Title 31A, Title 31A: Insurance Code

31A-22-644. Denial of coverage under a health benefit plan because of life expectancy or terminal condition. (1) As used in this section: "Health benefit plan" means the same as that term is defined in Section. 31A-1-301 "Terminal condition" means an irreversible condition: cause…

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: the Department of Health and Human Services, under; or Title 26B, Chap…

31A-22-646. Dental insurance -- Contract provision for noncovered services. (1) For purposes of this section: "Covered services" means dental services for which reimbursement: is available or would be reimbursable under an enrollee's dental plan but for the application of one or …

31A-22-646.1. Leasing requirements for dental plans. (1) As used in this section: "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 administrator o…

31A-22-646.2. Dental services jurisdiction. (1) Notwithstanding Section, 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 services, and re…

31A-22-647. Insurer shared savings program. (1) As used in this section: "Insurer" means a person who offers health care insurance, including a health maintenance organization as that term is defined in Section. 31A-8-101 "PEHP" means the Public Employees' Benefit and Insurance P…

31A-22-648. Vision insurance -- Contract provisions. (1) As used in this section: "Covered individual" means an individual who has insurance coverage under a vision plan. "Covered service" means a vision service that: is reimbursable under or would be reimbursable under an enroll…

31A-22-649. Coverage of telepsychiatric consultations. (1) As used in this section: "Telehealth services" means the same as that term is defined in Section. 26B-4-704 "Telepsychiatric consultation" means a consultation between a physician and a board certified psychiatrist, both …

31A-22-649.5. Insurance parity for telemedicine services -- Method of technology used. (1) As used in this section: "Mental health condition" means a mental disorder or a substance-related disorder that falls under a diagnostic category listed in the Diagnostic and Statistical Ma…

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

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

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 school district; a charter school; or the Utah Schools for the Deaf and the Blind. (2) A health benefit plan that is entered into or renewed on or after Janu…

31A-22-654. Study of coverage for in vitro fertilization and genetic testing -- Reporting -- Coverage requirements. (1) As used in this section: "Qualified condition" means the same as that term is defined in Section. 49-20-420 "Qualified insurer" means an insurer that provides a…

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: deny eligibility for coverage or limit coverage of a individual under an ac…

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, for an epinephrine aut…

31A-22-657. Application of health insurance mandates. (1) As used in this section: "Cost-sharing mandate" means a statutory requirement limiting a cost-sharing requirement. "Cost-sharing requirement" means a copayment, coinsurance, or deductible required by or on behalf of an enr…

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

31A-22-659. Provider administered drugs. (1) As used in this section: "Clinician-administered drug" means an outpatient prescription drug as defined in Sectionthat: 58-17b-102 cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual…

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) Except as provided in Subse…

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: "Covered insurer" means an insurer that offers health insurance that includes coverage for behavioral health services. "Behavioral health services" means: mental health …

31A-22-664. Health care provider directories. (1) As used in this section: "Division" means the Division of Professional Licensing created in Section. 58-1-103 "Exempt health care professional" means a person exempt from licensure under a title listed in Subsection. 58-13-3(2)(c)…

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

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

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 group: to which a group life insurance policy may be issued under Section,,,,,, or; and 31A-22-502 31A-22-503 31A-22-504 31A-22-505 …

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: to give written notice of …

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 Sectionmay 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 or 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. The right to extend coverage i…

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: the person is: an employee who is eligible, but not enrolled, for co…

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: that is necessary to avert: the death of the woman on whom the abortion is performed; or a se…

31A-22-727. Renewal, cancellation, and modification. (1) Except as provided in Section, for a group insurance policy offering accident and health insurance or a blanket insurance policy offering accident and health insurance, an insurer may: 31A-22-618.6 decline to renew the poli…

31A-22-728. Large employer health benefit plan required report. (1) As used in this section: "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. "Large employer…

31A-22-801. Scope of part. (1) Except as provided under Subsection, all life insurance and accident and health insurance in connection with loans or other credit transactions are subject to this part. (2) (2) Insurance written in connection with a credit transaction is not subjec…

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, 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 in …

31A-22-805. Beginning date of insurance. (1) Except as provided under Subsection, 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) (2) Where a grou…

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 …