(1) The premium charged may not be adjusted more frequently than annually, except the premium rate may be changed:
- (a) to reflect a change in enrollment;
- (b) to reflect a change to the contract; or
- (c) as expressly permitted by federal or state law.
(2) Premium rates may vary based only on the following:
(a) whether the plan covers an individual or a family, as follows:
- (i) the total family premium shall only include premiums for covered family members over the age of 21 and the three oldest children under the age of 21; and
- (ii) a rating variation based on age or tobacco use shall be applied separately to the portion of the premium attributable to each covered family member;
(b) geographic rating area, determined by the policyholder's primary address, as follows:
- (i) Area 1, Cache and Rich counties;
- (ii) Area 2, Box Elder, Morgan, and Weber counties;
- (iii) Area 3, Davis, Salt Lake, Summit, Tooele, and Wasatch counties;
- (iv) Area 4, Utah County;
- (v) Area 5, Iron and Washington counties; and
- (vi) Area 6, Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, and Wayne counties;
- (c) age of each enrollee, as of the date of the contract issuance or renewal, in accordance with the Utah Individual and Small Employer Health Benefit Plan Age Curve; and
- (d) tobacco rate factor not greater than 1.5.
(3) Subsection (2) does not apply to:
- (a) a large employer contract; or
(b) an individual or small employer contract issued before January 1, 2014, if the contract rating complies with:
- (i) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act; and
- (ii) Rule R590-167.
KEY: insurance, health insurance
Date of Last Change: June 10, 2025
Notice of Continuation: August 9, 2024
Authorizing, and Implemented or Interpreted Law: 31A-45-103; 31A-2-201(3)(a); 31A-23a-402(8); 31A-23a-412; 31A-2-202