R590-277-7. Restrictions Relating to Premium Rates

(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.