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H.B. 73
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INSURANCE COMPANIES NOTIFICATION IN
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DIVORCE SITUATIONS
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2000 GENERAL SESSION
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STATE OF UTAH
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Sponsor: Trisha S. Beck
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AN ACT RELATING TO HEALTH; REQUIRING HEALTH INSURERS TO NOTIFY A CHILD
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WHO DOES NOT LIVE AT THE SAME ADDRESS AS THE INSURED PARENT OF ANY
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COMMENCEMENT OR TERMINATION OF INSURANCE COVERAGE.
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This act affects sections of Utah Code Annotated 1953 as follows:
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AMENDS:
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31A-22-610.5, as last amended by Chapters 102 and 137, Laws of Utah 1995
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Be it enacted by the Legislature of the state of Utah:
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Section 1.
Section
31A-22-610.5
is amended to read:
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31A-22-610.5. Dependent coverage.
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(1) As used in this section, "child" has the same meaning as defined in Section
78-45-2
.
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(2) (a) Any individual or group health insurance policy or health maintenance organization
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contract that provides coverage for a policyholder's or certificate holder's dependent shall not
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terminate coverage of an unmarried dependent by reason of the dependent's age before the
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dependent's 26th birthday and shall, upon application, provide coverage for all unmarried
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dependents up to age 26.
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(b) The cost of coverage for unmarried dependents 19 to 26 years of age shall be included
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in the premium on the same basis as other dependent coverage.
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(c) This section does not prohibit the employer from requiring the employee to pay all or
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part of the cost of coverage for unmarried dependents.
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(3) An individual or group health insurance policy or health maintenance organization
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contract shall reinstate dependent coverage, and for purposes of all exclusions and limitations,
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shall treat the dependent as if the coverage had been in force since it was terminated; if:
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(a) the dependent has not reached the age of 26 by July 1, 1995;
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(b) the dependent had coverage prior to July 1, 1994;
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(c) prior to July 1, 1994, the dependent's coverage was terminated solely due to the age of
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the dependent; and
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(d) the policy has not been terminated since the dependent's coverage was terminated.
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(4) (a) At the time a child is enrolled in insurance coverage, the insurer shall determine
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whether the child lives at an address that is different than the insured parent.
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(b) If an insurer determines, during or after enrollment, that a child lives at an address that
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is different than the insured parent, the insurer shall send timely notice to the child's last-known
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address regarding any commencement or termination of insurance coverage.
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(c) A notice regarding the commencement of insurance coverage shall include information
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on:
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(i) coverage and benefits;
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(ii) participating health care providers; and
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(iii) the statutory right of a custodial parent to receive insurance information under
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Subsection (7).
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(d) A notice regarding the termination of insurance coverage shall include information on:
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(i) the date of termination;
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(ii) the options, if any, for extending coverage beyond the date of termination; and
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(iii) the commencement, if known, of any new insurance coverage for the child.
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[(4)] (5) (a) When a parent is required by a court or administrative order to provide health
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insurance coverage for a child, a disability insurer may not deny enrollment of a child under the
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disability insurance plan of the child's parent on the grounds the child:
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(i) was born out of wedlock and is entitled to coverage under Subsection [(6)] (7);
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(ii) was born out of wedlock and the custodial parent seeks enrollment for the child under
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the custodial parent's policy;
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(iii) is not claimed as a dependent on the parent's federal tax return; or
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(iv) does not reside with the parent or in the insurer's service area.
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(b) A disability insurer providing enrollment under Subsection [(4)] (5)(a)(iv) is subject
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to the requirements of Subsection [(5)] (6).
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[(5)] (6) A health maintenance organization or a preferred provider organization may use
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alternative delivery systems or indemnity insurers to provide coverage under Subsection [(4)]
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(5)(a)(iv) outside its service area. The provisions of Section
31A-8-408
do not apply to this
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Subsection (6).
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[(6)] (7) When a child has disability coverage through an insurer of a noncustodial parent
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the insurer shall:
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(a) provide information to the custodial parent as necessary for the child to obtain benefits
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through that coverage, but the insurer or employer, or the agents or employees of either of them,
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are not civilly or criminally liable for providing information in compliance with this Subsection
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(7)(a), whether the information is provided pursuant to a verbal or written request;
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(b) permit the custodial parent or the service provider, with the custodial parent's approval,
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to submit claims for covered services without the approval of the noncustodial parent; [and]
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(c) make payments on claims submitted in accordance with Subsection [(6)] (7)(b) directly
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to the custodial parent, the provider, or the state Medicaid agency.
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[(7)] (8) When a parent is required by a court or administrative order to provide health
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coverage for a child, and the parent is eligible for family health coverage, the insurer shall:
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(a) permit the parent to enroll, under the family coverage, a child who is otherwise eligible
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for the coverage without regard to an enrollment season restrictions;
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(b) if the parent is enrolled but fails to make application to obtain coverage for the child,
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enroll the child under family coverage upon application of the child's other parent, the state agency
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administering the Medicaid program, or the state agency administering 42 U.S.C. 651 through 669,
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the child support enforcement program; and
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(c) not disenroll or eliminate coverage of the child unless the insurer is provided
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satisfactory written evidence that:
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(i) the court or administrative order is no longer in effect; or
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(ii) the child is or will be enrolled in comparable disability coverage through another
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insurer which will take effect not later than the effective date of disenrollment.
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[(8)] (9) An insurer may not impose requirements on a state agency which has been
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assigned the rights of an individual eligible for medical assistance under Medicaid and covered for
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disability benefits from the insurer that are different from requirements applicable to an agent or
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assignee of any other individual so covered.
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[(9)] (10) Insurers may not reduce their coverage of pediatric vaccines below the benefit
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level in effect on May 1, 1993.
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[(10)] (11) When a parent is required by a court or administrative order to provide health
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coverage, which is available through an employer doing business in this state, the employer shall:
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(a) permit the parent to enroll under family coverage any child who is otherwise eligible
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for coverage without regard to any enrollment season restrictions;
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(b) if the parent is enrolled but fails to make application to obtain coverage of the child,
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enroll the child under family coverage upon application by the child's other parent, by the state
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agency administering the Medicaid program, or the state agency administering 42 U.S.C. 651
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through 669, the child support enforcement program;
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(c) not disenroll or eliminate coverage of the child unless the employer is provided
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satisfactory written evidence that:
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(i) the court order is no longer in effect;
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(ii) the child is or will be enrolled in comparable coverage which will take effect no later
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than the effective date of disenrollment; or
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(iii) the employer has eliminated family health coverage for all of its employees; and
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(d) withhold from the employee's compensation the employee's share, if any, of premiums
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for health coverage and to pay this amount to the insurer.
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[(11)] (12) An order issued under Section
62A-11-326.1
may be considered a "qualified
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medical support order" for the purpose of enrolling a dependent child in a group disability
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insurance plan as defined in Section 609(a), Federal Employee Retirement Income Security Act
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of 1974.
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[(12)] (13) This section does not affect any insurer's ability to require as a precondition of
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any child being covered under any policy of insurance that:
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(a) the parent continues to be eligible for coverage;
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(b) the child shall be identified to the insurer; and
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(c) the premium shall be paid when due.
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[(13)] (14) The provisions of this section apply to employee welfare benefit plans as
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defined in Section
26-19-2
.
Legislative Review Note
as of 1-18-00 7:06 AM
A limited legal review of this legislation raises no obvious constitutional or statutory concerns.