Title 33, Title 33

(1) Each group and individual disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for: (a) all stages of reconstruction of the breast on which a mastectomy h…

(1) Any insurer, health service corporation, or health maintenance organization issuing group disability coverage to the spouse or dependents of a peace officer as defined in 45-2-101, a game warden as defined in 19-8-101, a firefighter as defined in 19-13-104, or a volunteer fir…

(1) Each group or individual health insurance policy, certificate of insurance, and membership contract that covers prescription drugs and that is delivered, issued for delivery, renewed, extended, or modified in this state must provide that after the applicable deductible is met…

(1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider …

(1) Health insurance coverage sold in the group or individual market in this state must provide coverage for diagnosis and treatment of Down syndrome for a covered child 18 years of age or younger. (2) Coverage under this section must include: (a) habilitative or rehabilitative c…

As used in this chapter, unless the context requires otherwise, the following definitions apply: (1) "Beneficiary" has the meaning given the term by 29 U.S.C. 1002(33). (2) "Church plan" has the meaning given the term by 29 U.S.C. 1002(33). (3) "COBRA continuation provision" mean…

(1) (a) A period of creditable coverage may not be counted, with respect to enrollment of an individual under a group health plan, if there was a 63-day break in coverage. (b) The 63-day period provided for in subsection (1)(a) must be counted from the date that the certificate o…

(1) (a) A group health plan and a health insurance issuer offering group or individual health insurance coverage shall issue the certification described in subsection (3) within 10 days after a request by an individual who ceases to be covered under the group or individual health…

The commissioner may adopt rules to implement 33-22-140 through 33-22-142, 33-22-246, 33-22-247, 33-22-514, and 33-22-523 through 33-22-526.

(Effective October 1, 2026) Reciprocity in gender transition treatment coverage required. (1) A group or individual insurance policy that includes coverage for gender transition treatment or subsequent treatment directly related to the provision of gender transition treatment mus…

(1) Except as provided in subsection (3), (4), or (5), if a health insurance issuer limits the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer has the same time limit following payment of the claim to per…

A health insurance issuer may not collect a claim overpayment or other reimbursement by offsetting another claim payment made to a health care provider or other person unless the health care provider or other person has previously authorized the health insurance issuer in writing…

A health insurance issuer that issues or renews an individual or a group health insurance policy, certificate, or membership contract under which an individual's or employee's dependents are eligible for coverage may not terminate coverage on the basis of the age of an unmarried …

(1) A plan of group or individual health insurance coverage that is delivered, issued for delivery, renewed, extended, or modified in this state may not: (a) deny participation by a qualified individual in an approved clinical trial; (b) deny, limit, or impose additional conditio…

(1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage of prescription eyedrops may not deny coverage for a refill of a prescription eyedrop if: (a) the eyedrop i…

(1) Each group or individual disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state that includes coverage for prescription contraceptives must provide reimbursement for up to a 12-m…

(1) Each health insurance issuer that issues, delivers, or renews individual or small employer group health insurance coverage in the individual or small employer group market shall, at least 60 days before the rate goes into effect, file with the commissioner its rates, fees, du…

(1) (a) When reviewing a premium rate filing, the commissioner shall consider whether the proposed premium rate is excessive, inadequate, unjustified, or unfairly discriminatory. Rates may be considered excessive if they cause the premium charged for the health insurance coverage…

The commissioner, upon request by the health insurance issuer, may exempt from disclosure any part of a premium rate filing submitted pursuant to 33-22-156 that the commissioner determines to contain trade secrets as defined in 30-14-402. The commissioner may not disclose that pa…

The commissioner may adopt rules necessary to implement the provisions of 33-22-156 through 33-22-159, except that the administrative rules may not include by reference any provisions of Public Law 111-148 and Public Law 111-152 or any regulations promulgated under those laws.

A disability insurance policy subject to this chapter may contain a provision providing that, to the extent necessary for reimbursement of benefits paid to or on behalf of the insured, the insurer is entitled to subrogation, as provided for in 33-22-1602, against a judgment or re…

(1) If an insured intends to institute an action for damages against a third party, the insured shall give the insurer reasonable notice of the intention to institute the action. (2) The insured may request that the insurer pay a proportionate share of the reasonable costs of the…

(Temporary) Definitions. As used in 33-22-170 through 33-22-177 and 33-22-180, the following definitions apply: (1) "Contract pharmacy" means a pharmacy operating under contract with a federally certified health entity to provide dispensing services to the federally certified hea…

This part may be cited as the "Preferred Provider Agreements Act".

The purpose of this part is to allow a health care insurer providing disability insurance benefits to negotiate and contract with health care providers to: (1) provide health care services to its insureds or subscribers at a reduction in the fees customarily charged by the provid…

As used in this part, the following definitions apply: (1) "Emergency medical condition" means a condition manifesting itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in any o…

(1) Notwithstanding any other provision of law to the contrary, a health care insurer may: (a) enter into agreements with providers relating to health care services that may be rendered to insureds or subscribers on whose behalf the health care insurer is providing health care co…

(1) A health care insurer may issue a policy or a health benefit plan that provides for incentives for covered persons to use the health care services of preferred providers. The policy or health benefit plan must contain at least: (a) a provision that if a covered person receive…

(1) A provider agreement, insurance policy, or subscriber contract issued or delivered in this state may contain components designed to control the cost and improve the quality of health care for insureds and subscribers as provided in this part. (2) All terms or conditions of an…

The commissioner may adopt rules necessary to implement the provisions of this part.

(Temporary) Maximum allowable cost list -- limitations on drugs. Before a pharmacy benefit manager places or continues a drug on a maximum allowable cost list, the drug: (1) must be listed as "A" or "B" rated in the most recent version of the United States food and drug administr…

(Temporary) Maximum allowable cost or reference price list -- price formulation, updating, and disclosure -- exceptions. (1) At the time of entering into a contract with a pharmacy or a pharmacy services administrative organization and subsequently upon request, a plan sponsor, h…

(1) In contracting with a pharmacy or a pharmacy services administrative organization, a plan sponsor or pharmacy benefit manager shall: (a) provide a procedure by which a pharmacy or a pharmacy services administrative organization may appeal the price of a drug or drugs on the m…

(1) A pharmacist or pharmacy in a network plan with a plan sponsor, health insurance issuer, or pharmacy benefit manager providing covered drugs on a reference pricing basis may decline to provide a brand-name drug, multisource generic drug, supply, or service if the reference pr…

(Temporary) Allowable and prohibited fees on pharmacies. (1) A pharmacy benefit manager, a third-party payer, or a discount card processor may not directly or indirectly charge or hold a pharmacy responsible for a fee, including but not limited to the following: (a) a fee for sub…

A pharmacy benefit manager or third-party payer may not charge a patient a copayment that exceeds the cost of the prescription drug. If a patient pays a copayment, the dispensing provider or pharmacy may retain the adjudicated reimbursement and the pharmacy benefit manager or thi…

(Temporary) Rights of pharmacies. (1) A pharmacy benefit manager or third-party payer may not prohibit a pharmacist or pharmacy from: (a) participating in a class-action lawsuit; (b) disclosing to the plan sponsor or to the patient information regarding the adjudicated reimbursem…

(1) A health insurance issuer, a plan sponsor not subject to the Employee Retirement Income Security Act of 1974, as amended, or a pharmacy benefit manager may not include in a contract with a federally certified health entity provisions that allow: (a) payment for a prescription…

This part may be cited as the "Small Employer Health Insurance Availability Act".

(1) This part must be interpreted and construed to effectuate the following express legislative purposes: (a) to promote the availability of health insurance coverage to small employers regardless of health status or claims experience; (b) to prevent abusive rating practices; (c)…

As used in this part, the following definitions apply: (1) "Actuarial certification" means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with the provisions of…

(1) This part applies to a health benefit plan marketed through a small employer that provides coverage to the employees of a small employer in this state if any of the following conditions are met: (a) a portion of the premium or benefits is paid by or on behalf of the small emp…

(1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs that are related to the following reasons: (a) The small employer carrier uses more than one type of system for th…

(1) Premium rates for health benefit plans under this part are subject to the following provisions: (a) The index rate for a rating period for any class of business may not exceed the index rate for any other class of business by more than 20%. (b) For each class of business, the…

(1) A health benefit plan subject to the provisions of this part is renewable with respect to all eligible employees or their dependents, at the option of the small employer, except in any of the following cases: (a) nonpayment of the required premium; (b) fraud or misrepresentat…

(1) (a) As a condition of transacting business in this state with small employers, each small employer carrier must have approved for issuance to small employer groups at least two health benefit plans. (b) (i) A small employer carrier shall issue all plans marketed under this pa…