31A-30-104 - Applicability and scope.
31A-30-104. Applicability and scope.
(1) This chapter applies to any:
(a) health benefit plan that provides coverage to:
(i) individuals;
(ii) small employers; or
(iii) both Subsections (1)(a)(i) and (ii); or
(b) individual conversion policy for purposes of Sections 31A-30-106.5 and31A-30-107.5.
(2) This chapter applies to a health benefit plan that provides coverage to smallemployers or individuals regardless of:
(a) whether the contract is issued to:
(i) an association;
(ii) a trust;
(iii) a discretionary group; or
(iv) other similar grouping; or
(b) the situs of delivery of the policy or contract.
(3) This chapter does not apply to:
(a) a large employer health benefit plan, except as specifically provided in Part 2,Defined Contribution Arrangements;
(b) short-term limited duration health insurance; or
(c) federally funded or partially funded programs.
(4) (a) Except as provided in Subsection (4)(b), for the purposes of this chapter:
(i) carriers that are affiliated companies or that are eligible to file a consolidated taxreturn shall be treated as one carrier; and
(ii) any restrictions or limitations imposed by this chapter shall apply as if all healthbenefit plans delivered or issued for delivery to covered insureds in this state by the affiliatedcarriers were issued by one carrier.
(b) Upon a finding of the commissioner, an affiliated carrier that is a health maintenanceorganization having a certificate of authority under this title may be considered to be a separatecarrier for the purposes of this chapter.
(c) Unless otherwise authorized by the commissioner or by Chapter 42, DefinedContribution Risk Adjuster Act, a covered carrier may not enter into one or more cedingarrangements with respect to health benefit plans delivered or issued for delivery to coveredinsureds in this state if the ceding arrangements would result in less than 50% of the insuranceobligation or risk for the health benefit plans being retained by the ceding carrier.
(d) Section 31A-22-1201 applies if a covered carrier cedes or assumes all of theinsurance obligation or risk with respect to one or more health benefit plans delivered or issuedfor delivery to covered insureds in this state.
(5) (a) A Taft Hartley trust created in accordance with Section 302(c)(5) of the FederalLabor Management Relations Act, or a carrier with the written authorization of such a trust, maymake a written request to the commissioner for a waiver from the application of any of theprovisions of Subsection 31A-30-106(1) with respect to a health benefit plan provided to thetrust.
(b) The commissioner may grant a trust or carrier described in Subsection (5)(a) a waiverif the commissioner finds that application with respect to the trust would:
(i) have a substantial adverse effect on the participants and beneficiaries of the trust; and
(ii) require significant modifications to one or more collective bargaining arrangementsunder which the trust is established or maintained.
(c) A waiver granted under this Subsection (5) may not apply to an individual if theperson participates in a Taft Hartley trust as an associate member of any employee organization.
(6) Sections 31A-30-106, 31A-30-106.5, 31A-30-106.7, 31A-30-107, 31A-30-108, and31A-30-111 apply to:
(a) any insurer engaging in the business of insurance related to the risk of a smallemployer for medical, surgical, hospital, or ancillary health care expenses of the small employer'semployees provided as an employee benefit; and
(b) any contract of an insurer, other than a workers' compensation policy, related to therisk of a small employer for medical, surgical, hospital, or ancillary health care expenses of thesmall employer's employees provided as an employee benefit.
(7) The commissioner may make rules requiring that the marketing practices beconsistent with this chapter for:
(a) a small employer carrier;
(b) a small employer carrier's agent;
(c) an insurance producer; and
(d) an insurance consultant.
Amended by Chapter 12, 2009 General Session