reglab/housing_qa huggingface dataset:
UT Code § 31A-22-610.1 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 610.1 - Indemnity benefit for adoption or infertility treatments.

 Effective 1/1/2018  31A-22-610.1. Indemnity benefit for adoption or infertility treatments.    (1)   (a)   (i) If an insured has coverage for maternity benefits on the date of an adoptive placement, the insured's policy shall provide an adoption indemnity benefit payable to the insured, if a child is placed for adoption with the insured within 90 days of the child's birth. If more than one child from the same birth is placed for adoption with the insured, only one adoption indemnity benefit is required.     (ii) This section does not prevent an accident and health insurer from:   (A) adjusting the benefit payable under this section for cost sharing measures imposed under the policy or contract for maternity benefit coverage; or     (B) providing additional adoption indemnity benefits including:   (I) extending the period of time after birth in which a child must be placed with an insured; or     (II) providing a benefit in excess of the amount specified in Subsection (1)(c).           (b) An insurer that has paid the adoption indemnity benefit under Subsection (1)(a) may seek reimbursement of the benefit if:   (i) the postplacement evaluation disapproves the adoption placement; and     (ii) a court rules the adoption may not be finalized because of an act or omission of an adoptive parent or parents that affects the child's health or safety.       (c)   (i) The amount of the adoption indemnity benefit provided under Subsection (1) is $4,000 subject to the adjustments permitted by Subsection (1)(a)(ii).     (ii) An insurer may comply with the provisions of this section by providing the $4,000 adoption indemnity benefit to an enrollee to be used for the purpose of the enrollee obtaining infertility treatments rather than seeking reimbursement for an adoption in accordance with terms designated by the insurer.       (d) Each insurer shall pay its pro rata share of the adoption indemnity benefit if each adoptive parent:   (i) has coverage for maternity benefits with a different insurer; and     (ii) makes a claim for the adoption indemnity benefit provided in Subsection (1)(a).         (2) If a policy offers optional maternity benefits, it shall also offer coverage for adoption indemnity benefits if:   (a) a child is placed for adoption with the insured within 90 days of the child's birth; and     (b) the adoption is finalized within one year of the child's birth.       (3) If an insured qualifies for the adoption indemnity benefit under this section and receives services from a network provider, the network provider may only collect from the insured the amount that the contracting health care provider is entitled to receive for such services under the contract, including any applicable copayment.    Amended by Chapter 292, 2017 General Session
UT Code § 31A-22-610.2 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 610.2 - Maternity stay minimum limits.

31A-22-610.2. Maternity stay minimum limits.    (1)   (a) If an insured has coverage for maternity benefits, the policy may not be limited to a less than a 48-hour benefit for both mother and newborn with a normal vaginal delivery.     (b) If an insured has coverage for maternity benefits, the policy may not be limited to a less than 96-hour benefit for both mother and newborn with a caesarean section delivery.       (2) Subsection (1) applies to an accident and health insurer who offers maternity coverage.    Amended by Chapter 116, 2001 General Session
UT Code § 31A-22-610.6 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 610.6 - Special enrollment for individuals receiving premium assistance.

31A-22-610.6. Special enrollment for individuals receiving premium assistance.    (1) As used in this section:   (a) "Premium assistance" means assistance under Title 26, Chapter 18, Medical Assistance Act, in the payment of premium.     (b) "Qualified beneficiary" means an individual who is approved to receive premium assistance.       (2) Subject to the other provisions in this section, an individual may enroll under this section at a time outside of an employer health benefit plan open enrollment period, regardless of previously waiving coverage, if the individual is:   (a) a qualified beneficiary who is eligible for coverage as an employee under the employer health benefit plan; or     (b) a dependent of the qualified beneficiary who is eligible for coverage under the employer health benefit plan.       (3) To be eligible to enroll outside of an open enrollment period, an individual described in Subsection (2) shall enroll in the employer health benefit plan by no later than 30 days from the day on which the qualified beneficiary receives initial written notification, after July 1, 2008, that the qualified beneficiary is eligible to receive premium assistance.     (4) An individual described in Subsection (2) may enroll under this section only in an employer health benefit plan that is available at the time of enrollment to similarly situated eligible employees or dependents of eligible employees.     (5) Coverage under an employer health benefit plan for an individual described in Subsection (2) may begin as soon as the first day of the month immediately following enrollment of the individual in accordance with this section.     (6) This section does not modify any requirement related to premiums that applies under an employer health benefit plan to a similarly situated eligible employee or dependent of an eligible employee under the employer health benefit plan.     (7) An employer health benefit plan may require an individual described in Subsection (2) to satisfy a preexisting condition waiting period that:   (a) is allowed under the Health Insurance Portability and Accountability Act; and     (b) is not longer than 12 months.      Amended by Chapter 284, 2011 General Session
UT Code § 31A-22-611 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 611 - Coverage for children with a disability.

 Effective 5/14/2019  31A-22-611. Coverage for children with a disability.    (1) For the purposes of this section:   (a) "Dependent with a disability" means a child who is and continues to be both:   (i) unable to engage in substantial gainful employment to the degree that the child can achieve economic independence due to a medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months; and     (ii) chiefly dependent upon an insured for support and maintenance since the child reached the age specified in Subsection 31A-22-610.5(2).       (b) "Mental impairment" means a mental or psychological disorder such as:   (i) an intellectual disability;     (ii) organic brain syndrome;     (iii) emotional or mental illness; or     (iv) specific learning disabilities as determined by the insurer.       (c) "Physical impairment" means a physiological disorder, condition, or disfigurement, or anatomical loss affecting one or more of the following body systems:   (i) neurological;     (ii) musculoskeletal;     (iii) special sense organs;     (iv) respiratory organs;     (v) speech organs;     (vi) cardiovascular;     (vii) reproductive;     (viii) digestive;     (ix) genito-urinary;     (x) hemic and lymphatic;     (xi) skin; or     (xii) endocrine.         (2) The insurer may require proof of the impairment and dependency be furnished by the person insured under the policy within 30 days of the effective date or the date the child attains the age specified in Subsection 31A-22-610.5(2), and at any time thereafter, except that the insurer may not require proof more often than annually after the two-year period immediately following attainment of the limiting age by the dependent with a disability.     (3) Any individual or group accident and health insurance policy or health maintenance organization contract that provides coverage for a policyholder's or certificate holder's dependent shall, upon application, provide coverage for all unmarried dependents with a disability who have been continuously covered, with no break of more than 63 days, under any accident and health insurance since the age specified in Subsection 31A-22-610.5(2).     (4) Every accident and health insurance policy or contract that provides coverage of a dependent with a disability may not terminate the policy due to an age limitation.    Amended by Chapter 193, 2019 General Session
UT Code § 31A-22-612 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 612 - Conversion privileges for insured former spouse.

 Effective 5/5/2021  31A-22-612. Conversion privileges for insured former spouse.    (1) An accident and health insurance policy, that in addition to covering the insured also provides coverage to the spouse of the insured, may not contain a provision for termination of coverage of a spouse covered under the policy, except by entry of a valid decree of divorce, legal separation, or annulment between the parties.     (2) Every policy that contains the type of provision described in Subsection (1) shall provide that:   (a) upon the entry of the divorce decree the spouse is entitled to have issued an individual policy offering accident and health insurance without evidence of insurability, upon application to the company and payment of the appropriate premium; and     (b) the individual policy described in Subsection (2)(a) shall:   (i) provide the coverage that is most nearly similar to the terminated coverage; and     (ii) consider a probationary or waiting period satisfied to the extent the coverage was in force under the prior policy.         (3)   (a) When an insurer receives actual notice that the coverage of a spouse is to be terminated because of a divorce, legal separation, or annulment, the insurer shall promptly provide the spouse written notification of the right to obtain individual coverage as provided in Subsection (2), the premium amounts required, and the manner, place, and time in which premiums may be paid.     (b) The premium is determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of the persons to be covered and to the type and amount of coverage provided.     (c) If a spouse applies and tenders the first monthly premium to the insurer within 30 days after the day on which the spouse receives the notice provided by this Subsection (3), the spouse shall receive individual coverage that commences immediately upon termination of coverage under the insured's policy.       (4) This section does not apply to:   (a) a blanket insurance policy offering accident and health insurance; or     (b) a health benefit plan.      Amended by Chapter 252, 2021 General Session
UT Code § 31A-22-614 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 614 - Claims under accident and health policies.

31A-22-614. Claims under accident and health policies.    (1) Section 31A-21-312 applies generally to claims under accident and health policies.     (2)   (a) Subject to Subsection (1), an accident and health insurance policy may not contain a claim notice requirement less favorable to the insured than one which requires written notice of the claim within 20 days after the occurrence or commencement of any loss covered by the policy. The policy shall specify to whom claim notices may be given.     (b) If a loss of time benefit under a policy may be paid for a period of at least two years, an insurer may require periodic notices that the insured continues to have a disability, unless the insured is legally incapacitated. The insured's delay in giving that notice does not impair the insured's or beneficiary's right to any indemnity which would otherwise have accrued during the six months preceding the date on which that notice is actually given.       (3) An accident and health insurance policy may not contain a time limit on proof of loss which is more restrictive to the insured than a provision requiring written proof of loss, delivered to the insurer, within the following time:   (a) for a claim where periodic payments are contingent upon continuing loss, within 90 days after the termination of the period for which the insurer is liable; or     (b) for any other claim, within 90 days after the date of the loss.       (4)   (a)   (i) Section 31A-26-301 applies generally to the payment of claims.     (ii) Indemnity for loss of life is paid in accordance with the beneficiary designation effective at the time of payment. If no valid beneficiary designation exists, the indemnity is paid to the insured's estate. Any other accrued indemnities unpaid at the insured's death are paid to the insured's estate.       (b) Reasonable facility of payment clauses, specified by the commissioner by rule or in approving the policy form, are permitted. Payment made in good faith and in accordance with those clauses discharges the insurer's obligation to pay those claims.     (c) All or a portion of any indemnities provided under an accident and health policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering the services.      Amended by Chapter 366, 2011 General Session
UT Code § 31A-22-614.7 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 614.7 - Uniform claims processing -- Electronic exchange of prescription drug pre-authorization.

 Effective 5/9/2017  31A-22-614.7. Uniform claims processing -- Electronic exchange of prescription drug pre-authorization.  The commissioner shall consult with national and state organizations involved with the standardized exchange of health data, and the electronic exchange of health data, to study and review:   (1) the process of prior authorization of prescription drugs; and     (2) the standards for the use and electronic exchange of a uniform prescription drug prior authorization form that meet federal mandatory minimum standards and follow the adoption of national requirements for transaction and data elements in the federal Health Insurance Portability and Accountability Act.    Amended by Chapter 18, 2017 General Session
UT Code § 31A-22-618 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 618 - Nondiscrimination among health care professionals.

 Effective 5/14/2019  31A-22-618. Nondiscrimination among health care professionals.    (1) Except as provided under Section 31A-45-303 and Subsection (2), and except as to insurers licensed under Chapter 8, Health Maintenance Organizations and Limited Health Plans, no insurer may unfairly discriminate against any licensed class of health care providers by structuring contract exclusions which exclude payment of benefits for the treatment of any illness, injury, or condition by any licensed class of health care providers when the treatment is within the scope of the licensee's practice and the illness, injury, or condition falls within the coverage of the contract. Upon the written request of an insured alleging an insurer has violated this section, the commissioner shall hold a hearing to determine if the violation exists. The commissioner may consolidate two or more related alleged violations into a single hearing.     (2) Coverage for licensed providers for behavioral analysis may be limited by an insurer in accordance with Section 58-61-714. Nothing in this section prohibits an insurer from electing to provide coverage for other licensed professionals whose scope of practice includes behavior analysis.    Amended by Chapter 136, 2019 General Session
UT Code § 31A-22-618.5 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 618.5 - Coverage of insurance mandates imposed after January 1, 2009.

 Effective 1/1/2018  31A-22-618.5. Coverage of insurance mandates imposed after January 1, 2009.    (1) The purpose of this section is to increase the range of health benefit plans available in the small group, small employer group, large group, and individual insurance markets.     (2) A health maintenance organization that is subject to Chapter 8, Health Maintenance Organizations and Limited Health Plans:   (a) shall offer to potential purchasers at least one health benefit plan that is subject to the requirements of Chapter 8, Health Maintenance Organizations and Limited Health Plans; and     (b) may offer to a potential purchaser one or more health benefit plans that:   (i) are not subject to one or more of the following:   (A) the limitations on insured indemnity benefits in Subsection 31A-8-105(4);     (B) except as provided in Subsection (2)(b)(ii), basic health care services as defined in Section 31A-8-101; or     (C) coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that the insurer offers one plan under Subsection (2)(a) that covers the mandate enacted after January 1, 2009; and       (ii) when offering a health plan under this section, provide coverage for an emergency medical condition as required by Section 31A-22-627.         (3) An insurer that offers a health benefit plan that is not subject to Chapter 8, Health Maintenance Organizations and Limited Health Plans:   (a) may offer a health benefit plan that is not subject to Section 31A-22-618 and Subsection 31A-45-303(3)(b)(iii);     (b) when offering a health plan under this Subsection (3), shall provide coverage of emergency care services as required by Section 31A-22-627; and     (c) is not subject to coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that an insurer offers one plan that covers a mandate enacted after January 1, 2009.       (4) Section 31A-8-106 does not prohibit the offer of a health benefit plan under Subsection (2)(b).     (5)   (a) Any difference in price between a health benefit plan offered under Subsections (2)(a) and (b) shall be based on actuarially sound data.     (b) Any difference in price between a health benefit plan offered under Subsection (3)(a) shall be based on actuarially sound data.       (6) Nothing in this section limits the number of health benefit plans that an insurer may offer.    Amended by Chapter 292, 2017 General Session
UT Code § 31A-22-618.8 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 618.8 - Discontinuance and nonrenewal limitations for health benefit plans.

 Effective 5/5/2021  31A-22-618.8. Discontinuance and nonrenewal limitations for health benefit plans.    (1) Subject to Section 31A-4-115, an insurer that elects to discontinue offering a health benefit plan under Subsections 31A-22-618.6(5)(e) and 31A-22-618.7(3)(e) is prohibited from writing new business:   (a) in the market in this state for which the insurer discontinues or does not renew; and     (b) for a period of five years beginning on the day on which the last coverage that is discontinued.       (2) If an insurer is doing business in one established geographic service area of the state, Sections 31A-22-618.6 and 31A-22-618.7 apply only to the insurer's operations in that service area.     (3) The commissioner may, by rule or order, define the scope of service area.    Amended by Chapter 252, 2021 General Session
UT Code § 31A-22-619 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 619 - Coordination of benefits.

31A-22-619. Coordination of benefits.    (1) The commissioner shall:   (a) adopt rules concerning the coordination of benefits between accident and health insurance policies;     (b) publish a coordination of benefits guide;     (c) post the coordination of benefits guide on the state insurance exchange; and     (d) work with the Health Data Authority, health care provider groups, and with state and national organizations that are developing uniform standards for the electronic exchange of health insurance claims to develop standardized language regarding coordination of benefits for the purpose of including the standardized language in an insurer's explanation of benefits.       (2) Rules adopted by the commissioner under Subsection (1):   (a) may not prohibit coordination of benefits with individual accident and health insurance policies;     (b) shall apply equally to all accident and health insurance policies without regard to whether the policies are group or individual policies; and     (c) shall include standardized language regarding the coordination of benefits process that shall be included in each insurer's accident and health insurance policy.      Amended by Chapter 285, 2010 General Session
UT Code § 31A-22-623 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 623 - Coverage of inborn metabolic errors.

31A-22-623. Coverage of inborn metabolic errors.    (1) As used in this section:   (a) "Dietary products" means medical food or a low protein modified food product that:   (i) is specifically formulated to treat inborn errors of amino acid or urea cycle metabolism;     (ii) is not a natural food that is naturally low in protein; and     (iii) is used under the direction of a physician.       (b) "Inborn errors of amino acid or urea cycle metabolism" means a disease caused by an inherited abnormality of body chemistry which is treatable by the dietary restriction of one or more amino acid.       (2) The commissioner shall establish, by rule, minimum standards of coverage for dietary products used for the treatment of inborn errors of amino acid or urea cycle metabolism at levels consistent with the major medical benefit provided under an accident and health insurance policy.    Amended by Chapter 116, 2001 General Session
UT Code § 31A-22-624 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 624 - Primary care physician or physician assistant.

 Effective 5/14/2019  31A-22-624. Primary care physician or physician assistant.  An accident and health insurance policy that requires an insured to select a primary care physician to receive optimum coverage:  (1) shall permit an insured to select a participating provider who:   (a) is an:   (i) obstetrician;     (ii) gynecologist;     (iii) pediatrician; or     (iv) physician assistant who works with a physician:   (A) providing primary care; or     (B) described in Subsections (1)(a)(i), (ii), or (iii); and         (b) is qualified and willing to provide primary care services, as defined by the health care plan, as the insured's provider from whom primary care services are received;       (2) shall clearly state in literature explaining the policy the option available to insureds under Subsection (1); and     (3) may not impose a higher premium, higher copayment requirement, or any other additional expense on an insured because the insured selected a primary care physician in accordance with Subsection (1).    Amended by Chapter 349, 2019 General Session