New Bulletin Relating to Small Group Contribution and Participation Requirements

On Oct. 25, 2016, the Utah Insurance Department published Bulletin 2016-4. The new bulletin applies to health insurers offering coverage in the small group market, and provides guidance regarding the notices and requirements when applying employer contribution or group participation requirements.

Quickly, under Utah law, “participation” is defined as a requirement relating to the minimum percentage of eligible employees that must be enrolled in relation to the total number of eligible employees of an employer, reduced by each eligible employee who voluntarily waives coverage because they have other health insurance coverage. In addition, federal law requires insurers in the small group market to accept any employer that applies for coverage at any point during the year (although carriers may restrict the availability of coverage to an annual open enrollment period that begins November 15 and extends through December 15 each year). The bulletin reminds carriers of those two rules.

The bulletin also states that if a small employer is denied coverage for not meeting contribution or participation requirements, it must notify the small employer of those rules and that coverage offered during that November 15 to December 15 timeframe is not subject to employer contribution or group participation rules. Small employers in Utah should work with their carriers with any questions relating to contribution and participation requirements.

Bulletin 2016-4 »