reglab/statecodes huggingface dataset:
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 18 - Judges' Noncontributory Retirement Act › Part 5 - Death Benefit › Section 501 - Death benefit for members before retirement -- Computation.

Effective 5/10/2016
49-18-501.
Death benefit for members before retirement -- Computation.
(1) Upon the receipt of acceptable proof of death of a member before the member's retirement date, the member's surviving spouse shall have the choice of the following death benefits:
(a) a refund of the member's member contributions, if any, plus 65% of the member's most recent 12 months' compensation prior to death; or
(b) an allowance equal to 65% of the allowance computed in accordance with Section 49-18-402, but disregarding early retirement reductions.
(2) If there is no surviving spouse, member contributions shall be refunded to a beneficiary, in accordance with Sections 49-11-609 and 49-11-610.
(3)
(a) A surviving spouse who requests a benefit under this section shall apply in writing to the office.
(b) The allowance shall begin on the first day of the month:
(i) following the month in which the member died, if the application is received by the office within 90 days of the member's death; or
(ii) following the month in which the application is received by the office, if the application is received by the office more than 90 days after the member's death.
Amended by Chapter 84, 2016 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 18 - Judges' Noncontributory Retirement Act › Part 5 - Death Benefit › Section 502 - Benefits payable upon death of retired member.

Effective 5/10/2016
49-18-502.
Benefits payable upon death of retired member.
(1) The death benefit payable to a retiree's surviving spouse is an allowance equal to 65% of the allowance which was being paid to the retiree at the time of death.
(2)
(a) Notwithstanding the amount of the allowance under Subsection (1), at the time of retirement, a retiree may elect to increase the spousal death benefit up to 75% of an allowance computed in accordance with Section 49-18-402.
(b) If an election is made under Subsection (2)(a), the member's allowance shall be reduced to an amount payable monthly for life to reflect the actuarial equivalent necessary to pay for the increased spousal death benefit above 65%.
(3)
(a) A surviving spouse who qualifies for a monthly benefit under this section shall apply in writing to the office.
(b) The allowance shall begin on the first day of the month following the month in which the:
(i) member or participant died, if the application is received by the office within 90 days of the date of death of the member or participant; or
(ii) application is received by the office, if the application is received by the office more than 90 days after the date of death of the member or participant.
Amended by Chapter 84, 2016 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 18 - Judges' Noncontributory Retirement Act › Part 5 - Death Benefit › Section 503 - Surviving spouse includes certain former spouses -- Benefit calculation for former spouse.

Effective 5/10/2016
49-18-503.
Surviving spouse includes certain former spouses -- Benefit calculation for former spouse.
(1) The benefit calculation for a surviving spouse with a valid domestic relations order benefits on file with the office before the member's death date in accordance with Section 49-11-612 is calculated according to the manner in which the court order specified benefits to be partitioned, whether as a fixed amount or as a percentage of the benefit.
(2) If the death benefits under this section are partitioned among more than one surviving spouse due to domestic relations order benefits on file with the office before the member's death date in accordance with Section 49-11-612, the total amount received by the surviving spouses may not exceed the death benefits normally provided to one surviving spouse under this section.
Enacted by Chapter 84, 2016 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 18 - Judges' Noncontributory Retirement Act › Part 7 - Early Retirement Incentive › Section 701 - Judges' mandatory retirement age.

49-18-701.
Judges' mandatory retirement age.
(1) Except as provided in Subsection (2), a judge shall retire upon attaining the age of 75 years.
(2) A judge serving on July 1, 1996, who is 75 years of age or older on July 1, 1996, or who attains 75 years of age prior to the judge's next retention election may not be a candidate in that retention election and shall retire on or before December 31 of the year in which the judge would have been subject to a retention election.
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 1 - General Provisions › Section 101 - Title.

49-19-101.
Title.
This chapter is known as the "Utah Governors' and Legislators' Retirement Act."
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 1 - General Provisions › Section 102 - Definitions.

49-19-102.
Definitions.
As used in this chapter:
(1) "Governor" includes former governors.
(2) "Legislator" includes former legislators.
(3) "Plan" means the Utah Governors' and Legislators' Retirement Plan created under this chapter.
Enacted by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 1 - General Provisions › Section 103 - Creation of plan.

49-19-103.
Creation of plan.
There is created for Utah governors and legislators the "Utah Governors' and Legislators' Retirement Plan."
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 1 - General Provisions › Section 104 - Creation of trust fund.

49-19-104.
Creation of trust fund.
(1) There is created the "Utah Governors' and Legislators' Retirement Trust Fund" for the purpose of paying the benefits and costs of administering this plan.
(2) The fund shall consist of all money paid into it, including interest, in accordance with this chapter, whether in the form of cash, securities, or other assets, and of all money received from any other source.
(3) Custody, management, and investment of the fund shall be governed by Chapter 11, Utah State Retirement Systems Administration.
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 2 - Membership Eligibility › Section 201 - Plan participation -- Eligibility.

Effective 3/3/2014
49-19-201.
Plan participation -- Eligibility.
(1) A governor or legislator is eligible for service credit in this plan during their term of service in their elected position if the governor or legislator:
(a) entered office before July 1, 2011; or
(b) accrued service credit in a Tier I system or plan administered by the board before July 1, 2011.
(2) A governor or legislator initially entering office on or after July 1, 2011, who does not have service credit accrued before July 1, 2011, in a Tier I system or plan administered by the board:
(a) may not participate in this system;
(b) is only eligible to participate in the Tier II Defined Contribution Plan established under Chapter 22, Part 4, Tier II Defined Contribution Plan; and
(c) is not eligible to participate in the Tier II hybrid retirement system established under Chapter 22, Part 3, Tier II Hybrid Retirement System.
Amended by Chapter 15, 2014 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 3 - Contribution › Section 301 - Contribution rate -- Annual legislative appropriation.

49-19-301.
Contribution rate -- Annual legislative appropriation.
(1) The Legislature, by means of annual appropriations, shall maintain this plan on a financially and actuarially sound basis.
(2) The Legislature shall cause the appropriate amount to be paid to the office.
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 4 - Defined Benefit › Section 401 - Eligibility for an allowance -- Governor -- Legislator.

Effective 3/3/2014
49-19-401.
Eligibility for an allowance -- Governor -- Legislator.
(1) A governor is qualified to receive an allowance when:
(a) the governor has submitted to the office a retirement application form that states the proposed retirement date; and
(b) one of the following conditions is met as of the retirement date:
(i) the governor has completed at least one full term in office and has attained an age of 65 years; or
(ii) the governor has served as governor of the state for at least 10 years and has attained an age of 62 years.
(2) A legislator is qualified to receive an allowance when:
(a) the legislator has submitted to the office a retirement application form that states the proposed retirement date; and
(b) one of the following conditions is met as of the retirement date:
(i) the legislator has completed at least four years in the Legislature and has attained an age of 65 years; or
(ii) the legislator has completed at least 10 years in the Legislature and has attained an age of 62 years.
(3)
(a) The retirement date shall be the 1st or the 16th day of the month as selected by the member.
(b) The retirement date may not be more than 90 days before or after the date the application is received by the office.
(4) A member who withdraws member contributions shall forfeit all allowances based on those contributions.
(5) If a retired legislator is elected to another term in the Legislature or continues to serve in the Legislature, the legislative allowance ceases at the beginning of each session under rules established by the board, but is restored at the same amount at the end of the session.
(6) A member receiving an allowance while serving as a legislator is eligible for additional service credits and allowance adjustments at the end of each term of office if the legislator continues as a contributing member during the member's service as a legislator.
Amended by Chapter 15, 2014 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 4 - Defined Benefit › Section 402 - Calculation of allowance -- Reduction for early retirement.

49-19-402.
Calculation of allowance -- Reduction for early retirement.
(1)
(a) The base retirement amount for a governor under this plan is $500 per term, adjusted as provided in Section 49-19-404 since 1973.
(b) A governor's allowance shall be calculated by multiplying the base retirement amount at the retirement date by the number of terms the governor served, including fractions of terms.
(2)
(a) The base retirement amount for a legislator under this plan is $10 per year of service in the Legislature, adjusted as provided in Section 49-19-404, since 1967.
(b) A legislator's allowance shall be calculated by multiplying the base retirement amount at the retirement date by the number of years the legislator served, including fractions of years.
(3) If a governor or legislator retires prior to age 65, the allowance shall be reduced by 3% for each year of retirement between age 62 and age 65.
Amended by Chapter 118, 2004 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 4 - Defined Benefit › Section 403 - Retirement option.

Effective 7/1/2020
49-19-403.
Retirement option.
(1) A governor or legislator may elect to forfeit the allowance provided by this chapter and in lieu thereof participate, on the same basis as other state elected and appointed officers under Title 67, Chapter 22, State Officer Compensation, in a defined contribution plan administered by the office, in accordance with Section 49-11-801 and in accordance with federal law.
(2) A governor's or legislator's exclusion, exemption, participation, or election described in this section:
(a) shall be made in accordance with this section; and
(b) is subject to requirements under federal law and rules made by the board.
Amended by Chapter 24, 2020 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 4 - Defined Benefit › Section 404 - Annual cost-of-living adjustment.

49-19-404.
Annual cost-of-living adjustment.
(1) The office shall make an annual cost-of-living adjustment to:
(a) an original allowance paid under Section 49-19-402 and Part 5, Death Benefit, of this chapter if the benefit has been paid for at least one year;
(b) an original payment made to an alternate payee under a domestic relations order, if the payment is to be paid as a percentage of the allowance rather than a specific dollar amount; and
(c) the base retirement amount for governors and legislators under Section 49-19-402.
(2)
(a) The original allowance shall be increased by the annual increase in the Consumer Price Index up to a maximum of 4%.
(b) Annual increases in the Consumer Price Index in excess of 4% shall be accumulated and used in subsequent adjustments when the increase in the Consumer Price Index is less than 4%.
(3) The Consumer Price Index used in calculating adjustments shall be a United States Bureau of Labor Statistics Consumer Price Index average as determined by the board.
(4) The cost-of-living adjustment made under this section may not decrease the allowance.
Enacted by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 5 - Death Benefit › Section 501 - Death of member or retiree -- Surviving spouse benefit.

Effective 5/10/2016
49-19-501.
Death of member or retiree -- Surviving spouse benefit.
(1) Upon the death of a governor or legislator who has not yet retired and who has completed four or more years in the elected office, the member's surviving spouse shall receive an allowance equal to 50% of the allowance to which the governor or legislator would have been entitled upon reaching age 65, if the governor or legislator and surviving spouse had been married at least six months.
(2) Upon the death of a governor or legislator receiving an allowance under this plan, the member's surviving spouse is entitled to an allowance equal to 50% of the allowance being paid to the member at the time of death.
(3)
(a) A surviving spouse who requests a benefit under this section shall apply in writing to the office.
(b) The allowance shall begin on the first day of the month:
(i) following the month in which the member died, if the application is received by the office within 90 days of the member's death; or
(ii) following the month in which the application is received by the office, if the application is received by the office more than 90 days after the member's death.
Amended by Chapter 84, 2016 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 19 - Utah Governors' and Legislators' Retirement Act › Part 5 - Death Benefit › Section 502 - Surviving spouse at the time of death includes certain former spouses -- Benefit calculation for former spouse.

Effective 5/10/2016
49-19-502.
Surviving spouse at the time of death includes certain former spouses -- Benefit calculation for former spouse.
(1) The benefit calculation for a surviving spouse with a valid domestic relations order benefits on file with the office before the member's death date in accordance with Section 49-11-612 is calculated according to the manner in which the court order specified benefits to be partitioned, whether as a fixed amount or as a percentage of the benefit.
(2) If the death benefits under this section are partitioned among more than one surviving spouse due to domestic relations order benefits on file with the office before the member's death date in accordance with Section 49-11-612, the total amount received by the surviving spouses may not exceed the death benefits normally provided to one surviving spouse under this section.
Enacted by Chapter 84, 2016 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 1 - General Provisions › Section 101 - Title.

49-20-101.
Title.
This chapter is known as the "Public Employees' Benefit and Insurance Program Act."
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 1 - General Provisions › Section 102 - Definitions.

49-20-102.
Definitions.
As used in this chapter:
(1) "Covered employer" means an employer that offers employee benefit plans under this chapter to its employees and their dependents.
(2) "Covered individual" means an employee and the employee's dependents eligible for coverage under this chapter.
(3) "Employee Benefit Plans" means any group health, dental, medical, disability, life insurance, medicare supplement, conversion coverage, cafeteria, flex plans, or other program for covered individuals administered by the Public Employees' Benefit and Insurance Program.
(4) "Employer" means the state, its political subdivisions, and educational institutions.
(5) "Program" means the Public Employees' Benefit and Insurance Program.
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 1 - General Provisions › Section 103 - Creation of insurance program.

Effective 7/1/2017
49-20-103.
Creation of insurance program.
(1) There is created for the employees of the state, its educational institutions, and political subdivisions the "Public Employees' Benefit and Insurance Program" within the office.
(2) The program may also be known and function as the Public Employees' Health Program, PEHP, or PEHP Health and Benefits.
Amended by Chapter 141, 2017 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 1 - General Provisions › Section 104 - Creation of fund.

49-20-104.
Creation of fund.
(1) There is created the "Public Employees' Trust Fund" for the purpose of paying the benefits and the costs of administering this program.
(2) The fund shall consist of all money and interest paid into it in accordance with this chapter, whether in the form of cash, securities, or other assets, and of all money received from any other source.
(3) Custody, management, and investment of the fund shall be governed by Chapter 11, Utah State Retirement Systems Administration.
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 1 - General Provisions › Section 105 - Purpose -- Benefits are not a continuing obligation.

49-20-105.
Purpose -- Benefits are not a continuing obligation.
(1) The purpose of this chapter is to provide a mechanism for covered employers to provide covered individuals with group health, dental, medical, disability, life insurance, medicare supplement, conversion coverage, cafeteria, flex plan, and other programs requested by the state, its political subdivisions, or educational institutions in the most efficient and economical manner.
(2) The benefits provided to a covered individual under this chapter do not constitute a continuing obligation of the state, its political subdivisions, or educational institutions.
Amended by Chapter 406, 2012 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 2 - Membership Eligibility › Section 201 - Program participation -- Eligibility -- Optional for certain groups.

Effective 5/3/2023
49-20-201.
Program participation -- Eligibility -- Optional for certain groups.
(1)
(a) The state shall participate in the program on behalf of the state's employees.
(b) Other employers, including political subdivisions and educational institutions, are eligible, but are not required, to participate in the program on behalf of their employees.
(2)
(a) As provided in Subsection 26B-3-908(5), the Department of Health and Human Services may participate in the program for the purpose of providing health and dental benefits to children enrolled in the Utah Children's Health Insurance Program created in Title 26B, Chapter 3, Part 9, Utah Children's Health Insurance Program.
(b) If the Department of Health and Human Services participates in the program under the provisions of this Subsection (2), all insurance risk associated with the Utah Children's Health Insurance Program shall be the responsibility of the Department of Health and Human Services and not the program or the office.
(3) Volunteer emergency medical service personnel are eligible to participate in the program in accordance with Section 26B-4-136.
(4) A covered individual shall be eligible for coverage after termination of employment under rules adopted by the board.
(5) Only the following are eligible for Medicare supplement coverage under this chapter upon becoming eligible for Medicare Part A and Part B coverage:
(a) retirees;
(b) members;
(c) participants;
(d) employees who have medical employee benefit plan coverage at the time of their retirement; and
(e) current spouses of those who are eligible under Subsections (5)(a) through (d).
Amended by Chapter 328, 2023 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 2 - Membership Eligibility › Section 202 - Establishment of separate risk pools.

49-20-202.
Establishment of separate risk pools.
(1) The program shall establish separate risk pools for:
(a) state employees; and
(b) the Utah Children's Health Insurance Program.
(2) In accordance with participation standards established by the program, the following entities may elect to participate in the risk pool established under Subsection (1)(a):
(a) in accordance with Subsection (3)(b), an institution of higher education designated under Section 53B-1-102 with a total full-time equivalent enrollment of less than 18,000;
(b) an independent entity as defined in Section 63E-1-102; and
(c) a comprehensive regional college.
(3)
(a) The program shall create risk pools for other covered employers separate from those created in Subsection (1) as determined by the program.
(b)
(i) If an institution of higher education described in Subsection (2)(a) has 1,000 or more plan enrollees, the program shall establish a rate for the institution of higher education based 100% on experience; and
(ii) if the rate established under Subsection (3)(b)(i) is:
(A) less than the risk pool rate established for the state employees' risk pool, the program may include the institution of higher education in the state employees' risk pool described in Subsection (1)(a); or
(B) more than the risk pool rate established for the state employees' risk pool, the program shall create a risk pool for the institution of higher education that is separate from the state employees' risk pool under Subsection (1)(a).
Amended by Chapter 211, 2010 General Session
Amended by Chapter 318, 2010 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 3 - Premiums › Section 301 - Payments made by employer and employee.

49-20-301.
Payments made by employer and employee.
The program shall be maintained on a financially and actuarially sound basis by payments from covered employers and covered individuals.
Amended by Chapter 240, 2003 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 402 - Reserves to be held -- Refunds.

49-20-402.
Reserves to be held -- Refunds.
(1) The reserves in a risk pool in a given fiscal year shall be maintained at the level recommended by the program's consulting actuary and approved or ratified by the board. If the reserves drop below that level, covered employers in the risk pool are required to cure any deficiency in the reserve.
(2) If substantial excess reserves are accrued above those required by this chapter, and the board determines that a refund is appropriate, a refund shall be made:
(a) to covered employers which shall then make a refund to covered individuals on the basis of the contribution of each to the plan; or
(b) directly to covered individuals on the basis of the contribution of each to the plan.
Amended by Chapter 130, 2007 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 403 - Assistance to members in purchase of life, health, dental, and medical insurance after retirement -- Employment of personnel to administer section.

49-20-403.
Assistance to members in purchase of life, health, dental, and medical insurance after retirement -- Employment of personnel to administer section.
(1) The program may assist active and retired covered individuals and inactive covered individuals of the covered employers to purchase life, health, dental, and medical coverage on a group basis which can be continued after retirement under rules adopted by the board.
(2) The executive director may employ any personnel, including consultants, to administer this section.
Enacted by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 404 - Governors' and legislative paid-up group health coverage benefit -- Limitations -- Medicare supplemental coverage -- Spouse coverage -- Limitations.

49-20-404.
Governors' and legislative paid-up group health coverage benefit -- Limitations -- Medicare supplemental coverage -- Spouse coverage -- Limitations.
(1)
(a) Except as provided under Subsection (1)(b), the state shall pay the percentage of the cost of providing paid-up group health coverage under Subsection (3) for members and their surviving spouses covered under Chapter 19, Utah Governors' and Legislators' Retirement Act, or governors and legislators, as defined in Section 49-19-102, and their surviving spouses covered under Chapter 22, New Public Employees' Tier II Contributory Retirement Act, who:
(i) retire after January 1, 1998;
(ii) are at least 62 but less than 65 years of age;
(iii) elect to receive and apply for this benefit to the program; and
(iv) are active members at the time of retirement or have continued coverage with the program until the date of eligibility for the benefit under this Subsection (1).
(b) A governor or a legislator who begins service as a governor or legislator on or after January 1, 2012, and a surviving spouse of the governor or the legislator who begins service as a governor or legislator on or after January 1, 2012, is not eligible for the benefit provided under this Subsection (1).
(2) The state shall pay the percentage of the cost of providing Medicare supplemental coverage under Subsection (3) for members and their surviving spouses covered under Chapter 19, Utah Governors' and Legislators' Retirement Act who:
(a) began service as a governor or legislator before July 1, 2013;
(b) retire after January 1, 1998;
(c) are at least 65 years of age; and
(d) elect to receive and apply for this benefit to the program.
(3) The following percentages apply to the benefit described in Subsections (1)(a) and (2):
(a) 100% if the member has accrued 10 or more years of service credit;
(b) 80% if the member has accrued 8 or more years of service credit;
(c) 60% if the member has accrued 6 or more years of service credit; and
(d) 40% if the member has accrued 4 or more years of service credit.
Amended by Chapter 410, 2013 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 405 - Audit required -- Report to governor and Legislature.

49-20-405.
Audit required -- Report to governor and Legislature.
The Insurance Department shall biennially audit the Public Employees' Trust Fund and programs authorized under this chapter and report its findings to the governor and the Legislature, but the commissioner may accept the annual audited statement of the programs under this chapter in lieu of the biennial audit requirement.
Renumbered and Amended by Chapter 250, 2002 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 406 - Insurance benefits for employees' beneficiaries.

Effective 5/8/2018
49-20-406.
Insurance benefits for employees' beneficiaries.
(1) As used in this section:
(a) "Children" includes stepchildren and legally adopted children.
(b)
(i) "Line-of-duty death" means a death resulting from:
(A) external force or violence occasioned by an act of duty as an employee; or
(B) strenuous activity, including a heart attack or stroke, that occurs during strenuous training or another strenuous activity required as an act of duty as an employee.
(ii) "Line-of-duty death" does not include a death that:
(A) occurs during an activity that is required as an act of duty as an employee if the activity is not a strenuous activity, including an activity that is clerical, administrative, or of a nonmanual nature contributes to the employee's death;
(B) occurs during the commission of a crime committed by the employee;
(C) the employee's intoxication or use of alcohol or drugs, whether prescribed or nonprescribed, contributes to the employee's death; or
(D) occurs in a manner other than as described in Subsection (1)(b)(i).
(c)
(i) "Strenuous activity" means engagement involving a difficult, stressful, or vigorous fire suppression, rescue, hazardous material response, emergency medical service, physical law enforcement, prison security, disaster relief, or other emergency response activity.
(ii) "Strenuous activity" includes participating in a participating employer sanctioned and funded training exercise that involves difficult, stressful, or vigorous physical activity.
(2) The beneficiary of a covered individual who is employed by the state and who has a line-of-duty death shall receive:
(a) the proceeds of a $50,000 group term life insurance policy paid for by the state and administered and provided as part of the group life insurance program under this chapter; and
(b) group health coverage paid for by the state that covers the covered individual's:
(i) surviving spouse until becoming eligible for Medicare as long as the surviving spouse continues coverage with the program; and
(ii) unmarried children up to the age of 26.
(3) A covered employer not required to provide the benefits under Subsection (2) may provide either or both of the benefits under Subsection (2) by paying rates established by the program.
(4) The benefit provided under Subsection (2)(a) is subject to the same terms and conditions as the group life insurance program provided under this chapter.
Amended by Chapter 210, 2018 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 407 - Insurance mandates.

Effective 1/1/2018
49-20-407.
Insurance mandates.
Notwithstanding the provisions of Subsection 31A-1-103(3)(f):
(1) health coverage offered to the state employee risk pool under Subsection 49-20-202(1)(a) shall comply with the provisions of Sections 31A-22-605.5 and 31A-45-501; and
(2) a health plan offered to public school districts, charter schools, and institutions of higher education under Subsection 49-20-201(1)(b) shall comply with the provisions of Section 31A-22-605.5.
Amended by Chapter 292, 2017 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 408 - Prohibition against certain uses of Social Security numbers.

49-20-408.
Prohibition against certain uses of Social Security numbers.
Notwithstanding the provisions of Subsection 31A-1-103(3)(f), health, dental, medical, Medicare supplement, or conversion coverage offered under Section 49-20-202 shall comply with the provisions of Section 31A-22-634.
Enacted by Chapter 188, 2003 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 409 - Long-term disability -- Cost of health coverage benefit.

49-20-409.
Long-term disability -- Cost of health coverage benefit.
(1) Under the direction of the board, the program shall provide for health insurance coverage for state employees who receive a monthly disability benefit under Title 49, Chapter 21, Public Employees' Long-Term Disability Act.
(2) A risk pool, other than the state risk pool, may elect to provide a benefit for its employees similar to the benefit provided under Subsection (1).
Amended by Chapter 130, 2007 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 413 - Pilot program for on-site employee clinic.

Effective 5/12/2015
49-20-413.
Pilot program for on-site employee clinic.
(1) Within state premiums paid to the state risk pool from the Legislature, the program shall establish a primary care clinic:
(a) for state employees and their dependents;
(b) within a state building that is accessible to a large number of state employees; and
(c) in accordance with Subsection (2).
(2) The program shall:
(a) affiliate with an existing clinic:
(i) located in a building accessible to a large number of state employees; and
(ii) managed by a physician licensed in this state under Title 58, Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah Osteopathic Medical Practice Act; or
(b) request bids from private entities to establish the on-site primary care clinic in accordance with criteria established by the program, which shall include at least the following:
(i) the entity's ability to establish a primary care clinic that is designed to:
(A) be convenient for employees and their dependents;
(B) increase health of employees;
(C) increase compliance with health care screening and management of chronic health care conditions; and
(D) dispense commonly used, pre-packaged drugs in a cost effective manner;
(ii) the entity's organizational and financial independence from any particular hospital network, network of clinics, or network of health care providers; and
(iii) management of the clinic by a physician licensed in the state under Title 58, Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah Osteopathic Medical Practice Act.
Enacted by Chapter 68, 2015 General Session
Technically renumbered to avoid duplication of section number also used in SB265, Chapter 455.
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 414 - Telemedicine services -- Reimbursement -- Reporting.

Effective 5/3/2023
49-20-414.
Telemedicine services -- Reimbursement -- Reporting.
(1) As used in this section:
(a) "Network provider" means a health care provider who has an agreement with the program to provide health care services to a patient with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly from the managed care organization.
(b) "Telemedicine services" means the same as that term is defined in Section 26B-4-704.
(2) This section applies to the risk pool established for the state under Subsection 49-20-201(1)(a).
(3) The program shall, at the provider's request, reimburse a network provider for medically appropriate telemedicine services at a commercially reasonable rate.
(4) Before November 1, 2019, the program shall report to the Legislature's Public Utilities, Energy, and Technology Interim Committee and Health Reform Task Force on:
(a) the result of the reimbursement requirement described in Subsection (3);
(b) existing and potential uses of telehealth and telemedicine services;
(c) issues of reimbursement to a provider offering telehealth and telemedicine services;
(d) potential rules or legislation related to:
(i) providers offering and insurers reimbursing for telehealth and telemedicine services; and
(ii) increasing access to health care, increasing the efficiency of health care, and decreasing the costs of health care; and
(e) telemedicine services that the program declined to cover because the telemedicine services that were requested were not medically appropriate.
Amended by Chapter 328, 2023 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 415 - Prescribing policies for certain opioid prescriptions.

Effective 5/9/2017
49-20-415.
Prescribing policies for certain opioid prescriptions.
A plan offered to state employees under this chapter may implement a prescribing policy for certain opioid prescriptions in accordance with Section 31A-22-615.5.
Enacted by Chapter 53, 2017 General Session
Technically renumbered to avoid duplication of section number also enacted in HB154, Chapter 241.
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 416 - Screening, Brief Intervention, and Referral to Treatment program reimbursement.

Effective 5/9/2017
49-20-416.
Screening, Brief Intervention, and Referral to Treatment program reimbursement.
(1) As used in this section:
(a) "Controlled substance prescriber" means a controlled substance prescriber, as that term is defined in Section 58-37-6.5, who:
(i) has a record of having completed SBIRT training, in accordance with Subsection 58-37-6.5(2), before providing the SBIRT services; and
(ii) is a program enrolled controlled substance prescriber.
(b) "SBIRT" means the same as that term is defined in Section 58-37-6.5.
(2) The health program offered to the state employee risk pool under Section 49-20-202 shall reimburse a controlled substance prescriber who provides SBIRT services to a covered individual who is 13 years of age or older for the SBIRT services.
Enacted by Chapter 180, 2017 General Session
Technically renumbered to avoid duplication of section number also enacted in HB154, Chapter 241.
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 419 - Coverage of exome sequence testing.

Effective 5/14/2019
49-20-419.
Coverage of exome sequence testing.
(1) As used in this section, "exome sequence testing" means a genomic technique for sequencing the genome of an individual for diagnostic purposes.
(2) Beginning July 1, 2019, the program shall provide coverage for exome sequence testing:
(a) for a covered individual within the state risk pool who:
(i) is younger than 21 years of age; and
(ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related tests;
(b) performed by a nationally recognized provider with significant experience in exome sequence testing;
(c) that is medically necessary; and
(d) at a rate set by the program.
Enacted by Chapter 320, 2019 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 420 - Coverage for in vitro fertilization and genetic testing.

Affected by 63I-2-249 on 1/1/2030
Effective 5/12/2020
49-20-420.
Coverage for in vitro fertilization and genetic testing.
(1) As used in this section:
(a) "Qualified condition" means:
(i) cystic fibrosis;
(ii) spinal muscular atrophy;
(iii) Morquio Syndrome;
(iv) myotonic dystrophy; or
(v) sickle cell anemia.
(b) "Qualified individual" means a covered individual who:
(i) has been diagnosed by a physician as having a genetic trait associated with a qualified condition; and
(ii) intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the covered individual.
(2) For a plan year that begins on or after July 1, 2020, the program shall provide coverage for a qualified individual for:
(a) in vitro fertilization services; and
(b) genetic testing of a qualified individual who receives in vitro fertilization services under Subsection (2)(a).
(3) Before November 1, 2022, and before November 1 of every third year thereafter, the program shall:
(a) calculate the change in state spending attributable to the coverage under this section; and
(b) report the amount described in Subsection (3)(a) to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee.
Enacted by Chapter 187, 2020 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 421 - Prescription discount program.

Effective 5/3/2023
49-20-421.
Prescription discount program.
(1) As used in this section:
(a) "Discount program" means the prescription discount program created by this section.
(b) "Epinephrine auto-injector" means the same as that term is defined in Section 26B-4-401.
(c) "Insulin" means a prescription drug that contains insulin.
(d) "Participant" means a resident of Utah who:
(i) has a prescription or standing prescription for a qualified prescription;
(ii) does not receive health coverage under the program; and
(iii) enrolls in the discount program.
(e) "Prescription drug" means the same as that term is defined in Section 58-17b-102.
(f) "Qualified prescription" means a prescription drug, including insulin and epinephrine auto-injectors, that the program has determined:
(i) treats a serious, prevalent, and ongoing condition;
(ii) does not have a generic substitute;
(iii) qualifies for a substantial rebate; and
(iv) would not result in financial losses to the state risk pool if sold as part of the discount program.
(g) "Rebate" means the same as that term is defined in Section 31A-46-102.
(2) The program shall create a prescription discount program for a participant to purchase a qualified prescription at a discounted, post-rebate price.
(3) The program shall:
(a) provide a participant with a card or electronic document that identifies the participant as eligible for the discount on a qualified prescription;
(b) provide a participant with information about pharmacies that will honor the discount; and
(c) provide a participant with instructions to pursue a reimbursement of the purchase price from the participant's health insurer.
(4) The program may not retain any amount of a rebate for a qualified prescription except for an amount necessary to make the state risk pool whole for providing the qualified prescription to participants.
(5) For each drug added to the discount program, the program shall notify the Health and Human Services Interim Committee, providing:
(a) the name of the drug; and
(b) the primary condition the drug treats.
Amended by Chapter 267, 2023 General Session
Amended by Chapter 328, 2023 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 422 - Coverage of pregnancy and childbirth services, including doula, direct- entry midwife, and birthing center services.

Affected by 63I-2-249 on 7/1/2027
Effective 5/3/2023
49-20-422.
Coverage of pregnancy and childbirth services, including doula, direct- entry midwife, and birthing center services.
(1) As used in this section:
(a) "Doula" means an individual who:
(i) provides information and physical and emotional support:
(A) to a pregnant or postpartum individual; and
(B) related to the pregnant or postpartum individual's pregnancy; and
(ii) is certified by one or more organizations approved by the program.
(b) "Pregnancy and childbirth services" means services provided to a pregnant individual before, during, or shortly after childbirth:
(i) by a doula for the services described in Subsections (1)(a)(i) and (ii); and
(ii) at a birthing center that:
(A) is licensed under Title 26B, Chapter 2, Licensing and Certifications, or accredited by the Commission for the Accreditation of Birth Centers; and
(B) may include services by a direct-entry midwife licensed under Title 58, Chapter 77, Direct-Entry Midwife Act, if the direct-entry midwife is engaged in the practice of direct-entry midwifery, as defined in Section 58-77-102.
(c) "Qualified individual" means a covered individual who is:
(i) within the state employees' risk pool; and
(ii)
(A) is pregnant; or
(B) was pregnant within the past six months.
(2) For a plan year that begins on or after July 1, 2023, and before July 1, 2026, the program shall cover pregnancy and childbirth services to a qualified individual.
(3) The program may establish limits for coverage under Subsection (2), including limits based on:
(a) the type or number of services provided;
(b) a qualified individual's physical or emotional condition; and
(c) conditions for provider participation.
(4) The program shall report to the Health and Human Services Interim Committee on or before October 1 of each year regarding coverage provided under Subsection (2), including:
(a) covered providers;
(b) covered services;
(c) provider payment rates;
(d) covered-individual cost sharing;
(e) total provider payments and covered-individual cost sharing; and
(f) any indicators of whether pregnancy and childbirth services covered under Subsection (2) have:
(i) reduced pregnancy or postpartum coverage costs; or
(ii) improved pregnancy or postpartum care.
Enacted by Chapter 292, 2023 General Session
2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 5 - Pharmacy Benefits Manager Act › Section 502 - Definitions.

Effective 5/5/2021
49-20-502.
Definitions.
As used in this part:
(1) "Health benefit plan" means:
(a) a health benefit plan as defined in Section 31A-1-301; or
(b) a health, dental, medical, Medicare supplement, or conversion program offered under Title 49, Chapter 20, Public Employees' Benefit and Insurance Program Act.
(2) "Pharmacist" is as defined in Section 58-17b-102.
(3) "Pharmacy" is as defined in Section 58-17b-102.
(4) "Pharmacy benefits management service" means the same as that term is defined in Section 31A-46-102.
(5) "Pharmacy benefits manager" means a person that provides a pharmacy benefits management service to the program.
(6) "Pharmacy service" means a product, good, or service provided by a pharmacy or pharmacist to an individual.
Amended by Chapter 340, 2021 General Session