Title 31A, Title 31A: Insurance Code

31A-22-604. Reimbursement by insurers of Medicaid benefits. (1) As used in this section, "Medicaid" means the program under Title XIX of the federal Social Security Act. (2) Any accident and health insurer, including a group accident and health insurance plan, as defined in Secti…

31A-22-605. Accident and health insurance standards. (1) The purposes of this section include: reasonable standardization and simplification of terms and coverages of individual and franchise accident and health insurance policies, including accident and health insurance contract…

31A-22-605.1. Preexisting condition limitations. (1) Any provision dealing with preexisting conditions shall be consistent with this section, Section, and rules adopted by the commissioner. 31A-22-609 (2) Except as provided in this section, an insurer that elects to use an applic…

31A-22-605.5. Application. (1) For purposes of this section "insurance mandate": means a mandatory obligation with respect to coverage, benefits, or the number or types of providers imposed on policies of accident and health insurance; and does not mean: an administrative rule im…

31A-22-606. Policy examination period. (1) Except as provided in Subsection, all accident and health policies shall contain a notice prominently printed on or attached to the cover or front page stating that the policyholder has the right to return the policy for any reason withi…

31A-22-607. Grace period. (1) An individual or franchise accident and health insurance policy shall contain one or more clauses providing for a grace period for premium payment only of: at least 15 days for a weekly or monthly premium policy; and 30 days for a policy that is not …

31A-22-608. Reinstatement of individual or franchise accident and health insurance policies. (1) Every individual or franchise accident and health insurance policy shall contain a provision which reads substantially as follows:"REINSTATEMENT: If any renewal premium is not paid wi…

31A-22-609. Incontestability for accident and health insurance. (1) A statement made by an applicant relating to the person's insurability, except fraudulent misrepresentation, may not be a basis for avoidance of a policy, coverage, or denial of a claim for loss incurred or disab…

31A-22-610. Dependent coverage from moment of birth or adoption. (1) As used in this section: "Child" means, in connection with any adoption, or placement for adoption of the child, an individual who is younger than 18 years old as of the date of the adoption or placement for ado…

31A-22-610.1. Indemnity benefit for adoption or infertility treatments. (1) 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 for ad…

31A-22-610.2. Maternity stay minimum limits. (1) 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. If an insured has coverage for maternity benefits, the po…

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) Any individual or group accident and health insurance policy or managed care organization contract that provides coverage for a policyholder's or…

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

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

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) This section applies to all health benefit plans. Subsectionapplies to: (2) all health benefit plans; and coverage offered to state employees under Subsection. 49-20-202(1)(a) (2) The commissioner shall promote in…

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

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

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 Sectionand Subsection, and except as to insurers licensed under, no insurer may unfairly discriminate against any licensed class of health care providers by structuring contract exclusions…

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: with respect to all eligible employees and dependents; and at …

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

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

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

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

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

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: "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 service l…

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

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

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, a health benefit plan shall accept a correctly charged mileage ra…

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: "Adverse benefit determination" means the: denial of a benefit; reduction of a benefit; termination of a benefit; or failure to provide or make payment, in whole or in part, for a benefit. "Adv…

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: reconstruction of the breast on which the mastec…

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

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

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: funded through a life insurance vehicle by acceleration of the death benefit; and in benefit payment status. (2) The rep…

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: "Insurer" means: insurers governed by this part as described in Section, and includes: 31A-22-600 a health maintenance organization; and a…

31A-22-635. Uniform application -- Uniform waiver of coverage. (1) For purposes of this section, "insurer": is defined in Subsection; and 31A-22-634(1) includes the state employee's risk pool under Section. 49-20-202 (2) Insurers offering a health benefit plan to an individual or…

31A-22-636. Standardized health insurance information cards. (1) As used in this section, "insurer" means: an insurer governed by this part as described in Section; 31A-22-600 a health maintenance organization governed by; Chapter 8, Health Maintenance Organizations and Limited H…

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) An insurer shall provide its health care providers who are under contract with the insurer access to current informat…

31A-22-638. Coverage for prosthetic devices. (1) For purposes of this section: "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, hand…