31A-2-201.2. Evaluation of health insurance market.

384 words·~2 min read·/ut/title-31a/chapter-2/31a-2-201-2

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/1/2024

(a)Each year the commissioner shall:

(i)conduct an evaluation of the state's health insurance market;

(ii)report the findings of the evaluation to the Office of Legislative Research and General Counsel before February 1 of each year; and

(iii)publish the findings of the evaluation on the department website.

(b)After the president of the Senate and the speaker of the House of Representatives appoint members to the Health and Human Services Interim Committee for the year in which the Office of Legislative Research and General Counsel receives a report under this subsection, the Office of Legislative Research and General Counsel shall provide a copy of the report to each member of the committee.

(2)The evaluation required by this section shall:

(a)analyze the effectiveness of the insurance regulations and statutes in promoting a healthy, competitive health insurance market that meets the needs of the state, and includes an analysis of:

(i)the availability and marketing of individual and group products;

(ii)rate changes;

(iii)coverage and demographic changes;

(iv)benefit trends;

(v)market share changes; and

(vi)accessibility;

(b)assess complaint ratios and trends within the health insurance market, which assessment shall include complaint data from the Office of Consumer Health Assistance within the department;

(c)contain recommendations for action to improve the overall effectiveness of the health insurance market, administrative rules, and statutes;

(d)include claims loss ratio data for each health insurance company doing business in the state;

(e)include information about pharmacy benefit managers collected under Section 31A-46-301 ; and

(f)include information, for each health insurance company doing business in the state, regarding:

(i)preauthorization determinations; and

(ii)adverse benefit determinations.

(3)When preparing the evaluation and report required by this section, the commissioner may seek the input of insurers, employers, insured persons, providers, and others with an interest in the health insurance market.

(4)The commissioner may adopt administrative rules for the purpose of collecting the data required by this section, taking into account the business confidentiality of the insurers.

(5)Records submitted to the commissioner under this section shall be maintained by the commissioner as protected records under Title 63G, Chapter 2, Government Records Access and Management Act.

Amended by Chapter 120 , 2024 General Session