Utah Admin. Code R24 — Insurance

R590 Administration

Utah Admin. Code R590-67-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-2 Purpose and Scope

(1) The purpose of this rule is to establish requirements for:

(a) a proxy;

(b) a filing;

(d) information provided to a securities holder;

(e) a consent and authorization;

(f) a proposal;

(g) a false and misleading statement provision; and

(h) a provision related to an election contest.

(2)(a) This rule applies to a domestic stock insurer that has a class of equity securities held of record by 300 or more persons, directors, officers, or employees.

(b) This rule does not apply to an insurer if 95% or more of its equity securities are owned or controlled by a parent or an affiliated insurer and the remaining securities are held of record by less than 500 persons.

(c) This rule does not apply to a domestic stock insurer that files with the Securities and Exchange Commission, with respect to a class of securities, forms of proxies, consents, and authorizations complying with the requirements of the Securities Exchange Act of 1934 and its applicable regulations, with respect to that class of securities.

(d) This rule applies to a proxy, consent, or authorization of a class of equity securities of a domestic insurer solicited by or on behalf of the management of the insurer from the holders of record of the securities and its schedules before any annual or other meeting of the security holders.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Associate" means a relationship with:

(a) a corporation or organization, other than the issuer or a majority owned subsidiary of the issuer, of which the person is:

(i) an officer or partner; or

(ii) directly or indirectly the beneficial owner of 10% or more of any class of equity securities;

(b) a trust or other estate in which the person:

(i) has a substantial beneficial interest; or

(ii) serves as a trustee or in a similar fiduciary capacity; or

(c) a relative or spouse of the person, or any relative of the spouse, who has the same home as the person or who is a director or officer of the issuer or any of its parents or subsidiaries.

(2) "Beneficial owner" means a person who, directly or indirectly, through a contract, arrangement, understanding, relationship, or otherwise, has or shares:

(a) voting power, including the power to vote, or the power to direct voting of, a security; or

(b) investment power that includes the power to dispose of, or to direct the disposition of, a security.

(3) "Issuer" means the issuer of the security for which a proxy is solicited.

(4) "Last fiscal year" means the issuer's last fiscal year ending before the date of the meeting for which a proxy is solicited.

(5) "Officer" means a:

(a) president;

(b) secretary;

(d) vice president in charge of a principal business function; or

(e) person who performs a similar policy-making function for an insurer.

(6) "Parent" means an affiliate controlling a person directly or indirectly through one or more intermediaries.

(7) "Proxy statement" means a statement required by Section R590-67-7, whether or not contained in a single document.

(8)(a) "Solicitation" or "solicit" means:

(i) a request for a proxy, whether or not accompanied by or included in a proxy form;

(ii) a request to execute, to not execute, or to revoke, a proxy; or

(iii) furnishing a proxy form or other communication to a security holder under a circumstance reasonably calculated to result in the procurement, withholding, or revocation of a proxy.

(b) "Solicitation" or "solicit" does not mean:

(i) furnishing a proxy form to a security holder upon the unsolicited request of the security holder;

(ii) the performance by the issuer of an act required by Section R590-67-11; or

(iii) the performance by any person of a ministerial act on behalf of a person soliciting a proxy.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-4 Required Schedules

(1) The following schedules shall be used by an insurer complying with this rule:

(a) Schedule A, Required Proxy Form Information;

(b) Schedule B, Required Solicitation Information; and

(2) The schedules listed in Subsection (1) are available on the department's website, https://insurance.utah.gov.

(3) A solicitation may not be made unless each person solicited is furnished with a written proxy statement containing the information specified in Schedule A.

(4) A solicitation may not be made by any person other than the issuer unless, at least five business days before, or a shorter period authorized by the commissioner, a statement, on behalf of each participant, is filed with the commissioner, in duplicate, containing the information specified by Schedule B.

(5) For any solicitation, a domestic insurer shall file with the commissioner, and transmit to each security holder who is entitled to vote, a written information statement containing the information specified in Schedule C.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-5 False or Misleading Statements

A proxy statement, proxy form, notice of meeting, information statement, or other communication, written or oral, may not contain a statement that, at the time and in light of the circumstances under which it is made, is false or misleading with respect to any material fact, or which omits a material fact necessary in order to make the statements therein not false or misleading or necessary to correct any statement in any earlier communication with respect to the same meeting or subject matter that has become false or misleading.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-6 Solicitation

(1) Sections R590-67-6 through R590-67-13 apply to any solicitation, except for a solicitation:

(a) not made on behalf of an insurer where the total number of persons solicited is ten or fewer;

(b) by a person regarding a security carried in the person's name or in the name of the person's nominee, other than as a voting trustee, or held in the person's custody, if the person:

(i) does not receive commission or remuneration for the solicitation, directly or indirectly, other than reimbursement of reasonable expenses;

(ii) furnishes promptly to the solicited person a copy of all soliciting material with respect to the same subject matter or meeting received from all persons who furnish copies thereof for that purpose and who shall, if requested, defray the reasonable expenses to be incurred in forwarding the material; and

(iii) does no more than impartially instruct the person solicited to forward a proxy to the person, if any, to whom the person solicited desires to give a proxy, or impartially request from the person solicited instructions as to the authority to be conferred by the proxy and state that a proxy will be given if no instructions are received by a certain date;

(d) through a newspaper advertisement that informs security holders of a source where they may obtain copies of a proxy statement, proxy form, and other soliciting material, and only includes:

(i) the name of the issuer;

(ii) the reason for the advertisement; and

(iii) the proposal to be acted upon by security holders; and

(e) exempted from this rule by the commissioner.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-7 Information to be Provided to Security Holders

(1) If a solicitation is made on behalf of the issuer and relates to an annual meeting of security holders where directors are elected, each proxy statement shall be accompanied or preceded by an annual report to security holders that meets the provisions of this subsection.

(a) The report shall contain, in comparative columnar form, financial statements for the last two fiscal years, prepared on a consistent basis, that in the opinion of the management, adequately reflect the financial position of the issuer at the end of each year and the results of its operations for each year.

(i) Consolidated financial statements of the issuer and its subsidiaries shall be included in the report if they are necessary to reflect the financial position and results of operations of the issuer and its subsidiaries, but in that case, the individual statements of the issuer may be omitted.

(ii) The commissioner may, upon the request of the issuer, permit the omission of financial statements for the earlier of the two fiscal years upon a showing of good cause.

(b) The financial statements for the last two fiscal years required by Subsection (1)(a) shall be prepared in a manner acceptable to the commissioner.

(c) The report shall include, in comparative columnar form, a summary of the issuer's operations, or the operations of the issuer and its subsidiaries consolidated, or both as appropriate, for each of the last five fiscal years of the issuer, or the life of the issuer and its predecessors, if less.

(d) The report shall contain a brief description of the business done by the issuer and its subsidiaries during the most recent fiscal year that will, in the opinion of management, indicate the general nature and scope of the business of the issuer and its subsidiaries.

(e) The report shall identify;

(i) each of the issuer's directors and officers;

(ii) the principal occupation or employment of each person; and

(iii) the name and principal business of the organization where each person is employed.

(f) The report shall identify the principal market in which securities of any class entitled to vote at the meeting are traded, stating the range of bid and asked quotations for each quarterly period during the issuer's two most recent fiscal years, and shall set forth each dividend paid during the two-year period.

(g) The report may be in any form suitable to management and the information required by Subsections (1)(c) through (1)(f) may be presented in an appendix or other separate section of the report, if the attention of security holders is called to the presentation.

(2) Subsection (1) does not apply to a solicitation made on behalf of the management before the financial statements are available if:

(a) solicitation is being made at the time in opposition to the management; and

(b) the management's proxy statement includes an undertaking, in boldface type, to furnish the annual report to all persons being solicited at least 20 days before the date of the meeting.

(3) The report sent to security holders shall be filed with the commissioner, for the commissioner's information, no later than the later of:

(a) the date on which the report was first provided to security holders; or

(b) the date on which a preliminary copy of the solicitation material is filed pursuant to Section R590-67-10.

(4)(a) If securities of any class entitled to vote at a meeting where the issuer intends to solicit proxies, consents, or authorizations are held of record by a broker, dealer, bank, or voting trustee, or their nominees, the issuer shall inquire of the record holder at least 10 days before the record date for the meeting of security holders whether other persons are the beneficial owners of the securities and, if so, the number of copies of the proxy and other soliciting material and, in the case of an annual meeting at which directors are to be elected, the number of copies of the annual report to security holders, necessary to supply these materials to beneficial owners.

(b) The issuer shall supply the record holder in a timely manner with additional copies assembled in a form and at a place the record holder may reasonably request, in order to address and send one copy to each beneficial owner of securities so held and shall, upon the request of the record holder, pay its reasonable expenses for mailing the materials to the security holders to whom the material is sent.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-8 Proxy Requirements

(1) A proxy form shall:

(a) indicate, in boldface type, whether a proxy is solicited on behalf of the insurer's board of directors and, if not, by whom it is solicited;

(b) provide a specifically designated blank space for dating the proxy; and

(c) clearly and impartially identify each matter or group of related matters to be acted upon, whether proposed by the insurer or by a security holder.

(2) A process affording the solicited person an opportunity to specify by ballot a choice between approval, disapproval, or abstention with respect to each matter to be acted upon, other than officer elections, shall be provided in a proxy form.

(a) A proxy may confer discretionary authority regarding matters where a choice is not specified provided the proxy states, in boldface type, how it intends to vote the shares represented by the proxy in each case.

(b) A proxy that provides both for the election of directors and for action on other specified matters shall be prepared clearly to provide, by a box or otherwise, a process by which the security holder may withhold authority to vote for any nominee as a director.

(c) The executed proxy by the security holder to grant authority to vote for the election of all nominees grants authority for all nominees for which a vote is not withheld, provided the proxy so states in boldface type.

(3) A proxy may confer discretionary authority to vote with respect to the following:

(a) a matter that the person making the solicitation does not know, a reasonable time before the solicitation, will be presented at the meeting, if a specific statement to that effect is made in the proxy statement or proxy form;

(b) approval of the minutes of the prior meeting if the approval does not amount to ratification of the action taken at the meeting;

(c) the election of any person to any office for which a bona fide nominee is named in the proxy statement and the nominee is unable to serve or for good cause will not serve;

(d) a proposal omitted from the proxy statement and proxy form pursuant to Section R590-67-12; or

(e) a matter incident to the conduct of the meeting.

(4) A reference to a proposal where discretionary authority is given under Subsection (3) is not required.

(5)(a) A proxy may not confer authority to vote for the election of any person to an office for which a bona fide nominee is not named in the proxy statement, or to vote at an annual meeting, other than the next annual meeting, to be held after the date the proxy statement and proxy form are first sent or given to security holders.

(b) A person is not a bona fide nominee and may not be named as such unless the person consents to being named in the proxy statement and to serve if elected.

(6) A proxy statement or proxy form shall provide, subject to reasonable specified conditions, that the securities represented by the proxy will be voted and that where the person solicited specifies, by means of a ballot provided pursuant to Subsection (2), a choice with respect to any matter to be acted upon, the securities will be voted in accordance with the specifications made.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-9 Presentation of Information in Proxy Statement

(1) The information included in a proxy statement shall:

(a) be clearly presented;

(b) be divided into groups according to subject matter; and

(2)(a) A proxy statement shall disclose, under an appropriate caption, the date by which proposals of security holders intended to be presented at the next annual meeting shall be received by the issuer for inclusion in the issuer's proxy statement and proxy form relating to that meeting.

(b) The date in Subsection (2)(a) shall be calculated under Subsection R590-67-12(2).

(c) If the date of the next annual meeting is subsequently advanced by more than 30 calendar days or delayed by more than 90 calendar days from the date of the annual meeting to which the proxy statement relates, the issuer shall, in a timely manner and by reasonable means, inform security holders of the change and the date by which proposals of security holders shall be received.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-10 Material Required to be Filed

(1) A copy of the proxy statement, the proxy form, and any other soliciting material furnished to security holders with the proxy shall be filed with the commissioner at least 10 days before the date final copies of the material are first sent or given to security holders, or a shorter period authorized by the commissioner.

(2) A copy of any additional soliciting material relating to the same meeting or subject matter to be furnished to security holders after the proxy statement shall be filed with the commissioner at least two days before the date copies of the material are first sent or given to security holders, or a shorter period authorized by the commissioner.

(3) A copy of the proxy statement, the proxy form, and any other soliciting material in the form the material is furnished to security holders, shall be filed with the commissioner no later than the date the material is first sent or given to any security holder.

(4) A copy of soliciting material in the form of a speech, a press release, or a radio or television script may be filed with the commissioner before use or publication.

(a) A definitive copy shall be filed with the commissioner no later than the date the material is used or published.

(b) Subsections (1) and (2), and R590-67-14(1) apply to a reprint or reproduction of the soliciting material.

(5) An amended or revised copy of a proxy statement, proxy form, or other material shall be filed and clearly marked to indicate the changes.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-11 Mailing Communications to Security Holders

(1) The issuer shall mail or otherwise furnish to a security holder, as promptly as practicable after the receipt of the request:

(a) a statement of the approximate number of record owners and, to the extent known to the issuer, the approximate number of beneficial owners of any class of securities, any of whom have been or are to be solicited on behalf of the management, or any group of whom the security holder shall designate; and

(b) an estimate of the cost of mailing a specified proxy statement, proxy form, or other communication to the owners.

(2)(a) Copies of a proxy statement, a proxy form, or other communication furnished by the security holder shall be provided by the issuer to all security holders specified in Subsection (1)(a) as the security holder shall designate.

(b) The issuer is not required to mail or otherwise provide any material before the first day the solicitation is made on behalf of the issuer.

(d) The issuer may furnish promptly to a security holder a reasonably current list of the names and addresses of the record owners and the beneficial owners the security holder designates.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-12 Proposals of Security Holders

(1) "Proponent," for the purposes of this subsection, means a security holder.

(2)(a) If a proponent notifies an issuer, in writing and no less than 90 days before the issuer's annual meeting, of the security holder's intention to present a lawful proposal for action at an upcoming meeting of the issuer's security holders and the proponent is entitled to vote at least 1% of the votes entitled to be voted on the proposal, the issuer shall:

(i) set forth the proposal in its proxy statement;

(ii) identify the proposal in its proxy form; and

(iii) provide for the specification of approval or disapproval of the proposal.

(b) The proxy statement shall also include the name and address of the proponent.

(3) If an issuer opposes a proposal received from a proponent, it shall, at the request of the proponent, include in its proxy statement a statement of the proponent of not more than 200 words in support of the proposal.

(4) The issuer may omit a proposal and any statement in support thereof from its proxy statement and proxy form if:

(a) the proponent submitted more than one proposal in connection with a particular meeting;

(b) the proposal is more than 300 words long;

(c) the proposal or the supporting statement is contrary to this rule or Schedules A, B, or C, including Section R590- 67-5, which prohibits false or misleading statements in proxy soliciting materials;

(d) the proposal relates to the enforcement of a personal claim or the redress of a personal grievance against the issuer, its management, or any other person;

(e) the proposal deals with:

(i) a matter not significantly related to the issuer's business;

(ii) a matter beyond the issuer's power to effectuate;

(iii) a matter relating to the conduct of the issuer's ordinary business operations; or

(iv) an election to office;

(f) the proposal is counter to a proposal submitted by the issuer at the meeting, the proposal is moot, or the proposal relates to specific amounts of cash or stock dividends;

(g) the proposal is substantially duplicative of a proposal previously submitted to the issuer by another proponent, which proposal is included in the management's proxy material for the meeting; or

(h) substantially the same proposal was submitted to security holders in the issuer's proxy statement and proxy form relating to any annual or special meeting of security holders held within the preceding five calendar years and received less than 5% of the total number of votes cast at the time of its most recent submission.

(5) If the issuer intends to omit a proposal from its proxy statement or proxy forms, or both, it shall notify the proponent in writing of its intention at least 10 days before the issuer's preliminary proxy material is filed under Subsection R590-67-10(1).

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-13 Prohibition of Certain Solicitations

A person making a solicitation may not solicit an undated or postdated proxy or a proxy that is dated as of a date subsequent to the date it is signed by the security holder.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-14 Special Provisions Applicable to Solicitations

(1) This section applies to a solicitation by a person opposing a solicitation by another person with respect to the election or removal of directors at an annual or special meeting of security holders.

(2)(a) "Participant" or "participant in a solicitation," for purposes of this section, means:

(i) the issuer;

(ii) a director of the issuer or any nominee for whose election as a director proxies are solicited; and

(iii) a person acting alone or with one or more other persons, committees, or groups, in organizing, directing, or financing the solicitation.

(b) "Participant" and "participant in a solicitation" does not mean:

(i) a bank, broker, or dealer who, in the ordinary course of business, lends money or executes orders for the purchase or sale of securities and who is not otherwise a participant;

(ii) a person or organization retained or employed by a participant to solicit security holders or a person who merely transmits proxy soliciting material or performs ministerial or clerical duties;

(iii) a person employed in the capacity of attorney, accountant, advertising, public relations, or financial adviser, whose activities are limited to the performance of their duties in the course of employment;

(iv) a person regularly employed as an officer or employee of the issuer or any of its subsidiaries or affiliates who is not otherwise a participant; or

(v) an officer or director of, or any person regularly employed by, any other participant, if the officer, director, or employee is not otherwise a participant.

(3)(a) Within five business days after a solicitation is made by the issuer, or a longer period authorized by the commissioner, a statement, on behalf of each participant other than the issuer, shall be filed with the commissioner, in duplicate, containing the information specified by Schedule B.

(b) If any solicitation on behalf of the issuer or any other person has been made, or if proxy material is ready for distribution, before a solicitation subject to this section in opposition, a statement in duplicate containing the information specified in Schedule B shall be filed with the commissioner, by or on behalf of each participant in the prior solicitation, other than the issuer, as soon as reasonably practicable after the commencement of the solicitation in opposition.

(c) After filing the statements under Subsections (1) through (3), if additional persons become participants in a solicitation, a statement shall be filed with the commissioner, by or on behalf of each such person, in duplicate, containing the information specified in Schedule B, within three business days after the person becomes a participant, or a longer period authorized by the commissioner.

(d) If any material change occurs in the facts reported in any statement filed by or on behalf of any participant, an appropriate amendment to the statement shall be filed promptly with the commissioner.

(4) Notwithstanding Subsection R590-67-7(1), a solicitation may be made before furnishing security holders a written proxy statement containing the information specified in Schedule A with respect to the solicitation, provided that:

(a) the statements required by Subsection R590-67-14(3) are filed by or on behalf of each participant in the solicitation;

(b) a proxy form is not furnished to security holders before the time the written proxy statement under Subsection R590-67-14(5) is furnished to security holders, however, this Subsection R590-67-14(4)(b) may not apply where a proxy statement meeting the requirements of Schedule A is furnished to security holders;

(c) the information, or an appropriate summary, under Subsection R590-67-14(3) is filed by each participant and included in each communication furnished to security holders in connection with the solicitation; and

(d) a written proxy statement containing the information specified in Schedule A regarding a solicitation is furnished to security holders at the earliest practicable date.

(5) Proposed soliciting material furnished to security holders before the furnishing of the written proxy statement required by Subsection R590-67-7(1) shall be filed with the commissioner in preliminary form at least five business days before the date definitive copies of the material are first furnished, or a shorter period the commissioner may authorize.

(6) Notwithstanding Subsection R590-67-7(2), any portion of the annual report that refers to any solicitation or to any participant in any solicitation, other than the solicitation by management, shall be filed with the commissioner as proxy material, in preliminary form, at least five days before the date copies of the report are first furnished to security holders.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-67-15 Severability

If any provision of this rule, Rule R590-67, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-68 Insider Trading of Equity Securities of Domestic Stock Insurance Companies

Utah Admin. Code R590-68-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-5-303.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) define terms; and

(b) prescribe conditions regarding securities held in the ordinary course of business and incident to the establishment of maintenance of a primary or secondary market.

(2) This rule applies to a domestic stock insurance company.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-5-303. Additional terms are defined as follows:

(1) "Class" means all securities of an insurer that:

(a) are of substantially similar character; and

(b) provide substantially similar rights and privileges to the security holders.

(2) "Insurer," for purposes of this rule, means a domestic stock insurance company with an equity security subject to Section 31A-5-303.

(3) "Officer" means:

(a) a president;

(b) a vice president;

(d) an actuary;

(e) a secretary;

(f) a controller; or

(g) any other person who performs a similar policy-making function for an insurer.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-4 Securities Held of Record

(1) This section sets forth the method for determining whether the equity securities of an insurer are held of record by 100 or more persons.

(2) Securities are held of record by each person identified as the owner of the securities on records of security holders maintained by or on behalf of the insurer, subject to the following:

(a) where the records of a security holder are not maintained in accordance with an accepted practice, an additional person who is identified as an owner on the records if they are maintained in accordance with an accepted practice are included as a holder of the record;

(b) securities are held by one person if they are identified as held of record:

(i) by two or more persons as co-owners;

(ii) by a corporation;

(iii) by a partnership;

(iv) by a trust, whether or not the trustees are named;

(v) by another organization;

(vi) by one or more persons as trustees, executors, guardians, or custodians; or

(vii) in other fiduciary capacities with respect to a single trust, estate, or account;

(c) each outstanding unregistered or bearer certificate is included as held of record by a separate person, except to the extent that the insurer can establish that, if the securities were registered, they are held of record, under this rule, by a lesser number of persons; and

(d) securities registered in substantially similar names where the insurer has reason to believe that the names represent the same person, because of the address or other indications, may be included as held of record by one person.

(3)(a) Notwithstanding Subsections (1) and (2):

(i) securities held, to the knowledge of the insurer, subject to a voting trust, deposit agreement, or similar arrangement, are included as held of record by the record holders of the voting trust certificates, certificates of deposit, receipts, or similar evidences of interest in the securities; and

(ii) if the insurer knows or has reason to know that the form of holding securities of record is used primarily to circumvent the provisions of the Securities Exchange Act of 1934, 15 U.S.C. 78a, et seq, the beneficial owners of the securities are the record owners.

(b) An insurer may rely in good faith on such information as is received in response to its request from a nonaffiliated insurer of the certificates or evidence of interest.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-5 Filing Statements

(1) The following statements shall be used by an insurer when complying with this rule:

(a) Form A, Initial Statement of Beneficial Ownership of Equity Securities; and

(b) Form B, Statement of Changes in Beneficial Ownership of Securities.

(2) The forms listed in Subsection (1) are available on the department's website, https://insurance.utah.gov.

(3) An initial statement of beneficial ownership of an equity security under Section 31A-5-303 shall be filed on Form A.

(4) A statement regarding a change in beneficial ownership of equity securities shall be filed on Form B.

(a) A director or officer required to file a statement on Form B regarding a change in beneficial ownership of equity securities that occurs within six months after the director or officer became a director or officer of the insurer, or within six months after equity securities of the insurer are registered under Subsection 31A-5-303(1), shall include the information that caused the filing of the statement.

(b) A person who ceased to be a director or officer of an insurer with equity securities registered under Subsection 31A-5-303(1) shall file a statement on Form B regarding:

(i) a change in the person's beneficial ownership of equity securities of the insurer that occur on or after the date that the person ceased to be a director or officer; or

(ii) the date that the insurer ceased to have an equity security registered, if the change occurs within six months after any change in the beneficial ownership of the securities before that date.

(c) The statement on Form B shall be filed within 10 days after the end of the month in which the reported change in beneficial ownership occurs.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-6 Ownership of More Than 10% of an Equity Security

(1)(a) To determine if a person is the beneficial owner, directly or indirectly, of more than 10% of a class of an equity security, the class consists of the total amount of the class outstanding, excluding any securities of the class held by or for the account of the insurer or a subsidiary of the insurer.

(b) Except for the purpose of determining percentage ownership of voting trust certificates or certificates of deposit for equity securities, the class of voting trust certificates or certificates of deposit shall consist of the amount of voting trust certificates or certificates of deposit issuable with respect to the total amount of outstanding equity securities of the class that may be deposited under the voting trust agreement or deposit agreement in question, whether all of the outstanding securities are deposited.

(c) A person acting in good faith may rely on the information contained in the latest annual statement filed with the commissioner with respect to the number of securities of a class outstanding or, in the case of voting trust certificates or certificates of deposit, the amount issuable.

(2)(a) To determine if a person is the beneficial owner, directly or indirectly, of more than 10% of a class of equity securities, the person is the beneficial owner of securities of a class that the person has the right to acquire through the exercise of presently exercisable options, warrants, or rights, or through the conversion of presently convertible securities.

(b) The securities subject to such options, warrants, rights, or conversion privileges held by a person are outstanding for the purpose of computing the percentage of outstanding securities of the class owned by that person, but are not outstanding for the purpose of computing the percentage of the class owned by any other person.

(3) Subsection (2) does not relieve a person of a duty to comply with Section 31A-5-303 with respect to an equity security consisting of options, warrants, rights, or convertible securities that are subject as a class to Section 31A-5-303.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-7 Disclaimer of Beneficial Ownership

A person filing a statement may expressly declare, under Section 31A-5-303, that the filing of the statement may not be construed as an admission that a person is the beneficial owner of an equity security covered by the statement.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-8 Exemptions from Subsections 31A-5-303(1) and 31A-5-303(2)

(1) During the 12-month period following their appointment and qualification, securities held by the following persons are exempt from Subsections 31A-5-303(1) and 31A-5-303(2):

(a) an executor or administrator of the estate of a decedent;

(b) a guardian or committee for an incompetent; and

(c) a receiver, trustee in bankruptcy, assignee for the benefit of a creditor, conservator, liquidating agent, or other similar person duly authorized by law to administer the estate or assets of other persons.

(2) After the 12-month period following the appointment or qualification, the persons in Subsection (1) shall file reports regarding the securities held by the estates they administer under Subsection 31A-5-303(1), and are liable for profits realized from trading securities pursuant to Subsection 31A-5-303(2), only when the estate being administered is a beneficial owner of more than 10% of a class of equity security of an insurer subject to Section 31A-5-303.

(3) Securities reacquired by or for the account of an insurer and held by it for its account are exempt from Section 31A-5-303 during the time the securities are held by the insurer.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-9 Transactions Exempted from Subsection 31A-5-303(2)

An acquisition or disposition of an equity security by a director or officer of an insurer within six months before the effective date of Section 31A-5-303 applicable to the equity securities of the insurer is exempt from Subsection 31A-5-303(2).

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-10 Exemption From Section 31A-5-303 of Securities Purchased or Sold by Odd-Lot Dealers

Securities purchased or sold by an odd-lot dealer in odd lots to carry on odd-lot transactions, or in round lots to offset odd-lot transactions, executed in the usual course of business are exempt from Section 31A-5-303 regarding participation by the odd-lot dealer.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-11 Certain Transactions Subject to Subsection 31A-5-303(1)

(1) The acquisition or disposition of a transferable option, put, call, spread, or straddle is a change in the beneficial ownership of a security to which the privilege relates and requires the filing of a statement reflecting the acquisition or disposition of the privilege.

(2) Subsection (1) does not exempt a person from filing a statement required upon the exercise of an option, put, call, spread, or straddle.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-12 Ownership of Securities Held in Trust

(1)(a) "Immediate family of a trustee," as used in this section, means:

(i) a son or daughter of the trustee, or a descendant of either;

(ii) a stepson or stepdaughter of the trustee;

(iii) a father or mother of the trustee, or an ancestor of either;

(iv) a stepfather or stepmother of the trustee; and

(v) a spouse of the trustee.

(b) When determining a relation under Subsection (5)(a), a legally adopted child of a person is a child of the person by blood.

(2) Beneficial ownership of a security under Subsection 31A-5-303(1) includes:

(a) the ownership of securities as a trustee where either the trustee or a member of the trustee's immediate family has a vested interest in the income or corpus of the trust;

(b) the ownership of a vested beneficial interest in a trust; and

(c) the ownership of securities as a settlor of a trust in which the settlor has the power to revoke the trust without obtaining the consent of the beneficiaries.

(3)(a) Except as provided in Subsection (4), beneficial ownership of securities solely as a settlor or beneficiary of a trust are exempt from Section 31A-5-303 where less than 20% in market value of the securities having a readily ascertainable market value held by the trust, determined as of the end of the preceding fiscal year of the trust, consists of equity securities where reports would otherwise be required.

(b) Section 31A-5-303 exempts an obligation that is imposed solely by reason of ownership as settlor or beneficiary of securities held in trust, where the ownership, acquisition, or disposition of securities by the trust is made without prior approval by the settlor or beneficiary.

(c) An exemption under this Subsection (3) may not be acquired or lost solely as a result of changes in the value of the trust assets during any fiscal year or during any time when there is no transaction by the trust in securities otherwise subject to the reporting requirements of Subsection 31A-5-303(1).

(4) If 10% of a class of an equity security of an insurer is held in a trust, that trust and the trustees shall file the reports specified in Section 31A-5-303.

(5)(a) Only one report is required to report any holdings or with respect to any transaction in securities held by a trust, regardless of the number of officers, directors, or 10% stockholders who are either trustees, settlors, or beneficiaries of a trust, provided that the report filed discloses the names of trustees, settlors, and beneficiaries who are officers, directors, or 10% stockholders.

(b) A person having an interest only as a beneficiary of a trust is not required to file a report if the filer relies in good faith upon an understanding that the trustee of a trust will file the required reports of the beneficiary.

(6) To determine, for the purposes of Subsection 31A-5-303(1), whether a person is the beneficial owner, directly or indirectly, of more than 10% of any class of any equity security, the interest of a person in the remainder of a trust is excluded from the computation.

(7) A report is not required by any person, whether subject to the requirement of filing reports under Section 31A-5- 303, regarding the person's indirect interest in portfolio securities held by:

(a) a pension or retirement plan holding securities of an insurer whose employees generally are the beneficiaries of the plan; and

(b) a business trust with over 25 beneficiaries.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-13 Exemption for Small Transactions

(1) An acquisition of a security is exempt from Subsection 31A-5-303(1) if:

(a) the person effecting the acquisition does not, within six months after, effect any disposition other than by way of gift of a security of the same class; and

(b) the person effecting the acquisition does not participate in an acquisition or a disposition of a security of the same class having a total market value more than $3,000 for any six-month period during which the acquisition occurs.

(2) An acquisition or disposition of a security, by way of gift, where the total amount of gifts does not exceed $3,000 in market value for any six-month period, is exempt from Section 31A-5-303 and is excluded from the computations of Subsection (1)(b).

(3) A person exempted by Subsection (1) or (2) shall include in the first report filed, after a transaction within the exemption, a statement showing each acquisition and disposition for each six-month period or portion that elapsed since the last filing.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-14 Exemption From Subsection 31A-5-303(2) of Transactions That Need Not Be Reported Under Subsection 31A-5-303(1)

A transaction exempted from Subsection 31A-5-303(1), insofar as it is otherwise subject to the provisions of Subsection 31A-5-303(2), is likewise exempted from Subsection 31A-5-303(2).

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-15 Exemption from Subsection 31A-5-303(2) of Certain Transactions in Connection With a Distribution

(1) A transaction of purchase and sale, or sale and purchase, of a security in connection with the distribution of a substantial block of securities is exempt from Subsection 31A-5-303(2), to the extent specified in this section, upon the following conditions:

(a) the person carrying out the transaction is engaged in the business of distributing securities and is participating in good faith in the ordinary course of business in the distribution of a block of securities;

(b) the security involved in the transaction is:

(i) a part of a block of securities and is acquired by the person carrying out the transaction with a view to distribution from the insurer or other person on whose behalf securities are being distributed, or from a person who is participating in good faith in the distribution of a block of securities; or

(ii) a security purchased in good faith by or for the account of the person carrying out the transaction for the purpose of stabilizing the market price of securities of the class being distributed, or to cover an over-allotment or other short position created in connection with the distribution; and

(c) other persons not within the purview of Section 31A-5-303 are participating in the distribution of a block of securities on terms at least as favorable as those that a person is participating and to an extent at least equal to the aggregate participation of persons exempted from Section 31A-5-303.

(2) The performance of the functions of manager of a distributing group and the receipt of a bona fide payment for performing these functions does not preclude an exemption that is available under this section.

(3) The exemption of a transaction under this section regarding the participation of one party may not make the transaction exempt with respect to participation of any other party unless the other party also meets the conditions of this section.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-16 Exemption From Subsection 31A-5-303(2) of Acquisitions of Shares of Stock and Stock Options Under Certain Stock Bonus, Stock Option, or Similar Plans

(1) For purposes of this section, the following terms apply:

(a) "Plan" means any plan, whether set forth in a formal written document and whether approved in its entirety at one time.

(b) "Qualified stock option" and "employee stock purchase plan" mean the same as those terms are defined in Sections 422 and 423 of the Internal Revenue Code.

(d) "Exercise of an option, warrant, or right" does not include:

(i) the making of an election to receive, under a plan, an award of compensation in the form of stock or credits, provided that the election is made before the making of the award and that the election is irrevocable until at least six months after termination of employment;

(ii) the subsequent crediting of such stock;

(iii) the making of an election as to a time for delivery of the stock after termination of employment, provided that the election is made at least six months before delivery;

(iv) the fulfillment of a condition to the absolute right to receive stock; or

(v) the acceptance of certificates for shares of stock.

(2)(a) An acquisition of shares of stock is exempt from Subsection 31A-5-303(2) if the plan complies with this section.

(b) Notwithstanding Subsection (2)(a), an acquisition of shares of stock is not exempt if it is:

(i) acquired upon the exercise of an option, warrant, or right, pursuant to a stock bonus, profit sharing, retirement, incentive, thrift, savings, or similar plan;

(ii) an acquisition of a qualified or a restricted stock option pursuant to a qualified or a restricted stock option plan; or

(iii) a stock option pursuant to an employee stock purchase plan by a director or officer of an insurer issuing a stock or stock option.

(3)(a) The plan shall be approved, directly or indirectly, by:

(i) affirmative votes of the holders of a majority of the securities of the insurer present, or represented, and entitled to vote at a duly held meeting; or

(ii) written consent of the holders of a majority of the securities of an insurer entitled to vote.

(b) The insurer shall furnish the same information concerning the plan, in writing, to the holders of record of the securities entitled to vote for the plan, if:

(i) the vote or written consent was not solicited under the proxy rules of the NAIC in effect at the time of a vote or written consent; and

(ii) a proxy vote was solicited to approve or disapprove the plan.

(c) The information required by Subsection (2)(b) shall be furnished on or before the date of the first annual meeting of security holders held after the later of:

(i) the date Section 31A-5-303 first applies to the insurer; or

(ii) the acquisition of an equity security for which an exemption is claimed.

(d)(i) Written information may be furnished by mail to the last known address of the security holders of record within 30 days before the date of mailing.

(ii) The written information shall be filed with the commissioner no later than the date the written information is first provided to security holders of the insurer.

(e) "Insurer," for the purposes of this Subsection (3), includes a predecessor corporation if the plan or obligation to participate is assumed by the insurer in connection with the succession.

(4) Selection of a director or officer of the insurer may be subject to discretion if:

(a) the director or officer may be allocated stock;

(b) the director or officer may be granted qualified, restricted, or employee stock purchase plan stock options pursuant to the plan;

(c) a determination must be made regarding the number or maximum number of shares of stock that may be allocated to a director or officer, or that may be covered by qualified, restricted, or employee stock purchase plan stock options granted to a director or officer.

(5) If a selection in Subsection (4) is subject to discretion, the discretion shall be exercised as follows:

(a) with respect to the participation of a director:

(i) by the board of directors of the insurer, a majority of the board and a majority of the directors acting in the matter are disinterested persons;

(ii) by a committee of three or more persons having full authority to act in the matter, of the members of which are disinterested persons; or

(iii) in accordance with the plan if the plan:

(A) specifies the number or maximum number of shares of stock that directors may acquire or are subject to qualified, restricted, or employee stock purchase plan stock options granted to directors and the terms upon which, and the times at which, or the periods within which, the stock may be acquired or the options may be acquired and exercised; or

(B) sets forth, by formula or otherwise, effective and determinable limitations based upon earnings of the insurer, dividends paid, compensation received by participants, option prices, market value of shares, outstanding shares or percentages outstanding from time to time, or similar factors; or

(b) with respect to the participation of officers who are not directors:

(i) by the board of directors of the insurer or a committee of three or more directors; or

(ii) by a committee of three or more persons having full authority to act in the matter, of the members of which are disinterested persons.

(c) For the purposes of this Subsection (5), a director or committee member is a disinterested person only if the person is not eligible at the time the discretion is exercised, and has not at any time within the past year, been eligible for selection as a person to whom stock may be allocated or to whom qualified, restricted, or employee stock purchase plan stock options are granted pursuant to the plan, or any other plan of the insurer, or any of its affiliates entitling the participants to acquire stock, or qualified, restricted, or employee stock purchase plan stock options of the insurer or any of its affiliates.

(d) This Subsection (5) does not apply to an option granted, or other equity security acquired, before the date that Subsections 31A-5-303(1) through 31A-5-303(3) first applied to a class of equity security of an insurer.

(6)(a) For a participant that a plan limits the aggregate dollar amount or the aggregate number of shares of stock that may be allocated, or are subject to qualified, restricted, or employee stock purchase plan stock options granted, pursuant to the plan, the limitations may be established on an annual basis, or for the duration of the plan, whether the plan has a fixed termination date, and may be determined either by fixed or maximum dollar amounts, or fixed or maximum numbers of shares, or by formulas based upon earnings of the insurer, dividends paid, compensation received by participants, option prices, market value of shares, outstanding shares, or percentages outstanding from time to time, or similar factors that will result in an effective and determinable limitation.

(b) The limitations may be subject to a provision for adjustment of the plan or of stock allocable or portions outstanding to prevent dilution or enlargement of rights.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-17 Exemption from Subsection 31A-5-303(2) of Certain Transactions in Which Securities Are Received by Redeeming Other Securities

An acquisition of an equity security, other than a convertible security or right to purchase a security, by a director or officer of the insurer issuing the security, is exempt from Subsection 31A-5-303(2) if:

(1) the equity security is acquired by way of redemption of another security of an insurer whose assets, other than cash or government bonds, consist of securities of the insurer issuing the acquired equity security and which:

(a) is a stated or readily ascertainable amount of the equity security;

(b) has a value that is determined by the value of the equity security; and

(c) confers upon the holder the right to receive the equity security without the payment of consideration other than the security redeemed;

(2) no security of the same class as the security redeemed is acquired by the director or officer within:

(a) six months before redemption; or

(b) six months after redemption; and

(3) the insurer issuing the equity security acquired recognizes the applicability of Subsection (1) by appropriate corporate action.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-18 Exemption of Long-Term Profits Incident to Sales Within Six Months of the Exercise of an Option

(1) To the extent specified in Subsection (2), a transaction involving the purchase and sale, or sale and purchase, of an equity security, where the purchase is pursuant to the exercise of an option or similar right, is exempt if:

(a) acquired more than six months before its exercise; or

(b) acquired pursuant to the terms of an employment contract entered into more than six months before its exercise.

(2)(a) The profits inuring to the insurer may not exceed the difference between the proceeds of the sale and the lowest market price of a security of the same class within six months before or after the date of sale.

(b) This Section R590-68-18 does not enlarge the amount of profit that inures to the insurer in the absence of this section.

(3) The disposition of a security purchased in a transaction under Subsection (1) is exempt from Section 31A-3-505, pursuant to a plan or agreement for merger or consolidation, or reclassification of the insurer's securities, or for the exchange of its securities for the securities of another person that acquired its assets, or which is in control, as defined in Subsection 368(c) of the Internal Revenue Code, of a person who acquired its assets, where the terms of the plan or agreement are binding upon stockholders of the insurer except to the extent that dissenting stockholders are entitled, under statutory provisions or provisions contained in the certificate of incorporation, to receive the appraised or fair value of their holdings.

(4) The exemptions under this section do not apply to a transaction prohibited by Subsection 31A-5-303(3) or this rule.

(5) The burden of establishing market price of a security under this section is on the person claiming the exemption.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-19 Exemption From Subsection 31A-5-303(2) of Certain Acquisitions and Dispositions of Securities Pursuant to Merger or Consolidation

(1) The following transactions are exempt from Subsection 31A-5-303(2):

(a) the acquisition of a security of an insurer, pursuant to a merger or consolidation, in exchange for a security of a company that, before merger or consolidation, owned 85% or more of the equity securities of a company involved in the merger or consolidation except, in the case of consolidation, the resulting company;

(b) the disposition of a security, pursuant to a merger or consolidation of an insurer that, before merger or consolidation, owned 85% or more of the equity securities of a company involved in the merger or consolidation except, in the case of consolidation, the resulting company;

(c) the acquisition of a security of an insurer, pursuant to a merger or consolidation, in exchange for a security of a company that, before merger or consolidation, held over 85% of the combined assets of the companies undergoing merger or consolidation, computed according to their book values before the merger or consolidations as determined by reference to their most recent available financial statements for a 12-month period before the merger or consolidation; or

(d) the disposition of a security, pursuant to a merger or consolidation, of an insurer that, before merger or consolidation, held over 85% of the combined assets of the companies undergoing merger or consolidation, computed according to their book values before merger or consolidation, as determined by reference to their most recent available financial statements for a 12-month period before the merger or consolidation.

(2) A merger includes the sale or purchase of substantially all the assets of one insurer by another in exchange for stock that is then distributed to the security holders of the insurer that sold its assets.

(3) If an officer, director, or stockholder makes a purchase, other than a purchase exempted by this section, of a security in any company involved in the merger or consolidation and any sale, other than an exempted sale, of a security in any other company involved in the merger or consolidation within a period of less than six months during which the merger or consolidation took place, the exemption is unavailable to the officer, director, or stockholder.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-20 Exemption from Subsection 31A-5-303(2) of Certain Transactions Involving the Conversion of Equity Securities

(1) An acquisition or disposition of an equity security involved in the conversion of an equity security that, by its terms or pursuant to the terms of the insurer's charter or other governing instrument, is convertible immediately or after a stated period into another equity security of the same insurer, is exempt from Subsection 31A-5-303(2) if:

(a) a purchase of an equity security of the class convertible, including an acquisition of or change in a conversion privilege, and a sale is made of an equity security of the class issuable upon conversion; or

(b) a sale of an equity security of the class convertible and a purchase is made of an equity security issuable upon conversion, other than in a transaction involved in the conversion or in a transaction exempted under Subsection 31A-5-303(2), within a period of less than six months, including the date of conversion.

(2) An equity security may not be acquired or disposed of upon conversion of an equity security if the terms of the equity security converted require the payment or entail the receipt, in connection with the conversion, of cash or other property in connection with the conversion, of cash or other property, other than equity securities involved in the conversion, equal in value at the time of conversion to more than 15% of the value of the equity security issued upon conversion.

(3) An equity security is convertible if it is convertible at the option of the holder, some other person, or by operation of the terms of the security or the governing instruments.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-21 Exemption from Subsection 31A-5-303(2) of Certain Transactions Involving the Sale of Subscription Rights

(1) For purposes of this section, the following terms apply:

(a) "Subscription right" means any warrant or certificate evidencing a right to subscribe to, or otherwise acquire, an equity security.

(b) "Beneficiary security" means a security registered, pursuant to Section 12 of the Securities Exchange Act of 1934, 15 U.S.C. 78a, et seq., to the holders of which a subscription right is granted.

(2) A sale of a subscription right to acquire a subject security of the same insurer is exempt from Subsection 31A-5- 303(2) if:

(a) the subscription right is acquired, directly or indirectly, from the insurer without the payment of consideration;

(b) the subscription right, by its terms, expires within 45 days after issuance;

(c) the subscription right, by its terms, is issued on a pro rata basis to all holders of the beneficiary security of the insurer; and

(d) a registration statement under the Securities Act of 1933 is in effect as to each subject security, or the applicable terms of any exemption from registration are met with respect to each subject security.

(3) If a person purchases subscription rights for cash or other consideration, then a sale by such person of subscription rights otherwise exempted by this section is not exempted to the extent of such purchases within the six-month period preceding or following the sale.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-22 Exemption of Certain Securities From Subsection 31A-5-303(3)

A security is exempt from Subsection 31A-5-303(3) if necessary for the execution by a broker of an order for an account in which the broker has no direct or indirect interest.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-23 Exemption From Subsection 31A-5-303(3) of Certain Transactions Effected in Connection With a Distribution

(1) A security is exempt from Subsection 31A-5-303(3), if necessary for a sale made by or on behalf of a dealer in connection with a distribution of a substantial block of securities, if:

(a) the sale is represented by an over-allotment in which the dealer is participating as a member of an underwriting group, or the dealer or a person acting on the underwriter's behalf intends, in good faith, to offset the sale with a security to be acquired by or on behalf of the dealer as a participant in an underwriting, selling, or soliciting-dealer group that the dealer is a member of at the time of the sale, whether the security to be acquired is subject to a prior offering to existing security holders or some other class of persons; and

(b) other persons not within the purview of Subsection 31A-5-303(3) are participating in the distribution of the block of securities on terms at least as favorable as those on which the dealer is participating and to an extent at least equal to the aggregate participation of persons exempted from Subsection 31A-5-303(3).

(2) The performance of the functions of manager of a distributing group and the receipt of a bona fide payment for performing these functions may not preclude an exemption that is otherwise available under this section.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-24 Exemption From Subsection 31A-5-303(3) of Sales of Securities to Be Acquired

(1) When a person is entitled, as an incident to ownership of an issued security and without the payment of consideration, to receive another security when issued or when distributed, the security to be acquired is exempt from Subsection 31A-5-303(3) if:

(a) the sale is made subject to the same conditions as those attaching to the right of acquisition;

(b) a person exercises reasonable diligence to deliver the security to the purchaser promptly after the right of acquisition matures; and

(c) a person reports the sale on the appropriate form for reporting transactions by persons subject to Subsection 31A-5- 303(1).

(2) This section may not be construed as exempting a transaction involving both a sale of a security when issued or when distributed, and a sale of the security by virtue of which the seller expects to receive the security, if the two transactions combined result in a sale of more units than the aggregate of those owned by the seller plus those to be received pursuant to the right of acquisition.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-25 Arbitrage Transactions Under Subsection 31A-5-303(3)

(1) A director or officer of an insurer may not effect a foreign or domestic arbitrage transaction in an equity security of an insurer unless the director or officer:

(a) includes the transaction in the statements required by Subsection 31A-5-303(1); and

(b) accounts to an insurer for the profits arising from the transaction as provided in Subsection 31A-5-303(2).

(2) Subsection 31A-5-303(3) does not apply to an arbitrage transaction.

(3) Section 31A-5-303 does not apply to any bona fide foreign or domestic arbitrage transaction effected by a person other than the director or officer of the insurer.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

Utah Admin. Code R590-68-26 Severability

If any provision of this rule, Rule R590-68, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: June 9, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-5-303

R590-70 Insurance Holding Companies

Utah Admin. Code R590-70-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-16-116.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-2 Purpose and Scope

(1)(a) The purpose of this rule is to establish procedures that are necessary to carry out the National Association of Insurance Commissioners' Insurance Holding Company System Regulatory Act and Title 31A, Chapter 16, Insurance Holding Companies.

(b) The commissioner declares that the information called for by the Act and Title 31A, Chapter 16, Insurance Holding Companies, is necessary and appropriate, in the public interest, and for the protection of the policyholders in this state.

(2) This rule applies to a person that is a member of an insurance group within an insurance holding company system.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-3 Definitions

Terms used in this rule are defined in Section 31A-1-301 and Title 31A, Chapter 16, Insurance Holding Companies. Additional terms are defined as follows:

(1) The "Act" means the NAIC Insurance Holding Company System Regulatory Act.

(2) "Executive officer" means chief executive officer, chief operating officer, chief financial officer, treasurer, secretary, controller, and any other individual performing functions corresponding to those performed by the officers listed above under any other title.

(3) "NAIC" means the National Association of Insurance Commissioners.

(4) "Ultimate controlling person" means a person that is not controlled by any other person.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-4 Forms -- General Requirements

(1)(a) Form A, Form B, Form C, Form D, Form E, and Form F are intended to be guides for preparing statements required by Sections 31A-16-103, 31A-16-105, and 31A-16-106.

(b) The forms listed in Subsection (1)(a) are blank forms that are not intended to be filled in.

(c) Each statement filed shall contain the numbers and captions of each item, except that the text of the items may be omitted if the answers clearly indicate the scope and coverage of the items.

(d) Any instructions appearing under the items of the form or elsewhere shall be omitted.

(e) Unless otherwise required, if any item is inapplicable or the answer to the item is in the negative, a statement shall be made to that effect.

(2)(a) Each statement, including exhibits and any other documents filed as a part of the statement, shall be filed with the commissioner in a secure electronic form.

(b) Each statement shall be signed in the manner prescribed on the form. If the signature of any person is affixed pursuant to a power of attorney or other similar authority, a copy of the power of attorney or other authority shall be filed with the statement.

(3) If an applicant requests a consolidated hearing under Subsection 31A-16-103(10), the applicant shall file in electronic form:

(a) the Form A with the commissioner; and

(b) a copy of the Form A with the NAIC.

(4)(a) Each statement should be prepared electronically.

(b) Each statement shall be easily readable and suitable for review and reproduction.

(d) Each statement shall be in the English language.

(e) Monetary value shall be stated in United States currency.

(f) Any exhibit or other document filed with the statement in a foreign language shall be accompanied by an English language translation.

(g) Any monetary value shown in a foreign currency normally shall be converted into United States currency.

(5) Form A, Form B, Form C, Form D, Form E, and Form F can be obtained from the department's website at https://insurance.utah.gov.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-5 Forms -- Incorporation by Reference, Summaries and Omissions

(1)(a) Information required by any item of Form A, Form B, Form D, Form E, or Form F may be incorporated by reference in answer or partial answer to any other item.

(b) Information contained in any financial statement, annual report, proxy statement, statement filed with a governmental authority, or any other document may be incorporated by reference in answer or partial answer to any item of Form A, Form B, Form D, Form E, or Form F, provided the document is filed as an exhibit to the statement.

(d) A document currently on file with the department that was filed within three years need not be attached as an exhibit.

(e) A reference to information contained in an exhibit or in a document already on file with the department shall:

(i) clearly identify the material; and

(ii) specifically indicate that the material is to be incorporated by reference in answer to the item.

(f) Matter may not be incorporated by reference if incorporating by reference makes the statement incomplete, unclear, or confusing.

(2)(a) When an item requires a summary or outline of the provisions of any document, only a brief statement of the document's pertinent provisions shall be summarized or outlined.

(b) The summary or outline may incorporate by reference parts of any exhibit or document currently on file with the commissioner that:

(i) was filed within three years; and

(ii) may be qualified in its entirety by the incorporated reference.

(c) When two or more documents required to be filed as exhibits are substantially identical in all material respects, except for the parties to the document, the dates of execution, or other details, a copy of only one of the documents need be filed.

(d) The document referenced in Subsection (2)(b) to be filed shall be accompanied by a schedule that:

(i) identifies the omitted documents; and

(ii) provides material details regarding the differences between the documents.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-6 Forms -- Information Unknown or Unavailable and Extension of Time to Furnish

(1) A request for extension of time shall be filed with the commissioner when it is impractical to furnish any required information, document, or report at the required time.

(2) A request for extension of time shall:

(a) identify the information, document, or report in question;

(b) state why it is impractical to furnish the information, document, or report at the time required; and

(3) A request for extension shall be granted unless the commissioner enters an order denying the request within 60 days after receipt of the request.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-7 Forms -- Additional Information and Exhibits

(1) In addition to the information required to be included in Form A, Form B, Form C, Form D, Form E, and Form F, the commissioner may request additional information that may be necessary to ensure the information contained in the form is not misleading.

(2) The person filing the form may also file any other exhibit in addition to the exhibits required by the statement.

(3) Any additional exhibit shall be clearly marked to indicate the subject matter to which the exhibit refers.

(4) Any change to Form A, Form B, Form C, Form D, Form E, or Form F shall include:

(a) the phrase "Change No. (insert number) to" at the top of the cover page; and

(b) the date the form was changed and not the original filing date.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-8 Subsidiaries of Domestic Insurers

The authority to invest in a subsidiary under Subsection 31A-16-102.5(2) is in addition to any authority to invest in a subsidiary that may be contained in Title 31A, Insurance Code.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-9 Acquisition of Control -- Statement Filing (Form A)

(1) A person required to file a statement under Section 31A-16-103 shall furnish the required information on Form A.

(2) The person in Subsection (1) required to file a Form A shall also furnish the required information on Form E, as described in Section R590-70-12.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-10 Amendments to Form A

(1)(a) An applicant shall promptly notify the commissioner of any change in the information furnished on the Form A arising after the date the applicant furnished the information to the commissioner.

(b) The applicant shall notify the commissioner of the change in information prior to the commissioner's final decision regarding the application.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-11 Acquisition of Subsection 31A-16-103(1)(f)(i) Insurers

(1) If a person being acquired is a "domestic insurer" under Subsection 31A-16-103(1)(f)(i), the name of the domestic insurer on the cover page should be indicated as "ABC Insurance Company, a subsidiary of XYZ Holding Company."

(2) When a Subsection 31A-16-103(1)(f)(i) insurer is being acquired, references to "the insurer" contained in the Form A shall refer to the domestic subsidiary insurer and the person being acquired.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-12 Pre-acquisition Notification (Form E)

(1) If a domestic insurer, including any person controlling a domestic insurer, proposes a merger or acquisition under Subsection 31A-16-103(1), that person shall file a Form E pre-acquisition notification form.

(2)(a) If a non-domiciliary insurer licensed to do business in this state proposes a merger or acquisition under Section 31A- 16-104.5, that person shall file a Form E pre-acquisition notification form.

(b) No pre-acquisition notification form need be filed if the acquisition is beyond the scope of Section 31A-16-104.5 as set forth in Subsection 31A-16-104.5(2)(b).

(3) In addition to the information required by Form E, the commissioner may require an expert opinion regarding the competitive impact of the proposed acquisition.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-13 Annual Registration of Insurers -- Statement Filing (Form B)

An insurer required to file an annual registration statement pursuant to Section 31A-16-105 shall furnish the required information on Form B.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-14 Summary of Registration -- Statement Filing (Form C)

An insurer required to file an annual registration statement pursuant to Section 31A-16-105 shall furnish the required information on Form C.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-15 Amendments to Form B

(1) An amendment to Form B shall be filed within 15 days after the end of any month in which there is a material change to the information provided in the annual registration statement.

(2) An amendment shall be filed in the Form B format reporting only those items that are being amended.

(3) An amendment shall include at the top of the cover page "Amendment No. (insert number) to Form B for (insert year)", and shall provide the date of the change and not the original filing date.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-16 Alternative and Consolidated Registrations

(1)(a) Any authorized insurer may file a registration statement on behalf of any affiliated insurer that is required to register under Section 31A-16-105.

(b) A registration statement may include information not required by the Act and Title 31A, Chapter 16, Insurance Holding Companies, regarding any insurer in the insurance holding company system even if the insurer is not authorized to do business in this state.

(c) In lieu of filing a registration statement on Form B, an authorized insurer may file a copy of the required registration statement or similar report in the insurer's state of domicile, provided that:

(i) the statement or report contains substantially similar information required to be furnished on F orm B; and

(ii) the filing insurer is the principal insurance company in the insurance holding company system.

(2) An insurer filing a registration statement or report in lieu of Form B on behalf of an affiliated insurer shall set forth a brief statement of facts that substantiate the filing insurer's claim that it, in fact, is the principal insurer in the insurance holding company system.

(3) With the prior approval of the commissioner, an unauthorized insurer may follow any procedure that an authorized insurer may follow under Subsection (1).

(4) Any insurer may use the procedures in Subsections 31A-16-105(8) or 31A-16-105(9) without the commissioner's prior approval.

(5) The commissioner may require individual filings if the commissioner determines that the filings are necessary for clarity, ease of administration, or the public good.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-17 Disclaimers and Termination of Registration

(1) A disclaimer of affiliation or a request for termination of registration claiming that a person does not control any other person, or that a person will not control any other person upon the taking of some proposed action, hereinafter the "other person" referred to as the "subject", shall contain the following information:

(a) the number of the subject's authorized, issued, and outstanding voting securities;

(b) regarding the person denying control and the person's affiliates:

(i) the number and percentage of the subject's shares of voting securities that are held of record or known to be beneficially owned;

(ii) the number of the subject's shares held of record or beneficially owned in which there is a right to acquire, directly or indirectly; and

(iii) information regarding all transactions in any voting securities of the subject effected by the person denying control or the person's affiliates during the past six months.

(c) all material relationships and bases for affiliation between the subject and the person denying control and the person's affiliates; and

(d) a statement explaining why the person denying control does not control the subject.

(2) A request for termination of registration shall be granted unless the commissioner notifies the registrant that the request is denied within 30 days after receipt of the request.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-18 Transactions Subject to Prior Notice -- Notice Filing

(1) An insurer required to give notice of a proposed transaction pursuant to Section 31A-16-106 shall furnish the required information on Form D.

(2) An agreement for cost sharing services and management services shall at a minimum and as applicable:

(a) identify the person providing services and the nature of the services;

(b) provide the methods used to allocate costs;

(c) require timely settlement, not less frequently than on a quarterly basis, and in compliance with the requirements in the Accounting Practices and Procedures Manual;

(d) prohibit the insurer from advancing funds to the affiliate except to pay for services defined in the agreement;

(e) state that the insurer will maintain oversight for services provided to the insurer by the affiliate and that the insurer will monitor services annually for quality assurance;

(f) define the insurer's books and records to include all books and records developed or maintained under or related to the agreement;

(g) specify that the insurer's books and records are and remain the property of the insurer and are subject to the insurer's control;

(h) state that all of the insurer's funds and invested assets are the insurer's exclusive property, held for the insurer's benefit, and are subject to the insurer's control;

(i) include standards for terminating the agreement with and without cause;

(j) include provisions for indemnification of the insurer in the event of gross negligence or willful misconduct on the part of the affiliate providing the services;

(k) specify that, if the insurer is placed in receivership or seized by the commissioner under Title 31, Chapter 27a, Insurer Receivership Act:

(i) all of the insurer's rights under the agreement shall extend to the receiver or the commissioner;

(ii) all books and records will immediately be made available to the receiver or the commissioner; and

(iii) all books and records shall immediately be turned over to the receiver or the commissioner upon the receiver or the commissioner's request;

(l) specify that the affiliate has no automatic right to terminate the agreement if the insurer is placed in receivership pursuant to Title 31, Chapter 27a, Insurer Receivership Act; and

(m) specify that the affiliate will continue to maintain any system, program, or other infrastructure notwithstanding a seizure by the commissioner under Title 31, Chapter 27a, Insurer Receivership Act, and will make any system, program, or other infrastructure available to the receiver, for so long as the affiliate continues to receive timely payment for services rendered.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-19 Enterprise Risk Report

The ultimate controlling person of an insurer required to file an enterprise risk report pursuant to Subsection 31A-16-105(12) shall furnish the required information on Form F.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-20 Extraordinary Dividends and Other Distributions

(1) A request for approval of an extraordinary dividend or any other extraordinary distribution to shareholders shall include the following:

(a) the amount of the proposed dividend;

(b) the date established for payment of the dividend;

(d) for dividends in property, the statement referenced in Subsection (1)(c) shall include:

(i) a description of the property;

(ii) the cost of the property;

(iii) the fair market value of the property; and

(iv) an explanation of the basis for the valuation of the property;

(e) a work paper that shall include the following information:

(i) the calculations used to determine that the proposed dividend is extraordinary;

(ii) the amounts of the proposed dividend;

(iii) the date of the proposed dividend;

(iv) the form of payment of all dividends or distributions, including regular dividends, except for distributions of the insurer's own securities that are paid within a consecutive 12-month period that:

(A) ends on the date fixed for payment of the proposed dividend for which approval is sought; and

(B) begins on the day after the same day of the same month in the last preceding year;

(v) surplus as regards policyholders, total capital and surplus, as of the 31st day of December next preceding;

(vi) for a life insurer, the net gain from operations for the 12-month period ending the 31st day of December next preceding;

(vii) for an insurer that is not a life insurer, the net income less realized capital gains for the 12-month period ending the 31st day of December next preceding and the two preceding 12-month periods; and

(viii) for an insurer that is not a life insurer, the dividends paid to stockholders in the preceding two calendar years, excluding distributions of the insurer's own securities;

(f) a balance sheet and income statement for the period beginning on the date the last annual statement was filed with the commissioner and concluding at the end of the month preceding the month in which the request for dividend approval is submitted; and

(g) a brief statement regarding the proposed dividend's effect upon:

(i) the insurer's surplus and reasonableness of surplus in relation to the insurer's outstanding liabilities; and

(ii) the adequacy of the insurer's surplus relative to the insurer's financial needs.

(2)(a) Subject to Subsection 31A-16-106(2), each registered insurer shall report to the commissioner all dividends and other distributions to shareholders within 15 business days of declaring the dividend or other distribution.

(b) The report to the commissioner in Subsection (2)(a) shall include the information required by Subsection (1)(e).

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-21 Adequacy of Surplus

(1) In determining the adequacy and reasonableness of an insurer's surplus, the commissioner will consider the net effect of the factors set forth in Subsection 31A-16-106(4) and any other factors that, alone or in combination, bear upon the insurer's financial condition.

(2) In comparing the surplus maintained by other insurers, the commissioner will consider the extent to which each factor set forth in Subsection 31A-16-106(4) varies from company to company.

(3) In determining the quality and liquidity of an insurer's investments in subsidiaries, the commissioner will consider the individual subsidiary and may discount or disallow the subsidiary's valuation if warranted by the indivi dual investments.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-70-22 Severability

If any provision of this rule, Rule R590-70, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: October 25, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-79 Life Insurance Disclosure Rule

Utah Admin. Code R590-79-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-425.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-79-2 Purpose and Scope

(1) The purpose of this rule is to require an insurer to provide to a life insurance purchaser information to assist the purchaser in selecting a plan of life insurance appropriate for the purchaser's needs.

(2) This rule applies to:

(a) any solicitation, negotiation, or procurement of life insurance within this state; and

(b) any issuer of a life insurance contract including a fraternal benefit society.

(3) Unless otherwise included, this rule does not apply to:

(a) an annuity;

(b) credit life insurance;

(c) group life insurance, except that a disclosure relating to a preneed funeral contract or prearrangement shall extend to the issuance or delivery of a certificate as well as to the policy;

(d) a life insurance policy issued in connection with a pension and welfare plan as defined by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18, et seq.; or

(e) variable life insurance.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-79-3 Definitions

Terms used in this rule are defined in Section 31A-1-301 and Rule R590-177. Additional terms are defined as follows:

(1) "Buyer's guide" means a document that contains, and is limited to, the language contained in the "Life Insurance Buyer's Guide," as adopted and periodically amended by the National Association of Insurance Commissioners.

(2) "Current scale of nonguaranteed elements" means a formula or other mechanism that produces values for an illustration as if there is no change in the basis of those values after the time of illustration.

(3) "Generic name" means a short title descriptive of the policy being illustrated such as "whole life," "term life," or "flexible premium adjustable life."

(4)(a) "Nonguaranteed element" means a premium, benefit, value, credit, or charge under a life insurance policy that is not guaranteed or not determined at issue.

(b) An element is considered nonguaranteed if any underlying nonguaranteed element is used in its calculation.

(5) "Policy data" means a display or schedule of numerical values, both guaranteed and nonguaranteed, for each policy year or a series of designated policy years of the following information:

(a) illustrated annual, other periodic, and terminal dividends;

(b) premiums;

(d) cash surrender values; and

(e) endowment benefits.

(6) "Policy summary" means a written statement describing only the guaranteed elements of the policy.

(7) "Preneed funeral contract" and "prearrangement" each mean an agreement by or for an individual before that individual's death relating to the purchase or provisions of specific funeral or cemetery merchandise or services.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-79-4 Disclosure Requirements

(1) The insurer shall provide a buyer's guide and either a policy summary or illustration when the policy is delivered or prior to delivery of the policy if requested.

(2)(a) The policy summary must be a separate document.

(b) Any information required to be disclosed must be displayed in a way that does not minimize or obscure any portion of the information.

(c) Any amount that remains level for two or more years of the policy may be represented by a single number if it is clearly indicated which amount applies for each policy year.

(d) An amount in Subsection (3)(e) shall be listed in total, not on a per-thousand nor per-unit basis.

(e) If more than one insured is covered under one policy or rider, a death benefit shall be displayed separately for each insured or for each class of insureds if death benefits do not differ within the class.

(f) A zero amount shall be displayed as zero and may not be displayed as a blank space.

(3) A policy summary must include the following information:

(a) A prominently placed title as follows: STATEMENT OF POLICY COST AND BENEFIT INFORMATION.

(b) The name and address of the insurance producer or, if no producer is involved, the procedure to be followed to receive a response to an inquiry regarding the policy summary.

(c) The full name and home office or administrative office address of the company in which the life insurance policy is to be or has been written.

(d) The generic name of the policy and each rider.

(e) The following amounts, where applicable, for the first five policy years and representative policy years thereafter, sufficient to illustrate the premium and benefit patterns, including the 10th and 20th policy years, and at least one age from 60 through 65 or maturity, whichever is earlier:

(i) The annual premium for the policy.

(ii) The annual premium for each optional rider.

(iii) The guaranteed amount payable upon death, at the beginning of the policy year regardless of the cause of death or other specifically enumerated exclusion, that is provided by the policy and each optional rider, with benefits provided under the policy and each rider shown separately.

(iv) The total guaranteed cash surrender values at the end of the year with values shown separately for the policy and each rider.

(v) The guaranteed endowment amounts payable under the policy that are not included under the guaranteed cash surrender values in Subsection (3)(e)(iv).

(f)(i) The effective policy loan annual percentage interest rate, if the policy contains this provision, specifying whether this rate is applied in advance or in arrears.

(ii) If the policy loan interest rate is adjustable, the policy summary shall indicate the maximum annual percentage rate and shall indicate that the annual percentage rate will be determined by the company in accordance with the provisions of the policy and applicable law.

(g) The date on which the policy summary is prepared.

(4) For the purposes of this rule, the annual premium for a policy or rider, for which the company reserves the right to change the premium, shall be the maximum annual premium.

(5) For a policy commonly called "universal life insurance" and any similarly structured policy, the policy summary shall indicate when the policy will expire based on the interest rates and mortality rates and other charges guaranteed in the policy and the anticipated or assumed annual premiums shown in the policy summary.

(6) Upon request by the policyholder, the insurer shall furnish either policy data or an in-force illustration as follows:

(a) For a policy issued prior to January 1, 1997, the insurer shall furnish policy data or an in-force illustration.

(b) For a policy issued on or after January 1, 1997, and declared not to be used with an illustration, the insurer shall furnish policy data, limited to guaranteed values or an in-force illustration.

(c) For a policy issued on or after January 1, 1997, and declared to be used with an illustration, the insurer shall provide an in-force illustration.

(d)(i) Unless otherwise requested, the policy data shall be provided for 20 consecutive years beginning with the previous policy anniversary.

(ii) The statement of policy data shall include nonguaranteed elements according to the current scale, the amount of outstanding policy loans, and the current policy loan interest rate.

(iii) Any policy value shown shall be based on the current application of nonguaranteed elements in effect at the time of the request.

(iv) The insurer may charge a reasonable fee for the preparation of the statement after providing one annually without charge.

(7) For a life insurance policy or certificate with a death benefit not exceeding $15,000:

(a) the insurer shall disclose the following:

(i) the limited death benefit whenever a policy limits death benefits during a period following the inception date of coverage; and

(ii) the possibility that premiums paid over several years may exceed the death benefit whenever that possibility exists; and

(b) the disclosure shall be provided to the applicant no later than delivery of the policy or certificate.

(8) The following information shall be disclosed at the time an application is made for a preneed funeral contract or prearrangement that is or will be funded by a life insurance policy, prior to accepting the applicant's initial premium or deposit:

(a) the fact that a life insurance policy is involved or is being used to fund a prearrangement;

(b) the nature of the relationship among the soliciting producer or producers, the provider of the funeral or cemetery merchandise or services, the administrator, and any other person;

(c) the relationship of the life insurance policy to the funding of the prearrangement and the nature and existence of any guarantees relating to the prearrangement;

(d) the impact on the prearrangement of any:

(i) changes in the life insurance policy, including changes in the assignment, beneficiary designation, or use of the proceeds;

(ii) penalties to be incurred by the policyholder due to failure to make premium payments; and

(iii) penalties to be incurred or monies to be received due to cancellation or surrender of the life insurance policy;

(f) a list of the merchandise and services that are applied or contracted for in the prearrangement and any relevant information concerning the price of the funeral services, including an indication that the purchase price is either guaranteed at the time of purchase or to be determined at the time of need;

(g) any information concerning what occurs and whether any entitlements or obligations arise if there is a difference between the proceeds of the life insurance policy and the amount needed to fund the prearrangement; and

(h) whether a sales commission or other form of compensation is being paid and the identity of each individual or entity to whom it is paid.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-79-5 General Requirements

(1) Each insurer shall maintain at its home office or principal office, a complete and accurate record of each document provided to the policyholder under this rule.

(2)(a) A producer shall inform a prospective purchaser, prior to commencing a life insurance sales presentation, that the producer is acting as a life insurance producer.

(b) A producer shall inform the prospective purchaser of the full name of the insurance company the producer is representing.

(d) A presentation commences with an initial contact with a prospective purchaser in person, by telephone, by electronic communication, or by way of printed materials, particularly where rates or values are quoted or when policy or contract representations are made.

(3) A producer shall not use terms such as financial planner, investment advisor, financial consultant, or financial counseling:

(a) unless properly licensed if required; or

(b) to imply that the producer is generally engaged in an advisory business where compensation is unrelated to sales unless such is the case and is represented by way of a required disclosure.

(4) Any reference to a nonguaranteed element shall include:

(a) a statement that the item is not guaranteed and is based on the company's current scale of nonguaranteed elements;

(b) a statement that a nonguaranteed element may be reduced by the existence of a policy loan shall be included in any reference to a nonguaranteed element; and

(c) a presentation or depiction of a policy issued on or after January 1, 1997, that includes nonguaranteed elements over a period of years shall be governed by Rule R590-177.

(5) The policy summary, the illustration, and any other sales materials must be complete, consistent, and not mis leading.

(6) If the policy will lapse under the guaranteed assumptions unless a premium higher than the planned premium is paid, that fact must be disclosed and the date, policy duration, or attained age of lapse must be disclosed in the policy summary and any periodic report.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-79-6 Failure to Comply

Failure of an insurer to provide a buyer's guide and either a policy summary or illustration, as provided in this rule is an omission that misrepresents the benefits, advantages, conditions, or terms of an insurance policy.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-79-7 Severability

If any provision of this rule, Rule R590-79, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-83 Unfair Discrimination on the Basis of Gender or Marital Status

Utah Admin. Code R590-83-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-402.

History

KEY: insurance law
Date of Last Change: December 9, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402; 31A-2-201

Utah Admin. Code R590-83-2 Purpose and Scope

(1) The purpose of this rule is to identify and define certain practices that the commissioner finds are unfair and discriminatory.

(2) This rule applies to an insurer engaged in the business of insurance.

History

KEY: insurance law
Date of Last Change: December 9, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402; 31A-2-201

Utah Admin. Code R590-83-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance law
Date of Last Change: December 9, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402; 31A-2-201

Utah Admin. Code R590-83-4 Availability Requirements and Prohibited Transactions

(1) An insured or prospective insured may not be denied coverage on the basis of gender or marital status.

(a) The amount of benefits payable, or any term, condition, or type of coverage may not be restricted, modified, excluded, or reduced on the basis of gender or marital status.

(b) Marital status may not be considered when defining eligibility for dependent or family coverage.

(2) Prohibited practices include:

(a) denying, canceling or refusing to renew coverage, or providing coverage on different terms, because the insured or prospective insured is residing with another person not related by blood or marriage;

(b) offering coverage to an individual of a particular gender gainfully employed at home, employed part-time, or employed by relatives while denying or offering reduced coverage to an individual of a different gender similarly employed;

(c) reducing disability benefits for an individual of a particular gender who becomes disabled while not gainfully employed full-time outside the home when a similar reduction is not applied to an individual of a different gender;

(d) denying an individual of a particular gender a waiver of premium provisions that are available to an individual of a different gender, or offering the provisions to an individual of a particular gender only for contract limits that are lower than those available to an individual of a different gender;

(e) refusing to offer maternity benefits to an insured or prospective insured purchasing an individual contract when a comparable family coverage contract offers maternity benefits;

(f) denying, under a group contract, dependent coverage to the spouse of an employee of a particular gender when dependent coverage is available to the spouse of an employee of a different gender;

(g) offering coverage to an individual of a particular gender in certain occupations while denying coverage or offering more limited coverage to an individual of a different gender in the same occupational categories;

(h) offering an individual of a particular gender higher benefit levels or longer benefit periods, or both, than are offered to an individual of a different gender in the same classifications;

(i) offering a contract containing different definitions of disability for an individual of a particular gender and an individual of a different gender in the same classifications;

(j) offering a contract containing different waiting and elimination periods for an individual of a particular gender and an individual of a different gender;

(k) requiring an applicant of a particular gender to submit to a medical examination while not requiring an applicant of a different gender to submit to a medical examination for the same coverage;

(l) establishing different benefit options for an individual of a particular gender and an individual of a different gender;

(m) denying to a divorced or a single person coverage available to a married person;

(n) limiting the amount of coverage available to an insured or prospective insured based upon the person's marital status;

(o) denying an employee of a particular gender insurance benefits that are offered to a dependent who is of the same gender as the employee;

(p) denying a married or separated individual of a particular gender the right to obtain or continue coverage in the individual's own name when the same does not apply to an individual of a different gender;

(q) establishing different issue age requirements for an individual of a particular gender and an individual of a different gender;

(r) establishing different occupational classifications for an individual of a particular gender and an individual of a different gender;

(s) denying coverage to an unwed person or their dependent, or both.

History

KEY: insurance law
Date of Last Change: December 9, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402; 31A-2-201

Utah Admin. Code R590-83-5 Class Rating Differentials

(1) The establishment of reasonable and consistently applied class rating differentials does not constitute a practice prohibited by Section R590-83-3.

(2) Unless otherwise prohibited by law, this rule permits charging different premium rates on the basis of gender.

History

KEY: insurance law
Date of Last Change: December 9, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402; 31A-2-201

Utah Admin. Code R590-83-6 Severability

If any provision of this rule, Rule R590-83, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: December 9, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402; 31A-2-201

R590-85 Accident and Health Insurance and Medicare Supplement Rates

Utah Admin. Code R590-85-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-22-605, and 31A-22-620.

History

KEY: insurance law
Date of Last Change: March 4, 2022
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605; 31A-22-620

Utah Admin. Code R590-85-2 Purpose and Scope

(1) The purpose of this rule is to implement Subsections 31A-22-602(2), 31A-22-605(4)(e), and 31A-22-620(3)(e) by establishing minimum loss ratios and implementing procedures for the filing of accident and health insurance and Medicare supplement premium rates, including the initial filing of rates and any subsequent rate changes.

(2) This rule applies to:

(a) an individual accident and health insurance policy except as excluded under Subsection (3);

(b) a Medicare supplement policy; and

(3) This rule does not apply to:

(a) a policy subject to Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act, and Chapter 45, Managed Care Organizations, that complies with Rules R590-167 and R590-277;

(b) a long-term care policy subject to Rule R590-148; and

History

KEY: insurance law
Date of Last Change: March 4, 2022
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605; 31A-22-620

Utah Admin. Code R590-85-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Average annual premium per policy" means the average computed by the insurer based on an anticipated distribution of business by all applicable criteria having a price difference, such as age, sex, amount, dependent status, rider frequency, etc., except assuming an annual mode for all policies, for example, the fractional premium loading may not affect the average annual premium or anticipated loss ratio calculation.

(2) "Conditionally renewable" means renewal can be declined by class, geographic area, or for stated reasons other than deterioration of health.

(3) "Guaranteed renewable" means renewal cannot be declined by the insurance company for any reason, but the insurance company can revise rates on a class basis.

(4) "Non-cancelable" means renewal cannot be declined nor can the rates be revised by the insurance company.

(5) "Non-renewable" means renewal is not an option.

(6) "Optionally renewable" means renewal is at the option of the insurance company.

(7) "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

History

KEY: insurance law
Date of Last Change: March 4, 2022
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605; 31A-22-620

Utah Admin. Code R590-85-4 General Requirements

(1) When a Rate Filing is Required.

(a) Every filing for a policy, certificate, or endorsement affecting benefits shall be accompanied by a rate filing that complies with this rule.

(b) A rate filing is not required for an endorsement that has no rating effect.

(c) Any subsequent addition to or change in rates applicable to the policy, certificate, or endorsement shall also be filed prior to use.

(2) General Contents of All Rate Filings. Each rate submission shall include:

(a) rate sheets for current and proposed rates, if applicable, that are clearly identified;

(b) an actuarial memorandum describing the basis on which rates were determined, which includes:

(i) description of the policy, benefits, renewability, general marketing methods, and issue age limits;

(ii) description of how rates were determined, including a general description and source of each assumption used;

(iii) estimated average annual premium per policy for Utah;

(iv) anticipated loss ratio, including interest, of the present value of the expected benefits to the present value of the expected premiums over the entire period for which rates are computed to provide coverage;

(v) minimum anticipated loss ratio presumed reasonable in Subsection R590-85-5(1); and

(vi) signed certification by a qualified actuary stating that, to the best of the actuary's knowledge and judgment, the rate filing is in compliance with the applicable laws of Utah and the benefits are reasonable in relation to the premiums charged; and

(c) a statement that the rates have been filed with and approved by the home state, except as provided in Subsection (3).

(3) If the home state does not require approval, then alternative information must be submitted, including:

(a) a list of the states to which the rates were submitted;

(b) the date submitted; and

(4) Previously Filed Form. Filing a rate change for a previously filed rate shall include the following:

(a) a statement of the scope and reason for the change;

(b) a description of how revised rates were determined, including a general description and source of each assumption used;

(d) a comparison of Utah and average nationwide premiums, for representative rating cells based on the Utah distribution of business;

(e) a comparison of revised premiums with current scale;

(f) a statement as to whether the filing applies to new business, in-force business, or both, and the reasons;

(g) a detailed history of national experience, which includes the data in Subsection (5) that shows on a yearly and durational basis:

(i) premiums received;

(ii) earned premiums;

(iii) benefits paid;

(iv) incurred benefits;

(v) increase in active life reserves;

(vi) increase in claim reserves;

(vii) incurred loss ratio;

(viii) cumulative loss ratio; and

(ix) any other available data the insurer may wish to provide;

(h) detailed history of Utah experience, which includes the data in Subsection (5) that shows on a yearly basis:

(i) earned premiums;

(ii) incurred benefits;

(iii) incurred loss ratio; and

(iv) cumulative loss ratio;

(i) anticipated nationwide future loss ratio, which includes:

(i) projected premiums;

(ii) projected claims;

(iii) projected loss ratio; and

(iv) assumptions and calculations that include interest;

(j) anticipated Utah future loss ratio, which includes:

(i) projected premiums;

(ii) projected claims;

(iii) projected loss ratio; and

(iv) description of assumptions and calculations that include interest;

(k) cumulative past and projected future loss ratio and description of the calculation;

(l) the number of policyholders in Utah; and

(m) the date and magnitude of all previous rate changes for Utah and nationwide.

(5) Experience Records.

(a) As required by the Accident and Health Policy Experience Exhibit, an insurer shall maintain records of premiums collected, earned premiums, benefits paid, incurred benefits and reserves for each calendar year for each policy form, and applicable endorsements.

(i) Separate data may be maintained for each endorsement to the extent appropriate.

(ii) Experience under policies that provide substantially similar coverage may be combined.

(iii) The data shall be for all years of issue combined, for each calendar year of experience since the year the form was first issued.

(b) A rate revision must provide the information required in Subsection (5)(a) on both a national and a state basis.

(6) Evaluating Experience Data. In determining the credibility and appropriateness of experience data, all relevant factors shall be considered, including:

(a) statistical credibility of premiums and benefits, for example low exposure or low loss frequency;

(b) experience and projected trends relative to the kind of coverage, for example persistency, inflation in medical expenses, or economic cycles affecting disability income experience;

(c) concentration of experience at early policy durations where select morbidity and preliminary term reserves are applicable and where loss ratios are expected to be substantially lower than at later policy durations; and

(d) the mix of business by risk classification.

(7) Implementation of a filed rate increase must be initiated within 12 months from the filed date, otherwise a company forfeits the right to implement the increase.

(8) A filing may be rejected or prohibited if the company fails to submit all required information.

History

KEY: insurance law
Date of Last Change: March 4, 2022
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605; 31A-22-620

Utah Admin. Code R590-85-5 Reasonableness of Benefits in Relation to Premium

(1) With respect to a new form under which the average annual premium per policy is expected to be at least $200, the anticipated loss ratio shall be at least as great as shown in this subsection:

(a) Accident and Health Insurance Coverage. Except as provided in Subsections (1)(d) and (1)(e), the minimum loss ratio for:

(i) a non-renewable form is 65%;

(ii) an optionally renewable form is 60%;

(iii) a conditionally renewable form is 55%;

(iv) a guaranteed renewable form is 55%; and

(v) a non-cancelable form is 50%.

(b) Income Replacement Insurance Coverage. The minimum loss ratio for:

(i) a non-renewable form is 65%;

(ii) an optionally renewable form is 60%;

(iii) a conditionally renewable form is 55%;

(iv) a guaranteed renewable form is 50%; and

(v) a non-cancelable form is 45%.

(i) $100 or more but less than $200, subtract five percentage points; or

(ii) less than $100 subtract 10 percentage points.

(d) For a Medicare supplement policy, benefits shall be considered reasonable in relation to premiums if the anticipated loss ratio meets the requirements of Section R590-146-14.

(e) The minimum loss ratio for a short-term limited duration health insurance form is 70%.

(2) Rate Changes. With respect to the filing of a rate change for a previously filed form, the standards of this subsection shall be met.

(a) Subsections (2)(a)(i) and (2)(a)(ii) shall be at least as great as the standards in Subsection (1) and shall include interest in the calculation of benefits, premiums, and present values:

(i) the anticipated loss ratio over the entire period for which the changed rates are computed to provide coverage; and

(ii) the ratio of Subsections (2)(a)(ii)(A) and (2)(a)(ii)(B); where:

(A) is the sum of the accumulated benefits, from the original effective date of the form to the effective date of the change, and the present value of future benefits; and

(B) is the sum of the accumulated premiums from the original effective date of the form to the effective date of the change and the present value of future premiums, the present values to be taken over the entire period for which the changed rates are computed to provide coverage, and the accumulated benefits and premiums to include an explicit estimate of the actual benefits and premiums from the last date an accounting was made to the effective date of the change.

(b) If an insurer wishes to charge a premium for policies issued on or after the effective date of the change, which is different from the premium charged for the policies issued prior to the change date, then:

(i) with respect to policies issued prior to the effective date of the change, the requirements of Subsection (2)(a) must be satisfied; and

(ii) with respect to policies issued on and after the effective date of the change, the standards are the same as in Subsection (1), except that the average annual premium shall be determined based on an actual rather than an anticipated distribution of business.

(c) A company must review its experience periodically and file rate changes, as appropriate, in a timely manner to avoid the filing of exceptionally large rate increases.

(d) A rate filing requesting an increase may be prohibited if a company has failed to file rate changes in a timely manner.

History

KEY: insurance law
Date of Last Change: March 4, 2022
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605; 31A-22-620

Utah Admin. Code R590-85-6 Severability

If any provision of this rule, Rule R590-85, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: March 4, 2022
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605; 31A-22-620

R590-91 Credit Life Insurance and Credit Accident and Health Insurance

Utah Admin. Code R590-91-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) protect the interests of debtors and the public in this state; and

(b) establish a system of reasonable rating, policy form, and operating standards for credit insurance transactions.

(2) This rule applies to each credit insurance transaction within the scope of Title 31A, Chapter 22, Part 8, Credit Life and Accident and Health Insurance.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-802. Additional terms are defined as follows:

(1) "Credit insurance" means credit life insurance and credit accident and health insurance.

(2) "Open-end credit" means credit extended by a creditor under an agreement in which:

(a) the creditor reasonably contemplates repeated transactions;

(b) the creditor imposes a finance charge from time to time on an outstanding unpaid balance; and

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-4 Rights and Treatment of Debtors

(1)(a) If a creditor requires insurance, the creditor shall give the debtor the option to:

(i) furnish the required amount of insurance through an existing insurance policy the debtor owns or controls; or

(ii) obtain insurance coverage through any insurer authorized to transact insurance business in this state.

(b) If this subsection applies, the creditor shall inform the debtor of the debtor's right to provide alternative coverage before the transaction is completed.

(2) Evidence of coverage for credit insurance shall comply with Sections 31A-22-806 and 70C-6-104.

(3)(a) If the named insurer does not accept the risk, the insurer shall notify the debtor that the insurer did not accept the risk and did not provide the insurance.

(b) A substituted insurer, if any, shall deliver the policy or certificate according to Subsection 31A-22-806(5).

(4) No subsequent certificate is needed on an open-end credit arrangement after the initial indebtedness.

(5) Each policy application must identify the producer, if any, and provide the information required by Subsection 31A-22-806(4)(b).

(6)(a) If a debtor is covered by a group credit insurance policy in which each individual pays a single premium to the insurer, the policy shall include a provision indicating that if the policy is terminated for any reason, the debtor's insurance coverage shall continue for the period for which the debtor's premium has been paid.

(b) If a debtor is covered by a group credit insurance policy with a premium paid to the insurer on a monthly outstanding balance basis, the policy shall include a provision indicating that the debtor shall be given at least 30 days notice before the policy is terminated.

(i) the debtor obtains replacement coverage from the same or another insurer;

(ii) in the same or greater amount; and

(iii) the replacement coverage takes place without lapse of coverage.

(d) The insurer shall provide the notice required in Subsection (5)(b) or, at the insurer's option, the creditor may provide the notice.

(7) If the creditor adds any identifiable insurance charge or premium for credit insurance to the indebtedness, and the creditor adds any direct or indirect finance, carrying, credit, or other service charge on the insurance charge or premium, the following shall occur:

(a) the creditor must remit the insurance charge or premium to the insurer; and

(b) the insurer shall collect the insurance charge or premium within 60 days after the insurance charge or premium is added to the indebtedness.

(8) A provision in an individual policy or certificate that sets a maximum limit on total payments shall only apply to the individual policy or certificate that contains the provision.

(9) For credit life insurance, when the indebtedness of a debtor is prepaid in a manner other than a lump sum accident and health payment, or as a result of the debtor's death:

(a) any credit life insurance covering the indebtedness shall be terminated; and

(b) the debtor shall be refunded the credit life insurance premium according to the formula in Section R590-91-9.

(10)(a) For credit accident and health insurance, when the indebtedness of a debtor is prepaid in a manner other than a lump sum accident and health payment or as a result of the debtor's death:

(i) any credit accident and health insurance covering the indebtedness shall be terminated; and

(ii) the debtor shall be refunded the credit accident and health insurance premium according to the formula in Section R590-91-9.

(b) If there is a pending claim under the coverage when the indebtedness is paid, the refund amount may be determined as if the indebtedness was paid after the benefit payments terminated.

(d) A refund shall be computed as if the indebtedness was paid at the end of the disability period.

(11)(a) If an indebtedness is prepaid from the proceeds of a debtor's credit life insurance policy or from a disability claim lump sum payment under the debtor's credit insurance policy, the insurer shall be responsible for ensuring that the following are paid to the insured debtor if living, or to the debtor's named beneficiary, other than the creditor, or to the debtor's estate:

(i) when the indebtedness is prepaid from the proceeds of a credit life insurance policy, or from the proceeds of a lump sum total and permanent disability benefit under credit life insurance coverage, the credit accident and health insurance premium refund made according to the formula in Section R590-91-9; or

(ii) when the indebtedness is prepaid from a lump sum disability claim under credit accident and health insurance coverage, the credit life insurance premium refund made according to the formula in Section R590-91-9.

(b) For a debt paid under Subsection (11)(a), the benefit amount in excess of the amount required to repay the indebtedness after crediting any unearned interest or finance charges.

(12)(a) A credit life insurance benefit shall be consistent with the premium charge.

(b) Credit life insurance on preauthorized lines of credit not exceeding the commitment period may be written for the preauthorized amount on a nondecreasing or level term plan.

(d) When the insurance amount exceeds the unpaid indebtedness, the excess is payable to the debtor's named beneficiary, other than the creditor, or to the debtor's estate.

(13) A dividend on a participating individual credit insurance policy shall be payable to each individual insured.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-5 Policy Forms and Reserves

(1) Credit insurance shall be issued in a form described in Section 31A-22-803.

(2) Each policy form, certificate, notice of proposed insurance, application, endorsement, and rider to be delivered or issued for delivery in this state shall be filed with the commissioner as required by Sections 31A-21-201, 31A-22-807, and 31A- 22-808.

(3) Each filing is subject to the general filing requirements of Rule R590-228, Submission of Credit Life and Credit Accident and Health Insurance Form and Rate Filings.

(4) The commissioner may prohibit a form if the benefits provided are not reasonable in relation to the premium charged.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-6 Reasonableness of Benefits in Relation to Premium

(1) If any insurer files a form for approval that provides coverage that is different from the coverage described in Sections R590-91-7 and R590-91-8, the insurer shall demonstrate to the commissioner's satisfaction that the premium rates for the coverage will develop or may reasonably be expected to develop a loss ratio not less than that contemplated for standard coverage at the premium rates described in Sections R590-91-7 and R590-91-8.

(2) If the debtor is not specifically charged for credit insurance, the standards in Section 31A-22-807 and Section R590-91-11 are not required to be used.

(3) For the purposes of Subsection (2), the debtor is specifically charged for credit insurance if:

(a) an identifiable charge for insurance is disclosed in the credit or other instrument furnished to the debtor that sets out the credit transaction's financial elements; or

(b) there is a differential in finance, interest, service, or other similar charge made to debtors who are in like circumstances, except for their insured or noninsured status.

(4) Any charge described in Subsection (3) that exceeds the premium rate standards in Sections R590-91-7 and R590- 91-8, as adjusted under Section R590-91-10, shall be filed with the commissioner.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-7 Credit Life Insurance Prima Facie Rates

(1) Subsections (3) and (4) refer to credit life insurance prima facie premium rates for the insured portion of an indebtedness payable in equal monthly installments, when the insured portion of the indebtedness decreases uniformly by the amount of the monthly installment paid.

(2) Subsections (5), (6), and (7) refer to the prima facie premium rates for other benefit types alone or in combination with the benefit types in Subsections (3) and (4).

(3) If a premium is payable on a monthly outstanding balance basis, the prima facie rate shall be $0.65 per month per $1,000 of outstanding insured indebtedness.

(4) If a premium is payable on a single premium basis, the single premium prima facie rate per $100 of the initial indebtedness shall be ((N+1)/20)(Op):

(a) N is the credit term in months; and

(b) Op is the rate specified in Subsection (3).

(5) If a premium is payable on a single premium basis when the benefit provided is level term, the single premium prima facie rate per $100 of the initial indebtedness shall be (N/10)(Op):

(a) N is the credit term in months; and

(b) Op is the rate specified in Subsection (3).

(6) The joint coverage rate for Subsection (3), (4), or (5) may not be greater than 170% of the specific rate for the type of coverage.

(7) A combination of the appropriate rate for level term and the appropriate rate for decreasing term, with equal decrements, shall be used if coverage provided is a combination of level term and decreasing term, with equal decrements.

(8) If the benefits provided are other than the benefits described in Subsections (1) through (7), the benefit rates shall be actuarially consistent with the rates in Subsections (1) through (7).

(9)(a) The premium rates in Subsections (1) through (8) shall apply to each credit life insurance policy that is issued with or without evidence of insurability, that is offered to all eligible debtors, and that contains:

(i) no exclusion, except suicide within one year of the incurred indebtedness; and

(ii) either no age restriction or an age restriction making ineligible for coverage:

(A) a debtor age 65 or over at the time the indebtedness is incurred; or

(B) a debtor age 66 or over on the maturity date of the indebtedness.

(b) Insurance written for an open-end credit plan may:

(i) exclude from insurance eligibility debtor classes determined by age; and

(ii) provide for the insurance to stop or reduce the insurance amount when the debtor reaches age 65.

(c) Insurance written for an open-end credit plan where the amount of insurance is based on or limited to the outstanding unpaid balance may not include any provision excluding or denying a claim for death resulting from a preexisting condition, except for a condition that:

(i) the insured debtor received medical diagnosis or treatment within six months before the effective date of coverage; and

(ii) caused or substantially contributed to the insured debtor's death within six months after the effective date of coverage.

(d) The exclusion in Subsection (9)(c) shall apply to the initial indebtedness and all subsequent advances on an individual basis, only where evidence of individual insurability has not been required.

(e) The effective date of coverage for each part of the insurance attributable to a subsequent advance or increase to the outstanding balance is the date on which the advance or increase is posted to the plan account.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-8 Credit Accident and Health Insurance Prima Facie Rates

(1) Subsections (3) and (4) refer to credit accident and health insurance prima facie premium rates for the insured portion of an indebtedness repayable in equal monthly installments, when the insured portion of the indebtedness decreases uniformly by the amount of the monthly installment paid.

(2) Subsections (5), (7), (8), and (9) refer to the prima facie premium rates for other benefit types alone or in combination with the benefit types in Subsections (3) and (4).

(3) If a premium is payable on a single-premium basis for the duration of the coverage, the premium shall be as indicated on "R590-91 Attachment: Credit Disability Insurance" available on the department's website https://insurance.utah.gov.

(4) If a premium is paid on a premium rate per month per thousand of outstanding insured indebtedness, the premium shall be computed according to:

(a) the formula in Subsection (4)(c); or

(b) a formula approved by the commissioner that produces a rate actuarially equivalent to the single premium rate defined in Subsection (3).

(i) SPn = single premium rate per $100 of initial insured indebtedness repayable in n equal monthly installments;

(ii) OPn = monthly outstanding balance premium rate per $1,000; and

(iii) n = original payment period in months.

(5) The actuarial equivalent of Subsections (3) and (4) shall be used if the coverage provided is a constant maximum indemnity for a given time period.

(6) An appropriate combination of the premium rate for a constant maximum indemnity for a given time period and the premium rate for a maximum indemnity that decreases in equal amounts per month shall be used if the coverage provided is a combination of a constant maximum indemnity for a given time period after which the maximum indemnity begins to decrease in equal amounts per month.

(7) If the benefit provided is different from the benefits described in Subsections (1) through (6), the benefit rate shall be actuarially consistent with the rates in Subsections (3), (4), (5), and (6).

(8) The outstanding balance rate for credit accident and health insurance may be a term specified rate or a single composite term outstanding balance rate applicable to any loan made under an open-end credit plan.

(9)(a)(i) For an open-end credit plan, the monthly rate per $1,000 of outstanding principal balance shall be the rate calculated using the formula in Subsection (4) where n is the number of monthly indemnity payments required to completely extinguish the debt.

(ii) The rate shall be further reduced to appropriately account for the critical period, if applicable.

(b) The critical period factors shall be filed with the department and shall not exceed the factors based on the 1968 Credit A and H Two Composite Tables published by the NAIC (Proceedings - 1968 Vol. II).

(10) The premium rates in Subsections (1) through (9) shall apply to each credit accident and health insurance policy that is issued with or without evidence of insurability, that is offered to all eligible debtors, and that contains:

(a) no provision excluding or denying a disability claim resulting from a preexisting condition, except for a condition that:

(i) the insured debtor received medical advice, diagnosis, or treatment within six months before the effective date of the debtor's coverage; and

(ii) caused the insured debtor's loss within the six months after the effective date of coverage;

(b) no other provision that excludes or restricts liability for a disability caused in a specified manner, except for a provision that excludes or restricts coverage in the event of:

(i) normal pregnancy; and

(ii) an intentionally self-inflicted injury;

(d) no age restriction or an age restriction only making ineligible for coverage:

(i) a debtor age 65 or over at the time the indebtedness is incurred; or

(ii) a debtor who will have reached age 66 or over on the maturity date of the indebtedness;

(e) a daily benefit equal to 1/30th of the monthly benefit payable under the policy for the indebtedness; and

(f) a definition of disability that is no more restrictive than a definition requiring that:

(i) the insured be unable to perform the principal duties of the insured's occupation for 12 months from the time the insured's disability occurred; and

(ii) the insured be unable to perform the principal duties of any occupation the insured is reasonably qualified for by education, training, or experience after 12 months from the time the insured's disability occurred.

(11) Subsection (10)(f) may not apply to lump sum disability coverage.

(12) Insurance written for an open-end credit plan may:

(a) exclude from insurance eligibility debtor classes determined by age; and

(b) stop insurance coverage or reduce the amount of insurance when the debtor reaches age 65.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-9 Refund Formulas

(1) A refund formula shall be at least as favorable to the debtor as the formulas in this section.

(2) The refund formulas in this section are the minimum requirements for a plan described in Subsections (2)(a) through (c).

(a)(i) The pro rata unearned gross premium method shall provide the minimum refund amount for level term credit insurance and credit insurance coverage under which premiums are collected from the debtor on a basis other than the single premium basis.

(ii) Refund = t/n(original gross single premium)

(A) t = the number of remaining months; and

(B) n = the original loan term in months.

(b)(i) The Rule of 78 or sum of the digits unearned premium method shall provide the minimum refund amount for insurance coverage that:

(A) reduces in equal amounts per month; and

(B) the premiums are collected on a single premium basis.

(ii) Refund = (t(t+1)/n(n+1))(original gross single premium)

(A) t = the number of remaining months; and

(B) n= the original loan term in months.

(c) A combination of the pro rata method and the Rule of 78 method or, at the option of the insurer, the pro rata method shall be used for:

(i) credit life insurance provided as a combination of level and decreasing term coverage; and

(ii) credit accident and health insurance when the insured is:

(A) covered for a constant maximum indemnity for a given time period; and

(B) after the time period the maximum indemnity begins to decrease in equal amounts per month.

(3) For net indebtedness insurance, another type of insurance, and another mode of premium payment, each insurer shall:

(a) file for approval each formula and factor for a refund; and

(b) include in the policy:

(i) each formula and factor for a refund; or

(ii) reference each formula and factor filed and approved by the commissioner.

(4) For net indebtedness, the acceptable methods of refund calculations are:

(a) the actuarial method, also known as the U.S. Rule or the pure premium method; or

(b) an arithmetic average of refunds due under pro rata and Rule of 78 methods.

(5) When credit insurance is terminated:

(a) no charge may be made for the first 15 days of a loan month; and

(b) a full month may be charged for 16 days or more of a loan month, unless a refund is made on a pro rata basis for each day within the loan month.

(6) If the total of all refunds due to a debtor or joint debtors is less than $5, no refund is required.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-10 Adjustment of Prima Facie Rates

When the commissioner determines that it is necessary to revise the prima facie rates, the commissioner shall publish by order and after a hearing, the revised prima facie rates before September 1. The new prima facie rates shall be effective January 1 of the following year.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-11 Rating Procedures for Direct Business Only

(1) An insurer may file for approval and use a rate that is higher than a prima facie rate if the higher rate is expected to produce a minimum loss ratio that Section 31A-22-807 requires.

(2) An insurer may use a rate that is lower than the insurer's filed rate without notifying the commissioner.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-12 Disclosure to Debtor

(1) When a premium or identifiable charge is payable by a debtor for credit insurance coverage, the following information must be disclosed to the debtor at the time the debtor applies for the insurance:

(a) the optional nature of the coverage;

(b) each premium or identifiable charge separately listed by type of coverage;

(d) any age restriction regarding eligibility for insurance coverage at the time the indebtedness is incurred or stopped due to the debtor reaching a specific age.

(2) The disclosures in Subsection (1) shall be made to the principal debtor.

(3) The principal debtor shall receive a copy of the disclosures.

(4) The disclosures shall be retained in accordance with state and federal law.

(5) The disclosure language shall be prominently displayed near the signature space for the election to obtain coverage.

(6) The disclosures in Subsection (1) may be made in conjunction with:

(a) the Federal Truth-In-Lending disclosure;

(b) a Notice of Proposed Insurance;

(d) the policy or certificate.

(7) If, during the term of the loan, the insurance is insufficient to pay off the scheduled outstanding loan balance, the policy or certificate must clearly and prominently disclose to the prospective insured that the insurance is insufficient to pay off the outstanding loan balance.

(8) Each credit insurance policy and certificate shall clearly describe the benefit amount and the term of coverage.

(9) When the amount of credit life insurance exceeds the unpaid indebtedness:

(a) the certificate or policy shall clearly disclose the excess; and

(b) the excess shall be paid to the debtor's named beneficiary, other than the creditor, or to the debtor's estate.

(10) If any policy or certificate has a preexisting condition exclusion, the exclusion shall be clearly and prominently disclosed.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-91-13 Severability

If any provision of this rule, Rule R590-91, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: March 25, 2022
Notice of Continuation: October 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-93 Replacement of Life Insurance and Annuities

Utah Admin. Code R590-93-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-22-429, and 31A-23a-402.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) regulate the activities of insurers and producers regarding the replacement of existing life insurance and annuities;

(b) protect the interests of life insurance and annuity purchasers by establishing minimum standards of conduct for replacement or financed purchase transactions;

(d) reduce the opportunity for misrepresentation and incomplete disclosure.

(2) This rule applies to each insurer and producer transacting life insurance and annuity business in this state.

(3) Unless otherwise specifically included, this rule does not apply to a transaction involving:

(a) credit life insurance;

(b) group life insurance or a group annuity if there is no direct solicitation of an individual by a producer;

(d) an application to exercise a contractual change or a conversion privilege for an existing policy or contract when:

(i) the existing policy or contract is being replaced by the same insurer according to a program filed with the commissioner; or

(ii) when a term conversion privilege is exercised among corporate affiliates;

(e) proposed life insurance to replace life insurance under a binding or conditional receipt issued by the same insurer;

(f) except as outlined in Subsection (4), a policy or contract used to fund:

(i) an employee pension or welfare benefit plan covered by the Employee Retirement and Income Security Act, 29 U.S.C. 1001 (ERISA);

(ii) a plan described by Sections 401(a), 401(k), or 403(b) of the Internal Revenue Code, 26 U.S.C. Sec. 25, if the plan, for purposes of ERISA, is established or maintained by an employer;

(iii) a governmental or church plan defined in Section 414 of the Internal Revenue Code, a governmental or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax-exempt organization under Section 457 of the Internal Revenue Code; or

(iv) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;

(g) new coverage provided under a policy or contract and where the cost is borne wholly by the insured's employer or by an association of which the insured is a member;

(h) existing life insurance that is a non-convertible term life insurance policy that will expire in five years or less and cannot be renewed;

(i) an immediate annuity that is purchased with proceeds from an existing annuity contract; or

(j) a structured settlement.

(4) Notwithstanding Subsection (3)(f), this rule applies to a policy or contract used to fund any plan or arrangement that is funded solely by contributions an employee elects to make, whether on a pre-tax or after-tax basis, if:

(i) the insurer has been notified that a plan participant may choose from two or more insurers; and

(ii) there is a direct solicitation of an individual employee by an insurance producer for the purchase of a contract or policy.

(5) A registered contract is exempt from the requirements of Subsections R590-93-5(1)(b) and R590-93-6(2) regarding the provision of an illustration or policy summary; however, premium or contract contribution amounts and identification of the appropriate prospectus or offering circular are required instead.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Contract" means an annuity contract.

(2) "Direct-response solicitation" means a solicitation through a sponsoring or endorsing entity or individually solely through mail, telephone, the internet, or other mass communication media.

(3)(a) "Direct solicitation" means a personalized solicitation to a specific individual through an insurer or producer that is not a direct-response solicitation.

(b) Direct solicitation does not include a group meeting held by a producer solely for the purpose of educating or enrolling individuals or, when initiated by an individual member of the group, assisting with the selection of investment options offered by a single insurer in connection with enrolling that individual.

(4) "Existing insurer" means the insurance company whose policy or contract is changed or affected in a manner described within the definition of "replacement" in Subsection (12).

(5) "Existing policy or contract" means an individual policy or contract in force, including a policy under a binding or conditional receipt, or a policy or contract that is within an unconditional refund period.

(6)(a) "Financed purchase" means the purchase of a new policy involving the actual or intended use of funds obtained by the withdrawal or surrender of, or by borrowing from, values of an existing policy to pay all or part of any premium due on the new policy.

(b)(i) A withdrawal, surrender, or borrowing involving the policy values of an existing policy used to pay premiums on a new policy owned by the same policyholder and issued by the same company within four months before or 13 months after the effective date of the new policy is prima facie evidence of the policyholder's intent to finance the purchase of the new policy with existing policy yields.

(ii) The standard in Subsection (i) does not change the monitoring requirements in Subsection R590-93-4(1)(e).

(7) "Illustration" means a presentation or depiction that includes non-guaranteed elements of a policy over a period of years as defined in Rule R590-177.

(8) "Policy" means a life insurance policy.

(9)(a) "Policy summary," for a policy or contract other than a universal life policy, means a written statement regarding a policy or contract that includes the following information:

(i) the current death benefit;

(ii) the annual contract premium;

(iii) the current cash surrender value;

(iv) the current dividend;

(v) the application of current dividend; and

(vi) the amount of any outstanding loan.

(b) "Policy summary," for a universal life policy, means a written statement that includes the following information:

(i) the beginning and end date of the current report period;

(ii) the policy value at the end of the previous report period and at the end of the current report period;

(iii) the total amounts that have been credited or debited to the policy value during the current report period, identifying each by type, such as interest, mortality, expense, and riders;

(iv) the current death benefit at the end of the current report period on each life covered by the policy;

(v) the net cash surrender value of the policy as of the end of the current report period; and

(vi) the amount of outstanding loans, if any, as of the end of the current report period.

(10) "Registered contract" means a contract or policy subject to the prospectus delivery requirements of the Securities Act of 1933, 15 U.S.C. Sec. 77a.

(11) "Replacing insurer" means the insurance company that issues or proposes to issue a new policy or contract that:

(a) replaces an existing policy or contract; or

(b) is a financed purchase.

(12) "Replacement" means a transaction in which a new policy or contract is to be purchased, and the producer or insurer is aware, or should be aware, that an existing policy or contract is or will be:

(a) lapsed, forfeited, surrendered or partially surrendered, assigned to the replacing insurer, or otherwise terminated;

(b) converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;

(c) amended to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;

(d) reissued with any reduction in cash value; or

(e) used in a financed purchase.

(13)(a) "Replacement notice" means the same as the following documents, available on the department's website, https://insurance.utah.gov:

(i) Appendix A, Important Notice: Replacement of Life Insurance or Annuities;

(ii) Appendix B, Notice Regarding Replacement: Replacing Your Life Insurance Policy or Annuity; and

(iii) Appendix C, Important Notice: Replacement of Life Insurance or Annuities.

(b) The replacement notice shall be made available by the replacing insurer and must be imprinted with the name, address, and telephone number of the replacing insurer.

(14) "Sales material" means a sales illustration and any other written, printed, or electronically presented information provided by the company or producer and used in the presentation to the policy or contract holder related to the policy or contract purchased.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-4 Duties of an Insurer That Uses a Producer

(1) Each insurer shall maintain a system of supervision to ensure compliance with the requirements of Section 31A-22- 429 and this rule that includes the following:

(a) inform each producer of the requirements of Section 31A-22-429 and this rule and incorporate the requirements into each relevant producer training manual prepared by the insurer;

(b) provide each producer guidance and a written statement of the company's position regarding the acceptability and appropriateness of a replacement transaction;

(c) maintain a system to review the appropriateness of each replacement transaction that a producer does not indicate is in accord with Subsection (1)(b);

(d) establish procedures to confirm that the requirements of Section 31A-22-429 and this rule have been met;

(e) establish procedures to detect any transaction that is a replacement of an existing policy or contract by the existing insurer, but that has not been reported as such by the applicant or producer;

(f) establish procedures to determine that the sales material and illustrations required by Section 31A-22-429 are complete and accurate for the proposed policy or contract; and

(g) maintain any record in any means that accurately reproduces the actual document.

(2) Each insurer shall monitor each producer's policy and contract replacements and make available to the department, upon request, a record of each producer's:

(a) life replacements, including financed purchases, as a percentage of the producer's total annual sales for life insurance;

(b) number of lapses of policies by the producer as a percentage of the producer's total annual sales for life insurance;

(d) number of transactions that are unreported replacements of existing policies or contracts by the existing insurer detected by the company's monitoring system as required by Subsection R590-93-4(1)(e); and

(e) replacements, indexed by replacing producer and existing insurer.

(3)(a)(i) An insurer shall require a completed replacement notice with each application for life insurance or an annuity that indicates the proposed life insurance or annuity will replace, discontinue, or change an existing policy or contract.

(ii) The producer may elect to use the replacement notice in Appendix A or Appendix C.

(b) When the applicant has an existing policy or contract, an insurer shall maintain for at least five years after the termination or expiration of the proposed policy or contract:

(i) any sales material required by Subsection 31A-22-429(5);

(ii) the basic illustration and any supplemental illustrations related to the specific policy or contract that is purchased; and

(iii) the signed statement regarding financing and replacement.

(4) If an application does not meet the requirements of this rule, the insurer shall notify the producer and applicant and fulfill the outstanding requirements.

(5) Compliance with this rule may include the use of systematic customer surveys, interviews, confirmation letters, or internal monitoring programs.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-5 Duties of a Replacing Insurer That Uses a Producer

(1) If a replacement is involved in a transaction, the replacing insurer shall:

(a) verify that the required forms are received and comply with this rule;

(b) notify any other insurer who may be affected by the proposed replacement within five business days of receipt of a completed application indicating replacement, or when the replacement is identified if not indicated on the application, and send a copy of the available illustration or the policy summary for the proposed policy or disclosure document for the proposed contract within five business days of a request from an existing insurer;

(c) maintain copies of the replacement notice required in Subsection 31A-22-429(2), indexed by producer, for at least five years or until the next regular examination by the insurance department of a company's state of domicile, whichever is later; and

(d) provide to the policy or contract holder notice of the right to return the policy or contract within 30 days of the delivery of the contract and receive an unconditional full refund of all premiums or considerations paid on it.

(e) The notice in Subsection (1)(d) may be included in the documents Appendix A or Appendix C.

(2) Nothing in Subsection (1) preempts the requirements of Section 31A-22-423.

(3) In a transaction where the replacing insurer and the existing insurer are the same or are subsidiaries or affiliates under common ownership or control, the replacing insurer shall allow credit for the time elapsed under the replaced policy's or contract's incontestability and suicide periods up to:

(a) the face amount of the existing policy or contract; or

(b) in the case of a financed purchase, the reduction in the face amount of the existing policy due to the use of existing policy values to fund the new policy or contract.

(4) If an insurer prohibits the use of sales material other than that approved by the company, as an alternative to the requirements made of an insurer pursuant to Subsection 31A-22-429(5) regarding sales materials, the insurer may:

(a) require with each application a statement signed by the producer that:

(i) represents that the producer used only company-approved sales material; and

(ii) states that copies of all sales material were left with the applicant in accordance with Subsection 31A-22-429(4);

(b) within ten business days of the issuance of the policy or contract:

(i) a person whose duties are separate from the marketing area of the insurer shall notify the applicant that the producer has represented that copies of all sales material have been left with the applicant in accordance with Subsection 31A-22-429(4);

(ii) provide the applicant a toll-free number to contact company compliance personnel; and

(iii) stress the importance of retaining copies of the sales material for future reference; and

(c) maintain a copy of the letter or other verification in the policy file for at least five years after the termination or expiration of the policy or contract.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-6 Duties of the Existing Insurer

If a replacement is involved in a transaction, the existing insurer shall:

(1) retain each replacement notification received, indexed by replacing insurer, for at least five years or until the conclusion of the next regular examination conducted by the insurance department of the existing insurer's state of domicile, whichever is later;

(2) within five business days of receiving a replacement notification, notify the policy or contract holder of the right to receive information regarding the existing policy or contract values including an in-force illustration or a policy summary if an in-force illustration cannot be produced;

(3) provide the policy or contract information in Subsection (2) within five business days of receipt of the request from the policy or contract holder; and

(4) upon receipt of a request to borrow, surrender, or withdraw any policy values, send a notice advising the policyholder that the release of policy values may affect the guaranteed elements, non-guaranteed elements, face amount, or surrender value of the policy from which the values are released.

(a) The notice shall be sent directly to the policyholder if the check is sent to anyone other than the policyholder.

(b) In the case of consecutive automatic premium loans, the insurer is only required to send the notice at the time of the first loan.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-7 Duties of an Insurer Regarding a Direct-Response Solicitation

(1)(a) When an application is initiated from a direct-response solicitation, the insurer shall require with each completed application for a policy or contract, a statement asking whether the applicant intends to replace, discontinue, or change an existing policy or contract.

(b) If the applicant indicates a replacement or change is not intended or if the applicant fails to respond to the statement, the insurer shall send the applicant, with the policy or contract, the replacement notice in Appendix B, or other substantially similar form approved by the commissioner.

(2) If the insurer has proposed the replacement or if the applicant indicates a replacement is intended and the insurer continues with the replacement, the insurer shall:

(a) provide an applicant or prospective applicant a replacement notice in Appendix C, or other substantially similar document filed with the commissioner; and

(b) comply with the requirements of Subsection R590-93-5(1)(b), if the applicant furnishes the names of the existing insurers, and the requirements of Subsections R590-93-5(1)(c), R590-93-5(1)(d), and R590-93-5(2).

(3)(a) In an instance described in Subsection (2), an insurer may delete any reference to the producer, including the producer's signature, and any reference not applicable to the product being sold or replaced, without having to file the document with the commissioner.

(b) The insurer's obligation to obtain the applicant's signature is satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the replacement notice.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-8 Relationship to Other Statutes and Rules

If any portion of this rule is inconsistent with any provision of any statute or other rule dealing with life insurance or annuity marketing practices or disclosure, the inconsistent portion shall be interpreted to provide the greatest information or protection to the policyholder.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

Utah Admin. Code R590-93-9 Severability

If any provision of this rule, Rule R590-93, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: life insurance, annuity replacement
Date of Last Change: November 22, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-22-429

R590-94 Smoker and Nonsmoker Mortality Tables for Determining Minimum Reserve Liabilities and Nonforfeiture Benefits

Utah Admin. Code R590-94-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-408.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-408

Utah Admin. Code R590-94-2 Purpose and Scope

(1) The purpose of this rule is to permit the use of mortality tables that reflect differences in mortality between smokers and nonsmokers in determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits for life insurance policy forms with separate premium rates for smokers and nonsmokers.

(2) This rule applies to an insurer offering a life insurance policy.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-408

Utah Admin. Code R590-94-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "1980 CSO Table, with or without Ten-Year Select Mortality Factor" means the mortality table, consisting of separate rates of mortality for male and female lives, developed by the Society of Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard Individual Ordinary Life Insurance, incorporated in the 1980 NAIC Amendments to the Model Standard Valuation Law and Standard Nonforfeiture Law for Life Insurance, and referred to in those models as the Commissioner's 1980 Standard Ordinary Mortality table, with or without Ten-Year Select Mortality Factors. The same select factors will be used for both smokers and nonsmokers tables.

(2) "1980 CET Table" means the mortality table consisting of separate rates of mortality for male and female lives, developed by the Society of Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard Individual Ordinary Life Insurance, incorporated in the 1980 NAIC Amendments to the Model Standard Nonforfeiture Law for Life Insurance, and referred to in those models as the Commissioner's 1980 Extended Term Insurance Table.

(3) "1958 CSO Table" means the mortality table developed by the Society of Actuaries Special Committee on New Mortality Tables, incorporated in the NAIC Model Standard Nonforfeiture Law for Life Insurance, and referred to in that model as the Commissioners 1958 Standard Ordinary Mortality Table.

(4) "1958 CET Table" means the mortality table developed by the Society of Actuaries Special Committee on New Mortality Tables, incorporated in the NAIC Model Standard Nonforfeiture Law for Life Insurance, and referred to in that model as the Commissioners 1958 Extended Term Insurance Table.

(5) "Composite mortality tables" refers to the mortality tables defined in Subsections (1) through (4) as they were originally published with rates of mortality that do not distinguish between smokers and nonsmokers.

(6) "NAIC" means the National Association of Insurance Commissioners.

(7) "Smoker and nonsmoker mortality tables" refers to the mortality tables with separate rates of mortality for smokers and nonsmokers derived from the tables defined in Subsections (1) through (4) of this section which were developed by the Society of Actuaries Task Force on Smoker/Nonsmoker Mortality and the California Insurance Department staff and recommended by the NAIC Technical Staff Actuarial Group.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-408

Utah Admin. Code R590-94-4 Alternate Tables

(1) For any life insurance policy delivered or issued for delivery in this state after July 1, 1985, and before January 1, 1989, at the option of the company and subject to the conditions stated in Section R590-94-5:

(a) the 1958 CSO Smoker and Nonsmoker Mortality Tables may be substituted for the 1980 CSO Table, with or without Ten- Year Select Mortality Factors; and

(b) the 1958 CET Smoker and Nonsmoker Mortality Tables may be substituted for the 1980 CET Table for use in determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(2) For any life insurance policy delivered or issued for delivery in this state after July 1, 1985, at the option of the company and subject to the conditions stated in Section R590-94-5:

(a) the 1980 CSO Smoker and Nonsmoker Mortality Tables, with or without Ten-Year Select Mortality Factors, may be substituted for the 1980 CSO Table, with or without Ten-Year Select Mortality Factors; and

(b) the 1980 CET Smoker and Nonsmoker Mortality tables may be substituted for the 1980 CET Table for use in determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-408

Utah Admin. Code R590-94-5 Conditions

(1) For each life insurance policy form with separate rates for smokers and nonsmokers an insurer may:

(a) use composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits;

(b) use smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum reserves, if any, required by Section 31A-17-511, and use composite mortality tables to determine the basic minimum reserves, minimum cash surrender values and amounts of paid-up nonforfeiture benefits; or

(c) use smoker and nonsmoker mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(2) For life insurance issued on female lives with minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits determined using the 1958 CSO or 1958 CET Smoker and Nonsmoker Mortality Tables, these minimum values may be calculated according to an age not more than six years younger than the actual age of the insured.

(3) The substitution of the 1958 CSO or 1958 CET Smoker and Nonsmoker Mortality Tables is available only if made for each life insurance policy on a policy form delivered or issued for delivery on or after the operative date for that policy form and before a date not later than January 1, 1989.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-408

Utah Admin. Code R590-94-6 Severability

If any provision of this rule, Rule R590-94, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-408

R590-95 Minimum Nonforfeiture Standards for Men and Women Insureds Under the 1980 CSO and 1980 CET Mortality Tables

Utah Admin. Code R590-95-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-408.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

Utah Admin. Code R590-95-2 Purpose and Scope

(1) The purpose of this rule is to permit an individual life insurance policy to provide the same cash surrender values and paid- up nonforfeiture benefits to both a man and a woman.

(2) This rule applies to an insurer offering a life insurance policy.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

Utah Admin. Code R590-95-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "1980 CSO Table, with or without Ten-Year Select Mortality Factors" means the mortality table, consisting of separate rates of mortality for male and female lives, developed by the Society of Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard Individual Ordinary Life Insurance, incorporated in the 1980 NAIC Amendments to the Model Standard Valuation Law and Standard Nonforfeiture Law for Life Insurance, and referred to in those models as the Commissioners 1980 Standard Ordinary Mortality Table, with or without Ten-Year Select Mortality Factors.

(2) "1980 CSO Table (M), with or without Ten-Year Select Mortality Factors" means the mortality table consisting of the rates of mortality for male lives from the 1980 CSO Table, with or without Ten-Year Select Mortality Factors.

(3) "1980 CSO Table (F), with or without Ten-Year Select Mortality Factors means the mortality table consisting of the rates of mortality for female lives from the 1980 CSO Table with or without Ten-Year Select Mortality Factors.

(4) "1980 CET Table" means the mortality table consisting of separate rates of mortality for male and female lives, developed by the Society of Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard Individual Ordinary Life Insurance, incorporated in 1980 NAIC Amendments to the Model Standard Valuation Law and Standard Nonforfeiture Law for Life Insurance, and referred to in those models as the Commissioners 1980 Extended Term Insurance Table.

(5) "1980 CET Table (M)" means the mortality table consisting of the rates of mortality for male lives from the 1980 CET Table.

(6) "1980 CET Table (F)" means the mortality table consisting of the rates of mortality for female lives from the 1980 CET Table.

(7) "1980 CSO and 1980 CET Smoker and Nonsmoker Mortality Tables" mean the mortality tables with separate rates of mortality for smokers and nonsmokers derived from the 1980 CSO and 1980 CET Mortality Tables by the Society of Actuaries Task Force on Smoker/Nonsmoker Mortality and adopted by the NAIC in December 1983.

(8) "NAIC" means the National Association of Insurance Commissioners.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

Utah Admin. Code R590-95-4 Rule A

For any life insurance policy on either a male or female delivered or issued for delivery in this state after the operative date under Subsection 31A-22-408(6)(d) for that policy form, at the option of the company, the following substitutions are allowed:

(1) a mortality table that is a blend of the 1980 CSO Table (M) and the 1980 CSO Table (F) with or without Ten-Year Select Mortality Factors may be substituted for the 1980 CSO Table, with or without Ten-Year Select Mortality Factors; and

(2) a mortality table that is of the same blend as used in Subsection (1) but applied to form a blend of the 1980 CET Table (M) and the 1980 CET Table (F) may be substituted for the 1980 CET Table for use in determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(3) The following tables are acceptable:

(a) 100% Male 0% Female for tables to be designated as "the 1980 CSO-A" and "1980 CET-A" tables.

(b) 80% Male 20% Female for tables to be designated as the "1980 CSO-B" and "1980 CET-B" tables.

(d) 50% Male 50% Female for tables to be designated as the "1980 CSO-D" and "1980 CET-D" tables.

(e) 40% Male 60% Female for tables to be designated as the "1980 CSO-E" and "1980 CET-E" tables.

(f) 20% Male 80% Female for tables to be designated as the "1980 CSO-F" and "1980 CET-F" tables.

(g) 0% Male 100% Female for tables to be designated as the "1980 CSO-G" and "1980 CET-G" tables.

(4) Tables (a) and (g) may not be used with policies issued on or after January 1, 1985 except where the proportion of persons insured is anticipated to be 90% or more of one sex or the other or except for certain policies converted from group insurance. Such group conversions issued on or after January 1, 1986 must use mortality tables based on the blend of lives by sex expected for such policies if such group conversions are considered as extensions of the Norris decision.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

Utah Admin. Code R590-95-5 Rule B

In determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits for any life insurance policy on either a male or female on a policy form with separate rates for smokers and nonsmokers delivered or issued for delivery in this state after the operative date under Subsection 31A-22-408-(6)(d) for that policy form, at the option of the company, in addition to substitutions allowed under Section R590-95-4, the following substitutions are allowed:

(1) a mortality table that is a blend of the male and female rates of mortality according to the 1980 CSO Smoker Mortality Table, in the case of lives classified as smokers, or the 1980 CSO Nonsmoker Mortality Table, in the case of lives classified as nonsmokers, with or without Ten-Year Select Mortality Factors, may be substituted for the 1980 CSO Table, with or without Ten-Year Select Mortality Factors; and

(2) a mortality table that is of the same blend as used in Subsection (1) but applied to form a blend of the male and female rates of mortality according to the corresponding 1980 CET Smoker Mortality Table or 1980 CET Nonsmoker Mortality Table may be substituted for the 1980 CET Table.

(3) The following blended mortality tables are acceptable:

(a) SA: 100% Male 0% Female smoker tables designated as "1980 CSO-SA" and "1980 CET-SA" tables.

(b) SB: 80% Male 20% Female smoker tables designated as "1980 CSO-SB" and "1980 CET-SB" tables.

(d) SD: 50% Male 50% Female smoker tables designated as "1980 CSO-SD" and "1980 CET-SD" tables.

(e) SE: 40% Male 60% Female smoker tables designated as "1980 CSO-SE" and "1980 CET-SE" tables.

(f) SF: 20% Male 80% Female smoker tables designated as "1980 CSO-SF" and "1980 CET-SE" tables.

(g) SG: 0% Male 100% Female smoker tables designated as "1980 CSO-SG" and 1980 CET-SG" tables.

(h) NA: 100% Male 0% Female nonsmoker tables designated as "1980 CSO-NA" and "1980 CET-NA" tables.

(i) NB: 80% Male 20% Female nonsmoker tables designated as "1980 CSO-NB" and "1980 CET-NB" tables.

(j) NC: 60% Male 40% Female nonsmoker tables designated as "1980 CSO-NC" and "1980 CET-NC" tables.

(k) ND: 50% Male 50% Female nonsmoker tables designated as "1980 CSO-ND" and "1980 CET-ND" tables.

(l) NE: 40% Male 60% Female nonsmoker tables designated as "1980 CSO-NE" and "1980 CET-NE" tables.

(m) NF: 20% Male 80% Female nonsmoker tables designated as "1980 CSO-NF" and "1980 CET-NF" tables.

(n) NG: 0% Male 100% Female nonsmoker tables designated as "1980 CSO-NG" and "1980 CET-NG" tables.

(4) Tables (a), (g), (h), and (n) are not acceptable as blended tables unless the proportion of persons insured is anticipated to be 90% or more of one sex or the other.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

Utah Admin. Code R590-95-6 Unfair Discrimination

It is not a violation of Subsection 31A-23a-402(3) for an insurer to issue a life insurance policy on a sex distinct or a sex neutral basis.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

Utah Admin. Code R590-95-7 Severability

If any provision of this rule, Rule R590-95, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: September 22, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-101; 31A-2-201; 31A-22-408

R590-96 Mortality Tables for Determining Reserve Liabilities for Annuities

Utah Admin. Code R590-96-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-505.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-2 Purpose

The purpose of this rule is to recognize certain mortality tables for determining the minimum standard of valuation for an annuity and a pure endowment contract.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "1983 Table (a)" means the mortality table developed by the Society of Actuaries Committee to Recommend a New Mortality Basis for Individual Annuity Valuation, adopted by the NAIC in June 1982 as a recognized mortality table for annuities, and published in the 1982 Proceedings of the NAIC II, page 454.

(2) "1983 GAM Table" means the mortality table developed by the Society of Actuaries Committee on Annuities, adopted by the NAIC in December 1983 as a recognized mortality table for annuities, and published in 1984 Proceedings of the NAIC I, pages 414-415.

(3) "1994 GAM Table" means the 1994 Group Annuity Mortality Static Table, a period table containing loaded mortality rates for calendar year 1994, developed by the Society of Actuaries Group Annuity Valuation Table Task Force, and published in the Transactions of the Society of Actuaries, Vol. XLVII (1995), pages 898-899.

(4) "1994 GAR Table" means the 1994 Group Annuity Reserving Table, a generational mortality table developed by the Society of Actuaries Group Annuity Valuation Table Task Force, derived from a combination of 1994 GAM Table and the Projection Scale AA as described in Section R590-96-7, adopted by the NAIC in December 1996 as a recognized mortality table for annuities, and published in the Transactions of the Society of Actuaries, Vol. XLVII (1995), pages 866-867.

(5) "Annuity 2000 Mortality Table" means the mortality table developed by the Society of Actuaries Committee on Life Insurance Research adopted by the NAIC in December 1996 as a recognized mortality table for annuities, and published in the Transactions of the Society of Actuaries, Vol. XLVII (1995), page 240.

(6) "2012 IAM Period Table" means the period table containing loaded mortality rates for calendar year 2012, developed by the Society of Actuaries Committee on Life Insurance Research, and published in the 2012 Proceedings of the NAIC, Fall Volume I, pages 149-150.

(7) "2012 IAR Table" means the generational mortality table developed by Society of Actuaries Committee on Life Insurance Research, derived from a combination of the 2012 IAM Period Table and the Projection Scale G2 as described in Section R590-96-5, adopted by the NAIC in December 2012, and published in the 2012 Proceedings of the NAIC, Fall Volume I, pages 149-152.

(8) "Generational Mortality Table" means a mortality table containing a set of mortality rates that decrease for a given age from one year to the next based on a combination of a period table and a projection scale containing mortality improvement factors.

(9) "NAIC" means the National Association of Insurance Commissioners.

(10) "Period Table" means a table of mortality rates applicable to a given calendar year.

(11) "Projection Scale AA" means the table of annual mortality improvement factors for projecting future mortality rates beyond calendar year 1994, developed by the Society of Actuaries Group Annuity Valuation Table Task Force, and published in the Transactions of the Society of Actuaries, Vol. XLVII (1995), pages 824-826.

(12) "Projection Scale G2" means the table of annuity mortality improvement factors for projecting future mortality rates beyond calendar year 2012, developed by the Society of Actuaries Committee on Life Insurance Research, and published in the 2012 Proceedings of the NAIC, Fall Volume I, pages 151-152.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-4 Individual Annuity or Pure Endowment Contracts

(1) An individual annuity or a pure endowment contract issued on or after April 2, 1980, and before July 1, 1985, at the option of the company, may be valued using the 1983 Table (a).

(2) An individual annuity or a pure endowment contract issued on or after July 1 1985, and before July 1, 1999, shall be valued using the following tables:

(a) the 1983 Table (a); or

(b) the Annuity 2000 Mortality Table.

(3) Except as provided in Subsection (5), an individual annuity or a pure endowment contract issued on or after July 1, 1999, and before January 1, 2015, shall be valued using the Annuity 2000 Mortality Table.

(4) Except as provided in Subsection (5) an individual annuity or a pure endowment contract issued on or after January 1, 2015, shall be valued using the 2012 IAR Table.

(5) The 1983 Table (a) shall be used for determining the minimum standards of valuation for an individual annuity or a pure endowment contract issued on or after July 1, 1999, when the contract is based on life contingencies and is issued to fund periodic benefits arising from settlement of:

(a) claims pertaining to court settlements or out of court settlements from tort actions;

(b) similar actions such as worker's compensation claims; or

(c) long term disability claims where a temporary or life annuity has been used in lieu of continuing disability payments .

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-5 Application of the 2012 IAR Table

(1) In using the 2012 IAR Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows: q x 2012 + n = q x 2012 (1 - G2 x ) n , where q x 2012 is a mortality rate applicable to a person age x in the 2012 IAM Period Table and G2 x is an annual mortality improvement factor applicable to a person age x in the Projection Scale G2.

(2) The mortality rate q x 2012 + n shall be rounded to six decimal places.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-6 Group Annuity or Pure Endowment Contracts

(1) A group annuity or a pure endowment contract issued on or after April 2, 1980, and before July 1, 1985, at the option of the company, may be valued using the following tables:

(a) the 1983 GAM Table;

(b) the 1983 Table (a); or

(2) A group annuity or a pure endowment contract issued on or after July 1, 1985, and before July 1, 1999, shall be valued using the following tables:

(a) the 1983 GAM Table; or

(b) the 1994 GAR Table.

(3) A group annuity or a pure endowment contract issued on or after July 1, 1999, shall be valued using the 1994 GAR Table.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-7 Application of the 1994 GAR Table

In using the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is calculated as follows: q x 1994 + n = q x 1994 (1 - AA x ) n , where the q x 1994 is a mortality rate applicable to a person age x in the 1994 GAM Table and AA x is an annual mortality improvement factor applicable to a person age x in the Projection Scale AA.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

Utah Admin. Code R590-96-8 Severability

If any provision of this rule, Rule R590-96, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: October 29, 2021
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-505

R590-98 Unfair Practice in Payment of Life Insurance and Annuity Policy Values

Utah Admin. Code R590-98-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-402.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-98-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) require a prompt response to a policyholder's request for policy values; and

(b) limit the exercise of the statutory deferral option to a situation where the financial stability of the insurer i s at risk.

(2) This rule applies to an insurer engaged in the business of insurance.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-98-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "Deferral" means withholding or delaying payment of policy values to the policyholder.

(b) "Deferral" does not include withholding or delaying payment of variable life insurance and variable annuity payments when the value of investment assets on which payments are based cannot be obtained because:

(i) the Securities and Exchange Commission (SEC) has restricted trading;

(ii) the stock exchange is closed; or

(iii) the SEC permits deferral to protect the policyholder.

(2) "Policyholder" includes a certificate holder under a group policy.

(3) "Policy value" means any value to which the policyholder is entitled, upon request, for a policy loan, withdrawal, or surrender of a policy, and includes:

(a) cash values;

(b) accumulated dividends;

(d) other similar values.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-98-4 Unfair or Deceptive Acts or Practices

Unfair or deceptive acts or practices include:

(1) Failing to comply with a policyholder request for a policy value within 20 days of receiving the request.

(2) Exercising the nonforfeiture deferral option of Subsections 31A-22-408(2)(h), 31A-22-409(3)(d), or 31A-22-420(5), in response to a request for policy values unless the financial stability of the insurer is at risk.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-98-5 Requirements

(1) Before an insurer exercises the right to defer payment of any policy value, the insurer shall file with the commissioner a written request that shall include:

(a) an explanation of the reason for the deferment;

(b) the steps to be taken by the insurer to alleviate the situation;

(d) the notice to policyholders as to why the insurer is deferring payment; and

(e) the anticipated date the policy values are expected to be available.

(2)(a) If the policy does not specify a policy value between policy anniversaries, the policy value shall be:

(i) the value shown in the policy nonforfeiture value table as of the end of the policy year; or

(ii) computed by the interpolation of values between policy years.

(b) If the method in Subsection (2)(a)(i) is used:

(i) the insurer may deduct from the policy value any premium required to pay the policy to the next succeeding anniversary date; and

(ii) a premium may not be deducted that advances the paid-to date past the next succeeding anniversary date.

(3) A surrender or service charge assessed by an insurer may not be deducted from the policy value unless specifically provided for in the policy.

(4) With the consent of the policyholder, an insurer may process a policy loan in lieu of cash surrender to conserve business, but only if the following criteria are followed:

(a) the computation of policy values and premium deductions, if any, shall be calculated on the same basis as enumerated in Subsection (2);

(b) the policyholder shall receive:

(i) the reason the insurer is sending the proceeds of a policy loan as opposed to the cash surrender value;

(ii) an explanation of the effect the loan will have on the policyholder's interest charge, premium, and death benefit; and

(iii) the procedures for the repayment of the loan; and

(i) the loan shall be processed within 20 days of receiving the request to surrender;

(ii) the check for the policy loan value shall be immediately negotiable;

(iii) a stamped, self-addressed envelope and a cash surrender form shall accompany the loan value check, together with appropriate instructions on how the policyholder may obtain the full policy surrender value; and

(iv) a request for the balance of the cash surrender value shall be processed within 10 days of receiving the request.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-98-6 Severability

If any provision of this rule, Rule R590-98, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

R590-103 Security Deposits

Utah Admin. Code R590-103-1 Authority

This rule is promulgated by the commissioner pursuant to Subsections 31A-2-201(3) and 31A-2-206(17).

History

KEY: insurance
Date of Last Change: October 25, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-206

Utah Admin. Code R590-103-2 Purpose and Scope

(1) The purpose of this rule is to establish procedures and forms for a required deposit with the commissioner.

(2) This rule applies to each insurer licensee in this state.

History

KEY: insurance
Date of Last Change: October 25, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-206

Utah Admin. Code R590-103-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance
Date of Last Change: October 25, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-206

Utah Admin. Code R590-103-4 Rules

(1) Rule R590-178 and the federal book-entry system shall apply to a security deposited with the state.

(2) A security held by a qualified transfer deposit corporation may be a qualified deposit if the security is held:

(a) in accordance with Rule R590-178; and

(b) through a qualified custodian.

(3) If a declining balance security is deposited with the commissioner, the insurer depositing the security shall:

(a) report the balance to the commissioner at least on a quarterly basis; or

(b) if ordered by the commissioner, report the balance on a monthly basis.

(4)(a) The custodian institution holding a deposit, or the state treasurer, shall provide an annual report to the insurer and the commissioner indicating the amount of securities held on December 31 of each year.

(b) The report shall be submitted by January 15 of the following year.

(i) the Committee on Uniform Securities Identification Procedures (CUSIP) number;

(ii) the interest rate;

(iii) the par value; and

(iv) the maturity date.

(d) The report shall demonstrate that the securities held in the deposit satisfy the requirements of Subsection 31A-2-206(7).

(e) Failure to provide the report shall be grounds for appropriate action by the commissioner.

(5)(a) A certificate of deposit may be deposited in an amount not to exceed federal insurance limits.

(b) The face amount of the certificate of deposit shall be the market value.

(6) The following forms are available on the department's website at https://insurance.utah.gov:

(a) depository agreement;

(b) deposit request; and

(7) A deposit required under this section shall apply to each insurer licensee in this state.

(8) A foreign insurer may deposit a security in:

(a) the insurer's domiciliary state; or

(b) another state with comparable deposit statutes or rules.

(9) The only acceptable deposit is a deposit held for all policyholders.

History

KEY: insurance
Date of Last Change: October 25, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-206

Utah Admin. Code R590-103-5 Severability

If any provision of this rule, Rule R590-103, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: October 25, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-206

R590-108 Interest Rate During Grace Period or Upon Reinstatement of Policy

Utah Admin. Code R590-108-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-22-402, and 31A-22-407.

History

KEY: insurance companies
Date of Last Change: November 8, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-402; 31A-22-407

Utah Admin. Code R590-108-2 Purpose and Scope

(1) The purpose of this rule is to establish the interest rate an insurer may charge on premiums due under a life insurance or annuity contract during a grace period or upon subsequent reinstatement of the contract.

(2) This rule applies to an insurer offering a life insurance policy or annuity contract.

History

KEY: insurance companies
Date of Last Change: November 8, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-402; 31A-22-407

Utah Admin. Code R590-108-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance companies
Date of Last Change: November 8, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-402; 31A-22-407

Utah Admin. Code R590-108-4 Rule

The interest rate an insurer may charge during a grace period on overdue premium or subsequent reinstatement of a life insurance policy or annuity contract shall be the rate set in the policy or contract, except that:

(1) the interest rate may not exceed the interest rate in the policy loan provision in the policy; or

(2) in the absence of a policy loan provision, the interest rate may not exceed the maximum interest rate under Section 31A- 22-420.

History

KEY: insurance companies
Date of Last Change: November 8, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-402; 31A-22-407

Utah Admin. Code R590-108-5 Severability

If any provision of this rule, Rule R590-108, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: November 8, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-402; 31A-22-407

R590-114 Letters of Credit

Utah Admin. Code R590-114-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-404.

History

KEY: insurance
Date of Last Change: November 8, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-404

Utah Admin. Code R590-114-2 Purpose and Scope

(1) The purpose of this rule is to determine, in accordance with Subsection 31A-17-404(10)(c)(ii), the form of letter of credit security to protect a ceding insurer in a reinsurance transaction if:

(a) the requirement in Subsection 31A-17-404(3) or the alternative security factors in Subsection 31A-17-404(6) are not present; and

(b) the ceding insurer retains the reinsurer's funds in the form of a letter of credit.

(2) Security for a reinsurance transaction is maintained because the ceding insurer's reinsurance credit may be allowed as an asset or a deduction from liabilities.

(3) The allowance or disallowance of credit in a reinsurance transaction may be used to determine if the transaction complies with other financial requirements of Title 31A, Insurance Code.

(4) This rule applies to any person transacting insurance under Title 31A, Insurance Code.

History

KEY: insurance
Date of Last Change: November 8, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-404

Utah Admin. Code R590-114-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Clean" means a letter of credit that does not require the presentation of any document other than a sight draft for a draw upon available funds.

(2) "Evergreen clause" means a provision in a letter of credit that prevents the letter from expiring unless the issuer provides advance notice.

History

KEY: insurance
Date of Last Change: November 8, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-404

Utah Admin. Code R590-114-4 Rule

(1) A letter of credit issued to comply with Subsection 31A-17-404(10)(c)(ii) shall meet the requirements in this section.

(2) A letter of credit that takes the form of the Model Letter of Credit, available upon request from the department, complies with this rule.

(3) A letter of credit shall:

(a) be issued by a bank or trust company that is a member of the Federal Reserve system;

(b) name the ceding insurer as the sole beneficiary;

(d) be unconditional and not subject to any qualifications outside the letter of credit;

(e) be irrevocable;

(f) contain an evergreen clause;

(g) have a term of not less than one year;

(h) be automatically extended for not less than one additional year, unless the issuer notifies the ceding insurer and the reinsurer that the letter will not be renewed at least 30 days before the letter expires;

(i) state that a bank's obligation is not contingent upon reimbursement;

(j) state whether the letter of credit is subject to the laws of this state; and

(k) provide that any drafts drawn be presentable at a bank office in the United States.

(4) A letter of credit may not:

(a) contain references to any other agreement, document, or entity; or

(b) be reduced or revoked without the written consent of the beneficiary.

(5)(a) A letter of credit may contain a boxed reference section with the applicant's name and other appropriate information for internal identification.

(b) The information contained in the boxed reference section may not affect the terms of the letter or the obligations of the bank.

(6) When a letter of credit is not renewed or is withdrawn, the ceding insurer may:

(a) withdraw the balance of the letter of credit; and

(b) place the resulting sum in trust to secure continuing obligations under the reinsurance contract until the ceding insurer receives the following:

(i) a renewal letter of credit; or

(ii) an alternative form of security that complies with this rule and Title 31A, Insurance Code.

(7) A letter of credit used as security under this rule shall be available for inspection by the commissioner or the commissioner's designee upon request.

History

KEY: insurance
Date of Last Change: November 8, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-404

Utah Admin. Code R590-114-5 Separability

If any provision of this rule, Rule R590-114, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: November 8, 2021
Notice of Continuation: January 5, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-404

R590-116 Valuation of Assets

Utah Admin. Code R590-116-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-401.

History

KEY: insurance companies, rules and procedures
Date of Last Change: January 10, 2022
Notice of Continuation: January 24, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-401

Utah Admin. Code R590-116-2 Purpose and Scope

(1) The purpose of this rule is to provide direction to establish the value of insurer assets used to determine compliance with the financial requirements of Title 31A, Insurance Code.

(2) This rule applies to any person transacting insurance business under Title 31A, Insurance Code.

History

KEY: insurance companies, rules and procedures
Date of Last Change: January 10, 2022
Notice of Continuation: January 24, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-401

Utah Admin. Code R590-116-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Amortizable" means accorded that rating in Valuation of Securities.

(2) "In good standing" means accorded that rating in Valuation of Securities.

(3) "NAIC" means the National Association of Insurance Commissioners.

(4) "Purchase money mortgage" means a mortgage or lien received as consideration, either in whole or in part, on the disposal of real estate that secures the mortgage or lien.

(5) "Valuation of Securities" means the publication of the Securities Valuation Office of the NAIC.

History

KEY: insurance companies, rules and procedures
Date of Last Change: January 10, 2022
Notice of Continuation: January 24, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-401

Utah Admin. Code R590-116-4 Valuation of Assets

An insurer's assets shall be valued as follows:

(1) Bonds.

(a)(i) Each obligation with a fixed term and rate, if not in default on principal or interest, shall be valued:

(A) at the par value, if purchased at par; or

(B) at the value to par at maturity and to yield, in the meantime, the effective rate of interest at which the purchase was made, if purchased above or below par.

(ii) For valuation purposes, the purchase price may not be higher than actual market value at the date of acquisition, including brokerage and any other related fee.

(b) A bond may not be carried at a value greater than the call price at which the entire issue may be called.

(c)(i) An obligation subject to amortization under the published findings of the NAIC shall be carried at its amortized value.

(ii) An obligation that does not qualify for amortization under the published findings of the NAIC shall be carried at its market value or book value, whichever is lower.

(d) A demand deposit or certificate of deposit in a solvent bank or savings and loan institution shall be valued at the account or certificate balance.

(i) A negotiable certificate of deposit with a maturity term of less than three years shall be valued at face value.

(ii) A negotiable certificate of deposit with a maturity term of more than three years shall be valued at face value or market value, whichever is less.

(e) An obligation of an insurance subsidiary shall be valued in accordance with Subsection 31A-17-401(3)(a) and Section R590-116-5.

(2) Equipment Trust Certificates.

(a) An equipment trust certificate subject to amortization under the published findings of the NAIC shall be carried at the certificate's amortized value.

(b) An equipment trust certificate that is not listed as qualified for amortization under the published findings of the NAIC shall be carried at a value not to exceed the certificate's proportionate part of the aggregate principal amount of the equipment obligations outstanding times 70% of the net depreciated value of the equipment pledged.

(3) Loans Secured By Real Estate Interest.

(a) A loan, other than a purchase money mortgage, that is adequately secured by a real estate interest and is not in default on principal or interest, shall be valued at the unpaid principal balance if the acquisition was at par.

(b) A mortgage loan acquired at a premium or at a discount shall be valued at amortized cost as follows:

(i) for a Federal Housing Administration (FHA) or Veterans Administration (VA) mortgage:

(A) a premium shall be amortized and discounts accrued over a five-year period from date of acquisition; and

(B) a company may adjust the asset value to its face amount, but any excess of aggregate permissive amortized value, cost of mortgage less repayment of principal, adjusted for amortization of premium and accrual of discounts on a five-year basis, shall be treated as a nonadmitted asset; and

(ii) for a mortgage other than an FHA or VA Mortgage:

(A) the book value of a real estate mortgage acquired at a premium shall be reported at a value reflecting any write-off of the premium over a three-year period from date of acquisition; and

(B) a real estate mortgage purchased at a discount shall be carried at the amortized value.

(c) Premium amortization or discount accretion as required in Subsection (3)(b) shall be on the straight-line method of computation.

(d) An adequately secured purchase money mortgage shall be valued at the unpaid principal balance of the lien reduced by a reserve for unrealized gain on the sale of real estate; the reserve shall maintain the same proportionate relationship between the unpaid principal balance as the original gain on the sale bore to the original note principal balance.

(e) For a loan that is in default or in foreclosure proceedings, the carrying value may be adjusted for additional expenses, such as taxes, insurance, and legal fees, incurred to protect the investment or to obtain clear title to the property.

(i) If a cost is recoverable from the ultimate disposition of the property, the cost may be added to the carrying value of the mortgage loan.

(ii) A cost that cannot reasonably be expected to be recovered shall be expensed when incurred.

(f) A loan with any of the following provisions may be valued, at the option of the commissioner, at a discounted value that approximates the market value of the loan at the valuation date:

(i) a payment other than in equal installments;

(ii) a payment period less often than annually; or

(iii) interest below a conventional rate of return on the date the loan is granted.

(4) Loans Secured By Pledged Securities Or Evidences Of Debt Eligible For Investment Under Section 31A-18-105.

(a) A loan that is adequately secured by a pledge of securities or evidence of debt eligible for investment under Section 31A- 18-105 shall be valued at par, if the acquisition was at par.

(b) A loan acquired at a premium or at a discount shall be valued at the unpaid principal balance or cost, whichever is less.

(5) Preferred and Guaranteed Stocks.

(a) A company that maintains a mandatory securities valuation reserve shall value preferred or guaranteed stock in good standing at cost.

(b) A company that does not maintain a mandatory securities valuation reserve shall value preferred or guaranteed stock in good standing at market value.

(i) Market value, as used for valuation of preferred or guaranteed stock, means in accordance with the values listed in Valuation of Securities.

(ii) A security traded on a registered national securities exchange but not listed in Valuation of Securities may establish market value at the most recent published trade value.

(iii) A security not listed in Valuation of Securities and not actively traded on a major stock exchange shall have a market value that the insurer can justify to the commissioner.

(d) Preferred or guaranteed stock of an insurance subsidiary shall be valued under Subsection 31A-17-401(3)(a) and Section R590-116-5.

(6) Common Stock.

(a) Common stock shall be valued at market value.

(i) Market value, as used for valuation of common stocks, means in accordance with the values listed in Valuation of Securities.

(ii) A security traded on a registered national securities exchange but not listed in Valuation of Securities may establish market value at the most recent published trade value.

(iii) A security not listed in Valuation of Securities and not actively traded on a registered national securities exchange shall have a market value that the insurer can justify to the commissioner.

(b) Common stock of an insurance subsidiary shall be valued under Subsection 31A-17-401(3)(a).

(7) Real Estate.

(a) An investment in real estate shall be valued at not more than the reasonable cost of the property plus capitalized permanent improvements less depreciation spread evenly over the life of the property or, at the option of the company, less depreciation computed on any basis permitted under the Internal Revenue Code and regulations.

(b) Property acquired in satisfaction of a debt shall be valued at its fair market value or the amount of debt, including interest, taxes, and expenses incurred as cost in foreclosure, whichever is less.

(8) Loans Upon the Security of the Insurer's Own Policies. A loan upon the security of the insurer's own policies shall be valued at the unpaid loan balance or the policy reserve securing the loan, whichever is less.

(9) Financial Futures Contracts. A financial futures contract, if approved by department rule, shall be valued in the manner set forth by the commissioner.

(10)(a) Investment in Foreign Securities. A foreign security permitted under Subsection 31A-18-105(11) shall be valued as follows:

(i) if the value of the security is listed in Valuation of Securities, the market value shall be the listed value; or

(ii) if the value of the security is not listed in Valuation of Securities, the security shall have a market value that the insurer can justify to the commissioner.

(b) If the security is payable in a foreign currency, the value shall reflect the currency exchange rate.

(11) Separate Account Assets. Each separate account asset shall have a value as required under Subsection 31A-18-102(4).

History

KEY: insurance companies, rules and procedures
Date of Last Change: January 10, 2022
Notice of Continuation: January 24, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-401

Utah Admin. Code R590-116-5 Valuation of a Security Other Than Common Stock Issued by an Insurance Subsidiary

The following provisions supplement Subsection 31A-17-401(3)(a) in controlling the way assets of an insurance subsidiary are valued on the books of the parent insurer.

(1) A parent insurer may attribute value to the security of an insurance subsidiary only if a dividend or interest is being paid and payment is anticipated to continue.

(2) The value of a security other than common stock issued by an insurance subsidiary is the lesser of:

(a) the present value of future income to be derived under the security; or

(b) the amount the parent would receive following liquidation of the subsidiary with payment, in full, of each creditor and holder with senior priority.

(3) The present discounted value of future income under Subsection (2)(a) shall be determined as follows:

NPV = ((CF 1 )/((1 + i) 1 )) + ((CF 2 )/((1 + i) 2 )) + (CF 3 )/((1 + 3) 3 )) + ... ((CF n )/((1 + i) n ))

NPV = Net present value

CF = Cash flow

i = Assumed interest rate per period

n = Number of periods

If cash flows remain constant, the following formula may be used:

NPV = CF(1-(1 / (1 + i) n ) / i)

(4) The interest rate used shall be Moody's AA Bond rate for a security of substantially equal duration, or another rate that can be justified by the insurer and is accepted by the commissioner.

History

KEY: insurance companies, rules and procedures
Date of Last Change: January 10, 2022
Notice of Continuation: January 24, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-401

Utah Admin. Code R590-116-6 Separability

If any provision of this rule, Rule R590-116, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies, rules and procedures
Date of Last Change: January 10, 2022
Notice of Continuation: January 24, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-401

R590-117 Valuation of Liabilities

Utah Admin. Code R590-117-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-402.

History

KEY: insurance companies, rules and procedures
Date of Last Change: November 8, 2021
Notice of Continuation: January 26, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-402

Utah Admin. Code R590-117-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) define statutory liabilities; and

(b) establish a hierarchy of statutory requirements and accounting standards for the valuation of a liability.

(2) This rule applies to any person transacting insurance business under Title 31A, Insurance Code.

History

KEY: insurance companies, rules and procedures
Date of Last Change: November 8, 2021
Notice of Continuation: January 26, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-402

Utah Admin. Code R590-117-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Liabilities" shall include reserves for payment of future obligations.

History

KEY: insurance companies, rules and procedures
Date of Last Change: November 8, 2021
Notice of Continuation: January 26, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-402

Utah Admin. Code R590-117-4 Reported Liabilities and Valuation Hierarchy

(1) Reported liabilities include:

(a) any liability provided for or contemplated by the annual statement blank or other reporting form prescribed by the commissioner under Section 31A-2-202; and

(b) any other liability known to the reporting insurer, except a liability specifically exempted or precluded by the reporting form.

(2) The value of a reported liability shall be computed according to the first applicable method, in ascending order, from the following list:

(a) a specific provision of Title 31A, Insurance Code;

(b) a department rule that supersedes Rule R590-117;

(d) generally accepted accounting principles; or

(e) values a prudent person would establish and are accepted by the commissioner.

History

KEY: insurance companies, rules and procedures
Date of Last Change: November 8, 2021
Notice of Continuation: January 26, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-402

Utah Admin. Code R590-117-5 Severability

If any provision of this rule, Rule R590-117, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies, rules and procedures
Date of Last Change: November 8, 2021
Notice of Continuation: January 26, 2022
Authorizing, and Implemented or Interpreted Law: 31A-17-402

R590-120 Surety Bond Forms

Utah Admin. Code R590-120-1 Authority

This rule is promulgated by the commissioner pursuant to Subsections 31A-2-201(3) and 31A-21-101(5).

History

KEY: insurance rule
Date of Last Change: October 25, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-21-101

Utah Admin. Code R590-120-2 Purpose and Scope

(1) The purpose of this rule is to exempt certain surety bond forms from filing requirements and other requirements in Title 31A, Chapter 21, Insurance Contracts in General.

(2) This rule applies to each insurer transacting surety insurance business in this state.

History

KEY: insurance rule
Date of Last Change: October 25, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-21-101

Utah Admin. Code R590-120-3 Rule

(1) Surety insurance forms, except bail bond insurance forms, are exempt from Sections 31A-21-106, 31A-21-201, 31A-21- 303, 31A-21-308 and 31A-21-312.

(2) Bail bond surety forms used by surety insurers and bail bond surety companies must be filed in accordance with 31A-21- 201.

History

KEY: insurance rule
Date of Last Change: October 25, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-21-101

Utah Admin. Code R590-120-4 Severability

If any provision of this rule, Rule R590-120, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance rule
Date of Last Change: October 25, 2021
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-21-101

R590-121 Rate Modification Plan Rule

Utah Admin. Code R590-121-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-203, and 31A-19a-203.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-19a-201; 31A-19a-202; 31A-19a-203; 31A-23- 302

Utah Admin. Code R590-121-2 Purpose and Scope

(1) The purpose of this rule is to establish criteria for:

(a) modifying manual rates through insurer rate modification plans; and

(b) using rate modification plans to determine whether rates meet the standards under Section 31A-19a-201.

(2) This rule applies to:

(a) a property and casualty insurer;

(b) a rate service organization required to file rates and supplementary information under Section 31A-19a-203;

(d) workers' compensation insurance; and

(e) employers' liability insurance.

(3) This rule does not apply to:

(a) professional liability insurance;

(b) inland marine risks, which, by general custom, are not written according to manual rules or rating plans; and

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-19a-201; 31A-19a-202; 31A-19a-203; 31A-23- 302

Utah Admin. Code R590-121-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-19a-102. Additional terms are defined as follows:

(1) "Experience rating plan" means a rating plan or system where a manual rate for insurance is adjusted or modified based on the past loss experience of the insured.

(2) "Manual rate" means a rate, designed to apply on a generic basis to similar risks within the same market, filed with the department by an insurer or rate service organization and made part of the rating manual used by an insurer or rate service organization.

(3)(a) "Rate modification plan" means a rating plan or procedure that lists various risk characteristics or conditions and a range of modification factors that may be applied for those characteristics or conditions to the manual rate of a particular insurance risk, the effect of which is to increase (debit) or decrease (credit) the manual rate.

(b) Rate modification plans include plans commonly called Schedule Rating Plans and Individual Risk Premium Modification Plans.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-19a-201; 31A-19a-202; 31A-19a-203; 31A-23- 302

Utah Admin. Code R590-121-4 Rate Modification Justification

(1) A rate modification plan, justified according to the standards herein, is permitted.

(2) The commissioner determined that using an unjustified rate modification plan is unreasonable, is not based on reasonable criteria, and is unfairly discriminatory.

(3) The use of an unjustified rate modification plan in the rating of commercial property and casualty insurance risks located in Utah is prohibited.

(4) The following elements shall be considered in determining whether a rate modification plan is justified:

(a)(i) A rate modification plan must limit its application to maximum debits or credit s of 25%.

(ii) A modification generated by loss experience or company expense experience is not subject to this limitation.

(b) A rate modification plan must be based only on rating characteristics not already reflected in the manual rates, and the plan must clearly indicate the objective criteria to be used.

(c) A rate modification plan designed to be applied simultaneously to property, liability, or vehicle coverage shall contain reasonable factors that give appropriate recognition to the distinct exposures involved in the coverages.

(d) A rate modification plan must provide that when a risk is rated above the manual rate (debited), an insured, applicant, or their agent or broker, upon request, will be advised by the insurer of the factors that resulted in the adverse rating so that the insured or applicant will be fairly apprised of any corrective action that might be appropriate with respect to the insurance risk.

(e)(i) An insurer's filing of changes or revisions to a rate modification plan it previously filed may not result in the elimination of a debit or credit established under the prior plan for a risk currently insured by the insurer.

(ii) A change in an established debit or credit for a risk currently insured must be based on a change in the risk and not on a change in the provisions of a rate modification plan.

(f)(i) Any initial and succeeding filing of a rate modification plan must be submitted according to established filing procedures and must include a complete copy of the plan, even if only minor changes are being made.

(ii) The filing must also include a letter or filing memorandum from the insurer t hat provides:

(A) a comparison of the proposed changes to any existing plan as currently filed;

(B) the reasons and justification for the proposed changes; and

(C) a statement of the estimated number of Utah insureds affected by the changes and the estimated Utah premium dollar impact of the changes.

(5) The following elements shall be considered in determining whether the application of a rate modification plan is justified:

(a) A rate modification plan must be used to acknowledge variance in risk characteristics and not merely to gain competitive advantage.

(b)(i) Once a company has filed a rate modification plan, its use is mandatory.

(ii) The plan must be applied uniformly in a non-discriminatory manner for all eligible classes of risk even if the application of the plan results in a zero modification or no change in a previously applied modification.

(c) Once a rate modification plan has been applied to a risk and a debit or credit has been established, no changes in the established debit or credit can be made without appropriate justification and documentation.

(d)(i) Individual underwriting files must contain the specific criteria and document the particular circumstances of the risk that supports each debit or credit.

(ii) This documentation must be present in the file to enable the commissioner to verify compliance with this rule, and may include:

(A) inspection reports;

(B) photographs;

(D) insured's formal safety plans;

(E) premises evaluations; and

(F) narrative reports covering other aspects of the risk.

(e)(i) Individual underwriting files must contain documentation of the underwriter's evaluation of the risk under the rate modification plan and shall consist of the following:

(A) a worksheet that describes the risk characteristics of the filed plan and the range of debits or credits allowed for each risk characteristic;

(B) any debit, credit, or both, assigned to the risk characteristics by the underwriter and the sum of the debits and credits assigned;

(D) the date of the initial and any subsequent evaluation; and

(E) the signature of the individual conducting the evaluation.

(ii) A previous worksheet may be used when no change in the risk characteristics is indicated and a current date and signature are entered onto the worksheet.

(6) The commissioner determined that the misclassification of a risk is a modification without j ustification.

(7) Experience rating plans are calculated from at least the last three years' premium and loss data using premium and loss data that must be verifiable or justifiable.

(8)(i) Upon request, an insurer shall submit data to the commissioner establishing the relationship of the aggregate premium actually charged to policyholders for each line of commercial insurance to the aggregate premium that would have been produced by the insurer's filed unmodified rates for that line of commercial insurance.

(ii) A rate service organization may file the data on behalf of the insurer.

(9) The commissioner may order an examination pursuant to Sections 31A-2-203, 31A-2-204, and 31A-2-205 to determine compliance with this rule.

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-19a-201; 31A-19a-202; 31A-19a-203; 31A-23- 302

Utah Admin. Code R590-121-5 Severability

If any provision of this rule, Rule R590-121, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application..

History

KEY: insurance law
Date of Last Change: November 8, 2021
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-19a-201; 31A-19a-202; 31A-19a-203; 31A-23- 302

R590-122 Permissible Arbitration Provisions

Utah Admin. Code R590-122-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance law
Date of Last Change: November 22, 2021
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-122-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) recognize arbitration as an acceptable method of alternative dispute resolution; and

(b) provide guidelines for disclosure of a contract arbitration provision.

(2) Except as provided in Subsection (3), this rule applies to individual and group contracts and all classifications or lines of insurance.

(3) This rule does not apply to individual and group income replacement insurance or a health benefit plan that complies with Rule R590-215.

History

KEY: insurance law
Date of Last Change: November 22, 2021
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-122-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 78B-11-102. Additional terms are defined as follows:

(1) "Compulsory binding arbitration" means a contract provision requiring arbitration as an automatic and exclusive remedy for any dispute involving a contract of insurance to the exclusion of any otherwise available judicial remedy, provided that the claim or controversy exceeds the jurisdictional limit of the small claims court of the state where the action would be brought.

(2) "Compulsory non-binding arbitration" means a contract provision requiring an insured to exhaust a procedure of extra- judicial arbitration as a condition precedent to the pursuit of an otherwise available judicial remedy.

(3) "Optional binding arbitration" means a contract provision requiring any party to an insurance contract to submit to arbitration as set forth in the contract at the election of any contracting party, provided that the claim or controversy exceeds the jurisdictional limit of the small claims court of the state where the action would be brought.

(4) "Permissible arbitration provision" means an arbitration provision in an insurance policy that:

(a) allows for an action to be brought against an insurer;

(b) prohibits the insurance policy to be construed according to the laws of another jurisdiction, except as necessary to meet the requirements of compulsory insurance laws of other jurisdictions;

(d) limits the right of action against the insurer to less than three years from the date the cause of action accrues.

History

KEY: insurance law
Date of Last Change: November 22, 2021
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-122-4 Rule

(1) Compulsory non-binding arbitration is contrary to the public interest and is not a permissible arbitrati on provision.

(2) Optional binding arbitration at the exclusive election of an insured party is a permissible arbitration provision, in which case the disclosure provisions in Subsection (5) may not apply.

(3) Compulsory and optional binding arbitration at the election of either the insured or the insurer are permissible arbitration provisions.

(4)(a) A policy form containing an optional binding arbitration provision for the exclusive election of an insurer will be disapproved under Subsection 31A-21-201(3), and these provisions in any previously approved form are declared not enforceable.

(b) A policy form described in Subsection (4)(a) will be construed and applied as if in compliance with the Insurance Code, as permitted under Section 31A-21-107.

(5) Except as excluded in Subsection (2), each application or binder pertaining to an insurance policy that contains a permissible arbitration provision must include or have attached a prominent statement substantially as follows:

This statement must be disclosed prior to the execution of the insurance contract between the insurer and the policy holder and, in the case of group insurance, shall be contained in the certificate of insurance or other disclosure of benefits.

(6) No compulsory binding arbitration provision or optional binding arbitration provision may be construed to preclude any dispute resolution by any small claims court having jurisdiction.

(7) Any arbitration provision contained in an insurance policy shall comply with Title 78B, Chapter 11, Utah Uniform Arbitration Act.

(8) No agreement for arbitration may obligate an insured to pay more than 50% of the advance payments required to begin the arbitration process.

(9) No arbitration provision may require that arbitration be held at a place further from the residence of the insured than the nearest location of a State Court of General Jurisdiction.

History

KEY: insurance law
Date of Last Change: November 22, 2021
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-122-5 Severability

If any provision of this rule, Rule R590-122, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: November 22, 2021
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-124 Loss Information Rule

Utah Admin. Code R590-124-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-402.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-124-2 Purpose and Scope

(1) The purpose of this rule is to provide for prompt dissemination of loss information between an insurer and an insured.

(2) This rule applies to an insurer licensed in this state to do the following business:

(a) property and casualty;

(b) commercial property and commercial liability;

(d) surplus lines.

(3) This rule does not apply to disability insurance.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-124-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "First named insured" means the first entity named as a named insured in the declarations of the policy.

(2) "Loss" means the dollar amount paid to an insured or claimant by an insurer on a claim made against an insurance contract.

(3) "Named insured" means a person or organization listed in the policy declarations as the policyholder, or the policyholder's legal representative.

(4) "Notice of occurrence" means notice to an insurer of an occurrence that might result in a claim against an insurance contract.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-124-4 Loss Information

(1) An insurer shall provide loss information to the first named insured within 30 days of the receipt of a written request from the named insured.

(a) Loss information shall be provided for the three most recent policy years in which coverage was provided, or complete loss information if the policy has been in effect less than three years.

(b) An insurer shall advise the first named insured of the right to request the loss information if the insurer initiates the cancellation or the nonrenewal of a policy.

(2) The following loss information must be provided to comply with Subsection (1):

(a) information on closed claims where payment was allowed, including date of occurrence, type of loss, and amount of payments;

(b) information on all open claims, including date of occurrence, type of loss, and amount of payments, if any; and

(3) The required loss information need only be provided one time in any 12-month period and shall be provided at no cost to the insured.

(4) A loss information request received more than three years after the termination of coverage may be denied.

(5) The loss information required by this rule shall be provided in a format that is clear and understandable to the insured.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-124-5 Severability

If any provision of this rule, Rule R590-124, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

R590-126 Accident and Health Insurance Standards

Utah Admin. Code R590-126-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-22-605, 31A-22- 605.1, 31A-22-623, and 31A-22-626.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) standardize and simplify the terms and coverage of an accident and health insurance contract;

(b) facilitate public understanding and comparison of coverage;

(c) prohibit use of a provision that is misleading or confusing in connection with the purchase of coverage or the settlement of a claim;

(d) set minimum coverage requirements; and

(e) provide for full disclosure in the sale of insurance.

(2) This rule applies to an accident and health insurance contract that is not specifically exempted from this rule, regardless of:

(a) whether the contract is issued to an association, a trust, a discretionary group, or another similar group; or

(b) the situs of delivery of the contract.

(3) This rule does not apply to:

(a) an accident and health insurance contract issued to an employee group under Section 31A-22-502;

(b) a contract issued to an employee or member as an addition to a franchise plan in existence on January 1, 2006;

(d) a TRICARE policy, formerly known as a Civilian Health and Medical Program of the Uniformed Services, 10 U.S.C. 55, CHAMPUS settlement insurance policy;

(e) a health benefit plan subject to Title 31A, Chapter 45, Managed Care Organizations;

(f) a short-term limited duration health insurance contract subject to Rule R590-286; or

(g) a long-term care insurance contract subject to Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-22-605, 31A-22-620, and 31A-22-625. Additional terms are defined as follows:

(1) "Assisted living facility," "continued care retirement community," "convalescent nursing home," "extended care facility," "hospital," "residential health care facility," or "skilled nursing facility" means a facility licensed and operating within the scope of that license.

(2) "Buyer's guide" means the NAIC's Shopper's Guide to Cancer Insurance.

(3) "Certificate of completion" means a document issued by the Utah State Board of Education, or similar organization in another state, to an individual:

(a) who completes an approved course of study not leading to a diploma;

(b) who passes a challenge for the course of study in Subsection (3)(a); or

(4) "Complication of pregnancy" means a disease or condition that is distinct from pregnancy but is adversely affected or caused by pregnancy and is not associated with a normal pregnancy.

(a) "Complication of pregnancy" includes:

(i) acute nephritis;

(ii) nephrosis;

(iii) cardiac decompensation;

(iv) terminated ectopic pregnancy;

(v) spontaneous termination of pregnancy when a viable birth is not possible;

(vi) puerperal infection;

(vii) eclampsia;

(viii) pre-eclampsia; or

(ix) toxemia.

(b) "Complication of pregnancy" does not include:

(i) false labor;

(ii) occasional spotting;

(iii) doctor prescribed rest during pregnancy;

(iv) morning sickness; or

(v) a condition of comparable severity associated with management of a difficult pregnancy.

(5) "Contract" means a policy or certificate.

(6)(a) "Cosmetic surgery" or "reconstructive surgery" means a surgical procedure performed primarily to improve physical appearance.

(b) "Cosmetic surgery" or "reconstructive surgery" does not include surgery that is necessary:

(i) to correct damage caused by injury or sickness;

(ii) for reconstructive treatment following medically necessary surgery;

(iii) to provide or restore normal bodily function; or

(iv) to correct a congenital disorder that has resulted in a functional defect.

(7)(a) "Custodial care" means a plan of care that does not provide treatment for sickness or injury, but is for meeting personal needs and maintaining physical condition when there is no prospect of remission or restoration of the patient to a condition when care would not be required, and that may be provided by a person without nursing skills or qualifications.

(8) "Elimination period" or "waiting period" means the length of time an insured shall wait before benefits are paid under the contract.

(9) "Enrollment form" means an application as defined in Section 31A-1-301.

(10) Experimental treatment" means a medical treatment, service, supply, medication, drug, or other method of therapy or medical practice that is not accepted as a valid course of treatment by the U.S. Food and Drug Administration, the American Medical Association, or the Surgeon General.

(11) "Home health agency" means a public agency, a private organization, or a subdivision of a health care facility that is licensed and operating within the scope of that license.

(12) "Home health aide" means an individual who obtains a certificate of completion, as required by law, that allows performance of:

(a) health care and other related services under the supervision of a registered nurse from the home health agency; or

(b) a simple procedure as an extension of physical, speech, or occupational therapy under the supervision of a licensed therapist.

(13) "Home health care" means a service provided by a home health agency.

(14) "Homemaker" means an individual who cares for the home through duties such as housekeeping, meal planning and preparation, laundry, shopping, and errands.

(15) "Hospice" means a program of care for the terminally ill and their families that occurs in a home or health care facility and provides medical, palliative, psychological, spiritual, or supportive care and treatment and is licensed and operating within the scope of that license.

(16)(a) "Injury" means a bodily injury resulting from an accident, independent of disease, that occurs while the coverage is in force.

(b) "Injury" is not limited to an injury with external, violent, visible wound or similar description.

(17) "Immediate family" means an insured's parent, spouse, sibling, or child, including a step or in-law relationship.

(18) "Intermediate nursing care" means a nursing service provided by, or under the supervision of, a nurse to treat a condition when confinement is required.

(19) "Licensed practical nurse" means a licensed practical nurse who provides services within the scope of their license.

(20)(a) "Medical necessity" means a health care service or product that a prudent health care provider would provide to a patient to prevent, diagnose, or treat an illness, injury, disease, or its symptoms in a manner that is:

(i) in accordance with generally accepted standards of medical practice in the United States;

(ii) clinically appropriate in terms of type, frequency, extent, site, and duration;

(iii) not primarily for the convenience of the patient, physician, or other health care provider; and

(iv) covered under the contract.

(b) If a medical question-of-fact exists, "medical necessity" shall include the most appropriate available supply or level of service for the individual in question, considering potential benefits and harms to the individual, and known to be effective.

(c)(i) For an intervention not yet in widespread use, the effectiveness shall be based on scientific evidence.

(ii) For an established intervention, the effectiveness shall be based on:

(A) scientific evidence;

(B) professional standards; and

(21)(a) "Nurse" means a type of licensed nurse, such as an advanced practice nurse, a registered nurse, or a licensed practical nurse.

(b) If the word "nurse" is used without specific instruction, then the use of this term requires the insurer to recognize the services of any individual who qualifies under this terminology under applicable laws.

(22) "Nursing care" means assistance provided for the health care needs of a sick or disabled individual, by or under the direction of a nurse.

(23) "One period of confinement" means consecutive days of in-hospital service received as an inpatient, or successive confinements when discharge from and readmission to the hospital occurs within a period of not more than 90 days or three times the maximum number of days of in-hospital coverage provided by the contract up to a maximum of 180 days.

(24) "Partial disability" means an individual's inability to:

(a) perform some, but not all, of the major, important, or essential duties of the individual's employment or existing occupation;

(b) work a specified:

(i) percentage of time; or

(ii) number of hours; or

(25) "Personal care" means assistance in the activities of daily living provided to an individual under a plan of care by a home health agency.

(26) "Personal care aide" means an individual who obtains a certificate of completion, as required by law, that allows that individual to assist in the activities of daily living and emergency first aid, and who must be supervised by a registered nurse from a home health agency.

(27) "Physician," "qualified physician," or "licensed physician" means a physician who provides services within the scope of their license.

(28)(a) "Preexisting condition" means:

(i) the existence of a symptom or condition that would cause an ordinarily prudent person to seek diagnosis, care, or treatment within the 24-month period before the effective date of coverage; or

(ii) a condition for which medical advice or treatment was recommended or received from a health care provider within the 24-month period before the effective date of the coverage of the insured.

(b) This definition does not apply to a specified disease insurance contract.

(29) "Probationary period" means the length of time following the date of issuance or effective date of the contract before a benefit is paid under the contract.

(30) "Registered nurse" means a registered nurse who provides services within the scope of their license.

(31) "Residual disability" means an individual's relative reduction in earnings and may be related to the inability to perform either:

(a) some part of the major, important, or essential duties of the individual's employment or existing occupation; or

(b) the individual's usual work duties for as long as is usually required.

(32) "Respite care" means providing temporary support to the primary caregiver of an aged or disabled insured by taking over the tasks of that insured for a limited time period, whether in the home, an appropriate community location, or an appropriate institutional setting.

(33)(a) "Scientific evidence" means:

(i) a scientific study published or accepted by a medical journal that meets nationally recognized standards for scientific manuscripts and that submits its published articles for review by experts who are not part of the editorial staff; or

(ii) a finding, study, or research conducted by or under the auspices of a federal government agency or nationally recognized federal research institute.

(b) "Scientific evidence" does not include:

(i) published peer-reviewed literature sponsored by:

(A) a pharmaceutical manufacturing company; or

(B) a medical device manufacturer; or

(ii) a single study without other supportable studies.

(34) "Sickness" means illness, disease, or disorder of an insured.

(35) "Skilled nursing care" means nursing services provided by, or under the supervision of, a registered nurse to treat the condition for which the confinement is required and for not providing intermediate nursing care or custodial care.

(36) "Therapist" means a professionally trained or licensed individual, such as a physical therapist, occupational therapist, or speech therapist, who is skilled in applying treatment techniques and procedures under the general direction of a physician.

(37) "Total disability" means an individual who:

(a) is not engaged in employment or occupation for which the individual is or becomes qualified, by reason of education, training, or experience; and

(b) is unable to perform each substantial and material duty of the individual's regular occupation.

(38) "Usual and customary" means the most common charge for a similar service, medicine, or supply within the geographical area in which a charge is incurred, considering one or more of the following factors:

(a) the level of skill, extent of training, and experience required to perform the procedure or service;

(b) the length of time required to perform the procedure or service as compared to the length of time required to perform a similar service;

(d) the amount charged for the same or comparable service, medicine, or supply in the geographical area or in other parts of the country;

(e) the cost to the provider of providing the service, medicine, or supply; or

(f) another factor determined by the insurer to be appropriate.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-4 Prohibited Contract Provisions

(1)(a) A contract may not establish a probationary period when coverage is not provided, except under Subsection (1)(b), (1)(c), or (1)(d).

(b) A contract may specify a probationary period not to exceed six months for a loss resulting from:

(i) adenoids;

(ii) appendix;

(iii) disorder of a reproductive organ;

(iv) hernia;

(v) tonsils; or

(vi) varicose veins.

(c) Coverage shall be provided for a disease, condition, or procedure in Subsection (1)(b) if the disease, condition, or procedure is treated on an emergency basis.

(d) A probationary period for a specified disease insurance contract may not exceed 30 days.

(e) An accident insurance contract may not include a probationary period.

(2) Unless otherwise required by law, a contract may not limit or exclude coverage or benefits by type of illness, accident, injury, treatment, or medical condition, except:

(a) abortion;

(b) acupuncture or acupressure;

(c) administrative charge for completing an insurance form, duplication service, interest, finance charge, or other administrative charge, unless otherwise required by law;

(d) administrative exam or service;

(e) allergy test or treatment;

(f) aviation, to a non-fare-paying passenger;

(g) axillary hyperhidrosis;

(h) benefits paid for under:

(i) employer's liability or occupational disease law;

(ii) Medicare or another governmental program, except Medicaid; or

(iii) state or federal workers' compensation;

(i) charge for a missed appointment;

(j) chiropractic care;

(k) complementary or alternative medicine;

(l) corrective lens, including an examination for the prescription or fitting, except lens implant following cataract surgery;

(m) cosmetic surgery, including reversal, revision, repair, complication, or treatment related to a non-covered cosmetic surgery, except reconstructive surgery:

(i) when the service is incidental to or follows surgery resulting from trauma, infection, or other disease of the involved part; or

(ii) due to a congenital disease or anomaly of a covered dependent child that resulted in a functional defect;

(n) custodial care;

(o) dental care or treatment, except a dental contract;

(p) dietary products;

(q) educational or nutritional training, except as required under Rule R590-200;

(r) experimental or investigational service;

(s) felony, riot, or insurrection, when it is determined the insured was a voluntary participant;

(t) fitness training, exercise equipment, or a membership to a spa or health club;

(u)(i) foot care for a corn, a callus, a flat foot, a fallen arch, a weak foot, chronic foot strain, or symptomatic complaints of a foot, including an orthotic; and

(ii) the cutting or removal of a corn, a callus, or a nail may not be excluded when provided to an insured who has a systemic disease, such as diabetes with peripheral neuropathy or circulatory insufficiency if unskilled performance of the procedure would be hazardous;

(v)(i) gastric or intestinal bypass service, including lap banding, gastric stapling, or a similar procedure to facilitate weight loss;

(ii) the reversal or revision of a procedure in Subsection (2)(v)(i); or

(iii) a service required for the treatment of a complication from a procedure in Subsection (2)(v)(i);

(w) gender reassignment;

(x) gene therapy;

(y) genetic testing;

(z) hearing aid, including examination for the prescription or fitting;

(aa) incarceration, limited to income replacement insurance;

(bb) infertility service;

(cc) injury as a result of a motor vehicle, to the extent the insured is required to have no-fault coverage, up to the minimum coverage required by law, whether or not such coverage is in effect;

(dd) mental health condition or substance use disorder services;

(ee) nuclear release;

(ff) preexisting condition, except as required under Section 31A-22-605.1 and Subsection 31A-22-610(2);

(gg) pregnancy, except for a complication of pregnancy;

(hh) refractive eye surgery;

(ii) rehabilitation therapy service, such as physical, speech, and occupational, unless required to correct an impairment caused by a covered accident, injury, or illness;

(jj) respite care;

(kk) rest cure;

(ll) routine physical examination;

(mm) services performed by an insured's parent, spouse, sibling, or child, including a step or in-law relationship;

(nn) services performed by an employee of a hospital, laboratory, or other institution;

(oo) services for which no charge is normally made in the absence of insurance;

(pp) services while in the armed forces or an auxiliary unit;

(qq) sexual dysfunction procedure, equipment, or drug;

(rr) shipping or handling;

(ss) suicide, sane or insane, attempted suicide, or intentionally self-inflicted injury;

(tt) telephone or electronic consultation;

(uu) territorial limitation outside the United States, except as required under Section 31A-22-627;

(vv) terrorism, including an act of terrorism;

(ww) transplant;

(xx) transportation;

(yy) treatment provided in a government hospital, except for fixed indemnity insurance;

(zz) war or act of war, whether declared or undeclared;

(aaa) except under Subsection (2)(bbb), a loss directly related to the insured's voluntary participation in an activity when the insured:

(i) is found guilty of an illegal activity in a criminal proceeding, including a plea of guilty, a no contest plea, and a plea in abeyance; or

(ii) is found liable for the activity in a civil proceeding;

(bbb) a loss established under Subsection (3) that is directly related to the insured violating:

(i) Section 41-6a-502, if the loss occurred in Utah; or

(ii) a law in a state other than Utah that prohibits operating a motor vehicle while exceeding the legal limit of concentration of alcohol, drugs, or a combination of both, in the blood, if the loss occurred in the other state; or

(ccc) any other exclusion that, in the opinion of the commissioner, is not inequitable, misleading, deceptive, obscure, unjust, unfair, or unfairly discriminatory to an insured.

(3)(a) A violation under Subsection (2)(bbb) shall be established:

(i) in a criminal proceeding in which the insured is found guilty, enters a no contest plea, a plea in abeyance, or enters into a diversion agreement; or

(ii) by a request for an independent review when the findings support a decision to deny coverage based on the exclusion.

(b)(i) For purposes of Subsection (3)(a)(ii), an independent review means a process that:

(A) is conducted by an independent entity designated by the insurer;

(B) renders an independent and impartial decision on a decision to deny coverage based on the exclusion; and

(ii) The independent review entity may not have a material professional, familial, or financial conflict with:

(A) the insurer;

(B) an officer, director, or management employee of the insurer;

(D) the insured's health care provider;

(E) the health care provider's medical group or independent practice association; or

(F) a health care facility where services were provided.

(4)(a) An insurer may use a waiver to exclude, limit, or reduce coverage or benefits for a specifically named or described preexisting condition, physical condition, or extra hazardous activity.

(b) A signed acceptance by the insured is required if a waiver is required as a condition of issuance, renewal, or reinstatement.

(5) A contract provision precluded in this section may not be construed as a limitation on the commissioner's authority to prohibit a contract provision that, in the opinion of the commissioner, is unjust, unfair, or unfairly discriminatory to an insured.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-5 General Requirements

(1) A contract may not include a definition regarding a matter defined in Section R590-126-3 unless the definition complies with that section.

(2)(a) A contract that provides coverage to a spouse of the contract holder:

(i) may not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the contract holder, other than for nonpayment of premium;

(ii) shall provide that in the event of the contract holder's death, the spouse shall become the contract holder; and

(iii) shall use the age of the younger spouse as the basis for meeting the age and durational requirements of a noncancellation or renewal provision of a contract.

(b) The requirement in Subsection (2)(a)(iii) may not prevent termination of coverage of the older spouse upon attainment of the stated age limit in the contract, so long as the contract may be continued for the younger spouse to the age or durational period as specified in the renewal provision.

(3)(a) The term "conditionally renewable," "guaranteed renewable," "noncancellable," or "optionally renewable" may not be used without further explanatory language under the disclosure requirements of Subsection R590-126-6(2).

(b) The term "conditionally renewable" may be used only in a contract for which the insured has the right to continue coverage by the timely payment of premiums at least to age 65, during which period the insurer:

(i) may not make a unilateral change to a provision of the contract to the detriment of the insured; and

(ii) may, by timely notice:

(A) decline renewal by class, geographic area, or for a reason stated in the contract; and

(B) make changes in premium rates by class.

(c) The term "guaranteed renewable" may be used only in a contract for which the insured has the right to continue coverage by the timely payment of premiums at least to age 65, and during which period the insurer:

(i) may not:

(A) decline renewal; or

(B) make a unilateral change to a provision of the contract to the detriment of the insured while the contract is in force; and

(ii) may, by timely notice, make changes in premium rates by class.

(d) The term "noncancellable" may be used only in a contract for which the insured has the right to continue coverage by the timely payment of premiums at least to age 65, and during which period the insurer may not:

(i) decline renewal;

(ii) make a unilateral change to a provision of the contract to the detriment of the insured; or

(iii) make changes in premium rates by class.

(e) The term "optionally renewable" may be used only in a contract for which the insured has the right to continue coverage by the timely payment of premiums at least to age 65, and during which period the insurer:

(i) may not make a unilateral change to a provision of the contract to the detriment of the insured while the contract is in force; and

(ii) may, by timely notice:

(A) decline renewal; or

(B) make changes in premium rates by class.

(f) Notice of nonrenewal shall be given no less than 90 days before nonrenewal.

(g) A contract may not be canceled or nonrenewed solely on the grounds of deterioration of health.

(h) Termination of a contract shall be without prejudice to any continuous loss that commenced while the contract was in force.

(i) The continuous total disability of the insured may be a condition for an extension of benefits beyond the period the contract was in force, limited to the duration of the benefit period, if any, or payment of the maximum benefits.

(4) When accidental death and dismemberment coverage is offered under a contract, the contract holder shall have the option to include each insured under the coverage.

(5) If a contract includes a status-type military service exclusion or a provision that suspends coverage during military service, the contract shall, upon receipt of a written request, provide for a refund of premiums, as applicable, to the insured on a pro-rata basis.

(6)(a) If an insurer cancels or refuses to renew a contract providing pregnancy benefits, the contract shall provide an extension of benefits for the pregnancy benefits, if:

(i) the pregnancy commenced while the contract was in force; and

(ii) a benefit would have been payable had the contract remained in force.

(b) Subsection (6)(a) does not apply to a contract that is canceled due to the insured:

(i) failing to pay the required premium in accordance with the contract terms;

(ii) performing an act or practice that constitutes fraud in connection with the coverage; or

(iii) making an intentional misrepresentation of material fact under the terms of the contract.

(7) A contract providing convalescent care or extended care benefits following hospitalization may not condition the benefits upon admission to a convalescent nursing home or extended care facility within a period of less than 14 days after discharge from the hospital.

(8) A contract providing coverage for the recipient in a transplant operation shall also provide reimbursement of medically necessary transplant expenses of a live donor, to the extent benefits remain and are available under the recipient's contract and after benefits for the recipient's expenses have been paid.

(9)(a) A contract including a provision for total disability may not exclude or reduce benefits based on the insured's:

(i) ability to engage in any employment or occupation for wage or profit;

(ii) inability to perform any occupation, any occupational duty, or any and every duty of the insured's occupation; or

(iii) inability to engage in any training or rehabilitation program.

(b) A contract including a provision for total disability may require care by a physician other than the insured or a member of the insured's immediate family.

(10) A contract may include a provision relating to a recurrent disability, but the provision may not specify that a recurrent disability be separated by a period greater than six months.

(11) An accidental death and dismemberment benefit shall be payable if the loss occurs within 180 days from the date of the accident, regardless of total disability.

(12) A contract with an income replacement benefit may not require:

(a) the loss to begin less than 30 days after the date of accident; or

(b) the contract be in force at the time a disability commences if the accident occurred while the coverage was in force.

(13) A contract with a specific dismemberment benefit may not be in lieu of another benefit unless the specific benefit is equal to or exceeds the other benefit.

(14) A contract providing a fracture or dislocation benefit may not limit benefits based on a full or complete fracture or dislocation.

(15)(a) Specified disease insurance, also known as critical illness, dread disease, or similar language, sold in conjunction with other insurance, including a life insurance policy or an annuity contract, shall be in the form of a separate endorsement complying with each applicable provision of this rule.

(b) Specified disease insurance may not be incorporated into a life insurance or annuity contract.

(16) A premium change notice shall be given no less than 45 days before the renewal date.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-6 Required Provisions

(1)(a) An enrollment form question regarding a health condition may not be vague and shall reference a reasonable time frame in relation to the health condition.

(b)(i) A completed application shall be made part of the policy.

(ii) A copy of the completed enrollment form shall be provided to the applicant or insured before or at delivery of the contract.

(c) Except under Subsection (1)(f), an enrollment form shall include the following prominent disclosure statement, in either contrasting color or boldface type at least equal to the font size used for the headings or captions of sections of the enrollment form and in close conjunction with the signature block on the enrollment form, stating, "This (policy)(certificate) provides limited benefits. Review your (policy)(certificate) carefully."

(d) An enrollment form shall provide a statement regarding a preexisting waiting period and the requirement to receive any applicable credit for previous coverage.

(e)(i) An enrollment form shall include a question regarding whether the insurance to be issued is intended to replace any other accident and health insurance currently in force.

(ii) A supplementary enrollment form or other form signed by the applicant containing the question may be used.

(f) An enrollment form for dental or vision insurance shall include the following prominent disclosure statement, in either contrasting color or boldface type at least equal to the font size used for the headings or captions of sections of the enrollment form and in close conjunction with the signature block on the enrollment form, stating, "This (policy)(certificate) provides (dental)(vision) benefits only. Review your (policy)(certificate) carefully."

(2)(a) A contract shall include a renewal, continuation, and nonrenewal provision.

(b) Each provision shall:

(i) appear on the first page of the contract;

(ii) be appropriately captioned; and

(iii) clearly state the duration, if limited, and the renewability of the coverage.

(3)(a) Except for an endorsement by which the insurer effectuates a written request by the policyholder or exercises a specifically reserved right under the contract, signed acceptance by the policyholder is required for an endorsement that reduces or eliminates a benefit or coverage and is added to a contract after the date of issue, at reinstatement, or at renewal.

(b) After the contract issue date, an endorsement that increases a benefit or coverage with a concurrent increase in premium during the contract term shall be agreed to in writing and signed by the policyholder, except if the increased benefit or coverage is required by law.

(4) If a separate additional premium is charged for a benefit provided in connection with an endorsement, the premium charge shall be set forth in the contract.

(5) A contract that provides for the payment of a benefit based on a standard described as usual and customary, reasonable and customary, or similar words, shall include a definition and explanation of the term in the accompanying outline of coverage or benefit summary.

(6)(a) If a contract includes a limitation regarding a preexisting condition, the limitation shall appear as a separate paragraph in the contract and be labeled as "Preexisting Condition Limitation."

(b) The limitation shall include a description of the existence and term of the preexisting condition exclusion, including the maximum preexisting exclusion period.

(7)(a) An accident only insurance contract shall include the following prominent disclosure statement on the first page of the contract, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the contract, stating, "Notice to Buyer: This is an accident only (policy)(certificate) and it does not pay benefits for loss from sickness. Review your (policy)(certificate) carefully."

(b) An accident only insurance contract that provides coverage for hospital or medical care shall include the following statement in addition to the notice in Subsection (7)(a), "This (policy)(certificate) provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses."

(c) An accident only insurance contract providing benefits that vary according to the type of accidental cause shall prominently state in the outline of coverage the circumstances when benefits are payable that are less than the maximum amount payable under the policy.

(8) If age is used as a determining factor for reducing the maximum aggregate benefit available in the contract as originally issued, that fact shall be prominently set forth in the contract and outline of coverage.

(9) If a contract includes a disappearance benefit, payment shall be made within the time limits under Sections 31A- 26-301 and R590-192-9 when proper proof of loss, satisfactory to the insurer, is filed and it is reasonable to assume death occurred, but a body cannot be found.

(10)(a) If a contract includes a conversion privilege, it shall caption the provision as "Conversion Privilege" or similar language.

(b) The provision shall indicate each individual eligible for conversion, the circumstance applicable to the conversion privilege, including any limitation on the conversion, and how an individual may exercise a conversion privilege.

(c) The provision shall specify the benefits to be provided on conversion or may state that the converted coverage will be provided through a contract offered by the insurer for that purpose.

(11)(a) An insurer, except for a direct response insurer, shall give an applicant for a specified disease insurance contract a buyer's guide at the time of application and shall obtain the recipient's written acknowledgment of the guide's delivery.

(b) A direct response insurer shall provide a specified disease insurance buyer's guide upon request, but before or at the delivery of the contract.

(c) A specified disease insurance contract shall include the following prominent disclosure statement on the first page or attached to it, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the contract, stating, "Notice to Buyer: This is a specified disease (policy)(certificate). This (policy)(certificate) provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses. Read your (policy)(certificate) carefully with the outline of coverage and the buyer's guide."

(12) A fixed indemnity insurance or limited benefit health insurance contract shall include the following prominent disclosure statement on the first page of the contract, or attached to it, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the contract, "Notice to Buyer: This is a (fixed indemnity)(limited benefit health) (policy)(certificate). This (policy)(certificate) provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses."

(13) A basic hospital expense, a basic medical-surgical expense, or a basic hospital medical-surgical expense insurance contract shall include the following prominent disclosure statement on the first page of the contract, or attached to it, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the contract, "Notice to Buyer: This is a (basic hospital)(basic medical-surgical)(basic hospital/medical-surgical) expense (policy)(certificate). This (policy)(certificate) provides limited benefits and should not be considered a substitute for comprehensive health insurance coverage."

(14) A dental or vision contract shall include the following prominent disclosure statement on the first page of the contract, or attached to it, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the contract, "Notice to Buyer: This (policy)(certificate) provides (dental)(vision) coverage only."

(15)(a) A contract providing an accident benefit shall define accident, accidental injury, or accidental means to employ result language.

(b) A contract may not define accident, accidental injury, or accidental means to include words that establish an accidental means test or use words such as external, violent, visible wounds, or similar words.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-7 Accident and Health Benefit Standards

(1)(a) An accident and health insurance contract subject to this rule may not be delivered or issued for delivery unless it meets the required standard for the specified category in this section.

(b) This section does not preclude the issuance of a contract combining two or more categories set forth in Subsection 31A-22-605(5).

(c) Insurance coverage listed in this section shall include coverage for diabetes as required by Section 31A-22-626 and Rule R590-200, if applicable.

(2)(a) Basic hospital expense insurance provides coverage for a period of not less than 31 days during a continuous hospital confinement for an expense incurred for treatment or service rendered as a result of an accident or sickness, and shall include at a minimum:

(i) daily hospital room and board in an amount not less than:

(A) 80% of the charge for a semiprivate room accommodation; or

(B) $100 per day;

(ii) miscellaneous hospital services and supplies, that are customarily rendered by the hospital and provided for use during a single period of confinement, in an amount not less than:

(A) 80% of the charge incurred up to at least $3,000; or

(B) ten times the daily hospital room and board benefit; and

(iii) hospital outpatient services on the day of surgery of an amount not less than:

(A) $250 for hospital services rendered within 72 hours after an injury; and

(B) $200 for x-ray and laboratory tests to the extent that a benefit for the service would have been provided if rendered to an inpatient of the hospital.

(b) Benefits may be subject to a combined deductible amount of not more than $200.

(3) Basic medical-surgical expense insurance provides coverage for expenses incurred for services rendered by a physician for treatment of an injury or sickness and shall include:

(a) surgical services in an amount not less than:

(i) what is provided on a current procedure terminology based relative value fee schedule, up to a maximum of at least $1,000 for one procedure; or

(ii) 80% of the reasonable charges;

(b) anesthesia services, consisting of the administration of medically necessary general anesthesia and related procedures in connection with a covered surgical service rendered by a physician, other than the physician or the physician assistant, performing the surgical service:

(i) in an amount not less than 80% of the reasonable charge; or

(ii) 15% of the surgical service benefit; and

(c) hospital medical services, consisting of physician services rendered to a person who is an inpatient at a hospital for treatment of sickness or injury, other than when surgical care is required, in an amount not less than:

(i) 80% of the reasonable charges; or

(ii) $100 per day.

(4) Basic hospital and medical-surgical expense insurance shall meet the requirements of Subsections (1) and (2).

(5)(a) Hospital fixed indemnity insurance provides a daily benefit for hospital confinement on an indemnity basis and shall include:

(i) an indemnity amount of not less than $50 per day; and

(ii) coverage for at least 31 days during each one period of confinement for each insured.

(b) Benefits shall be paid regardless of other insurance.

(6)(a) Income replacement insurance provides for periodic payments, weekly or monthly, for a specified period during the continuance of a disability resulting from either sickness or injury, or a combination of both, that:

(i) if it includes an elimination period, it is no greater than:

(A) 90 days, in the case of coverage providing a benefit of one year or less;

(B) 180 days, in the case of coverage providing a benefit of more than one year but less than two years; or

(ii)(A) has a maximum period that is payable during a disability of at least six months, except in the case of a contract covering a disability arising out of pregnancy, childbirth, or miscarriage when the period for the disability may be one month; and

(B) may not be reduced because of an increase in Social Security or similar benefits during a benefit period.

(b) A contract that provides total disability or partial disability benefits may not require more than one elimination period.

(c)(i) A contract that provides for a residual disability benefit may require a qualification period, when the insured shall be totally disabled before the residual disability benefit is payable.

(ii) The qualification period for residual benefits may be longer than the elimination period for total disability.

(d) This Subsection (6) does not apply to a contract providing business buyout coverage.

(7) Accident only insurance provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by accident and shall include a benefit amount for:

(a) death, no less than $1,000;

(b) double dismemberment, no less than $1,000; and

(8) Specified accident insurance provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by a specific accident and shall include a benefit amount for:

(a) death, no less than $1,000;

(b) double dismemberment, no less than $1,000; and

(9) Specified disease insurance, or critical illness insurance, provides coverage for the diagnosis and treatment of at least one specifically named disease.

(a) A contract covering a single specified disease or combination of specified diseases may not be sold or offered for sale other than as specified disease insurance.

(b) A contract that conditions payment upon pathological diagnosis of a covered disease shall also provide that if a pathological diagnosis is medically inappropriate, a clinical diagnosis will be accepted.

(c) A specified disease insurance contract shall provide benefits to an insured, not only for the specified disease, but also for any other condition or disease directly caused or aggravated by the specified disease or treatment of the specified disease.

(d) A specified disease insurance contract may not be more restrictive than guaranteed renewable.

(e)(i) An enrollment form for specified disease insurance shall include a statement above the signature of the applicant that an individual is not eligible for specified disease insurance if covered by a Title XIX program, designated as Medicaid or any similar name.

(ii) The disclaimer may be combined with any other statement for which the insurer may require the applicant's signature.

(f) Payments may be conditioned upon an insured receiving medically necessary care, given in a medically appropriate location, and under a medically accepted course of diagnosis or treatment.

(g) Specified disease insurance benefits shall be paid regardless of other coverage.

(h) After the effective date of the contract, or the conclusion of an applicable probationary period, benefits shall begin with the first day of care or confinement, if such care or confinement is for a covered disease, even though the diagnosis is made at a later date.

(i) Hospice care is an optional benefit that, if offered, shall meet the following standards:

(i) benefits are payable when the attending physician provides a written statement that the insured has a life expectancy of six months or less;

(ii) a fixed-sum payment of at least $50 per day; and

(iii) a lifetime maximum benefit of at least $10,000.

(j) The following standards apply to specified disease insurance issued on an expense-incurred basis:

(i) a deductible amount may not exceed $250;

(ii) an aggregate benefit limit may not be less than $25,000;

(iii) a benefit period may not be less than three years;

(iv) services provided on an outpatient basis may be subject to a copayment that may not exceed 20% of covered services;

(v) covered services shall include:

(A) hospital room and board and any other hospital-furnished medical service or supply;

(B) treatment by, or treatment under the direction of, a physician or surgeon;

(D) x-ray, radium, chemotherapy, and other therapy procedures used in diagnosis and treatment;

(E) blood transfusions, including the administration and expense incurred for blood donors;

(F) drugs and medicines prescribed by a physician;

(G) professional ambulance for local service to or from a local hospital;

(H) the rental of any respiratory or other mechanical apparatus;

(I) braces, crutches, and wheelchairs as ordered by the physician for the treatment of the disease;

(J) emergency transportation if, in the opinion of the physician, it is necessary to transport the insured to another locality for treatment of the disease;

(K) home health care with a written prescribed plan of care;

(L) physical, speech, hearing, and occupational therapy;

(M) special equipment including a hospital bed, toilette, pulleys, wheelchairs, aspirator, chux, oxygen, surgical dressings, rubber shields, colostomy, and ileostomy appliances;

(N) prosthetic devices including wigs and artificial breasts;

(O) nursing home care for non-custodial services; and

(P) reconstructive surgery when deemed necessary by the physician.

(k) Specified disease insurance offered on a per diem basis shall include covered services for:

(i) hospital confinement benefit with a fixed-sum payment of at least $200 for each day of hospital confinement, for at least 365 days, with no deductible amount permitted;

(ii) outpatient benefit with a fixed-sum payment equal to one-half of the hospital inpatient benefit for each day of hospital or non-hospital outpatient surgery, radiation therapy, and chemotherapy, for at least 365 days of treatment;

(iii) blood and plasma benefit with a fixed-sum benefit of at least $50 per day, that includes their administration whether received as an inpatient or outpatient, for at least 365 days of treatment; and

(iv) benefits tied to confinement in a skilled nursing home or home health care, if offered:

(A) shall include a fixed-sum payment equal to:

(I) one-half of the hospital inpatient benefit for each day of skilled nursing home confinement for at least 180 days; and

(II) a fixed-sum payment equal to one-fourth of the hospital inpatient benefit for each day of home health care for at least 180 days; and

(B) may not include a restriction or limitation applied to the benefits that are more restrictive than those under Medicare.

(l) The following standards apply to specified disease insurance on a lump sum basis:

(i) benefits shall be payable as a fixed, one-time payment made within 30 days of submission to the insurer of proof of diagnosis of the specified disease, and shall be offered for sale only in even increments of $1,000; and

(ii) if coverage is advertised or otherwise represented to offer generic coverage of a disease or diseases, for example "cancer insurance" or "heart disease insurance," the minimum benefit shall be:

(A) the same dollar amount regardless of the subtype of the disease, for example lung or bone cancer; or

(B) a lesser amount for a subtype with significantly lower treatment costs, for example skin cancer, if clearly identifiable and the contract clearly differentiates each subtype and its benefits.

(10) Limited benefit health insurance coverage provides benefits less than the standards required under Subsections R590-126-7(1) through R590-126-7(9).

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-8 Outline of Coverage Requirements

(1) The outline of coverage in Table 1 shall be issued with a basic hospital expense insurance contract.

TABLE 1

Basic Hospital Expense Insurance Outline of Coverage

(COMPANY NAME)

BASIC HOSPITAL EXPENSE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS AND SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR COMPREHENSIVE HEALTH INSURANCE COVERAGE

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!

Basic hospital expense coverage is designed to provide, to persons insured, coverage for hospital expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services and hospital outpatient services, subject to any limitations, deductibles and copayment requirements set forth in the policy. Coverage is not provided for physician or surgeon fees or unlimited hospital expenses.

A brief specific description of the benefits, including dollar amounts and number of days duration where applicable, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; hospital outpatient services; and other benefits, if any.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(2) The outline of coverage in Table 2 shall be issued with a basic medical-surgical expense insurance contract.

TABLE 2

Basic Medical-Surgical Expense Insurance Outline of Coverage

(COMPANY NAME)

BASIC MEDICAL-SURGICAL EXPENSE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS AND SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR COMPREHENSIVE HEALTH INSURANCE COVERAGE

OUTLINE OF COVERAGE

Basic medical-surgical expense coverage is designed to provide, to persons insured, coverage for medical-surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for surgical services, anesthesia services, and in-hospital medical services, subject to any limitations, deductibles and copayments set forth in the policy. Coverage is not provided for hospital expenses or unlimited medical- surgical expenses.

A brief specific description of the benefits, including dollar amounts and number of days duration where applicable, contained in this policy, in the following order: surgical services; anesthesia services; in-hospital medical services; and other benefits, if any.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(3) The outline of coverage in Table 3 shall be issued with a basic hospital and medical-surgical expense insurance contract.

TABLE 3

Basic Hospital and Medical-Surgical Expense Insurance Outline of Coverage

(COMPANY NAME)

BASIC HOSPITAL/MEDICAL-SURGICAL EXPENSE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS AND SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR COMPREHENSIVE HEALTH INSURANCE COVERAGE

OUTLINE OF COVERAGE

Basic hospital/medical-surgical expense coverage is designed to provide, to persons insured, coverage for hospital and medical-surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, hospital outpatient services, surgical services, anesthesia services, and in-hospital medical services, subject to any limitations, deductibles and copayment requirements set forth in the policy. Coverage is not provided for unlimited hospital or medical surgical expenses.

A brief specific description of the benefits, including dollar amounts and number of days duration where applicable, contained in this policy, in the following order:

daily hospital room and board; miscellaneous hospital services; hospital outpatient services; surgical services; anesthesia services; in-hospital medical services; and other benefits, if any.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(4) The outline of coverage in Table 4 shall be issued with a hospital fixed indemnity insurance contract.

TABLE 4

Hospital Fixed Indemnity Insurance Outline of Coverage

(COMPANY NAME)

HOSPITAL CONFINEMENT INDEMNITY COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of coverage. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!

Hospital indemnity coverage is designed to provide, to persons insured, coverage in the form of a fixed daily benefit during periods of hospitalization resulting from a covered accident or sickness, subject to any limitations set forth in the policy. Coverage is not provided for any benefits other than the fixed daily indemnity for hospital confinement and any additional benefit described below.

A brief specific description of the benefits in the following order: daily benefit payable during hospital confinement; and duration of benefit

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefit.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

Any benefits provided in addition to the daily hospital benefit.

(5) The outline of coverage in Table 5 shall be issued with an income replacement insurance contact.

TABLE 5

Income Replacement Insurance Outline of Coverage

(COMPANY NAME)

INCOME REPLACEMENT INSURANCE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL EXPENSES

OUTLINE OF COVERAGE

Income replacement insurance coverage is designed to provide, to persons insured, coverage for disabilities resulting from a covered accident or sickness, subject to any limitations set forth in the policy. Coverage is not provided for basic hospital, basic medical-surgical, or major medical expenses.

A brief specific description of the benefits contained in the policy.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(6) The outline of coverage in Table 6 shall be issued with an accident only insurance contract.

TABLE 6

Accident Only Insurance Outline of Coverage

(COMPANY NAME)

ACCIDENT ONLY COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of the coverage. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!

Accident only coverage is designed to provide, to persons insured, coverage for certain losses resulting from a covered accident ONLY, subject to any limitations contained in the policy. Coverage is not provided for basic hospital, basic medical-surgical, or major medical expenses.

A brief specific description of the benefits.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(7) The outline of coverage in Table 7 shall be issued with a specified accident insurance contract.

TABLE 7

Specified Accident Insurance Outline of Coverage

(COMPANY NAME)

SPECIFIED ACCIDENT COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Specified accident coverage is designed to provide, to persons insured, restricted coverage paying benefits ONLY when certain losses occur as a result of specified accidents. Coverage is not provided for basic hospital, basic medical- surgical, or major medical expenses.

A brief specific description of the benefits, including dollar amounts.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(8) The outline of coverage in Table 8 shall be issued with a specified disease insurance contract.

TABLE 8

Specified Disease Insurance Outline of Coverage

(COMPANY NAME)

SPECIFIED DISEASE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Specified disease coverage is designed only as a supplement to a comprehensive health insurance policy and should not be purchased unless you have this underlying coverage. Persons covered under Medicaid should not purchase it. Read the Buyer's Guide to Specified Disease Insurance to review the possible limits on benefits in this type of coverage.

The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!

Specified disease coverage is designed to provide, to persons insured, restricted coverage paying benefits ONLY when certain losses occur as a result of specified diseases. Coverage is not provided for basic hospital, basic medical-surgical, or major medical expenses.

A brief specific description of the benefits, including dollar amounts.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(9) The outline of coverage in Table 9 shall be issued with a limited benefit health insurance contract.

TABLE 9

Limited Benefit Health Insurance Outline of Coverage

(COMPANY NAME)

LIMITED BENEFIT HEALTH COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Limited benefit health coverage is designed to provide, to persons insured, limited or supplemental coverage.

A brief specific description of the benefits, including amounts.

A description of any provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(10) The outline of coverage in Table 10 shall be issued with a dental insurance contract.

TABLE 10

Dental Insurance Outline of Coverage

(COMPANY NAME)

DENTAL COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL DENTAL EXPENSES

OUTLINE OF COVERAGE

A brief specific description of the benefits.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage including age restrictions or any reservations of right to change premiums.

(11) The outline of coverage in Table 11 shall be issued with a vision insurance contract.

TABLE 11

Vision Insurance Outline of Coverage

(COMPANY NAME)

VISION COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL VISION EXPENSES

OUTLINE OF COVERAGE

A brief specific description of the benefits.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(12) An insurer shall deliver an outline of coverage to an applicant or insured before or upon the sale of an accident and health insurance contract.

(13) If an outline of coverage was delivered at the time of application or enrollment and the contract is issued on a basis that requires a revision of the outline of coverage, a substitute outline of coverage describing the contract shall accompany the contract when it is delivered and shall include the following statement in no less than 12-point font, immediately above the company name, "NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application, and the coverage originally applied for has not been issued."

(14) An outline of coverage for fixed indemnity insurance, specified disease insurance, or limited benefit health insurance delivered to a person eligible for Medicare by reason of age shall include the following language, that shall be printed on or attached to the first page of the outline of coverage, "THIS IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for Medicare, review the Guide to Health Insurance for People With Medicare available from the company."

(15) If the outline of coverage is inappropriate for the coverage provided by the contract, an alternate outline of coverage shall be submitted to the commissioner for prior approval.

(16) An advertisement may fulfill the requirement for an outline of coverage if the advertisement satisfies the specified standards.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-9 Replacement of Accident and Health Insurance Requirements

(1)(a) Upon determining that a sale will involve replacement, an insurer or its producer, other than a direct response insurer or its producer, shall furnish to the applicant, before issuance or delivery of the contract, the notice in Table 12.

(b) The insurer shall retain a copy of the notice.

(2) A direct response insurer shall deliver to the applicant, upon issuance of the contract, the notice in Table 13, except that a notice is not required in the solicitation of an accident only insurance contract or single-premium nonrenewable contract.

TABLE 12

Notice to Applicant Regarding Replacement of Accident and Health Insurance

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND HEALTH INSURANCE

According to (your application)(information you have furnished), you intend to lapse or otherwise terminate existing accident and health insurance and replace it with a policy to be issued by (insert company name) Insurance Company. For your own information and protection, you should be aware of and seriously consider certain factors that may affect the insurance protection available to you under the new policy.

Health conditions that you may presently have (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

You may wish to secure the advice of your present insurer or its producer regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded.

The above "Notice to Applicant" was delivered to me on:

Date:

Applicant's Signature:

TABLE 13

Direct Response Notice to Applicant Regarding Replacement of Accident and Health Insurance

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND HEALTH INSURANCE

According to (your application)(information you have furnished), you intend to lapse or otherwise terminate existing accident and health insurance and replace it with the policy delivered herewith issued by (insert company name) Insurance Company. Your new policy provides 30 days within which you may decide without cost whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors that may affect the insurance protection available to you under the new policy.

(To be included only if the application is attached to the policy.) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (insert company name and address) within ten days if any information is not correct and complete, or if any past medical history has been left out of the application.

COMPANY NAME

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

Utah Admin. Code R590-126-10 Severability

If any provision of this rule, Rule R590-126, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance
Date of Last Change: May 8, 2026
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A- 22-626; 31A-23a-402; 31A-26-301

R590-127 Rate Filing Exemptions

Utah Admin. Code R590-127-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-19a-103.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) identify permissible rates and plans under Section 31A-19a-203;

(b) make exemptions for filing rates and plans under Section 31A-19a-203; and

(2) This rule applies to each insurer licensed in this state to write liability insurance, professional liability insurance, property insurance, vehicle liability and physical damage insurance, and workers' compensation insurance.

(3) This rule applies to:

(a) an (a) rate, including an (a) rate for:

(i) a class of risks that are so different from each other that no single manual rate could be representative of all of them;

(ii) a class of risks that does not develop enough experience to warrant credibility for ratemaking purposes; and

(iii) a risk that involves a new product or coverage for which there is no past experience nor appropriate analogy to similar exposures for ratemaking purposes; and

(b) the procedure for rating an exposure that does not have a published prospective loss cost or manual rate, termed (a) rating.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-3 Definitions

Terms in this rule are defined in Sections 31A-1-301 and 31A-19a-102. Additional terms are defined as follows:

(1) "(a) rate" means a rating rule or a rate expressed as the symbol "(a)" or the words "refer to company" listed opposite a classification code on the rule and rate pages of the Commercial Lines Manual.

(2) "(a) rating" means a special risk rating underwriting procedure used for classifying and rating any risk that presents a unique or unusual condition, exposure, or hazard for which the underwriter feels a Commercial Lines Manual classification or rate is not appropriate.

(3) "Commercial Lines Manual" means the manual of rates, classifications, and underwriting rules for commercial lines insurance, including:

(a) the Highly Protected Risk Plan, filed with the commissioner by the Insurance Services Office, Inc.; and

(b) any similar rating plan, manual or large risk property rating plan filed with the commissioner by another rate service organization or individual insurer.

(4) "Excess insurance" means a coverage designed to be:

(a)(i) in excess over one or more primary coverages; or

(ii) a self-insured retention; and

(b) that does not pay a loss until the loss amount exceeds a certain sum.

(5) "Guide (a) rate" means an advisory (a) rate that has been developed by a rate service organization or company home office underwriter that represents a rough average and is used as a guide or signpost.

(6) "Guide (a) Manual" means a collection of guide (a) rates with rules and procedures for use with (a) rates.

(7) "Increased limits factor" means a rating factor used to adjust a manual rate to a limit higher than the basic manual limit.

(8) "Self-insured retention" means the portion of a risk or potential loss assumed by an insured in an amount of at least $50,000 and in the form of a deductible, self-insurance, or no insurance.

(10) "Umbrella liability insurance" means insurance providing coverage in excess of the limits of a primary policy and additional basic liability coverages.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-4 Filing of Procedures

(1) Each insurer to which this rule applies shall maintain a general statement of company policies and procedures for underwriting and developing (a) rates and (a) rating.

(2) The general statement shall include:

(a) a delineation of the extent of home office and branch office authority regarding the promulgation of (a) rates; and

(b) formal guidelines the insurer has established for a situation described in Subsection (2)(a).

(3) The general statement shall be made available to the commissioner upon request.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-5 (a) Rates

(1) An (a) rate shall be exempt from the filing requirements of Section 31A-19a-203.

(2) When an (a) rate is used, the underwriting file shall contain full and supporting factual documentation verifying that the rate is an (a) rate and showing the development of the (a) rate assigned by the underwriter.

(a) If the insurer has a guide (a) Manual, the underwriter shall:

(i) start rate development with the guide (a) rate suggested in the manual;

(ii) document the steps in the development of an adjusted rate; and

(iii) show that the insurer's established procedure in the (a) rate development has been followed.

(b) If the insurer does not have a guide (a) rate, the underwriter shall document the steps in the development of the (a) rate, including:

(i) an analysis of the specific definable loss potential characteristics;

(ii) a comparison to similar risks and their manual rates;

(iii) available loss frequency and severity data;

(iv) an analysis of current engineering reports; and

(v) a discussion of any other pertinent underwriting criteria.

(3) As individual risk experience and characteristics are considered by the underwriter in developing the (a) rate, the only rate modification factors that may be applied to an (a) rate are:

(a) increased limits factors;

(b) package factors;

(d) expense modification factors; and

(e) deductible factors.

(4) If automated rating procedures automatically apply other modification factors, the underwriter should consider this fact when developing the initial rate.

(5) If an underwriter uses an increased limits factor that is different from the guide (a) increased limits factor in the Commercial Lines Manual, the underwriting file shall contain full and supporting factual data justifying the change in the guide (a) increased limits factor.

(6)(a) When an insurer renews a risk that contains an (a) rate, the underwriting file shall contain the following documentation:

(i) the underwriter's reevaluation of the (a) rate assigned; and

(ii) justification for the continuation of the (a) rate or the development of any new (a) rate.

(b) If the (a) rate previously assigned is revised more than plus or minus 25%, the underwriter's file documenting the (a) rate development for the prior year and the development and explanation for the new (a) rate shall be made available to the commissioner upon request.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-6 (a) Rating, Special Risk Rating

(1) A rate that is developed by an underwriter through an (a) rating process is exempt from the filing requirements of Section 31A-19a-203.

(2) An underwriter is permitted to use (a) rating only in the following circumstances:

(a) when the underwriter can clearly demonstrate that a risk described by specific classifications in the Commercial Lines Manual presents unique or unusual conditions of exposure or hazard such that the application of the normal manual rate for that classification does not produce a reasonable and equitable rate for the risk;

(i) the underwriter should bear in mind that a manual classification is understood to be general in nature and may not exactly describe the risk being considered; and

(ii) an (a) rating is not to be used simply because the risk does not exactly match the manual classification description;

(b) when the coverage to be written is broader or more restricted than the coverage the manual definition of coverage provides as limited by applicable manual exclusions;

(c) when the insurer has developed a program for a type of risk or coverage that is not included in the Commercial Lines Manual and for which there is limited statistical data for ratemaking purposes;

(d) when a risk develops more than $100,000 in annual manual basic limits unmodified premium for automobile liability, general liability, glass, and theft insurance, individually, or $250,000 in any combination; or

(e) when the one-year deposit premium charged for the coverages afforded is $50,000 or more for boiler and machinery risks.

(3)(a) When an underwriter uses (a) rating, the underwriting file shall contain the following:

(i) a full explanation showing that the risk fits one of the circumstances described in Subsection (2); and

(ii) full and supporting factual documentation showing the development of the rate assigned by the underwritercontaining an analysis of:

(A) the specific definable loss potential characteristics;

(B) a comparison to similar risks and their manual rates, available loss frequency, and severity data;

(D) any other pertinent underwriting criteria.

(b) The underwriting file shall be made available to the commissioner upon request.

(4)(a) When an insurer renews a risk that has been (a) rated according to Section R590-127-6, the underwriting file shall contain documentation of the underwriter's reevaluation of the (a) rating and justification for the continuation of the (a) rating.

(b) If the (a) rating produces a renewal premium that varies more than plus or minus 25% from the expiring policy premium, the underwriting file documenting the rate development for the prior term and the renewal term, and an explanation for the change in premium, shall be made available to the commissioner upon request.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-7 Commercial Excess and Umbrella Liability Insurance

(1) Rates and rating plans for commercial excess insurance or umbrella liability insurance are exempt from the filing requirements of Section 31A-19a-203.

(2)(a) The underwriting files of any excess insurance or umbrella liability insurance risk must contain full and supporting factual documentation justifying the rate and showing the development of the rate.

(b) The rate development documentation should analyze the specific definable loss potential characteristics regarding the risk's excess exposure and any other pertinent underwriting criteria.

(3) When an insurer renews a commercial excess or umbrella liability policy, the underwriting file shall contain the following documentation:

(a) the underwriter's reevaluation of the rate assigned; and

(b) justification for the continuation of the rate or the development of any new rate.

(4) The underwriting file shall be made available to the commissioner upon request.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

Utah Admin. Code R590-127-8 Severability

If any provision of this rule, Rule R590-127, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103

R590-128 Failure to Maintain Prior Owner's or Operator's Security

Utah Admin. Code R590-128-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance companies
Date of Last Change: November 22, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-128-2 Purpose and Scope

(1) The purpose of this rule is to identify permissible practices of an insurer when an applicant fails to maintain prior owner's or operator's security.

(2) This rule applies to an automobile insurance policy delivered or issued for delivery in this state.

History

KEY: insurance companies
Date of Last Change: November 22, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-128-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Failure to maintain prior owner's or operator's security" means:

(a) operating a motor vehicle at any time during the prior three years in violation of any state's compulsory auto insurance law; or

(b) after representing that prior owner's or operator's security was maintained, failing to provide or failing to assist an insurer in obtaining evidence of prior owner's or operator's security.

(2) "Failure to maintain prior owner's or operator's security" does not mean a lapse in coverage of up to 30 days due to an applicant's reasonable reliance on information from a producer or an insurer that the applicant was insured.

(3) "Owner's or operator's security" has the same meaning as defined in Section 41-12a-103.

History

KEY: insurance companies
Date of Last Change: November 22, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-128-4 Failure to Maintain Prior Owner's or Operator's Security

(1) If an applicant fails to maintain prior owner's or operator's security, an insurer may:

(a) refuse to insure or refuse to continue to insure;

(b) limit the amount, extent, or kinds of coverage available;

(d) designate an applicant as a non-standard, sub-standard, or otherwise worse than average risk to place an applicant in a specific insurer or rating tier.

(2) An insurer shall demonstrate with objective evidence, which may include an applicant's statement, that an applicant failed to maintain prior owner's or operator's security.

History

KEY: insurance companies
Date of Last Change: November 22, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

Utah Admin. Code R590-128-5 Severability

If any provision of this rule, Rule R590-128, or its application to any person or situation is held to be invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: November 22, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-23a-402

R590-129 Unfair Discrimination Based Solely Upon Blindness or Physical or Mental Impairment

Utah Admin. Code R590-129-1 Authority

This rule is promulgated by the commissioner pursuant to Subsections 31A-2-201(3) and 31A-23a-402(8).

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-129-2 Purpose and Scope

(1) The purpose of this rule is to identify and define certain practices that the commissioner finds are unfair and discriminatory.

(2) This rule applies to an insurance policy offered for sale in Utah.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-129-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-129-4 Prohibited Acts and Practices

(1) The following acts and practices are prohibited because of blindness, partial blindness, or physical or mental impairment:

(a) refusing to insure;

(b) refusing to continue to insure;

(d) charging a higher rate for the same coverage except where the refusal, limitation, or rate differential is based upon sound actuarial principles or reasonably anticipated loss experience.

(2) Refusing to insure includes an insurer denying coverage when the policy defines "disability" as being presumed if the insured suffers the loss of sight.

(3) Unless otherwise provided by law, it is not a violation of this rule to exclude from coverage any disability consisting of blindness, partial blindness, or physical or mental impairment when the condition existed at the time the policy was i ssued.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-129-5 Severability

If any provision of this rule, Rule R590-129, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: October 25, 2021
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

R590-130 Rules Governing Advertisements of Insurance

Utah Admin. Code R590-130-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-402.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) ensure that disclosures regarding benefits, limitations, and exclusions are clear and truthful; and

(b) establish guidelines and standards of conduct to prevent unfair, deceptive, and misleading insurance advertising.

(2) This rule applies to:

(a) an insurance advertisement intended for presentation, distribution, or dissemination in this state; or

(b) an insurer or a person on the insurer's behalf who presents, distributes, or disseminates an advertisement in this state.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Advertisement" means:

(a) printed and published material;

(b) audio or visual material;

(c) descriptive literature used in direct mail, a newspaper, a magazine, a radio script, a TV script, a website, an email, a billboard, or similar displays;

(d) a prepared sales talk, presentation, or material;

(e) promotional material included with a policy when the policy is delivered; and

(f) material used to solicit a renewal or reinstatement.

(2) "Invitation to contract" means an advertisement that describes one or more contract provisions for a specific insurance product.

(3) "Preneed funeral contract" means an agreement by or for an individual before that individual's death relating to the purchase or provision of specific funeral or cemetery merchandise or services.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-4 Method of Disclosure of Required Information

(1)(a) Any information required to be disclosed under this rule shall be:

(i) conspicuous and in close conjunction with the related statement; or

(ii) under appropriate captions.

(b)(i) The disclosure shall be prominent.

(ii) The disclosure may not be:

(A) minimized;

(B) rendered obscure;

(D) intermingled within the context of the advertisement.

(2) Advertising materials shall be identified by a unique form number.

(3) Advertising materials reproduced in quantity shall be identified by form numbers or other identifying means that are sufficient to distinguish an advertisement from any other advertising material, policy, application, or other material used by the insurer or advertiser.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-5 Content of Advertisements

(1) An insurance advertisement shall be complete, clear, and truthful.

(2) An insurance advertisement may not deceive or mislead the reader, viewer, or listener in fact or in implication.

(3) A word or phrase that requires familiarity with insurance terminology, or is clear only by implication, may be used only when clearly explained.

(4) An insurer must clearly identify the insurance policy as an insurance policy.

(5) A policy trade name must be followed by the words "Insurance Policy" or similar words:

(a) indicating that an insurance policy is being offered; or

(b) for a health maintenance organization, prepaid health plan, or other direct service organization, indicating that a health benefit product is being offered.

(6) An insurer, producer, or other person may not solicit a resident of this state to purchase insurance by:

(a) using a deceptive name; or

(b) misleading a resident in this state regarding:

(i) an insurer, producer, or other person's status, character, proprietary capacity, or representative capacity; or

(ii) an advertisement's true purpose.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-6 Advertisements of Benefits Payable, Losses Covered, or Premiums Payable

(1) Deceptive words, phrases, and illustrations are prohibited.

(a) An advertisement may not omit information or use words, phrases, statements, references, or illustrations that may mislead or deceive a purchaser or potential purchaser regarding:

(i) the nature or extent of a policy benefit payable;

(ii) the loss covered; or

(iii) the premium payable.

(b) The requirements in Subsection (a) must be satisfied even if:

(i) the prospective insured could review the policy before the sale; or

(ii) an unsatisfied purchaser is offered a refund of the premium.

(c) An advertisement may not contain or use words or phrases in a manner that exaggerates a policy benefit when viewing the policy as a whole, including:

(i) all;

(ii) full;

(iii) complete;

(iv) comprehensive;

(v) unlimited;

(vi) up to;

(vii) as high as;

(viii) this policy will help fill some of the gaps that Medicare and your present insurance leave out;

(ix) the policy will help to replace your income; or

(x) similar words and phrases.

(d) An advertisement that is also an invitation to join an association, trust, or discretionary group shall:

(i) solicit insurance coverage on a separate and distinct application that requires separate signatures for each application;

(ii) have separate and distinct applications on separate documents;

(iii) disclose:

(A) that the prospective members are purchasing insurance;

(B) applying for membership;

(D) the underwriter.

(e)(i) An advertisement may not describe policy limitations, exceptions, or reductions in a positive manner to imply that policy limitations, exceptions, and reductions are benefits.

(ii) The following are examples of prohibited uses:

(A) describing a waiting period as a "benefit builder"; or

(B) stating "even preexisting conditions are covered after two years."

(iii) Words and phrases used in an advertisement to describe the advertised policy's limitations, exceptions, and reductions shall fairly and accurately describe the negative features of the limitations, exceptions, and reductions.

(f)(i) An advertisement for a benefit that conditions payment on confinement in a hospital or similar facility may not use words or phrases that could mislead an individual to believe that the advertised policy enables an individual to profit from being hospitalized.

(ii) The following are prohibited phrases:

(A) tax-free;

(B) extra cash;

(D) extra pay; or

(E) substantially similar words or phrases.

(g) An advertisement for a fixed indemnity benefit that advertises weekly or monthly benefits shall explain in the advertisement, with equal prominence, that the benefits are based on an accumulated daily pro rata benefit.

(h) An advertisement for a policy covering one disease or a list of specified diseases may not:

(i) imply coverage beyond the policy's terms; or

(ii) use synonymous terms to refer to a disease that may imply broader coverage than is in the policy.

(i) An advertisement for a policy providing benefits for a specified illness, such as cancer, shall:

(i) state the policy's limited nature; and

(ii) use language identical or substantially similar to the following:

(A) "THIS IS A LIMITED POLICY"; or

(B) "THIS IS A CANCER ONLY POLICY".

(j) An advertisement for a policy providing benefits for a specified accident, such as an automobile accident, shall:

(i) state the policy's limited nature; and

(ii) use language identical or substantially similar to "THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY".

(k) An advertisement for a preneed funeral contract that is funded by a life insurance policy or annuity contract shall adequately disclose that a life insurance policy or annuity contract is:

(i) involved in the arrangement; or

(ii) being used to fund the arrangement.

(l) An advertisement for a life insurance policy may not use a phrase in the policy's name or title that does not include the words "life insurance," unless other accompanying language clearly indicates that the policy is life insurance.

(2) Exceptions, Reductions, and Limitations.

(a) An advertisement that is an invitation to contract shall disclose the policy's exceptions, reductions, and limitations that affect the policy's basic provisions.

(b) An advertisement that is an invitation to contract shall disclose a policy's waiting, elimination, probationary, or similar time period regarding:

(i) the policy's effective date and the effective date of coverage under the policy; or

(ii) the date of loss and the date benefits begin to accrue for the loss.

(c) An advertisement may not use words or phrases in a way that may minimize the effects of a policy's exceptions, reductions, limitations, or exclusions, including:

(i) only;

(ii) just;

(iii) merely;

(iv) necessary; or

(v) similar words or phrases.

(3) Preexisting Conditions.

(a) An advertisement that is an invitation to contract shall disclose in a negative tone any loss that is not covered if the cause of the loss is traceable to a condition existing prior to the policy's effective date.

(b) A description or definition must accompany the use of the term "preexisting condition."

(c) An advertisement may not state or imply that an applicant's physical condition or medical history will not affect the issuance of a policy or a claim being paid when an accident and health insurance policy does not cover losses resulting from a preexisting condition.

(d) An advertisement is prohibited from using the phrase "no medical examination required" or similar phrases.

(e) An advertisement is not prohibited from using the phrase "guaranteed issue" or "automatic issue."

(f) An advertisement that is an invitation to contract regarding a specified disease policy shall disclose if a medical examination is required.

(g)(i) When an advertisement contains an application form to be completed and returned, the application form shall contain a question or statement regarding the policy's preexisting condition provision, which shall be located:

(A) immediately preceding the blank space for the applicant's signature; or

(B) preceding the statement regarding the truthfulness of information provided in the application.

(ii) The following are examples of the question or statement required under Subsection (g)(i):

(A) Do you understand that this policy will not pay benefits during the first (insert period of time) after the issue date for a disease or physical condition that you now have or have had in the past? YES; or

(B) I understand that the policy applied for will not pay benefits for any loss incurred during the first (insert period of time) after the issue date on account of a disease or physical condition that I now have or have had in the past.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-7 Necessity for Disclosing Policy Provisions Relating to Renewability, Cancelability, and Termination

(1) An advertisement that is an invitation to contract shall disclose, in a manner that does not minimize or obscure the qualifying conditions, provisions regarding the following:

(a) cancellation, renewability, and termination; and

(b) modification of benefits, losses covered, or premiums.

(2) An advertisement may only use the term "noncancelable" to advertise a policy that:

(a) the insured has the right to continue in force coverage by timely paying the policy's premiums; and

(b) the insurer has no right to change provisions in the policy while the policy is in force.

(3) An advertisement may only use the term "guaranteed renewable" to advertise a policy that:

(a) the insured has the right to continue in force by timely paying the policy's premiums; and

(b) the insurer has no right to change provisions in the policy while the policy is in force, except that the insurer may make premium rate changes.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-8 Testimonials or Endorsements by Third Parties

(1) A person making a testimonial or endorsement is a spokesperson if the person:

(a) has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee, or otherwise;

(b) has been formed by the insurer;

(d) has a person in a policy making position that is affiliated with the insurer in a capacity described in Subsections (1)(a) through (1)(c); or

(e) is directly or indirectly compensated for making a testimonial or endorsement.

(2)(a) A testimonial or endorsement in an advertisement shall disclose in the introductory portion, in the same form and with equal prominence in the advertisement, that a spokesperson has the following interest or capacity in the insurer making the advertisement:

(i) a financial interest;

(ii) a proprietary interest; or

(iii) a representative capacity.

(b) An advertisement shall disclose if the spokesperson was directly or indirectly paid for making a testimonial or endorsement.

(i) using the phrase "Paid Endorsement" or words substantially similar; and

(ii) using a font and size at least equal to the font and size for whichever of the following is larger:

(A) the spokesperson's name; or

(B) the body of the testimonial or endorsement.

(d) A testimonial or endorsement disclosure for a non-print advertisement shall:

(i) make the disclosure in the advertisement's introductory portion; and

(ii) be given equal prominence in the advertisement.

(3)(a) An advertisement may not state or imply that an individual, group of individuals, society, association, or other organization has approved or endorsed an insurer or an insurance policy unless:

(i) the individual, group of individuals, society, association, or other organization has approved or endorsed the insurer or the insurance policy; and

(ii) the advertisement discloses any proprietary relationship between an organization and the insurer.

(b) An advertisement shall disclose, if applicable, the following regarding an entity making an endorsement or testimonial:

(i) the insurer formed the entity;

(ii) the insurer owns the entity;

(iii) the insurer controls the entity; or

(iv) a person that owns or controls the insurer formed, owns, or controls the entity.

(c) If the entity in Subsection (3)(a) is an association, the advertisement must disclose, if applicable, the following regarding an insurer:

(i) the insurer or the insurer's officer formed or controls the association; or

(ii) the insurer or the insurer's officer holds a policy making position in the association.

(4)(a) An insurer using a testimonial that refers to a benefit received under an insurance policy must retain for three years beginning when the insurer last used the testimonial in an advertisement:

(i) the specific claim data, including claim number;

(ii) the date of loss; and

(ii) any other pertinent information.

(b) A testimonial in an advertisement is prohibited if:

(i) the testimonial does not correctly reflect the insurer's present practice; or

(ii) the testimonial is not applicable to the advertised policy or benefit.

(5)(a) An advertisement may not imply that a state or federal agency or division has granted approval, accreditation, or endorsed an insurer's policy forms or advertisement.

(b) An insurer may not use the approval or filing of a policy form or advertisement to state or imply that a governmental agency has endorsed or recommended the following:

(i) the insurer;

(ii) the insurer's policy;

(iii) the insurer's advertisement; or

(iv) the insurer's financial condition.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-9 Use of Statistics and Exaggerations

(1) An advertisement may not represent or imply that:

(a) an insurer's claim settlement practice is liberal, generous, or similar; or

(b) an insurer's claim settlement practice is or will be beyond the contract's actual terms.

(2) An insurer may not mislead a consumer by advertising an unusual amount paid for a unique claim under an advertised policy.

(3) An advertisement shall identify the source of any statistical information used in the advertisement.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-10 Identification of Plan or Number of Policies

(1) An advertisement that is an invitation to contract and that advertises a choice in available benefits shall disclose that:

(a) the amount of benefits depends on the plan selected; and

(b) the premium amount varies depending on the amount of benefits selected.

(2) An advertisement that is an invitation to contract that refers to various benefits shall disclose that:

(a) two or more policies, other than a group master policy, may be issued; or

(b) the benefits are provided only through a combination of the policies.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-11 Identity of Insurer

(1)(a) An advertisement shall state the actual insurer's name.

(b) An advertisement that is an invitation to contract shall state the form number or policy number.

(c) An advertisement shall disclose the actual insurer's name before using any of the following, if the advertisement would be misleading or deceptive regarding the insurer's true identity:

(i) a trade name;

(ii) an insurance group designation;

(iii) an insurer's parent company's name;

(iv) the name of an insurer's particular division;

(v) a service mark;

(vi) a slogan;

(vii) a symbol; or

(viii) any other device.

(2) An advertisement may not use a word combination, symbol, or physical material in a manner that the content, phraseology, shape, color, or other characteristic:

(a) is similar to the word combination, symbol, or physical material used by a federal, state, or municipal governmental agency; and

(b) would confuse or mislead prospective insureds to believe that the advertisement is in some manner connected to a federal, state, or municipal governmental agency.

(3)(a) An advertisement, envelope, or stationery that uses words, letters, initials, symbols, or other devices that are similar to the words, letters, initials, symbols, layout, or other devices used by governmental agencies or other insurers is not permitted.

(b) An advertisement may not use words, letters, initials, symbols, or other devices that may lead the public to believe that a governmental agency or other insurer provided or endorsed the advertised coverages.

(c) An advertisement may not use words, letters, initials, symbols, or other devices that may lead the public to believe the advertiser is affiliated with or is endorsed by a governmental agency or other insurer.

(4) An advertisement may not use the name of a state or political subdivision in a policy description or name unless the company name contains the same state or political subdivision name.

(5) An advertisement may not use an envelope or stationery in a way that implies the insurer, the policy advertised, or the producer who may call on the consumer regarding the advertisement, is affiliated with a governmental agency.

(6)(a) An advertisement may not incorporate the word "Medicare" in the advertised plan or policy title.

(b) An advertisement may incorporate the word "Medicare" if the advertisement uses language differentiating the policy from the term "Medicare" in the advertisement.

(c) An advertisement may not use a phrase that includes "Medicare Department of an Insurance Company" or similar language.

(7) An advertisement may not imply that an individual may lose a right, privilege, or benefit under federal, state, or local law if the individual fails to respond to the advertisement.

(8) An advertisement may not use a letter, initial, or symbol of an insurer's corporate name or trademark that misleads or deceives the public regarding the insurer's identity, unless the advertisement:

(a) uses the insurer's correct and complete name; and

(b) places the insurer's correct and complete name in close conjunction with, and in the same type as the letters, initials, or symbols for the insurer's corporate name or trademark.

(9) An advertisement may not use an agency name, or a name that includes "Underwriters" or "Plan," in type, size, and location in the advertisement that may mislead or deceive a consumer regarding the identity of the insurer or advertiser.

(10) An advertisement may not use an address that is misleading or deceptive regarding an insurer or advertiser's:

(a) identity;

(b) location; or

(11) An advertisement may not use any terminology or word in a trade name of an insurer's insurance policy that is similar to a governmental agency or governmental program that may confuse, deceive, or mislead a prospective purchaser.

(12) An advertisement may not use any terminology or word in a trade name of an insurer's insurance policy that implies a sponsorship, endorsement, or connection with a governmental agency or governmental program.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-12 Group or Quasi-Group Implications

(1) An advertisement may not state or imply a preferred status in an advertisement unless the insurance policy provides the advertised renewal rate for:

(a) prospective insureds becoming group or quasi-group members covered under a group policy; or

(b) prospective insureds receiving special rates or underwriting under the group policy.

(2) When sold on an individual basis at regular rates, an advertisement may not solicit a particular class, such as governmental employees, by stating or implying that an occupational status entitles the member to a reduced rate for:

(a) a group; or

(b) another basis.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-13 Enforcement Procedures

(1) Each advertiser or insurer shall maintain a file containing advertisements for three years from the date last used including:

(a) every printed, published, or prepared advertisement of the advertiser or insurer's individual policies;

(b) every printed, published, or prepared advertisement of the advertiser or insurer's blanket, franchise, and group policies;

(c) any advertisement disseminated in this state and any other state whether or not the insurer is licensed in the other state; and

(d) a notation attached to each advertisement that includes:

(i) the manner and extent the advertiser or insurer distributed the advertisement; and

(ii) the advertised insurance policy's form number.

(2) Each advertiser or insurer shall maintain the file required in Subsection (1) at the advertiser or insurer's home office or principal office.

(3) The file required in Subsection (1) is subject to the department's regular and periodic inspection.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-14 Filing for Prior Review

(1) The commissioner may require an advertiser or insurer to file advertising material with the department for review before using the advertising material.

(2) The filing under Subsection (1) is for informational purposes only.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-130-15 Severability

If any provision of this rule, Rule R590-130, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: December 8, 2022
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

R590-131 Accident and Health Coordination of Benefits Rule

Utah Admin. Code R590-131-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-619.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish an order for an insurer to pay a coordination of benefits claim;

(b) establish when benefits may be reduced under a secondary plan; and

(2) This rule applies to an insurer offering accident and health insurance.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Allowable expense" means a health care expense, including coinsurance or a copayment without reduction for any applicable deductible, that is covered in full or in part by any plan covering an enrollee.

(a) If an enrollee advises an insurer that each plan covering the enrollee is a high-deductible health plan and the enrollee intends to contribute to a health savings account established in accordance with Section 223 of the Internal Revenue Code of 1986, then the primary high-deductible health plan's deductible is not an allowable expense, except for a health care expense incurred that is not subject to the deductible as described in Section 223(c)(2)(C) of the Internal Revenue Code of 1986.

(b) An expense or a portion of an expense that is not covered by any plan is not an allowable expense.

(c) Any expense that a provider, by law or in accordance with a contractual agreement, is prohibited from charging an enrollee is not an allowable expense.

(d) The examples in this subsection (1)(d) are not an allowable expense.

(i) If an enrollee is confined in a private hospital room, the difference between the cost of a semi-private room and the private room is not an allowable expense, unless one of the plans provides coverage for a private hospital room expense.

(ii) If an enrollee is covered by two or more plans that compute their benefit on the basis of a usual and customary fee, a relative value schedule, or other similar reimbursement methodology, any amount charged by the provider in excess of the highest reimbursement amount for a specified benefit is not an allowable expense.

(iii) If an enrollee is covered by two or more plans that provide a benefit or service on the basis of a negotiated fee, any amount in excess of the highest negotiated fee is not an allowable expense.

(iv) If an enrollee is covered by one plan that calculates its benefit or service on the basis of a usual and customary fee, a relative value schedule, or other similar reimbursement methodology and another plan that provides its benefit or service on the basis of a negotiated fee, then the primary plan's payment arrangement shall be the allowable expense for each plan.

(v) If a provider has a contract with the secondary plan to provide the benefit or service for a specific negotiated fee or payment amount that is different than the primary plan's payment arrangement, and if the provider's contract permits, that negotiated fee or payment shall be the allowable expense used by the secondary plan to determine its benefits.

(e) The definition of "allowable expense" may exclude certain types of coverage or benefits such as dental care, vision care, prescription drugs, or hearing aids.

(i) A plan that limits the application of COB to certain coverages or benefits may limit the definition of "allowable expense" in its contract to expenses that are similar to the expenses that it provides.

(ii) When COB is restricted to specific coverages or benefits in a contract, the definition of "allowable expense" shall include similar expenses to which COB applies.

(f) When a plan provides benefits in the form of a service, the reasonable cash value of each service will be considered an allowable expense and a benefit paid.

(g) The amount of a reduction may be excluded from allowable expense when an enrollee's benefits are reduced under a primary plan because the enrollee does not comply with the plan provisions concerning a second surgical opinion or pre- certification of an admission or a service.

(2)(a) "Birthday" means the month and day the enrollee was born.

(b) "Birthday" does not include the year the enrollee was born.

(3) "Child" means a:

(a) child as defined in Section 78B-12-102; or

(b) dependent child who is provided coverage pursuant to Sections 31A-22-610, 31A-22-610.5, and 31A-22-611.

(4)(a) "Claim" means a request that a plan's benefits be provided or paid.

(b) A benefit claimed may be in the form of:

(i) a service, including a supply;

(ii) payment for all or a portion of the expenses incurred;

(iii) a combination of Subsections (4)(b)(i) and (4)(b)(ii); or

(iv) an indemnification.

(5) "Closed panel plan" means a plan that:

(a) provides benefits to an enrollee primarily in the form of services through a panel of providers that have contracted with or are employed by an insurer; and

(b) excludes a benefit for a service provided by a non-panel provider, except in the case of:

(i) an emergency; or

(ii) a referral by a panel provider.

(6)(a) "Conforming plan" or "Plan" means a plan that allows COB.

(b) "Conforming plan" or "Plan" includes:

(i) an individual, group, or group-type accident and health insurance contract, including a closed panel plan;

(ii) a group or group-type uninsured arrangement;

(iii) a medical care benefit in a long-term care contract that provides reimbursement for an incurred expense, rather than an indemnity benefit; and

(iv) a Medicare or other governmental benefit, as permitted by law.

(7) "Continuation coverage" or "COBRA" means coverage provided under the Consolidated Omnibus Budget Reconciliation Act of 195, Section 31A-22-722, or another state extension required by law.

(8) "Coordinated package" means multiple plans or separate parts of a plan that are intended to be part of a coordinated plan of benefits.

(9) "Coordination of benefits" or "COB" means a plan provision that establishes an order in which a plan pays a coordination of benefit claim, and a plan, other than a primary plan, to reduce the plan benefits so that the combined benefit of all plans do not exceed the total allowable expense.

(10) "Custodial parent" means:

(a) the parent awarded custody of a child by a court order; or

(b) in the absence of a court order, the parent with whom the child resides more than one-half of the calendar year without regard to any temporary visitation.

(11)(a) "Group-type contract" means a contract that:

(i) is not available to the general public; and

(ii) is obtained and maintained only because of membership in, or a connection with, a particular organization or group, including blanket coverage.

(b) "Group-type contract" does not mean an individually underwritten guaranteed renewable policy even if the policy is purchased through payroll deduction at a premium savings and the enrollee has the right to maintain or renew the policy independently of continued employment with the employer.

(12) "High-deductible health plan" means a high-deductible plan as defined in Section 223, Internal Revenue Code.

(13)(a) "Hospital indemnity benefit" or "fixed indemnity benefit" means a benefit that is not related to actual incurred expenses.

(b) "Hospital indemnity benefit" or "fixed indemnity benefit" does not include a reimbursement-type benefit designed or administered to give the enrollee the right to elect an indemnity-type benefit at the time of a claim.

(14)(a) "Non-conforming plan" means a plan that may not coordinate benefits.

(b) "Non-conforming plan" includes:

(i) hospital indemnity benefits or fixed indemnity benefits;

(ii) accident-only coverage;

(iii) specified disease or specified accident coverage;

(iv) limited benefit health coverage described in Section R590-126-7;

(v) school accident coverage that covers a student for accidents only, including athletic injuries, either on a 24-hour basis or on a to-and-from-school basis;

(vi) benefits provided in a long-term care contract for a non-medical service, including:

(A) personal care, adult day care, homemaker services, assistance with activities of daily living, respite care, and custodial care; and

(B) a contract that pays a fixed daily benefit without regard to an expense incurred or the receipt of a service;

(vii) a Medicare supplement contract;

(viii) a state plan under Medicaid; and

(ix) a governmental plan that, by law, provides benefits that are in excess to any private insurance plan or other non- governmental plan.

(15)(a) "Primary plan" means a plan whose benefits for an enrollee's health care coverage must be determined without considering any other plan.

(b) A plan is a primary plan if:

(i) a plan either:

(A) has no order of benefit determination; or

(B) has a benefit determination provision that differs from the provisions in this rule; or

(ii) a plan uses this rule's order of benefit determination and under Section R590-131-6 the plan determines its benefits first.

(16) "Retiree employee benefit plan" means an employee benefit plan as defined in the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1002(3).

(17) "Secondary plan" means a plan that is not a primary plan.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-4 Coordination of Benefits Contract Provisions

(1) A COB provision may not be used that permits a plan to reduce the plan benefits on the basis that an enrollee is eligible to enroll in another plan and the enrollee did not enroll in that plan.

(2)(a) Under the terms of a closed panel plan, benefits are not payable if the enrollee does not use the services of a closed panel plan's providers.

(b) In most instances, COB does not occur if an enrollee is enrolled in two or more closed panel plans and obtains services from a provider in only one of the closed panel plans because the other closed panel plan, the one whose providers were not used, has no liability.

(c)(i) COB may occur when an enrollee receives emergency services that are covered by both plans.

(ii) The secondary plan shall use Section R590-131-7 to determine the amount it shall pay for the benefit.

(3) A plan may not use a COB or other provision that reduces the plan's benefits for non-conforming benefits.

(4) A coordinated package is one plan and there is no COB among the multiple plans or separate parts of a plan.

(5) If a plan coordinates benefits, the plan shall state the type of coverage that will be considered in applying the COB provision.

(6) Whether a plan uses the term "plan" or some other term such as "program," the definition may not be broader than the definition of "plan."

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-5 Rules for Coordination of Benefits

When an enrollee is covered by more than one plan, the rules for determining the order of benefit payments are as follows:

(1) The primary plan shall pay or provide benefits as if a secondary plan does not exist.

(2) If the primary plan is a closed panel plan and the secondary plan is not a closed panel plan, the secondary plan shall pay or provide benefits as the primary plan, except for an emergency service or an authorized referral that is paid by the primary plan.

(3) If an enrollee is covered by more than one secondary plan, the order of benefits is determined using Section R590- 131-6.

(4)(a) Except as provided in Subsection (4)(b), a plan that does not contain a COB provision consistent with this rule is the primary plan unless both plans state that the conforming plan is primary.

(b) Supplemental coverage that is obtained through membership in a group may be excess to a plan with a basic package of benefits.

(i) Supplemental coverage includes:

(A) major medical coverage that is superimposed over a base plan providing hospital and surgical expense benefits; and

(B) insurance type coverage that is written in connection with a closed panel plan to provide out-of-network benefits.

(ii) Supplemental coverage does not include a non-conforming plan.

(5) Consideration of benefits paid or provided by another plan may only occur when the plan is secondary to the other plan.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-6 Determining Order of Benefits

The order of benefits for each plan is determined using the first rule that applies in this section.

(1) Non-dependent or Dependent Rule.

The plan covering an enrollee as a non-dependent, such as an employee, member, policyholder, or retiree, is the primary plan and the plan covering the enrollee as a dependent is the secondary plan.

(2) Child Covered Under More Than One Plan Rule.

A plan covering a child shall determine the order of benefits as follows, unless there is a court order stating otherwise.

(a) For a child whose parents are married or whose parents are living together if they have never been married:

(i) the plan of the parent whose birthday falls earlier in the calendar year is the primary plan; or

(ii) if both parents have the same birthday, the plan that has covered the parent the longest is the primary plan.

(b) For a child whose parents are divorced, legally separated, or are not living together if they have never been married:

(i)(A) if a court order states that one of the parents is responsible for the child's health care expenses or health care coverage, the responsible parent's plan is the primary plan; or

(B) if the parent responsible for the child's health care expenses or health care coverage does not have health care coverage for the child, but the responsible parent's spouse has health care coverage for the child, the responsible parent's spouse's plan is the primary plan;

(ii) if a court order states that both parents are responsible for the child's health care expenses or health care coverage, Subsection (2)(a) applies;

(iii) if a court order states that the parents have joint custody without stating that one parent has responsibility for the health care expenses or health care coverage of the child, Subsection (2)(a) applies; and

(iv) if no court order allocates responsibility for the child's health care expenses or health care coverage, the order of benefits for the child is:

(A) the plan covering the custodial parent;

(B) the plan covering the custodial parent's spouse;

(D) the plan covering the non-custodial parent's spouse.

(c) If a plan provides coverage for a child through an individual who is not a parent of the child, the order of benefits is determined under Subsections (2)(a) and (2)(b) as if the individual is the child's parent.

(3) Active, Retired, or Laid-Off Employee Rule.

(a)(i) A plan covering an active employee who is not laid-off, retired, or a dependent of an active employee, is the primary plan.

(ii) A plan covering a retired employee or a laid-off employee, or a dependent of a retired employee or laid-off employee, is the secondary plan.

(b) Subsection (3) does not apply if:

(i) the other plan does not have an active, retired, or laid-off rule and the plans do not agree on the order of benefits; or

(ii) Subsection (1) determines the order of benefits.

(4) Continuation of Coverage Rule.

(a) If an enrollee is covered under a continuation of coverage law and another plan, the plan under a continuation of coverage law is the secondary plan.

(b) Subsection (4)(a) does not apply if:

(i) the other plan does not have a continuation of coverage rule and the plans do not agree on the order of benefits; or

(ii) Subsection (1) determines the order of benefits.

(5) Longer or Shorter Length of Coverage Rule.

(a) If Subsections (1) through (4) do not determine the order of benefits;

(i) the plan covering an enrollee for the longest time period is the primary plan; and

(ii) the plan covering an enrollee for the shortest time period is the secondary plan.

(b)(i) To determine the length of time an enrollee is covered under a plan, two successive plans are treated as one if the enrollee was eligible under the second plan within 24 hours after coverage under the first plan ended.

(ii) The start of a new plan does not include:

(A) a change in the amount or scope of a plan's benefits;

(B) a change in the entity that pays, provides, or administers the plan's benefits; or

(iii)(A) The time an enrollee is covered under a plan is measured from the enrollee's first date of coverage under that plan.

(B) If the date in Subsection (5)(b)(iii)(A) is not readily available, the date the enrollee first became a member of the group will determine the length of time the enrollee is covered under a plan.

(6) If Subsections (1) through (5) cannot determine the primary plan, the plans shall equally share the allowable expense.

(7)(a) If the plans cannot agree on the order of benefits within 30 calendar days after the plans have received the information needed to pay the claim, the plans shall immediately pay the claim in equal shares and determine their relative liabilities following payment.

(b) A plan is not required to pay more than it would have paid as a primary plan.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-7 Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim

(1) If a secondary plan coordinates benefits, the secondary plan shall:

(a) calculate the plan benefits it would have paid absent any other health care coverage; and

(b) apply the amount calculated in Subsection (1)(a) to any allowable expense unpaid by the primary plan.

(2) The secondary plan may reduce its payment amount so that when combined with the primary plan's payment, the total benefits paid or provided by all plans for the claim do not exceed 100% of the total allowable expense for that claim.

(3) The secondary plan shall credit to the plan deductible any amounts it would have credited to the plan deductible in the absence of other health care coverage.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-8 Miscellaneous Provisions

(1) Reasonable Cash Value of Services.

(a) A secondary plan that provides a benefit in the form of a service may recover the reasonable cash value of providing the service from the primary plan, if the service is covered by the primary plan and has not been paid or provided by the primary plan.

(b) Nothing in this Subsection may be interpreted to require a plan to reimburse an enrollee the cash value of a service provided by a plan that provides a benefit in the form of a service.

(2) Excess and Other Provisions.

(a) Except as provided in Subsection (2)(b), a conforming plan may not contain a provision that the plan benefits are excess or always secondary to any other plan or policy.

(b) A blanket accident-only plan may contain a provision that its benefits are excess or always secondary to any other plan.

(3) Non-conforming Plan.

(a) A conforming plan may coordinate benefits with a non-conforming plan.

(i) If the conforming plan is the primary plan, it shall pay or provide its benefits as the primary plan;

(ii) If the conforming plan is the secondary plan, it shall pay or provide its benefits as the secondary plan, and the payment shall be the limit of the conforming plan's liability.

(iii) If the non-conforming plan does not provide the information needed by the conforming plan to determine its benefits within a reasonable time after it is requested to do so, the conforming plan shall assume that the benefits of the non- conforming plan are identical to its own and shall pay its benefits accordingly.

(iv) If the conforming plan receives information as to the actual benefits of the non-conforming plan, it may adjust any payments in compliance with Subsection 31A-26-301.6(14)(a)(ii).

(b)(i) If a non-conforming plan reduces its benefits so that the enrollee receives less in benefits than the enrollee would have received had the conforming plan paid or provided its benefits as the secondary plan, and the non-conforming plan paid or provided its benefits as the primary plan, then the conforming plan shall advance to the enrollee, or on behalf of the enrollee, an amount equal to the difference.

(ii) In no event shall the conforming plan advance more than the conforming plan would have paid had it been the primary plan, less any amount it had previously paid.

(iii) In consideration of an advance, the conforming plan shall be subrogated to all rights of the covered person against the non-conforming plan in the absence of subrogation.

(iv) An advance by the conforming plan shall be without prejudice to any claim it may have against a non-conforming plan in the absence of subrogation.

(4) Subrogation.

COB differs from subrogation. Provisions for either COB or subrogation may be included in a contract without compelling the inclusion or exclusion of the other.

(5) Right To Receive and Release Needed Information.

(a) An insurer may obtain or give needed information to another person without obtaining consent from an enrollee.

(b) To facilitate cooperation with insurers, guidelines for medical privacy issues are provided under Rule R590-206, Privacy of Consumer Financial and Health Information Rule, and Gramm-Leach-Bliley Act of 1999, 15 U.S.C. 6801 et. seq.

(6) Right of Recovery.

(a) If an insurer is paid more than required under this rule, subject to Section 31A-26-301.6, the insurer may recover the overpayment from one or more of the following:

(i) the enrollee;

(ii) the provider;

(iii) an insurer; or

(iv) another organization.

(b) The insurer is responsible for adjustments between insurers and providers.

(7) Notice to Enrollee. The explanation of benefits provided to an enrollee shall include, "If you are covered by more than one health benefit plan, you should file all your claims with each plan."

(8) If covered benefits are due to a loss under Section 31A-22-306, an accident and health insurer may exclude benefits covered by personal injury protection described in Subsection 31A-22-307(1)(a), up to:

(a) the personal injury protection benefit provided by motor vehicle insurance; or

(b) if motor vehicle insurance is not in effect, the minimum amount provided in Subsection 31A-22-307(1)(a).

(9) Facility of Payment.

(a) If a plan pays an amount that should have been paid under an insurer's plan, the insurer may pay that amount to the other plan.

(b) The amount the insurer pays to the other plan is treated as a benefit paid under the plan and the insurer will not have to pay that amount again.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-9 COB Scenarios

The scenarios identified in this section are provided to demonstrate the possible use of the COB rules.

(1) Parents Not Married, Living Together, No Court Order. The order of benefits under Subsection R590-131-6(2)(a) is:

(a)(i) the parent whose birthday falls earlier in the calendar year; then

(ii) the parent whose birthday falls later in the calendar year; or

(b)(i) if the parents have the same birthday, the plan that has covered the parent the longest; then

(ii) the plan that has covered the parent the shortest.

(2) Parents Divorced, Separated, or Not Living Together.

(a) A court order awards joint custody to the parents, the father is responsible for the child's health care expenses or health care coverage, and the father has health care coverage. The order of benefits under Subsection R590-131-6(2)(b)(i) is:

(i) natural father;

(ii) stepmother;

(iii) natural mother;

(iv) stepfather.

(b) A court order awards joint custody to the parents, the order specifies the father is responsible for the child's health care expenses or health care coverage, the father does not have health care coverage, and the father's wife has health care coverage. The order of benefits under Subsection R590-131-6(2)(b)(i) is:

(i) stepmother;

(ii) natural mother;

(iii) stepfather.

(c) A court order awards custody to the father and requires both parents to share responsibility for the child's health care expenses or health care coverage. The father's birthday is December 1, the stepmother's birthday is February 17, the mother's birthday is August 23, and the stepfather's birthday is January 1. The order of benefits under Subsection R590-131- 6(2)(b)(ii) is:

(i) stepfather;

(ii) stepmother;

(iii) natural mother;

(iv) natural father.

(d) A court order awards joint custody, the father physical custody, and does not specify responsibility for the child's health care expenses or health care coverage. The father's birthday is December 1, the stepmother's birthday is February 17, the mother's birthday is August 23, and the stepfather's birthday is January 10. The order of benefits under Subsection R590-131- 6(2)(b)(iii) is:

(i) stepfather;

(ii) stepmother;

(iii) natural mother;

(iv) natural father.

(e) A court order awards joint custody and requires both parents to share responsibility for health care expenses or health care coverage. The child lives with the mother 51% of the year. The father's birthday is December 1, the stepmother's birthday is February 17, the mother's birthday is August 23, and the stepfather's birthday is January 10. The order of benefits under Subsection R590-131-6(2)(b)(ii) is:

(i) stepfather;

(ii) stepmother;

(iii) natural mother;

(iv) natural father.

(3) Parents Never Married, Not Living Together.

(a) No court order exists. The order of benefits under Subsection R590-131-6(2)(b)(iv) is;

(i) custodial parent;

(ii) custodial parent's spouse;

(iii) non-custodial parent;

(iv) non-custodial parent's spouse.

(b) A court order awards custody to the mother, and does not address the child's health care expenses or health care coverage. The order of benefits under Subsection R590-131-6(2)(b)(iv) is:

(i) natural mother;

(ii) stepfather;

(iii) natural father;

(iv) stepmother.

(4) Child No Longer a Minor.

(a) A court orders the natural father to provide health care coverage for a child up to age 18 or while attending high school, whichever is later, and custody is awarded to the natural mother. The child is now age 18, or older, no longer attends high school, and resides with the natural mother. The order of benefits under Subsection R590-131-6(2)(b)(iv) is:

(i) natural mother;

(ii) stepfather;

(iii) natural father;

(iv) stepmother.

(b) A court orders the natural father to provide health care coverage for a child up to age 18 or while attending high school, whichever is later, and custody is awarded to the natural mother. The child is now age 18, or older, no longer attends high school, and does not reside with either parent. The order of benefits under Subsection R590-131-6(5) is:

(i) the plan covering an enrollee for the longest period;

(ii) the plan covering an enrollee for the shortest period.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

Utah Admin. Code R590-131-10 Severability

If any provision of this rule, R590-131, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: August 22, 2022
Notice of Continuation: September 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-619

R590-132 Insurance Treatment of Human Immunodeficiency Virus (HIV) Infection

Utah Admin. Code R590-132-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-132-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) identify and restrict unfairly discriminatory underwriting, classification, or declination practices regarding HIV infection; and

(b) establish guidelines for the confidentiality of HIV-related testing.

(2) This rule applies to each licensee authorized to conduct insurance business.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-132-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "HIV" means the Human Immunodeficiency Virus.

(2) "HIV infection" means HIV is present in an individual and was detected by:

(a) the presence of HIV antibodies that are verified by an appropriate confirmatory test;

(b) the presence of HIV antigen;

(d) demonstration of HIV proviral DNA.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-132-4 Rule

(1) No individual with HIV infection will be singled out for unfairly discriminatory or preferential treatment for insurance purposes.

(2) To properly classify risks related to covering a prospective insured, an insurer may require reasonable testing.

(3) The application process must conform to the guidelines in Subsections (3)(a) through (f).

(a) No inquiry in an accident and health insurance application or a life insurance application may be directed toward determining the applicant's sexual orientation.

(b) No insurer or insurance support organization on the insurer's behalf may conduct an investigation in connection with an accident and health insurance application or a life insurance application to determine the applicant's sexual orientation.

(d) Insurance applicant testing shall be administered in a fair manner.

(e) If an insurer rates substandard or declines a prospective insured because of HIV infection, the insurer must base the decision on appropriate confirmatory tests.

(f) No person may require an individual applying for insurance to take an HIV test unless the individual signs a written release that includes:

(i) a statement explaining the test's purpose, content, and use;

(ii) a statement regarding disclosure of the test results, explaining to the applicant the following:

(A) the effect of releasing information to a person working in the insurance business;

(B) the insurer may disclose test results to others involved in the underwriting and claims review processes;

(C) if the HIV test is positive, the person conducting the test or the provider receiving the test results will report the results to the local health department; and

(D) if the insurer is a member of the Medical Information Bureau ("MIB, Inc."), the insurer may report the test results to MIB, Inc. in a generic code that signifies only non-specific test abnormalities; and

(iii) a provision for the applicant to designate a health care professional to receive any positive screen results for post-test counseling.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-132-5 Dissemination

Each insurer shall distribute a copy of this rule or an equivalent summary to all personnel engaged in activities requiring knowledge of this rule, and shall instruct each individual engaged in those activities on the rule's purpose, scope, and operation.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-132-6 Confidentiality

(1) Except as provided in Subsection R590-132-4(3)(f):

(a) a licensee shall hold an applicant's positive or indeterminate records that refer to HIV status as confidential records under restricted access; and

(b) a licensee may not re-release the records unless the applicant authorizes the re-disclosure.

(2) Re-release and re-disclosure are required when the applicant's test results are to be used for purposes other than the initial release.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-132-7 Severability

If any provision of this rule, Rule R590-132, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: February 8, 2022
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-133 Variable Contracts

Utah Admin. Code R590-133-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-20-106.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-2 Purpose and Scope

(1) The purpose of this rule is to regulate the issuance and sale of a variable contract.

(2) This rule applies to an insurer or producer offering variable life and annuity insurance business in this state.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Variable contract" means a life insurance policy or an annuity contract that provides a benefit that may vary according to the investment experience of any separate account the insurer establishes and maintains under Sections 31A-5-217 and 31A-18-102.

(2) "Variable contract producer" means a licensed producer with a variable contracts line of authority.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-4 Governance of Separate Accounts

Each separate account is governed by Sections 31A-5-217, 31A-5-217.5, 31A-18-102, 31A-20-106, 31A-21-301, 31A- 22-411, and this rule.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-5 Required Reports

(1) An insurer issuing an individual variable contract shall deliver to the contract holder at least once in each contract year after the first contract year a report of the investments held in the separate account.

(2) An insurer issuing an individual variable contract shall deliver to the contract holder at least once in each contract year after the first contract year a report of the following information as of a date no earlier than four months before the statement's delivery date:

(i) for an annuity contract when payments have not started:

(A) the number of accumulation units credited to the contract and the dollar value of a unit; or

(B) the contract holder's account value; and

(ii) for a life insurance policy, the death benefit dollar amount.

(3) An insurer shall submit annually to the commissioner a statement regarding the business of the insurer's separate account by the date and in a form prescribed by the NAIC.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-6 Foreign Insurers

If the laws or rules of a foreign insurer's domicile protects contract holders and the public to a degree substantially equal to the protections in this rule, the commissioner may exercise discretion and allow the foreign insurer's compliance with the domicile's laws and rules as compliance with this rule.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-7 Licensing of Variable Contract Producers

(1) A producer is not eligible to sell, offer for sale, or make a recommendation to purchase or terminate a variable contract until the producer is licensed as a variable contract producer.

(2) A producer's variable contract license is not effective until the producer:

(a) obtains a life insurance line of authority;

(b) provides evidence that the producer passed the Financial Industry Regulatory Authority examinations series six or seven and 63; and

(c) provides evidence of being Utah approved from the Financial Industry Regulatory Authority, Central Registration Depository.

(3) Notwithstanding Subsection (2), a nonresident producer may be licensed as a variable contract producer in this state upon providing evidence of being licensed as a variable contract producer in the resident state.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-8 Additional Provisions Applicable to Variable Contract Producers

(1) A person licensed in this state as a variable contract producer shall immediately report to the commissioner:

(a) any suspension or revocation of the variable contract producer's license or life insurance producer's license in any other state or territory of the United States;

(b) any disciplinary sanction imposed upon the producer by any:

(i) national securities exchange;

(ii) national securities organization; or

(iii) federal, state, or territorial agency with jurisdiction over securities or variable contracts; and

(i) fraud;

(ii) deceit;

(iii) misrepresentation;

(iv) violating an insurance or securities law; or

(v) violating an insurance or securities rule.

(2) The commissioner may reject an application for a variable contract producer's license upon any ground that would bar the applicant from being licensed to sell life insurance contracts in this state.

(3) The commissioner may suspend, revoke, or refuse to renew any variable contract producer's license upon any ground that would bar the producer from being licensed to sell a life insurance policy or an annuity contract in this state.

(4) A variable contract producer shall renew a license by following the same license renewal procedure for a life insurance producer.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-9 Disclosure

(1) The following information shall be furnished to a variable contract applicant before the applicant executes the application:

(a) a summary description of the insurer and the insurer's principal activities;

(b) a summary explanation of the following, in non-technical terms:

(i) the contract's principal variable features; and

(ii) how the variable benefits reflect the separate account's investment experience;

(d) a list of the separate account's investments beginning no earlier than the end of the last year that the insurer filed an annual statement with the commissioner of the insurer's domicile state; and

(e) a financial statement summary of the insurer and the separate account:

(i) based upon the last annual statement the insurer filed with the commissioner; or

(ii) for a period of four months after the insurer filed the last annual statement.

(2) The insurer may include additional information.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

Utah Admin. Code R590-133-10 Severability

If any provision of this rule, Rule R590-133, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: variable insurance
Date of Last Change: May 11, 2022
Notice of Continuation: December 8, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-20-106

R590-140 Reference Filings of Rate Service Organization Prospective Loss Costs

Utah Admin. Code R590-140-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-2 Purpose and Scope

(1)(a) The purpose of this rule is to regulate reference filings and insurers that make reference filings.

(b) This rule establishes procedures and requirements for a property and casualty insurer to comply with the requirements of Section 31A-19a-203 regarding rate and supplementary rate information filings that refer to and incorporate a rate service organization's prospective loss costs filings.

(2)(a) This rule applies to any kind or line of direct insurance written on risks or operations except insurance exempt under Subsection 31A-19a-101(2)(a)(ii).

(b) Except for an insurer exempt under Section 31A-19a-103, this rule applies to an insurer making a filing under Section 31A-19a-203.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-19a-102. Additional terms are defined as follows:

(1) "Reference filing" means a prospective loss costs filing, a supporting information filing, or both, made by a licensed rate service organization.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-4 Filings of Advisory Prospective Loss Costs and Adjustment Factors

(1) A rate service organization may develop and make a reference filing containing advisory prospective loss costs.

(2) Each reference filing shall:

(a) contain the statistical data and supporting information for each calculation or assumption underlying the prospective loss costs; and

(b) comply with the rate filing requirements under Section 31A-19a-203.

(3) An insurer may file rates if the insurer:

(a) becomes a participating insurer of a licensed rate service organization that makes an advisory prospective loss costs reference filing;

(b) authorizes the commissioner to accept a reference filing on the insurer's behalf; and

(4) If an insurer follows the procedure outlined in Subsection (3), the insurer's rates shall be:

(a) the prospective loss costs filed by the rate service organization; and

(b) any adjustment in effect for the insurer under Section R590-140-5 to the filed prospective loss costs.

(5) An insurer's adjustment regarding a prospective loss costs filing becomes effective in accordance with the rate filing requirements under Section 31A-19a-203.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-5 Required Filing Documents

(1) An insurer's filing that refers to a rate service organization's reference filing of prospective loss costs shall include:

(a) the Utah Insurer Loss Costs Multiplier Filing Forms pages one and two; and

(b) if applicable, the Expense Constant Supplement.

(2) Sample forms of the Utah Insurer Loss Costs Multiplier Filing Forms and the Expense Constant Supplement are available on the department's website: https://insurance.utah.gov.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-6 Supplementary Rate Information

(1) A rate service organization may develop and file supplementary rate information.

(2) Each supplementary rate information filing shall comply with Sections 31A-19a-203 and 31A-19a-205.

(3) An insurer may file supplementary rate information if the insurer:

(a) becomes a participating insurer of a licensed rate service organization; and

(b) authorizes the commissioner to accept a filing by the rate service organization on the insurer's behalf.

(4) Except for a modification filed by the insurer, the insurer's supplementary rate information filing must be the same as the rate service organization's supplementary rate information filing.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-7 Filing of Rate and Manual Pages

(1) An insurer is not required to develop or file final rate pages with the commissioner if the insurer's final rates are determined solely by applying the insurer's adjustment in the Utah Insurer Loss Costs Multiplier Filing Forms pages one and two and, if applicable, the Expense Constant Supplement to the prospective loss costs contained in the reference filing and printed in the rate service organization's rating manual.

(2) An insurer must file final rate pages with the commissioner if:

(a) the insurer prints and distributes the final rate pages for the insurer's own use; and

(b) the rates are based on the application of the insurer's filed adjustments to a rate service organization's prospective loss costs.

(3) An insurer must submit the insurer's rates to the commissioner when a rate service organization does not print prospective loss costs in the rate service organization's rating manual.

(4) An insurer must file certain premium elements, such as minimum premiums, when a rate service organization does not file the premium elements.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-8 Existing Rates and Deviations

(1) Nothing in this rule may require a rate service organization or the rate service organization's participating insurers to refile rates previously filed with the commissioner.

(2) A rate service organization's participating insurer may continue to use any rate and deviation currently filed for the insurer's use until the insurer:

(a) makes an independent filing to change the insurer's rates; or

(b) files the Utah Insurer Loss Costs Multiplier Filing Forms pages one and two and, if applicable, the Expense Constant Supplement adopting:

(i) a rate service organization's prospective loss costs; or

(ii) the insurer's adjustment to the rate service organization's prospective loss costs.

(3) An insurer shall maintain any document that:

(a) demonstrates the insurer is using rates and deviations that have been filed with the commissioner; and

(b) the commissioner may use to verify the insurer's rates.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-140-9 Severability

If any provision of this rule, Rule R590-140, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: February 5, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-142 Continuing Education Rule

Utah Admin. Code R590-142-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-23a-202, 31A-23b-205, 31A-23b- 206, and 31A-26-206.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-2 Purpose and Scope

(1) The purpose of this rule is to implement the continuing education requirements of Sections 31A-23a-202, 31A-23b- 206, and 31A-26-206.

(2) This rule applies to a continuing education provider, and an individual producer, consultant, navigator, and adjuster licensee under Sections 31A-23a-202, 31A-23b-206, and 31A-26-206.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-23a-102, 31A-23b-102, 31A-26-102, and 31A-35-102. Additional terms are defined as follows:

(1) "Classroom course" means:

(a) a course of study that:

(i) is taught on-site by a live instructor at the same location;

(ii) requires monitoring of a student; and

(iii) may require examination of course content by a student; or

(b) an interactive course of study that:

(i) is taught by a live instructor from a separate location;

(A) is delivered to a student via:

(I) computer;

(II) teleconference;

(III) webinar; or

(IV) another method acceptable to the commissioner; or

(ii) is not taught by a live instructor;

(A) is delivered to a student via computer; or

(B) another method acceptable to the commissioner;

(iii) requires two-way interaction between a student and the instrument of instruction;

(iv) requires monitoring of a student; and

(v) requires examination of course content by a student.

(2) "Credit hour" means one 50-minute period of insurance-related instruction consisting of:

(a) a classroom course;

(b) a home study course; or

(3) "Designated internet site" means an internet site that is designated by the commissioner for a registered provider to submit a student's course completion information.

(4) "Home study course" means a non-interactive course of study that:

(a) is not taught by a live instructor;

(b) is completed by a student via:

(i) computer;

(ii) video recording, if the video is professionally produced;

(iii) textbook; or

(iv) another method acceptable to the commissioner;

(d) does not require monitoring of a student; and

(e) requires examination of course content by the student.

(5) "Insurance-related instruction" means the amount of time assigned by the commissioner to a course of study to satisfy the requirements of continuing education credit hours under this rule, when the assignment of value shall be made based on:

(a) content;

(b) presentation; and

(6) "Monitoring of a student" means a person or system that verifies participation in and completion of a course.

(7) "Nonprofit provider" means an organization that fits the definition of nonprofit corporation as defined in Subsection 16-6a-102(35).

(8) "Registered provider" means a person who:

(a) satisfies the requirements of Sections R590-142-8 and R590-142-9; and

(b) offers a course of study or a program for credit that satisfies the continuing education requirements of this rule.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-4 Continuing Education Requirements

(1) A producer, consultant, adjuster, and navigator licensee shall comply with, and a registered provider shall be familiar with, the following continuing education requirements:

(a) upon renewal of a license, continuing education credit hours in excess of the number required to renew the license may not be carried over or applied to any subsequent licensing period;

(b) a licensee shall attend a course in its entirety to receive credit for the course; and

(c) a licensee may repeat a course for credit but may not take a course for credit more than once in a license continuation period.

(2) A producer, consultant, and adjuster licensee shall comply with, and a registered provider shall be familiar with, the following continuing education requirements:

(a) the number of credit hours of continuing education insurance-related instruction required to be completed every two years as a prerequisite to a license renewal shall be in accordance with Sections 31A-23a-202 and 31A-26-206;

(b) a producer, consultant, or adjuster licensee may obtain continuing education credit hours at any time during the two-year licensing period;

(c) not more than half of the total credit hours required shall be satisfied by courses provided to a producer, consultant, or adjuster licensee by one or more insurers;

(d) a nonresident producer, consultant, or adjuster licensee who satisfies the licensee's home state's continuing education requirement is considered to have satisfied Utah's continuing education requirement; and

(e) a producer, consultant, or adjuster licensee with a professional designation may use the continuing education credit hours required to maintain the designation to satisfy the requirement of the commissioner if:

(i) the hours are sufficient to meet the current continuing education requirement of Sections 31A-23a-202 and 31A-26- 206; and

(ii) the professional designation consists of one or more of the following:

(A) Accredited Customer Service Representative (ACSR);

(B) Accredited Financial Examiner (AFE) or Certified Financial Examiner (CFE);

(D) Certified Financial Planner (CFP);

(E) Certified Insurance Counselor (CIC);

(F) Certified Risk Manager (CRM);

(G) Registered Employee Benefits Consultant (REBC);

(H) Chartered Property Casualty Underwriter (CPCU) with completion of the Continuing Professional Development (CPD) program; or

(I) Certified Life Underwriter (CLU), Chartered Financial Consultant (ChFC) or Registered Health Underwriter (RHU) with completion of the Professional Achievement in Continuing Education (PACE) recertification program.

(f) Continuing education requirements may be administered by:

(i) the commissioner; or

(ii) a continuing education provider approved by and registered with the commissioner.

(3) A continuing education provider, including a state or national professional producer or consultant association, may:

(a) offer a qualified program on a geographically accessible basis; and

(b) collect a reasonable fee for funding and administration of a continuing education program, subject to the review and approval of the commissioner.

(4)(a) A navigator licensee shall comply with, and a registered provider shall be familiar with, the following continuing education requirements:

(i) the number of credit hours of continuing education instruction required to be completed annually as a prerequisite to license renewal shall be in accordance with Section 31A-23b-206; and

(ii) a navigator licensee may obtain continuing education credit hours at any time during the one-year licensing period;

(b) To act as a navigator, a person must successfully complete the federal navigator training and certification program requirements as established by federal regulation under PPACA and administered through the United States Department of Health and Human Services, including any applicable training and certification or recertification requirements under that program.

(c) A person has successfully completed the required continuing education requirements for a navigator license in accordance with Section 31A-23b-206 if the person has:

(i) met the requirements of Subsection (4)(b); and

(ii) completed at least 2 hours of ethics course.

(d) Continuing education requirements may be administered by:

(i) the commissioner;

(ii) a continuing education provider approved by and registered with the commissioner; or

(iii) a navigator-related training program administered through the United States Department of Health and Human Services.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-5 Experience Credit

(1) Continuing education credit hours may be granted to a producer, consultant, or adjuster licensee at the discretion of the commissioner for experience credit including credit for experience such as the authoring of an insurance book, course, or article.

(2) Membership by a producer or consultant in a state or national professional producer or consultant association is a substitute for two credit hours for each year during which the producer or consultant is a member of the association, except as provided in Subsection (3).

(3) No more than two hours of continuing education credit may be granted per year during the two-year license continuation period, regardless of the number of professional association memberships a producer or consultant maintains.

(4) An approved continuing education course taught by an approved instructor holding a Utah producer, consultant, or adjuster license shall receive twice the number of credit hours allocated by the commissioner for the course, except as provided in Subsection (5).

(5) Credit for instruction of a course shall be granted no more than once per license renewal period for each course taught.

(6) Continuing education experience credit may not be granted for committee service.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-6 Controls and Reporting of Credit Hours

(1) Within 14 days of completion of a course of study, the registered provider shall:

(a) furnish each student successfully completing the course with a certificate of completion; and

(b) submit through Sircon a course completion record identifying the:

(i) student that completed the course;

(ii) name and identifying course number of the course completed; and

(iii) number of credit hours completed by the student.

(2) If the registered provider fails to notify the commissioner of a student's course completion, the licensee may use the certificate of completion as proof of having successfully completed the course.

(3) The registered provider shall keep proof of successful electronic attendance submission on file for at least the current calendar year plus two years.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-7 Course Requirements

(1) Except as permitted in Subsection R590-142-4(3), before offering a course for credit in Utah, a person must register as a provider and submit a completed continuing education course filing form and course outline for review by the commissioner.

(2) Upon receipt of a completed continuing education course filing form and course outline from a registered provider, the commissioner shall:

(a)(i) approve a course as qualifying for credit in accordance with the standards of this rule;

(ii) issue a course number; and

(iii) assign the number of hours to be awarded to the approved course; or

(b)(i) disapprove a course as not qualifying for credit; and

(ii) furnish an explanation of the reason for disapproval of the course.

(3) A new course offered by a registered provider must be submitted to and approved by the commissioner at least 30 days before being offered, except that post-approval of a course may be granted by the commissioner upon submission of a written request and supporting documentation of a course attended.

(4) A course advertisement may not state or imply that a course has been approved by the commissioner unless written confirmation of the approval has been received by the registered provider.

(5) A department employee may attend a course at no cost to audit the course for compliance.

(6) The following course topics are examples of subject areas that qualify for approval if they contribute to the knowledge and professional competence of an individual licensee as a producer, consultant, or adjuster, and demonstrate a direct and specific application to insurance:

(a) a particular line of insurance:

(b) investments or securities in connection with variable contracts;

(d) insurance laws and administrative rules;

(e) tax laws related to insurance;

(f) accounting or actuarial considerations in insurance;

(g) business or legal ethics; and

(h) other course subject areas may be acceptable if the registered provider can demonstrate that the course contributes to professional competence and otherwise meets the standards set forth in this rule.

(7) The following course topics are examples of subject areas that do not qualify for approval:

(a) computer training and software presentations;

(b) motivation;

(d) sales training;

(e) communication skills;

(f) recruiting;

(g) prospecting;

(h) personnel management;

(i) time management; and

(j) any course not in accordance with this rule.

(8) The following continuing education standards must be met for a course offered by a registered provider to qualify for continuing education credit:

(a) the course must have significant intellectual or practical content to enhance and improve the insurance knowledge and professional competence of a participant;

(b) the course must be developed by persons who are qualified in the subject matter and instructional design;

(d) the instructor must be qualified with respect to course content and teaching methods;

(e) the instructor may be considered qualified if, through formal training or experience, the instructor has obtained sufficient knowledge to competently instruct the course;

(f) the number of participants and physical facilities for a course must be consistent with the teaching method specified;

(g) the course must include some means for evaluating the quality of the course content;

(h) the course must provide for a method to authenticate each student's identity; and

(i) the course must be taught in a manner that complies with the Americans with Disabilities Act of 1990, 42 U.S.C. 12102, to enable licensees with a physical or mental disability to complete the continuing education requirements.

(9) The following are additional requirements for an interactive computer course of study offered by a registered provider that is not taught by a live instructor:

(a) the course shall provide one or more of the following types of exam questions at the end of each section of course material presented:

(i) multiple choice;

(ii) matching; or

(iii) true or false;

(b) the exam questions shall cover material from the applicable section of the course that was presented to the student;

(c) only upon completion of an exam and not before or during the exam, the course shall identify all incorrect responses and inform the student of the correct response with an explanation of the correct answer;

(d) the course shall require answering 70% of the inquiries for each exam correctly to demonstrate mastery of the current section before the student is allowed by the program to proceed to the next section or complete the course;

(e) in the event a student does not achieve the 70% correct response rate necessary to advance to the next section, the course shall generate a different set of inquiries for the section, which may be repeated as necessary on a random or rotating basis;

(f) the course shall provide a method to authenticate the student's identity on a periodic hourly basis, including upon entering, during, and exiting the course;

(g) the course shall provide a method to ensure that the amount of time necessary for a student to complete course instruction and exam is no less than the amount of credit hours approved for the course; and

(h) the course shall provide for a method to directly transmit the final course completion results to the registered provider or a printed course completion receipt to be sent to the registered provider for issuance of a completion certificate.

(10) A continuing education course may not be offered or taught by a person who has:

(a) a lapsed, surrendered, suspended, or revoked provider registration;

(b) a suspended or revoked insurance license; or

(11) Continuing education credit may not be granted for a course offered by a registered provider in which the course is:

(a) not approved by the commissioner; or

(b) offered or taught by a person who has:

(i) a lapsed, surrendered, suspended, or revoked provider registration; or

(ii) been prohibited from teaching a course.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-8 Registered Provider Requirements

(1) A registered provider, or a state or national professional producer, consultant, adjuster, or navigator association, may:

(a) offer a qualified course for a license type or line of authority on a geographically accessible basis; and

(b) collect a reasonable fee for funding and administration of a continuing education program, subject to the review and approval of the commissioner.

(2) A person shall register with the commissioner as a provider before acting as a registered provider in Utah.

(3) Except as provided in Subsection (4), to initially register as a provider, a person must:

(a) submit a completed provider registration form via Sircon; and

(b) pay an initial registration fee in an amount annually established by the Utah Legislature under Section 63J-1-504.

(4)(a) To initially register as a nonprofit provider, a person must submit a completed provider registration form via:

(i) Sircon; or

(ii) facsimile, or as a PDF attachment to an email, using a form available on the department's website: https://insurance.utah.gov.

(b) A person initially registering as a nonprofit provider is not required to pay a registration fee.

(5) To renew a provider registration, a provider, other than a nonprofit provider, must:

(a) submit a completed provider renewal form via Sircon; and

(b) pay an annual renewal fee in an amount annually established by the Utah Legislature under Section 63J-1-504, before the annual renewal date.

(6)(a) To renew a nonprofit provider registration, a nonprofit provider must:

(i) submit a completed provider renewal form via:

(A) Sircon; or

(B) facsimile, or as a PDF attachment to an email using a form available on the department's website: https://insurance.utah.gov.

(b) A nonprofit provider is not required to pay an annual renewal fee.

(7) Before teaching a course, a registered provider shall:

(a) submit via Sircon, before offering the course, an outline that includes information regarding the course content and the number of credit hours requested;

(b) post the course offering to a designated internet site;

(d) include identifying information about any insurance license previously or currently held by each instructor who will be teaching the course.

(8) A registered provider shall report to the commissioner:

(a) an administrative action taken against the registered provider in any jurisdiction; and

(b) a criminal prosecution taken against the registered provider in any jurisdiction.

(9) The report required by Subsection (8) shall:

(a) be filed:

(i) when submitting the initial provider registration; and

(ii) within 30 days of the:

(A) final disposition of the administrative action; or

(B) initial appearance before a court; and

(b) include a copy of the complaint or other relevant legal documents related to the action or prosecution described in Subsection (8).

(10) The commissioner may prohibit any person from acting as a registered provider or instructor in Utah if the commissioner determines that:

(a) the person is not competent and trustworthy; or

(b) the person or course of study fails to meet the qualifying standards.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-9 Loss of Provider Registration and Course Disapproval

(1) A provider registration, other than a nonprofit provider registration, shall lapse if a provider fails to:

(a) submit a completed provider renewal form via Sircon; and

(b) pay an annual renewal fee before the annual renewal date.

(2) A nonprofit provider registration shall lapse if a nonprofit provider fails to submit a completed provider renewal form via:

(a) Sircon; or

(b) facsimile, or as a PDF attachment to an email, using a form available on the department's website: https://insurance.utah.gov.

(3) To reinstate a lapsed or surrendered provider registration, other than a nonprofit provider registration, a provider must:

(a) submit a completed provider reinstatement form via Sircon; and

(b) pay a reinstatement fee in an amount annually established by the Utah Legislature under Section 63J-1-504.

(4)(a) To reinstate a lapsed or surrendered nonprofit provider registration, a nonprofit provider must submit a completed provider registration form via:

(i) Sircon; or

(ii) facsimile, or as a PDF attachment to an email, using a form available on the department's website: http://insurance.utah.gov.

(b) A nonprofit provider is not required to pay a reinstatement fee.

(5) A provider registration may be denied, suspended, or revoked; an instructor prohibited from teaching a course; or a course disapproved, if the commissioner determines that:

(a) a course teaching method or course content fails to meet the standards of this rule;

(b) a registered provider reports that an individual completed a course in accordance with the standards furnished for course credit, when in fact the individual has not done so;

(c) a registered provider or instructor conducting a course instructs for less than the number of credit hours approved by the commissioner, but reports the full credits for the individual attending the course;

(d) credit for a course is not electronically reported to a designated internet site in a timely manner for an individual who satisfactorily completes a course in accordance with the standards furnished for course credit;

(e) a registered provider or instructor:

(i) lacks sufficient education or experience in the subject matter of the course;

(ii) has had a provider registration suspended or revoked in another jurisdiction;

(iii) has had an insurance license suspended or revoked;

(iv) uses course material that has been plagiarized; or

(v) is otherwise no longer qualified in accordance with the standards of this rule; or

(f) there is other good cause showing that:

(i) a provider registration should be suspended or revoked;

(ii) an instructor should be disallowed from teaching a course; or

(iii) a course should be disapproved.

(6) The commissioner may disapprove any course, even if it has been previously approved, if:

(a) the commissioner determines that the course of study fails to meet the qualifying standards;

(b) the commissioner determines that the course material has been plagiarized; or

(c) a change of 50% or more has been made in the course content since the initial approval of the course, subject to resubmission of the course for review and subsequent approval of the course by the commissioner.

(7) A registered provider may re-apply for a course that has been disapproved upon providing satisfactory proof to the commissioner that the conditions responsible for the disapproval have been corrected.

(8) To reinstate a suspended or revoked provider registration, a provider must:

(a) submit a completed provider registration form;

(b) submit a course outline that includes information regarding the course content and the number of credit hours requested for the course;

(c) pay a reinstatement fee in an amount annually established by the Utah Legislature under Section 63J-1-504, except as provided in Subsection R590-142-8(4); and

(d) provide satisfactory proof to the commissioner that each condition responsible for the suspension or revocation has been corrected.

(9) A person with a revoked provider registration may not apply for a new registration for five years from the date the registration was revoked without the express approval of the commissioner, unless otherwise specified in the revocation order.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

Utah Admin. Code R590-142-10 Severability

If any provision of this rule, Rule R590-142, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance continuing education
Date of Last Change: September 10, 2024
Notice of Continuation: February 28, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-202; 31A-23b-205; 31A-23b-206; 31A-26-206; 31A-26-209; 31A-35-401.5

R590-143 Life and Health Reinsurance Agreements

Utah Admin. Code R590-143-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-17-404, and 31A-17-404.3.

History

KEY: insurance law
Date of Last Change: March 16, 2022
Notice of Continuation: December 13, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-143-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) recognize that a licensed insurer may enter into a reinsurance agreement that yields legitimate relief to a ceding insurer; and

(b) establish criteria for a licensed insurer to enter into a reinsurance agreement.

(2)(a) This rule applies to:

(i) a domestic life insurer;

(ii) a domestic accident and health insurer;

(iii) a foreign life insurer not subject to a similar rule in its domiciliary state;

(iv) a foreign accident and health insurer not subject to a similar rule in its domiciliary state; and

(v) a property and casualty insurer with respect to its accident and health insurance business.

(b) This rule does not apply to:

(i) assumption reinsurance;

(ii) yearly renewable term reinsurance; and

(iii) certain nonproportional reinsurance, such as stop-loss or catastrophe reinsurance.

History

KEY: insurance law
Date of Last Change: March 16, 2022
Notice of Continuation: December 13, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-143-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "Credit Quality (C1)" means the risk that invested assets supporting the reinsured business will decrease in value due to:

(i) default; or

(ii) a decrease in earning power.

(b) Credit Quality (C1) does not include a change in interest rate.

(2) "Disintermediation (C3)" means the risk that interest rates rise and policy loans and surrenders increase, or that maturing contracts do not renew at anticipated rates of renewal where:

(i) there will be an increasing mismatch due to asset durations being greater than liability durations;

(ii) policyholders will move their funds into new products offering higher rates; and

(iii) the company may have to sell assets at a loss to provide for these withdrawals.

(3) "Lapse" means the risk that a policy will voluntarily terminate before the recoupment of a statutory surplus strain experienced at issue of the policy.

(4) "Reinvestment (C3)" means the risk that interest rates will fall and funds reinvested (coupon payments or monies received upon asset maturity or call) will therefore earn less than expected and there will be an increasing mismatch if asset durations are less than liability durations.

History

KEY: insurance law
Date of Last Change: March 16, 2022
Notice of Continuation: December 13, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-143-4 Accounting Requirements

(1) An insurer subject to this rule may not, for reinsurance ceded, reduce a liability or establish an asset in a financial statement filed with the department if, by the terms of a reinsurance agreement, any of the following conditions exist:

(a) Renewal expense allowances provided to a ceding insurer by a reinsurer in an accounting period are not sufficient to cover anticipated allocable renewal expenses of a ceding insurer on the portion of the business reinsured, unless a liability is established for the present value of the shortfall, using assumptions equal to the applicable statutory reserve basis on the business reinsured, including:

(i) commissions;

(ii) premium taxes; and

(iii) direct expenses, including:

(A) billing;

(B) valuation;

(D) maintenance expected by the company at the time the business is reinsured.

(b) A ceding insurer may be deprived of surplus or assets at the reinsurer's option or upon the occurrence of an event, such as the insolvency of the ceding insurer, except that it is not a deprivation of surplus or assets to terminate a reinsurance agreement by a reinsurer for nonpayment of reinsurance premiums or other amounts due, including:

(i) modified coinsurance reserve adjustments;

(ii) interest and adjustments on funds withheld; and

(iii) tax reimbursements.

(i) Reimbursement for negative experience does not include:

(A) offsetting experience refunds against current and prior years' losses under an agreement or;

(B) paying a ceding insurer an amount equal to the current and prior years' losses under an agreement upon voluntary termination of in force reinsurance by a ceding insurer.

(ii) Voluntary termination does not include a situation where termination occurs because of an unreasonable provision that allows a reinsurer to reduce its risk under an agreement, including a provision granting the reinsurer the right to increase reinsurance premiums or risk and expense charges to excessive levels, thereby forcing the ceding company to prematurely terminate the reinsurance treaty.

(d) A ceding insurer shall, at specific times listed in an agreement, terminate or automatically recapture all or part of the reinsurance ceded.

(e) A reinsurance agreement by a ceding insurer to a reinsurer involving payment of an amount that is not solely from income realized from the reinsured policy.

(f) A treaty does not transfer the significant risk inherent in the business being reinsured.

(i) The following table identifies the significant risks:

TABLE

Significant Risk Category

Health Insurance - other than LTC/LTD*

Health Insurance - LTC/LTD*

Immediate Annuities

Single Premium Deferred Annuities

Flexible Premium Deferred Annuities

Guaranteed Interest Contracts

Other Annuity Deposit Business

Single Premium Whole Life

Traditional Non-Par Permanent

Traditional Non-Par Term

Traditional Par Permanent

Traditional Par Term

Adjustable Premium Permanent

Indeterminate Premium Permanent

Universal Life Flexible Premium

Universal Life Fixed Premium

Universal Life Fixed Premium - dump-in premiums allowed

Significant

0 Insignificant

LTC = Long-term care insurance; LTD = Long-term disability insurance

(ii) The significant risk categories in the table in Subsection (1)(f)(i) are as follows:

(A) morbidity;

(B) mortality;

(D) credit quality (C1);

(E) reinvestment (C3); and

(F) disintermediation.

(iii) Products not specifically included in the table in Subsection (1)(f)(i) shall be determined consistent with the significant risk categories in Subsection (1)(f)(ii).

(g)(i) Credit quality, reinvestment, or disintermediation risks are significant for the business reinsured and the ceding company does not, other than for the classes of business exempt under Subsection (1)(g)(ii), transfer the underlying assets to the reinsurer or legally segregate such assets in a trust or escrow account or otherwise establish a mechanism satisfactory to the commissioner which legally segregates, by contract, the underlying assets.

(ii) Notwithstanding the requirements of Subsection (1)(g)(i), the assets supporting the reserves for the following classes of business and a class of business that does not have a significant credit quality, reinvestment, or disintermediation risk may be held by the ceding company without segregation of such assets:

(A) health insurance - LTC/LTD;

(B) traditional non-par permanent;

(D) adjustable premium permanent;

(E) indeterminate premium permanent; and

(F) universal life fixed premium, no dump-in premiums are allowed.

(iii)(A) A formula for determining the reserve interest rate adjustment shall reflect the ceding company's investment earnings and incorporate all realized and unrealized gains and losses reflected in the statutory statement.

(B) The following is an acceptable formula: Rate = 2 (I + CG)/(X + Y - I - CG):

(I) I is the net investment income;

(II) CG is capital gains less capital losses;

(III) X is the current year cash and invested assets plus investment income due and accrued less borrowed money; and

(IV) Y is the same as X but for the prior year.

(h) Settlement is made less frequently than quarterly or payment due from the reinsurer is not made in cash within 90 days of the settlement date.

(i) A ceding insurer shall make a representation or warranty not reasonably related to the business being reinsured.

(j) A ceding insurer shall make a representation or warranty about future performance of the business being reinsured.

(k) A reinsurance agreement is entered into for the principal purpose of producing significant surplus aid for the ceding insurer, typically on a temporary basis, while not transferring all the significant risks inherent in the business reinsured and, in substance or effect, the expected potential liability to the ceding insurer remains basically unchanged.

(2) Notwithstanding Subsection (1), an insurer subject to this rule may, with the prior approval of the commissioner, take reserve credit or establish an asset consistent with Title 31A, Insurance Code, and Title R590 including actuarial interpretations or standards adopted by the department.

(3)(a) An agreement involving the reinsurance of business, along with any subsequent amendments thereto, shall be filed by the ceding company with the commissioner within 30 days from its date of execution and shall include data detailing the financial impact of the transaction.

(b) A ceding insurer's actuary who signs the actuarial opinion regarding valuation of reserves shall comply with this rule and any applicable actuarial standards of practice when determining the proper credit in a financial statement filed with the department.

(i) describe the actuarial work performed for inclusion in a financial statement; and

(ii) demonstrate that such work conforms to this rule.

(d)(i) An increase in surplus, net of federal income tax resulting from arrangements described in Subsection (3)(a), shall be identified separately on the insurer's statutory financial statement as a surplus item, aggregate write-ins for gains and losses in surplus in the Capital and Surplus Account, page 4 of the Annual Statement, and recognition of the surplus increase as income shall be reflected on a net of tax basis in the "Reinsurance ceded" line, page 4 of the Annual Statement as earnings emerge from the business reinsured.

(ii)(A) For example, on the last day of calendar year N, company XYZ pays a $20 million initial commission and expense allowance to company ABC for reinsuring an existing block of business. Assuming a 34% tax rate, the net increase in surplus at inception is calculated by multiplying $20 million by 1 minus 0.34, resulting in $13.2 million, which is reported on the "Aggregate write-ins for gains and losses in surplus" line in the Capital and Surplus account. The 34% of $20 million, or $6.8 million, is reported as income on the "Commissions and expense allowances on reinsurance ceded" line of the Summary of Operations.

(B) At the end of year N+1 the business has earned $4 million. ABC has paid $0.5 million in profit and risk charges in arrears for the year and has received a $1 million experience refund. Company ABC's annual statement would report $1.65 million, calculated by taking 66% of the total of $4 million minus $1 million minus $0.5 million, up to a maximum of $13.2 million, on the "Commissions and expense allowance on reinsurance ceded" line of the Summary of Operations, and -$1.65 million on the "Aggregate write-ins for gains and losses in surplus" line of the Capital and Surplus account. The experience refund would be reported separately as a miscellaneous income item in the Summary of Operations.

History

KEY: insurance law
Date of Last Change: March 16, 2022
Notice of Continuation: December 13, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-143-5 Written Agreements

(1) A reinsurance agreement or an amendment may not be used to reduce a liability or to establish an asset in a financial statement filed with the department, unless an agreement, an amendment, or a binding letter of intent was executed by both parties no later than the "as of date" of the financial statement.

(2) A binding letter of intent, a reinsurance agreement, or an amendment to a reinsurance agreement shall be executed within a reasonable time, not to exceed 90 days from the execution date of the letter of intent, for credit to be granted for the reinsurance ceded.

(3) A reinsurance agreement shall contain the following provisions:

(a) the agreement constitutes the entire agreement between the parties; and

(b) any change or modification to the agreement is void unless made by amendment to the agreement and signed by both parties.

History

KEY: insurance law
Date of Last Change: March 16, 2022
Notice of Continuation: December 13, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-143-6 Severability

If any provision of this rule, R590-143, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: March 16, 2022
Notice of Continuation: December 13, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-144 Commercial Aviation Insurance Exemption From Rate and Form Filing

Utah Admin. Code R590-144-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-19a-103, and 31A-21-101.

History

KEY: insurance
Date of Last Change: November 22, 2021
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103; 31A-21-101

Utah Admin. Code R590-144-2 Purpose and Scope

(1) The purpose of this rule is to exempt commercial aviation insurance, as defined in this rule, from the rate filing requirements of Section 31A-19a-103 and the form filing requirements of Section 31A-21-101.

(2) This rule applies to:

(a) an insurer licensed to write commercial aviation insurance; and

(b) a rate service organization.

History

KEY: insurance
Date of Last Change: November 22, 2021
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103; 31A-21-101

Utah Admin. Code R590-144-4 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-19a-102. Additional terms are defined as follows:

(1) "Aviation insurance" means:

(a) Any type or class of property insurance on an aircraft and any class of property and interest with respect to, appertaining to, or in connection with any risk or peril of aerial navigation, transit, or transportation.

(b) Any type or class of casualty insurance in connection with the construction, repair, maintenance, operation, or use of an aircraft, and any type or class of casualty insurance in connection with the maintenance, operation, or use of an airport, including public liability and property damage.

(2) "Commercial aviation insurance" means any class of aviation insurance except insurance of aircraft used for private business and pleasure.

(3)(a) "Private business and pleasure" means the predominant use of an aircraft for pleasure or personal transportation purposes.

(b) The incidental use of an aircraft for an occupational or business interest is permissible.

History

KEY: insurance
Date of Last Change: November 22, 2021
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103; 31A-21-101

Utah Admin. Code R590-144-5 Findings

(1) Pursuant to Subsection 31A-21-101(5), the commissioner finds:

(a) the commercial aviation market segment is highly specialized, competitive, and global in nature;

(b) aviation insurance premiums rely on individual risk analysis, underwriting judgment, and the negotiation of a sophisticated business transaction between the insurer and an informed insured; and

(2) The commissioner finds that exemption from the rate and form filing requirements of Title 31A, Insurance Code, will not harm Utah insureds, creditors, or the public, and is not necessary to the regulation of these insurance products.

History

KEY: insurance
Date of Last Change: November 22, 2021
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103; 31A-21-101

Utah Admin. Code R590-144-6 Rule

(1)(a) An insurer or rate service organization is exempt from the rate filing requirements of Section 31A-19a-203 for commercial aviation insurance.

(b) This rule does not exempt an insurer or rate service organization from the rate standards of Section 31A-19a-201.

(2)(a) An insurer or rate service organization is exempt from the form filing requirements of Section 31A-21-201 for commercial aviation insurance.

(b) This rule does not permit an insurer or rate service organizations to issue a contract that does not conform to Section 31A- 22-101.

(3) Each insurer shall maintain fully documented underwriting files that must be made available to the commissioner upon request and must show that:

(a) rates are not excessive, inadequate, or unfairly discriminatory; and

(b) contracts are not inequitable, unfairly discriminatory, misleading, deceptive, obscure, encourage misrepresentation, or otherwise in violation of Utah law.

History

KEY: insurance
Date of Last Change: November 22, 2021
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103; 31A-21-101

Utah Admin. Code R590-144-7 Severability

If any provision of this rule, Rule R590-144, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: November 22, 2021
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-19a-103; 31A-21-101

R590-146 Medicare Supplement Insurance Standards

Utah Admin. Code R590-146-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) standardize coverage and simplify the terms and benefits of a Medicare supplement insurance policy;

(b) facilitate public understanding and comparison of Medicare supplement insurance coverage;

(c) eliminate provisions in a Medicare supplement insurance policy that are misleading or confusing in connection with the purchase of such policies or with the settlement of claims;

(d) provide disclosure requirements when issuing accident and health insurance coverage to a person eligible for Medicare; and

(e) establish rating and reporting requirements.

(2) This rule applies to a Medicare supplement insurance policy or certificate subject to Section 31A-22-620.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-3 Incorporation by Reference

The following documents are hereby incorporated by reference and are available in NAIC Medicare Supplement Insurance Minimum Standards Model Act, number 651, as approved by the NAIC in August 2016, and on the department's website, https://insurance.utah.gov:

(1) Application Supplementary Statements and Questions;

(2) Benefit Chart of Medicare Supplement Plans Sold on or after January 1, 2020;

(3) Disclosure Statements;

(4) Form for Reporting Medicare Supplement Policies;

(5) Medicare Supplement Refund Calculation Form;

(6) Notice to Applicant Regarding Replacement of Medicare Supplement Insurance or Medicare Advantage;

(7) Outline of Coverage Disclosures;

(8) Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies;

(9) Reporting Form for the Calculation of Benchmark Ratio Since Inception for Individual Policies; and

(10) Standardized Plan Descriptions.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-4 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-620. Additional terms are defined as follows:

(1) "1990 standardized plan" or "1990 plan" means group or individual Medicare supplement insurance issued on or after July 30, 1992, with an effective date of coverage before June 1, 2010, and includes Medicare supplement insurance renewed on or after that date that is not replaced by the issuer at the request of the insured.

(2) "2020 standardized plan" or "2020 plan" means group or individual Medicare supplement insurance issued with an effective date of coverage on or after June 1, 2010.

(3) "Activities of daily living" means:

(a) bathing;

(b) dressing;

(d) transferring;

(e) eating;

(f) ambulating;

(g) assistance with drugs that are normally self-administered;

(h) changing bandages or other dressings; or

(i) similar activities.

(4)(a) "At-home recovery benefit" means coverage for services to provide short-term, at-home assistance with activities of daily living for those recovering from an illness, injury, or surgery, if:

(i) the insured's attending physician certifies that the specific type and frequency of at-home recovery services are necessary because of a condition for which a home care plan of treatment was approved by Medicare; and

(ii) benefits are limited to:

(A) no more than the number and type of at-home recovery visits certified as necessary by the insured's attending physician;

(B) the total number of at-home recovery visits do not exceed the number of Medicare-approved home health care visits under a Medicare-approved home care plan of treatment;

(D) $1,600 per calendar year;

(E) seven visits in any one week;

(F) care furnished on a visiting basis in the insured's home;

(G) services provided by a care provider;

(H) at-home recovery visits not otherwise excluded; and

(I) at-home recovery visits received during the period the insured is receiving Medicare-approved home care services or no more than eight weeks after the service date of the last Medicare-approved home health care visit.

(b) "At-home recovery benefit" does not include:

(i) home care visits paid for by Medicare or other government programs; or

(ii) care provided by family members, unpaid volunteers, or providers who are not care providers.

(5) "At-home recovery visit" means the period of a visit required to provide at-home recovery care, without limit on the duration of the visit, except each consecutive four hours in a 24-hour period of services provided by a care provider is one visit.

(6) "Bankruptcy" means when a Medicare Advantage organization that is not an issuer files, or has had filed against it, a petition for declaration of bankruptcy and has stopped doing business in this state.

(7) "Basic core benefits" means:

(a) coverage of Medicare Part A eligible expenses for hospitalization, to the extent not covered by Medicare, from the 61st day through the 90th day in any Medicare benefit period;

(b) coverage of Medicare Part A eligible expenses incurred for hospitalization, to the extent not covered by Medicare, for each Medicare lifetime inpatient reserve day used;

(c) upon exhaustion of the Medicare Part A hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system rate or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days, which the provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(d) coverage under Medicare Part A and B for the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced in accordance with federal regulations; and

(e) coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Medicaid Part B regardless of hospital confinement, subject to the Medicare Part B deductible.

(8)(a) "Basic outpatient prescription drug benefit" means coverage for 50% of outpatient prescription drug charges, after a $250 calendar year deductible, to a maximum of $1,250 in benefits received by the insured per calendar year, to the extent not covered by Medicare.

(b) The outpatient prescription drug benefit may be included for sale or issuance in a policy until January 1, 2006.

(9) "Certificate" means a group Medicare supplement insurance certificate.

(10) "Cold lead advertising" means using, directly or indirectly, any method of marketing that fails to disclose in a conspicuous manner that the method of marketing is a solicitation of insurance and that contact will be made by a producer or an issuer.

(11) "Continuous period of creditable coverage" means the period during which an individual was covered by creditable coverage, if during the period of coverage the individual had no breaks in coverage greater than 63 days.

(12) "Employee welfare benefit plan" means a plan, fund, or program of employee benefits as defined in 29 U.S.C. Section 1002, Employee Retirement Income Security Act.

(13)(a) "Extended outpatient prescription drug benefit" means coverage for 50% of outpatient prescription drug charges, after a $250 calendar year deductible to a maximum of $3,000 in benefits received by the insured per calendar year, to the extent not covered by Medicare.

(b) The outpatient prescription drug benefit may be included for sale or issuance in a policy until January 1, 2006.

(14) "High pressure tactics" means using a method of marketing to induce, or tend to induce, the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.

(15)(a) "Home" means any place used by the insured as a place of residence, provided that the place would qualify as a residence for home health care services covered by Medicare.

(b) "Home" does not mean a hospital or skilled nursing facility.

(16) "Insolvency" means when an issuer licensed to transact the business of insurance in this state has a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer's state of domicile.

(17)(a) "Medically necessary emergency care in a foreign country" means:

(i) coverage that, to the extent not covered by Medicare for 80% of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician, and medical care received in a foreign country:

(A) would have been covered by Medicare if provided in the United States; and

(B) began during the first 60 consecutive days of a trip outside the United States; and

(ii) coverage that is subject to a calendar year deductible of $250 and a lifetime maximum benefit of $50,000.

(b) For the purposes of "medically necessary emergency are in a foreign country," "emergency care" means care needed immediately because of an injury or an illness of sudden and unexpected onset.

(18) "Medicare Advantage plan" means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

(a) coordinated care plans that provide health care services, including health maintenance organization plans, with or without a point-of-service option, plans offered by provider-sponsored organizations, and preferred provider organization plans;

(b) medical savings account plans coupled with a contribution into a Medicare Advantage plan medical savings account; and

(19) "Medicare Part A deductible" means coverage for a Medicare Part A inpatient hospital deductible amount per benefit period.

(20) "Medicare Part B deductible" means coverage for a Medicare Part B deductible amount per calendar year regardless of hospital confinement.

(21) "Medicare Part B excess charges" means coverage for the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(22) "Newly eligible" means an individual who became eligible for Medicare due to age, disability, or end-stage renal disease on or after January 1, 2020.

(23) "Policy" means a Medicare supplement insurance policy.

(24) "Pre-standardized plan" means group or individual Medicare supplement insurance issued before December 12, 1994.

(25)(a) "Preventive medical care benefit" means coverage for preventive health services not covered by Medicare as follows:

(i) an annual clinical preventive medical history and physical examination that may include tests, services, and patient education to address preventive health care measures; and

(ii) preventive screening tests or preventive services determined to be medically appropriate by the attending physician.

(b) "Preventive medical care benefit":

(i) is limited to reimbursement for actual charges, up to 100% of the Medicare-approved amount for each service, as if Medicare were to cover the service as identified in American Medical Association Current Procedural Terminology codes, to a maximum of $120 annually; and

(ii) may not include payment or a procedure covered by Medicare.

(26) "Secretary" means the Secretary of the United States Department of Health and Human Services.

(27) "Skilled nursing facility care" means coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A.

(28) "Standardized plan" means Medicare supplement:

(a) Plan A;

(b) Plan B;

(d) Plan D;

(e) Plan E;

(f) Plan F;

(g) Plan High Deductible F;

(h) Plan G;

(i) Plan High Deductible G;

(j) Plan H;

(k) Plan I;

(l) Plan J;

(m) Plan High Deductible J;

(n) Plan K;

(o) Plan L;

(p) Plan M; or

(q) Plan N.

(28) "Twisting" means knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policy or issuer to induce, or tend to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out an insurance policy with another issuer.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-5 Policy Definitions and Terms

A policy or certificate may not be advertised, solicited, or issued for delivery in this state unless the policy or certificate contains definitions or terms that conform to Section R590-146-4 and this section.

(1) "Accident," "accidental injury," or "accidental means" shall be defined to use result language and may not include words that establish an accidental means test or use words such as external, violent, visible wounds, or similar words of description or characterization.

(a) The definition may not be more restrictive than "'injury or injuries for which benefits are provided' means accidental bodily injury sustained by the insured person which is the direct result of an accident, independent of disease or bodily infirmity or any other cause, and occurs while insurance coverage is in force."

(b) The definition may exclude injuries for which benefits are provided or available under any workers' compensation, employer's liability or similar law, or motor vehicle no-fault plan, unless prohibited by law.

(2) "Benefit period" or "Medicare benefit period" may not be defined more restrictively than as defined in the Medicare program.

(3) "Care provider" means a qualified or licensed home health aide or homemaker, personal care aide or nurse provided through a licensed home health care agency or referred by a licensed referral agency or licensed nurse registry.

(4) "Convalescent nursing home," "extended care facility," or "skilled nursing facility" may not be defined more restrictively than as defined in the Medicare program.

(5) "Health care expenses" means, for purposes of Section R590-146-14, expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of an issuer.

(6) "Hospital" may be defined in relation to its status, facilities, and available services, or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals, but not more restrictively than as defined in the Medicare program.

(7) "Medicare eligible expenses" shall be defined to mean expenses of the kinds covered by Medicare Part A and B, to the extent recognized as reasonable and medically necessary by Medicare.

(8) "Physician" may not be defined more restrictively than as defined in the Medicare program.

(9) "Preexisting condition" may not be defined more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

(10)(a) "Sickness" may not be defined to be more restrictive than an illness or disease of an insured person which first manifests itself after the effective date of insurance and while insurance is in force.

(b) "Sickness" may be further modified to exclude sicknesses or diseases for which benefits are provided under any workers' compensation, occupational disease, employer's liability, or similar law.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-6 Policy Provisions

(1) Except for a permitted preexisting condition clause, a policy or certificate may not be advertised, solicited, or issued for delivery as a Medicare supplement insurance policy if the policy or certificate contains a preexisting limitation or exclusion that is more restrictive than those of Medicare.

(2) A policy or certificate may not use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

(3) A policy or certificate may not contain benefits that duplicate benefits provided by Medicare.

(4)(a) Subject to Subsections R590-146-7(1)(d), R590-146-7(1)(e), R590-146-7(1)(g), R590-146-8(1)(d), and R590- 146-8(1)(e), a policy with benefits for outpatient prescription drugs in existence before January 1, 2006, shall be renewed for current policyholders who do not enroll in Medicare Part D at the option of the policyholder.

(b) A policy with benefits for outpatient prescription drugs may not be issued after December 31, 2005.

(c) After December 31, 2005, a policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:

(i) the policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Medicare Part D plan; and

(ii) premiums are adjusted to reflect the elimination of outpatient prescription coverage as of Medicare Part D enrollment, accounting for any claims paid.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-7 Minimum Benefit Standards for Pre-Standardized Plans

A policy or certificate may not be advertised, solicited, or issued for delivery in this state as a pre-standardized plan unless it meets or exceeds the minimum standards of this section. The minimum standards do not preclude the inclusion of other provisions or benefits that are consistent with these standards.

(1) General Standards. The general standards apply to a policy or certificate and are in addition to any other requirement of this rule.

(a) A policy or certificate may not exclude or limit benefits for losses incurred more than six months after the effective date of coverage for a preexisting condition.

(b) A policy or certificate may not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(c) A policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes.

(d) A noncancelable, guaranteed renewable, or noncancelable and guaranteed renewable policy may not:

(i) provide for termination of coverage of a spouse solely because of an event specified for termination of coverage of the insured, other than the nonpayment of premium; or

(ii) be canceled or nonrenewed by the issuer solely on the grounds of deterioration of health.

(e)(i) Except as authorized by the commissioner, an issuer may not cancel or nonrenew a policy or certificate for any reason other than nonpayment of premium or material misrepresentation.

(ii) If a group policy is terminated by the group policyholder and not replaced as provided in Subsection (1)(e)(iv), the issuer shall offer to each certificate holder a policy with one of the choices as follows:

(A) an individual policy currently offered by the issuer having comparable benefits to those contained in the terminated group policy; or

(B) an individual policy that only provides benefits required to meet the basic core benefits under Subsection R590- 146-8a(2).

(iii) If membership in a group is terminated, the issuer shall:

(A) offer the certificate holder the conversion opportunity described in Subsection (1)(e)(ii); or

(B) at the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.

(iv) If a group policy is replaced by another group policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to each insured under the old group policy on its date of termination. Coverage under the new group policy may not result in an exclusion for a preexisting condition that would have been covered under the group policy being replaced.

(f)(i) Termination of a policy or certificate shall be without prejudice to any continuous loss that started while the policy or certificate was in force.

(ii) The extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to:

(A) the duration of the policy benefit period, if any; or

(B) payment of the maximum benefits.

(iii) Receipt of Medicare Part D benefits may not be considered in determining a continuous loss.

(g) If a policy eliminates an outpatient prescription drug benefit due to requirements imposed by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the modified policy is considered to satisfy the guaranteed renewal requirements of this subsection.

(2) An issuer shall include the minimum benefits:

(a) coverage of Medicare Part A eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(b) coverage for either all or none of the Medicare Part A inpatient hospital deductible amount;

(c) coverage of Medicare Part A eligible expenses incurred as daily hospital charges during use of Medicare's lifetime hospital inpatient reserve days;

(d) upon exhaustion of all Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 90% of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days;

(e) coverage under Medicare Part A for the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced in accordance with federal regulations or already paid for under Medicare Part B;

(f) coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount of Medicare eligible expenses under Medicare Part B regardless of hospital confinement, subject to a maximum calendar year out-of-pocket amount equal to the Medicare Part B deductible; and

(g) effective January 1, 1990, coverage under Medicare Part B for the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced in accordance with federal regulations or already paid for under Medicare Part A, subject to the Medicare deductible amount.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-8 Benefit Standards for 1990 Standardized Plans Issued for Delivery on or After July 30, 1992, and with an Effective Date for Coverage Prior to June 1, 2010

A policy or certificate may not be advertised, solicited, delivered, or issued for delivery in this state as a 1990 plan unless it complies with the standards in this section. A 1990 plan may not be offered for sale on or after June 1, 2010.

(1) General Standards. The general standards in this subsection apply to a 1990 plan, in addition to any other requirement of this rule.

(a) A policy or certificate may not exclude or limit benefits for losses incurred more than six months after the effective date of coverage for a preexisting condition.

(b) A policy or certificate may not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(d) A policy or certificate may not provide for termination of coverage of a spouse solely because of an event specified for termination of coverage of the insured, other than the nonpayment of premium.

(e) A policy shall be guaranteed renewable.

(i) An issuer may not cancel or nonrenew a policy solely on the grounds of the health status of an insured.

(ii) An issuer may not cancel or nonrenew a policy for any reason other than nonpayment of premium or material misrepresentation.

(iii) If a group policyholder terminates a policy and the policy is not replaced, the issuer shall offer each certificate holder a policy that, at the option of the certificate holder, provides for:

(A) continuation of the benefits contained in the group policy; or

(B) an individual policy with benefits that otherwise meet the requirements of this subsection.

(iv) If a certificate holder in a group terminates membership in the group, the issuer shall:

(A) offer the certificate holder a conversion opportunity; or

(B) at the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.

(v) If a group policy is replaced by another group policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to each insured covered under the prior group policy on its date of termination. Coverage under the new group policy may not result in an exclusion for a preexisting condition that would have been covered under the prior group policy.

(vi) If a policy eliminates an outpatient prescription drug benefit due to requirements imposed by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the modified policy satisfies the guaranteed renewal requirements of this subsection.

(f)(i) Termination of a policy or certificate shall be without prejudice to any continuous loss that started while the policy or certificate was in force.

(ii) The extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to:

(A) the duration of the policy benefit period, if any; or

(B) payment of the maximum benefits.

(iii) Receipt of Medicare Part D benefits may not be considered in determining a continuous loss.

(g)(i)(A) A policy or certificate shall provide that benefits and premiums be suspended at the request of the policyholder or certificate holder for a period, not to exceed 24 months, in which the policyholder or certificate holder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, if the policyholder or certificate holder notifies the issuer of the policy or certificate within 90 days after the date the insured becomes entitled to assistance.

(B) If the policy or certificate is suspended and the policyholder or certificate holder loses entitlement to medical assistance, the policy or certificate shall be automatically reinstated, effective on the date medical assistance terminated if the policyholder or certificate holder provides notice of loss of entitlement within 90 days after the date of loss and pays the required premium.

(ii)(A) A policy shall provide that benefits and premiums under a policy be suspended, for the period provided by federal regulation, at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan, as defined in Section 1862(b)(1)(A)(v) of the Social Security Act.

(B) If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy or certificate shall be automatically reinstated, effective on the date of loss of coverage, if the policyholder or certificate holder provides notice of loss of coverage within 90 days of the loss.

(iii) Reinstated coverage:

(A) may not include a preexisting condition waiting period;

(B)(I) shall provide for resumption of coverage substantially equivalent to the coverage in effect before the date of suspension; and

(II) if the suspended policy or certificate provided coverage for outpatient prescription drugs, the reinstated policy for Medicare Part D enrollees may not include coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and

(C) shall classify premiums on terms at least as favorable to the policyholder or certificate holder as the premium classification terms that applied had the coverage not been suspended.

(h) If an issuer makes a written offer to a policyholder or certificate holder to exchange a policy or certificate during a specified period from their 1990 plan to a 2010 plan, the offer and subsequent exchange shall comply with the requirements of this subsection:

(i) an issuer is not required to provide justification to the commissioner if an insured replaces a 1990 plan with an issue age rated 2010 plan at the insured's original issue age and duration;

(ii) if an insured's policy or certificate to be replaced is priced on an issue age rate schedule at the time of such offer, the rate charged to the insured for the new exchanged policy shall recognize the policy reserve buildup, due to the pre-funding inherent in the use of an issue age rate basis, for the benefit of the insured;

(iii) the rating class of the new policy or certificate shall be the class closest to the insured's class of the replaced coverage;

(iv) an issuer may not apply a new preexisting condition limitation or a new incontestability period to the new policy for those benefits contained in the exchanged 1990 plan, but may apply a preexisting condition limitation of no more than six months to any added benefits not contained in the exchanged policy; and

(v) the new policy or certificate shall be offered to each policyholder or certificate holder within a given plan, except when the offer or issue would be in violation of state or federal law.

(2) Standards for 1990 Plans A through J.

(a) An issuer shall offer to an applicant a policy or certificate that only includes the basic core benefits, Plan A. An issuer may offer any other 1990 plan, but not in lieu of Plan A.

(b) In addition to the basic core benefits, the benefits in this subsection shall be included in Plans B through J, only as provided in Section R590-146-9:

(i) 100% of the Medicare Part A deductible;

(ii) skilled nursing facility care;

(iii) 100% of the Medicare Part B deductible;

(iv) 80% of the Medicare Part B excess charges;

(v) 100% of the Medicare Part B excess charges;

(vi) basic outpatient prescription drug benefit;

(vii) extended outpatient prescription drug benefit;

(viii) medically necessary emergency care in a foreign country benefit;

(ix) preventive medical care benefit; and

(x) at-home recovery benefit.

(3) Standardized Plan K shall only include coverage for:

(a) 100% of the Medicare Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

(b) 100% of the Medicare Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

(c) upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days, which the provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(d) 50% of the Medicare Part A deductible until the out-of-pocket limitation is met;

(e) 50% of the skilled nursing facility care of the coinsurance amount until the out-of-pocket limitation is met;

(f) 50% of the hospice care coverage cost sharing for all Medicare Part A eligible expenses and respite care until the out-of-pocket limitation is met;

(g) 50%, under Medicare Part A or B, of the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced in accordance with federal regulations until the out- of-pocket limitation is met;

(h) except for coverage provided in Subsection (3)(i), 50% of the cost sharing otherwise applicable under Medicare Part B after the insured pays the Medicare Part B deductible until the out-of-pocket limitation is met;

(i) 100% of the cost sharing for Medicare Part B preventive services after the insured pays the Medicare Part B deductible; and

(j) 100% of all cost sharing under Medicare Part A and B for the balance of the calendar year after the insured has reached the out-of-pocket limitation on annual expenditures under Medicare Part A and B of $4,000 in 2006, as specified by the Secretary.

(4) Standardized Plan L shall only consist of:

(a) the benefits under Subsections (3)(a), (3)(b), (3)(c), and (3)(i);

(b) the benefits under Subsections (3)(d), (3)(e), (3)(f), (3)(g), and (3)(h), substituting 75% for 50%; and

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-8a Benefit Standards for 2010 Standardized Plans Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

A policy or certificate may not be advertised, solicited, delivered, or issued for delivery in this state as a 2010 plan unless it complies with the standards in this section.

(1) General Standards. The general standards in this subsection apply to a 2010 plan, in addition to any other requirement of this rule.

(a) A policy or certificate may not exclude or limit benefits for losses incurred more than six months after the effective date of coverage for a preexisting condition.

(b) A policy or certificate may not indemnify against losses resulting from a sickness on a different basis than losses resulting from accidents.

(e) A policy shall be guaranteed renewable.

(i) An issuer may not cancel or nonrenew a policy solely on the grounds of the health status of an insured.

(ii) An issuer may not cancel or nonrenew a policy for any reason other than nonpayment of premium or material misrepresentation.

(iii) If a group policyholder terminates a policy and the policy is not replaced as provided under Subsection (1)(e)(v), the issuer shall offer each certificate holder a policy that, at the option of the certificate holder, provides for:

(A) continuation of the benefits contained in the group policy; or

(B) an individual policy with benefits that otherwise meet the requirements of this subsection.

(iv) If a certificate holder in a group terminates membership in the group, the issuer shall:

(A) offer the certificate holder a conversion opportunity; or

(B) at the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.

(f)(i) Termination of a policy or certificate shall be without prejudice to any continuous loss that started while the policy or certificate was in force.

(ii) The extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to:

(A) the duration of the policy benefit period, if any; or

(B) payment of the maximum benefits.

(iii) Receipt of Medicare Part D benefits may not be considered in determining a continuous loss.

(g)(i) A policy or certificate shall provide that benefits and premiums be suspended at the request of the policyholder or certificate holder for a period, not to exceed 24 months, in which the policyholder or certificate holder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, if the policyholder or certificate holder notifies the issuer of the policy or certificate within 90 days after the date the insured becomes entitled to assistance.

(ii) If the policy or certificate is suspended and the policyholder or certificate holder loses entitlement to medical assistance, the policy or certificate shall be automatically reinstated, effective on the date medical assistance terminated if the policyholder or certificate holder provides notice of loss of entitlement within 90 days after the date of loss and pays the required premium.

(iii)(A) A policy shall provide that benefits and premiums under the policy be suspended, for any period that may be provided by federal regulation, at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan, as defined in Section 1862(b)(1)(A)(v) of the Social Security Act.

(B) If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy or certificate shall be automatically reinstated, effective on the date of loss of coverage if the policyholder or certificate holder provides notice of loss of coverage within 90 days of the loss.

(I) may not include a preexisting condition waiting period;

(II) shall provide for resumption of coverage substantially equivalent to the coverage in effect before the date of suspension; and

(III) shall classify premiums on terms at least as favorable to the policyholder or certificate holder as the premium classification terms that applied had the coverage not been suspended.

(2) Standards for 2010 Plans A, B, C, D, F, High Deductible F, G, M, and N.

(a) An issuer shall offer to an applicant a policy or certificate that only includes the basic core benefits, Plan A. An issuer may offer any other 2010 plan, but not in lieu of Plan A.

(b) In addition to the basic core benefits, the benefits in this subsection shall be included in Plans B, C, D, F, High Deductible F, G, M, and N, only as provided in Subsection R590-146-9a:

(i) 100% of the Medicare Part A deductible;

(ii) 50% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B deductible;

(v) 100% of the Medicare Part B excess charges; and

(vi) medically necessary emergency care in a foreign country.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-9 Standard Plans for 1990 Standardized Plans Issued for Delivery After July 30, 1992, and with an Effective Date for Coverage Prior to June 1, 2010

(1) An issuer offering a 1990 plan shall offer to an applicant a policy or certificate that only contains the basic core benefits.

(2) A group, package, or combinations of Medicare supplement insurance benefits, other than those listed in this section, may not be offered for sale, except as permitted in Subsection (6) and Section R590-146-10.

(3) A 1990 plan shall be:

(a) uniform in structure, language, designation, and format; and

(b) structured according to the format provided in Subsection R590-146-8(2), R590-146-8(3), or R590-146-8(4) and list the benefits in the order shown in Subsection (5) of this section.

(4) An issuer may use, in addition to the plan designations required in Subsection (3), other designations to the extent permitted by law.

(5) A 1990 plan shall include the benefits listed in this subsection.

(a) Standardized Plan A shall only include the basic core benefits.

(b) Standardized Plan B shall only include:

(i) basic core benefits; and

(ii) 100% of the Medicare Part A deductible.

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B deductible; and

(v) medically necessary emergency care in a foreign country.

(d) Standardized Plan D shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) medically necessary emergency care in a foreign country; and

(v) at-home recovery benefit.

(e) Standardized Plan E shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) medically necessary emergency care in a foreign country; and

(v) preventive medical care.

(f) Standardized Plan F shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B deductible;

(v) 100% of the Medicare Part B excess charges; and

(vi) medically necessary emergency care in a foreign country.

(g)(i) Standardized Plan High Deductible F shall only include 100% of covered expenses following the payment of the annual Plan High Deductible F deductible. The covered expenses after payment of the deductible include:

(A) basic core benefits;

(B) 100% of the Medicare Part A deductible;

(D) 100% of the Medicare Part B deductible;

(E) 100% of the Medicare Part B excess charges; and

(F) medically necessary emergency care in a foreign country.

(ii) The annual Plan High Deductible F deductible shall:

(A) consist of out-of-pocket expenses, other than premiums, for services covered by Plan F; and

(B) be in addition to any other specific benefit deductibles.

(iii) The annual Plan High Deductible F deductible shall be based on the calendar year as adjusted annually by the Secretary.

(h) Standardized Plan G shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 80% of the Medicare Part B excess charges;

(v) medically necessary emergency care in a foreign country; and

(vi) at-home recovery benefit.

(i) Standardized Plan H shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) for a policy issued before January 1, 2006, basic prescription drug benefit; and

(v) medically necessary emergency care in a foreign country.

(j) Standardized Plan I shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B excess charges;

(v) for a policy issued before January 1, 2006, basic prescription drug benefit;

(vi) medically necessary emergency care in a foreign country; and

(vii) at-home recovery benefit.

(k) Standardized Plan J shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B deductible;

(v) 100% of the Medicare Part B excess charges;

(vi) for a policy issued before January 1, 2006, extended prescription drug benefit;

(vii) medically necessary emergency care in a foreign country;

(viii) preventive medical care; and

(ix) at-home recovery benefit.

(l)(i) Standardized Plan High Deductible J shall only include 100% of covered expenses following the payment of the annual Plan High Deductible J deductible. The covered expenses after payment of the deductible include:

(A) basic core benefits;

(B) 100% of the Medicare Part A deductible;

(D) 100% of the Medicare Part B deductible;

(E) 100% of the Medicare Part B excess charges;

(F) for a policy issued before January 1, 2006, extended outpatient prescription drug benefit;

(G) medically necessary emergency care in a foreign country;

(H) preventive medical care benefit; and

(I) at-home recovery benefit.

(ii) The annual Plan High Deductible J deductible shall:

(A) consist of out-of-pocket expenses, other than premiums, for services covered by Plan J;

(B) be in addition to any other specific benefit deductibles; and

(m) Standardized Plan K shall only consist of those benefits under Subsection R590-146-8(3).

(n) Standardized Plan L shall only consist of those benefits under Subsection R590-146-8(4).

(6)(a) An issuer may, with the prior approval of the commissioner, offer a policy or certificate with a new or innovative benefit in addition to the standardized benefits provided in a policy or certificate.

(b)(i) A new or innovative benefit may include a benefit that is appropriate to Medicare supplement insurance, new or innovative, not otherwise available, cost effective, and offered in a manner that is consistent with the goal of simplification of a policy.

(ii) After December 31, 2005, an innovative benefit may not include an outpatient prescription drug benefit.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-9a Standard Plans for 2010 Standardized Plans Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

The standards in this section are applicable to any 2010 plan delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. A policy or certificate may not be advertised, solicited, delivered, or issued for delivery unless it complies with the standards in this section.

(1)(a) An issuer offering a 2010 plan shall offer to an applicant a policy or certificate that only contains the basic core benefits.

(b) If an issuer offers any of the additional benefits under Subsection R590-146-8a(2)(b), or offers Plans K or L under Subsection (5)(h) or (5)(i) of this section, the issuer shall also offer to an applicant either Plan C, under Subsection (5)(c) of this section, or Plan F, under Subsection (5)(e) of this section.

(2) A group, package, or combination of Medicare supplement insurance benefits, other than those listed in this section, may not be offered for sale except as permitted in Subsection (6) and in Section R590-146-10.

(3) A 2010 plan shall be:

(a) uniform in structure, language, designation, and format; and

(b) structured according to the format provided in Subsection R590-146-8a(2), or in the case of Plan K or L in Subsection (5)(h) or (5)(i) of this section, and list the benefits in the order shown.

(4) An issuer may use, in addition to the plan designations required under Subsection (3), other designations to the extent permitted by law.

(5) A 2010 plan shall only include the benefits listed in this subsection.

(a) Standardized Plan A shall only include the basic core benefits.

(b) Standardized Plan B shall only include:

(i) basic core benefits; and

(ii) 100% of the Medicare Part A deductible.

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B deductible; and

(v) medically necessary emergency care in a foreign country.

(d) Standardized Plan D shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care; and

(iv) medically necessary emergency care in a foreign country.

(e) Standardized Plan F shall only include:

(i) basic core benefits;

(ii) 100% of the Medicare Part A deductible;

(iii) skilled nursing facility care;

(iv) 100% of the Medicare Part B deductible;

(v) 100% of the Medicare Part B excess charges; and

(vi) medically necessary emergency care in a foreign country.

(f)(i) Standardized Plan High Deductible F shall only include 100% of covered expenses following the payment of the annual Plan High Deductible F deductible. The covered expenses after payment of the deductible include:

(A) basic core benefits;

(B) 100% of the Medicare Part A deductible;

(D) 100% of the Medicare Part B deductible;

(E) 100% of the Medicare Part B excess charges; and

(F) medically necessary emergency care in a foreign country.

(ii) The annual Plan High Deductible F deductible shall:

(A) consist of out-of-pocket expenses, other than premiums, for services covered by Plan F; and

(B) be in addition to any other specific benefit deductibles.

(iii) The annual Plan High Deductible F deductible shall be based on the calendar year as adjusted annually by the Secretary.

(g)(i) Standardized Plan G shall only include:

(A) basic core benefits;

(B) 100% of the Medicare Part A deductible;

(D) 100% of the Medicare Part B excess charges; and

(E) medically necessary emergency care in a foreign country.

(ii) Effective January 1, 2020, Plan High Deductible F under Subsection R590-146-9b(1)(d) is redesignated as Plan High Deductible G and may be offered to an individual eligible for Medicare before January 1, 2020.

(h) Standardized Plan K shall only include:

(i) 100% of the Medicare Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

(ii) 100% of the Medicare Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

(iii) upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days, which the provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(iv) 50% of the Medicare Part A deductible until the out-of-pocket limitation is met;

(v) 50% of the skilled nursing facility care coinsurance amount until the out-of-pocket limitation in Subsection (3)(h)(x) is met;

(vi) 50% of the hospice care cost sharing for all Medicare Part A eligible expenses and respite care until the out-of- pocket limitation is met;

(vii) 50%, under Medicare Part A or B, of the reasonable cost of the first 3 pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced in accordance with federal regulations until the out- of-pocket limitation is met;

(viii) except for coverage provided in Subsection (5)(h)(ix), 50% of the cost-sharing otherwise applicable under Medicare Part B after the insured pays the Medicare Part B deductible until the out-of-pocket limitation is met;

(ix) 100% of the cost-sharing for Medicare Part B preventive services after the insured pays the Part B deductible; and

(x) 100% of all cost sharing under Medicare Part A and B for the balance of the calendar year after the insured has reached the out-of-pocket limitation on annual expenditures under Medicare Part A and B of $4,000 in 2006, indexed each year by the Secretary.

(i) Standardized Plan L shall only include:

(i) the benefits under Subsections (5)(h)(i), (5)(h)(ii), (5)(h)(iii), and (5)(h)(ix);

(ii) the benefits under Subsections (5)(h)(iv), (5)(h)(v), (5)(h)(vi), (5)(h)(vii), and (5)(h)(viii), but substituting 75% for 50%; and

(iii) the benefits under Subsection (5)(h)(x), substituting $2,000 for $4,000.

(j) Standardized Plan M shall only include:

(i) basic core benefits;

(ii) 50% of the Medicare Part A deductible;

(iii) skilled nursing facility care; and

(iv) medically necessary emergency care in a foreign country.

(k)(i) Standardized Plan N shall only include:

(A) basic core benefits;

(B) 100% of the Medicare Part A deductible;

(D) medically necessary care in a foreign country.

(ii) The copayments for the benefits in Subsection (5)(k)(i) are the lesser of:

(A) $20 or the Medicare Part B coinsurance or copayment for each covered health care provider office visit, including visits to medical specialists; and

(B) $50 or the Medicare Part B coinsurance or copayment for each covered emergency room visit, however, this copayment shall be waived if the insured is admitted to a hospital and the emergency visit is subsequently covered as a Medicare Part A expense.

(b) A new or innovative benefit shall only include a benefit that is appropriate to Medicare supplement insurance, new or innovative, not otherwise available, and cost effective.

(i) adversely impact the goal of Medicare supplement simplification;

(ii) include an outpatient prescription drug benefit; or

(iii) be used to change or reduce benefits, including a change of any cost sharing provision, in any standardized plan.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-9b Standard Plans for 2020 Standardized Plans Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020

The standards in this section are applicable to any 2020 plan delivered or issued for delivery in this state to an individual newly eligible for Medicare with an effective date of coverage on or after January 1, 2020. A policy or certificate that provides coverage of the Medicare Part B deductible may not be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement insurance policy or certificate to an individual newly eligible for Medicare on or after January 1, 2020. A policy or certificate may not be advertised, solicited, delivered, or issued for delivery unless it complies with the standards in this section.

(1) The standards and requirements of Section R590-146-9a apply to a 2020 plan except:

(a) Plan C is redesignated as Plan D and shall provide the benefits in Subsection R590-146-9a(5)(c) but may not provide coverage for any portion of the Medicare Part B deductible;

(b) Plan F is redesignated as Plan G and shall provide the benefits in Subsection R590-146-9a(5)(e) but may not provide coverage for any portion of the Medicare Part B deductible;

(c) Plan C, F, or High Deductible F may not be offered to an individual newly eligible for Medicare on or after January 1, 2020;

(d) Plan High Deductible F is redesignated as Plan High Deductible G and shall provide the benefits in Subsection R590-146-9a(5)(f) but may not provide coverage for any portion of the Medicare Part B deductible, provided that the Medicare Part B deductible paid by the insured is considered an out-of-pocket expense in meeting the annual high deductible; and

(e) the reference to Plan C or F under Subsection R590-146-9a(1)(b) is considered a reference to Plan D or G for purposes of this section.

(2) This section applies to an individual who is newly eligible for Medicare on or after January 1, 2020:

(a) by reason of attaining age 65 on or after January 1, 2020; or

(b) by reason of entitlement to benefits under Medicare Part A pursuant to Section 226(b) or 226A of the Social Security Act, or who is considered to be eligible for benefits under Section 226(a) of the Social Security Act on or after January 1, 2020.

(3) For purposes of Subsection R590-146-12(5), in the case of an individual who is newly eligible for Medicare on or after January 1, 2020, a reference to Plan C or F, including High Deductible F, shall be deemed to be a reference to Plan D or G, including High Deductible G, respectively, that meet the requirements of this section.

(4) On or after January 1, 2020, the plans under Subsection (1)(d) may be offered to an individual who was eligible for Medicare prior to January 1, 2020, in addition to the standardized plans under Subsection R590-146-9a(5).

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-10 Medicare Select Policies and Certificates

(1)(a) This section applies to a Medicare Select policy and certificate.

(b) A policy or certificate may not be advertised as a Medicare Select policy or Medicare Select certificate unless it meets the requirements of this section.

(2) The definitions in this subsection apply to this section.

(a) "Complaint" means a dissatisfaction expressed by an insured concerning a Medicare Select issuer or its network providers.

(b) "Grievance" means dissatisfaction expressed in writing by an insured under a Medicare Select policy or Medicare Select certificate with the administration, claims practices, or provision of services concerning a Medicare Select issuer or its network providers.

(d) "Medicare Select policy" or "Medicare Select certificate" mean respectively a Medicare supplement policy or certificate that contains restricted network provisions.

(e) "Network provider" means a healthcare provider, or a group of healthcare providers, that enters into a written agreement with an issuer to provide benefits under a Medicare Select policy.

(f) "Restricted network provision" means a provision that conditions the payment of benefits, in whole or in part, on the use of network providers.

(g) "Service area" means a geographic area approved by the commissioner where a Medicare Select issuer is authorized to offer a Medicare Select policy.

(3) The commissioner may authorize an issuer to offer a Medicare Select policy or Medicare Select certificate under this section if the commissioner finds that the issuer has satisfied the requirements of this rule.

(4) A Medicare Select issuer may not issue a Medicare Select policy or Medicare Select certificate in this state until its plan of operation has been approved by the commissioner.

(5) A Medicare Select issuer shall file a proposed plan of operation with the commissioner that includes:

(a) evidence that each covered service that is subject to a restricted network provision is available and accessible through network providers, including a demonstration that:

(i) services may be provided by network providers with reasonable promptness for geographic location, hours of operation, and after-hours care based on the usual practice in the local area and the usual travel times within the community;

(ii) the number of network providers in the service area is sufficient, with respect to current and expected policyholders or certificate holders, either:

(A) to deliver adequate services subject to a restricted network provision; or

(B) to make appropriate referrals;

(iii) there are written agreements with network providers describing specific responsibilities;

(iv) emergency care is available 24 hours per day and seven days per week; and

(v) in the case of covered services that are subject to a restricted network provision and are provided on a prepaid basis, there are written agreements with network providers prohibiting the providers from billing or otherwise seeking reimbursement from, or recourse against, an insured under a Medicare Select policy or Medicare Select certificate, except that this subsection may not apply to supplemental charges or coinsurance amounts as stated in the Medicare Select policy or Medicare Select certificate;

(b) a statement or map providing a clear description of the service area;

(d) a description of the quality assurance program, including:

(i) the formal organizational structure;

(ii) the written criteria for selection, retention, and removal of a network provider; and

(iii) the procedures for evaluating quality of care provided by a network provider and the process to initiate corrective action when warranted;

(e) a list and description, by specialty, of each network provider;

(f) written information proposed to be used by the issuer to comply with Subsection (9); and

(g) any other information requested by the commissioner.

(6)(a) A Medicare Select issuer shall file with the commissioner any proposed change to the plan of operation, except for a change to the list of network providers, prior to implementing the changes.

(b) A change to the list of network providers shall be filed with the commissioner within 30 days of the change. The submission shall include each network provider and clearly identify new and discontinued providers.

(7) A Medicare Select policy or Medicare Select certificate may not restrict payment for covered services provided by a non-network provider if:

(a) the services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury, or condition; and

(b) it is unreasonable to obtain services through a network provider.

(8) A Medicare Select policy or Medicare Select certificate shall provide payment for full coverage under the policy for a covered service that is not available through a network provider.

(9) A Medicare Select issuer shall make full and fair disclosures in writing of each provision, restriction, and limitation of a Medicare Select policy or Medicare Select certificate to an applicant. The disclosure shall include:

(a) an outline of coverage sufficient to permit an applicant to compare the coverage and premiums of the Medicare Select policy or Medicare Select certificate with:

(i) other Medicare supplement insurance policies or certificates offered by the issuer; and

(ii) other Medicare Select policies or Medicare Select certificates;

(b) a description, including address, phone number, and hours of operation, of each network provider, including primary care physicians, specialty physicians, hospitals, and other providers;

(c) a description of the restricted network provisions, including payments for coinsurance and deductibles, when providers other than network providers are utilized, except to the extent specified in the Medicare Select policy or Medicare Select certificate, expenses incurred when using out-of-network providers do not count toward the out-of-pocket annual limit contained in a Plan K or L;

(d) a description of coverage for emergency and urgent care and other out-of-service area coverage;

(e) a description of any limitation on a referral to a restricted network provider or other provider;

(f) a description of the Medicare Select policyholder's rights to purchase another Medicare supplement insurance policy or certificate offered by the issuer; and

(g) a description of the Medicare Select issuer's quality assurance program and grievance procedure.

(10) Prior to the sale of a Medicare Select policy or Medicare Select certificate, a Medicare Select issuer shall obtain from the applicant a signed and dated form stating that the applicant has received the information required under Subsection (9) and that the applicant understands the restrictions of the Medicare Select policy or Medicare Select certificate.

(11) A Medicare Select issuer shall have and use procedures for hearing complaints and resolving written grievances from insureds. The procedures shall be aimed at mutual agreement for settlement and may include arbitration procedures.

(a) A grievance procedure shall be described in the Medicare Select policy, Medicare Select certificate, and outline of coverage.

(b) At the time a Medicare Select policy or Medicare Select certificate is issued, a Medicare Select issuer shall provide detailed information to the policyholder or certificate holder describing how a grievance may be registered with the issuer.

(c) An issuer shall consider a grievance in a timely manner and transmit it to an appropriate decision maker who has the authority to fully investigate the issuer and take corrective action.

(d) If a grievance is found to be valid, corrective action shall be promptly taken.

(e) Each concerned party shall be notified about the results of a grievance.

(f) A Medicare Select issuer shall report to the commissioner no lather than March 31 of each year the number of grievances filed in the past year and a summary of the subject, nature, and resolution of the grievances.

(12)(a) At the request of an insured, a Medicare Select issuer shall provide the insured the opportunity to purchase a Medicare supplement insurance policy or certificate offered by the issuer which has comparable or lesser benefits that does not contain a restricted network provision. The issuer shall make the Medicare supplement insurance policy or certificate available without requiring evidence of insurability after the Medicare Select policy or Medicare Select certificate has been in force for six months.

(b) For the purposes of this subsection, a Medicare supplement policy or certificate is considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or Medicare Select certificate being replaced. A significant benefit includes coverage for the Medicare Part A deductible, at-home recovery services, or the Medicare Part B excess charges.

(13)(a) A Medicare Select policy or Medicare Select certificate shall provide for continuation of coverage in the event the Secretary determines that Medicare Select policies and Medicare Select certificates should be discontinued due to either failure of the Medicare Select Program to be reauthorized under law or its substantial amendment.

(b) A Medicare Select issuer shall provide an insured under a Medicare Select policy or Medicare Select certificate the opportunity to purchase a Medicare supplement insurance policy or certificate offered by the issuer that has comparable or lesser benefits that does not contain a restricted network provision. The issuer shall make the Medicare supplement insurance policy or certificate available without requiring evidence of insurability.

(c) For the purposes of this subsection, a Medicare supplement insurance policy or certificate is considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or Medicare Select certificate being replaced. For this subsection, a significant benefit includes coverage for the Medicare Part A deductible, at-home recovery services, or the Medicare Part B excess charges.

(14) A Medicare Select issuer shall comply with reasonable requests for data to evaluate the Medicare Select Program.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-11 Open Enrollment

(1)(a) An issuer may not deny or condition the issuance or effectiveness of a policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted prior to or during the six month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B.

(b) Each policy or certificate currently available from an issuer shall be available to an applicant who qualifies under this section regardless of age.

(c) During an applicant's open enrollment period, an issuer shall offer the lowest rate available to an applicant without regard to health or smoker status.

(2)(a) An issuer may not exclude benefits based on a preexisting condition if an applicant described in Subsection (1) has had a continuous period of creditable coverage of at least six months.

(b) An issuer shall reduce the period of a preexisting condition exclusion by the aggregate of the period of creditable coverage if an applicant, described in Subsection (1), as of the date of application, has had a continuous period of creditable coverage that is less than six months. The Secretary shall specify the manner of the reduction under this subsection.

(3) Except as provided in Subsection (2) and Sections R590-146-12 and R590-146-13, Subsection (1) may not be construed as preventing the exclusion of benefits under a policy, during the first six months, for a preexisting condition.

(4)(a) An issuer shall offer an insured an annual election period that begins on the insured's birthday and ends 60 days later.

(b) During the annual election period, an issuer:

(i) shall offer to an existing insured each standardized plan the issuer currently offers for which benefits are considered equal to or less than the insured's current benefits, not including any innovative benefits;

(ii) may revise an insured's premium, in the same rating class, based on the insured's newly selected standardized plan; and

(iii) may not:

(A) underwrite or perform any activity that increases the insured's premium based on the insured's health status;

(B) impose a new benefit exclusion or exclusion period based on a preexisting condition; or

(C) discriminate in the pricing of the new plan because of health status, claims experience, receipt of health care, or medical condition.

(c) An issuer is not required to offer to an insured during the annual election period a standardized plan that is available through the issuer's affiliate.

(d) This Subsection (4):

(i) applies to an insured annually on each birthday after May 6, 2025; and

(ii) does not apply to an insured who is not currently insured in a Medicare supplement insurance policy with the issuer.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-12 Guaranteed Issue for Eligible Persons

(1)(a) An eligible person is an individual described in Subsection (2) who seeks to enroll under a policy or certificate during the period specified in Subsection (3), and who submits evidence of the date of termination, disenrollment, or Medicare Part D enrollment with an application for a policy or certificate.

(b) With respect to an eligible person, an issuer may not:

(i) deny or condition the issuance or effectiveness of a policy or certificate described in Subsection (5) that is offered and is available for issuance to new enrollees by the issuer;

(ii) discriminate in the pricing of a policy because of health status, claims experience, receipt of health care, or medical condition; or

(iii) impose a benefit exclusion based on a preexisting condition.

(2) An eligible person is an individual:

(a) enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare, and the plan terminates or the plan no longer provides all supplemental health benefits to the individual;

(b) enrolled with a Medicare Advantage organization under a Medicare Advantage plan, and one or more of the circumstances in this subsection apply, or the individual is 65 years of age or older and is enrolled with a Program of All- Inclusive Care for the Elderly, PACE, provider under Section 1894 of the Social Security Act, and there are circumstances similar to those described in this subsection that would permit discontinuance of the individual's enrollment with such provider if such individual were enrolled in a Medicare Advantage plan:

(i) the certification of the organization or plan has been terminated;

(ii) the organization has terminated or otherwise discontinued providing the plan in the area the individual resides;

(iii) the individual is no longer eligible to elect the plan because of a change in the individual's place of residence or other change in circumstances specified by the Secretary, but not including termination of the individual's enrollment on the basis described in Section 1851(g)(3)(B) of the Social Security Act, when the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under Section 1856, or the plan is terminated for each individual within a residence area;

(iv) the individual demonstrates, in accordance with guidelines established by the Secretary, that:

(A) the organization offering the plan substantially violated a material provision of the organization's contract under this part in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide such covered care in accordance with applicable quality standards; or

(B) the organization, or producer or other entity acting on the organization's behalf, materially misrepresented the plan's provisions in marketing the plan to the individual; or

(v) the individual meets such other exceptional conditions the Secretary may provide;

(c)(i) enrolled with:

(A) an eligible organization under a contract under Section 1876 of the Social Security Act;

(B) a similar organization operating under demonstration project authority, effective before April 1, 1999;

(D) an organization under a Medicare Select policy; and

(ii) enrollment ends under circumstances that would permit discontinuance of an individual's election of coverage under Subsection (2)(b);

(d) enrolled under a policy and the enrollment ends because of:

(i)(A) the insolvency of the issuer or bankruptcy of the non-issuer organization; or

(B) other involuntary termination of coverage or enrollment under the policy;

(ii) the issuer of the policy substantially violated a material provision of the policy; or

(iii) the issuer, or a producer or other entity acting on the issuer's behalf, materially misrepresented the policy's provisions in marketing the policy to the individual;

(e)(i) enrolled under a policy and terminates enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization under a Medicare Advantage plan, any eligible organization under a contract under Section 1876 of the Social Security Act, any similar organization operating under demonstration project authority, any PACE provider under Section 1894 of the Social Security Act, or a Medicare Select policy; and

(ii) subsequent enrollment under Subsection (2)(e)(i) is terminated by the enrollee during any period within the first 12 months of such subsequent enrollment, during which the enrollee is permitted to terminate such subsequent enrollment under Section 1851(e) of the Social Security Act;

(f) upon first becoming eligible for benefits under Medicare Part A at age 65, enrolls in a Medicare Advantage plan, or with a PACE provider under Section 1894 of the Social Security Act, and disenrolls from the plan or program within 12 months after the effective date of enrollment;

(g) enrolled in a Medicare Part D plan during the initial enrollment period and was enrolled under a policy that covers outpatient prescription drugs and the individual terminates enrollment in the policy and submits evidence of enrollment in Medicare Part D along with the application for a policy described in Subsection (5)(d); or

(h) enrolled under medical assistance under Title XIX of the Social Security Act, Medicaid, and is involuntarily terminated outside of requirements of Subsection R590-146-8(1)(g)(i) or R590-146-8a(1)(g)(i) and R590-146-8a(1)(g)(ii).

(3)(a) For an eligible person described in Subsection (2)(a), the guaranteed issue period extends for 63 days beginning on the later of:

(i) the date the individual receives a notice of termination or cessation of all supplemental health benefits or, if a notice is not received, notice that a claim has been denied because of a termination or cessation; or

(ii) the date that the applicable coverage terminates or ends.

(b) For an eligible person described in Subsection (2)(b), (2)(c), (2)(e), or (2)(f), whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends 63 days after the date applicable coverage is terminated.

(c) For an eligible person described in Subsection (2)(d)(i), the guaranteed issue period extends for 63 days beginning on the later of:

(i) the date that the individual receives a notice of termination, a notice of the issuer's bankruptcy or insolvency, or other such similar notice, if any; or

(ii) the date that the applicable coverage is terminated.

(d) For an eligible person described in Subsection (2)(b), (2)(d)(ii), (2)(d)(iii), (2)(e), or (2)(f) who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days before the effective date of the disenrollment and ends on the date that is 63 days after the effective date.

(e) For an eligible person described in Subsection (2)(g), the guaranteed issue period begins on the date the individual receives notice under Section 1882(v)(2)(B) of the Social Security Act from the issuer during the 60-day period immediately preceding the initial Medicare Part D enrollment period and ends on the date that is 63 days after the effective date of the individual's coverage under Medicare Part D.

(f) For an eligible person described in Subsection (2) but not described in Subsections (3)(a) through (e), the guaranteed issue period begins on the effective date of disenrollment and ends on the date that is 63 days after the effective date.

(4)(a) An eligible person described in Subsection (2)(e), or who is considered to be an eligible person under this subsection, whose enrollment with an organization or provider described in Subsection (2)(e)(i) is involuntarily terminated within the first 12 months of enrollment, and who, without an intervening enrollment, enrolls with another such organization or provider, the subsequent enrollment is considered to be an initial enrollment.

(b) An eligible person described in Subsection (2)(f), or who is considered to be an eligible person under this subsection, whose enrollment with a plan or in a program described in Subsection (2)(f) is involuntarily terminated within the first 12 months of enrollment, and who, without an intervening enrollment, enrolls in another such plan or program, the subsequent enrollment is considered to be an initial enrollment.

(c) For the purposes of Subsections (2)(e) and (2)(f), enrollment of an individual with an organization or provider described in Subsection (2)(e)(i) or with a plan or in a program described in Subsection (2)(f), may not be considered to be an initial enrollment under this subsection after the two-year period beginning on the date on which the individual first enrolled with the organization, provider, plan, or program.

(5)(a) An eligible person who is entitled to an open enrollment period under Subsection (2)(a), (2)(b), (2)(c), or (2)(d) may select Plan A, B, C, F, High Deductible F, K, or L if offered by any insurer.

(b)(i) Subject to Subsection (5)(b)(ii), the policy an eligible person is entitled to under Subsection (2)(e) is the same policy in which the individual was most recently previously enrolled, if available from the same issuer, or, if not available, a policy described in Subsection (5)(a).

(ii) After December 31, 2005, if the individual was most recently enrolled in a policy with an outpatient prescription drug benefit, a policy described in this subsection is:

(A) the policy available from the same issuer but modified to remove outpatient prescription drug coverage; or

(B) at the election of the policyholder, Plan A, B, C, F, High Deductible F, K, or L that is offered by any issuer.

(d) The policy an eligible person is entitled to under Subsection (2)(g) is Plan A, B, C, F, High Deductible F, K, or L, and is offered and available for issuance to new enrollees by the same issuer that issued the individual's policy with outpatient prescription drug coverage.

(6)(a) At the time of an event described in Subsection (2) because an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization, issuer, or administrator terminating the contract, agreement, policy, or plan, shall notify the individual of their rights under this section, and of the obligations of issuers of Medicare supplement insurance policies under Subsection (1). The notice shall be communicated with the notification of termination.

(b) At the time of an event described in Subsection (2) because an individual ends enrollment under a contract, agreement, policy, or plan, the organization, issuer, or administrator offering the contract, agreement, policy, or plan, regardless of the basis for ending enrollment, shall notify the individual of their rights under this section, and of the obligations of issuers of Medicare supplement insurance policies under Subsection (1). The notice shall be provided within ten working days of the issuer receiving notification of disenrollment.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-13 Standards for Claims Payment

(1) An issuer shall comply with Section 1882(c)(3) of the Social Security Act, as enacted by Section 4081(b)(2)(c) of the Omnibus Budget Reconciliation Action of 1987, OBRA, 1987, Pub. L. No. 100-203, by:

(a) accepting a notice from a Medicare issuer on dually assigned claims submitted by a participating physician and supplier as a claim for benefits in place of any other claim form otherwise required and making a payment determination based on the information contained in that notice;

(b) notifying the participating physician or supplier and the beneficiary of the payment determination;

(d) furnishing, at enrollment, each enrollee with a card listing the policy name, number, and a central mailing address to which notices from an issuer may be sent;

(e) paying user fees for claim notices that are transmitted electronically or otherwise; and

(f) providing to the Secretary, at least annually, a central mailing address where each claim may be sent by an issuer.

(2) Compliance with the requirements in this section shall be certified on the Medicare supplement insurance experience reporting form.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-14 Loss Ratio Standards and Filing Requirements

(1)(a)(i) A policy or certificate may not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to policyholders and certificate holders in the form of aggregate benefits, not including anticipated refunds or credits, provided under the policy form or certificate form:

(A) at least 75% of the aggregate amount of premiums earned, in the case of group policies; or

(B) at least 65% of the aggregate amount of premiums earned, in the case of individual policies.

(ii) The loss ratio shall be calculated based on incurred claims experience or incurred health care expenses when coverage is provided by a health maintenance organization on a service, rather than reimbursement, basis and earned premiums for the period and in accordance with accepted actuarial principles and practices. Incurred health care expenses when coverage is provided by a health maintenance organization may not include:

(A) home office and overhead costs;

(B) advertising costs;

(D) taxes;

(E) capital costs;

(F) administration costs; and

(G) claims processing costs.

(b) Rate filings and rating schedules shall demonstrate that expected claims in relation to premiums comply with the requirements of this section when combined with actual experience to date. Rate revision filings shall also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards, and comply with the requirements of Rule R590-85.

(c) For purposes of this subsection, policies issued through the mail or by mass media advertising, including both print and broadcast advertising, are considered to be individual policies.

(d) For policies issued before July 30, 1992, expected claims in relation to premiums shall meet:

(i) the originally filed anticipated loss ratio when combined with the actual experience since inception;

(ii) the appropriate loss ratio requirement from Subsection (1)(a)(i) when combined with actual experience beginning with the effective date of October 31, 1994; and

(iii) the appropriate loss ratio requirement from Subsection (1)(a)(i) over the entire future period for which the rates are computed to provide coverage.

(2)(a) An issuer shall collect, complete, and file with the commissioner by May 31 of each year:

(i) the Medicare Supplement Refund Calculation report;

(ii) the Calculation of Benchmark Ratio Since Inception for Group Policies report; and

(iii) the Calculation of Benchmark Ratio Since Inception for Individual Policies report.

(b) If, based on the experience as reported, the benchmark ratio since inception, ratio 1, exceeds the adjusted experience ratio since inception, ratio 3, then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis for each standardized plan type in a standardized plan. For purposes of the refund or credit calculation, experience on policies issued within the reporting year shall be excluded.

(c) For this section and for policies or certificates issued before July 30, 1992, the issuer shall make the refund or credit calculation separately for all individual policies, including all group policies subject to an individual loss ratio standard when issued, combined, and all other group policies combined for experience after the effective date of this rule.

(d) A refund or credit shall be made when the benchmark loss ratio exceeds the adjusted experience loss ratio and the amount to be refunded or credited exceeds a de minimis level. The refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the Secretary, but in no event shall it be less than the average rate of interest for 13-week Treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.

(3)(a) An issuer shall annually file a report with the commissioner that includes the rates, rating schedule, and supporting documentation, including ratios of incurred losses to earned premiums by policy duration in accordance with the filing requirements and procedures prescribed by the commissioner.

(b) The supporting documentation shall demonstrate, in accordance with actuarial standards of practice using reasonable assumptions, that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed. The demonstration shall exclude active life reserves. An expected third-year loss ratio, which is greater than or equal to the applicable percentage, shall be demonstrated for policies or certificates in force less than three years.

(4)(a) An issuer shall file with the commissioner, in accordance with the applicable filing procedures, appropriate premium adjustments necessary to produce loss ratios as anticipated for the current premium for the applicable policies or certificates. The supporting documents necessary to justify the adjustment shall accompany the filing. The filing:

(i) shall include premium adjustments necessary to produce an expected loss ratio under the policy or certificate to conform to minimum loss ratio standards and are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the issuer for the policies or certificates; and

(ii) may not include a premium adjustment that:

(A) modifies the loss ratio experience under the policy other than the adjustments described in this subsection; and

(B) is made at any time other than the renewal date or anniversary date.

(b) If an issuer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds, or premium credits deemed necessary to achieve the loss ratio required by this section.

(5)(a) An issuer shall annually file by May 31 the Utah rate and enrollment information for standardized Medicare supplement insurance plans as specified in the Medicare Supplement Rate Data Template spreadsheet, available on the department's website, https://insurance.utah.gov

(b) The report shall be filed at https://medigap.utah.gov/provider/upload no later than May 31 each year and in compliance with Rule R590-220.

(6) The commissioner may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate if the experience of the policy form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance is made without consideration of any refund or credit for the reporting period. Public notice of the hearing shall be furnished in a manner prescribed by the commissioner.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-15 Filing Policies, Certificates, and Premium Rates

(1) For the purpose of this subsection, "type" means:

(a) an individual policy;

(b) a group policy;

(d) a group Medicare Select policy.

(2) An issuer may not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed in accordance with filing requirements and procedures prescribed by the commissioner.

(3) An issuer may not use or change premium rates unless the rates, rating schedule, and supporting documentation have been filed in accordance with the filing requirements and procedures prescribed by the commissioner.

(4)(a) Except as provided in Subsection (4)(b), an issuer may not file more than one policy form or certificate form of each standardized plan type for each standardized plan.

(b) An issuer may offer, with the approval of the commissioner, up to four additional policy forms or certificate forms of the same standardized plan type, one for:

(i) the inclusion of new or innovative benefits;

(ii) the addition of either direct response or producer marketing methods;

(iii) the addition of either guaranteed issue or underwritten coverage; and

(iv) the offering of coverage to individuals eligible for Medicare by reason of disability.

(c) A policy form issued under Section R590-146-9b is not considered a new policy form, and is not a permissible separate rating class.

(5)(a) Except as provided in Subsection (5)(b), an issuer shall continue to make available for purchase each policy form or certificate form that has been filed with the commissioner. A policy form or certificate form is not considered available for purchase unless the issuer has actively offered it for sale in the previous 12 months.

(b) An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the commissioner, in writing, its decision at least 30 days before discontinuing the availability of the policy form or certificate form. After receipt of the notice by the commissioner, the issuer may no longer offer for sale the policy form or certificate form in this state.

(i) An issuer that discontinues the availability of a policy form or certificate form under this subsection may not file a new policy form or certificate form of the same standardized plan type for the same standardized plan as the discontinued form for a period of five years after the issuer provides notice to the commissioner of the discontinuance. The period of discontinuance may be reduced if the commissioner determines that a shorter period is appropriate.

(ii) The sale or other transfer of Medicare supplement insurance business to another issuer is considered a discontinuance.

(iii)(A) A change in the rating structure or methodology shall be considered a discontinuance unless the issuer:

(I) provides an actuarial memorandum, in a form and manner prescribed by the commissioner, describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates; and

(II) does not subsequently put into effect a change of rates or rating factors that causes the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change.

(B) The commissioner may approve a change to the differential that is in the public interest.

(C) A revised rating methodology may only apply to a policy or certificate issued after the effective date of the revision.

(6)(a) Except as provided in Subsection (6)(b), the experience of all policy forms or certificate forms of the same type in a standardized plan shall be combined for purposes of the refund or credit calculation prescribed in Section R590-146-14.

(b) Policy forms assumed under an assumption reinsurance agreement may not be combined with the experience of other forms for purposes of the refund or credit calculation.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-16 Permitted Compensation Arrangements

(1) An issuer or other entity may provide commission or other compensation to a producer or other representative for the sale of a policy or certificate only if the first-year commission or other first-year compensation is no more than 200% of the commission or other compensation paid for selling or servicing the policy or certificate in the second year.

(2) The commission or other compensation provided in subsequent renewal years shall be the same as that provided in the second year and shall be provided for at least five renewal years.

(3) An issuer or other entity may not provide compensation to its producers, and a producer may not receive, compensation greater than the renewal compensation payable by the replacing issuer on a renewal policy or certificate if an existing policy or certificate is replaced.

(4) An issuer may not create a disincentive to sell a policy during the open enrollment period by establishing compensation arrangements that result in a producer receiving substantially lower or no compensation for policies sold during open enrollment.

(5) For purposes of this section, compensation includes pecuniary or non-pecuniary remuneration of any kind relating to the sale or renewal of a policy or certificate including a bonus, gift, prize, award, or finder's fee.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-17 Required Disclosure Provisions

(1)(a) A policy or certificate shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent with the type of policy issued. The provision shall be appropriately captioned, appear on the first page of the policy or certificate, and include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the insured's age.

(b)(i) A rider or endorsement added to a policy after the date of issue or at reinstatement or renewal that reduces or eliminates a benefit or coverage in the policy shall require a signed acceptance by the insured, unless the issuer:

(A) is effectuating a request made in writing by the insured;

(B) is exercising a specifically reserved right under a policy; or

(ii) After the issue date of a policy or certificate, a rider or endorsement that increases benefits or coverage with an associated increase in premium during the policy term shall be agreed to in writing signed by the insured, unless:

(A) the benefits are required by the minimum standards for Medicare supplement insurance policies; or

(B) the increased benefit or coverage is required by law.

(iii) When a separate additional premium is charged for benefits provided in connection with a rider or endorsement, the premium charge shall be stated in the policy.

(c) A policy or certificate may not provide for the payment of benefits based on standards described as "usual and customary," "reasonable and customary," or similar words.

(d) If a policy or certificate contains a limitation regarding a preexisting condition, the limitation shall appear as a separate section of the policy and be labeled as "Preexisting Condition Limitations."

(e) A policy and certificate shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating that the policyholder or certificate holder has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the insured is not satisfied for any reason.

(f)(i) An issuer of an accident and health insurance policy or certificate that provides hospital or medical expense coverage on an expense incurred or indemnity basis to an individual eligible for Medicare shall provide to the applicant the Guide to Health Insurance for People with Medicare in the form developed jointly by the NAIC and the Centers for Medicare and Medicaid Services in a font no smaller than 12-point.

(ii) Delivery of the guide shall be made whether or not the policy or certificate is advertised, solicited, or issued as a Medicare supplement insurance policy or certificate

(A) Except in the case of a direct response issuer, delivery of the guide shall be made to the applicant at application and acknowledgement of receipt of the guide shall be obtained by the issuer.

(B) A direct response issuer shall deliver the guide to the applicant upon request but not later than when the policy is delivered.

(2)(a) As soon as practicable, but no later than 30 days before the annual effective date of any Medicare benefit change, an issuer shall notify each policyholder and certificate holder of a modification it has made to a policy or certificate in a format acceptable to the commissioner. The notice shall:

(i) include a description of the revisions to the Medicare program and a description of each modification made to the coverage provided under the policy or certificate; and

(ii) inform each policyholder or certificate holder when a premium adjustment is made due to changes in Medicare.

(b) The notice of a benefit modification and any premium adjustment shall be in outline form and in clear and simple terms.

(3)(a) An issuer shall provide an outline of coverage to an applicant when the application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgement of receipt of the outline of coverage from the applicant.

(b) If an outline of coverage is provided at the time of application and a policy or certificate is issued on a basis that requires a revision to the outline of coverage, a substitute outline of coverage describing the policy or certificate shall accompany the policy or certificate when it is delivered, and shall state, in no less than 12-point bold font, immediately above the company name, "NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application and the coverage originally applied for has not been issued."

(c)(i) The outline of coverage shall be in no less than 12-point font and include five parts, in the following order:

(A) a cover page;

(B) premium information;

(D) Outline of Coverage Disclosures; and

(E) Standardized Plan Description for each standardized plan offered by the issuer.

(ii) Each standardized plan shall be shown on the cover page, and the plans offered by the issuer shall be prominently identified.

(iii)(A) Premium information for the offered plans shall be shown on the cover page or immediately following the cover page, and shall be prominently displayed.

(B) The premium and payment mode shall be stated for each plan that is offered to the applicant.

(4)(a) An accident and health insurance policy or certificate, other than a Medicare supplement insurance policy, or other policy identified in Subsection 31A-22-620(2)(b), issued for delivery in this state to an individual eligible for Medicare, shall notify an insured that the policy is not a Medicare supplement insurance policy or certificate. The notice shall either be printed or attached to the first page of the outline of coverage delivered to an insured, or if no outline of coverage is delivered, to the first page of the accident and health insurance policy or certificate delivered to an insured. The notice shall be in no less than 12-point font and shall state, "THIS (POLICY OR CERTIFICATE) IS NOT A MEDICARE SUPPLEMENT (POLICY OR CERTIFICATE). If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company."

(b) An application for an accident and health insurance policy or certificate provided to an individual eligible for Medicare described in Subsection (3)(a) shall disclose, using the applicable statement in Subsection R590-146-3(3), the extent to which the policy duplicates Medicare. The disclosure statement shall be provided as a part of, or together with, the application for the policy or certificate.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-18 Requirements for Application Forms and Replacement Coverage

(1)(a) An application form shall include questions designed to elicit information as to whether, as of the date of the application, the applicant:

(i) has Medicare supplement insurance, Medicare Advantage coverage, Medicaid coverage, or other accident and health insurance currently in force; or

(ii) intends to replace any other accident and health insurance policy or certificate currently in force.

(b) A supplementary application or other form to be signed by the applicant and producer containing the questions and statements in the Application Supplementary Statements and Questions may be used.

(2) A producer shall list all other health insurance policies they have sold to the applicant, including a list of each policy sold:

(a) that is still in force; and

(b) in the past five years, that is no longer in force.

(3) In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant and acknowledged by the issuer, shall be returned to the applicant by the issuer at policy delivery.

(4)(a) Upon determining a sale will involve Medicare supplement insurance coverage replacement, an issuer, other than a direct response issuer or its producer, shall provide to the applicant, prior to issuance or delivery of the policy or certificate, the Notice to Applicant Regarding Replacement of Medicare Supplement Insurance or Medicare Advantage.

(b) One copy of the notice signed by the applicant and the producer, except when the coverage is sold without a producer, shall be provided to the applicant and an additional signed copy shall be retained by the issuer.

(c) A direct response issuer shall deliver to the applicant when issuing the policy the Notice to Applicant Regarding Replacement of Medicare Supplement Insurance or Medicare Advantage.

(d) The notice shall be provided in substantially the same format in no less than 12-point font.

(5) Paragraphs one and two of the notice may be deleted by an issuer if the replacement does not involve application of a new preexisting condition limitation.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-19 Filing Requirements for Advertising

An issuer shall, upon request from the commissioner, file a copy of any Medicare supplement insurance advertisement intended for use in this state whether through printed, audio, or visual medium.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-20 Marketing Standards

(1) An issuer, directly or through its producers, shall:

(a) establish marketing procedures to assure that any comparison of policies by its producers will be fair and accurate;

(b) establish marketing procedures to assure excessive insurance is not sold or issued;

(c) display prominently by type, in bold font, stamp, or other appropriate means on the first page of the policy: "Notice to buyer: This policy may not cover all of your medical expenses.";

(d) inquire and otherwise make a reasonable effort to identify whether an applicant already has accident and health insurance and the types and amounts of any such insurance; and

(e) establish auditable procedures for verifying compliance.

(2) In addition to the practices prohibited in Title 31A, Chapter 23a, Part 4, Marketing Practices, the following acts and practices are prohibited:

(a) cold lead advertising;

(b) high pressure tactics; or

(3) The terms "Medicare Supplement," "Medigap," "Medicare wrap-around," or similar words may not be used unless the policy is issued in compliance with this rule.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-21 Appropriateness of Recommended Purchase and Excessive Insurance

(1) A producer shall make a reasonable effort to determine the appropriateness of a recommended purchase or replacement of a Medicare supplement insurance policy or certificate.

(2) The sale of a Medicare supplement insurance policy or certificate that provides an individual more than one Medicare supplement insurance policy or certificate is prohibited.

(3) An issuer may not issue a Medicare supplement insurance policy or certificate to an individual enrolled in a Medicare Advantage plan unless the effective date of the new policy or certificate is after the termination date of the individual's Medicare Advantage plan coverage.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-22 Multiple Policies Report

(1) On or before May 31 of each year, an issuer shall file the Form for Reporting Medicare Supplement Policies report for each individual resident of this state for which the issuer has in force more than one Medicare supplement insurance policy or certificate.

(2) The information shall be grouped by individual policyholder.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-23 Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods, and Probationary Periods in Replacement Policies or Certificates

(1) If a Medicare supplement insurance policy or certificate replaces another Medicare supplement insurance policy or certificate, the replacing issuer shall waive any time periods applicable to a preexisting condition, a waiting period, an elimination period, or a probationary period in the new Medicare supplement policy or certificate to the extent the time was spent under the original policy.

(2) If a Medicare supplement insurance policy or certificate replaces another Medicare supplement insurance policy or certificate that is in effect for at least six months, the replacing policy may not provide any time period applicable to a preexisting condition, a waiting period, an elimination period, or a probationary period for a benefit similar to those contained in the original policy or certificate.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-24 Prohibition Against Use of Genetic Information and Requests for Genetic Testing

(1) An issuer may not:

(a) deny or condition the issuance or effectiveness of a policy or certificate, including the imposition of an exclusion of benefits under the policy based on a preexisting condition, based on the genetic information of the individual; or

(b) discriminate in the pricing of the policy or certificate, including the adjustment of premium rates, of an individual based on the genetic information of the individual.

(2) Nothing in this section shall be construed to limit the ability of an issuer, to the extent otherwise permitted by law, from:

(a) denying or conditioning the issuance or effectiveness of a policy or certificate or increasing the premium for a group based on the manifestation of a disease or disorder of an insured or applicant; or

(b) increasing the premium for a policy issued to an individual based on the manifestation of a disease or disorder of an individual who is covered under the policy.

(3) An issuer may not request or require an individual or a family member of an individual to undergo a genetic test.

(4) Subsection (3) does not preclude an issuer from obtaining and using the results of a genetic test in making a determination regarding payment if it is consistent with Subsection (1).

(5) For purposes of Subsection (4), an issuer may only request the minimum amount of information necessary to accomplish the intended purpose.

(6) Notwithstanding Subsection (3), an issuer may request, but not require, that an individual or a family member of an individual undergo a genetic test if each condition in this subsection is met:

(a) a request is made for research that complies with Part 46 of Title 45, Code of Federal Regulations, or equivalent federal regulations, and any applicable state or local law or regulations for the protection of human subjects in research;

(b) an issuer clearly indicates to each individual, or in the case of a minor child, to the legal guardian of such child, to whom the request is made that:

(i) compliance with the request is voluntary; and

(ii) non-compliance will have no effect on enrollment status, premium, or contribution amounts;

(c) genetic information collected or acquired is not used for underwriting, determination of eligibility to enroll or maintain enrollment status, premium rates, or the issuance, renewal, or replacement of a policy or certificate;

(d) an issuer notifies the Secretary in writing that the issuer is conducting activities under this exception, including a description of the activities conducted; and

(e) an issuer complies with other conditions as the Secretary may, by regulation, require for activities conducted under this subsection.

(7) An issuer may not request, require, or purchase genetic information for underwriting purposes.

(8) An issuer may not request, require, or purchase genetic information with respect to an individual prior to the individual's enrollment under a policy.

(9) If an issuer obtains genetic information incidental to requesting, requiring, or purchasing of other information concerning an individual, such request, requirement, or purchase may not be considered a violation of Subsection (8) if such request, requirement, or purchase is not in violation of Subsection (7).

(10) For the purposes of this section:

(a) "Family member" means an individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of an individual.

(b) "Genetic information" means information about an individual's genetic tests, the genetic tests of family members of an individual, and the manifestation of a disease or disorder in family members of an individual.

(i) "Genetic information" includes a request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or a family member of an individual. Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman includes genetic information of any fetus carried by a pregnant woman, or with respect to an individual or family member utilizing reproductive technology, includes genetic information of an embryo legally held by an individual or family member.

(ii) "Genetic information" does not include information about the sex or age of an individual.

(c) "Genetic services" means a genetic test, genetic counseling, including obtaining, interpreting, or assessing genetic information, or genetic education.

(d)(i) "Genetic test" means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detect genotypes, mutations, or chromosomal changes.

(ii) "Genetic test" does not include an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.

(e) "Issuer" includes a third-party administrator or other person acting for or on behalf of the issuer.

(f) "Underwriting purposes" means:

(i) rules for, or determination of, eligibility, including enrollment and continued eligibility, for benefits;

(ii) computation of premium or contribution amounts;

(iii) application of a preexisting condition exclusion; and

(iv) any other activity related to the creation, renewal, or replacement of health benefits or an accident and health insurance policy.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

Utah Admin. Code R590-146-25 Severability

If any provision of this rule, Rule R590-146, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620

R590-147 Annual and Quarterly Statement Filing Instructions

Utah Admin. Code R590-147-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-4-113.

History

KEY: insurance
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-4-113

Utah Admin. Code R590-147-2 Purpose and Scope

(1) The purpose of this rule is to provide instructions for filing an annual statement, a quarterly statement, and any required supplemental schedule, exhibit, or document.

(2) This rule applies to an insurer required to file an annual statement or a quarterly statement with the commissioner.

History

KEY: insurance
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-4-113

Utah Admin. Code R590-147-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Insurer" means a licensee who is licensed under Title 31A, Chapters 5, 7, 8, 9, 14, or 15.

(2) "NAIC" means the National Association of Insurance Commissioners.

History

KEY: insurance
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-4-113

Utah Admin. Code R590-147-4 Annual and Quarterly Statement Filings

(1) An annual statement, quarterly statement, and any required supplemental schedule, exhibit, or document shall be prepared according to the latest edition of the NAIC annual and quarterly statement instructions and the Accounting Practices and Procedures Manual published by the NAIC.

(2)(a) An insurer shall file its annual statement, quarterly statement, and any required supplemental schedule, exhibit, or document electronically with the NAIC according to the NAIC annual and quarterly statement instructions.

(b) A foreign insurer or an alien insurer may not file a paper copy of any document required by Subsection (1) with the department, unless specifically requested by the commissioner.

(3) NAIC and department filing instructions, including due dates, may be found at the following websites: www.naic.org and https://insurance.utah.gov.

History

KEY: insurance
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-4-113

Utah Admin. Code R590-147-5 Severability

If any provision of this rule, Rule R590-147, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-4-113

R590-148 Long-Term Care Insurance Rule

Utah Admin. Code R590-148-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-1404.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) implement standards for full and fair disclosure of the manner, content, and required disclosures for long-term care insurance;

(b) protect applicants from unfair or deceptive sales or enrollment practices;

(d) facilitate flexibility and innovation in the development of long-term care insurance.

(2)(a) This rule applies to long-term care insurance delivered to or issued for delivery in this state on or after January 1, 1993.

(b) This rule also applies to an income replacement policy offering indemnity benefits triggered by activities of daily living, if:

(i) the benefits are dependent on or vary in amount based on the receipt of long-term care services;

(ii) the income replacement policy is advertised, marketed, or offered as insurance for long-term care services; or

(iii) the benefits under the policy may commence after the insured has reached Social Security's normal retirement age, unless the benefits are designed to replace lost income or pay for specific expenses other than long-term care services.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-1402. Additional terms are defined as follows:

(1) "Attained age rating" means a schedule of premiums starting from the issue date that increases with age at least 1% per year before age 50, and at least 3% per year beyond age 50.

(2)(a) "Benefit trigger" means a provision conditioning the payment of a benefit on a determination of the insured's:

(i) ability to perform activities of daily living; and

(ii) cognitive impairment.

(b) "Benefit trigger," when used in a tax-qualified long-term care insurance contract, includes a determination by a licensed health care practitioner that an insured is a chronically ill individual.

(3) "Cold lead advertising" means using, directly or indirectly, any method of marketing that fails to disclose in a conspicuous manner the method of marketing is a solicitation of insurance and that contact will be made by a producer or an insurer.

(4) "Chronically ill individual" has the same meaning as defined in Section 7702B(c)(2), Internal Revenue Code.

(5) "Continuation of coverage" means a provision that:

(a) maintains coverage under the existing group policy when the coverage would otherwise terminate; and

(b) is subject only to the continued timely payment of premium when due.

(6) "Conversion of coverage" means a provision that an individual whose coverage under the group policy would otherwise terminate or has been terminated for any reason, including discontinuance of the group policy in its entirety or with respect to an insured class, is entitled to the issuance of a converted policy by the insurer, without evidence of insurability, if the individual was continuously insured under the group policy or another group policy that it replaced six months immediately before termination.

(7) "Exceptional increase" means a premium rate increase filed by an insurer as exceptional that the commissioner determines is justified due to:

(a) a change in laws applicable to long-term care insurance; or

(b) an increased and unexpected utilization that affects the majority of insurers of a similar product.

(8) "High pressure tactics" means using a method of marketing to induce, or tend to induce, the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.

(9) "Incidental" means the value of the long-term care benefits provided is less than 10% of the total value of the benefits provided over the life of the policy measured as of the date of issue.

(10) "Independent review organization" means an organization that conducts an independent review of a long-term care benefit trigger decision.

(11) "Licensed health care practitioner" has the same meaning as defined in Section 7702B(c)(4), Internal Revenue Code.

(12) "Licensed health care professional" means an individual qualified by education and experience in an appropriate field to determine, by record review, an insured's actual functional or cognitive impairment.

(13)(a) "Maintenance or personal care services" means any care that is primarily intended to provide needed assistance with any disability that causes an individual to be certified as a chronically ill individual.

(b) "Maintenance or personal care services" includes protection from threats to health and safety due to severe cognitive impairment.

(14) "Managed care plan" means a health care or assisted living arrangement designed to coordinate patient care or control costs through utilization review, case management, or use of specific provider networks.

(15) "Misrepresentation" means presenting a material fact in an incomplete, incorrect, partially complete, or partially correct manner when selling or offering to sell a policy or certificate.

(16) "Policy" means a long-term care insurance policy, contract subscriber agreement, rider, or endorsement that is delivered or issued in this state.

(17) "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

(18) "Qualified long-term care services" has the same meaning as defined in Section 7702B(c), Internal Revenue Code.

(19)(a) "Similar policy forms" means all long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered.

(b) A group long-term care insurance certificate issued under Subsection 31A-22-504(1)(a) is not considered similar to policies or certificates otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications.

(i) institutional long-term care benefits only;

(ii) non-institutional long-term care benefits only; or

(iii) comprehensive long-term care benefits.

(20) "Twisting" means knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policy or insurer to induce, or tend to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out an insurance policy with another insurer.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-4 Policy Definitions

A policy may not use the terms in this section unless the terms are defined and comply with Section R590-148-3 and this section.

(1) "Activities of daily living" means bathing, continence, dressing, eating, toileting, and transferring.

(2) "Acute condition" means an individual is medically unstable and requires frequent monitoring by a medical professional, such as a physician or registered nurse, to maintain their health status.

(3)(a) "Adult day care" means a facility licensed and operating within the scope of the license.

(b) An adult day care facility may not be defined more restrictively than a program, for three or more individuals, of social and health-related services provided during the day in a community group setting to support frail, impaired, elderly, or other disabled adults who can benefit from care in a group setting outside the home.

(4) "Bathing" means washing oneself:

(a) by sponge bath; or

(b) in either a tub or shower, including the task of getting into or out of the tub or shower.

(5) "Cognitive impairment" means a deficiency in a person's:

(a) short-term or long-term memory;

(b) orientation as to person, place, and time;

(d) safety awareness judgment.

(6) "Continence" means the ability to maintain control of bowel and bladder function or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene, including caring for catheter or colostomy bag.

(7) "Dressing" means putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs.

(8) "Eating" means feeding oneself by getting food into the body from a receptacle, such as a plate, cup, or table, or by a feeding tube or intravenously.

(9) "Hands-on assistance" means physical assistance, whether minimal, moderate, or maximal, without which the individual would not be able to perform the activity of daily living.

(10)(a) "Home health care services" means medical and nonmedical services provided to an ill, disabled, or infirm individual in the individual's residence.

(b) "Home health care services" may include homemaker services, assistance with activities of daily living, and respite care services.

(11) "Mental or nervous disorder" means, and may not be defined more restrictively than, a neurosis, psychoneurosis, psychopathy, psychosis, or other mental or emotional disease or disorder that does not have a demonstrable organic cause.

(12) "Personal care" means hands-on services to assist an individual with activities of daily living.

(13) "Skilled nursing care," "intermediate care," "personal care," "home care," "assisted living care," and any other service shall be defined in relation to the level of skill required, the nature of the care, and the setting where the care is delivered.

(14)(a) "Skilled nursing facility," "extended care facility," "intermediate care facility," "convalescent nursing home," "personal care facility," "home care agency," and any other provider of services shall be defined in relation to the services and facilities required to be available and the licensure, certification, registration, or degree status of those providing or supervising the services.

(b) When the definition requires the provider to be appropriately licensed, certified, or registered, it shall also state what requirements a provider must meet in lieu of licensure, certification, or registration when the state where the service is to be furnished does not require a provider of these services to be licensed, certified, or registered, or when the state licenses, certifies, or registers the provider of services under another name.

(15) "Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

(16) "Transferring" means moving into or out of a bed, chair, or wheelchair.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-5 Required Forms, Reports, and Disclosures

The documents in this section shall be used by an insurer offering a long-term care insurance policy or certificate. The documents were adopted by the NAIC, Long-Term Care Insurance Model Regulation, number 641, and are available on the department's website, http://insurance.utah.gov:

(1) Claims Denial Reporting Form Long-Term Care Insurance Rescission Reporting Form;

(2) Long-Term Care Insurance Outline of Coverage;

(3) Long-Term Care Insurance Personal Worksheet;

(4) Long-Term Care Insurance Suitability Letter;

(5) Notice to Applicant Regarding Replacement of Accident and Sickness or Long-Term Care Insurance;

(6) Notice to Applicant Regarding Replacement of Individual Accident and Sickness or Long-Term Care Insurance;

(7) Rescission Reporting Form;

(8) Replacement and Lapse Reporting Form;

(9) Suitability Reporting Form;

(10) Things You Should Know Before You Buy Long-Term Care Insurance;

(11) Triggers for a Substantial Premium Increase; and

(12) Worksheet Potential Rate Increase Disclosure Form.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-6 Required Provisions and Practices

(1) The terms "guaranteed renewable" and "noncancellable" may not be used in an individual policy without further explanatory language in accordance with the disclosure requirements of Subsection (1)(b).

(a) An individual policy may not contain a renewal provision other than "guaranteed renewable" or "noncancellable."

(i) The term "guaranteed renewable" may be used only when:

(A) an insured has the right to continue the policy in force by the timely payment of premiums; and

(B) an insurer does not have a unilateral right to make a change in a policy or rider provision while the insurance is in force, and may not decline to renew, except that rates may be revised by the insurer on a class basis.

(ii) The term "noncancellable" may be used only when an insured has the right to continue the policy in force by the timely payment of premiums during which period the insurer does not have a right to unilaterally make any change to any policy provision or the premium rate.

(b)(i) An individual policy shall contain a renewability provision.

(ii) The provision shall:

(A) be appropriately captioned;

(B) appear on the first page of the policy;

(C) clearly state the duration, when limited, of renewability and the duration of the term of coverage for which the policy is issued; and

(D) how the policy may be renewed.

(iii) The provision does not apply to a policy when the right to non-renew the policy is reserved solely to the policyholder.

(c) A qualified long-term care insurance contract shall be guaranteed renewable as defined in Section 7702B(b)(1)(C), Internal Revenue Code.

(2)(a) Except as provided in Subsection (2)(b), a policy may not be delivered or issued for delivery in this state if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident.

(b) An insurer may have an exclusion or limitation:

(i) by provider type; or

(ii) for territorial limitations outside the United States.

(3) If a policy or certificate contains a preexisting condition limitation, the limitation shall appear as a separate paragraph of the policy or certificate and be labeled as "Preexisting Condition Limitations."

(4)(a) Activities of daily living and cognitive impairment may be used to measure an insured's need for long-term care benefits and shall be described in the policy or certificate as a separate paragraph, including any additional benefit triggers, and be labeled "Eligibility for the Payment of Benefits."

(b) Any additional benefit triggers shall also be explained in the paragraph.

(c) If the triggers differ for different benefits, an explanation of each trigger shall accompany each benefit description.

(d) If an attending physician or other specified person is required to certify a certain level of functional dependency to qualify for benefits, the requirements shall be specified.

(5)(a) Termination of long-term care insurance shall be without prejudice to any benefit payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without interruption after termination.

(b) The extension of a benefit beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefit and may be subject to any policy waiting period and any other applicable policy provision.

(6)(a) If a group policy is replaced by another group policy issued to the same policyholder, the succeeding insurer shall offer coverage to each person covered under the previous group policy on the date of termination.

(b) Coverage provided or offered to an individual and the premium charged to an insured under the new group policy may not:

(i) result in an exclusion for a preexisting condition that would have been covered under the group policy being replaced; or

(ii) vary or otherwise depend on the individual's health or disability status, claim experience, or use of long-term care services.

(7)(a) The term "level premium" may be used only if an insurer may not change the premium.

(b) A policy or certificate, other than one for which an insurer may not change the premium, shall include a statement that premium rates may change.

(i)(A) the purchase of additional coverage is not considered a premium rate increase; and

(B) the premium attributable to the additional coverage shall be added to and considered part of the initial annual premium; and

(ii)(A) a reduction in a benefit is not considered a premium change; and

(B) the initial annual premium shall be based on the reduced benefits under Section R590-148-14.

(8)(a) A rider or endorsement added to a policy after the date of issue or at reinstatement or renewal that reduces or eliminates a benefit or coverage in the policy shall require a signed acceptance by the insured, unless the insurer:

(i) is effectuating a request made in writing by the insured; or

(ii) is exercising a specifically reserved right under a policy.

(b) After the issue date of a policy, a rider or endorsement that increases a benefit or coverage with an associated increase in premium during the policy term shall be agreed to in writing and signed by the insured, unless the increased benefit or coverage is required by law.

(c) When a separate additional premium is charged for a benefit provided in connection with a rider or endorsement, the premium charge shall be set forth in the policy, rider, or endorsement.

(9) A policy or certificate providing payment of a benefit based on a standard described as "usual and customary," "reasonable and customary," or similar language, shall include a definition of the term and an explanation of the term in the outline of coverage.

(10) If a policy or certificate contains a limitation or condition for eligibility, other than those prohibited in Section 31A-22-1407, the limitation, including any required number of days of confinement, shall appear in a separate paragraph of the policy or certificate and be labeled "Limitations or Conditions on Eligibility for Benefits."

(11)(a) A life insurance policy that includes a long-term care benefit shall include a disclosure statement, at the time of application for a policy or a rider and at the time a benefit payment request is submitted, that receipt of these benefits may be taxable and that assistance should be sought from a personal tax advisor.

(b) The disclosure statement shall be prominently displayed on the first page of the policy or rider and any other related document.

(12) A qualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage stating that the policy is intended to be a qualified long-term care insurance contract under Section 7702B(b), Internal Revenue Code.

(13) A nonqualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage stating that the policy is not intended to be a qualified long-term care insurance contract.

(14)(a) Long-term care insurance sold in conjunction with another insurance product, including a life insurance policy or annuity contract, shall be in a separate rider and shall comply with this rule.

(b) Long-term care insurance may not be incorporated into a life insurance policy or an annuity contract.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-7 Minimum Standards for Home Health and Community Care Benefits in a Long-Term Care Insurance Policy

(1) If a policy or certificate provides benefits for home health care services, it may not limit or exclude benefits by:

(a) requiring the insured would need care in a skilled nursing facility if home health care services are not provided;

(b) requiring the insured first or simultaneously receive nursing or therapeutic services, or both, in a home, community, or institutional setting before covering home health care services;

(d) requiring that a nurse or therapist provide covered services that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of the aide or worker's licensure or certification;

(e) excluding coverage for personal care services provided by a home health aide;

(f) requiring that the home health care services be at a level of certification or licensure greater than that required for the eligible service;

(g) requiring that the insured have an acute condition before covering home health care services;

(h) limiting benefits to services provided by a Medicare-certified agency or provider; or

(i) excluding coverage for adult day care services.

(2) Home health care coverage may be applied to non-home health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.

(3)(a) A policy or certificate, if it provides for home care or community care services, shall provide total home care or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, when covered home care or community care services are received.

(b) The requirement in Subsection (3)(a) does not apply to a policy or certificate issued to a resident of a continuing care retirement community.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-8 Benefit Trigger Standards

(1)(a) A policy shall condition the payment of benefits on a determination of the insured's:

(i) ability to perform activities of daily living; or

(ii) cognitive impairment.

(b) Eligibility for the payment of benefits may not be more restrictive than requiring either:

(i) a deficiency in the ability to perform not more than three of the activities of daily living; or

(ii) the presence of cognitive impairment.

(2) An insurer may use additional activities of daily living to trigger covered benefits in addition to those listed in Section R590-148-4 if the terms are defined in the policy.

(3) An insurer may use additional provisions to determine when benefits are payable, but the provisions may not restrict, and are not in lieu of, the requirements under Subsections (1) and (2).

(4) For purposes of this section, the determination of a deficiency may not be more restrictive than:

(a) requiring the hands-on assistance of another person to perform the prescribed activities of daily living; or

(b) if the deficiency is due to the presence of a cognitive impairment, needing supervision or verbal cuing by another person to protect the insured or others.

(5) An assessment of activities of daily living or cognitive impairment shall be performed by a licensed or certified professional, such as a physician, nurse, or social worker.

(6) A policy shall include a clear description of the process for appealing and resolving a benefit determination.

(7) The requirements in this section are effective January 1, 2003.

(a) This section applies to a policy issued in this state on or after July 1, 2002.

(b) This section does not apply to a certificate issued on or after July 1, 2002, under a group policy that was in force before July 1, 2002.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-9 Benefit Trigger Standards for Qualified Long-Term Care Insurance Contracts

(1) A qualified long-term care insurance contract shall pay only for qualified long-term care services received by a chronically ill individual provided under a plan of care prescribed by a licensed health care practitioner.

(2) A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's inability to perform the activities of daily living for an expected period of at least 90 days due to a loss of functional capacity or severe cognitive impairment.

(3) A certification regarding the activities of daily living or cognitive impairment required under Subsection R590- 148-9(2) shall be performed by a licensed or certified:

(a) physician;

(b) registered professional nurse;

(d) another individual who meets the requirements prescribed by the Secretary of the Treasury.

(4)(a) Except as provided in Subsection (4)(b), a certification required under Subsection (2) may be performed by a licensed health care professional at the direction of the insurer as reasonably necessary for a specific claim.

(b) When a licensed health care practitioner certifies that an insured is unable to perform the activities of daily living for an expected period of at least 90 days due to a loss of functional capacity and the insured is in claim status, the certification may not be rescinded and an additional certification may not be performed until after the expiration of the 90-day period.

(5) A qualified long-term care insurance contract shall include a clear description of the process for appealing and resolving a dispute with respect to a benefit determination.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-10 Continuation and Conversion

(1) A group policy issued in this state on or after July 1, 2002, shall include a provision for continuation of coverage or conversion of coverage.

(2)(a) A group policy that restricts benefits and services or contains incentives to use certain providers or facilities may provide continuation of coverage or conversion of coverage benefits that are substantially equivalent to the benefits of the existing group policy.

(b) The commissioner shall make a determination as to the substantial equivalency of benefits, taking into consideration the differences between managed care and non-managed care plans, including provider system arrangements, service availability, benefit levels, and administrative complexity.

(3)(a) The insured shall make a written application for the converted policy and pay the first premium, if any, as directed by the insurer within 60 days after the termination of coverage under the group policy.

(b) The converted policy shall be issued effective on the day following the termination of coverage under the group policy and shall be renewable annually.

(4)(a) Unless the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated based on the insured's age at inception of coverage under the group policy replaced.

(b) If the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated based on the insured's age at inception of coverage under the group policy replaced.

(5) The premium for the individual converted policy may not exceed the insurer's premium rate at the time of the termination applicable to:

(a) the policy form;

(b) the benefit amount of the individual policy; and

(6) Continuation of coverage or issuance of a converted policy is mandatory, except when:

(a) termination of group coverage resulted from an individual's failure to make any required payment of premium or contribution when due; or

(b) the terminating coverage is replaced within 31 days after termination by group coverage effective on the day following the termination of coverage:

(i) providing benefits identical to, or benefits determined by the commissioner to be substantially equivalent to or in excess of, those provided by the terminating coverage; and

(ii) having premiums calculated in a manner consistent with the requirements of Subsection (4).

(7)(a) Notwithstanding any other provision of this section, a converted policy issued to an individual who, at the time of conversion, is covered by another long-term care insurance policy that provides benefits on the basis of an incurred expense, may contain a provision that results in a reduction of benefits payable if the benefits provided under the additional coverage, together with the full benefits provided by the converted policy, result in payment of more than 100% of incurred expenses.

(b) Subsection (7)(a) applies only if the converted policy provides for a premium decrease or refund that reflects the reduction in benefits payable.

(8) The converted policy may provide that the converted policy benefits, together with the benefits payable under the group policy from which conversion is made, not exceed what would have been payable had the individual's coverage under the group policy remained in force and in effect.

(9) Notwithstanding any other provision of this section, if an insured's eligibility for a group policy is based upon the insured's relationship to another insured, the insured is entitled to continuation of coverage under the group policy upon termination of the qualifying relationship by death or dissolution of marriage.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-11 Unintentional Lapse and Reinstatement

(1)(a) An applicant may designate at least one person to receive the notice of lapse or termination, in addition to the applicant.

(i) Designation of an additional person does not constitute acceptance of any liability on the third party for services provided to the insured.

(ii) The form used for the written designation shall provide space clearly designated for listing at least one additional person, including each person's full name and home address.

(iii) A policy or certificate may not be issued until the insurer has received from the applicant:

(A) a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy or certificate for nonpayment of premium; or

(B) a written waiver dated and signed by the applicant electing not to designate an additional person to receive notice of lapse or termination.

(iv) If an applicant elects not to designate an additional person, the waiver shall state, "Protection against unintended lapse. I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this long-term care insurance policy for nonpayment of premium. I understand that notice will not be given until 30 days after a premium is due and unpaid. I elect NOT to designate a person to receive this notice."

(v) The form used for the written designation shall provide a space clearly designated for listing at least one person that includes each person's full name and home address.

(vi) The insurer shall notify the insured of the right to change their written designation at least once every two years.

(b) If an insured pays a premium through a payroll or pension deduction plan, the insurer shall meet the requirements of this subsection within 60 days after the insured is no longer on the payment plan.

(c)(i) A policy or certificate may not lapse or be terminated for nonpayment of premium unless the insurer, at least 30 days before the effective date of the lapse or termination, gives notice to the insured and each person designated under Subsection (1)(a), at the address provided by the insured for receiving notice of lapse or termination.

(ii) The notice in Subsection (1)(c)(i):

(A) shall be given by postage prepaid first-class United States mail;

(B) may not be given until 30 days after a premium is due and unpaid; and

(2) A policy or certificate shall include a provision for providing for reinstatement of coverage in the event of lapse if the insurer is provided proof that the insured was cognitively impaired or had a loss of functional capacity before the grace period expired.

(a) The option in this subsection shall be available to the insured if requested within five months after termination and shall allow for the collection of past due premium, when appropriate.

(b) The standard of proof of cognitive impairment or loss of functional capacity may not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy or certificate.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-12 Requirements for Application Forms and Replacement Coverage

(1) An application or enrollment form for a policy or certificate, except those that are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(2)(a) If an application or enrollment form contains a question that asks whether the applicant has had medication prescribed by a physician, it must also ask the applicant to list the prescribed medication.

(b) If the prescribed medications listed in the application are known by the insurer, or should have been known at the time of application, to be directly related to a medical condition for which coverage would otherwise be denied, then the policy or certificate may not be rescinded for that condition.

(3) An application or enrollment form shall clearly state the payment plan selected by the applicant.

(4) Except for a policy or certificate that is guaranteed issue:

(a) the following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application or enrollment form, "Caution: If your answers on this application are incorrect or untrue, (company) has the right to deny benefits or rescind your policy."; and

(b) the following language, or language substantially similar to the following, shall be set out conspicuously on the policy or certificate at the time of delivery, "Caution: The issuance of this long-term care insurance (policy) (certificate) was based upon your responses to the questions on your application. A copy of your (application) (enrollment form) (is enclosed) (was retained by you when you applied). If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: (insert address)."

(5) Before issuing a policy or certificate to an applicant age 80 or older, the insurer shall obtain:

(a) a report of a physical examination;

(b) an assessment of functional capacity;

(d) copies of medical records.

(6) A copy of the completed application or enrollment form shall be delivered to the insured with the policy or certificate, unless it was provided to the applicant at the time of application.

(7)(a) An application or enrollment form shall include questions designed to elicit information as to whether, as of the date of the application:

(i) the applicant currently has another long-term care insurance policy or certificate in force; or

(ii) the long-term care policy or certificate is intended to replace any other accident and health insurance or long-term care insurance policy or certificate currently in force.

(b) A supplementary application or other form signed by the applicant and producer may be used, except when the coverage is sold without a producer.

(c) For a replacement policy issued to a group, other than an employee or labor union group, the questions may be modified to the extent necessary to elicit information about other accident and health insurance or long-term care insurance other than the group policy being replaced, provided that the certificate holders have been notified of the replacement.

(d) The questions in Subsection (7)(a) shall include:

(i) "Do you have another long-term care insurance policy or certificate in force, including health care service contract, health maintenance organization contract?";

(ii) "Did you have another long-term care insurance policy or certificate in force during the last 12 months?

If so, with which company?

If that policy lapsed, when did it lapse?";

(iii) "Are you covered by Medicaid?"; and

(iv) "Do you intend to replace any of your medical or health insurance coverage with this policy/certificate?".

(8) A producer shall list all other accident and health insurance policies they have sold to the applicant, including a list of each policy sold:

(a) that is still in force; and

(b) in the past five years, that is no longer in force.

(9)(a) An insurer using a solicitation method other than direct response shall, upon determining that a sale involves a replacement, provide to the applicant, before issuance or delivery of the individual policy, a notice regarding replacement of accident and health insurance or long-term care insurance.

(b) A copy of the notice shall be provided to the applicant and an additional copy signed by the applicant shall be retained by the insurer.

(c) The required notice shall be provided in a manner substantially similar to the Notice to Applicant Regarding Replacement of Individual Accident and Sickness or Long-Term Care Insurance.

(10)(a) An insurer using a direct response solicitation method shall deliver a notice regarding replacement of accident and health insurance or long-term care insurance to the applicant upon issuance of the policy.

(b) The required notice in Subsection (10)(a) shall be provided in a manner substantially similar to the Notice to Applicant Regarding Replacement of Accident and Sickness or Long-Term Care Insurance.

(11)(a) If replacement is intended, the replacing insurer shall notify the existing insurer in writing of the proposed replacement, identifying the insurer, the insured, and the policy number or address including zip code.

(b) The notice shall be made within five working days from the date the application is received by the insurer or the date the policy or certificate is issued, whichever is sooner.

(12)(a) A life insurance policy or certificate that provides long-term care benefits shall comply with this section if the policy being replaced is a long-term care insurance policy.

(b) If the policy being replaced is a life insurance policy, the insurer shall comply with the replacement requirements of Rule R590-93.

(c) If a life insurance policy that provides long-term care benefits is replaced by another similar policy, the replacing insurer shall comply with both the long-term care insurance and the life insurance replacement requirements in Subsections (12)(a) and (12)(b).

(13) A requirement under a group policy that a signature of an insured be obtained by a producer or an insurer is satisfied if:

(a) consent is obtained by telephonic or electronic enrollment by the group policyholder or insurer;

(b) verification of enrollment information is provided to the enrollee; and

(i) accuracy, retention, and prompt retrieval of records; and

(ii) the ongoing confidentiality of individually identifiable information and privileged information under Section 63G- 2-202.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-13 Requirement to Offer Inflation Protection

(1) An insurer may not offer a policy unless the insurer also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations that account for reasonably anticipated increases in the cost of long-term care services covered by the policy.

(a) An insurer shall offer to a policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than the following:

(i) increases benefit levels that are compounded annually at a rate not less than 5%;

(ii) guarantees the insured the right to periodically increase benefit levels without providing evidence of insurability or health status if the option for the previous period was not declined; or

(iii) covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.

(b) The offer under Subsection (1)(a)(ii) shall comply with this subsection.

(i) The premium rate for the additional benefit may not exceed the insurer's customary rate at the time the offer is made, that applies to:

(A) the form and amount of the policy;

(B) the class of risk to which the person belonged at the time of issue of the policy; and

(ii) The amount of the additional benefit may not be less than the difference between the existing policy benefit and the benefit compounded annually at a rate of at least 5% for the period beginning with the purchase of the existing benefit and extending until the year the offer is made.

(2) If a policy is issued to a group, except a continuing care retirement community center, the offer under Subsection (1) shall be made to the group policyholder and to each proposed certificate holder.

(3)(a) An insurer shall include the following information in or with the outline of coverage:

(i) a graphic comparison of the benefit levels over at least a 20-year period of a policy that increases benefits over the policy period with a policy that does not increase benefits; and

(ii) any expected premium increases or additional premiums to pay for automatic or optional benefit increases.

(b) An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.

(4) Inflation protection benefit increases under a policy that contains this benefit shall continue without regard to an insured's age, claim status, claim history, or the length of time the individual has been insured under the policy.

(5)(a) An inflation protection offer that provides for automatic benefit increases shall include an offer of a premium that the insurer expects to remain constant.

(b) The offer shall disclose, in a conspicuous manner, that the premium may change in the future unless the premium is guaranteed to remain constant.

(6)(a) Inflation protection under Subsection (1)(a)(i) shall be included unless an insurer obtains a rejection of inflation protection signed by the policyholder or certificate holder, either in the application or on a separate form.

(b) The rejection is considered a part of the application and shall state, "I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans (indicate), and I reject inflation protection."

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-14 Nonforfeiture and Contingent Benefit Requirements

(1) To comply with the requirement to offer a nonforfeiture benefit under Section 31A-22-1412:

(a) a policy or certificate offered with nonforfeiture benefits shall have coverage elements, eligibility, benefit triggers, and benefit length that are the same as coverage to be issued without nonforfeiture benefits;

(b) the nonforfeiture benefit included in the offer shall be the benefit described in Subsection (4); and

(c) the offer shall be in writing if the nonforfeiture benefit is not otherwise described in the outline of coverage or other materials given to the prospective policyholder.

(2) If the offer required under Section 31A-22-1412 is rejected, the insurer shall provide the contingent benefit upon lapse as described in this section.

(3)(a) After rejection of the offer required under Section 31A-22-1412, for individual and group policies without nonforfeiture benefits issued after July 1, 2002, the insurer shall provide a contingent benefit upon lapse.

(b) If a group policyholder elects to make the nonforfeiture benefit an option to a certificate holder, a certificate shall provide either the nonforfeiture benefit or the contingent benefit upon lapse.

(c)(i) A contingent benefit upon lapse shall be triggered each time an insurer:

(A) increases the premium rates to a level that results in a cumulative increase of the annual premium, based on the insured's issue age, equal to or exceeding the percentage of the insured's initial annual premium shown in the Triggers for a Substantial Premium Increase; and

(B) the policy or certificate lapses within 120 days of the due date of the increased premium.

(ii) Unless otherwise required, each policyholder shall be notified at least 30 days before the due date of the increased premium.

(d) On or before the effective date of a substantial premium increase, the insurer shall:

(i) offer to reduce policy benefits provided by the current coverage without additional underwriting so required premium payments are not increased;

(ii) offer to convert the coverage to a paid-up status with a shortened benefit period under Subsection (4), if elected at any time during the 120-day period referenced in Subsection (3)(c)(i)(B); and

(iii) notify the insured that a default or lapse at any time during the 120-day period referenced in Subsection (3)(c)(i)(B) is an election of the offer to convert in Subsection (3)(d)(ii).

(4) Benefits continued as nonforfeiture benefits, including contingent benefits upon lapse, are described in this subsection.

(a)(i) For purposes of this subsection, the nonforfeiture benefit shall be a shortened benefit period providing paid-up long-term care insurance coverage after lapse;

(ii) the same benefits, amounts, and frequency in effect at the time of lapse, but not increased thereafter, will be payable for a qualifying claim; and

(iii) the lifetime maximum dollars or days of benefits shall be determined under Subsection (4)(b).

(b)(i) The standard nonforfeiture credit shall be equal to 100% of the sum of all premiums paid, including the premiums paid before any changes in benefits.

(ii) An insurer may offer additional shortened benefit period options, if the benefits for each duration equal or exceed the standard nonforfeiture credit for that duration.

(iii) The minimum nonforfeiture credit may not be less than 30 times the daily nursing home benefit at the time of lapse.

(iv) The calculation of the nonforfeiture credit is subject to Subsection (5).

(c)(i)(A) The nonforfeiture benefit shall begin no later than the end of the third year following the policy or certificate issue date.

(B) The contingent benefit upon lapse shall be effective during the first three years and thereafter.

(ii) Notwithstanding Subsection (4)(c)(i), for a policy or certificate with attained age rating, the nonforfeiture benefit shall begin on the earlier of:

(A) the end of the tenth year following the policy or certificate issue date; or

(B) the end of the second year following the date the policy or certificate is no longer subject to attained age rating.

(d) Nonforfeiture credits may be used for all care and services that qualify for benefits under the terms of the policy or certificate, up to the limits specified in the policy or certificate.

(5) All benefits paid by the insurer while the policy or certificate is in premium paying status, and in the paid-up status, may not exceed the maximum benefits that would be payable if the policy or certificate had remained in premium paying status.

(6) There is no difference in the minimum nonforfeiture benefits under this section for a group or individual policy.

(7)(a) Except as provided in Subsection (7)(b), the requirements set forth in this section are effective January 1, 2003, and apply to a policy issued in this state on or after July 1, 2002.

(b) This section does not apply to a certificate issued on or after July 1, 2002, under a group policy that was in force on January 1, 2002.

(8) A premium charged for a policy or certificate containing a nonforfeiture benefit or a contingent benefit upon lapse is subject to the loss ratio requirements of Section R590-148-22 treating the policy as a whole.

(9) To determine whether a contingent nonforfeiture upon lapse provision is triggered under Subsection (3)(c), a replacing insurer that purchased or otherwise assumed a block of policies from another insurer shall calculate the percentage increase based on the initial annual premium paid by the insured when the policy was first purchased from the original insurer.

(10) A nonforfeiture benefit for a qualified long-term care insurance contract offering a level premium shall:

(a) be appropriately captioned;

(b) provide a benefit available in the event of a default in the payment of a premium and state that the amount of the benefit may be adjusted after being initially granted as necessary to reflect a change in claims, persistency, and interest as reflected in a change in rates for a premium paying contract approved by the commissioner for the same contract form; and

(i) reduced paid-up insurance;

(ii) extended term insurance;

(iii) shortened benefit period; or

(iv) a similar offering approved by the commissioner.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-15 Standard Format Outline of Coverage

(1) An insurer shall use an outline of coverage that conforms with the Long-Term Care Insurance Outline of Coverage.

(2) The outline of coverage shall be in at least ten-point font.

(3) The outline of coverage may not contain advertising material.

(4) Capitalized or underscored text in the standard format outline of coverage may be emphasized by other means that provide equal prominence to capitalization or underscoring.

(5) The text and sequence of text of the standard format outline of coverage is mandatory, unless otherwise specifically stated.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-16 Requirement to Deliver Shopper's Guide

(1)(a) A long-term care insurance shopper's guide, in the format developed by the NAIC, shall be provided to a prospective applicant.

(b) A producer shall deliver the shopper's guide before the presentation of an application or enrollment form.

(c) For a direct response solicitation, the shopper's guide must be presented in conjunction with an application or enrollment form.

(2) A life insurance policy or rider that provides incidental long-term care benefits:

(a) is not required to furnish the shopper's guide; and

(b) shall furnish the policy summary required under Subsection 31A-22-1409(8).

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-17 Suitability

(1) An insurer shall:

(a) develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the applicant;

(b) train its producers in its suitability standards; and

(2)(a) To determine whether an applicant meets the insurer's standards, the producer and insurer shall develop a procedure that considers:

(i) the applicant's ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage;

(ii) the applicant's goals or needs regarding long-term care and the advantages and disadvantages of insurance to meet those goals or needs; and

(iii) the values, benefits, and costs of the applicant's existing insurance, if any, when compared to the values, benefits, and costs of the recommended purchase or replacement.

(b)(i) The insurer and producer shall:

(A) make a reasonable effort to obtain the information in Subsection (2)(a); and

(B) present to the applicant, at or before application, the Long-Term Care Insurance Personal Worksheet, in at least 12- point font.

(ii) The insurer may request that the applicant provide additional information to comply with the insurer's suitability standards.

(c)(i) A completed Long-Term Care Insurance Personal Worksheet shall be returned to the insurer before the insurer considers the applicant for coverage.

(ii) The Long-Term Care Insurance Personal Worksheet is not required for a sale to an employee and their spouse under an employer group policy.

(d) The sale or dissemination, outside the company or agency by the insurer or producer, of information obtained through the Long-Term Care Insurance Personal Worksheet is prohibited.

(3) An insurer shall use its suitability standards to determine whether issuing long-term care insurance coverage to an applicant is appropriate.

(4) A producer shall use the insurer's suitability standards.

(5) When the Long-Term Care Insurance Personal Worksheet is provided to the applicant, the Things You Should Know Before You Buy Long-Term Care Insurance disclosure shall be provided in at least 12-point font.

(6)(a) If an insurer determines that the applicant does not meet its suitability standards, or if the applicant declines to provide the requested information, the insurer may reject the application.

(b)(i) The insurer shall send the applicant a letter similar to the Long-Term Care Insurance Suitability Letter.

(ii) If the applicant declines to provide financial information, the insurer may use another method to verify the applicant's intent.

(c) Either the applicant's returned letter or a record of the alternative method of verification shall be made part of the applicant's file.

(7) If replacing a policy or certificate, the replacing insurer shall waive all time periods applicable to a preexisting condition and probationary period in the new policy or certificate for a similar benefit, to the extent the exclusions were satisfied under the original policy.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-18 Marketing Standards

(1) An insurer shall:

(a) establish marketing procedures to assure that a comparison of policies by its producers is fair and accurate;

(b) establish marketing procedures to assure excessive insurance is not sold or issued;

(c) display prominently, on the first page of the outline of coverage and the policy, "Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations.";

(d) provide to the applicant a copy of the Long-Term Care Insurance Personal Worksheet and the Worksheet Potential Rate Increase Disclosure Form;

(e)(i) identify whether a prospective applicant for long-term care insurance has accident and health or long-term care insurance, including the insurance types and amounts;

(ii) in the case of a qualified long-term care insurance contract, an inquiry into whether a prospective applicant has accident and health insurance is not required;

(f) establish an audit procedure to verify compliance with this Subsection (1);

(g) provide written notice to the prospective insured that a senior insurance counseling program is available, with the name, address, and telephone number of the program;

(h) use the terms "noncancellable" or "level premium" only when the policy or certificate complies with Subsections R590-148-6(1)(c) and R590-148-6(1)(d); and

(i) provide an explanation of contingent benefits upon lapse under Subsection R590-148-14(3)(c).

(2) In addition to the practices prohibited in Title 31A, Chapter 23a, Part 4, Marketing Practices, the following acts and practices are prohibited:

(a) cold lead advertising;

(b) high pressure tactics;

(d) twisting.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-19 Required Disclosure of Rating Practices to Consumer

(1)(a) Except as provided in Subsection (1)(b), this section applies to a policy or certificate issued on or after January 1, 2003.

(b) For a certificate issued on or after July 1, 2002, under a group policy that was in force on July 1, 2002, this section shall apply on the first policy anniversary after January 1, 2003.

(2)(a) Except for a policy for which no applicable premium rate or rate schedule increase can be made, an insurer shall provide the information in Subsection (3) to the applicant at the time of application or enrollment.

(b) If the method of application or enrollment does not allow for delivery at the time of application or enrollment, an insurer shall provide the information in this Subsection (3) to the applicant or enrollee no later than at delivery of the policy or certificate.

(3)(a) The information to be disclosed under Subsection (2) includes:

(i) a statement that the policy may be subject to rate increases in the future;

(ii) an explanation of potential future premium rate revisions that includes the insured's options in the event of a premium rate revision;

(iii) the premium rate or rate schedule in effect until a request is made for an increase;

(iv) a general explanation for applying a premium rate or rate schedule adjustment that includes:

(A) a description of when a premium rate or rate schedule adjustment will be effective, such as the next policy anniversary date or the next billing date; and

(B) the right to a revised premium rate or rate schedule under Subsection (3)(b), if the premium rate or rate schedule is changed;

(v) information regarding each premium rate increase on the policy form or a similar policy form during the past ten years for this state or any other state that, at a minimum, identifies:

(A) each policy form for which a premium rate has been increased;

(B) each calendar year the policy form was available for purchase; and

(C) the amount, percent, and date of implementation for each increase, expressed as a percentage of the premium rate before the increase, or as a minimum and a maximum percentage, if the rate increase is variable by rating characteristics; and

(vi) additional explanatory information related to the rate increases, as necessary.

(b)(i) An insurer may exclude from the disclosure a premium rate increase that only applies to a block of business acquired from a nonaffiliated insurer or the policies acquired from a nonaffiliated insurer when the increase occurred before the acquisition.

(ii) If an acquiring insurer files a rate increase on a policy form or a block of policy forms acquired from a nonaffiliated insurer on or before the effective date of this section, or the end of a 24-month period following the acquisition, the acquiring insurer may exclude that rate increase from the disclosure, however, the selling company shall include the disclosure of the rate increase under this subsection.

(iii) If the acquiring insurer files for a subsequent rate increase on the same policy form or block of policy forms acquired from a nonaffiliated insurer, the acquiring insurer shall make each disclosure required by this subsection, including disclosure of an earlier rate increase.

(4)(a) An applicant shall sign an acknowledgment at the time of application that the insurer made the disclosure required under this subsection, unless the method of application does not allow for signature at that time.

(b) If, due to the method of application, the applicant cannot sign an acknowledgment at the time of application, the applicant shall sign the acknowledgment no later than at delivery of the policy or certificate.

(5) An insurer shall use the Long-Term Care Insurance Personal Worksheet and Worksheet Potential Rate Increase Disclosure Form to comply with this section.

(6) An insurer shall provide notice of an upcoming premium rate schedule increase to each insured, if applicable, at least 45 days before the implementation of a premium rate schedule increase.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-20 Filing Requirements for Advertising

(1) Upon request, an insurer shall file with the commissioner a copy of any long-term care insurance advertisement intended for use in this state.

(2) An insurer shall retain an advertisement for at least three years from the date the advertisement was first used.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-21 Initial Filing Requirements for Long-Term Care Policies Issued After January 1, 2003

(1) An insurer shall file the following information before making a policy form available for sale:

(a) a copy of the disclosure documents required under Section R590-148-19; and

(b) an actuarial certification that includes:

(i) a statement that the initial premium rate schedule is sufficient to cover anticipated costs under moderately adverse experience and that the premium rate schedule is reasonably expected to be sustainable over the life of the form with no future premium increases anticipated;

(ii) a statement that the policy design and coverage provided have been reviewed and considered;

(iii) a statement that the underwriting and claim adjudication processes have been reviewed and considered;

(iv) a complete description of the basis for contract reserves anticipated to be held under the form, including:

(A) sufficient detail or sample calculations to ensure a complete depiction of the reserve amounts to be held;

(B) a statement that the assumptions used for reserves contain reasonable margins for adverse experience;

(C) a statement that the net valuation premium for renewal years does not increase, except for attained age rating when permitted; and

(D) a statement that the difference between the gross premium and the net valuation premium for renewal years is sufficient to cover expected renewal expenses, or if such a statement cannot be made, a complete description of the situations when this does not occur;

(I) an aggregate distribution of anticipated issues may be used if the underlying gross premiums maintain a reasonably consistent relationship; and

(II) if the gross premiums for certain age groups appear to be inconsistent with this requirement, the commissioner may request a demonstration under Subsection (2) based on a standard age distribution; and

(v)(A) a statement that the premium rate schedule is not less than the premium rate schedule for existing similar policy forms available from the insurer, except for reasonable differences attributable to benefits; or

(B) a comparison of the premium schedules for similar policy forms that are currently available from the insurer, with an explanation of the differences.

(2)(a) The commissioner may request an actuarial demonstration that benefits are reasonable in relation to premiums.

(b) The actuarial demonstration shall include:

(i) premium and claim experience on similar policy forms, adjusted for any premium or benefit differences;

(ii) relevant and credible data from other studies; or

(iii) both.

(3) The premium charged to an insured may not increase due to:

(a) the increasing age of the insured at an age beyond 65; or

(b) the duration the insured has been covered under the policy.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-22 Loss Ratio

(1) This section applies to all individual long-term care insurance policies except those covered in Sections R590-148- 21 and R590-148-24.

(2) Benefits under an individual policy are considered reasonable in relation to the premium if the expected loss ratio is at least 60%, calculated in a manner that provides for adequate reserving of the long-term care insurance risk.

(3) In evaluating the expected loss ratio, consideration shall be given to each relevant factor, including:

(a) statistical credibility of incurred claims experience and earned premiums;

(b) the period that rates are computed to provide coverage;

(d) concentration of experience within early policy duration;

(e) expected claim fluctuation;

(f) experience refunds, adjustments, or dividends;

(g) renewability features;

(h) all appropriate expense factors;

(i) interest;

(j) experimental nature of the coverage;

(k) policy reserves;

(l) mix of business by risk classification; and

(m) product features such as long elimination periods, high deductibles, and high maximum limits.

(4) The premium charged to an insured may not increase due to:

(a) the increasing age of the insured at an age beyond 65; or

(b) the duration the insured has been covered under the policy.

(5) Rate filing documents shall contain the information required in Section R590-85-4.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-23 Reserve Standards

(1)(a) When long-term care benefits are provided through the acceleration of benefits under a life insurance policy or rider, policy reserves for the benefits shall be determined in accordance with Subsection 31A-17-504(7).

(b) Claim reserves shall be established when the policy or rider is in claim status.

(c)(i) Reserves for a policy or rider subject to this subsection shall be based on the multiple decrement model utilizing all relevant decrements except for voluntary termination rates.

(ii) Single decrement approximations are acceptable if the calculation produces similar reserves, if the reserve is clearly more conservative, or if the reserve is immaterial.

(iii) The calculations may consider the reduction in life insurance benefits due to the payment of long-term care benefits, however in no event may the reserves for the long-term care benefit and the life insurance benefit be less than the reserves for the life insurance benefit assuming no long-term care benefit.

(d) In the development and calculation of reserves for policies and riders subject to this subsection, due consideration shall be given to the applicable policy provisions, marketing methods, administrative procedures, and all other considerations that have an impact on projected claim costs, including:

(i) definition of insured events;

(ii) covered long-term care events;

(iii) existence of home convalescence care coverage;

(iv) definition of facilities;

(v) existence or absence of barriers to eligibility;

(vi) premium waiver provision;

(vii) renewability;

(viii) ability to raise premiums;

(ix) marketing method;

(x) underwriting procedures;

(xi) claims adjustment procedures;

(xii) waiting period;

(xiii) maximum benefit;

(xiv) availability of eligible facilities;

(xv) margins in claim costs;

(xvi) optional nature of benefit;

(xvii) delay in eligibility for benefit;

(xviii) inflation protection provisions; and

(xix) guaranteed insurability option.

(e) Any applicable valuation morbidity table shall be certified, as appropriate, as a statutory valuation table by a member of the American Academy of Actuaries.

(2) When long-term care benefits are provided other than as in Subsection (1), reserves shall be determined according to the Minimum Reserve Standards for Individual and Group Health Insurance Contracts, Appendix A-010, Accounting Practices and Procedures Manual, edition March 2001, published by the NAIC.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-24 Premium Rate Schedule Increases

(1)(a) This section applies to a policy or certificate issued in this state on or after January 1, 2003; and

(b) for a certificate issued on or after July 1, 2002, under a group policy that was in force on July 1, 2002, this section shall apply on the first policy anniversary after January 1, 2003.

(2) An insurer shall file notice of a pending premium rate schedule increase, including an exceptional increase, with the commissioner before sending the notice to a policyholder. The notice shall include:

(a) information required under Section R590-148-19;

(b) certification by a qualified actuary that:

(i) if the requested premium rate schedule increase is implemented and the underlying assumptions that reflect moderately adverse conditions are realized, no further premium rate schedule increases are anticipated; and

(ii) the premium rate filing complies with this section;

(i)(A) lifetime projections of earned premiums and incurred claims based on the filed premium rate schedule increase and the method and assumptions used to determine the projected values, including reflection of any assumptions that deviate from those used for pricing other forms currently available for sale;

(B) the projections shall include the development of the lifetime loss ratio, unless the rate increase is an exceptional increase;

(D) for an exceptional increase:

(I) the projected experience shall be limited to the increases in claims expenses attributable to the approved reasons for the exceptional increase; and

(II) in the event the commissioner determines that offsets may exist, the insurer shall use appropriate net projected experience;

(ii) disclosure of how reserves are incorporated in this rate increase when the rate increase triggers contingent benefit upon lapse;

(iii) disclosure of the analysis performed to determine why a rate adjustment is necessary, which pricing assumptions are not realized and why, and what other actions taken by the insurer were relied on by the actuary;

(iv) a statement that policy design, underwriting, and claim adjudication practices were considered; and

(v) if it is necessary to maintain a consistent premium rate for a new certificate and a certificate receiving a rate increase, the insurer shall file composite rates reflecting projections of new certificates;

(d) a statement that renewal premium rate schedules are not greater than new business premium rate schedules except for differences attributable to benefits, unless sufficient justification is provided to the commissioner; and

(e) sufficient information for review of the premium rate schedule increase.

(3) A premium rate schedule increase shall be determined using the following requirements:

(a) an exceptional increase shall provide that at least 70% of the present value of projected additional premium from the exceptional increase will be returned to a policyholder in benefits;

(b) a premium rate schedule increase shall be calculated such that the sum of the accumulated value of incurred claims, without the inclusion of active life reserves, and the present value of future projected incurred claims, without the inclusion of active life reserves, will not be less than the sum of the following:

(i) the accumulated value of the initial earned premium times 58%;

(ii) 85% of the accumulated value of prior premium rate schedule increases on an earned basis;

(iii) the present value of future projected initial earned premium times 58%; and

(iv) 85% of the present value of future projected premium not included in Subsection (3)(b)(iii) on an earned basis;

(c) if a policy form has both exceptional and other increases, the values in Subsections (3)(b)(ii) and (3)(b)(iv) shall also include 70% for exceptional rate increase amounts; and

(d) all present and accumulated values used to determine rate increases shall use the maximum valuation interest rate for contract reserves that is the maximum rate permitted by law in the valuation of whole life insurance issued on the same date as the health insurance policy.

(4) The actuary shall disclose, as part of the actuarial memorandum, the use of any appropriate averages.

(5)(a) An insurer may request a premium rate schedule increase that is lower than the rate increase necessary to provide the certification required in Subsection (2)(b)(i) and the commissioner may accept such premium rate schedule increase, without submission of the certification required in Subsection (2)(b)(i), if:

(i) in the opinion of the commissioner, accepting a lower premium rate schedule increase is in the best interest of Utah insureds;

(ii) the actuarial memorandum discloses the rate increase necessary to provide the certification required in Subsection (2)(b)(i); and

(iii) the rate increase filing satisfies each requirement of this section.

(b) The commissioner may condition the acceptance of the premium rate schedule increase under Subsection (4)(a) upon:

(i) the disclosure, to the affected policyholder, of the premium rate schedule increase necessary to provide the certification required in Subsection (2)(b)(i); and

(ii) the extension of a contingent nonforfeiture benefit upon lapse to policyholders who would have been eligible for contingent nonforfeiture benefit upon lapse based on the premium rate schedule increase necessary to provide certification required in Subsection (2)(b)(i).

(6)(a) For each rate increase that is implemented, an insurer shall annually file a report with the commissioner for the next three years updated projections, as provided in Subsection (2)(c)(i), and include a comparison of actual results to projected values.

(b) The commissioner may extend the period to more than three years if actual results are not consistent with projected values from prior projections.

(c) For a group insurance policy that meets the conditions in Subsection (13), the projections required by this Subsection (6) shall be provided to the policyholder in lieu of filing with the commissioner.

(7)(a) If any premium rate in the revised premium rate schedule is greater than 200% of the comparable rate in the initial premium schedule, lifetime projections, under Subsection (2)(c)(i), shall be filed every five years following the end of the required period in Subsection (6).

(b) For a group insurance policy that meets the conditions in Subsection (13), the projections required by Subsection (6) shall be provided to the policyholder in lieu of filing with the commissioner.

(8)(a) If the commissioner determines that the actual experience following a rate increase does not adequately match the projected experience and that the current projections under moderately adverse conditions demonstrate that incurred claims will not exceed proportions of premiums specified in Subsection (3), the commissioner may require the insurer to implement:

(i) premium rate schedule adjustments; or

(ii) other measures to reduce the difference between the projected and actual experience.

(b) To determine whether the actual experience adequately matches the projected experience, Subsection (2)(c)(v) shall be considered, if applicable.

(9) If the majority of the policies or certificates to which the increase applies are eligible for the contingent benefit upon lapse, the insurer shall file:

(a) a plan, subject to commissioner approval, for improved administration or claim processing designed to eliminate the potential for further deterioration of the policy form requiring further premium rate schedule increases, or both, or to demonstrate that appropriate administration and claims processing have been implemented or are in effect, otherwise the commissioner may impose the conditions in Subsection (10); and

(b) the original anticipated lifetime loss ratio and the premium rate schedule increase calculated according to Subsection (3) had the greater of the original anticipated lifetime loss ratio or 58% been used in the calculations under Subsections (3)(a)(i) and (3)(a)(iii).

(10)(a) The commissioner shall review, for each policy included in the filing, the projected lapse rates and past lapse rates during the 12 months following each increase to determine if significant adverse lapsation has occurred or is anticipated, for a rate increase filing that:

(i) the rate increase is not the first rate increase requested for the specific policy form or forms;

(ii) the rate increase is not an exceptional increase; and

(iii) the majority of the policies or certificates to which the increase applies are eligible for the contingent benefit upon lapse.

(b) In the event significant adverse lapsation has occurred, is anticipated in the filing, or is evidenced in the actual results as presented in the updated projections provided by the insurer following the requested rate increase, the commissioner may determine that a rate spiral exists.

(i) Following the determination that a rate spiral exists, the commissioner may require the insurer to offer, without underwriting, to each in force insured subject to the rate increase, the option to replace existing coverage with one or more reasonably comparable products being offered by the insurer or its affiliates. The offer shall:

(A) be subject to the approval of the commissioner;

(B) be based on actuarially sound principles, but not be based on attained age; and

(C) provide that maximum benefits under any new policy accepted by an insured shall be reduced by comparable benefits already paid under the existing policy.

(ii) The insurer shall maintain the experience of all the replacement insureds separate from the experience of insureds originally issued the policy forms. In the event of a request for a rate increase on the policy form, the rate increase shall be limited to the lesser of:

(A) the maximum rate increase determined based on the combined experience; or

(B) the maximum rate increase determined based only on the experience of the insureds originally issued the form plus 10%.

(11) If the commissioner determines that an insurer exhibits a persistent practice of filing inadequate initial premium rates for long-term care insurance, the commissioner may, in addition to Subsection (10), prohibit the insurer from:

(a) filing and marketing comparable coverage for a period of up to five years; or

(b) offering any other similar coverages and limit marketing of new applications to the products subject to recent premium rate schedule increases.

(12) Subsections (1) through (11) do not apply to a policy when the long-term care benefits provided by the policy are incidental, if the policy complies with the following provisions:

(a) the interest credited internally to determine cash value accumulations, including long-term care, if any, are guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;

(b) the portion of the policy that provides insurance benefits other than long-term care coverage meets the nonforfeiture requirements as applicable in:

(i) Section 31A-22-408; or

(ii) Section 31A-22-409;

(c) the policy meets the disclosure requirements of Subsections 31A-22-1409(7) and 31A-22-1409(8) and Section 31A-22-1410;

(d) the portion of the policy that provides insurance benefits other than long-term care coverage meets the following requirements, as applicable:

(i) policy illustrations under Rule R590-177; and

(ii) disclosure requirements under Rule R590-133; and

(e) an actuarial memorandum is filed with the commissioner that includes:

(i) a description of the basis on how the long-term care rates were determined;

(ii) a description of the basis for the reserves;

(iii) a summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;

(iv) a description and a table of each actuarial assumption used, and for expenses, an insurer shall include percent of premium dollars per policy and dollars per unit of benefits, if any;

(v) a description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;

(vi) the estimated average annual premium per policy and the average issue age;

(vii)(A) a statement as to whether underwriting is performed at the time of application;

(B) the statement shall indicate whether underwriting is used and, if used, shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting; and

(C) for a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting will occur; and

(viii) a description of the effect of the policy provision on the required premiums, nonforfeiture values, and reserves on the underlying insurance policy, both for active lives and those in long-term care claim status.

(13) Subsections (8) and (10) do not apply to a group policy when:

(a) the policy insures 250 or more persons, and the policyholder has 5,000 or more eligible employees of a single employer; or

(b) the policyholder, and not the certificate holders, pays a material portion of the premium that is not less than 20% of the total premium for the group in the calendar year before the year a rate increase is filed.

(14)(a) An exceptional increase is subject to the same requirements as other premium rate schedule increases.

(b) The commissioner may request that an independent actuary, or a professional actuarial body, review the basis for an insurer's request for an exceptional increase.

(c) The commissioner, in determining that the necessary basis for an exceptional increase exists, shall determine any potential offsets to higher claims costs.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-25 Reporting Requirements

(1)(a) An insurer shall maintain records for each producer detailing the:

(i) producer's number of replacement sales as a percent of the agent's total annual sales; and

(ii) amount of lapses of long-term care insurance policies sold by the producer as a percent of the producer's total annual sales.

(b) An insurer shall report the 10% of its producers with the greatest percentage of lapses and replacements under Subsection (1)(a).

(i) lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year; and

(ii) replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year.

(d) The reports required by this subsection shall be reported on the Replacement and Lapse Reporting Form.

(e) Reported replacement and lapse rates do not, by themselves, constitute a violation of Utah laws nor do they necessarily imply wrongdoing. The reports are for reviewing producer activities regarding the sale of long-term care insurance.

(2)(a) An insurer shall report, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied.

(b) The report shall include, at a minimum, the information contained in the Claims Denial Reporting Form Long- Term Care Insurance.

(3) An insurer shall maintain a record of each policy or certificate rescission, both state and nationwide, except those the insured voluntarily effectuated, and shall annually report this information on the Rescission Reporting Form.

(4)(a) An insurer shall report the total number of applications received from Utah residents, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards, and the number of those who chose to confirm after receiving a suitability letter.

(b) The report shall be submitted on the Suitability Reporting Form.

(5) For purposes of this section:

(a) "claim" means a request for payment of benefits under an in force policy, regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

(b) "denied" means that an insurer refused to pay a claim for any reason other than for claims not paid for failure to meet a waiting period or due to a preexisting condition; and

(6) A report required under this section shall be filed with the commissioner annually on or before June 30 and in compliance with Rule R590-220.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-26 Licensing

A producer is not authorized to sell, solicit, or negotiate long-term care insurance except as authorized by Title 31A, Chapter 23a, Insurance Marketing - Licensing Agents, Brokers, Consultants and Reinsurance Intermediaries.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-27 Discretionary Powers of the Commissioner

The commissioner may, upon written request and after a hearing, issue an order modifying or suspending a provision of this rule upon a finding that:

(1) the modification or suspension is in the best interest of the insured;

(2) the purpose of the provision cannot be effectively or efficiently achieved without the modification or suspension; and

(3) one of the following:

(a) the modification or suspension is necessary to the development of an innovative, reasonable approach for insuring long-term care;

(b) the policy or certificate will be issued to residents of a life care or continuing care retirement community, or some other residential community for the elderly, and the modification or suspension is reasonably related to the special needs or nature of the community; or

(c) the modification or suspension is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

Utah Admin. Code R590-148-28 Severability

If any provision of this rule, Rule R590-148, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: October 22, 2024
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404

R590-149 Americans with Disabilities Act Grievance Procedures

Utah Admin. Code R590-149-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-2 Purpose and Scope

(1) The purpose of this rule is to implement the Americans with Disabilities Act (ADA), 42 U.S.C. 12101-12213 and 28 CFR 35, which provides that no individual may be excluded from participation in or be denied the benefits of the services, programs, or activities of the department, or be subjected to discrimination by the department because of a disability.

(2) This rule applies to:

(a) a qualified individual; and

(b) the department.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. The definitions in the Americans with Disabilities Act, 42 U.S.C. 12101-12213 and 28 CFR 35, are incorporated by reference. Additional terms are defined as follows:

(1)(a) "ADA coordinator" means an employee assigned by the commissioner to investigate and facilitate the prompt and equitable resolution of a complaint filed by a qualified individual.

(b) The ADA coordinator may be a representative of the Department of Government Operations, Division of Human Resource Management assigned to the department.

(2) "Complainant" means a qualified individual or a qualified individual's authorized representative.

(3)(a) "Designee" means an individual appointed by the commissioner to investigate an allegation of ADA noncompliance when the ADA coordinator is unable or unwilling to investigate for any reason, including a conflict of interest.

(b) A designee does not have to be an employee of the department; however, the designee must have a working knowledge of the responsibilities and obligations required of employers and employees by the ADA.

(4) "Director" means the head of the division of the department affected by a complaint filed under this rule.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-4 Complaint

(1) Any qualified individual may file a complaint alleging noncompliance with the ADA or a federal regulation promulgated thereunder.

(2) A qualified individual shall file a complaint with the ADA coordinator, unless the complaint alleges that the ADA coordinator is non-compliant, in which case a qualified individual shall file a complaint with the designee.

(3) A qualified individual shall file a complaint within 90 days after the date of the alleged noncompliance to facilitate the prompt and effective consideration of pertinent facts and appropriate remedies; however, the commissioner has the discretion to direct that the grievance process be utilized to address legitimate complaints filed more than 90 days after alleged noncompliance.

(4) Each complaint shall:

(a) include the qualified individual's name and address;

(b) include the nature and extent of the qualified individual's disability;

(c) describe the department's alleged discriminatory action in sufficient detail to inform the department of the nature and date of the alleged violation;

(d) describe the action and accommodation desired; and

(e) be signed by the complainant.

(5) A complaint filed on behalf of a class of qualified individuals or a third party shall describe and identify by name, if possible, the alleged victims of discrimination.

(6) If a complaint is not in writing, the ADA coordinator or designee shall reduce the complaint to writing.

(7) By filing a complaint or a subsequent appeal, the complainant authorizes the ADA coordinator or designee to conduct a confidential review of all relevant information, including:

(a) any record classified as private or controlled under Sections 63G-2-302 and 63G-2-304, consistent with 42 U.S.C. Section 12112(d)(3)(B) and (C) and 42 U.S.C. 12112(d)(4)(A), (B), and (C); and

(b) any relevant information otherwise protected by statute, rule, regulation, or other law.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-5 Investigation

(1) The ADA coordinator or designee shall investigate each complaint received to the extent necessary to assure all relevant facts are determined and documented.

(2)(a) The ADA coordinator or designee may seek assistance from the Attorney General's Office and the Division of Human Resource Management to determine what action, if any, should be taken on the complaint.

(b) The ADA coordinator or designee may also consult with the director of the affected division in making a recommendation.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-6 Decision

(1) The ADA coordinator or designee shall issue a recommendation to the director within 15 working days after receiving the complaint.

(2) If the ADA coordinator or designee is unable to make a recommendation within 15 working days, the complainant shall be notified that the recommendation is delayed and given an estimate of the additional time needed.

(3) The director may confer with the ADA coordinator or designee and the complainant and may accept or modify the recommendation from the ADA coordinator or designee to resolve the complaint.

(4) The director shall issue a written decision within 15 working days after the director's receipt of the recommendation from the ADA coordinator or designee.

(5) The director shall take all reasonable steps to implement the decision.

(6) The ADA coordinator or designee shall consult with representatives from other state agencies that may be affected by the decision, including the Governor's Office of Planning and Budget, the Division of Human Resource Management, the Division of Risk Management, the Division of Facilities Construction Management, and the Office of the Attorney General before making any recommendation that would require:

(a) an expenditure of funds beyond the applicable budgetary line item;

(b) a facility modification; or

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-7 Appeal

(1) The complainant may appeal the decision of the director to the commissioner by filing an appeal within ten working days of receipt of the director's decision.

(2) The appeal shall be filed in writing, or in another accessible format reasonably suited to the complainant's ability.

(3)(a) The commissioner may name an assistant to help with the appeal.

(b) Neither the director, the ADA coordinator, nor the designee may be the commissioner's assistant for the appeal.

(4) The appeal shall describe, in sufficient detail, why the director's decision does not effectively address the complainant's requirements.

(5)(a) The commissioner shall review the ADA coordinator's recommendation, the director's decision, and the issues raised on appeal prior to reaching a decision.

(b) The commissioner may direct additional investigation, as necessary.

(6) The commissioner shall consult with representatives from any other state agency that may be affected by the decision, as provided in Subsection R590-149-6(6).

(7) The final written decision shall be issued by the commissioner within 15 working days of receiving the appeal.

(8) If the commissioner is unable to reach a final decision within 15 working days, the qualified individual will be notified that the final decision is being delayed and given an estimate of the additional time needed to reach a decision.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-8 Records Classification

(1)(a) A record created in administering this rule is classified as "protected" under Section 63G-2-305.

(b) After a decision is issued under Section R590-149-6 or a final decision on appeal under Section R590-149-7, any portion of the record pertaining to the qualified individual's medical condition shall remain classified as "private" under Section 63G-2-302 or "controlled" under Section 63G-2-304, consistent with 42 U.S.C. 12112(d)(4)(A), (B), and (C) and 42 U.S.C. 12112(d)(3)(B) and (C).

(2) Notwithstanding Subsection (1), the written decision of the director or commissioner is classified as "public" under Section 63G-2-301.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-9 Relationship to Other Laws

This rule does not prohibit or limit the use of any remedy available to an individual under:

(1) Title 34A, Chapter 5, Utah Antidiscrimination Act;

(2) the Americans with Disabilities Act, 42 U.S.C. Section 12101-12213; or

(3) any other state or federal law that provides equal or greater protection for the rights of an individual with a disability.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

Utah Admin. Code R590-149-10 Severability

If any provision of this rule, Rule R590-149, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, ADA
Date of Last Change: January 10, 2022
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 63G-3-201(2)

R590-150 Commissioner's Acceptance of Examination Reports

Utah Admin. Code R590-150-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-203.

History

KEY: insurance companies
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-203(4)

Utah Admin. Code R590-150-2 Purpose and Scope

(1) The purpose of this rule is to identify the examination reports acceptable to the commissioner.

(2) This rule applies to an insurer licensed under Title 31A, Chapter 5, 9, or 14.

History

KEY: insurance companies
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-203(4)

Utah Admin. Code R590-150-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance companies
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-203(4)

Utah Admin. Code R590-150-4 Rule

An examination report prepared by the state of domicile or port of entry state will be accepted in lieu of an examination under Section 31A-2-203 if:

(1) the insurance department that prepared the report was, at the time of the examination, accredited under the National Association of Insurance Commissioners' Financial Regulation Standards and Accreditation Program;

(2) the examination is performed under the supervision of an accredited insurance department; or

(3) the examination is performed with the participation of one or more examiners employed by an accredited insurance department who, after a review of the examination work papers and report, state under oath that the examination was performed in a manner consistent with the standards and procedures required by their insurance department.

History

KEY: insurance companies
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-203(4)

Utah Admin. Code R590-150-5 Severability

If any provision of this rule, Rule R590-150, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: January 10, 2022
Notice of Continuation: January 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-203(4)

R590-152 Health Discount Programs and Value-Added Benefit Rule

Utah Admin. Code R590-152-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-8a-210.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-2 Purpose and Scope

(1) The purpose of this rule is to establish standards for:

(a) a health discount program; and

(b) a value-added benefit.

(2) This rule applies to:

(a) a person offering, operating, or marketing a health discount program; and

(b) a value-added benefit provided by a person licensed under:

(i) Title 31A, Chapter 7, Nonprofit Health Service Insurance Corporations; or

(ii) Title 31A, Chapter 8, Health Maintenance Organizations and Limited Health Plans.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-8a-102. Additional terms are defined as follows:

(1) "Private label entity" means an entity that purchases a health discount program from a health discount program operator and issues or markets the health discount program under the entity's name or logo.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-4 Licensing (Application, Initial, Renewal)

(1) An application for a health discount program operator or a health discount program marketer shall be complete and submitted with the appropriate fee.

(2) An application may be denied if the applicant, in any jurisdiction:

(a) is under investigation; or

(b) has been found in violation of a statute or regulation.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-5 Fees and Other Authorized Charges

(1) A health discount program operator may provide a discount or free service through a contracted provider to a member purchaser in exchange for a periodic payment to the program or as a benefit in connection with a membership.

(2) A health discount program operator may charge:

(a) a non-refundable one-time membership charge; and

(b) a refundable periodic fee.

(3) If a membership is cancelled by a health discount program operator that charges a fee in excess of one month, the health discount program operator shall make a pro rata refund of the excess fees paid by the purchaser.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-6 Required Practices

(1) A health discount program operator shall have an active toll-free telephone number for an enrollee to call.

(2) Any communication with a purchaser, a member, or a potential purchaser shall state that the health discount program is a discount plan and not insurance.

(3) When a health discount program operator or a health discount program marketer markets or sells a health discount program with any other product that can be purchased separately, including insured benefits, an itemized list including each fee and premium for each individual product must be provided in writing to the potential purchaser at the time of solicitation.

(4) Information available online to a member must be updated within 30 days from the date of the change.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-7 Value-Added Benefit

(1) Evidence of a value-added benefit shall be available to the commissioner upon request.

(2) Before offering a value-added benefit, a licensee shall:

(a) file with the commissioner a value-added benefit list that includes the following:

(i) the insurer's name and address;

(ii) each form to which the value-added benefit applies; and

(iii) a description of each benefit offered; and

(b) comply with Sections R590-152-10 and R590-152-11, if providing a discount card to a member.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-8 Prohibited Practices

(1) A health discount program operator may not make any payment to a provider for:

(a) participation in the health discount program;

(b) a capitation arrangement;

(d) a bonus; or

(e) any other form of compensation.

(2) A health discount program operator may not offer any insurance benefit unless licensed as an insurance producer and contracted and appointed by the insurer providing the insurance benefit.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-9 Advertising and Marketing

(1) The format and content of any advertisement shall be complete and clear to avoid deceiving or misleading the reader, viewer, or listener.

(2) An advertisement of any insurance product or benefit must comply with:

(a) Section 31A-23a-402; and

(b) Rule R590-130, Rules Governing Advertisements of Insurance.

(3) A health discount program operator must have an executed written agreement with a health discount program marketer before the health discount plan marketer markets, promotes, sells, or distributes a health discount program.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-10 Disclosures

(1) A membership card shall prominently state: "This is not health insurance."

(2) In addition to the disclosures required by Section 31A-8a-205, disclosure materials provided to a purchaser or potential purchaser shall include:

(a) membership materials;

(b) new enrollment information;

(c) a list of the providers that have agreed in writing to accept the health discount program, whether in print or accessible on the health discount program operator's website;

(d) a statement that "A health discount program purchaser is responsible for the entire payment of their medical or health care bill after the discount is applied."; and

(e) the complete terms and conditions of any refund policy.

(4) A health discount program operator or health discount program marketer shall:

(a) provide a purchaser a 30-day money-back guarantee, which allows the purchaser to terminate the contract and receive a full refund of any periodic fee paid; and

(b) start the 30-day money-back guarantee period when the purchaser receives the membership materials.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-11 Contracts

(1) A provider agreement between a health discount program operator and a provider network shall require:

(a) the provider network to have a written agreement with each provider in the network authorizing the provider network to contract with a health discount program operator on behalf of the provider; and

(b) the health discount program operator to provide each provider within the contracted provider network with information about the health discount program.

(2) A provider agreement between a health discount program operator and another health discount program operator that has contracted with a provider network shall require the contract with the provider network to comply with Subsection (1).

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-152-12 Severability

If any provision of this rule, Rule R590-152, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, medical discount program
Date of Last Change: June 21, 2022
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

R590-154 Unfair Marketing Practices Rule; Misleading Names

Utah Admin. Code R590-154-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-2 Purpose and Scope

(1) The purpose of this rule is to provide guidance to a licensee regarding unfair marketing practices.

(2) This rule applies to a licensee under Title 31A, Insurance Code.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Licensee" means a person who holds a license.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-4 Prohibited Practices Findings

The commissioner finds that each practice prohibited in this rule constitutes a misleading, deceptive, or unfairly discriminatory practice that unreasonably restrains competition, except as specifically allowed in this rule.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-5 Licensee Name

(1) A licensee may not use any name that:

(a) is misleading or deceptive;

(b) is likely to be mistaken for another licensee already in business; or

(c) implies association or connection with any other organization where actual bona fide association or connection does not exist.

(2) "Insurance consulting," "insurance consultants" or similar words shall only be used if the licensee is licensed as a consultant.

(3) A licensee shall be licensed using the licensee's legal name.

(4) A licensee may use its legal name or an assumed name if the commissioner is notified.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-6 Selling, Soliciting, or Negotiating for Insurance or Advising or Consultin g About Insurance

(1) When selling, soliciting, or negotiating for insurance or advising or consulting about insurance, a licensee shall:

(a) disclose that the licensee is an insurance licensee; and

(b) use the name of the agency licensee if the individual licensee is designated to act under an agency's license.

(2) When selling, soliciting, or negotiating for insurance or advising or consulting about insurance, a licensee may not:

(a) use or imply a license type or line of authority not held by the licensee; and

(b) sell, solicit, or negotiate insurance or consult or advise for an agency licensee unless the individual licensee is designated to act under the agency's license.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-7 Claiming or Representing Department Approval

(1) A licensee may not represent, either directly or indirectly, that the department, the commissioner, or any employee of the department, has approved, reviewed, or endorsed any marketing program, insurance product, insurance company, practice, or act.

(2) A licensee may report:

(a) the filing of any form, financial report, or other document with the department; or

(b) any licensure, examination, or other action involving the department or the commissioner.

(3) A licensee may not misrepresent the effect or import of any item reported under Subsection (2).

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-8 Unfair Inducements

(1) A multi-level marketing program, investment program, membership, or other similar program designed or represented to produce or provide funds to pay any part of the cost of insurance constitutes an unfair inducement.

(2) A bona fide employee benefit program is not an unfair inducement.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-9 Premium Reduction Through Commissions or Consulting Fees

(1) A licensee may not give or offer to give a premium reduction through a commission or a consulting fee back to the insurer for any purpose, including competition, unless the reduction is for expense savings and is justified by a reasonable standard and with reasonable accuracy.

(2)(a) An insurer's underwriting files must document any savings to enable the commissioner to verify compliance.

(b) The documentation must demonstrate legitimate expense savings realized by the insurer and its producer.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-10 Prohibited Financing Arrangements

A licensee may not obtain or arrange for third party financing of premium without the knowledge and consent of the insured.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-11 Acting as a Licensee in Other Jurisdictions

A resident licensee may not sell, solicit, or negotiate insurance or advise or consult about insurance in another jurisdiction unless licensed or permitted by law to do so in that jurisdiction.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-12 Use of Comparative Information

(1) An insurer marketing insurance in Utah shall establish written marketing procedures to assure that any comparison of insurance contracts, annuities, or insurance companies by its producers will be fair and accurate.

(2) A licensee may not use any published rating information regarding an insurer in connection with the marketing of any insurance contract or annuity unless that person also provides at the same time an explanation of what the rating means, as defined by a credit rating agency.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-13 Disclosure of Insurer in Group Insurance

A certificate of insurance or booklet describing coverage of a group insurance policy shall prominently state on the cover of the certificate or booklet the legal name and address of the actual insurer.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

Utah Admin. Code R590-154-14 Severability

If any provision of this rule, Rule R590-154, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, unfair marketing practices, misleading names
Date of Last Change: January 10, 2022
Notice of Continuation: March 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402; 31A-23a-110

R590-155 Utah Life and Health Insurance Guaranty Association Summary Document

Utah Admin. Code R590-155-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-28-119.

History

KEY: insurance
Date of Last Change: January 24, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-28-119

Utah Admin. Code R590-155-2 Purpose and Scope

(1) The purpose of this rule is to provide guidelines regarding the form and content of the Utah Life and Health Insurance Guaranty Association summary and disclosure document.

(2) This rule applies to a life insurance policy, a health insurance policy, and an annuity contract.

History

KEY: insurance
Date of Last Change: January 24, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-28-119

Utah Admin. Code R590-155-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Contract holder" means the holder of an annuity contract.

History

KEY: insurance
Date of Last Change: January 24, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-28-119

Utah Admin. Code R590-155-4 Rule

(1) An insurer shall disclose to a policyholder and to a contract holder that the Utah Life and Health Guaranty Association may not cover the contractual guarantees in the policy or contract.

(2) The disclosure required in Subsection (1) shall be:

(a) in writing;

(b) given before or at the time a policy, contract, or certificate is delivered;

(d) filed with the commissioner.

(3) The disclosure required in Subsection (1) shall use the text in the Utah Life and Health Insurance Guaranty Association's Notice of Protection, which is available on the department's website, https://insurance.utah.gov.

History

KEY: insurance
Date of Last Change: January 24, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-28-119

Utah Admin. Code R590-155-5 Severability

If any provision of this rule, Rule R590-155, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: January 24, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-28-119

R590-157 Surplus Lines Insurance Premium Tax and Stamping Fee

Utah Admin. Code R590-157-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-3-303, and 31A-15-103.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

Utah Admin. Code R590-157-2 Purpose and Scope

(1) The purpose of this rule is to prescribe:

(a) the amount of the stamping fee;

(b) the accounting and reporting forms and procedures to be used in calculating the surplus lines premium tax and the stamping fee; and

(c) the entities authorized to examine a surplus lines transaction and collect and receive the surplus lines premium tax and the stamping fee.

(2) This rule applies to:

(a) a surplus lines insurer, a surplus lines producer, and a policyholder required to pay a premium tax and stamping fee;

(b) the advisory organization authorized to examine surplus lines transactions; and

(i) collecting the stamping fee and premium tax; and

(ii) remitting the premium tax to the commissioner.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

Utah Admin. Code R590-157-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Courtesy filing" means a surplus lines policy filing done by a resident surplus lines producer on behalf of a resident or non-resident producer whose licensure does not include a surplus lines line of authority.

(2) "Courtesy filing fee" means a fee charged by a resident surplus lines producer for a courtesy filing.

(3) "Stamping fee" means a percentage of policy premium payable for the examination of a surplus lines transaction as required under Subsection 31A-15-103(11).

(4) "Surplus Line Association" or "Association" means the Surplus Line Association of Utah.

(5) "Surplus lines producer" means a person licensed under Subsection 31A-23a-106(1)(i) to place insurance with eligible unauthorized insurers pursuant to Section 31A-15-103.

(6) "Surplus lines insurer" means an unauthorized foreign or alien insurer that is:

(a) subject to Section 31A-15-103;

(b) doing business in this state through surplus lines producers; and

(7) "Surplus lines premium" means the monetary consideration for an insurance policy procured from an unauthorized insurer, and includes policy fees, membership fees, required contributions, or monetary consideration, however designated.

(8) "Surplus lines transaction" means:

(a) the placement of an insurance policy or certificate of insurance with a surplus lines insurer; and

(b) any cancellation, endorsement, audit, or other adjustment to a surplus lines insurance policy that affects the premium.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

Utah Admin. Code R590-157-4 Stamping Fee Amounts

(1) Pursuant to Subsection 31A-15-103(11)(d), the stamping fee for the examination of a surplus lines transaction is 0.18% of the policy premium payable.

(2) A late surplus lines stamping fee payment may be subject to late fees of:

(a) 25% of the stamping fee due;

(b) 1.5% per month from the time of default until the stamping fee is paid in full; and

(3) A courtesy filing fee may not be included as a surplus lines premium when computing premium taxes and stamping fees.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

Utah Admin. Code R590-157-5 Authorized Agency

(1) The commissioner authorizes the Surplus Line Association to act as the commissioner's agent for:

(a) collecting and remitting the premium tax imposed under Section 31A-3-301 on an insurance transaction subject to Sections 31A-15-103, 31A-15-104, and 31A-15-106;

(b) examining surplus lines transactions under Section 31A-15-111;

(d) prescribing the forms and procedures that surplus lines producers may use.

(2) The Surplus Line Association shall remit all premium taxes it collects according to Section R590-157-6.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

Utah Admin. Code R590-157-6 Accounting Procedures

(1) Within 60 days of the effective date of a surplus lines transaction, the surplus lines producer shall file with the Surplus Line Association:

(a) a copy of the insurance policy, binder, certificate, endorsement, or other documentation sufficient to identify the subject of the insurance;

(b) the coverage, conditions, and term of insurance;

(d) the effective date;

(e) the premium charged;

(f) the premium taxes payable;

(g) the policyholder's name and address; and

(h) the surplus lines insurer's name and address.

(2) For each surplus lines producer, the Surplus Line Association shall prepare a monthly statement of surplus lines transactions reported during the preceding 30 days that lists:

(a) each transaction and premium amount reported;

(b) the surplus lines premium taxes due under Section 31A-3-301; and

(3) The monthly statement shall be mailed to each surplus lines producer by the first day of each month.

(4) A surplus lines producer shall pay to the Surplus Line Association, by the 25 th day of each month, the amounts due shown on the monthly statement.

(5) A surplus lines producer shall hold, in trust, any premium taxes and stamping fees until the premium taxes and stamping fees are remitted to the Surplus Lines Association.

(6) The Surplus Line Association shall deposit, in a qualified depository approved by the Office of the State Treasurer, for the credit of the Utah Insurance Department, any funds received as payment of the surplus lines premium tax within three days of receipt.

(7)(a) The Surplus Line Association shall submit a request for payment to the department for premium tax credits for return surplus lines premiums that are not offset by charges in the monthly statement.

(b) The department will, pursuant to the Division of Finance's policies and procedures, issue a reimbursement to the designated person.

(8) The Surplus Line Association shall prepare the following reports for the commissioner's benefit:

(a) a monthly report, submitted by the 15th of the subsequent month, that lists:

(i) the name of each surplus lines producer that reported surplus lines premiums written during the month;

(ii) the amount of each surplus lines producer's reported surplus lines premiums, taxes, and fees;

(iii) the name of each surplus lines insurer; and

(iv) the amount of written surplus lines premium attributed to each surplus lines insurer for the month;

(b) an annual report, submitted by January 31 of each year, that lists:

(i) all surplus lines premiums reported during the previous year; and

(ii) all premium taxes paid during the previous calendar year; and

(c) an annual financial report, submitted within 30 days after the Surplus Line Association's fiscal year ends, that includes the Association's:

(i) income;

(ii) expenses; and

(iii) balance sheet.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

Utah Admin. Code R590-157-7 Severability

If any provision of this rule, Rule R590-157, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance fee, taxes
Date of Last Change: March 16, 2022
Notice of Continuation: December 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-3-303; 31A-15-103

R590-160 Adjudicative Proceedings

Utah Admin. Code R590-160-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 63G-4-102, and 63G-4-203.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-2 Purpose and Scope

(1) The purpose of this rule is to establish procedures governing the designation and conduct of an adjudicative proceeding before the commissioner.

(2)(a) This rule applies to:

(i) an adjudicative proceeding commenced by a complainant;

(ii) an adjudicative proceeding commenced by a petitioner;

(iii) a respondent in an adjudicative proceeding; and

(iv) an intervenor in an adjudicative proceeding.

(b) This rule does not apply to a public hearing under Section 63G-3-302.

(d) The commissioner may permit a deviation from this rule for good cause.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 63G-4-103. Additional terms are defined as follows:

(1) "Commissioner," for purposes of this rule, means Utah's insurance commissioner or a presiding officer designated by Utah's insurance commissioner.

(2) "Complainant" means the department in an action against a licensee or other person alleged to have committed a violation of statute, rule, or order of the commissioner.

(3) "Intervenor" means a person, not a party, permitted to intervene in a formal proceeding under Section 63G-4-207.

(4) "Licensee" means a person who is issued a license or certificate, or is registered under Title 31A, Insurance Code.

(5) "Petitioner" means a person, other than the department, who commences an adjudicative proceeding.

(6) "Pleading" means a document authorized to be filed under Title 63G, Chapter 4, Administrative Procedures Act, and this rule.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-4 Designations of Proceedings

(1) The commissioner designates each of the following as an informal adjudicative proceeding:

(a) denial of an application for a license or a certificate of authority;

(b) disapproval of a rate or form filing;

(d) a matter involving a technical or minor violation of law; or

(e) the entry of a stipulated pleading.

(2) The department may commence an informal or formal adjudicative proceeding pursuant to this rule.

(3) A petitioner may commence a formal adjudicative proceeding pursuant to this rule.

(4) The commissioner shall conduct an informal or formal adjudicative proceeding.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-5 Rules Applicable to Any Adjudicative Proceeding

The following rules apply to an adjudicative proceeding:

(1)(a) The time within which an act is completed is computed by excluding the first day and including the last day, unless the last day is a Saturday, Sunday, or a legal holiday.

(b) If the last day is a Saturday, Sunday, or a legal holiday, the last day is excluded and the period runs until the end of the next day that is not a Saturday, Sunday, or a legal holiday.

(2) A party to a proceeding is named in the caption as petitioner, complainant, respondent, or intervenor.

(3) Representing a party and entering an appearance.

(a) Representing a party.

(i) An attorney who is an active member, in good standing, of the Utah State Bar or an attorney with an active license from another jurisdiction may represent a party.

(ii) An individual who is a party to an adjudicative proceeding may self-represent.

(iii) An officer authorized by corporate resolution may represent a corporation that is registered with the Department of Commerce, Division of Corporations and Commercial Code.

(iv) A general partner may represent a partnership.

(v) An authorized member or manager may represent a limited liability company that is registered with the Department of Commerce, Division of Corporations and Commercial Code.

(vi) The legal, registered owner of a business conducted under an assumed name is considered the legal party in interest and only the legal party in interest or an attorney may represent the business.

(b) Entering an appearance.

(i) A party's attorney or representative enters an appearance by:

(A) filing a notice of agency action;

(B) filing a request for agency action;

(D) filing a notice of appearance; or

(E) orally stating an appearance at a hearing.

(ii) The appearance shall include the attorney's or representative's name, address, email, telephone number, and the party's position or interest in the proceeding.

(4) Pleadings.

(a) A pleading shall be in substantially the following form:

(i) centered heading, BEFORE THE UTAH INSURANCE COMMISSIONER;

(ii) left side, identification of parties;

(iii) right side, title of pleading;

(iv) right side, name of presiding officer; and

(v) right side, docket number.

(b) A pleading shall clearly and concisely present a party's position or request, and the grounds in support.

(d) Signing a pleading.

(i) A pleading shall be signed and dated by the party, the party's attorney, or other authorized representative, and shall include the signer's address, telephone number, and email.

(ii) The signature in Subsection (4)(d)(i) certifies that:

(A) the signer has read the pleading; and

(B) to the best of the signer's knowledge and belief, there are grounds to support the pleading.

(e) Motion.

(i) A motion, other than a motion made orally at a hearing, shall be in writing and shall state the basis for relief.

(A) An affidavit, declaration, or other document may be submitted in support of a motion.

(B) The commissioner may decide a motion with or without a hearing.

(ii) A motion shall be filed and served at least ten days before the date set for the hearing.

(5)(a) A pleading is filed with the commissioner by mail or by submitting a PDF to uidadmincases@utah.gov.

(b) A pleading is filed on the date received.

(6) Service of a pleading.

(a) A copy of a pleading filed with the commissioner shall be served on each party to the proceeding.

(b) The department may be served with a summons, complaint, petition, or other pleading that commences a proceeding by sending a copy of the document by certified mail to the commissioner.

(c) The department may be served with any other pleading by ordinary mail or by sending a PDF to the email address of the attorney representing the department in the proceeding.

(d) A licensee or a certificate holder may be served by:

(i) regular mail;

(ii) sending a PDF to the current email address provided to the department by the licensee under Rule R590-258; or

(iii) sending a PDF to the current email address set forth in the pleading last filed by or on behalf of the licensee.

(e) A pleading shall include a certificate of service that:

(i) identifies the person that was served with the pleading;

(ii) contains the service email address or mailing address; and

(iii) certifies the date and method of service.

(f) When an attorney or other authorized representative represents a party, service upon the attorney or representative constitutes service upon the party.

(7) Disqualification of a presiding officer designated by the commissioner.

(a) A party may move to disqualify a presiding officer by filing a motion with the commissioner alleging the basis for disqualification.

(b) The commissioner may request additional briefing, evidence, or testimony as necessary to decide the motion.

(i) An adjudicative proceeding is stayed until the commissioner decides the motion.

(ii) A party may not appeal the commissioner's decision regarding the motion to disqualify until a final order is entered on the motion.

(d) If a presiding officer is disqualified, the commissioner shall appoint another presiding officer.

(8) Ex parte contact may not occur between the commissioner and a party, the party's attorney, or the party's representative.

(9) An issue of fact in an adjudicative proceeding is decided by a preponderance of the evidence.

(10) Burden of proof.

(a) A party that commences an adjudicative proceeding has the burden to prove entitlement to the relief sought.

(b) A party that asserts an affirmative defense to a request for relief has the burden to prove entitlement to the affirmative defense.

(11) Dismissing an adjudicative proceeding.

(a) A complainant or a petitioner may dismiss an adjudicative proceeding by filing:

(i) a notice of dismissal before the respondent serves a response to the initial pleading; or

(ii) a stipulation of dismissal signed by each party that has appeared.

(b) Except as provided in Subsection (11)(a), the commissioner, by order, may dismiss an adjudicative proceeding at a party's request only on terms the commissioner considers proper.

(c) If a complainant or a petitioner fails to prosecute the adjudicative proceeding, the commissioner may dismiss the proceeding after applying the standard for dismissal for failure to prosecute under Utah Rules of Civil Procedure, Rule 41.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-6 Rules Applicable to a Formal Adjudicative Proceeding

(1) A hearing in a formal adjudicative proceeding shall comply with Section 63G-4-206.

(2) The commissioner may direct the parties to participate in a prehearing conference.

(3) The commissioner may grant a motion to continue a proceeding for good cause.

(4) Unless ordered closed by the commissioner for good cause, a hearing in a formal adjudicative proceeding is open to the public.

(5) Telephonic testimony.

(a) The commissioner may, when the witness's identity can be established with reasonable certainty, take testimony telephonically.

(b) If telephonic testimony is taken, a party may hear the testimony and examine or cross-examine the witness.

(6) Record of a hearing.

(a) Recording.

(i) A record of a hearing is made by audio recording.

(ii) The commissioner shall provide a copy of the recording at the request and expense of a party other than the department.

(b) Transcript of a hearing.

(i) On reasonable notice to and approval from the commissioner, a party may employ a certified court reporter to record and transcribe a hearing.

(ii) The party seeking approval to use a court reporter shall pay for the reporter and file the original transcript with the commissioner at no cost to the department.

(iii) A party requesting a copy of the transcript may purchase the transcript copy from the reporter.

(7) Subpoenas.

(a) A subpoena is issued and served under the Utah Rules of Civil Procedure, Rule 45.

(b) A party requesting a subpoena shall pay a witness the same fee and mileage the law allows for a district court.

(8) Discovery may be conducted by:

(a) the parties' agreement; or

(b) the commissioner's order.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-7 Rules Applicable to an Informal Adjudicative Proceeding

(1)(a) The department may commence an informal adjudicative proceeding by issuing a Notice of Agency Action and Order under Subsection R590-160-4(1).

(b) The order in Subsection (1)(a) is based on information contained in:

(i) an affidavit;

(ii) a declaration; or

(iii) the department's files.

(c) The order in Subsection (1)(a) constitutes a proposed order that becomes final 15 days after service on the respondent unless a written request for a hearing is received before the expiration of 15 days.

(2) A respondent's failure to timely request a hearing in an informal adjudicative proceeding is a failure to exhaust administrative remedies.

(3) When a hearing is requested in an informal adjudicative proceeding, a notice of a prehearing conference is issued stating the matters to be decided and giving notice of the prehearing scheduling conference's date, time, and location.

(4) A hearing in an informal adjudicative proceeding may be of record.

(5)(a) At a hearing in an informal adjudicative proceeding, the commissioner may receive, regarding the issues to be decided, the following;

(i) testimony;

(ii) proffer of evidence;

(iii) affidavit;

(iv) declaration; or

(v) argument.

(b) The commissioner may issue a subpoena requiring a witness's attendance or the production of necessary evidence.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-8 Agency Review

(1)(a) Agency review of an adjudicative proceeding, except an informal adjudicative proceeding that becomes final without a request for a hearing under Subsection R590-160-7(1), is available to a party to a proceeding by filing a request for agency review with the commissioner within 30 days of the date of the order.

(b) Failure to seek agency review is a failure to exhaust administrative remedies.

(2) Agency review shall comply with Section 63G-4-301.

(3)(a) The commissioner or the commissioner's designee shall conduct the review.

(b) A designee may not be the presiding officer who issued the decision under review.

(d) The commissioner will make the final decision and sign the order.

(4) Content of a request for agency review.

(a) A request for agency review shall comply with Subsection 63G-4-301(1)(b), and shall include the following:

(i) a copy of the order that is the subject of the request;

(ii) the factual basis for the request, including:

(A) citation to the record of the formal adjudicative proceeding; and

(B) clear reference to evidence or a proffer of evidence in an informal adjudicative proceeding;

(iii) the legal basis for the request, including citation to supporting authority;

(iv) for a challenge to a finding of fact in a formal adjudicative proceeding, the reason that the finding is not supported by substantial evidence based on the entire record; and

(v) for a challenge to a finding of fact in an informal adjudicative proceeding, the reason that the finding is not supported by substantial evidence based on the evidence received or proffered.

(b) A party challenging a finding of fact in a formal adjudicative proceeding shall:

(i) order a transcript of the recording relevant to the finding;

(ii) certify that a transcript is ordered;

(iii) file the transcript with the commissioner or the commissioner's designee;

(iv) serve a copy of the transcript on each party; and

(v) pay the cost of preparing the transcript.

(5) Memoranda.

(a)(i) A party requesting agency review shall submit a supporting memorandum with the request.

(ii) If a transcript is necessary to conduct agency review, a supporting memorandum shall be filed no later than 15 days after the service of the transcript on the opposing party.

(b) An opposing memorandum shall be filed no later than 15 days after the supporting memorandum is filed.

(d) The commissioner or the commissioner's designee may order a party to submit additional memoranda to assist in conducting agency review.

(6) Request for a stay.

(a) On motion by a party and for good cause, the commissioner or commissioner's designee may stay the presiding officer's order during the pendency of agency review.

(b) A motion for a stay shall be made in writing and may be made at any time during the pendency of agency review.

(7)(a) A party may request oral argument in the party's initial pleading.

(b) The commissioner or the commissioner's designee may grant oral argument if requested in a party's initial pleading.

(8) Failure to comply with Section R590-160-8 may result in the commissioner or the commissioner's designee dismissing the request for agency review.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-9 Sanctions

(1)(a) The commissioner may sanction a party, a party's representative, a witness, or a witness's representative for:

(i) contemptuous conduct;

(ii) disobedient conduct; or

(iii) failure to comply with this rule or a lawful order.

(b) A sanction may include:

(i) excluding evidence;

(ii) dismissing one or more claims;

(iii) striking a pleading or a portion of a pleading;

(iv) entering a default judgment; or

(v) ordering payment of costs, expenses, reasonable attorney fees, and other fees.

(2) The commissioner may take reasonable steps to control the conduct of an adjudicative proceeding.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

Utah Admin. Code R590-160-10 Severability

If any provision of this rule, R590-160, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: October 11, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 63G-4-102; 63G-4-203

R590-161 Income Replacement Insurance Policy Disclosure

Utah Admin. Code R590-161-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-161-2 Purpose and Scope

(1) The purpose of this rule is to require that an insurer providing an income replacement insurance policy give notice to each insured regarding reduction of benefit provisions.

(2) This rule applies to an insurer that provides an income replacement insurance policy.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-161-3 Definition

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-161-4 Rule

Unless the reduction is clearly explained in the outline of coverage, the group certificate, and the policy, the amount of benefit payable by an insurer under an income replacement insurance policy may not be reduced by any:

(1) worker's compensation benefit paid to the insured;

(2) social security benefit paid to the insured; or

(3) other amount the insured has received, or is entitled to receive by law or contract, including any other income replacement insurance policy.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-161-5 Severability

If any provision of this rule, Rule R590-161, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: December 9, 2021
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-162 Actuarial Opinion and Memorandum Rule

Utah Admin. Code R590-162-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-503.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-2 Purpose and Scope

(1) The purpose of this rule is to prescribe:

(a) requirements for statements of actuarial opinion and memoranda in support that are submitted under Section 31A- 17-503;

(b) guidance for adequacy of reserves; and

(2)(a) This rule applies to a company that:

(i) files a life, accident and health annual statement; or

(ii) is authorized to reinsure life insurance, annuities, or accident and health insurance business.

(b) This rule allows an appointed actuary to use professional judgment in performing an asset adequacy analysis and developing an actuarial opinion and supporting memoranda, consistent with applicable actuarial standards of practice.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Actuarial opinion" means an opinion of an appointed actuary regarding the adequacy of reserves and related actuarial items based on an asset adequacy test under Section R590-162-5 and applicable actuarial standards of practice.

(2) "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.

(3) "Annual statement" means a statement required under Section 31A-4-113.

(4) "Appointed actuary" means an individual who is appointed or retained in accordance with the requirements in Subsection R590-162-4(2) to provide the actuarial opinion and supporting memorandum required under Section 31A-17-503.

(5)(a) "Asset adequacy analysis" means an analysis that meets the standards of practice of the Actuarial Standards Board and this rule and that forms the basis of the statement of actuarial opinion.

(b) An asset adequacy analysis may take the form of:

(i) cash flow testing;

(ii) sensitivity testing; or

(iii) an application of risk theory.

(6) "Company" means a life insurance company, a fraternal benefit society, or a reinsurer.

(7)(a) "Qualified actuary" means an individual who:

(i) is a member in good standing of the American Academy of Actuaries;

(ii) is qualified to sign a statement of actuarial opinion for a life and health insurance company annual statement in accordance with the American Academy of Actuaries qualification standards for actuaries signing an annual statement; and

(iii) is familiar with the valuation requirements applicable to a life and health insurance company.

(b) "Qualified actuary" does not include an individual who:

(i) has been found by the commissioner, following notice and hearing, to have:

(A) violated a provision of Utah law in the course of a person's dealings as a qualified actuary;

(B) been guilty of fraudulent or dishonest practices;

(D) submitted to the commissioner, during the past five years, an actuarial opinion or memorandum that the commissioner rejected because it did not meet the provisions of this rule or the standards set by the Actuarial Standards Board; or

(E) resigned or been removed as an actuary within the past five years because of acts or omissions indicated in any adverse report on examination or because of a failure to adhere to generally acceptable actuarial standards; or

(ii) failed to notify the commissioner of any action taken by a commissioner of another state similar to that in this Subsection (7)(b).

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-4 General Requirements of an Actuarial Opinion

(1) Submitting a Statement of Actuarial Opinion.

(a) A statement of an appointed actuary setting forth an opinion relating to reserves and related actuarial items held in support of a policy or a contract, entitled Statement of Actuarial Opinion, shall be included with the annual statement.

(b) For a foreign or an alien company, the commissioner may accept a statement of actuarial opinion filed by a company with the insurance regulator of another state if the commissioner determines that the opinion reasonably meets the requirements applicable to a company domiciled in this state.

(2) Appointed Actuary.

(a) An appointed actuary shall be appointed either directly by or by the authority of the Board of Directors through an executive officer of the company other than the appointed actuary.

(b) A company shall:

(i) give the commissioner timely written notice of the name, title, and, in the case of a consulting actuary, the name of the firm and manner of appointment or retention of each person appointed by a company as an appointed actuary; and

(ii) state in the notice that the individual meets the requirements of a qualified actuary.

(c) When notice is provided, no further notice is required for the appointed actuary, provided the company gives the commissioner timely written notice that the actuary ceases to be appointed or meet the requirements of a qualified actuary.

(d) If an appointed actuary replaces a previously appointed actuary, the notice shall give the reasons for replacement.

(3) Liabilities to be Covered.

(a) Under Section 31A-17-503, a statement of actuarial opinion applies to an in-force business on the statement date, whether directly issued or assumed, regardless of when or where issued.

(b) If an appointed actuary determines, as the result of an asset adequacy analysis, that a reserve should be held in addition to the aggregate reserve held by a company and calculated in accordance with methods under Title 31A, Chapter 17, Part 5, Standard Valuation Law, the company shall establish the additional reserve.

(c) Additional reserves established under Subsection (3)(b) and considered not necessary in subsequent years may be released.

(i) Reserves that are released shall be disclosed in the actuarial opinion for the applicable year.

(ii) The release of reserves is not an adoption of a lower standard of valuation.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-5 Statement of Actuarial Opinion Based on an Asset Adequacy Analysis

(1) General Description.

(a) A statement of actuarial opinion based on an asset adequacy analysis shall include a paragraph identifying:

(i) the appointed actuary and the appointed actuary's qualifications;

(ii) the scope of the actuarial opinion, describing:

(A) the appointed actuary's work, with a tabulation delineating the reserves and related actuarial items analyzed for asset adequacy and the method of analysis; and

(B) the reserves and related actuarial items covered by the opinion that were not analyzed;

(iii) the areas where the appointed actuary deferred to another expert in developing data, procedures, or assumptions, such as anticipated cash flows from currently owned assets including variation in cash flows according to economic scenarios, supported by a statement of each expert in the form prescribed by Subsection (5); and

(iv) the appointed actuary's opinion of the adequacy of the supporting assets to mature the liabilities.

(b) Additional paragraphs may be needed if the appointed actuary:

(i) considers it necessary to state a qualification of the opinion;

(ii) is required to disclose the method of aggregation for reserves of different products or lines of business for asset adequacy analysis;

(iii) is required to disclose reliance upon a portion of the assets supporting the Asset Valuation Reserve (AVR), Interest Maintenance Reserve (IMR), or other mandatory or voluntary statement of reserves for asset adequacy analysis;

(iv) is required to disclose an inconsistency in the method of analysis or basis of asset allocation used at the prior year opinion;

(v) is required to disclose whether additional reserves of the prior year opinion are released as of the current year opinion, and the extent of the release; or

(vi) chooses to add a paragraph briefly describing the assumptions that form the basis for the actuarial opinion.

(2) Required Language.

The language in a statement of actuarial opinion may be modified as needed to meet the circumstances of a particular case, but the appointed actuary shall use language that clearly expresses the appointed actuary's professional judgment. The following paragraphs shall be included in the statement of actuarial opinion.

(a)(i) The opening paragraph shall state the appointed actuary's relationship to the company and the appointed actuary's qualifications to sign the opinion.

(ii) For a company actuary, the opening paragraph of the actuarial opinion shall read as follows:

"I, (name), am (title) of (insurance company name) and a member of the American Academy of Actuaries. I was appointed by, or by the authority of, the Board of Directors of said insurer to render this opinion as stated in the letter to the commissioner dated (insert date). I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."

(iii) For a consulting actuary, the opening paragraph shall read as follows:

"I, (name), a member of the American Academy of Actuaries, am associated with the firm of (name of consulting firm). I have been appointed by, or by the authority of, the Board of Directors of (name of company) to render this opinion as stated in the letter to the commissioner dated (insert date). I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."

(b) The scope paragraph shall include the following statement:

"I have examined the actuarial assumptions and actuarial methods used in determining reserves and related actuarial items listed below, as shown in the annual statement of the company, as prepared for filing with state regulatory officials, as of

December 31, 20__. Tabulated below are those reserves and related actuarial items which have been subjected to asset adequacy analysis."

(c)(i) If an appointed actuary relies on another expert to develop certain portions of the analysis, a reliance paragraph shall include the following statement:

"I have relied on (name), (title) for (e.g., anticipated cash flows from currently owned assets, including variations in cash flows according to economic scenarios or certain critical aspects of the analysis performed in conjunction with forming my opinion), as certified in the attached statement I have reviewed the information relied upon for reasonableness."

(ii) A statement of reliance on another expert shall be accompanied by a statement from each expert in a form prescribed by Subsection (5).

(d) If an appointed actuary examined the underlying asset and liability records, the reliance paragraph shall include the following:

"My examination included such review of the actuarial assumptions and actuarial methods and of the underlying basic asset and liability records and such tests of the actuarial calculations as I considered necessary. I also reconciled the underlying basic asset and liability records to (exhibits and schedules listed as applicable) of the company's current annual statement."

(e)(i) If an appointed actuary has not examined the underlying records, but has relied upon data prepared by the company or a third party, the reliance paragraph shall include the following statement:

"In forming my opinion on (specify types of reserves) I have relied upon data prepared by (name and title of company officer certifying in-force records or other data) as certified in the attached statement. I evaluated that data for reasonableness and consistency. I also reconciled that data to (exhibits and schedules to be listed as applicable) of the company's current annual statement. In other respects my examination included such review of the actuarial assumptions and actuarial methods and such tests of the actuarial calculations as I considered necessary."

(ii) A statement of reliance shall be accompanied by a statement from each person relied upon in a form prescribed by Subsection (5).

(f) The opinion paragraph shall include:

(i) "In my opinion the reserves and related actuarial values concerning the statement items identified above:

(A) are computed in accordance with presently accepted actuarial standards consistently applied and are fairly stated, in accordance with sound actuarial principles;

(B) are based on actuarial assumptions which produce reserves at least as great as those called for in any contract provision as to reserve basis and method, and are in accordance with all other contract provisions;

(C) meet the requirements of the insurance laws and rules of the state of (state of domicile) and are at least as great as the minimum aggregate amounts required by the state in which this statement is filed;

(D) are computed on the basis of assumptions consistent with those used in computing the corresponding items in the annual statement of the preceding year-end (with any exceptions noted below);

(E) include provision for all actuarial reserves and related statement items which ought to be established";

(ii) "The reserves and related items, when considered in light of the assets held by the company with respect to such reserves and related actuarial items including, but not limited to, the investment earnings on such assets, and the considerations anticipated to be received and retained under such policies and contracts, make adequate provision, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the company";

(iii) "The actuarial methods, considerations and analyses used in forming my opinion conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis of this statement of opinion';

(iv)(A) "This opinion is updated annually as required by statute. To be best of my knowledge, there have been no material changes from the applicable date of the annual statement to the date of the rendering of this opinion which should be considered in reviewing this opinion"; or

(B) "The following material change(s) which occurred between the date of the statement for which this opinion is applicable and the date of this opinion should be considered in reviewing this opinion (describe the change or changes)";

(v) "The impact of unanticipated events subsequent to the date of this opinion is beyond the scope of this opinion. The analysis of asset adequacy portion of this opinion should be viewed recognizing that the company's future experience may not follow all the assumptions used in the analysis"; and

(vi) a signature block including the:

(A) signature of the appointed actuary;

(B) address of the appointed actuary;

(D) date.

(3) Assumption for New Issue.

The adoption for new issues or new claims or other new liabilities of an actuarial assumption that differs from a corresponding assumption used for prior new issues or new claims or other new liabilities is not a change in an actuarial assumption within the meaning of this section.

(4) Adverse Opinion.

(a) If an appointed actuary cannot form an opinion, the actuary shall refuse to issue a statement of actuarial opinion.

(b)(i) If an appointed actuary's opinion is adverse or qualified, the actuary shall issue an adverse or qualified actuarial opinion explicitly stating the reason for the opinion.

(ii) The explicit statement required under Subsection (4)(b)(i) shall follow the scope paragraph and precede the opinion paragraph.

(5) Reliance on Data Furnished by Other Persons.

(a) If an appointed actuary relies on the certification of others on matters concerning the accuracy or completeness of any data underlying the actuarial opinion, or the appropriateness of any other information used by the appointed actuary in forming the actuarial opinion, the actuarial opinion shall state the persons the actuary is relying on and identify the items the actuary is relying on.

(b)(i) A person that the appointed actuary relies on shall provide a certification that identifies the items the person is providing information about and a statement as to the accuracy, completeness, or reasonableness of the items.

(ii) The certification shall include the signature, date, title, company, address, and telephone number of the person providing the certification.

(6) Alternate Option.

(a) As an alternative to the requirements of Subsection (2)(f)(i)(C), an appointed actuary may state that the reserves and related actuarial values "meet the requirements of the insurance laws and rules of the State of (state of domicile) and I have verified that the company's request to file an opinion based on the laws of the state of domicile has been approved by the commissioner and that any conditions required by the commissioner for approval of the request have been met."

(b)(i) To use an alternative, the company shall file a request with the commissioner, along with justification for its use, no later than April 30 of the year the opinion is filed.

(ii) The request is approved on October 1 of that year if the commissioner has not denied the request by that date.

(c)(i) The commissioner may reject an opinion based on the laws of the state of domicile and require an opinion based on the laws of this state.

(ii) If a company cannot provide the opinion within 60 days of the request or other period determined by the commissioner after consultation with the company, the commissioner may contract with an independent actuary at the company's expense to prepare and file the opinion.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-6 Description of Actuarial Memorandum Including an Asset Adequacy Analysis

(1) General Provisions of Actuarial Memorandum.

(a)(i) Under Section 31A-17-503, an appointed actuary shall prepare a memorandum to a company describing the analysis done in support of the opinion with respect to reserves, and shall make it available for examination by the commissioner upon request.

(ii) The memorandum shall be returned to the company after examination by the commissioner and is not considered a record of the department or subject to automatic filing with the commissioner.

(b) In preparing the memorandum, the appointed actuary may rely on, and include as a part of the memorandum, memoranda prepared and signed by other qualified actuaries, with respect to the areas covered in the memoranda.

(c)(i) If the commissioner requests a memorandum and a memorandum does not exist or if the commissioner finds that the analysis described in the memorandum fails to meet the standards of the Actuarial Standards Board or the standards and requirements of this rule, the commissioner may designate a qualified actuary to review the opinion and prepare a supporting memorandum as required for review.

(ii) A reasonable and necessary expense of the independent review shall be paid by the company but the review is directed and controlled by the commissioner.

(d)(i) The reviewing actuary has the same status as an examiner for purposes of obtaining data from the company.

(ii) The work papers and documentation of the reviewing actuary are retained by the commissioner; however, any information provided by the company to the reviewing actuary and included in the work papers are considered material provided by the company to the commissioner and are kept confidential pursuant to Section 31A-17-517.

(iii) The reviewing actuary may not be an employee of a consulting firm involved with the preparation of any prior memorandum or opinion for the insurer pursuant to this rule for the current year or the preceding three years.

(e)(i) Under Section 31A-17-503, the appointed actuary shall prepare a regulatory asset adequacy issues summary, pursuant to Subsection (3).

(ii) A company domiciled in this state shall submit the regulatory asset adequacy issues summary no later than March 15 of the year following the year a statement of actuarial opinion based on asset adequacy is required.

(iii) A foreign company shall make the regulatory asset adequacy issues summary available to the commissioner upon request.

(iv) The regulatory asset adequacy issues summary is kept confidential to the same extent and under the same conditions as the actuarial memorandum.

(2) Detail of the Memorandum Documenting Asset Adequacy Analysis.

The memorandum documenting asset adequacy analysis shall demonstrate that the analysis was done in accordance with the standards for asset adequacy and shall include:

(a) for reserves:

(i) product descriptions including market description, underwriting and other aspects of a risk profile, and the specific risks the appointed actuary considers significant;

(ii) source of liability in force;

(iii) reserve method and basis;

(iv) investment reserves;

(v) reinsurance arrangements;

(vi) identification of an explicit or implied guarantee made, the general account in support of benefits provided through a separate account or under a separate account policy or contract, and the method used by the appointed actuary to provide for the guarantee in the asset adequacy analysis; and

(vii) documentation of assumptions to test reserves for the following:

(A) lapse rates, including both base and excess;

(B) interest crediting strategy;

(D) policyholder dividend strategy;

(E) competitor or market interest rate;

(F) annuitization rates;

(G) commissions and expenses; and

(H) morbidity;

(b) for assets:

(i) portfolio descriptions, including a risk profile disclosing the quality, distribution, and types of assets;

(ii) investment and disinvestment assumptions;

(iii) source of asset data;

(iv) asset valuation bases; and

(v) documentation of assumptions made for:

(A) default costs;

(B) bond call function;

(D) determining market value for assets sold due to disinvestment strategy; and

(E) determining yield on assets acquired through the investment strategy;

(i) methodology;

(ii) rationale for inclusion or exclusion of different blocks of business and how pertinent risks were analyzed;

(iii) rationale for degree of rigor in analyzing different blocks of business, including the level of materiality used to determine how rigorously to analyze different blocks of business;

(iv) criteria for determining asset adequacy, including the criteria used to determine if assets are adequate to cover reserves under moderately adverse conditions or other conditions specified in relevant actuarial standards of practice; and

(v) effect of federal income taxes, reinsurance, and other relevant factors;

(d) summary of material changes in methods, procedures, or assumptions from prior year's asset adequacy analysis;

(e) summary of results; and

(f) conclusions.

(3) Detail of the Regulatory Asset Adequacy Issues Summary.

A regulatory asset adequacy issues summary shall include:

(a) a description of the scenarios tested, including whether those scenarios are stochastic or deterministic, and the sensitivity testing done relative to those scenarios;

(i) if negative ending surplus results under certain tests in aggregate, the actuary shall describe those tests and the amount of additional reserve as of the valuation date that, if held, would eliminate the negative aggregate surplus values; and

(ii) ending surplus values shall be determined by either extending the projection period until the in force and associated assets and liabilities at the end of the projection period are immaterial or by adjusting the surplus amount at the end of the projection period by an amount that appropriately estimates the value that can reasonably be expected to arise from the assets and liabilities remaining in force;

(b) the extent to which the appointed actuary uses assumptions in the asset adequacy analysis that are materially different than the assumptions used in the previous asset adequacy analysis;

(c) the amount of reserves and the identity of the product lines subject to asset adequacy analysis in the prior year opinion but not subject to analysis for the current year opinion;

(d) comments on any interim results that may be of significant concern to the appointed actuary, for example, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserve during one or more interim periods;

(e) the methods used by the actuary to recognize the impact of reinsurance on the company's cash flows, including both assets and liabilities, under each scenario tested;

(f) whether the actuary is satisfied that all options, whether explicit or embedded, in any asset or liability, including those affecting cash flows embedded in fixed income securities, and equity-like features in an investment were appropriately considered in the asset adequacy analysis;

(g) the name of the company the regulatory asset adequacy issues summary is being prepared for;

(h) the signature of the appointed actuary; and

(i) the date of the actuarial opinion.

(4) Documentation.

(a) The appointed actuary shall retain, for at least seven years, sufficient documentation to determine the procedures followed, the analyses performed, the bases for assumptions, and the results obtained.

(b) The documentation shall be of such quality that an actuary reviewing the actuarial memorandum can form a conclusion as to the reasonableness of the assumptions.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-7 Exemptions

(1) Unless ordered by the commissioner, a company that is under supervision, rehabilitation, or liquidation is exempt from the requirements of this rule.

(2)(a) At the discretion of the commissioner, a company domiciled in this state and doing business only in this state may submit an opinion without the statement required under Subsection R590-162-5(2)(f)(ii).

(b) If the commissioner grants an exemption under Subsection (2)(a), the company is exempt from preparing and submitting the regulatory asset adequacy issues summary document required under Subsection R590-162-6(1)(e).

(3) A company domiciled in this state may apply to the commissioner for an exemption from:

(a) the requirement to submit an actuarial opinion under Subsection R590-162-4(1)(a);

(b) the requirement to include within its actuarial opinion the statement under Subsection R590-162-5(2)(f)(ii); or

(c) the requirement to prepare and submit the regulatory asset adequacy issues summary document under Subsection R590-162-6(1)(e).

(2) A company seeking an exemption under Subsection (3) shall:

(a) submit a written request for an exemption no later than November 1 of the year for which the exemption is sought; and

(b) provide a written explanation and supporting documents explaining how complying with the requirement for which an exemption is sought would not enhance the department's understanding of the financial position of the company and, therefore, be an unnecessary burden on the company.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

Utah Admin. Code R590-162-8 Severability

If any provision of this rule, Rule R590-162, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: August 8, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-17-503

R590-164 Uniform Health Billing Rule

Utah Admin. Code R590-164-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-614.5.

History

KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5

Utah Admin. Code R590-164-2 Purpose and Scope

(1) The purpose of this rule is to designate uniform claim forms, billing codes, and compatible electronic data interchange standards for use by health payers and providers.

(2) This rule applies to a health claim, a health encounter, and any electronic data interchange between a payer and a provider.

(3) Except as otherwise specifically provided, this rule applies to a payer and a provider.

(4) This rule does not prohibit a payer from requesting additional information to determine eligibility of a claim under the terms of the policy or certificate issued to the claimant.

(5) This rule does not prohibit a payer or provider from using alternative forms or procedures specified in a written contract between the payer and provider.

(6) This rule does not exempt a payer or provider from data reporting requirements under state or federal law or regulation.

History

KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5

Utah Admin. Code R590-164-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "CMS" means the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.

(2) "Electronic Data Interchange Standard" means:

(a) the ASC X12N standard format developed by the Accredited Standards Committee X12N Insurance Subcommittee of the American National Standards Institute and the ASC X12N implementation guides as modified by the UHIN Standards Committee; and

(b) any other standard developed by the UHIN Standards Committee at the request of the commissioner and incorporated by the commissioner in rule.

(3) "HIPAA" means the federal Health Insurance Portability and Accountability Act.

(4) "HPID" means Health Plan Identifier, which is the national unique health plan identifier assigned to identify each individual health plan.

(5) "NUBC" means the National Uniform Billing Committee.

(6) "NUCC" means the National Uniform Claim Committee.

(7) "Payer" means an insurer or third-party administrator that pays, or reimburses for, the costs of health care.

(8) "Provider" means any person, partnership, association, corporation, or other facility or institution that renders health care or professional services, and any officer, employee, or agent of any of the above acting in the course and scope of their employment.

(9) "UHIN Standards Committee" means the Standards Committee of the Utah Health Information Network.

(10) Uniform Claim Codes are defined as:

(a) "ASA codes" means the codes contained in the ASA Relative Value Guide maintained by the American Society of Anesthesiologists to describe anesthesia services and related modifiers.

(b) "CDT codes" means the Current Dental Terminology published by the American Dental Association.

(d) "DRG codes" means Diagnosis Related Group codes, which are universal grouping codes used to clarify the type of inpatient care received, and, when used with a diagnosis code and the length of the inpatient stay, to determine payment and reimbursement for claims.

(e) "HCPCS" means Healthcare Common Procedure Coding System, a coding system that describes products, supplies, procedures, and health professional services, including:

(i) "HCPCS Level 1 codes," which are CPT codes and modifiers for professional services and procedures; and

(ii) "HCPCS Level 2 codes," which are national alphanumeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in CPT codes.

(f) "ICD-CM codes" means the diagnosis and procedure codes in the International Classification of Diseases, Clinical Modifications published by the U.S. Department of Health and Human Services.

(g) "NDC" means the National Drug Codes of the Food and Drug Administration.

(h) "UB-04 Rate Codes" means the code structure and instructions established for use by the NUBC.

(12) Uniform Claim Forms are defined as:

(a) "UB-04" means the health insurance claim form maintained by NUBC for use by institutional care providers.

(b) "Form CMS 1500" means the health insurance claim form maintained by NUCC for use by health care providers.

(d) "NCPDP" means the National Council for Prescription Drug Program's Claim Form or its electronic counterpart.

History

KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5

Utah Admin. Code R590-164-4 Paper Claim Transactions

(1) A payer may require the applicable uniform claim forms competed with the uniform claim codes.

(2) A payer shall accept the applicable uniform claim forms completed with the uniform claim codes.

History

KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5

Utah Admin. Code R590-164-5 Electronic Data Interchange Transactions

(1)(a) The commissioner shall use the UHIN Standards Committee to develop electronic data interchange standards for use by payers and providers transacting health insurance business electronically.

(b) In developing standards for the commissioner, the UHIN Standards Committee shall consult with national standard-setting entities including CMS, NUCC, ASC X12N, NCPDM, and NUBC.

(2) The commissioner shall incorporate a standard adopted by the UHIN Standards Committee into rule before it is required for use by payers and providers.

(3) A payer shall accept the applicable electronic data if transmitted in accordance with the electronic data interchange standard that is incorporated in rule.

(4) A payer may reject electronic data if not transmitted in accordance with the electronic data interchange standard that is incorporated in rule.

(5) The HIPAA electronic data interchange standards described in this Subsection (5) and adopted by the UHIN Standards Committee are incorporated by reference by the commissioner and are available at https://insurance.utah.gov.

(a) "999 Implementation Acknowledgement For Health Care Insurance Standard v3.4." The purpose of the standard is to detail the standard transaction for the reporting of transmission receipt and transaction or functional group X12 and implementation guide error, and adopt the use of the ASC X12 999 transaction.

(b) "Adaptive Behavior Services/Applied Behavior Analysis (ABA) Billing Standard" v3.1." The purpose of the standard is to detail the billing for the transmission of ABA services.

(c) "Administrative Transaction Acknowledgements Standard v3.1." The purpose of the standard is to create a process for acknowledging all electronic transactions between trading partners based on the communication, syntax, semantic, and business process specifications.

(d) "Anesthesia Standard v3.1." The purpose of the standard is to standardize the transmission of anesthesia data for health care services. The standard does not alter any contractual agreement between providers and payers.

(e) "Benefits Enrollment and Maintenance Standard v3.1." The purpose of the standard is to detail the standard transactions for the transmission of health care benefits enrollment and maintenance.

(f) "Claim Acknowledgement Standard v3.2." The purpose of the standard is to provide a standardized claim acknowledgement in response to a claim submission, which is used to report on the status of a claim or encounter at the pre- adjudication processing stage, for example, before the payer is legally required to keep a history of the claim or encounter.

(g) "Claim Status Inquiry and Response Standard v3.2." The purpose of the standard is to detail the standard transactions for the transmission of health care claim status inquiries and response, allow the provider to reduce the need for claim follow-up, and facilitate the correction of claims.

(h) "CMS 1500 Paper Claim Form Standard v3.3." The purpose of the standard is to describe the standard use of each box for print images, and its crosswalk to the HIPAA 837 005010X222A1 Professional implementation guide.

(i) "Coordination of Benefits Standard v3.2." The purpose of the standard is to streamline the coordination of benefits process between payers and providers or payer to payers, define the data to be exchanged for coordination of benefits, and to increase effective communications.

(j) "Dental Claim Billing Standard -- J430 v5." The purpose of the standard is to describe the standard use of each item number for print images, and its crosswalk to the HIPAA 837 005010x02241A1 dental implementation guide, and adopt the American Dental Association Dental Claim Form J43024.

(k) "Electronic Remittance Advice Standard v3.5." The purpose of the standard is to detail the standard transaction for the transmission of a health care remittance advice.

(l) "Eligibility Inquiry and Response Standard v3.3." The purpose of the standard is to detail the standard transactions for the transmission of a health care eligibility inquiry and response.

(m) "Health Care Claim/Encounter Standard v3.2." The purpose of the standard is to detail the standard transaction for the transmission of a health care claim, encounter, and an associated transaction.

(n) "Health Identification Card Standard v1.3." The purpose of the standard is to standardize the patient health identification card information and address the human-readable appearance and machine-readable information used by the healthcare industry to obtain eligibility.

(o) "Health Plan Identifier (HPID) and Other Entity Identifier (OEID) Standard v1.1." The purpose of the standard is to inform providers of the HIPD and OEID and their usage within the administrative transactions.

(p) "Home Health Standard v3.1." The purpose of the standard is to provide a uniform standard of billing for a home health care claim and encounter.

(q) "ICD-10 Standard v1.2." The purpose of the standard is to create the business requirement for a payer and a provider to implement the International Classification of Diseases 10th Revisions, ICD-10, within the administrative transaction.

(r) "Individual Name Standard v2.1." The purpose of the standard is to provide guidance for entering names into provider, payer, or sponsor systems for a patient, enrollee, and any other person associated with a record.

(s) "Metabolic Dietary Products Standard v2.1." The purpose of the standard is to provide a uniform standard for the billing of a metabolic dietary product.

(t) "NPI and Atypical Provider Standard v3.1." The purpose of the standard is to inform a provider of the national provider identifier requirements and the usage within a transaction.

(u) "Pain Management Standard v3.1." The purpose of the standard is to provide a uniform method of submitting a pain management claim, encounter, pre-authorization, and notification.

(v) "Patient Identification Number v3.0." The purpose of the standard is to describe the standard for the patient identification number.

(w) "Premium Payment v3.0." The purpose of the standard is to detail the standard transaction for the transmission of a premium payment.

(x) "Prior Authorization/Referral Standard v3.0." The purpose of the standard is to provide general recommendations to payers and providers about handling an electronic prior authorization and referral.

(y) "Required Unknown Values Standard v3.0." The purpose of the standard is to provide guidance for the use of common data values that can be used within the HIPAA transaction when a required data element is not known by the provider, payer, or sponsor for a patient, enrollee, and any other person associated with the transaction. The data values should only be used when the data is not available or known and may not be used to replace known data.

(z) "Telehealth Standard v3.2." The purpose of the standard is to provide a uniform standard of billing for a health care claim and encounter delivered through telehealth.

(aa) "UB04 Form Locator Elements v3.0." The purpose of the standard is to describe the use of each form locator in the UB-04 claim billing form and its crosswalk to the HIPAA 837 005010X223A2 institutional implementation guide.

History

KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5

Utah Admin. Code R590-164-6 Severability

If any provision of this rule, Rule R590-164, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5

R590-166 Home Protection Service Contracts

Utah Admin. Code R590-166-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-6a-110.

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

Utah Admin. Code R590-166-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish exemptions from certain requirements of Title 31A, Chapter 6a, Service Contracts;

(b) allow for the use of a security deposit, a surety bond, or an irrevocable letter of credit in place of a reimbursement insurance policy; and

(2) This rule applies to a home protection company that chooses to be backed by a security deposit, a surety bond, or an irrevocable letter of credit.

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

Utah Admin. Code R590-166-3 Definition

Terms used in this rule are defined in Sections 31A-1-301 and 31A-6a-101. Additional terms are defined as follows:

(1) "Home protection service contract," "home service contract," or "home warranty" has the same meaning as the term "home warranty service contract" under Section 31A-6a-101.

(2) "Home protection company" has the same meaning as the term "service contract provider" under Section 31A-6a-101.

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

Utah Admin. Code R590-166-4 Exemption from Requirements of Title 31A, Chapter 6a

(1) Upon registering, a home protection company that does not maintain a reimbursement insurance policy shall maintain a security deposit, a surety bond, or an irrevocable letter of credit.

(2) A home protection company that maintains a security deposit, a surety bond, or an irrevocable letter of credit is exempt from the requirements of Subsections 31A-6a-103(1)(a) and (b), 31A-6a-103(2)(b)(iv), 31A-6a-104(1)(a) and (b), 31A-6a-104(2)(a)(i), and 31A-6a-104(3)(a)(i).

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

Utah Admin. Code R590-166-5 Security Deposit, Surety Bond, or Irrevocable Letter of Credit

(1) A home protection company that maintains a security deposit, a surety bond, or an irrevocable letter of credit shall comply with this subsection.

(a)(i) A security deposit shall be in an amount not less than $10,000 for each 500 home protection service contracts in force in this state, but not to exceed $100,000.

(ii) A security deposit must be made in a federally insured financial institution under a tri-party agreement that names the commissioner as a party.

(iii) If a home protection company fails to perform its obligations to its contract holders, the commissioner may make equitable distributions to contract holders from funds on deposit.

(b)(i) A surety bond shall be in favor of the commissioner in the amount of $50,000.

(ii) When the number of home protection service contracts issued by a home protection company in force in this state exceeds 2,500, the amount of a surety bond shall be increased to $100,000.

(iii) A surety bond shall be issued by an insurer authorized to transact surety business in this state.

(iv) A surety bond may not be cancelled or subject to cancellation unless at least 30 days advance written notice is filed with the commissioner and evidence of other security is provided.

(c)(i) An irrevocable letter of credit shall be in favor of the commissioner in the amount of $50,000.

(ii) When the number of home protection service contracts issued by a home protection company in force in this state exceeds 2,500, the amount of an irrevocable letter of credit shall be increased to $100,000.

(iii) An irrevocable letter of credit shall be issued from a bank approved by the commissioner and in a form acceptable to the commissioner.

(iv) An irrevocable letter of credit may not be cancelled or subject to cancellation unless at least 30 days advance written notice is filed with the commissioner and evidence of other security is provided.

(d)(i) Proceeds from a security deposit, a surety bond, or an irrevocable letter of credit under this rule may be administered by the commissioner for the benefit of a person sustaining actionable injury due to the insolvency or impairment of a home protection company.

(ii) At the option of the commissioner, the commissioner may seek to arrange the assumption of an insolvent home protection company's obligations and business on behalf of a solvent company, and apply the insolvent home protection company's deposits or proceeds of a surety bond or an irrevocable letter of credit with the assuming company.

(2)(a) A security deposit, a surety bond, or an irrevocable letter of credit shall be maintained unimpaired while a home protection company continues to do business in this state.

(b) When a home protection company ceases to do business in this state and furnishes the commissioner proof that it has discharged or otherwise adequately provided for each of its obligations to its contract holders, the commissioner shall authorize release of a security deposit, a surety bond, or an irrevocable letter of credit on file at that time.

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

Utah Admin. Code R590-166-6 Annual Statement

(1) A home protection company subject to this rule shall annually, within 90 days after the close of its fiscal year, file with the commissioner an annual statement in a form prescribed by the commissioner.

(2) An annual statement shall include:

(a) a current financial statement prepared in accordance with generally accepted accounting principles, reviewed by an independent certified public accountant and verified by the home protection company's president and principal financial officer;

(b) a home protection company's volume of business in this state during the preceding fiscal year;

(d) a list showing each security deposit, surety bond, and irrevocable letter of credit at year end; and

(e) a statement of assets and liabilities.

(3) A home protection company that fails to timely file its annual statement may be:

(a) fined $500 for each month, or any part thereof, during which such delinquency continues;

(b) subject to suspension until the delinquency is cured to the satisfaction of the commissioner; and

(4) The commissioner may require a home protection company to file additional regular or special reports, as the commissioner considers necessary.

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

Utah Admin. Code R590-166-7 Severability

If any provision of this rule, Rule R590-166, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: February 8, 2022
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-6a-110

R590-167 Individual, Small Employer, and Group Health Benefit Plan Rule

Utah Admin. Code R590-167-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-212, 31A-30-104, 31A-30-106, 31A-30-106.1, and 31A-30-117.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) enhance the availability of health insurance coverage to individuals and small employers;

(b) regulate and prevent abuse in insurer rating practices and establish limits on differences in rates between health benefit plans;

(d) establish limitations on the use of preexisting condition exclusions;

(e) prescribe the way case characteristics may be used;

(f) regulate the use and establishment of separate classes of business;

(g) provide for portability;

(h) improve the overall fairness and efficiency of the individual and small employer health insurance market;

(i) promote broader spreading of risk in the individual and small employer marketplace; and

(j) regulate rating practices for all health benefit plans sold to an individual and a small employer, whether sold directly or through an association or another group of individuals and small employers.

(2)(a) This rule applies to a health benefit plan that:

(i) meets one or more of the criteria in Subsections 31A-30-104(1) and 31A-30-104(2); and

(ii) provides coverage to a covered insured in Utah.

(b) A carrier that issues a health benefit plan to an individual or small employer is not subject to this rule solely because an individual or a small employer that was issued a health benefit plan in another state moves to Utah.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1) "Act" means Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act.

(2) "Change in a rating factor" means the cumulative change of a rating factor over a 12-month period.

(3) "Change in rating method" means:

(a) a change in the number of case characteristics used to determine health benefit plan premium rates in a class of business;

(b) a change in the manner or procedure by which an insured is assigned into a category for applying a case characteristic to determine health benefit plan premium rates in a class of business;

(d) a change in one or more rating factors for any case characteristic if the change produces a change in premium for an individual or small employer that exceeds 10%.

(4) "New entrant" means an eligible employee, or a dependent of an eligible employee, who becomes part of a small employer group after the initial period for enrollment in a health benefit plan.

(5) "Risk characteristic" means a rating factor related to the demographics, health status, or experience of an individual, a small employer, or a member of a small employer group, other than a case characteristic under Section 31A-30-106 or 31A-30-106.1, as applicable, including:

(a) exact age;

(b) gender;

(d) health status;

(e) claims experience;

(f) duration of coverage; or

(g) any similar characteristic.

(6) "Risk load" means the percentage above the base premium rate charged by a covered carrier to a covered insured reflecting the risk characteristics of the covered individual.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-4 Establishment of Classes of Business

(1) A covered carrier with more than one class of business under Section 31A-30-105 shall maintain, for inspection by the commissioner, the following information with respect to each class of business:

(a) a description of all criteria used by the covered carrier or its agents to determine membership in the class of business;

(b) a statement justifying the establishment of each separate class of business and documentation that the establishment of each class of business reflects substantial differences in expected claims experience or administrative costs; and

(c) a statement disclosing each health benefit plan currently available for purchase in the class and any significant limitations related to the purchase of such plans.

(2) For policies issued or renewed on or after January 1, 2011, a covered carrier may not establish a separate class of business without the commissioner's prior approval.

(3) To establish a separate class of business under Subsection (2), a covered carrier shall submit a filing in compliance with Rule R590-220 that includes:

(a) a written request to establish a separate class of business;

(b) a description of all criteria used by the covered carrier, or its agents, to determine membership in the class of business;

(c) a disclosure of each health benefit plan that will be available for purchase in the class and any significant limitations related to the purchase of such plans;

(d) a statement demonstrating that the use of a separate class of business is necessary due to substantial differences in either expected claims experience or administrative costs related to the covered carrier:

(i) using more than one system for the marketing and sale of a health benefit plan to covered insureds;

(ii) acquiring a class of business from another covered carrier; or

(iii) providing coverage to one or more association groups;

(e) a list of previously approved classes of business; and

(f) for each class of business used before January 1, 2011, a certification that the continued use of the class of business is necessary under Subsection (3)(d).

(4) A covered carrier may not, directly or indirectly, use group size as a criterion for establishing eligibility for a class of business.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-5 Transition for Assumptions of Business from Another Carrier

(1)(a) A covered carrier may not transfer or assume the entire insurance obligation, risk, or both, of a health benefit plan covering an individual or a small employer in Utah unless:

(i) commissioner of the state of domicile of the assuming carrier approves the transaction;

(ii) the commissioner of the state of domicile of the ceding carrier approves the transaction;

(iii) the covered carrier provides notice to the commissioner at least 60 days before the date of the proposed assumption, containing the information specified in Subsection (1)(c)(i) for a health benefit plan covering individuals and small employers in Utah; and

(iv) the transaction meets the requirements of this Section R590-167-5.

(b)(i) A covered carrier domiciled in Utah proposing to assume or cede the entire insurance obligation, risk, or both, of one or more health benefit plans covering covered individuals from or to another carrier shall file for approval with the commissioner at least 60 days before the date of the proposed assumption.

(ii) The commissioner may approve the transaction if the commissioner finds that the transaction is in the best interest of the individuals insured under the health benefit plans to be transferred and is consistent with the purposes of the act and this rule.

(iii) The commissioner may not approve the transaction until at least 30 days after the date of the filing, except that if the carrier is in a hazardous financial condition, the commissioner may approve the transaction as soon as the commissioner finds reasonable after the filing.

(c)(i) The filing required under Subsection (1)(b) shall:

(A) describe the class of business, including any eligibility requirements of the ceding carrier;

(B) describe whether the assuming carrier will:

(I) maintain the assumed health benefit plans as a separate class of business under Subsection (3); or

(II) incorporate the health benefit plans into an existing class of business under Subsection (4);

(D) describe whether the assumed health benefit plans are currently available for purchase by individuals or small employers;

(E) describe the effect of the assumption on the benefits provided by the health benefit plans;

(F) describe the effect of the assumption on the health benefit plans' premiums; and

(G) describe any other material effect of the assumption on the coverage provided to the individuals and small employers covered by the assumed health benefit plans.

(ii)(A) A covered carrier required to make a filing under Subsection (1)(b) shall make an informational filing with the commissioner of each state where there is an individual or small employer health benefit plan included in the transaction.

(B) The informational filing to each state shall be made concurrently with the filing made under Subsection (1)(b) and shall include at least the information specified in Subsection (1)(c)(i) for the individual or small employer health benefit plans in that state.

(2)(a) Except as provided in Subsection (2)(b), a carrier may not cede or assume the entire insurance obligation, risk, or both, of an individual or small employer health benefit plan unless the transaction cedes to the assuming carrier the entire class of business.

(b) A covered carrier may cede less than an entire class of business to an assuming carrier if:

(i)(A) one or more individuals or small employers in the class of business exercise their right under contract law or state law to reject the ceding of their health benefit plan to another carrier; and

(B) the transaction includes each health benefit plan in the class of business except those health benefit plans for which an individual or a small employer has rejected the proposed cession; or

(ii) after a written request from the ceding carrier, the commissioner determines that the transfer of less than the entire class of business is in the best interest of the individuals or small employers insured in that class of business.

(3) A carrier that assumes one or more health benefit plans from a covered carrier and maintains the health benefit plans as a separate class of business shall submit a filing requesting approval to establish a separate class of business.

(4) A carrier that assumes one or more health benefit plans from a covered carrier and incorporates the health benefit plans into an existing class of business shall comply with this Subsection (4).

(a) The assumed health benefit plans shall be transferred into a single class of business operated by the assuming carrier.

(b) The assuming carrier shall select the class of business the assumed health benefit plans will be transferred into in a manner that results in the least possible change to the benefits and rating method of the assumed health benefit plans.

(c) A transfer under Subsection (4)(b) shall occur on the anniversary date of a health benefit plan, except that the transfer period may be extended beyond the first anniversary date up to 12 months, if the anniversary date occurs within three months of the date of assumption.

(d) An assuming carrier making a transfer under Subsection (4) may alter the benefits of the assumed health benefit plans to conform with the benefits offered by the carrier in the class of business the health benefit plans are transferred into.

(e)(i) The assuming carrier may not modify the premium rate for the assumed health benefit plans until the health benefit plans are transferred under Subsection (4).

(ii) The assuming carrier shall calculate a new premium rate for the health benefit plans from the rate manual established for the class of business the health benefit plans are transferred into.

(iii) The risk load applied to the health benefit plan may not be higher than the risk load applied to the health benefit plan before the assumption.

(f) During the 15-month period under Subsection (4)(b), the transfer of health benefit plans from the assumed class of business does not violate Subsection 31A-30-106(3)(a) or 31A-30-106.1(8)(a).

(5) An assuming carrier may not apply eligibility requirements, including minimum participation and contribution requirements, to an assumed or subsequently offered health benefit plan, that are more stringent than the requirements applicable to the health benefit plan before assumption.

(6) The act and Section R590-167-5 do not:

(a) reduce any legal or contractual obligation or requirement, including an obligation under Section 31A-14-213, of the ceding or assuming carrier related to the transaction;

(b) authorize a carrier not admitted to transact the business of insurance to offer or insure a health benefit plan in Utah; or

(c) reduce the protections of an assumption reinsurance transaction under Section 31A-14-213 or otherwise provided by law.

(8) Once a health benefit plan has been assumed, the assuming carrier is considered a covered carrier.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-6 Restrictions on Premium Rates

(1)(a) A covered carrier shall develop a separate rate manual for each class of business.

(b) Base premium rates and new business premium rates charged to an individual or a small employer shall be computed solely from the applicable rate manual.

(c) To the extent that a portion of the premium rate is based on the carrier's discretion, the rate manual shall specify the criteria and factors considered by the covered carrier in exercising such discretion.

(2)(a)(i) A covered carrier may not modify the rating method used in the rate manual for a class of business until the change has been approved by the commissioner.

(ii) The commissioner may approve a change to a rating method if the commissioner finds that the change is reasonable, actuarially appropriate, and consistent with the purposes of the act and this rule.

(b) A covered carrier may modify the rating method for a class of business after filing an actuarial certification that clearly requests approval for a change in rating method and contains the following information:

(i) the reason for the change in rating method;

(ii) a complete description of each proposed modification to the rating method;

(iii) a description of how the change in rating method will affect the premium rates currently charged in the class of business;

(iv) an estimate from a qualified actuary of the number of individuals and small employers, including a description of the types of individuals and small employers, whose premium rates may change by more than 10% due to the proposed change in rating method, not including general increases in premium rates;

(v) a certification from a qualified actuary that the new rating method is based on objective and credible data and is actuarially sound and appropriate; and

(vi) a certification from a qualified actuary that the proposed change in rating method does not produce premium rates for an individual or small employer that violate Sections 31A-30-106, 31A-30-106.1, and 31A-30-106.5.

(c)(i) A request for approval for a change in rating method shall be submitted as a separate filing.

(ii) The filing description shall state in the first line of the first paragraph, "REQUEST FOR APPROVAL FOR CHANGE IN RATING METHOD."

(3) The rate manual shall specify the case characteristics and rate factors to be applied by the covered carrier in establishing premium rates for the class of business.

(4)(a)(i) A covered carrier may not use case characteristics other than those specified in Sections 31A-30-106 and 31A-30-106.1 without the commissioner's prior approval.

(ii) A covered carrier seeking an approval under this Subsection (4)(a) shall make a filing with the commissioner for a change in rating method under Subsection (2)(b).

(b) Tobacco use is not an allowable case characteristic and may only be used under Subsection 31A-30-106(1)(b).

(c) The ratio of the base rate for any age band case characteristic under Subsection 31A-30-106.1(7) to the base rate for a less than 20 age band may not exceed the following:

(i) 1.22 for age band 20 to 24;

(ii) 1.34 for age band 25 to 29;

(iii) 1.46 for age band 30 to 34;

(iv) 1.60 for age band 35 to 39;

(v) 1.80 for age band 40 to 44;

(vi) 2.20 for age band 45 to 49;

(vii) 2.80 for age band 50 to 54;

(viii) 3.60 for age band 55 to 59;

(ix) 4.25 for age band 60 to 64; and

(x) 5.00 for age band 65 and above.

(d) A covered carrier shall use the same case characteristics in establishing premium rates for each health benefit plan in a class of business and shall apply them in the same manner in establishing premium rates.

(e) Risk characteristics may not be considered when applying case characteristics.

(5)(i) The rate manual shall clearly illustrate the relationship among the base premium rates charged for each health benefit plan in a class of business.

(ii) If the new business premium rate is different from the base premium rate for a health benefit plan, the rate manual shall illustrate the difference.

(6) Differences among base premium rates for health benefit plans shall be based solely on the reasonable and objective differences in the design and benefits of the health benefit plans and may not be based in any way on the nature of an individual or a small employer that chooses or is expected to choose a particular health benefit plan.

(7) A covered carrier shall apply case characteristics and rate factors within a class of business in a manner that assures that premium differences among health benefit plans for identical individuals or small employers vary only due to reasonable and objective differences in the design and benefits of the health benefit plans and are not due to the nature of the individuals or small employers that choose or are expected to choose a particular health benefit plan.

(8) The rate manual shall provide for premium rates to be developed in a two-step process.

(a) In step one, a base premium rate shall be developed to reflect the allowable case characteristics that result in individuals or small employers with identical case characteristics.

(b) In step two, the resulting base premium rate may be adjusted by a risk load to reflect the risk characteristics, subject to Sections 31A-30-106, 31A-30-106.1, and 31A-30-106.5.

(9)(a) Except as provided in Subsection (4)(b), a premium may not include a separate application fee, underwriting fee, or any other separate fee or charge.

(b) A covered carrier may charge a separate fee for an individual or a small employer health benefit plan, but only one fee per plan, provided the fee is no more than $5 per month per individual or employee and is applied in a uniform manner to each health benefit plan in a class of business.

(10) The premium rate change restrictions in Subsections 31A-30-106(1)(c) and 31A-30-106.1(3) shall be applied as follows:

(a) a covered carrier shall revise its rate manual each rating period to reflect changes in base premium rates and changes in new business premium rates;

(b)(i) if, for any health benefit plan with respect to any rating period, the percentage change in the new business premium rate is less than or the same as the percentage change in the base premium rate, the change in the new business premium rate shall be the change in the base premium rate; or

(ii) if, for any health benefit plan with respect to any rating period, the percentage change in the new business premium rate exceeds the percentage change in the base premium rate, the health benefit plan shall be considered a health benefit plan in which the covered carrier is no longer enrolling new individuals or small employers;

(i) details for the trend rate calculation shall be filed annually in the rate manual; and

(ii) the trend increase is limited to a 12-month period; and

(d) if, for any rating period, the change in the new business premium rate for a health benefit plan differs from the change in the new business premium rate for any other health benefit plan in the same class of business by more than 20%, the covered carrier shall file with the commissioner 30 days before the beginning of the rating period an explanation of how the respective changes in the new business premium rates were established and the reason for the difference.

(11)(a) Except as provided in Subsection (11)(b), a change in premium rate for an individual or small employer shall produce a revised premium rate that is no more than the following:

(i) the base premium rate for the individual or small employer, as shown in the rate manual as revised for the rating period, multiplied by:

(ii) one plus the sum of:

(A) the risk load applicable to the individual or small employer during the previous rating period; and

(B) 15%, prorated for periods of less than one year.

(b) In the case of a health benefit plan into which a covered carrier is no longer enrolling new individuals or small employers, a change in premium rate for an individual or small employer shall produce a revised premium rate that is no more than the following:

(i) the base premium rate for the individual or small employer, given its present composition and as shown in the rate manual in effect for the individual or small employer at the beginning of the previous rating period, multiplied by:

(ii) one plus the lesser of:

(A) the change in the base rate; or

(B) the percentage change in the new business premium for the most similar health benefit plan into which the covered carrier is enrolling new individuals or small employers, multiplied by:

(iii) one plus the sum of:

(A) the risk load applicable to the individual or small employer during the previous rating period; and

(B) 15%, prorated for periods of less than one year.

(c) Except as provided in Subsections (11)(a) and (11)(b), a change in premium rate for an individual or small employer may not produce a revised premium rate that would exceed the limitations on rates provided in Subsections 31A-30- 106(1)(b) and 31A-30-106.1(2)(b).

(12) A Taft-Hartley trust requesting a waiver of Subsection 31A-30-106(1) or 31A-30-106.1(1) shall file with the commissioner a request that identifies the provisions for which the trust is seeking the waiver that describes the extent each provision will:

(a) adversely affect the participants and beneficiaries of the trust; and

(b) require modifications to one or more of the collective bargaining agreements under which the trust is established or maintained.

(13) A covered carrier shall maintain, for a period of at least six years, any update or change to a rate manual, including the calculations used to determine the change in base premium rates and new business premium rates for each health benefit plan for each rating period.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-7 Application to Reenter State

(1)(a) A carrier that is prohibited from writing new business for an individual or small employer health benefit plan in Utah under Section 31A-22-618.8 may not resume offering an individual or small employer health benefit plan in Utah until the carrier petitions the commissioner to be reinstated as a covered carrier and the petition is approved.

(b) The commissioner may ask for information and assurances the commissioner finds reasonable and appropriate to make a decision.

(2)(a) If a covered carrier is doing business in only one established geographic service area of Utah and the covered carrier elects to discontinue a health benefit plan under Section 31A-22-618.6 or 31A-22-618.7, the covered carrier is prohibited from offering a health benefit plan to an individual or small employer in any part of the service area for a period of five years.

(b) The covered carrier may not offer a health benefit plan to an individual or small employer in any other geographic area of Utah without the commissioner's prior approval.

(c) The commissioner may ask for information and assurances the commissioner finds reasonable and appropriate to make a decision.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-8 Qualifying Previous Coverage

(1) A covered carrier may not deny, exclude, or limit benefits because of a preexisting condition without first ascertaining the existence and source of previous coverage.

(2) A covered carrier has the responsibility to contact the source of previous coverage to resolve any questions about the benefits or limitations related to the previous coverage.

(3) Previous coverage includes coverage that continues after the issuance of the new health benefit plan.

(4) The previous carrier shall fully cooperate in furnishing the information required by this section.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-9 Restrictive Riders

(1) A restrictive rider, endorsement, or other provision that violates Section 31A-30-107.5 may not remain in force.

(2) A covered carrier shall immediately provide written notice to any individual or small employer whose coverage will be changed pursuant to this section.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-10 Status of a Carrier as a Covered Carrier

(1)(a) Before marketing a health benefit plan, a carrier shall file with the commissioner its intent to operate as a covered carrier in Utah under the terms of the act and of this rule.

(b) The filing shall state if the carrier intends to market to individuals, small employers, or both, and shall be signed by an officer of the company.

(2) Except as provided by Subsection (3), a carrier may not offer a health benefit plan to an individual or a small employer in Utah, or continue to provide coverage under a health benefit plan previously issued to an individual or a small employer in Utah, unless the filing under Subsection (1) indicates that the carrier intends to operate as a covered carrier in Utah.

(3)(a) If a carrier does not intend to operate as a covered carrier in Utah, the carrier may continue to provide coverage under a health benefit plan previously issued to an individual or a small employer in Utah if:

(i) the carrier complies with the act with respect to each health benefit plan previously issued to an individual or a small employer;

(ii) the carrier provides coverage to each new entrant to a health benefit plan previously issued to an individual or a small employer;

(iii) the carrier complies with Sections 31A-30-106 and 31A-30-106.1 and this rule as they apply to an individual or a small employer whose coverage was terminated, limited, or restricted by the carrier; and

(iv) the carrier files a letter of intent indicating the carrier does not intend to operate as a covered carrier in Utah and will maintain the business in compliance with the act and this rule.

(b)(i) If a filing made under Subsection (3) indicates that a carrier does not intend to operate as a covered carrier in Utah, the carrier is precluded from operating as a covered carrier in Utah, except as provided for in Subsection (3), for a period of five years from the date of the filing.

(ii) Upon written request from the carrier, the commissioner may reduce the five-year period if the commissioner finds that permitting the carrier to operate as a covered carrier would be in the best interests of the individuals and small employers in Utah.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-11 Actuarial Certification and Additional Filing Requirements

(1)(a) An actuarial certification filing under Subsection 31A-30-106(4)(b) or 31A-30-106.1(13)(b) shall:

(i) include a written statement that meets the requirements of the act, this rule, and the applicable standards of practice promulgated by the Actuarial Standards Board;

(ii) be signed by the actuary and state that the actuary meets the qualifications of Subsection 31A-30-103(1);

(iii) contain the following statement: "I, (name), certify that (name of covered carrier) is in compliance with Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act, and Rule R590-167, based upon the examination of (name of covered carrier), including review of the appropriate records and of the actuarial assumptions and methods utilized by (name of covered carrier) in establishing premium rates for applicable health benefit plans";

(iv) list and describe each written demonstration used by the actuary to establish compliance with the act and this rule;

(v) list all affiliated insurers, defining each class of business that includes the commissioner's approval date if more than one class of business exists; and

(vi) include the System for Electronic Rates and Forms Filing, SERFF, filing number for each applicable rate manual filing.

(b) The actuarial certification applies to an individual or a small employer health benefit plan issued before March 23, 2010, and maintains grandfathered status.

(2)(a) A covered carrier shall file with the commissioner a copy of the applicable rate manual for a health benefit plan that is subject to the act and this rule, for both new business and renewal rates, and shall include:

(i) a signed certification by an actuary that, to the best of the actuary's knowledge and judgment, the rate filing complies with the applicable laws and rules of Utah;

(ii) a complete and detailed description of how the final premium, including any fees, is calculated from the rate manual;

(iii) all changes and updates, including a complete and detailed description of how the final premium, including any fees, is calculated from the rate manual;

(iv) an identification of the covered carrier's classes of business under Subsection R590-167-4(1);

(v) all information required by 45 CFR 154.215(b)(1); and

(vi) for a rate increase subject to review by 45 CFR 154.200(a)(1), all information required by 45 CFR 154.215(b)(2).

(b) The rate manual shall be filed:

(i) with an initial product filing; or

(ii) 30 days before use, for an existing health benefit plan.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-12 Records

(1) Except as provided in Subsection (2), a record submitted to the commissioner under this rule shall be maintained as a protected record under Title 63G, Chapter 2, Government Records Access and Management Act.

(2) The commissioner classifies the following records as public:

(a) the status of a filing; and

(b) information submitted under Subsections R590-167-11(2)(a)(v) and R590-167-11(2)(a)(vi).

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

Utah Admin. Code R590-167-13 Severability

If any provision of this rule, Rule R590-167, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance
Date of Last Change: February 21, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1

R590-170 Fiduciary and Trust Account Obligations

Utah Admin. Code R590-170-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-2 Purpose and Scope

(1) The purpose of this rule is to set minimum standards for a licensee's trust account obligations.

(2) This rule applies to a licensee holding funds in a fiduciary capacity.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Trust account" means a checking or savings account where funds are held in a fiduciary capacity.

(2) "Accounts receivable" means a licensee's invoiced premiums, fees, or taxes.

(3) "Accounts payable" means:

(a) premiums or fees due to insurers that a licensee is responsible for invoicing and collecting from insureds on an insurer or licensee's behalf; and

(b) premium taxes due to taxing entities.

(4) "Licensee" means a person licensed under:

(a) Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries; or

(b) Title 31A, Chapter 25, Third Party Administrators.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-4 Establishing a Trust Account

(1)(a) Each record relating to a trust account shall be identified with the wording "trust account" or wording similar to the term "trust account," including the term "premium fund account."

(b) A trust account record includes a:

(i) check;

(ii) bank statement;

(iii) general ledger; or

(iv) bank-retained record pertaining to the trust account.

(2) A licensee shall open a trust account with a Federal Employer Identification number or a Social Security number.

(3)(a) A trust account shall be a separate and distinct account from the licensee's operating and personal accounts.

(b) The trust account shall have:

(i) a separate account number;

(ii) a separate account register; and

(iii) separate checks, deposit slips, and withdrawal slips.

(4) A person other than a licensee may be a signatory on a licensee's trust account only if that person:

(a) is an employee of the licensee; and

(b) has specific responsibility for the licensee's trust account.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-5 Maintaining a Trust Account

(1) Funds deposited into a trust account shall be limited to:

(a) premiums, which may include commissions;

(b) return premiums;

(d) financed premiums;

(e) funds held pursuant to a third-party administrator contract;

(f) funds deposited with a title insurance agent regarding an escrow settlement or closing;

(g) funds necessary to cover trust account bank charges; and

(h) interest on the trust account, except as provided under Subsection 31A-23a-406(2)(b).

(2) Disbursements from a trust account shall be limited to:

(a) premiums paid to insurers;

(b) return premiums to policyholders;

(d) fees or taxes collected with premiums paid to an insurer or taxing authority;

(e) funds paid pursuant to a third-party administrator contract;

(f) funds a title insurance agent disburses regarding an escrow settlement or closing; and

(g) accrued interest transfers.

(3) Personal or business expenses may not be paid from a trust account, even if the trust account has sufficient commissions to cover the personal or business expenses.

(4) A commission may not be disbursed from a trust account before the beginning of the policy period for which the premium is collected.

(5) A commission attributed to premiums and fees collected shall be disbursed from a trust account on a date no later than the first business day of the calendar quarter after the end of the policy period for which the funds were collected.

(6) A premium due to an insurer may not be paid from a trust account unless:

(a) the premiums relating to the amount due are being held in the trust account; or

(b) a licensee placed the funds in the trust account to finance premiums on the insured's behalf.

(7) Premiums financed by a licensee shall be accounted for as a loan and accrue interest at the contracted rate.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-6 Insurers' Access to a Trust Account

(1) An insurer may access licensee trust funds in a trust relationship when a licensee takes reasonable steps to prevent misappropriation by limiting access to trust funds.

(2) An insurer may access funds in a licensee's trust account if:

(a)(i) the contract between the insurer and the licensee allows fund transfers into or out of the licensee's trust account;

(ii) the contract expressly permits the insurer to withdraw only the amount the licensee authorizes for each transaction; and

(iii) the insurer receives the licensee's authorization to withdraw a specific amount from the licensee's trust account before the insurer withdraws the funds; or

(b) the licensee provides the insurer electronic funds transfer into or out of a separate trust account set up solely for trust funds deposited for that insurer.

(3) An insurer that implements electronic funds transfers from a licensee's trust account accepts the commissioner's right to oversight on all electronic funds transfers between the insurer and the licensee.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-7 Maintaining Accounting Records

(1) Trust account bank statements shall be reconciled monthly.

(2) An accounts receivable report showing each credit and debit shall be maintained and reconciled monthly, and shall list, at a minimum, the following:

(a) the account name;

(b) the amount and date due for each receivable; and

(3) The report required under Subsection (2) shall list separately each receivable and their sums that are over 90 days old.

(4) An accounts payable report showing each account's status shall be maintained and reconciled monthly.

(5) Adequate records shall be maintained to establish ownership of all funds in the trust account, including:

(a) records showing from whom the funds were received; and

(b) records showing for whom the funds are held.

(6) Trust account registers shall maintain a running balance.

(7) All accounting records relating to the business of insurance shall be maintained in a manner that facilitates an audit.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-8 Insurer Responsibility

(1) Insurers and their managing general agents shall provide a written report to the commissioner within 15 days if:

(a) a licensee fails to pay an account payable within 30 days of the due date; or

(b) a licensee issues a check that is not honored when presented to the bank or is returned because of insufficient funds.

(2) Subsection (1)(a) may not apply when a legitimate dispute exists regarding the account payable if:

(a) the licensee has properly notified the insurer of any disputed items; and

(b) the licensee has provided documentation to the insurer supporting the licensee's position.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

Utah Admin. Code R590-170-9 Severability

If any provision of this rule, Rule R590-170, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: May 26, 2022
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-406; 31A-23a-409; 31A-23a-412; 31A-25-305

R590-171 Surplus Lines Procedures Rule

Utah Admin. Code R590-171-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-15-103, and 31A-15-111.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) recognize the Surplus Line Association of Utah as the advisory organization of surplus lines producers;

(b) authorize the Surplus Line Association of Utah to conduct the examination of surplus lines transactions;

(d) require that a surplus lines producer be a member of the advisory organization;

(e) regulate access and exceptions to the surplus lines market; and

(f) prescribe procedures for the placement of insurance with a surplus lines insurer.

(2) This rule applies to a person placing insurance with a surplus lines insurer on a risk located in Utah.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "Exempt commercial purchaser" means a person purchasing commercial insurance from the surplus lines market that meets the following requirements:

(i) the person employs or retains a qualified risk manager to negotiate insurance coverage;

(ii) the person paid aggregate nationwide commercial property and casualty insurance premiums of more than $100,000 in the immediately preceding 12 months; and

(iii) the person meets one or more of the following criteria:

(A) the person possesses a net worth of more than $20,000,000 as adjusted under Subsection (1)(b);

(B) the person generates annual revenues of more than $50,000,000 as adjusted under Subsection (1)(b);

(C) the person employs more than 500 full-time or full-time equivalent employees per individual insured or is a member of an affiliated group employing more than 1,000 employees in the aggregate;

(D) the person is a not-for-profit organization or public entity generating annual budgeted expenditures of at least $30,000,000 as adjusted under Subsection (1)(b); or

(E) the person is a municipality with a population of more than 50,000 persons.

(b) The amounts in Subsections (1)(a)(iii)(A), (1)(a)(iii)(B), and (1)(a)(iii)(D) are adjusted each fifth January beginning January 1, 2015, to reflect the percentage change for such five-year period in the Consumer Price Index for All Urban Consumers published by the Bureau of Labor Statistics of the Department of Labor.

(2) "Export list" means a list, published and determined by the commissioner, of coverages and classes of insurance for which no general market exists with an admitted insurer.

(3) "Surplus lines insurer" means a non-admitted insurer that may place business in Utah with a surplus lines producer.

(4) "Surplus lines producer" means a licensee holding a license type described in Subsection 31A-23a-106(2)(b).

(5) "Surplus lines transaction" means:

(a) the solicitation, negotiation, procurement, or effectuation with a surplus lines insurer of an insurance contract or certificate of insurance; or

(b) a renewal, cancellation, endorsement, audit, or other adjustment to an insurance contract.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-4 Surplus Line Association of Utah

(1) The Surplus Line Association of Utah is recognized as the advisory organization of surplus lines producers under Section 31A-15-111.

(2) A licensed surplus lines producer shall be a member of the Surplus Line Association of Utah.

(3) The Surplus Line Association of Utah is authorized to:

(a) facilitate and encourage compliance by its members with:

(i) the laws of Utah; and

(ii) the rules of the commissioner related to surplus lines insurance;

(b) act in other matters specified by Section 31A-15-111;

(d) determine if a surplus lines transaction complies with Subsection 31A-15-103(11) and with Sections R590-171-6 and R590-171-7; and

(e) collect the stamping fee under Subsection 31A-15-103(11)(d).

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-5 Export List

(1) The commissioner shall maintain an export list of insurance coverages and classes that may be placed with a surplus lines insurer.

(a) The commissioner considers the following in determining the insurance coverages and classes to be included on the export list:

(i) the current marketplace;

(ii) information from the Surplus Line Association of Utah's board of directors;

(iii) information from admitted and surplus lines insurers doing business in Utah;

(iv) information from other sources, including producers and consumers; and

(v) other relevant information.

(b)(i) A person may request, in writing, that the commissioner add or remove a coverage or a class of insurance from the export list.

(ii) The person shall provide evidence of market conditions to substantiate the request.

(2) The export list shall be published at least annually but may be revised and republished at any time.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-6 Conditions for Placing Insurance with a Surplus Lines Insurer

Placement of insurance with a surplus lines insurer is subject to Subsections (1) through (3). All information relating to the placement of insurance pursuant to Section 31A-15-103 shall be made available to the commissioner upon request.

(1) Insurance coverages and classes included on the export list may be placed with a surplus lines insurer.

(2)(a) Insurance coverages and classes not included on the export list may be placed with a surplus lines insurer only if:

(i) a good faith effort is made to place the insurance with an admitted insurer that the producer believes will write the type of coverage or class of insurance involved consistent with the following:

(A) the insurance cannot be obtained due to underwriting reasons, or the insured requires specific terms and conditions of coverage that are unavailable through an admitted insurer;

(B) placement with a surplus lines insurer solely to obtain a better price does not constitute good faith unless the producer demonstrates that the price quoted by the admitted market is excessive under Subsection 31A-19a-201(2); and

(C) the inability to place insurance through an admitted insurer with whom the producer has an established relationship is not an exception to the obligation to place the insurance with an admitted insurer; and

(ii) the producer documents the good faith efforts made to place the insurance with an admitted insurer.

(b)(i) The good faith effort documentation in Subsection (2)(a)(ii) shall include a record of the efforts made to place the insurance together with a written explanation confirming that the effort is made in good faith.

(ii) The good faith effort documentation shall be maintained in the surplus lines producer's and the originating producer's files for at least three years from the inception date of coverage or renewal.

(3) An exempt commercial purchaser may purchase commercial insurance from the surplus market.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-7 Conditions for Marketing Insurance with a Surplus Lines Insurer

A producer may not solicit business on behalf of a surplus lines insurer except as allowed in this section.

(1) A producer may advertise the availability of an insurance product for the insurance coverages and classes included on the export list to potential insureds and other producers.

(2)(a) A surplus lines producer may advertise its services and product lines to other producers.

(b) A surplus lines producer advertisement:

(i) shall identify that the insurance will be placed with a surplus lines insurer;

(ii) may not identify the insurer by name;

(iii) may not act as a solicitation on behalf of any surplus lines insurer; and

(iv) may not identify specific rates or specific policy provisions.

(3) Once negotiations over the available terms and conditions for specific coverages and classes begin, the producer shall disclose, in writing, to the potential insured:

(a) that the insurance will be placed through a surplus lines insurer;

(b) the name of the insurer;

(c) that the producer is not a producer of the potential insurer because surplus lines insurers are not permitted to appoint producers;

(d) that the surplus lines market is a specialty market with limited regulatory oversight by the commissioner, and specifically, there is no regulation of policy coverage forms or rates; and

(e) that no protection is given under any Utah guaranty fund association.

(4) Subject to Section 31A-23a-501, a surplus lines producer may:

(a) originate surplus lines insurance;

(b) accept an application for surplus lines insurance from a producer licensed as to the kinds of insurance involved; and

(5)(a) Only the portion of a risk that is unacceptable to the admitted market may be placed with a surplus lines insurer.

(b) If it is not possible to obtain the full amount of insurance required by segmenting the risk, or if the only portion that the admitted market will write is incidental to the principal elements of coverage, it is permissible to place the full amount with a surplus lines insurer.

(c) If a full amount is placed with a surplus lines insurer under Subsection (5)(b), an explanation shall be provided in the submission documentation outlined in Section R590-171-8.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-8 Reporting and Examination

(1) No later than 60 days after the effective date of a policy or a certificate of insurance placed with a surplus lines insurer, the surplus lines producer shall file with the Surplus Line Association of Utah a complete copy of the policy or certificate of insurance together with justification for placement with a surplus lines insurer.

(2) Justification for placement with a surplus lines insurer shall include:

(a) for insurance placed pursuant to Subsection R590-171-6(1), identification of the specific coverage or class on the export list;

(b) for insurance placed pursuant to Subsection R590-171-6(2), a record of the effort to place the insurance with an admitted insurer under Subsection R590-171-6(2)(a)(ii);

(d) if applicable, an explanation required by Subsection R590-171-7(5)(c); and

(e) any other information or documentation pertinent to the surplus lines placement.

(3) The Surplus Line Association of Utah shall provide submission forms for compliance with Subsection (2).

(4) If a policy or certificate of insurance is not available within 60 days, a binder with sufficient detail to determine the subject of the insurance, coverages, insured, insurer, premium amount and the justification required by Subsection (2) shall be filed with the Surplus Line Association of Utah.

(5)(a) If, during an examination performed by the Surplus Line Association of Utah, it determines that a person placing a policy or certificate of insurance with a surplus lines insurer is noncompliant with Subsection 31A-15-103(11)(a) or this rule, the Surplus Line Association of Utah shall take corrective action against the person

(b)(i) The board of directors of the Surplus Line Association of Utah shall determine what corrective action is appropriate.

(ii) The corrective action is subject to the review of the commissioner.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-9 Rule Distribution

The Surplus Line Association of Utah shall distribute a copy of Rule R590-171 to every surplus lines producer and shall instruct the surplus lines producers of the scope, purpose, and operation of the rule.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

Utah Admin. Code R590-171-10 Severability

If any provision of this rule, Rule R590-171, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: January 24, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-15-103; 31A-15-111

R590-173 Credit For Reinsurance

Utah Admin. Code R590-173-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-404.3.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-2 Purpose and Scope

(1) The purpose of this rule is to provide procedural requirements to comply with Sections 31A-17-404, 31A-17-404.1, 31A-17-404.3, and 31A-17-404.4.

(2) This rule applies to an insurer, including a reinsurer, authorized to do business in this state.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-3 Definitions

Terms used in this rule are defined in Section 31A-1-301 and 31A-17-404. Additional terms are defined as follows:

(1) "Accredited reinsurer" means an insurer that meets the requirements of Section R590-173-5.

(2)(a)(i) "Beneficiary" as used in Section R590-173-12 means a person for whose sole benefit a trust is established and a successor of the beneficiary by operation of law.

(ii) If a court appoints a successor in interest to the named beneficiary, the named beneficiary includes the court appointed domiciliary receiver, rehabilitator, or liquidator.

(b) "Beneficiary" as used in Section R590-173-13 means a domestic insurer for whose benefit a letter of credit is established and a successor of the beneficiary by operation of law.

(3) "Covered agreement" means an agreement entered into pursuant to the Dodd-Frank Wall Street Reform and Consumer Protection Act, 31 U.S.C. 313 and 314, that:

(a) is currently in effect or in a period of provisional application; and

(b) addresses the elimination, under specified conditions, of collateral requirements as a condition for entering into a reinsurance agreement with a ceding insurer domiciled in this state or allows the ceding insurer to recognize credit for reinsurance.

(4) "Grantor" as used in Section R590-173-12 means an unlicensed, unaccredited assuming insurer that establishes, in conjunction with a reinsurance agreement, a trust for the sole benefit of a beneficiary.

(5) "Jurisdiction" as used in Section R590-173-10 means:

(a) a state, district, or territory of the United States; or

(b) a lawful national government.

(6) "Liabilities" as used in Section R590-173-7 means an assuming insurer's gross liabilities attributable to reinsurance ceded by a U.S. domiciled insurer, excluding liabilities that are otherwise secured by acceptable means, including:

(a) for business ceded by a domestic insurer authorized to write accident and health, and property and casualty insurance:

(i) losses and allocated loss expenses paid by the ceding insurer, recoverable from the assuming insurer;

(ii) reserves for losses reported and outstanding;

(iii) reserves for losses incurred but not reported;

(iv) reserves for allocated loss expenses; and

(v) unearned premiums; and

(b) for business ceded by a domestic insurer authorized to write life, health, and annuity insurance:

(i) aggregate reserves for life policies and contracts net of policy loans, net due, and deferred premiums;

(ii) aggregate reserves for accident and health policies;

(iii) deposit funds and other liabilities without life or disability contingencies; and

(iv) liabilities for policy and contract claims.

(7) "Manufactured home" has the same meaning as that term is defined in 42 U.S.C. 5402.

(8) "Mortgage-related security" means an obligation that is rated AA or higher, or the equivalent, by a securities rating agency recognized by the Securities Valuation Office of the NAIC and that:

(a) represents ownership of a promissory note, a certificate of interest, or participation in a note that includes a right designed to assure servicing of, or the receipt or timeliness of receipt by a holder of the note, certificate, or participation of an amount payable under a note, certificate, or participation, that:

(i) is directly secured by a first lien on a single parcel of real estate, including stock allocated to a dwelling unit in a residential cooperative housing corporation, where:

(A) a dwelling or mixed residential and commercial structure is located; or

(B) a residential manufactured home, whether the manufactured home is considered real or personal property under the laws of the state, is located; and

(ii) is originated by:

(A) a savings and loan association;

(B) a savings bank;

(D) a credit union;

(E) an insurance company;

(D) a similar institution that is supervised and examined by a federal or state housing authority;

(G) a mortgage approved by the Secretary of Housing and Urban Development under 12 U.S.C. 1709 and 12 U.S.C. 1715b; or

(H) where a note involves a lien on a manufactured home, by an institution or by a financial institution approved for insurance by the Secretary of Housing and Urban Development pursuant to 12 U.S.C. 1703; or

(b)(i) is secured by a promissory note, certificate of deposit, or participation in a note, with or without recourse to the insurer of the note; and

(ii) by its terms, provides for a payment of principal in relation to a payment, or a reasonable projection of a payment, or note meeting the requirements of Subsections (8)(a)(i) and (8)(a)(ii).

(9) "Obligation" means:

(a) reinsured losses and allocated loss expenses paid by a ceding company, but not recovered from an assuming insurer;

(b) reserves for reinsured losses reported and outstanding;

(d) reserves for allocated reinsured loss expenses and unearned premium.

(10) "Promissory note," used in connection with a manufactured home means:

(a) a loan;

(b) an advance or credit sale evidenced by a retail installment sales contract or another instrument.

(11)(a) "Qualified jurisdiction" means a jurisdiction that:

(i) requires an insurer with its domicile or head office in the qualified jurisdiction to receive credit for reinsurance ceded to a U.S. domiciled assuming insurer in the same manner as credit for reinsurance is received for reinsurance assumed by an insurer domiciled in the qualified jurisdiction;

(ii) recognizes a U.S. state's regulatory approach to group supervision and group capital by providing written confirmation, by a competent regulatory authority in the qualified jurisdiction, that an insurer and an insurance group that is domiciled or maintains its head office in this state or another jurisdiction accredited by the NAIC is subject only to worldwide prudential insurance group supervision including:

(A) worldwide group governance;

(B) solvency and capital; and

(iii) provides written confirmation by a competent regulatory authority in the qualified jurisdiction that information regarding an insurer and its parent, subsidiary, or affiliated entities are provided to the commissioner in accordance with a memorandum of understanding or similar document between the commissioner and the qualified jurisdiction, including:

(A) the International Association of Insurance Supervisors Multilateral Memorandum of Understanding; or

(B) other multilateral memoranda of understanding coordinated by the NAIC; and

(iv) is designated as a qualified jurisdiction by the commissioner pursuant to Subsection 31A-17-404(7)(d) and this rule.

(b) A qualified jurisdiction may not:

(i) require a U.S. domiciled assuming insurer to establish or maintain a local presence as a condition for entering into a reinsurance agreement with a ceding insurer subject to regulation by the non-U.S. jurisdiction or as a condition to allow a ceding insurer to recognize credit for reinsurance; and

(ii) be subject to group supervision at the level of the worldwide parent undertaking of an insurance or reinsurance group by the qualified jurisdiction.

(12) "Reciprocal jurisdiction" means a jurisdiction, as designated by the commissioner under Section R590-173-9, that is:

(a) a non-U.S. jurisdiction subject to an in-force covered agreement with the United States, within its legal authority;

(b) in the case of a covered agreement between the United States and the European Union, a member state of the European Union;

(c) a U.S. jurisdiction that meets the requirements for accreditation under the NAIC financial standards and accreditation program; or

(d) a qualified jurisdiction, as determined by the commissioner pursuant to Subsection R590-173-8(6), that is not otherwise described in Subsection (12)(a), (12)(b), or (12)(c).

(13) "Solvent scheme of arrangement" means a foreign or alien statutory or regulatory compromise procedure subject to:

(a) requisite majority creditor approval;

(b) judicial sanction in the assuming insurer's home jurisdiction to:

(i) commute liabilities of noticed classed members or creditors of a solvent debtor; or

(ii) reorganize or restructure the debts and obligations of a solvent debtor on a financial basis; and

(c) possible judicial recognition and enforcement of an arrangement by a governing authority outside the ceding insurer's home jurisdiction.

(14) "Statutory financial statement" means a quarterly, annual, or other financial statement required by law.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-4 Credit for Reinsurance -- Reinsurer Licensed in Utah

(1) Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed in Utah as of the date the ceding insurer claims reinsurance credit in a statutory financial statement.

(2) The requisite conditions for credit shall exist at the time the credit is claimed or reported in a statutory financial statement.

(3) The conditions in Subsection (2) shall remain satisfied until the information reported in one statement is replaced by information reported in a subsequent statement.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-5 Credit for Reinsurance -- Accredited Reinsurer in Utah

(1) Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer that is accredited as a reinsurer in Utah as of the date the ceding insurer claims reinsurance credit in a statutory financial statement.

(2) An accredited reinsurer shall:

(a) file with the commissioner a completed Form AR-1, available on the department's website, https://insurance.utah.gov, evidencing:

(i) the insurer's submission to Utah's jurisdiction; and

(ii) Utah's authority to examine its books and records;

(b) file with the commissioner a certified copy of a certificate of authority or other acceptable evidence that the accredited reinsurer:

(i) is licensed to transact insurance or reinsurance in at least one state; or

(ii) in the case of a U.S. branch of an alien assuming insurer, is entered through and licensed to transact insurance or reinsurance in at least one state;

(i)(A) the insurance department of its state of domicile; or

(B) in the case of an alien assuming insurer, with the state through which it is entered and is licensed to transact insurance or reinsurance;

(ii) a copy of its most recent audited financial statement; and

(d)(i) maintain a surplus regarding policyholders in an amount not less than $20 million; or

(ii) obtain the affirmative approval of the commissioner upon a finding that:

(A) the insurer has adequate financial capacity to meet its reinsurance obligations; and

(B) is otherwise qualified to assume reinsurance from a domestic insurer.

(3) If the commissioner determines that an assuming insurer failed to meet or maintain any qualification, the commissioner may suspend or revoke the accreditation upon written notice and opportunity for hearing.

(4) Credit may not be allowed a domestic ceding insurer if:

(a) the assuming insurer's accreditation is revoked by the commissioner; or

(b) the reinsurance was ceded while the assuming insurer's accreditation was suspended by the commissioner.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-6 Credit for Reinsurance -- Reinsurer Domiciled in Another State

(1) Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer as of any date a ceding insurer claims reinsurance credit in a statutory financial statement.

(2) Credit is allowed when the assuming insurer:

(a) is domiciled in, or in the case of a U.S. branch of an alien assuming insurer, is entered through a state that employs standards regarding credit for reinsurance that is equal to or exceeds those applicable under law;

(b) maintains a surplus regarding policyholders in an amount not less than $20 million; and

(c) files with the commissioner a completed Form AR-1, available on the department's website, https://insurance.utah.gov, evidencing its submission to Utah's authority to examine its books and records.

(3) Subsection (2)(b) does not apply to reinsurance ceded and assumed under a pooling arrangement among insurers in the same holding company system.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-7 Credit for Reinsurance -- Reinsurer Maintains a Trust Fund

(1)(a) Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer that, as of any date a ceding insurer claims reinsurance credit in a statutory financial statement, and thereafter for so long as:

(i) credit for reinsurance is claimed; and

(ii) the assuming insurer maintains a trust fund:

(A) in an amount prescribed in Subsection (2)(a); and

(B) in a qualified United States financial institution for the payment of the valid claims of its U.S. domiciled ceding insurers, their assigns, and successors in interest.

(b) An assuming insurer shall report annually to the commissioner substantially the same information required to be reported on the NAIC annual statement form by a licensed insurer, for the commissioner to determine the sufficiency of the trust fund.

(2) This subsection applies to each category of an assuming insurer.

(a) A trust fund for a single assuming insurer shall consist of funds in trust:

(i) in an amount not less than the assuming insurer's liabilities attributable to reinsurance ceded by a U.S. domiciled insurer; and

(ii) a trusteed surplus of not less than $20 million, except as provided in Subsection (2)(b).

(b)(i) The commissioner with principal regulatory oversight of the trust may authorize a reduction in the required trusteed surplus if:

(A) the assuming insurer permanently discontinues underwriting new business secured by the trust for at least three years; and

(B) the commissioner makes a risk assessment finding that the new required surplus level is adequate for the protection of U.S. ceding insurers, policyholders, and claimants in light of reasonably foreseeable adverse loss development.

(ii) The risk assessment in Subsection (2)(b)(i):

(A) may involve an actuarial review, including an independent analysis of reserves and cash flows; and

(B) shall consider all material risk factors including:

(I) the lines of business involved;

(II) the stability of the incurred loss estimates; and

(III) the effect of surplus requirements on the assuming insurer's liquidity or solvency.

(iii) A reduction in trusteed surplus under Subsection (2)(b) may not fall below 30% of the assuming insurer's liabilities attributable to reinsurance ceded by U.S. ceding insurers covered by the trust.

(c)(i) A trust fund for a group including incorporated and individual unincorporated underwriters shall consist of:

(A) for reinsurance ceded under a reinsurance agreement with an inception, amendment, or renewal date on or after January 1, 1993, funds in trust in an amount not less than the respective underwriters' several liabilities attributable to business ceded by U.S. domiciled ceding insurers to any underwriter of the group;

(B) for reinsurance ceded under a reinsurance agreement with an inception date on or before December 31, 1992, and not amended or renewed after that date, notwithstanding the other provisions of this rule, funds in trust in an amount not less than the respective underwriters' several insurance and reinsurance liabilities attributable to business written in the United States; and

(C) a trusteed surplus of which $100 million is held jointly for the benefit of the U.S. domiciled ceding insurers of any member of the group for all the years of account.

(ii) The incorporated members of the group:

(A) may not engage in any business other than underwriting as a member of the group; and

(B) are subject to the same level of regulation and solvency control by the group's domiciliary regulator as are the unincorporated members.

(iii) The group shall, within 90 days after its financial statements are due to be filed with the group's domiciliary regulator, provide to the commissioner:

(A) an annual certification by the group's domiciliary regulator of the solvency of each underwriter member of the group; or

(B) if a certification is unavailable, a financial statement, prepared by an independent public accountant, of each underwriter member of the group.

(d)(i) A trust fund for a group of incorporated insurers under common administration, whose members possess aggregate policyholders surplus of $10 billion, calculated and reported in substantially the same manner as prescribed by the annual statement instructions and the Accounting Practices and Procedures Manual of the NAIC, and that continuously transacted an insurance business outside the United States for at least three years immediately prior to applying for accreditation, shall:

(A) consist of funds in trust in an amount not less than the assuming insurers' several liabilities attributable to business ceded by U.S. domiciled ceding insurers to any members of the group pursuant to reinsurance contracts issued in the name of the group;

(B) maintain a joint trusteed surplus of which $100 million is held jointly for the benefit of the U.S. domiciled ceding insurers of any member of the group; and

(C)(I) file with the commissioner a completed Form AR-1, available on the department's website, https://insurance.utah.gov, evidencing each member's submission to Utah's authority to examine its books and records; and

(II) certify that the member examined will bear the expense of the examination.

(ii) For each underwriter member of a group described in Subsection (2)(d)(i), the group shall file within 90 days after the financial statements are due to be filed with the group's domiciliary regulator:

(A) an annual certification of its solvency by its domiciliary regulator; and

(B) a financial statement prepared by an independent public accountant.

(3)(a) Credit for reinsurance may not be granted unless the form of the trust and any amendments to the trust have been approved by either:

(i) the commissioner of the state where the trust is domiciled; or

(ii) the commissioner of another state who, pursuant to the terms of the trust instrument, accepted responsibility for regulatory oversight of the trust.

(b) The form of a trust and a trust amendment shall be filed with the commissioner of every state in which the ceding insurer beneficiaries of the trust are domiciled.

(i) contested claims be valid and enforceable out of funds in trust to the extent that they remain unsatisfied 30 days after entry of the final order of any court of competent jurisdiction in the United States;

(ii) legal title to the assets of the trust be vested in the trustee for the benefit of the grantor's U.S. ceding insurers, their assigns, and successors in interest;

(iii) it is subject to examination as determined by the commissioner;

(iv) it remains in effect for as long as the assuming insurer, or any member or former member of a group of insurers, has outstanding obligations under reinsurance agreements subject to the trust; and

(v) no later than February 28 of each year, the trustee of the trust submit a written report to the commissioner that:

(A) sets forth the balance in the trust;

(B) lists the trust's investments at the preceding year-end; and

(C)(I) certifies the date of termination of the trust, if planned; or

(II) certifies that the trust may not expire before the following December 31.

(d)(i) Notwithstanding any provision in the trust instrument, a trustee shall comply with an order of the commissioner with regulatory oversight over the trust, or with an order of a court of competent jurisdiction, that directs the trustee to transfer to a receiver, including a commissioner with regulatory oversight over the trust, the assets of the trust if:

(A) the trust fund is inadequate because it contains an amount less than the amount required by Subsection (3)(d); or

(B) the grantor of the trust is declared insolvent or placed into receivership, rehabilitation, liquidation, or similar proceedings under the laws of its state or country of domicile.

(ii) A receiver described in Subsection (3)(d) shall receive and value claims and distribute assets in accordance with the laws applicable to the liquidation of a domestic insurer in the state in which the trust is domiciled.

(iii) If a receiver described in Subsection (3)(d) determines that the assets of the trust fund or any part thereof are not necessary to satisfy the claims of the U.S. beneficiaries of the trust, the receiver shall return the assets, or any part thereof, to the trustee for distribution in accordance with the trust agreement.

(iv) The grantor shall waive any right otherwise available to it under U.S. law that is inconsistent with Subsection (3)(d).

(4)(a) An asset deposited in a trust shall:

(i) be valued according to its current fair market value; and

(ii) consist only of:

(A) cash in U.S. dollars;

(B) certificates of deposit issued by a qualified United States financial institution; and

(C) clean, irrevocable, unconditional, and "evergreen" letters of credit issued or confirmed by a qualified United States financial institution; and

(D) an investment in or issued by an entity controlling, controlled by, or under common control with either a grantor or a beneficiary of the trust, not to exceed 5% of total investments;

(b) No more than 20% of the total investment in the trust may be foreign investments authorized under Subsection (4)(d)(i)(E), (4)(d)(iii), (4)(d)(iv), or (4)(d)(vi).

(c)(i) No more than 10% of the total investment in the trust may be securities denominated in foreign currencies.

(ii) A depository receipt denominated in U.S. dollars and representing rights conferred by a foreign security is classified as a foreign investment denominated in a foreign currency.

(d) An asset of a trust may be invested only in:

(i) a valid and legally authorized government obligation that is not in default as to principal and interest and is issued, assumed, or guaranteed by:

(A) the United States or its agency or instrumentality;

(B) a state of the United States;

(D) an agency or instrumentality of a governmental unit in Subsection (4)(d)(i)(B) or (4)(d)(i)(C) if the obligation is payable, as to principal and interest, from taxes levied or by law required to be levied, or from adequate special revenues pledged or otherwise appropriated, or by law required to be provided for making these payments, but not if the obligation is payable solely out of special assessments on properties benefited by local improvements; or

(E) the government of a country that is a member of the Organization for Economic Cooperation and Development and whose government obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;

(ii) an obligation that satisfies the following requirements:

(A)(I) is issued in the United States;

(II) is dollar denominated and issued in a non-U.S. market by a solvent U.S. institution other than an insurance company; or

(III) is assumed or guaranteed by a solvent U.S. institution other than an insurance company;

(B) is not in default as to principal or interest;

(C)(I) is rated A or higher, or the equivalent, by a securities rating agency recognized by the Securities Valuation Office of the NAIC; or

(II) is similar in structure and other material respects to other obligations of the same institution that are rated A or higher; and

(D)(I) is insured by at least one authorized insurer, other than the investing insurer or a parent, subsidiary, or affiliate of the investing insurer, licensed to insure obligations in this state, and, after considering the insurance, is rated AAA or the equivalent by a securities rating agency recognized by the Securities Valuation Office of the NAIC; or

(II) is designated as Class One or Class Two by the Securities Valuation Office of the NAIC;

(iii) an obligation rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC and is:

(A) issued, assumed, or guaranteed by a solvent non-U.S. institution chartered in a country that is a member of the Organization for Economic Cooperation and Development; or

(B) an obligation of a U.S. corporation issued in a non-U.S. currency;

(iv) an equity interest in a solvent U.S. institution other than an insurance company, if:

(A) the institution's obligations and preferred shares are eligible as investments under Subsection (4)(d)(iv); and

(B) the equity interest is:

(I) registered on a national securities exchange under the Securities Exchange Act of 1934, 15 U.S.C. Sections 78a to 78kk; or

(II) otherwise registered under the Securities Exchange Act of 1934 and a price quotation for the interest is furnished through a nationwide automated quotation system approved by the Financial Industry Regulatory Authority or successor organization; and

(v) an equity interest in a solvent non-U.S. institution that is organized under the laws of a member country of the Organization for Economic Cooperation and Development, if:

(A) the institution's obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;

(B) the institution's equity interests are registered on a securities exchange regulated by the government of a member country of the Organization for Economic Cooperation and Development;

(C) an investment in or loan upon the institution's outstanding equity interests does not exceed 1% of the assets of the trust; and

(D) the cost of investments in equity interests, when added to the aggregate cost of other investments in equity interests already held pursuant to Subsection (4)(d)(v), may not exceed 10% of the assets in the trust;

(vi) an obligation issued, assumed, or guaranteed by a multinational development bank, if the obligation is rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;

(vii) securities of an investment company registered pursuant to the Investment Company Act of 1940, 15 U.S.C. Sec. 80a, if the investment company:

(A)(I) invests at least 90% of its assets in the types of securities that qualify as an investment under Subsection (4)(d)(i), (4)(d)(ii), or (4)(d)(iii);

(II) invests in securities that the commissioner determines are substantively similar to the types of securities set forth in Subsections (4)(d)(i), (4)(d)(ii), and (4)(d)(iii); or

(III) invests at least 90% of its assets in the types of equity interests that qualify as an investment under Subsection (4)(d)(iv); and

(B) includes the aggregate amount of investments in qualifying investment companies when calculating the permissible aggregate value of equity interests pursuant to Subsection (4)(d)(iv); or

(viii) a letter of credit, if:

(A) in the case where a letter of credit expires without being renewed or replaced, the trustee has the right and duty under the deed of trust or other binding agreement, as approved by the commissioner, to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust; and

(B) the trust agreement provides that the trustee is liable for negligence, willful misconduct, or lack of good faith, which may include the failure of a trustee to draw against a letter of credit.

(e) An investment made pursuant to Subsection (4)(d) is subject to the following additional limitations:

(i) an investment in or loan on the obligations of an institution other than an institution that issues mortgage-related securities may not exceed 5% of the assets of the trust;

(ii) an investment in a mortgage-related security may not exceed 5% of the assets of the trust;

(iii) the aggregate total investment in mortgage-related securities may not exceed 25% of the assets of the trust;

(iv) preferred or guaranteed shares issued or guaranteed by a solvent U.S. institution are permissible investments if the institution's obligations are eligible under Subsections (4)(d)(ii)(D)(I) and (4)(d)(ii)(D)(II), but may not exceed 2% of the assets of the trust;

(v) a trust's investment in investment companies may not exceed 10% of the assets in the trust;

(vi) the aggregate amount of investments in qualifying investment companies may not exceed 25% of the assets in the trust; and

(vii) an investment in an investment company qualifying under Subsection (4)(e)(vi) may not exceed 5% of the assets in the trust.

(5) A specific security provided to a ceding insurer by an assuming insurer pursuant to Section R590-173-11 is applied, until exhausted, to the payment of liabilities of the assuming insurer to the ceding insurer holding the specific security prior to, and as a condition precedent for, presenting a claim by the ceding insurer for payment by a trustee of a trust established by the assuming insurer.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-8 Credit for Reinsurance -- Reinsurer is a Certified Reinsurer

(1) Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer that is certified as a reinsurer in this state whenever the ceding insurer claims credit for reinsurance in a statutory financial statement.

(2) The credit allowed in Subsection (1) is based on the security held by or on behalf of the ceding insurer in accordance with a rating assigned to the certified reinsurer by the commissioner.

(3) The security is in a form consistent with Subsection 31A-17-404(7), and Sections R590-173-12 through R590-173- 14.

(4) The amount of security required for full reinsurance credit shall correspond with the requirements of this subsection.

(a) Table 1 sets forth the security required for each rating.

TABLE 1

Rating

Security Required

Secure -- 1

Secure -- 2

10%

Secure -- 3

20%

Secure -- 4

50%

Secure -- 5

75%

Vulnerable -- 6

100%

(b) An affiliated reinsurance transaction shall receive the same opportunity for a reduced security requirement as any other reinsurance transaction.

(c) A certified reinsurer shall post 100% security, for the benefit of the ceding insurer or its estate, upon the entry of an order of receivership, rehabilitation, or liquidation against the ceding insurer.

(d)(i) A certified reinsurer may post security for catastrophe recoverables for a period of one year from the date of the first instance of a liability reserve entry by the ceding company as a result of a loss from a catastrophic occurrence as recognized by the commissioner.

(ii) The one-year deferral period is contingent on the certified reinsurer continuing to pay claims in a timely manner.

(iii) Reinsurance recoverables for the following lines of business, as reported on the NAIC annual financial statement related to the catastrophic occurrence, shall be included in the deferral:

(A) Line 1, Fire;

(B) Line 2, Allied Lines;

(D) Line 4, Homeowners multiple peril;

(E) Line 5, Commercial multiple peril;

(F) Line 9, Inland Marine;

(G) Line 12, Earthquake; and

(H) Line 21, Auto physical damage.

(e) Credit for reinsurance under this section is available only for a reinsurance contract that is:

(i) entered into or renewed on or after the effective date of the assuming insurer's certification;

(ii) entered into before the effective date of the certification and is amended with an effective date after the effective date of certification but only for losses incurred and reserves reported after the effective date of certification; or

(iii) new and covers a risk for which credit is allowed before certification based on collateral provided, if the new contract's effective date is after the effective date of certification, but only for losses incurred and reserves reported after the effective date of certification.

(f) A reinsurance agreement may establish security requirements that exceed the minimum security requirements for certified reinsurers in this section.

(5)(a) After receiving an application for certification, the commissioner shall post notice of the application on the department's website, https://insurance.utah.gov, and include instructions on how the public may respond to the application.

(b) The commissioner may not take final action on the application until at least 30 days after posting the notice required in Subsection (5)(a).

(c)(i) The commissioner shall notify the applicant in writing of the final action.

(ii) If the application is approved, the notice shall state the certified reinsurer's rating.

(d) The commissioner shall publish on the department's website a list of all certified reinsurers and their ratings.

(e) An assuming insurer shall meet the following requirements to qualify for certification:

(i) be domiciled and licensed to transact insurance or reinsurance in a qualified jurisdiction, as determined by the commissioner under Subsection (7);

(ii)(A) maintain capital and surplus, or its equivalent, of not less than $250 million, calculated in accordance with Subsection (5)(f)(ii)(H); and

(B) this requirement may be satisfied by an association including incorporated and individual unincorporated underwriters having:

(I) minimum capital and surplus equivalents, net of liabilities, of at least $250 million; and

(II) a central fund containing a balance of at least $250 million;

(iii)(A) the assuming insurer shall maintain financial strength ratings from two or more rating agencies acceptable to the commissioner;

(B) the ratings shall:

(I) be based on interactive communication between the rating agency and the assuming insurer;

(II) not be based solely on publicly available information; and

(III) be one factor used by the commissioner in determining the rating that is assigned to the assuming insurer; and

(I) Standard & Poor's;

(II) Moody's Investors Service;

(III) Fitch Ratings;

(IV) A.M. Best Company; or

(V) any other nationally recognized statistical rating organization; and

(iv) the certified reinsurer shall comply with all requirements reasonably imposed by the commissioner.

(f)(i) A certified reinsurer is rated on a legal entity basis, with due consideration given to the group rating where appropriate, except that an association including incorporated and individual unincorporated underwriters that are approved to do business as a single certified reinsurer may be evaluated on the basis of its group rating.

(ii) Factors that may be considered as part of the evaluation process include:

(A) a certified reinsurer's maximum financial strength rating, calculated based on Table 2;

(I) the lowest financial strength rating given by an approved rating agency is used; and

(II) a certified reinsurer shall maintain at least two financial strength ratings to maintain eligibility;

TABLE 2

Rating

Best

S&P

Moody's

Fitch

Secure -- 1

A++

AAA

Aaa

AAA

Secure -- 2

A+

AA+, AA, AA-

Aa1, Aa2, Aa3

AA+, AA, AA-

Secure -- 3

A+, A

A1, A2

A+, A

Secure -- 4

A-

Secure -- 5

B++, B+

BBB+, BBB, BBB-

Baa1, Baa2, Baa3

BBB+, BBB, BBB-

Vulnerable -- 6

B, B-, C++, C+, C, C-, D, E, F

BB+, BB, BB-, B+, B, B-, CCC, CC, C, D, R

Ba1, Ba2, Ba3, B1, B2, B3, Caa, Ca, C

BB+, BB, BB-, B+, B, B-, CCC+, CC, CCC-, DD

(B) the business practices of a certified reinsurer dealing with its ceding insurers, including its record of compliance with reinsurance contractual terms and obligations;

(C) for certified reinsurers domiciled in the U.S., a review of the most recent applicable NAIC Annual Statement Blank, either Schedule F for property and casualty reinsurers or Schedule S for life and health reinsurers, available on the department's website, https://insurance.utah.gov;

(D) for certified reinsurers not domiciled in the U.S., an annual review of Form CR-F for property and casualty reinsurers or Form CR-S for life and health reinsurers, available on the department's website, https://insurance.utah.gov;

(E) a certified reinsurer's reputation for prompt payment of claims under reinsurance agreements, based on an analysis of a ceding insurer's Schedule F reporting of overdue reinsurance recoverables, including the proportion of obligations that are more than 90 days past due or are in dispute, with specific attention given to obligations payable to companies that are in delinquency, administrative proceedings, or receivership;

(F) regulatory action against the certified reinsurer;

(G) the report of the independent auditor on a financial statement of the insurance enterprise, under Subsection (5)(f)(ii)(H);

(H) for a certified reinsurer not domiciled in the U.S.:

(I) audited financial statements, regulatory filings, and actuarial opinions, filed with the non-U.S. jurisdiction supervisor, translated into English; and

(II) the audited financial statements filed with the non-U.S. jurisdiction supervisor for the last two years;

(I) the liquidation priority of obligations to a ceding insurer in the certified reinsurer's domiciliary jurisdiction in the context of an insolvency proceeding;

(J) a certified reinsurer's participation in any solvent scheme of arrangement, or similar procedure, that involves U.S. ceding insurers, if the commissioner received prior notice from a certified reinsurer that proposes participation by the certified reinsurer in a solvent scheme of arrangement; and

(K) any other information relevant to the commissioner.

(g) Based on the analysis conducted under Subsection (5)(f)(ii)(E) of a certified reinsurer's reputation for prompt payment of claims, the commissioner may make appropriate adjustments in the security that the certified reinsurer is required to post to protect its liabilities to U.S. ceding insurers, provided the commissioner increases the security the certified reinsurer is required to post by one rating level under Subsection (5)(f)(ii) if the commissioner finds that:

(A) more than 15% of the certified reinsurer's ceding insurance clients have overdue reinsurance recoverables on paid losses of 90 days or more that are not in dispute and exceed $100,000 for each cedent; or

(B) the aggregate amount of reinsurance recoverables on paid losses that are not in dispute that are overdue by 90 days or more exceeds $50 million.

(h) The assuming insurer shall file with the commissioner a completed Form CR-1, available on the department's website, https://insurance.utah.gov, evidencing its:

(i) submission to the jurisdiction of this state;

(ii) appointment of the commissioner as an agent for service of process; and

(iii) agreement to provide security for 100% of the assuming insurer's liabilities attributable to reinsurance ceded by U.S. ceding insurers if it resists enforcement of a final U.S. judgment.

(i) The commissioner may not certify any assuming insurer that is domiciled in a jurisdiction that the commissioner determines does not adequately and promptly enforce final U.S. judgments or arbitration awards.

(j)(i) The certified reinsurer shall agree to meet applicable information filing requirements as determined by the commissioner for an initial application for certification and on an ongoing basis.

(ii) All information submitted by a certified reinsurer that is not public information subject to disclosure is exempted from disclosure under Title 63G, Chapter 2, Government Records Access and Management Act, and is withheld from public disclosure.

(k) A certified reinsurer shall notify or file with the commissioner the following:

(i) within 10 days of any regulatory action taken against the certified reinsurer:

(A) any change in the provisions of its domiciliary license; or

(B) any change in rating by an approved rating agency, including a statement describing the changes and the reasons therefor;

(ii) Form CR-F or CR-S annually, as applicable;

(iii) annually, a report of the independent auditor on the financial statements of the insurance enterprise;

(iv) the most recent audited financial statements, regulatory filings, and actuarial opinion filed with the certified reinsurer's supervisor, translated into English;

(v) upon initial certification, audited financial statements for the last two years filed with the certified reinsurer's supervisor;

(vi) at least annually, an updated list of all disputed and overdue reinsurance claims regarding reinsurance assumed from U.S. domestic ceding insurers;

(vii) a certification from the certified reinsurer's domestic regulator that the certified reinsurer is in good standing and maintains capital in excess of the jurisdiction's highest regulatory action level; and

(viii) any other information the commissioner reasonably requires.

(l) A change in rating or revocation of certification is subject to the following:

(i) in the case of a downgrade by a rating agency or other disqualifying circumstance, the commissioner shall assign a new rating to the certified reinsurer under Subsection (5)(f)(ii)(A);

(ii) the commissioner may suspend, revoke, or modify a certified reinsurer's certification if:

(A) the certified reinsurer fails to meet its obligations or security requirements under this section; or

(B) other financial or operating results of the certified reinsurer, or documented significant delays in payment by the certified reinsurer, lead the commissioner to reconsider the certified reinsurer's ability or willingness to meet its contractual obligations;

(iii) if a certified reinsurer's rating is upgraded by the commissioner, the certified reinsurer may meet the security requirements applicable to its new rating on a prospective basis, but the commissioner requires the certified reinsurer to post security under the previously applicable security requirements as to all contracts in force on or before the effective date of the upgraded rating;

(iv) if a certified reinsurer's rating is downgraded by the commissioner, the commissioner requires the certified reinsurer to meet the security requirements applicable to its new rating for all business it assumed as a certified reinsurer;

(v) if the commissioner revokes a certified reinsurer's certification for the ceding insurer to continue to take credit for reinsurance ceded to the assuming insurer:

(A) the assuming insurer shall post security under Section R590-173-11; or

(B) if the funds continue to be held in trust under Section R590-173-7, the commissioner may allow additional credit equal to the ceding insurer's pro rata share of such funds, discounted to reflect the risk of uncollectability and anticipated expenses of trust administration; and

(vi) notwithstanding the change of a certified reinsurer's rating or revocation of its certification, a domestic insurer that cedes reinsurance to a certified reinsurer may not be denied credit for reinsurance for a period of three months for all reinsurance ceded to that certified reinsurer unless the reinsurance is found by the commissioner to be at high risk of uncollectability.

(6) If, upon conducting an evaluation under this section with respect to the reinsurance supervisory system of any non- U.S. assuming insurer, the commissioner determines that the jurisdiction is recognized as a qualified jurisdiction, the commissioner shall:

(a) publish notice and evidence of the recognition on the department's website, https://insurance.utah.gov; and

(b) establish a procedure to withdraw recognition of the jurisdiction that is no longer qualified.

(7) If the domiciliary jurisdiction of a non-U.S. assuming insurer is eligible to be recognized as a qualified jurisdiction under Subsection (6), the commissioner shall:

(a) evaluate the reinsurance supervisory system of the non-U.S. jurisdiction, both initially and on an ongoing basis;

(b) consider the rights, benefits, and extent of reciprocal recognition afforded by the non-U.S. jurisdiction to reinsurers licensed and domiciled in the U.S.;

(d) create and publish a list of jurisdictions whose reinsurers are approved by the commissioner as eligible for certification;

(e) obtain an agreement from a qualified jurisdiction to share information and cooperate with the commissioner with respect to all certified reinsurers domiciled in that jurisdiction;

(f) consider additional factors, at the commissioner's discretion, including:

(i) the framework the assuming insurer is regulated under;

(ii) the structure and authority of the domiciliary regulator regarding solvency regulation requirements and financial surveillance;

(iii) the substance of financial and operating standards for an assuming insurer in the domiciliary jurisdiction;

(iv) the form and substance of financial reports required to be filed or made publicly available by a reinsurer in the domiciliary jurisdiction;

(v) the accounting principles used;

(vi) the domiciliary regulator's willingness to cooperate with U.S. regulators in general and the commissioner in particular;

(vii) the history of performance by assuming insurers in the domiciliary jurisdiction;

(viii)(A) any documented evidence of substantial problems with the enforcement of final U.S. judgments in the domiciliary jurisdiction; and

(B) a jurisdiction may not be considered a qualified jurisdiction if the commissioner determines that it does not adequately and promptly enforce final U.S. judgments or arbitration awards;

(ix) any relevant international standards or guidance with respect to mutual recognition of reinsurance supervision adopted by the International Association of Insurance Supervisors or successor organization; and

(x) any relevant factors established by the commissioner;

(g) consider the list of qualified jurisdictions published through the NAIC committee process in determining qualified jurisdictions;

(h) provide thoroughly documented justification of the criteria under Subsections (7)(f)(i) through (7)(f)(x) if the commissioner approves a jurisdiction as qualified; and

(i) recognize as qualified jurisdictions, U.S. jurisdictions that meet the requirements for accreditation under the NAIC financial standards and accreditation program.

(8) If an applicant for certification is certified as a reinsurer in an NAIC accredited jurisdiction, the commissioner may:

(a) defer to that jurisdiction's certification;

(b) defer to the rating assigned by that jurisdiction if the assuming insurer:

(i) files with the commissioner a completed Form CR-1, available on the department's website, https://insurance.utah.gov; and

(ii) provides additional information required by the commissioner; and

(9) A change in a certified reinsurer's status or rating in another jurisdiction automatically applies in this state as of the date it takes effect in the other jurisdiction.

(10) The certified reinsurer shall notify the commissioner of any change in its status or rating within 10 days after receiving notice of the change.

(11) In recognizing a certification from an accredited jurisdiction, the commissioner may:

(a) withdraw recognition of the other jurisdiction's rating at any time and assign a new rating under Subsection (5)(l); and

(b) withdraw recognition of the other jurisdiction's certification, upon written notice to the certified reinsurer.

(12) Unless the commissioner suspends or revokes a certified reinsurer's certification, the certified reinsurer's certification is in good standing for three months, and shall be extended if additional time is necessary to consider the assuming insurer's application for certification in this state.

(13) In addition to the requirements of Section R590-173-15, a reinsurance contract entered into or renewed under this section shall include a proper funding clause requiring the certified reinsurer to provide and maintain security in an amount sufficient to avoid the imposition of any financial statement penalty on the ceding insurer for reinsurance ceded to the certified reinsurer.

(14) The commissioner shall comply with all reporting and notification requirements established by the NAIC regarding certified reinsurers and qualified jurisdictions.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-9 Credit for Reinsurance -- Reinsurer is from a Reciprocal Jurisdiction

(1) Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed to write reinsurance by, and has its head office or is domiciled in, a reciprocal jurisdiction, and meets the requirements of this rule.

(2) Credit is allowed when reinsurance is ceded from an insurer domiciled in this state to an assuming insurer if the assuming insurer:

(a) is licensed to transact reinsurance by, and has its head office or is domiciled in, a reciprocal jurisdiction;

(b) meets and maintains minimum capital and surplus, or its equivalent, calculated on at least an annual basis as of the preceding December 31 or on the annual date reported to the reciprocal jurisdiction; and

(c) the minimum capital and surplus is confirmed under Subsection (2)(g) according to the methodology of its domiciliary jurisdiction, in the following amounts:

(A) no less than $250 million; or

(B) if the assuming insurer is an association, including incorporated and individual unincorporated underwriters:

(I) minimum capital and surplus equivalents, net of liabilities, or own funds of the equivalent of at least $250 million; and

(II) a central fund containing a balance of the equivalent of at least $250 million;

(d) meets and maintains on an ongoing basis a minimum solvency or capital ratio as follows:

(i) if the assuming insurer has its head office or is domiciled in a reciprocal jurisdiction as defined in Subsection R590- 173-3(12)(a), the ratio specified in the applicable covered agreement;

(ii) if the assuming insurer is domiciled in a reciprocal jurisdiction as defined in Subsection R590-173-3(12)(b), a risk- based capital ratio of 300% of the authorized control level, calculated according to the formula developed by the NAIC; or

(iii) if the assuming insurer is domiciled in a reciprocal jurisdiction as defined in Subsection R590-173-3(12)(c), after consultation with the reciprocal jurisdiction and considering any recommendations published through the NAIC committee process, such solvency or capital ratio as the commissioner determines to be an effective measure of solvency;

(e) provides adequate assurance in a completed Form RJ-1, available on the department's website, https://insurance.utah.gov, that the assuming insurer:

(i) will provide prompt written notice and explanation to the commissioner if:

(A) it falls below the minimum requirements set forth in Subsection (2)(b) or (2)(c); or

(B) any regulatory action is taken against it for serious noncompliance with applicable law;

(ii) consents to the jurisdiction of the courts of this state and appoints the commissioner as agent for service of process;

(iii) consents in writing to pay all final judgments, wherever enforcement is sought, obtained by a ceding insurer that is enforceable where the judgment was obtained;

(iv) includes in every reinsurance agreement a requirement that it will provide security in an amount equal to 100% of liabilities attributable to reinsurance ceded pursuant to the agreement if it resists enforcement of a final judgment that is enforceable under the law of the jurisdiction in which it was obtained, or a properly enforceable arbitration award, whether obtained by the ceding insurer or by its legal successor on behalf of its estate;

(v) confirms that it is not participating in a solvent scheme of arrangement that involves this state's ceding insurers;

(vi) on entering into a solvent scheme of arrangement, agrees to:

(A) notify the ceding insurer and the commissioner; and

(B) provide 100% security to the ceding insurer consistent with the terms of the scheme, and in a form consistent with the provisions of law and this rule; and

(vii) agrees in writing to meet the applicable information filing requirements of Subsection (2)(f);

(f) provides, if requested by the commissioner, on behalf of itself and any legal predecessors, the following documentation:

(i) for the two years preceding entry into the reinsurance agreement and on an annual basis thereafter, its annual audited financial statements, in accordance with the applicable law of the jurisdiction of its head office or domiciliary jurisdiction, including the external audit report;

(ii) for the two years preceding entry into the reinsurance agreement, its solvency and financial condition report or actuarial opinion, if filed with its supervisor;

(iii) before entry into the reinsurance agreement and not more than semi-annually thereafter, an updated list of all disputed and overdue reinsurance assumed from ceding insurers domiciled in the United States; and

(iv) before entry into the reinsurance agreement and not more than semi-annually thereafter, information regarding its:

(A) assumed reinsurance by the ceding insurer;

(B) ceded reinsurance by the assuming insurer; and

(C) reinsurance recoverables on its paid and unpaid losses allowing for the evaluation of the criteria set forth in Subsection (2)(g);

(g) maintains a practice of promptly paying reinsurance claims as follows:

(i) no more than 15% of its reinsurance recoverables are overdue and in dispute, as reported to the commissioner;

(ii) no more than 15% of its ceding insurers or reinsurers have overdue reinsurance recoverables on paid losses of 90 days or more that are:

(A) not in dispute and exceed for each ceding insurer $100,000; or

(B) as specified in a covered agreement; or

(iii) the aggregate amount of reinsurance recoverables on undisputed paid losses are:

(A) overdue by 90 days or more and exceed $50 million; or

(B) as specified in a covered agreement; and

(h) complies with Subsections (2)(b) and (2)(c) as confirmed by its supervisory authority to the commissioner on an annual basis.

(3) An assuming insurer may provide the commissioner with information on a voluntary basis.

(4) An assuming insurer's consent to the jurisdiction of the courts of this state and to appointing the commissioner as agent for service of process shall be included in each reinsurance agreement under the commissioner's jurisdiction.

(5) Parties to a reinsurance agreement may agree to alternative dispute resolution mechanisms, except to the extent such agreements are unenforceable under applicable insolvency or delinquency laws.

(6)(a) The commissioner shall create and publish a list of reciprocal jurisdictions that includes a reciprocal jurisdiction as defined under Subsection R590-173-3(12)(a), R590-173-3(12)(b), or R590-173-3(12)(c).

(b) The commissioner shall consider a reciprocal jurisdiction included on the NAIC list of reciprocal jurisdictions.

(7) The commissioner may approve a jurisdiction that does not appear on the NAIC list of reciprocal jurisdictions as provided by applicable law, regulation, or in accordance with criteria published through the NAIC committee process.

(8)(a) The commissioner may remove a jurisdiction from the list of reciprocal jurisdictions on a determination that the jurisdiction no longer meets one or more of the requirements of a reciprocal jurisdiction, as provided by applicable law or in accordance with a process published through the NAIC committee process.

(b) The commissioner may not remove from the list a reciprocal jurisdiction defined under Subsection R590-173- 3(12)(a), R590-173-3(12)(b), or R590-173-3(12)(c).

(c) When removing a reciprocal jurisdiction from the commissioner's list, credit for reinsurance ceded to an assuming insurer domiciled in that jurisdiction is permitted, if otherwise allowed by law.

(9) The commissioner shall create and publish a list of assuming insurers that qualify as reinsurers from reciprocal jurisdictions satisfying the conditions of this section and where cessions are granted reinsurance credit.

(a) If an NAIC accredited jurisdiction determines that the conditions set forth in Subsection (9)(b) are met, the commissioner may:

(i) defer to that jurisdiction's determination;

(ii) add the assuming insurer to the list of insurers where cessions are granted reinsurance credit; and

(iii) accept financial documentation filed with another NAIC accredited jurisdiction or with the NAIC under Subsection (9)(b).

(b) A request to defer to another NAIC accredited jurisdiction's determination shall include:

(i) a completed Form RJ-1, available on the department's website, https://insurance.utah.gov; and

(ii) additional information the commissioner may require.

(i) notify other states of the request through the NAIC committee process; and

(ii) provide relevant information about the determination of eligibility.

(10) If the commissioner determines that an assuming insurer no longer meets one or more of the requirements under this section, the commissioner may revoke or suspend the eligibility of the assuming insurer.

(a) During a suspension period, a reinsurance agreement may not be issued, amended, or renewed after the effective date of the suspension qualifies for credit except to the extent that the assuming insurer's obligations under the contract are secured under Section R590-173-11.

(b) Credit for reinsurance may not be available after the effective date of the revocation for a reinsurance agreement entered into before the date of revocation, except to the extent that the assuming insurer's obligations under the contract are secured in a form acceptable to the commissioner and consistent with Section R590-173-11.

(11) Before denying statement credit, requiring security under Subsection (10), or adopting a similar requirement with the same regulatory impact to requiring security, the commissioner shall:

(a) notify the following that the assuming insurer no longer satisfies one of the conditions listed in Subsection (2):

(i) the ceding insurer;

(ii) the assuming insurer; and

(iii) the assuming insurer's supervisory authority;

(b) give the assuming insurer:

(i) 30 days to submit a plan to remedy the defect; and

(ii) 90 days to remedy the defect unless a shorter period is necessary to protect policyholders and consumers;

(d) provide the assuming insurer a written explanation for action taken.

(12) A ceding insurer may seek a court order that requires an assuming insurer in receivership, rehabilitation, or liquidation to post security for the assuming insurer's outstanding liabilities.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-10 Credit for Reinsurance Required by Law

Credit is allowed for reinsurance ceded by a domestic insurer to an assuming insurer that does not meet the requirements of this rule but only for the insurance of risks located in a reciprocal jurisdiction defined in Subsection R590-173- 3(12), where the reinsurance is required by the laws of that jurisdiction.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-11 Reinsurance Ceded to an Unauthorized Reinsurer Not Meeting the Requirements of Sections R590-173-4 Through R590-173-10

(1) A reduction is allowed from liability for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of Subsections 31A-17-404(3) through 31A-17-404(8).

(2) A reduction from liability is:

(a) an amount not exceeding the liabilities carried by the ceding insurer; and

(b) the amount of funds held by or on behalf of the ceding insurer, including funds held in trust for the exclusive benefit of the ceding insurer, under a reinsurance contract with such assuming insurer as security for the payment of obligations under the reinsurance contract which funds shall be:

(i) held in the United States subject to withdrawal solely by, and under the exclusive control of, the ceding insurer; or

(ii) in the case of a trust, held in a qualified United States financial institution.

(3) The security held under Subsection (2)(b) may be in the form of:

(a) cash;

(b) securities listed by the Securities Valuation Office of the NAIC, including those deemed exempt from filing as defined by the Purposes and Procedures Manual of the Securities Valuation Office, and qualifying as admitted assets;

(i) are issued or confirmed by a qualified United States financial institution;

(ii) are effective no later than December 31 of the year the filing is made;

(iii) are in the possession of, or in trust for, the ceding insurer on or before the filing date of its annual statement; and

(iv) meet the issuer's standards of acceptability at the time of issuance until their expiration, extension, renewal, modification, or amendment, whichever occurs first; or

(d) any other security acceptable to the commissioner.

(2) An admitted asset or a reduction from liability for reinsurance ceded to an unauthorized assuming insurer pursuant to this section is allowed only when the requirements of the following are satisfied:

(a) Section R590-173-15; and

(b) the applicable provisions of:

(i) Section R590-173-12;

(ii) Section R590-173-13; or

(iii) Section R590-173-14.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-12 Trust Agreement Qualified Under Section R590-173-11

(1) A trust agreement qualified under Section R590-173-11 shall:

(a) be between a beneficiary, a grantor, and a trustee that is a qualified United States financial institution;

(b) create a trust account where assets are deposited;

(d) provide that:

(i) the beneficiary may withdraw assets from the trust account at any time, without notice to the grantor, subject only to written notice from the beneficiary to the trustee;

(ii) no other statement or document is required to be presented to withdraw assets, except that the beneficiary may be required to acknowledge receipt of withdrawn assets;

(iii) it is not subject to a condition or qualification outside of the trust agreement; and

(iv) it may not contain a reference to another agreement or document except as provided for in Subsections (k) and (l);

(e) be established for the sole benefit of the beneficiary;

(f) require the trustee to:

(i) receive and hold all assets in a safe place;

(ii) place assets in a form that allows the beneficiary, or the trustee upon direction by the beneficiary, to negotiate the assets without consent or signature from the grantor or any other person or entity;

(iii) furnish to the grantor and the beneficiary a statement of all assets in the trust account upon its inception and at intervals no less frequent than the end of each calendar quarter;

(iv) notify the grantor and the beneficiary within 10 days of a deposit to or withdrawal from the trust;

(v) on a beneficiary's written request, immediately take steps necessary to transfer absolutely and unequivocally all right, title, and interest in the assets held in the trust account to the beneficiary and deliver physical custody of the assets to the beneficiary; and

(vi) not allow a substitution or withdrawal of an asset from the trust account, except:

(A) on written instruction from the beneficiary; and

(B) the trustee may, without the consent of but with notice to the beneficiary, upon call or maturity of any trust asset, withdraw such asset upon condition that the proceeds are paid into the trust account;

(g) provide written notification of termination at least 30 days, but not more than 45 days, before termination of the trust, to the trustee and to the beneficiary;

(h) be subject to the laws of the state in which the trust is domiciled;

(i) prohibit invasion of the trust corpus for the purpose of paying commission to, or reimbursing the expenses of, the trustee, except that in order for a letter of credit to qualify as an asset of the trust, the trustee shall have the right and the obligation pursuant to the deed of trust or some other binding agreement to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust if the letter of credit expires without being renewed or replaced;

(j) provide that the trustee is liable for its:

(i) negligence or willful misconduct, including the failure of the trustee to draw against the letter of credit in circumstances where the draw would be required; and

(ii) lack of good faith;

(k) notwithstanding other provisions of this rule, when a trust agreement is established in conjunction with a reinsurance agreement covering risks other than life, annuity, and accident and health, where a trust agreement is provided for a specific purpose, the trust agreement may provide that the ceding insurer undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:

(i) to pay or reimburse the ceding insurer for:

(A) the assuming insurer's share under the specific reinsurance agreement regarding any losses and allocated loss expenses paid by the ceding insurer, but not recovered from the assuming insurer; and

(B) the unearned premiums due to the ceding insurer if not paid by the assuming insurer;

(ii) to pay the assuming insurer any amount held in the trust account that exceeds 102% of the actual amount required to fund the assuming insurer's obligations under the specific reinsurance agreement; or

(iii) to withdraw amounts equal to the obligations and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified United States financial institution separate from its general assets, in trust for such uses and purposes specified in Subsections (1)(k)(i) and (1)(k)(ii) as may remain executory after such withdrawal and for any period after the termination date where:

(A) the ceding insurer received notification of termination of the trust account; and

(B) the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged 10 days before the termination date;

(l) notwithstanding other provisions of this rule, when a trust agreement is established to meet the requirements of Subsection (2) in conjunction with a reinsurance agreement covering life, annuity, or accident and health risks, where a trust agreement is provided for a specific purpose, the trust agreement may provide that the ceding insurer undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:

(i) to pay or reimburse the ceding insurer for:

(A) the assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owners of policies reinsured under the reinsurance agreement on account of cancellation of the policies; and

(B) the assuming insurer's share under the specific reinsurance agreement of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurer, under the terms and provisions of the policies reinsured under the reinsurance agreement;

(ii) to pay the assuming insurer amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; or

(iii) to withdraw amounts equal to the assuming insurer's share of liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer, and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified United States financial institution separate from its general assets, in trust for the uses and purposes specified in Subsections (1)(l)(i) and (1)(l)(ii) as may remain executory after withdrawal and for any period after the termination date where:

(A) the ceding insurer received notification of termination of the trust; and

(B) the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged 10 days before the termination date; and

(m) either the reinsurance agreement or the trust agreement shall provide that assets deposited in the trust account:

(i) be valued according to their current fair market value; and

(ii) consist only of:

(A) cash in United States dollars;

(B) certificates of deposit issued by a United States bank and payable in United States dollars;

(D) a combination of Subsections (1)(m)(A) through (1)(m)(C), provided:

(I) investments in or issued by an entity controlling, controlled by, or under common control with either the grantor or the beneficiary of the trust may not exceed 5% of total investments; and

(II) investments are of a type of investment specified in the trust agreement; and

(iii) include provisions required by Subsection (1)(m) if the reinsurance agreement covers life, annuity, or accident and health risks.

(2) Permitted conditions.

(a) The trust agreement may provide that:

(i) the trustee may resign on delivery of a written notice of resignation, effective not less than 90 days after the beneficiary and grantor receive the notice; and

(ii) the trustee may be removed by the grantor on delivery to the trustee and the beneficiary of a written notice of removal, effective not less than 90 days after the trustee and the beneficiary receive the notice, if:

(A) no such resignation or removal is effective until a successor trustee is duly appointed and approved by the beneficiary; and

(B) the grantor and all assets in the trust are duly transferred to the new trustee.

(b) The grantor has the full and unqualified right to:

(i) vote any shares of stock in the trust account; and

(ii) receive, from time to time, payments of any dividends or interest upon any shares of stock or obligations included in the trust account, if any interest or dividends are:

(A) forwarded promptly upon receipt to the grantor; or

(B) deposited in a separate account established in the grantor's name.

(c) The trustee has authority to invest, and accept substitutions of, any funds in the account if no investment or substitution is made without prior approval of the beneficiary, unless the trust agreement:

(i) specifies categories of investments acceptable to the beneficiary; and

(ii) authorizes the trustee to invest funds and to accept substitutions that the trustee determines are:

(A) at least equal in current fair market value to the assets withdrawn; and

(B) consistent with the restrictions in Subsection (3)(a)(ii).

(d) The trust agreement may provide that:

(i) the beneficiary may at any time designate a party to which all or part of the trust assets are to be transferred, conditioned upon the trustee receiving, prior to or simultaneously, other specified assets; and

(ii) upon termination of the trust account, all assets not previously withdrawn by the beneficiary shall, with written approval by the beneficiary, be delivered to the grantor.

(3) A reinsurance agreement may:

(a) require the assuming insurer to:

(i) enter into a trust agreement;

(ii) establish a trust account for the benefit of the ceding insurer; and

(iii) specify what the agreement is to cover;

(b) require the assuming insurer, before depositing assets with the trustee, to:

(i) execute assignments or endorsements in blank; or

(ii) transfer legal title to the trustee of all shares, obligations, or other assets requiring assignment, so the ceding insurer or the trustee, upon direction of the ceding insurer, may, when necessary, negotiate the assets without consent or signature from the assuming insurer or another entity;

(c) require that all settlements of account between the ceding insurer and the assuming insurer are in cash or its equivalent;

(d) state that the assuming insurer and the ceding insurer agree that the assets in the trust account may be withdrawn by the ceding insurer at any time, notwithstanding any other provisions in the reinsurance agreement, which assets are used for the following purposes:

(i) to be utilized and applied by the ceding insurer or its successors in interest by operation of law, including any liquidator, rehabilitator, or receiver, without diminution because of insolvency on the part of the ceding insurer or the assuming insurer to pay or reimburse the ceding insurer for:

(A) the assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owner of a policy reinsured under the reinsurance agreement due to cancellation of the policy;

(B) the assuming insurer's share of surrenders and benefits or losses paid by the ceding insurer pursuant to the provisions of the policy reinsured under the reinsurance agreement; and

(C) any other amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; and

(ii) to pay the assuming insurer amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer;

(e) give the assuming insurer the right to seek approval from the ceding insurer, which may not be unreasonably or arbitrarily withheld, to withdraw from the trust account all or any part of the trust assets and transfer those assets to the assuming insurer, provided:

(i) the assuming insurer replaces, at the time of withdrawal, the withdrawn assets with other qualified assets having a current fair market value equal to the market value of the assets withdrawn to always maintain the deposit in the required amount; or

(ii) after withdrawal and transfer, the current fair market value of the trust account is no less than 102% of the required amount;

(f) provide for the return of:

(i) an amount withdrawn in excess of the actual amount under Subsection (3)(d); and

(ii) interest payments at a rate not to exceed the prime rate of interest on such amount; and

(g) permit the award by an arbitration panel or court of competent jurisdiction of:

(i) interest at a rate different from that provided in Subsection (3)(f);

(ii) court or arbitration costs;

(iii) attorney's fees; and

(iv) other reasonable expenses.

(4) A trust agreement may be used to reduce a liability for reinsurance ceded to an unauthorized assuming insurer in a financial statement required to be filed with the department in compliance with the provisions of this rule when:

(a) established on or before the date of filing of the financial statement of the ceding insurer;

(b) the reduction for the existence of an acceptable trust account is not more than the current fair market value of acceptable assets available to be withdrawn from the trust account at the time the trust is established; and

(c) the reduction is not greater than the specific obligations under the reinsurance agreement that the trust account was established to secure.

(5) Failure of a trust agreement to specifically identify the beneficiary may not be construed to affect an action or right that the commissioner may take or possess pursuant to the provisions of the laws of this state.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-13 Letter of Credit Qualified Under Section R590-173-11

(1)(a) A letter of credit shall be:

(i) clean;

(ii) irrevocable;

(iii) unconditional; and

(iv) issued or confirmed by a qualified United States financial institution.

(b) A letter of credit shall contain:

(i) an issue date;

(ii) an expiration date; and

(iii) statements that:

(A) to obtain funds, a beneficiary is required only to draw a sight draft under a letter of credit and present it; and

(B) the letter of credit is not subject to a condition or qualification not stated in it.

(2) The heading of a letter of credit may include a boxed section containing the name of the applicant and other appropriate notations shall be clearly marked to indicate that the information is for internal identification purposes only.

(3) A letter of credit shall contain a statement that the issuing financial institution's obligation under the letter of credit is not contingent on reimbursement.

(4)(a) The term of a letter of credit shall be for at least one year.

(b) A letter of credit shall contain an evergreen clause that:

(i) prevents the letter of credit from expiring without notice from the issuer; and

(ii) requires no less than 30 days' notice before the expiration date for nonrenewal.

(5)(a) A letter of credit shall state whether it is subject to and governed by:

(i) the laws of this state;

(ii) the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce Publication 600 (UCP 600);

(iii) International Standby Practices of the International Chamber of Commerce Publication 590 (ISP98); or

(iv) any successor publication to those named in Subsection (5)(a)(ii) or (5)(a)(iii).

(b) Drafts drawn under Subsection (5)(a) shall be presentable at an office in the United States of a qualified United States financial institution.

(6) A letter of credit under Subsections (5)(a)(ii) through (5)(a)(iv) shall specifically address and provide for an extension of time to draw against the letter of credit in the event that one or more of the occurrences specified in Article 36 of UCP600 or any successor publication occur.

(7) If the letter of credit is issued by a financial institution authorized to issue letters of credit, other than a qualified United States financial institution, the following requirements shall be met:

(a) the issuing financial institution shall formally designate the confirming qualified United States financial institution as its agent for the receipt and payment of the drafts; and

(b) the evergreen clause shall provide for 30 days' notice before the expiration date for nonrenewal.

(8) Reinsurance agreement provisions.

(a) A reinsurance agreement obtained together with a letter of credit may:

(i) require the assuming insurer to provide letters of credit to the ceding insurer and specify what they cover; or

(ii) state that the assuming insurer and ceding insurer agree that the letter of credit provided by the assuming insurer pursuant to the provisions of the reinsurance agreement may be drawn upon at any time, notwithstanding any other provisions in the agreement, and shall be utilized by the ceding insurer or its successors in interest only for one or more of the following reasons:

(A) to pay or reimburse the ceding insurer for:

(I) the assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurers, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of such policies;

(II) the assuming insurer's share, under the specific reinsurance agreement, of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurers, under the terms and provisions of the policies reinsured under the reinsurance agreement; and

(III) any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; and

(B) where the letter of credit will expire without renewal or be reduced or replaced by a letter of credit for a reduced amount and where the assuming insurer's entire obligations under the reinsurance agreement remain unliquidated and undischarged 10 days before the termination date, to withdraw amounts equal to the assuming insurer's share of the liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer and exceed the amount of any reduced or replacement letter of credit, the assuming insurer shall deposit the amounts withdrawn in a separate account in the name of the ceding insurer in a qualified United States financial institution apart from its general assets, in trust for such uses and purposes specified in Subsection (8)(ii)(A) as may remain after withdrawal and for any period after the termination date.

(iii) The provisions of Subsection (8)(a) apply without diminution because of insolvency on the part of the ceding insurer or assuming insurer.

(b) Nothing in Subsection (8)(a) precludes the ceding insurer and assuming insurer from providing for:

(i) an interest payment, at a rate not in excess of the prime rate of interest, on the amounts held under Subsection (8)(b); or

(ii) the return of any amounts drawn down on the letters of credit in excess of the actual amounts required for the above or any amounts that are subsequently determined not to be due.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-14 Other Security

A ceding insurer may take credit for unencumbered funds withheld by the ceding insurer in the United States subject to withdrawal solely by the ceding insurer and under its exclusive control.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-15 Required Provisions in a Reinsurance Contract

Credit for reinsurance may not be granted, and an asset or reduction from liability allowed, to a ceding insurer for reinsurance effected with assuming insurers meeting the requirements of this rule or Section 31A-17-404 unless the reinsurance agreement:

(1) includes a proper insolvency clause, stipulating that reinsurance is payable directly to the liquidator or successor without diminution regardless of the status of the ceding company;

(2) includes a provision that the assuming insurer, if an authorized assuming insurer:

(a) submits to the jurisdiction of an alternative dispute resolution panel or court of competent jurisdiction within the United States;

(b) complies with all requirements necessary to give the court or panel jurisdiction;

(d) agrees to abide by the final decision of the court or panel; and

(3) includes a proper reinsurance intermediary clause stipulating that the credit risk for the intermediary is carried by the assuming insurer.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-173-16 Severability

If any provision of this rule, Rule R590-173, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: July 29, 2022
Notice of Continuation: June 21, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-176 Health Benefit Plan Enrollment

Utah Admin. Code R590-176-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-202.

History

KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-176-2 Purpose and Scope

(1) The purpose of this rule is to provide enrollment requirements under Section 31A-30-108.

(2) This rule applies to a carrier that provides health benefit plan coverage to individuals and small employers under Section 31A-30-104.

History

KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-176-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows.

(1) "Time period" means the period such as daily, weekly, or monthly, as determined by the carrier, in which applications are grouped.

History

KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-176-4 General Provisions

(1) Any attempt to selectively or unfairly delay, obstruct, or hinder any person from obtaining coverage under Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act, is a violation of Section 31A-30-108.

(2) Enrollment shall be equally available through all distribution systems.

(3) A carrier may not market or encourage producers to market individual or small employer health benefit plans to lessen the incentive to insure business with greater health risks.

(4) Each record regarding an enrollment application or underwriting determination shall:

(a) be retrievable for examination by the time period the application was received;

(b) include any document pertaining to the application and its underwriting; and

(5) A document described in Subsection (4)(b) includes:

(a) an application and date received;

(b) any notification to the applicant and date of notification;

(d) an underwriting decision and date of decision.

History

KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-176-5 Application and Enrollment

(1) A carrier shall keep a record of each application for coverage that includes the time period the application is received by the carrier.

(2) All applications shall be treated consistently.

(3)(a) A complete application shall be processed and the applicant shall be given written notice of the decision within 30 days of the decision.

(b) A carrier may not require that an application be complete to qualify as an application for coverage.

(c) If an application is incomplete, the carrier shall notify the applicant of the incomplete areas and the information required to complete the application within 15 days of receipt of the application.

(d) Before an application can be rejected as incomplete, an applicant shall have at least 30 days to provide the required information.

History

KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-176-6 Severability

If any provision of this rule, Rule R590-176, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

R590-177 Life Insurance Illustrations Rule

Utah Admin. Code R590-177-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-22-425, and 31A-23a-402.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish rules for life insurance policy illustrations to protect consumers and foster consumer education;

(b) provide formats, standards, and required disclosures; and

(2) This rule applies to a group or individual life insurance policy or certificate sold on or after January 1, 1997, except:

(a) variable life insurance;

(b) individual and group annuity contracts;

(d) a life insurance policy with no illustrated death benefit on any individual exceeding $10,000.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Actuarial Standards Board" means the board established by the American Academy of Actuaries to promulgate standards of actuarial practice.

(2) "Contract premium" means the gross premium required to be paid under a policy, including the premium for a rider if the rider benefits are shown in the illustration.

(3) "Currently payable scale" means a scale of non-guaranteed elements in effect for a policy form as of the preparation date of the illustration or declared to become effective within the next 95 days.

(4)(a) "Disciplined current scale" means a scale of non-guaranteed elements, certified annually by an illustration actuary, constituting a limit on illustrations currently being illustrated by an insurer and reasonably based on recent historical experience.

(b) Further guidance in determining the disciplined current scale, as contained in standards established by the Actuarial Standards Board, may be relied upon if the standards:

(i) are consistent with this rule;

(ii) limit a disciplined current scale to reflect only actions that have already been taken or events that have already occurred;

(iii) do not permit a disciplined current scale to include any projected trends of improvements in experience or any assumed improvements in experience beyond the illustration date; and

(iv) do not permit assumed expenses to be less than minimum assumed expenses.

(5) "Generic name" means a short title descriptive of the policy being illustrated such as "whole life," "term life," or "flexible premium adjustable life."

(6) "Guaranteed element" means a premium, benefit, value, credit, or charge under a life insurance policy that is guaranteed and determined at issue.

(7) "Non-guaranteed element" means a premium, benefit, value, credit, or charge under a life insurance policy that is not guaranteed or not determined at issue.

(8) "Illustrated scale" means a scale of non-guaranteed elements that is not more favorable to the policy owner than the lesser of:

(a) the disciplined current scale; or

(b) the currently payable scale.

(9) "Illustration" means a presentation or depiction that includes a non-guaranteed element of a life insurance policy over a period of years as defined below:

(a) "Basic illustration" means a ledger or proposal used in the sale of a life insurance policy that shows both guaranteed and non-guaranteed elements.

(b) "Supplemental illustration" means an illustration furnished in addition to a basic illustration that may be presented in a format differing from the basic illustration, but may only depict a scale of non-guaranteed elements permitted in a basic illustration.

(10) "Illustration actuary" means an actuary who meets the requirements of Section R590-177-10 and certifies an illustration based on the standard of practice promulgated by the Actuarial Standards Board.

(11) "Lapse-supported illustration" means an illustration of a policy form failing the test of self-supporting as defined in this rule, under a modified persistency rate assumption using persistency rates underlying the disciplined current scale for the first five years and 100% policy persistency thereafter.

(12)(a) "Minimum assumed expense" means the minimum expense that may be used in the calculation of the disciplined current scale for a policy form.

(b) An insurer may choose to designate the method of determining assumed expenses each year for all policy forms from the following:

(i) fully allocated expenses;

(ii) marginal expenses; and

(iii) a generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies and approved by the NAIC or the commissioner.

(d) If no generally recognized expense table is approved, fully allocated expenses must be used.

(13) "Non-term group life" means a group life insurance policy or an individual life insurance policy issued to a member of an eligible group where:

(a) each plan of coverage was selected by the group representative;

(b) some portion of the premium is paid by the group or through payroll deduction; and

(14) "Policy owner" means the owner named in a policy or the certificate holder in the case of a group policy.

(15) "Premium outlay" means the amount of premium assumed to be paid by the policy owner or other premium payer out-of-pocket.

(16)(a) "Self-supporting illustration" means an illustration of a policy form for which it can be demonstrated that, when using experience assumptions underlying the disciplined current scale, for all illustrated points in time on or after the 15th policy anniversary or the 20th policy anniversary for second-or-later-to-die policies, or upon policy expiration if sooner, the accumulated value of all policy cash flows equals or exceeds the total policy owner value available.

(b) The policy owner value in a self-supporting illustration includes cash surrender values and any other illustrated benefit amounts available at the policy owner's election.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-4 Policies to Be Illustrated

(1) An insurer marketing a policy subject to this rule shall notify the commissioner whether a policy form will be marketed with or without an illustration.

(a) The notice shall be made in writing at the time of filing.

(b) Any previous identification may be changed by notice to the commissioner.

(2) If an insurer identifies a policy form to be marketed without an illustration, any use of an illustration before the first policy anniversary is prohibited.

(3) If a policy form is marketed with an illustration, a basic illustration that complies with this rule is required.

(a) A basic illustration need not be provided to individual members of a group or to individuals insured under multiple lives coverage issued to a single applicant unless the coverage is marketed to these individuals.

(b) The illustration furnished to an applicant for a group life insurance policy or a policy issued to a single applicant on multiple lives may be either an individual or composite illustration representative of the coverage on the lives of members of the group or the multiple lives covered.

(4) Potential enrollees of non-term group life insurance subject to this rule shall be furnished a quotation with the enrollment materials.

(a) The quotation shall show potential policy values for sample ages and policy years on a guaranteed and non- guaranteed basis appropriate to the group and the coverage.

(b) The quotation is not considered an illustration under this rule, but all information provided shall be consistent with the illustrated scale.

(c) A basic illustration shall be provided at delivery of the certificate to an enrollee for non-term group life insurance who enrolls for more than the minimum premium necessary to provide pure death benefit protection.

(d) The insurer shall make a basic illustration available to any non-term group life insurance enrollee who requests it.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-6 General Rules and Prohibitions

(1) An illustration used in the sale of a life insurance policy shall comply with this rule, be clearly labeled "life insurance illustration," and contain the following information:

(a) the name and address of the insurer;

(b) the name and business address of the producer or insurer's authorized representative, if any;

(d) the underwriting or rating classification on which the illustration is based;

(e) the generic name of the policy, the company product name, if different, and form number;

(f) the initial death benefit; and

(g) the dividend option election or application of non-guaranteed elements, if applicable.

(2) When using an illustration in the sale of a life insurance policy, an insurer or its producer or other authorized representative may not:

(a) represent the policy as anything other than a life insurance policy;

(b) use or describe a non-guaranteed element in a manner that is misleading or has the capacity or tendency to mislead;

(d) use an illustration that does not comply with the requirements of this rule;

(e) use an illustration that at any policy duration depicts policy performance more favorable to the policy owner than that produced by the illustrated scale of the insurer whose policy is being illustrated;

(f) provide an applicant with an incomplete illustration;

(g) represent or imply that a premium payment will not be required for each year of the policy maintain the illustrated death benefit, unless that is the fact;

(h) use the term "vanish" or "vanishing premium," or a similar term that implies the policy becomes paid up, to describe a plan for using a non-guaranteed element to pay a portion of future premiums;

(i) except for a policy that can never develop nonforfeiture values, use an illustration that is "lapse-supported"; or

(j) use an illustration that is not "self-supporting."

(3) If an interest rate used to determine an illustrated non-guaranteed element is shown, it may not be greater than the earned interest rate underlying the disciplined current scale.

(4) An insurer may not use a footnote or caveat to define contract terms.

(5) An insurer shall use language that is understood by an average person.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-6 Standards for Basic Illustrations

(1) Format. A basic illustration shall conform to the following requirements:

(a) The illustration shall be labeled with the date it was prepared.

(b) Each page, including any explanatory notes or pages, shall be numbered and show its relationship to the total number of pages in the illustration, for example, the fourth page of a seven-page illustration shall be labeled "page 4 of 7 pages".

(d) If the age of the proposed insured is shown as a component of the tabular detail, it shall be issue age plus the number of years the policy is assumed to have been in force.

(e)(i) The assumed payments the illustrated benefits and values are based on shall be identified as premium outlay or contract premium, as applicable.

(ii) For a policy that does not require a specific contract premium, the illustrated payments shall be identified as a premium outlay.

(f) Any guaranteed death benefit and values available upon surrender for the illustrated premium outlay or contract premium shall be shown and clearly labeled guaranteed.

(g) If the illustration shows any non-guaranteed elements, they cannot be based on a scale more favorable to the policy owner than the insurer's illustrated scale at any duration, and shall be clearly labeled non-guaranteed.

(h) Any guaranteed elements shall be shown before corresponding non-guaranteed elements and shall be specifically referred to on any page of an illustration that shows or describes only the non-guaranteed elements, for example, "see page one for guaranteed elements."

(i) The account or accumulation value of a policy, if shown, shall be identified by the name this value is given in the policy being illustrated and shown near the corresponding value available upon surrender.

(j) The value available upon surrender shall be identified by the name this value is given in the policy being illustrated and shall be the amount available to the policy owner in a lump sum after deduction of surrender charges, policy loans, and policy loan interest, as applicable.

(k) An illustration may show policy benefits and values in graphic or chart form in addition to the tabular form.

(l) Any illustration of a non-guaranteed element shall be accompanied by a statement indicating that:

(i) the benefits and values are not guaranteed;

(ii) the assumptions on which they are based are subject to change by the insurer; and

(iii) actual results may be more or less favorable.

(m) If the illustration shows that the premium payer may have the option to allow policy charges to be paid using a non-guaranteed value, the illustration must clearly disclose that:

(i) a charge continues to be required; and

(ii) depending on actual results, the premium payer may need to continue or resume premium outlays.

(A) Similar disclosure shall be made for a premium outlay of lesser amounts or shorter durations than the contract premium.

(B) If a contract premium is due, the premium outlay display may not be left blank or show zero unless accompanied by an asterisk or similar mark to draw attention to the fact that the policy is not paid up.

(n) If the applicant plans to use dividends or policy values, guaranteed or non-guaranteed, to pay all or a portion of the contract premium or policy charges, or for any other purpose, the illustration may reflect those plans and the impact on future policy benefits and values.

(o) The illustration shall be complete, not misleading, and the narrative summary, numeric summary, and tabular detail shall be consistent.

(2) Narrative Summary. A basic illustration shall include:

(a) a brief description of the policy being illustrated, including a statement that it is a life insurance policy;

(b)(i) a brief description of the premium outlay or contract premium, as applicable, for the policy; or

(ii) for a policy that does not require payment of a specific contract premium, an illustration of the premium outlay that must be paid to guarantee coverage for the term of the contract, subject to maximum premium allowable to qualify as a life insurance policy under the applicable provisions of the Internal Revenue Code;

(c) a brief description of any policy feature, rider, or option, guaranteed or non-guaranteed, shown in the basic illustration and the impact they may have on the benefits and values of the policy;

(d) identification and a brief definition of column headings and key terms used in the illustration; and

(e) a statement containing substantially the following: "This illustration assumes that the currently illustrated non- guaranteed elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown."

(3) Numeric Summary.

(a) Following the narrative summary, a basic illustration shall include a numeric summary of the death benefit and values and the premium outlay and contract premium, as applicable.

(i) For a policy that provides for a contract premium, the guaranteed death benefit and values shall be based on the contract premium and shall be shown for at least policy years 5, 10, and 20, and at age 70, if applicable, on the bases in Subsection (3)(a)(iii).

(ii) For multiple life policies, the summary shall show at least policy years 5, 10, 20, and 30 on the bases in Subsection (3)(a)(iii).

(iii) The bases to be shown in a numeric summary are:

(A) policy guarantees;

(B) insurer's illustrated scale; and

(I) dividends at 50% of the dividends contained in the illustrated scale used;

(II) non-guaranteed credited interest at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used; and

(III) all non-guaranteed charges, including term insurance charges, and mortality and expense charges, at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.

(b) In addition, if coverage would cease before policy maturity or age 100, the year in which coverage ceases shall be identified for each of the three bases.

(4) Statements. Statements substantially similar to the following shall be included on the same page as the numeric summary and signed by the applicant, or the policy owner in the case of an illustration provided at time of delivery, as required in this rule.

(a) A statement signed and dated by the applicant or policy owner as follows: "I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The producer has told me they are not guaranteed."

(b) A statement signed and dated by the insurance producer or other authorized representative of the insurer as follows: "I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration."

(5) Tabular Detail.

(a) A basic illustration shall include the following for at least each policy year from one to ten and for every fifth policy year thereafter ending at age 100, policy maturity, or final expiration and, except for term insurance beyond the 20th year, for any year in which the premium outlay and contract premium, if applicable, is to change:

(i) the premium outlay and mode the applicant plans to pay and the contract premium, as applicable;

(ii) the corresponding guaranteed death benefit, as provided in the policy; and

(iii) the corresponding guaranteed value available upon surrender, as provided in the policy.

(b) For a policy that provides for a contract premium, the guaranteed death benefit and value available upon surrender shall correspond to the contract premium.

(i) In the case of an illustration for a policy on which the insurer intends to credit terminal dividends, non-guaranteed elements may be shown if the insurer's current practice is to pay terminal dividends.

(ii) If any non-guaranteed elements are shown they must be shown at the same durations as the corresponding guaranteed elements, if any.

(iii) If no guaranteed benefit or value is available at any duration for which a non-guaranteed benefit or value is shown, a zero shall be displayed in the guaranteed column.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-7 Standards for Supplemental Illustrations

(1) A supplemental illustration may be provided if:

(a) it is appended to, accompanied by, or preceded by a basic illustration that complies with this rule;

(b) the non-guaranteed elements shown are not more favorable to the policy owner than the corresponding elements based on the scale used in the basic illustration;

(d) for a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration; and

(e) for a policy that does not require a contract premium, the premium outlay underlying the supplemental illustration shall be equal to the premium outlay shown in the basic illustration.

(2) The supplemental illustration shall include a notice referring to the basic illustration for guaranteed elements and other important information.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-8 Delivery of Illustration and Record Retention

(1)(a) If a basic illustration is used in the sale of a life insurance policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with this rule, shall be:

(i) submitted to the insurer at the time of policy application; and

(ii) provided to the applicant.

(b) If the policy issued is not as applied for, a revised basic illustration conforming to the policy as issued shall:

(i) be sent with the policy;

(ii) conform to the requirements of this rule;

(iii) be labeled "Revised Illustration"; and

(iv) be signed and dated by the applicant or policy owner and producer or other authorized representative of the insurer no later than the time the policy is delivered; and

(2)(a) If no illustration is used by an insurance producer or other authorized representative in the sale of a life insurance policy or if the policy applied for is not as illustrated, the producer or representative shall certify to that effect in writing on a form provided by the insurer.

(i) The form shall include an acknowledgement from the applicant that:

(A) no illustration conforming to the policy applied for was provided; and

(B) an illustration conforming to the policy as issued will be provided no later than at the time of policy delivery.

(ii) The form shall be submitted to the insurer at the time of policy application.

(b) If the policy is issued, a basic illustration conforming to the policy as issued shall be sent with the policy and signed no later than the time the policy is delivered, and a copy shall be provided to the insurer and the policy owner.

(3) If the basic or revised illustration is sent to the applicant or policy owner by mail from the insurer, it shall include instructions for the applicant or policy owner to sign the duplicate copy of the numeric summary page of the illustration for the policy issued and return the signed copy to the insurer.

(a) The insurer's obligation is satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the numeric summary page.

(b) The requirement to make a diligent effort is satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed numeric summary page.

(4)(a) A copy of any basic or revised basic illustration, signed as applicable, shall be retained by the insurer until three years after the policy is no longer in force, along with any certification that either:

(i) no illustration was used; or

(ii) the policy applied for was not as illustrated.

(b) A copy of a basic or revised basic illustration need not be retained if no policy is issued.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-9 Annual Report; Notice to Policy Owners

(1) If a policy is designated as one for which an illustration will be used, the insurer shall provide each policy owner with an annual report on the status of the policy that shall contain the information in Subsection (1)(a) or (1)(b).

(a) For a universal life insurance policy, the report shall include the following:

(i) the beginning and end date of the current report period;

(ii) the policy value at the end of the previous report period and at the end of the current report period;

(iii) the total amounts that have been credited or debited to the policy value during the current report period, identifying each by type, such as interest, mortality, expense, and riders;

(iv) the current death benefit at the end of the current report period on each life covered by the policy;

(v) the net cash surrender value of the policy as of the end of the current report period;

(vi) the amount of any outstanding loans as of the end of the current report period; and

(vii) if, assuming guaranteed interest, mortality and expense loads, and any required premium payments, the policy's net cash surrender value is such that it would not maintain insurance in force until the end of the next reporting period, a notice shall be included in the report.

(b) For any other policy, where applicable:

(i) the current death benefit;

(ii) the annual contract premium;

(iii) the current cash surrender value;

(iv) the current dividend;

(v) the application of current dividend; and

(vi) the amount of any outstanding loan.

(c) An insurer writing a life insurance policy that does not develop nonforfeiture values is only required to provide an annual report for those years when a change has been made to non-guaranteed policy elements by the insurer.

(2)(a) If the annual report does not include an in force illustration, it shall prominently display the following notice:

"IMPORTANT POLICY OWNER NOTICE: You should consider requesting more detailed information about your policy to understand how it may perform in the future. You should not consider replacement of your policy or make changes in your coverage without requesting a current illustration. You may annually request, without charge, such an illustration by calling (insurer's phone number), writing to (insurer's name) at (insurer's address) or contacting your producer. If you do not receive a current illustration of your policy within 30 days from your request, you should contact your state insurance department."

(b) The insurer may vary the sequential order of the methods for obtaining an in force illustration.

(3) Upon the request of a policy owner, an insurer shall furnish an in force illustration of current and future benefits and values based on the insurer's present illustrated scale.

(a) The illustration shall comply with the requirements of Subsections R590-177-5(1), R590-177-5(2), R590-177-6(1), and R590-177-6(5).

(b) No signature or acknowledgment of receipt of this illustration is required.

(4) If, since the last annual report, an insurer has made an adverse change in a non-guaranteed element that could affect the policy, the annual report shall prominently display a notice describing the nature of the change.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-10 Annual Certifications

(1) The board of directors of each insurer shall appoint one or more illustration actuaries.

(2) The illustration actuary shall certify that:

(a) the disciplined current scale used in any illustration conforms to the Actuarial Standard of Practice No. 24, Compliance with the NAIC Life Insurance Illustrations Model Regulation promulgated by the Actuarial Standards Board; and

(b) the illustrated scale used in an insurer-authorized illustration meets the requirements of this rule.

(3) The illustration actuary shall:

(a) be a member in good standing of the American Academy of Actuaries;

(b) be familiar with the standard of practice regarding life insurance policy illustrations;

(i) violated any provision of, or any obligation imposed by, the insurance law or other law in the course of dealings as an illustration actuary;

(ii) been found guilty of fraudulent or dishonest practices;

(iii) demonstrated incompetence, lack of cooperation, or untrustworthiness to act as an illustration actuary; or

(iv) resigned or been removed as an illustration actuary within the past five years as a result of acts or omissions indicated in any adverse report on examination or as a result of a failure to adhere to generally acceptable actuarial standards;

(d) notify the commissioner of any action taken by a commissioner of another state similar to that under Subsection (3)(c);

(e) disclose in the annual certification whether, since the last certification, a currently payable scale applicable for business issued within the previous five years and within the scope of the certification has been reduced for a reason other than a change in the experience factors underlying the disciplined current scale;

(i) if a non-guaranteed element illustrated for a new policy is not consistent with the illustration for a similar in force policy, this shall be disclosed in the annual certification; and

(ii) if a non-guaranteed element illustrated for both a new and an in force policy is not consistent with the non- guaranteed element being paid, charged, or credited to the same or similar form, this shall be disclosed in the annual certification; and

(f) disclose in the annual certification the method used to allocate overhead expenses for all illustrations:

(i) fully allocated expenses;

(ii) marginal expenses; or

(iii) a generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies and approved by the NAIC or by the commissioner.

(4)(a) The illustration actuary shall file a certification with the insurer's board of directors:

(i) annually for all policy forms for which illustrations are used; and

(ii) before a policy form is illustrated.

(b) If the illustration actuary becomes aware of an error in a previous certification, the illustration actuary shall promptly notify the insurer's board of directors and the commissioner.

(5) If an illustration actuary certify the scale for any policy form illustration the insurer intends to use, the actuary shall promptly notify the insurer's board of directors and the commissioner.

(6) An officer of the insurer, other than the illustration actuary, shall certify annually:

(a) that the illustration formats meet the requirements of this rule and that the scales used in any illustration are scales certified by the illustration actuary; and

(b) that the company has provided each producer and authorized representative information about the expense allocation method used by the company in its illustrations and disclosed as required in Subsection (3)(f).

(7) The annual certification shall be:

(a) completed each year by a date determined by the insurer;

(b) maintained by the insurer for a period of five years; and

(8) If an insurer changes the illustration actuary responsible for any portion of the company's policy forms, the insurer shall notify the commissioner and disclose the reason for the change.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

Utah Admin. Code R590-177-11 Severability

If any provision of this rule, Rule R590-177, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: January 24, 2023
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-23-302

R590-178 Securities Custody

Utah Admin. Code R590-178-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-206, and 31A-4-108.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) authorize a domestic insurance company to use a modern system for holding and transferring a security without physical delivery of a security certificate; and

(b) establish standards for a person in Subsection (2)(b) through (2)(e) to qualify and operate as a custodian for insurance company securities.

(2) This rule applies to:

(a) a domestic insurance company;

(b) a national bank;

(d) a trust company; and

(e) a broker/dealer.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-2-206, and 70A-8-101. Additional terms are defined as follows:

(1) "Agent" means a national bank, state bank, trust company, or broker/dealer that maintains an account in its name in a clearing corporation or that is a member of the Federal Reserve System and through which a custodian participates in a clearing corporation or the Federal Reserve book-entry system.

(2) "Clearing corporation" means a corporation that is organized for the purpose of effecting transactions in securities by computerized book-entry. Clearing corporation also includes "Treasury/Reserve Automated Debt Entry Securities System" and "Treasury Direct" book-entry securities systems established pursuant to 31 U.S.C. 3100 et seq., 12 U.S.C. 391 and 5 U.S.C. 301.

(3) "Custodian" means:

(a) a national bank, state bank, or trust company that shall at all times during which it acts as a custodian pursuant to this rule, be no less than adequately capitalized as determined by the standards adopted by United States banking regulators and that is regulated by either state banking laws or is a member of the Federal Reserve System and that is legally qualified to accept custody of securities in accordance with the standards set forth below; or

(b) a trust company with minimum net worth of $1,500,000 at all times during which it acts as a custodian, is licensed by the United States or any state thereof as a trust company, and is in compliance with the regulatory authority as verified through regular examination by the regulatory authority; or

(c) a broker/dealer that shall be registered with and subject to jurisdiction of the Securities and Exchange Commission, maintains membership in the Securities Investor Protection Corporation, and has a tangible net worth equal to or greater than $250,000,000.

(4) "Custodied securities" means securities held by the custodian or its agent, or that are being cleared or transferred through a clearing corporation.

(5) "Tangible net worth" means shareholders equity, less intangible assets, as reported in the broker/dealer's most recent Annual or Transition Report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Form 10-K, filed with the Securities and Exchange Commission.

(6) "Treasury/Reserve Automated Debt Entry Securities System" (TRADES) and "Treasury Direct" mean the book entry securities systems established pursuant to 31 U.S.C. 3100 et seq., 12 U.S.C. 391, and 5 U.S.C. 301. The operation of TRADES and Treasury Direct are subject to 31 C.F.R. 357 et seq.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-4 Use of Book-Entry Systems

A custodian may use a clearing corporation to clear and transfer securities when depositing or arranging for the deposit of securities held in or purchased for a domestic insurance company's general account or its separate accounts. When a clearing corporation is used to clear and transfer securities, securities of the same class of the same issuer may be merged and held in bulk in the name of the nominee of such clearing corporation regardless of the ownership of such securities and securities of small denominations may be merged into larger denominations. The records of any custodian using a clearing corporation to clear and transfer securities shall at all times show that such securities are held for such insurance company and for which accounts thereof. Ownership of, and other interest in, such securities may be transferred by bookkeeping entry on the books of such clearing corporation without physical delivery of certificates representing such securities.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-5 Requirements for Custodial Agreements

(1) An insurance company may, by written agreement with a custodian, provide for the custody of its securities with that custodian. The securities that are the subject of the agreement may be held by the custodian or its agent, by the Federal Reserve book-entry system, or may be cleared or transferred through a clearing corporation.

(2) Agreements shall be in writing and shall be authorized by a resolution of the Board of Directors of the insurance company or of an authorized committee of the board pursuant to Section 31A-5-412. The terms of the agreement shall comply with the following:

(a) Securities' certificates held by the custodian shall be held separate from the securities' certificates of the custodian and of all of its other customers.

(b) Securities held indirectly by the custodian or its agent, by the Federal Reserve book-entry system, and securities being cleared or transferred through a clearing corporation shall be separately identified on the custodian's official records as being owned by the insurance company. The records shall identify which securities are held by the custodian or its agent, by the Federal Reserve book-entry system, and which securities are being cleared or transferred through a clearing corporation. If the securities are with the Federal Reserve book-entry system or are being cleared or transferred through a clearing corporation, the records shall also identify where the securities are and the name of the clearing corporation. If the securities are held by an agent of the custodian, the records shall contain the name of the agent.

(c) All custodied securities shall be registered in the name of the insurance company or in the name of a nominee of the insurance company or in the name of the custodian or its nominee or, if in a clearing corporation, in the name of the clearing corporation or its nominee.

(d) Custodied securities shall be held subject to the instructions of the insurance company and shall be withdrawable upon the demand of the insurance company, except that custodied securities used to meet the deposit requirements set forth in Subsection 31A-2-206(2) shall, to the extent required by Subsection 31A-2-206(2), be under the control of the insurance commissioner and shall not be withdrawn by the insurance company without the prior written approval of the insurance commissioner. Broker/dealers are not authorized to hold custodied securities that are used to meet the deposit requirements set forth in Subsection 31A-2-206(2). To the extent that national banks, state banks, and trust companies hold custodied securities that are used to meet the deposit requirements set forth in Subsection 31A-2-206(2), these custodied securities must be held in an account separate from other custodied securities of the insurance company.

(e) The custodian shall be required to send or cause to be sent to the insurance company a confirmation of all transfers of custodied securities to or from the account of the insurance company. In addition, the custodian shall be required to furnish no less than monthly the insurance company with reports of holdings of custodied securities at times and containing information reasonably requested by the insurance company. The custodian's annual report of the insurance company's accounts shall also be provided to the insurance company. Reports and verifications may be transmitted in electronic or paper form.

(f) During the course of the custodian's regular business hours, an officer or employee of the insurance company, an independent accountant selected by the insurance company, or a representative of the Insurance Department shall be entitled to examine, on the premises of the custodian, the custodian's records relating to custodied securities, but only upon furnishing the custodian with written instructions to that effect from an appropriate officer of the insurance company.

(g) Upon written request from the insurance company, the custodian and its agents shall be required to send to the insurance company:

(i) all reports they receive from a clearing corporation on their respective systems of internal accounting control; and

(ii) reports prepared by outside auditors on the custodian's or its agent's internal accounting control of custodied securities that the insurance company may reasonably request.

(h) The custodian shall maintain records sufficient to determine and verify information relating to custodied securities that may be reported in the insurance company's annual statement and supporting schedules and information required in an audit of the financial statements of the insurance company.

(i) The custodian shall provide, upon written request from an appropriate officer of the insurance company, the appropriate affidavits with respect to custodied securities. These shall be substantially in the form of Custodian Affidavits, Form A, 298-6, Form B, 298-7, and Form C, 298-8, published by NAIC Model Regulation Service.

(i) Form A is to be used by a custodian where securities entrusted to its care have not been redeposited elsewhere;

(ii) Form B is to be used in instances where a custodian corporation maintains securities on deposit with The Depository Trust Company or like entity; and

(iii) Form C is to be used where ownership is evidenced by book entry at a Federal Reserve Bank.

(j) A national bank, state bank, or trust company shall secure and maintain insurance protection in an adequate amount covering the bank's or trust company's duties and activities as custodian for the insurance company's assets, and shall state in the custody agreement that protection is in compliance with the requirements of the custodian's banking regulator or other regulator of a trust company. A broker/dealer shall secure and maintain insurance protection for each insurance company's custodied securities in excess of that provided by the Securities Investor Protection Corporation in an amount equal to or greater than the market value of each respective insurance company's custodied securities. The commissioner may determine whether the type of insurance is appropriate and the amount of coverage is adequate.

(k) The custodian shall be obligated to indemnify the insurance company for any loss of custodied securities occasioned by the negligence or dishonesty of the custodian's officers or employees, and for burglary, robbery, holdup, theft, and mysterious disappearance, including loss by damage or destruction.

(l) In the event that there is loss of custodied securities, for which the custodian shall be obligated to indemnify the insurance company as provided in Subsection (2)(k), the custodian shall promptly replace the securities or the fair value thereof and the value of any loss of rights or privileges resulting from the loss of securities.

(m) The agreement may provide that the custodian will not be liable for failure to take an action required under the agreement in the event and to the extent that the taking of such action is prevented or delayed by war, whether declared or not and including existing wars, revolution, insurrection, riot, civil commotion, act of God, accident, fire, explosion, stoppage of labor, strikes or other differences with employees, laws, regulations, orders, other acts of any governmental authority, or any other cause beyond its reasonable control.

(n) In the event that the custodian gains entry in a clearing corporation through an agent, there shall be an agreement between the custodian and the agent under which the agent shall be subject to the same liability for loss of custodied securities as the custodian. However, if the agent shall be subject to regulation under the laws of a jurisdiction that is different from the jurisdiction the laws of which regulate the custodian, the Commissioner of Insurance of the state of domicile of the insurance company may accept a standard of liability applicable to the agent that is different from the standard of liability applicable to the custodian.

(o) The custodian shall provide written notification to the insurance company's domiciliary commissioner if the custodial agreement with the insurance company has been terminated or if 100% of the account assets in any one custody account have been withdrawn. This notification shall be remitted to the insurance commissioner within three business days of the receipt by the custodian of the insurance company's written notice of termination or within three business days of the withdrawal of 100% of the account assets.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-6 Requirements for Deposits with Affiliates

(1) Nothing in this rule shall prevent an insurance company from depositing securities with another insurance company with which the depositing insurance company is affiliated, provided that the securities are deposited pursuant to a written agreement authorized by the board of directors of the depositing insurance company or an authorized committee thereof and that the receiving insurance company is organized under the laws of one of the states of the United States or of the District of Columbia. If the respective states of domicile of the depositing and receiving insurance companies are not the same, the depositing insurance company shall have given notice of the deposit to the insurance commissioner in the state of its domicile and the insurance commissioner shall not have objected to it within 30 days of the receipt of the notice.

(2) The terms of the agreement shall comply with the following:

(a) The insurance company receiving the deposit shall maintain records adequate to identify and verify the securities belonging to the depositing insurance company.

(b) The receiving insurance company shall allow representatives of an appropriate regulatory body to examine records relating to securities held subject to the agreement.

(i) to hold the securities of the depositing insurance company in bulk, in certificates issued in the name of the receiving insurance company or its nominee, and to commingle them with securities owned by other affiliates of the receiving insurance company; and

(ii) to provide for the securities to be held by a custodian, including the custodian of securities of the receiving insurance company, or in a clearing corporation.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-7 Penalties and Prohibitions

(1) Insurance companies found to be or to have been in violation of this rule shall be subject to fine, suspension, and revocation of license or other penalties permitted by Section 31A-2-308.

(2) Insurance companies are not authorized to provide for the custody of their securities except as granted in this rule. Custodial securities held in violation of this rule shall be disregarded in determining and reporting the financial condition of an insurer.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

Utah Admin. Code R590-178-8 Separability

If any provision of this rule, Rule R590-178, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-4-108

R590-181 Yankee Bond Rule

Utah Admin. Code R590-181-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-18-101.

History

KEY: insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-18-105

Utah Admin. Code R590-181-2 Purpose and Scope

(1) The purpose of this rule is to permit an insurer to invest, within the limits prescribed by this rule, in a bond that is:

(a) denominated in U.S. Dollars; and

(b) issued by:

(i) a foreign government;

(ii) an entity backed by a foreign government; or

(iii) a corporation not domiciled in the United States of America.

(2) This rule applies to an insurer or reinsurer doing business in this state.

History

KEY: insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-18-105

Utah Admin. Code R590-181-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Investment quality" means a quality rating of "1" or "2" assigned by the National Association of Insurance Commissioners' Securities Valuation Office (SVO).

(a) A Yankee bond that is not SVO rated at the time of purchase by an insurer shall be submitted to the SVO for rating within 90 days of purchase.

(b)(i) A Yankee bond that is not SVO rated at the time of purchase by an insurer may be temporarily considered investment quality if the insurer demonstrates to the satisfaction of the commissioner that an SVO rating of "1" or "2" is likely.

(ii) The assumption of quality is in effect only until rating by the SVO is complete.

(2) "Qualified assets" means the same as that term is defined in Subsection 31A-17-201(2).

(3) "Yankee bond" means a fixed income bond issued:

(a) in a U.S. Dollar denomination by a foreign government;

(b) by an entity whose bonds are guaranteed by a foreign government; or

History

KEY: insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-18-105

Utah Admin. Code R590-181-4 Investments in Yankee Bonds

(1) An insurer may invest in Yankee bonds of investment quality limited to 20% of the insurer's qualified assets.

(2) Subject to Subsection (3), an insurer's investment in Yankee bonds of investment quality issued by a single entity, its affiliates, or subsidiaries, is limited to 3% of the insurer's qualified assets.

(3) An investment in Yankee bonds of investment quality issued by an entity within a single sovereign foreign nation, is limited to:

(a) 5% of the insurer's qualified assets if the bonds are rated "1" by the SVO; and

(b) 3% of the insurer's qualified assets if the bonds are rated "2" by the SVO.

History

KEY: insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-18-105

Utah Admin. Code R590-181-5 Separability

If any provision of this rule, Rule R590-181, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: March 25, 2022
Notice of Continuation: November 19, 2021
Authorizing, and Implemented or Interpreted Law: 31A-18-105

R590-186 Bail Bond Business

Utah Admin. Code R590-186-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-35-104 and 31A-35-301.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-2 Purpose and Scope

(1) The purpose of this rule is to establish

(a) licensing criteria;

(b) certification guidelines; and

(2) This rule applies to a person licensed as:

(a) a bail bond agency;

(b) a bail bond producer; or

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-35-102. Additional terms are defined as follows:

(1) "Bail bond business" means engaging in conduct authorized under Title 31A, Chapter 35, Bail Bond Act.

(2) "Persons or members of their immediate families," used in Subsection 31A-35-701(5), means a spouse, child, stepchild, child-in-law, parent, sibling, parent-in-law, sibling-in-law, stepparent, stepsibling, or half-sibling.

(3) "Unprofessional conduct" means a violation of an insurance law, rule, or order of the commissioner.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-4 Initial and Renewal Agency License

(1) An application for an initial or a renewal bail bond agency license shall be filed with the commissioner.

(2) An application shall include:

(a) an initial or renewal license fee in an amount annually established by the Utah Legislature under Section 63J-1- 504; and

(b) proof that an applicant satisfies the minimum financial requirements for a bail bond agency license under Section 31A-35-404.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-5 Bail Bond Producer License and Renewal

(1) A bail bond agency or surety insurer shall issue a bail bond through a licensed bail bond producer who is designated by the bail bond agency or is contracted with and appointed by the surety insurer.

(2)(a) A person doing business as a bail bond producer shall be licensed in accordance with:

(i) Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries;

(ii) Section 31A-35-406; and

(iii) any applicable rule regarding individual producer licensing.

(b) A bail bond producer license is an individual limited line license.

(c) A bail bond producer license is issued for a two-year period and requires no licensing examination or continuing education.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-6 Unprofessional Conduct

A person licensed as a bail bond agency, a bail bond producer, or a surety insurer may not engage in unprofessional conduct, which includes any of the following acts:

(1) having a professional or occupational license revoked in this or any other state;

(2) being involved in a transaction that shows unfitness to act in a fiduciary capacity;

(3) willfully misstating or negligently reporting a material fact in the initial or renewal application or procuring a misstatement in a document supporting an initial or renewal application;

(4) being the subject of an outstanding civil judgment that reduces a bail bond agency's net worth below the minimum required for licensure;

(5) being convicted of a felony;

(6) being convicted of a misdemeanor that involves the misappropriation of money or property, dishonesty, or perjury;

(7) failing to report collateral taken as security on a bail bond to the principal, indemnitor, or depositor of such collateral;

(8) failing to preserve, or to retain separately, or both, any collateral taken as security on a bail bond;

(9) failing to return collateral taken as security on a bail bond to the depositor of such collateral, or the depositor's designee, within ten business days of being notified of the exoneration of the bail bond or upon payment of all fees owed to the bail bond agent, whichever is later;

(10) failing to advise the commissioner of a change that has reduced the bail bond agency's net worth below the minimum required for licensure;

(11) using a relationship with a person employed by a jail facility or incarcerated in a jail facility to obtain bail bond referrals;

(12) offering consideration or a gratuity to jail personnel, a peace officer, or an inmate under a circumstance that infers the consideration was offered to induce a bail bond referral or recommendation;

(13) failing to deliver to an incarcerated person, or a person arranging bail on behalf of an incarcerated person, before the time the incarcerated person is released from jail, a one-page disclosure form that includes:

(a) the amount of the bail;

(b) the amount of the bail bond agency's fee, including bail bond premium, preparation fees, and credit transaction fees;

(d) the incarcerated person's obligations to the bail bond agency and the court;

(e) the conditions upon which the bail bond may be revoked;

(f) additional charges or interest that may accrue;

(g) co-signors or indemnitors that will be required; and

(h) the conditions under which the bail bond may be exonerated and the collateral returned;

(14) using an unlicensed bail bond agent or unlicensed bail bond enforcement agent;

(15) using a bail bond agent not contracted and appointed by a bail bond agency or surety insurer;

(16) charging excessive or unauthorized premiums, excessive fees, or other unauthorized charges;

(17) requiring unreasonable collateral security;

(18) failing to provide an itemized statement of expenses deducted from collateral;

(19) requiring that a specific attorney be used as a condition to execute a bail bond;

(20) preparing or issuing a fraudulent or forged bail bond or power of attorney;

(21) signing, executing, or issuing a bail bond by an unlicensed person;

(22) executing a bail bond without countersignature by a licensed bail bond producer at time of issue;

(23) failing to account for and pay premiums held by a bail bond producer or a bail bond agency in a fiduciary capacity to the bail bond agency, surety insurer, or other person who may receive them;

(24) knowingly violating, advising, encouraging, or assisting in violating a statute, court order, or injunction in the course of the bail bond business;

(25) conviction of an act of personal violence or force against any person or conviction of threatening to commit an act of personal violence or force against any person, including a violent felony as defined under Section 76-3-203.5;

(26) soliciting a sexual favor as a condition of obtaining, maintaining, or exonerating a bail bond, regardless of the identity of the person who performs the favor;

(27) acting as an unlicensed bail bond enforcement agent;

(28) failing to satisfy an outstanding judgment; and

(29) using deceptive or intimidating practices.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-7 Investigating Unprofessional Conduct

(1) The commissioner shall investigate a complaint of unprofessional conduct submitted in writing to the commissioner.

(2) Once an investigation is complete, the commissioner shall report findings and a recommended disposition to the board.

(3) A report from the commissioner is confidential and may not be disclosed beyond the department and the board.

(4) After obtaining the board's recommendations concerning an investigation, the commissioner will determine the appropriate disposition.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-8 Bonding Limits

(1) A bail bond agency that maintains a qualified power of attorney from a surety insurer may not maintain outstanding bail bond obligations over the amount allowed by the surety insurer.

(2) A bail bond agency that pledges assets of a letter of credit or pledges personal or real property may not maintain outstanding bail bond obligations over the amounts provided in the table below:

TABLE

Financial Requirements

Ratio of Outstanding Obligations to Letter of Credit or Net Worth and Liquidity Amounts

Licensed 0 to 36 months: 5 to 1

$250,000 line of credit or net worth/$50,000 liquidity

Licensed over 36 months: 5 to 1

$300,000 or more line of credit limit or net worth/at

Licensed 0 to 36 months: 5 to 1 least $100,000 liquidity

Licensed over 36 months: 10 to 1

(3) The commissioner may reduce the bail bonding limit of a bail bond agency that is backed by a letter of credit or a bail bond agency that pledges personal or real property, if the bail bond agency meets the 10 to 1 ratio and the bail bond agency's line of credit, net worth, or liquidity limit falls below the limits stated in Subsection (2).

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-186-9 Severability

If any provision of this rule, Rule R590-186, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

R590-190 Unfair Property, Casualty, and Title Claims Settlement Practices Rule

Utah Admin. Code R590-190-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-21-312, 31A-26-301, and 31A-26- 303.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) set standards for the investigation and disposition of property, casualty, and title claims; and

(b) identify an unfair claim practice.

(2) This rule applies to:

(a) a property and casualty insurer;

(b) a title insurer; and

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Authorized agent" means an individual, corporation, association, organization, partnership, or other legal entity authorized to represent an insurer with respect to a claim.

(2) "Claim file" means a record either in its original form or as recorded by a process that can accurately and reliably reproducer the original material regarding a claim, its investigation, adjustment, and settlement.

(3)(a) "Claimant" means a first party claimant, a third party claimant, or both.

(b) "Claimant" includes a claimant's designated legal representative and an immediate family member.

(4) "Day" means calendar day.

(5) "Documentation" means a physical or an electronic record related to a claim.

(6)(a) "First party claimant" means a person asserting a right to a benefit under a policy to which the person is a party.

(b) "First party claimant" includes a person's designated legal representative and an immediate family member.

(7) "General business practice" means a pattern of conduct in a business.

(8) "Investigation" means an activity by or on behalf of an insurer related to determining a claim under a policy.

(9) "Notice of loss" means a claimant's notice that reasonably informs an insurer of facts related to a claim.

(10) "Proof of loss" means an insured's reasonable documentation in support of a claim.

(11) "Third party claimant" means a person asserting a claim against an insured.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-4 File and Record Documentation

(1) An insurer's claim file is subject to examination by the commissioner.

(2) To aid in an examination, an insurer shall:

(a) maintain claim data that is accessible and retrievable; and

(b) maintain detailed documentation in each claim file permitting reconstruction of the insurer's activities related to the claim.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-5 Misrepresentation of Policy Provisions

(1) An insurer and its representatives shall fully disclose to a first party claimant any pertinent benefit, coverage, or other provision of a policy under which a claim is presented.

(2) An insurer is prohibited from denying a claim based on a first party claimant's failure to make the property available for inspection unless there is documentation of a breach of a policy provision in the claim file.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-6 Failure to Acknowledge Communication

(1) An insurer shall acknowledge receiving a notice of loss within 15 days of receipt unless:

(a) payment is made within 15 days of a notice of loss; or

(b) the insurer reasonably explains the failure to acknowledge receipt.

(2) Notice given to an agent of an insurer is notice to the insurer.

(3) Within 15 days, an insurer shall provide a substantive response to a claimant if a response has been requested.

(4) Upon receiving a notice of loss, an insurer shall, within 15 days, provide any necessary claim forms, instructions, and reasonable assistance so that a first party claimant can comply with the policy.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-7 Notice of Loss

(1) If a notice of loss is required by an insurer, it is timely if made according to the terms of the policy, this rule, and Section 31A-21-312.

(2) A notice of loss may be given by an insured to an authorized agent, authorized adjuster, or other agent of an insurer unless the insurer directs otherwise pursuant to a specific disclosure.

(3) The general business practice of an insurer when accepting a notice of loss shall be consistent for all policyholders.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-8 Proof of Loss

If a proof of loss is required by an insurer, it is timely if made according to the terms of the policy, this rule, and Section 31A-21-312.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-9 Unfair Claim Settlement Practices

The commissioner finds that the following acts or general business practices are unfair claim settlement practices and are misleading, deceptive, unfairly discriminatory, overreaching, or an unreasonable restraint on competition in settling a claim:

(1) denying or threatening to deny a claim, or rescinding, canceling, or threatening to rescind or cancel coverage under a policy for a reason that is not clearly described in a policy as a reason for denial, cancellation, or rescission;

(2) failing to provide an insured or a beneficiary a written explanation of the evidence of an investigation or the claim file materials supporting a denial of a claim based on misrepresentation or fraud on an insurance application, if misrepresentation or fraud is the basis for the denial;

(3) compensating an employee, producer, or contractor an amount based on savings to the insurer due to denying payment of a claim;

(4) failing to deliver to the department a copy of an insurer's guidelines during an investigation of a claim, if requested;

(5) refusing to pay a claim without conducting a reasonable investigation;

(6) offering a first party claimant substantially less than a claim's reasonable value as established by an independent source;

(7) making a claim payment to an insured or a beneficiary without a statement or explanation of benefits that describes the coverage under which a payment is made and how a payment amount is calculated;

(8) failing to pay a first party claim within 30 days of receiving a proof of loss if liability is reasonably clear under one coverage to influence a settlement under another portion of the insurance policy or under another insurance policy;

(9) refusing to pay a claim solely based on an insured's request unless:

(a) the insured claims sovereign, eleemosynary, diplomatic, military service, or other immunity from suit or liability with respect to the claim; or

(b) the insured is granted the right under the policy to consent to settlement of a claim;

(10) advising a claimant not to obtain the services of an attorney or suggesting a claimant will receive less money if an attorney is used to pursue a claim or advise on the merits of a claim;

(11) misleading a claimant about applicable statutes of limitation;

(12) requiring an insured to sign a release that extends beyond the occurrence or cause of action that gave rise to a claim payment;

(13) deducting from a loss or claim payment made under one policy the premiums owed by the insured on another policy, unless the insured consents;

(14) failing to settle a first party claim on the basis that responsibility for payment of the claim should be assumed by others, except as provided by a policy provision;

(15) issuing a check or a draft in partial settlement of a loss or a claim under a specified coverage if the check or draft contains language that releases an insurer from total liability;

(16) refusing to provide a written basis for the denial of a claim upon demand of an insured;

(17) denying a claim for medical treatment after preauthorization is given, except in a case where an insurer obtains and provides to a claimant documentation of the pre-existing condition for which preauthorization was given or if a claimant is not eligible for coverage;

(18) refusing to pay a reasonably incurred expense to an insured if the expense resulted from a delay, prohibited by this rule, in a claim settlement or a claim payment;

(19) if an automobile insurer represents both a tort feasor and a claimant:

(a) failing to advise a claimant under any coverage that the same insurance company represents both the tort feasor and the claimant as soon as such information becomes known to the insurer; and

(b) allocating medical payments to the tort feasor's liability coverage before exhausting a claimant's personal injury protection coverage;

(20) except for a failure to pay personal injury protection expenses when due, failing to pay interest at the legal rate, as provided in Title 15, Contracts and Obligations in General, on first party and third party claim amounts that are overdue under this rule; and

(21) failing to deliver or mail the amount owed on a first party or third party claim within 30 days after the insurer receives written proof of a covered loss and its amount, except:

(a) if the insurer does not receive written proof of the entire loss, the insurer shall deliver or mail a partial amount supported by written proof or investigation within 30 days; and

(b) a payment is not overdue if the insurer has reasonable evidence to dispute its responsibility for payment.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-10 Minimum Standards for Prompt, Fair, and Equitable Settlement

(1) An insurer shall provide to a claimant a statement describing the time and way a claim shall be made and the type of proof of loss required by the insurer.

(2)(a) Within 30 days after receiving a complete proof of loss, an insurer shall complete its investigation of the claim and shall notify the first party claimant of its acceptance or denial of the claim unless the investigation cannot reasonably be completed within that time.

(b) If the insurer needs more time to determine whether the first party claim should be accepted or denied, it shall notify the first party claimant within 30 days after receipt of the proof of loss, giving the reasons more time is needed.

(c) If the investigation remains incomplete, the insurer shall, within 45 days after sending the initial notification and within every 45 days thereafter, send to the first party claimant a letter setting forth the reasons additional time is needed for the investigation, unless the first party claimant is represented by legal counsel or a public adjuster.

(d) Any basis for the denial of a claim shall be noted in the insurer's claim file and promptly communicated, in writing, to the first party claimant.

(e) An insurer is prohibited from denying a claim on the grounds of a specific provision, condition, or exclusion unless reference to the provision, condition, or exclusion is included in the denial.

(3)(a) If negotiations continue for settlement of a claim with a first party claimant or a third party claimant who is not represented by legal counsel or a public adjuster, an insurer shall notify the claimant of the date on which the applicable statute of limitation or other time limit expires.

(b) The notice shall be given at least 60 days before the expiration date.

(4) An insurer is prohibited from making a statement that the rights of a third party claimant may be impaired if a form or release is not completed within a given period, unless the statement is given to notify a third party claimant of a statute of limitation.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-11 Standards for Prompt, Fair, and Equitable Settlement for Automobile Insurance

(1) If an automobile insurance policy provides for an adjustment and settlement of a total loss for a first party claimant based on actual cash value or replacement with another automobile of like kind and quality, one of the methods in this Subsection (1) shall apply.

(a)(i) An insurer may offer a replacement automobile that is comparable to the insured's automobile, with all applicable taxes, license fees, and transfer of ownership fees paid, at no cost, less any deductible provided in the policy; and

(ii) an offer and any rejection shall be documented in the claim file.

(b)(i) An insurer may offer a cash settlement based on the actual cost, less any deductible provided in the policy, to purchase a comparable automobile, including all applicable taxes, license fees, and transfer of ownership fees of a comparable automobile for a cost determined in this Subsection (1)(b)(i).

(A) The cost of at least two comparable automobiles in the local market area, if an automobile was available within the last 90 days to consumers in the local market area.

(B) The cost of at least two comparable automobiles in areas proximate to the local market area, including the closest major metropolitan area in or out of the state, that were available within the last 90 days to consumers, if comparable automobiles are not available in the local market area.

(C) At least two quotes from at least two qualified dealers located within the local market area, if a comparable automobile is not available in the local market area.

(D) Any source to determine a statistically valid fair market value that meets the following criteria:

(I) the source gives primary consideration to the value of vehicles in the local market area and may consider data on vehicles outside the area;

(II) the source produces value for at least 85% of the makes and models for the last 15 model years, taking into account the value of all major options for such vehicles; and

(III) the source produces fair market value based on current data available from the area surrounding the location where the insured vehicle was principally garaged or a necessary expansion of the parameters, such as time and area, to assure statistical validity.

(ii) An insurer shall reopen its claim file and comply with the following procedures upon notice that a first party claimant cannot purchase a comparable vehicle at market value within 30 days of receiving a cash settlement payment under this Subsection (1)(b); and

(A) locate a comparable vehicle by the same manufacturer, same year, similar body style, and similar options and price range for an insured for the market value determined by the insurer at the time of settlement available through a licensed dealer or private seller;

(B) either:

(I) pay the difference between market value before applicable deductions and the cost of the comparable vehicle of like kind and quality that the insured has located; or

(II) negotiate and effectuate the purchase of the vehicle for the insured;

(D) conclude the loss settlement under the appraisal section of the policy in force at the time of the loss.

(iii) An insurer is not required to take action under Subsection (1)(b)(ii) if its documentation to the first party claimant, at the time of settlement, included written notification of the availability and location of a specified and comparable vehicle of the same manufacturer, same year, similar body style, and similar options in as good or better condition as the total loss vehicle that could be purchased for the market value determined by the insurer before applicable deductions.

(c) If a first party claimant automobile total loss is settled on a basis that deviates from the methods described in Subsection (1)(a) or (1)(b), the deviation shall be supported by documentation giving particulars of the automobile condition.

(i) Any deduction from the cost, including a deduction for salvage, shall be measurable, itemized, and specified as to dollar amount and shall be reasonable in amount.

(ii) The basis for the settlement shall be fully explained to the first party claimant.

(2)(a) A total loss settlement with a third party claimant shall be based on the market value or actual cost of a comparable automobile at the time of loss including all applicable taxes, license fees, and transfer of ownership fees.

(b) Except for Subsection (1)(b)(ii), settlement procedures shall comply with Subsection (1)(b).

(3) Where liability and damages are reasonably clear, an insurer is prohibited from recommending that a third party claimant make a claim under the third party claimant's own policy solely to avoid paying a claim under the insurer's policy.

(4) An insurer is prohibited from requiring a claimant to travel an unreasonable distance to inspect a replacement automobile, to obtain a repair estimate, or to have an automobile repaired at a specific repair shop.

(5)(a) An insurer shall include a first party claimant's deductible, if any, in a subrogation demand initiated by an insurer.

(b) A subrogation recovery may be shared on a proportionate basis with a first party claimant if an agreement is reached for less than the full amount of the loss, unless the deductible amount has been otherwise recovered.

(c) A subrogation recovery shall be applied first to reimburse a first party claimant for the amount or share of the deductible if the full amount or share of the deductible has been recovered.

(d)(i) A deduction for expenses may not be made from the deductible recovery unless an outside attorney is retained to collect the recovery.

(ii) If taken, a deduction shall be a pro rata share of the allocated loss adjustment expense.

(e) If subrogation is initiated but discontinued, the insured shall be advised.

(6)(a) If an insurer prepares or approves an estimate for automobile repairs, the estimated cost shall reasonably be expected to repair the damage to the automobile.

(b) If an insurer prepares an estimate, it shall give a copy of the estimate to the claimant and may provide the claimant the names of one or more conveniently located repair shops.

(7) If the amount claimed is reduced due to betterment or depreciation, all information for the reduction shall be contained in the claim file.

(a) The deduction shall be itemized with specificity as to dollar amount and shall be reasonable.

(b) The insurer shall provide a written explanation of the deductions to the claimant upon request.

(8) If an insurer elects to repair an automobile and designates a specific repair shop for the repairs, the insurer shall cause the damaged automobile to be restored to its condition before the loss at no additional cost to the claimant other than as stated in the policy and within a reasonable period.

(9)(a) If coverage exists, payment shall be made to a claimant for:

(i) reasonably incurred cost of transportation; or

(ii) reasonably incurred rental cost of a substitute vehicle, including collision damage waiver, unless the claimant has physical damage coverage available.

(b) A payment under Subsection (9)(a) shall be made for:

(i) the period the automobile is necessarily withdrawn from service to obtain parts or effect repair; or

(ii) if the automobile is a total loss and the claim has been timely made, the period from the date of loss until a reasonable settlement offer has been made by the insurer.

(c) An insurer may not refuse to pay for loss of use for the period that an insurer is examining the claim or making other determinations as to the validity of the loss, unless the delay reveals that an insurer is not liable to pay the claim.

(d) A loss of use payment shall be an amount in addition to a payment for the value of an automobile.

(10) An insurer shall fairly, equitably, and in good faith attempt to compensate a first party claimant for all losses covered by the policy based on the following standards:

(a) an offer of settlement may not be based solely on the useful life of the damaged part or vehicle;

(b) an estimate of the amount of compensation for a claimant shall include the actual wear and tear, or lack thereof, of the damaged part or vehicle;

(d) an actual estimate of the true useful life remaining in the part or vehicle shall be considered in establishing the amount of compensation of a claim; and

(e) actual cash value shall include taxes and other fees incurred by a claimant in replacing the part or vehicle or in compensating the claimant for the loss incurred.

(11) An insurer may not demand reimbursement of a personal injury protection payment from a first party claimant from a settlement or judgment against a third party, except as provided by law.

(12)(a) An insurer shall provide reasonable written notice to a claimant before termination of payment for automobile storage charges and claim documentation of the denial.

(b) An insurer shall provide a reasonable time for the claimant to remove the vehicle from storage before terminating a payment.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-12 Unfair Claim Settlement Practices for Automobile Insurance

The commissioner finds the following acts to be misleading, deceptive, unfairly discriminatory, overreaching, or an unreasonable restraint on competition in settling a claim:

(1) settling a claim for an amount that is less than the amount the insurer would be charged if repairs were made, unless the amount is agreed to by the claimant or provided for by the policy;

(2) refusing to settle a claim based solely upon a police agency issuing or failing to issue a traffic citation;

(3) failing to disclose all coverages for which an application for benefits is required by the insurer;

(4) failing to disclose all coverages, including loss of use, household services, and any other coverages available to the claimant;

(5) requiring a claimant to use only the insurer's claim service to perfect a claim;

(6) failing to provide to a claimant, if requested, the name and address of the salvage dealer who provided a salvage quote for the amount deducted by an insurer in a total loss settlement;

(7) refusing to disclose policy limits if requested by a claimant;

(8) using a release on the back of a check or draft that requires a claimant to release an insurer from an obligation on further claims to process a current claim if an insurer knows or reasonably should know that there may be future liability on the part of the insurer;

(9) refusing to use a separate release of claim document, rather than one on the back of a check or draft, if requested to do so by a claimant;

(10) intentionally offering less money to a first party claimant than the claim is reasonably worth;

(11) refusing to offer to pay a claim based on comparative negligence without a reasonable basis for doing so; and

(12) imputing the negligence of a permissive user of a vehicle to the owner of the vehicle in a bailment situation.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-13 Standards for Prompt, Fair, and Equitable Settlement for Fire and Extended Coverage Type Policies with Replacement Cost Coverage

(1)(a) If a policy provides for the adjustment and settlement of first party losses based on replacement cost, the following apply:

(i) if a loss requires repair or replacement of an item or part, any significant physical damage incurred in making such repair or replacement not otherwise excluded by the policy shall be included in the loss; and

(ii) if a loss requires repair or replacement of items and the repaired or replaced items do not match in color, texture, or size, the insurer shall repair or replace items to conform to a reasonably uniform appearance for both interior and exterior losses.

(b) For a settlement described in Subsection (1)(a), an insured is only responsible for the applicable deductible.

(2)(a)(i) If a policy provides for an adjustment and settlement of loss on an actual cash value basis on residential fire and extended coverage, an insurer shall determine actual cash value as the replacement cost of property at the time of the loss less depreciation, if any.

(ii) Upon an insured's request, an insurer shall provide a copy of any relevant documentation from the claim file detailing each deduction for depreciation.

(b)(i) If an insured's interest is limited because the property has nominal or no economic value, or a value disproportionate to replacement cost less depreciation, the determination of actual cash value is not required.

(ii) In a case described in Subsection (2)(b)(i), an insurer shall provide, upon the insured's request, a written explanation of the basis for limiting the amount of recovery along with the amount payable under the policy.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

Utah Admin. Code R590-190-14 Severability

If any provision of this rule, Rule R590-190, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308

R590-191 Unfair Life Insurance Claim Settlement Practice Rule

Utah Admin. Code R590-191-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-21-312, 31A-26-301, and 31A-26- 303.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) set standards for the investigation and disposition of an annuity contract or life insurance claim; and

(b) identify an unfair claim practice.

(2) This rule applies to an insurer and an authorized agent.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Authorized agent" means an individual, corporation, association, organization, partnership, or other legal entity authorized to represent an insurer with respect to a claim.

(2) "Beneficiary" means a party entitled to receive proceeds or benefits under a contract or policy.

(3) "Claim file" means a record that can accurately and reliably reproduce the original material regarding a claim, its investigation, adjustment, and settlement.

(4) "Claimant" means an insured or an insured's legal representative, including an immediate family member designated by the insured.

(5) "Days" means calendar days.

(6) "Documentation" means a physical or an electronic record related to a claim.

(7) "General business practice" means a pattern of conduct in a business.

(8) "Investigation" means an activity of an insurer related to the determination of liability of a claim.

(9) "Notice of loss" means a claimant's notice that reasonably informs an insurer of the facts related to a claim.

(10) "Proof of loss" means a claimant's reasonable documentation in support of a claim.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-4 File and Record Documentation

(1) An insurer's claim file is subject to examination by the commissioner.

(2) To aid in an examination, an insurer shall maintain:

(a) claim data that is accessible and retrievable for examination, including:

(i) the policy number;

(ii) the certificate number, if any;

(iii) a duplicate of the policy, as issued;

(iv) the claim number;

(v) the date of loss;

(vi) the date the notice of loss was received;

(vii) the date the proof of loss was received;

(viii) the date an investigation began and was complete;

(ix) the date of the settlement of the claim;

(x) the type of settlement, indicated as:

(A) payment, including the amount paid;

(B) settled without payment; or

(xi) documentation supporting how the claim was settled and how any payments were calculated; and

(xii) other documentation relied upon for claim settlement;

(b) detailed documentation in each claim file permitting the reconstruction of the insurer's activities relative to the claim; and

(3) The data in Subsection (2) shall:

(a) be available for each open and closed file for at least the most recent three-year period; or

(b) for a Utah domiciled insurer, be available from the date of the previous examination by the department.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-5 Disclosure of Policy Provisions

(1) An insurer or an authorized agent shall disclose to a claimant any benefit, limitation, or exclusion of a policy that relates to a particular claim presented.

(2) An insurer or an authorized agent shall disclose to a claimant any provision of a policy that relates to an inquiry regarding coverage.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-6 Notice and Proof of Loss

(1)(a) A notice of loss to an insurer, if required, is considered timely if made according to the terms of the policy, this rule, and Section 31A-21-312.

(b) A notice of loss may be given to an insurer or an authorized agent.

(d) The general business practice of an insurer when accepting a notice of loss shall be consistent for all policyholders.

(e) Within 15 days of receiving a notice of loss from a claimant, an insurer shall provide necessary claim forms, instructions, and reasonable assistance so the claimant can properly comply with the insurer's requirements for filing a claim.

(2)(a) A proof of loss to an insurer is considered timely if made according to the terms of the policy, this rule, and Section 31A-21-312.

(b) A proof of loss requirement may not be unreasonable and shall consider the circumstances surrounding a given claim.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-7 Minimum Standards for Prompt, Fair, and Equitable Benefit Determination and Settlement

(1)(a) A benefit determination time period begins once an insurer receives a claim, regardless of whether all necessary information was filed with the original claim.

(b) If an insurer requires an extension due to a claimant's failure to submit necessary information, the time period for making a decision is tolled from the date the notice is sent to the claimant through:

(i) the date the claimant provides the necessary information; or

(ii) 48 hours after the end of the time period for the claimant to provide the additional information.

(2) Within 15 days of receiving a proof of loss from a claimant, an insurer shall:

(a) provide written acknowledgment of receipt of the proof of loss;

(b) request any necessary additional information from the claimant; and

(c) begin any necessary investigation of the claim, including requesting additional information from other parties having documentation or information relating to the claim.

(3) If no additional information or investigation is necessary under Subsection (2), an insurer shall provide the claim settlement and a written explanation of benefits to the claimant.

(4) Within 15 days of receiving any communication relating to a claim that reasonably suggests that a response is expected, an insurer shall substantively respond to the communication.

(5)(a) Within 30 days of receiving a proof of loss from a claimant, an insurer shall complete the investigation of the claim.

(b) If the investigation cannot reasonably be completed within 30 days, an insurer shall:

(i) establish, with adequate records, that the investigation could not be completed within 30 days of its receipt of the proof of loss;

(ii) communicate to the claimant, in writing, the reasons for the delay; and

(iii) continue to communicate in writing at least every 30 days until the claim is either settled or denied.

(6) Within 15 days of completing an investigation, an insurer shall:

(a) provide a claim settlement and a written explanation to the claimant; or

(b) provide, in writing, a denial of the claim and an explanation to the claimant of the reason for the denial.

(7) Closing a claim file without settlement is a denial and must be communicated, in writing, to the claimant according to this rule and the policy provisions.

(8) If recalculation or revisitation of a claim is necessary, the insurer shall comply with the initial claim handling process requirements described in this section.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-8 Unfair Claim Settlement Practices

(1) concealing from or failing to fully disclose to a claimant a benefit, limitation, exclusion, coverage, or other relevant provision of a contract or policy under which a claim is presented;

(2) denying or threatening to deny a claim, rescinding, canceling, or threatening to rescind or cancel coverage under a policy for a reason that is not clearly described in the contract or policy as a reason for denial, cancellation, or rescission;

(3) refusing to settle a claim without conducting a reasonable investigation;

(4) refusing to provide a written basis for denying a claim upon demand of a claimant;

(5) failing to provide a claimant with a written explanation of the evidence of an investigation or the claim file materials supporting a denial of a claim based on misrepresentation or fraud, if misrepresentation or fraud is the basis for the denial;

(6) compensating an employee, producer, or contractor an amount based on savings to the insurer due to reducing or denying a claim;

(7) making a claim settlement to a claimant without a statement or explanation that describes the coverage under which the settlement is made and how the settlement amount was calculated;

(8) failing to settle a claim following receipt of a proof of loss if liability is reasonably clear to influence another claim settlement under another portion of the policy or under another policy;

(9) advising a claimant not to obtain the services of an attorney or other advocate, or suggesting a claimant will receive less money if an attorney is used to:

(a) pursue a claim; or

(b) advise on the merits of a claim;

(10) misleading a claimant about applicable statutes of limitation;

(11) issuing a check or a draft in partial settlement that contains language that releases an insurer from total liability;

(12)(a) a policy issued before May 5, 2008, that fails to pay interest at the legal rate, under Title 15, Chapter 1, Interest, on an amount that is overdue;

(b) a claim is overdue if not settled within 15 days of completing the investigation; and

(13) a policy issued on or after May 5, 2008, that fails to pay interest under Section 31A-22-428.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

Utah Admin. Code R590-191-9 Severability

If any provision of this rule, Rule R590-191, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: August 22, 2023
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-22-428; 31A-26- 301; 31A-26-303

R590-192 Unfair Accident and Health Insurance Claim Settlement Practice Rule

Utah Admin. Code R590-192-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-216, 31A-21-312, 31A-22-629, 31A-26-301, 31A-26-301.6, and 31A-26-303.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) set standards for the investigation and disposition of an accident and health insurance claim; and

(b) identify an unfair claim practice.

(2) This rule applies to an insurer and an authorized agent.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-22-629, and 29 CFR 2560.503-1(m). Additional terms are defined as follows:

(1) "Authorized agent" means an individual, corporation, association, organization, partnership, or other legal entity authorized to represent an insurer with respect to a claim.

(2) "Claim file" means a record that can accurately and reliably reproduce the original material regarding a claim, its investigation, adjustment, and settlement.

(3) "Claimant" means an insured or an insured's legal representative, including an immediate family member designated by the insured.

(4) "Concurrent care" or "ongoing care" means an insurer approves an ongoing course of treatment over a specific period or number of treatments.

(5) "Days" means calendar days.

(6) "Documentation" means a physical or an electronic record related to a claim.

(7) "General business practice" means a pattern of conduct in a business.

(8) "Investigation" means an activity of an insurer related to the determination of liability of a claim.

(9) "Medical necessity" means:

(a) a health care service or product that a prudent health care professional would provide to a patient to prevent, diagnose, or treat an illness, injury, disease, or its symptoms in a manner that is:

(i) in accordance with generally accepted standards of medical practice in the United States;

(ii) clinically appropriate in terms of type, frequency, extent, site, and duration;

(iii) not primarily for the convenience of the patient, physician, or other health care provider; and

(iv) covered under the policy; and

(b) if a medical question-of-fact exists, "medical necessity" shall include the most appropriate available supply or level of service for the individual in question, considering potential benefits and harms to the individual, and known to be effective.

(i) For an intervention not yet in widespread use, the effectiveness shall be based on scientific evidence.

(ii) For an established intervention, the effectiveness shall be based on:

(A) scientific evidence;

(B) professional standards; and

(10) "Misrepresentation" for a health benefit plan means an intentional misrepresentation of a material fact.

(11) "Notice of loss" means a claimant's notice that reasonably informs an insurer of the facts related to a claim.

(12) "Proof of loss" means a claimant's reasonable documentation in support of a claim.

(13)(a) "Scientific evidence" means:

(i) a scientific study published or accepted by a medical journal that meets nationally recognized standards for a scientific manuscript and that submits its published articles for review by experts who are not part of the editorial staff; or

(ii) a finding, a study, or research conducted by or under the auspices of the federal government or a nationally recognized federal research institute.

(b) "Scientific evidence" does not include:

(i) published peer-reviewed literature sponsored by:

(A) a pharmaceutical manufacturing company; or

(B) a medical device manufacturer; or

(ii) a single study without other supportable studies.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-4 File and Record Documentation

(1) An insurer's claim file is subject to examination by the commissioner.

(2) To aid in an examination, an insurer shall maintain:

(a) claim data that is accessible and retrievable for examination, including:

(i) the policy number;

(ii) the certificate number, if any;

(iii) a duplicate of the policy, as issued;

(iv) the claim number;

(v) the date of loss;

(vi) the date the notice of loss was received, if required;

(vii) the date the proof of loss was received;

(viii) the date an investigation began and was complete;

(ix) the date of a benefit determination;

(x) the date of the settlement of the claim;

(xi) the type of settlement, indicated as:

(A) payment, including the amount paid;

(B) settled without payment; or

(xii) documentation supporting how the claim was settled and how any payments were calculated; and

(xiii) other documentation relied upon for claim settlement;

(b) detailed documentation in each claim file permitting the reconstruction of the insurer's activities related to the claim; and

(3) The data in Subsection (2) shall:

(a) be available for all open and closed files for at least the most recent three-year period; or

(b) for a Utah domiciled insurer, be available from the date of the previous examination by the commissioner.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-5 Disclosure of Policy Provisions

(1) An insurer or an authorized agent shall disclose to a claimant any benefit, limitation, or exclusion of a policy that relates to a diagnosis or service of a particular claim presented.

(2) An insurer or an authorized agent shall disclose to a claimant any provision of a policy that relates to an inquiry regarding coverage.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-6 Notice and Proof of Loss

(1)(a) A notice of loss to an insurer, if required, is considered timely if made according to the terms of the policy, this rule, and Section 31A-21-312.

(b) A notice of loss may be given to an insurer or an authorized agent.

(d) The general business practice of an insurer when accepting a notice of loss shall be consistent for all policyholders.

(2)(a) A proof of loss to an insurer is considered timely if made according to the terms of the policy, this rule, and Section 31A-21-312.

(b) A proof of loss requirement may not be unreasonable and shall consider the circumstances surrounding a given claim.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-7 Notification

(1) An insurer shall notify a claimant of a benefit determination and include:

(a) the specific reason or reasons for the benefit determination;

(b) reference to the specific policy provision that the benefit determination is based upon;

(d) with a notice of an adverse benefit determination:

(i) a description of the appeal procedures and any time limitations;

(ii) a description of how to initiate an appeal along with conspicuous disclosure of the insurer's address and telephone number that is followed by a statement regarding assistance available at the Utah Insurance Department, Office of Consumer Health Assistance; and

(iii) the claimant's right to bring civil action.

(2)(a) If a claimant fails to follow an insurer's procedure for filing a pre-service claim, an insurer or authorized agent shall:

(i) notify the claimant of the failure;

(ii) provide the claimant with the proper procedure to file a claim for benefits; and

(iii) provide notification to the claimant:

(A) no later than five days from the failure; or

(B) within 24 hours of the failure for a claim involving urgent care.

(b) Notification of a failure may be oral unless written notification is requested by a claimant.

(3)(a) A notice of adverse benefit determination for a health benefit plan shall comply with Rule R590-261.

(b) Subsection (3)(a) does not apply to a grandfathered health plan defined in 45 CFR 147.140.

(4) A notice of an adverse benefit determination for income replacement insurance shall:

(a) provide the criteria relied upon in making the adverse determination; and

(b) disclose that a copy of the criteria will be provided free of charge upon request.

(5) If an adverse benefit determination is based on medical necessity, experimental treatment, or similar exclusion or limit, an insurer shall provide either:

(a) an explanation of the scientific or clinical judgment for the determination that applies the terms of the plan to the insured's medical circumstances; or

(b) a statement that the explanation in Subsection (5)(a) will be provided free of charge upon request.

(6) An adverse benefit determination for a claim involving urgent care shall:

(a) provide written or electronic notification to the claimant no later than three days after an oral notification; and

(b) provide a description of the expedited review process applicable to each claim.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-8 Minimum Standards for Prompt, Fair, and Equitable Benefit Determination and Settlement

(1)(a) A benefit determination time period begins once an insurer receives a claim, regardless of whether all necessary information was filed with the original claim.

(i) the date the claimant provides the necessary information; or

(ii) 48 hours after the end of the time period for the claimant to provide the additional information.

(2)(a) When a claim involves urgent care, an insurer shall notify a claimant of the insurer's benefit decision as soon as possible, considering the medical exigencies of the situation, but no later than 72 hours after receipt of the claim.

(b) An insurer shall determine whether a claim is urgent based on the information provided by the claimant.

(c) If a claimant does not provide sufficient information for an insurer to make a decision, the insurer must notify the claimant as soon as possible, but not later than 24 hours after receipt of the claim, and specify the information that is required.

(d) A claimant shall be given reasonable time, but not less than 48 hours, to provide the required information.

(e) An insurer shall notify a claimant of the insurer's decision as soon as possible, but not later than 48 hours after the earlier of:

(i) the insurer's receipt of the requested information; or

(ii) the end of the time given to the claimant to provide the information.

(3)(a) A reduction or termination of concurrent care during treatment is considered an adverse benefit determination.

(b) Before a reduction or termination of concurrent care occurs, an insurer shall provide a claimant notice, with sufficient time to appeal and receive a decision on the adverse benefit determination.

(c)(i) A claimant may request an extension of concurrent care beyond what is approved.

(ii) If a request for an extension is made at least 24 hours before the end of the concurrent care, the insurer shall notify the claimant of the insurer's decision as soon as possible, but not later than 24 hours after receipt of the request.

(iii) If the request for extension does not involve urgent care, the insurer shall notify the claimant of the insurer's benefit decision using the response times for a post-service claim.

(4)(a) An insurer shall notify a claimant of the insurer's pre-service benefit decision within 15 days of receipt of the request for care.

(b)(i) If an insurer cannot make a decision within 15 days due to circumstances beyond the insurer's control, such as late receipt of medical records, the insurer may extend the time up to 15 additional days.

(ii) If an insurer chooses to extend up to 15 days, the insurer shall notify the claimant before the expiration of the original 15 days.

(i) state what information the claimant must submit; and

(ii) give the claimant at least 45 days to submit the requested information.

(d) If a pre-service claim determination is made and the medical care is rendered, the claim shall be processed according to the time requirements of a post-service claim.

(5)(a) For a post-service claim, an insurer shall notify a claimant of the insurer's benefit decision within 30 days of receipt of a notice of loss.

(b)(i) If an insurer is unable to make a decision within 30 days due to circumstances beyond the insurer's control, such as late receipt of medical records, the insurer may extend the time up to 15 additional days.

(ii) If an insurer chooses to extend up to 15 days, the insurer shall notify the claimant before the expiration of the original 30 days.

(i) state what information the claimant must submit; and

(ii) give the claimant at least 45 days to submit the requested information.

(6) An insurer offering a health benefit plan shall provide continued coverage for an ongoing course of treatment pending the outcome of an internal appeal.

(7) Except for a grandfathered individual health benefit plan as defined in 45 CFR 147.140, an insurer offering an individual health benefit plan shall provide only one level of internal appeal before the final determination is made.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-9 Additional Standards for Prompt, Fair, and Equitable Benefit Determination and Settlement for Income Replacement Insurance

(1) An insurer shall notify a claimant of an adverse benefit determination of an income replacement insurance benefit within 45 days of receipt of a claim.

(a)(i) If an insurer is unable to make a decision within 45 days due to circumstances beyond the insurer's control, the insurer may extend the time up to 30 additional days.

(ii) If an insurer chooses to extend up to 30 days, the insurer shall notify the claimant before the expiration of the original 45 days.

(iii) The notification shall include:

(A) the circumstances requiring the extension; and

(B) the date by which the insurer expects to render a decision.

(b)(i) If an insurer cannot render a decision within the first 30-day extension due to circumstances beyond the insurer's control, the insurer may extend the time up to 30 additional days.

(ii) If an insurer chooses to extend up to 30 days, the insurer shall notify the claimant before the expiration of the first 30-day extension.

(iii) The notification shall include:

(A) the circumstances requiring the extension; and

(B) the date by which the insurer expects to render a decision.

(i) the basis for the extension;

(ii) each unresolved issue that prevents a decision on the claim;

(iii) the information needed to resolve each unresolved issue; and

(iv) that the claimant is given at least 45 days to provide the information.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-10 Unfair Claim Settlement Practices

(1) concealing from or failing to fully disclose to a claimant a benefit, limitation, exclusion, coverage, or other relevant provision of a policy under which a claim is presented;

(2) denying or threatening to deny a claim, rescinding, canceling, or threatening to rescind or cancel coverage under a policy for any reason that is not clearly described in a policy as a reason for denial, cancellation, or rescission;

(3) refusing to settle a claim without conducting a reasonable investigation;

(4) denying or paying a claim without:

(a) providing a notification or an explanation of benefits describing the exclusion or benefit; and

(b) explaining how the denial or payment is calculated;

(5) failing to provide a claimant a written explanation of the evidence of an investigation or the claim file materials supporting a denial of a claim based on misrepresentation or fraud, if misrepresentation or fraud is the basis for the denial;

(6) compensating an employee, producer, or contractor an amount based on savings to the insurer due to denying or reducing payment of a claim, unless the compensation relates to the discovery of a billing or processing error;

(7) failing to pay a claim following receipt of a proof of loss if liability is reasonably clear under one coverage to influence settlement:

(a) under another portion of the policy; or

(b) under another policy;

(8) advising a claimant not to obtain the services of an attorney or other advocate, or suggesting a claimant will receive less money if an attorney is used to:

(a) pursue a claim; or

(b) advise on the merits of a claim;

(9) misleading a claimant about applicable statutes of limitation;

(10) deducting from a claim payment made under one policy the premium owed by the claimant on another policy, unless the claimant consents;

(11) failing to pay a claim on the basis that responsibility for payment of the claim should be assumed by someone else, except as provided by a policy provision;

(12) issuing a check or draft in partial settlement that contains language that releases an insurer from total liability;

(13) refusing to provide a written basis for the denial of a claim upon demand of a claimant;

(14) refusing to pay a reasonable incurred expense to a claimant if the expense resulted from a delay, prohibited by this rule, in a claim settlement or claim payment;

(15) failing to pay interest at the legal rate under Title 15, Chapter 1, Interest:

(a) on an amount that is overdue and unpaid within 20 days of completing an investigation; or

(b) to a health care provider on an amount that is overdue under Section 31A-26-301.6;

(16) failing to provide a claimant with an explanation of benefits; and

(17) for a health benefit plan, failing to:

(a) permit a claimant to review the claim file and present evidence as part of the claim and appeal process;

(b) provide a claimant, at no cost, new or additional evidence considered, relied upon, or generated by the insurer in connection with the claim; or

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

Utah Admin. Code R590-192-11 Severability

If any provision of this rule, Rule R590-192, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: October 29, 2025
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26- 303

R590-194 Coverage of Dietary Products for Inborn Errors of Amino Acid or Urea Cycle Metabolism

Utah Admin. Code R590-194-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-623.

History

KEY: insurance law
Date of Last Change: January 10, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-614.5; 31A-22-623

Utah Admin. Code R590-194-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish minimum standards of coverage for dietary products, including formulas and low protein modified food products, used for the treatment of inborn errors of amino acid or urea cycle metabolism; and

(b) identify a uniform billing code standard to be used for processing claims for dietary formulas in conjunction with the treatment of specific inborn metabolic errors.

(2) This rule applies to an insurer offering an accident and health insurance policy that contains major medical benefits.

History

KEY: insurance law
Date of Last Change: January 10, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-614.5; 31A-22-623

Utah Admin. Code R590-194-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-623.

History

KEY: insurance law
Date of Last Change: January 10, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-614.5; 31A-22-623

Utah Admin. Code R590-194-4 Minimum Standards and General Provisions

(1) Preauthorization for dietary products may be required if it is stated in the policy.

(2) Each insurer shall provide direct access to a designated person familiar with dietary products to facilitate the processing of claims.

(3) Dietary products shall be paid under the major medical benefit as any other illness and not under any limited benefit, such as durable medical equipment (DME).

(4) An insurer may request additional information required to determine the eligibility of the claim under the terms of the policy.

(5)(a) "Coverage for Metabolic Dietary Products Standard version 2.1," adopted by the Utah Health Information Network (UHIN), is incorporated by reference and is available on the department's website, https://insurance.utah.gov.

(b) This uniform billing standard shall be utilized for billing and processing claims for dietary products.

History

KEY: insurance law
Date of Last Change: January 10, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-614.5; 31A-22-623

Utah Admin. Code R590-194-5 Severability

If any provision of this rule, Rule R590-194, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: January 10, 2023
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-614.5; 31A-22-623

R590-196 Bail Bond Premium and Fee Standards, Collateral Standards, and Disclosure Form

Utah Admin. Code R590-196-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-35-104.

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

Utah Admin. Code R590-196-2 Purpose and Scope

(1) The purpose of this rule is to establish:

(a) uniform premium and fees; and

(b) collateral standards.

(2) This rule applies to a person engaged in the bail bond business.

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

Utah Admin. Code R590-196-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-35-102. Additional rules are defined as follows:

(1) "Bail bond business" means engaging in conduct authorized under Title 31A, Chapter 35, Bail Bond Act.

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

Utah Admin. Code R590-196-4 Premium and Fee Standards

(1) Initial bail bond premium and fees.

(a) Bail bond premium amounts:

(i) the minimum premium charged may not be less than 10% of the bail bond amount;

(ii) the maximum premium charged may not exceed 20% of the bail bond amount.

(b) A document preparation fee may not exceed $20 per set of forms relating to a bail bond.

(2) Additional fees.

(a) Fees are limited to actual and reasonable expenses incurred by a surety insurer or a bail bond agency when:

(i) the defendant fails to appear before the court at a designated date and time;

(ii) the defendant fails to comply with a court order; or

(iii) the defendant or the co-signer fails to comply with the terms of a bail bond agreement or a promissory note relating to that agreement.

(b) Reasonable mileage expense fees are allowed pursuant to the Internal Revenue Service standard mileage rates for a business.

(c) Reasonable apprehension expenses such as meals, lodging, commercial travel, and communication, regardless of whether the defendant is apprehended, are limited to actual expenses incurred and must be reasonable, for example, meals at mid- range restaurants, lodging at mid-range hotels, commercial travel in coach class, etc.

(d) Collateral expense fees are allowed for:

(i) actual expenses to obtain collateral; and

(ii) storage expenses, if in a secured storage area, limited to actual expenses.

(e) A late payment fee of $20 or 5% of the delinquent periodic payment, whichever is less, is allowed.

(f) If a fee is charged by a court or a jail to process a bail bond, the actual fee charged may be passed through to the defendant or the co-signer.

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

Utah Admin. Code R590-196-5 Collateral Standards

(1) Collateral may be provided to:

(a) secure bail bond fees;

(b) secure the face amount of a bail bond; or

(2) If a surety insurer or a bail bond agency accepts the same collateral to secure the bail bond fee and the face amount of a bail bond, the collateral may not be converted until the bail bond is exonerated or judgment entered against the surety insurer or bail bond agency and the depositor has been given at least 15 days to pay any bail bond fees owing.

(3) If a surety insurer or bail bond agency accepts different collateral to secure the bail bond fee and the face amount of a bail bond:

(i) the collateral securing the bail bond fees may not be converted until payment has been defaulted under the terms of the promissory note for those fees, and the depositor of the collateral has been given at least 15 days to make the required payment;

(ii) the collateral securing the face amount of the bail bond may not be converted until the bail bond is exonerated or judgment entered against the surety insurer or bail bond agency and the depositor of the collateral has been given at least 15 days to reimburse the surety insurer or bail bond agency for any amounts owed to the surety insurer or bail bond agency.

(4) A surety insurer, a bail bond agency, or a bail bond producer taking possession of collateral shall hold the collateral as a fiduciary until ownership of the collateral passes to the surety insurer or bail bond agency.

(5) Collateral held may not be used by a surety insurer, a bail bond agency, or a bail bond producer without the specific written permission of the depositor of the collateral.

(6) If proceeds from converted collateral exceed the outstanding balance due, the surety insurer or bail bond agency shall return the excess proceeds to the depositor of the collateral.

(7) Notice under this rule is proper if sent via first class mail to the address provided by the depositor of the collateral.

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

Utah Admin. Code R590-196-6 Disclosure Form

A surety insurer, bail bond agency, or bail bond producer shall use the following disclosure form, or a form that contains substantially similar language.

TABLE

XYZ Bail Bonds Disclosure Form

1234 South 1234 East, Salt Lake City, UT 84444:

801-123-4567 fax: 801-098-7654

Defendant:

Cosigner:

Court:

Charge:

Bail bond amount:

Bail bond number:

Initial Premium and Fees, non-refundable.

....bail bond premium, maximum: no more than 20%; minimum: not less than 10%

$......

....document preparation, not to exceed $20 per set of bail bond forms

$......

....credit card fee, not to exceed 5% of amount charged to credit card

$......

total initial premium and fees

$......

Additional Fees.

(1) Limited to actual and reasonable expenses required because the defendant fails to appear before the court at any designated time, fails to comply with a court order, or fails to comply with the terms of a bail bond agreement or a promissory note pertaining to that agreement. The following are reasonable expense fees:

(i) reasonable mileage expense fee pursuant to IRS standard mileage rates for business;

(ii) reasonable and actual apprehension expense fees, including meals at mid-range restaurants, lodging at mid-range hotels, transportation at no more than coach fares; and

(iii) collateral expense fees: actual expenses to obtain collateral and actual storage expenses, if collateral is in a secured storage area.

(2) A late payment fee of $20 or 5% of the delinquent periodic payment whichever is less.

(3) If a fee is charged by a court or a jail to process a bail bond, the actual fee charged may be passed through to the defendant or the co-signer.

Grounds for Revocation of a Bail Bond.

(1) If the defendant violates any of the following, the defendant shall be subject to immediate bond revocation and the defendant, or the co-signer, or both, shall be subject to all the costs incurred to return the defendant to the court.

(2) Grounds for revocation include the following:

(a) the defendant or co-signer providing materially false information on bail bond application;

(b) the court's increasing the amount of bail beyond sound underwriting criteria employed by the bail bond producer, bail bond agency, or surety insurer;

(d) the defendant changes their address or telephone number or employer without giving reasonable notice to the bail bond producer, bail bond agency, or surety insurer;

(e) the defendant is arrested for another crime, other than a minor traffic violation, while on bail;

(f) the defendant returns to jail in any jurisdiction and revocation is served on the defendant before the defendant is released;

(g) failure by the defendant to appear in court at any appointed time;

(h) the defendant is found guilty by a court of competent jurisdiction;

(i) a request by the co-signer based on reasons (a) through (h) above.

Items (a) through (h) pertain to the defendant; items (a), (c), (e) (g), and (i) pertain to co-signers, if any.

Collateral.

The following has been given as collateral to guarantee all court appearances of the defendant until the bail bond is exonerated:

List collateral......

The following has been given as collateral to guarantee payment of bail bond premium or fees:

List collateral......

If judgment is entered against the surety insurer or bail bond agency, or the bonding premium or fee is not paid according to the terms of the bail bond agreement and its promissory note, if any, following written notice to the undersigned of such judgment or non-payment, the undersigned authorize XYZ Bail Bonds to convert the appropriate collateral to collect the judgment or the unpaid bail bond premium or fees. If proceeds from the sale of the collateral are insufficient to cover the outstanding balance due, the defendant, the co- signer, or both, agree to be personally liable for the difference. If proceeds from the sale exceed the outstanding balance, the difference will be returned to the depositor of the collateral. The depositor's signature below constitutes acknowledgment of a Bill of Sale for the collateral. The depositor accepts this agreement as a bill of sale for the collateral.

By signing below, I certify that I have read and understand this disclosure form, the bail bond agreement and its attached promissory note, if any. I certify under penalty of perjury that all information given to XYZ Bail Bonds verbally and in writing on all documents relevant to this bail bond are true and accurate. The co-signer agrees that should the co-signer request XYZ Bail Bonds to revoke the defendant's bail bond, with or without probable cause, the co-signer will be responsible to pay XYZ Bail Bonds and their agents for the time returning the defendant to jail at the rates stated above, in additional fees. If the co-signer requests to revoke the bail bond without probable cause, the co-signer will be responsible to reimburse the defendant the bail bond premium or fees.

Date:

Defendant:

Date:

Co-Signer:

Date:

Depositor:

I,......................................., agent of XYZ Bail Bonds, certify that I have given a copy of all documents pertaining to this bail bond agreement to the defendant, the co-signer, the depositor, or any of the above, at the time and date said bail bond agreement was executed.

Date:

Bail Bond Agent:

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

Utah Admin. Code R590-196-7 Severability

If any provision of this rule, Rule R590-196, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, bail bonds
Date of Last Change: June 7, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-35-104

R590-197 Treatment of Guaranty Association Assessments as Qualified Assets

Utah Admin. Code R590-197-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-17-201, and 31A-28-109.

History

KEY: insurance law
Date of Last Change: January 24, 2023
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-201

Utah Admin. Code R590-197-2 Purpose and Scope

(1) The purpose of this rule is to establish the standard by which an assessment paid by an insurer to an insurance guaranty association may be treated as a qualified asset.

(2) This rule applies to an insurer licensed in Utah.

History

KEY: insurance law
Date of Last Change: January 24, 2023
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-201

Utah Admin. Code R590-197-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-17-201. Additional terms are defined as follows:

(1) "Qualified asset," as defined in Section 31A-17-201, includes a guaranty fund or guaranty association assessment paid in any state, if it is probable that the insurer can offset the assessment against present or future premium tax or income tax paid in the state in which the assessment was paid.

History

KEY: insurance law
Date of Last Change: January 24, 2023
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-201

Utah Admin. Code R590-197-4 Paid Assessments Are Qualified Assets

(1) The amount of an assessment allowed as a qualified asset may not exceed 2-1/2 times the amount of premium or income tax paid for the previous calendar year.

(2) The commissioner may disallow an assessment as a qualified asset if the commissioner determines a company is unlikely to realize a present or future premium tax or income tax offset because of the assessment.

(3) An insurer is considered to have paid income or premium tax when it reduces its gross premium tax liability by use of a credit or other legally allowable deduction.

History

KEY: insurance law
Date of Last Change: January 24, 2023
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-201

Utah Admin. Code R590-197-5 Severability

If any provision of this rule, Rule R590-197, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: January 24, 2023
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-201

R590-198 Valuation of Life Insurance Policies

Utah Admin. Code R590-198-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-17-402, and 31A-17-512.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

Utah Admin. Code R590-198-2 Purpose and Scope

(1) The purpose of this rule is to provide:

(a) tables of select mortality factors;

(b) rules for use of select mortality factors;

(d) minimum standards for the valuation of plans with secondary guarantees.

(2) The method for calculating basic reserves defined in this rule constitutes the Commissioners' Reserve Valuation Method for policies to which this rule applies.

(3) This rule applies to a life insurance policy, with or without nonforfeiture values, issued on or after January 4, 2000, subject to the following exceptions and conditions.

(4) This rule does not apply to:

(a) an individual life insurance policy issued on or after January 4, 2000, if the policy is issued in accordance with and as a result of the exercise of a reentry provision contained in the original life insurance policy of the same or greater face amount, issued before January 4, 2000, that guarantees the premium rates of the new policy;

(b) a subsequent policy issued as a result of the exercise of a provision described in Subsection (4)(a), or a derivation of the provision, in the new policy;

(i) any secondary guarantee period is five years or less;

(ii) a specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the 1980 CSO valuation tables as defined in Subsection R590-198-3(1) and the applicable valuation interest rate; and

(iii) the initial surrender charge is not less than 100% of the first year annualized specified premium for the secondary guarantee period;

(c) a variable life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts; and

(d) a group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required to continue coverage in force for a period in excess of one year.

(5) Conditions.

(a) Calculation of the minimum valuation standard for a policy with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits, other than universal life policies, or both, shall be in accordance with Section R590-198-5.

(b) Calculation of the minimum valuation standard for flexible premium and fixed premium universal life insurance policies that contain provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period shall be in accordance with Section R590-198-6.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

Utah Admin. Code R590-198-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "1980 CSO valuation tables" means the Commissioners' 1980 Standard Ordinary Mortality Table, 1980 CSO Table, without ten-year selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law, and variations of the 1980 CSO Table approved by the NAIC, such as the smoker and nonsmoker versions approved in December 1983.

(2) "Basic reserves" means reserves calculated in accordance with Section 31A-17-504.

(3) "Contract segmentation method" means the method of dividing the period from issue to mandatory expiration of a policy into successive segments, with the length of each segment being defined as the period from the end of the prior segment, from policy inception, for the first segment, to the end of the latest policy year as determined below. All calculations are made using the 1980 CSO valuation tables, as defined in Subsection (1), or any other valuation mortality table adopted by the NAIC after January 4, 2000 and promulgated by rule by the commissioner for this purpose, and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in Subsection R590-198-4(2).

The length of a particular contract segment shall be set equal to the minimum of the value t for which G t is greater than R t , if G t never exceeds R t the segment length is deemed to be the number of years from the beginning of the segment to the mandatory expiration date of the policy, where G t and R t are defined as follows: G t = GP x+k+t / GP x+k+t-1 where: x =original issue age; k =the number of years from the date of issue to the beginning of the segment; t =1, 2, ...; t is reset to 1 at the beginning of each segment; GP x+k+t-1 =Guaranteed gross premium per thousand of face amount for year t of the segment, ignoring policy fees only if level for the premium paying period of the policy.

R t = q x+k+t / q x+k+t-1 , However, R t may be increased or decreased by 1% in any policy year, at the insurer's option, but R t shall not be less than one; where: x, k and t are as defined above, and q x+k+t-1 =valuation mortality rate for deficiency reserves in policy year k+t but using the mortality of Section 5B(2) if Section 5B(3) is elected for deficiency reserves.

However, if GP x+k+t is greater than 0 and GP x+k+t-1 is equal to 0, G t shall be deemed to be 1,000. If GP x+k+t and GP x+k+t-1 are both equal to 0, G t shall be equal to 0.

(4) "Deficiency reserves" means the excess, if greater than zero, of minimum reserves calculated in accordance with Section 31A-17-507 over basic reserves.

(5) "Guaranteed gross premiums" means the premiums under a life insurance policy that are guaranteed and determined at issue.

(6) "Maximum valuation interest rates" means the interest rates defined in Section 31A-17-506 that are to be used in determining the minimum standard for the valuation of life insurance policies.

(7)(a) "Scheduled gross premium" for a universal life insurance policy means the smallest specified premium described in Subsection R590-198-6(1)(c), if any, or else the minimum premium described in Subsection R590-198-6(1)(d).

(b) "Scheduled gross premium" for a policy other than a universal life insurance policy means the smallest illustrated gross premium at issue.

(8)(a) "Segmented reserves" means reserves, calculated using segments produced by the contract segmentation method, equal to the present value of all future guaranteed benefits less the present value of all future net premiums to the mandatory expiration of a policy, where the net premiums within each segment are a uniform percentage of the respective guaranteed gross premiums within the segment. The uniform percentage for each segment is such that, at the beginning of the segment, the present value of the net premiums within the segment equals:

(i) The present value of the death benefits within the segment, plus

(ii) The present value of any unusual guaranteed cash value, see Subsection R590-198-5(4), occurring at the end of the segment, less

(iii) Any unusual guaranteed cash value occurring at the start of the segment, plus

(iv) For the first segment only, the excess of the Subsection (A) over Subsection (B), as follows:

(A) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for in the first segment after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary within the first segment on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the 19-year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one-year higher than the age at issue of the policy.

(B) A net one-year term premium for the benefits provided for in the first policy year.

(b) The length of each segment is determined by the contract segmentation method, as defined in Subsection (3).

(c) The interest rates used in the present value calculations for a policy may not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the sum of the lengths of all segments of the policy.

(d) For both basic reserves and deficiency reserves computed by the segmented method, present values shall include future benefits and net premiums in the current segment and in all subsequent segments.

(9) "Tabular cost of insurance" means the net single premium at the beginning of a policy year for one-year term insurance in the amount of the guaranteed death benefit in that policy year.

(10) "Ten-year select factors" means the select factors adopted with the 1980 amendments to the NAIC Standard Valuation Law.

(11)(a) "Unitary reserves" means the present value of all future guaranteed benefits less the present value of all future modified net premiums, where:

(i) guaranteed benefits and modified net premiums are considered to the mandatory expiration of the policy; and

(ii) modified net premiums are a uniform percentage of the respective guaranteed gross premiums, where the uniform percentage is such that, at issue, the present value of the net premiums equals the present value of all death benefits and pure endowments, plus the excess of Item (A) over Item (B), as follows:

(A) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the 19-year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one-year higher than the age at issue of the policy.

(B) A net one-year term premium for the benefits provided for in the first policy year.

(b) The interest rates used in the present value calculations for any policy may not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the length from issue to the mandatory expiration of the policy.

(12) "Universal life insurance policy" means an individual life insurance policy under which separately identified interest credits, other than in connection with dividend accumulations, premium deposit funds, or other supplementary accounts, and mortality or expense charges are made to the policy.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

Utah Admin. Code R590-198-4 General Calculation Requirements for Basic Reserves and Premium Deficiency Reserves

(1) At the election of the insurer for any one or more specified life insurance plans, the minimum mortality standard for basic reserves may be calculated using the 1980 CSO valuation tables with select mortality factors, or any other valuation mortality table adopted by the NAIC after January 4, 2000, and promulgated by rule by the commissioner for this purpose. If select mortality factors are elected, they may be:

(a) the ten-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law, see Rule R590-95;

(b) the select mortality factors adopted by the NAIC at the 1999 Spring National Meeting; or

(c) any other table of select mortality factors adopted by the NAIC after January 4, 2000, and promulgated by rule by the commissioner for the purpose of calculating basic reserves.

(2) Deficiency reserves, if any, are calculated for each policy as the excess, if greater than zero, of the quantity A over the basic reserve. The quantity A is obtained by recalculating the basic reserve for the policy using guaranteed gross premiums instead of net premiums when the guaranteed gross premiums are less than the corresponding net premiums. At the election of the insurer for any one or more specified plans of insurance, the quantity A and the corresponding net premiums used in the determination of quantity A may be based upon the 1980 CSO valuation tables with select mortality factors or any other valuation mortality table adopted by the NAIC after January 4, 2000, and promulgated by rule by the commissioner. If select mortality factors are elected, they may be:

(a) the ten-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law;

(b) the select mortality factors adopted by the NAIC at the 1999 Spring National Meeting;

(c) for durations in the first segment, X percent of the select mortality factors adopted by the NAIC at the 1999 Spring National Meeting, subject to the following:

(i) X may vary by policy year, policy form, underwriting classification, issue age, or any other policy factor expected to affect mortality experience;

(ii) X is such that, when using the valuation interest rate used for basic reserves, Item (A) is greater than or equal to Item (B);

(A) the actuarial present value of future death benefits, calculated using the mortality rates resulting from the application of X;

(B) the actuarial present value of future death benefits calculated using anticipated mortality experience without recognition of mortality improvement beyond the valuation date;

(iii) X is such that the mortality rates resulting from the application of X are at least as great as the anticipated mortality experience, without recognition of mortality improvement beyond the valuation date, in each of the first 5-years after the valuation date;

(iv) the appointed actuary shall increase X at any valuation date where it is necessary to continue to meet all the requirements of Subsection (2)(c);

(v) the appointed actuary may decrease X at any valuation date as long as it continues to meet all the requirements of Subsection (2)(c);

(vi) the appointed actuary shall consider the adverse effect on expected mortality and the lapsing of any anticipated or actual increase in gross premiums; and

(vii) if X is less than 100% at any duration for any policy, the following requirements shall be met:

(A) the appointed actuary shall disclose, in the Regulatory Asset Adequacy Issues Summary required by Section R590- 162-6, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods; and

(B) the appointed actuary shall annually opine for all policies subject to this rule as to whether the mortality rates resulting from the application of X meet the requirements of Subsection (2)(c). This opinion shall be supported by an actuarial report, subject to appropriate Actuarial Standards of Practice promulgated by the Actuarial Standards Board of the American Academy of Actuaries. The X factors shall reflect anticipated future mortality, without recognition of mortality improvement beyond the valuation date, considering relevant emerging experience; or

(d) any other table of select mortality factors adopted by the NAIC after January 4, 2000, and promulgated by rule by the commissioner for the purpose of calculating deficiency reserves.

(3) This subsection applies to both basic reserves and deficiency reserves. Any set of select mortality factors may be used only for the first segment. However, if the first segment is less than ten years, the appropriate ten-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law may be used thereafter through the tenth policy year from the date of issue.

(4)(a) In determining basic reserves or deficiency reserves, guaranteed gross premiums without policy fees may be used if the calculation involves the guaranteed gross premium but only if the policy fee is a level dollar amount after the first policy year. In determining deficiency reserves, policy fees may be included in guaranteed gross premiums, even if not included in the actual calculation of basic reserves.

(b) Reserves for policies that have changes to guaranteed gross premiums, guaranteed benefits, guaranteed charges, or guaranteed credits that are unilaterally made by the insurer after issue and that are effective for more than one year after the date of the change shall be the greatest of the following:

(i) reserves calculated ignoring the guarantee;

(ii) reserves assuming the guarantee was made at issue; and

(iii) reserves assuming that the policy was issued on the date of the guarantee.

(5) The commissioner may require the insurer to document the extent of the adequacy of reserves for specified blocks, including but not limited to policies issued before January 4, 2000. This documentation may include a demonstration of the extent to which aggregation with other non-specified blocks of business is relied upon in the formation of the appointed actuary opinion pursuant to Section R590-162-5.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

Utah Admin. Code R590-198-5 Calculation of Minimum Valuation Standard for Policies with Guaranteed Nonlevel Gross Premiums or Guaranteed Nonlevel Benefits Other than Universal Life Policies

(1) Basic Reserves.

Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Both the segmented reserves and the unitary reserves for a policy shall use the same valuation mortality table and selection factors. At the option of the insurer, in calculating segmented reserves and net premiums, either of the adjustments described in Subsection (1)(a) or (1)(b) may be made.

(a) Treat the unitary reserve, if greater than zero, applicable at the end of each segment as a pure endowment and subtract the unitary reserve, if greater than zero, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.

(b) Treat the guaranteed cash surrender value, if greater than zero, applicable at the end of each segment as a pure endowment; and subtract the guaranteed cash surrender value, if greater than zero, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.

(2) Deficiency Reserves.

(a) The deficiency reserve at any duration shall be calculated:

(i) on a unitary basis if the corresponding basic reserve determined by Subsection (1) is unitary;

(ii) on a segmented basis if the corresponding basic reserve determined by Subsection (1) is segmented; or

(iii) on the segmented basis if the corresponding basic reserve determined by Subsection (1) is equal to both the segmented reserve and the unitary reserve.

(b) Subsection (2) applies to any policy for which the guaranteed gross premium at any duration is less than the corresponding modified net premium calculated by the method used in determining the basic reserves, but using the minimum valuation standards of mortality, specified in Subsection R590-198-4(2), and rate of interest.

(c) Any deficiency reserves shall be calculated for each policy as the excess if greater than zero, for the current and all remaining periods, of the quantity A over the basic reserve, where A is obtained as indicated in Subsection R590-198-4(2).

(d) For deficiency reserves determined on a segmented basis, the quantity A is determined using segment lengths equal to those determined for segmented basic reserves.

(3) Minimum Value.

Basic reserves may not be less than the tabular cost of insurance for the balance of the policy year, if mean reserves are used. Basic reserves may not be less than the tabular cost of insurance for the balance of the current modal period or to the paid- to-date, if later, but not beyond the next policy anniversary, if mid-terminal reserves are used. The tabular cost of insurance shall use the same valuation mortality table and interest rates as used for the calculation of the segmented reserves. If select mortality factors are used, they shall be the ten-year select factors incorporated into the 1980 amendments of the NAIC Standard Valuation Law. In no case may total reserves, including basic reserves, deficiency reserves, and any reserves held for supplemental benefits that would expire upon contract termination, be less than the amount that the policyowner would receive, including the cash surrender value of the supplemental benefits, if any, referred to above, exclusive of any deduction for policy loans, upon termination of the policy.

(4) Unusual Pattern of Guaranteed Cash Surrender Values.

(a) For any policy with an unusual pattern of guaranteed cash surrender values, the reserves actually held before the first unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the first unusual guaranteed cash surrender value as a pure endowment and treating the policy as an n-year policy providing term insurance plus a pure endowment equal to the unusual cash surrender value, where n is the number of years from the date of issue to the date the unusual cash surrender value is scheduled.

(b) The reserves actually held after any unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the policy as an n-year policy providing term insurance plus a pure endowment equal to the next unusual guaranteed cash surrender value, and treating any unusual guaranteed cash surrender value at the end of the prior segment as a net single premium, where:

(i) n is the number of years from the date of the last unusual guaranteed cash surrender value before the valuation date to the earlier of:

(A) the date of the next unusual guaranteed cash surrender value, if any, that is scheduled after the valuation date; or

(B) the mandatory expiration date of the policy;

(ii) the net premium for a given year during the n-year period is equal to the product of the net to gross ratio and the respective gross premium; and

(iii) the net to gross ratio is equal to Item (A) divided by Item (B) as follows:

(A) The present value, at the beginning of the n-year period, of death benefits payable during the n-year period plus the present value, at the beginning of the n-year period, of the next unusual guaranteed cash surrender value, if any, minus the amount of the last unusual guaranteed cash surrender value, if any, scheduled at the beginning of the n-year period.

(B) The present value, at the beginning of the n-year period, of the scheduled gross premiums payable during the n- year period.

(c) For purposes of Subsection (4), a policy is considered to have an unusual pattern of guaranteed cash surrender values if any future guaranteed cash surrender value exceeds the prior year's guaranteed cash surrender value by more than the sum of:

(i) 110% of the scheduled gross premium for that year;

(ii) 110% of one year's accrued interest on the sum of the prior year's guaranteed cash surrender value and the scheduled gross premium using the nonforfeiture interest rate used for calculating policy guaranteed cash surrender values; and

(iii) 5% of the first policy year surrender charge, if any.

(5) Optional Exemption for Yearly Renewable Term (YRT) Reinsurance.

At the option of the insurer, the following approach for reserves on YRT reinsurance may be used:

(a) Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year.

(b) Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in Subsection (3).

(i) For each policy year, calculate the excess, if greater than zero, of the valuation net premium over the respective maximum guaranteed gross premium.

(ii) Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with Subsection (5)(c)(i).

(d) For purposes of this subsection, the calculations use the maximum valuation interest rate and the 1980 CSO mortality tables with or without ten-year select mortality factors, or any other table adopted after January 4, 2000, by the NAIC and promulgated by rule by the commissioner for this purpose.

(e) A reinsurance agreement shall be considered YRT reinsurance for purposes of this subsection if only the mortality risk is reinsured.

(f) If the assuming insurer chooses this optional exemption, the ceding insurer's reinsurance reserve credit shall be limited to the amount of reserve held by the assuming insurer for the affected policies.

(6) Optional Exemption for Attained-Age-Based Yearly Renewable Term Life Insurance Policies.

At the option of the insurer, the following approach for reserves for attained-age-based YRT life insurance policies may be used:

(a) Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year.

(b) Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in Subsection (3).

(i) For each policy year, calculate the excess, if greater than zero, of the valuation net premium over the respective maximum guaranteed gross premium.

(ii) Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with Subsection (6)(c)(i).

(d) For purposes of this subsection, the calculations use the maximum valuation interest rate and the 1980 CSO valuation tables with or without ten-year select mortality factors, or any other table adopted after January 4, 2000, by the NAIC and promulgated by rule by the commissioner for this purpose.

(e) A policy shall be considered an attained-age-based YRT life insurance policy for purposes of this subsection if:

(i) the premium rates, on both the initial current premium scale and the guaranteed maximum premium scale, are based upon the attained age of the insured such that the rate for any given policy at a given attained age of the insured is independent of the year the policy was issued; and

(ii) the premium rates, on both the initial current premium scale and the guaranteed maximum premium scale, are the same as the premium rates for policies covering all insureds of the same sex, risk class, plan of insurance, and attained age.

(f) For policies that become attained-age-based YRT policies after an initial period of coverage, the approach of this subsection may be used after the initial period if:

(i) the initial period is constant for all insureds of the same sex, risk class, and plan of insurance; or

(ii) the initial period runs to a common attained age for all insureds of the same sex, risk class, and plan of insurance; and

(iii) after the initial period of coverage, the policy meets the conditions of Subsection (6)(e).

(g) If this election is made, this approach shall be applied in determining reserves for all attained-age-based YRT life insurance policies issued on or after January 4, 2000.

(7) Exemption from Unitary Reserves for Certain n-Year Renewable Term Life Insurance Policies.

Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met:

(a) the policy consists of a series of n-year periods, including the first period and all renewal periods, where n is the same for each period, except that for the final renewal period, n may be truncated or extended to reach the expiry age, provided that this final renewal period is less than ten years and less than twice the size of the earlier n-year periods, and for each period, the premium rates on both the initial current premium scale and the guaranteed maximum premium scale are level;

(b) the guaranteed gross premiums in all n-year periods are not less than the corresponding net premiums based upon the 1980 CSO Table with or without the ten-year select mortality factors; and

(8) Exemption from Unitary Reserves for Certain Juvenile Policies.

Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met, based upon the initial current premium scale at issue:

(a) at issue, the insured is age 24 or younger;

(b) until the insured reaches the end of the juvenile period, which shall occur at or before age 25, the gross premiums and death benefits are level, and there are no cash surrender values; and

(c) after the end of the juvenile period, gross premiums are level for the remainder of the premium paying period, and death benefits are level for the remainder of the life of the policy.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

Utah Admin. Code R590-198-6 Calculation of Minimum Valuation Standard for Flexible Premium and Fixed Premium Universal Life Insurance Policies That Contain Provisions Resulting in the Ability of a Policyowner to Keep a Policy in Force Over a Secondary Guarantee Period

(1) General.

(a) Policies with a secondary guarantee include:

(i) a policy with a guarantee that the policy will remain in force at the original schedule of benefits, subject only to the payment of specified premiums;

(ii) a policy in which the minimum premium at any duration is less than the corresponding one-year valuation premium, calculated using the maximum valuation interest rate and the 1980 CSO valuation tables with or without ten-year select mortality factors, or any other table adopted after January 4, 2000, by the NAIC and promulgated by rule by the commissioner for this purpose; or

(iii) a policy with any combination of Subsections (1)(i) and (1)(ii).

(b) A secondary guarantee period is the period for which the policy is guaranteed to remain in force subject only to a secondary guarantee. If a policy contains more than one secondary guarantee, the minimum reserve shall be the greatest of the respective minimum reserves at that valuation date of each unexpired secondary guarantee, ignoring all other secondary guarantees. Secondary guarantees that are unilaterally changed by the insurer after issue shall be considered to have been made at issue. Reserves described in Subsections (2) and (3) shall be recalculated from issue to reflect these changes.

(c) Specified premiums mean the premiums specified in the policy, the payment of which guarantees that the policy will remain in force at the original schedule of benefits, but which otherwise would be insufficient to keep the policy in force in the absence of the guarantee if maximum mortality and expense charges and minimum interest credits were made and any applicable surrender charges were assessed.

(d) For purposes of Subsection (1), the minimum premium for any policy year is the premium that, when paid into a policy with a zero account value at the beginning of the policy year, produces a zero account value at the end of the policy year. The minimum premium calculation shall use the policy cost factors, including mortality charges, loads and expense charges, and the interest crediting rate, which are all guaranteed at issue.

(e) The one-year valuation premium means the net one-year premium based upon the original schedule of benefits for a given policy year. The one-year valuation premiums for all policy years are calculated at issue. The select mortality factors defined in Subsections R590-198-4(2)(b), R590-198-4(2)(c), and R590-198-4(2)(d) may not be used to calculate the one-year valuation premiums.

(f) The one-year valuation premium should reflect the frequency of fund processing, as well as the distribution of deaths assumption employed in the calculation of the monthly mortality charges to the fund.

(2) Basic Reserves for the Secondary Guarantees.

Basic reserves for the secondary guarantees shall be the segmented reserves for the secondary guarantee period. In calculating the segments and the segmented reserves, the gross premiums shall be set equal to the specified premiums, if any, or otherwise to the minimum premiums, that keep the policy in force and the segments will be determined according to the contract segmentation method as defined in Subsection R590-198-3(3).

(3) Deficiency Reserves for the Secondary Guarantees.

Deficiency reserves, if any, for the secondary guarantees shall be calculated for the secondary guarantee period in the same manner as described in Subsection R590-198-5(2) with gross premiums set equal to the specified premiums, if any, or otherwise to the minimum premiums that keep the policy in force.

(4) Minimum Reserves.

The minimum reserves during the secondary guarantee period are the greater of:

(a) the basic reserves for the secondary guarantee plus the deficiency reserve, if any, for the secondary guarantees; or

(b) the minimum reserves required by other rules or rules governing universal life plans.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

Utah Admin. Code R590-198-7 Severability

If any provision of this rule, Rule R590-198, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance companies
Date of Last Change: December 8, 2022
Notice of Continuation: November 4, 2024
Authorizing, and Implemented or Interpreted Law: 31A-17-402; 31A-17-512

R590-199 Plan of Orderly Withdrawal Rule Relating to Health Benefit Plans

Utah Admin. Code R590-199-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-4-115.

History

KEY: health insurance
Date of Last Change: June 7, 2022
Notice of Continuation: April 26, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-115; 31A-30-106; 31A-30-107

Utah Admin. Code R590-199-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) maintain a health benefit plan market that is stable and fair;

(b) ensure and maintain access to health benefit plan coverage; and

(c) promote an orderly process without causing disruption to the health insurance market when an insurer elects to withdraw or nonrenew health benefit plan coverage.

(2) This rule applies to an insurer offering a health benefit plan.

History

KEY: health insurance
Date of Last Change: June 7, 2022
Notice of Continuation: April 26, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-115; 31A-30-106; 31A-30-107

Utah Admin. Code R590-199-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1) "Annual renewal date" means the annual anniversary of the date a policy or plan, under which health insurance benefits are provided, is initially issued.

History

KEY: health insurance
Date of Last Change: June 7, 2022
Notice of Continuation: April 26, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-115; 31A-30-106; 31A-30-107

Utah Admin. Code R590-199-4 Plan of Orderly Withdrawal

(1) A carrier and each affiliate of a carrier that elects to withdraw or nonrenew coverage under a health benefit plan must file a plan of orderly withdrawal with the commissioner.

(2)(a) The plan of orderly withdrawal must be filed with the commissioner no later than 30 working days before the notice given under Subsection 31A-22-618.6(5)(e)(ii) or 31A-22-618.7(3)(e)(ii).

(b) The plan of orderly withdrawal shall be accompanied by:

(i) a $50,000 withdrawal fee; or

(ii) proof of placement or assumption of all business to another carrier.

(3) The plan of orderly withdrawal shall include the following information:

(a) the name and telephone number of the company representative to contact regarding the withdrawal;

(b) a list of all policy forms affected by the withdrawal;

(d) the number of covered lives, including the insured, spouse, and dependents, under each health benefit plan policy form;

(e) the number of COBRA or Utah mini-COBRA policies and the number of covered lives for each policy form;

(f) a copy of the notice required by Section 31A-22-618.6 or 31A-22-618.7, as applicable;

(g) the service or coverage areas, indicating the withdrawal area, within the state;

(h) a list of all types of insurance coverage offered in Utah in the prior year, by line of business, and the premium volume generated;

(i) any reinsurance ceding arrangements relating to the health benefit plans being withdrawn;

(j) a list of all affiliated carriers described in Subsection 31A-30-104(4);

(k) if more than 100 covered individuals are being nonrenewed:

(i) a certified actuarial analysis from a qualified actuary of the impact that the withdrawal will have on the individual and employer market in Utah; and

(ii) an actuarial certification from a qualified actuary certifying to the level of liability related to the health benefit plans being nonrenewed;

(l) any proposal to withdraw or nonrenew any other line of business in Utah in the next 12 months;

(m) a statement that the nonrenewal of any coverage under a health benefit plan will occur on the annual renewal date of each policy or plan;

(n) proof that all liabilities relating to the policies that will be nonrenewed are fully satisfied or adequately reserved; and

(o) an acknowledgement that the company is prohibited from writing new business in the health benefit plan market withdrawn from for a period of five years beginning on the date of discontinuation of the last coverage nonrenewed.

(4) If both the written notice and a complete plan of orderly withdrawal are not received, the partial submission will be returned and considered not received by the commissioner.

(5) Availability of coverage through a special enrollment period or open enrollment under Section 31A-30-117 is not considered assumption or placement with another carrier.

History

KEY: health insurance
Date of Last Change: June 7, 2022
Notice of Continuation: April 26, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-115; 31A-30-106; 31A-30-107

Utah Admin. Code R590-199-5 Implementation of Withdrawal

(1) A carrier and all its affiliates withdrawing from the market must provide written notice of the decision to withdraw to all affected insureds and to the insurance commissioner in each state in which an affected insured resides.

(2) The carrier's certificate of authority will be modified to prohibit writing business from which the carrier has withdrawn.

(3) A carrier's affiliates, as described in Subsection 31A-30-104(4), may also be required to withdraw, as determined by the commissioner.

(4) Nonrenewal shall occur on the annual renewal date.

History

KEY: health insurance
Date of Last Change: June 7, 2022
Notice of Continuation: April 26, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-115; 31A-30-106; 31A-30-107

Utah Admin. Code R590-199-6 Severability

If any provision of this rule, Rule R590-199, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance
Date of Last Change: June 7, 2022
Notice of Continuation: April 26, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-115; 31A-30-106; 31A-30-107

R590-200 Diabetes Treatment and Management

Utah Admin. Code R590-200-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-626.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-626

Utah Admin. Code R590-200-2 Purpose and Scope

(1) The purpose of this rule is to establish minimum standards of coverage for diabetes.

(2) This rule applies to each accident and health insurance policy that provides a health insurance benefit.

(3) This rule does not prohibit an insurer from requesting additional information to determine eligibility of a claim under the terms of a policy, certificate, or both.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-626

Utah Admin. Code R590-200-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "Diabetes" means diabetes mellitus, a common chronic, serious systemic disorder of energy metabolism including a heterogeneous group of metabolic disorders characterized by an elevated blood glucose level.

(b) The terms "diabetes" and "diabetes mellitus" are synonymous and defined to include:

(i) a person using insulin;

(ii) a person not using insulin;

(iii) an individual with an elevated blood glucose level induced by pregnancy; and

(iv) a person with another medical condition or medical therapy that wholly or partially consists of an elevated blood glucose level.

(i) complete insulin deficiency, or type 1 diabetes;

(ii) insulin resistance with partial insulin deficiency, or type 2 diabetes; and

(iii) an elevated blood glucose level induced by pregnancy, or gestational diabetes.

(2)(a) "Diabetes self-management training" means a program designed to help an individual learn to manage their diabetes in an outpatient setting.

(b) Self-management training topics include:

(i) making lifestyle changes to effectively manage diabetes;

(ii) avoiding or delaying the complications, hospitalizations, and emergency room visits associated with diabetes; and

(iii) medical nutrition therapy.

(3) "Medical equipment" means non-disposable or durable equipment used to treat diabetes.

(4) "Medical nutrition therapy" means the assessment and therapy of a patient's nutritional status including diet modification, planning, and counseling services furnished by a registered licensed dietitian.

(5) "Medical supplies" means a generally accepted single-use item used to manage, monitor, and treat diabetes, and to administer diabetic specific medication.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-626

Utah Admin. Code R590-200-4 Minimum Standards and General Provisions

(1) Coverage for diabetes treatment is subject to the deductibles, copayments, out-of-pocket maximums, and coinsurance of the policy.

(2)(a) An accident and health insurance policy that provides a health insurance benefit shall cover diabetes self- management training and patient management, including medical nutrition therapy, when medically necessary and prescribed by a physician.

(b) The diabetes self-management training services must be provided by a diabetes self-management training program:

(i) recognized by the Centers for Medicare and Medicaid Services;

(ii) certified by the Utah Department of Health and Human Services; or

(iii) approved or accredited by a national organization certifying standards of quality in the provision of diabetes self- management education.

(i) a diagnosis with diabetes;

(ii) a significant change in a diabetes-related condition;

(iii) a change in diagnostic levels; or

(iv) a change in treatment regimen.

(3) An accident and health insurance policy that provides a health insurance benefit shall cover the following when medically necessary:

(a) blood glucose monitors designed for diabetic patients;

(b) blood glucose monitors for the legally blind designed for use with adaptive devices;

(d) visual reading strips for glucose and ketones;

(e) urine testing strips for glucose and ketones;

(f) lancet devices and lancets for monitoring glycemic control;

(g) insulin, including analog, in either vial or cartridge;

(h) injection aids, including those adaptable to meet the needs of the legally blind;

(i) syringes, including insulin syringes, pen-like insulin injection devices, needles for pen-like insulin injection devices, and other disposable parts required for insulin injection aids;

(j) insulin pumps, including insulin infusion pumps;

(k) medical supplies for use:

(i) with insulin pumps and insulin infusion pumps, including infusion sets, cartridges, syringes, skin preparation, batteries, and other disposable supplies needed to maintain insulin pump therapy; and

(ii) with or without insulin pumps and insulin infusion pumps, including durable and disposable devices for the injection of insulin and infusion sets;

(l) prescription oral agents of each class approved by the FDA for treatment of diabetes, and a variety of drugs, when available, within each class; and

(m) glucagon kits.

(4)(a) No later than June 1 each year, the department shall publish on the department's website at www.insurance.utah.gov:

(i) the price of insulin available under the discount program described in Section 49-20-421;

(ii) the insulin prescription caps for the following calendar year; and

(iii) the average wholesale price of insulin per milliliter, AWP/mL, for each calendar year 2019 and later.

(b) The insulin prescription caps are calculated using data provided by Public Employees Health Plan (PEHP) based on the annual change in the average AWP/mL.

(i) The calculation considers the following initial reference values:

(A) PEHP's average insulin AWP/mL in 2019 of $40.18, Base AWP/mL;

(B) the 2021 insulin prescription cap in Subsection 31A-22-626(4)(a) of $30, Base Low Cap; and

(ii)(A) The insulin prescription cap is rounded to the nearest dollar.

(B) Effective for plan years on or after January 1, 2025, the insulin prescription cap is rounded down to the nearest multiple of $5.

(c)(i) The insulin prescription cap formula for years after 2021 for Subsection 31A-22-626(4)(a) is: Year X low cap = (Average AWP/mL for Year X-2 / Base AWP/mL) * (Base Low Cap) rounded to the nearest dollar.

(ii) The insulin prescription cap formula for years after 2024 for Subsection 31A-22-626(4)(a) is rounded down to the nearest multiple of $5.

(d)(i) The insulin prescription cap formula for years after 2021 for Subsection 31A-22-626(6)(b) is: Year X high cap = (Average AWP/mL for Year X-2 / Base AWP/mL) * (Base High Cap) rounded to the nearest dollar.

(ii) The insulin prescription cap formula for years after 2024 for Subsection 31A-22-626(6)(b) is rounded down to the nearest multiple of $5.

(e) The adjusted insulin prescription cap posted on June 1 takes effect for a policy issued or renewed on or after January 1 of the following calendar year.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-626

Utah Admin. Code R590-200-5 Severability

If any provision of this rule, Rule R590-200, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: February 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-626

R590-203 Health Grievance Review Process

Utah Admin. Code R590-203-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-203, and 31A-22-629.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-2 Purpose and Scope

(1) The purpose of this rule is to ensure that a carrier's grievance review procedure for an individual and a group health insurance and disability income insurance plan complies with 29 CFR 2560.503-1, and Sections 31A-4-116 and 31A-22-629.

(2) This rule applies to individual and group:

(a) health insurance;

(b) disability income insurance; and

(3) Long-term care insurance and Medicare supplement insurance are not considered health insurance under this rule.

(4) A disability income insurance policy is exempt from Section R590-203-5.

(5) This rule does not apply to a health benefit plan that complies with Rule R590-261.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-629. Additional terms are defined as follows:

(1) "Carrier" means a person providing health insurance or disability income insurance including:

(a) an insurance company;

(b) a prepaid hospital or medical care plan;

(d) a multiple employer welfare arrangement;

(e) a managed care organization; and

(f) any other person providing health insurance or disability income insurance under Title 31A, Insurance Code.

(2) "Claimant" means an insured or an insured's legal representative, including an immediate family member designated by the insured.

(3) "Consumer representative" means an employee of a carrier who represents a consumer perspective, if the employee is not:

(a) the individual who made the adverse benefit determination; or

(b) subordinate to the individual who made the adverse benefit determination.

(4)(a) "Health insurance" means insurance providing:

(i) a health care benefit; or

(ii) payment of an incurred health care expense.

(b) Health insurance includes an accident and health insurance policy allowing for an adverse benefit determination on the basis of medical necessity, rather than a specified event.

(5)(a) "Independent review organization" means an entity that conducts independent external reviews of adverse determinations and final adverse determinations.

(b) The independent review organization chosen may not own or control, be a subsidiary of, or in any way be owned or controlled by, or exercise control with a health insurance plan, a national, state, or local trade association of health insurance plans, and a national, state, or local trade association of health care providers.

(6)(a) "Medical necessity" means a health care service or product that a prudent health care professional would provide to a patient to prevent, diagnose, or treat an illness, injury, disease, or its symptoms in a manner that is:

(i) in accordance with generally accepted standards of medical practice in the United States;

(ii) clinically appropriate in terms of type, frequency, extent, site, and duration;

(iii) not primarily for the convenience of the patient, physician, or other health care provider; and

(iv) covered under the policy.

(i) For an intervention not yet in widespread use, the effectiveness is based on scientific evidence.

(ii) For an established intervention, the effectiveness is based on:

(A) scientific evidence;

(B) professional standards; and

(7)(a) "Scientific evidence" means:

(i) a scientific study published in or accepted by a medical journal that meets nationally recognized standards for scientific manuscripts and that submits its published articles for review by experts who are not part of the editorial staff; or

(ii) a finding, study, or research conducted by or under the auspices of a federal government agency or nationally recognized federal research institute.

(b) "Scientific evidence" does not include:

(i) published peer-reviewed literature sponsored by:

(A) a pharmaceutical manufacturing company; or

(B) a medical device manufacturer; or

(ii) a single study without other supportable studies.

(8)(a) "Urgent care claim" means a request for a health care service or course of treatment for which the time period for making non-urgent care request determination:

(i) could seriously jeopardize the life or health of an insured or the ability of an insured to regain maximum function; or

(ii) in the opinion of a physician with knowledge of the insured's medical condition, would subject an insured to severe pain that cannot be adequately managed without the health care service or treatment that is the subject of the request.

(b)(i) Except as provided in Subsection (8)(a)(ii), an individual acting on behalf of a carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine to determine whether a request is an urgent care claim.

(ii) If a physician with knowledge of an insured's medical condition determines that a request is an urgent care request within the meaning of Subsection (8)(a), the request shall be treated as an urgent care claim.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-4 Adverse Benefit Determination

(1) An adverse benefit determination review procedure shall comply with the adverse benefit determination review requirements set forth in 29 CFR 2560.503-1.

(2) A carrier's adverse benefit determination appeal board or body shall include at least one consumer representative who is present at every meeting.

(3) A carrier's adverse benefit determination notice shall conspicuously disclose the carrier's address and telephone number before the Utah Insurance Department's address and telephone number.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-5 Independent and Expedited Adverse Benefit Determination Reviews for Health Insurance

(1) A carrier shall provide an independent review procedure as a voluntary option to resolve an adverse benefit determination of medical necessity.

(2) An independent review procedure shall be conducted by an independent review organization, person, or entity other than the carrier, the plan, the plan's fiduciary, the employer, or any employee or agent of any of the foregoing, that do not have any material professional, familial, or financial conflict of interest with the health plan, any officer, director, or management employee of the health plan, the enrollee, the enrollee's health care provider, the provider's medical group or independent practice association, the health care facility where service would be provided and the developer or manufacturer of the service being provided.

(3)(a) An independent review organization is designated by the carrier or the commissioner.

(b) The independent review organization chosen may not be owned or controlled by, or exercise control with:

(i) the insurer;

(ii) the health plan;

(iii) the health plan's fiduciary;

(iv) a national, state, or local trade association of:

(A) health insurance plans; or

(B) trade association of health care providers;

(v) the employer; or

(vi) an employee or agent of any person listed in Subsections (3)(b)(i) through (v).

(c) An independent review organization chosen may not have a material professional, familial, or financial conflict of interest with:

(i) the health plan;

(ii) an officer, director, or management employee of the health plan;

(iii) the enrollee;

(iv) the enrollee's health care provider;

(v) the health care provider's medical group or independent practice association;

(vi) a health care facility where service would be provided; or

(vii) the developer or manufacturer of the service that would be provided.

(4) Submission to an independent review procedure is voluntary and at the discretion of the claimant.

(5)(a) A voluntary independent review procedure shall:

(i) waive any right to assert that a claimant has failed to exhaust administrative remedies because the claimant did not elect to submit a dispute of medical necessity to a voluntary level of appeal provided by the plan;

(ii) agree that any statute of limitation or other defense based on timeliness is tolled while a voluntary appeal is pending;

(iii) allow a claimant to submit a dispute of medical necessity to a voluntary level of appeal only after exhaustion of the appeals permitted under 29 CFR 2560.503-1(c)(2);

(iv) upon request from a claimant, provide sufficient information relating to the voluntary level of appeal to enable the claimant to make an informed decision about whether to submit a dispute of medical necessity to the voluntary level of appeal; and

(v) disclose that:

(A) an independent review conducted under Section 31A-22-629 and this rule may be binding on both parties; and

(B) a claimant's submission to a binding independent review is voluntary and disclosure and notification must be given under 29 CFR 2560.503-1.

(b) If requested, the information to be provided under Subsection (5)(a)(iv) shall contain:

(i) a statement that the decision to use a voluntary level of appeal will not affect the claimant's right to any other benefit under the plan; and

(ii) information about the applicable rules, the claimant's right to representation, and the process for submitting an independent review.

(6) Standards for voluntary independent review:

(a) A carrier's internal adverse benefit determination process must be exhausted unless the carrier and claimant agree to waive the internal process.

(b) Any adverse benefit determination of medical necessity may be the subject of an independent review.

(c) The claimant has 180 calendar days from the date of the final internal review decision to request an independent review.

(d) A carrier shall use the same minimum standard and notification requirement for an independent review that is used for internal levels of review, as set forth in 29 CFR 2560.503-1(h)(3), 29 CFR 2560.503-1(i)(2) and 29 CFR 2560.503-1(j).

(7) A carrier shall provide an expedited review process for urgent care claims.

(8)(a) A request for expedited review of an adverse benefit determination of medical necessity may be submitted either orally or in writing.

(b) If a request is made orally, a carrier shall send written confirmation to the claimant acknowledging the receipt of the request within 24 hours.

(9) An expedited review shall require a carrier to:

(a) transmit all necessary information between the plan and the claimant electronically, including the plan's original adverse benefit determination;

(b) notify the claimant of the adverse benefit determination review, as soon as possible, considering the medical urgency, but not later than 72 hours after receipt of the claimant's request for review of an adverse benefit determination; and

(c) use the same minimum standard for timing and notification as set forth in 29 CFR 2560.503-1(h), 29 CFR 2560.503-1(i)(2)(i), and 29 CFR 2560.503-1(j).

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-6 Disability Income Insurance Adverse Benefit Determination Review

(1) A carrier shall notify a claimant of an adverse benefit determination review within 45 days of receipt of the claimant's request for review of an adverse benefit determination.

(2) The time for making an adverse benefit determination review may be extended for up to 45 days if necessary due to matters beyond the carrier's control.

(3) If the response time is extended due to the claimant's failure to submit information necessary to decide a claim, the time for making the benefit determination on an adverse benefit determination review shall be tolled from the date on which the notification of the extension is sent until the date on which the claimant responds to the request for additional information.

(4) Upon request, relevant information must be provided to the claimant on any adverse benefit determination free of charge.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-7 File and Record Documentation

A carrier shall:

(1) upon request by the commissioner, make available all adverse benefit determination review files and related documentation; and

(2) maintain these records for the current calendar year plus five years.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

Utah Admin. Code R590-203-8 Severability

If any provision of this rule, Rule R590-203, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: October 29, 2025
Notice of Continuation: March 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-4-116; 31A-22-629

R590-206 Privacy of Consumer Financial and Health Information Rule

Utah Admin. Code R590-206-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-417, and the Gramm- Leach-Bliley Act, 15 U.S.C. Sec. 6801 through 6820.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) govern a licensee's treatment of an individual's nonpublic personal health information and nonpublic personal financial information;

(b) require a licensee to provide notice to an individual about the licensee's privacy policies and practices;

(c) describe the conditions under which a licensee may disclose an individual's nonpublic personal health information and nonpublic personal financial information to an affiliate or nonaffiliated third party; and

(d) provide means by which an individual may prevent a licensee from disclosing the individual's nonpublic information.

(2) This rule applies to a licensee who obtains nonpublic personal financial information or nonpublic personal health information regarding a customer or consumer of a product or service primarily for a personal, family, or household purpose.

(3) This rule does not apply to:

(a) a licensee with information about a person who obtains a product or service for a business, commercial, or agricultural purpose;

(b) a person selling or providing:

(i) a manufacturer warranty;

(ii) a manufacturer service contract paid for with consideration, in addition to the consideration paid for the product; or

(iii) a service contract for the repair or maintenance of goods, including motor vehicles, that is paid for with consideration in addition to consideration paid for the product;

(d) a securities broker or dealer; or

(e) a credit union that engages in an activity or function that does not require a license from the commissioner.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "Clear and conspicuous" means that a notice is reasonably understandable and designed to call attention to the nature and significance of the information in the notice.

(b) "Clear and conspicuous" includes:

(i) presenting the information in the notice in clear, concise sentences, paragraphs, and sections;

(ii) using short explanatory sentences or bulleted lists whenever possible;

(iii) using definite, concrete, everyday words and active voice whenever possible;

(iv) avoiding multiple negatives;

(v) avoiding legal and highly technical business terminology;

(vi) avoiding explanations that are imprecise and readily subject to different interpretations;

(vii) using a plain-language heading to call attention to the notice;

(viii) using a typeface and type size that are easy to read;

(ix) providing wide margins and ample line spacing;

(x) using boldface or italics for key words; and

(xi) using distinctive type size, style, and graphic devices, such as shading or sidebars.

(i) calling attention to the nature and significance of the information in the notice by using text or visual cues to encourage scrolling down the web page, if necessary, to view the entire notice and ensure that other elements on the web page, such as text, graphics, hyperlinks, or sound, do not distract attention from the notice;

(ii) placing the notice on a screen that consumers frequently access, such as a page where transactions are conducted; or

(iii) placing a link that connects directly to the notice and is labeled appropriately to convey the importance, nature, and relevance of the notice.

(2) "Collect" means to obtain information that the licensee organizes or can retrieve by the name of an individual or by identifying number, symbol, or other identifying particular assigned to the individual, irrespective of the source of the underlying information.

(3) "Company" means a corporation, limited liability company, business trust, general or limited partnership, association, sole proprietorship, or similar organization.

(4)(a) "Consumer" means an individual who seeks to obtain, obtains, or has obtained an insurance product or service from a licensee that is used primarily for a personal, family, or household purpose, and about whom the licensee has nonpublic personal information, or that individual's legal representative.

(b) "Consumer" includes:

(i) an individual who provides nonpublic personal information to a licensee in connection with obtaining or seeking to obtain financial, investment, or economic advisory services relating to an insurance product or service;

(ii) an applicant for insurance before the start of insurance coverage;

(iii) an individual who is a beneficiary of a life insurance policy underwritten by the licensee;

(iv) an individual who is a claimant under an insurance policy issued by a licensee;

(v) an individual who is an insured or an annuitant under an insurance policy or an annuity; and

(vi) an individual who is a mortgagor under a mortgage insurance policy.

(i) an individual who is a consumer of another financial institution, solely because the licensee acts as agent for, or provides processing or other services to, that financial institution;

(ii) a participant or a beneficiary of an employee benefit plan that the licensee administers or sponsors or for which the licensee acts as a trustee, insurer, or fiduciary;

(iii) a person covered under a group or blanket insurance policy or group annuity contract;

(iv) a claimant covered by a workers' compensation plan;

(v) an individual, solely because the individual is a beneficiary of a trust for which the licensee is a trustee; or

(vi) an individual, solely because the individual designates the licensee as trustee for a trust.

(5) "Consumer reporting agency" has the same meaning as in the Fair Credit Reporting Act, 15 U.S.C. 1681a(f).

(6) "Control," for purposes of this rule, means:

(a) ownership, control, or power to vote 25% or more of the outstanding shares of a class of voting security of a company, directly or indirectly, or acting through one or more other persons;

(b) control over the election of a majority of the directors, trustees or general partners, or individuals exercising similar functions, of a company; or

(c) the power to exercise, directly or indirectly, a controlling influence over the management or policies of a company, as the commissioner determines.

(7) "Customer" means a consumer who has a customer relationship with a licensee.

(8)(a) "Customer relationship" means a continuing relationship between a consumer and a licensee under which the licensee provides one or more insurance products or services to the consumer that are used primarily for a personal, family, or household purpose.

(b) "Customer relationship" includes a consumer having a continuing relationship with a licensee if:

(i) the consumer is a current policyholder of an insurance product issued by or through the licensee; or

(ii) the consumer obtains financial, investment, or economic advisory services relating to an insurance product or service from the licensee for a fee.

(i) a consumer applies for insurance but does not purchase the insurance;

(ii) a licensee sells a consumer airline travel insurance in an isolated transaction;

(iii) an individual is no longer a current policyholder of an insurance product or no longer obtains insurance services with or through the licensee;

(iv) a consumer is a beneficiary or a claimant under a policy and submitted a claim under the policy choosing a settlement option involving an ongoing relationship with the licensee;

(v) a consumer is a beneficiary or a claimant under a policy and submitted a claim under the policy choosing a lump sum settlement option;

(vi) a customer's policy is lapsed, expired, or otherwise inactive or dormant under the licensee's business practices, and the licensee has not communicated with the customer about the relationship for 12 consecutive months, other than annual privacy notices, material required by law or rule, communication at the direction of a state or federal authority, or promotional materials;

(vii) an individual is an insured or an annuitant under an insurance policy or annuity but is not the policyholder or owner of the insurance policy or annuity; or

(viii) mail sent to an individual's last known address according to the licensee's records is returned by the postal authorities as undeliverable, and subsequent attempts by the licensee to obtain a current valid address for the individual are unsuccessful.

(9)(a) "Financial institution" means an institution that engages in activities that are financial in nature or incidental to financial activities described in Section 4(k) of the Bank Holding Company Act of 1956, 12 U.S.C. 1843(k).

(b) "Financial institution" does not mean:

(i) a person or entity that is subject to the jurisdiction of the Commodity Futures Trading Commission under the Commodity Exchange Act, 7 U.S.C. 1 et seq.;

(ii) the Federal Agricultural Mortgage Corporation or any entity charged and operating under the Farm Credit Act of 1971, 12 U.S.C. 2001 et seq.; or

(iii) an institution chartered by Congress specifically to engage in securitizations, secondary market sales, including sales of servicing rights, or a similar transaction related to a transaction of a consumer, if the institution does not sell or transfer nonpublic personal information to a nonaffiliated third party.

(10)(a) "Financial product or service" means a product or service that a financial holding company offers by engaging in an activity that is financial in nature or incidental to a financial activity under Section 4(k) of the Bank Holding Company Act of 1956, 12 U.S.C. 1843(k).

(b) "Financial product or service" includes a financial institution's evaluation or brokerage of information that the financial institution collects in connection with a request or an application from a consumer for a financial product or service.

(11) "Health care," for purposes of this rule, means:

(a) any preventive, diagnostic, therapeutic, rehabilitative, maintenance or palliative care, service, procedure, test, or counseling that:

(i) relates to the physical, mental, or behavioral condition of an individual; or

(ii) affects the structure or function of the human body or any part of the human body, including banking of blood, sperm, organs, or any other tissue; or

(b) prescribing, dispensing, or furnishing to an individual:

(i) drugs or biologicals;

(ii) medical devices; or

(iii) health care equipment and supplies.

(12) "Health care provider," for purposes of this rule, means:

(a) a physician or other health care practitioner who is licensed, accredited, or certified to perform specified health services consistent with state law; or

(b) a health care facility.

(13) "Health information" means information or data, except age or gender, whether oral or recorded in any form or medium, created by or derived from a health care provider or a consumer, that relates to:

(a) the past, present, or future physical, mental, or behavioral health or condition of an individual;

(b) the provision of health care to an individual; or

(14)(a) "Insurance product or service" means a product or service offered by a licensee.

(b) "Insurance product or service" includes a licensee's evaluation, brokerage, or distribution of information that the licensee collects in connection with a request or an application from a consumer for an insurance product or service.

(15) "Joint agreement" means a written contract where a licensee and one or more financial institutions jointly offer, endorse, or sponsor a financial product or service.

(16)(a) "Licensee" means a licensed insurer, producer, or other person licensed or required to be licensed, or authorized or required to be authorized, or registered or required to be registered, in this state.

(b) A licensee is not subject to the notice and opt out requirements for nonpublic personal financial information in Sections R590-206-4 through R590-206-17 if the licensee is an employee, agent, or other representative of another licensee, the principal, and:

(i) the principal complies with and provides the notice required by this rule; and

(ii) the licensee does not disclose nonpublic personal information to a person other than the principal or its affiliates in a manner permitted by this rule.

(c)(i) Subject to Subsection R590-206-3(16)(c)(ii), "licensee" includes an unauthorized insurer that accepts business placed through a licensed surplus lines broker in this state, but only in regard to the surplus lines placements placed pursuant to Section 31A-15-103.

(ii) A surplus lines broker or surplus lines insurer is compliant with the notice and opt out requirements for nonpublic personal financial information under Sections R590-206-4 through R590-206-17 provided:

(A) the broker or insurer does not disclose nonpublic personal financial information of a consumer or a customer to a nonaffiliated third party for any purpose, including joint servicing or marketing under Section R590-206-15, except as permitted by Section R590-206-16 or R590-206-17; and

(B) the broker or insurer delivers a notice to the consumer at the time a customer relationship is established on which the following is printed in 16-point type:

PRIVACY NOTICE

"NEITHER THE U.S. BROKERS THAT HANDLED THIS INSURANCE NOR THE INSURERS THAT HAVE UNDERWRITTEN THIS INSURANCE WILL DISCLOSE NONPUBLIC PERSONAL INFORMATION CONCERNING THE BUYER TO NONAFFILIATES OF THE BROKERS OR INSURERS EXCEPT AS PERMITTED BY LAW."

(17)(a) "Nonaffiliated third party" means a company that is an affiliate solely by virtue of the direct or indirect ownership or control of the company by the licensee or its affiliate in conducting merchant banking or investment banking activities or insurance company investment activities under the Bank Holding Company Act, 12 U.S.C. 1843(k)(4)(H) and (I).

(b) "Nonaffiliated third party" does not include:

(i) an affiliate; or

(ii) a person employed jointly by a licensee and a company that is not an affiliate, but nonaffiliated third party includes the other company that jointly employs the person.

(18) "Nonpublic personal information" means nonpublic personal financial information and nonpublic personal health information.

(19)(a) "Nonpublic personal financial information" means:

(i) personally identifiable financial information; and

(ii) any list, description, or other grouping of consumer information and publicly available information pertaining to the consumer, that is derived using any personally identifiable financial information that is not publicly available.

(b) "Nonpublic personal financial information" includes any list of individuals' names and street addresses that is derived in whole or in part using personally identifiable financial information that is not publicly available, such as an account number.

(i) health information;

(ii) publicly available information;

(iii) a list, description, or other grouping of consumer information;

(iv) publicly available information pertaining to a consumer that is derived without using personally identifiable financial information that is not publicly available; or

(v) a list of names and addresses that contains only publicly available information, is not derived in whole or in part using personally identifiable financial information that is not publicly available, and is not disclosed in a manner that indicates that any of the individuals on the list is a consumer of a financial institution.

(20) "Nonpublic personal health information" means health information:

(a) that identifies an individual who is the subject of the information; or

(b) that could reasonably be used to identify an individual.

(21)(a) "Personally identifiable financial information" means any information:

(i) a consumer provides to a licensee to obtain an insurance product or service;

(ii) about a consumer resulting from a transaction involving an insurance product or service between a licensee and a consumer; or

(iii) obtained by a licensee about a consumer in connection with providing an insurance product or service to that consumer.

(b) "Personally identifiable financial information" includes:

(i) information a consumer provides to a licensee on an application to obtain an insurance product or service;

(ii) account balance information and payment history;

(iii) information that an individual is or has been a customer or has obtained an insurance product or service from the licensee;

(iv) information about a consumer if it is disclosed in a manner that indicates that the individual is or has been a consumer of the licensee;

(v) information that a consumer provides to a licensee or that the licensee or its agent otherwise obtains in connection with collecting on a loan or servicing a loan;

(vi) information the licensee collects through the internet, cookies, or an information-collecting device from a web server; and

(vii) information from a consumer report.

(i) health information;

(ii) a list of names and addresses of customers of an entity that is not a financial institution; and

(iii) information that does not identify a consumer, such as aggregate information or blind data that does not contain personal identifiers such as account numbers, names, or addresses.

(22)(a) "Publicly available information" means any information that a licensee has a reasonable basis to believe is lawfully made available to the general public from:

(i) federal, state, or local government records;

(ii) widely distributed media;

(iii) disclosures to the public that are required to be made by federal, state, or local law;

(iv) information that is available to the public;

(v) information that an individual can direct to not be made available to the public, and the individual has not done so;

(vi) government real estate records and security interest filings; and

(vii) widely distributed media including information from:

(A) a telephone book;

(B) television;

(D) a newspaper; or

(E) a website that is available to the general public.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-4 Rules of Construction

(1)(a) The examples in this rule, the sample clauses in Appendix A, and the Federal Model Privacy Form in Appendix B are not exclusive.

(b) Appendix A, "Privacy of Consumer Financial and Health Information Regulation," and Appendix B, "Privacy of Consumer Financial and Health Information Regulation," adopted April 11, 2017, by the NAIC shall be used to comply with this rule, and are available on the department's website, https://insurance.utah.gov.

(c) Compliance with an example or use of a sample clause, to the extent applicable, constitutes compliance with this rule.

(d) A licensee domiciled in this state that complies with this rule in a state that has not enacted laws or rules that meet the requirements of Title V of the Gramm-Leach-Bliley Act (PL 102-106) is compliant with Title V of the Gramm-Leach-Bliley Act in the other state.

(2)(a) A licensee may rely on use of the Federal Privacy Form in Appendix B, consistent with the form's instructions, as a safe harbor of compliance with the privacy notice content requirements of this rule.

(b) A licensee may continue to use a privacy notice, including a notice that contains the examples in this rule, provided that the notice accurately describes the licensee's privacy practices and complies with this rule.

(3) A licensee may not rely on a privacy notice with the sample clauses in Appendix A as a safe harbor of compliance with the notice content requirements of this rule.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-5 Required Initial Privacy Notice to Consumers

(1) A licensee shall provide a clear and conspicuous notice that accurately reflects its privacy policies and practices to:

(a) a customer, no later than when the licensee establishes a customer relationship, except as provided in Subsection (5); and

(b) a consumer, before a licensee discloses any nonpublic personal financial information about the consumer to any nonaffiliated third party if the licensee makes a disclosure other than as authorized by Sections R590-206-16 and R590-206-17.

(2) A licensee is not required to provide an initial notice to a consumer if:

(a) the licensee does not disclose any nonpublic personal financial information about the consumer to a nonaffiliated third party, other than as authorized by Sections R590-206-16 and R590-206-17, and the licensee does not have a customer relationship with the consumer; or

(b) a notice has been provided by an affiliated licensee, and the notice clearly identifies all licensees to whom the notice applies and is accurate with respect to the licensee and the other institutions.

(3) A licensee establishes a customer relationship:

(a) at the time the licensee and the consumer enter into a continuing relationship;

(b) when the consumer becomes a policyholder following delivery of an insurance policy or contract to the consumer, or in the case of a licensee that is an insurance producer or insurance broker, obtains insurance through that licensee; or

(c) when the consumer agrees to obtain financial, economic, or investment advisory services relating to an insurance product or service for a fee.

(4)(a) When an existing customer obtains a new insurance product or service from a licensee that is used primarily for personal, family, or household purposes, the licensee satisfies the initial notice requirements if the licensee provides a revised policy notice, under Section R590-206-9, that covers the customer's new insurance product or service.

(b) If the initial, revised, or annual notice most recently provided to the customer was accurate with respect to the new insurance product or service, a new privacy notice is not required.

(5) A licensee may provide the initial notice required by Subsection (1)(a) within a reasonable time after the licensee establishes a customer relationship if:

(a) establishing the customer relationship is not at the customer's election, such as if a licensee acquires or is assigned a customer's policy from another person and the customer does not have a choice about the acquisition or assignment; or

(b) providing notice no later than when the licensee establishes a customer relationship would substantially delay the customer's transaction and the customer agrees to receive the notice later.

(6)(a) When a licensee is required to deliver an initial privacy notice by this section, the licensee shall deliver it according to Section R590-206-11.

(b) If a licensee uses a short-form initial notice for a consumer according to Subsection R590-206-7(4), the licensee may deliver its privacy notice according to Subsection R590-206-7(4)(c).

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-6 Required Annual Privacy Notice to Consumers

(1) A licensee shall provide a clear and conspicuous notice to customers that accurately reflects its privacy policies and practices not less than once in a 12 consecutive month period during the continuation of the customer relationship.

(2) A licensee that provides nonpublic personal information to a nonaffiliated third party under Sections R590-206-15 through R590-206-17 and has not changed its policies and practices regarding its disclosure of nonpublic personal information from the policies and practices disclosed in the most recent notice sent to a consumer under Section R590-206-5 or R590-206-6 is not required to provide an annual disclosure until the licensee fails to comply with this Subsection (2).

(3) A licensee is not required to provide an annual notice to a former customer.

(4) When delivery of an annual privacy notice is required, a licensee shall deliver it according to Section R590-206-11.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-7 Information to be Included in a Privacy Notice

(1) An initial, annual, or revised privacy notice that a licensee provides under Section R590-206-5, R590-206-6, or R590-206-9 shall include the following:

(a) the categories of nonpublic personal financial information that the licensee collects;

(b) the categories of nonpublic personal financial information that the licensee discloses:

(c) the categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic personal financial information, other than those parties to whom the licensee discloses information under Section R590-206-16 or R590- 206-17;

(d) the categories of nonpublic personal financial information about former customers that the licensee discloses and the categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic personal financial information about former customers, other than those parties to whom the licensee discloses information under Section R590-206-16 or R590-206-17;

(e) if a licensee discloses nonpublic personal financial information to a nonaffiliated third party under Section R590- 206-14, and no other exception in Section R590-206-16 or R590-206-17 applies to that disclosure, a separate description of the categories of information the licensee discloses and the categories of third parties with whom the licensee has a contract;

(f) an explanation of the consumer's right under Subsection R590-206-12(1) to opt out of the disclosure of nonpublic personal financial information to nonaffiliated third parties, including the methods the consumer may exercise at that time;

(g) a disclosure that the licensee makes under Section 603(d)(2)(A)(iii) of the Fair Credit Reporting Act, 15 U.S.C. 1681a(d)(2)(A)(iii);

(h) the licensee's policies and practices regarding protecting the confidentiality and security of nonpublic personal information;

(i) any disclosure that the licensee makes under Subsection (2); and

(j) any other information the licensee chooses to provide that applies to the licensee and to the consumer to whom the licensee sends its privacy notice.

(2)(a) If a licensee discloses nonpublic personal financial information under Section R590-206-16 or R590-206-17, the licensee is not required to list those exceptions in the initial or annual privacy notices required by Sections R590-206-5 and R590-206-6.

(b) When describing the categories of parties to whom disclosure is made, a licensee shall state that it makes disclosures to other affiliated or nonaffiliated third parties, as permitted by law.

(c) A licensee shall categorize the nonpublic personal financial information it collects according to the source of the information, as follows:

(i) information from the consumer;

(ii) information about the consumer's transactions with the licensee or its affiliates;

(iii) information about the consumer's transactions with a nonaffiliated third party; and

(iv) information from a consumer reporting agency.

(d)(i) A licensee shall categorize nonpublic personal financial information it discloses according to the source of the information, as described in Subsection (2)(c), and provide examples to illustrate the types of information in each category, including:

(A) information from the consumer, including application information, such as assets and income, and identifying information, such as name, address, and social security number;

(B) transaction information, such as information about balances, payment history, and parties to the transaction; and

(ii) The information that a licensee discloses is not adequately categorized if the licensee uses only general terms, such as transaction information about the consumer.

(iii) If a licensee reserves the right to disclose any nonpublic personal financial information about a consumer that it collects, the licensee may state that fact without describing the categories or examples of nonpublic personal financial information.

(e)(i) A licensee shall categorize the affiliates and nonaffiliated third parties to which the licensee discloses nonpublic personal financial information about consumers if the licensee identifies the types of businesses in which they engage.

(ii) Types of businesses may be described in general terms only if a licensee uses illustrative examples of significant lines of business.

(iii) A licensee may use more detailed categories to categorize the affiliates and nonaffiliated third parties to which it discloses nonpublic personal financial information about consumers.

(f) If a licensee discloses nonpublic personal financial information under the exception in Section R590-206-14 to a nonaffiliated third party to market products or services that it offers alone or jointly with another financial institution, the licensee shall:

(i) list the categories of nonpublic personal financial information it discloses, using the same categories and examples the licensee used under Subsection (1)(b); and

(ii) state whether the third party is:

(A) a service provider that performs marketing services on the licensee's behalf or on behalf of the licensee and another financial institution; or

(B) a financial institution with whom the licensee has a joint marketing agreement.

(g) If a licensee does not disclose, and does not reserve the right to disclose, nonpublic personal financial information about customers or former customers to affiliates or nonaffiliated third parties except as authorized under Section R590-206-16 or R590-206-17, the licensee may state that fact, in addition to the information under Subsections (1)(a), (1)(h), (1)(i), and (2).

(h)(i) A licensee shall describe its policies and practices regarding protecting the confidentiality and security of nonpublic personal financial information as follows:

(A) describe, in general terms, who is authorized to have access to the information; and

(B) state whether the licensee has security practices and procedures in place to ensure the confidentiality of the information in accordance with the licensee's policy.

(ii) A licensee is not required to describe technical information about the safeguards it uses.

(3)(a) A licensee satisfies the initial notice requirements in Subsections R590-206-5(1)(b) and R590-206-8(3) for a consumer who is not a customer by providing a short-form initial notice at the time the licensee delivers an opt out notice under Section R590-206-8.

(b) A short-form notice shall:

(i) be clear and conspicuous;

(ii) state that the licensee's privacy notice is available upon request; and

(iii) explain where the consumer may obtain the notice.

(c)(i) A licensee shall deliver its short-form initial notice according to Section R590-206-11.

(ii) A licensee is not required to deliver its privacy notice with its short-form initial notice.

(iii) A licensee may provide the consumer a reasonable means to obtain its privacy notice.

(iv) If a consumer requests the privacy notice, the licensee shall deliver it according to Section R590-206-10.

(4) A licensee's notice may include:

(a) categories of nonpublic personal financial information that a licensee reserves the right to disclose in the future, but does not currently disclose; and

(b) categories of affiliates or nonaffiliated third parties to whom a licensee reserves the right, in the future, to disclose, but to whom the licensee does not currently disclose, nonpublic personal financial information.

(5) Sample clauses illustrating notice content required by this section are included in Appendix A and Appendix B.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-8 Form of Opt Out Notice to Consumers and Opt Out Methods

(1)(a) If a licensee is required to provide an opt out notice under Subsection R590-206-12(1), it shall provide a clear and conspicuous notice to each of its consumers that accurately explains the right to opt out and that states:

(i) that the licensee discloses or reserves the right to disclose nonpublic personal financial information about its consumer to a nonaffiliated third party;

(ii) that the consumer has the right to opt out of that disclosure; and

(iii) that the consumer may exercise the right to opt out.

(b) A licensee provides an adequate opt out notice of the disclosure of nonpublic personal financial information to a nonaffiliated third party if the licensee:

(i) identifies each category of nonpublic personal financial information that it discloses or reserves the right to disclose, and each category of nonaffiliated third parties to which the licensee discloses the information, as described in Subsections R590-206-7(1)(b) and R590-206-7(1)(c), and states that the consumer can opt out of the disclosure of that information; and

(ii) identifies the insurance product or service that the consumer obtains from the licensee, either singly or jointly, to which the opt out direction applies.

(i) designates check-off boxes in a prominent position on the relevant forms with the opt out notice;

(ii) includes a reply form with the opt out notice;

(iii) provides an electronic means to opt out, such as a form that can be sent via email or a process on the licensee's website, if the consumer agrees to the electronic delivery of information; or

(iv) provides a toll-free telephone number that consumers may call to opt out.

(d) A licensee does not provide a reasonable means of opting out if:

(i) the only means of opting out is for the consumer to write a letter to exercise that opt out right; or

(ii) the only means of opting out is using a check-off box that the licensee provided with an initial notice but did not include with any subsequent notice.

(e) A licensee may require each consumer to opt out through a specific means if that means is reasonable for the consumer.

(2) A licensee may provide the opt out notice together with or on the same written or electronic form as the initial notice the licensee provides in accordance with Section R590-206-5.

(3) If a licensee provides an opt out notice later than required for the initial notice under Section R590-206-5, the licensee shall include a copy of the initial notice with the opt out notice in writing or, if the consumer agrees, electronically.

(4)(a) If two or more consumers jointly obtain an insurance product or service from a licensee, the licensee may provide a single opt out notice.

(b) The opt out notice shall explain how the licensee will treat an opt out direction by a joint consumer under this Subsection (4).

(d) A licensee may:

(i) treat an opt out direction by a joint consumer as applying to all joint consumers; or

(ii) permit each joint consumer to opt out separately.

(e) If a licensee permits each joint consumer to opt out separately, the licensee shall permit one of the joint consumers to opt out on behalf of all joint consumers.

(f) A licensee may not require all joint consumers to opt out before it implements any opt out direction.

(5) A licensee shall comply with a consumer's opt out direction as soon as reasonably practicable after the licensee receives it.

(6) A consumer may exercise the right to opt out at any time.

(7)(a) A consumer's direction to opt out is effective until the consumer revokes it in writing or, if the consumer agrees, electronically.

(b) When a customer relationship terminates, the customer's opt out direction continues to apply to the nonpublic personal financial information the licensee collected during or related to that relationship.

(c) If the individual establishes a new customer relationship with the licensee, the opt out direction that applied to the former relationship does not apply to the new relationship.

(8) When a licensee is required to deliver an opt out notice by this section, the licensee shall deliver it according to Section R590-206-10.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-9 Revised Privacy Notices

(1) Except as otherwise permitted, a licensee may not, directly or through an affiliate, disclose nonpublic personal financial information about a consumer to a nonaffiliated third party other than as described in the initial notice under Section R590-206-5, unless:

(a) the licensee provides the consumer a clear and conspicuous revised notice that accurately describes its policies and practices;

(b) the licensee provides the consumer a new opt out notice;

(c) the licensee gives the consumer a reasonable opportunity to opt out of the disclosure before the licensee discloses the information to the nonaffiliated third party; and

(d) the consumer does not opt out.

(2)(a) Except as otherwise permitted by Sections R590-206-15 through R590-206-17, a licensee shall provide a revised notice before it discloses:

(i) a new category of nonpublic personal financial information to any nonaffiliated third party;

(ii) nonpublic personal financial information to a new category of nonaffiliated third party; or

(iii) nonpublic personal financial information about a former customer to a nonaffiliated third party, if that former customer has not had the opportunity to exercise an opt out right regarding that disclosure.

(b) A revised notice is not required if the licensee discloses nonpublic personal financial information to a new nonaffiliated third party that the licensee adequately described in its prior notice.

(3) When a licensee is required to deliver a revised privacy notice, the licensee shall deliver it according to Section R590-206-11.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-10 Privacy Notices to Group Policyholders

Unless a licensee is providing a privacy notice directly to a covered individual described in Subsection R590-206-3(4), a licensee shall provide initial, annual, and revised notices to the plan sponsor, group, or blanket insurance policyholder or group annuity contract holder, or workers' compensation policyholder, in the manner described in Sections R590-206-5 through R590- 206-9 of this rule, describing the licensee's privacy practice with respect to nonpublic personal information about an individual covered under the policy, contract, or plan.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-11 Delivery

(1) A licensee shall provide a notice under this rule to ensure that each consumer will receive actual notice in writing or, if the consumer agrees, electronically.

(2)(a) A consumer will receive actual notice if the licensee:

(i) hand delivers a printed copy of the notice to the consumer;

(ii) mails a printed copy of the notice to the last known address of the consumer separately, in a policy, in a billing statement, or other written communication;

(iii) for a consumer who conducts transactions electronically, posts the notice on the licensee's website and requires the consumer to acknowledge receipt of the notice as a necessary step to obtain a particular insurance product or service; or

(iv) for an isolated transaction with a consumer, posts the notice and requires the consumer to acknowledge receipt of the notice as a necessary step to obtain the particular insurance product or service.

(b) A consumer does not receive actual notice if the licensee:

(i) posts a sign in its office or generally publishes an advertisement of its privacy policies and practices; or

(ii) sends the notice via electronic mail to a consumer who does not obtain an insurance product or service from the licensee electronically.

(3) A licensee may reasonably expect that a customer will receive actual notice of the licensee's annual privacy notice if:

(a) the customer uses the licensee's website to access an insurance product or service electronically and agrees to receive notices at the website and the licensee posts its current privacy notice continuously, in a clear and conspicuous manner, on the website; or

(b) the customer requests that the licensee refrain from sending any information regarding the customer relationship, and the licensee's current privacy notice remains available to the customer upon request.

(4) A licensee may not provide any notice required by this rule solely by orally explaining the notice, either in person or over the telephone.

(5) A licensee shall provide the initial notice required by Subsection R590-206-5(1)(a), the annual notice required by Subsection R590-206-6(1), and the revised notice required by Subsection R590-206-9(1) upon request, in writing or, if the customer agrees, electronically.

(6)(a) A licensee may provide a joint notice from the licensee and one or more of its affiliates or other financial institutions identified in the notice, if the notice is accurate.

(b) A licensee may provide a notice on behalf of another financial institution.

(7) If two or more consumers jointly obtain an insurance product or service from a licensee, the licensee may satisfy the initial, annual, and revised notice requirements of Subsections R590-206-5(1), R590-206-6(1), and R590-206-9(1) by providing one notice to the consumers jointly.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-12 Limitations on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties

(1)(a) Except as otherwise provided, a licensee may not, directly or through any affiliate, disclose nonpublic personal financial information about a consumer to a nonaffiliated third party unless:

(i) the licensee provides the consumer an initial notice required under Section R590-206-5;

(ii) the licensee provides the consumer an opt out notice required under Section R590-206-8;

(iii) the licensee provides the consumer a reasonable opportunity to opt out of the disclosure before it discloses the information to the nonaffiliated third party; and

(iv) the consumer does not opt out.

(b) Opt out occurs when a consumer directs the licensee to not disclose the consumer's nonpublic personal financial information to a nonaffiliated third party, except as permitted under Sections R590-206-15 through R590-206-17.

(2)(a) This Section R590-206-12 applies regardless of whether the licensee and the consumer have a customer relationship.

(b) A licensee may not, directly or through any affiliate, disclose nonpublic personal financial information about a consumer regardless of whether the licensee collected it before or after receiving the direction to opt out.

(3) A consumer may select certain nonpublic personal financial information or certain nonaffiliated third parties that the consumer wishes to opt out.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-13 Limits on Reusing Nonpublic Personal Financial Information

(1)(a) If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution under an exception in Section R590-206-16 or R590-206-17, disclosure and use of that information is limited as follows:

(i) a licensee may disclose the information to an affiliate of the financial institution from which the licensee received the information;

(ii) a licensee may disclose the information to its affiliate, but the affiliate may disclose and use the information only to the extent that the licensee may disclose and use the information; and

(iii) a licensee may disclose and use the information in the ordinary course of business to carry out the activity covered by the exception under which the licensee received the information.

(b) If a licensee receives information from a nonaffiliated financial institution for claims settlement purposes, the licensee may disclose the information for fraud prevention, or in response to a properly authorized subpoena.

(c) A licensee may not disclose information to a third party for marketing purposes or use the information for its own marketing purposes.

(2)(a) If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution other than under an exception in Section R590-206-16 or R590-206-17, the licensee may disclose the information:

(i) to an affiliate of the financial institution from which the licensee received the information;

(ii) to its affiliate, but its affiliate may disclose the information only to the extent the licensee may disclose the information; and

(iii) to any other person, if the disclosure is lawful if made directly to that person by the financial institution from which the licensee received the information.

(b) If a licensee obtains a customer list from a nonaffiliated financial institution outside of the exceptions in Sections R590-206-16 and R590-206-17, a licensee may:

(i) use the list for its own purposes; and

(ii) disclose the list to a nonaffiliated third party if the financial institution from which the licensee purchased the list could have lawfully disclosed the list to that third party.

(3) If a licensee discloses nonpublic personal financial information to a nonaffiliated third party under an exception in Section R590-206-16 or R590-206-17, the third party may disclose and use the information as follows:

(a) to an affiliate of the licensee;

(b) to its affiliate, but its affiliate may disclose and use the information only to the extent that the third party may disclose and use the information; and

(c) in the ordinary course of business to carry out the activity covered by the exception under which it received the information.

(4) If a licensee discloses nonpublic personal financial information to a nonaffiliated third party other than under an exception in Section R590-206-16 or R590-206-17, the third party may disclose the information:

(a) to an affiliate of the licensee;

(b) to its affiliate, but its affiliate may disclose the information only to the extent the third party may disclose the information; and

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-14 Limits on Sharing Account Number Information for Marketing Purposes

(1) A licensee may not, directly or through an affiliate, disclose a consumer's policy number or similar access number or access code to a nonaffiliated third party for use in telemarketing, direct mail marketing, or other marketing through electronic mail.

(2) Subsection (1) does not apply if a licensee discloses a policy number or similar access number or access code to:

(a) a service provider to perform marketing for a licensee's product or service, if the service provider is not authorized to directly initiate charges to the account;

(b) a producer to perform marketing for a licensee's product or service; or

(c) a participant in an affinity or similar program if the participant in the program is identified to the customer when the customer enters into the program.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-15 Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for a Service Provider and Joint Marketing

(1)(a) The opt out requirements under Sections R590-206-8 and R590-206-12 do not apply when a licensee provides nonpublic personal financial information to a nonaffiliated third party to perform a service for the licensee or a function on the licensee's behalf, if the licensee:

(i) provides the initial notice under Section R590-206-5; and

(ii) enters into a contractual agreement with a third party that prohibits the third party from disclosing or using the information other than to carry out the purpose for which the licensee disclosed the information, including use under an exception in Section R590-206-16 or R590-206-17.

(b) If a licensee discloses nonpublic personal financial information to a financial institution with which the licensee performs joint marketing, the licensee's contractual agreement with the institution meets the requirements of Subsection (1)(a)(ii) if it prohibits the institution from disclosing or using the nonpublic personal financial information except as necessary to carry out the joint marketing or an exception under Section R590-206-16 or R590-206-17.

(2) The service a nonaffiliated third party performs for a licensee under Subsection (1) may include marketing of the licensee's product or service or marketing of a financial product or service offered pursuant to a joint agreement between a licensee and a financial institution.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-16 Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions

(1) The initial notice requirements under Subsection R590-206-5(1)(b), the opt out requirements under Sections R590- 206-8 and R590-206-12, and the service provider and joint marketing requirements under Section R590-206-15 do not apply if a licensee discloses nonpublic personal financial information necessary to cause, administer, or enforce a transaction that a consumer requests or authorizes, or is in connection with:

(a) servicing or processing an insurance product or service requested or authorized by a consumer;

(b) maintaining or servicing a consumer's account with a licensee or with another entity as part of a private label credit card program or other extension of credit;

(c) a proposed or actual securitization, secondary market sale, including sales of servicing rights, or a similar transaction; or

(d) reinsurance or stop loss insurance.

(2) A notice that is necessary to cause, administer, or enforce a transaction includes a disclosure that:

(a) is lawful or appropriate to enforce a licensee's rights or the rights of another person engaged in carrying out the financial transaction or providing the product or service; or

(b) is a usual, appropriate, or acceptable method:

(i) to carry out a transaction or a product or service business of which the transaction is a part, and record, service, or maintain the consumer's account in the ordinary course of providing the insurance product or service;

(ii) to administer or service benefits or claims relating to a transaction or a product or service business;

(iii) to provide a confirmation, a statement, or other record of a transaction, or information on the status or value of an insurance product or service to the consumer or the licensee;

(iv) to accrue or recognize an incentive or bonus associated with a transaction that is provided by a licensee or any other party;

(v) to underwrite insurance at the consumer's request or the following purposes:

(A) account administration;

(B) reporting;

(D) processing premium payments;

(E) processing insurance claims;

(F) administering insurance benefits, including utilization review activities; and

(G) participating in research projects; or

(vi) in connection with:

(A) authorizing, settling, billing, processing, clearing, transferring, reconciling, or collecting amounts charged, debited, or otherwise paid using a debit, credit, or other payment card, check, account number, or by other payment means;

(B) transferring receivables, accounts, or interest; or

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-17 Other Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information

(1) The initial notice requirements under Subsection R590-206-5(1)(b), the opt out requirements under Sections R590- 206-8 and R590-206-12, and the service provider and joint marketing requirements under Section R590-206-15 do not apply when a licensee discloses nonpublic personal financial information:

(a) with the consent, or at the direction of, a consumer, provided the consumer has not revoked the consent or direction;

(b) to protect:

(i) the confidentiality or security of a licensee's records pertaining to a consumer, service, product, or transaction;

(ii) against, or prevent, actual or potential fraud or an unauthorized transaction;

(iii) against institutional risk control or resolving a consumer dispute or inquiry;

(iv) a person holding a legal or beneficial interest relating to the consumer; or

(v) a person acting in a fiduciary or representative capacity on behalf of the consumer;

(c) to provide information to an insurance rate advisory organization, a guaranty fund, an agency, an agency that rates a licensee, a person that assesses the licensee's compliance with industry standards, and the licensee's attorney, accountant, and auditor;

(d) to the extent permitted under the Right to Financial Privacy Act of 1978, U.S.C. 3401 et seq., to a law enforcement agency, a state insurance department, the Federal Trade Commission, a self-regulatory organization, or for an investigation on a matter related to public safety;

(e)(i) to a consumer reporting agency under the Fair Credit Reporting Act, 15 U.S.C. 1681 et seq.; or

(ii) from a consumer report from a consumer reporting agency;

(f) in connection with a proposed or actual sale, merger, transfer, or exchange of all or a portion of a business or operating unit if the disclosure of nonpublic personal financial information concerns solely a consumer of the business or unit;

(g)(i) to comply with a federal, state, or local law, rule, or other legal requirement;

(ii) to comply with a civil, criminal, or regulatory investigation, or a subpoena or summons by a federal, state, or local authority; or

(iii) to respond to a judicial process or government regulatory authority having jurisdiction over a licensee for examination, compliance, or another purpose, as authorized by law; or

(h) for purposes related to the replacement of a group benefit plan, a group health plan, a group welfare plan, or a workers' compensation policy.

(2) An insurer subject to a formal delinquency proceeding under Section 31A-27a-207, 31A-27a-301, or 31A-27a-401 is not subject to the requirements of Subsection R590-206-5(1)(b) or the opt out requirements of this rule.

(3) A consumer may revoke consent by exercising the right to opt out of future disclosures of nonpublic personal information under Subsection R590-206-8(6).

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-18 Required Authorization for Disclosure of Nonpublic Personal Health Information

(1) A licensee may not disclose nonpublic personal health information about a consumer or customer unless an authorization is obtained from the consumer or customer before the disclosure.

(2) This Section R590-206-18 does not prohibit, restrict, or require an authorization for the disclosure of nonpublic personal health information by a licensee for the performance of the following:

(a) claims administration, adjustment, or management;

(b) detecting, investigating, or reporting fraud, misrepresentation, or criminal activity;

(d) policy placement or issuance;

(e) loss control;

(f) ratemaking or guaranty fund functions;

(g) reinsurance or excess loss insurance;

(h) risk management;

(i) case management;

(j) disease management;

(k) quality assurance or quality improvement;

(l) performance evaluation;

(m) provider credentialing verification;

(n) utilization review;

(o) peer review activities;

(p) actuarial, scientific, medical, or public policy research;

(q) grievance procedures;

(r) internal administration of compliance, managerial, or information systems;

(s) policyholder service functions;

(t) auditing;

(u) reporting;

(v) database security;

(w) administration of consumer disputes and inquiries;

(x) external accreditation standards;

(y) replacement of a group benefit plan or workers compensation policy or program;

(z) activities in connection with a sale, merger, transfer, or exchange of all or part of a business or operating unit;

(aa) an activity that permits disclosure without authorization pursuant to the Health Insurance Portability and Accountability Act;

(bb) disclosure that is required to enforce a licensee's rights or the rights of other persons engaged in carrying out a transaction or providing a product or service that a consumer requests or authorizes; and

(cc) an activity permitted by law, required by a governmental reporting authority, or to comply with legal process.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-19 Authorization

(1) A valid authorization to disclose nonpublic personal health information pursuant to Sections R590-206-18 through R590-206-22 shall be in written or electronic form and contain the following:

(a) the identity of the consumer or customer who is the subject of the nonpublic personal health information;

(b) a general description of the type of nonpublic personal health information to be disclosed;

(c) a general description of the party to whom the licensee discloses nonpublic personal health information, including the purpose of the disclosure and how the information will be used;

(d) the signature of the consumer or customer who is the subject of the nonpublic personal health information or the individual who is legally authorized to grant authority, and the date signed; and

(e) notice of:

(i) the length of time the authorization is valid;

(ii) that the consumer or customer may revoke the authorization at any time; and

(iii) the procedure to revoke the authorization.

(2) An authorization under Sections R590-206-18 through R590-206-22 shall specify the length of time the authorization will remain valid, but may not be valid for more than 24 months.

(3) A consumer or customer who is the subject of nonpublic personal health information may revoke an authorization under Sections R590-206-18 through R590-206-22 at any time, subject to the rights of the individual who acted in reliance on the authorization before revocation.

(4) A licensee shall retain the authorization, or a copy thereof, in the record of the individual who is the subject of nonpublic personal health information.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-20 Authorization Request Delivery

(1) A request for authorization and an authorization form may be delivered to a consumer or a customer as part of an opt out notice under Section R590-206-11 if the request and the authorization form are clear and conspicuous.

(2) An authorization form is not required to be delivered to a consumer or customer, or included in any other notice, unless the licensee intends to disclose protected health information under Subsection R590-206-18(1).

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-21 Relationship to Federal Rules

Except for its effective date provision, if a licensee complies with all requirements of the Health Insurance Portability and Accountability Act, a licensee is not subject to Sections R590-206-18 through R590-206-22.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-22 Relationship to State Laws

Sections R590-206-18 through R590-206-22 do not preempt or supersede existing state law related to medical records, health, or insurance information privacy.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-23 Protection of Fair Credit Reporting Act

Nothing in this rule may be construed to modify, limit, or supersede the operation of the Fair Credit Reporting Act, 15 U.S.C. 1681 et seq., and no interference may be drawn on the basis of the provisions of this rule regarding whether information is transaction or experience information under Section 603 of that Act.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-24 Nondiscrimination

(1) A licensee may not discriminate against a consumer or customer because the consumer or customer opted out from the disclosure of their nonpublic personal financial information.

(2) A licensee may not discriminate against a consumer or customer because the consumer or customer did not authorize the disclosure of their nonpublic personal health information.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

Utah Admin. Code R590-206-25 Severability

If any provision of this rule, Rule R590-206, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: November 21, 2023
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-417; 15 U.S.C. 6801-6820

R590-207 Health Producer Commissions for Small Employer Groups

Utah Admin. Code R590-207-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-30-104.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-207-2 Purpose and Scope

(1) The purpose of this rule is to establish guidelines relating to commission structure for insurance producers in the small employer group market that affect access to health insurance coverage for small employer groups.

(2) This rule applies to a carrier offering a health benefit plan in the small employer market.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-207-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-207-4 Commission Schedule Structure

(1) A carrier may not structure a producer commission schedule that, directly or indirectly, creates a restriction, hindrance, or barrier to access to coverage for the smallest groups or groups with the greatest health risks.

(2) The commission in the commission schedule for the smallest groups or the groups with the greatest health risks may not be designed to avoid, directly or indirectly, the requirements of guaranteed issue or renewal in the marketing of health insurance to small business owners.

(3) An insurer may not design a commission structure that lessens the incentive to insure a small employer group that is smallest in size or with the greatest health risks.

(4)(a) An insurer is not required to base commissions on a percentage.

(b) An insurer may elect not to pay commissions on all business.

(5) Examples of commission structures that comply with this rule include:

(a)(i) a 10% commission for group size 2-5;

(ii) a 9% commission for group size 6-25; and

(iii) a 7% commission for group size 26-50; or

(b)(i) $20 per member per month (PMPM) for group size 2-5;

(ii) $18 PMPM for group size 6-25; and

(iii) $16 PMPM for group size 26-50.

(6) An example of a commission structure that does not comply with this rule is:

(a) 3% commission for group size 2-5;

(b) 8% commission for group size 6-25; and

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-207-5 Severability

If any provision of this rule, Rule R590-207, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: August 8, 2022
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

R590-208 Uniform Application for Certificates of Authority

Utah Admin. Code R590-208-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-202.

History

KEY: insurance certificate of authority
Date of Last Change: October 24, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-208-2 Purpose and Scope

(1) The purpose of this rule is to ensure consistency between the commissioner's requirements for a domestic, foreign, or alien insurer application to obtain a certificate of authority in Utah and the requirements of:

(a) other states;

(b) the information included in the Uniform Certificate of Authority Primary Application; and

(2) This rule applies to each applicant seeking to obtain:

(a) a certificate of authority for an insurer; or

(b) an application for an organization permit to organize an insurer under Title 31A, Insurance Code.

History

KEY: insurance certificate of authority
Date of Last Change: October 24, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-208-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance certificate of authority
Date of Last Change: October 24, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-208-4 Uniform Application for Admission as an Insurer

(1) The information included in the Uniform Certificate of Authority Primary Application and Uniform Certificate of Authority Expansion Application of the NAIC shall be submitted in accordance with Sections 31A-5-204, 31A-7-201, 31A-8- 205, 31A-9-205, 31A-10-203, 31A-11-105, and 31A-14-201.

(2) If a section specified in Subsection (1) requires information that is not required in these uniform applications, an applicant for a certificate of authority or organization permit shall furnish the additional information as a supplement to the information required in the uniform applications.

History

KEY: insurance certificate of authority
Date of Last Change: October 24, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

Utah Admin. Code R590-208-5 Severability

If any provision of this rule, Rule R590-208, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance certificate of authority
Date of Last Change: October 24, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202

R590-215 Permissible Arbitration Provisions for Individual and Group Health Insurance

Utah Admin. Code R590-215-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: health insurance arbitration
Date of Last Change: July 27, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 29 CFR 2560.503-1

Utah Admin. Code R590-215-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) recognize arbitration as an acceptable method of alternative dispute resolution;

(b) provide guidelines for disclosure of a contract arbitration provision; and

(2) This rule applies to an individual insurance policy and a group insurance policy issued or renewed on or after July 1, 2002 for:

(a) income replacement insurance; and

(b) a health benefit plan.

(3) Long-term care and Medicare supplement policies are not considered health benefit plans.

History

KEY: health insurance arbitration
Date of Last Change: July 27, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 29 CFR 2560.503-1

Utah Admin. Code R590-215-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-22-629, and 29 CFR 2560.503-1(m). Additional terms are defined as follows:

(2) "Compulsory non-binding arbitration" means a contract provision requiring an insured to exhaust a procedure of extra-judicial arbitration as a condition before the pursuit of an otherwise available judicial remedy.

(3) "Permissible arbitration provision" means an arbitration provision in an insurance policy that:

(a) allows for an action to be brought against an insurer;

(b) prohibits the insurance policy to be construed according to the laws of another jurisdiction, except as necessary to meet the requirements of compulsory insurance laws of the other jurisdiction;

(d) limits the right of action against the insurer to less than three years from the date the cause of action accrues.

(4) "Voluntary binding arbitration" means a contract provision that, at the election of the insured, requires an insurer to submit to arbitration, provided that the claim or controversy exceeds the jurisdictional limit of the small claims court of the state where the action would be brought.

History

KEY: health insurance arbitration
Date of Last Change: July 27, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 29 CFR 2560.503-1

Utah Admin. Code R590-215-4 Permissible Arbitration Provisions

(1) Compulsory binding arbitration is not a permissible arbitration provision.

(2) Compulsory non-binding arbitration is a permissible arbitration provision when used as an internal review of an adverse benefit determination under 29 CFR 2560.503-1(c)(4).

(3) Voluntary binding arbitration, at the election of an insured, is a permissible arbitration provision, and may only be used as a voluntary level of review under 29 CFR 2560.503-1(c)(3)(iii).

(4) A policy form containing a compulsory binding or a voluntary binding arbitration provision for the exclusive election of an insurer will be disapproved under Subsection 31A-21-201(3)(a)(iv), and these provisions in any previously filed form are declared not enforceable.

(5)(a) Each application for an individual or group health benefit plan or income replacement insurance policy that contains a voluntary arbitration provision shall include or have attached a prominent statement substantially as follows:

ANY MATTER IN DISPUTE BETWEEN YOU AND THE COMPANY MAY BE SUBJECT TO ARBITRATION AS AN ALTERNATIVE TO COURT ACTION PURSUANT TO THE RULES OF (THE AMERICAN ARBITRATION ASSOCIATION OR OTHER RECOGNIZED ARBITRATOR), A COPY OF WHICH IS AVAILABLE ON REQUEST FROM THE COMPANY. THE COMPANY SHALL BEAR THE COSTS OF ARBITRATION, FILING FEES, ADMINISTRATIVE FEES AND ARBITRATOR FEES. OTHER EXPENSES OF ARBITRATION, INCLUDING, BUT NOT LIMITED TO: ATTORNEY FEES, EXPENSES OF DISCOVERY, WITNESSES, STENOGRAPHER, TRANSLATORS, AND SIMILAR EXPENSES, WILL BE BORNE BY THE PARTY INCURRING THOSE EXPENSES. ANY DECISION REACHED BY ARBITRATION SHALL BE BINDING UPON BOTH YOU AND THE COMPANY. THE ARBITRATION AWARD MAY INCLUDE ATTORNEY'S FEES, IF ALLOWED BY STATE LAW, AND MAY BE ENTERED AS A JUDGMENT IN ANY COURT OF PROPER JURISDICTION.

(b) The statement described in Subsection (5)(a) shall be disclosed prior to the execution of the insurance contract between the insurer and the policyholder and shall be contained in the certificate of insurance or other disclosure of benefits.

(6) A voluntary binding arbitration provision may not preclude a dispute from being resolved through any small claims court having jurisdiction.

(7) Any arbitration provision contained in an insurance policy shall comply with Title 78B, Chapter 11, Utah Uniform Arbitration Act.

(8) An agreement for arbitration may not obligate an insured to pay for the arbitration as part of the voluntary appeal in accordance with 29 CFR 2560.503-1(c)(3)(v).

(9) An arbitration provision may not require that arbitration be held at a place further from the residence of the insured than the nearest location of a State Court of General Jurisdiction.

History

KEY: health insurance arbitration
Date of Last Change: July 27, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 29 CFR 2560.503-1

Utah Admin. Code R590-215-5 Severability

If any provision of this rule, Rule R590-215, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance arbitration
Date of Last Change: July 27, 2022
Notice of Continuation: December 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 29 CFR 2560.503-1

R590-216 Standards for Safeguarding Customer Information

Utah Admin. Code R590-216-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-417.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

Utah Admin. Code R590-216-2 Purpose and Scope

(1) The purpose of this rule is to establish standards to assist a licensee in developing and implementing administrative, technical, and physical safeguards to protect the security, confidentiality, and integrity of customer information under the Gramm-Leach-Bliley Act, 15 U.S.C. 6801, 6805(b), and 6807.

(2) This rule applies to a licensee of the department that obtains any nonpublic information from a customer, including:

(a) nonpublic personal financial information; or

(b) nonpublic personal health information.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

Utah Admin. Code R590-216-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Customer" means a customer of the licensee as defined in Section R590-206-4.

(2) "Customer information" has the same meaning as "nonpublic personal information" as defined in Section R590- 206-4 about a customer, whether in paper, electronic, or other form, that is maintained by or on behalf of the licensee.

(3) "Customer information system" means any electronic or physical method used to access, collect, store, use, transmit, protect, or dispose of customer information.

(4)(a) "Licensee" means a licensee as defined in Section R590-206-4.

(b) "Licensee" does not mean:

(i) a purchasing group;

(ii) a manufacturer or seller warranty provider or manufacturer or seller service contract provider exempted by Section R590-206-2; or

(iii) an unauthorized insurer regarding the excess line business conducted pursuant to Section 31A-15-103.

(5) "Service provider" means a person who maintains, processes, or otherwise is permitted access to customer information through the provision of services directly to the licensee.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

Utah Admin. Code R590-216-4 Information Security Program

(1) A licensee shall implement a comprehensive written information security program including administrative, technical, and physical safeguards to protect customer information.

(2) The administrative, technical, and physical safeguards included in the information security program shall be appropriate to the size and complexity of the licensee and the nature and scope of its activities.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

Utah Admin. Code R590-216-5 Objectives of Information Security Program

A licensee's information security program shall:

(1) ensure the security and confidentiality of customer information;

(2) protect against any anticipated threat or hazard to the security or integrity of the information; and

(3) protect against unauthorized access to or use of the information that could result in substantial harm or inconvenience to any customer.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

Utah Admin. Code R590-216-6 Methods of Development and Implementation

(1) For purposes of risk assessment, a licensee may:

(a) identify reasonably foreseeable internal or external threats that could result in unauthorized disclosure, misuse, alteration, or destruction of customer information or customer information systems;

(b) assess the likelihood and potential damage of these threats, taking into consideration the sensitivity of customer information; and

(c) assess the sufficiency of policies, procedures, customer information systems, and other safeguards in place to control risks.

(2) For purposes of risk management and control, a licensee may:

(a) design its information security program to control the identified risks, consistent with the sensitivity of the information, as well as the complexity and scope of the licensee's activities;

(b) train staff to implement the licensee's information security program; and

(c) regularly test or otherwise monitor the key controls, systems, and procedures of the information security program, the frequency and nature of which shall be determined by the licensee's risk assessment.

(3) For purposes of service provider arrangement oversight, a licensee may:

(a) exercise due diligence in selecting its service providers; and

(b) require its service providers to implement appropriate measures designed to meet the objectives of this rule, and, where indicated by the licensee's risk assessment, take appropriate steps to confirm that its service providers have satisfied these obligations.

(4) For purposes of program adjustment, a licensee may monitor, evaluate, and adjust the information security program considering:

(a) any relevant change in technology;

(b) the sensitivity of its customer information;

(d) the licensee's changing business arrangements, such as mergers and acquisitions, alliances and joint ventures, outsourcing arrangements, and changes to customer information systems.

(5) Subsections (1) through (4) are examples of implementation methods. A licensee may adopt other actions or procedures to implement Sections R590-216-4 and R590-216-5.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

Utah Admin. Code R590-216-7 Severability

If any provision of this rule, Rule R590-216, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: August 17, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-23a-417; 15 U.S.C. 6801; 15 U.S.C. 6805; 15 U.S.C. 6807

R590-219 Credit Scoring

Utah Admin. Code R590-219-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-320.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

Utah Admin. Code R590-219-2 Purpose and Scope

(1) The purpose of this rule is to set forth minimum standards for a property and casualty insurer doing private passenger automobile business.

(2) This rule applies to a property and casualty insurer that uses credit history or an insurance score as part of its underwriting criteria or rating plans.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

Utah Admin. Code R590-219-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-2-320. Additional terms are defined as follows:

(1) "Adverse action" is defined in the Fair Credit Reporting Act, 15 U.S.C. Sec 1681 et seq.

(a) "Adverse action" includes:

(i) cancellation, denial, or non-renewal of insurance coverage; and

(ii) charging a higher premium than would have been offered if the credit history or credit score had been more favorable, whether the charge is by:

(A) application of a rating rule;

(B) assignment to a rating category within a single insurer, into which insureds with substantially like risk or exposure factors and expense elements are placed for purposes of determining rate or premium, that does not have the lowest available rates;

(C) placement with an affiliate insurer that does not offer the lowest rates available to the consumer within the affiliate group of insurers; or

(D) a reduction or an adverse or unfavorable change in the terms of coverage or amount of insurance owing to a consumer's credit history or insurance score.

(b) A reduction or an adverse or unfavorable change in the terms of coverage occurs when:

(i) coverage provided to the consumer is not as broad in scope as coverage requested by the consumer but available to other insureds of the insurer or any affiliate; or

(ii) the consumer is not eligible for a benefit, such as a dividend, that is available through an affiliate insurer.

(2)(a) "Initial underwriting" includes:

(i) the decision whether to issue a policy to the consumer;

(ii) the amount and terms of the coverage;

(iii) the duration of the policy;

(iv) the rates or fees charged; and

(v) the additional drivers related to the named insured or spouse by blood, marriage, adoption, or guardianship who were emancipated before becoming an additional driver in the named insured's household.

(b) "Initial underwriting" does not include an additional vehicle or driver added to the household of a current auto insurance policyholder of the insurer, provided:

(i) the additional vehicle is owned by the named insured, spouse, or a person related to the named insured by blood, marriage, adoption, or guardianship that is a resident of the named insured's household;

(ii) the additional driver is related to the named insured or spouse by blood, marriage, adoption, or guardianship and is a resident of the named insured's household, including a person who usually makes their home in the same household but temporarily lives elsewhere; or

(iii) the additional driver is a divorced spouse or child for whom an insurer has a record of the driving history from an existing policy.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

Utah Admin. Code R590-219-4 Insurer's Obligation If Credit Information Is Used

(1) An insurer shall comply with the federal Fair Credit Reporting Act, 15 U.S.C. 1681 et seq.

(2) If an adverse action is taken, an insurer shall provide to the applicant or insured:

(a) the identity, telephone number, and address of any consumer-reporting agency from which a credit report was obtained;

(b) notification of the applicant's or insured's right to receive a free copy of their credit report from the consumer- reporting agency for 60 days from the date of application; and

(c) notification of the applicant's or insured's right to file a dispute with the consumer-reporting agency and have erroneous information corrected in accordance with the Fair Credit Reporting Act.

(3)(a) After an adverse action is taken, if it is later determined that the initial information in the credit report was incorrect, the insurance company, at the request of the applicant or insured, shall underwrite or rate the policy again using the correct information.

(b) If the insurer determines that the insured has overpaid premium, the insurer shall refund to the insured the amount of overpayment calculated back to the shorter of either the last 12 months of coverage or the actual policy period.

(4) An insurer shall establish procedures that allow a consumer or an insurance producer to request that a person's credit history or score be re-examined if a correction has been made to the consumer's credit report.

(5) An insurer may not penalize a consumer on a new or renewal policy issued on or after the effective date of this rule based on:

(a) identity theft;

(b) a credit inquiry not initiated by the consumer;

(d) a medical related collection account, if the information can be identified on a credit report; and

(e) multiple lender inquiries, if captured on a credit report as being from the home mortgage industry and made within a 30-day period, unless only one inquiry is considered.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

Utah Admin. Code R590-219-5 Prohibited Uses of Credit Information

An insurer may not use credit information:

(1) to cancel or non-renew a private passenger auto insurance policy that has been in effect for 60 days or more;

(2) for initial underwriting, unless risk related factors, other than credit information, are considered;

(3) to determine rates as part of a filed rating plan for private passenger auto insurance, except to provide a premium discount or similar reduction in rates and, when an insurer issues a new or renewal policy on or after the effective date of this rule with a discount based on credit, that discount may not be removed or reduced based on credit information only;

(4) to cancel or non-renew an existing private passenger auto insurance policy that has been in effect for 60 days or more, nor decline or refuse to issue a new policy or coverage for an additional vehicle owned by the named insured or a person related to the named insured by blood, marriage, adoption, or guardianship, and who is a resident of the named insured's household; or

(5) to cancel or non-renew an existing private passenger auto insurance policy that has been in effect for 60 days or more when adding a newly licensed driver related to the named insured by blood, marriage, adoption, or guardianship, and who continues to be a resident of the named insured's household.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

Utah Admin. Code R590-219-6 Offer of Placement

Placing a policy with an affiliated insurance company is not a cancellation, non-renewal, declination, or refusal to issue a policy.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

Utah Admin. Code R590-219-7 Severability

If any provision of this rule, Rule R590-219, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, credit scoring
Date of Last Change: May 9, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-320

R590-220 Submission of Accident and Health Insurance Filings

Utah Admin. Code R590-220-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-2-202, 31A-2-212, 31A-22-605, 31A-22-620, 31A-22-1404, 31A-22-2006, 31A-30-106, 31A-30-106.1, 31A-43-304, and 31A-45-103.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-2 Purpose and Scope

(1) The purpose of this rule is to establish procedures for submitting:

(a) an accident and health insurance filing including a stop-loss insurance filing; and

(b) a report filing.

(2) This rule applies to an insurer offering accident and health insurance, including a group accident and health insurance policy issued to a nonresident when a Utah resident is covered under the policy.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1) "Certification" means a statement that a submitted filing is compliant.

(2) "Compliant" means a filing that is complete and that complies with Title 31A, Insurance Code, and this rule.

(3) "Discretionary group" means a group that is authorized by the commissioner under Subsection 31A-22-701(1)(b).

(4) "Electronic filing" means a filing submitted using SERFF.

(5) "Eligible group" means a group that meets the requirements in Section 31A-22-701.

(6) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(7) "File before use" means a filing is used, sold, or offered for sale after it is filed with the department and a stated period of time elapses from the date filed.

(8) "File for acceptance" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is accepted.

(9) "File for approval" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is approved.

(10) "Filing objection letter" means a letter issued by the commissioner when a review of the filing determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(11) "Filing status information" means a list of states a similar filing was submitted to, the date submitted, and the action taken by each state, including their responses.

(12) "Letter of authorization" means a letter signed by an officer of the insurer giving authority to a third party to submit a filing on behalf of the insurer.

(13) "Market type" means a policy that specifies a targeted market.

(14) "NAIC Product Coding Matrix" means a numerical coding system developed by the NAIC that provides uniform naming convention, uniform terminology, and uniform description for a type of insurance product in a filing.

(15) "Non-2014 PPACA compliant health benefit plan" means a health benefit plan that is:

(a) a grandfathered health plan under 45 CFR 147.140(a); or

(b) a transitional health benefit plan, also known as a grandmothered plan, under:

(i) the letter from the Centers for Medicare and Medicaid Services dated November 14, 2013; and

(ii) Subsection 31A-30-117(3).

(16) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(17) "Change in rating methodology," for the purposes of a non-2014 PPACA compliant health benefit plan, means a change in:

(a) the number of case characteristics used by an insurer to determine premium rates in a class of business;

(b) the manner or procedures used to assign an insured into categories for the purpose of applying a case characteristic to determine premium rates in a class of business;

(d) a rating factor, with respect to any case characteristic, if the change would produce a change in premium that exceeds 10% for an individual or small employer.

(18) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the insurer stating the reason for rejection; and

(19) "Resubmission" means a correction, modification, or replacement of a previously rejected, withdrawn, or prohibited filing.

(20) "SERFF" means the System for Electronic Rates and Form Filings.

(21) "Stop-loss insurance" means insurance purchased by an employer for which the stop-loss insurer assumes all loss amounts of the employer's plan in excess of a stated amount, subject to the policy limit.

(22) "Type of insurance" or "TOI" means a specific accident and health insurance product identified by the NAIC Product Coding Matrix that can be selected in SERFF when submitting a filing in Utah.

(23) "Utah filed date" means the date the department indicates a paper filing is accepted.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-4 Documents Used in a Filing

The documents designated in this rule are required for all filings.

(1) An actual copy or a created version may be used.

(2) If created, the content, size, font, and format shall be similar to the actual copy.

(3) The documents referenced in this rule are found on the department's website, https://insurance.utah.gov.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-5 General Filing Information

(1)(a) A filing shall be accurate, consistent, complete, and contain all required documents.

(b) The commissioner may request additional information, as necessary.

(2)(a) An insurer is responsible for assuring that any document in a filing is compliant.

(b) A filing that is not compliant is subject to regulatory action.

(3)(a) A filing that is not compliant shall be rejected.

(b) A rejected filing:

(i) may be resubmitted under a new filing; and

(ii) may not be reopened for purposes of resubmission.

(4) A prior filing will not be researched to determine the purpose of the current filing.

(5) The department does not review every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) when a complaint is received;

(iii) during a regulatory examination or investigation; or

(iv) when the department considers a review necessary.

(b) If a filing is reviewed and is found not compliant, the commissioner:

(i) shall issue a filing objection letter or an order to prohibit use; and

(ii) may require an insurer to disclose deficiencies in a form or a rating practice to each affected insured.

(6)(a) A correction to a filing in an open status may be made at any time.

(b) A correction to a filing in a closed status:

(i) may not be made;

(ii) requires a new filing; and

(iii) shall reference the original filing in the filing description of the new filing.

(7) An insurer shall notify the department when discontinuing or withdrawing a previously filed form, rate, or supplementary information.

(8) If the Utah filed date is used for compliance with this rule, a complete copy with all subsequent amendments, including the Utah filed date, shall be attached as a supporting document.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-6 Filing Submission Requirements

(1) General Filing Requirements.

(a) A filing shall be submitted:

(i) electronically through SERFF; and

(ii) using the NAIC Product Coding Matrix, including the:

(A) TOI; and

(B) sub-TOI.

(b) A filing may not include more than one:

(i) TOI; or

(ii) insurer.

(2) SERFF Filing.

(a) Filing Description. The filing description on the general information tab shall contain the following information, in the sequence listed.

(i) Provide a description of the filing, including:

(A) the intent of the filing; and

(B) the purpose of each document within the filing.

(ii) Indicate if the filing:

(A) is a first-time filing;

(B) is a new form revising an existing form;

(D) is a resubmission that includes a summary of the changes made and the previous filing's Utah filed date or SERFF tracking number;

(E) includes informational documents, referencing the Utah filed date or SERFF tracking number; or

(F) does not include the policy, and if so, provide the Utah filed date or SERFF tracking number of the policy and each amendment, summarizing the effect on the policy.

(iii) Identify any provision that is unusual, innovative, controversial, or that was previously objected to or prohibited, and explain why the provision is included in the filing.

(iv) List the range of minimum and maximum ages for which the policy will be issued.

(v) If any of the information required under Subsection (2)(a) is not available, provide a detailed explanation of why the information is not available.

(b) Filing Certification.

(i) The insurer shall certify that a filing and all related documents are compliant.

(ii) The following statement shall be included in the filing description: "BY SUBMITTING THIS FILING I CERTIFY THAT THE ATTACHED FILING HAS BEEN COMPLETED IN ACCORDANCE WITH UTAH ADMINISTRATIVE RULE R590-220 AND IS COMPLIANT WITH APPLICABLE UTAH LAW."

(iii)(A) The Utah Accident and Health Insurance Filing Certification shall be fully completed and attached to the supporting documentation tab.

(B) If an item on the Utah Accident and Health Insurance Filing Certification does not apply to the filing being submitted, mark the item as not applicable.

(iv) A filing may be rejected if the filing certification is false, missing, or incomplete.

(v) A false certification may subject the insurer to administrative action.

(c) Domiciliary Approval and Filing Status Information. A filing for a foreign insurer shall include on the supporting documentation tab:

(i) filing status information, including:

(A) a list of states where a similar filing is submitted;

(B) the date of submission; and

(ii) if the filing is specific to Utah and only filed in Utah, include:

(A) the phrase "NO SIMILAR FILING HAS BEEN SUBMITTED TO ANY OTHER STATE"; and

(B) the reason the filing is only filed in Utah.

(d) Group Questionnaire or Authorization Letter. A group filing shall attach to the supporting documentation tab:

(i) a complete Utah Accident and Health Insurance Group questionnaire;

(ii) a copy of the discretionary group authorization letter; or

(iii) a copy of the bona fide employer association group authorization letter.

(e) Letter of Authorization.

(i) A filing submitted by a third party shall have a letter of authorization from the insurer attached to the supporting documentation tab.

(ii) The insurer is responsible for the filing being compliant.

(f) Variable Data.

(i)(A) Variable data is denoted by brackets and is defined either by embedding the variable data in the form or in a separate form with a unique form number and an edition date.

(B) Variable data submitted as a separate form shall be in a manner that follows the construction of the form, by page and paragraph, or page and footnote.

(ii) A certification statement of variability shall be attached to the supporting documentation tab and shall certify that:

(A) the final form will not contain brackets;

(B) the use of variable data is administered in a uniform and non-discriminatory manner that will not result in unfair discrimination;

(D) any changes to variable data shall be filed before implementation.

(iii) Any variation of the variable data shall be disclosed, for example "Deductible is $(xxx.xx) in $(xxx.xx) increments."

(iv) Variable data shall be reasonable, appropriate, and compliant.

(v) The use of unfiled variable data is prohibited.

(g) Items Submitted for Filing.

(i) A form shall be attached to the form schedule tab.

(ii) All rating documentation, including actuarial memoranda and rate schedules, shall be attached to the rate/rule schedule tab.

(h) A report is exempt from a filing submission requirement under:

(i) Subsections (2)(a)(ii) through (2)(a)(v);

(ii) Subsection (2)(c);

(iii) Subsection (2)(d); and

(iv) Subsection (2)(f).

(i) Underlining and Strikethrough. A resubmission or a new form revising an existing form shall include an underline and strikethrough version of the form and the final form on the form schedule tab.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-7 Procedures for Form Filings

(1) Forms in General.

(a) A form is a file and use filing.

(b) A form shall be identified by a unique form number that may not be variable.

(d) Blank spaces within a form shall be completed to accurately represent the purpose and use.

(2) Application Filing.

(a) An application or enrollment form may be submitted as a separate filing or filed with its related policy or certificate filing.

(b) If an application was previously filed or is filed separately, an informational copy of the application shall be included with the policy or certificate filing.

(3) Policy Filing.

(a) Each TOI shall be filed separately.

(b) A policy filing consists of one policy form, including the application, outline of coverage, certificate, and rider or endorsement.

(d) Notwithstanding Subsections (3)(a) through (3)(c), a Medicare supplement filing may include more than one policy but is limited to only one of each of the Medicare supplement policies A through N.

(4) Rider or Endorsement Filing.

(a) Related riders or endorsements may be filed together.

(b) A single rider or endorsement that affects multiple forms may be filed if the filing description references each affected form.

(i) a list of each policy form number, title, and Utah filed date or SERFF tracking number; and

(ii) a description of how each rider or endorsement affects the policy.

(d) Unrelated riders or endorsements may not be filed together.

(5) Outline of Coverage. If an outline of coverage is required to be issued with a policy, a rider, or an endorsement, the outline of coverage shall be filed when the policy, rider, or endorsement is filed.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-8 Additional Procedures for Individual Accident and Health Market Filings

(1)(a) An insurer filing an individual accident and health insurance filing shall comply with:

(i) Title 31A, Chapter 22, Part 6, Accident and Health Insurance;

(ii) Rule R590-85;

(iii) Rule R590-122;

(iv) Rule R590-126;

(v) Rule R590-131;

(vi) Rule R590-192;

(vii) Rule R590-203;

(viii) Rule R590-215; and

(ix) Rule R590-286.

(b) An insurer filing a health benefit plan filing shall comply with:

(i) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act;

(ii) Title 31A, Chapter 45, Managed Care Organizations;

(iii) Rule R590-167;

(iv) Rule R590-176;

(v) Rule R590-194;

(vi) Rule R590-200;

(vii) Rule R590-233;

(viii) Rule R590-237;

(ix) Rule R590-247;

(x) Rule R590-259;

(xi) Rule R590-261;

(xii) Rule R590-266;

(xiii) Rule R590-269;

(xiv) Rule R590-271;

(xv) Rule R590-277; and

(xvi) Rule R590-283.

(2) Rate Filings.

(a) A rate filing submitted with a new form filing is a file and use filing.

(b) A rate revision filing is a file for acceptance filing.

(c)(i) An individual accident and health insurance policy, rider, or endorsement affecting a benefit shall be accompanied by a rate filing with an actuarial memorandum signed by a qualified actuary.

(ii) A rate filing is not required if the form filing does not impact the premium, however the filing description shall explain the reason there is not a change in the premium.

(3) A long-term care insurance filing, including an endorsement or rider attached to a life insurance policy, shall comply with:

(a) Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards;

(b) Rule R590-148; and

(4) A limited long-term care insurance filing shall comply with:

(a) Title 31A, Chapter 22, Part 20, Limited Long-Term Care Insurance Act;

(b) Rule R590-285; and

(5) A Medicare supplement filing shall comply with:

(a) Section 31A-22-620;

(b) Rule R590-85;

(d) Sections R590-220-11 and R590-220-15.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-9 Additional Procedures for Group Market Form Filings

(1) An insurer filing a group accident and health insurance filing shall comply with:

(a) Title 31A, Chapter 22, Part 6, Accident and Health Insurance;

(b) Title 31A, Chapter 22, Part 7, Group Accident and Health Insurance;

(d) Title 31A, Chapter 22, Part 20, Limited Long-Term Care Insurance Act;

(e) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act;

(f) Title 31A, Chapter 45, Managed Care Organizations;

(g) Rule R590-85;

(h) Rule R590-122;

(i) Rule R590-126;

(j) Rule R590-131;

(k) Rule R590-146;

(l) Rule R590-148;

(m) Rule R590-192;

(n) Rule R590-203;

(o) Rule R590-215;

(p) Rule R590-277;

(q) Rule R590-283; and

(r) Rule R590-285.

(2) An insurer filing a group health benefit plan filing shall comply with:

(a) Rule R590-167;

(b) Rule R590-176;

(d) Rule R590-200;

(e) Rule R590-233;

(f) Rule R590-237;

(g) Rule R590-247;

(h) Rule R590-259;

(i) Rule R590-261;

(j) Rule R590-266;

(k) Rule R590-271;

(l) Rule R590-277; and

(m) Section R590-220-10.

(3) An insurer shall determine if a group is an eligible group or a discretionary group.

(a) Eligible Group.

(i) A filing for an eligible group shall include a compliant Utah Accident and Health Insurance Group Questionnaire.

(ii) A questionnaire shall be completed for each eligible group under Section 31A-22-701.

(iii) When a filing applies to more than one employer or employee group, only one questionnaire is required.

(iv) A filing for a bona fide employer association shall include a compliant Utah Bona Fide Employer Association Group Authorization Questionnaire.

(v) A filing for a non-employer group shall comply with Rule R590-126.

(b) Discretionary Group.

(i) If a group is not an eligible group, specific discretionary group authorization shall be obtained.

(ii) If a form filing is submitted without discretionary group authorization, the filing shall be rejected.

(A) A filing may not include a rate or form filing before receiving discretionary group authorization.

(B) If a rate or form filing is submitted without discretionary group authorization, the filing shall be rejected.

(C) A discretionary group authorization filing may include a copy of the policy or certificate for informational purposes only, and such an inclusion does not satisfy a form filing requirement.

(iii) To obtain discretionary group authorization, a compliant Utah Accident and Health Insurance Request for Discretionary Group Authorization shall be submitted.

(iv) A change to an authorized discretionary group shall be submitted to the department within 30 days of the change.

(v) The commissioner may periodically re-evaluate a group's authorization.

(vi)(A) An insurer shall file a separate discretionary group authorization to add another TOI to a previously authorized group.

(B) The discretionary group authorization shall specify the TOI products that a discretionary group may offer.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-10 Additional Procedures for Individual, Small Employer, and Group Health Benefit Plan Filings

(1) An insurer filing a health benefit plan filing shall comply with:

(a) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act;

(b) Title 31A, Chapter 45, Managed Care Organizations;

(d) Rule R590-277.

(2) Form Filing.

(a) A non-2014 PPACA compliant health benefit plan form filing shall include the SERFF tracking number for the form's applicable rate manual filing.

(b) A grandfathered or transitional plan shall be filed separate from a 2014 PPACA compliant health benefit plan.

(3) Rate Manual Filing for a Non-2014 PPACA Compliant Health Benefit Plan.

(a) A rate manual filing that does not request a change in rating methodology is a file before use filing.

(b) A change in a rating methodology filing is a file for approval filing.

(i) include an actuarial certification signed by a qualified actuary; and

(ii) be filed 30 days before use.

(d) The company rate information on the rate/rule schedule tab shall be compliant.

(4) Rate Filing for a 2014 PPACA Compliant Health Benefit Plan.

(a) A rate filing shall be filed according to the department's annual bulletin to insurers.

(b) Quarterly changes to a rate filing shall be filed according to Bulletin 2015-3.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-11 Additional Procedures for Medicare Supplement Filings

(1)(a) An insurer filing a Medicare supplement filing shall comply with:

(i) Section 31A-22-620;

(ii) Rule R590-85; and

(iii) Rule R590-146.

(b) A Medicare supplement form filing that affects rates shall include all required rating documentation.

(2) Rates.

(a) Rate and rate documentation submitted with a new form filing are a file and use filing.

(b) A rate revision filing is a file for acceptance filing.

(i) Section 31A-22-602;

(ii) Rule R590-85; and

(iii) Rule R590-146.

(d) An insurer may not use or change a premium rate for a Medicare supplement policy or certificate unless the rate, rating schedule, and supporting documentation are filed.

(e) A rate revision request may not be used to satisfy the annual filing requirements of Rule R590-146.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-12 Additional Procedures for a Policy, Endorsement, or Rider Providing Life Insurance and Accident and Health Insurance Benefits

(1) An accident and health insurance filing that includes a life insurance benefit or an accident and health insurance endorsement or rider to a life insurance policy shall comply with Rule R590-226.

(2)(a) A combination filing is a policy, rider, or endorsement that creates a product providing both life insurance and accident and health insurance benefits.

(b) The acceptable combination filings are:

(i) a rider or endorsement; or

(ii) an integrated policy.

(c) A combination filing shall be submitted separately to both the health instance and the life instance in SERFF, as both instances will process the filing.

(d) A rider or endorsement shall be submitted to the appropriate instance in SERFF based on the benefits provided in the rider or endorsement.

(3) The filing description shall include the Utah filed date or SERFF tracking number and shall identify the filing as a combination of TOIs, such as:

(a) a whole life insurance policy with a long-term care insurance benefit; or

(b) a major medical health policy that includes a life insurance benefit.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-13 Additional Procedures for Long-Term Care Insurance Products

(1)(a) An insurer filing a long-term care insurance filing shall comply with:

(i) Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards; and

(ii) Rule R590-148.

(b) A long-term care insurance form filing that affects rates shall be filed with all required rating documentation.

(2) Rates.

(a) Rate and rate documentation submitted with a new form filing are a file and use filing.

(b) A rate revision filing is a file for acceptance filing.

(d) An insurer may not use or change a premium rate for a long-term care insurance policy or certificate unless the rate, rating schedule, and supporting documentation are filed.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-14 Additional Procedures for Limited Long-Term Care Insurance Products

(1)(a) An insurer filing a limited long-term care insurance filing shall comply with:

(i) Title 31A, Chapter 22, Part 20, Limited Long-Term Care Insurance Act; and

(ii) Rule R590-285.

(b) A limited long-term care insurance form filing that affects rates shall be filed with all required rating documentation.

(2) Rates.

(a) Rate and rate documentation submitted with a new form filing are a file and use filing.

(b) A rate revision filing is a file for acceptance filing.

(d) An insurer may not use or change a premium rate for a limited long-term care insurance policy or certificate unless the rate, rating schedule, and supporting documentation are filed.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-15 Reports

(1) Health Benefit Plan Reports.

(a) Actuarial Certification Report.

(i) An individual or a small employer insurer maintaining a non-2014 PPACA compliant health benefit plan shall file an actuarial certification under Sections 31A-30-106 and 31A-30-106.1, and Subsection R590-167-11(1)(a).

(ii) The report is due annually on April 1.

(iii) Each report shall be filed by market type and shall be properly identified.

(iv) A report shall be submitted using the appropriate TOI and the filing type of "Report."

(b) Defrayal of State-Required Benefits Report.

(i) An insurer anticipating a defrayal of state-required benefits shall file a request under Section 31A-30-118 and Subsection R590-283-6(3).

(A) The report is due quarterly on February 15, May 15, August 15, and November 15.

(B) Each report shall be filed by market type and shall be properly identified.

(ii) An insurer seeking a defrayal of state-required benefits shall file a request under Section 31A-30-118 and Subsection R590-283-4(2).

(A) The report is due annually on September 1.

(B) Each report shall be filed by market type and shall be properly identified.

(2) Medicare Supplement Reports.

(a) Annual Medicare Supplement Reports.

(i) The report is due annually on May 31.

(ii) The report shall include the sub-reports outlined in this subsection.

(A) Report of Multiple Policies.

(I) An issuer of a Medicare supplement policy shall submit a report of multiple policies issued to a single insured under Section R590-146-22.

(II) The report shall list each insured with multiple policies or state "NO MULTIPLE POLICIES WERE ISSUED."

(B) Annual Filing of Rates and Supporting Documentation.

(I) An issuer of Medicare supplement policies and certificates shall file its rates, rating schedule, and supporting documentation, including ratios of incurred losses to earned premiums by policy duration, under Section R590-146-14.

(II) The NAIC Medicare Supplement Insurance Model Regulations Manual sets forth the requirements of the annual rate filing.

(III) An annual report submitted with a request or any type of reference to a rate revision shall be rejected.

(C) Refund Calculation and Benchmark Ratio. An issuer shall file the Medicare Supplement Refund Calculation Form and Reporting Form for the calculation of benchmark ratios since inception under Section R590-146-14.

(iii) A report for pre-standardized Medicare supplement benefit plans and 1990 standardized Medicare supplement benefit plans shall be submitted together as one filing using a TOI of "MS06" and a filing type of "Report."

(iv) A report for 2010 standardized Medicare supplement benefit plans shall be submitted together as one filing using a TOI of "MS09" and a filing type of "Report."

(v) If all Medicare supplement reports are not submitted together as one filing, the filing is considered incomplete and shall be rejected.

(b) Medicare Select Reports.

(i) An issuer offering a Medicare Select policy or certificate shall file a grievance report required under Section R590- 14-10.

(A) The report is due annually on March 31.

(B) A report shall be filed by market type and shall be properly identified.

(ii) An issuer offering a Medicare Select policy or certificate shall submit any change to the list of network providers under Section R590-146-10.

(A) The report is due within 30 days of the change.

(B) A report shall be filed by market type and shall be properly identified.

(3) Long-Term Care Insurance Reports.

(a) The long-term care reports required under Section R590-148-25 shall be submitted together as one filing.

(b) If the reports are not submitted as one filing, the filing is considered non-compliant and shall be rejected.

(d) The report is due annually on June 30.

(e) All long-term care reports shall be filed using a TOI of "LTC06" and a filing type of "Report."

(4) Limited Long-Term Care Insurance Reports.

(a) Annual Limited Long-Term Care Report.

(i) The following limited long-term care reports required by Section R590-285-14 shall be submitted together as one filing.

(ii) If the reports are not submitted as one filing, the filing is considered non-compliant and shall be rejected.

(iii) If there is no information to report, the form shall state "NONE."

(iv) The report is due annually on June 30.

(v) The limited long-term care reports shall be filed using a TOI of "LTC06" and a filing type of "Report."

(b) Independent Review Organization Certification for a Limited Long-Term Care Insurance Report Under Section R590-285-25.

(i) The report is due annually on June 1.

(ii) The report shall be properly identified.

(iii) The report shall be filed using a TOI of "LTC06" and a filing type of "Report."

(5) Miscellaneous Reports.

(a)(i) Reporting criteria for adding or terminating participating providers shall be submitted using a TOI of "H21" and a filing type of "Report."

(ii) The filing description shall state "Preferred Provider Agreement" as required by Section 31A-45-304.

(b) Stop-Loss Certification of Compliance.

(i) An insurer making available a small employer stop-loss plan shall file an actuarial certification and experience report under Sections 31A-43-302 and R590-268-8.

(ii) The report is due annually on April 1.

(iii) The report shall be submitted using a TOI of "H12" and a filing type of "Report."

(i) A report shall be filed by market type and properly identified.

(ii) Each report shall be submitted using the appropriate TOI and the filing type of "Report."

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-16 Binders

A binder filing for a 2014 PPACA compliant health benefit plan or a certified stand-alone dental plan shall be filed in accordance with the department's annual bulletin to an insurer offering a health benefit plan or stand-alone dental plan.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-17 Classification of Documents

(1) A record submitted under this rule is subject to Title 63G, Chapter 2, Government Records Access and Management Act.

(2) Notwithstanding Subsection (1), a record provided under 45 CFR 154.200(a)(1), 45 CFR 154.215(b)(1), or 45 CFR 154.215(b)(2) is classified as public.

(3) A record submitted under Section 31A-2-201.2, 31A-30-106, or 31A-30-106.1 is classified as protected.

(4) Notwithstanding Subsections (1) through (3), a record may be classified as protected if:

(a) requested under Section 63G-2-309;

(b) the request in Subsection (4)(a) includes each required element of Subsections 63G-2-309(1)(a)(i)(A) and 63G-2- 309(1)(a)(i)(B); and

(5) A filing may not be reopened to reclassify a previously filed document.

(6) A pattern of requesting that non-qualifying documents be protected, including putting both protected and public information in one document, may violate this rule.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-18 Objection Letter and Disposition Procedures

(1) Response to a Filing Objection Letter.

(a) A response to a filing objection letter shall:

(i) address each objection;

(ii) include an explanation identifying each change made;

(iii) include an underline and strikeout version of each revised document;

(iv) provide a final version of the revised document, incorporating all changes;

(v) attach each document under the appropriate tab; and

(vi) reference any additional document attached under the supporting documentation tab if the content is not included in the response.

(b) An attachment or separate letter as a response may not be filed.

(2) Order to Prohibit Use.

(a) An order to prohibit use is final 15 days after the date of the order to prohibit use.

(b) A filing that is prohibited pursuant to an order to prohibit use shall be discontinued by the date specified in the order to prohibit use.

(c) To contest an order to prohibit use, the insurer shall request a hearing, in writing, no later than 15 days after the date of the order to prohibit use.

(d) Notwithstanding Subsection (2)(c), an insurer may submit a resubmission that shall:

(i) make the requested changes addressed in the filing objection letter; and

(ii) reference the previously prohibited filing.

(3) Filing Rejection.

(a) An insurer may submit a resubmission.

(b) A resubmission shall reference the previously rejected filing.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

Utah Admin. Code R590-220-19 Severability

If any provision of this rule, Rule R590-220, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance filings
Date of Last Change: July 21, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A- 30-106

R590-222 Life Settlements

Utah Admin. Code R590-222-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-36-119.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-2 Purpose and Scope

(1) The purpose of this rule is to implement procedures for:

(a) licensing a life settlement provider or life settlement producer;

(b) a life settlement provider or a life settlement producer annual report;

(d) advertising;

(e) reporting of fraud;

(f) prohibited practices;

(g) standards for life settlement payments; and

(h) procedures for a request for verification of coverage.

(2) This rule applies to:

(a) a life settlement provider;

(b) a life settlement producer; or

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-36-102. Additional terms are defined as follows:

(1) "Compliant" means a filing that is complete and complies with Title 31A, Insurance Code, and Title R590, Administration.

(2) "Insured" means, for purposes of this rule, a person covered under a settled policy.

(3) "Patient identifying information" means an insured's address, telephone number, facsimile number, email address, photograph or likeness, employer, employment status, social security number, or any other identifiable information.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-4 Appendices Used by a Licensee

The following appendices shall be used as described in this rule and are available on the department's website, https://insurance.utah.gov:

(1) Appendix A, Utah Life Settlement Provider Initial Application, dated 2009;

(2) Appendix B, Utah Life Settlement Provider Annual Report, dated 2009;

(3) Appendix C, NAIC Life Settlement brochure Selling Your Life Insurance Policy, dated 2004;

(4) Appendix D, NAIC Verification of Coverage for Life Insurance Policies, dated 2004; and

(5) Appendix E, Utah Life Settlement Provider Renewal Application, dated 2020.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-5 License Requirements

(1) Life Settlement Provider License.

(a) A person may not perform or advertise a service as a life settlement provider without a valid license.

(b) A life settlement provider license is issued on an annual basis upon:

(i) the submission of a complete initial or renewal application; and

(ii) the payment of any applicable fee under Section 31A-3-103.

(i) submit:

(A) Appendix A for an initial application; or

(B) Appendix B for a renewal application;

(ii) for an initial application, provide a copy of the applicant's plan of operation that:

(A) describes the market the applicant intends to target;

(B) explains who will produce business for the applicant and how they will be recruited, trained, and compensated;

(D) describes the corporate organizational structure of the applicant, its parent company, and each affiliate;

(E) describes the procedures used by the applicant to ensure that life settlement proceeds will be sent to the owner within three business days under Subsection 31A-36-110(3); and

(F) describes the procedures used by the applicant to ensure that the identity, financial information, and medical information of an insured are not disclosed except as authorized under Section 31A-36-106;

(iii) for an initial application, provide an antifraud plan required by Section 31A-36-117;

(iv) for both an initial application and a renewal application, provide evidence of financial responsibility in the amount of $250,000 in the form of a surety bond issued by an insurer authorized in this state, according to the following terms:

(A) the surety bond shall be in the favor of the state and shall specifically authorize recovery by the commissioner on behalf of any person in this state who sustained damages as the result of erroneous acts, failure to act, conviction of fraud, or conviction of unfair practices by the life settlement provider;

(B) the evidence of financial responsibility shall remain in force for as long as the licensee is active;

(C) the bond may not be terminated or reduced without 30 days prior written notice to the licensee and the commissioner; and

(D) the commissioner may accept as evidence of financial responsibility proof that a surety bond is filed with the commissioner of any other state where the life settlement provider is licensed as a life settlement provider as long as the benefits provided by the surety bond extend to this state; and

(v) provide other information required by the commissioner.

(d) A new or renewal application may be denied if an officer holding more than 10% of the provider's stock, a partner, or a director fails to comply with Title 31A, Chapter 36, Life Settlements Act.

(e) Failure to pay the renewal fee, submit the renewal application, or submit the annual report under Section R590-222-6 shall:

(i) result in lapse of the license; and

(ii) subject the life settlement provider to administrative penalty and forfeiture.

(f) If a life settlement provider has, at the time of license renewal, life settlements where the insured has not died, the life settlement provider shall:

(i) renew or maintain its current license status until the earlier of:

(A) the date the life settlement provider properly assigns, sells, or otherwise transfers the life settlements where the insured has not died; or

(B) the date that the last insured covered by a life settlement transaction has died; and

(ii) designate, in writing, either the life settlement provider that entered into the life settlement or the life settlement producer who received commission from the life settlement, or a life settlement provider or life settlement producer licensed in this state, to make all inquiries to the owner, or the owner's designee, regarding health status of the insured and any other matters.

(g) A license may not be issued to a nonresident life settlement provider unless a written designation of an agent for service of process is filed and maintained with the commissioner.

(2) Life Settlement Producer license. A life settlement producer shall be licensed under Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries, with a life insurance line of authority.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-6 Annual Report

(1)(a) By March 1 of each calendar year, a life settlement provider shall submit an annual report to the commissioner.

(b) The report in Subsection (1)(a) is limited to all life settlement transactions where the owner is a resident of this state.

(2) The report shall:

(a) contain information for the previous calendar year for each life settlement contracted during the reporting period;

(b) be submitted in the format in Appendix B; and

(i) a coded identifier;

(ii) a policy issue date;

(iii) a date of the life settlement;

(iv) a net death benefit settled;

(v) an amount available to the policyholder under the terms of the policy at the time of the settlement; and

(vi) a net amount paid to the owner.

(3) The completed report shall be submitted by email to life.uid@utah.gov.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-7 Payment Requirements

(1) Payment of the proceeds of a life settlement pursuant to Subsection 31A-36-110(3) shall be by:

(a) wire transfer to an account designated by the owner;

(b) certified check; or

(2)(a) Payment of the proceeds to the owner pursuant to a life settlement shall be made in a lump sum except where the life settlement provider purchases an annuity or similar financial instrument issued by a licensed life insurance company or bank, or an affiliate of either.

(b) Retention of a portion of the proceeds, not disclosed or described in the life settlement by the life settlement provider or escrow agent, is not permissible without written consent of the owner.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-8 Disclosures

(1) The disclosure required by Subsection 31A-36-108(1), provided in a separate document no later than the time of the application for the life settlement and signed by the owner and the life settlement provider or life settlement producer, shall contain:

(a) the alternatives to a life settlement, including any accelerated death benefit, loan, or other benefit offered under the owner's life insurance policy;

(b) the proceeds of the life settlement may be taxable under federal and state income tax laws, and assistance should be sought from a professional tax advisor;

(d) receipt of the proceeds of a life settlement may adversely affect the owner's eligibility for Medicaid or other government benefits or entitlements, and advice should be obtained from the appropriate government agencies;

(e) the owner of the life settlement may rescind a life settlement within 15 calendar days after receipt of the life settlement proceeds under Subsection 31A-36-109(7);

(f) if the insured dies during the rescission period, the life settlement is rescinded;

(g) rescission is subject to repayment of all life settlement proceeds, any premiums, loans, and loan interest to the life settlement provider;

(h) funds are sent to the owner of the life settlement within three business days after the life settlement provider receives the insurer or group administrator's written acknowledgment that ownership of the policy or interest in the certificate is transferred and the beneficiary is designated;

(i) entering into a life settlement may cause other rights or benefits, including conversion rights and waiver of premium benefits that exist under the policy or certificate, to be forfeited by the owner and assistance should be sought from a financial adviser;

(j) the disclosure to an owner of a life settlement shall include Appendix C;

(k) the following language: "All medical, financial or personal information solicited or obtained by a life settlement provider or life settlement producer about an insured, including the insured's identity or the identity of family members, a spouse or a significant other may be disclosed as necessary to effect the life settlement between the owner and the life settlement provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years."; and

(l) the insured, following execution of a life settlement, may be contacted to determine the insured's health status and to confirm the insured's street address and telephone number;

(i) contact is limited to once every three months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less; and

(ii) contacts may be made by a life settlement provider licensed in the state in which the owner resided at the time of the life settlement, or by the authorized representative of a licensed life settlement provider.

(2)(a) A life settlement provider shall provide the owner of the life settlement with a disclosure no later than the date the life settlement is signed by the parties.

(b) The disclosure shall be conspicuously displayed in the life settlement or in a separate document, signed by the owner, and provide:

(i) any affiliation between the life settlement provider and the issuer of the settled insurance policy;

(ii) the name, business address, and telephone number of the life settlement provider;

(iii)(A) the amount and method used to calculate the compensation paid or to be paid to the life settlement producer or other person acting for the owner of the life settlement, in connection with the transaction;

(B) "compensation" includes anything of value paid or given for the placement of a policy;

(iv) if an insurance policy to be settled is issued as a joint policy or involves family riders or coverage of a life other than the insured under the policy to be settled, the owner shall be informed of the possible loss of coverage on the other lives under the policy and should consult an insurance producer or the insurer issuing the policy for advice on the proposed life settlement;

(v) state the dollar amount of the current death benefit payable to the life settlement provider under the policy or certificate, if known, the availability of any additional guaranteed insurance benefits, the dollar amount of any accidental death and dismemberment benefits under the policy or certificate, and the extent to which the owner's interest in those benefits will be transferred because of the life settlement;

(vi) the name, business address, and telephone number of the independent third-party escrow agent; and

(vii) that the owner may inspect or receive copies of the relevant escrow or trust agreements or documents.

(3) If a life settlement provider transfers ownership or changes the beneficiary of the insurance policy, the provider shall communicate, in writing, the change in ownership or beneficiary to the insured within 20 days after the change.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-9 Standards for Evaluation of Reasonable Payments

A life settlement provider shall guarantee that the net proceeds from the life settlement exceed the benefits available at the time of the life settlement under the terms of the policy including cash surrender, long-term care, and accelerated death benefits.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-10 Requests for Verification of Coverage

(1) An insurer whose policy is settled shall respond to a request for verification of coverage from a life settlement provider or life settlement producer within 30 days of the date a request is received, subject to:

(a) a current authorization consistent with applicable law, signed by the policyholder or certificate holder, shall accompany the request;

(b) in the case of an individual policy, submission of a form substantially similar to Appendix D that is completed by the life settlement provider or life settlement producer in accordance with the instructions on the form;

(i) submission of a form substantially similar to Appendix D that is completed by the life settlement provider or life settlement producer in accordance with the instructions on the form; and

(ii) is referred to the group policyholder and completed to the extent the information is available to the group policyholder.

(2) An insurer whose policy is being settled may not charge a fee for responding to a request for information from a life settlement provider or life settlement producer more than any usual and customary charges to policyholders, certificate holders, or insureds for similar services.

(3)(a) An insurer whose policy is being settled shall send an acknowledgment of receipt of the request for verification of coverage to the policyholder or certificate holder and, if the policyholder or certificate holder is other than the insured, to the insured.

(b) The acknowledgment may contain a general description of any accelerated death benefit or similar benefit available under a provision of or rider to the life insurance contract.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-11 Advertisement

(1) The form and content of an advertisement of a life settlement shall be complete and clear to avoid misleading or deceiving the reader, viewer, or listener.

(2) An advertisement may not contain false or misleading information, including information that is false or misleading because it is incomplete.

(3) Information required to be disclosed may not be minimized, rendered obscure, or presented in an ambiguous fashion or intermingled with the text of the advertisement to be confusing or misleading.

(4) An advertisement may not omit material information or use words, phrases, statements, references, or illustrations if the omission or use has the capacity, tendency, or effect of misleading or deceiving owners as to the nature or extent of any benefit, loss covered, premium payable, or state or federal tax consequence.

(5) An advertisement may not use the name or title of an insurer or an insurance policy unless the affected insurer approves the advertisement.

(6) An advertisement may not state or imply that interest charged on an accelerated death benefit or a policy loan is unfair, inequitable, or in any manner an incorrect or improper practice.

(7) The words "free," "no cost," "without cost," "no additional cost", "at no extra cost," or words of similar meaning may not be used regarding any benefit or service unless the statement is true.

(8) An advertisement may specify the charge for a benefit or a service or may state that a charge is included in the payment or use other appropriate language.

(9)(a) Testimonials, appraisals or analysis used in an advertisement shall:

(i) be genuine;

(ii) represent the current opinion of the author;

(iii) apply to the life settlement product or service advertised; and

(iv) be accurately reproduced to avoid misleading or deceiving prospective owners as to the nature or scope of the testimonials, appraisal, analysis, or endorsement.

(b) When using testimonials, appraisals, or analysis, the statements become the statements of the life settlement licensee and are subject to this Section R590-222-11.

(c) If an individual making a testimonial, appraisal, analysis, or endorsement has a financial interest in the party using the testimonial, appraisal, analysis, or endorsement, either directly or through a related entity as a stockholder, director, officer, employee, or otherwise, or receives any benefit directly or indirectly other than required union scale wages, that fact shall be prominently disclosed in the advertisement.

(d)(i) An advertisement may not state or imply that a life settlement benefit or service is approved or endorsed by a group of individuals, society, association, or other organization unless:

(A) it is a factual statement; and

(B) a relationship between an organization and the life settlement licensee is disclosed.

(ii) If the entity making the endorsement or testimonial is owned, controlled, or managed by the life settlement licensee, or receives any payment or other consideration from the life settlement licensee for making an endorsement or testimonial, that information shall be disclosed in the advertisement.

(e) When an endorsement refers to benefits received under a life settlement, all pertinent information shall be retained for a period of five years after its use.

(9) An advertisement may not contain statistical information unless it accurately reflects recent and relevant facts and identifies the source of all statistics used in an advertisement.

(10) An advertisement may not disparage insurers, life settlement providers, life settlement producers, life settlement investment agents, anyone who may recommend a life settlement, insurance producers, policies, services, or methods of marketing.

(11)(a) The name of a life settlement licensee shall be clearly identified in all advertisements about the licensee or its life settlement products or services, and, if any specific life settlement is advertised, the life settlement shall be identified either by form number or another appropriate description.

(b) If an application is part of the advertisement, the name and business address of the life settlement provider shall be shown on the application.

(12) An advertisement may not use a trade name, group designation, name of a parent company of a life settlement licensee, name of a particular division of a life settlement licensee, service mark, slogan, symbol, or other device or reference without disclosing the name of the life settlement licensee if the advertisement has the capacity or tendency to mislead or deceive as to the true identity of the life settlement licensee, or to create the impression that a company other than the life settlement licensee has any responsibility for the financial obligation under a life settlement.

(13) An advertisement may not use any combination of words, symbols, or physical materials that by their content, phraseology, shape, color, or other characteristics are so similar to a combination of words, symbols, or physical materials used by a government program or agency or otherwise appear to be of such a nature that they tend to mislead prospective owners into believing that the solicitation is in some manner connected with a government program or agency.

(14)(a) An advertisement may state that a life settlement licensee is licensed in the state where the advertisement appears, provided it does not exaggerate that fact or suggest or imply that a competing life settlement licensee may not be so licensed.

(b) The advertisement may ask the audience to consult the licensee's web site or contact the department to find out if the state requires licensing and, if so, whether the life settlement provider or life settlement producer is licensed.

(15) An advertisement may not create the impression that the life settlement provider, its financial condition or status, the payment of its claims, or the merits, desirability, or advisability of its life settlements are recommended or endorsed by any government entity.

(16)(a) The name of the actual licensee shall be stated in its advertisements.

(b) An advertisement may not use a trade name, a group designation, name of an affiliate or controlling entity of the licensee, service mark, slogan, symbol, or other device in a manner that has the capacity or tendency to mislead or deceive as to the true identity of the actual licensee or create the false impression that an affiliate or controlling entity has any responsibility for the financial obligation of the licensee.

(17) An advertisement may not, directly or indirectly, create the impression that any division or agency of the state or of the U.S. government endorses, approves, or favors:

(a) a life settlement licensee, its business practices, or methods of operations;

(b) the merits, desirability, or advisability of a life settlement;

(d) a life insurance policy or life insurer.

(18) If an advertisement emphasizes the speed with which a settlement will occur, the advertisement shall disclose the average time frame from completed application to the date of offer and from acceptance of the offer to receipt of the funds by the owner.

(19) If an advertisement emphasizes the dollar amounts available to owners, the advertisement shall disclose the average purchase price as a percent of face value obtained by owners contracting with the licensee during the past six months.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-12 Reporting of Fraud

(1) A life settlement licensee that knows or suspects that any person violated or will violate Section 31A- 36-113, shall, upon acquiring the knowledge, promptly notify the commissioner and provide a complete and accurate statement of all relevant facts and circumstances.

(2) Any other person acquiring such knowledge may furnish the information to the commissioner in the same manner.

(3) The fraud report is a protected communication and when made without actual malice does not subject the person making the report to liability.

(4) The commissioner may suspend, revoke, or refuse to renew the license of a person who fails to comply with this section.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-13 Prohibited Practices

(1)(a) A life settlement provider or life settlement producer shall obtain from a person, who is provided with patient identifying information, a signed affirmation that the person will not further divulge the patient identifying information without procuring the express, written consent of the insured for the disclosure.

(b) Notwithstanding Subsection (1)(a), if a life settlement provider or a life settlement producer produces records containing patient identifying information pursuant to a subpoena, the owner and the insured shall be notified, in writing, at their last known addresses and within five business days after receiving notice of the subpoena.

(2) A life settlement provider may not act as a life settlement producer in the same life settlement, whether entitled to collect a fee directly or indirectly.

(3) A life settlement producer may not seek or obtain compensation from the owner without first obtaining the owner's written agreement before performing a service in connection with a life settlement.

(4) A life settlement provider or life settlement producer may not unfairly discriminate in the making or soliciting of life settlements, or discriminate between owners with dependents and without dependents.

(5) A life settlement provider or life settlement producer may not pay or offer to pay a finder's fee, commission, or other compensation to an insured's physician, attorney, accountant, or another person providing medical, legal, or financial planning services to the owner or to a person acting as an agent of the owner, other than a life settlement producer, regarding the life settlement.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-14 Filing Forms

(1)(a) A form used for a life settlement shall be filed with the commissioner before use.

(b) A form is a "filed for use" filing when the compliant form is submitted to the department.

(i) life settlement;

(ii) disclosure to the owner;

(iii) notice of intent to settle;

(iv) verification of coverage; and

(v) application.

(2) A form filing shall include:

(a) a cover letter on the licensee's letterhead providing:

(i) a list of the forms being filed, by title and identification number;

(ii) a description of the filing; and

(iii) an indication if the form:

(A) is a new filing; or

(B) is replacing or modifying a previously filed form, including the changes made, the reason for the changes, and the previous filing's filed date; and

(b) a copy of each form to be filed.

(3) The form filing and any response shall be submitted by email to life.uid@utah.gov.

(4) If a filing is rejected, the filing shall be resubmitted as a new filing.

(5) If a filing objection letter is issued, the response shall include:

(a) a new cover letter identifying the changes made; and

(b) a copy of the revised form.

(6) A person may request the status of their filing by email, telephone, or mail after 30 days from the date of submission.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

Utah Admin. Code R590-222-15 Severability

If any provision of this rule, Rule R590-222, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, life settlement
Date of Last Change: July 25, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-36-119

R590-223 Rule to Recognize the 2001 CSO Mortality Table for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits

Utah Admin. Code R590-223-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-17-402, and 31A-22-408.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-2 Purpose and Scope

(1) The purpose of this rule is to recognize, permit, and prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality Table in accordance with Sections 31A-17-504 and 31A-22-408, and Section R590-198-4.

(2) This rule applies to a life insurance policy.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-17-501. Additional terms are defined as follows:

(1) "2001 CSO Mortality Table" means a mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC, 2nd Quarter 2002. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(2) "2001 CSO Mortality Table (F)" means a mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

(3) "2001 CSO Mortality Table (M)" means a mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

(4) "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

(5) "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-4 Incorporation by Reference

The tables identified in Subsections R590-223-3(1) through (5) are incorporated by reference and are available on the department's website, https://insurance.utah.gov.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-5 2001 CSO Mortality Table

(1)(a) At the election of the company for any one or more specified plans of insurance and subject to the conditions stated in this rule, the 2001 CSO Mortality Table may be used as the minimum standard for policies issued on or after July 1, 2003 and before January 1, 2009, to which Subsections 31A-17-504(1)(c) and 31A-22-408(6)(d)(x), and Subsections R590-198- 4(1) and R590-198-4(2) are applicable.

(b) If the company elects to use the 2001 CSO Mortality Table, it shall do so for both valuation and nonforfeiture purposes.

(2) Subject to the conditions stated in this rule, the 2001 CSO Mortality Table shall be used in determining minimum standards for policies issued on and after January 1, 2009, to which Subsections 31A-17-504(1)(c) and 31A-22-408(6)(d)(x), and Subsections R590-198-4(1) and R590-198-4(2) are applicable.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-6 Conditions

(1) For each plan of insurance with separate rates for smokers and nonsmokers an insurer may use:

(a) composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits;

(b) smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum reserves, if any, required by Section 31A-17-511 and use composite mortality tables to determine the basic minimum reserves, minimum cash surrender values and amounts of paid-up nonforfeiture benefits; or

(c) smoker and nonsmoker mortality to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(2) For plans of insurance without separate rates for smokers and nonsmokers, the composite mortality tables shall be used.

(3) To determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits, the 2001 CSO Mortality Table may, at the option of the company for each plan of insurance, be used in its ultimate or select and ultimate form, subject to the restrictions of Section R590-223-7 and Rule R590-198 relative to use of the select and ultimate form.

(4)(a) When the 2001 CSO Mortality Table is the minimum reserve standard for any plan for a company, the actuarial opinion in the annual statement filed with the commissioner shall be based on an asset adequacy analysis in conformance with the requirements of Section R590-162-6.

(b) The commissioner may exempt a company from this requirement if it only does business in this state and in no other state.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-7 Applicability of the 2001 CSO Mortality Table to Rule R590-198

(1) The 2001 CSO Mortality Table may be used in applying Rule R590-198 in the following manner, subject to the transition dates for use of the 2001 CSO Mortality Table in Section R590-223-5:

(a) Subsection R590-198-2(4)(c)(ii), the net level reserve premium is based on the ultimate mortality rates in the 2001 CSO Mortality Table.

(b) Subsection R590-198-3(3), all calculations are made using the 2001 CSO Mortality Table, and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in Subsection R590-223-7(1)(d). The value of "q x+k+t-1 " is the valuation mortality rate for deficiency reserves in policy year k+t, but using the unmodified select mortality rates if modified select mortality rates are used in the computation of deficiency reserves.

(d) Subsection R590-198-4(2), the 2001 CSO Mortality Table is the minimum standard for deficiency reserves. If select mortality rates are used, they may be multiplied by X percent for durations in the first segment, subject to the conditions specified in Subsections R590-198-4(2)(c)(i) through (vii). In demonstrating compliance with those conditions, the demonstrations may not combine the results of tests that utilize the 1980 CSO Mortality Table with those tests that utilize the 2001 CSO Mortality Table, unless the combination is explicitly required by rule or necessary to be in compliance with relevant Actuarial Standards of Practice.

(e) Subsection R590-198-5(3), the valuation mortality table used in determining the tabular cost of insurance shall be the ultimate mortality rates in the 2001 CSO Mortality Table.

(f) Subsection R590-198-5(5)(d), the calculations specified in Subsection R590-198-5(5) shall use the ultimate mortality rates in the 2001 CSO Mortality Table.

(g) Subsection R590-198-5(6)(d), the calculations specified in Subsection R590-198-5(6) shall use the ultimate mortality rates in the 2001 CSO Mortality Table.

(h) Subsection R590-198-5(7)(b), the calculations specified in Subsection R590-198-5(7) shall use the ultimate mortality rates in the 2001 CSO Mortality Table.

(i) Subsection R590-198-6(1)(b), the one-year valuation premium shall be calculated using the ultimate mortality rates in the 2001 CSO Mortality Table.

(2) Nothing in this section shall be construed to expand the applicability of Rule R590-198 to include life insurance policies exempted under Subsection R590-198-2(4).

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-8 Gender-Blended Tables

(1)(a) For an ordinary life insurance policy delivered or issued for delivery in this state after June 30, 2003, that utilizes the same premium rates and charges for male and female lives or is issued in circumstances where applicable law does not permit distinctions on the basis of gender, a mortality table that is a blend of the 2001 CSO Mortality Table (M) and the 2001 CSO Mortality Table (F) may, at the option of the company for each plan of insurance, be substituted for the 2001 CSO Mortality Table for use in determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(b) No change in minimum valuation standards is implied by this section of the rule.

(2) The company may choose from among the blended tables developed by the American Academy of Actuaries CSO Task Force and adopted by the NAIC in December 2002.

(3) It may not, in and of itself, be a violation of Subsection 31A-23a-402(3) for an insurer to issue the same kind of policy of life insurance on both a sex-distinct and sex-neutral basis.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-223-8 Separability

If any provision of this rule, Rule R590-223, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance reserves and nonforfeitures
Date of Last Change: November 21, 2023
Notice of Continuation: May 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

R590-225 Submission of Property and Casualty Rate and Form Filings

Utah Admin. Code R590-225-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-2-202, and 31A-19a- 203.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-2 Purpose and Scope

(1) The purpose of this rule is to set forth procedures for submitting:

(a) property and casualty and title form filings under Section 31A-21-201;

(b) property and casualty and title rates, and supplementary information under Section 31A-19a-203;

(d) bail bond form filings under Section 31A-35-607 and Rule R590-196; and

(e) guaranteed asset protection waiver filings under Sections 31A-6b-202 and 31A-6b-203.

(2) This rule applies to each line of property and casualty insurance, including;

(a) title insurance;

(b) bail bonds;

(d) guaranteed asset protection waivers.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-19a-102. Additional terms are defined as follows:

(1) "Certification" means a statement that the filing being submitted is compliant.

(2)(a) "Compliant" means a filing complies with:

(i) Title 31A, Utah Insurance Code; and

(ii) Title R590, Administration.

(b) In addition to Subsection (2)(a), a title insurer, agency title insurance producer, or individual title insurance producer shall comply with Title R592, Title and Escrow Commission.

(3) "Electronic filing" means a:

(a) filing submitted using the System for Electronic Rate and Form Filings, SERFF; or

(b) filing submitted using an email system.

(4) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(5) "File before use" means a filing is used, sold, or offered for sale after it is filed with the department and a stated period has elapsed from the date filed.

(6) "Filer" means a person who submits a filing.

(7) "Filing objection letter" means a letter issued by the commissioner when a review determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(8) "Letter of authorization" means a letter signed by an officer of the licensee giving authority to the filer to submit a filing on behalf of the licensee.

(9) "Licensee" means an insurer, a bail bond agency, a service contract provider, or a guaranteed asset protection provider.

(10) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(11) "RSO" means rate service organization.

(12) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the filer stating the reason for rejection; and

(13) "Type of insurance" or "TOI" means a specific line of property and casualty insurance including:

(a) general liability;

(b) commercial property;

(d) automobile;

(e) homeowners;

(f) title;

(g) bail bonds;

(h) service contracts; and

(i) guaranteed asset protection waivers.

(14) "Use and file" means a filing is used, sold, or offered for sale if it is filed within a stated period after its initial use.

(15) "Utah filed date" means the date provided to a filer by the department indicating a filing is accepted.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-4 Forms Used in a Filing

(1) The documents identified in this section shall be used for each filing.

(a) An actual copy or a created version may be used.

(b) If created, the content, size, font, and format shall be similar to the actual copy.

(2) The following filing forms shall be used and are available on the department's website, https:// insurance.utah.gov:

(a) NAIC Uniform Property and Casualty Transmittal Document, dated January 1, 2020;

(b) NAIC Uniform Property and Casualty Coding Matrix, dated January 1, 2021;

(d) Utah Workers Compensation Insurer Loss Cost Multiplier Filing Form, dated April 2017.

(3) If the dated version of a form in Subsection (2) is unavailable, a more recent version is acceptable.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-5 General Filing Information

(1)(a) A filing shall be accurate, consistent, complete, and contain all required documents for the filing to be processed in a timely and efficient manner.

(b) The commissioner may request additional information as necessary.

(2) A licensee and a filer are responsible for assuring that a filing is compliant.

(3) A rate filing, a form filing, and supplementary information applying to a specific program or product may be submitted as one filing.

(4) A filing that is not compliant will be rejected and returned to the filer.

(5) A rejected filing:

(a) is not considered filed;

(b) shall be submitted as a new filing; and

(6) A prior filing will not be researched to determine the purpose of the current filing.

(7) The department does not review every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) when a complaint is received;

(iii) during a regulatory examination or investigation; or

(iv) when the department considers a review necessary.

(b) If a filing is reviewed and is not compliant, a filing objection letter or an order to prohibit use shall be issued to the filer.

(c) The commissioner may require the licensee to disclose deficiencies in forms or rating practices to affected consumers.

(8) Correcting a Filing.

(a) A correction to a filing in an open status may be made at any time.

(b) A correction to a filing in a closed status:

(i) may not be made;

(ii) requires a new filing; and

(iii) shall reference the original filing in the filing description of the new filing.

(9) A filer shall notify the department when withdrawing a previously filed form, rate, or supplementary information.

(10) A filing that is withdrawn may not be used.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-6 Filing Submission Requirements

(1) All filings shall be submitted electronically.

(a) All filers shall use SERFF to submit a filing.

(b) A bail bond agency, a service contract provider, and a guaranteed asset protection waiver provider may use email instead of SERFF to submit a filing.

(2) A rate filing for private passenger auto, homeowners, or workers compensation TOI shall include a certification signed by a qualified actuary stating that the rates are not inadequate, excessive, or unfairly discriminatory under Subsection 31A-19a-201(1).

(3)(a) A filing shall be submitted by market type and TOI.

(b) The annual statement line number may not be used.

(4)(a) A filing may not include more than one TOI unless the filing is a commercial or personal inter-line form filing.

(b) The inter-line use of a form must be explained in the filing description.

(5) A filer may submit a filing for more than one insurer if each insurer is listed in the filing.

(6) A cover letter may not be submitted with a filing.

(7) SERFF Filing.

(a) Filing Description. The filing description contained on the general information tab shall contain the following information in the order shown below.

(i) A filer shall certify that a filing is complete and compliant.

(A) The following statement shall be included in the filing description: "BY SUBMITTING THIS FILING I CERTIFY THAT THE ATTACHED FILING HAS BEEN COMPLETED IN ACCORDANCE WITH UTAH ADMINISTRATIVE RULE R590-225 AND IS IN COMPLIANCE WITH APPLICABLE UTAH LAWS AND RULES".

(B) A filing shall be rejected if the certification is false, missing, or incomplete.

(ii) The filing description shall include:

(A) the intent of the filing; and

(B) the purpose of each document submitted with the filing.

(iii) The filing shall indicate if the filing:

(A) is new;

(B) is replacing or modifying a previous filing, describing the changes made, the reasons for the previous rejection, and the previous filing's Utah filed date;

(D) does not include the policy; if so, provide the Utah filed date of the base policy and describe the effect on the base policy.

(iv) The filing shall identify if a provision is unusual, controversial, or has been previously objected to or prohibited, and explain why the provision is included in the filing.

(b) Letter of Authorization.

(i) When the filer is not the licensee, a letter of authorization from the licensee shall be attached to the supporting documentation tab.

(ii) The licensee is responsible for a filing being compliant.

(i) All forms shall be attached to the form schedule tab.

(ii) All rates and supplementary rating information shall be attached to the rate/rule schedule tab.

(iii) The actuarial certification under Subsection (2) shall be attached to the supporting documentation tab.

(d) The filer shall refer to each applicable section of this rule for additional procedures on how to submit a form, rate, or supplementary information.

(8) Email Filing.

(a) The title of the email shall include the licensee's name only.

(b) Transmittal. The NAIC Uniform Property and Casualty Transmittal Document shall be properly completed.

(i) Complete the transmittal by referencing the following:

(A) NAIC Coding Matrix; and

(B) Utah Property and Casualty Content Standards.

(ii) Do not submit the documents described in Subsections (8)(b)(i)(A) and (8)(b)(i)(B) with the filing.

(c) Filing Description. In section 21 of the NAIC Uniform Property and Casualty Transmittal Document, complete the filing description with the following information, in the order shown below.

(i) The filer shall certify that a filing is complete and compliant.

(B) A filing shall be rejected if the certification is false, missing, or incomplete.

(ii) The filing description shall include:

(A) the intent of the filing; and

(B) the purpose of each document submitted with the filing.

(iii) The filing shall indicate if the filing:

(A) is new;

(B) is replacing or modifying a previous filing, describing the changes made, the reasons for the previous rejection, and the previous filing's Utah filed date; or

(iv) The filing shall identify provisions that are unusual, controversial, or have been previously objected to or prohibited, and explain why the provision is included in the filing.

(d) Letter of Authorization.

(i) When the filer is not the licensee, a letter of authorization from the licensee shall be attached to the supplementary documentation tab.

(ii) The licensee is responsible for the filing being compliant.

(e) The filer shall refer to each applicable section of this rule for additional procedures on how to submit a form, rate, or supplementary information.

(f) An item submitted for filing shall be in PDF format.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-7 Procedures for Form Filings

(1) Forms in General.

(a) Forms are file and use filings.

(b) Service contracts, bail bonds, and guaranteed asset protection waivers are file before use filings.

(d) A form shall be in final printed form; a draft may not be submitted.

(2) Filings by RSO.

(a) An RSO is authorized to make a form filing on behalf of an insurer.

(b) If the effective date is delayed, the filing is not adopted, or the filing is altered, a filing is required.

(d) Copies of the RSO's forms are not required to be attached to a filing when the forms are referenced in a filing.

(e) If an RSO is not authorized to file forms on behalf of an insurer, the insurer shall include a letter stating that the insurer adopts RSO forms for the insurer's use.

(f) Copies of the RSO forms are not required to be filed.

(g) A filing shall include a complete list of the RSO forms the insurer adopts by form number, title, name, and filing identification number of the RSO.

(4) A "Me Too" filing, referencing a filing submitted by another licensee is not permitted.

(5) If a previously filed Utah amendatory endorsement is used in connection with the form being filed, explain this in the filing description section of the transmittal and include a copy of the amendatory endorsement with the filing.

(6) If a filing is for more than one insurer, only one copy of each form is required.

(7) A separate filing is required for each company, insurer, or unique insurer logo used on a form.

(8) A form is not required to be re-filed if the implementation date of the original filing changes.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-8 Procedures for Rate and Supplementary Information Filings

(1) Rates and supplementary information are use and file filings.

(a) Title and workers compensation rates and supplementary information are file before use filings.

(b) A service contract provider, a bail bond agency, or a guaranteed asset protection waiver provider is exempt from this section.

(c) A rate filing for private passenger auto, homeowners, or workers compensation TOI shall include a certification signed by a qualified actuary stating that the rates are not inadequate, excessive, or unfairly discriminatory under Subsection 31A-19a-201(1).

(2) Filings by an RSO authorized by an insurer to make a prospective loss cost, supplementary information filing, or both, are not required if the insurer implements the filing submitted by the RSO.

(a) If the effective date is delayed, the filing is not adopted, or the filing is altered, a filing is required.

(b) A filing shall be received by the department within 30 days of the effective date established by the RSO.

(3)(a) If an RSO is not authorized to file the prospective loss cost, supplementary rating information, or both, on an insurer's behalf, the insurer:

(a) shall include a letter stating that the insurer adopts the RSO prospective loss cost, supplementary rating information filing, or both, for the insurer's use.

(b) A filer shall file copies of any RSO manual pages as if they are the insurer's own and provide the insurer's actuarial justification.

(4) A "Me Too" filing, referencing a filing submitted by another licensee, is not permitted.

(5) If a filing is for more than one insurer and the supporting data and manual pages are identical for each insurer included in the filing, only one copy of the supporting data and manual pages shall be submitted.

(a) Rate and supplementary information filings shall be supported and justified by each insurer.

(b) A justification shall include:

(i) a submission of each factor used in determining the initial supplementary information and rates or changes in existing supplementary information and rates; and

(ii) a complete explanation of each factor and how it is used.

(d) Underwriting criteria used to differentiate between rating tiers is required.

(6)(a) When submitting a filing for a rating plan, a rating modification plan, or a credit and debit plan, an insurer shall include:

(i) a statement identifying the arithmetic process used and whether factors will be added or multiplied when applying them to base rates; and

(ii) a justification for the method used.

(b) A filing shall be rejected as incomplete if it does not provide the information in Subsection (6).

(7) Utah and countrywide statistical data for the latest three years available shall be submitted with each filing.

(a) The data shall include:

(i) earned premiums;

(ii) incurred losses;

(iii) loss ratios;

(iv) establishment of expense factors; and

(v) expected loss ratios.

(b) Calculations used in establishing rates from loss experience shall be shown, including the establishment of trend factors and loss development factors.

(c) If the information in Subsection (7) is not available, a detailed explanation of the reason the information is not available shall be provided with the filing.

(8) Prospective loss cost and loss cost multiplier.

(a) An individual insurer adjustment to the RSO prospective loss cost must be made as part of the calculation of the loss cost multiplier and must be included in the Utah Insurer Loss Cost Multiplier Filing Forms.

(b) This form allows for the inclusion of an individual insurer modification of the RSO prospective loss cost.

(9) Procedures for Reference Filings to Advisory Prospective Loss Cost.

(a) An RSO develops and files a reference filing containing advisory prospective loss cost and supporting actuarial and statistical data.

(b) Each insurer must individually determine the rates it will file and the effective date of any rate changes.

(c) If an insurer that is a member, subscriber, or service purchaser of an RSO that uses the prospective loss cost in an RSO reference filing in support of its own filing, the insurer shall make a filing using the Utah Insurer Loss Cost Multiplier Filing Forms.

(d) The insurer's filed rates are a combination of the RSO's prospective loss cost and the loss cost multiplier contained in the Utah Insurer Loss Cost Multiplier Filing Forms.

(e) An insurer may file a modification of the prospective loss cost in the RSO reference filing based on its own anticipated experience.

(f) An actuarial justification is required for a modification, upward or downward, of the prospective loss cost in the reference filing.

(g) An insurer may request to have its loss cost adjustments remain on file and reference all subsequent RSO prospective loss cost reference filings.

(i) Upon receipt of a subsequent RSO reference filing, the insurer's filed rates are a combination of the RSO's prospective loss cost and the loss cost adjustments contained in the Utah Insurer Loss Cost Multiplier Filing Forms on file and are effective on the effective date of the prospective loss cost.

(ii) The insurer need not file any further filings.

(h) If a filer wants to have its filed loss cost adjustments remain on file, but intends to delay, modify, or not adopt a particular RSO's reference filing, the filer shall make an appropriate filing.

(i) An insurer's filed loss cost adjustments shall remain in effect until the filer withdraws the filing or files a revised Utah Insurer Loss Cost Multiplier Filing Form.

(j) A filer may file other relevant information.

(k) If an insurer proposes to use minimum premiums, it must file those minimum premiums.

(10) Supplementary Rate Information.

(a) An RSO filing containing a revision of rules, relativities, and supplementary rate information shall include:

(i) policy-writing rules;

(ii) rating plans;

(iii) classification codes and descriptions; and

(iv) territory codes, descriptions, and rules, including increased limits factors, classification relativities, or similar factors.

(b) A supplementary rate information filing is made by an RSO on behalf of an insurer that authorizes the RSO to file rules, relativities, and supplementary rating information on its behalf.

(d) If an insurer authorizes an RSO to file on its behalf and the insurer decides to use the revisions and the RSO's effective date, the insurer need not file any further filings.

(e) If an insurer authorizes an RSO to file on its behalf and the insurer decides to use the revisions as filed, and with a different effective date, the insurer shall notify the commissioner of the insurer's effective date within 30 days of the RSO's effective date.

(f) If an insurer authorizes an RSO to file on its behalf, and the insurer decides not to use the revision, the insurer shall notify the commissioner within 30 days of the RSO's effective date.

(g) If an insurer authorizes an RSO to file on its behalf, and the insurer decides to use the revision with modification, the insurer must file the modification specifying the basis for the modification and the insurer's effective date within 30 days of the RSO's effective date.

(11) Consent-to-Rate Filing. The filing description shall:

(a) indicate that the filing is a consent-to-rate filing;

(b) show the filed rate;

(d) set forth the reasons for the difference.

(12) Individual Risk Filing.

(a) Rule R590-127 sets forth when an individual risk filing is permitted.

(b) An individual risk filing shall be filed with the commissioner.

(i) The filing shall consist of a copy of the declarations page, a copy of any pertinent coverage form or rating schedule, and premium development.

(ii) The filing description shall indicate that it is an individual risk filing, and contain the underwriter's explanation for the filing.

(13) Tiered rating plans are permitted by a single insurer or insurer group with common ownership.

(a) A filing shall show that the tiers are based on mutually exclusive underwriting rules, based on clear, objective criteria that lead to a logical distinguishing of potential risk.

(b) A filing shall provide supporting information that shows a clear distinction between the expected losses and expenses for each tier.

(c) If an insurer group uses a tiered rating structure, the group of insurers may not all file the same loss cost multiplier and then file standard percentage deviations.

(i) A difference shall be demonstrated in the loss cost multiplier formula, either as a modification of the RSO prospective loss cost or in the insurer expense factor.

(ii) An individual insurer adjustment or modification shall be supported by actuarial data that establishes a reasonable standard for measuring probable insurer variations in historical or prospective experience, underwriting standards, expense and profit factors.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-9 Additional Procedures for Workers Compensation Rate Filings

(1) A rate filing for workers compensation shall include a certification signed by a qualified actuary stating that the rates are not inadequate, excessive, or unfairly discriminatory under Subsection 31A-19a-201(1).

(2) A rate filing and supplementary information shall be filed 30 days before they are used.

(3)(a) Each insurer shall individually determine the rates it will file.

(b) Filed rates.

(i) An insurer's workers compensation filed rates are the combination of the most current prospective loss cost filed by the designated rate service organization and the insurer's loss cost adjustment, known as the loss cost multiplier (LCM), as calculated, and filed using the Utah Worker's Compensation Insurer Loss Cost Multiplier Filing Form.

(ii) An insurer shall implement the designated RSO's current prospective loss cost on the effective date assigned by the designated RSO, and may not defer nor delay adoption of the lost cost multiplier.

(iii) An insurer's filed loss cost multiplier shall remain in effect until the insurer withdraws it or files a new loss cost multiplier.

(iv) Upon receiving a subsequent designated RSO reference filing, an insurer's filed rates are the combination of the designated RSO's prospective loss cost and the loss cost multiplier contained in the insurer's most current Utah Loss Cost Multiplier Filing Form on file with the department.

(4)(a) An insurer may file a modification to the designated RSO prospective loss cost in the subject reference filing based on its own anticipated experience.

(b) Supporting documentation is required for any modification, upward or downward, of the designated RSO prospective loss cost.

(5)(a) An insurer may vary expense loads by individual classification or grouping.

(b) An insurer may use variable or fixed expense loads or a combination of these to establish its expense loadings.

(6) A filing for a workers compensation rating plan, a rating modification plan, or a credit and debit plan shall include:

(a) a statement identifying the arithmetic process used and whether factors will be added or multiplied when applying them to base rates; and

(b) a justification for the method used.

(7)(a) If an insurer's rates are determined solely by applying its loss cost multiplier, as presented in the Utah Worker's Compensation Insurer Loss Cost Multiplier Filing Forms to the prospective loss cost contained in a designated RSO reference filing and contained in the designated RSO's rating manual, the insurer need not develop or file its rate pages.

(b) If an insurer chooses to distribute rate pages for its own use, based solely upon the application of its filed loss cost multiplier, the insurer need not file those pages.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-10 Additional Procedures for Title Rate Filings

(1) A title rate and a supplementary information filing are file before use filings and shall be filed 30 days before use.

(2)(a) A change or amendment to a schedule of rates shall state the effective date of the change or amendment, which may not be less than 30 days after the date of filing.

(b) A change or amendment remains in force for a period of at least 90 days from its effective date.

(3)(a) Supplementary information and rate filings shall be supported and justified by each insurer.

(b) A justification shall include:

(i) submission of all factors used in determining initial supplementary information and rates or changes in existing supplementary information and rates; and

(ii) a complete explanation of each factor and how it is used.

(4) Rates that vary by risk classification, such as extended coverage or standard coverage, and discount factors, such as refinance, subdivision, or construction for purpose of resale discounts, shall be supported by differences in expected losses or expenses.

(5) A rate may not be filed or used that requires a title insurer, an agency title insurance producer, or an individual title insurance producer to operate at less than the cost of doing business or inadequately underwrite a title insurance policy.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-11 Classification of Documents

(1) A record submitted under this rule is subject to Title 63G, Chapter 2, Government Records and Access Management Act (GRAMA).

(2) Notwithstanding Subsection (1), a record filed under Section 31A-19a-204 is classified as public.

(3) Notwithstanding Subsections (1) and (2), a record may bem classified as protected if requested under Section 63G- 2-309.

(4) A filing may not be reopened to reclassify a previously filed document.

(5) A pattern of requesting that non-qualifying documents be protected, including putting both protected and public information in one document, may violate this rule.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-12 Correspondence and Status Checks

(1) When corresponding with the department, provide sufficient information to identify the original filing including:

(a) the TOI;

(b) the date of filing; and

(d) the tracking number.

(2) Status Checks.

(a) A filer may request the status of its filing 60 days after the date of submission.

(b) A response will not be provided to a status request before 60 days.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-13 Filing Objection Letter and Order to Prohibit Use

(1) When responding to a filing objection letter, a filer shall:

(a) provide an explanation identifying each change made;

(b) include an underline and strikeout version for each revised document;

(d) for a filing submitted in SERFF, attach the documents described in Subsections (1)(b) and (1)(c) to the appropriate form schedule or rate/rule schedule tabs.

(2) Order to Prohibit Use.

(a) An order to prohibit use is final 15 days after the date of the order.

(b) Use of the filing shall be discontinued no later than the date specified in the order.

(c) To contest an order to prohibit use, a written request for a hearing shall be filed no later than 15 days after the date of the order.

(d) A new filing is required if the licensee chooses to make the requested changes addressed in the filing objection letter and must reference the previously prohibited filing.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

Utah Admin. Code R590-225-14 Severability

If any provision of this rule, Rule R590-225, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: property casualty insurance filing
Date of Last Change: March 10, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-19a-203

R590-226 Submitting Life Insurance Filings

Utah Admin. Code R590-226-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-201.1.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-2 Purpose and Scope

(1) The purpose of this rule is to establish procedures for submitting a life insurance filing.

(2) This rule applies to an insurer offering life insurance, including a group life insurance policy issued to a nonresident policyholder when a Utah resident is provided coverage under the policy.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Certification" means a statement that a submitted filing is compliant.

(2) "Compliant" means a filing that is complete and complies with Title 31A, Insurance Code, and Title R590, Administration.

(3) "Data page" means the page or pages in a policy or certificate providing the specific data for the insured and detailing the coverage provided.

(4) "Discretionary group" means a group that is specifically authorized by the commissioner under Section 31A-22- 509.

(5) "Electronic filing" means a filing submitted using SERFF.

(6) "Eligible group" means a group that meets the requirements in Sections 31A-22-501.1 through 31A-22-508.

(7) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(8) "Filing objection letter" means a letter issued by the commissioner when a review of a filing determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(9) "Letter of authorization" means a letter signed by an officer of the insurer giving authority to a third party to submit a filing on behalf of the insurer.

(10) "NAIC Product Coding Matrix" means a numerical coding system developed by the NAIC that provides uniform naming convention, uniform terminology, and uniform description for a type of insurance product in a filing.

(11) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(12) "Qualified actuary" means an individual who is qualified to sign the applicable state of actuarial opinion in accordance with the American Academy of Actuaries qualification standards.

(13) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the insurer stating the reason for rejection; and

(14) "Resubmission" means a correction, modification, or replacement of a previously rejected, withdrawn, or prohibited filing.

(15) "SERFF" means the System for Electronic Rate and Form Filing.

(16) "Type of insurance" or "TOI" means:

(a) a specific life insurance product identified by the NAIC Product Coding Matrix including term, universal, variable, or whole life; and

(b) a TOI that can be selected in SERFF when submitting a filing in Utah.

(17) "Utah filed date" means the date the department indicates a paper filing is accepted.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-4 General Filing Information

(1)(a) A filing shall be accurate, consistent, complete, and contain all required documents.

(b) The commissioner may request additional information, as necessary.

(2)(a) An insurer is responsible for assuring that any document in a filing is compliant.

(b) A filing that is not compliant is subject to regulatory action.

(3)(a) A filing that is not compliant shall be rejected.

(b) A rejected filing:

(i) may be resubmitted under a new filing; and

(ii) may not be reopened for purposes of resubmission.

(4) A prior filing will not be researched to determine the purpose of the current filing.

(5) The department does not review every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) when a complaint is received;

(iii) during a regulatory examination or investigation; or

(iv) when the department considers a review necessary.

(b) If a filing is reviewed and is found not compliant, the commissioner:

(i) shall issue a filing objection letter or an order to prohibit use; and

(ii) may require the insurer to disclose deficiencies in a form or a rating practice to each affected insured.

(6)(a) A correction to a filing in an open status may be made at any time.

(b) A correction to a filing in a closed status:

(i) may not be made;

(ii) requires a new filing; and

(iii) shall reference the original filing in the filing description of the new filing.

(7) An insurer shall notify the department when discontinuing or withdrawing a previously filed form or supplementary information.

(8) If the Utah filed date is used for compliance with this rule, a complete copy with all subsequent amendments, including the Utah filed date, shall be attached as a supporting document.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-5 Filing Submission Requirements

(1) General Filing Requirements.

(a) A filing shall be submitted:

(i) electronically through SERFF, except that a life settlement filing may be submitted using email; and

(ii) using the NAIC Product Coding Matrix, including the:

(A) TOI; and

(B) sub-TOI.

(b) A filing may not include more than one:

(i) TOI; or

(ii) insurer.

(2) SERFF Filing.

(a) Filing Description. The filing description on the general information tab shall contain the following information, in the sequence listed.

(i) Provide a summary, including:

(A) the intent of the filing; and

(B) the purpose of each document within the filing.

(ii) Indicate if the filing:

(A) is a first-time filing;

(B) is a new form revising an existing form;

(D) is a resubmission that includes a summary of the changes made and the previous filing's Utah filed date or SERFF tracking number;

(E) includes informational documents, referencing the Utah filed date or SERFF tracking number; or

(F) does not include the policy, and if so, provide the Utah filed date or SERFF tracking number of the policy and each amendment, summarizing the effect on the policy.

(iii) Identify any provision that is unusual, innovative, controversial, or that was previously objected to or prohibited, and explain why the provision is included in the filing.

(iv) List the range of minimum and maximum ages for which the policy will be issued.

(v) Indicate if the policy or associated forms have been submitted to the Interstate Insurance Product Regulation Commission.

(vi) Identify the intended market for filing, such as senior citizens, nonprofit organizations, association members, corporate-owned, or bank-owned.

(vii) Indicate if the form is illustrated.

(b) Filing Certification.

(i) The insurer shall certify that a filing and all related documents are compliant.

(iii) The Utah Life and Annuity Filing Certification shall be attached to the supporting documentation tab.

(iv) A filing may be rejected if the filing certification is false, missing, or incomplete.

(v) A false filing certification may subject the insurer to administrative action.

(c) Domiciliary Approval and Filing Status Information. A filing for a foreign insurer shall include on the supporting documentation tab:

(i) filing status information, including:

(A) a list of states where a similar filing is submitted;

(B) the date of submission; and

(ii) if the filing is specific to Utah and only filed in Utah, include:

(A) the phrase "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE"; and

(B) the reason the filing is only filed in Utah.

(d) Group Questionnaire or Discretionary Group Authorization Letter. A group filing shall attach to the supporting documentation tab:

(i) a complete Utah Life and Annuity Group Questionnaire; or

(ii) a copy of the discretionary group authorization letter.

(e) Letter of Authorization.

(i) A filing submitted by a third party shall have a letter of authorization from the insurer attached to the supporting documentation tab.

(ii) The insurer is responsible for the filing being compliant.

(f) Variable Data.

(i)(A) Variable data is denoted by brackets, and is defined either by embedding the variable data in the form or in a separate form with a unique form number and an edition date.

(B) Variable data submitted as a separate form shall be in a manner that follows the construction of the form, by page and paragraph, or page and footnote.

(ii) A certification statement of variability shall be attached to the supporting documentation tab and shall certify that:

(A) the final form will not contain brackets;

(B) the use of variable data is administered in a uniform and non-discriminatory manner that will not result in unfair discrimination;

(D) any changes to variable data shall be filed before implementation.

(iii) Any variation of the variable data shall be disclosed, for example "Deductible is $(xxx.xx) in $(xxx.xx) increments."

(iv) Variable data shall be reasonable, appropriate, and compliant.

(v) The use of unfiled variable data is prohibited.

(g) Life Insurance Illustration Materials. If a life insurance form is identified as illustrated, the filing shall include:

(i) a basic illustration completed with data; and

(ii) an illustration actuary's certification.

(h) Items Submitted for Filing.

(i) A form shall be attached to the form schedule tab.

(ii) All supporting documentation, including actuarial memoranda, shall be attached to the supporting documentation schedule tab.

(iii) An actuarial memorandum required under Section R590-226-7, R590-226-8, or R590-226-9 shall include a certification of compliance with nonforfeiture and valuation laws by a qualified actuary.

(iv) A report is exempt from a filing submission requirement under:

(A) Subsections (2)(a)(ii) through (2)(a)(vi);

(B) Subsection (2)(c);

(D) Subsection (2)(f).

(v) Underlining and Strikethrough. A resubmission or a new form revising an existing form shall include an underline and strikethrough version of the form and the final form on the form schedule tab.

(3) An insurer submitting a life settlement filing is exempt from:

(a) Subsections (2)(a)(iv) through (2)(a)(vii);

(b) Subsections (2)(b) through (2)(e); and

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-6 Procedures for Filings

(1) Forms in General.

(a) A form is a file and use filing.

(b) A form shall be identified by a unique form number that may not be variable.

(d) Blank spaces within a form shall be completed to accurately represent the purpose and use.

(i) If the intended market is for a senior age market, the form shall be completed with data representative of senior insureds.

(ii) Any data in a form, including the data page, shall be consistent with the actuarial memorandum, the basic illustration, the statement of policy cost and benefit information, and the application, as applicable.

(2) Application Filing.

(a) An application or enrollment form may be submitted as a separate filing or filed with its related policy or certificate filing.

(b) If an application was previously filed or is filed separately, an informational copy of the application shall be included with the policy or certificate filing.

(3) Policy Filing.

(a) Each TOI shall be filed separately.

(b) A policy filing consists of one policy form, including the application, data page, certificate, rider, endorsement, and actuarial memorandum.

(d)(i) Only one policy filing for a single TOI may be filed.

(ii) A life insurance policy with different premium payment periods is considered one form.

(4) Rider or Endorsement Filing.

(a) Related riders or endorsements may be filed together.

(b) A single rider or endorsement that affects multiple forms may be filed if the filing description references each affected form.

(c) A rider or endorsement that is based on morbidity risks, such as critical illness or long-term care, is accident and health insurance and shall be filed under Rule R590-220.

(d) The filing description shall include:

(i) a list of each policy form number, title, and Utah filed date or SERFF tracking number;

(ii) a description of how each filed rider or endorsement affects the policy; and

(iii) a data page with data for the submitted form.

(e) Unrelated riders or endorsements may not be filed together.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-7 Additional Procedures for Individual Life Insurance Forms and Group Life Insurance Certificates Marketed Individually

(1) An insurer filing a life insurance form shall comply with:

(a) Title 31A, Chapter 21, Insurance Contracts in General;

(b) Title 31A, Chapter 22, Part 4, Life Insurance and Annuities;

(d) Rule R590-93;

(e) Rule R590-94;

(f) Rule R590-95;

(g) Rule R590-98;

(h) Rule R590-108;

(i) Rule R590-122;

(j) Rule R590-177;

(k) Rule R590-191;

(l) Rule R590-198; and

(m) Rule R590-223.

(2) A life insurance policy, rider, or endorsement filing shall include an actuarial memorandum that demonstrates compliance with Section 31A-22-408 for:

(a) an individual life insurance policy; or

(b) a group life insurance policy that is marketed individually.

(3) The actuarial memorandum shall include:

(a) a detailed description of the coverage;

(b) a demonstration of compliance with nonforfeiture law;

(d) a certification of compliance with applicable nonforfeiture and valuation laws by a qualified actuary.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-8 Additional Procedures for Group Market Filings

(1) A group life insurance filing shall comply with:

(a) Title 31A, Chapter 21, Insurance Contracts in General;

(b) Title 31A, Chapter 22, Part 4, Life Insurance and Annuities;

(d) Rule R590-79;

(e) Rule R590-108;

(f) Rule R590-122;

(g) Rule R590-177; and

(h) Rule R590-191.

(2) Statement of Policy Cost and Benefit Information.

(a) A statement of policy cost and benefit information shall be included in group life insurance that includes a preneed funeral policy or prearrangement.

(b) The disclosure requirement extends to the issuance or delivery of a certificate and the policy under Section R590- 79-4.

(3) Actuarial Memorandum.

(a) An actuarial memorandum shall be included in a non-term group life insurance filing.

(b) A filing for a policy, a rider, or an endorsement shall include an actuarial memorandum that demonstrates compliance with Section 31A-22-515.

(i) a detailed description of the coverage;

(ii) a demonstration of compliance with nonforfeiture law;

(iii) the specific basis for exemption from nonforfeiture law; and

(iv) a certification of compliance with applicable nonforfeiture and valuation laws by a qualified actuary.

(4) An insurer shall determine if the group is an eligible group or a discretionary group.

(a) Eligible Group.

(i) A filing for an eligible group shall include a Utah Life and Annuity Group Questionnaire.

(ii) A questionnaire shall be completed for each eligible group under Sections 31A-22-501.1 through 31A-22-508.

(iii) When a filing applies to more than one employer or employee group, only one questionnaire is required.

(b) Discretionary Group.

(i) If a group is not an eligible group, a discretionary group authorization shall be obtained.

(ii) If a form filing is submitted without discretionary group authorization, the filing shall be rejected.

(iii) To obtain discretionary group authorization, a compliant Utah Life and Annuity Request for Discretionary Group Authorization must be submitted.

(iv) A change to an authorized discretionary group shall be submitted to the department within 30 days of the change.

(v) The commissioner may periodically re-evaluate a group's authorization.

(vi) An insurer shall file a separate discretionary group authorization to add another TOI to a previously authorized group.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-9 Additional Procedures for Variable Life Filings

(1) An insurer submitting a variable life insurance filing shall comply with:

(a) Section 31A-22-411; and

(b) Rule R590-133.

(2) An insurer submitting a variable life insurance policy shall certify it has:

(a) a variable contract line of authority; and

(b) a separate account established in the state of domicile.

(3) Actuarial Memorandum. An actuarial memorandum shall:

(a) be included in a variable life insurance filing;

(b) describe the type of accounts available in the policy, identifying the accounts that are separate accounts, including modified guaranteed accounts, and general accounts;

(i) separate accounts pursuant to Section 31A-22-411; and

(ii) fixed interest general accounts pursuant to Section 31A-22-408;

(d) identify a fixed account's:

(i) guaranteed minimum interest rate; and

(ii) maximum surrender charge; and

(e) include a certification of compliance with applicable nonforfeiture and valuation laws by a qualified actuary.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-10 Additional Procedures for a Policy, Rider, or Endorsement Providing Life Insurance and Accident and Health Insurance Benefits

(1) A life insurance filing that includes an accident and health insurance benefit, rider, or endorsement shall comply with Rule R590-220.

(2)(a) A combination filing is a policy, rider, or endorsement that creates a product providing both life insurance and accident and health insurance benefits.

(b) The acceptable combination filings are:

(i) a rider or endorsement; or

(ii) an integrated policy.

(c) A combination filing shall be submitted separately to both the health instance and the life instance in SERFF, as both instances will process the filing.

(d) A rider or endorsement shall be submitted to the appropriate instance in SERFF based on the benefits provided in the rider or endorsement.

(3) The filing description shall include the Utah filed date or SERFF tracking number and shall identify the filing as a combination of TOIs, such as:

(a) a whole life insurance policy with a long-term care insurance benefit; or

(b) a major medical health policy that includes a life insurance benefit.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-11 Classification of Documents

(1) A record submitted under this rule is subject to Title 63G, Chapter 2, Government Records Access and Management Act.

(2) A record may be classified as protected if:

(a) requested under Section 63G-2-309;

(b) the request in Subsection (2)(a) includes each required element of Subsections 63G-2-309(1)(a)(i)(A) and 63G-2- 309(1)(a)(i)(B); and

(3) A filing may not be reopened to reclassify a previously filed document.

(4) A pattern of requesting that non-qualifying documents be protected, including putting both protected and public information in one document, may violate this rule.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-12 Insurer Annual Reports

(1) An annual report shall be properly identified and shall be filed separately from any other filing.

(2) An annual report shall be submitted when requested.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-13 Objection Letter and Disposition Procedures

(1) Response to a Filing Objection Letter. A response to a filing objection letter shall:

(a) be provided in SERFF under the filing correspondence tab;

(b) address each objection;

(d) include an underline and strikeout version of each revised document;

(e) provide a final version of the revised document, incorporating all changes;

(f) attach each document under the appropriate tab; and

(g) reference any additional document attached under the supporting documentation tab if the content is not included in the response.

(2) Order to Prohibit Use.

(a) An order to prohibit use is final 15 days after the date of the order to prohibit use.

(b) A filing that is prohibited pursuant to an order to prohibit use shall be discontinued by the date specified in the order to prohibit use.

(c) To contest an order to prohibit use, the insurer shall request a hearing, in writing, no later than 15 days after the date of the order to prohibit use.

(d) Notwithstanding Subsection (2)(c), an insurer may submit a resubmission that shall:

(i) make the requested changes addressed in the filing objection letter; and

(ii) reference the previously prohibited filing.

(3) Filing Rejection.

(a) An insurer may submit a resubmission.

(b) A resubmission shall reference the previously rejected filing.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-226-14 Severability

If any provision of this rule, Rule R590-226, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: life insurance filings
Date of Last Change: April 21, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

R590-227 Submitting Annuity Filings

Utah Admin. Code R590-227-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-201.1.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-2 Purpose and Scope

(1) The purpose of this rule is to establish procedures for submitting an annuity filing.

(2) This rule applies to an insurer offering an annuity contract, including a group annuity contract issued to a nonresident contract holder, when a Utah resident is provided coverage under the contract.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Certification" means a statement that a submitted filing is compliant.

(2) "Compliant" means a filing that is complete and complies with Title 31A, Insurance Code, and Title R590, Administration.

(3) "Contract" means an annuity policy including attached endorsements and riders.

(4) "Data page" means the page or pages in a contract or certificate providing the specific data for the annuitant and detailing the coverage provided.

(5) "Discretionary group" means a group that is authorized by the commissioner under Section 31A-22-509.

(6) "Electronic filing" means a filing submitted using SERFF.

(7) "Eligible group" means a group that meets the requirements in Sections 31A-22-501.1 through 31A-22-508.

(8) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(9) "Filing objection letter" means a letter issued by the commissioner when a review of a filing determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(10) "Letter of authorization" means a letter signed by an officer of the insurer giving authority to a third party to submit a filing on behalf of the insurer.

(11) "NAIC Product Coding Matrix" means a numerical coding system developed by the NAIC that provides uniform naming convention, uniform terminology, and uniform description for a type of insurance product in a filing.

(12) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(13) "Qualified actuary" means an individual who is qualified to sign the applicable state of actuarial opinion in accordance with the American Academy of Actuaries qualification standards.

(14) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the insurer stating the reason for rejection; and

(15) "Resubmission" means a correction, modification, or replacement of a previously rejected, withdrawn, or prohibited filing.

(16) "SERFF" means the System for Electronic Rate and Form Filing.

(17) "Type of insurance" or "TOI" means:

(a) a specific type of annuity product identified by the NAIC Product Coding Matrix including equity indexed annuity, single premium immediate annuity, modified guaranteed annuity, deferred annuity, or variable annuity; and

(b) a TOI that can be selected in SERFF when submitting a filing in Utah.

(18) "Utah filed date" means the date the department indicates a paper filing is accepted.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-4 General Filing Information

(1)(a) A filing shall be accurate, consistent, complete, and contain all required documents.

(b) The commissioner may request additional information, as necessary.

(2)(a) An insurer is responsible for assuring that any document in a filing is compliant.

(b) A filing that is not compliant is subject to regulatory action.

(3)(a) A filing that is not compliant may be rejected.

(b) A rejected filing:

(i) may be resubmitted under a new filing; and

(ii) may not be reopened for purposes of resubmission.

(4) A prior filing will not be researched to determine the purpose of the current filing.

(5) The department does not review every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) when a complaint is received;

(iii) during a regulatory examination or investigation;

(iv) when the department considers a review necessary.

(b) If a filing is reviewed and is found not compliant, the commissioner:

(i) shall issue a filing objection letter or an order to prohibit use; and

(ii) may require the insurer to disclose deficiencies in a form or a rating practice to each affected insured.

(6)(a) A correction to a filing in an open status may be made at any time.

(b) A correction to a filing in a closed status:

(i) may not be made;

(ii) requires a new filing; and

(iii) shall reference the original filing in the filing description of the new filing.

(7) An insurer shall notify the department when discontinuing or withdrawing a previously filed form or supplementary information.

(8) If the Utah filed date is used for compliance with this rule, a complete copy with all subsequent amendments, including the Utah filed date, shall be attached as a supporting document.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-5 Filing Submission Requirements

(1) General Filing Requirements.

(a) A filing shall be submitted:

(i) electronically through SERFF; and

(ii) using the NAIC Product Coding Matrix, including the:

(A) TOI; and

(B) sub-TOI.

(b) A filing may not include more than one:

(i) TOI; or

(ii) insurer.

(2) SERFF Filings.

(a) Filing Description. The filing description on the general information tab shall contain the following information, in the sequence listed.

(i) Provide a summary, including:

(A) the intent of the filing; and

(B) the purpose of each document within the filing.

(ii) Indicate if the filing:

(A) is a first-time filing;

(B) is a new form revising an existing form;

(D) is a resubmission that includes a summary of the changes made and the previous filing's Utah filed date or SERFF tracking number;

(E) includes informational documents, referencing the Utah filed date or SERFF tracking number; or

(F) does not include the contract, and if so, provide the Utah filed date or SERFF tracking number of the contract and each amendment, summarizing the effect on the contract.

(iii) Identify if any provision is unusual, innovative, controversial, or that was previously objected to or prohibited, and explain why the provision is included in the filing.

(iv) List the range of minimum and maximum ages for which the contract will be issued.

(v) Indicate if the contract or associated forms have been submitted to the Interstate Insurance Product Regulation Commission.

(vi) Indicate and describe any market value adjustment feature.

(b) Filing Certification.

(i) The insurer shall certify that a filing and all related documents are compliant.

(iii) The Utah Life and Annuity Filing Certification shall be attached to the supporting documentation tab.

(iv) A filing may be rejected if the certification is false, misleading, or incomplete.

(v) A false certification may subject the insurer to administrative action.

(c) Domiciliary Approval and Filing Status Information. A filing for a foreign insurer shall include on the supporting documentation tab:

(i) filing status information, including:

(A) a list of states where a similar filing is submitted;

(B) the date of submission; and

(ii) if the filing is specific to Utah and only filed in Utah, include:

(A) the phrase "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE"; and

(B) the reason the filing is only filed in Utah.

(d) Group Questionnaire or Discretionary Group Authorization Letter. A group filing shall attach to the supporting documentation tab:

(i) a complete Utah Life and Annuity Group Questionnaire; or

(ii) a copy of the discretionary group authorization letter.

(e) Letter of Authorization.

(i) A filing submitted by a third party shall have a letter of authorization from the insurer attached to the supporting documentation tab.

(ii) The insurer is responsible for the filing being compliant.

(f) Variable Data.

(i)(A) Variable data is denoted by brackets, and is defined either by embedding the variable data in the form or in a separate form with a unique form number and an edition date.

(B) Variable data submitted as a separate form shall be in a manner that follows the construction of the form, by page and paragraph, or page and footnote.

(ii) A certification statement of variability shall be attached to the supporting documentation tab and shall certify that:

(A) the final form will not contain brackets;

(B) the use of variable data is administered in a uniform and non-discriminatory manner and will not result in unfair discrimination;

(D) any changes to variable data shall be filed before implementation.

(iii) Any variation of the variable data shall be disclosed, for example "Deductible is $(xxx.xx) in $(xxx.xx) increments."

(iv) Variable data shall be reasonable, appropriate, and compliant.

(v) The use of unfiled variable data is prohibited.

(g) Items Submitted for Filing.

(i) A form shall be attached to the form schedule tab.

(ii) All supporting documentation, including actuarial memoranda, shall be attached to the supporting documentation schedule tab.

(iii) An actuarial memorandum required under Section R590-227-7 or R590-227-9 shall include a certification of compliance with applicable nonforfeiture and valuation laws by a qualified actuary.

(iv) Underlining and Strikethrough. A resubmission or a new form revising an existing form shall include an underline and strikethrough version of the form and the final form on the form schedule tab.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-6 Procedures for Filings

(1) Forms in General.

(a) A form is a file and use filing.

(b) A form shall be identified by a unique form number that may not be variable.

(d) Blank spaces within a form shall be completed to accurately represent the purpose and use.

(i) If the intended market is for a senior age market, the form shall be completed with data representative of senior annuitants.

(ii) Any data in a form, including the data page, shall be consistent with the actuarial memorandum, the application, and any marketing materials, as applicable.

(2) Application Filing.

(a) An application or enrollment form may be submitted as a separate filing or filed with its related contract or certificate filing.

(b) If an application was previously filed or is filed separately, an informational copy of the application shall be included with the contract or certificate filing.

(3) Contract Filing.

(a) Each TOI shall be filed separately.

(b) A contract filing consists of one contract form, including the application, data page, rider, endorsement, and actuarial memorandum.

(d) Only one contract filing for a single TOI may be filed.

(4) Rider or Endorsement Filing.

(a) Related riders or endorsements may be filed together.

(b) A single rider or endorsement that affects multiple forms may be filed if the filing description references each affected form.

(c) A rider or endorsement that is based on morbidity risks, such as critical illness or long-term care, is accident and health insurance and shall be filed under Rule R590-220.

(d) The filing description shall include:

(i) a list of each contract form number, title, and Utah filed date or SERFF tracking number;

(ii) a description of how each filed rider or endorsement affects the contract; and

(iii) a data page with data for the submitted form.

(e) Unrelated riders or endorsements may not be filed together.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-7 Additional Procedures for Fixed Annuity Filings

(1) An insurer filing an annuity form shall comply with:

(a) Title 31A, Chapter 21, Contracts in General;

(b) Title 31A, Chapter 22, Part 4, Life Insurance and Annuities;

(d) Rule R590-96; and

(e) Rule R590-191.

(2) A filing of an annuity contract, rider, or endorsement shall include an actuarial memorandum that demonstrates compliance with Section 31A-22-409.

(3) Actuarial Memorandum.

(a) An actuarial memorandum shall be included in each fixed annuity contract filing;

(b) The actuarial memorandum shall:

(i) identify the specific subsections of the Utah nonforfeiture law that apply to the submitted annuity;

(ii) describe each contract provision in detail including any guaranteed and non-guaranteed elements that affect the value;

(iii) identify the guaranteed minimum interest crediting rate;

(iv) describe the methods of crediting interest, including:

(A) guaranteed fixed interest rates; and

(B) guaranteed interest terms;

(v) identify and describe each charge and fee, including loads, surrender charges, market value adjustments, or any other adjustment feature;

(vi) describe each account and factor used to calculate guaranteed minimum nonforfeiture values and minimum cash surrender values in the contract and the elements used in the calculation of the minimum values; and

(vii) include each formula used to calculate the minimum guaranteed values provided by the contract and each formula used to calculate the minimum guaranteed values required by nonforfeiture law.

(i) compare a minimum contract value with a minimum nonforfeiture value;

(ii) be based on a representative premium pattern and show values for:

(A) issue age 35 and age 60; and

(B) flexible premium contract, for a single premium and for a level premium; and

(iii) numerically demonstrate that the values based on the guaranteed minimum interest rate, the maximum surrender charges, fees, loads, and any other factor affecting the value, provide values that are in compliance with the Standard Nonforfeiture Law using both the retrospective and the prospective tests.

(d) The actuarial memorandum shall clearly identify the tests in Subsection (3)(c)(iii) and shall include the following:

(i) for the retrospective test:

(A) describe the net consideration and the interest rates used for the accumulation; and

(B) numerically compare the guaranteed contract values with the minimum values required by the nonforfeiture law; and

(ii) for the prospective test:

(A) identify the maturity value and the interest rate used for each respective year to determine the present value; and

(B) numerically compare the guaranteed contract values with the minimum values required by the nonforfeiture law.

(e) The actuarial memorandum shall include:

(i) a certification of compliance with applicable nonforfeiture and valuation laws by a qualified actuary;

(ii) a confirmation that the formulas used and values provided are compliant.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-8 Additional Procedures for Group Annuity Filings

(1) A group annuity filing shall comply with:

(a) Title 31A, Chapter 21, Insurance Contracts in General;

(b) Title 31A, Chapter 22, Part 4, Life Insurance and Annuities;

(d) Rule R590-191.

(2) An insurer shall determine if a group is an eligible group or a discretionary group.

(a) Eligible Group.

(i) A filing for an eligible group shall include a Utah Life and Annuity Group Questionnaire.

(ii) A questionnaire shall be completed for each eligible group under Sections 31A-22-501.1 through 31A-22-508.

(iii) When a filing applies to more than one employer or employee group, only one questionnaire is required.

(b) Discretionary Group.

(i) If a group is not an eligible group, specific discretionary group authorization shall be obtained.

(ii) If a filing is submitted without discretionary group authorization, the filing shall be rejected.

(iii) To obtain discretionary group authorization, a compliant Utah Life and Annuity Request for Discretionary Group Authorization shall be submitted.

(d) The commissioner may periodically re-evaluate a group's authorization.

(e) An insurer shall file a separate discretionary group authorization to add another TOI to a previously authorized group.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-9 Additional Procedures for Variable Annuity Filings

(1) An insurer submitting a variable annuity filing shall comply with:

(a) Section 31A-22-411; and

(b) Rule R590-133.

(2) An insurer submitting a variable annuity contract shall certify it has:

(a) a variable contract line of authority; and

(b) a separate account established in the state of domicile.

(3) Actuarial Memorandum.

(a) An actuarial memorandum shall be included in a variable annuity filing.

(b) An actuarial memorandum shall:

(i) describe the type of accounts available in the contract; and

(ii) identify the accounts that are separate accounts, including modified guaranteed annuities and general accounts.

(c) The actuarial memorandum shall describe all contract provisions in detail, including all guaranteed and non- guaranteed elements that may affect the value.

(d) The actuarial memorandum shall include a demonstration of compliance with nonforfeiture law and shall:

(i) identify and describe all guaranteed factors that affect values, including:

(A) the guaranteed minimum interest rate for a fixed account, if applicable; and

(B) the maximum surrender charges and loads; and

(ii) numerically demonstrate compliance with:

(A) Section 31A-22-409 for a fixed interest general account; and

(B) Section 31A-22-411 for a variable annuity.

(e) An actuarial memorandum shall include a certification of compliance with applicable nonforfeiture and valuation laws by a qualified actuary.

(4) A rider or an endorsement that provides a benefit, such as a guaranteed minimum death benefit or guaranteed minimum withdrawal benefit, shall be filed and shall include an actuarial memorandum.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-10 Classification of Documents

(1) A record submitted under this rule is subject to Title 63G, Chapter 2, Government Records Access and Management Act.

(2) A record may be classified as protected if:

(a) requested under Section 63G-2-309;

(b) the request in Subsection (2)(a) includes each required element of Subsections 63G-2-309(1)(a)(i)(A) and 63G-2- 309(1)(a)(i)(B); and

(3) A filing may not be reopened to reclassify a previously filed document.

(4) A pattern of requesting that non-qualifying documents be protected, including putting both protected and public information in one document, may violate this rule.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-11 Objection Letter and Disposition Procedures

(1) Response to a Filing Objection Letter. A response to a filing objection letter shall:

(a) be provided in SERFF under the filing correspondence tab;

(b) address each objection;

(d) include an underline and strikeout version of each revised document;

(e) provide a final version of the revised document, incorporating all changes;

(f) attach each document under the appropriate tab; and

(g) reference any additional document attached under the supporting documentation tab if the content is not included in the response.

(2) Order to Prohibit Use.

(a) An order to prohibit use is final 15 days after the date of the order to prohibit use.

(b) A filing that is prohibited pursuant to an order to prohibit use shall be discontinued by the date specified in the order to prohibit use.

(c) To contest an order to prohibit use, the insurer shall request a hearing, in writing, no later than 15 days after the date of the order to prohibit use.

(d) Notwithstanding Subsection (c), an insurer may submit a resubmission that shall:

(i) make the requested changes addressed in the filing objection letter; and

(ii) reference the previously prohibited filing.

(3) Filing Rejection.

(a) An insurer may submit a resubmission.

(b) A resubmission shall reference the previously rejected filing.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-227-12 Severability

If any provision of this rule, Rule R590-227, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: annuity insurance filings
Date of Last Change: May 1, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

R590-228 Submitting Credit Life and Credit Accident and Health Insurance Filings

Utah Admin. Code R590-228-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-201.1.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-2 Purpose and Scope

(1) The purpose of this rule is to establish procedures for submitting a credit life insurance or credit accident and health insurance filing.

(2) This rule applies to an insurer offering credit life insurance or credit accident and health insurance, including group credit life insurance or group credit accident and health insurance issued to a nonresident policyholder, when a Utah resident is provided coverage under the policy.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-802. Additional terms are defined as follows:

(1) "Certification" means a statement that a submitted filing is compliant.

(2) "Compliant" means a filing that is complete and complies with Title 31A, Insurance Code, and Title R590, Administration.

(3) "Electronic filing" means a filing submitted using SERFF.

(4) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(5) "File for approval" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is approved.

(6) "Filing objection letter" means a letter issued by the commissioner when a review of the filing determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(7) "Letter of authorization" means a letter signed by an officer of the insurer giving authority to a third-party to submit a filing on behalf of the insurer.

(8) "NAIC Product Coding Matrix" means a numerical coding system developed by the NAIC that provides uniform naming convention, uniform terminology, and uniform description for a type of insurance product in a filing.

(9) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(10) "Qualified actuary" means an individual who is qualified to sign the applicable state of actuarial opinion in accordance with the American Academy of Actuaries qualification standards.

(11) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the insurer stating the reason for rejection; and

(12) "Resubmission" means a correction, modification, or replacement of a previously rejected, withdrawn, or prohibited filing.

(13) "SERFF" means the System for Electronic Rate and Form Filing.

(14) "Type of insurance" or "TOI" means:

(a) a specific credit life insurance or credit accident and health insurance product identified by the NAIC Product Coding Matrix including gross decreasing term, net decreasing term, level term, open end, closed end, single premium, or truncated coverage; and

(b) a TOI that can be selected in SERFF when submitting a filing in Utah.

(15) "Utah filing date" means the date the department indicates a paper filing is accepted.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-4 General Filing Information

(1)(a) A filing shall be accurate, consistent, complete, and contain all required documents.

(b) The commissioner may request additional information, as necessary.

(2)(a) An insurer is responsible for assuring that any document in a filing is compliant.

(b) A filing that is not compliant is subject to regulatory action.

(3)(a) A filing that is not compliant may be rejected.

(b) A rejected filing:

(i) may be resubmitted under a new filing; and

(ii) may not be reopened for purposes of resubmission.

(4) A prior filing will not be researched to determine the purpose of the current filing.

(5) The department does not review every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) when a complaint is received;

(iii) during a regulatory examination or investigation; or

(iv) when the department considers a review necessary.

(b) If a filing is reviewed and is found not compliant, the commissioner:

(i) shall issue a filing objection letter or an order to prohibit use; and

(ii) may require the insurer to disclose deficiencies in a form or a rating practice to each affected insured.

(6)(a) A correction to a filing that is in an open status may be made at any time.

(b) A correction to a filing that is in a closed status:

(i) may not be made;

(ii) requires a new filing; and

(iii) shall reference the original filing in the filing description.

(7) An insurer shall notify the department when discontinuing or withdrawing a previously filed form, rate, or supplementary information.

(8) If the Utah filed date is used for compliance with this rule, a complete copy with all subsequent amendments, including the Utah filed date, shall be attached as a supporting document.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-5 Filing Submission Requirements

(1) General Filing Requirements.

(a) A filing shall be submitted:

(i) electronically through SERFF; and

(ii) using the NAIC Product Coding Matrix, including the:

(A) TOI; and

(B) sub-TOI.

(b) A filing may not include more than one:

(i) TOI; or

(ii) insurer.

(2) SERFF Filing.

(a) Filing Description. The filing description on the general information tab shall contain the following information, in the sequence listed.

(i) Provide a summary, including:

(A) the intent of the filing; and

(B) the purpose of each document within the filing.

(ii) Indicate if the filing:

(A) is a first-time filing;

(B) is a new form revising an existing form;

(D) is a resubmission that includes a summary of the changes made and the previous filing's Utah filed date or SERFF tracking number;

(E) includes informational documents, referencing the Utah filed date or SERFF tracking number; or

(F) does not include the policy, and if so, provide the Utah filed date or SERFF tracking number of the policy and each amendment, summarizing the effect on the policy.

(iii) Identify any provision that is unusual, innovative, controversial, or that was previously objected to or prohibited, and explain why the provision is included in the filing.

(iv) List the range of minimum and maximum ages for which the policy will be issued.

(v) Identify the type and duration of any loan to be insured.

(b) Filing Certification.

(i) The insurer shall certify that a filing and all related documents are compliant.

(iii) The Utah Credit Life and Credit Accident and Health Filing Certification shall be attached to the supporting documentation tab.

(iv) A filing may be rejected if the filing certification is false, missing, or incomplete.

(v) A false certification may subject the insurer to administrative action.

(c) Domiciliary Approval and Filing Status Information. A filing for a foreign insurer shall include on the supporting documentation tab:

(i) filing status information including:

(A) a list of states where a similar filing is submitted;

(B) the date of submission; and

(ii) if the filing is specific to Utah and only filed in Utah, include:

(A) the phrase "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE"; and

(B) the reason the filing is only filed in Utah.

(d) Letter of Authorization.

(i) A filing submitted by a third party shall have a letter of authorization from the insurer attached to the supporting documentation tab.

(ii) The insurer is responsible for the filing being compliant.

(e) Variable Data.

(i)(A) Variable data is denoted by brackets and is defined either by embedding the variable data in the form or in a separate form with a unique form number and an edition date.

(B) Variable data submitted as a separate form shall be in a manner that follows the construction of the form, by page and paragraph, or page and footnote.

(ii) A certification statement of variability shall be attached to the supporting documentation tab and shall certify that:

(A) the final form does not contain brackets;

(B) the use of variable data is administered in a uniform and non-discriminatory manner and will not result in unfair discrimination;

(D) any changes to variable data shall be filed prior to implementation.

(iii) Any variation of the variable data shall be disclosed, for example "Deductible is $(xxx.xx) in $(xxx.xx) increments."

(iv) Variable data shall be reasonable, appropriate, and compliant.

(v) The use of unfiled variable data is prohibited.

(f) Items Submitted for Filing.

(i) A form shall be attached to the form schedule tab.

(ii) All rating documentation, including actuarial memoranda and rate schedules, shall be attached to the rate/rule schedule tab.

(g) Underline and Strikethrough. A resubmission or a new form revising an existing form shall include an underline and strikethrough version of the form and the final form on the form schedule tab.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-6 Procedures for Filings

(1) Forms in General.

(a) A form is a file and use filing.

(b) A form shall be identified by a unique form number that may not be variable.

(d) Blank spaces within a form shall be completed to accurately represent the purpose and use.

(i) If the intended market is for a senior age market, the form shall be completed with data representative of senior insureds.

(ii) Any data in a form, including premium rates and benefits, shall be consistent with the actuarial memorandum and rate schedule.

(2) Application Filing.

(a) An application or enrollment form may be submitted as a separate filing or filed with its related policy or certificate filing.

(b) If an application was previously filed or is filed separately, an informal copy of the application shall be included with a policy or certificate filing.

(3) Policy Filings.

(a) Each TOI shall be filed separately.

(b) A policy filing consists of one policy form, including the application, certificate, rider, endorsement, actuarial memorandum, and rate schedule.

(4) Rider or Endorsement Filing.

(a) Related riders or endorsements may be filed together.

(b) A single rider or endorsement that affects multiple forms may be filed if the filing description references each affected form.

(i) a list of each policy form number, title, and Utah filed date or SERFF tracking number; and

(ii) a description of how each rider or endorsement affects the policy.

(d) Unrelated riders or endorsements may not be filed together.

(5) Rates. A rate is a file for approval filing.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-7 Additional Procedures for Credit Life and Credit Accident and Health Form and Rate Filings

(1) An insurer filing a credit life or a credit accident and health form shall comply with:

(a) Title 31A, Chapter 21, Insurance Contracts in General;

(b) Title 31A, Chapter 22, Part 4, Life Insurance and Annuities;

(d) Title 31A, Chapter 22, Part 6, Accident and Health Insurance;

(e) Title 31A, Chapter 22, Part 7, Group Accident and Health Insurance;

(f) Title 31A, Chapter 22, Part 8, Credit Life and Accident and Health;

(g) Rule R590-91;

(h) Rule R590-191; and

(i) Rule R590-192.

(2)(a) A credit life or credit accident and health insurance policy, rider, or endorsement affecting a benefit shall be accompanied by a rate filing.

(b) A rate filing is not required if the form filing does not impact the rate, however the filing description shall explain the reason there is not a change in the rate.

(3) Actuarial Memorandum.

(a) An actuarial memorandum shall be included in a credit life and credit accident and health insurance rate filing.

(b) An actuarial memorandum shall demonstrate compliance with Section 31A-22-807.

(i) type of coverage, such as gross or net, level or decreasing, single or joint life, full term or truncated, or critical period;

(ii) type of loan to be insured, such as open end or closed end;

(iii) type of premium charge, such as single premium, monthly outstanding balance, or another method explained in detail;

(iv) duration of loan and duration of coverage;

(v) rates per unit, ratings, and premium methodologies, including;

(A) formulas used for each type of coverage and premium method; and

(B) sample calculations for each type of coverage and premium method;

(vi) refund method and calculation, including formulas for each type of coverage; and

(vii) reserve bases, including methods used.

(d)(i) An actuarial memorandum shall include certification of compliance with Section 31A-22-807 by a qualified actuary.

(ii) The certification shall confirm that the formulas and methods used produce rates that are compliant for each type of coverage and duration in the filing.

(4) Rate Schedules.

(a) A rate schedule shall be included for:

(i) each type of coverage; and

(ii) representative durations.

(b) Rates shall be identified as:

(i) prima facie rates;

(ii) deviated rates submitted pursuant to Section 31A-22-807; or

(iii) rates on nonstandard coverage pursuant to Subsection R590-91-6(1).

(5)(a) Each benefit shall be reasonable in relation to the premium charge.

(b) An insurer filing for approval of a rate higher than a prima facie rate shall comply with:

(i) Section 31A-22-807; and

(ii) Section R590-91-11.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-8 Classification of Documents

(1) A record submitted under this rule is subject to Title 63G, Chapter 2, Government Records and Access Management Act.

(2) A record may be classified as protected if

(a) requested under Section 63G-2-309;

(b) the request in Subsection (2)(a) includes each required element of Subsections 63G-2-309(1)(a)(i)(A) and 63G-2- 309(1)(a)(i)(B); and

(3) A filing may not be reopened to reclassify a previously filed document.

(4) A pattern of requesting that non-qualifying documents be protected, including putting both protected and public information in one document, may violate this rule.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-9 Objection Letter and Disposition Procedures

(1) Response to a Filing Objection Letter. A response to a filing objection letter shall:

(a) be provided in SERFF under the filing correspondence tab;

(b) address each objection;

(d) include an underline and strikethrough version of each revised document;

(e) provide a final version of the revised document, incorporating all changes;

(f) attach each document under the appropriate tab; and

(g) reference any additional document attached under the supporting documentation tab if the content is not included in the response.

(2) Order to Prohibit Use.

(a) An order to prohibit use is final 15 days after the date of the order to prohibit use.

(b) A filing that is prohibited pursuant to an order to prohibit use shall be discontinued by the date specified in the order to prohibit use.

(c) To contest an order to prohibit use, the insurer shall request a hearing, in writing, no later than 15 days after the date of the order to prohibit use.

(d) Notwithstanding Subsection (2)(c), an insurer may submit a resubmission that shall:

(i) make the requested changes addressed in the filing objection letter; and

(ii) reference the previously prohibited filing.

(3) Filing Rejection.

(a) An insurer may submit a resubmission.

(b) A resubmission shall reference the previously rejected filing.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

Utah Admin. Code R590-228-10 Severability

If any provision of this rule, Rule R590-228, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: credit insurance filings
Date of Last Change: October 16, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202

R590-229 Annuity Disclosure

Utah Admin. Code R590-229-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-425.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-229-2 Purpose and Scope

(1) The purpose of this rule is to provide a standard for the disclosure of information in connection with the sale of an annuity contract to protect a consumer and foster consumer education.

(2) This rule applies to an insurer when offering an individual or group annuity contract or certificate except:

(a) a registered or non-registered variable annuity or other registered product;

(b) a structured settlement annuity;

(d) an annuity used to fund:

(i) an employee pension plan that is covered by the Employee Retirement Income Security Act (ERISA);

(ii) a plan described by Section 401(a), 401(k), or 403(b) of the Internal Revenue Code where the plan is established or maintained by an employer;

(iii) a government or church plan defined in Section 414, Internal Revenue Code;

(iv) a deferred compensation plan of a state, a local government, or a tax-exempt organization under Section 457, Internal Revenue Code; or

(v) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.

(3) Notwithstanding Subsection (2)(d), this rule applies to an annuity used to fund a plan or arrangement that:

(a) is funded only by contributions an employee elects to make on a pre-tax or after-tax basis; and

(b) where there is direct solicitation of an individual employee by a producer for the purchase of an annuity contract.

(4) An immediate or deferred annuity that does not contain a nonguaranteed element is exempt from the disclosure document requirement of this rule.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-229-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Buyer's guide" means a document that contains, and is limited to, the language contained in the "Buyer's Guide for Deferred Annuities," "Buyer's Guide for Deferred Annuities - Fixed," and "Buyer's Guide for Deferred Annuities - Variable" as adopted and periodically amended by the NAIC.

(2) "Contract owner" means the owner named in the annuity contract or certificate holder in the case of a group annuity contract.

(3)(a) "Determinable element" means an element derived from a process or method that is guaranteed at issue and not subject to company discretion, but where the value or amount cannot be determined until some point after issue.

(b) An element is considered determinable if all the underlying elements that go into its calculation are either guaranteed or determinable.

(4)(a) "Direct solicitation" means a personalized solicitation to a specific individual through an insurer or producer that is not a direct-response solicitation.

(b) "Direct solicitation" does not include a group meeting held by a producer solely educating or enrolling individuals or, when initiated by an individual member of the group, assisting with the selection of investment options offered by a single insurer in connection with enrolling that individual.

(5) "Disclosure document" means a document that describes, outlines, and specifies the required information to be provided to a prospective applicant.

(6) "Funding agreement" means an agreement for an insurer to accept and accumulate funds and to make one or more payments at a future date in amounts that are not based on a mortality or morbidity contingency.

(7) "Generic name" means a short title that describes the premium and benefit patterns of an annuity contract, such as "single premium deferred annuity."

(8)(a) "Guaranteed element" means any of the following elements that are guaranteed and determined at issue:

(i) a premium;

(ii) a credited interest rate with applicable bonus;

(iii) a benefit;

(iv) a value;

(v) a non-interest-based credit;

(vi) a charge; or

(vii) an element of a formula used to determine an element in Subsections (9)(a)(i) through (9)(a)(vi).

(b) An element is considered guaranteed if all the underlying elements that go into its calculation are guaranteed.

(9)(a) "Nonguaranteed element" means any of the following elements that are subject to company discretion and are not guaranteed or not determined at issue:

(i) a premium;

(ii) a credited interest rate with applicable bonus;

(iii) a benefit;

(iv) a value;

(v) a non-interest-based credit;

(iv) a charge; or

(vii) an element of a formula used to determine an element in Subsections (10)(a)(i) through (10)(a)(vi).

(b) An element is considered nonguaranteed if any underlying element that goes into its calculation is nonguaranteed.

(10) "Structured settlement annuity" means an annuity that is or would be a "qualified funding asset" as defined in Section 130(d), Internal Revenue Code, but for the fact that it is not owned by an assignee under a qualified assignment.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-229-4 Appropriate Buyer's Guide

(1) The "Buyer's Guide for Deferred Annuities" is the appropriate buyer's guide for an annuity product.

(2) Notwithstanding Subsection (1):

(a) the "Buyer's Guide for Deferred Annuities - Fixed" may be used as the appropriate buyer's guide for a non-variable annuity product; and

(b) the "Buyer's Guide for Deferred Annuities - Variable" may be used as the appropriate buyer's guide for a variable annuity product.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-229-5 Standards for the Disclosure Document and Buyer's Guide

(1)(a) When an application for an annuity contract is taken in a face-to-face meeting, the applicant shall, at or before the time of application, be given both the disclosure document described in Subsection (2) and the appropriate buyer's guide described in Section R590-229-4.

(b) When an application for an annuity contract is not taken in a face-to-face meeting, the applicant shall be sent both the disclosure document described in Subsection (2) and the appropriate buyer's guide described in Section R590-229-4 no later than five business days after the completed application is received by the insurer.

(i) For an application received as a result of a solicitation through the mail:

(A) providing a buyer's guide in the mailing inviting a prospective applicant to apply for an annuity contract shall satisfy the requirement that the appropriate buyer's guide is provided no later than five business days after receipt of the application; and

(B) providing a disclosure document in the mailing inviting a prospective applicant to apply for an annuity contract shall satisfy the requirement that the disclosure document is provided no later than five business days after receipt of the application.

(ii) For an application received via the internet:

(A) making the appropriate buyer's guide available for viewing and printing on the insurer's website shall satisfy the requirement that the appropriate buyer's guide is provided no later than five business days after receipt of the application; and

(B) making the disclosure document available for viewing and printing on the insurer's website shall satisfy the requirement that the disclosure document is provided no later than five business days after receipt of the application.

(c) A solicitation for an annuity contract provided in other than a face-to-face meeting shall include a statement that the prospective applicant can obtain from the insurer a free annuity buyer's guide upon request.

(2) Disclosure document. The following information shall be included in the disclosure document:

(a) the generic name of the contract, the company product name, if different, the form number, and the fact that it is an annuity;

(b) the insurer's name and address;

(c) a description of the contract and its benefits, emphasizing its long-term nature, and examples, as appropriate, including:

(i) the guaranteed, nonguaranteed and determinable elements of the contract, their limitations, and an explanation of how they operate;

(ii) an explanation of the initial crediting rate, specifying any bonus or introductory portion, the duration of the rate and the fact that the rate may change from time to time and is not guaranteed;

(iii) periodic income options, both on a guaranteed and nonguaranteed basis;

(iv) any value reduction caused by a withdrawal from or surrender of the contract;

(v) how the value of the contract can be accessed;

(vi) the death benefit, if available, and how it is calculated;

(vii) a summary of the federal tax status of the contract and any penalty applicable on a withdrawal of a value from the contract; and

(viii) the impact of any rider, such as a long-term care rider;

(d) the specific dollar amount or percentage of any charge or fee shall be listed with an explanation of how it applies; and

(e) information about the current guaranteed rate for a new contract that contains a clear notice that the rate is subject to change.

(3) An insurer shall define terms used in the disclosure document in language that is understandable by a typical person within the segment of the public to which the disclosure document is directed.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-229-6 Report to Contract Owners

(1) The insurer shall provide to a contract owner, at least annually, a report on the status of an annuity contract for:

(a) an annuity in the payout period with changes in nonguaranteed elements; or

(b) a deferred annuity in the accumulation period.

(2) The report shall contain at least the following information:

(a) the beginning and end date of the current report period;

(b) any accumulation or cash surrender value at the end of the previous report period and at the end of the current report period;

(d) the amount of any outstanding loan as of the end of the current report period.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-229-7 Severability

If any provision of this rule, Rule R590-229, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, annuity disclosure
Date of Last Change: November 7, 2024
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

R590-230 Suitability in Annuity Transactions

Utah Admin. Code R590-230-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-425.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) require a producer to act in the best interest of the consumer when making a recommendation of an annuity; and

(b) require an insurer to establish and maintain a system to supervise recommendations so the insurance needs and financial objectives of a consumer at the time of the transaction are effectively addressed.

(2) Nothing herein shall be construed to:

(a) create or imply a private cause of action for a violation of this rule; or

(b) subject a producer to civil liability under the best interest standard of care under Section R590-230-4 or under standards governing the conduct of a fiduciary or a fiduciary relationship.

(3)(a) This rule applies to any sale or recommendation of an annuity.

(b) Unless otherwise specifically included, this rule does not apply to a transaction involving:

(i) a direct response solicitation where there is no recommendation based on information collected from the consumer pursuant to this rule;

(ii) a contract used to fund:

(A) an employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act of 1974, as amended;

(B) a plan described by Section 401(a), 401(k), 403(b), 408(k), or 408(p), Internal Revenue Code, as amended, if established or maintained by an employer;

(C) a government or church plan defined in Section 414, Internal Revenue Code, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under Section 457, Internal Revenue Code; or

(D) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;

(iii) a settlement of or an assumption of liabilities associated with personal injury litigation or any dispute or claim resolution process; or

(iv) a formal prepaid funeral contract.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-3 Definitions

Terms used in this rule are defined in Section 31A-1-301 and Rule R590-93. Additional terms are defined as follows:

(1) "Annuity" means an insurance product under state law that is individually solicited, whether the product is classified as an individual or a group annuity.

(2) "Cash compensation" means a discount, concession, fee, service fee, commission, sales charge, loan, override, or cash benefit received by a producer in connection with the recommendation or sale of an annuity from an insurer, intermediary, or directly from the consumer.

(3) "Comparable standards" means:

(a) with respect to a broker-dealer and a registered representative of a broker-dealer, applicable Securities and Exchange Commission and Financial Industry Regulatory Authority rules pertaining to best interest obligations and supervision of annuity recommendations and sales including, but not limited to, Regulation Best Interest and any amendments or successor regulations;

(b) with respect to an investment adviser registered under federal or state securities laws or an investment adviser representative, the fiduciary duties and all other requirements imposed on an investment adviser or an investment adviser representative by contract or under the Investment Advisers Act of 1940 or applicable state securities law including, but not limited to, the Form ADV and interpretations; and

(c) with respect to a plan fiduciary or a fiduciary, the duties, obligations, prohibitions, and all other requirements attendant to such status under the Employee Retirement Income Security Act or the Internal Revenue Code and any amendments or successor statutes thereto.

(4) "Consumer profile information" means information that is reasonably appropriate to determine whether a recommendation addresses the consumer's financial situation, insurance needs, and financial objectives including, at a minimum, the following:

(a) age;

(b) annual income;

(d) financial situation and needs, including debts and other obligations;

(e) financial experience;

(f) financial objectives;

(g) insurance needs;

(h) financial resources used to fund the annuity;

(i) financial time horizon;

(j) intended use of the annuity;

(k) liquidity needs;

(l) liquid net worth;

(m) risk tolerance, including willingness to accept non-guaranteed elements in the annuity; and

(n) tax status.

(5) "Financial professional" means a producer that is regulated and acting as:

(a) a broker-dealer registered under federal or state securities laws or a registered representative of a broker-dealer;

(b) an investment advisor registered under federal or state securities laws or an investment adviser representative associated with the federal or state registered investment adviser; or

(c) a plan fiduciary under Section 3(21), Employee Retirement Income Security Act, or fiduciary under Section 4975(e)(3), Internal Revenue Code, or any amendments or successor statutes thereto.

(6) "Intermediary" means an entity contracted directly with an insurer or with another entity contracted with an insurer to facilitate the sale of the insurer's annuities by producers.

(7)(a) "Material conflict of interest" means a financial interest of the producer in the sale of an annuity that a reasonable person would expect to influence the impartiality of a recommendation.

(b) "Material conflict of interest" does not include cash compensation or non-cash compensation.

(8) "Non-cash compensation" means any form of compensation that is not cash compensation including, but not limited to, health insurance, office rent, office support, and retirement benefits.

(9)(a) "Non-guaranteed element" means a premium, credited interest rate including any bonus, benefit, value, dividend, non-interest based credit, charge, or elements of formulas used to determine any of these, that are subject to company discretion and are not guaranteed at issue.

(b) An element is non-guaranteed if a non-guaranteed element is used in its calculation.

(10)(a) "Producer" means a person licensed in this state to sell, solicit, or negotiate insurance, including annuities.

(b) "Producer" includes an insurer where no producer is involved.

(11)(a) "Recommendation" means advice provided by a producer to an individual consumer that results, or is intended to result, in a purchase, an exchange, or a replacement of an annuity in accordance with that advice.

(b) "Recommendation" does not include general communication to the public, generalized customer service assistance or administrative support, general educational information and tools, prospectuses, or other product and sales material.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-4 Duties of Insurers and of Producers

(1) Best interest obligations. A producer, when making a recommendation of an annuity, shall act in the best interest of the consumer under the circumstances known at the time the recommendation is made, without placing the producer's or the insurer's financial interest ahead of the consumer's interest. A producer acts in the best interest of the consumer if they satisfy the obligations of this Subsection (1).

(a) Care obligation.

(i) The producer, in making a recommendation shall exercise reasonable diligence, care, and skill to:

(A) know the consumer's financial situation, insurance needs, and financial objectives;

(B) understand the available recommendation options after making a reasonable inquiry into options available to the producer;

(C) have a reasonable basis to believe the recommended option effectively addresses the consumer's financial situation, insurance needs, and financial objectives over the life of the product, as evaluated in light of the consumer profile information; and

(D) communicate the basis or bases of the recommendation.

(ii) The requirements of care obligation:

(A) include making reasonable efforts to obtain consumer profile information from the consumer prior to the recommendation of an annuity;

(B) require a producer to consider the types of products the producer is authorized and licensed to recommend or sell that address the consumer's financial situation, insurance needs, and financial objectives;

(C) include having a reasonable basis to believe the consumer would benefit from certain features of the annuity, such as annuitization, death or living benefit, or other insurance-related features; and

(D) only create a regulatory obligation as established in this rule.

(iii)(A) The requirements of care obligation do not:

(I) include analysis or consideration of any products outside the authority and license of the producer or other possible alternative products or strategies available in the market at the time of the recommendation;

(II) create a fiduciary obligation or relationship;

(III) mean the annuity with the lowest one-time or multiple occurrence compensation structure shall necessarily be recommended; and

(IV) mean the producer has ongoing monitoring obligations, although such an obligation may be separately owed under the terms of a fiduciary, consulting, investment advising, or financial planning agreement between the consumer and the producer.

(B) The producer shall be held to standards applicable to producers with similar authority and licensure.

(iv) The consumer profile information, characteristics of the insurer, and product costs, rates, benefits, and features are the factors relevant in making a determination whether an annuity effectively addresses the consumer's financial situation, insurance needs, and financial objectives, but the level of importance of each factor under care obligation may vary depending on the facts and circumstances of a particular case, but each factor may not be considered in isolation.

(v) The care obligation applies to the particular annuity as a whole and the underlying subaccounts to which funds are allocated at the time of purchase or exchange of an annuity, rider, and similar product enhancement, if any.

(vi) In the case of an exchange or replacement of an annuity, the producer shall consider the whole transaction, which includes taking into consideration whether:

(A) the consumer will incur a surrender charge, be subject to the commencement of a new surrender period, lose existing benefits, such as death, living, or other contractual benefits, or be subject to increased fees, investment advisory fees, or charges for riders and similar product enhancements;

(B) the replacing product would substantially benefit the consumer in comparison to the replaced product over the life of the product; and

(C) the consumer has had another annuity exchange or replacement and, in particular, an exchange or replacement within the preceding 60 months.

(vii) Nothing in this rule shall be construed to require a producer to obtain a license other than a producer license with the appropriate line of authority to sell, solicit, or negotiate insurance in this state, including any securities license, in order to fulfill the duties and obligations contained in this rule, if the producer does not give advice or provide services that are otherwise subject to securities laws or engage in another activity requiring other professional licenses.

(b) Disclosure obligation.

(i) Before the recommendation or sale of an annuity, the producer shall prominently disclose to the consumer on a form substantially similar to Appendix A of the NAIC Suitability in Annuity Transactions Model Regulation:

(A) a description of the scope and terms of the relationship with the consumer and the role of the producer in the transaction;

(B) an affirmative statement on whether the producer is licensed and authorized to sell the following products:

(I) fixed annuities;

(II) fixed indexed annuities;

(III) variable annuities;

(IV) life insurance;

(V) mutual funds;

(VI) stocks and bonds; and

(VII) certificates of deposit;

(C) an affirmative statement describing the insurers the producer is authorized, contracted, appointed, or otherwise able to sell an insurance product for, using the following descriptions:

(I) one insurer;

(II) from two or more insurers; or

(III) from two or more insurers although primarily contracted with one insurer;

(D) a description of each source and type of cash compensation and non-cash compensation to be received by the producer, including whether the producer is to be compensated for the sale of a recommended annuity by commission as part of the premium or other remuneration received from the insurer, intermediary, or other producer, or by a fee as a result of a contract for advice or consulting services; and

(E) a notice of the consumer's right to request additional information regarding cash compensation described in Subsection (1)(b)(ii).

(ii) Upon request of the consumer or the consumer's designated representative, the producer shall disclose:

(A) a reasonable estimate of the amount of cash compensation to be received by the producer, which may be stated as a range of amounts or percentages; and

(B) whether the cash compensation is a one-time or multiple occurrence amount, and if a multiple occurrence amount, the frequency and amount of the occurrence, which may be stated as a range of amounts or percentages.

(iii) Before or at the time of the recommendation or sale of an annuity, the producer shall have a reasonable basis to believe the consumer has been informed of various features of the annuity, such as the potential surrender period and surrender charge, potential tax penalty if the consumer sells, exchanges, surrenders, or annuitizes the annuity, mortality and expense fees, investment advisory fees, any annual fees, potential charges for and features of riders or other options of the annuity, limitations on interest returns, potential changes in non-guaranteed elements of the annuity, insurance, and investment components and market risk.

(iv) The requirements of the disclosure obligation shall supplement and not replace the disclosure requirements of Rule R590-229.

(c) Conflict of interest obligation. A producer shall identify and avoid or reasonably manage and disclose any material conflict of interest, including a material conflict of interest related to an ownership interest.

(d) Documentation obligation. A producer shall, at the time of recommendation or sale:

(i) make a written record of any recommendation and the basis for the recommendation subject to this rule;

(ii) obtain a consumer signed statement on a form substantially similar to Appendix B of the NAIC Suitability in Annuity Transactions Model Regulation documenting:

(A) a customer's refusal to provide the consumer profile information, if any; and

(B) a customer's understanding of the ramifications of not providing their consumer profile information or providing insufficient consumer profile information; and

(iii) obtain a consumer signed statement on a form substantially similar to Appendix C of the NAIC Suitability in Annuity Transactions Model Regulation acknowledging the annuity transaction is not recommended if a customer decides to enter into an annuity transaction that is not based on the producer's recommendation.

(e) Application of the best interest obligation. Any requirement applicable to a producer under this Subsection (1) shall apply to each producer who has exercised material control or influence in the making of a recommendation and has received direct compensation as a result of the recommendation or sale, regardless of whether the producer has had any direct contact with the consumer. Activities such as providing or delivering marketing or educational materials, product wholesaling or other back office product support, and general supervision of a producer do not, in and of themselves, constitute material control or influence.

(2) Transactions not based on a recommendation.

(a) Except as provided in Subsection (2)(b), a producer is not obligated to a consumer under Subsection (1)(a) related to any annuity transaction if:

(i) no recommendation is made;

(ii) a recommendation was made and was later found to have been prepared based on materially inaccurate information provided by the consumer;

(iii) a consumer refuses to provide relevant consumer profile information and the annuity transaction is not recommended; or

(iv) a consumer decides to enter into an annuity transaction that is not based on a recommendation of the producer.

(b) An insurer's issuance of an annuity subject to Subsection (2)(a) shall be reasonable under the circumstances known to the insurer at the time the annuity is issued.

(3) Supervision system.

(a) Except as permitted under Subsection (2), an insurer may not issue an annuity recommended to a consumer unless there is a reasonable basis to believe the annuity would effectively address the consumer's financial situation, insurance needs, and financial objectives based on the consumer profile information.

(b) An insurer shall establish and maintain a supervision system that is reasonably designed to achieve the insurer's and its producers' compliance with this rule. The supervision system shall include at a minimum the items in this Subsection (3)(b).

(i) The insurer shall establish and maintain reasonable procedures to inform its producers of the requirements of this rule and shall incorporate the requirements of this rule into relevant producer training manuals.

(ii) The insurer shall establish and maintain standards for producer product training and shall establish and maintain reasonable procedures to require its producers to comply with the requirements of Section R590-230-5.

(iii) The insurer shall provide product-specific training and training materials that explain all material features of its annuity products to its producers.

(vi)(A) The insurer shall establish and maintain procedures for the review of each recommendation prior to issuance of an annuity that are designed to ensure there is a reasonable basis to determine that the recommended annuity would effectively address the particular consumer's financial situation, insurance needs, and financial objectives.

(B) The review procedures may apply a screening system for the purpose of identifying selected transactions for additional review and may be accomplished electronically or through other means including, but not limited to, physical review.

(C) An electronic or other system may be designed to require additional review only of those transactions identified for additional review by the selection criteria.

(v)(A) The insurer shall establish and maintain reasonable procedures to detect recommendations that are not in compliance with Subsections (1), (2), (4), and (5) that may include confirmation of the consumer profile information, systematic customer surveys, producer and consumer interviews, confirmation letters, producer statements or attestations, and programs of internal monitoring.

(B) Nothing in this Subsection (3)(a)(v) prevents an insurer from complying with this Subsection (3)(a)(v) by applying sampling procedures, or by confirming the consumer profile information or other required information under this section after issuance or delivery of the annuity.

(vi) The insurer shall establish and maintain reasonable procedures to assess, prior to or upon issuance or delivery of an annuity, whether a producer has provided the consumer the information required under this section.

(vii) The insurer shall establish and maintain reasonable procedures to identify and address suspicious consumer refusals to provide consumer profile information.

(viii)(A) The insurer shall establish and maintain reasonable procedures to identify and eliminate any sales contests, sales quotas, bonuses, and non-cash compensation that are based on the sales of specific annuities within a limited period of time.

(B) The requirements of this Subsection (3)(b)(viii) are not intended to prohibit the receipt of health insurance, office rent, office support, retirement benefits, or other employee benefits by employees if those benefits are not based upon the volume of sales of a specific annuity within a limited period.

(ix) The insurer shall annually provide a written report to senior management, including to the senior manager responsible for audit functions, that details a review, with appropriate testing, reasonably designed to determine the effectiveness of the supervision system, the exceptions found, and corrective action taken or recommended, if any.

(c)(i) Nothing in Subsection (3) restricts an insurer from contracting for the performance of a function, including maintenance of procedures. An insurer is responsible for taking appropriate corrective action and may be subject to sanctions and penalties regardless of whether the insurer contracts for the performance of a function and regardless of the insurer's compliance with Subsection (3)(c)(ii).

(ii) An insurer's supervision system under this Subsection (3) shall include supervision of contractual performance that includes:

(A) monitoring and, as appropriate, conducting audits to assure that the contracted function is properly performed; and

(B) annually obtaining a certification from a senior manager who has responsibility for the contracted function that the manager has a reasonable basis to represent, and does represent, that the function is properly performed.

(d) An insurer is not required to include in its system of supervision:

(i) a producer's recommendations to consumers of products other than the annuities offered by the insurer; or

(ii) consideration of or comparison to options available to the producer or compensation relating to those options other than annuities or other products offered by the insurer.

(4) Prohibited practices. Neither a producer nor an insurer shall dissuade, or attempt to dissuade, a consumer from:

(a) truthfully responding to an insurer's request for confirmation of the consumer profile information;

(b) filing a complaint; or

(5) Safe harbor.

(a)(i) Recommendations and sales of annuities made in compliance with comparable standards shall satisfy the requirements under this rule.

(ii) This Subsection (5) applies to all recommendations and sales of annuities made by financial professionals in compliance with business rules, controls, and procedures that satisfy a comparable standard even if such standard would not otherwise apply to the product or recommendation at issue.

(b) Nothing in Subsection (5)(a) limits the insurer's obligation to comply with Subsection R590-230-4(3), although the insurer may base its analysis on information received from either the financial professional or the entity supervising the financial professional.

(i) monitor the relevant conduct of the financial professional seeking to rely on Subsection (5)(a) or the entity responsible for supervising the financial professional, such as the financial professional's broker-dealer or an investment adviser registered under federal or state securities laws using information collected in the normal course of an insurer's business; and

(ii) provide to the entity responsible for supervising the financial professional seeking to rely on Subsection (5)(a), such as the financial professional's broker-dealer or investment adviser registered under federal or state securities laws, information and reports that are reasonably appropriate to assist such entity to maintain its supervision system.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-5 Producer Training

(1) A producer may not solicit the sale of an annuity product unless the producer has adequate knowledge of the product to recommend the annuity and the producer is in compliance with the insurer's standards for product training.

(2)(a)(i) A producer who engages in the sale of annuity products on or after July 1, 2024, shall complete a one-time approved four credit training course.

(ii) A producer who holds a life insurance line of authority before July 1, 2024, and who desires to sell an annuity shall complete the requirements of this subsection by July 1, 2025.

(iii) A producer that obtains a life insurance line of authority on or after July 1, 2024, may not engage in the sale of an annuity until the required annuity training is completed.

(iv) A producer who completed an approved training course under Subsections (2)(b), (2)(c), and (2)(d) between January 1, 2024 and July 1, 2024, is considered to have met the training requirements under this Subsection (2)(a).

(b) The minimum length of the training under this Subsection (2) shall be sufficient to qualify for at least four continuing education credits but may be longer.

(i) the types of annuities and various classifications of annuities;

(ii) identification of the parties to an annuity;

(iii) how product specific annuity contract features affect consumers;

(iv) the application of income taxation of qualified and non-qualified annuities;

(v) the primary uses of annuities; and

(vi) appropriate standards of conduct, sales practices, replacement, and disclosure requirements.

(d)(i) A provider of a course complying with this section shall cover all topics listed in the prescribed outline and may not present any marketing information or provide training on sales techniques or provide specific information about a particular insurer's products.

(ii) Additional topics may be offered in conjunction with and in addition to the required outline.

(e) A provider of an annuity course complying with this section shall register as a continuing education provider and comply with Section 31A-23a-202 and Rule R590-142.

(f) A producer who, before July 1, 2024, completed an annuity training course that does not meet the standards under Subsections (2)(b), (2)(c), and (2)(d) shall, by July 1, 2025, complete either:

(i) a new four credit approved annuity training course on appropriate sales practices, replacement, and disclosure requirements under the amended provisions of this rule; or

(ii) an additional one-time single credit approved annuity training course on appropriate sales practices, replacement, and disclosure requirements under the amended provisions of this rule.

(g) An annuity training course may be conducted and completed by classroom or self-study methods.

(h) Satisfying the training requirements of another state that are substantially similar to the requirements of this subsection shall satisfy the training requirements.

(i) Satisfying the components of the training requirements of any course or courses with components substantially similar to the requirements of this subsection shall satisfy the training requirements.

(j)(i) An insurer shall verify that a producer has completed the required annuity training course before allowing the producer to sell an annuity product for that insurer.

(ii) An insurer may satisfy its responsibility under this Subsection (2)(j) by obtaining certificates of completion of the training course or obtaining reports provided by database systems or vendors, or from a reasonably reliable commercial database vendor that has a reporting arrangement with approved insurance education providers.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-6 Compliance Mitigation, Penalties, and Enforcement

(1) An insurer is responsible for compliance with this rule. If a violation occurs, either because of the action or inaction of the insurer or its producer, the commissioner may order:

(a) an insurer to take reasonably appropriate corrective action for any consumer harmed by a failure to comply with this rule by the insurer, an entity contracted to perform the insurer's supervisory duties, or by the producer;

(b) a general agency, independent agency, or a producer to take reasonably appropriate corrective action for any consumer harmed by the producer's violation of this rule; and

(2) Any applicable penalty under Section 31A-2-308 for a violation of this rule may be reduced or eliminated if corrective action for the consumer is taken promptly after a violation is discovered or the violation is not part of a pattern or practice.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-7 Records

(1)(a) A licensee shall maintain records of the information collected from the consumer, disclosures made to the consumer, including summaries of oral disclosures, and other information used in making the recommendations that were the basis for insurance transactions for the current calendar year plus three years after the insurance transaction is completed by the insurer.

(b) An insurer may maintain documentation on behalf of a producer.

(2) Records required to be maintained by this rule:

(a) shall be made available to the commissioner upon request; and

(b) may be maintained in paper, photographic, micro-process, magnetic, mechanical, electronic media, or by any process that accurately reproduces the actual document.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-8 Effective Date

The revised provisions of this rule are effective on July 1, 2024.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

Utah Admin. Code R590-230-10 Severability

If any provision of this rule, Rule R590-230, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, annuity suitability
Date of Last Change: June 7, 2024
Notice of Continuation: May 21, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-425

R590-233 Health Benefit Plan Insurance Standards

Utah Admin. Code R590-233-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-22-605, 31A-22- 605.1, 31A-22-623, 31A-22-626, and 31A-23a-402.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) standardize and simplify the terms and coverage of a health benefit plan contract;

(b) facilitate public understanding and comparison of coverage;

(c) prohibit use of a provision that is misleading or confusing in connection with the purchase of coverage or the settlement of a claim;

(d) set minimum coverage requirements; and

(e) provide for full disclosure in the sale of insurance.

(2)(a) Except as excluded in Subsection (2)(b), this rule applies to a health benefit plan contract.

(b) This rule does not apply to a:

(i) health benefit plan issued to an employee group under Section 31A-22-502;

(ii) health benefit plan subject to Rule R590-277; or

(iii) short-term limited duration health insurance contract subject to Rule R590-286.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-625. Additional terms are defined as follows:

(1) "Certificate of completion" means a document issued by the Utah State Board of Education, or a similar organization in another state, to an individual:

(a) who completes an approved course of study not leading to a diploma;

(b) who passes a challenge for the course of study in Subsection (1)(a); or

(2) "Complication of pregnancy" means a disease or condition that is distinct from pregnancy but is adversely affected or caused by pregnancy and is not associated with a normal pregnancy.

(a) "Complication of pregnancy" includes:

(i) acute nephritis;

(ii) nephrosis;

(iii) cardiac decompensation;

(iv) terminated ectopic pregnancy;

(v) spontaneous termination of pregnancy when a viable birth is not possible;

(vi) puerperal infection;

(vii) eclampsia;

(viii) pre-eclampsia; or

(ix) toxemia.

(b) "Complication of pregnancy" does not include:

(i) false labor;

(ii) occasional spotting;

(iii) doctor prescribed rest during pregnancy;

(iv) morning sickness; or

(v) a condition of comparable severity associated with management of a difficult pregnancy.

(3) "Contract" means a policy or certificate.

(4) "Convalescent nursing home," "extended care facility," "hospital," or "skilled nursing facility" means such facility is licensed and operating within the scope of that license.

(5)(a) "Cosmetic surgery" or "reconstructive surgery" means a surgical procedure performed primarily to improve physical appearance.

(b) "Cosmetic surgery" or "reconstructive surgery" does not include surgery that is necessary:

(i) to correct damage caused by injury or sickness;

(ii) for reconstructive treatment following medically necessary surgery;

(iii) to provide or restore normal bodily function; or

(iv) to correct a congenital disorder that has resulted in a functional defect.

(6) "Custodial care" means a plan of care that does not provide treatment for sickness or injury, is for meeting personal needs and maintaining physical condition when there is no prospect of remission or restoration of the patient to a condition when care would not be required, and that may be provided by a person without nursing skills or qualifications.

(7) "Enrollment form" means an application as defined in Section 31A-1-301.

(8) "Experimental treatment" means a medical treatment, service, supply, medication, drug, or other method of therapy or medical practice that is not accepted as a valid course of treatment by the U.S. Food and Drug Administration, the American Medical Association, or the Surgeon General.

(9) "Home health agency" means a public agency, a private organization, or a subdivision of a health care facility that is licensed and operating within the scope of that license.

(10) "Home health aide" means an individual who obtains a certificate of completion, as required by law, that allows performance of:

(a) health care and other related services under the supervision of a registered nurse from the home health agency; or

(b) a simple procedure as an extension of physical, speech, or occupational therapy under the supervision of a licensed therapist.

(11) "Home health care" means a service provided by a home health agency.

(12) "Homemaker" means an individual who cares for the home through duties such as housekeeping, meal planning and preparation, laundry, shopping, and errands.

(13) "Hospice" means a program of care for the terminally ill and their families that occurs in a home or health care facility and provides medical, palliative, psychological, spiritual, or supportive care and treatment and is licensed and operating within the scope of that license.

(14)(a) "Injury" means a bodily injury resulting from an accident, independent of disease, that occurs while the coverage is in force.

(b) "Injury" is not limited to an injury with external, violent, visible wound, or similar description.

(15) "Intermediate nursing care" means a nursing service provided by, or under the supervision of, a nurse to treat a condition when confinement is required.

(16) "Licensed practical nurse" means a licensed practical nurse who provides services within the scope of their license.

(17)(a) "Medical necessity" means a health care service or product that a prudent health care provider would provide to a patient to prevent, diagnose, or treat an illness, injury, disease, or its symptoms in a manner that is:

(i) in accordance with generally accepted standards of medical practice in the United States;

(ii) clinically appropriate in terms of type, frequency, extent, site, and duration;

(iii) not primarily for the convenience of the patient, physician, or other health care provider; and

(iv) covered under the contract.

(c)(i) For an intervention not yet in widespread use, the effectiveness shall be based on scientific evidence.

(ii) For an established intervention, the effectiveness shall be based on:

(A) scientific evidence;

(B) professional standards; and

(18)(a) "Nurse" means a type of licensed nurse, such as a registered nurse or a licensed practical nurse.

(19) "Nursing care" means assistance provided for the health care needs of a sick or disabled individual, by or under the direction of a nurse.

(20) "Physician," "qualified physician," or "licensed physician" means a physician who provides services within the scope of their license.

(21) "Probationary period" or "waiting period" means the length of time following the date of issuance or effective date of the contract before a benefit is paid under the contract.

(22) "Registered nurse" means a registered nurse who provides services within the scope of their license.

(23)(a) "Scientific evidence" means:

(ii) a finding, study, or research conducted by or under the auspices of a federal government agency or nationally recognized federal research institute.

(b) "Scientific evidence" does not include:

(i) published peer-reviewed literature sponsored by:

(A) a pharmaceutical manufacturing company; or

(B) a medical device manufacturer; or

(ii) a single study without other supportable studies.

(24) "Sickness" means illness, disease, or disorder of an enrollee.

(25) "Skilled nursing care" means nursing services provided by, or under the supervision of, a registered nurse to treat the condition for which confinement is required and not for providing intermediate nursing care or custodial care.

(26) "Summary of benefits and coverage" means a written summary of the contract as described under 45 CFR 147.200.

(27) "Therapist" means a professionally trained or licensed individual, such as a physical therapist, occupational therapist, or speech therapist, who is skilled in applying treatment techniques and procedures under the general direction of a physician.

(28)(a) "Total disability" means an individual who:

(i) is not engaged in employment or occupation for which the individual is or becomes qualified by reason of education, training, or experience; and

(ii) is unable to perform each substantial and material duty of the individual's regular occupation.

(29) "Usual and customary" means the most common charge for a similar service, medicine, or supply within the geographical area in which a charge is incurred, considering one or more of the following factors:

(a) the level of skill, extent of training, and experience required to perform the procedure or service;

(b) the length of time required to perform the procedure or service as compared to the length of time required to perform a similar service;

(d) the amount charged for the same or comparable service, medicine, or supply in the geographical area or in other parts of the country;

(e) the cost to the provider of providing the service, medicine, or supply; or

(f) another factor determined by the insurer to be appropriate.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-4 Prohibited Contract Provisions

(1)(a) A contract may not establish a probationary period when coverage is not provided, except under Subsections (1)(b) and (1)(c).

(b) A contract may specify a probationary period not to exceed 12 months for a loss resulting from:

(i) amenorrhea;

(ii) cataracts;

(iii) a congenital deformity, except as required under Subsection 31A-22-610(2);

(iv) cystocele;

(v) dysmenorrhea;

(vi) enterocele;

(vii) infertility;

(viii) rectocele;

(ix) seasonal allergy, limited to testing and treatment;

(x) sleep disorder, including sleep studies;

(xi) surgical treatment for:

(A) adenoidectomy;

(B) bunionectomy;

(D) hysterectomy, except in a case of malignancy;

(E) joint replacement;

(F) reduction mammoplasty;

(G) Morton's neuroma;

(H) myringotomy and tympanotomy, with or without tubes inserted;

(I) nasal septal repair, except for an injury after the effective date of coverage;

(J) retained hardware removal;

(K) sterilization; and

(L) tonsillectomy;

(xii) urethrocele;

(xiii) uterine prolapse; and

(xiv) varicose veins.

(c) Coverage shall be provided for a disease, condition, or procedure in Subsection (1)(b) if the disease, condition, or procedure is treated on an emergency basis.

(2) Unless otherwise required by law, a contract may not limit or exclude coverage or benefits by type of illness, accident, injury, treatment, or medical condition, except:

(a) abortion;

(b) acupuncture or acupressure;

(c) administrative charge for completing an insurance form, duplication service, interest, finance charge, or other administrative charge;

(d) administrative exam or service;

(e) allergy test or treatment;

(f) applied behavioral analysis therapy, except as required under Section 31A-22-642;

(g) aviation, to a non-fare-paying passenger;

(h) axillary hyperhidrosis;

(i) benefits paid for under:

(i) employer's liability or occupational disease law;

(ii) Medicare or another governmental program, except Medicaid; or

(iii) state or federal workers' compensation;

(j) charge for a missed appointment;

(k) chiropractic care;

(l) complementary or alternative medicine;

(m) corrective lens, including an examination for prescription or fitting, except lens implant following cataract surgery;

(n) cosmetic surgery, including reversal, revision, repair, complication, or treatment related to a non-covered cosmetic surgery, except reconstructive surgery:

(i) when the service is incidental to or follows surgery resulting from trauma, infection, or other disease of the involved part; or

(ii) due to a congenital disease or anomaly of a covered dependent child that resulted in a functional defect;

(o) custodial care;

(p) dental care or treatment;

(q) dietary products, except as required under Rule R590-194;

(r) educational or nutritional training, except as required under Rule R590-200;

(s) expenses before coverage begins or after coverage ends;

(t) experimental or investigational service;

(u) felony, riot, or insurrection, when it is determined the enrollee was a voluntary participant;

(v) fitness training, exercise equipment, or a membership fee to a spa or health club;

(w)(i) foot care for a corn, a callus, a flat foot, a fallen arch, a weak foot, chronic foot strain, or symptomatic complaints of a foot, including an orthotic; and

(ii) the cutting or removal of a corn, a callus, or a nail may not be excluded when provided to an enrollee who has a systemic disease, such as diabetes with peripheral neuropathy or circulatory insufficiency, if unskilled performance of the procedure would be hazardous;

(x)(i) gastric or intestinal bypass service, including lap banding, gastric stapling, or a similar procedure to facilitate weight loss;

(ii) the reversal or revision of a procedure in Subsection (2)(x)(i); or

(iii) a service required for the treatment of a complication from a procedure in Subsection (2)(x)(i);

(y) gender reassignment, except as required under Section 1557 of PPACA;

(z) gene therapy;

(aa) genetic testing;

(bb) hearing aid, including examination for the prescription or fitting;

(cc) infertility service, except as required under Subsection 31A-22-610.1(1);

(dd) injury as a result of a motor vehicle, to the extent the enrollee is required to have no-fault coverage, up to the minimum coverage required by law whether or not coverage is in effect;

(ee) mental health condition or substance use disorder, except as required under 45 CFR 147.160 and Section 31A-22- 625;

(ff) nuclear release;

(gg) preexisting condition, except as required under Section 31A-22-605.1 and Subsection 31A-22-610(2);

(hh) pregnancy, except for a complication of pregnancy;

(ii) refractive eye surgery;

(jj) rehabilitation therapy service, such as physical, speech, and occupational, unless required to correct an impairment caused by a covered accident, injury, or illness;

(kk) respite care;

(ll) rest cure;

(mm) routine physical examination;

(nn) services performed by an enrollee's parent, spouse, sibling, or child, including a step or in-law relationship;

(oo) services performed by an employee of a hospital, laboratory, or other institution;

(pp) services that are not medically necessary;

(qq) services for which no charge is normally made in the absence of insurance;

(rr) services while in the armed forces or an auxiliary unit;

(ss) sexual dysfunction procedure, equipment, or drug;

(tt) shipping or handling;

(uu) suicide, sane or insane, attempted suicide, or intentionally self-inflicted injury;

(vv) telephone or electronic consultation, except as required under Sections 31A-22-649 and 31A-22-649.5;

(ww) territorial limitation outside the United States, except as required under Section 31A-22-627;

(xx) terrorism, including an act of terrorism;

(yy) transplant;

(zz) transportation, except medically necessary ambulance services;

(aaa) war or act of war, whether declared or undeclared;

(bbb) except under Subsection (2)(ccc), a loss directly related to the enrollee's voluntary participation in an activity when the enrollee:

(i) is found guilty of an illegal activity in a criminal proceeding, including a plea of guilty, a no contest plea, and a plea in abeyance; or

(ii) is found liable for the activity in a civil proceeding;

(ccc) a loss established under Subsection (3)(a) that is directly related to the enrollee violating:

(i) Section 41-6a-502, if the loss occurred in Utah; or

(ii) a law in a state other than Utah that prohibits operating a motor vehicle while exceeding the legal limit of concentration of alcohol, drugs, or a combination of both in the blood, if the loss occurred in the other state; or

(ddd) any other exclusion that, in the opinion of the commissioner, is not inequitable, misleading, deceptive, obscure, unjust, unfair, or unfairly discriminatory to an enrollee.

(3)(a) A violation under Subsection (2)(ccc) shall be established:

(i) in a criminal proceeding in which the enrollee is found guilty, enters a no contest plea or a plea in abeyance, or enters into a diversion agreement; or

(ii) by a request for an independent review when the findings support a decision to deny coverage based on the exclusion.

(b)(i) For purposes of Subsection (3)(a)(ii), an independent review means a process that:

(A) is conducted by an independent entity designated by the insurer;

(B) renders an independent and impartial decision on a decision to deny coverage based on the exclusion; and

(ii) The independent review entity may not have a material professional, familial, or financial conflict of interest with:

(A) the insurer;

(B) an officer, director, or management employee of the insurer;

(D) the enrollee's health care provider;

(E) the health care provider's medical group or independent practice association; or

(F) a health care facility where services were provided.

(4)(a) A waiver shall comply with Section 31A-30-107.5.

(b) A signed acceptance by the enrollee is required if a waiver is required as a condition of issuance, renewal, or reinstatement.

(5) A contractual provision precluded in this section may not be construed as a limitation on the commissioner's authority to prohibit a contract provision that, in the opinion of the commissioner, is unjust, unfair, or unfairly discriminatory to an enrollee.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-5 General Requirements

(1) A contract may not include a definition regarding a matter defined in Section R590-233-3 unless the definition complies with that section.

(2) A contract that provides coverage to a spouse of the contract holder:

(a) may not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the contract holder, other than for nonpayment of premium; and

(b) shall provide that in the event of the contract holder's death, the spouse shall become the contract holder.

(3)(a) Termination of a contract shall be without prejudice to any continuous loss that commenced while the contract was in force.

(b) The continuous total disability of the enrollee may be a condition for an extension of benefits beyond the period the contract was in force, limited to the duration of the benefit period, if any, or payment of the maximum benefits.

(4) If a contract includes a status-type military service exclusion or a provision that suspends coverage during military service, the contract shall, upon receipt of a written request, provide for a refund of premiums, as applicable, to the enrollee on a pro-rata basis.

(5)(a) If an insurer cancels or refuses to renew a contract providing pregnancy benefits, the contract shall provide an extension of benefits for the pregnancy benefit, if:

(i) the pregnancy commenced while the contract was in force; and

(ii) a benefit would have been payable had the contract remained in force.

(b) Subsection (5)(a) does not apply to a contract that is canceled due to the enrollee:

(i) failing to pay the required premium in accordance with the contract terms;

(ii) performing an act or practice that constitutes fraud in connection with the coverage; or

(iii) making an intentional misrepresentation of material fact under the terms of the contract.

(6) A contract providing coverage for the recipient in a transplant operation shall also provide reimbursement of all medically necessary transplant expenses of a live donor, to the extent benefits remain and are available under the recipient's contract and after benefits for the recipient's expenses have been paid.

(7) A premium change notice shall be given no less than 45 days before the renewal date.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-6 Required Provisions

(1)(a) An enrollment form question regarding a health condition may not be vague and shall reference a reasonable time frame in relation to the health condition.

(b)(i) A completed application shall be made part of the policy.

(ii) A copy of the completed enrollment form shall be provided to the applicant or enrollee before or at delivery of the contract.

(i) provide a statement regarding a preexisting waiting period and the requirement to receive any applicable credit for previous coverage; and

(ii) include a question regarding whether the insurance to be issued is intended to replace any other accident and health insurance presently in force.

(d) A supplementary enrollment form or other form signed by the applicant or enrollee containing the question in Subsection (1)(c)(ii) may be used.

(2)(a) A contract shall include a provision for renewal, continuation, and nonrenewal.

(b) Each provision shall:

(i) appear on the first page of the contract;

(ii) be appropriately captioned; and

(iii) clearly state the renewability of coverage.

(3)(a) Except for an endorsement by which the insurer effectuates a written request by the contract holder or exercises a specifically reserved right under the contract, signed acceptance by the policyholder is required for an endorsement that reduces or eliminates a benefit or coverage and is added to a contract after the date of issue, at reinstatement, or at renewal.

(b) After the contract issue date, an endorsement that increases a benefit or coverage with a concurrent increase in premium during the contract term shall be agreed to in writing and signed by the contract holder, except if the increased benefit or coverage is required by law.

(4) If a separate additional premium is charged for a benefit provided in connection with an endorsement, the premium charge shall be set forth in the contract.

(5) A contract that provides for the payment of a benefit based on a standard described as usual and customary, reasonable and customary, or similar words, shall include a definition and explanation of the term in its accompanying outline of coverage or benefit summary.

(6)(a) If a contract includes a limitation regarding a preexisting condition, the limitation shall appear as a separate paragraph in the contract and be labeled as "Preexisting Condition Limitation."

(b) The limitation shall include a description of the existence and term of the preexisting condition exclusion, including the maximum preexisting exclusion period.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-7 Accident and Health Benefit Standards

(1)(a) An accident and health insurance contract subject to this rule may not be delivered or issued for delivery unless it meets the required standard for the specified category in this section.

(b) This section does not preclude the issuance of a contract combining two or more categories set forth in Subsection 31A-22-605(5).

(i) inborn metabolic errors, as required by Section 31A-22-623 and Rule R590-194; and

(ii) diabetes, as required by Section 31A-22-636 and Rule R590-200.

(2)(a) Major medical expense coverage provides hospital, medical, and surgical coverage for an expense incurred for a sickness or injury.

(b)(i) A major medical expense contract may include:

(A) a lifetime maximum not less than $1,000,000 per enrollee;

(B) a coinsurance percentage or copay not to exceed 50% of covered charges per enrollee per year;

(D) a deductible on a per enrollee, per family, per illness, per benefit period, or per year basis.

(ii) A combination of the bases in Subsection (2)(b)(i) may not exceed 5% of the lifetime maximum per enrollee.

(i) daily hospital room and board expenses, which may be limited to the average daily cost of the semiprivate room rate in the area where the enrollee resides;

(ii) miscellaneous hospital services and supplies;

(iii) surgical services;

(iv) anesthesia services;

(v) medical services while inpatient;

(vi) outpatient care for physician services provided on an ambulatory basis for:

(A) diagnosis and treatment of a sickness or an injury;

(B) diagnostic x-ray;

(D) radiation therapy; and

(E) hemodialysis ordered by a physician; and

(vii) at least three of the following additional benefits shall also be provided:

(A) inpatient private duty nursing services;

(B) convalescent nursing home care;

(D) medical equipment rental, as defined in the contract;

(E) artificial limbs or eyes, casts, splints, trusses, or braces;

(F) treatment for mental health conditions; or

(G) outpatient prescription drugs and medications.

(d) Benefits may be subject to a deductible, coinsurance, a copay, and the contract exclusion or limitation provisions.

(e) A major medical expense contract may limit a service covered under Subsection (c).

(f) Except under Subsection (2)(e), a major medical expense contract shall cover the usual and customary or reasonable charges, after the deductible, coinsurance, and copay, for a covered service up to the lifetime maximum.

(3) Basic medical expense coverage provides hospital, medical, and surgical coverage for an expense incurred for a sickness or injury.

(a) A basic medical expense contract may include:

(i) a lifetime maximum not less than $500,000 per enrollee;

(ii) a coinsurance percentage or copay not to exceed 50% of covered charges per enrollee per year;

(iii) an out-of-pocket maximum, after a deductible, that does not exceed $25,000 per enrollee per year; or

(iv) a deductible on a per enrollee, per family, per illness, per benefit period, or per year basis.

(b) A combination of the bases in Subsections (1)(a)(ii), (1)(a)(iii), and (1)(a)(iv) may not exceed 10% of the aggregate maximum limit under the contract.

(i) daily hospital room and board expenses that may be limited to the semiprivate room rate in the area where the enrollee resides or another rate agreed to between the insurer and provider, for a period of not less than 31 days during a continuous hospital confinement;

(ii) miscellaneous hospital services and supplies;

(iii) surgical services;

(iv) anesthesia services;

(v) medical services while inpatient;

(vi) outpatient care, for physician services provided on an ambulatory basis for:

(A) diagnosis and treatment of a sickness or an injury;

(B) diagnostic x-ray;

(D) radiation therapy; and

(E) hemodialysis ordered by a physician; and

(vii) three of the following additional benefits shall also be provided:

(A) inpatient private duty nursing services;

(B) convalescent nursing home care;

(D) medical equipment rental, as defined in the contract;

(E) artificial limbs or eyes, casts, splints, trusses, or braces;

(F) treatment for mental health conditions; or

(G) outpatient prescription drugs and medications.

(d) If a basic medical expense contract is to complement an underlying basic hospital expense contract and basic medical-surgical expense contract, the deductible may be increased by the amount of the benefits provided by the underlying contract.

(e) Benefits may be subject to a deductible, coinsurance, a copay, and the contract exclusion or limitation provisions.

(f) A basic medical expense contract may have an internal limitation for:

(i) prescription drugs;

(ii) a nursing facility;

(iii) an intensive care facility;

(iv) a mental health condition or substance abuse treatment;

(v) a transplant;

(vi) experimental treatment;

(vii) a mandated benefit required by law;

(viii) services in Subsection (3)(c); and

(ix) other internal limitations as approved by the commissioner.

(g) Except under Subsection (3)(f), a basic medical expense contract shall cover the usual and customary or reasonable charges, after the deductible, coinsurance, and copay, for a covered service up to the lifetime maximum.

(4) Catastrophic coverage is a contract that:

(a) provides a benefit for a medical expense to a lifetime maximum of not less than $1,000,000 per enrollee;

(b) does not include a separate internal dollar limit;

(c) may be subject to a deductible that does not exceed 2% of the contract limit or the amount of another in-force accident and health insurance contract for the same medical expenses; and

(d) does not include a percentage participation or coinsurance clause for an expense that exceeds the deductible.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-8 Outline of Coverage Requirements

(1) The outline of coverage in Table 1 shall be issued with a major medical expense insurance contract.

TABLE 1

Major Medical Expense Insurance Outline of Coverage

(COMPANY NAME)

MAJOR MEDICAL EXPENSE COVERAGE

OUTLINE OF COVERAGE

Major medical expense coverage is designed to provide, to persons insured, comprehensive coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, inpatient medical services, and out-of-hospital care, subject to any deductible, copayment provisions, or other limitations that may be set forth in the policy.

A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; surgical services; anesthesia services; inpatient medical services; outpatient care; maximum dollar amount for covered charges; and other benefits, if any.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(2) The outline of coverage in Table 2 shall be issued with a basic medical expense insurance contract.

TABLE 2

Basic Medical Expense Insurance Outline of Coverage

(COMPANY NAME)

BASIC MEDICAL EXPENSE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

OUTLINE OF COVERAGE

Basic medical expense coverage is designed to provide, to persons insured, limited coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, inpatient medical services, and outpatient care, subject to any limitations, deductibles and copayment requirements set forth in the policy.

A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; hospital outpatient services; surgical services; anesthesia services; in hospital medical services; and other benefits, if any.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(3) The outline of coverage in Table 3 shall be issued with a catastrophic expense insurance contract.

TABLE 3

Catastrophic Expense Insurance Outline of Coverage

(COMPANY NAME)

CATASTROPHIC EXPENSE COVERAGE

OUTLINE OF COVERAGE

Catastrophic coverage is designed to provide benefits for medical expenses incurred by the insured. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, inpatient medical services, and outpatient care, subject to any deductibles with no separate internal dollar limits.

A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; surgical services; anesthesia services; in hospital medical services; outpatient care; and other benefits, if any.

A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(4) An insurer shall deliver an outline of coverage to an applicant or enrollee before or upon the sale of an individual accident and health insurance contract as required in this rule.

(5) If an outline of coverage was delivered at the time of application or enrollment and the contract is issued on a basis that would require revision of the outline of coverage, a substitute outline of coverage describing the contract shall accompany the contract when it is delivered and shall include the following statement in no less than 12-point font, immediately above the company name, "NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application, and the coverage originally applied for has not been issued."

(6) If the outline of coverage is inappropriate for the coverage provided by the contract, an alternate outline of coverage shall be submitted to the commissioner for prior approval.

(7) An advertisement may fulfill the requirement for an outline of coverage if the advertisement satisfies the standards specified in this rule.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-9 Replacement of Accident and Health Insurance Requirements

(b) The insurer shall retain a copy of the notice.

(2) A direct response insurer shall deliver to the applicant, upon issuance of the contract, the notice in Table 5.

TABLE 4

Notice to Applicant Regarding Replacement of Accident and Health Insurance

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND HEALTH INSURANCE

After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded.

The above "Notice to Applicant" was delivered to me on:

Date:

Applicant's Signature

TABLE 5

Direct Response Notice to Applicant Regarding Replacement of Accident and Health Insurance

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND HEALTH INSURANCE

You may wish to secure the advice of your present insurer or its producer regarding the proposed replacement of your present policy.

This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

COMPANY NAME

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

Utah Admin. Code R590-233-10 Severability

If any provision of this rule, Rule R590-233, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A- 23a-402; 31A-23a-412; 31A-26-301

R590-235 Medicare Prescription Drug Plan

Utah Admin. Code R590-235-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: prescription drug plans
Date of Last Change: December 8, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-235-2 Purpose and Scope

(1) The purpose of this rule is to establish licensing and regulatory requirements for a stand-alone Medicare PDP.

(2) This rule applies to a person that offers a stand-alone Medicare PDP.

History

KEY: prescription drug plans
Date of Last Change: December 8, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-235-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-620, and Rule R590-146. Additional terms are defined as follows:

(1) "Medicare Advantage company" means a company selling a Medicare Advantage plan.

(2)(a) "Stand-alone Medicare PDP" means a Medicare prescription drug plan offered by an insurer or a private company to provide Medicare Part D benefits.

(b) "Stand-alone Medicare PDP" does not mean a Medicare prescription drug plan included in the benefit package offered by a Medicare Advantage company.

History

KEY: prescription drug plans
Date of Last Change: December 8, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-235-4 Licensure and Regulatory Requirements

(1) A stand-alone Medicare PDP sponsor shall be licensed as a risk-bearing entity in the jurisdiction where the sponsor proposes to serve Medicare Part D beneficiaries.

(2) A stand-alone Medicare PDP may be licensed and regulated as either a Utah domiciled health maintenance organization (HMO), a limited health plan, or a Utah domiciled or foreign indemnity insurer.

(a) Regulatory requirements for a Utah domiciled stand-alone Medicare PDP organized as an HMO or limited health plan are established by Title 31A, Chapter 8, Health Maintenance Organizations and Limited Health Plans.

(b) Regulatory requirements for a Utah domiciled stand-alone Medicare PDP organized as an indemnity insurer are established by Title 31A, Chapter 5, Domestic Stock and Mutual Insurance Corporations.

(3) A stand-alone Medicare PDP shall file Quarterly and Annual Statement Blanks pursuant to the instructions provided by the NAIC and in accordance with statutory accounting principles.

(4) A stand-alone Medicare PDP applicant shall apply for licensure using the appropriate NAIC Uniform Certificate of Authority Application form:

(a) Primary Application Form, for a Utah domiciled insurer stand-alone Medicare PDP; or

(b) Expansion Application Form, for a foreign indemnity insurer stand-alone Medicare PDP.

History

KEY: prescription drug plans
Date of Last Change: December 8, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201

Utah Admin. Code R590-235-5 Severability

If any provision of this rule, Rule R590-235, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: prescription drug plans
Date of Last Change: December 8, 2022
Notice of Continuation: April 6, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201

R590-237 Access to a Health Care Provider in a Rural County

Utah Admin. Code R590-237-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-45-501.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) identify each county with a population density of less than 100 people per square mile;

(b) identify independent hospitals;

(d) describe how a managed care organization:

(i) uses the information described in Subsections (1)(a), (b), and (c);

(ii) notifies enrollees, independent hospitals, and federally qualified health centers of the information described in Subsections (1)(a), (b), and (c); and

(iii) provides notice required by Subsection 31A-45-501(8)(d)(ii).

(2) This rule applies to a managed care organization.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-45-102. Additional terms are defined as follows:

(1)(a) "Board of directors" means a local board of directors for an independent hospital that is directly responsible for the daily policy and financial decisions of the hospital.

(b) A board of directors does not include a corporate board of directors for an entity that owns an independent hospital.

(2)(a) "Local practice location" means a provider's office where services are provided.

(b) A local practice location is:

(i) permanently located within a county with a population density of:

(A) less than 100 people per square mile before December 31, 2000; or

(B) less than 30 people per square mile; and

(ii) within 30 miles of paved roads of:

(A) the place where an enrollee lives or resides; or

(B) the location of an independent hospital or federally qualified health center where an enrollee may receive health care services.

(3) "Policy and financial decision" means a day-to-day decision made by a board of directors regarding an independent hospital's policy and financial solvency.

(4) "Provider" means a person who:

(a) furnishes health care directly to an enrollee; and

(b) is licensed or authorized to furnish health care.

(5) "Referral" means:

(a) a request by a health care provider for an item, service, test, or procedure to be performed by another health care provider;

(b) a request by a physician for a consultation with another physician; or

(6) "Rural county" means a county with a population density of less than 100 people per square mile.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-4 Rural Counties

(1) Under Subsection 31A-45-501(8)(c)(ii)(A), a county with a population density of less than 100 people per square mile, as reported by the Utah Office of Vital Statistics as of February 11, 2019, includes each county except:

(a) Cache;

(b) Davis;

(d) Utah; and

(e) Weber.

(2) Under Subsection 31A-45-501(2)(b), a rural county where an independent hospital was built before December 31, 2000, includes each county except:

(a) Davis;

(b) Salt Lake;

(d) Weber.

(3) Under Subsection 31A-45-501(2)(b), a rural county where an independent hospital was built after December 31, 2000, includes each county except;

(a) Cache;

(b) Davis;

(d) Utah;

(e) Washington; and

(f) Weber.

(4) Under Subsection 31A-45-501(6)(b)(i), a non-contracting provider referral to a non-contracting provider is allowed in each county except:

(a) Cache;

(b) Davis;

(d) Utah;

(e) Washington; and

(f) Weber.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-5 Independent Hospitals

The following are independent hospitals under Subsections 31A-45-501(1)(e) and 31A-45-501(2)(b):

(1) Beaver Valley Hospital, Beaver, Beaver County;

(2) Blue Mountain Hospital, Blanding, San Juan County;

(3) Central Valley Medical Center, Nephi, Juab County;

(4) Gunnison Valley Hospital, Gunnison, Sanpete County;

(5) Kane County Hospital, Kanab, Kane County;

(6) Milford Valley Memorial Hospital, Milford, Beaver County;

(7) Moab Regional Hospital, Moab, Grand County;

(8) San Juan Hospital, Monticello, San Juan County; and

(9) Uintah Basin Medical Center, Roosevelt, Duchesne County.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-6 Federally Qualified Health Centers

The following are federally qualified health centers under Subsection 31A-45-501(3)(b):

(1) Bear Lake Community Health Center, Garden City, Rich County;

(2) Bear River Health Clinic, Tremonton, Box Elder County;

(3) Blanding Family Chiropractic, Blanding, San Juan County;

(4) Blanding Family Practice Community Health Center, Blanding, San Juan County;

(5) Blanding Family Vision Center, Blanding, San Juan County;

(6) Box Elder Community Health Center, Brigham City, Box Elder County;

(7) Brigham City Community Health Center, Brigham City, Box Elder County;

(8) Carbon Medical Service Association -- Helper Clinic, Helper, Carbon County;

(9) Carbon Medical Service Association, Sunnyside, Carbon County;

(10) Cedar Community Health Center, Cedar City, Iron County;

(11) Family Healthcare, Cedar City, Iron County;

(12) Green River Medical Center, Green River, Emery County;

(13) Kanosh Community Health Center, Kanosh, Millard County;

(14) Kazan Memorial Clinic, Escalante, Garfield County;

(15) Koosharem Community Health Center, Richfield, Sevier County;

(16) Montezuma Creek Community Health Center, Montezuma Creek, San Juan County;

(17) Mountainlands Community Health Center, Vernal, Uintah County;

(18) Southwest WCHC Mental Health, Panguitch, Garfield County;

(19) Wayne Community Health Center, Hanksville, Wayne County; and

(20) Wayne Community Health Center, Bicknell, Wayne County.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-7 Rural Health Notification

(1) A managed care organization shall provide to an enrollee the notice under Subsection 31A-45-501(8)(d)(ii) no later than:

(a) at the time of enrollment; or

(b) when the group or individual contract and certificate of coverage are issued.

(2) A managed care organization shall provide the notice under Subsection 31A-45-501(8)(d)(ii) upon request thereafter.

(3) The notice shall be easily accessible on the managed care organization's website.

(4) When a rural county, independent hospital, or federally qualified health center is reclassified, the managed care organization shall provide an updated notice to each affected enrollee within 30 days of the change.

(5) When an independent hospital or federally qualified health center is reclassified, a managed care organization shall provide notice to the independent hospital or federally qualified health center within 30 days of the change.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

Utah Admin. Code R590-237-8 Severability

If any provision of this rule, R590-237, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health care providers
Date of Last Change: June 21, 2023
Notice of Continuation: July 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-45-501

R590-238 Captive Insurance Companies

Utah Admin. Code R590-238-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-37-106.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-2 Purpose and Scope

(1) The purpose of this rule is to set forth the financial, reporting, record-keeping, and other requirements for the regulation of captive insurance companies and special purpose financial captive insurance companies.

(2) This rule applies to:

(a) a captive insurance company licensed under Title 31A, Chapter 37, Captive Insurance companies Act; and

(b) a special purpose financial captive insurance company licensed under Title 31A, Chapter 37a, Special Purpose Financial Captive Insurance Company Act.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-37-102, and 31A-37a-102. Additional terms are defined as follows:

(1) "AICPA" means the American Institute of Certified Public Accountants.

(2) "Captive insurance manager" means a person who:

(a) is on the Utah Approved Captive Management Firms list, available on the department's website, https://insurance.utah.gov/captive;

(b) pursuant to a written contract with a company, provides and coordinates services including:

(i) accounting;

(ii) statutory filings;

(iii) signed annual statements; and

(iv) coordination of related services; and

(c) acts as an intermediary that facilitates and assists the company in meeting its statutory requirements under Title 31A, Insurance Code.

(3) "Company" means:

(a) a captive insurance company as defined in Section 31A-1-301; and

(b) a special purpose financial captive insurance company as defined in Section 31A-37a-102.

(4) "GAAP" means generally accepted accounting procedures.

(5) "Work papers" or "working papers" include schedules, analyses, reconciliations, abstracts, memoranda, narratives, flow charts, copies of company records, or other documents prepared or obtained by the accountant and the accountant's employees in the conduct of their audit of the company.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-4 Annual Reporting Requirements

(1) A company shall file an annual report of its financial condition with the commissioner as required by Section 31A- 37-501.

(2) The report required in Subsection (1) shall be:

(a) verified by oath of at least two individuals who are executive officers of the company and by the captive manager or a appointed representative;

(b) prepared using GAAP; and

(3)(a) A company, except for a company under Subsection (3)(b), shall use the Captive Insurance Company Annual Statement Form.

(b) A risk retention group and a special purpose financial captive shall use the NAIC's Annual and Quarterly Statements.

(4) An annual report shall include a Statement of Economic Benefit to the State of Utah that is filed in accordance with Subsection (2)(c).

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-5 Annual Audit

(1) A company shall file the following reports with the commissioner on or before June 30 for the preceding year:

(a) an audit by an independent certified public accountant, approved by the commissioner; and

(b) a Statement of Actuarial Opinion setting forth the qualified actuary's opinion relating to loss and loss adjustment expense reserves.

(2) The audit report and Statement of Actuarial Opinion are part of the company's annual report of financial condition except for the date by which it must be filed with the commissioner.

(3) The annual audit report shall include:

(a) an opinion of an independent certified public accountant that:

(i) includes financial statements examined by the independent certified public accountant in accordance with GAAP, as determined by the AICPA;

(ii) covers all years presented; and

(iii) is on the accountant's stationery showing the address of issuance, date of issuance, and bearing original signatures;

(b) a report of evaluation of internal controls, including:

(i) an evaluation of the methods and procedures used in the securing of assets and the reliability of the financial records, including controls of the system of authorization and approval, and the separation of duties; and

(ii) a review conducted in accordance with GAAP and filed with the commissioner;

(i) that the accountant is independent from the company and conforms to the standards of the accountant's profession as contained in the Code of Professional Ethics and pronouncements of the AICPA and pronouncements of the Financial Accounting Standards Board;

(ii) the general background and experience of the staff engaged in the audit, including their experience in auditing captive or other insurance companies;

(iii) that the accountant understands that the audited annual report and the accountant's opinions thereon will be filed in compliance with this rule;

(iv) that the accountant consents to the requirements of Section R590-238-9;

(v) that the accountant consents and agrees to make the work papers available for review by the commissioner, the commissioner's designee, or the commissioner's appointed agent; and

(vi) that the accountant is properly licensed by an appropriate state licensing authority;

(d) financial statements, including:

(i) a balance sheet;

(ii) a statement of gain or loss from operations;

(iii) a statement of changes in financial position;

(iv) a statement of cash flow;

(v) a statement of changes in capital paid up, gross paid in, and contributed surplus and unassigned funds; and

(vi) notes to financial statements required by GAAP, including:

(A) a reconciliation of any differences between the audited financial report and the statement or form filed with the commissioner;

(B) a summary of ownership and relationship of the company and all affiliated corporations or companies insured by the captive; and

(C) a narrative explanation of each material transaction with the company that involves 3% or more of a company's assets as of the December 31 next preceding; and

(e) a certification of loss reserves and loss expense reserves of the company's opining actuary, including:

(i) an actuarial opinion of the reasonableness of the company's loss reserves and loss expense reserves, unless waived by the commissioner; and

(ii) a certification by the individual who certifies the reasonableness of reserves.

(4) The actuary who certifies the reasonableness of reserves under Subsection (3)(e) shall be:

(a) approved by the commissioner;

(b) a member in good standing of the American Academy of Actuaries; and

(i) the Casualty Actuarial Society, for property and casualty companies; or

(ii) the Society of Actuaries, for life and health companies.

(5) A certification under Subsection (3)(e) shall be in a form prescribed by the commissioner.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-6 Designation of Independent Certified Public Accountant

(1) A company shall appoint an independent certified public accountant retained to conduct the independent annual audit from the list of approved certified public accounting firms or individual certified public accountants maintained by the commissioner.

(2) A company that terminates the appointment of an independent certified public accountant retained to conduct the annual audit required in this rule shall, within 90 days of termination, report to the commissioner in writing:

(a) the name and address of the certified public accountant that is terminated; and

(b) the name and address of the certified public accountant that is subsequently retained.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-7 Notification of Adverse Financial Condition

(1) A company shall require an independent certified public accountant to immediately notify an officer and the board of directors, in writing, of any determination that the company has materially misstated its financial condition in its report to the commissioner.

(2) The company shall notify the commissioner of the adverse financial condition within five business days.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-8 Additional Capital Requirement

(1) If the commissioner determines that the financial condition of a company warrants additional capital, the commissioner may require the company to deposit, in trust for the company:

(a) cash;

(b) a security approved by the commissioner; or

(2) The commissioner shall return the deposit or letter of credit if the company ceases to do business, but only after being satisfied that the company has discharged all of its obligations.

(3) A company may receive interest or dividends from the deposit or exchange of the deposits for another deposit of equal value, upon approval of the commissioner.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-9 Availability and Maintenance of Working Papers of the Independent Certified Public Accountant

(1) A company's independent certified public accountant shall:

(a) make available for review by the commissioner, or the commissioner's appointed agent, all work papers prepared in the conduct of the audit or examination of the company;

(b) retain the work audit papers for a period of not less than seven years after the period reported upon; and

(2) The department may retain photocopies of any working papers.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-10 Documentation Required to be Held in Utah by a Licensed Captive

(1)(a) A company shall maintain and make available for inspection by the commissioner, or the commissioner's appointed agent, all documents pertaining to the formation, operation, management, finances, insurance, and reinsurance of each company.

(b) A company shall keep the original documents in the offices of the company's captive manager, the company's parent, or the company itself.

(2) A company shall hold complete copies of the documents under Subsection (1)(a) in an office located in Utah that is designated by the company and approved by the commissioner.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-11 Reinsurance

(1) A company may take credit for reserves on risks ceded to a reinsurer subject to the following limitations:

(a) credit may not be allowed for reinsurance when the reinsurance contract does not result in the transfer of the risk or liability to the reinsurer; and

(b) credit may not be allowed, as an asset or a deduction from liability, to a ceding insurer for reinsurance unless the reinsurance is payable by the assuming insurer based on the liability of the ceding insurer under the contract reinsured without diminution because of the insolvency of the ceding insurer.

(2) Reinsurance is effected through a written agreement of reinsurance setting forth the terms, provisions, and conditions governing the reinsurance.

(3) The commissioner may require that complete copies of all reinsurance treaties and contracts be filed and approved.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-12 Service Providers

(1) A person may not act, in or from this state, as a captive insurance manager, broker, agent, salesperson, or reinsurance intermediary for captive business without the commissioner's authorization.

(2) An application for authorization shall be on a form prescribed by the commissioner.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-13 Directors and Managers

(1) A company shall report any change in any executive officer, director, or manager to the commissioner within 30 days and shall include in its report a biographical affidavit of any new executive officer, director, or manager.

(2) An officer, director, manager, or employee of a company may not, except on behalf of the company, accept or be the beneficiary of any fee, brokerage, gift, or other emolument because of any investment, loan, deposit, purchase, sale, payment, or exchange made by or for the company.

(3) An officer, director, manager, or employee may receive reasonable compensation for necessary services provided to the company in their usual private, professional, or business capacity.

(4) Any profit or gain received by or on behalf of a person in violation of Subsection (2) shall inure to the company.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-14 Conflict of Interest

(1)(a) A company shall adopt a conflict of interest statement for its directors, managers, and key employees.

(b) The conflict of interest statement shall disclose that the individual has no outside commitments, personal or otherwise, that would divert the individual from the individual's duty to further the interests of the company.

(c) The conflict of interest statement does not preclude an individual from being an officer, director, or manager in more than one insurance company.

(2) Each officer, director, manager, and key employee shall file a yearly disclosure with the board of directors.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-15 Suspension or Revocation

(1) In addition to the grounds in Section 31A-37-505, the commissioner may suspend or revoke the license of a company or place a company on probation for the following reasons:

(a) the company has not commenced business according to its plan of operation within two years of being licensed;

(b) the company ceased to carry on insurance business in or from Utah; or

(2) An action taken by the commissioner shall be in accordance with Title 63G, Chapter 4, Utah Administrative Procedures Act.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-16 Change of Information in Initial Application

(1) A material change in a company's business plan, including changes to lines of coverage and limits filed with the commissioner at the time of initial application, requires prior approval of the commissioner.

(2) A change in any other information filed with the initial application shall be submitted to the commissioner within 60 days, but does not require prior approval.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-17 Application

(1) An application to form a company shall be submitted to the commissioner on the Application to Form a Captive Insurance Company Form.

(2) A complete application including forms, attachments, exhibits, and all other papers and supporting documents shall be filed electronically with the commissioner through the department's website, https://insurance.utah.gov/captive.

(3)(a) The application shall be signed in the manner prescribed on the application form.

(b) If the signature of any person is affixed pursuant to a power of attorney or other similar authority, a copy of the power of attorney or other authority shall also be filed with the application.

(4)(a) A company shall include with its application a feasibility study of the company's business plan.

(b) The department may test the feasibility of the study by examining the company's corporate records, including:

(i) the charter;

(ii) the bylaws and minute books;

(iii) verification of capital and surplus;

(iv) verification of principal place of business;

(v) determination of assets and liabilities; and

(vi) other factors the commissioner considers necessary.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-18 Fee Schedule; Initial Application; Renewal

(1) An applicant for a certificate of authority under Title 31A, Chapter 37, Captive Insurance Companies Act, or Title 31A, Chapter 37a, Special Purpose Financial Captive Insurance Company Act, shall pay to the department, at the time the application is filed, a nonrefundable fee established by the Utah Legislature under Section 63J-1-504.

(2) An applicant may pay fees associated with the application:

(a) in person;

(b) online at https://payment.uid.utah.gov/s/;

(c) by mail, addressed to Office of the Commissioner, Utah Insurance Department, 4315 S. 2700 W., Suite 2300, Taylorsville, UT 84129, Attention: Captive Insurance Administrator; or

(d) by phone at 801-957-9200.

(3) A company shall pay an initial license fee for the initial year of registration and a renewal fee for each succeeding year in the amount annually established by the Utah Legislature under Section 63J-1-504.

(4) A company, except for a captive cell company, shall pay the department a nonrefundable electronic commerce fee in the amount annually established by the Utah Legislature under Section 63J-1-504.

(5) A company shall pay the department other fees annually established by the Utah Legislature under Section 63J-1- 504.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-19 Authorized Forms

(1) An applicant shall use the following forms, available on the department's website, https://insurance.utah.gov/captive, when applying for a certificate of authority for a new company:

(a) Application to Form a Captive Insurance Company;

(b) Appointment of the Insurance Commissioner for the State of Utah as Attorney to Accept Service of Process;

(d) Biographical Affidavit for Captive Insurance Company;

(e) Captive Insurance Company Annual Statement Form;

(f) Statement of Economic Benefit to the State of Utah; and

(g) Utah Approved Irrevocable Letter of Credit.

(2) An applicant shall use the following forms, available on the department's website, https://insurance.utah.gov/captive, when applying to become an approved captive insurance company service provider:

(a) Application for Placement on Approved Captive Insurer Management Firm List;

(b) Application to Certify Loss and Expense for Captive Insurance Companies Captive Actuary Application; and

(3) A company, except as provided under Subsection R590-238-4(2)(b), shall use the Captive Insurance Company Annual Statement Form.

(4) A company shall file a Statement of Economic Benefit to the State of Utah form with its initial application and for each year.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

Utah Admin. Code R590-238-20 Severability

If any provision of this rule, Rule R590-238, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106

R590-239 Exemption of Student Health Centers From Insurance Code

Utah Admin. Code R590-239-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-1-103 and 31A-2-201.

History

KEY: health insurance exemption
Date of Last Change: January 10, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-239-2 Purpose and Scope

(1) The purpose of this rule is to exempt a student health center established by an institution of higher education from regulation under Title 31A, Insurance Code.

(2)(a) This rule applies to a student health center established by an institution of higher education.

(b) This rule does not exempt health insurance from an insurer made available by an institution to its students from Title 31A, Insurance Code, under this rule, even if:

(i) use of the institution's student health center is an integral part of the health care coverage offered to the institution's students under the insurer's policy; or

(ii) the health insurance offered to the institution's students requires that initial treatment for any illness or injury be at the institution's student health center.

History

KEY: health insurance exemption
Date of Last Change: January 10, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-239-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-8-101. Additional terms are defined as follows:

(1) "Board" means the Utah Board of Higher Education established in Section 53B-1-402.

(2) "Eligible recipient" means:

(a) an eligible student;

(b) a spouse of an eligible student;

(d) an officer, faculty member, or employee of the institution; or

(e) upon application by the institution or the institution's student health center, a person approved by written order of the commissioner.

(3) "Eligible student" is as defined by each institution, but shall, at a minimum, require that the student be enrolled with the institution.

(4) "Institution" means an institution of higher education or postsecondary educational institute that consists of the following:

(a) an institution described in Section 53B-1-102; or

(b) an institution of higher education that has been accredited by the Northwest Commission on Colleges and Universities.

(8) "Student health center" means a facility that is operated to provide health care services to an eligible recipient:

(a) by that institution or pursuant to a contract with that institution;

(b) that employs a health care provider, or contracts with a health care provider, that may make a referral to another health care provider;

(c) that is funded, at least in part, by payment from one of the following sources, which payment grants access to the student health center during the period the eligible student is registered:

(i) a fee assessed to and paid by each eligible student at registration; or

(ii) the tuition paid by the eligible student;

(d) that may accept an insurance payment, or assist a user in completing a claim form for an insurance claim; and

(e) that may require an eligible recipient to pay;

(i) an additional fee for each time the student health center is visited;

(ii) an additional fee for a specialty service;

(iii) an additional fee for medical equipment; or

(iv) an additional fee for medication received at the student health center.

History

KEY: health insurance exemption
Date of Last Change: January 10, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-239-4 Findings

Pursuant to Subsection 31A-1-103(3)(d), the commissioner makes the following findings.

(1) Many institutions establish a student health center to provide limited health care to an eligible recipient. A student health center arranges for health care services to be provided by employing a health care provider at the student health center, or by contracting with a health care provider for health care services at the student health center or another facility that may be located in close proximity to the institution's campus. The student health center may also contract with a specialist to come to the student health center on a periodic basis, or to provide a service off-campus when the student health center provides a referral to that specialist.

(2) The operation of the student health center is paid at least in part from funds generated by the tuition of an eligible student or from a fee for that express purpose that each eligible student is required to pay. In return, the eligible student is entitled to limited health care services at the student health center during the ensuing quarter, semester, or school year. An eligible student usually pays a nominal fee each time they use the facility.

(3) A student health center does not provide all basic health care services required of a health maintenance organization but does enter into arrangements with some of the persons listed in the definition of a limited health plan to provide health care services to the institution's eligible recipients. While a student health center is not a health maintenance organization, it does come within the definition of a limited health plan. Unless exempt from regulation by statute or administrative rule, a student health center must comply with Title 31A, Insurance Code.

(4) An institution has an interest in providing an eligible student with basic health care to reduce the possibility that progress toward a degree will be impeded by unattended medical needs. In addition, an institution has an interest in mitigating the potential economic hardships placed on a health care provider directly, and the public in general, from an institution's eligible students receiving medical services and then not being able to pay for those services.

(5) An institution may establish a student health center to meet the basic medical needs of a student, and reduce any potential negative impact on a local health care provider and the public. Other than treating a visitor on campus occasionally on an emergency basis, a student health center provides health care services only to an eligible student or another eligible recipient. Providing a health care service or arranging for a health care service for a student is not the primary purpose of an institution; it is only incidental to the institution's primary purpose, which is to educate those that matriculate with the institution. A student health center is not established to enable the institution to make a profit from providing health care services at the student health center.

(6) An institution is either a state institution under the direct control of, and supervised by, the Board, or it must be accredited by a regional accreditation organization. To be accredited, an institution must meet strict accounting standards, and be able to demonstrate it is financially solid. An institution must therefore comply with the strict accounting and financial requirements of the Board, or of a regional accrediting entity, which would include the need to reflect on the financial statements of the institution the liability for any risks the institution assumes, or costs the institution may incur, for its student health center. Any shortfall in providing health care services at the student health center would become the obligation of the institution. The institution can and must protect itself from financial shortfalls that could cause the providers to be left unpaid, and the students without health care services at the student health center; the institution does this by fixing the institution's liability either by employing the health care providers, or by contracting with health care providers for a fixed fee for the number of hours the health care provider is at the student health center, regardless of the number of patients or students the health care provider might see during that time. Since only limited health care services are provided at the student health center, there is little or no likelihood the institution will need to cover expenses such as major surgery, or extended hospital stays.

History

KEY: health insurance exemption
Date of Last Change: January 10, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-239-5 Rule Exempting a Student Health Center From Title 31A, Insurance Code

Pursuant to Subsection 31A-1-103(3)(d)(i), the commissioner finds that a student health center established by an institution does not require regulation for the protection of the interests of the residents of this state and that a student health center is exempt from regulation under Title 31A, Insurance Code.

History

KEY: health insurance exemption
Date of Last Change: January 10, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-239-6 Severability

If any provision of this rule, Rule R590-239, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance exemption
Date of Last Change: January 10, 2023
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

R590-240 Procedure to Obtain Exemption of Student Health Programs From Insurance Code

Utah Admin. Code R590-240-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-1-103 and 31A-2-201.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-240-2 Purpose and Scope

(1) The purpose of this rule is to create a procedure for a student health program established by an institution of higher education to obtain an exemption from regulation under Title 31A, Insurance Code.

(2)(a) This rule applies to a student health program established by an institution of higher education.

(b) This rule does not exempt from Title 31A, Insurance Code, health insurance from an insurer made available by an institution to its students, even if:

(i) the insurer's policy is integrated into the overall student health program offered by the institution to its students; or

(ii) use of the institution's student health center is an integral, or mandatory, part of health care coverage under the insurer's policy.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-240-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Board" means the Utah Board of Higher Education established in Section 53B-1-402.

(2) "Eligible member" means:

(a) an eligible student;

(b) a spouse of an eligible student; or

(3) "Eligible recipient" means:

(a) an eligible member;

(b) an officer of the institution, a faculty member, or an employee; or

(c) upon application by the institution or the institution's student health center, a person approved by written order of the commissioner.

(4) "Eligible student" is as defined by each institution, but shall, at a minimum, require that the student be enrolled with the institution.

(5) "Institution" means an institution of higher education or postsecondary educational institute that consists of the following:

(a) an institution described in Section 53B-1-102; or

(b) an institution of higher education that has been accredited by the Northwest Commission on Colleges and Universities.

(6) "Student health center" means a facility that:

(a) is operated to provide health care services to an eligible recipient by an institution or pursuant to a contract with that institution;

(b) employs a health care provider, or contracts with a health care provider, which may make a referral to another health care provider;

(c) is funded, at least in part, by payment from one of the following sources, which payment grants access to the student health center during the period the eligible student is registered:

(i) a fee assessed to and paid by each eligible student at registration; or

(ii) the tuition paid by the eligible student;

(d) may accept insurance payments, or assist a user in completing a claim form for an insurance claim; and

(e) may require an eligible recipient to pay an additional fee for:

(i) each time the student health center is visited;

(ii) a specialty service;

(iii) medical equipment; or

(iv) medication received at the student health center.

(7)(a) "Student health program" means a plan organized, established, or adopted by an institution to provide or arrange for health care services for eligible members.

(b) "Student health program" may include coverage for:

(i) limited health care services;

(ii) health care services on an emergency basis; or

(iii) health care services by an out-of-area health care provider under the following situations:

(A) on an emergency basis, where a prudent layperson would expect the absence of immediate medical attention to result in placing the eligible member's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part;

(B) during a period when the individual is not enrolled in any classes at the institution but is still matriculated with the institution, including time between semesters or quarters, traditional breaks for the summer, or time away from the institution while attending another higher education institution under a plan approved by the institution; and

(C) during a period when the individual is enrolled in classes at the institution but is not living within commuting distance of the institution, such as while participating in an internship program.

(8)(a) "Supplemental health care services" means health care services provided by the student health program in addition to those available at a student health center.

(b) "Supplemental health care services" includes health care services provided by contract between:

(i) the institution; and

(ii) any of the following or any combination of the following:

(A) a healthcare provider;

(B) a clinic or other association of healthcare providers;

(D) an insurer authorized to provide health insurance.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-240-4 Findings

Pursuant to Subsection 31A-1-103(3)(d), the commissioner makes the following findings:

(1) A student health program is an insurer as defined in Section 31A-1-301 and shall comply with the requirements of Title 31A, Insurance Code, unless it is exempted from regulation by statute or this rule.

(2) An institution may offer a student health program only to an eligible member at the institution.

(a) An institution has an interest in providing affordable health care coverage to its students to enable the students to receive limited health care to ensure that progress toward a degree or certificate is not impeded by unattended medical needs.

(b) In some instances, an institution may also offer a student health program to a spouse or dependent of a student.

(3) A student health program is not established to enable an institution to make a profit from providing health care coverage.

(a) Providing or arranging for health care services for a student is not the primary purpose of an institution, but rather incidental to the institutions' primary purpose, which is to educate those that matriculate with the institution.

(b) The economic impact on a health care provider directly, and the public indirectly, from students receiving medical services and then not being able to pay for those services, is mitigated by an institution providing its students with access to affordable health care coverage through a student health program.

(4) An institution is either a state institution under the direct control of, and supervised by, the Board, or it is accredited by the Northwest Commission on Colleges and Universities.

(a) To be accredited, an institution shall meet strict accounting standards and be able to demonstrate it is financially solid.

(b) An institution shall comply with the strict accounting and financial requirements of the Board or the Northwest Commission on Colleges and Universities, which include the need to reflect on the financial statements of the institution any liability for risks the institution assumes, or costs the institutions may incur, for its student health program.

(5) A student health program that operates under Section R590-240-5 and obtains an order of exemption under Section R590-240-6 does not require regulation for the protection of the interests of the residents of this state, and is exempt from Title 31A, Insurance Code.

(6) If an institution assumes any risk of a student health program, the institution shall:

(a) apply for a certificate of authority to conduct the business of an insurer; or

(b) apply to the commissioner for an exemption under this rule.

(7) Health insurance from an insurer made available by an institution to its eligible members is not exempt from Title 31A, Insurance Code, under this rule even if the health insurance from a health insurer is integrated into the overall student health program offered by the institution, or use of the institution's student health center is an integral or required part of the health care coverage under the insurer's policy.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-240-5 Exemption Requirements for a Student Health Program

(1) The commissioner may exempt an institution's student health program from Title 31A, Insurance Code, if:

(a) the student health program meets the requirements of this section;

(b) the institution applies for an exemption under Section R590-240-6; and

(2) A student health program shall:

(a) be established by an institution;

(b) have assets that are owned by:

(i) an institution;

(ii) a trust; or

(iii) the trustees, in their fiduciary capacities, of a trust established by an institution; and

(i) an institution; or

(ii) the institution's authorized agent or affiliate.

(3) The primary purpose of the institution shall be higher education, not providing a student health program.

(4) Payment of covered claims of the student health program shall be secured by adequate assets:

(a) that are:

(i) secured by being:

(A) pledged;

(B) guaranteed;

(D) placed in trust; or

(E) a combination of Subsections (4)(a)(i)(A) through (4)(a)(i)(D); and

(ii) secured under Subsection (4)(a)(i) by:

(A) the student health program;

(B) the institution that organizes, adopts, or establishes the student health program;

(D) an affiliate of the entity described in Subsection (4)(a)(ii)(C); or

(E) a combination of the entities described in Subsections (4)(a)(ii)(A) through (4)(a)(ii)(D); and

(b)(i) in an amount and type required under Title 31A, Chapter 17, Determination of Financial Condition; or

(ii) as approved by the commissioner by written order; and

(5) An institution may not offer a student health program to or enroll anyone other than an eligible member.

(6) A student health program shall have a comprehensive legal structure that demonstrates that:

(a) the assets described in Subsection (4) are administered in a fiduciary manner to guarantee that assets are available to provide eligible health care services and to provide payments to health care providers as outlined in any contracts between the student health program and health care providers;

(b) the student health program is administered by an experienced administrator; and

(i)(A)(I) the student health program;

(II) the institution; or

(III) both the student health program and the institution; and

(B) the enrollees; and

(ii)(A)(I) the student health program;

(II) the institution; or

(III) both the student health program and the institution; and

(B) health care providers.

(7) Except for an emergency health care service or an out-of-area or an out-of-country health care provider, a health care service for an enrollee shall be provided:

(a) at a student health center; or

(b) pursuant to a contract with a health care service provider, by which the health care provider provides a health care service upon a referral from the student health center.

(8) A supplemental health care service provided by the student health program shall:

(a) be obtained from an insurer authorized to provide health insurance;

(b) be backed by assets described in Subsection (4); or

(9) A student health program shall provide review procedures substantially similar, and materially equal, to those presently in effect for insurers, health maintenance organizations, and limited health programs.

(10) A student health program or an institution, or both, shall annually provide the department an informational copy of all current policies, booklets, and advertising.

(11) A student health program or an institution, or both, shall state in a prominent and appropriate place in all policies, contracts, booklets, explanatory material, advertising or other promotional material, and any presentations relating to solicitations of the student health program, that the student health program is not insurance and is exempt from Title 31A, Insurance Code, and shall cite the date, docket number, and title of the docket by which the exemption was granted.

(12) A student health program shall reduce any applicable preexisting condition provisions for any individual covered by the student health program by the amount of previous creditable coverage.

(13) A student health program shall provide a certificate of creditable coverage upon request by an individual who was covered by the student health program.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-240-6 Procedure for Obtaining Exemption

(1)(a) An institution seeking to have its student health program exempted from Title 31A, Insurance Code, shall file with the department an application in a form prescribed by the commissioner for an order exempting the student health program, and shall provide verifiable documentation in support of its application, including documentation to support that the exemption requirements in Section R590-240-5 have been met.

(b) The application shall provide assurance that the institution has sufficient assets placed in trust, or otherwise pledged or guaranteed under Section R590-240-5 under conditions acceptable to the commissioner, to meet any liability the institution has for its student health program.

(2) When considering an institution's request for exemption, the commissioner may require the following:

(a) additional evidence or information from the institution;

(b) an examination of the institution's student health program by the department, at the institution's expense; or

(3)(a) Upon a finding that a student health program complies with this rule, the commissioner may issue an order exempting the student health program from Title 31A, Insurance Code.

(b) The commissioner may place any restrictions or conditions upon the exemption the commissioner believes to be necessary to protect the interests of the residents of this state.

(4) A student health program is not exempt from Title 31A, Insurance Code, unless the commissioner has issued a written order explicitly stating the student health program is so exempt.

(5) The department shall retain continuing jurisdiction over an institution's student health program to assure compliance with the terms and conditions in Section R590-240-5, including any changes in the law or the facts upon which the exemption is granted.

(6) Any inconsistencies between this rule and any order previously issued exempting a student health program from Title 31A, Insurance Code, are resolved by incorporating this rule.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

Utah Admin. Code R590-240-7 Severability

If any provision of this rule, Rule R590-240, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance exemptions
Date of Last Change: November 21, 2023
Notice of Continuation: June 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-1-103; 31A-2-201

R590-241 Preferred Mortality Tables to Determine Minimum Reserve Liabilities

Utah Admin. Code R590-241-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-402.

History

KEY: life insurance mortality tables
Date of Last Change: May 26, 2022
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402

Utah Admin. Code R590-241-2 Purpose and Scope

(1) The purpose of this rule is to recognize, permit, and prescribe the use of mortality tables that reflect differences in mortality between preferred and standard lives to determine minimum reserve liabilities under Sections 31A-17-504 and R590- 198-5.

(2) This rule applies to a life insurance company or a fraternal benefit society:

(a) doing business in this state or;

(b) authorized to reinsure life insurance business in this state.

History

KEY: life insurance mortality tables
Date of Last Change: May 26, 2022
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402

Utah Admin. Code R590-241-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "2001 CSO Mortality Table" means the mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC, 2nd Quarter 2002 and is supplemented by the 2001 CSO Preferred Class Structure Mortality Table. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables. Mortality tables in the 2001 CSO Mortality Table include the following:

(a) "2001 CSO Mortality Table (F)" means the mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

(b) "2001 CSO Mortality Table (M)" means the mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

(c) "Composite mortality table" means the mortality table with rates of mortality that do not distinguish between smokers and nonsmokers.

(d) "Smoker and nonsmoker mortality table" means the mortality table with separate rates of mortality for smokers and nonsmokers.

(2) "2001 CSO Preferred Class Structure Mortality Table" means mortality tables with separate rates of mortality for Super Preferred Nonsmokers, Preferred Nonsmokers, Residual Standard Nonsmokers, Preferred Smokers, and Residual Standard Smoker splits of the 2001 CSO Nonsmoker and Smoker tables as adopted by the NAIC at the September 2006 national meeting and published in the Proceedings of the NAIC, 3rd Quarter 2006. Unless the context indicates otherwise, the "2001 CSO Preferred Class Structure Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table. It includes both the smoker and nonsmoker mortality tables. It includes both the male and female mortality tables and the gender composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality table.

(3) "Statistical agent" means an entity with a proven system that:

(a) protects confidential information of:

(i) an insured; and

(ii) an insurer;

(b) demonstrates a history of ongoing electronic communications and data transfer integrity with insurers; and

(c) demonstrates a history of aggregation of data and accurate promulgation of experience modifications in a timely manner.

History

KEY: life insurance mortality tables
Date of Last Change: May 26, 2022
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402

Utah Admin. Code R590-241-4 2001 CSO Preferred Class Structure Table

(1) An insurer, for each calendar year of issue and for a specified plan of insurance, may substitute the 2001 CSO Preferred Class Structure Mortality Table for the 2001 CSO Smoker or Nonsmoker Mortality Table as the minimum valuation standard for a policy issued on or after January 1, 2007.

(2) An insurer may not make the substitution in Subsection (1) unless the insurer demonstrates that at least 20% of the business to be valued on this table is in one or more preferred classes.

(3) A table from the 2001 CSO Preferred Class Structure Mortality Table used in place of a 2001 CSO Mortality Table, shall be treated as part of the 2001 CSO Mortality Table only for purposes of reserve valuation.

History

KEY: life insurance mortality tables
Date of Last Change: May 26, 2022
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402

Utah Admin. Code R590-241-5 Conditions

(1)(a) An insurer offering an insurance plan with separate rates for preferred and standard nonsmoker lives may substitute Super Preferred Nonsmoker, Preferred Nonsmoker, and Residual Standard Nonsmoker tables for the Nonsmoker mortality table found in the 2001 CSO Mortality Table to determine minimum reserves.

(b) At the time of substitution and annually thereafter, except for business valued under the Residual Standard Nonsmoker Table, an appointed actuary shall certify that:

(i) the present value of death benefits over the next ten years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class; and

(ii) the present value of death benefits over the future life of the contracts, using anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.

(2)(a) An insurer offering an insurance plan with separate rates for preferred and standard smoker lives may substitute the Preferred Smoker and Residual Standard Smoker tables for the 2001 CSO Mortality Table to determine minimum reserves.

(b) At the time of substitution and annually thereafter, for business valued under the Preferred Smoker Table, an appointed actuary shall certify that:

(3)(a) Unless exempted by the commissioner, an insurer using the 2001 CSO Preferred Class Structure Table shall annually file with the commissioner or, at the direction of the commissioner, with the NAIC or a statistical agent designated by the NAIC and acceptable to the commissioner, statistical reports showing mortality and other information required by the commissioner.

(b) The reports shall be in a form approved by the commissioner.

History

KEY: life insurance mortality tables
Date of Last Change: May 26, 2022
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402

Utah Admin. Code R590-241-6 Severability

If any provision of this rule, Rule R590-241, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: life insurance mortality tables
Date of Last Change: May 26, 2022
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402

R590-242 Military Sales Practices

Utah Admin. Code R590-242-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-402.

History

KEY: insurance, military sales practices
Date of Last Change: November 21, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-242-2 Purpose and Scope

(1)(a) The purpose of this rule is to set forth standards to protect an active duty service member of the United States Armed Forces from dishonest and predatory insurance sales practices.

(b) Nothing in this rule creates or implies a private cause of action for a violation of this rule.

(2)(a) This rule applies to the solicitation, negotiation, or sale of a life insurance product, including an annuity, by an insurer or insurance producer to an active duty service member of the United States Armed Forces.

(b) This rule does not apply to a solicitation, negotiation, or sale involving:

(i) credit insurance;

(ii) group life insurance or a group annuity where there is no in-person, face-to-face solicitation of individuals by an insurance producer, or where the policy, contract, or certificate does not include a side fund;

(iii) an application to the existing insurer that issued the existing policy or contract when:

(A) a contractual change or a conversion privilege is being exercised;

(B) the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the commissioner; or

(iv) individual stand-alone health insurance, including income insurance;

(v) a contract offered by SGLI or VGLI;

(vi) life insurance offered through or by a nonprofit military association, qualifying under Section 501(c)(23) of the Internal Revenue Code, and that is not underwritten by an insurer; or

(vii) a contract used to fund:

(A) an employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act;

(B) a plan described by Section 401(a), 401(k), 403(b), 408(k), or 408(p) of the Internal Revenue Code, as amended, if established or maintained by an employer;

(C) a government or church plan defined in Section 414 of the Internal Revenue Code, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under Section 457 of the Internal Revenue Code;

(D) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;

(E) a settlement of or assumption of liabilities associated with personal injury litigation or any dispute or claim resolution process; or

(F) a prearranged funeral contract.

(c) This rule does not prohibit a nonprofit organization from educating a member of the United States Armed Forces in accordance with the DOD Instruction 1344.07 - Personal Commercial Solicitation on DOD Installations or a successor directive.

History

KEY: insurance, military sales practices
Date of Last Change: November 21, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-242-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "Active duty" means full-time duty in the active military service of the United States including members of the National Guard and Reserve, while serving under published orders for active duty or full-time training.

(b) "Active duty" does not include members of the reserve component who are performing active duty or active duty for training under military calls or orders specifying periods of less than 31 calendar days.

(2) "Department of Defense personnel" and "DOD personnel" mean all active duty service members and all civilian employees, including nonappropriated fund employees and special government employees, of the DOD.

(3) "DOD" means the U.S. Department of Defense.

(4) "Door to door" means a solicitation or sales method where an insurance producer proceeds randomly or selectively from household to household without a specific appointment.

(5) "General advertisement" means an advertisement with its purpose being the promotion of the reader's or viewer's interest in the concept of insurance, the promotion of the insurer, or the promotion of an insurance producer.

(6) "Known" or "knowingly" means, depending on its usage, an insurance producer or insurer having actual awareness, or in the exercise of ordinary care should have known that the person solicited:

(a) is a service member; or

(b) is a service member with a pay grade of E-4 or below.

(7) "Insurable needs" means the risks associated with premature death, taking into consideration the financial obligations and immediate and future cash needs of the applicant's estate, survivors or dependents.

(8) "Military installation" means a federally owned, leased, or operated base, reservation, post, camp, building, or other facility to which service members are assigned for duty, including barracks, transient housing, and family quarters.

(9) "MyPay" means the Defense Finance and Accounting Service web-based system that enables service members to process certain discretionary pay transactions or provide updates to personal information data elements without using paper forms.

(10) "Other military survivor benefits" includes the following benefits:

(a) the death gratuity;

(b) funeral reimbursement;

(d) survivor and dependents' educational assistance;

(e) dependency and indemnity compensation;

(f) TRICARE healthcare benefits;

(g) survivor housing benefits and allowance;

(h) federal income tax forgiveness; and

(i) Social Security survivor benefits.

(11) "SGLI" means Servicemembers' Group Life Insurance as authorized by 38 U.S.C. Section 1965 et seq.

(12) "Service member" means an active duty officer, commissioned and warrant, or enlisted member of the United States Armed Forces.

(13)(a) "Side fund" means a fund or reserve that is part of, or otherwise attached to, a life insurance policy, except for individually issued annuities, by rider, endorsement, or other mechanism that accumulates premium or deposits with interest or by other means.

(b) "Side fund" does not include:

(i) accumulated value, cash value, or secondary guarantees provided by a universal life policy;

(ii) cash value provided by a whole life policy subject to standard nonforfeiture law for life insurance; or

(iii) a premium deposit fund that:

(A) contains only premiums paid in advance that accumulate interest;

(B) imposes no penalty for withdrawal;

(D) is not marketed or intended as an investment; and

(E) does not carry a commission, either paid or calculated.

(14)(a) "Solicitation" means an offer to a person in this state, either directly or through a third party, to effect insurance.

(b) "Solicitation" does not mean:

(i) a general advertisement;

(ii) a direct mailing;

(iii) internet marketing; or

(iv) telephone marketing, provided the caller explicitly and conspicuously discloses that the product that is the subject of the call is life insurance.

(15) "Specific appointment" means a prearranged appointment agreed upon by both parties and definite as to place and time.

(16) "United States Armed Forces" means all components of the Army, Navy, Air Force, Marine Corps, and Coast Guard.

(17) "VGLI" means Veterans' Group Life Insurance as authorized by 38 U.S.C. Section 1965 et seq.

History

KEY: insurance, military sales practices
Date of Last Change: November 21, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-242-4 False, Misleading, Deceptive, or Unfair Practices on a Military Installation

(1) The acts or practices in this Subsection (1), when committed on a military installation by an insurer or insurance producer during an in-person, face-to-face solicitation, negotiation, or sale of life insurance, are false, misleading, deceptive, or unfair.

(a) Knowingly soliciting the purchase of a life insurance product door to door, or without first establishing a specific appointment with a prospective purchaser.

(b) Soliciting service members in a group, mass, or captive audience where attendance is not voluntary.

(c) Knowingly making an appointment with or soliciting a service member during the service member's normally scheduled duty hours.

(d) Making an appointment with or soliciting a service member in barracks, day rooms, unit areas, transient personnel housing, or other areas where the installation commander prohibits solicitation.

(e) Soliciting the sale of life insurance without first obtaining permission from the installation commander or the commander's designee.

(f) Posting an unauthorized bulletin, notice, or advertisement on a military installation.

(g) Failing to present DD Form 2885, Personal Commercial Solicitation Evaluation, to a solicited service member or encouraging a solicited service member not to complete or submit DD Form 2885.

(h) Knowingly accepting an application for life insurance or issuing a life insurance policy on the life of an enlisted member of the United States Armed Forces without first obtaining a completed copy of any required form confirming that the applicant received counseling or fulfilled any other similar requirement for the sale of life insurance established by regulations, directives, or rules of the DOD or any branch of the United States Armed Forces.

(2) An act or practice in this Subsection (2), when committed on a military installation by an insurer or insurance producer is a corrupt practice, improper influence, or inducement that is false, misleading, deceptive, or unfair.

(a) Using DOD personnel, directly or indirectly, as a representative or agent in an official or business capacity, with or without compensation, regarding the solicitation or sale of life insurance to any service member.

(b) Using an insurance producer to participate in any United States Armed Forces sponsored education or orientation program.

History

KEY: insurance, military sales practices
Date of Last Change: November 21, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-242-5 False, Misleading, Deceptive, or Unfair Practices Regardless of Location

(1) The acts or practices by an insurer or insurance producer in this Subsection (1) are corrupt practices, improper influences, or inducements that are false, misleading, deceptive, or unfair.

(a)(i) Submitting, processing, or assisting in the submission or processing of an allotment form or similar device used by the United States Armed Forces to direct a service member's pay to a third party for the purchase of life insurance, including using or assisting with a service member's MyPay account or other similar internet or electronic medium for such purposes.

(ii) Subsection (1)(a)(i) does not prohibit assisting a service member by providing insurer or premium information necessary to complete an allotment form.

(b)(i) Knowingly receiving funds from a service member for the payment of premium from a depository institution with which the service member has no formal banking relationship.

(ii) A formal banking relationship is established when a depository institution:

(A) provides the service member with a deposit agreement and periodic statements, and makes the disclosures required by the Truth in Savings Act, 12 U.S.C. Section 4301 et seq. and the rules promulgated thereunder; and

(B) permits the service member to make deposits and withdrawals unrelated to the payment or processing of insurance premiums.

(c) Entering into an agreement where funds received from a service member by allotment, for the payment of insurance premiums, are identified on the service member's Leave and Earnings Statement, or equivalent, or successor form as savings or checking when the service member has no formal banking relationship.

(d) Entering into an agreement with a depository institution to receive funds from a service member where the depository institution, with or without compensation, agrees to accept direct deposits from a service member with whom it has no formal banking relationship.

(e) Using DOD personnel, directly or indirectly, as a representative or agent in any official or unofficial capacity, with or without compensation, regarding the solicitation or sale of life insurance to any service member who is junior in rank or grade, or to any family member of such personnel.

(f) Offering or giving anything of value, directly or indirectly, to DOD personnel to procure their assistance in encouraging, assisting, or facilitating the solicitation, negotiation, or sale of life insurance to another service member.

(g) Knowingly offering or giving anything of value to a service member with a pay grade of E-4 or below for the service member's attendance to any event where an application for life insurance is solicited.

(h) Advising a service member with a pay grade of E-4 or below to change the service member's income tax withholding or state of legal residence for the sole purpose of increasing disposable income to purchase life insurance.

(2) The acts or practices by an insurer or insurance producer in this Subsection (2) regarding source, sponsorship, approval, or affiliation are confusing and are false, misleading, deceptive, or unfair.

(a) Making any representation, or using any device, title, descriptive name, or identifier that has the tendency or capacity to confuse or mislead a service member into believing that the insurer, insurance producer, or product offered is affiliated, connected, or associated with, endorsed, sponsored, sanctioned, or recommended by the United States Government, the United States Armed Forces, or any state or federal agency or government entity.

(i) Prohibited insurance producer titles include the following:

(A) Battalion Insurance Counselor;

(B) Unit Insurance Advisor;

(D) Veteran's Benefits Counselor; or

(E) a similar title.

(ii) This rule does not prohibit a person from using a professional designation awarded after the successful completion of a course of instruction in the business of insurance by an accredited institution of higher learning including:

(A) Chartered Life Underwriter, CLU;

(B) Chartered Financial Consultant, ChFC;

(D) Master of Science in Financial Services, MSFS; or

(E) Masters of Science Financial Planning, MS.

(b) Soliciting the purchase of a life insurance product through the use of or in conjunction with a third party organization that promotes the welfare of or assists members of the United States Armed Forces in a manner that may confuse or mislead a service member into believing that either the insurer, insurance producer, or insurance product is affiliated, connected, or associated with, endorsed, sponsored, sanctioned, or recommended by the United States Government, or the United States Armed Forces.

(3) The acts or practices by an insurer or insurance producer in this Subsection (3) are confusing regarding premiums, costs, or investment returns and are false, misleading, deceptive, or unfair.

(a) Using or describing the credited interest rate on a life insurance policy in a manner that implies that the credited interest rate is a net return on premium paid.

(b) Except for individually issued annuities, misrepresenting the mortality costs of a life insurance product, including stating or implying that the product "costs nothing" or is "free".

(4) The acts or practices by an insurer or insurance producer in this Subsection (4) regarding SGLI or VGLI are false, misleading, deceptive, or unfair.

(a) Making any representation regarding the availability, suitability, amount, cost, exclusions, or limitations of coverage provided to a service member or a service member's dependents by SGLI or VGLI.

(b) Making any representation regarding conversion requirements, including the costs of coverage, exclusions or limitations to coverage of SGLI or VGLI to private insurers.

(c) Suggesting, recommending, or encouraging a service member to cancel or terminate a SGLI policy or issuing a life insurance policy that replaces an existing SGLI policy unless the replacement takes effect upon or after the service member's separation from the United States Armed Forces.

(5) The acts or practices by an insurer or insurance producer in this Subsection (5) regarding disclosure are false, misleading, deceptive, or unfair.

(a) Deploying, using, or contracting for any lead generating materials designed exclusively for use with service members that do not clearly and conspicuously disclose that the service member will be contacted by an insurance producer, if that is the case, to solicit the purchase of life insurance.

(b) Failing to disclose that a solicitation for the sale of life insurance will be made when making a specific appointment for an in-person, face-to-face meeting with a prospective purchaser.

(c) Except for an individually issued annuity, failing to clearly and conspicuously disclose the fact that the product being sold is life insurance.

(d) Knowingly failing to make, at the time of sale or offer to an individual known to be a service member, the written disclosures under Section 10 of the Military Personnel Financial Services Protection Act, Pub. L. No. 109-290.

(e)(i) Except for an individually issued annuity, when a sale is conducted during an in-person, face-to-face meeting with a known service member, failing to provide the applicant, when the application is taken:

(A) an explanation of any free look period with instructions on how to cancel if a policy is issued; and

(B) a copy of the application or a written disclosure.

(ii) The copy of the application or the written disclosure shall clearly and concisely set out the type of life insurance, the death benefit applied for, and its expected first year cost.

(iii) A basic illustration that meets the requirements of Rule R590-177 meets this requirement for a written disclosure.

(6) The acts or practices by an insurer or insurance producer in this Subsection (6) regarding the sale of certain life insurance products are false, misleading, deceptive, or unfair.

(a) Except for an individually issued annuity, recommending the purchase of a life insurance product that includes a side fund to a service member in a pay grade E-4 and below unless the insurer has reasonable grounds for believing that the life insurance death benefit, standing alone, is suitable.

(b) Offering for sale or selling a life insurance product that includes a side fund to a service member in a pay grade E-4 and below who is currently enrolled in SGLI, is presumed unsuitable unless, after the completion of a needs assessment, the insurer demonstrates that the applicant's SGLI death benefit, together with any other military survivor benefits, savings, investments, survivor income, and other life insurance are insufficient to meet the applicant's insurable needs for life insurance.

(c) Except for an individually issued annuity, offering for sale or selling a life insurance policy that includes a side fund:

(i) unless interest credited accrues from the date of deposit to the date of withdrawal and permits withdrawals without limit or penalty;

(ii) unless the applicant is provided with a schedule of effective rates of return based upon cash flows of the combined product, wherein the effective rate of return considers all premiums and cash contributions made by the policyholder and all cash accumulations and cash surrender values available to the policyholder in addition to life insurance coverage, and is provided for at least each policy year from one to ten and for every fifth policy year thereafter ending at age 100, policy maturity, or final expiration; and

(iii) that, by default, diverts or transfers funds accumulated in the side fund to pay, reduce, or offset any premiums due.

(d) Except for an individually issued annuity, offering for sale or selling a life insurance policy that, after considering all policy benefits including an endowment, a return of premium, or persistency, does not comply with Section 31A-22-408.

(e) Selling to a known service member a life insurance policy that excludes coverage if the insured's death is related to war, declared or undeclared, or an act related to military service except for an accidental death coverage.

History

KEY: insurance, military sales practices
Date of Last Change: November 21, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-242-6 Severability

If any provision of this rule, Rule R590-242, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, military sales practices
Date of Last Change: November 21, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

R590-243 Commercial Motor Vehicle Insurance Coverage

Utah Admin. Code R590-243-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-315.

History

KEY: commercial motor vehicle insurance
Date of Last Change: June 21, 2022
Notice of Continuation: January 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-315

Utah Admin. Code R590-243-2 Purpose and Scope

(1) The purpose of this rule is to define commercial motor vehicle insurance coverage.

(2) This rule applies to a person required to report on commercial motor vehicle insurance.

History

KEY: commercial motor vehicle insurance
Date of Last Change: June 21, 2022
Notice of Continuation: January 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-315

Utah Admin. Code R590-243-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Commercial motor vehicle insurance coverage" means any coverage provided under a commercial automobile, garage, or truckers policy form, regardless of the number of vehicles or entities covered, and rated from either a commercial manual or rating rule.

History

KEY: commercial motor vehicle insurance
Date of Last Change: June 21, 2022
Notice of Continuation: January 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-315

Utah Admin. Code R590-243-4 Commercial Motor Vehicle Classification

Any person required to report under this rule shall use the definition of commercial motor vehicle insurance coverage in Section R590-243-3 to identify a motor vehicle within this classification when reporting as required by Subsection 31A-22- 315(2)(b).

History

KEY: commercial motor vehicle insurance
Date of Last Change: June 21, 2022
Notice of Continuation: January 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-315

Utah Admin. Code R590-243-5 Severability

If any provision of this rule, Rule R590-243, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: commercial motor vehicle insurance
Date of Last Change: June 21, 2022
Notice of Continuation: January 23, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-315

R590-244 Individual and Agency Licensing Requirements

Utah Admin. Code R590-244-1 Authority

This rule is promulgated by the commissioner pursuant to:

(1) Section 31A-2-201;

(2) Section 31A-23a-102;

(3) Section 31A-23a-108;

(4) Section 31A-23a-111;

(5) Section 31A-23a-115;

(6) Section 31A-23a-203.5;

(7) Section 31A-23a-302;

(8) Section 31A-23b-102;

(9) Section 31A-23b-205;

(10) Section 31A-23b-207;

(11) Section 31A-23b-209;

(12) Section 31A-23b-401;

(13) Section 31A-25-201;

(14) Section 31A-25-208;

(15) Section 31A-26-207;

(16) Section 31A-26-210;

(17) Section 31A-26-213;

(18) Section 31A-35-104;

(19) Section 31A-35-301;

(20) Section 31A-35-401; and

(21) Section 31A-35-406.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-2 Purpose and Scope

(1) The purpose of this rule is to provide standards for:

(a) an individual or agency licensee for:

(i) obtaining, renewing, or reinstating a license;

(ii) maintaining any legal liability coverage or surety bond requirements; and

(iii) making other miscellaneous license amendments;

(b) an insurer for the initial appointment or the termination of an appointment of an individual or agency licensee; and

(c) an agency for the initial designation or the termination of a designation of an individual licensee to the agency's license.

(2) This rule applies to:

(a) an individual or agency licensed under:

(i) Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries;

(ii) Title 31A, Chapter 23b, Navigator License Act;

(iii) Title 31A, Chapter 25, Third Party Administrators;

(iv) Title 31A, Chapter 26, Insurance Adjusters; and

(v) Title 31A, Chapter 35, Bail Bond Act; and

(b) an admitted insurer doing business in Utah.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-23a-102, 31A-23b-102, 31A-26-102, and 31A-35-102. Additional terms are defined as follows:

(1) "Active license" means authorization by the commissioner to engage in an activity that is part of or related to the insurance business.

(2) "Inactive license" means a licensee is no longer authorized by the commissioner to engage in an activity that is part of or related to the insurance business.

(3) "Lapse" means the inactivation of an active license by expiration of the period for which the license was issued or by operation of law.

(4) "License application" means information submitted by a license applicant that is used by the commissioner to evaluate the applicant's qualifications and decide whether to:

(a) issue or decline to issue a license;

(b) add or decline to add an additional line of authority to an active license;

(d) reinstate or decline to reinstate an inactive license.

(5) "License type" means a category of license identifying a specific functional area of insurance activity for which the commissioner may grant authority to do business.

(6) "Line of authority" means a line of insurance in a particular subject matter area within a license type for which the commissioner may grant authority to do business.

(7) "NIPR" means an electronic application software provided by the National Insurance Producer Registry.

(8) "Reinstate" means the activation of an inactive license within 365 days of the inactivation date.

(9) "Renewal" means the continuation of an active license from one two-year licensing period to another, except that the licensing period for a bail bond agency is one year.

(10) "Resident," for the purpose of a resident insurance license, means a person claims this state as the person's home state in which the person:

(a) maintains the person's principal place of business or residence; and

(b) is licensed to do insurance business.

(11) "Sircon" means an electronic application software provided by Vertafore or its acquiring parent company.

(12) "Termination for cause" means:

(a) an insurer or an agency has ended its relationship with a licensee or has cancelled the licensee's authority to act on behalf of the insurer or agency for one of the reasons identified in Subsection 31A-23a-111(5); or

(b) a licensee has been found to have engaged in any of the activities identified in Subsection 31A-23a-111(5), 31A- 23b-401(4), or 31A-26-213(5), by a court, government body, or self-regulatory organization authorized by law.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-4 Requirement to Electronically Submit a License Application, Appointment, Designation, or License Amendment

(1) Except as otherwise provided in this rule, the following shall be submitted electronically to the department using SIRCON or NIPR:

(a) an individual or agency license application for a person listed in Subsection R590-244-2(a) as prescribed in Sections R590-244-7, R590-244-9, and R590-244-10 for:

(i) a new license;

(ii) an additional license type or line of authority;

(iii) a license renewal; or

(iv) a license reinstatement;

(b) an appointment, termination of appointment, designation, or termination of designation as prescribed in Sections R590-244-11 and R590-244-12;

(c) a miscellaneous license amendment pertaining to an individual or agency license for a person listed in Subsection R590-244-2(a) as prescribed in Section R590-244-13;

(d) any document related to reporting to the commissioner of criminal prosecution or administrative action taken against a licensee as required under:

(i) Title 31A, Chapter 23a, Insurance Marketing - Licensing Procedures, Consultants, and Reinsurance Intermediaries;

(ii) Title 31A, Chapter 23b, Navigator License Act;

(iii) Title 31A, Chapter 25, Third Party Administrator;

(iv) Title 31A, Chapter 26, Insurance Adjusters; or

(v) Title 31A, Chapter 35, Bail Bond Act; and

(e) any additional documentation required in connection with an application, except as shown in Subsection (1)(e)(iv), including:

(i) written explanation and documentation for positive responses to background questions;

(ii) evidence of specific experience, bonding, or other requirements for certain license types or lines of authority; or

(iii) evidence of continuing education requirements for a renewal or reinstatement application if there is a question regarding the number of course hours completed.

(iv) If an electronic attachment function for attaching a document required with an application is not available in the attachment utility from Sircon or NIPR, the document shall be submitted electronically via facsimile or as a PDF attachment to an email, until an electronic attachment function for submitting the document in connection with the application becomes available from Sircon or NIPR.

(2) Submission of an electronic application or other form under this rule constitutes the applicant's or submitter's attestation under penalties of perjury that the information contained in the application or form is true and correct.

(3) A submission that does not comply with this rule, including an application that remains incomplete for a period of 30 days following the initial submission, may be rejected as incomplete and returned to the submitter without being processed, with any paid fees forfeited to the state.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-5 Requirement of an Active License to Sell, Solicit, or Negotiate Insurance

(1) To sell, solicit, or negotiate insurance, a person shall have an active license matching the type and line of insurance being sold, solicited, or negotiated.

(2) If the person is an agency, the person shall have an appointment from an insurer in addition to an active license described in Subsection (1).

(3)(a) If the person is an individual, the person shall have an appointment from an insurer or a designation from an agency in addition to an active license described in Subsection (1).

(b) An individual licensed as a resident producer shall maintain legal liability errors and omissions insurance coverage not less than $250,000 per claim and $500,000 annual aggregate limit.

(4) A licensee whose license is inactive may not sell, solicit, or negotiate insurance from the date the active license is inactivated until the date the inactive license is reactivated.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-6 Requirement of an Active License to Act as a Navigator

(1) A person shall have the following to act as a navigator:

(a)(i) an active navigator license issued under Chapter 31A-23b, Navigator License Act, or

(ii) an active producer license issued under Chapter 31A-23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries, with an accident and health line of authority; and

(b)(i) a surety bond not less than $50,000 to cover the legal liability of the navigator as the result of an erroneous act or failure to act in the navigator's capacity as a navigator, as applicable; or

(ii) legal liability errors and omissions insurance coverage not less than $250,000 per claim and $500,000 annual aggregate limit, as applicable.

(2) A professional liability coverage plan is a form of errors and omissions insurance coverage.

(3) A navigator whose license is inactive may not act as a navigator from the date the active license is inactivated until the date the inactive license is reactivated.

(4) A navigator license includes the following lines of authority:

(a) navigator; and

(b) certified application counselor.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-7 New License Application

A resident or non-resident license application for a new license, or for the addition of an additional license type or line of authority, shall be submitted using either Sircon or NIPR, except:

(1) an application for a navigator license shall be submitted using Sircon; and

(2) a non-resident license application for a license type or line of authority not offered in the person's home state shall be submitted to the commissioner via facsimile or as a PDF attachment to an email using a form available through the department's website, https://insurance.utah.gov, until an electronic application becomes available from Sircon or NIPR.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-8 Examination and Training

(1) Examination and training requirements may be administered by:

(a) the commissioner;

(b) a testing vendor approved and contracted by the commissioner; or

(2) To act as a navigator in Utah, a person shall successfully complete the federal navigator training and certification program requirements under PPACA and administered through the United States Department of Health and Human Services, including any applicable training, examination, certification or recertification requirements.

(3) A person who has successfully completed the federal navigator training and certification has successfully completed the required Utah training and examination requirements for a navigator license.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-9 Renewal and Non-renewal of an Active License

(1) An active license shall be renewed on or before the license expiration date by submitting a resident or non-resident license renewal application online via Sircon or NIPR.

(2) A new individual license expires on the last day of the licensee's birth month following the two-year anniversary of the license issue date, unless renewed, except as shown in Subsection (4).

(3) A renewed individual license expires on the last day of the licensee's birth month every two years, unless renewed, except as shown in Subsection (4).

(4) An individual navigator license expires annually on the last day of the month from the most recent license issue or renewal date, unless renewed.

(5) An agency license expires on the last day of the month every two years from the most recent license issue or renewal date, unless renewed, except as shown in Subsection (6).

(6) A bail bond agency license expires annually on August 14, unless renewed.

(7) Renewal Notice.

(a) Before the license expiration date, the commissioner may, as a courtesy, send a renewal notice to the licensee's business email address as shown on the records of the department.

(b) A renewal notice sent by the commissioner to the business email address, as shown on the records of the department, shall be considered received by the licensee.

(8) A license shall non-renew effective the license expiration date if it is not renewed on or before the expiration date, and:

(a) the non-renewed license shall be inactivated;

(b) all agency designations and insurer appointments shall be terminated; and

(9) An active licensee that fails to renew a license shall not engage in the business of insurance during the period of time from the expiration date of the license until the date the inactive license is reinstated or a new license is issued.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-10 Reinstatement of Inactive License

(1) A license that has been inactive for a period of one year or less following the license expiration date may be reinstated under the relevant provisions of this section.

(2) An inactive license that has not been reinstated within one year following its expiration date may not be reinstated and the inactive licensee may apply as a new license applicant.

(3) A reinstatement applicant shall:

(a) comply with each requirement for renewal of a license, including any applicable continuing education or examination requirements if the reinstatement applicant is an individual; and

(b) pay a reinstatement fee.

(4) A resident or non-resident license application for reinstatement of an inactive license shall be submitted using either Sircon or NIPR, except as stated in Subsection (5).

(5)(a) The following license applications for reinstatement of an inactive license shall be submitted to the department via facsimile or as a PDF attachment to an email using a form available through the department's website, until such time that an electronic application becomes available from Sircon or NIPR:

(i) a non-resident reinstatement application for a person whose license is inactive for failure to maintain an active license in the person's home state;

(ii) a resident or non-resident reinstatement application for a person whose license has been voluntarily surrendered; and

(iii) a resident or non-resident reinstatement application for a person whose license is inactive due to an incomplete renewal application, except as stated in Subsection (5)(b).

(b) If a resident license is inactive due to a renewal application that was incomplete solely for failure to meet the continuing education requirements, a resident reinstatement application shall be submitted to the department:

(i) during the first 30 days after a license expiration date as a facsimile or as a PDF attachment to an email using a form available through the department's website; or

(ii) 31 days to one year after a license expiration date through Sircon or NIPR.

(6) A license that is voluntarily surrendered:

(a) may be reinstated:

(i) during the license period in which the license was surrendered; and

(ii) no later than one year from the date the license was surrendered; and

(b) shall comply with the reinstatement requirements in Subsection (3), except that no continuing education requirement will apply for an individual license applicant because the reinstatement is within the current license period.

(7) A reinstated license expires on the same date it would have expired had the license not become inactive.

(8) A person with a reinstated license shall complete any required insurer contracts and appointments or agency designations before the reinstated licensee can resume doing business.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-11 Appointment and Termination of Appointment by an Insurer

(1) Appointment.

(a) An insurer shall appoint an individual or agency licensee with whom the insurer has a producer contract.

(b) An appointment is continuous until terminated by the insurer or canceled by the department.

(d) To appoint, an insurer shall:

(i) state the date on which the appointment is effective; and

(ii) submit the appointment to the commissioner using Sircon or NIPR no later than 15 days after:

(A) the date on which the producer contract is executed; or

(B) the date on which the insurer receives the first insurance application from the licensee.

(2) Terminating an Appointment.

(a) An insurer shall terminate an appointment when a previously appointed individual or agency is no longer authorized to conduct business for the insurer in Utah.

(b) To terminate an appointment, an insurer shall:

(i) state the date on which the termination is effective; and

(ii) submit the termination to the commissioner using Sircon or NIPR no later than 30 days after the effective date of termination.

(c) Within 15 days after submitting a termination, an insurer shall notify the licensee of the termination and the reason for it by mail or email at the licensee's last known address or email address.

(3) Reporting Termination for Cause.

(a) An insurer that terminates an appointment for cause shall report to the commissioner the cause of termination if required by Subsection 31A-23a-115(3)(a).

(b) The report and attachments shall be submitted to licensing.uid@utah.gov within 15 days after submitting the notice of termination required by Subsection (2)(c).

(i) quote the specific reason or reasons from Subsection 31A-23a-111(5)(b);

(ii) state the specific facts and reasoning on which the decision to terminate was based;

(iii) list and include any document, photograph, video or audio recording, or other material that supports the insurer's decision to terminate;

(iv) include a copy of each written finding or conclusion by a court, government body, agency, or self-regulatory organization that supports the termination; and

(v) include a copy of the notice required by Subsection (2)(c).

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-12 Designation and Termination of Designation by an Agency

(1) Designation.

(a) An agency shall designate a licensed individual to the agency license to do business on behalf of the agency in Utah.

(b) A designation is continuous until terminated by the agency or canceled by the department.

(i) state the date on which the designation is effective; and

(ii) submit the designation to the commissioner using Sircon or NIPR no later than 15 days after the designation effective date.

(2) Terminating a Designation.

(a) An agency shall terminate a designation when a previously designated individual is no longer authorized to conduct business for the agency in Utah.

(b) To terminate a designation, an agency shall:

(i) state the date on which the termination is effective; and

(ii) submit the termination to the commissioner using Sircon or NIPR no later than 30 days after the termination effective date.

(c) Within 15 days after submitting a termination, an agency shall notify the licensee of the termination and the reason for it by mail or email at the licensee's last known address or email address.

(3) Reporting Termination for Cause.

(a) An agency that terminates a designation for cause shall report to the commissioner the cause of termination if required by Subsection 31A-23a-302(4).

(b) The report and attachments shall be submitted to licensing.uid@utah.gov within 15 days after submitting the notice of termination required by Subsection (2)(c).

(i) quote the specific reason or reasons from Subsection 31A-23a-111(5)(b);

(ii) state the specific facts and reasoning on which the decision to terminate was based;

(iii) list and include any document, photograph, video or audio recording, or any other material that supports the agency's decision to terminate;

(iv) include a copy of each written finding or conclusion by a court, government body, agency, or self-regulatory organization that supports the termination; and

(v) include a copy of the notice required by Subsection (2)(c).

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-13 Miscellaneous License Amendments and Changes to an Agency's Employer Identification Number

(1) A miscellaneous license amendment shall be submitted electronically.

(2) The following miscellaneous license amendments shall be submitted via Sircon or NIPR:

(a) a change of residence, business, or mailing address within the same state;

(b) a change of residence, business, or mailing address from one nonresident state to another nonresident state;

(d) a change of telephone number;

(e) a change of an individual licensee's name; or

(f) a change of the licensed individual designated as the person responsible for the regulatory compliance of the agency.

(3) The following miscellaneous license amendments shall be submitted electronically via facsimile or as a PDF attachment to an email, except that the license amendment identified in Subsection (3)(d) shall be submitted via Sircon or NIPR once the amendment becomes available electronically from Sircon or NIPR:

(a) a voluntary surrender of a license or line or authority;

(b) a clearance letter request;

(d) a change of an owner, partner, officer, or director of an agency.

(4) A submitted miscellaneous license amendment shall contain:

(a) the name and title of the individual submitting the amendment;

(b) the relationship to the licensee of the individual submitting the amendment; and

(c) the following attestation made by the individual submitting the amendment: "I hereby attest that the information submitted is true and correct, and that I am the individual licensee for whom the requested change is being submitted, or an authorized responsible representative of the individual or agency licensee for whom the requested change is being submitted."

(5) A change of Employer Identification Number:

(a) cannot be processed as a miscellaneous license amendment; and

(b) requires the entity to apply as a new license applicant.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

Utah Admin. Code R590-244-14 Severability

If any provision of this rule, Rule R590-244, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance licensing requirements
Date of Last Change: April 7, 2023
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-102; 31A-23a-111; 31A-23a-115; 31A-23a-203.5; 31A-23a-302; 31A-23b-102; 31A-23b-205; 31A-23b-207; 31A-23b-209; 31A-23b-401; 31A-25-201; 31A-25-208; 31A-26- 207; 31A-26-210; 31A-26-213; 31A-35-104; 31A-35-301; 31A-35-401; 31A-35-406

R590-245 Self-Service Storage Insurance

Utah Admin. Code R590-245-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-23a-104, 31A-23a-106, 31A-23a- 110, and 31A-23a-111.

History

KEY: self-service storage, insurance
Date of Last Change: June 21, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-104; 31A-23a-106; 31A-23a-110; 31A-23a-111; 31A-1-301; 31A-23a-102

Utah Admin. Code R590-245-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) recognize self-service storage as a limited line producer line of authority; and

(b) establish standards of licensing for self-service storage related insurance business.

(2) This rule applies to a person selling, soliciting, or negotiating self-service storage related insurance business.

History

KEY: self-service storage, insurance
Date of Last Change: June 21, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-104; 31A-23a-106; 31A-23a-110; 31A-23a-111; 31A-1-301; 31A-23a-102

Utah Admin. Code R590-245-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-23a-102. Additional terms are defined as follows:

(1) "Rental agreement" means a written agreement setting forth the terms and conditions governing the use of storage space provided by a self-service storage facility.

(2) "Renter" means a person who uses storage space from a self-service storage facility pursuant to a rental agreement.

(3) "Self-service storage facility" means a person or agency engaged in the business of providing leased or rented storage space to the public.

(4) "Self-service storage insurance" means a contract of insurance issued to a renter as part of an agreement of self- service storage with respect to:

(a) hazard insurance coverage provided to a renter for loss or damage to tangible personal property in storage or in transit during the rental period; or

(b) tenant liability insurance coverage.

(5) "Self-service storage insurance license" means a limited line producer license with a self-service storage insurance limited line producer line of authority that authorizes a person licensed under this rule to offer self-service storage insurance in connection with, and incidental to, a rental agreement on behalf of an insurer.

(6) "Storage space" means a room, unit, locker, or open space offered for rental to the public for temporary storage of personal belongings or light commercial goods.

History

KEY: self-service storage, insurance
Date of Last Change: June 21, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-104; 31A-23a-106; 31A-23a-110; 31A-23a-111; 31A-1-301; 31A-23a-102

Utah Admin. Code R590-245-4 Licensing and Renewal

(1) A person involved in the sale, solicitation, or negotiation of self-service storage insurance must be licensed pursuant to Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries, and this rule.

(2) A self-service storage insurance license is issued for a two-year period and does not require examination or continuing education.

(3) A self-service storage insurance license must be renewed at the end of the two-year licensing period pursuant to Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries, and this rule.

(4) A self-service storage insurance license may be held by a self-service storage facility or a franchisee of a self- service storage facility.

(5) An individual licensed under this rule shall:

(a) be appointed by an insurance company underwriting the insurance policy the individual sells; or

(b) be designated to act by an agency licensed under this rule.

(6) An agency licensed under this rule shall:

(a) be appointed by an insurance company underwriting the insurance policies the agency sells; and

(b) designate a licensed individual to be responsible for the regulatory compliance of the agency.

(7)(a) An agency licensed under this rule may employ non-licensed personnel as a self-service storage counter sales representative to sell, solicit, or negotiate self-service storage insurance.

(b) Any non-licensed employee shall:

(i) be trained and supervised in the sale of a self-service storage insurance product; and

(ii) be responsible to a licensed individual designated by the agency.

(8) A self-service storage facility, or a franchisee of a self-service storage facility, may not offer or sell self-service storage insurance unless it complies with the requirements of this rule and is licensed by the commissioner.

History

KEY: self-service storage, insurance
Date of Last Change: June 21, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-104; 31A-23a-106; 31A-23a-110; 31A-23a-111; 31A-1-301; 31A-23a-102

Utah Admin. Code R590-245-5 Severability

If any provision of this rule, Rule R590-245, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: self-service storage, insurance
Date of Last Change: June 21, 2022
Notice of Continuation: September 15, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-104; 31A-23a-106; 31A-23a-110; 31A-23a-111; 31A-1-301; 31A-23a-102

R590-247 Universal Health Insurance Application Rule

Utah Admin. Code R590-247-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-212, 31A-22-635, 31A-30-102, and 31A-30-117.

History

KEY: universal health insurance application
Date of Last Change: August 8, 2022
Notice of Continuation: June 9, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-102

Utah Admin. Code R590-247-2 Purpose and Scope

(1) The purpose of this rule is to establish a universal application for all insurers offering a health benefit plan.

(2) This rule applies to:

(a) an individual health benefit plan offered outside the Federally Facilitated Marketplace; and

(b) a small employer health benefit plan.

History

KEY: universal health insurance application
Date of Last Change: August 8, 2022
Notice of Continuation: June 9, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-102

Utah Admin. Code R590-247-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-635.

History

KEY: universal health insurance application
Date of Last Change: August 8, 2022
Notice of Continuation: June 9, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-102

Utah Admin. Code R590-247-4 General Instructions

(1) An insurer or producer shall use the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application.

(2) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application shall be used without insurer identifying logos or addresses to facilitate multiple insurer submissions using a single application.

(3) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application are available on the department's website, https://insurance.utah.gov.

(4) The Utah Individual Health Insurance Application and Utah Small Employer Health Insurance Application may be altered for:

(a) electronic application and submission, including electronic signature disclaimers;

(b) languages other than English; and

(5) An insurer shall offer compatible systems for electronic submission of the Utah Individual Health Insurance Application and the Utah Small Employer Health Insurance Application.

(6) If an employee chooses to waive coverage, an insurer shall not require the employee to complete any section of the Utah Small Employer Health Insurance Application other than the Waiver of Coverage section.

(7) An insurer offering an individual health benefit plan shall use the Utah Health Insurance Application dated June 2016 for coverage outside of the Federally Facilitated Marketplace.

(8) An insurer offering a small employer health benefit plan shall use the Utah Small Employer Health Insurance Application dated January 2014 for an application with a coverage effective date on or after January 1, 2014.

History

KEY: universal health insurance application
Date of Last Change: August 8, 2022
Notice of Continuation: June 9, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-102

Utah Admin. Code R590-247-5 Severability

If any provision of this rule, Rule R590-247, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: universal health insurance application
Date of Last Change: August 8, 2022
Notice of Continuation: June 9, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-102

R590-249 Secondary Medical Condition Exclusion

Utah Admin. Code R590-249-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: health insurance, exclusions
Date of Last Change: July 25, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-22-613.5

Utah Admin. Code R590-249-2 Purpose and Scope

(1) The purpose of this rule is to establish examples of coverage limitations or exclusions, including a related secondary condition as required under Section 31A-22-613.5.

(2) This rule applies to an insurer offering a health benefit plan.

History

KEY: health insurance, exclusions
Date of Last Change: July 25, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-22-613.5

Utah Admin. Code R590-249-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: health insurance, exclusions
Date of Last Change: July 25, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-22-613.5

Utah Admin. Code R590-249-4 General Instructions

An insurer shall provide a clear written statement that discloses any policy limitation or exclusion, including a related secondary medical condition, that is set forth in the policy:

(1) upon application;

(2) when requested by the insured; and

(3) in any materials a carrier is required to provide to an insured, including the Summary of Benefits and Coverage as defined in 45 CFR 147.200.

History

KEY: health insurance, exclusions
Date of Last Change: July 25, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-22-613.5

Utah Admin. Code R590-249-5 Examples

The following are examples of permissible policy limitations or exclusions and are not all inclusive:

(1) a charge in connection with reconstructive or plastic surgery that may have a limited benefit, such as a chemical peel that does not alleviate a functional impairment;

(2) a complication relating to services and supplies for, or in connection with:

(a) gastric or intestinal bypass;

(b) gastric stapling;

(d) a procedure related to the reversal or revision of a procedure in Subsections (2)(a) through (2)(c); or

(e) any direct complication or consequence of a procedure in Subsections (2)(a) through (2)(d);

(3) a complication due to infection from a cosmetic procedure, except in a case of reconstructive surgery:

(a) when the service is incidental to or follows a surgery resulting from trauma, infection, or other disease of the involved part; or

(b) related to a congenital disease or anomaly of a covered dependent child that has resulted in functional defect; or

(4) a complication that results from an injury or illness resulting from voluntary participation in an illegal activity described in Section R590-227-4.

History

KEY: health insurance, exclusions
Date of Last Change: July 25, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-22-613.5

Utah Admin. Code R590-249-6 Severability

If any provision of this rule, Rule R590-249, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance, exclusions
Date of Last Change: July 25, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-22-613.5

R590-250 Professional Employer Organization License Procedure and Assurance Organization Designation

Utah Admin. Code R590-250-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-40-103, 31A-40-302, and 31A-40- 303.

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

Utah Admin. Code R590-250-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) define terms used in Title 31A, Chapter 40, Professional Employer Organization Licensing Act;

(b) establish a licensing process; and

(2) This rule applies to:

(a) a PEO;

(b) an unlicensed person doing the business of a PEO; and

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

Utah Admin. Code R590-250-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-40-102. Additional terms are defined as follows:

(1) "Fully insured," as used in Title 31A, Chapter 40, Professional Employer Organization Licensing Act, and described in Section R590-250-4 means a health benefit plan where 100% of the liability is assumed by an insurer authorized to conduct business in Utah.

(2) "PEO" means a professional employer organization.

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

Utah Admin. Code R590-250-4 Fully Insured Health Benefit Plan

(1) A fully insured health benefit plan may include financial responsibility for claims assumed by the PEO if the insurer is responsible for 100% of the PEO's liability for non-payment by the PEO.

(2) A covered individual in a fully insured health benefit plan may make a claim for payment directly to the insurer.

(3) A fully insured health benefit plan may have co-pay or deductible requirements as required by contract.

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

Utah Admin. Code R590-250-5 Initial and Renewal Licensing Process

(1) A PEO shall complete and submit an initial or a renewal license application form together with supporting documents to the commissioner electronically.

(2) A PEO shall complete the appropriate PEO license application:

(a) Professional Employer Organization - Not Certified Through an Assurance Organization;

(b) Professional Employer Organization - Certified Through an Assurance Organization; or

(3) PEO application forms are available on the department's website, https://insurance.utah.gov.

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

Utah Admin. Code R590-250-6 Assurance Organization Designation Process

The commissioner may designate an assurance organization that submits a request containing:

(1) an explanation of how the assurance organization will certify the qualification criteria under Subsection 31A-40- 303(3); and

(2) evidence that the assurance organization is licensed by one or more states to certify the qualifications of a PEO.

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

Utah Admin. Code R590-250-7 Severability

If any provision of this rule, Rule R590-250, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, assurance organization designation
Date of Last Change: January 10, 2023
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-40-303(3)

R590-251 Preneed Life Insurance Minimum Standards to Determine Reserve Liabilities and Nonforfeiture Values

Utah Admin. Code R590-251-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-17-402, and 31A-22-408.

History

KEY: preneed life insurance standards
Date of Last Change: November 22, 2022
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-251-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish minimum mortality standards for reserves and nonforfeiture values for a preneed life insurance product; and

(b) require the use of the Ultimate 1980 CSO to determine:

(i) the minimum standard of valuation of reserve liabilities; and

(ii) the minimum standard for nonforfeiture values.

(2) This rule applies to preneed insurance contracts and similar policies and certificates issued on or after January 1, 2009.

History

KEY: preneed life insurance standards
Date of Last Change: November 22, 2022
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-251-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1)(a) "2001 CSO Mortality Table" means the mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002.

(b) Unless otherwise indicated, the "2001 CSO Mortality Table" includes:

(i) the ultimate form of the table;

(ii) the select and ultimate form of the table;

(iii) the smoker and nonsmoker mortality tables;

(iv) the composite mortality tables; and

(v) the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(2) "Goods and services" include embalming, cremation, body preparation, viewing or visitation, coffin or urn, memorial stone, and transportation of the deceased.

(3)(a) "Preneed insurance" means a life insurance policy or certificate that is issued in combination with a prearrangement agreement for goods and services provided at the time of or immediately following the death of the insured.

(b) The status of the policy or contract as preneed insurance is determined at the time of issue.

(4) "Ultimate 1980 CSO" means the Commissioners' 1980 Standard Ordinary Life Valuation Mortality Tables without 10-year selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law approved in December 1983.

History

KEY: preneed life insurance standards
Date of Last Change: November 22, 2022
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-251-4 Minimum Standards

(1) Mortality Standards. The mortality standard used to determine reserve liabilities and nonforfeiture values for both male and female insureds is the Ultimate 1980 CSO.

(2) Interest Rate Standards.

(a) The interest rates used to determine the minimum standard for valuation are the calendar year statutory valuation interest rates defined in Section 31A-17-506.

(b) The interest rates used to determine the minimum standard for nonforfeiture values are the calendar year statutory nonforfeiture interest rates defined in Section 31A-22-408.

(3) Valuation and Nonforfeiture Method Standards.

(a) The method used to determine the minimum standard for valuation of reserves of preneed insurance is the method defined in Title 31A, Chapter 17, Part 5, Standard Valuation Law.

(b) The method used to determine the minimum nonforfeiture values for preneed insurance is the method defined in Section 31A-22-408.

History

KEY: preneed life insurance standards
Date of Last Change: November 22, 2022
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-251-5 Transition Rules

(1) Preneed policies subject to this rule issued before January 1, 2012, may use the 2001 CSO Mortality Table as the minimum mortality standard for reserves and minimum standard for nonforfeiture values for both male and female insureds.

(2)(a) If an insurer elects to use the 2001 CSO Mortality Table as a minimum standard for a policy subject to this rule issued before January 1, 2012, the insurer shall provide, as a part of the actuarial opinion memorandum submitted in support of the insurer's asset adequacy testing, an annual written notification to the commissioner of its domiciliary state.

(b) The notification shall include:

(i) a complete list of all policy forms that use the 2001 CSO Mortality Table as a minimum mortality standard;

(ii) a certification signed by the appointed actuary stating that the reserve methodology used by the insurer to determine reserve liabilities for the policies subject to this rule and using the 2001 CSO Mortality Table as a minimum mortality standard, develop adequate reserves; and

(iii) supporting information regarding the adequacy of reserves for policies subject to this rule and using the 2001 CSO Mortality Table as a minimum mortality standard for reserve liabilities.

(3) When determining the adequacy of the reserves required under Subsection (2)(b), the policies subject to this rule and using the 2001 CSO Mortality Table as a minimum mortality standard may not be aggregated with other policies.

(4) A policy subject to this rule issued on or after January 1, 2012, shall use the Ultimate 1980 CSO to calculate minimum reserve liabilities and minimum nonforfeiture values.

History

KEY: preneed life insurance standards
Date of Last Change: November 22, 2022
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

Utah Admin. Code R590-251-6 Severability

If any provision of this rule, Rule R590-251, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: preneed life insurance standards
Date of Last Change: November 22, 2022
Notice of Continuation: August 1, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-402; 31A-22-408

R590-252 Use of Senior-Specific Certifications and Professional Designations

Utah Admin. Code R590-252-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-402.

History

KEY: senior-specific insurance designations
Date of Last Change: April 7, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-252-2 Purpose and Scope

(1) The purpose of this rule is to establish standards to protect consumers from misleading or fraudulent marketing practices concerning the use of senior-specific certifications and professional designations in the solicitation, sale or purchase of, or advice made in connection with, an annuity, accident and health, or life insurance product.

(2) This rule applies to a producer or consultant offering a solicitation, sale, purchase, or advice in connection with an annuity, accident and health, or life insurance product.

History

KEY: senior-specific insurance designations
Date of Last Change: April 7, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-252-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: senior-specific insurance designations
Date of Last Change: April 7, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-252-4 Findings

The commissioner finds that an act prohibited by this rule is unfair, misleading, and deceptive within the meaning of Section 31A-23a-402.

History

KEY: senior-specific insurance designations
Date of Last Change: April 7, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-252-5 Prohibited Uses of Senior-Specific Certifications and Professional Designations

(1)(a) A producer or consultant may not use a senior-specific certification or professional designation that indicates or implies, in a way that misleads a consumer, that the producer or consultant has special certification or training in:

(i) advising or servicing seniors in connection with the solicitation, sale, or purchase of any annuity, accident and health, or life insurance product; or

(ii) the provision of advice as to the value of or the advisability of purchasing or selling an annuity, accident and health, or life insurance product.

(b) The prohibited use of senior-specific certifications or professional designations may not be provided:

(i) either directly or indirectly;

(ii) through a publication or writing; or

(iii) by issuing or promulgating an analysis or report related to an annuity, accident and health, or life insurance product.

(i) use of a certification or professional designation by a producer or consultant who has not earned or is otherwise ineligible to use the certification or designation;

(ii) use of a nonexistent or self-conferred certification or professional designation;

(iii) use of a certification or professional designation that indicates or implies a level of occupational qualification obtained through education, training, or experience that the producer or consultant using the certification or designation does not have; and

(iv) use of a certification or professional designation that was obtained from a certifying or designating organization that:

(A) is primarily engaged in the business of instruction in sales or marketing;

(B) does not have reasonable standards or procedures for assuring the competency of its certificants or designees;

(C) does not have reasonable standards or procedures for monitoring and disciplining its certificants or designees for improper or unethical conduct; or

(D) does not have reasonable continuing education requirements for its certificants or designees in order to maintain the certificate or designation.

(2) There is a rebuttable presumption that a certifying or designating organization is not disqualified solely for purposes of Subsection (1)(c)(iv) when the certification or designation issued from the organization does not primarily apply to sales or marketing and when the organization or the certification or designation in question has been accredited by:

(a) the American National Standards Institute;

(b) the National Commission for Certifying Agencies; or

(c) any organization that is on the U.S. Department of Education's list entitled "Accrediting Agencies Recognized for Title IV Purposes."

(3) In determining whether a combination of words or an acronym standing for a combination of words constitutes a certification or professional designation indicating or implying that a person has special certification or training in advising or servicing seniors, factors to be considered shall include:

(a) use of one or more words such as senior, retirement, elder or like words combined with one or more words such as certified, registered, chartered, advisor, specialist, consultant, planner or like words, in the name of the certification or professional designation; and

(b) the manner in which those words are combined.

(4)(a) For purposes of this rule, a job title within an organization that is licensed or registered by a state or federal financial services regulatory agency is not a certification or professional designation, unless it is used in a manner that would confuse or mislead a reasonable consumer, when the job title:

(i) indicates seniority or standing within the organization; or

(ii) specifies an individual's area of specialization within the organization.

(b) For purposes of this subsection, financial services regulatory agency includes an agency that regulates insurers, insurance producers, insurance consultants, broker-dealers, investment advisers, or investment companies as defined under the Investment Company Act of 1940.

History

KEY: senior-specific insurance designations
Date of Last Change: April 7, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

Utah Admin. Code R590-252-6 Severability

If any provision of this rule, Rule R590-252, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: senior-specific insurance designations
Date of Last Change: April 7, 2023
Notice of Continuation: February 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-402

R590-254 Annual Financial Reporting Rule

Utah Admin. Code R590-254-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-203, and 31A-5-412.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-2 Purpose and Scope

(1) The purpose of this rule is to improve the commissioner's surveillance of the financial condition of insurers by requiring the submission of the following reports and documents:

(a) an annual audit of financial statements reporting the financial position and the results of operations of an insurer by an independent certified public accountant;

(b) Communication of Internal Control Related Matters Noted in an Audit; and

(2) This rule applies to an insurer, as defined in Section R590-254-3.

(3) An insurer is exempt from this rule for the calendar year if an insurer:

(a) has direct written premium of less than $1,000,000 written in this state in any calendar year; and

(b) less than 1,000 policyholders or certificate holders of direct written policies nationwide at the end of the calendar year.

(4) The exemption under Subsection (3) applies unless:

(a) the commissioner makes a specific finding that compliance is necessary for the commissioner to carry out statutory responsibilities; or

(b) the insurer has assumed premiums pursuant to contracts and treaties, or both, of reinsurance of $1,000,000 or more.

(5) A foreign or alien insurer filing an audited financial report in another state, pursuant to that state's requirement for filing of audited financial reports, which has been found by the commissioner to be substantially similar to the requirements in this rule, is exempt from Sections R590-254-4 through R590-254-13 if:

(a) a copy of the audited financial report, Communication of Internal Control Related Matters Noted in an Audit, and the Accountant's Letter of Qualifications that are filed with the other state are filed with the commissioner in accordance with the filing dates specified in Sections R590-254-4, R590-254-11, and R590-254-12, respectively; or

(b) a Canadian insurer may submit accountants' reports as filed with the Office of the Superintendent of Financial Institutions, Canada; and

(c) a copy of any Notification of Adverse Financial Condition Report filed with the other state is filed with the commissioner within the time specified in Section R590-254-10.

(6) A foreign or alien insurer required to file a Management's Report of Internal Control over Financial Reporting in another state is exempt from filing the Report in this state provided the other state has:

(a) substantially similar reporting requirements; and

(b) the report is filed with the commissioner of the other state within the time specified.

(7) This rule may not prohibit, preclude, or in any way limit the commissioner from ordering, conducting, or performing examinations of insurers under the rules, practices, and procedures of the department.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Other terms are defined as follows:

(1) "Accountant" or "independent certified public accountant" means an independent certified public accountant or accounting firm in good standing:

(a) with the American Institute of Certified Public Accountants (AICPA); and

(b) in all states in which the accountant or independent certified public accountant is licensed to practice;

(2) An "affiliate" of, or person "affiliated" with, a specific person, is a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified.

(3) "Audit committee" means a committee, or equivalent body, established by the board of directors of an entity for the purpose of overseeing the accounting and financial reporting processes of an insurer or group of insurers, and audits of financial statements of the insurer or group of insurers.

(a) The audit committee of any entity that controls a group of insurers may be the audit committee for one or more of these controlled insurers solely for the purposes of this rule at the election of the controlling person pursuant to Subsection R590- 254-14(6).

(b) If an audit committee is not designated by the insurer, the insurer's entire board of directors shall constitute the audit committee.

(4) "Audited financial report" means and includes the items specified in Section R590-254-5.

(5) "Indemnification" means an agreement of indemnity or a release from liability where the intent or effect is to shift or limit in any manner the potential liability of the person or firm for failure to adhere to applicable auditing or professional standards, whether or not resulting in part from knowing of other misrepresentations made by the insurer or its representatives.

(6) "Independent board member" has the same meaning as described in Subsection R590-254-14(4).

(7) "Group of insurers" means those licensed insurers:

(a) included in the reporting requirements of Chapter 31A-16, Insurance Holding Companies; or

(b) a set of insurers as identified by management, for the purpose of assessing the effectiveness of internal control over financial reporting.

(8) "Internal control over financial reporting" means a process effected by an entity's board of directors, management, and other personnel designed to provide reasonable assurance regarding the reliability of the financial statements specified in Subsections R590-254-5(2)(b) through R590-254-5(2)(g) and includes those policies and procedures that:

(a) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of assets;

(b) provide reasonable assurance that transactions are recorded as necessary to permit preparation of the financial statements specified in Subsections R590-254-5(2)(b) through R590-254-5(2)(g) and that receipts and expenditures are being made only in accordance with authorizations of management and directors; and

(c) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of assets that could have a material effect on the financial statements specified in Subsections R590-254-5(2)(b) through R590-254-5(2)(g).

(9) "SEC" means the United States Securities and Exchange Commission.

(10) "Section 404" means Section 404 of the Sarbanes-Oxley Act of 2002 and the SEC's rules and regulations promulgated thereunder.

(11) "Section 404 Report" means management's report on "internal control over financial reporting" as defined by the SEC and the related attestation report of the independent certified public accountant.

(12) "SOX compliant entity" means an entity that either is required to be compliant with, or voluntarily is compliant with, each of the following provisions:

(a) the preapproval requirements of Section 201 of the Sarbanes-Oxley Act of 2002, under Section 10A(i) of the Securities Exchange Act of 1934;

(b) the audit committee independence requirements of Section 301 of the Sarbanes-Oxley Act of 2002, under Section 10A(m)(3) of the Securities Exchange Act of 1934; and

(c) the internal control over financial reporting requirements of Section 404 of the Sarbanes-Oxley Act of 2002, under Item 308 of SEC Regulation S-K.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-4 General Requirements Related to Filing and Extensions for Filing of an Annual Audited Financial Report and Audit Committee Appointment

(1) An insurer shall have an annual audit by an independent certified public accountant and shall file an audited financial report with the commissioner on or before June 1 for the year ended December 31 immediately preceding. The commissioner may require an insurer to file an audited financial report earlier than June 1 with 90 days advance notice to the insurer.

(2) Extensions of the June 1 filing date may be granted by the commissioner for 30-day periods upon a showing by the insurer and its independent certified public accountant of the reasons for requesting an extension and determination by the commissioner of good cause for an extension. The request for extension must be submitted in writing not less than 10 days before the due date in sufficient detail to permit the commissioner to make an informed decision with respect to the requested extension.

(3) If an extension is granted in accordance with Subsection (2), a similar extension of 30 days is granted to the filing of Management's Report of Internal Control over Financial Reporting.

(4) Each insurer required to file an annual audited financial report pursuant to this rule shall designate a group of individuals as constituting its audit committee, as defined in Section R590-254-3. The audit committee of an entity that controls an insurer may be the insurer's audit committee for purposes of this rule at the election of the controlling person.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-5 Contents of an Annual Audited Financial Report

(1) An annual audited financial report shall report the financial position of the insurer as of the end of the most recent calendar year and the results of its operations, cash flows, and changes in capital and surplus for the year then ended in conformity with statutory accounting practices prescribed, or otherwise permitted, by the department of insurance of the state of domicile.

(2) The annual audited financial report shall include the following:

(a) report of independent certified public accountant;

(b) balance sheet reporting admitted assets, liabilities, capital, and surplus;

(d) statement of cash flow;

(e) statement of changes in capital and surplus;

(f) notes to financial statements:

(i) these notes shall be those required by the appropriate NAIC Annual Statement Instructions and the NAIC Accounting Practices and Procedures Manual; and

(ii) the notes shall include a reconciliation of differences, if any, between the audited statutory financial statements and the annual statement filed pursuant to Sections 31A-4-113 and 31A-4-113.5 with a written description of the nature of these differences; and

(g) the financial statements included in the audited financial report:

(i) the statements shall be prepared in a form and using language and groupings substantially the same as the relevant sections of the annual statement of the insurer filed with the commissioner; and

(ii) shall be comparative, presenting the amounts as of December 31 of the current year and the amounts as of the immediately preceding December 31, except that the comparative data may be omitted in the first year in which an insurer is required to file an audited financial report.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-6 Designation of Independent Certified Public Accountant

(1) Each insurer required by this rule to file an annual audited financial report must within 60 days after becoming subject to the requirement, register with the commissioner in writing the name and address of the independent certified public accountant or accounting firm retained to conduct the annual audit set forth in this rule.

(2) Any insurer not retaining an independent certified public accountant on the effective date of this rule shall register the name and address of their retained independent certified public accountant not less than six months before the date when the first audited financial report is to be filed.

(3) The insurer shall obtain a letter from the accountant, and file a copy with the commissioner stating that the accountant is aware of the provisions of the insurance code and the rules of the insurance department of the state of domicile that relate to accounting and financial matters and affirming that the accountant will express an opinion on the financial statements in terms of their conformity to the statutory accounting practices prescribed or otherwise permitted by that insurance department, specifying such exceptions as the accountant may believe appropriate.

(4) If an accountant who was the accountant for the immediately preceding filed audited financial report is dismissed or resigns, the insurer shall:

(a) within five business days notify the commissioner of this event;

(b) furnish the commissioner with a separate letter within ten business days of the above notification stating whether in the 24 months preceding such event there were any disagreements with the former accountant on any matter of accounting principles or practices, financial statement disclosure, or auditing scope or procedure; which disagreements, if not resolved to the satisfaction of the former accountant, would have caused the accountant to make reference to the subject matter of the disagreement in connection with an opinion:

(i) the disagreements required to be reported in response to this section include both those resolved to the former accountant's satisfaction and those not resolved to the former accountant's satisfaction; and

(ii) disagreements contemplated by this section are those that occur at the decision-making level, such as between personnel of the insurer responsible for presentation of its financial statements and personnel of the accounting firm responsible for rendering its report; and

(c) in writing, request the former accountant to furnish a letter addressed to the insurer stating whether the accountant agrees with the statements contained in the insurer's letter and, if not, stating the reasons for which the accountant does not agree; the insurer shall furnish the response letter from the former accountant to the commissioner together with its own.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-7 Qualifications of Independent Certified Public Accountant

(1) The commissioner may not recognize a person or firm as a qualified independent certified public accountant if the person or firm:

(a) is not in good standing with the AICPA and in all states in which the accountant is licensed to practice, or, for a Canadian or British company, that is not a chartered accountant; or

(b) has either directly or indirectly entered into an agreement of indemnity or release from liability, collectively referred to as indemnification, with respect to the audit of the insurer.

(2) Except as otherwise provided in this rule, the commissioner shall recognize an independent certified public accountant as qualified as long as the accountant conforms to the standards of the profession, as contained in the Code of Professional Ethics of the AICPA and Rules and Regulations and Code of Ethics and Rules of Professional Conduct of the Utah Division of Professional Licensing for Accountancy, or similar code.

(3) A qualified independent certified public accountant may enter into an agreement with an insurer to have disputes relating to an audit resolved by mediation or arbitration. However, in the event of a delinquency proceeding commenced against the insurer under Chapter 31A-27a, Insurer Receivership Act, the mediation or arbitration provisions shall operate at the option of the statutory successor.

(4)(a) The lead, or coordinating, audit partner, having primary responsibility for the audit, may not act in that capacity for more than five consecutive years.

(i) The person shall be disqualified from acting in that or a similar capacity for the same company or its insurance subsidiaries or affiliates for a period of five consecutive years.

(ii) An insurer may apply to the commissioner for relief from the above rotation requirement on the basis of unusual circumstances.

(iii) This application should be made at least 30 days before the end of the calendar year.

(iv) The commissioner may consider the following factors in determining if the relief should be granted:

(A) number of partners, expertise of the partners, or the number of insurance clients in the currently registered firm;

(B) premium volume of the insurer; or

(b)(i) The insurer shall file, with its annual statement filing, the approval for relief from Subsection (4)(a) with the states that it is licensed in or doing business in and with the NAIC.

(ii) If the nondomestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC.

(5) The commissioner may neither recognize as a qualified independent certified public accountant, nor accept an annual audited financial report, prepared in whole or in part by, a natural person who:

(a) is convicted of fraud, bribery, a violation of the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. Sections 1961 to 1968, or any dishonest conduct or practices under federal or state law;

(b) is found to have violated the insurance laws of this state with respect to any previous reports submitted under this rule; or

(c) demonstrates a pattern or practice of failing to detect or disclose material information in previous reports filed under the provisions of this rule.

(6) The commissioner, as provided in Subsection 31A-2-201(4), may, as provided in Subsection 31A-2-201(5), hold a hearing to determine whether an independent certified public accountant is qualified and, considering the evidence presented, may rule that the accountant is not qualified for purposes of expressing an opinion on the financial statements in the annual audited financial report made pursuant to this rule and require the insurer to replace the accountant with another whose relationship with the insurer is qualified within the meaning of this rule.

(7)(a) The commissioner may not recognize as a qualified independent certified public accountant, nor accept an annual audited financial report, prepared in whole or in part by an accountant who provides to an insurer, contemporaneously with the audit, the following non-audit services:

(i) bookkeeping or other services related to the accounting records or financial statements of the insurer;

(ii) financial information systems design and implementation;

(iii) appraisal or valuation services, fairness opinions, or contribution-in-kind reports;

(iv) actuarially-oriented advisory services involving the determination of amounts recorded in the financial statements except that:

(A) the accountant may assist an insurer in understanding the methods, assumptions, and inputs used in the determination of amounts recorded in the financial statement only if it is reasonable to conclude that the services provided will not be subject to audit procedures during an audit of the insurer's financial statements; and

(B) an accountant's actuary may also issue an actuarial opinion or certification opinion on an insurer's reserves if the following conditions have been met:

(I) neither the accountant nor the accountant's actuary has performed any management functions or made any management decisions;

(II) the insurer has competent personnel, or engages a third-party actuary, to estimate the reserves for which management takes responsibility; and

(III) the accountant's actuary tests the reasonableness of the reserves after the insurer's management has determined the amount of the reserves;

(v) internal audit outsourcing services;

(vi) management functions or human resources;

(vii) broker or dealer, investment adviser, or investment banking services;

(viii) legal services or expert services unrelated to the audit; or

(ix) any other services that the commissioner determines, by rule, are impermissible.

(b) In general, the principles of independence with respect to services provided by the qualified independent certified public accountant are largely predicated on three basic principles, violations of which would impair the accountant's independence. The accountant:

(i) cannot function in the role of management;

(ii) cannot audit the accountant's own work; and

(iii) cannot serve in an advocacy role for the insurer.

(8) Insurers having direct written and assumed premiums of less than $100,000,000 in any calendar year may request an exemption from Subsection (7)(a).

(a) The insurer shall file with the commissioner a written statement discussing the reasons why the insurer should be exempt from these provisions.

(b) If the commissioner finds, upon review of this statement, that compliance with this rule would constitute a financial or organizational hardship upon the insurer, an exemption may be granted.

(9) A qualified independent certified public accountant who performs the audit may engage in other non-audit services, including tax services, that are not described in Subsection (7)(a) or that do not conflict with Subsection (7)(b), only if the activity is approved in advance by the audit committee, in accordance with Subsection (10).

(10)(a) All auditing services and non-audit services provided to an insurer by the qualified independent certified public accountant of the insurer shall be preapproved by the audit committee.

(b) The preapproval requirement is waived with respect to non-audit services if the insurer is a SOX compliant entity or a direct or indirect wholly-owned subsidiary of a SOX compliant entity or:

(i) the aggregate amount of all such non-audit services provided to the insurer constitutes not more than 5% of the total amount of fees paid by the insurer to its qualified independent certified public accountant during the fiscal year in which the non- audit services are provided;

(ii) the services were not recognized by the insurer at the time of the engagement to be non-audit services; and

(iii) the services are promptly brought to the attention of the audit committee and approved before the completion of the audit by the audit committee or by one or more members of the audit committee who are the members of the board of directors to whom authority to grant such approvals has been delegated by the audit committee.

(11)(a) The audit committee may delegate to one or more designated members of the audit committee the authority to grant the preapprovals required by Subsection (10).

(b) The decisions of any member to whom this authority is delegated shall be presented to the full audit committee at each of its scheduled meetings.

(12)(a)(i) The commissioner may not recognize an independent certified public accountant as qualified for a particular insurer if a member of the board, president, chief executive officer, controller, chief financial officer, chief accounting officer, or any person serving in an equivalent position for that insurer, was employed by the independent certified public accountant and participated in the audit of that insurer during the one-year period preceding the date that the most current statutory opinion is due.

(ii) This section applies only to partners and senior managers involved in the audit.

(iii) An insurer may apply to the commissioner for relief from the requirement in Subsection (12)(a) on the basis of unusual circumstances.

(b)(i) The insurer shall file, with its annual statement filing, the approval for relief from Subsection (12)(a) with the states that it is licensed in or doing business in and the NAIC.

(ii) If the nondomestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-8 Consolidated or Combined Audits

An insurer may make written application to the commissioner for approval to file audited consolidated or combined financial statements in lieu of separate annual audited financial statements if the insurer is part of a group of insurance companies that utilizes a pooling or 100% reinsurance agreement that affects the solvency and integrity of the insurer's reserves and the insurer cedes all of its direct and assumed business to the pool. In such cases, a columnar consolidating or combining worksheet shall be filed with the report, as follows:

(1) amounts shown on the consolidated or combined audited financial report shall be shown on the worksheet;

(2) amounts for each insurer subject to this section shall be stated separately;

(3) noninsurance operations may be shown on the worksheet on a combined or individual basis;

(4) explanations of consolidating and eliminating entries shall be included; and

(5) a reconciliation shall be included of any differences between the amounts shown in the individual insurer columns of the worksheet and comparable amounts shown on the annual statements of the insurers.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-9 Scope of Audit and Report of Independent Certified Public Accountant

(1) Financial statements furnished pursuant to Section R590-254-5 shall be examined by the independent certified public accountant.

(2) The audit of the insurer's financial statements shall be conducted in accordance with generally accepted auditing standards.

(3) In accordance with AU Section 319 of the Professional Standards of the AICPA, Consideration of Internal Control in a Financial Statement Audit, the independent certified public accountant should obtain an understanding of internal control sufficient to plan the audit.

(4) To the extent required by AU 319, for those insurers required to file a Management's Report of Internal Control over Financial Reporting pursuant to Section R590-254-17, the independent certified public accountant should consider, as that term is defined in Statement on Auditing Standards (SAS) No. 102, Defining Professional Requirements in Statements on Auditing Standards or its replacement, the most recently available report in planning and performing the audit of the statutory financial statements.

(5) Consideration shall be given to the procedures illustrated in the Financial Condition Examiners Handbook promulgated by the NAIC as the independent certified public accountant deems necessary.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-10 Notification of Adverse Financial Condition

(1) The insurer required to furnish the annual audited financial report shall require the independent certified public accountant to report, in writing, within five business days to the board of directors or its audit committee any determination by the independent certified public accountant that the insurer has materially misstated its financial condition as reported to the commissioner as of the balance sheet date currently under audit or that the insurer does not meet the minimum capital and surplus requirement of Title 31A, Insurance Code, as of that date.

(a) An insurer that has received a report pursuant to Subsection (1) shall forward a copy of the report to the commissioner within five business days of receipt of the report and shall provide the independent certified public accountant making the report with evidence of the report being furnished to the commissioner.

(b) If the independent certified public accountant fails to receive the evidence within the required five business day period, the independent certified public accountant shall furnish to the commissioner a copy of its report within the next five business days.

(2) No independent certified public accountant shall be liable in any manner to any person for any statement made in connection with Section R590-254-10 if the statement is made in good faith in compliance with Subsection (1).

(3) If the accountant, subsequent to the date of the audited financial report filed pursuant to this rule, becomes aware of facts that might have affected a report, the commissioner notes the obligation of the accountant to take such action as prescribed in Volume 1, Section AU 561 of the Professional Standards of the AICPA.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-11 Communication of Internal Control Related Matters Noted in an Audit

(1) In addition to the annual audited financial report, each insurer shall furnish the commissioner with a written communication as to any unremediated material weaknesses in its internal control over financial reporting noted during the audit.

(a) Such communication shall be prepared by the accountant within 60 days after the filing of the annual audited financial report, and shall contain a description of any unremediated material weakness, as the term material weakness is defined by Statement on Auditing Standard 60, Communication of Internal Control Related Matters Noted in an Audit, or its replacement, as of December 31 immediately preceding, so as to coincide with the audited financial report discussed in Subsection R590-254-4(1), in the insurer's internal control over financial reporting noted by the accountant during the course of their audit of the financial statements.

(b) If no unremediated material weaknesses were noted, the communication should so state.

(2) The insurer shall provide a description of remedial actions taken or proposed to correct unremediated material weaknesses, if the actions are not described in the accountant's communication.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-12 Accountant's Letter of Qualifications

(1) The accountant shall furnish the insurer in connection with, and for inclusion in, the filing of the annual audited financial report, a letter stating:

(a) that the accountant is independent with respect to the insurer and conforms to the standards of the profession as contained in the Code of Professional Ethics and pronouncements of the AICPA and the Rules of Professional Conduct of the Utah Division of Professional Licensing for Accountancy, or similar code;

(b) the background and experience in general, and the experience in audits of insurers of the staff assigned to the engagement and whether each is an independent certified public accountant;

(c) that the accountant understands the annual audited financial report and that the accountant's opinion thereon will be filed in compliance with this rule and that the commissioner will be relying on this information in the monitoring and regulation of the financial position of insurers;

(d) that the accountant consents to the requirements of Section R590-254-13 of this rule and that the accountant consents and agrees to make available for review by the commissioner, or the commissioner's designee or appointed agent, the workpapers, as defined in Section R590-254-13;

(e) a representation that the accountant is properly licensed by an appropriate state licensing authority and is a member in good standing in the AICPA; and

(f) a representation that the accountant is in compliance with the requirements of Section R590-254-7.

(2) Nothing within this rule shall be construed as prohibiting the accountant from utilizing staff as appropriate where use is consistent with the standards prescribed by generally accepted auditing standards.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-13 Definition, Availability, and Maintenance of Independent Certified Public Accountants Workpapers

(1)(a) Workpapers are the records kept by the independent certified public accountant of the procedures followed, the tests performed, the information obtained, and the conclusions reached pertinent to the accountant's audit of the financial statements of an insurer.

(b) Workpapers may include audit planning documentation, work programs, analyses, memoranda, letters of confirmation and representation, abstracts of company documents, and schedules or commentaries prepared or obtained by the independent certified public accountant in the course of an audit of the financial statements of an insurer and that support the accountant's opinion.

(2)(a) Each insurer required to file an audited financial report pursuant to this rule, shall require the accountant to make available for review by insurance department examiners, all workpapers prepared in the conduct of the accountant's audit and any communications related to the audit between the accountant and the insurer, at the offices of the insurer, at the insurance department or at any other reasonable place designated by the commissioner.

(b) The insurer shall require that the accountant retain the audit workpapers and communications until the insurance department has filed a report on examination covering the period of the audit but no longer than seven years from the date of the audit report.

(3)(a) In the conduct of the aforementioned periodic review by the insurance department examiners, it shall be agreed that photocopies of pertinent audit workpapers may be made and retained by the department.

(b) Such reviews by the department examiners shall be considered investigations and all working papers and communications obtained during the course of such investigations shall be afforded the same confidentiality as other examination workpapers generated by the department.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-14 Requirements for Audit Committees

(1) This section does not apply to foreign or alien insurers licensed in this state or an insurer that is a SOX compliant entity or a direct or indirect wholly-owned subsidiary of a SOX compliant entity.

(2) The audit committee shall be directly responsible for the appointment, compensation, and oversight of the work of any accountant, including resolution of disagreements between management and the accountant regarding financial reporting, for the purpose of preparing or issuing the audited financial report or related work pursuant to this rule. Each accountant shall report directly to the audit committee.

(3) Each member of the audit committee shall be a member of the board of directors of the insurer or a member of the board of directors of an entity elected pursuant to Subsection (6) and Subsection R590-254-3(3).

(4) To be considered independent for purposes of this section, a member of the audit committee:

(a) may not, other than in the capacity as a member of the audit committee, the board of directors, or any other board committee, accept any consulting, advisory, or other compensatory fee from the entity, or be an affiliated person of the entity or any subsidiary of the entity; or

(b) if law requires board participation by otherwise non-independent members, that law shall prevail and such members may participate in the audit committee and be designated as independent for audit committee purposes, unless they are an officer or employee of the insurer or one of its affiliates.

(5) If a member of the audit committee ceases to be independent for reasons outside the member's reasonable control, that person, with notice by the responsible entity to the state, may remain an audit committee member of the responsible entity until the earlier of the next annual meeting of the responsible entity or one year from the occurrence of the event that caused the member to be no longer independent.

(6) To exercise the election of the controlling person to designate the audit committee for purposes of this rule, the ultimate controlling person shall provide written notice to the commissioners of the affected insurers.

(a) Notification shall be made timely before the issuance of the statutory audit report and include a description of the basis for the election.

(b) The election can be changed through notice to the commissioner by the insurer, which shall include a description of the basis for the change.

(7)(a) The audit committee shall require the accountant that performs for an insurer any audit required by this rule to timely report to the audit committee in accordance with the requirements of SAS 61, Communication with Audit Committees, or its replacement, including:

(i) all significant accounting policies and material permitted practices;

(ii) all material alternative treatments of financial information within statutory accounting principles that have been discussed with management officials of the insurer, ramifications of the use of the alternative disclosures and treatments, and the treatment preferred by the accountant; and

(iii) other material written communications between the accountant and the management of the insurer, such as any management letter or schedule of unadjusted differences.

(b) If an insurer is a member of an insurance holding company system, the reports required by Subsection (7)(a) may be provided to the audit committee on an aggregate basis for insurers in the holding company system, provided that any substantial differences among insurers in the system are identified to the audit committee.

(8) The proportion of independent audit committee members shall meet or exceed the following criteria:

Table

$0 - $300,000,000

No minimum requirements. See also Notes A and B.

Over $300,000,000 - $500,000,000

Majority (50% or more) of members shall be independent. See also Notes A and B.

Over $500,000,000

Super majority of members (75% or more) shall be independent. See also Note A.

Note A: The commissioner has authority afforded by state law to require the entity's board to enact improvements to the independence of the audit committee membership if the insurer is in an RBC action level event, meets one or more of the standards of an insurer deemed to be in hazardous financial condition, or otherwise exhibits qualities of a troubled insurer.

Note B: All insurers with less than $500,000,000 in prior year direct written and assumed premiums are encouraged to structure their audit committees with at least a supermajority of independent audit committee members.

Note C: Prior calendar year direct written and assumed premiums shall be the combined total of direct premiums and assumed premiums from non-affiliates for the reporting entities.

(9)(a) An insurer with direct written and assumed premium, excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than $500,000,000 may apply to the commissioner for a waiver from the requirements of Section R590-254-14 based upon hardship.

(b) The insurer shall file, with its annual statement filing, the approval for relief from Section R590-254-14 with the states that it is licensed in or doing business in and the NAIC. If the nondomestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-15 Internal Audit Function Requirements

(1) An insurer is exempt from the requirements of this section if:

(a) the insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, of less than $500,000,000; and

(b) if the insurer is a member of a group of insurers, the group has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, of less than $1,000,000,000.

(2)(a) The insurer or group of insurers shall establish an internal audit function providing independent, objective, and reasonable assurance to the audit committee and insurer management regarding the insurer's governance, risk management, and internal controls.

(b) The assurance required by Subsection (2)(a) shall be provided by:

(i) performing general and specific audits, reviews, and tests; and

(ii) employing other techniques deemed necessary to:

(A) protect assets;

(B) evaluate control, effectiveness, and efficiency; and

(3) The internal audit function shall be organizationally independent.

(4) The internal audit function may not defer ultimate judgment on audit matters to others.

(5) An individual shall be appointed to head the internal audit function with direct and unrestricted access to the board of directors.

(6) Nothing in Section R590-254-15 precludes dual-reporting relationships.

(7) The head of the internal audit function shall report to the audit committee at least annually on:

(a) the periodic audit plan;

(b) factors that may adversely impact the internal audit function's independence or effectiveness;

(d) the appropriateness of corrective actions implemented by management as a result of audit findings.

(8) If an insurer is a member of an insurance holding company system or is included in a group of insurers, the insurer may satisfy the internal audit function requirements set forth in Section R590-254-15 at:

(a) the ultimate controlling parent level;

(b) an intermediate holding company level; or

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-16 Conduct of Insurer in Connection with the Preparation of Required Reports and Documents

(1) A director or officer of an insurer may not, directly or indirectly:

(a) make or cause to be made a materially false or misleading statement to an accountant in connection with any audit, review, or communication required under this rule; or

(b) omit to state, or cause another person to omit to state, any material fact necessary in order to make statements made, in light of the circumstances under which the statements were made, not misleading to an accountant in connection with any audit, review, or communication required under this rule.

(2) An officer or director of an insurer, or any other person acting under the direction thereof, may not directly or indirectly take any action to coerce, manipulate, mislead, or fraudulently influence any accountant engaged in the performance of an audit pursuant to this rule if that person knew or should have known that the action, if successful, could result in rendering the insurer's financial statements materially misleading.

(3) For purposes of Subsection (2), actions that, "if successful, could result in rendering the insurer's financial statements materially misleading" include actions taken at any time with respect to the professional engagement period to coerce, manipulate, mislead, or fraudulently influence an accountant:

(a) to issue or reissue a report on an insurer's financial statements that is not warranted in the circumstances, due to material violations of statutory accounting principles prescribed by the commissioner, generally accepted auditing standards, or other professional or regulatory standards;

(b) not to perform audit, review, or other procedures required by generally accepted auditing standards or other professional standards;

(d) not to communicate matters to an insurer's audit committee.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-17 Management's Report of Internal Control over Financial Reporting

(1)(a) Each insurer required to file an audited financial report pursuant to this rule that has annual direct written and assumed premiums, excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, of $500,000,000 or more shall prepare a report of the insurer's or group of insurers' internal control over financial reporting.

(b) The report shall be filed with the commissioner along with the Communication of Internal Control Related Matters Noted in an Audit described under Section R590-254-11.

(2) Notwithstanding the premium threshold in Subsection (1)(a), the commissioner may require an insurer to file Management's Report of Internal Control over Financial Reporting if the insurer is in any RBC level event, or meets any one or more of the standards of an insurer deemed to be in hazardous financial condition as defined in Section 31A-27a-207 and the NAIC Model Regulation to Define Standards and Commissioner's Authority for Companies Deemed to be in Hazardous Financial Condition.

(3)(a) An insurer or a group of insurers that is:

(i) directly subject to Section 404;

(ii) part of a holding company system whose parent is directly subject to Section 404;

(iii) not directly subject to Section 404 but is a SOX compliant entity; or

(iv) a member of a holding company system whose parent is not directly subject to Section 404 but is a SOX compliant entity;

(b) may file its or its parent's Section 404 Report and an addendum in satisfaction of Subsection (1), provided that those internal controls of the insurer or group of insurers having a material impact on the preparation of the insurer's or group of insurers' audited statutory financial statements, as included in Subsections R590-254-5(2)(b) through R590-254-5(2)(g), were included in the scope of the Section 404 Report.

(i) The addendum shall be a positive statement by management that there are no material processes with respect to the preparation of the insurer's or group of insurers' audited statutory financial statements, as included in Subsections R590-254- 5(2)(b) through R590-254-5(2)(g), excluded from the Section 404 Report.

(ii) If there are internal controls of the insurer or group of insurers that have a material impact on the preparation of the insurer's or group of insurers' audited statutory financial statements and those internal controls were not included in the scope of the Section 404 Report, the insurer or group of insurers may either file:

(A) a Section R590-254-17 report; or

(B) the Section 404 Report and a Section R590-254-17 report for those internal controls that have a material impact on the preparation of the insurer's or group of insurers' audited statutory financial statements not covered by the Section 404 Report.

(4) Management's Report of Internal Control over Financial Reporting shall include:

(a) a statement that management is responsible for establishing and maintaining adequate internal control over financial reporting;

(b) a statement that management has established internal control over financial reporting and an assertion, to the best of management's knowledge and belief, after diligent inquiry, as to whether its internal control over financial reporting is effective to provide reasonable assurance regarding the reliability of financial statements in accordance with statutory accounting principles;

(c) a statement that briefly describes the approach or processes by which management evaluated the effectiveness of its internal control over financial reporting;

(d) a statement that briefly describes the scope of work that is included and whether any internal controls were excluded;

(e) disclosure of any unremediated material weaknesses in the internal control over financial reporting identified by management as of December 31 immediately preceding;

(f) a statement regarding the inherent limitations of internal control systems; and

(g) signatures of the chief executive officer and the chief financial officer, or equivalent position.

(5) Management shall document and make available upon financial condition examination the basis upon which its assertions, required in Subsection (4), are made.

(a) Management may base its assertions, in part, upon its review, monitoring, and testing of internal controls undertaken in the normal course of its activities.

(b) Management shall have discretion as to the nature of the internal control framework used, and the nature and extent of documentation, in order to make its assertion in a cost-effective manner and, as such, may include assembly of or reference to existing documentation.

(c) Management's Report on Internal Control over Financial Reporting, required by Subsection (1), and any documentation provided in support thereof during the course of a financial condition examination, shall be kept confidential by the department.

(d) Management is not permitted to conclude that the internal control over financial reporting is effective to provide reasonable assurance regarding the reliability of financial statements in accordance with statutory accounting principles if there is one or more unremediated material weaknesses in its internal control over financial reporting.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-18 Exemptions and Implementation Dates

(1) Upon written application of any insurer, the commissioner may grant an exemption from compliance with any and all provisions of this rule if the commissioner finds, upon review of the application, that compliance with this rule would constitute a financial or organizational hardship upon the insurer.

(a) An exemption may be granted at any time and from time to time for a specified period or periods.

(b) Within ten days from a denial of an insurer's written request for an exemption from this rule, the insurer may request in writing a hearing on its application for an exemption.

(c) The hearing shall be held in accordance with the rules of the department pertaining to administrative hearing procedures.

(2) Foreign insurers shall comply with this rule.

(3)(a) An insurer or group of insurers that is not required to have independent audit committee members or only a majority of independent audit committee members, as opposed to a supermajority, because the total written and assumed premium is below the threshold and subsequently becomes subject to one of the independence requirements due to changes in premium, shall have one year following the year the threshold is exceeded to comply with the independence requirements.

(b) An insurer that becomes subject to one of the independence requirements as a result of a business combination shall have one calendar year following the date of acquisition or combination to comply with the independence requirements.

(4)(a) An insurer or group of insurers that is not required to file a report because the total written premium is below the threshold, and subsequently becomes subject to the reporting requirements, shall have two years following the year the threshold is exceeded to file a report.

(b) An insurer acquired in a business combination shall have two calendar years following the date of acquisition or combination to comply with the reporting requirements.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-19 Canadian and British Companies

(1) In the case of Canadian and British insurers, the annual audited financial report shall be defined as the annual statement of total business on the form filed by such companies with their supervision authority duly audited by an independent chartered accountant.

(2) For such insurers, the letter required in Subsection R590-254-6(3) shall state that the accountant is aware of the requirements relating to the annual audited financial report filed with the commissioner pursuant to Section R590-254-4 and shall affirm that the opinion expressed is in conformity with those requirements.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

Utah Admin. Code R590-254-20 Severability

If any provision of this rule, Rule R590-254, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance company financial reporting
Date of Last Change: January 10, 2023
Notice of Continuation: June 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-203; 31A-5-412

R590-258 Email Address Requirement

Utah Admin. Code R590-258-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 46-4-501.

History

KEY: insurance, email address requirement
Date of Last Change: January 10, 2023
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 46-4-501

Utah Admin. Code R590-258-2 Purpose and Scope

(1) The purpose of this rule is to require a person who is licensed or registered with the commissioner, or should be licensed or registered with the commissioner, to have a current valid email address on file with the commissioner to:

(a) improve the accuracy, reliability, and promptness of communication between the department and any licensed or registered person;

(b) reduce mailing expense; and

(2) This rule applies to a person who is licensed or registered by the commissioner, or should be licensed or registered with the commissioner, to do business in Utah.

History

KEY: insurance, email address requirement
Date of Last Change: January 10, 2023
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 46-4-501

Utah Admin. Code R590-258-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance, email address requirement
Date of Last Change: January 10, 2023
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 46-4-501

Utah Admin. Code R590-258-4 Requirement to Submit and Maintain a Valid Email Address

(1) A person who is licensed or registered with the commissioner, or should be licensed or registered with the commissioner, shall submit to, and maintain with, the commissioner one or more valid business email addresses where the person can receive from the department, communication including:

(a) a general notification;

(b) a license renewal notice;

(d) a consumer complaint;

(e) a request for information; or

(f) other correspondence.

(2) A licensed or registered person shall confirm that the spam filter for an email address required in Subsection (1) will accept email correspondence from the department.

(3) Correspondence sent by the department to an email address required in Subsection (1) shall be considered received by the person.

(4) A change of email address shall be submitted electronically at no cost to the licensed or registered person.

(a) An individual or agency licensee shall submit the change at http://www.sircon.com/utah or http://www.nipr.com/.

(b) A licensed or registered person, other than an individual or agency licensee, shall submit the change at http://clr.utah.gov/.

History

KEY: insurance, email address requirement
Date of Last Change: January 10, 2023
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 46-4-501

Utah Admin. Code R590-258-5 Severability

If any provision of this rule, Rule R590-258, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, email address requirement
Date of Last Change: January 10, 2023
Notice of Continuation: August 18, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 46-4-501

R590-259 Dependent Coverage to Age 26

Utah Admin. Code R590-259-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-212, and 31A-22-605.

History

KEY: health insurance open enrollment
Date of Last Change: November 21, 2023
Notice of Continuation: January 7, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605

Utah Admin. Code R590-259-2 Purpose and Scope

(1) The purpose of this rule is to clarify standards relating to dependent coverage of a child in a health benefit plan.

(2) This rule applies to an insurer providing a health benefit plan.

History

KEY: health insurance open enrollment
Date of Last Change: November 21, 2023
Notice of Continuation: January 7, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605

Utah Admin. Code R590-259-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-22-611, and 31A-30-103. Additional terms are defined as follows:

(1) "Child" means an individual who is a son, daughter, stepson, or stepdaughter of an insured.

(2) "Grandfathered plan" is as defined in 45 CFR 147.140.

History

KEY: health insurance open enrollment
Date of Last Change: November 21, 2023
Notice of Continuation: January 7, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605

Utah Admin. Code R590-259-4 Eligibility for Dependent Coverage to Age 26; Uniformity of Plan Terms

(1) A health insurer that provides dependent coverage shall make that coverage available until the end of the month the child turns 26 years of age.

(2) With respect to a child who has not turned 26 years of age, an insurer may not define a dependent for purposes of eligibility other than in the terms of a relationship between a child and the insured.

(3) An insurer may not deny or restrict coverage for a child who has not turned 26 years of age based on:

(a) the child's financial dependency;

(b) the child's residency;

(d) the child's employment status;

(e) the child's eligibility for other coverage, except as provided in Subsection (5); or

(f) any combination thereof.

(4) The dependent coverage may not vary based on age except for a dependent with a disability.

(5) A group grandfathered plan issued before January 1, 2014, may exclude an adult child who has not turned 26 years of age if the adult child is eligible to enroll in an eligible employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the Internal Revenue Code, other than an eligible employer-sponsored health benefit plan of a parent.

History

KEY: health insurance open enrollment
Date of Last Change: November 21, 2023
Notice of Continuation: January 7, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605

Utah Admin. Code R590-259-5 Severability

If any provision of this rule, Rule R590-259, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance open enrollment
Date of Last Change: November 21, 2023
Notice of Continuation: January 7, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605

R590-261 Health Benefit Plan Adverse Benefit Determinations

Utah Admin. Code R590-261-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-212, and 31A-22-629.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-2 Purpose and Scope

(1) The purpose of this rule is to provide a uniform standard for the establishment and maintenance of an:

(a) independent review procedure to assure that a claimant has the opportunity for an independent review of a final adverse benefit determination; and

(b) external review of a non-formulary drug under 45 CFR 156.122.

(2)(a) This rule applies to a carrier offering a health benefit plan.

(b) This rule does not apply to a:

(i) grandfathered health benefit plan; or

(ii) transitional health benefit plan.

(c) If all grandfathered health benefit plans are administered consistently, a carrier may voluntarily comply with the independent review process outlined in this rule.

(d) A self-funded health plan may voluntarily comply with the independent review process outlined in this rule.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-3 Definitions

Terms used in this rule are defined in Section 31A-1-301 and 45 CFR 147.140. Additional terms are defined as follows:

(1)(a) "Adverse benefit determination" means:

(i) based on the carrier's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered benefit, the:

(A) denial of a benefit;

(B) reduction of a benefit;

(D) failure to provide or make payment, in whole or part, for a benefit; or

(ii) rescission of coverage.

(b) "Adverse benefit determination" includes:

(i) denial, reduction, termination, or failure to provide or make payment that is based on a determination of an insured's eligibility to participate in a health benefit plan;

(ii) failure to provide or make payment, in whole or part, for a benefit resulting from the application of a utilization review; and

(iii) failure to cover an item or service for which benefits are otherwise provided because it is determined to be:

(A) experimental;

(B) investigational; or

(2) "Authorized representative" means:

(a) a person to whom an insured has given express written consent for representation in an external review;

(b) a person authorized by law to provide substituted consent for an insured; or

(i) a family member of the insured; or

(ii) the insured's treating health care provider.

(3) "Carrier" means a person that provides health insurance in this state including:

(a) an insurance company;

(b) a prepaid hospital or medical care plan;

(d) a multiple employer welfare arrangement; and

(e) any other person providing a health insurance plan under Title 31A, Insurance Code.

(4) "Claimant" means the insured or the insured's authorized representative.

(5) "Clinical reviewer" means a physician or other appropriate health care provider who:

(a) is an expert in the treatment of the medical condition that is the subject of the review;

(b) is knowledgeable about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar medical condition;

(d) has no history of disciplinary actions or sanctions.

(6) "Final adverse benefit determination" means an adverse benefit determination that has been upheld by a carrier at the completion of the carrier's internal review process.

(7) "Independent review" means a process that:

(a) is a voluntary option for the resolution of a final adverse benefit determination;

(b) is conducted at the discretion of the claimant;

(d) renders an independent and impartial decision on a final adverse benefit determination; and

(e) may not require the claimant to pay a fee for requesting the independent review.

(8) "Non-formulary drug" means a prescription drug that is not included on a carrier's covered formulary drug list.

(9) "Non-formulary drug exception process" means a process for a claimant to request a review of a decision for a drug not covered by the health benefit plan.

(10)(a) "Rescission" means a cancellation or discontinuance of coverage under a health benefit plan that has a retroactive effect.

(b) "Rescission" does not include a cancellation or discontinuance of coverage under a health benefit plan if the cancellation or discontinuance of coverage:

(i) has only a prospective effect; or

(ii) is effective retroactively to the extent it is attributable to a failure to timely pay required premiums or contributions toward the cost of coverage.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-4 Adverse Benefit Determination Procedure Compliance

An adverse benefit determination procedure shall comply with this rule, 29 CFR 2560.503-1, 45 CFR 147.136, and 45 CFR 156.122.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-5 Notice of Right to Independent Review

(1) A carrier shall provide written notice of a claimant's right to an independent review with each notice of rescission of coverage or final adverse benefit determination.

(2) The notice in Subsection (1) shall include the following, or substantially equivalent, statement:

"We have rescinded your coverage or denied your request for the provision of or payment for a health care service or course of treatment. You may have the right to have our decision reviewed by a health care professional who has no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, health care setting, level of care, or effectiveness of the health care service or treatment you requested. To receive additional information about an independent review, visit https://insurance.utah.gov/consumers/health-insurance/independent-review/ or contact the Utah Insurance Department by mail at 4315 S. 2700 W., Suite 2300, Taylorsville, UT 84129; by phone at 801-957-9280; or by email at healthappeals@utah.gov."

(3) The statement required in Subsection (2) shall follow the description of any appeal disclosure required by Section R590-192-7.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-6 Exhaustion of Internal Review Process

A carrier's internal review process shall be exhausted before an independent review unless:

(1) the carrier agrees to waive the internal review process;

(2) the carrier did not comply with its internal review process, except for a minor violation that:

(a) does not cause prejudice or harm to the claimant; and

(b) is not part of a pattern or practice of violations; or

(3) the claimant requests an expedited independent review pursuant to Section R590-261-10 at the same time the claimant requests an expedited internal review.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-7 Independent Review Organizations

(1) The commissioner shall compile and maintain a list of approved independent review organizations.

(2) To be considered for placement on the list in Subsection (1), an independent review organization shall:

(a) be accredited by a nationally recognized private accrediting entity;

(b) comply with the requirements of this rule; and

(i) all reviews are conducted within a specified time frame;

(ii) a clinical reviewer is qualified and impartial;

(iii) confidentiality of medical and treatment records and clinical review criteria; and

(iv) any person employed by or under contract with the independent review organization adheres to the requirements of this rule.

(3) An applicant requesting placement on the list in Subsection (1) shall submit to the commissioner:

(a) a completed Independent Review Organization Application form, available on the department's website, https://insurance.utah.gov;

(b) all documentation and information requested on the application, including proof of accreditation by a nationally recognized private accrediting entity; and

(4) An independent review organization shall be removed from the list in Subsection (1) if the commissioner finds that the independent review organization lost its accreditation or no longer satisfies the minimum requirements for approval.

(5)(a) An independent review organization may not be owned or controlled by, or exercise control over:

(i) a carrier;

(ii) a health benefit plan;

(iii) a health benefit plan's fiduciary;

(iv) a national, state, or local trade association of:

(A) health benefit plans;

(B) carriers; or

(v) an employer; or

(vi) an employee or agent of a person listed in Subsections (5)(a)(i) through (5)(a)(v).

(b) An independent review organization and a clinical reviewer assigned to conduct an independent review may not have a professional, familial, or financial conflict of interest with:

(i) the carrier;

(ii) an officer, director, or management employee of the health plan;

(iii) the health benefit plan;

(iv) the plan administrator, plan fiduciary, or a plan employee;

(v) the claimant;

(vi) the insured's health care provider;

(vii) the health care provider's medical group or independent practice association;

(viii) the health care facility where the service is provided; or

(ix) the developer or manufacturer of the service that is provided.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-8 General Independent Review Requirements

(1) An independent review is available to a claimant regardless of the dollar amount of the claim involved.

(2)(a) A claimant has 180 calendar days after receiving a notice of a final adverse benefit determination to file a request with the commissioner for an independent review.

(b) A claimant shall use the Independent Review Request Form available on the department's website, https://insurance.utah.gov, or a substantially similar form, to file a request.

(c) A request for an independent review sent to a carrier instead of to the commissioner shall be forwarded to the commissioner by the carrier within one business day of receipt.

(3) A carrier shall pay to the independent review organization the cost of conducting the independent review.

(4) The independent review decision is binding on the carrier and the claimant except to the extent that other remedies are available under federal or state law.

(5)(a) If a carrier fails to provide the requested information to an independent review organization, as outlined in Subsections R590-261-9(2)(b), R590-261-10(3)(b), and R590-261-11(3)(b), the independent review organization may terminate the independent review and make a decision to reverse the adverse benefit determination.

(b) Within one business day after making a decision under Subsection (5)(a), the independent review organization shall notify:

(i) the claimant;

(ii) the carrier; and

(iii) the commissioner.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-9 Standard Independent Review

(1)(a) Upon receiving a request for an independent review, the commissioner shall send a copy of the request to the carrier for an eligibility review.

(b) Within five business days after receiving the request, the carrier shall determine if:

(i) the individual was an insured in the health benefit plan at the time:

(A) of rescission; or

(B) the health care service was requested or provided;

(ii) the health care service is a covered benefit;

(iii) the claimant exhausted the carrier's internal review process; and

(iv) the claimant provided the information and forms required to process an independent review.

(c)(i) Within one business day after completing the eligibility review, the carrier shall notify the commissioner and claimant in writing if:

(A) the request is complete; and

(B) the request is eligible for independent review.

(ii) If the request is not complete, the carrier shall inform the claimant and the commissioner, in writing, of the information or materials needed to make the request complete.

(iii) If the request is not eligible for independent review, the carrier shall:

(A) inform the claimant and the commissioner, in writing, of the reasons for ineligibility; and

(B) inform the claimant that the determination may be appealed to the commissioner.

(d)(i) The commissioner may determine that a request is eligible for independent review, notwithstanding the carrier's initial determination that the request is ineligible, and may require that the request be referred for independent review.

(ii) In making the determination in Subsection (1)(d)(i), the commissioner's decision shall be made in accordance with the terms of the insured's health benefit plan and shall be subject to all applicable provisions of this rule.

(2) Upon receiving a carrier's determination that a request is eligible for an independent review, the commissioner shall:

(a) assign, on a random basis, an independent review organization from the list of approved independent review organizations based on the nature of the health care service that is the subject of the review;

(b) notify the carrier of the assignment and that the carrier shall, within five business days, provide to the assigned independent review organization the documents and any information considered in making the adverse benefit determination; and

(i) the request for independent review is accepted; and

(ii) the claimant may submit additional information to the independent review organization within five business days of receiving the commissioner's notification.

(3) The independent review organization shall forward any additional information submitted by a claimant under Subsection (2)(c) to the carrier within one business day of receipt.

(4) Within 45 calendar days after receiving a request for an independent review, the independent review organization shall provide written notice of its decision to:

(a) the claimant;

(b) the carrier; and

(5) Within one business day of receiving notice that an adverse benefit determination is overturned, the carrier shall:

(a) approve the coverage that is the subject of the adverse benefit determination; and

(b) process any benefit that is due.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-10 Expedited Independent Review

(1) An expedited independent review process shall be available if the adverse benefit determination:

(a) involves an insured's medical condition that may seriously jeopardize the life or health of the insured or the insured's ability to regain maximum function;

(b) may, in the opinion of the insured's attending provider, subject the insured to severe pain that cannot be adequately managed without the care or treatment that is the subject of the adverse benefit determination; or

(c) involves an admission, availability of care, continued stay, or health care service for which the insured received emergency medical services, but has not been discharged from a facility.

(2)(a) Upon receiving a request for an expedited independent review, the commissioner shall immediately send a copy of the request to the carrier for an eligibility review.

(b) Immediately upon receiving the request, the carrier shall determine if:

(i) the individual was an insured in the health benefit plan at the time the health care service was requested or provided;

(ii) the health care service is a covered benefit; and

(iii) the claimant provided the information and forms required to process an expedited independent review.

(c)(i) The carrier shall immediately notify the claimant and the commissioner if:

(A) the request is complete; and

(B) the request is eligible for an expedited independent review.

(ii) If the request is not complete, the carrier shall inform the claimant and the commissioner, in writing, of the information or materials needed to make the request complete.

(iii) If the request is not eligible for an expedited independent review, the carrier shall:

(A) inform the claimant and the commissioner, in writing, of the reasons for ineligibility; and

(B) inform the claimant that the determination may be appealed to the commissioner.

(d)(i) The commissioner may determine that a request is eligible for an expedited independent review, notwithstanding the carrier's initial determination that the request is ineligible, and may require that the request be referred for an expedited independent review.

(ii) In making the determination in Subsection (2)(d)(i), the commissioner's decision shall be made in accordance with the terms of the insured's health benefit plan and shall be subject to this rule.

(3) Upon receiving the carrier's determination that a request is eligible for an expedited independent review, the commissioner shall immediately:

(a) assign an independent review organization from the list of approved independent review organizations;

(b) notify the carrier of the assignment and that the carrier shall, upon receipt, provide to the assigned independent review organization the documents and any information considered in making the adverse benefit determination; and

(i) the request is accepted; and

(ii) the claimant may immediately submit additional information to the independent review organization.

(4) The independent review organization shall forward any additional information submitted by a claimant under Subsection (3)(c)(ii) to the carrier within one business day of receipt.

(5)(a) As expeditiously as the insured's medical condition or circumstance requires, but no later than 72 hours after receiving the request for an expedited independent review, the independent review organization shall provide notice of its decision to:

(i) the carrier;

(ii) the claimant; and

(iii) the commissioner.

(b) If notice of the independent review organization's decision is not in writing, the independent review organization shall provide written confirmation of its decision within 48 hours after the date of notification.

(6) Upon receiving notice that an adverse benefit determination is overturned, the carrier shall:

(a) approve the coverage that is the subject of the adverse benefit determination; and

(b) process any benefit that is due.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-11 Independent Review of Experimental or Investigational Service or Treatment

(1)(a) A request for an independent review, based on an experimental or investigational service or treatment, shall be submitted with certification from the insured's health care provider that:

(i) the standard health care service or treatment is not effective in improving the insured's condition;

(ii) the standard health care service or treatment is not medically appropriate for the insured; or

(iii) there is no available standard health care service or treatment covered by the carrier that is more beneficial than the recommended or requested health care service or treatment.

(b) A claimant may make an oral or written request for an expedited independent review if the insured's health care professional certifies, in writing, that the recommended or requested health care service or treatment would be significantly less effective if not initiated promptly.

(2)(a) Within one business day after receiving a request for an independent review involving an experimental or investigational service or treatment, or immediately for an expedited review, the commissioner shall send a copy of the request to the carrier for an eligibility review.

(b) Within five business days after receiving the request, or immediately for an expedited review, the carrier shall determine if:

(i) the individual was an insured in the health benefit plan at the time the health care service was requested or provided;

(ii) the health care service or treatment is a covered benefit, except for the carrier's determination that the service or treatment:

(A) is experimental or investigational for a particular medical condition; and

(B) is not explicitly listed as an excluded benefit under the insured's health benefit plan;

(iii) the insured's health care provider:

(A) has certified one of the following situations applies:

(I) the standard health care services have not been effective in improving the condition of the insured;

(II) the standard health care services or treatments are not medically appropriate for the covered person; or

(III) there is no available standard health care service or treatment covered by the carrier that is more beneficial than the recommended or requested health care service or treatment;

(B) has certified in writing:

(I) in their opinion, the health care service or treatment is likely to be more beneficial to the insured than any available standard health care service or treatment; and

(II) scientifically valid studies using accepted protocols demonstrate that the health care service or treatment is likely to be more beneficial to the insured than any available standard health care service or treatment; and

(C) is licensed, board certified, or board eligible to practice in the area of medicine appropriate to treat the insured's condition;

(iv) the claimant exhausted the carrier's internal review process, unless the request is for an expedited review; and

(v) the claimant provided the information and forms required to process an independent review.

(c)(i) Within one business day after completing the eligibility review, or immediately for an expedited review, the carrier shall notify the commissioner and the claimant, in writing, if:

(A) the request is complete; and

(B) the request is eligible for independent review.

(ii) If the request is not complete, the carrier shall inform the claimant and commissioner, in writing, of the information or materials needed to make the request complete.

(iii) If the request is not eligible for independent review, the carrier shall:

(A) inform the claimant and the commissioner, in writing, of the reasons for ineligibility; and

(B) inform the claimant that the determination may be appealed to the commissioner.

(d)(i) The commissioner may determine that a request is eligible for independent review, notwithstanding the carrier's initial determination that the request is ineligible, and require that the request be referred for independent review.

(ii) In making the determination in Subsection (2)(d)(i), the commissioner's decision shall be made in accordance with the terms of the health benefit plan and shall be subject to all applicable provisions of this rule.

(3) Upon receiving the carrier's determination that the request is eligible for an independent review, the commissioner shall:

(a) assign an independent review organization from the list of approved independent review organizations;

(b) notify the carrier of the assignment and that the carrier shall, within five business days, or immediately for an expedited review, provide to the assigned independent review organization the documents and any information considered in making the adverse benefit determination; and

(c) notify the claimant that the request has been accepted and that the claimant may, within five business days, or immediately for an expedited review, submit additional information to the independent review organization.

(4) The independent review organization shall forward any additional information submitted by a claimant under Subsection (3)(c) to the carrier within one business day of receipt, or immediately for an expedited review.

(5) Within one business day after receiving the request, or immediately for an expedited review, the independent review organization shall select one or more clinical reviewers to conduct the review.

(6) The clinical reviewer shall provide to the independent review organization a written opinion within 20 calendar days, or five calendar days for an expedited review, after being selected.

(7) The independent review organization, within 20 calendar days of receiving the clinical reviewer's opinion, or no later than 72 hours for an expedited review, shall provide notice of its decision to:

(a) the claimant;

(b) the carrier; and

(8) Within one business day of receiving notice that an adverse benefit determination is overturned, the carrier shall:

(a) approve the coverage that is the subject of the adverse benefit determination; and

(b) process any benefit that is due.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-12 Non-Formulary Drug Exception Process

(1) A carrier shall have the following exception processes that comply with 45 CFR 156.122(c) for a non-formulary drug:

(a) standard exception request;

(b) expedited exception request; and

(2) A carrier may require a request for an exception to be submitted with clinical documentation from the insured's health care provider.

(3)(a) An external exception request review shall be reviewed by an independent review organization.

(b) A carrier that fails to establish an external exception request review through an independent review organization shall comply with Section R590-261-10.

(4) A granted exception shall:

(a) treat the excepted drug as an essential health benefit; and

(b) count any cost-sharing towards the plan's annual limitation on cost sharing.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-13 Disclosure Requirements

(1) A carrier shall include a description of the independent review procedure in or attached to the policy and certificate, and may include a description with other evidence of coverage provided to the insured.

(2) The description required in Subsection (1) shall:

(a) include a statement that informs the insured:

(i) of the right to file a request for an independent review of a final adverse benefit determination, including the website, phone number, and address of the Utah Insurance Department; and

(ii) that an authorization to obtain medical records is required for reaching a decision; and

(b) be listed after the description of an appeal procedure.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-14 Records

(1) An independent review organization shall maintain a written record of each independent review for the current year plus five years.

(2) The records of an independent review organization shall be available for review by the commissioner upon request.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

Utah Admin. Code R590-261-15 Severability

If any provision of this rule, Rule R590-261, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health benefit plan insurance
Date of Last Change: August 27, 2025
Notice of Continuation: May 19, 2026
Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212

R590-262 Health Data Authority Health Insurance Claims Reporting

Utah Admin. Code R590-262-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-614.5.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish the requirements for entities that pay for health care to submit data to the Utah Department of Health and Human Services;

(b) coordinate with:

(i) Sections 26B-8-411 and 26B-85-504; and

(ii) Rules R428-1 and R428-15;

(c) allow the data to be shared with the state's designated secure health information master patient index, Clinical Health Information Exchange (cHIE), to be used:

(i) in compliance with data security standards established by:

(A) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936: and

(B) the electronic commerce agreements established in a business associate agreement;

(ii) for coordination of health insurance benefits; and

(iii) for the enrollment data elements identified in Rule R428-15.

(2) This rule applies to an insurer offering or administering health insurance, including a self-funded employee health plan that opts-in under Section R590-262-7.

(3) This rule does not apply to:

(a) an insurer that, as of the first day of the reporting period, covers fewer than 2,500 individual Utah residents;

(b) a long-term care insurance policy;

(d) except as provided in Subsection (2)(c), a self-funded employee health plan.

(4)(a) The submission of data by an insurer on behalf of a self-funded employee health plan is considered mandatory if the employer sponsoring the self-funded employee health plan opts-in under Section R590-262-7.

(b) An insurer is not obligated to submit data on behalf of a self-funded employee health plan that opts-out or fails to respond to an opt-in request required in Section R590-262-7.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 26B-8-501. Additional terms are defined as follows:

(1) "Data" means information consisting of, or derived directly from, enrollment, medical claims, dental claims, and pharmacy claims that this rule requires an insurer to report.

(2) "Insurer," for purposes of this rule, means:

(a) a person engaged in the business of offering health insurance;

(b) a third-party administrator that settles claims for:

(i) health insurance policies; or

(ii) a self-funded employee health plan if the employer of the self-funded employee health plan opts-in under Section R590-262-7;

(d) a non-electing church plan as described in Section 410(d), Internal Revenue Code; or

(e) a licensed professional employer organization that is acting as an administrator of a health insurance policy.

(3) "Office" means the Healthcare Information and Analysis Program within the Utah Department of Health and Human Services Division of Data, Systems, and Evaluation.

(4) "Reporting period" means a calendar year.

(5)(a) "Self-funded employee health plan" means:

(i) an employee welfare benefit plan as defined in 29 U.S.C. Section 1002(1) whose health coverage is provided other than through an insurance policy; and

(ii) the plan has opted-in under Section R590-262-7.

(b) Self-funded employee health plan does not include:

(i) a governmental plan as defined in Section 414(d), Internal Revenue Code;

(ii) a non-electing church plan as described in Section 410(d), Internal Revenue Code; or

(iii) the Public Employees' Benefit and Insurance Program created in Section 49-20-103.

(6) "Technical specifications" means the technical specifications document published by the Health Data Committee describing the variables and formats of the data that are to be submitted as well as submission directions and guidelines.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-4 Reporting Requirements

(1) An insurer shall submit the data described in this rule and Section R428-15-3, if Utah is the patient's primary residence, for a service provided in or out of Utah.

(2) An insurer shall permit the Utah Department of Health and Human Services to redisclose the enrollment and eligibility information with the state designated entity for coordination of benefits.

(3) An insurer shall submit monthly data no later than the last day of the following month.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-5 Reporting Process

(1) Submission procedures and guidelines are described in detail in the technical specifications published by the Health Data Committee.

(2) The data shall be formatted and submitted according to the technical specifications in Subsection (1).

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-6 Required Data Elements

(1) An insurer shall submit the data required by Rule R428-15 and the Utah All-Payer Claims Database Data Submission Guide if the data are available to the insurer.

(2) The Utah All-Payer Claims Database Data Submission Guide is available on the Utah Department of Health and Human Services website at https://healthcarestats.utah.gov.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-7 Voluntary Opt-In for a Self-Funded Employee Health Plan

(1)(a) An insurer providing claim administration services for a self-funded employee health plan shall provide the employer for the self-funded employee health plan a copy of the APCD Self-funded Employee Health Plan Opt-In Form, available on the department's website, https://insurance.utah.gov, to determine if the employer agrees to opt-in to submission of its self-funded employee health plan's data as described in this rule.

(b) An insurer may use a form the insurer has developed for multi-state use instead of the form referenced in Subsection (1)(a) if the form is substantially similar and is approved in advance by the office.

(c) An insurer shall provide the APCD Self-funded Employee Health Plan Opt-In Form within 15 days after claims administration services are retained and it is determined the employer meets the requirements of this section.

(2)(a) Except as provided in Subsection (c), an opt-in is effective for the reporting period in which it is signed and all future reporting periods.

(b) An employer may not opt-in for a partial reporting period.

(c) An employer that has opted-in may opt-out for subsequent reporting periods by notifying the insurer in writing at least 30 days before the beginning of the next reporting period.

(3) For a self-funded employee health plan whose employer has made an affirmative election for the submission of data, the insurer shall include the self-funded employee health plan data as part of the insurer's data submission otherwise required by this rule.

(4) An insurer shall file with the office, annually by January 31 of each year, the following for the prior calendar year:

(a) a list of self-funded employee health plans whose employer made an affirmative election for the submission of data;

(b) a list of employers who previously filed an opt-in request and have elected to opt-out for future reporting periods as provided under Subsection (2)(c);

(c) a certification from an officer of the insurer that the insurer has taken reasonable efforts to provide the form to all known required employers; and

(d) a list identifying the employers to whom the form was provided and their contact information.

(5) The APCD Self-funded Employee Health Plan Opt-In Form is for use only with self-funded employee health plans and does not affect the mandatory reporting otherwise required by this rule.

(6) Nothing in this section requires an insurer to submit data for claims processed before the insurer was contracted to provide services.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-8 Third-party Contractors

The office may contract with a third party to collect and process the data and shall prohibit the third party from using the data in any way not specifically designated in the scope of work.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-9 Insurer Registration

An insurer shall register with the office by completing the registration on the office's website, https://healthcarestats.utah.gov/, no later than 30 days after becoming subject to this rule and annually thereafter by no later than September 1.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-10 Testing of Files

An insurer that becomes subject to this rule shall submit to the office a dataset for determining compliance with the standards for data submission no later than 90 days after the first date of becoming subject to the rule.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-11 Rejection of Files

(1) The office or its designee may reject and return any data submission that fails to conform to the submission requirements.

(2) An insurer whose submission is rejected shall resubmit the data in the appropriate, corrected format to the office, or its designee, within ten state business days of notice that the data does not meet the submission requirements.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-12 Replacement of Data Files

(1) An insurer may replace a complete dataset submission if no more than one year has passed since the end of the month in which the file was submitted.

(2) The office may allow a later submission if the insurer can establish exceptional circumstances for the replacement.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-13 Provider Notification

(1) The following notification shall be provided to a person that receives shared data: "This shared data is provided for informational purposes only. Contact the insurer for current, specific eligibility, or benefits coverage determination."

(2) The notification in this section shall be provided in coordination with provider participation in the master patient index and the cHIE programs.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-14 Limitation of Liability

(1) A person furnishing information described in this rule is immune from liability and civil action if the information is furnished to or received from:

(a) the commissioner, the executive director of the Utah Department of Health and Human Services, or employees or representatives of the Utah Insurance Department or the Utah Department of Health and Human Services;

(b) federal, state, or local law enforcement or regulatory officials or their employees or representatives; or

(2) As provided in Section 26B-1-229, an insurer that submits data pursuant to this rule cannot be held liable for having provided the required information to the office.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-15 Exemptions and Extensions

(1) The office may grant an exemption or extension from reporting requirements in this rule under certain circumstances.

(2) The office may grant an exemption from a reporting requirement in this rule to an insurer when the insurer demonstrates that compliance imposes an unreasonable cost.

(a)(i) An insurer may request an exemption from any particular requirement or set of requirements of this rule.

(ii) The insurer must submit a request for exemption no less than 30 calendar days before the date the insurer would have to comply with the requirement.

(b)(i) The office may grant an exemption for a maximum of one calendar year.

(ii) An insurer wishing an additional exemption must submit an additional, separate request.

(3) The office may grant an extension from a reporting requirement in this rule to an insurer when the insurer demonstrates that technical or unforeseen difficulties prevent compliance.

(a)(i) An insurer may request an extension for any deadline required in this rule.

(ii) For each deadline for which the insurer requests an extension, the insurer must submit its request no less than seven calendar days before the deadline in question.

(b)(i) The office may grant an extension for a maximum of 30 calendar days.

(ii) An insurer wishing an additional extension must submit an additional, separate request.

(4) An insurer requesting an extension or exemption shall include:

(a) the insurer's name, mailing address, telephone number, and contact person;

(b) the dates the exemption or extension is to start and end;

(d) a statement of facts, reasons, or legal authority in support of the request; and

(e) a proposed alternative to the requirement or deadline.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

Utah Admin. Code R590-262-16 Severability

If any provision of this rule, Rule R590-262, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: health insurance claims reporting
Date of Last Change: October 22, 2024
Notice of Continuation: March 3, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

R590-264 Property and Casualty Actuarial Opinion Rule

Utah Admin. Code R590-264-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-4-113.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

Utah Admin. Code R590-264-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) require a property and casualty insurer doing business in Utah to prepare annually an actuarial opinion summary providing details of the analysis performed by the appointed actuary; and

(b) require a property and casualty insurer domiciled in Utah to file the actuarial opinion summary with the commissioner.

(2) This rule applies to a property and casualty insurer doing business in Utah.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

Utah Admin. Code R590-264-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Appointed actuary" means a qualified actuary appointed by the insurer's board of directors or its equivalent, or by a committee of the board, to provide the actuarial opinion to be filed with the insurer's annual statement.

(2) "Qualified actuary" means a person who:

(a)(i) meets the basic education, experience, and continuing education requirements of the American Academy of Actuaries;

(ii) has obtained and maintains an accepted actuarial designation specified by the NAIC Property and Casualty Annual Statement Instructions; and

(iii) is a member of a professional actuarial association that:

(A) requires adherence to the same code of professional conduct and U.S. qualification standards of the American Academy of Actuaries; and

(B) participates in the Actuarial Board for Counseling and Discipline when its association members are practicing in the U.S.; or

(b) is a member of the American Academy of Actuaries approved as qualified to sign casualty loss reserves opinions by the Casualty Practice Council of the American Academy of Actuaries.

(3) "Statement of actuarial opinion" means a statement prepared by the appointed actuary that:

(a) sets forth the actuary's opinion of the insurer's reserves; and

(b) is prepared in accordance with the NAIC Property and Casualty Annual Statement Instructions.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

Utah Admin. Code R590-264-4 Actuarial Opinion Summary

(1) A property and casualty insurer domiciled in this state and required to submit a statement of actuarial opinion shall annually file with the commissioner an actuarial opinion summary, prepared and signed by the insurer's appointed actuary.

(2) The actuarial opinion summary shall be prepared in accordance with the appropriate NAIC Property and Casualty Annual Statement Instructions

(3) The actuarial opinion summary is considered a document supporting the actuarial opinion.

(4) A property and casualty insurer licensed but not domiciled in this state shall provide the actuarial opinion summary upon request.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

Utah Admin. Code R590-264-5 Actuarial Report

(1) A statement of actuarial opinion submitted annually by a property and casualty insurer shall be supported by an actuarial report prepared and signed by the insurer's appointed actuary.

(2) The actuarial report required by Subsection R590-264-5(1) shall be:

(a) prepared in accordance with the NAIC Property and Casualty Annual Statement Instructions; and

(b) provided to the commissioner upon request.

(3) The commissioner may engage a qualified actuary at the expense of the insurer to review the actuarial opinion and the basis for the opinion, and prepare, if requested, the supporting actuarial report or work papers if:

(a) the insurer fails to provide an actuarial report to the commissioner upon request; or

(b) the commissioner determines that the actuarial report provided by the insurer is unacceptable.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

Utah Admin. Code R590-264-6 Confidentiality

(1) A property and casualty insurer filing an actuarial opinion summary with the commissioner may, at the time of the filing, request that all or a part of the actuarial opinion summary be classified as a protected record under Subsection 63G-2- 305(1) or 63G-2-305(2).

(2) An insurer making a confidentiality claim under Subsection R590-264-6(1) shall comply with Section 63G-2-309.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

Utah Admin. Code R590-264-7 Severability

If any provision of this rule, Rule R590-264, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: property casualty insurance
Date of Last Change: June 9, 2023
Notice of Continuation: June 30, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-4-113

R590-265 Hazardous Financial Condition

Utah Admin. Code R590-265-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-27a-101.

History

KEY: insurers, hazardous financial conditions
Date of Last Change: January 10, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-27-503(1)(a)(v); 31A-27a-101(3)(c)

Utah Admin. Code R590-265-2 Purpose and Scope

(1) The purpose of this rule is to set forth the standards the commissioner may use to identify an insurer in a hazardous financial condition.

(2) This rule applies to:

(a) an insurer; and

(b) a reinsurer.

History

KEY: insurers, hazardous financial conditions
Date of Last Change: January 10, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-27-503(1)(a)(v); 31A-27a-101(3)(c)

Utah Admin. Code R590-265-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurers, hazardous financial conditions
Date of Last Change: January 10, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-27-503(1)(a)(v); 31A-27a-101(3)(c)

Utah Admin. Code R590-265-4 Standards Used by the Commissioner to Determine Hazardous Financial Condition

The commissioner may consider the following standards, either singly or a combination of two or more, to determine whether the continued operation of an insurer is hazardous to its policyholders, creditors, or the general public:

(1) adverse findings reported in:

(a) a financial condition examination report;

(b) a market conduct examination report;

(d) an actuarial opinion, report or summary;

(2) the NAIC Regulatory Information System and its other financial analysis solvency tools and reports;

(3) whether the insurer made adequate provision, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the insurer, when the assets held by the insurer for the reserves and related actuarial items include:

(a) the investment earnings on such assets; and

(b) the considerations anticipated to be received and retained under the policies and contracts;

(4) an assuming reinsurer's ability to perform and whether the insurer's reinsurance program provides sufficient protection for the insurer's remaining surplus after considering:

(a) the insurer's cash flow;

(b) the classes of business written; and

(5) whether the insurer's operating loss in the last 12-month period or any shorter period of time, including net capital gain or loss, change in non-admitted assets, and cash dividend paid to shareholders, is greater than 50% of the insurer's remaining surplus as regards policyholders in excess of the minimum required;

(6) whether the insurer's operating loss in the last 12-month period or any shorter period of time, excluding net capital gains, is greater than 20% of the insurer's remaining surplus as regards policyholders in excess of the minimum required;

(7) whether an obligor or an entity within the insurer's holding company system is insolvent, nearly insolvent, or delinquent in payment of its monetary or other obligations, and in the opinion of the commissioner it may impact the solvency of the insurer;

(8) contingent liabilities, pledges, or guaranties that either individually or collectively involve a total amount that, in the opinion of the commissioner, may impact the solvency of the insurer;

(9) whether a controlling person of an insurer is delinquent in transmitting or paying net premiums to the insurer;

(10) the age and collectability of receivables;

(11) whether an officer, a director, or any other person who directly or indirectly controls the operation of the insurer, fails to possess and demonstrate competence, fitness, and reputation considered necessary to serve the insurer in such position;

(12) whether the insurer failed to respond to an inquiry regarding the condition of the insurer or has furnished false and misleading information concerning an inquiry;

(13) whether the insurer failed to meet financial and holding company filing requirements, absent a reason satisfactory to the commissioner;

(14) whether an insurer:

(a) filed a false or misleading sworn financial statement;

(b) released a false or misleading financial statement to a lending institution or to the general public; or

(15) whether the insurer has grown so rapidly and to such an extent that it lacks adequate financial and administrative capacity to meet obligations in a timely manner;

(16) whether the insurer has experienced or will experience in the foreseeable future cash flow or liquidity problems;

(17) whether the insurer established reserves that do not comply with minimum standards established by insurance laws and rules, statutory accounting standards, sound actuarial principles, and standards of practice;

(18) whether the insurer persistently engages in under reserving, resulting in adverse development;

(19) whether transactions among affiliates, subsidiaries, or controlling persons for which the insurer receives assets or capital gains do not provide sufficient value, liquidity, or diversity to assure the insurer's ability to meet its outstanding obligations as they mature; or

(20) any other finding determined by the commissioner to be hazardous to the insurer's policyholders, creditors, or the general public.

History

KEY: insurers, hazardous financial conditions
Date of Last Change: January 10, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-27-503(1)(a)(v); 31A-27a-101(3)(c)

Utah Admin. Code R590-265-5 Commissioner's Authority

(1) To determine an insurer's financial condition under this rule, the commissioner may:

(a) disregard any credit or amount receivable resulting from a transaction with a reinsurer that is insolvent, impaired, or otherwise subject to a delinquency proceeding;

(b) make appropriate adjustments including disallowance to asset values attributable to an investment in or transaction with a parent, subsidiary, or affiliate consistent with the NAIC Accounting Practices and Procedures Manual and state laws and rules;

(c) refuse to recognize the stated value of accounts receivable if the ability to collect receivables is highly speculative in view of the age of the account or the financial condition of the debtor; or

(d) increase the insurer's liability in an amount equal to any contingent liability, pledge, or guarantee not otherwise included if there is a substantial risk that the insurer will be called upon to meet the obligation undertaken with the next 12-month period.

(2) If the commissioner determines that the continued operation of the insurer may be hazardous to its policyholders, creditors, or the general public, the commissioner may issue an order requiring the insurer to:

(a) reduce the total amount of present and potential liability for policy benefits by reinsurance;

(b) reduce, suspend, or limit the volume of business being accepted or renewed;

(d) increase the insurer's capital and surplus;

(e) suspend or limit the declaration and payment of dividend by an insurer to its stockholders or to its policyholders;

(f) file reports in a form acceptable to the commissioner concerning the market value of an insurer's assets;

(g) limit or withdraw from certain investments or discontinue certain investment practices to the extent the commissioner considers necessary;

(h) document the adequacy of premium rates in relation to the risks insured;

(i) file, in addition to regular annual statements, interim financial reports on the form adopted by the NAIC or in a format adopted by the commissioner;

(j) correct corporate governance practice deficiencies, and adopt and utilize governance practices acceptable to the commissioner;

(k) provide a business plan to the commissioner to continue to transact business in the state; or

(l) notwithstanding any other provision of law limiting the frequency or amount of premium rate adjustments, adjust rates for any non-life insurance product written by the insurer that the commissioner considers necessary to improve the financial condition of the insurer.

(3) The commissioner's order against a foreign insurer may be limited to the extent provided by statute.

(4) An insurer subject to an order under Subsection (1) may request a hearing to review the order. The notice of hearing shall:

(a) be served upon the insurer pursuant to Section 31A-27-503;

(b) state the time and place of the hearing; and

(5) Unless mutually agreed upon by the commissioner and the insurer, a hearing under Subsection (4) shall:

(a) occur not less than 10 days or more than 30 days after notice is served; and

(b) be conducted in Salt Lake County or in another location convenient to the parties designated by the commissioner.

History

KEY: insurers, hazardous financial conditions
Date of Last Change: January 10, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-27-503(1)(a)(v); 31A-27a-101(3)(c)

Utah Admin. Code R590-265-6 Severability

If any provision of this rule, Rule R590-265, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurers, hazardous financial conditions
Date of Last Change: January 10, 2023
Notice of Continuation: October 31, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-27-503(1)(a)(v); 31A-27a-101(3)(c)

R590-266 Utah Essential Health Benefits Package

Utah Admin. Code R590-266-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-212.

History

KEY: essential health benefit, insurance
Date of Last Change: June 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-30-201(3)(a); 31A-2-212(5)

Utah Admin. Code R590-266-2 Purpose and Scope

(1) The purpose of this rule is to designate an essential health benefits package as required by PPACA.

(2) This rule applies to a non-grandfathered individual or small employer health benefit plan issued or renewed on or after January 1, 2014.

History

KEY: essential health benefit, insurance
Date of Last Change: June 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-30-201(3)(a); 31A-2-212(5)

Utah Admin. Code R590-266-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1) "Essential health benefits" means the following health care service categories:

(a) ambulatory patient services;

(b) emergency services;

(d) pregnancy, maternity, and newborn care;

(e) mental health and substance use disorder services, including behavioral health treatment;

(f) prescription drugs;

(g) rehabilitative and habilitative services and devices;

(h) laboratory services;

(i) preventive and wellness services and chronic disease management; and

(j) pediatric services, including oral and vision care.

(2) "Grandfathered health plan" means an individual or small employer health benefit plan that:

(a) was in existence when the PPACA was enacted on March 23, 2010;

(b) has not had any significant changes that reduce benefits or increase costs to the consumer including:

(i) a significant cut or reduction in benefits;

(ii) an increase in co-pays by more than $5, adjusted annually for medical inflation, or a percentage equal to medical inflation plus 15%;

(iii) an employer reduction in contributions by more than five percentage points; or

(iv) a reduction of annual dollar limits, or addition of a new limit; and

(3)(a) "Habilitative" means health care services that help a person keep, learn, or improve skills and functioning for daily living.

(b) Habilitative services may include:

(i) physical therapy;

(ii) occupational therapy;

(iii) speech-language pathology; or

(iv) other services.

(4) "Non-grandfathered health plan" means an individual or small employer health benefit plan:

(a) that is issued after the PPACA was enacted on March 23, 2010; or

(b) a grandfathered health plan that has made significant changes that:

(i) reduce benefits or increase costs to the consumer; and

(ii) caused the plan to lose the grandfathered status as provided in Subsection (2)(b).

(5) "Rehabilitative" means the treatment of disease, injury, developmental delay, or other cause, by physical agents and methods to assist in the rehabilitation of normal physical bodily function, that is goal-oriented and where the person has potential for functional improvement and ability to progress.

(6) "Utah essential health benefits package" means the benefits designated in this rule by the commissioner as essential health benefits.

History

KEY: essential health benefit, insurance
Date of Last Change: June 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-30-201(3)(a); 31A-2-212(5)

Utah Admin. Code R590-266-4 Utah Essential Health Benefits

(1)(a) The PEHP Utah Basic Plus 2013 plan is designated as the Utah essential health benefits package.

(b) The PEHP Utah Basic Plus 2013 Plan is available at https://insurance.utah.gov/consumer/health/reform.

(c) The PEHP Utah Basic Plus 2013 Plan was issued on July 1, 2013, and some of the benchmark plan benefits may not comply with current state or federal requirements.

(2)(a) Except as provided in Subsections (2)(b) and (2)(c), an individual or small employer insurer who issues or renews a non-grandfathered plan on or after January 1, 2014, must include at least the benefits of the Utah essential health benefits package.

(b) An insurer may substitute coverage provided in the Utah essential health benefits package if the substitution is actuarially equivalent and complies with 42 CFR 457.431.

(c) A health benefit plan may exclude the pediatric dental essential health benefit if there is at least one insurer offering a certified stand-alone dental plan that provides the pediatric dental essential health benefit in the PEHP Utah Basic Plus 2013 Plan.

(3) An individual or small employer insurer may offer a non-grandfathered plan with benefits in addition to the Utah essential health benefits package.

History

KEY: essential health benefit, insurance
Date of Last Change: June 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-30-201(3)(a); 31A-2-212(5)

Utah Admin. Code R590-266-5 Severability

If any provision of this rule, Rule R590-266, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: essential health benefit, insurance
Date of Last Change: June 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-30-201(3)(a); 31A-2-212(5)

R590-267 Personal Injury Protection Relative Value Study Rule

Utah Admin. Code R590-267-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)

Utah Admin. Code R590-267-2 Purpose and Scope

(1) The purpose of this rule is to establish a reasonable value of services and accommodations for the diagnosis, care, recovery, or rehabilitation of an injured person under automobile personal injury protection coverage under Subsection 31A-22- 307(1)(a).

(2) This rule applies to services and accommodations provided under automobile personal injury protection coverage under Subsection 31A-22-307(1)(a) on or after January 1, 2014.

History

KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)

Utah Admin. Code R590-267-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Conversion factor" means a multiplier used to convert the relative value unit or units of a service or a procedure to a reimbursement rate.

(2) "Relative value unit" means a numerical value assigned to a medical or dental procedure as published in an edition of the RVP or RVD.

(3) "RVD 2025" means 2025 Edition of the Relative Values for Dentists published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.

(4) "RVD 2023" means 2023 Edition of the Relative Values for Dentists published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.

(5) "RVP 2025" means 2025 Edition of the Relative Values for Physicians published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.

(6) "RVP 2023" means 2023 Edition of the Relative Values for Physicians published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.

History

KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)

Utah Admin. Code R590-267-4 Conversion Factors

(1)(a) The following conversion factors shall be used with RVP 2025 to determine the reasonable value of each medical service or accommodation provided on or after January 1, 2026:

(i) anesthesia, 127.29;

(ii) surgery, 266.92;

(iii) radiology, 38.34;

(iv) pathology, 24.67;

(v) medicine, 14.67;

(vi) evaluation and management, 21.41.

(b) The conversion factor used with RVD 2025 to determine the reasonable value of each dental service or accommodation provided on or after January 1, 2026 shall be 86.88.

(2)(a) The following conversion factors shall be used with RVP 2023 to determine the reasonable value of each medical service or accommodation provided from January 1, 2024 through December 31, 2025:

(i) anesthesia, 116.11;

(ii) surgery, 248.75;

(iii) radiology, 37.50;

(iv) pathology, 25.00;

(v) medicine, 13.81; and

(vi) evaluation and management, 16.81.

(b) The conversion factor used with RVD 2023 to determine the reasonable value of each dental service or accommodation provided from January 1, 2024 through December 31, 2025 shall be 75.00.

History

KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)

Utah Admin. Code R590-267-5 Fee Schedule

The reasonable value of any service or accommodation shall be calculated by multiplying the relative value unit assigned to the service or accommodation by the applicable conversion factor prescribed in Section R590-267-4.

History

KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)

Utah Admin. Code R590-267-6 Severability

If any provision of this rule, Rule R590-267, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)

R590-268 Small Employer Stop-Loss Insurance

Utah Admin. Code R590-268-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-43-304.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) provide the content of a stop-loss insurance policy disclosure;

(b) define prohibited lasering practices; and

(i) a rate and form filing and;

(ii) a report filing, including:

(A) the insurer's stop-loss experience;

(B) an actuarial certification of compliance; and

(2) This rule applies to an insurer marketing or offering a small employer stop-loss contract.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-43-102. Additional terms are defined as follows:

(1) "Qualified actuary" means an individual who is qualified to sign the applicable statement of actuarial opinion in accordance with the American Academy of Actuaries qualification standards.

(2) "SERFF" means the System for Electronic Rate and Form Filing.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-4 Stop-Loss Insurance Disclosure

(1) An insurer offering stop-loss insurance to a small employer shall use the Utah Stop-Loss Disclosure dated July 1, 2019, available on the department's website, https://insurance.utah.gov.

(2) An insurer may display the insurer's name, identifying logo, and address on the disclosure.

(3) The disclosure may be altered upon approval of the commissioner.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-5 Lasering

The following lasering practices are prohibited under Section 31A-43-301:

(1) assigning a different attachment point for an individual based on the individual's expected claims or a given diagnosis;

(2) assigning a deductible to an individual that must be met before stop-loss coverage applies;

(3) denying stop-loss coverage to an individual who is otherwise covered by the small employer's health plan; and

(4) applying an actively at work exclusion to stop-loss coverage.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-6 Form and Rate Filings

(1) An insurer shall file a stop-loss insurance contract and application with:

(a) any related documents;

(b) if altered, a disclosure as outlined in Section R590-268-4; and

(2) A new or a revised rate filing shall:

(a) include:

(i) a summary of the rate calculation;

(ii) geographic rating area factors applicable in Utah;

(iii) a description of how the overall rate is compliant; and

(iv) an actuarial certification signed by a qualified actuary; and

(b) be filed no later than 30 days before use.

(3) A stop-loss contract shall be consistently applied to each small employer.

(4) A filing shall be submitted using SERFF.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-7 Annual Certification

(1) An insurer shall, on or before April 1, submit the following using SERFF:

(a) stop-loss experience as described in Subsections (2) and (3) for the previous two years;

(b) an actuarial certification of compliance with Title 31A, Chapter 43, Small Employer Stop-Loss Insurance Act; and

(2)(a) An insurer's stop-loss experience shall be presented by:

(i) small employer; and

(ii) experience year.

(b) An insurer's stop-loss experience shall include:

(i) a group identifier that uniquely identifies the employer group and is consistent from year to year for the same employer group;

(ii) the effective date of coverage for each policy year;

(iii) the contract term;

(iv) the employer size, including number of covered lives and employees, at the beginning of the contract;

(v) the number of covered lives and employee exposure years for the period of the experience;

(vi) the specific attachment point;

(vii) expected claims absent stop-loss insurance;

(viii) expected claims under the specific attachment point;

(ix) the aggregate attachment point;

(x) earned premium; and

(xi) claims paid by the stop-loss insurance separated by specific losses and aggregate losses.

(i) be aggregated over the entire contract period, rather than aggregated by month; and

(ii) only include stop-loss contracts where the final claim date is contained within the two calendar years before the submission date.

(d) Runout claims that are paid after the submission date shall be updated in the following years' experience submission.

(3) An insurer's stop-loss experience shall be submitted using the Utah Stop-Loss Experience Report dated July 1, 2019, available on the department's website, https://insurance.utah.gov.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

Utah Admin. Code R590-268-8 Severability

If any provision of this rule, Rule R590-268, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: small employer stop-loss
Date of Last Change: May 9, 2023
Notice of Continuation: March 7, 2024
Authorizing, and Implemented or Interpreted Law: 31A-43-304; Title 31A, Chapter 43

R590-269 Individual Open Enrollment Period

Utah Admin. Code R590-269-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-30-117.

History

KEY: individual open enrollment period
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-117(1)(c)

Utah Admin. Code R590-269-2 Purpose and Scope

(1) The purpose of this rule is to establish an open enrollment period for an insurer that offers an individual health benefit plan outside the health insurance exchange.

(2) This rule applies to an individual carrier that offers an individual health benefit plan outside the health insurance exchange with an effective date on or after January 1, 2014.

History

KEY: individual open enrollment period
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-117(1)(c)

Utah Admin. Code R590-269-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1)(a) "Loss of minimum essential coverage" means the circumstances described in 26 CFR 54.9801-6(a)(3)(i) through (iii).

(b) "Loss of minimum essential coverage" does not include termination or loss due to:

(i) failure to pay premiums on a timely basis, including COBRA premiums before the expiration of COBRA coverage; or

(ii) a situation allowing for a rescission as specified in 45 CFR 147.128.

(2) "Qualifying life event" means an event that triggers a special enrollment period because an individual or dependent:

(a) loses minimum essential coverage;

(b) gains a dependent or becomes a dependent through marriage, birth, adoption, or placement for adoption;

(c) is unintentionally, inadvertently, or erroneously enrolled or non-enrolled as a result of the error, misrepresentation, or inaction of an officer, employee, or agent of an exchange or the United States Department of Health and Human Services, or its instrumentalities as evaluated and determined by an exchange;

(d) demonstrates to the individual carrier that the health benefit plan in which the individual was enrolled substantially violated a material provision of its contract in relation to the enrollee;

(e) is newly ineligible for advance payment of premium tax credits; or

(f) permanently moves into a new service area.

History

KEY: individual open enrollment period
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-117(1)(c)

Utah Admin. Code R590-269-4 Open and Special Enrollment Periods

(1)(a) The open enrollment period for an individual health benefit plan outside the health insurance exchange shall coincide with the open enrollment period for the health insurance exchange.

(b) Open enrollment period coverage begins on:

(i) January 1 for an individual who enrolls on or before December 15;

(ii) the first day of the following month, for an individual who enrolls between the first and the fifteenth of the month; and

(iii) the first day of the second following month for an individual who enrolls between the sixteenth and the last day of the month.

(2) An insurer shall offer an individual experiencing a qualifying life event a special enrollment period for at least 60 days.

(a) In the case of birth, adoption, or placement for adoption, the coverage is effective on the date of:

(i) birth;

(ii) adoption; or

(iii) placement for adoption.

(b) Coverage is effective on the first day of the month following the date the insurer receives the request for special enrollment when:

(i) an individual or dependent marries;

(ii) an individual or dependent loses minimum essential coverage;

(iii) an individual or dependent is unintentionally, inadvertently, or erroneously enrolled or non-enrolled as a result of the error, misrepresentation, or inaction of an officer, employee, or agent of an exchange or the United States Department of Health and Human Services, or its instrumentalities as evaluated and determined by an exchange;

(iv) an individual demonstrates to the insurer that the health benefit plan in which the individual was enrolled substantially violated a material provision of its contract regarding the enrollee; or

(v) an individual permanently moves into a new service area.

History

KEY: individual open enrollment period
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-117(1)(c)

Utah Admin. Code R590-269-5 Severability

If any provision of this rule, Rule R590-269, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: individual open enrollment period
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 31A-30-117(1)(c)

R590-271 Data Reporting for Consumer Quality Comparison

Utah Admin. Code R590-271-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-216.

History

KEY: data, data reporting, insurance
Date of Last Change: July 23, 2024
Notice of Continuation: June 2, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-216

Utah Admin. Code R590-271-2 Purpose and Scope

(1) The purpose of this rule is to require an insurer to comply with the HEDIS reporting requirements under the Department of Health and Human Services.

(2)(a) This rule applies to an insurer offering a health benefit plan.

(b) This rule does not apply to an insurer whose health benefit plans cover fewer than 3,000 individual Utah residents in aggregate.

History

KEY: data, data reporting, insurance
Date of Last Change: July 23, 2024
Notice of Continuation: June 2, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-216

Utah Admin. Code R590-271-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "HEDIS" means the Healthcare Effectiveness Data and Information Set.

History

KEY: data, data reporting, insurance
Date of Last Change: July 23, 2024
Notice of Continuation: June 2, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-216

Utah Admin. Code R590-271-4 Reporting Requirements

An insurer shall comply with the reporting guidelines, procedures, and format of Rule R428-13 and submit HEDIS data for the preceding calendar year to the Utah Department of Health and Human Services Office of Health Care Statistics.

History

KEY: data, data reporting, insurance
Date of Last Change: July 23, 2024
Notice of Continuation: June 2, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-216

Utah Admin. Code R590-271-5 Severability

If any provision of this rule, Rule R590-271, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: data, data reporting, insurance
Date of Last Change: July 23, 2024
Notice of Continuation: June 2, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-216

R590-273 Continuing Care Provider Rule

Utah Admin. Code R590-273-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-44-202, 31A-44-203, 31A-44-401, 31A-44-402, 31A-44-502, 31A-44-503, 31A-44-601, and 31A-44-602.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) define financial hardship;

(b) establish procedures to register or renew as a provider;

(d) determine market value of land and infrastructure improvements of a facility in liquidation;

(e) set forth conditions when a lien is superior to a property lease; and

(f) establish enforcement procedures.

(2) This rule applies to a provider that markets a continuing care facility project.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-44-102. Additional terms are defined as follows:

(1) "Financial hardship," under Subsection 31A-44-401(3), means a resident of a continuing care facility:

(a) with regular monthly expenses exceeding the resident's regular monthly income; and

(b) with net assets of less than $25,000, over and above the resident's entrance fee at the continuing care facility.

(2) "Qualified actuary" means:

(a) a member of the American Academy of Actuaries;

(b) a member of the Society of Actuaries; or

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-4 Registration

(1) Thirty days before entering into a continuing care contract or reservation agreement, a provider shall complete and submit electronically to the commissioner:

(a) an initial registration form, supporting documentation, and all attachments; and

(b) payment of the initial registration fee, in an amount annually established by the Utah Legislature under Section 63J-1-504, using the department's secure payment portal.

(2) Registration forms are available on the department's website, https://insurance.utah.gov.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-5 Registration Renewal

(1) By September 30 of each year, a provider shall complete and submit electronically to the commissioner:

(a) a registration renewal form; and

(b) payment of the registration renewal fee, in an amount annually established by the Utah Legislature under Section 63J-1-504, using the department's secure payment portal.

(2) Registration renewal forms are available on the department's website, https://insurance.utah.gov.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-6 Additional Reserve Fund

(1) A provider shall create an additional reserve fund if directed to do so by the commissioner.

(2) The additional reserve fund amount shall be determined by a qualified actuary.

(3) An independent actuarial review shall determine the adequacy of an additional reserve fund.

(4) A provider shall pay the reasonable costs of the actuarial review under Subsection 31A-44-603(4).

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-7 Market Value of Land and Infrastructure Improvements in Rehabilitation or Liquidation

To determine the market value of land and infrastructure improvements under an order of rehabilitation or liquidation pursuant to Subsection 31A-44-502(2)(d) or 31A-44-503(4)(e), the commissioner shall:

(1) consider the most probable price, as of a specified date, that the land and infrastructure improvements owned in fee by the ground lesser should sell for:

(a) after reasonable exposure in a competitive market;

(b) under all conditions of a fair sale;

(d) assuming neither buyer nor seller acts under duress;

(2) disregard the existence or terms of the ground lease; and

(3) determine if a commercial appraisal is required to assign the market value.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-8 Lien Held by the Commissioner in Favor of a Resident or a Group of Residents

The lien amount on a provider's property that is superior to the lien described in Subsection 31A-44-601(1) is limited to the portion of the funds secured by the lien used by the provider, including:

(1) an amount used to pay fees and costs for the design of the facility, including architectural and engineering fees and costs;

(2) an amount paid for engineering, environmental, and similar studies, reports, and surveys for the facility;

(3) an amount paid for appraisals, marketing, and other reports and surveys for construction, acquisition, or improvement of the facility;

(4) fees and costs paid to contractors, developers, brokers, salespersons, and other employees and agents, including affiliates of the provider;

(5) a fee, charge, assessment, or tax charged or imposed by a governmental unit, district, or similar body having jurisdiction over the facility; and

(6) reimbursement to a provider for expenditures that qualify under Subsection 31A-44-601(1) or this rule, if paid directly from loan proceeds.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-9 Enforcement

(1) The commissioner may conduct an examination or investigation of a provider to:

(a) determine the financial solvency of a facility;

(b) determine the adequacy of the additional reserve fund under Section R590-273-6;

(d) act on a complaint against a provider or a facility;

(e) obtain documents requested by the commissioner; or

(f) take corrective action to enforce compliance.

(2) The commissioner may take corrective action, including:

(a) suggesting corrective business practices;

(b) restricting or prohibiting behavior by a provider that is misleading, unfair, or abusive;

(d) suspending, revoking, or non-renewing a provider's registration;

(e) requiring information to compare continuing care contracts, providers, or facilities;

(f) requiring disclosure of all terms and conditions of continuing care contracts and agreements;

(g) requiring disclosure of any financial risks; and

(h) promoting certain communications between the residents and the provider.

(3)(a) The provider shall give the commissioner access to the books and papers relating to the business and affairs of the provider.

(b) The books and records required under Subsection 31A-44-603(2)(a) shall be available for inspection by the commissioner during normal business hours from the date of the transaction and for no less than three years, plus the current calendar year.

(4) The commissioner may bill the provider for the reasonable costs of an examination or investigation, including the cost of the review by an actuary.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

Utah Admin. Code R590-273-10 Severability

If any provision of this rule, Rule R590-273, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, continuing care facility
Date of Last Change: September 10, 2024
Notice of Continuation: April 7, 2022
Authorizing, and Implemented or Interpreted Law: 31A-44-202(2); 31A-2-201; 31A-44-314; 31A-44-401(3); 31A-44- 402(2); 31A-44-502(2)(d); 31A-44-503(4)(d); 31A-44-601(6)(f); 31A-44-602(2)(b); 31A-44-203(4)

R590-274 Submission and Required Disclosures of Public Adjuster Contracts

Utah Admin. Code R590-274-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-26-401 and 31A-26-403.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) set forth procedures for a public adjuster to submit a required form filing to the commissioner; and

(b) provide notice requirements, information, and disclosures that must be included in a public adjuster contract.

(2) This rule applies to a:

(a) resident public adjuster individual or organization; and

(b) nonresident public adjuster individual or organization.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-19a-102. Additional terms are defined as follows:

(1) "Certification" means a statement that a submitted filing is compliant.

(2) "Compliant" means a filing that is complete and that complies with Title 31A, Insurance Code, and this rule.

(3) "Electronic filing" means a filing submitted using an email system.

(4) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department.

(5) "Filer" means a person who submits a filing.

(6) "Filing objection letter" means a letter issued by the commissioner when a review determines the filing is not compliant and may require:

(a) correction of non-compliant items;

(b) clarification; or

(7) "Form" has the same meaning as "contract" for the purposes of this rule.

(8) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing.

(9) "Rejected" means a filing is:

(a) not compliant;

(b) returned to the filer stating the reason for rejection; and

(10) "Utah filed date" means the date the department indicates a filing is accepted.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-4 General Filing Information

(1)(a) A filing shall be accurate, consistent, complete, and contain all required documents.

(b) The commissioner may request additional information, as necessary.

(2) A filer is responsible for assuring that a filing is compliant.

(3) A filing that is not submitted correctly will be rejected and returned to the filer.

(4) A rejected filing:

(a) is not considered filed;

(b) shall not be used;

(d) may not be reopened for purposes of resubmission.

(5) A prior filing will not be researched to determine the purpose of the current filing.

(6) The department does not review every filing.

(a) A filing may be reviewed:

(i) when submitted;

(ii) when a complaint is received;

(iii) during a regulatory examination or investigation; or

(iv) when the commissioner considers a review necessary.

(b) If a filing is reviewed and is found not complaint, the commissioner:

(i) shall issue a filing objection letter or an order to prohibit use; and

(ii) may require an insurer to disclose deficiencies in a form or rating practice to each affected consumer.

(7)(a) A correction to a filing in a review status may be made at any time.

(b) A correction to a filing in a closed status:

(i) may not be made;

(ii) requires a new filing; and

(iii) shall reference the original filing in the filing description of the new filing.

(8) A response to a filing objection letter shall include:

(a) an explanation identifying each change;

(b) an underline and strikeout version of each revised document; and

(9)(a) An order to prohibit use becomes final 15 days after the date of the order.

(b) Use of a filing shall be discontinued no later than the date specified in the order.

(c) To contest an order to prohibit use, a written request for a hearing shall be submitted no later than 15 days after the date of the order.

(d) A new filing is required if the filer chooses to make the requested changes addressed in the filing objection letter, and shall reference the previously prohibited filing.

(10) A filer shall notify the department when withdrawing a previously filed form.

(11) A filing that is withdrawn may not be used.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-5 Filing Requirements

(1)(a) A form is a file and use filing.

(b) A form shall be submitted in PDF format.

(d) Blank spaces within a form shall be labeled accurately to represent purpose and use.

(2) A filing shall be submitted as an electronic filing via email at pcforms@utah.gov.

(3) A complete filing shall contain the following information, in the sequence listed.

(a) The title of the email shall display the individual public adjuster or the public adjuster organization's name and that it is a public adjuster contract filing.

(b) The filer shall certify that a filing is complete and compliant.

(i) To certify, the following statement shall be included in the email: "BY SUBMITTING THIS FILING I CERTIFY THAT THE ATTACHED FILING HAS BEEN COMPLETED IN ACCORDANCE WITH UTAH ADMINISTRATIVE RULE R590-274 AND IS IN COMPLIANCE WITH APPLICABLE UTAH LAWS AND RULES."

(ii) A filing may be rejected if the certification is false, missing, or incomplete.

(iii) A false certification may subject the licensee to administrative action.

(i) the intent of the filing; and

(ii) the purpose of each document within the filing.

(d) Indicate if the filing:

(i) is new; or

(ii) is replacing or modifying a previous filing, describing the changes made, the reasons for the previous rejection, and the previous filing's Utah filed date.

(e) Identify any provision that is unusual, innovative, controversial, or that was previously objected to or prohibited, and explain why the provision is included in the filing.

(f) If the filing is being made on behalf of a resident or nonresident public adjuster organization, the email shall list each public adjuster individual conducting business on behalf of the public adjuster organization, including:

(i) name;

(ii) contact information; and

(iii) license number.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-6 General Contract Requirements

(1)(a) A contract shall contain the following:

(i) the name of the public adjuster or the public adjuster organization that employs the public adjuster;

(ii) the mailing and physical addresses of the public adjuster's or the public adjuster organization's principal place of business;

(iii) the public adjuster's or public adjuster organization's telephone and fax numbers;

(iv) the license number of the public adjuster or public adjuster organization and the employer;

(v) the public adjuster's or public adjuster organization's email address;

(vi) the public adjuster's or public adjuster organization's website, if applicable;

(vii) the date and time the contract was signed;

(viii) a general description of services the public adjuster will provide under the contract;

(ix) a description of the claim, property damage, location, and event;

(x) a unique identifying form number at the bottom of each page of the contract, including the month and the year the contract is filed following the unique identifying form number;

(xi) any term or condition that applies to the contract; and

(xii) the contract disclosures in Section R590-274-7.

(b) If the public adjuster or the public adjuster organization is a nonresident licensee, the contract shall also include the service of process address of the public adjuster or the public adjuster organization.

(2) A contract may not contain a term or condition that limits or nullifies any law.

(3) A signed copy of the contract shall be provided to the insured at the time of signing.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-7 Required Disclosures Regarding a Public Adjuster's Services

(1) The following disclosure shall be on the first page of a contract at the top of the page in no smaller than 12-point boldface type: "YOU DO NOT HAVE TO ENTER INTO THIS CONTRACT TO MAKE A CLAIM FOR LOSS OR DAMAGE ON A POLICY OF INSURANCE. YOU WILL BE CHARGED A FEE FOR THE PUBLIC ADJUSTER'S SERVICES."

(2) A contract shall include a separate page that contains the following statements.

(a) The public adjuster you hire may not be paid to repair your damaged property, nor may the public adjuster receive a finder's fee from, or have a financial interest in, the company that does the repair work.

(b) A public adjuster may not act on behalf of an attorney by having you sign an attorney representation agreement.

(d) A public adjuster may not require you to refuse to cooperate with your insurer to settle your claim.

(e) You may contact the Utah Insurance Department to verify that the public adjuster is licensed to do business in Utah, what your rights are as a consumer, or for information about filing a complaint, by calling 801-957-9305 or toll free at 800- 439-3805, or by visiting the department's website, https://insurance.utah.gov.

(f) A public adjuster may not offer to pay an insured's deductible.

(g) A public adjuster may not assert that the insurer will waive the insured's deductible.

(h) A public adjuster may not offer to conduct a free inspection of property other than property that is the subject of an insured's claim;

(i) After being hired, a public adjuster may not sell you home repair, disaster clean up, or appraising services.

(j) If the contract is rescinded, the public adjuster must return anything of value to the claimant within 15 days.

(3) Immediately below the statements in Subsection (2), the following shall be set forth:

(a) the statement: "I acknowledge that I have read and understand the statements listed above"; and

(b) a date line and signature line for the insured.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-8 Required Disclosures Regarding a Public Adjuster's Compensation

(1)(a) A public adjuster contract shall contain one of the following compensation disclosures in a clear and prominent statement:

(i) if an hourly rate, the contract shall state the hourly rate and how it will be applied to hours of service provided by the public adjuster to calculate the amount payable;

(ii) if a flat fee, the contract shall state the amount payable to the public adjuster;

(iii) if a percentage, the contract:

(A) shall state and display the exact percentage that will be applied to the settlement of the claim to calculate the amount payable to the public adjuster; and

(B) may not display a blank space; or

(iv) if another method of calculation is chosen, the contract shall include a detailed explanation of how the amount payable will be determined based on service provided by the adjuster.

(b) Notwithstanding the chosen payment method, a public adjuster may not:

(i) charge, agree to, or accept as compensation or reimbursement, a payment, commission, fee, or other thing of value equal to more than:

(A) 10% for a catastrophic insurance claim settlement; or

(B) 20% for a non-catastrophic insurance claim settlement; or

(ii) require, demand, or accept a fee, retainer, compensation, deposit, or other thing of value before the settlement of a claim.

(c) Notwithstanding the chosen payment method, a public adjuster shall provide to the insured, at the conclusion of a claim, an itemized invoice of each expense the public adjuster incurs during the process of resolving a claim.

(2) The following disclosures shall be included on the same page as the disclosures required in Subsection (1).

(a) A public adjuster may not receive compensation for referring the insured to a particular attorney, appraiser, umpire, construction company, contractor, repair firm, or salvage company.

(b) A public adjuster may not receive compensation for a claim if the insurer pays or commits in writing to pay the policy limits within 72 hours of the loss report.

(c)(i) Except for direct payment of compensation by the insured, any draft or check shall include the insured as a payee and shall require the written signature or endorsement of the insured.

(ii) A public adjuster may not sign or endorse any payment draft or check on behalf of the insured.

(d) A public adjuster may not enter into a contract with an insured or collect compensation as provided in the contract without performing the service customarily provided by a licensed public adjuster for the insured.

(e) The type of initial expenses, with dollar estimates, that the insured approves to reimburse the public adjuster from the proceeds of the claim payment.

(3) A public adjuster contract may not include the following compensation terms:

(a) a term allowing a public adjuster to collect the public adjuster's percentage fee when money is due from an insurance company but the insurance company has not paid;

(b) a term allowing a public adjuster to collect the entire fee from the first check an insurance company issues instead of a percentage of each check the insurance company issues;

(c) a term requiring an insured to authorize an insurance company to issue a check only in the name of the public adjuster;

(d) a term imposing a collection cost or a late fee;

(e) a term preventing an insured from pursuing a civil remedy; or

(f) a term that allows a public adjuster to accept a payment in violation of a statute or this rule.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

Utah Admin. Code R590-274-9 Severability

If any provision of this rule, Rule R590-274, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, public adjusters
Date of Last Change: June 23, 2026
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-26-401; 31A-26-403

R590-275 Qualified Health Plan Alternate Enrollment

Utah Admin. Code R590-275-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-2-212.

History

KEY: insurance, enrollment
Date of Last Change: May 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-212(5)

Utah Admin. Code R590-275-2 Purpose and Scope

(1) The purpose of this rule is to identify an alternate enrollment system for a PPACA qualified health plan as provided in 45 CFR 155.335(j)(3).

(2) This rule applies:

(a) when an insurer will have no qualified health plan available to an individual on the health insurance exchange for the upcoming plan year;

(b) to an insurer who offers a qualified health plan to an individual on the health insurance exchange; and

History

KEY: insurance, enrollment
Date of Last Change: May 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-212(5)

Utah Admin. Code R590-275-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1)(a) "Metal level" means the health plan category based on how an insured individual and the plan split the cost of health care.

(b) A plan in the marketplace is presented in one of four health plan categories:

(i) bronze;

(ii) silver;

(iii) gold; or

(iv) platinum.

(2) "Qualified health plan" or "QHP" means a health benefit plan that is certified to meet the standards recognized by the health insurance exchange.

History

KEY: insurance, enrollment
Date of Last Change: May 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-212(5)

Utah Admin. Code R590-275-4 Alternate Enrollment Process

(1) If an insurer will have no health insurance exchange option available for the upcoming plan year due to the insurer no longer offering an individual QHP in a particular service area in which it previously offered coverage on the health insurance exchange, the health insurance exchange shall direct enrollment for an enrollee to a QHP issued by a different insurer subject to Subsection (3) and the insurer's ability to absorb new enrollment.

(2) At renewal, if an enrollee does not have an individual QHP available from the same insurer through the health insurance exchange in which to enroll, the health insurance exchange shall direct enrollment for an enrollee to a QHP issued by a different insurer subject to Subsection (3) and the insurer's ability to absorb new enrollment.

(3)(a) The enrollee's coverage will be matched to a QHP in the same service area:

(i) at the same metal level; or

(ii) if more than one QHP is available, the coverage will be matched to a QHP at the same metal level with the lowest premium.

(b) If no QHP is available at the same metal level in the same service area, the enrollee will be matched to a QHP in the same service area:

(i) that is one metal level lower than the enrollee's current QHP; or

(ii) if more than one QHP is available, coverage will be matched to a QHP at one metal level lower with the lowest premium.

(c) If no QHP is available at the same metal level or one metal level lower and in the same service area, the enrollee will be matched to a QHP that is:

(i) one metal level higher than the enrollee's current QHP; or

(ii) if more than one QHP is available at one metal level higher, coverage will be matched to a QHP at one metal level higher with the lowest premium.

(d) If no QHP is available at the same metal level, one metal level lower, or one metal level higher in the same service area, the enrollee will be matched to any QHP at any metal at the lowest premium in the same service area.

(4) The alternate enrollment provisions in Subsection (3) do not apply to an enrollee who terminates coverage, including termination of coverage in connection with voluntarily selecting a different QHP in accordance with 45 CFR 155.430.

History

KEY: insurance, enrollment
Date of Last Change: May 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-212(5)

Utah Admin. Code R590-275-5 Severability

If any provision of this rule, Rule R590-275, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, enrollment
Date of Last Change: May 9, 2023
Notice of Continuation: October 14, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-212(5)

R590-276 Record Retention for Foreign Insurers, Alien Insurers, Commercially Domiciled Insurers, Foreign Title Insurers, and Foreign Fraternals

Utah Admin. Code R590-276-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-14-205.5, and 31A-23a-412.

History

KEY: insurance, record retention
Date of Last Change: January 10, 2023
Notice of Continuation: April 20, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-14-205.5(5)(a); 31A-23a-412(5)

Utah Admin. Code R590-276-2 Purpose and Scope

(1) The purpose of this rule is to establish record retention requirements for:

(a) a foreign insurer;

(b) an alien insurer;

(d) a foreign title insurer; and

(e) a foreign fraternal.

(2) This rule applies to a foreign insurer, alien insurer, commercially domiciled insurer, foreign title insurer, or foreign fraternal licensed to do business in Utah.

History

KEY: insurance, record retention
Date of Last Change: January 10, 2023
Notice of Continuation: April 20, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-14-205.5(5)(a); 31A-23a-412(5)

Utah Admin. Code R590-276-3 Definitions

Terms used in this rule are defined in Section 31A-1-301.

History

KEY: insurance, record retention
Date of Last Change: January 10, 2023
Notice of Continuation: April 20, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-14-205.5(5)(a); 31A-23a-412(5)

Utah Admin. Code R590-276-4 Retention Requirements

(1) Except as provided in Subsection (2), the retention requirement for the books and records of an insurer or fraternal subject to Title 31A, Chapter 14, Foreign Insurers, is three years plus the current year.

(2)(a) The retention requirement for the books and records of a foreign title insurer, including records related to title search, examination, and underwriting used for determining insurability, is 15 years, pursuant to Subsection 31A-20-110(1).

(b) The retention requirement for books and records related to escrow transactions involving real property is three years plus the current year, pursuant to Subsection 31A-23a-412(5).

(3) All books and records shall be made available during normal business hours.

(4) Nothing in this section prohibits electronically stored books and records.

History

KEY: insurance, record retention
Date of Last Change: January 10, 2023
Notice of Continuation: April 20, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-14-205.5(5)(a); 31A-23a-412(5)

Utah Admin. Code R590-276-5 Severability

If any provision of this rule, Rule R590-276, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, record retention
Date of Last Change: January 10, 2023
Notice of Continuation: April 20, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-14-205.5(5)(a); 31A-23a-412(5)

R590-277 Managed Care Health Benefit Plan Policy Standards

Utah Admin. Code R590-277-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-22-623, 31A-22- 626, and 31A-45-103.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) standardize and simplify the terms and coverage of a managed care health benefit plan;

(b) facilitate public understanding and comparison of coverage;

(c) prohibit use of a provision that is misleading or confusing in connection with the purchase of coverage or the settlement of a claim;

(d) set minimum coverage requirements; and

(e) provide for full disclosure in the sale of insurance.

(2) This rule applies to a health benefit plan issued by a managed care organization.

(3) This rule does not apply to short-term limited duration health insurance subject to Rule R590-286.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-45-102, and Rules R590-126, R590-192, R590-233, R590-261, and R590-266.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-4 Prohibited Provisions

(1) A contract may not impose a preexisting condition limitation or exclusion provision.

(2) Unless otherwise required by law, a contract may not limit or exclude coverage or benefits by type of illness, accident, injury, treatment, or medical condition except:

(a) abortion;

(b) acupuncture or acupressure services;

(c) administrative charge for completing an insurance form, duplication service, interest, finance charge, or other administrative charge;

(d) administrative exam or service;

(e) applied behavioral analysis therapy, except as required under Section 31A-22-642;

(f) aviation, to a non-fare-paying passenger;

(g) axillary hyperhidrosis;

(h) benefits paid for under:

(i) employers' liability or occupational disease law;

(ii) Medicare or another governmental program except Medicaid; or

(iii) state or federal workers' compensation;

(i) charge for a missed appointment;

(j) chiropractic care;

(k) complementary or alternative medicine;

(l) corrective lenses, including examination for the prescription or fitting, except:

(i) lens implant following cataract surgery; and

(ii) as required under Rule R590-266;

(m) cosmetic surgery including reversal, revision, repair, complication, or treatment related to a non-covered cosmetic surgery, except reconstructive surgery:

(i) when the service is incidental to or follows surgery resulting from trauma, infection, or other disease; or

(ii) due to a congenital disease or anomaly of a covered dependent child that has resulted in a functional defect;

(n) custodial care;

(o) dental care or treatment, except as required under Section R590-266-4;

(p) dietary products, except as required under Rule R590-194;

(q) educational or nutritional training, except as required under Rule R590-200;

(r) experimental or investigational services;

(s) expenses before coverage begins or after coverage ends;

(t) felony, riot, or insurrection, when it is determined the enrollee was a voluntary participant;

(u) fitness training, exercise equipment, or membership fee to a spa or health club;

(v)(i) foot care for a corn, a callus, flat feet, a fallen arch, a weak foot, chronic foot strain, or symptomatic complaints of a foot, including an orthotic; and

(w)(i) gastric or intestinal bypass service, including lap banding, gastric stapling, or a similar procedure to facilitate weight loss;

(ii) the reversal or revision of a procedure under Subsection (2)(w)(i); or

(iii) a service required for the treatment of a complication from a procedure in Subsection (2)(w)(i);

(x) gender reassignment, except as required under Section 1557 of PPACA;

(y) gene therapy;

(z) genetic testing;

(aa) hearing aid, including examination for the prescription or fitting;

(bb) infertility services, except as required under Subsection 31A-22-610.1(1);

(cc) injury as a result of a motor vehicle, to the extent the enrollee is required to have no-fault coverage, up to the minimum coverage required by law, whether or not coverage is in effect;

(dd) mental health condition or substance use disorder services, except as required under Section 31A-22-625 and Rule R590-266;

(ee) nuclear release;

(ff) refractive eye surgery;

(gg) rehabilitation or habilitative therapy services, such as physical, speech, and occupational, unless required to correct an impairment caused by a covered accident, injury, or illness, or as required under Rule R590-266;

(hh) respite care;

(ii) rest cures;

(jj) services performed by an enrollee's parent, spouse, sibling, or child, including a step or in-law relationship;

(kk) services performed by an employee of a hospital, laboratory, or other institution;

(ll) services that are not medically necessary;

(mm) services for which no charge is normally made in the absence of insurance;

(nn) services while in the armed forces or an auxiliary unit;

(oo) services in connection with a prearranged surrogacy agreement, except for services for the baby, where the covered person relinquishes a baby and receives payment or other compensation arising out of such services;

(pp) sexual dysfunction procedures, equipment, or drugs;

(qq) shipping or handling;

(rr) telephone or electronic consultation, except as required under Sections 31A-22-649 and 31A-22-649.5;

(ss) territorial limitations outside the United States, except as required under Section 31A-22-627;

(tt) terrorism, including acts of terrorism;

(uu) transplants, except as required by Rule R590-266;

(vv) transportation, except medically necessary ambulance services;

(ww) war or act of war, whether declared or undeclared;

(xx) except under Subsection (2)(yy), a loss directly related to the enrollee's voluntary participation in an activity when the enrollee:

(i) is found guilty of an illegal activity in a criminal proceeding, including a plea of guilty, a no contest plea, and a plea in abeyance; or

(ii) is found liable for the activity in a civil proceeding;

(yy) a loss established under Subsection (3) that is directly related to the enrollee violating:

(i) Section 41-6a-502, if the loss occurred in Utah; or

(zz) any other exclusion that, in the opinion of the commissioner, is not inequitable, misleading, deceptive, obscure, unjust, unfair, or unfairly discriminatory to an enrollee.

(3)(a) A violation under Subsection (2)(yy) shall be established:

(i) in a criminal proceeding in which the enrollee is found guilty, enters a no contest plea or a plea in abeyance, or enters into a diversion agreement; or

(ii) by a request for an independent review when the findings support a decision to deny coverage based on the exclusion.

(b)(i) For purposes of Subsection (3)(a)(ii), an independent review means a process that:

(A) is conducted by an independent entity designated by the managed care organization;

(B) renders an independent and impartial decision on a decision to deny coverage based on the exclusion; and

(ii) The independent review entity may not have a material professional, familial, or financial conflict of interest with:

(A) the managed care organization;

(B) an officer, director, or management employee of the managed care organization;

(D) the enrollee's health care provider;

(E) the health care provider's medical group or independent practice association; or

(F) a health care facility where services were provided.

(4) A contract provision precluded in this section may not be construed as a limitation on the commissioner's authority to prohibit a contract provision that, in the opinion of the commissioner, is unjust, unfair, or unfairly discriminatory to an enrollee.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-5 General Requirements

(1) A contract may not include a definition regarding a matter defined in Section R590-277-3 unless the definition complies with that section.

(2) Except for an employer-sponsored health benefit plan, a contract:

(a) may not provide for termination of coverage of the spouse or a dependent solely because of the occurrence of an event specified for termination of coverage of the contract holder, other than for nonpayment of premium; and

(b) shall provide that in the event of the contract holder's death, the spouse shall become the contract holder.

(3) A contract providing coverage for the recipient in a transplant operation shall also provide reimbursement of medically necessary transplant expenses of a live donor.

(4) A premium change notice shall be given no less than 45 days before the renewal date.

(5)(a) Except under Subsection (5)(b), a completed application:

(i) is made part of the contract; and

(ii) shall be provided to the applicant before, or at delivery, of the contract.

(b) Subsection (5)(a) does not apply to:

(i) an employer-sponsored health benefit plan; or

(ii) an individual if the application was submitted through the health insurance exchange.

(6) A managed care organization offering an individual health benefit plan shall issue with an individual policy:

(a)(i) an outline of coverage; or

(ii) a benefit summary; and

(b) a summary of benefits and coverage.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-6 Required Provisions

(1)(a) A contract shall include a renewal, continuation, and nonrenewal provision.

(b) Each provision shall:

(i) appear on the first page of the contract;

(ii) be appropriately captioned; and

(iii) clearly state the renewability of coverage.

(2)(a) Except for an endorsement by which the managed care organization effectuates a written request by the policyholder or exercises a specifically reserved right under the contract, signed acceptance by the policyholder is required for an endorsement that reduces or eliminates a benefit or coverage and is added to a contract after the date of issue, at reinstatement, or at renewal.

(3) If a separate additional premium is charged for a benefit provided in connection with an endorsement, the premium charge shall be set forth in the contract.

(4) A contract that provides for the payment of a benefit based on a standard described as usual and customary, reasonable and customary, or similar words, shall include a definition and explanation of the term in the accompanying outline of coverage or benefit summary.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-7 Restrictions Relating to Premium Rates

(1) The premium charged may not be adjusted more frequently than annually, except the premium rate may be changed:

(a) to reflect a change in enrollment;

(b) to reflect a change to the contract; or

(2) Premium rates may vary based only on the following:

(a) whether the plan covers an individual or a family, as follows:

(i) the total family premium shall only include premiums for covered family members over the age of 21 and the three oldest children under the age of 21; and

(ii) a rating variation based on age or tobacco use shall be applied separately to the portion of the premium attributable to each covered family member;

(b) geographic rating area, determined by the policyholder's primary address, as follows:

(i) Area 1, Cache and Rich counties;

(ii) Area 2, Box Elder, Morgan, and Weber counties;

(iii) Area 3, Davis, Salt Lake, Summit, Tooele, and Wasatch counties;

(iv) Area 4, Utah County;

(v) Area 5, Iron and Washington counties; and

(vi) Area 6, Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, and Wayne counties;

(c) age of each enrollee, as of the date of the contract issuance or renewal, in accordance with the Utah Individual and Small Employer Health Benefit Plan Age Curve; and

(d) tobacco rate factor not greater than 1.5.

(3) Subsection (2) does not apply to:

(a) a large employer contract; or

(b) an individual or small employer contract issued before January 1, 2014, if the contract rating complies with:

(i) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act; and

(ii) Rule R590-167.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

Utah Admin. Code R590-277-8 Severability

If any provision of this rule, Rule R590-277, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2- 202

R590-279 Rule Designating Fraud Division Offices as a Secured Area

Utah Admin. Code R590-279-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 76-8-311.1.

History

KEY: insurance, firearms
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 76-8-3.11.1; 31A-2-201(3)

Utah Admin. Code R590-279-2 Purpose and Scope

(1) The purpose of this rule is to designate the offices of the Utah Insurance Fraud Division as a secured area.

(2) This rule applies to:

(a) the offices of the Utah Insurance Fraud Division; and

(b) a person visiting the offices of the Utah Insurance Fraud Division.

History

KEY: insurance, firearms
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 76-8-3.11.1; 31A-2-201(3)

Utah Admin. Code R590-279-3 Definitions

Terms used in this rule are defined in Section 31A-1-301, 76-8-311.1, and 76-10-501.

History

KEY: insurance, firearms
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 76-8-3.11.1; 31A-2-201(3)

Utah Admin. Code R590-279-4 Prohibition

(1) An area, other than an area generally accessible to the public, that is owned, leased, or operated by the commissioner for law enforcement officers employed pursuant to Section 31A-2-104 is established as a secure area in which any firearm, ammunition, dangerous weapon, or explosive is prohibited.

(2) Any firearm, ammunition, dangerous weapon, or explosive in the possession of a law enforcement officer or prosecutor is exempt from the prohibition in Subsection (1).

History

KEY: insurance, firearms
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 76-8-3.11.1; 31A-2-201(3)

Utah Admin. Code R590-279-5 Severability

If any provision of this rule, Rule R590-279, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, firearms
Date of Last Change: January 10, 2023
Notice of Continuation: December 18, 2023
Authorizing, and Implemented or Interpreted Law: 76-8-3.11.1; 31A-2-201(3)

R590-280 Counting Short-Term Funds

Utah Admin. Code R590-280-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-18-105.

History

KEY: insurance
Date of Last Change: January 10, 2023
Notice of Continuation: April 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-18-105(16); 31A-2-201(3)

Utah Admin. Code R590-280-2 Purpose and Scope

(1) The purpose of this rule is to define short-term funds as a permitted class of investment.

(2) This rule applies to an insurer authorized to do business in Utah.

History

KEY: insurance
Date of Last Change: January 10, 2023
Notice of Continuation: April 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-18-105(16); 31A-2-201(3)

Utah Admin. Code R590-280-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-17-601. Additional terms are defined as follows:

(1) "SBA" means the United States Small Business Administration.

(2) "Short-term funds" means a sum of money that an insurer loans to an SBA borrower to fund the SBA borrower's anticipated use of SBA 504 loan proceeds where the insurer's loan is secured by a lien on real property or by any other form of collateral authorized by the commissioner.

History

KEY: insurance
Date of Last Change: January 10, 2023
Notice of Continuation: April 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-18-105(16); 31A-2-201(3)

Utah Admin. Code R590-280-4 Requirements for Counting Short-Term Funds

An insurer may count short-term funds for the purposes specified under Title 31A, Chapter 17, Part 6, Risk-Based Capital, if:

(1) the total amount of short-term funds, set forth in the insurer's annual or quarterly statutory financial statement that was last filed with the NAIC, does not exceed the following:

(a) 1.5% of the insurer's total assets determined under Subsection 31A-18-106(4); and

(b) 15% of the insurer's capital and surplus;

(2) the duration of each loan does not exceed 150 days;

(3) the insurer provides satisfactory proof of compliance with this rule, upon request;

(4) the filing of the insurer's most recent RBC report did not qualify as an action level event or as a control level event under Title 31A, Chapter 17, Part 6, Risk-Based Capital; and

(5) at the time of the insurer's loan to the SBA borrower, the insurer is not subject to administrative action under Title 31A, Chapter 27, Part 5, Administrative Actions.

History

KEY: insurance
Date of Last Change: January 10, 2023
Notice of Continuation: April 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-18-105(16); 31A-2-201(3)

Utah Admin. Code R590-280-5 Severability

If any provision of this rule, Rule R590-280, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: January 10, 2023
Notice of Continuation: April 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-18-105(16); 31A-2-201(3)

R590-281 License Application Submitted by an Individual Who Has a Criminal Conviction or Pending Proceeding

Utah Admin. Code R590-281-1 Authority

This rule is promulgated by the commissioner pursuant to Section 31A-2-201.

History

KEY: insurance, licensing
Date of Last Change: June 23, 2026
Notice of Continuation: June 14, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)

Utah Admin. Code R590-281-2 Purpose and Scope

(1) The purpose of this rule is to set eligibility requirements for a license applicant who has a criminal conviction or a pending proceeding.

(2) This rule applies to a license applicant who has a criminal conviction or a pending proceeding.

History

KEY: insurance, licensing
Date of Last Change: June 23, 2026
Notice of Continuation: June 14, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)

Utah Admin. Code R590-281-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Criminal conviction" means a felony, or a misdemeanor involving fraud, misrepresentation, theft, or dishonesty, that results in:

(a) judgment of guilt entered by a court;

(b) an admission;

(d) a no contest plea;

(e) a proceeding involving a plea in abeyance; or

(f) another deferred adjudication agreement that has not yet been dismissed.

(2) "License" means an initial license issued by the commissioner.

(3) "License applicant" means an individual applying for a license under:

(a) Title 31A, Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries;

(b) Title 31A, Chapter 23b, Navigator License Act;

(d) Title 31A, Chapter 26, Insurance Adjusters.

(4) "Proceeding" means:

(a) a criminal proceeding in which an individual is charged with a felony, or a misdemeanor involving fraud, misrepresentation, theft, or dishonesty; or

(b) an administrative, civil, or regulatory enforcement proceeding in which an individual is alleged to have engaged in conduct involving fraud, misrepresentation, theft, or dishonesty.

History

KEY: insurance, licensing
Date of Last Change: June 23, 2026
Notice of Continuation: June 14, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)

Utah Admin. Code R590-281-4 Eligibility to Apply for a License

(1) Except as provided in Subsections (3) through (5), an individual who has a criminal conviction is eligible to apply for a license if:

(a) the individual has completed probation, parole, or has been released from incarceration;

(b) the individual has no criminal proceeding pending;

(d) the individual has paid in full all restitution ordered by the court related to the criminal conviction; and

(e) the following time periods have elapsed from the date the individual was convicted, released from incarceration, parole, or probation, or the expiration of the probationary term, whichever occurred last:

(i) seven years in the case of a felony;

(ii) five years in the case of a class A misdemeanor;

(iii) four years in the case of a class B misdemeanor; or

(iv) three years in the case of any other misdemeanor.

(2) Any pending administrative, civil, criminal, or regulatory proceeding must be resolved before an individual is eligible to apply for a license.

(3) Subsection (1) does not apply to:

(a) a juvenile adjudication; or

(b) an individual whose criminal charge was dismissed pursuant to a plea in abeyance agreement under Title 77, Chapter 2a, Pleas in Abeyance.

(4) The department will give effect to a conviction for a lower degree of offense pursuant to Section 76-3-402.

(5)(a)(i) An individual convicted of violating the federal Violent Crime Control and Law Enforcement Act of 1994, 18 U.S.C. Sec. 1033, or who under 18 U.S.C. Sec. 1033 has been convicted of a felony involving dishonesty or breach of trust, may not apply for a license without first obtaining written consent from the commissioner to engage or participate in the business of insurance.

(ii) The policy and application for written consent are available on the department's website, https://insurance.utah.gov.

(b) An individual who obtains written consent may apply for a license, subject to all other license application requirements.

(i) a felony conviction involving dishonesty or breach of trust has been dismissed pursuant to a plea in abeyance agreement under Title 77, Chapter 2a, Pleas in Abeyance;

(ii) a felony conviction involving dishonesty or breach of trust has been reduced to a lower degree of offense under Section 76-3-402; or

(iii) a felony conviction involving dishonesty or breach of trust has been expunged under Title 77, Chapter 40a, Expungement.

(6) The department shall deny a license application submitted by an individual who is not eligible under this section.

(7) Eligibility to apply for a license under this Rule R590-281 is a separate determination from and does not affect eligibility to engage in the business of insurance under 18 U.S.C. Sec. 1033.

History

KEY: insurance, licensing
Date of Last Change: June 23, 2026
Notice of Continuation: June 14, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)

Utah Admin. Code R590-281-5 Severability

If any provision of this rule, R590-281, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, licensing
Date of Last Change: June 23, 2026
Notice of Continuation: June 14, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)

R590-282 Pharmacy Benefit Managers

Utah Admin. Code R590-282-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-46-202, and 31A-46-301.

History

KEY: insurance, pharmacy benefit manager
Date of Last Change: September 10, 2024
Notice of Continuation: December 20, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-46-301(3)(c)(ii); 31A-46-202(1)(a)

Utah Admin. Code R590-282-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) define terms;

(b) provide licensing requirements; and

(2) This rule applies to a pharmacy benefit manager operating in Utah on or after July 1, 2019.

History

KEY: insurance, pharmacy benefit manager
Date of Last Change: September 10, 2024
Notice of Continuation: December 20, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-46-301(3)(c)(ii); 31A-46-202(1)(a)

Utah Admin. Code R590-282-3 Licensing

(1)(a) To obtain or renew a pharmacy benefit manager license, an applicant shall:

(i) submit the Utah Insurance Department Pharmacy Benefit Manager Application and the required attachments; and

(ii) pay the fee in an amount annually established by the Utah Legislature under Section 63J-1-504.

(b) The Utah Insurance Department Pharmacy Benefit Manager Application is available on the Department's website, https://insurance.utah.gov.

(2)(a) The licensing period begins on April 1 of each year and ends on March 31 of the following year.

(b) A license for which a renewal license application is not received by the commissioner before April 1 is considered expired.

(4) Any material changes to the information submitted in an application shall be reported to the commissioner no later than 30 days after the day on which the information changes.

History

KEY: insurance, pharmacy benefit manager
Date of Last Change: September 10, 2024
Notice of Continuation: December 20, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-46-301(3)(c)(ii); 31A-46-202(1)(a)

Utah Admin. Code R590-282-5 Reporting Requirements

(1)(a) Beginning on April 1, 2020, and each year thereafter, a pharmacy benefit manager shall submit the Utah Pharmacy Benefit Manager Report.

(b) The Utah Pharmacy Benefit Manager Report and its instructions are available on the Department's website, https://insurance.utah.gov.

(2)(a) At least 30 days prior to publishing any data derived from the Utah Pharmacy Benefit Manager Report, the commissioner shall email to each pharmacy benefit manager submitting data under Subsection (1), a general description of the data to be published.

(b)(i) A pharmacy benefit manager may respond to the email by submitting the information specified in Subsection 31A-46-301(3)(c)(ii) to the Health Research folder of the Department's secure file upload website, https://forms.uid.utah.gov/fileUploads/.

(ii) A response must be received within 30 days of the date of the email described in Subsection (2)(a).

History

KEY: insurance, pharmacy benefit manager
Date of Last Change: September 10, 2024
Notice of Continuation: December 20, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-46-301(3)(c)(ii); 31A-46-202(1)(a)

Utah Admin. Code R590-282-6 Severability

If any provision of this rule, Rule R590-282, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, pharmacy benefit manager
Date of Last Change: September 10, 2024
Notice of Continuation: December 20, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-46-301(3)(c)(ii); 31A-46-202(1)(a)

R590-283 Defrayal of State-Required Benefits

Utah Admin. Code R590-283-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-22-642, and 31A-30-118.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-2 Purpose and Scope

(1) The purpose of this rule is to establish the method and timing for the defrayal of the cost of a state-required benefit enacted on or after January 1, 2012, that is subject to 45 CFR 155.170 of PPACA.

(2) This rule applies to a health benefit plan that:

(a) is a qualified health plan;

(b) is offered on the exchange in the individual or small group market;

(d) offers a state-required benefit in excess of the Utah Essential Health Benefits Package.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103, and Rule R590-266. Additional terms are defined as follows:

(1) "Defrayal payment" means the amount payable to a carrier from the state for expenses incurred for a state-required benefit under:

(a) 45 C.F.R. 155.170(b);

(b) Section 31A-30-118; and

(2) "EHB" means essential health benefits.

(3) "Exchange" means exchange as defined in 45 CFR 155.20.

(4) "Member month" means a count of one for each month during a calendar year during which an individual has coverage under a plan subject to this rule where coverage is evaluated on the first of the month.

(5) "Qualified health plan" means a qualified health plan as defined in 45 CFR 155.20.

(6) "State-required benefit" means a benefit required by the state:

(a) on or after January 1, 2012;

(b) for a purpose other than compliance with a federal requirement;

(d) that is eligible for a defrayal payment.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-4 Defrayal of a State-Required Benefit

(1) A health benefit plan offering a state-required benefit that is offered exclusively off-exchange is not eligible for a defrayal payment.

(2) A carrier seeking a defrayal payment shall, on or before September 1 of each year, submit to the commissioner a request that includes the following information:

(a) the state-required benefit for which the carrier is seeking a defrayal payment;

(b) the Mandate Defrayal Data template with the final data submission tab completed;

(c) an explanation for any increase in the allowable amount in the per unit cost for each CPT code that increased more than 5%;

(d) a description of any treatment plan review under Subsection 31A-22-642(6); and

(e) a certification stating:

(i) any durational limit, amount limit, deductible, copayment, and coinsurance for the treatment of autism spectrum disorder are similar to, or identical to, coverage provided for other illnesses or diseases; and

(ii) the defrayal payment request complies with Subsection 31A-30-118(1)(b).

(3)(a) The total defrayal payments are based on an aggregate of the data received under Subsection (2) from all carriers.

(b) The defrayal payment is calculated based on the sum of the total state-required benefit defrayable costs incurred across all carriers divided by the sum of the total member months of individuals receiving state-required benefit services across all carriers, and the result is multiplied by the sum of the member months of individuals receiving state-required benefit services for each carrier.

(c) A carrier may not receive a defrayal payment in excess of the amount the carrier incurred for a state-required benefit during the preceding calendar year.

(4) A request for defrayal payment shall be submitted via the System for Electronic Rate and Form Filings, SERFF.

(5)(a) Each defrayal payment is paid in arrears.

(b) The defrayal payment will be paid in the first quarter of the state's fiscal year following the submission of a valid request for a defrayal payment submitted under Subsection (2).

(c) For example, a carrier submits a request for a defrayal payment in August 2023 for claims incurred during calendar year 2022. The defrayal payment will be paid during the first quarter of the state's fiscal year 2025, July 1, 2024, through September 30, 2024.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-5 Unified Rate Review Template, Rate Data Template, and Plans and Benefits Template Modifications

(1) A carrier that expects to be eligible to receive a defrayal payment shall modify a federal rate filing template as follows:

(a) exclude the expected defrayal payment from the rates submitted on both the Unified Rate Review Template and the Rate Data Template;

(b) indicate in the rate filing's actuarial memorandum:

(i) whether the carrier anticipates a defrayal payment from the state for the cost of an eligible state-required benefit;

(ii) that the cost of the state-required benefit is not included in the premiums; and

(iii) the defrayal payment amount the carrier expects to receive; and

(c) indicate in the "Benefits Information" field on the Plans and Benefits Template that the carrier covers the state- required benefits, selecting the state-required benefit of "Not EHB" for the "EHB Variance Reason" field.

(2)(a) A carrier may not factor a state-required benefit into the calculation for the "EHB Percent of Total Premium" field on the Plans and Benefits Template.

(b) A state-required benefit may not be included in the total premium from which the "EHB Percent of Total Premium" field is calculated.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-6 Reporting

(1) This rule incorporates by reference the Utah Health Information Network's (UHIN) "Adaptive Behavior Services/Applied Behavior Analysis (ABA) Billing Standard" version 3.1, which is available on the department's website at https://insurance.utah.gov or on UHIN's website at https://uhin.org.

(2) A carrier shall use the UHIN "Adaptive Behavior Services/Applied Behavior Analysis (ABA) Billing Standard" version 3.1 to identify and report state-required benefit claims subject to defrayal under Subsection R590-283-4(2)(c) and this section.

(3)(a) To project the state's defrayal payments, a carrier anticipating a defrayal payment shall submit to the commissioner on a quarterly basis the Mandate Defrayal Data template for the current reporting period.

(b) A report shall be filed:

(i) on or before May 15 of each year for the period January 1 through March 31;

(ii) on or before August 15 of each year for the period January 1 through June 30;

(iii) on or before November 15 of each year for the period January 1 through September 30;

(iv) on or before February 15 of each year for the period January 1 through December 31 of the previous year; and

(v) for the purpose of Section R590-283-4, on or before September 1 of each year for the period January 1 through December 31 of the previous year.

(4) Reports shall be submitted via the System for Electronic Rate and Form Filings, SERFF.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-7 Claims Auditing

The commissioner may audit a carrier's:

(1) state-required benefit claims that are eligible for a defrayal payment; and

(2) process for determining which state-required benefit claims are eligible for a defrayal payment.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

Utah Admin. Code R590-283-8 Severability

If any provision of this rule, Rule R590-283, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: June 9, 2023
Notice of Continuation: December 16, 2024
Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)

R590-284 Corporate Governance Annual Disclosure Rule

Utah Admin. Code R590-284-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-16b-104.

History

KEY: corporate governance disclosure
Date of Last Change: May 9, 2023
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-16b-104

Utah Admin. Code R590-284-2 Purpose and Scope

(1) The purpose of this rule is to set forth the filing procedure and the content requirements for the CGAD required by Title 31A, Chapter 16b, Corporate Governance Annual Disclosure Act.

(2) This rule applies to an insurer or an insurance group domiciled in Utah.

History

KEY: corporate governance disclosure
Date of Last Change: May 9, 2023
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-16b-104

Utah Admin. Code R590-284-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "CGAD" means corporate governance annual disclosure.

(2) "Insurance group" means the insurers and affiliates included within an insurance holding company system.

(3)(a) "Senior management" means any corporate officer responsible for:

(i) reporting information to the board of directors at regular intervals; or

(ii) providing the information in Subsection (3)(a)(i) to shareholders or regulators.

(b) "Senior management" includes:

(i) the chief executive officer;

(ii) the chief financial officer;

(iii) the chief operations officer;

(iv) the chief procurement officer;

(v) the chief legal officer;

(vi) the chief information officer;

(vii) the chief technology officer;

(viii) the chief revenue officer;

(ix) the chief visionary officer; or

(x) any other "C" level executive.

History

KEY: corporate governance disclosure
Date of Last Change: May 9, 2023
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-16b-104

Utah Admin. Code R590-284-4 Filing Procedures

(1) An insurer or insurance group has discretion regarding the appropriate format for providing the information required by this rule and may customize the CGAD to provide the most relevant information necessary to give the commissioner an understanding of the corporate governance structure, policies, and practices utilized by the insurer or insurance group.

(2)(a) An insurer or insurance group may comply with this rule by referencing any other existing document, for example, an ORSA Summary Report, a Holding Company Form B or F Filing, a Securities and Exchange Commission Proxy Statement, or foreign regulatory reporting requirements, if the document provides information that is comparable to the information described in Section R590-284-5.

(b) An insurer or insurance group shall clearly reference the location of the relevant information within the CGAD and attach the referenced document if it is not already filed or available to the commissioner.

(3)(a) Each year following the initial filing of the CGAD, an insurer or insurance group shall file an amended version of the previously filed CGAD indicating any changes.

(b) If no changes were made in the information or activities reported by the insurer or insurance group, the filing shall state that there was no change.

History

KEY: corporate governance disclosure
Date of Last Change: May 9, 2023
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-16b-104

Utah Admin. Code R590-284-5 Contents of the CGAD

(1) An insurer or insurance group shall provide thorough descriptions in the CGAD and shall include any existing document used in the governance process to demonstrate the strengths of the insurer's or insurance group's governance framework and practices.

(2) The CGAD shall describe an insurer's or insurance group's corporate governance framework and structure, including consideration of the following:

(a) the insurer's board of directors and its committees that are responsible for overseeing the insurer or insurance group;

(b) the level or levels at which oversight occurs, including ultimate control level, intermediate holding company, or legal entity;

(c) the rationale for the current size and structure of the board of directors, including the role of the chief executive officer and the chairman of the board;

(d) the duties of the board of directors and each committee; and

(e) how the board of directors and each committee is governed, for example through bylaws, a charter, or an informal mandate.

(3) An insurer or insurance group shall describe the policies and practices of the most senior governing entity and its committees, including:

(a) how the qualifications, expertise, and experience of each board member meet the needs of the insurer or insurance group;

(b) how an appropriate amount of independence is maintained on the board of directors and its committees;

(c) the number of meetings held by the board of directors and its committees over the past year, as well as information on director attendance;

(d) how the insurer or insurance group identifies, nominates, and elects members to the board of directors and its committees, including:

(i) whether a nomination committee is in place to identify and select individuals for consideration;

(ii) whether term limits are placed on directors;

(iii) how the election and re-election processes function; and

(iv) whether a board of directors diversity policy is in place and, if so, how it functions; and

(e) the processes in place for the board of directors to evaluate its performance and the performance of its committees, as well as any recent measures taken to improve performance, including board of directors or committee training programs.

(4) An insurer or insurance group shall describe the policies and practices for directing senior management, including:

(a) any process or suitability standards used to determine whether an officer or key person in a control function has the appropriate background, experience, and integrity to fulfill their role, including:

(i) identification of each specific position for which suitability standards have been developed and a description of the standards employed; and

(ii) any change in an officer's or key person's suitability as outlined by the insurer's or insurance group's standards and procedures to monitor and evaluate such changes;

(b) the insurer's or insurance group's code of business conduct and ethics, including:

(i) compliance with laws, rules, and regulations; and

(ii) proactive reporting of any illegal or unethical behavior;

(c) the insurer's or insurance group's processes for performance evaluation, compensation, and corrective action to ensure effective senior management throughout the organization, including:

(i) the general objectives of any significant compensation program;

(ii) what each program is designed to reward; and

(iii) how the organization ensures that a compensation program does not encourage or reward excessive risk taking, including:

(A) the role of the board of directors in overseeing management compensation programs and practices;

(B) the elements of compensation awarded in each compensation program and how the insurer or insurance group determines and calculates the amount of each element of compensation paid;

(D) whether each compensation program includes risk adjustments and how those adjustments are incorporated into the programs for employees at different levels;

(E) any clawback provision built into a compensation program to recover awards or payments if the performance measures they are based on are restated or adjusted; and

(F) any other factor relevant in understanding how the insurer or insurance group monitors its compensation policies to determine whether its risk management objectives are met by incentivizing its employees; and

(d) the insurer's or insurance group's plans for chief executive officer and senior management succession.

(5)(a) An insurer or insurance group shall describe any process used by the board of directors, its committees, or senior management to ensure appropriate oversight of each critical risk area impacting the insurer's or insurance group's business activities, including:

(i) how oversight and management responsibilities are delegated between the board of directors, its committees, and senior management;

(ii) how the board of directors is kept informed of the insurer's or insurance group's strategic plans, the associated risks, and steps that senior management takes to monitor and manage those risks; and

(iii) how reporting responsibilities are organized for each critical risk area.

(b) The description shall inform the commissioner of the frequency at which information on each critical risk area is reported to and reviewed by senior management and the board of directors.

(A) a risk management process, such as an ORSA Summary Report pursuant to Title 31A, Chapter 16a, Risk Management and Own Risk and Solvency Assessment Act;

(B) an actuarial function;

(D) a reinsurance decision-making process;

(E) a business strategy or finance decision-making process;

(F) a compliance function;

(G) a financial report or internal audit; and

(H) a market conduct decision-making process.

History

KEY: corporate governance disclosure
Date of Last Change: May 9, 2023
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-16b-104

Utah Admin. Code R590-284-6 Severability

If any provision of this rule, R590-284, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: corporate governance disclosure
Date of Last Change: May 9, 2023
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-16b-104

R590-286 Minimum Standards for Short-Term Limited Duration Health Insurance

Utah Admin. Code R590-286-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-201.1, 31A-22-605, and 31A-22- 605.1.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) standardize and simplify the terms of coverage of a short-term limited duration health insurance contract;

(b) facilitate public understanding and comparison of coverage;

(c) prohibit use of a provision that is misleading or confusing in connection with the purchase of coverage or the settlement of a claim;

(d) set minimum coverage requirements;

(e) establish requirements for a producer that offers a short-term limited duration health insurance policy; and

(f) provide for full disclosure in the sale of insurance.

(2) This rule applies to a short-term limited duration health insurance contract.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-3 Definitions

Terms used in this rule are defined in Section 31A-1-301 and 31A-22-625. Additional terms are defined as follows:

(1) "Certificate" means a short-term limited duration health insurance certificate.

(2) "Complication of pregnancy" means a disease or condition that is distinct from pregnancy but is adversely affected or caused by pregnancy and is not associated with a normal pregnancy.

(a) "Complication of pregnancy" includes:

(i) acute nephritis;

(ii) nephrosis;

(iii) cardiac decompensation;

(iv) ectopic pregnancy;

(v) spontaneous termination of pregnancy when a viable birth is not possible;

(vi) puerperal infection;

(vii) eclampsia;

(viii) pre-eclampsia; and

(ix) toxemia.

(b) "Complication of pregnancy" does not include:

(i) false labor;

(ii) occasional spotting;

(iii) doctor prescribed rest during pregnancy;

(iv) morning sickness; or

(v) a condition of comparable severity associated with management of a difficult pregnancy.

(3) "Contract" means a short-term limited duration health insurance policy or certificate.

(4) "Cosmetic surgery" or "reconstructive surgery" means a surgical procedure performed primarily to improve physical appearance.

(a) "Cosmetic surgery" or "reconstructive surgery" does not include surgery that is necessary:

(i) to correct damage caused by injury or sickness;

(ii) for reconstructive treatment following medically necessary surgery;

(iii) to provide or restore a normal bodily function; or

(iv) to correct a congenital disorder that has resulted in a functional defect.

(b) "Cosmetic surgery" or "reconstructive surgery" does not require coverage for a preexisting condition that is otherwise excluded.

(5) "Custodial care" means a plan of care that does not provide treatment for sickness or injury, is for meeting personal needs and maintaining physical condition when there is no prospect of remission or restoration of the patient to a condition when care would not be required, and that may be provided by a person without nursing skills or qualifications.

(6) "Elimination period" or "waiting period" means the length of time an insured shall wait before benefits are paid under the contract.

(7) "Enrollment form" means an application as defined in Section 31A-1-301.

(9) "Hospital" means a facility that is licensed and operating within the scope of that license.

(10)(a) "Injury" means a bodily injury resulting from an accident, independent of disease, that occurs while the coverage is in force.

(b) "Injury" is not limited to an injury with external, violent, visible wounds, or similar words of characterization or description.

(11)(a) "Medical necessity" means a health care service or product that a prudent health care provider would provide to a patient to prevent, diagnose, or treat an illness, injury, disease, or its symptoms in a manner that is:

(i) in accordance with generally accepted standards of medical practice in the United States;

(ii) clinically appropriate in terms of type, frequency, extent, site, and duration;

(iii) not primarily for the convenience of the patient, physician, or other health care provider; and

(iv) covered under the contract.

(c)(i) For an intervention not yet in widespread use, the effectiveness shall be based on scientific evidence.

(ii) For an established intervention, the effectiveness shall be based on:

(A) scientific evidence;

(B) professional standards; and

(12) "Policy" means a short-term limited duration health insurance policy.

(13) "Preexisting condition" means:

(a) the existence of a symptom or a condition that would cause an ordinarily prudent person to seek diagnosis, care, or treatment within the 24-month period before the effective date of coverage of the insured; or

(b) a condition for which medical advice or treatment was recommended or received from a health care provider within a 12-month period before the effective date of the coverage of the insured person.

(14)(a) "Scientific evidence" means:

(ii) a finding, study, or research conducted by or under the auspices of a federal government agency or nationally recognized federal research institute.

(b) "Scientific evidence" does not include:

(i) published peer-reviewed literature sponsored by:

(A) a pharmaceutical manufacturing company; or

(B) a medical device manufacturer; or

(ii) a single study without other supportable studies.

(15) "Sickness" means illness, disease, or disorder of an insured person.

(16) "Usual and customary" means the most common charge for a similar service, medicine, or supply within the area in which a charge is incurred, considering one or more of the following factors:

(a) the level of skill, extent of training, and experience required to perform the procedure or service;

(b) the length of time required to perform the procedure or service as compared to the length of time required to perform a similar service;

(d) the amount charged for the same or comparable service, medicine, or supply in the geographical area or in other parts of the country;

(e) the cost to the provider of providing the service, medicine, or supply; or

(f) another factor determined by the insurer to be appropriate.

(17) "Waiting period" means "elimination period."

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-4 Prohibited Provisions

(1) For the entire term of the contract, including any renewal or re-issuance, coverage may not exclude a loss due to a preexisting condition for a period greater than 12 months following the initial issuance of the contract.

(2) Unless otherwise required by law, a contract may not limit or exclude coverage or benefits by type of illness, injury, treatment, or medical condition, except:

(a) abortion;

(b) acupuncture and acupressure;

(c) administrative charges for completing an insurance form, duplication service, interest, finance charge, or other administrative charge, unless otherwise required by law;

(d) administrative exam or service;

(e) applied behavioral analysis therapy;

(f) aviation, to a non-fare-paying passenger;

(g) axillary hyperhidrosis;

(h) benefits paid for under:

(i) employer's liability or occupational disease law;

(ii) Medicare or another governmental program, except Medicaid; or

(iii) state or federal workers' compensation;

(i) charge for a missed appointment;

(j) chiropractic care;

(k) complementary or alternative medicine;

(l) corrective lens, including an examination for prescription or fitting, except lens implant following cataract surgery;

(m) cosmetic surgery including reversal, revision, repair, complication, or treatment related to a non-covered cosmetic surgery, except reconstructive surgery:

(i) when the service is incidental to or follows surgery resulting from trauma, infection, or other disease of the involved part; or

(ii) due to a congenital disease or anomaly of a covered dependent child that resulted in a functional defect;

(n) custodial care;

(o) dental care or treatment;

(p) dietary products, except as required under Rule R590-194;

(q) educational and nutritional training, except as required under Rule R590-200;

(r) experimental or investigational service;

(s) expenses before coverage begins or after coverage ends;

(t) felony, riot, or insurrection, when it is determined the enrollee was a voluntary participant;

(u) fitness training, exercise equipment, or membership fee to a spa or health club;

(v)(i) foot care for a corn, a callus, a flat foot, a fallen arch, a weak foot, chronic foot strain, or symptomatic complaints of a foot, including an orthotic; and

(w)(i) gastric or intestinal bypass service, including lap banding, gastric stapling, or a similar procedure to facilitate weight loss;

(ii) the reversal or revision of a procedure in Subsection (2)(w)(i); or

(iii) a service required for the treatment of a complication from a procedure in Subsection (2)(w)(i);

(x) gene therapy;

(y) genetic testing;

(z) hearing aid, including examination for the prescription or fitting;

(aa) infertility services;

(bb) injury as a result of a motor vehicle, to the extent the covered person is required to have no-fault coverage, up to the minimum coverage required by law whether or not coverage is in effect;

(cc) mental health condition or substance use disorder services;

(dd) nuclear release;

(ee) preexisting condition, except:

(i) as required under Sections 31A-22-605.1 and R590-286-5, and Subsection 31A-22-610(2); and

(ii) for coverage of a congenital anomaly as required under Section 31A-22-610;

(ff) pregnancy, except for a complication of pregnancy;

(gg) refractive eye surgery;

(hh) rehabilitation or habilitative therapy services, such as physical, speech, and occupational, except as required to correct an impairment caused by a covered injury or illness;

(ii) respite care;

(jj) rest cure;

(kk) services while in the armed forces or an auxiliary unit;

(ll) services performed by an enrollee's parent, spouse, sibling, or child, including a step or in-law relationship;

(mm) services performed by an employee of a hospital, laboratory, or other institution;

(nn) services that are not medically necessary;

(oo) services for which no charge is normally made in the absence of insurance;

(pp) sexual dysfunction procedure, equipment, or drug;

(qq) shipping or handling, except as required by law;

(rr) telephone or electronic consultation;

(ss) territorial limitation outside the United States, except as required under Section 31A-22-627;

(tt) terrorism, including an act of terrorism;

(uu) transplant;

(vv) transportation, except medically necessary ambulance services;

(ww) war or act of war, whether declared or undeclared;

(xx) except as provided in Subsection (2)(yy), a loss directly related to an enrollee's voluntary participation in an activity when the enrollee:

(i) is found guilty of an illegal activity in a criminal proceeding, including a plea of guilty, a no contest plea, and a plea in abeyance; or

(ii) is found liable for the activity in a civil proceeding;

(yy) a loss established under Subsection (3)(a) that is directly related to the enrollee violating:

(i) Section 41-6a-502, if the loss occurred in Utah; or

(zz) any other exclusion that, in the opinion of the commissioner, is not inequitable, misleading, deceptive, obscure, unjust, unfair, or unfairly discriminatory to an enrollee.

(3)(a) A violation of Subsection R590-286-4(2)(yy) shall be established:

(i) in a criminal proceeding in which the enrollee is found guilty, enters a no contest plea or a plea in abeyance, or enters into a diversion agreement; or

(ii) by a request for an independent review when the findings support a decision to deny coverage based on the exclusion.

(b)(i) For purposes of Subsection (3)(a)(ii), an independent review means a process that:

(A) is conducted by an independent entity designated by the insurer;

(B) renders an independent and impartial decision on a decision to deny coverage based on the exclusion; and

(ii) The independent review entity may not have a material professional, familial, or financial conflict of interest with:

(A) the insurer;

(B) an officer, director, or management employee of the insurer;

(D) the enrollee's health care provider;

(E) the health care provider's medical group or independent practice association; or

(F) a health care facility where services were provided.

(5) A contract provision precluded in this section may not be construed as a limitation on the commissioner's authority to prohibit a contract provision that the commissioner finds is unjust, unfair, or unfairly discriminatory to an enrollee.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-5 General Requirements and Required Provisions

(1) A contract may not include a definition regarding a matter defined in Section R590-286-3 unless the definition complies with that section.

(2)(a) A contract shall include:

(i) an expiration provision that specifies the condition for renewal or extension; and

(ii) the total number of months or days for the full term of the contract under Subsection (1)(c).

(b) The provision shall be appropriately captioned and appear on the first page of the contract.

(3) A contract that provides coverage to a spouse of the contract holder:

(b) shall provide that in the event of the contract holder's death, the spouse shall become the contract holder.

(4)(a) An application or enrollment form question regarding a health condition may not be vague and shall reference a reasonable time frame in relation to the health condition.

(b)(i) A completed enrollment form shall be made part of the policy.

(ii) A copy of the completed application or enrollment form shall be provided to the applicant or enrollee before or upon delivery of the contract.

(i) on the first page of the contract, or attached to it, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the contract, the following prominent disclosure statement, "Short-Term Limited Duration Health Insurance provides limited benefits. The (policy)(certificate), either by itself or bundled with other limited benefit products, is not meant to replace comprehensive health care insurance. It does not include benefits required by PPACA. Review your (policy)(certificate) carefully.";

(ii) a statement regarding any preexisting waiting period as required by Subsection 31A-22-605.1(5)(b); and

(iii) a question regarding whether the contract to be issued is intended to replace any other accident and health insurance presently in force.

(d) A supplementary application or other form signed by the applicant containing the question in Subsection (4)(c)(iii) may be used.

(5)(a) Except for an endorsement by which the insurer effectuates a written request by the policyholder, signed acceptance by the policyholder is required for an endorsement that reduces or eliminates a benefit or coverage and is added to a policy after the date of issue.

(b) After the date of policy issue, an endorsement that increases a benefit or coverage with a concurrent increase in premium during the policy term shall be agreed to in writing and signed by the policyholder, except if the increased benefit or coverage is required by law.

(6) When a separate additional premium is charged for a benefit provided in connection with an endorsement, the premium charge shall be set forth in the policy and certificate.

(7) A contract that provides for the payment of a benefit based on a standard described as usual and customary, reasonable and customary, or similar words, shall include a definition and explanation of the term in its accompanying outline of coverage or certificate.

(8)(a) If a policy or certificate includes a limitation regarding preexisting conditions, the limitation shall appear as a separate paragraph and be labeled as "Preexisting Condition Limitation."

(b) The limitation shall include a description of the existence and term of the preexisting condition exclusion, including the maximum preexisting exclusion period.

(9) A short-term limited duration health insurance policy or certificate shall include, on the first page of the policy or certificate, or attached to it, in either contrasting color or boldface type at least equal to the font size used for headings or captions of sections in the policy or certificate, the following prominent disclosure statement, "Notice to Buyer: This coverage is not required to comply with certain federal market requirements for comprehensive health insurance, principally those contained in the Affordable Care Act. Be sure to read your (policy)(certificate) carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits, such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services. Your (policy)(certificate) might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage."

(10) Termination of a policy shall be without prejudice to any continuous loss or deterioration of health that commenced while the policy or certificate was in force, limited to the duration of the benefit period or payment of the maximum benefits.

(11) A contract may not be offered:

(a) to an employer group as directed by:

(i) Part A of Title XXVII of the Public Health Services Act;

(ii) Part 7 of ERISA; or

(iii) Chapter 100 of the Internal Revenue Code; or

(b) as a blanket insurance policy.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-6 Minimum Benefit Standards

(1)(a) A short-term limited duration health insurance contract shall specify that the initial term is less than 12 months.

(b) The maximum duration, including any extensions, has an expiration date that is not more than 36 months after the first issuance of the policy or certificate.

(2) A contract shall provide medical coverage that includes, at a minimum, the following benefits:

(a) hospital, surgical, and medical expense coverage, to an aggregate maximum of not less than:

(i) $1,000,000; and

(ii) copayment or coinsurance not to exceed 50% of covered charges;

(b) hospital services, including:

(i) inpatient services; and

(ii) other miscellaneous services associated with admission to a hospital for diagnosis and treatment of a covered condition, including medically necessary services delivered in a hospital setting, including:

(A) professional services;

(B) anesthesia;

(D) supplies;

(E) imaging;

(F) laboratory;

(G) pharmacy services and prescription drugs;

(H) treatments;

(I) therapy; and

(J) other services delivered on an inpatient basis;

(c) outpatient services, including medically necessary services ordered by the enrollee's attending health care practitioner and provided on an ambulatory basis for the diagnosis and treatment of a covered condition, including:

(i) office and clinic visits;

(ii) diagnostic imaging;

(iii) laboratory services;

(iv) radiation therapy;

(v) physical therapy;

(vi) speech therapy;

(vii) occupational therapy; and

(viii) hemodialysis;

(d) surgical services for the diagnosis and treatment of a covered condition, which must include:

(i) inpatient and outpatient surgical services at a hospital, ambulatory surgical facility, surgical suite, or a provider's office; and

(ii) medically necessary services related to a surgical service delivered in a hospital, ambulatory surgical facility, surgical suite, or a provider's office, including:

(A) a professional service;

(B) anesthesiology;

(D) a supply;

(E) laboratory; and

(F) a pharmaceutical service or prescription drug related to, or required as a result of, the surgical procedure; and

(e) a medical service for the diagnosis and treatment of a covered condition, including:

(i) an office visit;

(ii) a benefit for inborn metabolic errors as required under Section 31A-22-623 and Rule R590-194;

(iii) a benefit for diabetes as required under Section 31A-22-626 and Rule R590-220; and

(iv) telehealth services and telemedicine services as appropriate.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-7 Outline of Coverage and Disclosure Requirements

(1) An insurer shall deliver to an applicant the Short-Term Limited Duration Health Insurance Disclosure at the time of application.

(2) The outline of coverage in Table 1 shall be issued with a contract.

TABLE 1

Short-Term Limited Duration Outline of Coverage

(COMPANY NAME)

SHORT-TERM LIMITED DURATION HEALTH INSURANCE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS ARE SUPPLEMENTAL AND ARE NOT INENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Short-term limited duration health insurance coverage is designed to provide, to persons insured, limited or supplemental coverage.

A brief specific description of the benefits, including dollar amounts.

A description of any provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(3) A policy delivered to a person eligible for Medicare by reason of age shall include the following language printed on or attached to the first page of the outline of coverage, "THIS IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for Medicare, review the Guide to Health Insurance for People With Medicare available from the company."

(4) An application for short-term limited duration health insurance shall include a statement by the applicant attesting and acknowledging the following:

(a) the insured has received the Short-Term Limited Duration Health Insurance Disclosure;

(b) coverage does not meet minimum essential coverage;

(d) exclusions or limitations, including a preexisting condition exclusion or limitation, may apply;

(e) lifetime dollar limits may apply; and

(f) annual dollar limits may apply.

(5) An insurer shall, upon request from the commissioner, file for use a copy of any short-term limited duration health insurance advertisement intended for written, radio, electronic, or television use in this state.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

Utah Admin. Code R590-286-8 Severability

If any provision of this rule, Rule R590-286, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, health, short-term limited duration
Date of Last Change: March 24, 2025
Notice of Continuation: March 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22- 605.1(1); 31A-45-103

R590-287 Manufacturer Data Reporting

Utah Admin. Code R590-287-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-48-103.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-2 Purpose and Scope

(1) The purpose of this rule is to establish the:

(a) method for reporting information, and

(b) information required to promote comparability of the information reported to the department.

(2) This rule applies to a manufacturer.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-48-102. Additional terms are defined as follows:

(1) "Drug product" means the finished dosage form of a drug that contains a drug substance, in association with other active or inactive ingredients, and that has a unique NDC.

(2) "FDA" means the United States Food and Drug Administration.

(3) "National Drug Code" or "NDC" means a three-segment code maintained by the FDA that is converted to an 11- digit format and includes a:

(a) labeler code;

(b) product code; and

(4) "WAC" means wholesale acquisition cost.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-4 Manufacturer Reporting and Submission

(1) For each drug product that experiences a wholesale acquisition cost increase, a manufacturer shall submit the following information to the department:

(a) WAC history;

(b) approval history; and

(2) The reported information shall comply with the instructions provided by the Utah Insurance Department Pharmacy Web Portal User Guide available at https://insurance.utah.gov/consumer/other/pharmacy.

(3) The information required under this rule and Subsection 31A-48-103(1) shall be submitted electronically at https://pharma.utah.gov/.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-5 WAC History

The reported WAC history shall include the following information:

(1) the name of the manufacturer;

(2) the drug product's NDC;

(3) a description of the drug product that includes the;

(a) name;

(b) strength;

(d) package size;

(4) the FDA classification of the drug product as brand or generic;

(5) the effective date of the WAC increase for the drug product;

(6) the amount of the WAC increase for the drug product;

(7) the WAC resulting from the reported cost increase for the drug product;

(8) the WAC one calendar year prior to the effective date of the reported cost increase of the drug product;

(9) the WAC two calendar years prior to the effective date of the reported cost increase of the drug product;

(10) a written description, suitable for public release, of the factors that led to the increase in the WAC of the drug product and the significance of each factor; and

(11) the manufacturer's aggregate company-wide research and development costs for the most recent year for which final audit data is available.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-6 Approval History

The reported approval history shall include the following information for a manufacturer's drug that was approved by the FDA during the three calendar years prior to the effective date of the reported cost increase for the drug product reported in Section R590-287-5:

(1) the name of the drug; and

(2) the date when the drug was approved by the FDA.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-7 Patent History

The reported patent history shall include the following information for a manufacturer's drug that lost patent exclusivity in the United States during the three calendar years prior to the effective date of the reported cost increase for the drug product reported in Section R590-287-5:

(1) the name of the drug; and

(2) the date when the patent expired.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

Utah Admin. Code R590-287-8 Severability

If any provision of this rule, R590-287, or its application to any person or situation is held to be invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: data, data reporting, insurance, pharmacy manufacturer
Date of Last Change: May 11, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-48-103

R590-288 Limited Line Producer Line of Authority for Pet Insurance

Utah Admin. Code R590-288-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-23a-106.

History

KEY: insurance
Date of Last Change: July 8, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-106

Utah Admin. Code R590-288-2 Purpose and Scope

(1) The purpose of this rule is to recognize a limited line producer line of authority for pet insurance.

(2) This rule applies to a person holding a producer license for a line of authority under Subsection 31A-23a-106(2)(a).

History

KEY: insurance
Date of Last Change: July 8, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-106

Utah Admin. Code R590-288-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Other terms are defined as follows:

(1) "Pet insurance" means a property insurance policy that provides coverage for an accident or illness of a pet.

History

KEY: insurance
Date of Last Change: July 8, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-106

Utah Admin. Code R590-288-4 Limited Line Producer Line of Authority for Pet Insurance

(1) The commissioner recognizes a limited line producer line of authority for pet insurance.

(2) A person holding a property insurance producer license for a line of authority under Subsection 31A-23a- 106(2)(a)(iv) may offer pet insurance without any additional license requirements.

(3) A person holding a producer license for a line of authority under Subsections 31A-23a-106(2)(a)(i) through 31A- 23a-106(2)(a)(iii) or 31A-23a-106(2)(a)(v) through 31A-23a-106(2)(a)(vii) may apply for a pet insurance limited line producer license.

(4) A person holding a limited line producer license for pet insurance is not required to complete continuing education regarding pet insurance.

History

KEY: insurance
Date of Last Change: July 8, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-106

Utah Admin. Code R590-288-5 Severability

If any provision of this rule, Rule R590-288, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance
Date of Last Change: July 8, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-106

R590-289 Term and Universal Life Insurance Reserve Financing

Utah Admin. Code R590-289-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-17-404.3.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

Utah Admin. Code R590-289-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish among NAIC members uniform standards governing reserve financing arrangements that pertain to:

(i) a life insurance policy containing guaranteed nonlevel gross premiums;

(ii) a life insurance policy containing guaranteed nonlevel benefits; and

(iii) a universal life insurance policy with secondary guarantees; and

(b) ensure that, with respect to each such financing arrangement, funds consisting of primary security and other security, as defined in this rule, are held by or on behalf of each ceding insurer in the forms and amounts required in this rule.

(2) This rule applies to a reinsurance treaty that cedes liabilities pertaining to a covered policy, as that term is defined in this rule, issued by any life insurance company domiciled in this state.

(3) In the event of a conflict between this rule and Rule R590-173, this rule applies to the extent of the conflict.

(4) This rule does not apply to a transaction described in this subsection.

(a) Reinsurance of:

(i) a policy that satisfies the criteria for exemption set forth in Sections R590-198-6.F and R590-198-6.G and is issued before the later of:

(A) the effective date of this rule; or

(B) the date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;

(ii) a portion of a policy that satisfies the criteria for exemption set forth in Section R590-198-6.E and is issued before the later of:

(A) the effective date of this rule; or

(B) the date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;

(iii) a universal life policy that meets the following requirements:

(A) the secondary guarantee period, if any, is five years or less;

(B) the specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the Commissioners Standard Ordinary (CSO) valuation tables and valuation interest rate applicable to the issue year of the policy; and

(C) the initial surrender charge is not less than 100% of the first year annualized specified premium for the secondary guarantee period;

(iv) a credit life insurance policy;

(v) a variable life insurance policy where the amount of insurance or duration of coverage varies according to the investment experience of a separate account; or

(vi) a group life insurance certificate, unless the certificate provides for a stated or implied schedule of maximum gross premiums required to continue coverage in force for a period in excess of one year.

(b) Reinsurance ceded to an assuming insurer that meets the applicable requirements of Subsection 31A-17-404(6).

(i) meets the applicable requirements of Subsections 31A-17-404(3), 31A-17-404(4), and 31A-17-404(5);

(ii) prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual, without any departures from NAIC statutory accounting practices and procedures pertaining to the admissibility or valuation of assets or liabilities that increase the assuming insurer's reported surplus and are material enough that they need to be disclosed in the financial statement of the assuming insurer pursuant to Statement of Statutory Accounting Principles No. 1 ("SSAP 1"); and

(iii) is not in a Company Action Level Event, Regulatory Action Level Event, Authorized Control Level Event, or Mandatory Control Level Event as those terms are defined in Title 31A, Chapter 17, Part 6, Risk-Based Capital, when its risk- based capital, (RBC) is calculated in accordance with the life risk-based capital report including overview and instructions for companies, which may be amended by the NAIC from time to time, without deviation.

(d) Reinsurance ceded to an assuming insurer that:

(i) meets the applicable requirements of Section 31A-17-404;

(ii) is not an affiliate, as that term is defined in Section 31A-1-301, of:

(A) the insurer ceding the business to the assuming insurer; or

(B) an insurer that directly or indirectly ceded the business to that ceding insurer;

(iii) prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual;

(iv) is both:

(A) licensed or accredited in at least ten states including its state of domicile; and

(B) not licensed in any state as a captive, special purpose vehicle, special purpose financial captive, special purpose life reinsurance company, limited purpose subsidiary, or any other similar licensing regime; and

(v) is not, or would not be, below 500% of the Authorized Control Level RBC as that term is defined in Title 31A, Chapter 17, Part 6, Risk-Based Capital, when its RBC is calculated in accordance with the life risk-based capital report including overview and instructions for companies, which may be amended by the NAIC from time to time, without deviation, and without recognition of any departures from NAIC statutory accounting practices and procedures pertaining to the admission or valuation of assets or liabilities that increase the assuming insurer's reported surplus.

(e) Reinsurance ceded to an assuming insurer that meets the requirements of Subsection 31A-17-404.3(5).

(f) Reinsurance not otherwise exempt under Subsections (4)(a) through (4)(e) if the commissioner, after consulting with the NAIC Financial Analysis Working Group or other group of regulators designated by the NAIC, as applicable, determines under all the facts and circumstances that the following apply:

(i) the risks are clearly outside of the intent and purpose of this rule;

(ii) the risks are included within the scope of this rule only as a technicality; and

(iii) the application of this rule to those risks is not necessary to provide appropriate protection to policyholders.

(5) A decision to exempt a reinsurance treaty under Subsection (4)(f) shall be written and shall include the general basis for the decision and a summary description of the treaty.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

Utah Admin. Code R590-289-3 Definitions

Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:

(1) "Actuarial method" means the methodology used to determine the required level of primary security.

(2) "Covered policy" means a policy, other than a grandfathered policy, that is:

(a) a life insurance policy with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits, except for flexible premium universal a life insurance policy; or

(b) a flexible premium universal life insurance policy with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period.

(3) "Grandfathered policy" means a covered policy that was:

(a) issued before January 1, 2015; and

(b) ceded, as of December 31, 2014, as part of a reinsurance treaty that would not have met one of the exemptions set forth in Subsection R590-289-2(4) had that section then been in effect.

(4) "Non-covered policy" means a policy that does not meet the definition of a covered policy, including a grandfathered policy.

(5) "Other security" means security acceptable to the commissioner other than security meeting the definition of primary security.

(6) "Primary security" means:

(a) cash;

(b) security meeting the requirements of Subsection 31A-17-404.1(2)(b), but excluding:

(i) a synthetic letter of credit, contingent note, credit-linked note, or other similar security that operates in a manner similar to a letter of credit; and

(ii) security issued by the ceding insurer or its affiliate; and

(i) a commercial loan in good standing of CM3 quality or higher;

(ii) a policy loan; or

(iii) a derivative acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policy ceded pursuant to the reinsurance treaty.

(7) "Required level of primary security" means the dollar amount determined by applying the actuarial method to the risks ceded with respect to a covered policy, but not more than the total reserve ceded.

(8) "Valuation manual" means the valuation manual adopted by the NAIC as described in Subsection 31A-17- 514(2)(a).

(9) "VM-20" means "Requirements for Principle-Based Reserves for Life Products," including all relevant definitions, from the Valuation Manual.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

Utah Admin. Code R590-289-4 The Actuarial Method

(1) The actuarial method to establish the required level of primary security for each reinsurance treaty subject to this rule shall be VM-20, applied on a treaty-by-treaty basis, including all relevant definitions, from the valuation manual as then in effect, applied as follows:

(a)(i) For a covered policy described in Subsection R590-289-3(2)(a), the actuarial method is the greater of the deterministic reserve or the net premium reserve (NPR) regardless of whether the criteria for exemption testing can be met.

(ii) If a covered policy does not meet the requirements of the stochastic reserve exclusion test in the valuation manual, then the actuarial method is the greatest of the deterministic reserve, the stochastic reserve, or the NPR.

(iii) If a covered policy is reinsured in a reinsurance treaty that also contains a covered policy described in Subsection R590-289-4(2)(b), the ceding insurer may elect to instead use Subsection (1)(b) as the actuarial method for the entire reinsurance agreement.

(iv) Regardless of whether the actuarial method described in Subsection (1)(a) or (1)(b) is used, the actuarial method must comply with any requirement or restriction that the valuation manual imposes when aggregating these policy types for purposes of principle-based reserve calculations.

(b) For a covered policy described in Subsection R590-289-3(2)(b), the actuarial method is the greatest of the deterministic reserve, the stochastic reserve, or the NPR regardless of whether the criteria for exemption testing can be met.

(c) Except as provided in Subsection (1)(d), the actuarial method is to be applied on a gross basis to all risks with respect to the covered policy as originally issued or assumed by the ceding insurer.

(d) If the reinsurance treaty cedes less than 100% of the risk with respect to a covered policy, then the required level of primary security may be reduced as follows:

(i) if a reinsurance treaty cedes only a quota share of some or all of the risks pertaining to a covered policy, the required level of primary security, as well as any adjustment under Subsection (1)(d)(iii), may be reduced to a pro rata portion in accordance with the percentage of the risk ceded;

(ii) if the reinsurance treaty in a non-exempt arrangement cedes only the risks pertaining to a secondary guarantee, the required level of primary security may be reduced by an amount determined by applying the actuarial method on a gross basis to all risks, other than risks related to the secondary guarantee, pertaining to the covered policies, except that for covered policies for which the ceding insurer did not elect to apply the provisions of VM-20 to establish statutory reserves, the required level of primary security may be reduced by the statutory reserve retained by the ceding insurer on those covered policies, where the retained reserve of those covered policies should be reflective of any reduction pursuant to the cession of mortality risk on a yearly renewable term basis in an exempt arrangement;

(iii) if a portion of the covered policy risk is ceded to another reinsurer on a yearly renewable term basis in an exempt arrangement, the required level of primary security may be reduced by the amount resulting by applying the actuarial method including the reinsurance section of VM-20 to the portion of the covered policy risks ceded in the exempt arrangement, except that for a covered policy issued before January 1, 2017, this adjustment is not to exceed the formula:

(A) cx / (2 * number of reinsurance premiums per year)

(B) where cx is:

(I) the cost of life insurance for one year for an individual aged x; and

(II) calculated using the same mortality table used in calculating the net premium reserve; and

(iv) for any other treaty ceding a portion of risk to a different reinsurer, including but not limited to stop loss, excess of loss, and other non-proportional reinsurance treaties, there will be no reduction in the required level of primary security.

(v) It is possible for any combination of Subsections (1)(d)(i) through (1)(d)(iv) to apply. Adjustments to the required level of primary security will be done in the sequence that accurately reflects the portion of the risk ceded via the treaty. The ceding insurer should document the rationale and steps taken to accomplish the adjustments to the required level of primary security due to the cession of less than 100% of the risk. The adjustments for other reinsurance will be made only with respect to reinsurance treaties entered into directly by the ceding insurer. The ceding insurer will make no adjustment as a result of a retrocession treaty entered into by the assuming insurers.

(e) In no event will the required level of primary security resulting from application of the actuarial method exceed the amount of statutory reserves ceded.

(f) If the ceding insurer cedes risks with respect to a covered policy, including any riders, in more than one reinsurance treaty subject to this rule, in no event will the aggregate required level of primary security for those reinsurance treaties be less than the required level of primary security calculated using the actuarial method as if all risks ceded in those treaties were ceded in a single treaty subject to this rule.

(g) If a reinsurance treaty subject to this rule cedes risk on both covered and non-covered policies, credit for the ceded reserves shall be determined as follows:

(A)(I) the actuarial method shall be used to determine the required level of primary security for the covered policies; and

(II) Section R590-289-5 shall be used to determine the reinsurance credit for the covered policy reserves; and

(B) credit for the non-covered policy reserves shall be granted only to the extent that security, in addition to the security held to satisfy the requirements of Subsection (1)(a), is held by or on behalf of the ceding insurer in accordance with Sections 31A-17-404 and 31A-17-404.1. Any primary security used to meet the requirements of this subsection may not be used to satisfy the required level of primary security for a covered policy.

(2) In calculating the required level of primary security pursuant to the actuarial method, and in determining the amount of primary security and other security, as applicable, held by or on behalf of the ceding insurer, the following shall apply:

(a) for assets, including assets held in trust that would be admitted under the NAIC Accounting Practices and Procedures Manual if they were held by the ceding insurer, the valuations are to be determined:

(i) according to statutory accounting procedures as if the assets were held in the ceding insurer's general account; and

(ii) without taking into consideration the effect of any prescribed or permitted practices;

(b) for all other assets, the valuations are those assigned to the assets for the purpose of determining the amount of reserve credit taken; and

(c) the asset spread tables and asset default cost tables required by VM-20 shall be included in the actuarial method if adopted by the NAIC's Life Actuarial (A) Task Force no later than the December 31 on or immediately preceding the valuation date for which the required level of primary security is being calculated.

(3) The tables of asset spreads and asset default costs shall be incorporated into the actuarial method in the manner specified in VM-20.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

Utah Admin. Code R590-289-5 Requirements Applicable to a Covered Policy to Obtain Credit for Reinsurance; Opportunity for Remediation

(1) Except as provided in Subsections R590-289-2(4) and R590-289-5(2), credit for reinsurance is allowed with respect to ceded liabilities pertaining to a covered policy if, in addition to all other requirements imposed by law, the following requirements are met on a treaty-by-treaty basis:

(a)(i) the ceding insurer's statutory policy reserves with respect to the covered policy are established in full and in accordance with the applicable requirements of Title 31A, Chapter 17, Part 5, Standard Valuation Law, and related rules and actuarial guidelines; and

(ii) credit claimed for any reinsurance treaty subject to this rule does not exceed the proportionate share of those reserves ceded under the contract;

(b) the ceding insurer determines the required level of primary security with respect to each reinsurance treaty subject to this rule and provides support for its calculation as determined to be acceptable to the commissioner;

(c) funds consisting of primary security, in an amount at least equal to the required level of primary security, are held by or on behalf of the ceding insurer, as security under the reinsurance treaty within the meaning of Section 31A-17-404.1 on a funds withheld, trust, or modified coinsurance basis;

(d) funds consisting of other security, in an amount at least equal to any portion of the statutory reserves as to which primary security is not held pursuant to Subsection (1)(c) are held by or on behalf of the ceding insurer as security under the reinsurance treaty within the meaning of Section 31A-17-404.1;

(e) any trust used to satisfy the requirements of this rule shall comply with all conditions and qualifications of Section R590-173-12, except that:

(i) funds consisting of primary security or other security held in trust will be valued according to the valuation rules set forth in Subsection R590-289-4(2), as applicable;

(ii) there are no affiliate investment limitations with respect to any security held in the trust if the security is not needed to satisfy the requirements of Subsection (1)(c); and

(iii) the reinsurance treaty must prohibit withdrawals or substitutions of trust assets that would leave the fair market value of the primary security within the trust, when aggregated with primary security outside the trust that is held by or on behalf of the ceding insurer in the manner required by Subsection (1)(c), below 102% of the level required by Subsection (1)(c) at the time of the withdrawal or substitution;

(f) the determination of reserve credit under Subsection R590-173-12(4) shall be determined according to the valuation rules set forth in Subsection R590-289-5(2), as applicable; and

(g) the reinsurance treaty has been approved by the commissioner.

(2)(a) The requirements of Subsection (1) must be satisfied as of the date that risks under a covered policy are ceded if such date is on or after the effective date of this rule and on an ongoing basis thereafter.

(b) Under no circumstances will a ceding insurer take or consent to any action or series of actions that would result in a deficiency under Subsection (1)(c) or (1)(d) with respect to any reinsurance treaty under which a covered policy has been ceded, and if a ceding insurer becomes aware at any time that a deficiency exists, it shall use its best efforts to arrange for the deficiency to be eliminated as expeditiously as possible.

(c) Before the due date of each quarterly or annual statement, each life insurance company that has ceded reinsurance within the scope of this rule shall perform an analysis, on a treaty-by-treaty basis, to determine, as to each reinsurance treaty under which a covered policy has been ceded, whether as of the end of the immediately preceding calendar quarter, or valuation date, the requirements of Subsections (1)(c) and (1)(d) were satisfied.

(d) The ceding insurer shall establish a liability equal to the excess of the credit for reinsurance taken over the amount of primary security actually held pursuant to Subsection (1)(c) unless:

(i) the requirements of Subsections (1)(c) and (1)(d) were satisfied as of the valuation date as to such reinsurance treaty; or

(ii) the deficiency has been eliminated before the due date of the quarterly or annual statement to which the valuation date relates through the addition of primary security or other security, as the case may be, in the amount and in the form as would have caused the requirements of Subsections (1)(c) and (1)(d) to be fully satisfied as of the valuation date.

(e) Nothing in Subsection (1)(b) may be construed to allow a ceding company to maintain any deficiency under Subsection (1)(c) or (1)(d) for any period of time longer than is reasonably necessary to eliminate it.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

Utah Admin. Code R590-289-6 Prohibition Against Avoidance

No insurer that has a covered policy to which this rule applies may take any action or series of actions, or enter into any transaction or arrangement, or series of transactions or arrangements, if the purpose of the action, transaction, or arrangement or series is to avoid the requirements or circumvent the intent of this rule.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

Utah Admin. Code R590-289-7 Severability

If any provision of this rule, Rule R590-289, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: life insurance, solvency, credit for reinsurance
Date of Last Change: November 22, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-17-404.3

R590-290 Investment Requirements for Health Maintenance Organizations

Utah Admin. Code R590-290-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-8-103.

History

KEY: insurance, health maintenance organizations, investments
Date of Last Change: August 7, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-8-103

Utah Admin. Code R590-290-2 Purpose and Scope

(1) The purpose of this rule is to set investment requirements for a health maintenance organization.

(2) This rule applies to a health maintenance organization authorized to do business under Title 31A, Insurance Code.

History

KEY: insurance, health maintenance organizations, investments
Date of Last Change: August 7, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-8-103

Utah Admin. Code R590-290-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-8-101.

History

KEY: insurance, health maintenance organizations, investments
Date of Last Change: August 7, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-8-103

Utah Admin. Code R590-290-4 Investment Requirements for a Health Maintenance Organization

A health maintenance organization shall comply with Title 31A, Chapter 18, Investments.

History

KEY: insurance, health maintenance organizations, investments
Date of Last Change: August 7, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-8-103

Utah Admin. Code R590-290-5 Effective Date

The commissioner will begin enforcing this rule on the rule's effective date.

History

KEY: insurance, health maintenance organizations, investments
Date of Last Change: August 7, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-8-103

Utah Admin. Code R590-290-6 Severability

If any provision of this rule, Rule R590-290, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, health maintenance organizations, investments
Date of Last Change: August 7, 2025
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-8-103

R590-291 Use of Fire Hazard Data in Rating and Underwriting

Utah Admin. Code R590-291-1 Authority

This rule is promulgated by the commissioner pursuant to Sections 31A-2-201 and 31A-22-1310.

History

KEY: property and casualty insurance, wildfire
Date of Last Change: February 18, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1310

Utah Admin. Code R590-291-2 Purpose and Scope

(1) The purpose of this rule is to identify the circumstances under which a property and casualty insurer may use fire hazard data other than the wildfire risk assessment mapping tool maintained by the Division of Forestry, Fire, and State Lands.

(2)(a) This rule applies to a property and casualty insurer doing business in Utah.

(b) This rule does not apply to:

(i) an inland marine insurer; or

(ii) a surplus lines insurer.

History

KEY: property and casualty insurance, wildfire
Date of Last Change: February 18, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1310

Utah Admin. Code R590-291-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-22-1310. Additional terms are defined as follows:

(1) "Boundary determination" means the boundary provided in the wildfire risk assessment mapping tool maintained by the Division of Forestry, Fire, and State Lands in accordance with Subsection 65A-8-203(8).

(2) "Insurer" means an insurer that issues property or casualty insurance for property located within the boundary of high risk wildland urban interface as designated by the wildfire risk assessment tool in Subsection 65A-8-203(8)(a) and defined by rule made in accordance with Subsection 65A-8-402(5)(a).

(3) "Mapping tool" means the wildfire risk assessment mapping tool maintained by the Division of Forestry, Fire, and State Lands in accordance with Subsection 65A-8-203(8).

History

KEY: property and casualty insurance, wildfire
Date of Last Change: February 18, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1310

Utah Admin. Code R590-291-4 Use of Fire Hazard Data in Rating and Underwriting

(1) In rating or underwriting high risk wildland urban interface property, an insurer may use fire hazard data other than the boundary determination provided in the mapping tool.

(2) Other fire hazard data may only be used if an insurer objectively demonstrates, in a reasonable manner acceptable to the commissioner, that the data are compliant with the mapping tool.

(3) An insurer shall provide to the commissioner, upon request, evidence and information demonstrating compliance with Subsection (2).

(4) Nothing in this rule affects the requirements of the Utah Rate Regulation Act, Title 31A, Chapter 19a.

History

KEY: property and casualty insurance, wildfire
Date of Last Change: February 18, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1310

Utah Admin. Code R590-291-5 Effective Date

The commissioner will begin enforcing this rule July 1, 2026.

History

KEY: property and casualty insurance, wildfire
Date of Last Change: February 18, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1310

Utah Admin. Code R590-291-6 Severability

If any provision of this rule, R590-291, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule which can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: property and casualty insurance, wildfire
Date of Last Change: February 18, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1310

R592 Title and Escrow Commission

R592-6 Unfair Inducements and Marketing Practices in Obtaining Title Insurance Business

Utah Admin. Code R592-6-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsection 31A-2-404(2).

History

KEY: title insurance
Date of Last Change: June 23, 2026
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-6-2 Purpose and Scope

(1) The purpose of this rule is to identify practices that constitute unfair methods of competition because the practices create unfair inducements for the placement of title insurance business.

(2) This rule applies to any person identified in Subsection 31A-23a-402(2)(a).

History

KEY: title insurance
Date of Last Change: June 23, 2026
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-6-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-2-402. Additional terms are defined as follows:

(1)(a) "Business activities" include sporting events, sporting activities, musical events, art events, and similar activities.

(b) "Business activities" do not include:

(i) awards banquets, recognition events, or similar activities that are sponsored or hosted by or for clients; or

(ii) commercial travel.

(2)(a) "Business meals" include breakfast, brunch, lunch, dinner, cocktails, and tips.

(b) "Business meals" do not include awards banquets, recognition events, or similar activities sponsored by or for clients.

(3)(a) "Client" means any person who influences, or who may influence, the placement of title insurance business or who is engaged in a business, profession, or occupation of:

(i) buying or selling interests in real property; or

(ii) making loans secured by interests in real property.

(b) "Client" may include real estate agents, real estate brokers, mortgage brokers, lending or financial institutions, builders, developers, subdividers, attorneys, consumers, escrow companies, and their employees, agents, representatives, and solicitors.

(4) "Official trade association publication" means:

(a) a membership directory, provided its exclusive purpose is that of providing the distribution of an annual roster of the association's members to the membership and other interested parties; or

(b) an annual, semiannual, quarterly, or monthly publication containing information and topical material for the benefit of the members of the association.

(5) "Title insurance business" means the business of title insurance and the conducting of escrow.

(6) "Title producer" means a title insurer, agency title insurance producer, or individual title insurance producer.

(7) "Trade association" means a recognized association of persons, a majority of whom are clients or persons whose primary activity involves real property.

History

KEY: title insurance
Date of Last Change: June 23, 2026
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-6-4 Prohibited Unfair Methods of Competition

A person identified in Section R592-6-2 who provides or offers to provide, directly or indirectly, any of the following benefits to any client has violated Section 31A-23a-402 and has engaged in an unfair method of competition.

(1) Waiving any charge, premium, or rate for insurance or services otherwise due and payable.

(2) Furnishing services not related to a bona fide title insurance, escrow, settlement, or closing transaction without receiving fair market payment for the services provided.

(3) Paying for, furnishing, or waiving all or any part of the rental or lease charge for space that is occupied by a client.

(4) Renting or leasing space from a client at a rate that is excessive or inadequate when compared with rental or lease charges for comparable space in the same geographic area, or paying rental or lease charges based in whole or in part on the volume of business generated by the client.

(5) Furnishing any part of a title producer's facilities, including conference rooms or meeting rooms, to a client, for anything other than providing escrow or title services, or related meetings, without receiving a fair rental or lease charge comparable to other rental or lease charges for facilities in the same geographic area.

(6) Furnishing all or any part of the time or productive effort of any employee of the title producer, including a secretary, clerk, messenger, or escrow officer, to any client when such time or productive effort is not reasonably related to a bona fide title insurance, escrow, settlement, or closing transaction.

(7) Paying a client or an employee of a client for a referral of business.

(8)(a) Payment or pre-payment of the following:

(i) fees or charges of a professional, including an appraiser, surveyor, engineer, or attorney, whose services are required by any party or client to structure or complete a particular transaction; or

(ii) fees or charges of a client or party to the transaction, for example, subordination, loan, or HOA payoff request fees, that are required by any party or client to structure or complete a particular transaction.

(b) Subsection (8)(a) does not prohibit pre-payment of overnight mail and delivery fees.

(9)(a) Except as provided in Subsection (9)(b), sponsoring, cosponsoring, subsidizing, contributing fees, prizes, gifts, food, or otherwise providing anything of value for an activity of a client including:

(i) an open house at a home or property for sale;

(ii) a meeting;

(iii) a breakfast, luncheon, or dinner;

(iv) a convention;

(v) an installation ceremony;

(vi) a celebration;

(vii) an outing;

(viii) a cocktail party;

(ix) a hospitality room function;

(x) an open house celebration;

(xi) a dance;

(xii) a sporting event of any kind, including a fishing trip, gambling trip, hunting trip or outing, or golf or ski tournament;

(xiii) an artistic performance; or

(xiv) an outing in a recreation or entertainment area.

(b) A title producer may attend an activity of a client if:

(i) there is no additional cost to the title producer, other than the title producer's own entry fee, registration fee, and meals; and

(ii) the fees in Subsection (9)(b)(i) are not greater than those charged to a client or other person attending the function.

(10) Sponsoring a trade association event at a cost that is greater than the sponsorships offered to members of the association, affiliates, vendors, or other participants of the event.

(11) Furnishing or providing the following, even for a cost:

(a) building plans;

(b) construction critical path timelines;

(d) surveys;

(e) appraisals;

(f) credit reports;

(g) mortgage leads for loans;

(h) rental or apartment lists; or

(i) printed labels.

(12)(a) Engaging in the following advertising activity:

(i) paying for any advertising on behalf of a client;

(ii) advertising jointly with a client;

(iii) placing an advertisement in a publication, including an internet web page and its links, that is hosted, published, produced for, or distributed by or on behalf of a client;

(iv) placing an advertisement that fails to comply with Section 31A-23a-402 and Rule R590-130;

(v) placing an advertisement that is in an official trade association publication that does not offer each title producer an equal opportunity to advertise in the publication and at the standard rates other advertisers in the publication are charged;

(vi) advertising with free or paid social media services that are not open and available to the general public; or

(vii) paying a fee to share, like, respond to, comment on, or increase the visibility, ranking, or distribution of any social media involving a client or a client's social media page.

(b) Nothing in Subsection (12)(a) prohibits the following:

(i) advertising independently that the title producer has provided title insurance for a particular subdivision or condominium project, but the title producer may not indicate that all future title insurance will be written by that title producer; or

(ii)(A) writing or posting on social media services about an event that directly involves the title producer and a client; and

(B) referencing or linking to the event on the client's social media page or the client company's social media page.

(13)(a) Holding more than two self-promotional open houses per calendar year for each owned or occupied facility, including branch offices.

(b) Holding a self-promotional open house at a location other than a registered office of the title producer.

(14) Making a donation to a charitable organization controlled or managed by a client.

(15) Distributing to a client, consumer, or member of the general public a self-promotional item that:

(a) has a cost of more than $25;

(b) is edible;

(d) is personalized in the donee's name.

(16) Making an expenditure for a business meal or business activity on behalf of any person, whether a client or not, as a method of advertising if:

(a) the person representing the title producer is not present during the business meal or business activity;

(b) a substantial title insurance business discussion does not occur directly before, during, or after the business meal or business activity;

(d) more than three individuals from an office of a client are provided a business meal or business activity in a single day by an individual title producer; or

(e) the entire business meal or business activity takes place on a client's premises.

(17) Conducting education that:

(a) does not address title insurance, escrow, or a related subject;

(b) involves expenditure of more than $20 per anticipated person including the cost of meals and refreshments;

(d) is conducted at an individual, physical office location of a client more than once per calendar quarter.

(18)(a) Acknowledging a wedding, a birth or adoption of a child, or a funeral of a client or a member of the client's immediate family with flowers or gifts exceeding $150.

(b) Acknowledging any other life event of a client or a member of the client's immediate family with a gift or anything of value.

History

KEY: title insurance
Date of Last Change: June 23, 2026
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-6-5 Severability

If any provision of this rule, Rule R592-6, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: title insurance
Date of Last Change: June 23, 2026
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404

R592-7 Title Insurance Continuing Education

Utah Admin. Code R592-7-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsection 31A-2-404(2)(a)(iii).

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

Utah Admin. Code R592-7-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) adopt continuing education requirements for approving a continuing education course under Subsection 31A-2- 404(2)(a)(iii);

(b) delegate authority from the Commission to the commissioner to approve a continuing education course related to a title licensee; and

(2) This rule applies to:

(a) a title licensee; and

(b) a continuing education provider related to title insurance.

(3) This rule does not apply to an individual who has met the continuing education requirements under Subsection 31A-23a- 202(3)(b)(iii)(C).

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

Utah Admin. Code R592-7-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-2-402, and Rule R590-142. An additional term is defined as follows:.

(1) "Continuing education course" means a continuing education course related to title insurance.

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

Utah Admin. Code R592-7-4 Continuing Education Course and Approval

(1) The Commission delegates to the commissioner the authority to approve a continuing education course under Subsection 31A-2-404(2)(e).

(2) The commissioner shall use the requirements of Rule R590-142, Continuing Education Rule, when considering a request for a continuing education course approval.

(3) When the commissioner approves a continuing education course, the course:

(a) is considered approved by the Commission and has concurrence of the commissioner under Subsection 31A-2-404(2)(e) and Subsection R592-7-4(1); and

(b) is added to the department's approved course list.

(4) The commissioner shall provide a report to the Commission on a quarterly basis listing continuing education courses approved during the prior quarter.

(5) If the commissioner disapproves a continuing education course, the commissioner shall:

(a) remove the course from the department's approved course list; and

(b) notify the course provider of the disapproved course.

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

Utah Admin. Code R592-7-5 Course Submission

A continuing education provider shall submit to the commissioner a request for approval of a continuing education course under Section 31A-23a-202 and Rule R590-142.

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

Utah Admin. Code R592-7-6 Licensee Course Requirements

(1) The continuing education credit hours required for the renewal of a title insurance producer license under Subsections 31A-23a-202(3)(b)(iii)(A) and (B), may be satisfied by completing an approved course that is:

(a) related to title insurance, escrow, real estate, or ethics; and

(b) categorized by the commissioner as:

(i) title;

(ii) title ethics; or

(iii) ethics.

(2) The restrictions under Subsection R590-142-4(2)(c) do not apply to a title licensee.

(3) A title licensee may obtain required credit hours through one or more insurers.

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

Utah Admin. Code R592-7-7 Severability

If any provision of this rule, Rule R592-7, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: title insurance continuing education
Date of Last Change: September 8, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-202

R592-8 Application Process for an Attorney Exemption for Agency Title Insurance Producer Licensing

Utah Admin. Code R592-8-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Sections 31A-2-404 and 31A-23a-204.

History

KEY: attorney exemption application process
Date of Last Change: October 12, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-102; 31A-23a-204

Utah Admin. Code R592-8-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) delegate to the commissioner preliminary approval or denial of a request for an attorney exemption;

(b) provide acceptable real estate experience that may be used by an attorney seeking an exemption;

(d) provide a process to appeal a denial of an attorney exemption.

(2) This rule applies to an attorney seeking an exemption under Section 31A-23a-204.

History

KEY: attorney exemption application process
Date of Last Change: October 12, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-102; 31A-23a-204

Utah Admin. Code R592-8-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-2-402, and 31A-23a-10. Additional terms are defined as follows:

(1) "Attorney" means a person licensed, in good standing, with the Utah State Bar.

(2) "Real estate experience" includes:

(a) law firm transactional experience consisting of any of the following:

(i) real estate transactions, drafting documents, reviewing and negotiating contracts of sale, real estate purchase contracts (REPC), commercial transactions, residential transactions;

(ii) financing and securing construction and permanent financing;

(iii) title review, due diligence, consulting and negotiating with title companies, researching and drafting title opinions, coordinating with title companies, pre-closing;

(iv) zoning, development, construction, homeowners' associations, subdivisions, condominiums, planned unit developments;

(v) conducting closings; and

(vi) estate planning, probate-related transactions and conveyances.

(b) law firm litigation experience consisting of any of the following:

(i) foreclosures;

(A) judicial and non-judicial;

(B) homeowner association (HOA) lien foreclosure;

(ii) homeowner vs. HOA litigation;

(iii) state construction registry litigation, mechanics lien fili ng and litigation;

(iv) real estate disputes or litigation involving:

(A) a real estate contract;

(B) a boundary line;

(D) a zoning issue;

(E) a property tax issue;

(F) a title issue or claim;

(G) an issue between a landlord and a tenant; and

(F) an estate or probate litigation, or both, involving real property assets, claims, and disputes.

(i) real estate agent, broker, developer, investor;

(ii) mortgage broker;

(iii) general contractor;

(iv) professor or instructor teaching real estate licensing, real estate contracts, or real estate law;

(v) lender involved with any of the following real estate lending activities:

(A) lending;

(B) escrow; or

(vi) private lender;

(vii) in-house counsel involved in real estate transactions for bank, mortgage lender, credit union, title company, or agency title insurance producer;

(viii) employment with or counsel to a government agency involved in regulation of real estate, such as HUD, FHA, zoning, tax assessor, county recorder, insurance department, and federal or state legislatures;

(ix) escrow officer;

(x) title searcher; or

(xi) surveyor; and

(d) other experience with real estate not included in Subsections (a), (b), and (c).

History

KEY: attorney exemption application process
Date of Last Change: October 12, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-102; 31A-23a-204

Utah Admin. Code R592-8-4 Delegation of Authority

The Commission hereby grants to the commissioner its preliminary concurrence for approval or denial of an attorney exemption under Section 31A-23a-204.

History

KEY: attorney exemption application process
Date of Last Change: October 12, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-102; 31A-23a-204

Utah Admin. Code R592-8-5 Request for Exemption Process

(1) An individual title licensee, who is an attorney seeking an agency title insurance producer license under Subsection 31A- 23a-204(1)(c), shall submit a letter addressed to the Commission:

(a) requesting an exemption from the licensing time period requirements in Subsection 31A-23a-204(1)(a); and

(b) providing the following information:

(i) the applicant's name, mailing address, email address, telephone number, and title license number;

(ii) a description of the applicant's real estate experience; and

(iii) a statement explaining why the applicant feels the experience qualifies the applicant for the exemption.

(2) The commissioner shall review the request for exemption within five business days of its receipt, and:

(a) request additional information from the applicant, if necessary;

(b) preliminarily approve the request for exemption; or

(3) The commissioner shall report monthly to the Commission any preliminarily approved or denied requests for exemption received and reviewed.

(4) The Commission shall concur or not concur with the commissioner's preliminary approval or denial of a request for exemption.

(5) If the commissioner's preliminary denial of a request for exemption is concurred with by the Commission, the commissioner will:

(a) notify the applicant of the denial; and

(b) inform the applicant of the applicant's right to a hearing.

(6) If the Commission concurs with the commissioner's preliminary approval of a request for exemption, the commissioner will expeditiously notify the applicant to submit an electronic license application and pay any required fee or assessment.

(7) If the Commission does not concur with the commissioner's preliminary approval or preliminary denial, the applicant shall be informed of the applicant's right to a hearing.

History

KEY: attorney exemption application process
Date of Last Change: October 12, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-102; 31A-23a-204

Utah Admin. Code R592-8-6 Severability

If any provision of this rule, Rule R592-8, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: attorney exemption application process
Date of Last Change: October 12, 2021
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-308; 31A-2-402; 31A-2-404; 31A-23a-102; 31A-23a-204

R592-9 Assessment for Title Insurance Recovery, Education, and Research Fund

Utah Admin. Code R592-9-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Sections 31A-2-404 and 31A-41-202.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

Utah Admin. Code R592-9-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) establish the amount for an individual title insurance producer assessment; and

(b) establish the amount for an agency title insurance producer assessment.

(2) This rule applies to:

(a) an agency title insurance producer; and

(b) an individual title insurance producer.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

Utah Admin. Code R592-9-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-41-102.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

Utah Admin. Code R592-9-4 Establishing Assessment Amounts

The Commission adopts the Annual Title Recovery, Education, and Research Fund assessment in the amount annually established by the Utah Legislature under Section 63J-1-504.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

Utah Admin. Code R592-9-5 Individual Title Insurance Producer Assessment

An individual title insurance producer assessment shall be paid in an amount annually established by the Utah Legislature under Section 63J-1-504.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

Utah Admin. Code R592-9-6 Agency Title Insurance Producer Assessment

An agency title insurance producer assessment shall be paid in an amount annually established by the Utah Legislature under Section 63J-1-504.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

Utah Admin. Code R592-9-7 Severability

If any provision of this rule, Rule R592-9, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: title insurance recovery assessment
Date of Last Change: September 10, 2024
Notice of Continuation: June 10, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-308; 31A-41-202

R592-10 Assessment for the Title Licensee Enforcement Restricted Account

Utah Admin. Code R592-10-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsections 31A-2-404(2)(d) and 31A-23a- 415(2)(d).

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-2 Purpose and Scope

(1) The purpose of this rule is to:

(a) determine the assessment on a title insurer and an agency title insurance producer;

(b) establish the costs and expenses covered by the assessment;

(c) require a title insurer and an agency title insurance producer to report the mailing address and physical location of each office in each county where the title insurer or agency title insurance producer maintains an office;

(d) calculate the number of title insurer or agency title insurance producer offices; and

(e) determine the premium year used in calculating the assessment of title insurers.

(2) This rule applies to each title insurer and each agency title insurance producer.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-2-402, and 31A-23a-415. Additional terms are defined as follows:

(1)(a) "Office" means each physical location of a title insurer or an agency title insurance producer in a county.

(b) "Office" includes any physical location that is open and available to the public.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-4 Costs and Expenses

The assessment under Section 31A-23a-415 covers the cost of one full-time equivalent employee, as determined by the department's budget and approved by the Legislature, including:

(1) salary and state paid benefits;

(2) travel expenses, including daily vehicle expenses;

(3) computer hardware and software expenses;

(4) e-commerce expenses;

(5) wireless communications expenses; and

(6) training expenses.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-5 Office Report

(1) A title insurer and an agency title insurance producer shall submit a completed Office Report Form within 30 days after the date a change described in this subsection occurs in a county where the title insurer or agency title insurance producer maintains an office:

(a) the opening or closing of an office; or

(b) a change of address of an office.

(2) An Office Report Form shall be submitted electronically via email to licensing.uid@utah.gov.

(3) The department's Office Report Form is available on the department's website, https://insurance.utah.gov.

(a) A copy of the form may be used or may be adapted to a particular word processing system.

(b) If adapted, the content, size, font, and format must be similar.

(4) All offices reported under Section R592-10-5 are used to calculate the assessment.

(5) An annual assessment calculation for a title insurer or an agency title insurance producer that uses an incorrect number of offices because the number of offices was incorrectly reported will not be recalculated.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-6 Premium Year for Title Insurer Assessment

The title insurance assessment is calculated using direct premium written during the preceding calendar year and shall be taken from the insurer's annual statements for that year.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-7 Assessment Payment

(1) An annual assessment shall be paid by the due date on the invoice.

(2) Payments shall be made in an amount annually established by the Utah Legislature under Section 63J-1-504.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

Utah Admin. Code R592-10-8 Severability

If any provision of this rule, Rule R592-10, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: title insurance
Date of Last Change: September 10, 2024
Notice of Continuation: July 7, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-23a-415

R592-11 Title Insurance Producer Annual Reports

Utah Admin. Code R592-11-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Sections 31A-2-404, 31A-23a-406, and 31A- 23a-413.

History

KEY: title insurance
Date of Last Change: January 22, 2025
Notice of Continuation: June 8, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)(a); 31A-23a-406(1)(g); 31A-23a-413; 31A-23a-503(8)

Utah Admin. Code R592-11-2 Purpose and Scope

(1) The purpose of this rule is to establish the requirements of and a filing deadline for the Title Insurance Producer Annual Report required by Section 31A-23a-413.

(2) This rule applies to an agency title insurance producer.

History

KEY: title insurance
Date of Last Change: January 22, 2025
Notice of Continuation: June 8, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)(a); 31A-23a-406(1)(g); 31A-23a-413; 31A-23a-503(8)

Utah Admin. Code R592-11-3 Title Insurance Producer Annual Report

(1) An agency title insurance producer shall file a Title Insurance Producer Annual Report not later than May 1 of each year.

(2) A Title Insurance Producer Annual Report shall include:

(a) the number and location of each title or escrow trust account;

(b) proof of financial protection under Subsection 31A-23a-204(2)(a);

(c) the name of the individual title insurance producer designated as the "qualifying licensee" under Subsection 31A- 23a-204(1);

(d) the physical address in Utah maintained by an agency title insurance producer;

(e) the physical address of each Utah branch office maintained by an agency title insurance producer;

(f) a verified statement of the agency title insurance producer's financial condition, transactions, and affairs of the preceding two calendar years, including:

(i) a balance sheet;

(ii) a cash flow statement; and

(iii) an income statement; and

(g) a list of all currently contracted underwriters.

History

KEY: title insurance
Date of Last Change: January 22, 2025
Notice of Continuation: June 8, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)(a); 31A-23a-406(1)(g); 31A-23a-413; 31A-23a-503(8)

Utah Admin. Code R592-11-4 Electronic Filing of Title Insurance Producer Annual Report

The Title Insurance Producer Annual Report shall be submitted electronically using the department's secure file upload site located at https://portal.uid.utah.gov/sife.

History

KEY: title insurance
Date of Last Change: January 22, 2025
Notice of Continuation: June 8, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)(a); 31A-23a-406(1)(g); 31A-23a-413; 31A-23a-503(8)

Utah Admin. Code R592-11-5 Severability

If any provision of this rule, Rule R592-11, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: title insurance
Date of Last Change: January 22, 2025
Notice of Continuation: June 8, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)(a); 31A-23a-406(1)(g); 31A-23a-413; 31A-23a-503(8)

R592-14 Unfair or Deceptive Acts or Practices Affecting Title to Real Property

Utah Admin. Code R592-14-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsections 31A-2-404(2) and 31A-23a-406(8).

History

KEY: insurance law
Date of Last Change: January 10, 2022
Notice of Continuation: January 13, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-14-2 Purpose and Scope

(1) The purpose of this rule is to identify a misleading, unfair, or deceptive act or practice affecting title to real property.

(2) This rule applies to a title insurance company, an agency title insurance producer, and an individual title insurance producer.

History

KEY: insurance law
Date of Last Change: January 10, 2022
Notice of Continuation: January 13, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-14-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-2-402. Additional terms are defined as follows:

(1) "Document" means a written instrument that:

(a) relates to real property described in a title insurance policy, contract, or commitment; and

(b) is required to support an insurance provision in a policy.

(2) "Record" means to cause to be delivered to the county recorder, or other appropriate public official, a document in the possession or control of a title insurance company, an agency title insurance producer, and an individual title insurance producer when a request to record has been made by an insured party, a title insurance company, an agency title insurance producer, or an individual title insurance producer.

History

KEY: insurance law
Date of Last Change: January 10, 2022
Notice of Continuation: January 13, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-14-4 Prohibited Acts or Practices Affecting Title to Real Property

A title insurance company, an agency title insurance producer, and an individual title insurance producer are prohibited from engaging in the following unfair or deceptive acts or practices:

(1) knowingly failing to obtain a document for recording or knowingly failing to record a document that results in unmarketable or uninsurable title to real property; or

(2) issuing or agreeing to issue title insurance, or affirming current marketability of title to real property when:

(a) necessary documents for title have not been recorded; and

(b) the record does not manifest an insurable title, according to generally accepted title insurance standards.

History

KEY: insurance law
Date of Last Change: January 10, 2022
Notice of Continuation: January 13, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-404

Utah Admin. Code R592-14-5 Severability

If any provision of this rule, Rule R592-14, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance law
Date of Last Change: January 10, 2022
Notice of Continuation: January 13, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-404

R592-16 Escrow Settlement Closing Transactions

Utah Admin. Code R592-16-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsection 31A-2-404(2).

History

KEY: escrow insurance flip
Date of Last Change: December 23, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-16-2 Purpose and Scope

(1) The purpose of this rule is to identify certain escrow practices involving two or more back-to-back sales and purchases of the same parcel of real property where funds from the final purchaser are received by the initial seller despite having no contractual privity, which the Commission finds may violate Sections 31A-23a-406 and R592-6-4.

(2) This rule applies to:

(a) a title insurance company;

(b) an agency title insurance producer;

(d) an employee, representative, or any other party working for or on behalf of a title insurance company, an agency title insurance producer, or an individual title insurance producer, whether as a full-time or part-time employee or as an independent contractor.

History

KEY: escrow insurance flip
Date of Last Change: December 23, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-16-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-2-402. Additional terms are defined as follows:

(1) "Land flip" means two or more escrows involving real property where the following or similar circumstances exist:

(a) A agrees to sell real property to B;

(b) B then agrees to sell the same real property to C; and

History

KEY: escrow insurance flip
Date of Last Change: December 23, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-16-4 Prohibited Escrow Involving a Land Flip

A title insurance company, an agency title insurance producer, or an individual title insurance producer may not conduct escrow involving a land flip unless:

(1) each real estate transaction stands on its own; and

(2) the funds used in each transaction are separate and distinct from the funds used in a subsequent transaction.

History

KEY: escrow insurance flip
Date of Last Change: December 23, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-16-5 Severability

If any provision of this rule, Rule R592-16, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: escrow insurance flip
Date of Last Change: December 23, 2021
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

R592-17 Requirements for an Interest Bearing Account Used for Trust Fund Deposits

Utah Admin. Code R592-17-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsection 31A-2-404(2).

History

KEY: insurance, title
Date of Last Change: December 23, 2021
Notice of Continuation: February 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-201(1); 31A-23a-409(2)(b)

Utah Admin. Code R592-17-2 Purpose and Scope

(1) The purpose of this rule is to specify the type of depository account that a title insurance company, an agency title insurance producer, or an individual title insurance producer shall use for depositing trust funds.

(2) This rule applies to:

(a) a title insurance company;

(b) an agency title insurance producer;

History

KEY: insurance, title
Date of Last Change: December 23, 2021
Notice of Continuation: February 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-201(1); 31A-23a-409(2)(b)

Utah Admin. Code R592-17-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301, 31A-2-402, and 31A-23a-102. Additional terms are defined as follows:

(1) "Demand deposit account" means a federally insured deposit account from which withdrawals may be made at any time without advance notice.

(2) "Depositor" means a person that deposits, in a qualifying trust account, funds held in trust in connection with a real estate transaction.

(3) "Depository institution" means a depository institution as defined in Section 7-1-103.

(4) "Money market mutual fund" means a mutual fund that:

(a) invests in highly liquid, near-term instruments;

(b) is registered under federal and state securities laws to sell its shares to the public; and

(5) "Repurchase agreement" means an agreement in which a depository institution agrees to sell to a depositor a security or other asset at a specified price with a commitment to repurchase the security or other asset at a later date for a specified price.

(6) "Sweep account" means a demand deposit account subject to an agreement authorizing the depository institution to withdraw funds from the account that exceed a specified amount and deposit those funds into an interest bearing account, purchase specified securities subject to a repurchase agreement, or purchase shares of a mutual fund, then redeposit those funds into the demand deposit account to pay checks presented for payment or other requests for withdrawal.

(7) "Trust account" means an account denominated as a trust account in which the depositor is a trustee.

History

KEY: insurance, title
Date of Last Change: December 23, 2021
Notice of Continuation: February 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-201(1); 31A-23a-409(2)(b)

Utah Admin. Code R592-17-4 Account Requirements

(1) A title insurance company, an agency title insurance producer, and an individual title insurance producer shall retain adequate records of each deposit in a trust account or a sweep account to establish individual account balances for each person whose funds are held in trust.

(2) Funds subject to this rule must be deposited in:

(a) a deposit account insured by the Federal Deposit Insurance Corporation or the National Credit Union Share Insurance Fund or any successor federal deposit insurance; or

(b) a sweep account that meets the following qualifications:

(i) funds are initially deposited into a federally insured demand deposit account;

(ii) the depository institution purchases:

(A) U.S. Government securities held in a segregated account, subject to a repurchase agreement between the depositor and the depository institution; or

(B) shares in a money market mutual fund that only holds obligations of the U.S. Treasury or agencies of the U.S. Government; and

(iii) the depository institution can repurchase the securities or sell or redeem the shares or interest, at any time, at par and deposit the funds in the demand deposit account to maintain a minimum balance and pay withdrawals.

(3) A depositor may only deposit funds into a sweep account if it agrees to reimburse a trust beneficiary for any decline in value below par of the funds deposited, regardless of the cause of the decline in value.

(4) A depositor who uses an account described in Subsection R592-17-4(2)(b) must:

(a) receive written authorization from each trust beneficiary stating that the depositor may receive any earnings that are realized from the trust fund deposit; and

(b) provide full written disclosure to each trust beneficiary explaining the characteristics of a sweep account deposit as described in Subsection R592-17-4(2)(b).

History

KEY: insurance, title
Date of Last Change: December 23, 2021
Notice of Continuation: February 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-201(1); 31A-23a-409(2)(b)

Utah Admin. Code R592-17-5 Severability

If any provision of this rule, Rule R592-17, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, title
Date of Last Change: December 23, 2021
Notice of Continuation: February 9, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-201(1); 31A-23a-409(2)(b)

R592-18 Construction Disbursement Transactions

Utah Admin. Code R592-18-1 Authority

This rule is promulgated by the Title and Escrow Commission pursuant to Subsection 31A-2-404(2).

History

KEY: insurance, title, escrow
Date of Last Change: April 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-18-2 Purpose and Scope

(1) The purpose of this rule is to clarify and implement the statutory prohibition contained in Subsection 31A-23a- 406(2)(h).

(2) This rule applies to:

(a) an individual title insurance producer;

(b) an agency title insurance producer; and

History

KEY: insurance, title, escrow
Date of Last Change: April 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-18-3 Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-2-402.

History

KEY: insurance, title, escrow
Date of Last Change: April 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-18-4 Holding Construction Money and Money Held for Exchange

(1) This section applies to a transaction involving escrow funds for disbursement to a:

(a) borrower under a construction loan;

(b) general contractor;

(d) supplier.

(2) For a transaction described in Subsection (1), an individual title insurance producer or agency title insurance producer may not hold escrow funds for:

(a) a disbursement occurring more than two business days after:

(i) the closing of a real estate transaction in which an owner's or lender's policy of title insurance is issued; or

(ii) the issuance of an endorsement on a lender's policy of title insurance; or

(b) an exchange under Section 1031, Internal Revenue Code, occurring more than two business days after the closing of a real estate transaction in which a policy of title insurance is issued.

History

KEY: insurance, title, escrow
Date of Last Change: April 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-18-5 Effective Date

The commissioner will begin enforcing this rule on the date it becomes effective.

History

KEY: insurance, title, escrow
Date of Last Change: April 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R592-18-6 Severability

If any provision of this rule, Rule R592-18, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.

History

KEY: insurance, title, escrow
Date of Last Change: April 21, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-404(2)

Utah Admin. Code R24 — Insurance

R590 Administration

R590-67 Proxy, Consent, and Authorization of a Domestic Stock Insurer

Utah Admin. Code R590-67-1 Authority

Utah Admin. Code R590-67-2 Purpose and Scope

Utah Admin. Code R590-67-3 Definitions

Utah Admin. Code R590-67-4 Required Schedules

Utah Admin. Code R590-67-5 False or Misleading Statements

Utah Admin. Code R590-67-6 Solicitation

Utah Admin. Code R590-67-7 Information to be Provided to Security Holders

Utah Admin. Code R590-67-8 Proxy Requirements

Utah Admin. Code R590-67-9 Presentation of Information in Proxy Statement

Utah Admin. Code R590-67-10 Material Required to be Filed

Utah Admin. Code R590-67-11 Mailing Communications to Security Holders

Utah Admin. Code R590-67-12 Proposals of Security Holders

Utah Admin. Code R590-67-13 Prohibition of Certain Solicitations

Utah Admin. Code R590-67-14 Special Provisions Applicable to Solicitations

Utah Admin. Code R590-67-15 Severability

R590-68 Insider Trading of Equity Securities of Domestic Stock Insurance Companies

Utah Admin. Code R590-68-1 Authority

Utah Admin. Code R590-68-2 Purpose and Scope

Utah Admin. Code R590-68-3 Definitions

Utah Admin. Code R590-68-4 Securities Held of Record

Utah Admin. Code R590-68-5 Filing Statements

Utah Admin. Code R590-68-6 Ownership of More Than 10% of an Equity Security

Utah Admin. Code R590-68-7 Disclaimer of Beneficial Ownership

Utah Admin. Code R590-68-8 Exemptions from Subsections 31A-5-303(1) and 31A-5-303(2)

Utah Admin. Code R590-68-9 Transactions Exempted from Subsection 31A-5-303(2)

Utah Admin. Code R590-68-10 Exemption From Section 31A-5-303 of Securities Purchased or Sold by Odd-Lot Dealers

Utah Admin. Code R590-68-11 Certain Transactions Subject to Subsection 31A-5-303(1)

Utah Admin. Code R590-68-12 Ownership of Securities Held in Trust

Utah Admin. Code R590-68-13 Exemption for Small Transactions

Utah Admin. Code R590-68-14 Exemption From Subsection 31A-5-303(2) of Transactions That Need Not Be Reported Under Subsection 31A-5-303(1)

Utah Admin. Code R590-68-15 Exemption from Subsection 31A-5-303(2) of Certain Transactions in Connection With a Distribution

Utah Admin. Code R590-68-16 Exemption From Subsection 31A-5-303(2) of Acquisitions of Shares of Stock and Stock Options Under Certain Stock Bonus, Stock Option, or Similar Plans

Utah Admin. Code R590-68-17 Exemption from Subsection 31A-5-303(2) of Certain Transactions in Which Securities Are Received by Redeeming Other Securities

Utah Admin. Code R590-68-18 Exemption of Long-Term Profits Incident to Sales Within Six Months of the Exercise of an Option

Utah Admin. Code R590-68-19 Exemption From Subsection 31A-5-303(2) of Certain Acquisitions and Dispositions of Securities Pursuant to Merger or Consolidation

Utah Admin. Code R590-68-20 Exemption from Subsection 31A-5-303(2) of Certain Transactions Involving the Conversion of Equity Securities

Utah Admin. Code R590-68-21 Exemption from Subsection 31A-5-303(2) of Certain Transactions Involving the Sale of Subscription Rights

Utah Admin. Code R590-68-22 Exemption of Certain Securities From Subsection 31A-5-303(3)

Utah Admin. Code R590-68-23 Exemption From Subsection 31A-5-303(3) of Certain Transactions Effected in Connection With a Distribution

Utah Admin. Code R590-68-24 Exemption From Subsection 31A-5-303(3) of Sales of Securities to Be Acquired

Utah Admin. Code R590-68-25 Arbitrage Transactions Under Subsection 31A-5-303(3)

Utah Admin. Code R590-68-26 Severability

R590-70 Insurance Holding Companies

Utah Admin. Code R590-70-1 Authority

Utah Admin. Code R590-70-2 Purpose and Scope

Utah Admin. Code R590-70-3 Definitions

Utah Admin. Code R590-70-4 Forms -- General Requirements

Utah Admin. Code R590-70-5 Forms -- Incorporation by Reference, Summaries and Omissions

Utah Admin. Code R590-70-6 Forms -- Information Unknown or Unavailable and Extension of Time to Furnish

Utah Admin. Code R590-70-7 Forms -- Additional Information and Exhibits

Utah Admin. Code R590-70-8 Subsidiaries of Domestic Insurers

Utah Admin. Code R590-70-9 Acquisition of Control -- Statement Filing (Form A)

Utah Admin. Code R590-70-10 Amendments to Form A

Utah Admin. Code R590-70-11 Acquisition of Subsection 31A-16-103(1)(f)(i) Insurers

Utah Admin. Code R590-70-12 Pre-acquisition Notification (Form E)

Utah Admin. Code R590-70-13 Annual Registration of Insurers -- Statement Filing (Form B)

Utah Admin. Code R590-70-14 Summary of Registration -- Statement Filing (Form C)

Utah Admin. Code R590-70-15 Amendments to Form B

Utah Admin. Code R590-70-16 Alternative and Consolidated Registrations

Utah Admin. Code R590-70-17 Disclaimers and Termination of Registration

Utah Admin. Code R590-70-18 Transactions Subject to Prior Notice -- Notice Filing

Utah Admin. Code R590-70-19 Enterprise Risk Report

Utah Admin. Code R590-70-20 Extraordinary Dividends and Other Distributions

Utah Admin. Code R590-70-21 Adequacy of Surplus

Utah Admin. Code R590-70-22 Severability

R590-79 Life Insurance Disclosure Rule

Utah Admin. Code R590-79-1 Authority

Utah Admin. Code R590-79-2 Purpose and Scope

Utah Admin. Code R590-79-3 Definitions

Utah Admin. Code R590-79-4 Disclosure Requirements

Utah Admin. Code R590-79-5 General Requirements

Utah Admin. Code R590-79-6 Failure to Comply

Utah Admin. Code R590-79-7 Severability

R590-83 Unfair Discrimination on the Basis of Gender or Marital Status

Utah Admin. Code R590-83-1 Authority

Utah Admin. Code R590-83-2 Purpose and Scope

Utah Admin. Code R590-83-3 Definitions