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Utah Insurance

Utah Mental Health Parity Survey Instructions & Forms

The 2019 Utah Mental Health Parity Survey is a new survey specifically for Utah’s Comprehensive health insurance market. The purpose of this survey is to collect information on mental health parity for H16 Major Medical health benefit plans being offered in Utah as of July 1, 2019.

Who is required to file?

All Fraternal, Health, Life and Property & Casualty insurers who have Comprehensive Hospital & Medical (Major Medical) business in Utah are required to complete and file this survey. All other insurers are exempt. The completed survey form should be sent to the Utah Insurance Department by November 15, 2019. Failure to file by the deadline may subject your company to the enforcement penalties under Utah Code § 31A-2-308.

General Instructions

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

The Utah Insurance Department has made a change in how it handles the security of electronic transmissions. As of January 1, 2017, the Utah Insurance Department will only accept electronic submissions of the Utah Mental Health Parity Survey as Adobe PDF forms via the UID secure file upload website at: All survey files should be uploaded to the “Health Research” Division. Filings submitted to other divisions will not be accepted.

Any other forms of data submission are not acceptable. Also, do not make any changes to the formatting of the Adobe PDF forms. This file is designed to allow us to import your data directly into a software database, while attempting to remain “user friendly”. Any modification of the Adobe PDF forms (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.

How to get the survey

Please download the instructions, the signature form, and the survey forms 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 forms are available as three data entry forms in Adobe PDF format.

Insurers are expected to read the instructions before completing the form. Questions regarding the survey should be directed to Daron Funn, Research Assistant at

Survey Instructions in Adobe PDF format: <PDF format>

Signature Form in Adobe PDF format: <PDF format>

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

Survey Form for the Individual market in Adobe PDF format: <PDF format>

Survey Form for the Small Group market in Adobe PDF format: <PDF format>

Survey Form for the Large Group market in Adobe PDF format: <PDF format>