Annotated § 31A-2-308.

Status of the survey for data year 2014

The Utah Accident & Health Survey for 2014 follows the template used previously for Parts 1 through 6. However, there have been significant changes and additions for comprehensive hospital & medical (Parts 7 and beyond). We also added two new survey supplements for companies with Administrative Services business and Stop Loss insurance that are to be filed along with the survey. If your company does not have Administrative Services business or Stop Loss insurance, you are exempt from filing these survey supplements. None reports are not required.

Please review the instructions and survey forms carefully so that you will understand how to report your data. This will save time 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 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.

Utah Accident & Health Survey Instructions in Adobe PDF format:

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Signature Form in Adobe PDF format (covers survey and supplements):

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(Please note that the Signature Form should be submitted along with the Utah Accident & Health Survey Form.)

Utah Accident & Health Survey Form in Microsoft Excel format:

<Excel format>

How to get the survey supplements?

There are two survey supplements, one for Administrative Services business and one for Stop Loss insurance. If your company does not have Administrative Services business or Stop Loss insurance, you are exempt from filing these survey supplements. None reports are not required.

For the Administrative Services supplement click here: ASO Survey

For Stop Loss supplement click here: Stop Loss Survey