§ 31A-22-647 — Insurer shared savings program.

(1) As used in this section:

(1)(a) "Insurer" means a person who offers health care insurance, including a health maintenance organization as that term is defined in Section 31A-8-101.
(1)(b) "PEHP" means the Public Employees' Benefit and Insurance Program created in Section 49-20-103.
(1)(c) "Savings reward program" means a program to reward a health insurance enrollee if the enrollee receives services:
(1)(c)(i) covered by the enrollee's health plan; and
(1)(c)(ii) from a provider whose costs for services are lower than the average costs for the services.
(2) An insurer may, in accordance with Subsection (4), establish a savings reward program for a health benefit plan that is:

(2)(a) offered by the insurer; and
(2)(b) entered into or renewed on or after January 1, 2019.
(3) PEHP shall, in accordance with Subsection (4), establish a savings reward program for a health plan that is:

(3)(a) offered to state employees under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act; and
(3)(b) entered into or renewed on or after July 1, 2019.
(4) A savings reward program described in Subsection (2) or (3) may include, in accordance with federal and state law, rewards to the enrollee through:

(4)(a) premium discounts;
(4)(b) rebates;
(4)(c) reduction of out-of-pocket costs; or
(4)(d) other rewards or incentives developed by the insurer.

Legislative History

Enacted by Chapter 181, 2018 General Session