1. (1) Health Benefit Plan Reports.

   1. (a) Actuarial Certification Report.

      1. (i) An individual or a small employer insurer maintaining a non-2014 PPACA compliant health benefit plan shall file an actuarial certification under Sections 31A-30-106 and 31A-30-106.1, and Subsection R590-167-11(1)(a).
      2. (ii) The report is due annually on April 1.
      3. (iii) Each report shall be filed by market type and shall be properly identified.
      4. (iv) A report shall be submitted using the appropriate TOI and the filing type of "Report."

   2. (b) Defrayal of State-Required Benefits Report.

      1. (i) An insurer anticipating a defrayal of state-required benefits shall file a request under Section 31A-30-118 and Subsection R590-283-6(3).

         1. (A) The report is due quarterly on February 15, May 15, August 15, and November 15.
         2. (B) Each report shall be filed by market type and shall be properly identified.
         3. (C) Reports shall be submitted using the appropriate TOI and the filing type of "Report."

      2. (ii) An insurer seeking a defrayal of state-required benefits shall file a request under Section 31A-30-118 and Subsection R590-283-4(2).

         1. (A) The report is due annually on September 1.
         2. (B) Each report shall be filed by market type and shall be properly identified.
         3. (C) The report shall be submitted using the appropriate TOI and the filing type of "Report."

2. (2) Medicare Supplement Reports.

   1. (a) Annual Medicare Supplement Reports.

      1. (i) The report is due annually on May 31.

      2. (ii) The report shall include the sub-reports outlined in this subsection.

         1. (A) Report of Multiple Policies.
         2. (I) An issuer of a Medicare supplement policy shall submit a report of multiple policies issued to a single insured under Section R590-146-22.
         3. (II) The report shall list each insured with multiple policies or state "NO MULTIPLE POLICIES WERE ISSUED."
         4. (B) Annual Filing of Rates and Supporting Documentation.
         5. (I) An issuer of Medicare supplement policies and certificates shall file its rates, rating schedule, and supporting documentation, including ratios of incurred losses to earned premiums by policy duration, under Section R590-146-14.
         6. (II) The NAIC Medicare Supplement Insurance Model Regulations Manual sets forth the requirements of the annual rate filing.
         7. (III) An annual report submitted with a request or any type of reference to a rate revision shall be rejected.
         8. (C) Refund Calculation and Benchmark Ratio. An issuer shall file the Medicare Supplement Refund Calculation Form and Reporting Form for the calculation of benchmark ratios since inception under Section R590-146-14.
      3. (iii) A report for pre-standardized Medicare supplement benefit plans and 1990 standardized Medicare supplement benefit plans shall be submitted together as one filing using a TOI of "MS06" and a filing type of "Report."
      4. (iv) A report for 2010 standardized Medicare supplement benefit plans shall be submitted together as one filing using a TOI of "MS09" and a filing type of "Report."
      5. (v) If all Medicare supplement reports are not submitted together as one filing, the filing is considered incomplete and shall be rejected.

   2. (b) Medicare Select Reports.

      1. (i) An issuer offering a Medicare Select policy or certificate shall file a grievance report required under Section R590-14-10.

         1. (A) The report is due annually on March 31.
         2. (B) A report shall be filed by market type and shall be properly identified.
         3. (C) The report shall be submitted using the appropriate Medicare Select TOI and a filing type of "Report."

      2. (ii) An issuer offering a Medicare Select policy or certificate shall submit any change to the list of network providers under Section R590-146-10.

         1. (A) The report is due within 30 days of the change.
         2. (B) A report shall be filed by market type and shall be properly identified.
         3. (C) The report shall be submitted using the appropriate Medicare Select TOI and a filing type of "Report."

3. (3) Long-Term Care Insurance Reports.

   1. (a) The long-term care reports required under Section R590-148-25 shall be submitted together as one filing.
   2. (b) If the reports are not submitted as one filing, the filing is considered non-compliant and shall be rejected.
   3. (c) If there is no information to report, the form shall state "NONE."
   4. (d) The report is due annually on June 30.
   5. (e) All long-term care reports shall be filed using a TOI of "LTC06" and a filing type of "Report."

4. (4) Limited Long-Term Care Insurance Reports.

   1. (a) Annual Limited Long-Term Care Report.

      1. (i) The following limited long-term care reports required by Section R590-285-14 shall be submitted together as one filing.
      2. (ii) If the reports are not submitted as one filing, the filing is considered non-compliant and shall be rejected.
      3. (iii) If there is no information to report, the form shall state "NONE."
      4. (iv) The report is due annually on June 30.
      5. (v) The limited long-term care reports shall be filed using a TOI of "LTC06" and a filing type of "Report."

   2. (b) Independent Review Organization Certification for a Limited Long-Term Care Insurance Report Under Section R590-285-25.

      1. (i) The report is due annually on June 1.
      2. (ii) The report shall be properly identified.
      3. (iii) The report shall be filed using a TOI of "LTC06" and a filing type of "Report."

5. (5) Miscellaneous Reports.

   1. (a)(i) Reporting criteria for adding or terminating participating providers shall be submitted using a TOI of "H21" and a filing type of "Report."

      1. (ii) The filing description shall state "Preferred Provider Agreement" as required by Section 31A-45-304.

   2. (b) Stop-Loss Certification of Compliance.

      1. (i) An insurer making available a small employer stop-loss plan shall file an actuarial certification and experience report under Sections 31A-43-302 and R590-268-8.
      2. (ii) The report is due annually on April 1.
      3. (iii) The report shall be submitted using a TOI of "H12" and a filing type of "Report."

   3. (c) All Other Reports Not Specified in This Rule.

      1. (i) A report shall be filed by market type and properly identified.
      2. (ii) Each report shall be submitted using the appropriate TOI and the filing type of "Report."

KEY: health insurance filings

Date of Last Change: July 21, 2023

Notice of Continuation: February 7, 2024

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A-30-106