31A-30-207 - Rating and underwriting restrictions for health plans in the defined contribution arrangement market.
31A-30-207. Rating and underwriting restrictions for health plans in the definedcontribution arrangement market.
(1) The rating and underwriting restrictions for defined benefit plans and for the definedcontribution arrangement health benefit plans offered in the Health Insurance Exchange definedcontribution arrangement market shall be:
(a) for small employer groups, in accordance with Section 31A-30-106.1;
(b) for large employer groups, as determined by the risk adjuster board for participationin the risk adjustment mechanism under Chapter 42, Defined Contribution Risk Adjuster Act;and
(c) established in accordance with the plan adopted under Chapter 42, DefinedContribution Risk Adjuster Act.
(2) All insurers who participate in the defined contribution market shall:
(a) participate in the risk adjuster mechanism developed under Chapter 42, DefinedContribution Risk Adjuster Act for all defined contribution arrangement health benefit plans;
(b) provide the risk adjuster board with:
(i) an employer group's risk factor; and
(ii) carrier enrollment data; and
(c) submit rates to the exchange that are net of commissions.
(3) When an employer group of any size enters the defined contribution arrangementmarket for either a defined contribution arrangement health benefit plan, or a defined benefitplan, and the employer group has a health plan with an insurer who is participating in the definedcontribution arrangement market, the risk factor applied to the employer group when it enters thedefined contribution market may not be greater than the employer group's renewal risk factor forthe same group of covered employees and the same effective date, as determined by the employergroup's insurer.
Amended by Chapter 68, 2010 General Session