Instructions & Form
The Utah Accident & Health Survey (Stop-Loss Supplement) is a follow-up survey for the Utah Accident & Health Survey. The purpose of this follow-up survey is to provide more detailed information on the Stop-Loss business reported on the Utah Accident & Health Survey.
The completed survey is due April 1, 2019 and should be filed along with the 2018 Utah Accident & Health Survey. Only companies that reported Stop-Loss business on part 1, line 12 of the Utah Accident & Health Survey should file this supplement. All other companies are exempt. None reports are not required. Failure to file by the deadline may subject your company to the enforcement penalties under Utah Code § 31A-2-308.
Status of the survey for data year 2018
Please review the instructions and survey form 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.
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 Accident & Health Survey (Stop-Loss Supplement) as an Excel spreadsheet via the UID secure file upload website at: https://forms.uid.utah.gov/insurance/fileUploads/. The website address is case sensitive. 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. 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 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 are available in Adobe PDF format. The survey form is available as a data entry form in Microsoft Excel format. A separate signature form is not required as long as the signature form for the 2018 Utah Accident & Health Survey is filed correctly.
Insurers are expected to read the instructions before completing the form. Questions regarding the survey should be directed to Daron Funn, Research Assistant at email@example.com.
Stop-Loss Supplement Instructions in Adobe PDF format:
Stop-Loss Supplement Form in Microsoft Excel format: