31A-30-105 - Establishment of classes of business.
31A-30-105. Establishment of classes of business.
(1) For policies that go into effect on or after January 1, 2011, a covered carrier may notestablish a separate class of business unless:
(a) the covered carrier submits an application to the department to establish a separateclass of business;
(b) the covered carrier demonstrates to the satisfaction of the department that a separateclass of business is justified under the provisions of this section; and
(c) the department approves the carrier's application for the use of a separate class ofbusiness.
(2) (a) The presumption of the department shall be against the use of a separate class ofbusiness by a covered insured, except when the covered carrier demonstrates that the provisionsof this Subsection (2) apply.
(b) The department may approve the use of a separate class of business only if thecovered carrier can demonstrate that the use of a separate class of business is necessary due tosubstantial differences in either expected claims experience or administrative costs related to thefollowing reasons:
(i) the covered carrier uses more than one type of system for the marketing and sale ofhealth benefit plans to covered insureds;
(ii) the covered carrier has acquired a class of business from another covered carrier; or
(iii) the covered carrier provides coverage to one or more association groups.
(3) The commissioner may establish regulations to provide for a period of transition inorder for a covered carrier to come into compliance with Subsection (2) in the instance ofacquisition of an additional class of business from another covered carrier.
(4) The commissioner may approve the establishment of up to five classes of businessper covered carrier upon application to the commissioner and a finding by the commissioner thatsuch action would substantially enhance the efficiency and fairness of the health insurancemarketplace subject to this chapter.
(5) A covered carrier may not establish a class of business based solely on the marketingor sale of a health benefit plan as a defined contribution arrangement health benefit plan, orthrough the Health Insurance Exchange.
Amended by Chapter 68, 2010 General Session