Title 31A, Insurance Code

31A-22-650. Health care preauthorization requirements -- Notice -- Reporting -- Retroactive denial prohibited. (1) As used in this section: (a) "Adverse preauthorization determination" means a determination by an insurer that health care does not meet the preauthorization require…

31A-22-650. Health care preauthorization requirements. (1) As used in this section: (a) "Adverse preauthorization determination" means a determination by an insurer that health care does not meet the preauthorization requirement for the health care. (b) "Authorization" means a de…

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…

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 o…

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 pr…

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 a…

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 epine…

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 o…

31A-22-658. Health care provider behavioral health treatment -- Single case agreement. (1) As used in this section: (a) "Mental health condition" means the same as that term is defined in Section 31A-22-649.5. (b) "Mental health provider" means: (i) a mental health therapist, as …

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 i…

31A-22-660. Definitions -- Prohibitions concerning organ harvesting -- Severability. (1) As used in this section, "forced organ harvesting" means the removal of one or more organs from a living individual, or from an individual killed for the purpose of removal of one or more of …

31A-22-661. Health benefit plan procedures related to prescription drugs. (1) As used in this section, "long-term drug" means an enrollee's prescription drug where the prescription has been active for at least 180 days with the health benefit plan. (2)(a) Except as provided in Su…

31A-22-662. Pharmacist as a health care provider. (1) As used in this section, "pharmacist" means the same as that term is defined in Section 58-17b-102. (2) An insurer that provides a health benefit plan shall consider a pharmacist as a health care provider for a consultation th…

31A-22-663. Timely access to behavioral health services -- Single case agreement. (1) As used in this section: (a) "Covered insurer" means an insurer that offers health insurance that includes coverage for behavioral health services. (b)(i) "Behavioral health services" means: (A)…

31A-22-664. Health care provider directories. (1) As used in this section: (a) "Division" means the Division of Professional Licensing created in Section 58-1-103. (b) "Exempt health care professional" means a person exempt from licensure under a title listed in Subsection 58-13-…

31A-22-665. Continuity of mental health treatment and services for a child leaving foster care. (1) As used in this section: (a)(i) "Covered child" means an insured child who: (A) while in the custody of the Division of Child and Family Services, was receiving mental health treat…

31A-22-666. Coverage for reversal of sex transition procedures. (1) As used in this section: (a) "Hormonal transgender treatment" means the same as that term is defined in Section 58-1-603. (b) "Primary sex characteristic surgical procedure" means the same as that term is defined…

31A-22-667. Anesthesia services. (1) A health benefit plan shall provide coverage for medically necessary anesthesia services, regardless of the duration, for any procedure covered by the health benefit plan. (2) A health benefit plan is prohibited from denying payment or reimbur…

31A-22-701. Groups eligible for group or blanket insurance. (1) A group insurance policy offering accident and health insurance may be issued to: (a) a group: (i) to which a group life insurance policy may be issued under Section 31A-22-502, 31A-22-503, 31A-22-504, 31A-22-505, 31…

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 reducti…

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…

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 no…

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 …

31A-22-722. Utah mini-COBRA benefits for employer group coverage. (1) An employer's group policy shall offer an employee's coverage to be extended under the current employer's group policy for a period of 12 months, except as provided in Subsection (2). The right to extend covera…

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…

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;…

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 …

31A-22-728. Large employer health benefit plan required report. (1) As used in this section: (a) "Claims run-out period" means the period beginning on the first day following the last day of a plan year and ending on the 90th day following the last day of a plan year. (b) "Large …

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 sub…

31A-22-802. Definitions. As used in this part: (1) "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. (2) "Creditor" means the lender of money or the vendor or les…

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 issu…

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…

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 g…

31A-22-806. Provisions of policies and certificates. (1) All credit life insurance and credit accident and health insurance shall be evidenced by an individual policy, or, in the case of group insurance, by a certificate of insurance delivered to the debtor. (2) Each of these typ…

31A-22-807. Filing and approval of forms -- Loss ratio standards. (1) A policy, certificate of insurance, statement of insurance, or endorsement form intended for use in Utah is subject to Section 31A-21-201. (2) In addition to the grounds for prohibiting use of a form under Subs…

31A-22-808. Premiums and refunds. (1) Each policy, certificate, or statement of insurance shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for insurance shall be pa…

31A-22-809. Right of debtor to choose insurer. When credit life insurance or credit accident and health insurance is required as security for any indebtedness, the creditor shall inform the debtor of the debtor's option to furnish the required insurance through existing policies …

31A-22-901. Laws applicable to contracts of fraternal insurers. Except as otherwise provided under this part, or in Chapter 9, Insurance Fraternals, insurance contracts issued by fraternal insurers are subject to the contract provisions of the Insurance Code in the same manner as…

31A-22-902. Fraternal contract. (1) A fraternal shall issue to each benefit member a policy or certificate specifying the benefits provided and containing at least the substance of all sections of the laws of the fraternal which might result in the termination of coverage or the …

31A-22-903. Fraud in obtaining membership. Subject to Sections 31A-22-403 and 31A-22-405, any certificate of membership secured by misrepresentation with reference to any application for membership, document, or other proof, for the purpose of obtaining membership in, or an insur…

31A-22-904. Beneficiaries in fraternal contracts. (1) Any member may designate as beneficiary any person permitted by the laws of the fraternal. Those laws shall allow the designation of the member's estate as beneficiary. (2) Subject to Subsection (1), Section 31A-22-413 applies…

31A-23a-1001. Definitions. As used in this part: (1) "Affiliated business" means the gross transaction revenue of a title entity's title insurance business in the state that is the result of an affiliated business arrangement. (2) "Affiliated business arrangement" means the same …

31A-23a-1002. Regulation of affiliated business -- Applicable law. (1) Except as provided in this part, for purposes of state law, Section 8 of RESPA governs an affiliated business arrangement involving a title entity. (2) The division shall enforce the provisions of this part, i…

31A-23a-1003. Affiliated business arrangements. (1) An affiliated business arrangement between a person and a title entity violates Section 8 of RESPA for purposes of state law if: (a) the title entity does not have sufficient capital and net worth in a reserve account in the tit…

31A-23a-1004. Annual affiliated business report. Before March 1 each year, each new or newly affiliated title entity shall submit a report to the division that: (1) contains the following for the preceding calendar year: (a) the name and address of any producer or associate that …

31A-23a-1005. Investigations. (1) To enforce the provisions of this part, including Section 8 of RESPA, the division may conduct a public or private investigation within or outside of the state as the division considers necessary to determine whether a person has violated a provi…