Accident & Health
Filing instructions
General
The Utah Statutory provisions for filing insurance policy forms, rates, and rating plans vary by type and line of insurance. Refer to the “Filing Procedure Instructions” section included in the appropriate rules and bulletins listed below.
Filing electronically
Effective July 1, 2007, the Utah Insurance Department will only accept electronic filings. All filers, except those specifically exempted in Bulletin 2007-3, must file using SERFF.
Filing submission rule
R590-220: Submission of Accident and Health insurance filings
Utah Mental Health Parity and Substance Abuse Attestation
ACA Small Employer Off Exchange Composite Rating Methodology
The Interstate Insurance Compact (“Compact”): An important modernization initiative that benefits state insurance regulators, consumers, and the insurance industry. The Compact established a multi-state public entity, the Interstate Insurance Product Regulation Commission (IIPRC) which serves as an instrumentality of the Member States. The IIPRC serves as a central point of electronic filing for certain insurance products, including life insurance, annuities, disability income and long-term care insurance to develop uniform product standards, affording a high level of protection to purchasers of asset protection insurance products. We encourage insurance companies to submit filings through the Interstate Compact.
Content Standards
Accident and Health Content Standards are a resource used when preparing accident and health insurance forms and rates.
The standards listed below are for insurers to use as a resource when preparing accident and health insurance forms and rates. The documents are intended to provide you with a brief summary of the requirements of Utah law and the Insurance Department’s position in dealing with these provisions and issues. The standards are not all-inclusive. As required by Utah Code 31A-21-201(2), the insurer is responsible for assuring that forms and rates submitted comply with Utah Insurance Code and Rules.
The standards below are new and effective as of December 1, 2022.
- Accident or Specified Accident
- Accidental Death & Dismemberment
- Basic Medical – Surgical
- Blanket Accident / Sickness
- Dental
- Disability Income
- Health Benefit Plans:
- Hospital & Other Indemnity
- Long-Term Care
- Medicare Supplement / Medigap
- Short-Term Limited Duration
- Specified Disease
- Stop-Loss
- Vision Plan
Health Division Reports
Overview
Actuarial Certification: All individual and small employer carriers shall file an actuarial certification, 31A-30-106 and Rule R590-167. Due April 1 each year.
All health benefit plan reports must be filed with SERFF using a type of insurance of “H16I” or “H16G“, and a filing type of Report.
Health Maintenance Organizations must file with SERFF and use “HOrg02I” or “HOrg02G” as the type of insurance and the filing type of Report.
Long term care reports
- An issuer of long-term care insurance shall file the following reports in a single filing, R590-148-25. The report filing is due June 30 each year.
- Replacement and Lapse Report (Appendix G). 10% of its agents with the great percentages of lapses and replacements.
- Claims Denial Report (Appendix E). Number of claims denied for each class of business, expressed as a percentage of claims denied.
- Rescission Report (Appendix A). Record of all policy or certificate recessions.
- Suitability Report (Appendix H). Number of applications received, number of applicants who declined to provide personal worksheet information, the number of applicants who did not meet the suitability standards, and the number of applicants who confirmed after receiving a suitability letter.
All long term care reports must be filed with SERFF using a type of insurance of “LTC06” and a filing type of Report. All four reports must be included with the filing or the filing will be rejected.
Medicare supplement reports
- Annual Filing of Premium Rates. An issuer of Medicare supplement shall file annually its rates, rating schedule and supporting documentation, including ratios of incurred losses to earned premiums by policy duration, R590-146-14. Refer to the NAIC Medicare Supplement Insurance Model Regulations Manual for required components. Due May 31 each year.
- Refund Calculation and Benchmark Ratio. An issuer of Medicare supplement shall file the Medicare Supplement Refund Calculation Form and Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies reports, R590-146-14. Due May 31 each year.
- Report of Multiple Policies. An issuer of Medicare supplement shall annually submit a report of multiple policies the insurer has issued to a single insured. The report is required each year listing each insured with multiple policies or stating that no multiple policies were issued, R590-146-22. Due May 31 each year.
- Medicare Select Grievance Report. An issuer of Medicare Select shall report the number of grievances filed in the previous year that includes a summary of the subject, nature and resolution of each grievance, R590-146-10. Due March 31 each year.
All Medicare supplement reports must be filed with SERFF using a type of insurance of “MS06” and a filing type of Report.
Utah accident & health survey
All insurers with accident & health business shall file the Utah Accident & Health Survey. The purpose 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,
31A-2-201.2. Due April 1 each year.
Value added benefits
All insurers with accident & health business are required to file a list of all value-added benefits offered at no cost to its enrollees, 31A-8a-207. Due March 1 each year.
Objective criteria for adding or terminating participating providers
All insurers with accident & health business shall establish criteria for adding health care providers to a new or existing panel and file a copy of these criteria with the Utah Insurance Department, 31A-22-617.1. The filing does not have a specific due date. Each insurer must file an updated copy as needed.