R590-283-3. Definitions

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: (1) "Defrayal payment" means the amount payable to a carrier from the state for expenses incurred for a state-required benefit under: (a) 45 C.F.R. 155.170(b); (b) Section 31A-30-118; and (c) this rule. (2) "EHB" means essential health benefits. (3) "Exchange" means exchange as defined in 45 CFR 155.20. (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) "Qualified health plan" means a qualified health plan as defined in 45 CFR 155.20. (6) "State-required benefit" means a benefit required by the state: (a) on or after January 1, 2012; (b) for a purpose other than compliance with a federal requirement; (c) that is in excess of the Utah Essential Health Benefits Package; and (d) that is eligible for a defrayal payment.