R590-220-3. Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows: (1) "Certification" means a statement that a submitted filing is compliant. (2) "Compliant" means a filing that is complete and that complies with Title 31A, Insurance Code, and this rule. (3) "Discretionary group" means a group that is authorized by the commissioner under Subsection 31A-22-701(1)(b). (4) "Electronic filing" means a filing submitted using SERFF. (5) "Eligible group" means a group that meets the requirements in Section 31A-22-701. (6) "File and use" means a filing is used, sold, or offered for sale after it is filed with the department. (7) "File before use" means a filing is used, sold, or offered for sale after it is filed with the department and a stated period of time elapses from the date filed. (8) "File for acceptance" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is accepted. (9) "File for approval" means a filing is used, sold, or offered for sale after receiving written confirmation that the filing is approved. (10) "Filing objection letter" means a letter issued by the commissioner when a review of the filing determines the filing is not compliant and may require: (a) correction of non-compliant items; (b) clarification; or (c) additional information related to the filing. (11) "Filing status information" means a list of states a similar filing was submitted to, the date submitted, and the action taken by each state, including their responses. (12) "Letter of authorization" means a letter signed by an officer of the insurer giving authority to a third party to submit a filing on behalf of the insurer. (13) "Market type" means a policy that specifies a targeted market. (14) "NAIC Product Coding Matrix" means a numerical coding system developed by the NAIC that provides uniform naming convention, uniform terminology, and uniform description for a type of insurance product in a filing. (15) "Non-2014 PPACA compliant health benefit plan" means a health benefit plan that is: (a) a grandfathered health plan under 45 CFR 147.140(a); or (b) a transitional health benefit plan, also known as a grandmothered plan, under: (i) the letter from the Centers for Medicare and Medicaid Services dated November 14, 2013; and (ii) Subsection 31A-30-117(3). (16) "Order to prohibit use" means an order issued by the commissioner prohibiting the use of a filing. (17) "Change in rating methodology," for the purposes of a non-2014 PPACA compliant health benefit plan, means a change in: (a) the number of case characteristics used by an insurer to determine premium rates in a class of business; (b) the manner or procedures used to assign an insured into categories for the purpose of applying a case characteristic to determine premium rates in a class of business; (c) the method of allocating expenses in a class of business; or (d) a rating factor, with respect to any case characteristic, if the change would produce a change in premium that exceeds 10% for an individual or small employer. (18) "Rejected" means a filing is: (a) not compliant; (b) returned to the insurer stating the reason for rejection; and (c) not considered filed with the department. (19) "Resubmission" means a correction, modification, or replacement of a previously rejected, withdrawn, or prohibited filing. (20) "SERFF" means the System for Electronic Rates and Form Filings. (21) "Stop-loss insurance" means insurance purchased by an employer for which the stop-loss insurer assumes all loss amounts of the employer's plan in excess of a stated amount, subject to the policy limit. (22) "Type of insurance" or "TOI" means a specific accident and health insurance product identified by the NAIC Product Coding Matrix that can be selected in SERFF when submitting a filing in Utah. (23) "Utah filed date" means the date the department indicates a paper filing is accepted.