1. (1) "Defrayal payment" means the amount payable to a carrier from the state for expenses incurred for a state-required benefit under:

   1. (a) 45 C.F.R. 155.170(b);
   2. (b) Section 31A-30-118; and
   3. (c) this rule.
2. (2) "EHB" means essential health benefits.
3. (3) "Exchange" means exchange as defined in 45 CFR 155.20.
4. (4) "Member month" means a count of one for each month during a calendar year during which an individual has coverage under a plan subject to this rule where coverage is evaluated on the first of the month.
5. (5) "Qualified health plan" means a qualified health plan as defined in 45 CFR 155.20.

6. (6) "State-required benefit" means a benefit required by the state:

   1. (a) on or after January 1, 2012;
   2. (b) for a purpose other than compliance with a federal requirement;
   3. (c) that is in excess of the Utah Essential Health Benefits Package; and
   4. (d) that is eligible for a defrayal payment.

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103, and Rule R590-266. Additional terms are defined as follows:

KEY: insurance

Date of Last Change: June 9, 2023

Notice of Continuation: December 16, 2024

Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)