1. (1) A covered carrier with more than one class of business under Section 31A-30-105 shall maintain, for inspection by the commissioner, the following information with respect to each class of business:

   1. (a) a description of all criteria used by the covered carrier or its agents to determine membership in the class of business;
   2. (b) a statement justifying the establishment of each separate class of business and documentation that the establishment of each class of business reflects substantial differences in expected claims experience or administrative costs; and
   3. (c) a statement disclosing each health benefit plan currently available for purchase in the class and any significant limitations related to the purchase of such plans.
2. (2) For policies issued or renewed on or after January 1, 2011, a covered carrier may not establish a separate class of business without the commissioner's prior approval.

3. (3) To establish a separate class of business under Subsection (2), a covered carrier shall submit a filing in compliance with Rule R590-220 that includes:

   1. (a) a written request to establish a separate class of business;
   2. (b) a description of all criteria used by the covered carrier, or its agents, to determine membership in the class of business;
   3. (c) a disclosure of each health benefit plan that will be available for purchase in the class and any significant limitations related to the purchase of such plans;

   4. (d) a statement demonstrating that the use of a separate class of business is necessary due to substantial differences in either expected claims experience or administrative costs related to the covered carrier:

      1. (i) using more than one system for the marketing and sale of a health benefit plan to covered insureds;
      2. (ii) acquiring a class of business from another covered carrier; or
      3. (iii) providing coverage to one or more association groups;
   5. (e) a list of previously approved classes of business; and
   6. (f) for each class of business used before January 1, 2011, a certification that the continued use of the class of business is necessary under Subsection (3)(d).
4. (4) A covered carrier may not, directly or indirectly, use group size as a criterion for establishing eligibility for a class of business.

KEY: health insurance

Date of Last Change: February 21, 2024

Notice of Continuation: August 9, 2024

Authorizing, and Implemented or Interpreted Law: 31A-30-106; 31A-30-106.1