Title 31A, Insurance Code

31A-22-610.1. Indemnity benefit for adoption or infertility treatments. (1)(a)(i) If an insured has coverage for maternity benefits on the date of an adoptive placement, the insured's policy shall provide an adoption indemnity benefit payable to the insured, if a child is placed …

31A-22-610.2. Maternity stay minimum limits. (1)(a) If an insured has coverage for maternity benefits, the policy may not be limited to a less than a 48-hour benefit for both mother and newborn with a normal vaginal delivery. (b) If an insured has coverage for maternity benefits,…

31A-22-610.5. Dependent coverage. (1) As used in this section, "child" means the same as that term is defined in Section 81-6-101. (2)(a) Any individual or group accident and health insurance policy or managed care organization contract that provides coverage for a policyholder's…

31A-22-610.6. Special enrollment for individuals receiving premium assistance. (1) As used in this section: (a) "Premium assistance" means assistance under Title 26B, Chapter 3, Health Care - Administration and Assistance, in the payment of premium. (b) "Qualified beneficiary" me…

31A-22-611. Coverage for children with a disability. (1) For the purposes of this section: (a) "Dependent with a disability" means a child who is and continues to be both: (i) unable to engage in substantial gainful employment to the degree that the child can achieve economic ind…

31A-22-612. Conversion privileges for insured former spouse. (1) An accident and health insurance policy, that in addition to covering the insured also provides coverage to the spouse of the insured, may not contain a provision for termination of coverage of a spouse covered unde…

31A-22-613. Permitted provisions for accident and health insurance policies. The following provisions may be contained in an accident and health insurance policy, but if they are in that policy, they shall conform to at least the minimum requirements for the policyholder in this …

31A-22-613.5. Price and value comparisons of health insurance. (1)(a) This section applies to all health benefit plans. (b) Subsection (2) applies to: (i) all health benefit plans; and (ii) coverage offered to state employees under Subsection 49-20-202(1)(a). (2) The commissioner…

31A-22-614. Claims under accident and health policies. (1) Section 31A-21-312 applies generally to claims under accident and health policies. (2)(a) Subject to Subsection (1), an accident and health insurance policy may not contain a claim notice requirement less favorable to the…

31A-22-614.5. Uniform claims processing -- Electronic exchange of health information. (1)(a) Except as provided in Subsection (1)(c), an insurer offering health insurance shall use a uniform claim form and uniform billing and claim codes. (b) Beginning January 1, 2011, all health…

31A-22-614.7. Uniform claims processing -- Electronic exchange of prescription drug pre-authorization. The commissioner shall consult with national and state organizations involved with the standardized exchange of health data, and the electronic exchange of health data, to study…

31A-22-618. Nondiscrimination among health care professionals. (1) Except as provided under Section 31A-45-303 and Subsection (2), and except as to insurers licensed under Chapter 8, Health Maintenance Organizations and Limited Health Plans, no insurer may unfairly discriminate a…

31A-22-618.5. Coverage of insurance mandates imposed after January 1, 2009. (1) The purpose of this section is to increase the range of health benefit plans available in the small group, small employer group, large group, and individual insurance markets. (2) A health maintenance…

31A-22-618.6. Discontinuance, nonrenewal, or changes to group health benefit plans. (1) Except as otherwise provided in this section, a group health benefit plan for a plan sponsor is renewable and continues in force: (a) with respect to all eligible employees and dependents; and…

31A-22-618.7. Discontinuance, nonrenewal, and modification for individual health benefit plans. (1)(a) Except as otherwise provided in this section, a health benefit plan offered on an individual basis is renewable and continues in force: (i) with respect to all enrollees or depe…

31A-22-618.8. Discontinuance and nonrenewal limitations for health benefit plans. (1) Subject to Section 31A-4-115, an insurer that elects to discontinue offering a health benefit plan under Subsection 31A-22-618.6(5)(e) or 31A-22-618.7(3)(e) is prohibited from writing new busine…

31A-22-619. Coordination of benefits. (1) The commissioner shall: (a) adopt rules concerning the coordination of benefits between accident and health insurance policies; (b) publish a coordination of benefits guide; (c) post the coordination of benefits guide on the state insuran…

31A-22-620. Medicare Supplement Insurance Minimum Standards Act. (1) As used in this section: (a) "Applicant" means: (i) in the case of an individual Medicare supplement insurance policy, the person who seeks to contract for insurance benefits; and (ii) in the case of a group Med…

31A-22-623. Coverage of inborn metabolic errors. (1) As used in this section: (a) "Dietary products" means medical food or a low protein modified food product that: (i) is specifically formulated to treat inborn errors of amino acid or urea cycle metabolism; (ii) is not a natural…

31A-22-624. Primary care physician, physician assistant, or physical therapist. (1) An accident and health insurance policy that requires an insured to select a primary care provider or physician to receive optimum coverage shall permit an insured to select a participating provid…

31A-22-624. Primary care physician, physician assistant, or physical therapist. (1) An accident and health insurance policy that requires an insured to select a primary care provider or physician to receive optimum coverage shall permit an insured to select a participating provid…

31A-22-625. Catastrophic coverage of mental health conditions. (1) As used in this section: (a)(i) "Catastrophic mental health coverage" means coverage in a health benefit plan that does not impose a lifetime limit, annual payment limit, episodic limit, inpatient or outpatient se…

31A-22-626. Coverage of diabetes. (1) As used in this section: (a) "Diabetes" includes individuals with: (i) complete insulin deficiency or type 1 diabetes; (ii) insulin resistant with partial insulin deficiency or type 2 diabetes; or (iii) elevated blood glucose levels induced b…

31A-22-627. Coverage of emergency medical services. (1) A health insurance policy or managed care organization contract: (a) shall provide coverage of emergency services; and (b) may not: (i) require any form of preauthorization for treatment of an emergency medical condition unt…

31A-22-627.1. Ground ambulance reimbursement. (1) As used in this section,"base rate" means the same as that term is defined in Section 53-2d-503. (2) For a mileage rate established in a rule created under Section 53-2d-503, a health benefit plan shall accept a correctly charged …

31A-22-628. Standing referral to a specialist. (1) With respect to a health insurance policy or managed care organization contract that does not allow an insured to have direct access to a health care specialist, the insurer shall establish and implement a procedure by which an i…

31A-22-629. Adverse benefit determination review process. (1) As used in this section: (a)(i) "Adverse benefit determination" means the: (A) denial of a benefit; (B) reduction of a benefit; (C) termination of a benefit; or (D) failure to provide or make payment, in whole or in pa…

31A-22-630. Mastectomy coverage. (1) If an insured has coverage that provides medical and surgical benefits with respect to a mastectomy, it shall provide coverage, with consultation of the attending physician and the patient, for: (a) reconstruction of the breast on which the ma…

31A-22-630.1. Mobile mammography screening coverage. (1) As used in this section: (a) "Approved mobile mammography unit" means a mobile mammography bus or vehicle that is: (i) equipped with mammography equipment to perform a mobile mammography screening; and (ii) approved by an a…

31A-22-631. Policy summary or illustration. (1)(a) Except as provided in Subsection (1)(b), at the time a life insurance policy is delivered, a policy summary or illustration shall be delivered for the life insurance policy if: (i) the life insurance policy includes riders or sup…

31A-22-632. Report to policy holder. (1) An insurer shall provide the policyholder a monthly report if an accident and health rider or supplemental benefit is: (a) funded through a life insurance vehicle by acceleration of the death benefit; and (b) in benefit payment status. (2)…

31A-22-633. Exemptions from standards. Notwithstanding the provisions of this title, any accident and health insurer or health maintenance organization may offer a choice of coverage that is less or different than is otherwise required by applicable state law if: (1) the Departme…

31A-22-634. Prohibition against certain use of Social Security number -- Exceptions -- Applicability of section. (1) As used in this section: (a) "Insurer" means: (i) insurers governed by this part as described in Section 31A-22-600, and includes: (A) a health maintenance organiz…

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 in…

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 Li…

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 infor…

31A-22-638. Coverage for prosthetic devices. (1) For purposes of this section: (a) "Orthotic device" means a rigid or semirigid device supporting a weak or deformed leg, foot, arm, hand, back, or neck, or restricting or eliminating motion in a diseased or injured leg, foot, arm, …

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…

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 chemot…

31A-22-642. Insurance coverage for autism spectrum disorder. (1) As used in this section: (a) "Applied behavior analysis" means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant im…

31A-22-643. Prescription synchronization -- Copay and dispensing fee restrictions -- Rebate requirements -- Pharmacy networks. (1) For purposes of this section: (a) "Administrative fee" means the same as that term is defined in Section 31A-46-102. (b) "Copay" means the copay norm…

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 conditio…

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, C…

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…

31A-22-646.1. Leasing requirements for dental plans. (1) As used in this section: (a) "Contracting entity" means a person that enters into a direct contract with a provider for the delivery of dental services in the ordinary course of business, including a third party administrat…

31A-22-646.2. Dental services jurisdiction. (1)(a) Notwithstanding Section 31A-1-103, an insurer that provides coverage for dental services that are completed in Utah to a patient that is a Utah resident shall comply with all Utah laws related to covered services, non-covered ser…