reglab/statecodes huggingface dataset:
2023 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
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 6 - Accident and Health Insurance › Section 636 - Standardized health insurance information cards.

Effective 5/3/2023
31A-22-636.
Standardized health insurance information 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.
(3) The health benefit plan information 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 and Human Services, the Health Data Authority, health care providers groups, and with state and national organizations that develop uniform standards for the electronic exchange of health insurance claims or uniform standards for the electronic exchange of clinical health records.
(b) The commissioner may make rules in accordance with 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 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection, shall work together to implement the adoption of card swipe technology.
Amended by Chapter 328, 2023 General Session
2023 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
2023 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
2023 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
2023 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.
2023 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
2023 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 5/3/2023
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 Health and Human Services, under Title 26B, Chapter 2, Part 1, Human Services Programs and Facilities; or
(ii) the Department of Health and Human Services; 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.
Amended by Chapter 328, 2023 General Session
2023 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.
2023 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
2023 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 5/3/2023
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 26B-4-704.
(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 328, 2023 General Session
2023 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 5/3/2023
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 26B-5-301.
(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 26B-5-351.
Amended by Chapter 328, 2023 General Session
2023 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
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 6 - Accident and Health Insurance › Section 654 - Study of coverage for in vitro fertilization and genetic testing -- Reporting -- Coverage requirements.

Effective 5/5/2021
31A-22-654.
Study of coverage for in vitro fertilization and genetic testing -- Reporting -- Coverage requirements.
(1) As used in this section:
(a) "Qualified condition" means the same as that term is defined in Section 49-20-420.
(b) "Qualified insurer" means an insurer that provides a health benefit plan as defined in Section 31A-1-301 to more than 25,000 enrollees in the state as of December 31 of the preceding reporting year.
(c) "Qualified enrollee" means an enrollee of a qualified insurer 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 enrollee.
(2)
(a) A qualified insurer shall submit the information described in this Subsection (2) to the department for a plan year beginning:
(i) on or after January 1, 2022, but before December 31, 2022; and
(ii) on or after January 1, 2025, but before December 31, 2025.
(b) A qualified insurer shall study whether providing the coverage for the services described in Subsections (3)(a) and (b) for qualified enrollees will result in cost savings for the qualified insurer.
(c)
(i) If a qualified insurer determines that providing the coverage described in Subsection (3) for qualified enrollees will result in cost savings for the qualified insurer, the qualified insurer shall submit a summary of the results of the study described in Subsection (2)(b), and:
(A) describe how the qualified insurer intends to provide the coverage described in Subsection (3); or
(B) submit an explanation of why the insurer will not provide the coverage described in Subsection (3).
(ii) If a qualified insurer determines that providing the coverage described in Subsection (3) will not result in cost savings to the qualified insurer, the qualified insurer shall submit a summary of the results of the study described in Subsection (2)(b).
(d) A qualified insurer shall provide the information required under this Subsection (2) to the department no later than:
(i) January 1, 2022, for a plan year beginning on or after January 1, 2022, but before December 31, 2022; and
(ii) January 1, 2025, for a plan year beginning on or after January 1, 2025, but before December 31, 2025.
(3) A qualified insurer shall consider coverage for:
(a) in vitro fertilization services for a qualified enrollee; and
(b) genetic testing of a qualified enrollee who received in vitro fertilization services under Subsection (3)(a).
(4) The department shall report the information received under Subsection (2) to the Health and Human Services Interim Committee on or before:
(a) for information submitted under Subsection (2)(a)(i), November 1, 2022; and
(b) for information submitted under Subsection (2)(a)(ii), November 1, 2025.
Amended by Chapter 252, 2021 General Session
2023 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.
2023 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
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 6 - Accident and Health Insurance › Section 657 - Application of health insurance mandates.

Effective 5/3/2023
31A-22-657.
Application of health insurance mandates.
(1) As used in this section:
(a) "Cost-sharing mandate" means a statutory requirement limiting a cost-sharing requirement.
(b) "Cost-sharing requirement" means a copayment, coinsurance, or deductible required by or on behalf of an enrollee in order to receive a benefit under a qualified high-deductible health plan.
(c) "Health savings account" means the same as that term is defined in 26 U.S.C. Sec. 223(d)(1).
(d) "Qualified high-deductible health plan" means a high-deductible health plan as defined in 26 U.S.C. Sec. 223(c)(2)(A) that is used in conjunction with a health savings account.
(2)
(a) Except as provided in Subsection (2)(b), if under federal law, a cost-sharing mandate would result in an enrollee becoming ineligible for a health savings account, the cost-sharing mandate applies only to the enrollee's qualified high-deductible health plan after the enrollee satisfies the enrollee's health plan deductible.
(b) Subsection (2)(a) does not apply to an item or service that is preventive care under 26 U.S.C. Sec. 223(c)(2)(C).
Amended by Chapter 139, 2023 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 6 - Accident and Health Insurance › Section 659 - Provider administered drugs.

Effective 5/3/2023
31A-22-659.
Provider administered drugs.
(1) As used in this section:
(a) "Clinician-administered drug" means an outpatient prescription drug as defined in Section 58-17b-102 that:
(i) cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the patient with self-administration;
(ii) is typically administered:
(A) by a health care provider; and
(B) in a physician's office or a health care facility as defined in Section 26B-2-201; and
(iii) is not a vaccine.
(b) "Health insurer" means a person who offers health care insurance, including a health maintenance organization as defined in Section 31A-8-101.
(2) A health insurer may not require a pharmacy to dispense a clinician-administered drug directly to an enrollee with the intention that the enrollee will transport the drug to a health care provider for administering.
Enacted by Chapter 323, 2023 General Session
Technically renumbered to avoid duplication of newly enacted Chapter also in HB 78, Chapter 449.
2023 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
2023 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
2023 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
2023 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
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 7 - Group Accident and Health Insurance › Section 725 - Special enrollment periods relating to Medicaid and Children's Health Insurance Program.

31A-22-725.
Special enrollment periods relating to Medicaid and Children's Health Insurance Program.
(1) A person is eligible to enroll for coverage under the terms of an employer's group health benefit plan if:
(a) the person is:
(i) an employee who is eligible, but not enrolled, for coverage under the terms of the employer's group health benefit plan; or
(ii) a dependent of an employee, if the dependent is eligible, but not enrolled, for coverage under the terms of the employer's group health benefit plan; and
(b) the conditions of either Subsection (2) or (3) are met.
(2) Subsection (1) applies if:
(a) the employee or dependent is covered under:
(i) a Medicaid health benefit plan under Title XIX of the Social Security Act; or
(ii) a state child health benefit plan under Title XXI of the Social Security Act;
(b) coverage of the employee or dependent described in Subsection (2)(a) is terminated as a result of loss of eligibility for the coverage; and
(c) the employee requests coverage under the employer's group health plan no later than 60 days after the date of termination of the coverage described in Subsection (2)(a).
(3) Subsection (1) applies if:
(a) the employee or dependent becomes eligible for assistance, with respect to coverage under the employer's group health plan under a plan described in Subsection (2)(a), including under a waiver or demonstration project conducted under or in relation to a plan described in Subsection (2)(a); and
(b) the employee requests coverage under the employer's group health plan no later than 60 days after the date the employee or dependent is determined to be eligible for the assistance described in Subsection (3)(a).
Enacted by Chapter 10, 2010 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 7 - Group Accident and Health Insurance › Section 726 - Abortion coverage restriction in health benefit plan and on health insurance exchange.

Effective 5/14/2019
31A-22-726.
Abortion coverage restriction in health benefit plan and on health insurance exchange.
(1) As used in this section, "permitted abortion coverage" means coverage for abortion:
(a) that is necessary to avert:
(i) the death of the woman on whom the abortion is performed; or
(ii) a serious risk of substantial and irreversible impairment of a major bodily function of the woman on whom the abortion is performed;
(b) of a fetus that has a defect that is documented by a physician or physicians to be uniformly diagnosable and uniformly lethal; or
(c) where the woman is pregnant as a result of:
(i) rape, as described in Section 76-5-402;
(ii) rape of a child, as described in Section 76-5-402.1; or
(iii) incest, as described in Subsection 76-5-406(2)(j) or Section 76-7-102.
(2) A person may not offer coverage for an abortion in a health benefit plan, unless the coverage is a type of permitted abortion coverage.
(3) A person may not offer a health benefit plan that provides coverage for an abortion in a health insurance exchange created under the federal Patient Protection and Affordable Care Act, 111 P.L. 148, unless the coverage is a type of permitted abortion coverage.
Amended by Chapter 189, 2019 General Session
Amended by Chapter 193, 2019 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 7 - Group Accident and Health Insurance › Section 727 - Renewal, cancellation, and modification.

Effective 5/4/2022
31A-22-727.
Renewal, cancellation, and modification.
(1) Except as provided in Section 31A-22-618.6, for a group insurance policy offering accident and health insurance or a blanket insurance policy offering accident and health insurance, an insurer may:
(a) decline to renew the policy on the date the policy term expires for a reason stated in the policy; or
(b) cancel the policy at any time for:
(i) nonpayment of a premium when due;
(ii) intentional misrepresentation of a material fact in connection with the coverage;
(iii) performance of an act or practice that constitutes fraud in connection with the coverage; or
(iv) noncompliance with an employer eligibility provision.
(2) Except for a modification required by law, an insurer may only modify a policy at renewal.
(3) Subsection (2) does not apply to an endorsement by which the insurer:
(a) effectuates a request the policyholder made in writing; or
(b) exercises a specifically reserved right under the policy.
Enacted by Chapter 198, 2022 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 8 - Credit Life and Accident and Health Insurance › Section 801 - Scope of part.

Effective 5/9/2017
31A-22-801.
Scope of part.
(1) Except as provided under Subsection (2), all life insurance and accident and health insurance in connection with loans or other credit transactions are subject to this part.
(2)
(a) Insurance written in connection with a credit transaction is not subject to this part, but is subject to other provisions of this title, if the credit transaction is:
(i) secured by a first mortgage or deed of trust; and
(ii) made to finance the purchase of real property or the construction of a dwelling thereon, or to refinance a prior credit transaction made for such a purpose.
(b) Isolated transactions on the part of an insurer that are not related to an agreement or plan for insuring debtors of the creditor are not subject to this part.
Amended by Chapter 168, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 8 - Credit Life and Accident and Health Insurance › Section 802 - Definitions.

31A-22-802.
Definitions.
As used in this part:
(1) "Credit accident and health insurance" means insurance on a debtor to provide indemnity for payments coming due on a specific loan or other credit transaction while the debtor has a disability.
(2) "Credit life insurance" means life insurance on the life of a debtor in connection with a specific loan or credit transaction.
(3) "Credit transaction" means any transaction under which the payment for money loaned or for goods, services, or properties sold or leased is to be made on future dates.
(4) "Creditor" means the lender of money or the vendor or lessor of goods, services, or property, for which payment is arranged through a credit transaction, or any successor to the right, title, or interest of any lender or vendor.
(5) "Debtor" means a borrower of money or a purchaser, including a lessee under a lease intended as security, of goods, services, or property, for which payment is arranged through a credit transaction.
(6) "Indebtedness" means the total amount payable by a debtor to a creditor in connection with a credit transaction, including principal finance charges and interest.
(7) "Net indebtedness" means the total amount required to liquidate the indebtedness, exclusive of any unearned interest, any insurance on the monthly outstanding balance coverage, or any finance charge.
(8) "Net written premiums" means gross written premiums minus refunds on termination.
Amended by Chapter 366, 2011 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 8 - Credit Life and Accident and Health Insurance › Section 803 - Forms of insurance permitted.

31A-22-803.
Forms of insurance permitted.
Credit life insurance and credit accident and health insurance may be issued only in the following forms:
(1) individual policies of term life insurance issued to debtors;
(2) individual policies of term accident and health insurance issued to debtors, or accident and health benefit provisions in individual policies of credit life insurance;
(3) group policies of term life insurance issued to creditors, providing insurance upon the lives of debtors;
(4) group policies of term accident and health insurance issued to creditors insuring debtors, or accident and health benefit provisions in group credit life insurance policies.
Amended by Chapter 116, 2001 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 8 - Credit Life and Accident and Health Insurance › Section 804 - Limitations on amounts of insurance.

31A-22-804.
Limitations on amounts of insurance.
(1) Except as provided under Subsection (2), the initial amount of credit life insurance on the life of any one debtor may not exceed the total amount repayable under the contract of indebtedness. Where an indebtedness is repayable in substantially equal periodic installments, the amount of insurance may not exceed the scheduled or actual amount of unpaid indebtedness, whichever is greater.
(2) Subsection (1) does not apply to:
(a) insurance on agricultural credit transaction commitments not exceeding the commitment period, which may be written for the amount of the commitment on a nondecreasing or level term plan;
(b) insurance on educational credit transaction commitments, which may be written to include the portion of the commitment that has not been advanced by the creditor;
(c) insurance on preauthorized lines of credit not exceeding the commitment period which may be written for the preauthorized amount on a nondecreasing or level term plan, whether secured or unsecured; and
(d) insurance on any other class of lawful credit transaction or commitment, which in the commissioner's opinion does not require the application of the restrictions under Subsection (1), in which case the commissioner may authorize by rule a class exception to Subsection (1).
(3) The total amount of indemnity payable by credit accident and health insurance in the event of disability, as defined in the policy, may not exceed the aggregate of the periodic scheduled unpaid installments of the indebtedness. The amount of each periodic indemnity payment may not exceed the total amount repayable under the contract of indebtedness divided by the number of periodic installments.
Amended by Chapter 116, 2001 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 8 - Credit Life and Accident and Health Insurance › Section 805 - Beginning date of insurance.

31A-22-805.
Beginning date of insurance.
(1) Except as provided under Subsection (2), any credit life insurance or credit accident and health insurance, subject to acceptance by the insurer, commences on the date when the debtor becomes obligated to the creditor.
(2)
(a) Where a group policy provides coverage for existing obligations, the insurance on a debtor with respect to that indebtedness commences on the effective date of the policy.
(b) Where evidence of insurability is required and the evidence is furnished more than 30 days after the debtor becomes obligated to the creditor, the insurance may commence when the insurance company determines the evidence of insurability to be satisfactory. In this event, the insurer shall make an appropriate refund or adjustment of any charge to the debtor for insurance.
(3) The insurance may not extend more than 15 days beyond the scheduled maturity date of the indebtedness, unless it does so at no additional cost to the debtor.
(4) If the indebtedness is discharged due to renewal or refinancing prior to the scheduled maturity date, the insurance in force shall terminate before any new insurance may be issued in connection with the renewed or refinanced indebtedness. In all cases of termination prior to scheduled maturity, a refund shall be paid or credited as provided in Section 31A-22-808.
Amended by Chapter 116, 2001 General Session