Instructions & Forms
The 2021 Utah Pharmacy Premium Impact Survey is an annual survey specifically for Utah’s individual, small group, and large group comprehensive hospital & medical markets. The purpose of this survey is to meet the statutory requirements of Utah Code § 31A-48-103(2).
Who is required to file?
All health insurers in Utah who issue Comprehensive Hospital & Medical (Major Medical) Insurance in either the Individual or Small Group or Large Group Markets 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 August 1, 2022. Failure to file by the deadline may subject your company to the enforcement penalties under Utah Code § 31A-2-308.
Please review the instructions and new 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 form.
The Utah Insurance Department will only accept electronic submissions of the Utah Pharmacy Premium Impact Survey as an Excel spreadsheet via the UID secure file upload website at https://forms.uid.utah.gov/fileUploads/. All survey files should be uploaded to the “Health Research” folder. Do not use another folder to submit your files.
Any other forms of data submission 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. The 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 the Research Assistant at firstname.lastname@example.org.