R305. Environmental Quality, Administration.
R305-5. Health Reform -- Health Insurance Coverage in DEQ State Contracts -- Implementation.
The purpose of this rule is to comply with the provisions of UCA Section 19-1-206.
This rule is established under UCA Section19-1-206(6) which authorizes the Department of Environmental Quality to make rules governing health insurance in certain design and construction contracts.
(1) "Employee" means an "employee," "worker," or "operative" as defined in UCA Section 34A-2-104 who works in the State at least 30 hours per calendar week, and meets employer eligibility waiting requirements for health care insurance which may not exceed the first day of the calendar month following 90 days from the date of hire.
(2) "Health benefit plan" has the same meaning as provided in UCA Section 31A-1-301.
(3) "Qualified health insurance coverage" means at the time the contract is entered into or renewed:
(a) a health benefit plan and employer contribution level with a combined actuarial value at least actuarially equivalent to the combined actuarial value of the benchmark plan (posted at http://dfcm.utah.gov/downloads/Health%20Insurance%20Benchmark.pdf) determined by the Children's Health Insurance Program under UCA Section 26-40-106(2)(a), and a contribution level of 50% of the premium for the employee and the dependents of the employee who reside or work in the state, in which:
(i) the employer pays at least 50% of the premium for the employee and the dependents of the employee who reside or work in the state; and
(ii) for purposes of calculating actuarial equivalency under this Subsection (3)(a):
(A) rather than the benchmark plan's deductible, and the benchmark plan's out-of-pocket maximum based on income levels the deductible is $750 per individual and $2,250 per family; and the out-of-pocket maximum is $3,000 per individual and $9,000 per family;
(B) dental coverage is not required; and
(C) other than UCA Section 26-40-106(2)(a), the provisions of UCA Section 26-40-106 do not apply; or
(b)(i) is a federally qualified high deductible health plan that, at a minimum, has a deductible that is either the lowest deductible permitted for a federally qualified high deductible health plan; or a deductible that is higher than the lowest deductible permitted for a federally qualified high deductible health plan, but includes an employer contribution to a health savings account in a dollar amount at least equal to the dollar amount difference between the lowest deductible permitted for a federally qualified high deductible plan and the deductible for the employer offered federally qualified high deductible plan;
(ii) an out-of-pocket maximum that does not exceed three times the amount of the annual deductible; and
(iii) under which the employer pays 75% of the premium for the employee and the dependents of the employee who work or reside in the state.
(4) "Subcontractor" has the same meaning provided for in UCA Section 63A-5-208.
R305-5-4. Applicability of Rule.
(1)(a) Except as provided in Subsection R305-5-4(2) below, this Rule R305-5 applies to a design or construction contract entered into by or delegated to the department or a division or board of the department on or after July 1, 2009, and to a prime contractor or subcontractor in accordance with Subsection (1)(b)
(b)(i) A prime contractor is subject to this section if the prime contract is in the amount of $1,500,000 or greater.
(ii) A subcontractor is subject to this section if a subcontract is in the amount of $750,000 or greater.
(2) This Rule R305-5 does not apply to contracts entered into by the department or a division or board of the department if:
(a) the application of this Rule R305-5 jeopardizes the receipt of federal funds;
(b) the contract or agreement is between the department or a division or board of the department and another agency of the state, the federal government, another state, an interstate agency, a political subdivision of this state, or a political subdivision of another state;
(c) the executive director determines that applying the requirements of this section to a particular contract interferes with the effective response to an immediate health and safety threat from the environment; or
(d) the contract is a sole source contract or an emergency procurement.
(3) This Rule R305-5 does not apply to a change order as defined in UCA Section 63G-6-103, or a modification to a contract, when the contract does not meet the initial threshold required by R305-5-4(1).
R305-5-5. Compliance Requirement.
A contractor or subcontractor that is subject to the requirements of R305-5 shall have and will maintain an offer of qualified health insurance coverage for the contractor's or subcontractor's employees and dependents during the duration of the contract.
R305-5-6. Demonstration of Compliance.