reglab/housing_qa huggingface dataset:
UT Code § 31A-22-626.5 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 626.5 - Affordable insulin study.

 Effective 7/1/2020  31A-22-626.5. Affordable insulin study.    (1) As used in this section, "insulin" means a prescription drug that contains insulin.     (2) The department shall obtain funding through grants to fund a study on insulin costs.     (3) If the department obtains the funding described in Subsection (2), the department shall, on or before October 30, 2020, complete a study on the cost of insulin manufacturing and factors that determine the price of insulin.     (4) The department shall use public, readily available data accessible to the department to conduct the study described in Subsection (3).     (5) The study described in Subsection (3) shall investigate:   (a) current and historical trend information about the wholesale acquisition cost of insulin;     (b) the cost to produce insulin;     (c) explanations for increases in insulin costs;     (d) expenditures of drug manufacturers in marketing insulin;     (e) manufacturers' net profits from insulin;     (f) the portion of drug manufacturers' total net profits that is composed of insulin net profits;     (g) financial assistance currently available to individuals who use insulin through patient prescription assistance programs;     (h) value to individuals who use insulin benefits including:   (i) coupons provided directly to individuals who use insulin; and     (ii) programs to assist individuals who use insulin in paying co-payments and coinsurance;       (i) costs to drug manufacturers of the programs described in Subsection (5)(h);     (j) total value of benefits manufacturers provide in the form of rebates for insulin to health plans or pharmacy benefit managers in Utah; and     (k) additional information that the department determines will aid the Legislature in developing policy to reduce insulin prices in Utah.       (6)   (a) On or before October 30, 2020, the department shall submit a final report on the study described in Subsection (3) to the Health and Human Services Interim Committee and the Business and Labor Interim Committee.     (b) The department's report may include recommendations on legislation for:   (i) increased drug pricing transparency; and     (ii) programs that would meaningfully reduce the cost of insulin.       (c) The final report shall include references to all sources of information and data used in the report and study, except the department may not disclose information that is proprietary or protected under state law or federal law or regulation.      Amended by Chapter 4, 2020 Special Session 5
UT Code § 31A-22-627 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 627 - Coverage of emergency medical services.

 Effective 5/5/2021  31A-22-627. Coverage of emergency medical services.    (1) A health insurance policy or managed care organization contract:   (a) shall provide coverage of emergency services; and     (b) may not:   (i) require any form of preauthorization for treatment of an emergency medical condition until after the insured's condition has been stabilized;     (ii) deny a claim for any covered evaluation, covered diagnostic test, or other covered treatment considered medically necessary to stabilize the emergency medical condition of an insured; or     (iii) impose any cost-sharing requirement for out-of-network that exceeds the cost-sharing requirement imposed for in-network.         (2)   (a) A health insurance policy or managed care organization contract may require authorization for the continued treatment of an emergency medical condition after the insured's condition has been stabilized.     (b) If authorization described in Subsection (2)(a) is required, an insurer who does not accept or reject a request for authorization may not deny a claim for any evaluation, diagnostic testing, or other treatment considered medically necessary that occurred between the time the request was received and the time the insurer rejected the request for authorization.       (3) For purposes of this section:   (a) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson, who possesses an average knowledge of medicine and health, would reasonably expect the absence of immediate medical attention through a hospital emergency department to result in:   (i) placing the insured's health, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy;     (ii) serious impairment to bodily functions; or     (iii) serious dysfunction of any bodily organ or part.       (b) "Hospital emergency department" means that area of a hospital in which emergency services are provided on a 24-hour-a-day basis.     (c) "Stabilize" means the same as that term is defined in 42 U.S.C. Sec. 1395dd(e)(3).       (4) Nothing in this section may be construed as:   (a) altering the level or type of benefits that are provided under the terms of a contract or policy; or     (b) restricting a policy or contract from providing enhanced benefits for certain emergency medical conditions that are identified in the policy or contract.       (5) Notwithstanding Section 31A-2-308, if the commissioner finds an insurer has violated this section, the commissioner may:   (a) work with the insurer to improve the insurer's compliance with this section; or     (b) impose the following fines:   (i) not more than $5,000; or     (ii) twice the amount of any profit gained from violations of this section.         Amended by Chapter 252, 2021 General Session
UT Code § 31A-22-628 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 628 - Standing referral to a specialist.

 Effective 5/9/2017  31A-22-628. Standing referral to a specialist.    (1) With respect to a health insurance policy or managed care organization contract that does not allow an insured to have direct access to a health care specialist, the insurer shall establish and implement a procedure by which an insured may obtain a standing referral to a health care specialist.     (2) The procedure established under Subsection (1):   (a) shall provide for a standing referral to a specialist if the insured's primary care provider determines, in consultation with the specialist, that the insured needs continuing care from the specialist; and     (b) may require the insurer's approval of a treatment plan designed by the specialist, in consultation with the primary care provider and the insured, which may include:   (i) a limit on the number of visits to the specialist;     (ii) a time limit on the duration of the referral; and     (iii) mandatory updates on the insured's condition.        Amended by Chapter 292, 2017 General Session
UT Code § 31A-22-630 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 630 - Mastectomy coverage.

31A-22-630. Mastectomy coverage.    (1) If an insured has coverage that provides medical and surgical benefits with respect to a mastectomy, it shall provide coverage, with consultation of the attending physician and the patient, for:   (a) reconstruction of the breast on which the mastectomy has been performed;     (b) surgery and reconstruction of the breast on which the mastectomy was not performed to produce symmetrical appearance; and     (c) prostheses and physical complications with regards to all stages of mastectomy, including lymphedemas.       (2)   (a) This section does not prevent an accident and health insurer from imposing cost-sharing measures for health benefits relating to this coverage, if cost-sharing measures are not greater than those imposed on any other medical condition.     (b) For purposes of this Subsection (2), cost-sharing measures include imposing a deductible or coinsurance requirement.       (3) Written notice of the availability of the coverage described in Subsection (1) shall be delivered to the participant:   (a) upon enrollment; and     (b) annually after the enrollment.      Amended by Chapter 116, 2001 General Session
UT Code § 31A-22-631 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 631 - Policy summary or illustration.

31A-22-631. Policy summary or illustration.    (1)   (a) Except as provided in Subsection (1)(b), at the time a life insurance policy is delivered, a policy summary or illustration shall be delivered for the life insurance policy if:   (i) the life insurance policy includes riders or supplemental benefits, including accelerated benefits; and     (ii) receipt of benefits under the life insurance policy is contingent upon morbidity requirements.       (b) In the case of a direct response solicitation, the insurer shall deliver the policy summary or illustration at the sooner of:   (i) the applicant's request; or     (ii) at the time of policy delivery regardless of whether the applicant requests a policy summary or illustration.         (2) In addition to complying with all applicable requirements, the policy summary or illustration shall include:   (a) a clear and prominent disclosure of how the rider or supplemental benefit interacts with other components of the policy, including deductions from death benefits and policy values;     (b) an illustration for each covered person of:   (i) the amount of benefits;     (ii) the length of benefits; and     (iii) the guaranteed lifetime benefits, if any;       (c) a disclosure of the maximum premiums for the rider or supplemental benefit;     (d) any exclusions, reductions, or limitations on the benefits of the rider or supplemental benefit; and     (e) if applicable to the policy type:   (i) a disclosure of the effects of exercising other rights under the policy; and     (ii) guaranteed maximum lifetime benefits.        Enacted by Chapter 116, 2001 General Session
UT Code § 31A-22-632 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 632 - Report to policy holder.

31A-22-632. Report to policy holder.    (1) An insurer shall provide the policyholder a monthly report if an accident and health rider or supplemental benefit is:   (a) funded through a life insurance vehicle by acceleration of the death benefit; and     (b) in benefit payment status.       (2) The report required by Subsection (1) shall include:   (a) any rider or supplemental benefits paid out during the month;     (b) an explanation of any changes in the policy due to rider or supplemental benefits being paid out such as:   (i) death benefits; or     (ii) cash values; and       (c) the amount of the rider or supplemental benefits existing or remaining.      Enacted by Chapter 116, 2001 General Session
UT Code § 31A-22-633 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 633 - Exemptions from standards.

31A-22-633. Exemptions from standards.  Notwithstanding the provisions of Title 31A, Insurance Code, any accident and health insurer or health maintenance organization may offer a choice of coverage that is less or different than is otherwise required by applicable state law if:  (1) the Department of Health offers a choice of coverage as part of a Medicaid waiver under Title 26, Chapter 18, Medical Assistance Act, which includes:   (a) less or different coverage than the basic coverage;     (b) less or different coverage than is otherwise required in an insurance policy or health maintenance organization contract under applicable state law; or     (c) less or different coverage than required by Subsection 31A-22-605(4)(b); and       (2) the choice of coverage offered by the carrier:   (a) is the same or similar coverage as the coverage offered by the Department of Health under Subsection (1);     (b) is offered to the same or similar population as the coverage offered by the Department of Health under Subsection (1); and     (c) contains an explanation for each insured of coverage exclusions and limitations.      Amended by Chapter 167, 2013 General Session
UT Code § 31A-22-634 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 634 - Prohibition against certain use of Social Security number -- Exceptions -- Applicability of section.

31A-22-634. Prohibition against certain use of Social Security number -- Exceptions -- Applicability of section.    (1) As used in this section:   (a) "Insurer" means:   (i) insurers governed by this part as described in Section 31A-22-600, and includes:   (A) a health maintenance organization; and     (B) a third-party administrator that is subject to this title; and       (ii) notwithstanding Subsection 31A-1-103(3)(f) and Section 31A-22-600, a health, dental, medical, Medicare supplement, or conversion program offered under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act.       (b) "Publicly display" or "publicly post" means to intentionally communicate or otherwise make available to the general public.       (2) An insurer or its subcontractors, including a pharmacy benefit manager, may not do any of the following:   (a) publicly display or publicly post in any manner an individual's Social Security number; or     (b) print an individual's Social Security number on any card required for the individual to access products or services provided or covered by the insurer.       (3) This section does not prevent the collection, use, or release of a Social Security number as required by state or federal law, or the use of a Social Security number for internal verification or administrative purposes, or the release of a Social Security number to a health care provider for claims administration purposes, or as part of the verification, eligibility, or payment process.     (4) If a federal law takes effect requiring the United States Department of Health and Human Services to establish a national unique patient health identifier program, an insurer that complies with the federal law shall be considered in compliance with this section.     (5) An insurer shall comply with the provisions of this section by July 1, 2004.     (6)   (a) An insurer may obtain an extension for compliance with the requirements of this section in accordance with Subsections (6)(b) and (c).     (b) The request for extension:   (i) shall be submitted in writing to the department prior to July 1, 2004; and     (ii) shall provide an explanation as to why the insurer cannot comply with the requirements of this section by July 1, 2004.       (c) The commissioner shall grant a request for extension:   (i) for a period of time not to exceed March 1, 2005; and     (ii) if the commissioner finds that the explanation provided under Subsection (6)(b)(ii) is a reasonable explanation.        Amended by Chapter 297, 2011 General Session
UT Code § 31A-22-635 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 635 - Uniform application -- Uniform waiver of coverage.

 Effective 1/1/2018  31A-22-635. Uniform application -- Uniform waiver of coverage.    (1) For purposes of this section, "insurer":   (a) is defined in Subsection 31A-22-634(1); and     (b) includes the state employee's risk pool under Section 49-20-202.       (2)   (a) Insurers offering a health benefit plan to an individual or small employer shall use a uniform application form.     (b) The uniform application form:   (i) may not include questions about an applicant's health history; and     (ii) shall be shortened and simplified in accordance with rules adopted by the commissioner.       (c) Insurers offering a health benefit plan to a small employer shall use a uniform waiver of coverage form, which may not include health status related questions, and is limited to:   (i) information that identifies the employee;     (ii) proof of the employee's insurance coverage; and     (iii) a statement that the employee declines coverage with a particular employer group.         (3) Notwithstanding the requirements of Subsection (2)(a), the uniform application and uniform waiver of coverage forms may, if the combination or modification is approved by the commissioner, be combined or modified to facilitate a more efficient and consumer friendly experience for insurers using electronic applications.     (4)   (a) The uniform application form, and uniform waiver form, shall be adopted and approved by the commissioner in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.     (b) The commissioner shall regulate the fees charged by insurers to an enrollee for a uniform application form or electronic submission of the application forms.      Amended by Chapter 292, 2017 General Session
UT Code § 31A-22-636 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 636 - Standardized health benefit plan cards.

31A-22-636. Standardized health benefit plan cards.    (1) As used in this section, "insurer" means:   (a) an insurer governed by this part as described in Section 31A-22-600;     (b) a health maintenance organization governed by Chapter 8, Health Maintenance Organizations and Limited Health Plans;     (c) a third party administrator; and     (d) notwithstanding Subsection 31A-1-103(3)(f) and Section 31A-22-600, a health, medical, or conversion policy offered under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act.       (2) In accordance with Subsection (3), an insurer shall use and issue a health benefit plan information card for the insurer's enrollees upon the purchase or renewal of, or enrollment in, a health benefit plan on or after July 1, 2010.     (3) The health benefit plan card shall include:   (a) the covered person's name;     (b) the name of the carrier and the carrier network name;     (c) the contact information for the carrier or health benefit plan administrator;     (d) general information regarding copayments and deductibles; and     (e) an indication of whether the health benefit plan is regulated by the state.       (4)   (a) The commissioner shall work with the Department of Health, the Health Data Authority, health care providers groups, and with state and national organizations that are developing uniform standards for the electronic exchange of health insurance claims or uniform standards for the electronic exchange of clinical health records.     (b) When the commissioner determines that the groups described in Subsection (4)(a) have reached a consensus regarding the electronic technology and standards necessary to electronically exchange insurance enrollment and coverage information, the commissioner shall begin the rulemaking process under Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to adopt standardized electronic interchange technology.     (c) After rules are adopted under Subsection (4)(a), health care providers and their licensing boards under Title 58, Occupations and Professions, and health facilities licensed under Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act, shall work together to implement the adoption of card swipe technology.      Amended by Chapter 297, 2011 General Session
UT Code § 31A-22-637 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 637 - Health care provider payment information -- Notice of admissions.

31A-22-637. Health care provider payment information -- Notice of admissions.    (1) For purposes of this section, "insurer" is as defined in Section 31A-22-636.     (2)   (a) An insurer shall provide its health care providers who are under contract with the insurer access to current information necessary for the health care provider to determine:   (i) the effect of procedure codes on payment or compensation before a claim is submitted for a procedure;     (ii) the plans and carrier networks that the health care provider is subject to as part of the contract with the carrier; and     (iii) in accordance with Subsection 31A-26-301.6(10)(f), the specific rate and terms under which the provider will be paid for health care services.       (b) The information required by Subsection (2)(a) may be provided through a website, and if requested by the health care provider, notice of the updated website shall be provided by the carrier.       (3)   (a) An insurer may not require a health care provider by contract, reimbursement procedure, or otherwise to notify the insurer of a hospital in-patient emergency admission within a period of time that is less than one business day of the hospital in-patient admission, if compliance with the notification requirement would result in notification by the health care provider on a weekend or federal holiday.     (b) Subsection (3)(a) does not prohibit the applicability or administration of other contract provisions between an insurer and a health care provider that require pre-authorization for scheduled in-patient admissions.      Amended by Chapter 297, 2011 General Session
UT Code § 31A-22-639 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 639 - Statement of preauthorization.

31A-22-639. Statement of preauthorization.    (1) An insurer who requires preauthorization or preapproval for coverage under accident and health insurance shall, beginning January 1, 2011, provide an enrollee with a statement of preauthorization if:   (a) the applicable CPT codes have been submitted to the insurer to determine whether a particular procedure is covered under the terms of the accident and health insurance policy;     (b) the enrollee has met the requirements for preauthorization of the procedure or encounter; and     (c) the enrollee requests a statement of preauthorization.       (2) A statement of preauthorization under Subsection (1) may be sent:   (a) by mail; or     (b) electronically.       (3) A statement of preauthorization shall include a statement that the preauthorization is:   (a) not a guarantee of payment by an insurer; and     (b) subject to the policy and contract provisions of the accident and health insurance contract.      Enacted by Chapter 204, 2010 General Session