R590-167-11. Actuarial Certification and Additional Filing Requirements

  (1) Actuarial Certification.

  (a) An actuarial certification shall be filed annually and meet the requirements of Subsections 31A-30-106(4)(b) or 31A-30-106.1(9)(b), or both, as applicable, and the following:

  (i) the actuarial certification shall be a written statement that meets the requirements of Title 31A Chapter 30, R590-167, and the applicable standards of practice as promulgated by the Actuarial Standards Board;

  (ii) the actuary must state that he or she meets the qualifications of Subsection 31A-30-103(1);

  (iii) the actuarial certification shall:

  (A) contain the following statement: "I, (name), certify that (name of covered carrier) is in compliance with the provisions of Title 31A Chapter 30, and R590-167, based upon the examination of (name of covered carrier), including review of the appropriate records and of the actuarial assumptions and methods utilized by (name of covered carrier) in establishing premium rates for applicable health benefit plans;"

  (B) list and describe each written demonstration used by the actuary to establish compliance with Title 31A Chapter 30 and R590-167; and

  (C) include a list of all affiliated insurers, define each class of business which includes the commissioner's approval date if more than one class of business exists, and the SERFF filing number for each applicable rate manual filing.

  (b) The actuarial certification shall be filed no later than April 1 of each year.

  (c) The actuarial certification required by Subsections 31A-30-106(4)(b) and 31A-30-106.1(13)(b) and this subsection, applies only to an individual or small employer health benefit plan issued prior to March 23, 2010, and has maintained grandfathered status.

  (2) Rating Manual.

  (a) For every health benefit plan subject to the Act and this rule, the carrier shall file with the commissioner a copy of the applicable rating manual, for both new business and renewal rates, which includes:

  (i) signed certification by an actuary that to the best of the actuary's knowledge and judgment the rate filing is in compliance with the applicable laws and rules of the State of Utah;

  (ii) a complete and detailed description of how the final premium, including any fees, is calculated from the rating manual;

  (iii) all changes and updates, which includes a complete and detailed description of how the final premium, including any fees, is calculated from the rating manual;

  (iv) an identification of the carrier's classes of business as described in Subsection R590-167-4(1);

  (v) all information required by 45 CFR 154.215(b)(1);

  (vi) for a rate increase subject to review as required by 45 CFR 154.200(a)(1), all information required by 45 CFR 154.215(b)(2); and

  (vii) all information required by the Utah Accident and Health Comprehensive Health Insurance Rate Filing Checklist.

  (b) The rate manual shall be filed:

  (i) with an initial product filing; or

  (ii) within 30 days prior to use for an existing health benefit plan.