R590-277-7. Restrictions Relating to Premium Rates

  (1) The premium charged shall not be adjusted more frequently than annually, except that the premium rates may be changed:

  (a) to reflect changes to the enrollment;

  (b) to reflect changes to the health benefit plan; or

  (c) as expressly permitted by federal or state law.

  (2) Premium rates may vary only with respect to the particular coverage involved on the basis of the following:

  (a) whether the plan covers an individual or family:

  (i) the total family premium shall include only the premiums for all covered family members over the age of twenty-one and the three oldest children under the age of twenty one; and

  (ii) any rating variation on the basis of age or tobacco use must 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, comprised of Cache and Rich counties;

  (ii) Area 2, comprised of Box Elder, Morgan, and Weber counties;

  (iii) Area 3, comprised of Davis, Salt Lake, Summit, Tooele, and Wasatch counties;

  (iv) Area 4, comprised of Utah county;

  (v) Area 5, comprised of Iron and Washington counties; and

  (vi) Area 6, comprised of 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 policy 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) R590-277-7(2) does not apply to:

  (a) a large employer health benefit plan; or

  (b) an individual or small employer health benefit plan issued prior to January 1, 2014 in which the policy rating complies with:

  (i) Title 31A-30, Individual, Small Employer, and Group Health Insurance Act; and

  (ii) Rule R590-167, Individual, Small Employer, and Group Health Benefit Plan Rule.