reglab/housing_qa huggingface dataset:
UT Code § 31A-22-641 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 641 - Cancer treatment parity.

31A-22-641. Cancer treatment parity.    (1) For purposes of this section:   (a) "Cost sharing" means the enrollee's maximum out-of-pocket costs as defined by the health benefit plan.     (b) "Health insurer" is as defined in Subsection 31A-22-634(1).     (c) "Intravenously administered chemotherapy" means a physician-prescribed cancer treatment that is used to kill or slow the growth of cancer cells, that is administered through injection directly into the patient's circulatory system by a physician, physician assistant, nurse practitioner, nurse, or other medical personnel under the supervision of a physician, and in a hospital, medical office, or other clinical setting.     (d) "Oral chemotherapy" means a United States Food and Drug Administration-approved, physician-prescribed cancer treatment that is used to kill or slow the growth of cancer cells, that is taken orally in the form of a tablet or capsule, and may be administered in a hospital, medical office, or other clinical setting or may be delivered to the patient for self-administration under the direction or supervision of a physician outside of a hospital, medical office, or other clinical setting.       (2) This section applies to health benefit plans renewed or entered into on or after October 1, 2013.     (3) A health benefit plan that covers prescribed oral chemotherapy and intravenously administered chemotherapy shall:   (a) except as provided in Subsection (3)(b), ensure that the cost sharing applied to the covered oral chemotherapy is no more restrictive than the cost sharing applied to the covered intravenously administered chemotherapy; or     (b) if the cost sharing for oral chemotherapy is more restrictive than the cost sharing for intravenous chemotherapy, the health benefit plan may not apply cost sharing for the oral chemotherapy that exceeds $300 per filled prescription.       (4)   (a) A health insurer shall not increase the cost sharing for intravenously administered chemotherapy for the purpose of achieving compliance with this section.     (b) The commissioner may adopt administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to enforce the provisions of this section.      Enacted by Chapter 164, 2013 General Session
UT Code § 31A-22-643 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 643 - Prescription synchronization -- Copay and dispensing fee restrictions.

 Effective 5/13/2014  31A-22-643. Prescription synchronization -- Copay and dispensing fee restrictions.    (1) For purposes of this section:   (a) "Copay" means the copay normally charged for a prescription drug.     (b) "Health insurer" means an insurer, as defined in Subsection 31A-22-634(1).     (c) "Network pharmacy" means a pharmacy included in a health insurance plan's network of pharmacy providers.     (d) "Prescription drug" means a prescription drug, as defined in Section 58-17b-102, that is prescribed for a chronic condition.       (2) A health insurance plan may not charge an amount in excess of the copay for the dispensing of a prescription drug in a quantity less than the prescribed amount if:   (a) the pharmacy dispenses the prescription drug in accordance with the health insurer's synchronization policy; and     (b) the prescription drug is dispensed by a network pharmacy.       (3) A health insurance plan that includes a prescription drug benefit:   (a) shall implement a synchronization policy for the dispensing of prescription drugs to the plan's enrollees; and     (b) may not base the dispensing fee for an individual prescription on the quantity of the prescription drug dispensed to fill or refill the prescription unless otherwise agreed to by the plan and the contracted pharmacy at the time the individual requests synchronization.       (4) This section applies to health benefit plans renewed or entered into on or after January 1, 2015.    Enacted by Chapter 111, 2014 General Session  Technically renumbered to avoid duplication of section number used in SB57, Chapter 379.
UT Code § 31A-22-644 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 644 - Denial of coverage under a health benefit plan because of life expectancy or terminal condition.

 Effective 5/12/2015  31A-22-644. Denial of coverage under a health benefit plan because of life expectancy or terminal condition.    (1) As used in this section:   (a) "Health benefit plan" means the same as that term is defined in Section 31A-1-301.     (b) "Terminal condition" means an irreversible condition:   (i) caused by disease, illness, or injury; and     (ii) if:   (A) the irreversible condition will result in imminent death within a six-month period after the date the condition is diagnosed; and     (B) the application of life-sustaining treatment only prolongs the process of dying.           (2) This section applies to a health benefit plan under:   (a) this part; or     (b)Chapter 8, Health Maintenance Organizations and Limited Health Plans.       (3) Except as provided by law, and subject to the other provisions of this section, a health benefit plan may not deny coverage for medically necessary treatment if the medically necessary treatment is:   (a) prescribed by a physician;     (b) agreed to:   (i) by a person who is:   (A) insured under the health benefit plan; and     (B) fully informed regarding the person's life expectancy or diagnosis with a terminal condition; or       (ii) if the person described in Subsection (3)(b)(i) lacks legal capacity to consent, by another person who:   (A) has legal authority to consent on behalf of the person described in Subsection (3)(b)(i); and     (B) is fully informed regarding the life expectancy or diagnosis with a terminal condition of the person described in Subsection (3)(b)(i); and         (c) denied solely because:   (i) of the life expectancy of the person described in Subsection (3)(b)(i); or     (ii) the person has been diagnosed with a terminal condition.         (4) A denial of coverage described in Subsection (3) for medically necessary treatment is a violation of this section.     (5) Whether treatment is considered to be medically necessary treatment is determined by the defined standards and policies of the health benefit plan.     (6) This section may not be interpreted to:   (a) require an insurer to offer a particular benefit or service as part of a health benefit plan; or     (b) alter the clinical policies of a health benefit plan regarding the appropriate location for services.       (7) This section does not create a new or additional private right of action.    Enacted by Chapter 375, 2015 General Session
UT Code § 31A-22-645 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 645 - Alcohol and drug dependency treatment.

 Effective 5/9/2017  31A-22-645. Alcohol and drug dependency treatment.    (1) An insurer offering a health benefit plan providing coverage for alcohol or drug dependency treatment may require an inpatient facility to be licensed by:   (a)   (i) the Department of Human Services, under Title 62A, Chapter 2, Licensure of Programs and Facilities; or     (ii) the Department of Health; or       (b) for an inpatient facility located outside the state, a state agency similar to one described in Subsection (1)(a).       (2) For inpatient coverage provided pursuant to Subsection (1), an insurer may require an inpatient facility to be accredited by the following:   (a) the Joint Commission; and     (b) one other nationally recognized accrediting agency.      Enacted by Chapter 168, 2017 General Session
UT Code § 31A-22-646 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 646 - Dental insurance -- Contract provision for noncovered services.

 Effective 5/9/2017  31A-22-646. Dental insurance -- Contract provision for noncovered services.    (1) For purposes of this section:   (a) "Covered services" means dental services for which reimbursement:   (i) is available or would be reimbursable under an enrollee's dental plan but for the application of one or more of the following contractual provisions:   (A) deductibles;     (B) copayments;     (C) coinsurance;     (D) waiting periods;     (E) annual or lifetime maximums;     (F) frequency limitations; or     (G) alternative benefit payments; and       (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.       (b) "Dental plan"means:   (i) a health benefit plan that includes coverage for dental services; and     (ii) a policy or certificate that provides coverage solely for dental services.       (c) "Dentist" means an individual licensed under Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act.       (2)   (a) This section applies to:   (i) a dental plan that is entered into or renewed on or after January 1, 2018; and     (ii) an administrator providing third-party administration services or a provider network for a dental plan.       (b) This section does not apply to a self-insured dental plan that is regulated by federal law.       (3) A contract between a dental plan and a dentist to provide covered services may not:   (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:   (i) the dental services are covered services under the dental plan; or     (ii)   (A) the dental services are not reimbursed by the dental plan;     (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and     (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and          (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the noncovered services.      Enacted by Chapter 101, 2017 General Session  Technically renumbered to avoid duplication of section number also enacted in HB42, Chapter 168.
UT Code § 31A-22-647 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 647 - Insurer shared savings program.

 Effective 5/8/2018  31A-22-647. Insurer shared savings program.    (1) As used in this section:   (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.     (b) "PEHP" means the Public Employees' Benefit and Insurance Program created in Section 49-20-103.     (c) "Savings reward program" means a program to reward a health insurance enrollee if the enrollee receives services:   (i) covered by the enrollee's health plan; and     (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:   (a) offered by the insurer; and     (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:   (a) offered to state employees under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act; and     (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:   (a) premium discounts;     (b) rebates;     (c) reduction of out-of-pocket costs; or     (d) other rewards or incentives developed by the insurer.      Enacted by Chapter 181, 2018 General Session
UT Code § 31A-22-649.5 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 649.5 - Insurance parity for telemedicine services -- Method of technology used.

 Effective 3/22/2021  31A-22-649.5. Insurance parity for telemedicine services -- Method of technology used.    (1) As used in this section:   (a) "Mental health condition" means a mental disorder or a substance-related disorder that falls under a diagnostic category listed in the Diagnostic and Statistical Manual, as periodically revised.     (b) "Telemedicine services" means the same as that term is defined in Section 26-60-102.       (2) Notwithstanding the provisions of Section 31A-22-618.5, a health benefit plan offered in the individual market, the small group market, or the large group market shall:   (a) provide coverage for:   (i) telemedicine services that are covered by Medicare; and     (ii) treatment of a mental health condition through telemedicine services if:   (A) the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and     (B) the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and         (b) reimburse a network provider that provides the telemedicine services described in Subsection (2)(a) at a negotiated commercially reasonable rate.       (3)   (a) Notwithstanding Section 31A-45-303, a health benefit plan providing coverage under Subsection (2)(a) may not impose originating site restrictions, geographic restrictions, or distance-based restrictions.     (b) A network provider that provides the telemedicine services described in Subsection (2)(a) may utilize any synchronous audiovisual technology for the telemedicine services that is compliant with the federal Health Insurance Portability and Accountability Act of 1996.      Amended by Chapter 19, 2021 General SessionAmended by Chapter 404, 2021 General SessionAmended by Chapter 404, 2021 General Session, (Coordination Clause)Amended by Chapter 448, 2020 General Session, (Coordination Clause)
UT Code § 31A-22-651 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 651 - Insurance coverage for assisted outpatient treatment.

 Effective 5/14/2019  31A-22-651. Insurance coverage for assisted outpatient treatment.    (1) As used in this section, "assisted outpatient treatment" means the same as that term is defined in Section 62A-15-602.     (2) A health insurance provider may not deny an insured the benefits of the insured's policy solely because the health care that the insured receives is provided under a court order for assisted outpatient treatment, as provided in Section 62A-15-630.5.    Enacted by Chapter 256, 2019 General Session  Technically renumbered to avoid duplication of section number used in SB 264, Chapter 439
UT Code § 31A-22-652 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 652 - Coverage for mental health services in schools.

 Effective 5/14/2019  31A-22-652. Coverage for mental health services in schools.    (1) As used in this section, "local education agency" means:   (a) a school district;     (b) a charter school; or     (c) the Utah Schools for the Deaf and the Blind.       (2) A health benefit plan that is entered into or renewed on or after January 1, 2020, may not deny a claim for a covered mental health service solely because the mental health service is provided:   (a) at a local education agency building or facility; or     (b) by an employee or contractor of a local education agency.       (3) Nothing in this section:   (a) prohibits a health benefit plan from denying a claim:   (i) by an individual that is not a licensed health care provider;     (ii) by a health care provider practicing outside the health care provider's scope of practice;     (iii) that is submitted by a person that is not a network provider;     (iv) for a mental health service that is not medically necessary as determined by the health benefit plan; or     (v) that does not otherwise comply with the health benefit plan's policies; or       (b) requires a health benefit plan to pay a claim for a service that is:   (i) provided under an individualized education program as defined in Section 53E-4-301; or     (ii) administrative in nature to the local education agency.        Enacted by Chapter 172, 2019 General Session  Technically renumbered to avoid duplication of section number used in SB 264, Chapter 439
UT Code § 31A-22-655 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 655 - Living organ donor coverage.

 Effective 5/12/2020  31A-22-655. Living organ donor coverage.    (1) For the purposes of this section, "living organ donor" means an individual who has donated all or part of an organ and is not deceased.     (2) An insurer may not:   (a) deny eligibility for coverage or limit coverage of a individual under an accident and health insurance policy or contract solely due to the status of the individual as a living organ donor;     (b) preclude an individual from donating all or part of an organ as a condition of receiving or continuing to receive coverage under an accident and health insurance policy or contract; or     (c) discriminate in the offering, issuance, cancellation, amount of coverage, price, or any other condition of an accident and health insurance policy or contract for an individual based upon the status of the individual as a living organ donor without any additional actuarial risk.       (3) The commissioner shall make educational materials available to insurers and the public on the access of living organ donors to insurance.     (4) The commissioner may make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement the provisions of this section.    Enacted by Chapter 128, 2020 General Session  Technically renumbered to avoid duplication of section number also enacted in SB155, Chapter 382 and HB214, Chapter 187.
UT Code § 31A-22-656 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 656 - Coverage of epinephrine auto-injector.

 Effective 7/1/2021  31A-22-656. Coverage of epinephrine auto-injector.  A health benefit plan entered into or renewed on or after July 1, 2021, that provides coverage of an epinephrine auto-injector is not required to reimburse a participant, as that term is defined in Section 49-20-421, for an epinephrine auto-injector the participant obtains through the discount program described in Section 49-20-421. Enacted by Chapter 255, 2021 General Session
UT Code § 31A-22-702 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 7 - Group Accident and Health Insurance|Section 702 - Adjustment of premium rate and application of dividends or rate reductions.

31A-22-702. Adjustment of premium rate and application of dividends or rate reductions.  Any group accident and health insurance policy may provide for the adjustment of the rate of premium based upon the experience under the contract. If a policy dividend is declared or a reduction in rate is made or continued for the first or any subsequent year of insurance under any policy of group accident and health insurance, the excess, if any, of the aggregate dividends or rate reductions under the policy and all other group insurance policies of the policyholder over the aggregate expenditure for insurance under those policies made from funds contributed by the policyholder, including expenditures made in connection with the administration of the policies, shall be applied by the policyholder for the sole benefit of insured employees or members unless the insured employee or member explicitly elects otherwise.  Amended by Chapter 116, 2001 General Session
UT Code § 31A-22-716 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 7 - Group Accident and Health Insurance|Section 716 - Required provision for notice of termination.

 Effective 5/5/2021  31A-22-716. Required provision for notice of termination.    (1) A group insurance policy offering accident and health insurance or a blanket insurance policy offering accident and health insurance shall include a provision that obligates the policyholder:   (a) to give written notice of termination to each employee or group member 30 days before the day on which the policy terminates; and     (b) to notify each employee or group member of the employee's or group member's rights to continue coverage upon termination.       (2)   (a) An insurer's monthly notice to the policyholder of premium payments due shall include a statement of the policyholder's obligations as set forth in Subsection (1).     (b) Insurers shall provide a sample notice to the policyholder at least once a year.      Amended by Chapter 252, 2021 General Session
UT Code § 31A-22-717 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 7 - Group Accident and Health Insurance|Section 717 - Provisions pertaining to service members and their families affected by mobilization into the armed forces.

 Effective 5/5/2021  31A-22-717. Provisions pertaining to service members and their families affected by mobilization into the armed forces.  For a group insurance policy offering accident and health insurance or a blanket insurance policy offering accident and health insurance, an insurer:  (1) may not refuse to reinstate an insured or the insured's family whose coverage lapsed due to the insured's mobilization into the United States armed forces provided application is made within 180 days after the day on which the insured is released from active duty;     (2) shall reinstate an insured in full upon payment of the first premium without the requirement of a waiting period or exclusion for preexisting conditions or any other underwriting requirements that were covered previously; and     (3) may not increase the insured's premium in excess of what the premium would have been increased to in the normal course of time had the insured not been mobilized into the United States armed forces.    Amended by Chapter 252, 2021 General Session
UT Code § 31A-22-719 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 7 - Group Accident and Health Insurance|Section 719 - Mastectomy coverage.

31A-22-719. Mastectomy coverage.    (1) A group policy subject to Section 31A-22-630 may not deny a person's eligibility or continued eligibility to enroll or renew coverage under the terms of the group policy plan solely for the purpose of avoiding the requirements of this section or Section 31A-22-630.     (2) A group policy subject to Section 31A-22-630 may not do any of the following to induce a provider to provide care to an insured in a manner inconsistent with this section or Section 31A-22-630:   (a) penalize or otherwise reduce or limit the reimbursement of an attending provider; or     (b) provide incentives to an attending provider whether or not the incentives are monetary.      Enacted by Chapter 114, 2000 General Session