31A-22-728. Large employer health benefit plan required report.

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Effective 5/3/2023

(1)As used in this section:

(a)"Claims run-out period" means the period beginning on the first day following the last day of a plan year and ending on the 90th day following the last day of a plan year.

(b)"Large employer" means an employer who:

(i)with respect to a calendar year and to a plan year:

(A)employed an average of at least 51 employees on a business day during the preceding calendar year; and

(B)employs at least one employee on the first day of the plan year; and

(ii)has at least 51 but fewer than 100 enrolled eligible employees enrolled in a group health benefit plan during each consecutive month during the plan year.

(c)"Medical loss ratio" means a group health benefit plan's paid claims incurred during a plan year, including the claims run-out period, divided by the total premium revenue collected for the plan year.

(2)Except as provided in Subsection

(6), beginning on January 1, 2024, an insurer that offers a large employer health benefit plan to a large employer shall annually provide a report, upon request of:

(a)the large employer;

(b)the large employer's appointed producer; or

(c)the large employer's consultant.

(3)The report described in Subsection

(2)shall include:

(a)after the first renewal, the health benefit plan's aggregate performance from the immediately preceding plan year that describes whether the health benefit plan had a medical loss ratio of:

(i)less than 85%;

(ii)between 85% and 125%; or

(iii)greater than 125%; and

(b)after the second renewal and each subsequent renewal thereafter, a summary of the health benefit plan's aggregate 24-month medical loss ratio from the immediately preceding two plan years combined.

(4)An insurer that offers a large employer health benefit plan shall provide the requested report described in Subsection

(2)not less than 30 days after the claims run-out period.

(a)The report described in Subsection

(2)is proprietary to the large employer, the large employer's appointed producer, or the large employer's consultant.

(b)A person may not share the report described in Subsection

(2)with a party other than a party described in Subsection (5)(a) .

(6)An insurer is not required to provide a report as described in this section if:

(a)the health benefit plan is a qualified health plan as defined in 45 C.F.R. Sec. 155.20;

(b)the health benefit plan is issued to a group other than an employee group described in Section 31A-22-502 ;

(c)the large employer has not had continuous large employer health benefit plan coverage with the insurer for at least 18 months before the date on which the large employer requests the report;

(d)the large employer does not renew coverage with the insurer; or

(e)the insurer reasonably believes that providing the report would disclose information described in Subsection 13-61-102(2)(g) .

(7)An insurer that provides a report in compliance with this section is immune from civil liability for the insurer's acts or omissions in providing information required under Subsection

(3).

Enacted by Chapter 194 , 2023 General Session