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S.B. 42
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EQUITY IN PRESCRIPTION COVERAGE
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2001 GENERAL SESSION
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STATE OF UTAH
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Sponsor: Paula F. Julander
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This act modifies the Insurance Code to require health insurance policies that cover
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prescription drugs to cover FDA-approved prescription contraceptive articles and related
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outpatient services. This act creates an exemption for religious organizations. This act takes
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effect on July 1, 2001.
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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-22-613, as last amended by Chapter 160, Laws of Utah 2000
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Be it enacted by the Legislature of the state of Utah:
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Section 1.
Section
31A-22-613
is amended to read:
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31A-22-613. Permitted provisions for disability insurance policies.
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The following provisions may be contained in a disability insurance policy, but if they are
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in that policy, they shall conform to at least the following minimum requirements for the
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policyholder:
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(1) Any provision respecting change of occupation may provide only for a lower maximum
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benefit payment and for reduction of loss payments proportionate to the change in appropriate
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premium rates, if the change is to a higher rated occupation, and this provision shall provide for
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retroactive reduction of premium rates from the date of change of occupation or the last policy
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anniversary date, whichever is the more recent, if the change is to a lower rated occupation.
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(2) Section
31A-22-405
applies to misstatement of age in disability policies, with the
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appropriate modifications of terminology.
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(3) Any policy which contains a provision establishing, as an age limit or otherwise, a date
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after which the coverage provided by the policy is not effective, and if that date falls within a
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period for which a premium is accepted by the insurer or if the insurer accepts a premium after that
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date, the coverage provided by the policy continues in force, subject to any right of cancellation,
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until the end of the period for which the premium was accepted. This Subsection (3) does not
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apply if the acceptance of premium would not have occurred but for a misstatement of age by the
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insured.
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(4) Any provision dealing with preexisting conditions shall be consistent with Subsections
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31A-22-605
(9)(a) and
31A-22-609
(2), and any applicable rule adopted by the commissioner.
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(5) (a) If an insured is otherwise eligible for maternity benefits, a policy may not contain
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language which requires an insured to obtain any additional preauthorization or preapproval for
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customary and reasonable maternity care expenses or for the delivery of the child after an initial
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preauthorization or preapproval has been obtained from the insurer for prenatal care. A
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requirement for notice of admission for delivery is not a requirement for preauthorization or
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preapproval, however, the maternity benefit may not be denied or diminished for failure to provide
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admission notice. The policy may not require the provision of admission notice by only the
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insured patient.
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(b) This Subsection (5) does not prohibit an insurer from:
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(i) requiring a referral before maternity care can be obtained;
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(ii) specifying a group of providers or a particular location from which an insured is
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required to obtain maternity care; or
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(iii) limiting reimbursement for maternity expenses and benefits in accordance with the
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terms and conditions of the insurance contract so long as such terms do not conflict with
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Subsection (5)(a).
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(6) An insurer may only represent that a policy:
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(a) offers a vision benefit if the policy:
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(i) charges a premium for the benefit; and
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(ii) provides reimbursement for materials or services provided under the policy; and
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(b) covers laser vision correction, whether photorefractive keratectomy, laser assisted
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in-situ keratomelusis, or related procedure, if the policy:
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(i) charges a premium for the benefit; and
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(ii) the procedure is at least a partially covered benefit.
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(7) (a) Except as provided in Subsection (7)(b), a health insurance policy or health
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maintenance organization contract that provides coverage for outpatient prescription drugs shall
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cover to the same extent and subject to the same policy or contract terms:
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(i) contraceptive articles; and
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(ii) outpatient services for contraceptive articles.
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(b) A religious organization may, at its option, request that the coverage required by
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Subsection (7)(a) be excluded from a policy or contract purchased by or otherwise offered through
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the organization for the benefit of the organization's employees.
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(c) The commissioner shall adopt rules as necessary to ensure that health insurance
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policies and health maintenance organization contracts are in compliance with this Subsection (7).
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(d) As used in this Subsection (7):
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(i) "Contraceptive article" means:
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(A) any drug, medicine, mixture, preparation, instrument, article, or device of any nature
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that is:
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(I) approved by the federal Food and Drug Administration to prevent a pregnancy; and
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(II) prescribed by a licensed health care provider for use to prevent a pregnancy; or
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(B) any hormonal compound that is taken orally and that is approved by the federal Food
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and Drug Administration for use to prevent a pregnancy.
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(ii) "Contraceptive article" does not include any drug, medicine, mixture, preparation,
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instrument, article, or device of any nature that is prescribed by a licensed health care professional
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for use in terminating a pregnancy.
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Section 2. Effective date.
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This act takes effect on July 1, 2001.
Legislative Review Note
as of 11-30-00 9:23 AM
A limited legal review of this legislation raises no obvious constitutional or statutory concerns.