31A-30-205 - Health benefit plans offered in the defined contribution market.
31A-30-205. Health benefit plans offered in the defined contribution market.
(1) An insurer who offers a defined contribution arrangement health benefit plan shalloffer the following health benefit plans as defined contribution arrangements:
(a) the basic benefit plan;
(b) one health benefit plan with an aggregate actuarial value at least 15% greater than theactuarial value of the basic benefit plan;
(c) on or before January 1, 2011, one health benefit plan that is a federally qualified highdeductible health plan that has an individual deductible of $2,500 and a deductible of $5,000 forcoverage including two or more individuals, and does not exceed an annual out-of-pocketmaximum equal to three times the amount of the annual deductible;
(d) on or before January 1, 2011, one health benefit plan that is a federally qualified highdeductible health plan that has a deductible that is within $250 of the highest deductible thatqualifies as a federally qualified high deductible health plan as adjusted by federal law, and doesnot exceed an annual out-of-pocket maximum equal to three times the amount of the annualdeductible; and
(e) the insurer's five most commonly selected health benefit plans that:
(i) include:
(A) the provider panel;
(B) the deductible;
(C) co-payments;
(D) co-insurance; and
(E) pharmacy benefits; and
(ii) are currently being marketed by the carrier to new groups for enrollment.
(2) (a) The provisions of Subsection (1) do not limit the number of defined contributionarrangement health benefit plans an insurer may offer in the defined contribution arrangementmarket.
(b) An insurer who offers the health benefit plans required by Subsection (1) may alsooffer any other health benefit plan as a defined contribution arrangement if:
(i) the health benefit plan provides benefits that are of greater actuarial value than thebenefits required in the basic benefit plan; or
(ii) the health benefit plan provides benefits with an aggregate actuarial value that is nolower than the actuarial value of the plan required in Subsection (1)(c).
Amended by Chapter 68, 2010 General Session
Amended by Chapter 149, 2010 General Session, (Coordination Clause)
Amended by Chapter 149, 2010 General Session