Title 49, Title 49: Utah State Retirement and Insurance Benefit Act

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,…

49-20-201. Program participation -- Eligibility -- Optional for certain groups. (1) The state shall participate in the program on behalf of the state's employees. Other employers, including political subdivisions and educational institutions, are eligible, but are not required, t…

49-20-202. Establishment of separate risk pools. (1) The program shall establish separate risk pools for: state employees; and the Utah Children's Health Insurance Program. (2) In accordance with participation standards established by the program, the following entities may elect…

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.

49-20-401. Program -- Powers and duties. (1) The program shall: act as a self-insurer of employee benefit plans and administer those plans; enter into contracts with private insurers or carriers to underwrite employee benefit plans as considered appropriate by the program; indemn…

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 th…

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 employe…

49-20-404. Governors' and legislative paid-up group health coverage benefit -- Limitations -- Medicare supplemental coverage -- Spouse coverage -- Limitations. (1) Except as provided under Subsection, the state shall pay the percentage of the cost of providing paid-up group healt…

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 accep…

49-20-406. Insurance benefits for employees' beneficiaries. (1) As used in this section: "Children" includes stepchildren and legally adopted children. "Line-of-duty death" means a death resulting from: external force or violence occasioned by an act of duty as an employee; or st…

49-20-407. Insurance mandates. Notwithstanding the provisions of Subsection: (1) health coverage offered to the state employee risk pool under Subsectionshall comply with the provisions of Sectionsand; and 49-20-202(1)(a) 31A-22-605.5 31A-45-501 (2) a health plan offered to publi…

49-20-407.1. Time to add child to plan. (1) After a birth or adoption, the program shall allow an individual to add the individual's newly born or adopted child to the individual's health plan or health coverage for a period of 60 days after the day the birth or adoption of the c…

49-20-408. Prohibition against certain uses of Social Security numbers. Notwithstanding the provisions of Subsection, health, dental, medical, Medicare supplement, or conversion coverage offered under Sectionshall comply with the provisions of Section.

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 …

49-20-410. High deductible health plan -- Health savings account -- Contributions. (1) In addition to other employee benefit plans offered under Subsection, the office shall offer at least one federally qualified high deductible health plan with a health savings account as an opt…

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: for state employees and their dependents; within a state building that is accessible to a large num…

49-20-414. Telemedicine services -- Reimbursement -- Reporting. (1) As used in this section: "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 coi…

49-20-416. Screening, Brief Intervention, and Referral to Treatment program reimbursement. (1) As used in this section: "Controlled substance prescriber" means a controlled substance prescriber, as that term is defined in Section, who: 58-37-303 has a record of having completed S…

49-20-417. Insurance coverage for amino acid-based formula. (1) As used in this section: "Amino acid-based elemental formula" means a nutrition formula: made from individual nonallergenic amino acids that are broken down to enhance absorption and digestion; and designed for indiv…

49-20-418. Expanded infertility treatment benefit. (1) As used in this section: "Assisted reproductive technology" means the same as the term is defined in 42 U.S.C. Sec. 263a-7. "Physician" means the same as the term is defined in Section. 58-67-102 "Qualified assisted reproduct…

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 tes…

49-20-420. Coverage for in vitro fertilization and genetic testing. (1) As used in this section: "Qualified condition" means: cystic fibrosis; spinal muscular atrophy; Morquio Syndrome; myotonic dystrophy; or sickle cell anemia. "Qualified individual" means a covered individual w…

49-20-421. Prescription discount program. (1) As used in this section: "Discount program" means the prescription discount program created by this section. "Epinephrine auto-injector" means a portable, disposable drug delivery device that contains a measured, single dose of epinep…

49-20-422. Coverage of pregnancy and childbirth services, including doula, direct- entry midwife, and birthing center services. (1) As used in this section: "Doula" means an individual who: provides information and physical and emotional support: to a pregnant or postpartum indiv…

49-20-501. Title. This part is known as the "Pharmacy Benefits Manager Act."

49-20-502. Definitions. As used in this part: (1) "Health benefit plan" means: a health benefit plan as defined in Section; or 31A-1-301 a health, dental, medical, Medicare supplement, or conversion program offered under. Title 49, Chapter 20, Public Employees' Benefit and Insura…

49-20-503. Request for proposals for pharmacy benefits manager for Public Employees' Benefit and Insurance Program. (1) When the board issues a request for proposals for a pharmacy benefits manager to provide pharmacy benefits management services for the program, the request for …