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H.B. 289
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8 LONG TITLE
9 General Description:
10 This bill amends the Accident and Health Insurance part of the Insurance Code to
11 require health insurance policies and health maintenance organization contracts to
12 provide coverage for the cost of prescriptive contraceptives.
13 Highlighted Provisions:
14 This bill:
15 . requires all health insurance policies and health maintenance organization contracts
16 provide coverage for the cost of prescriptive contraceptives;
17 . defines contraceptive article; and
18 . provides a religious exemption for coverage of prescriptive contraceptives.
19 Monies Appropriated in this Bill:
20 None
21 Other Special Clauses:
22 This bill takes effect on July 1, 2007.
23 Utah Code Sections Affected:
24 AMENDS:
25 31A-22-613, as last amended by Chapter 78, Laws of Utah 2005
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27 Be it enacted by the Legislature of the state of Utah:
28 Section 1. Section 31A-22-613 is amended to read:
29 31A-22-613. Permitted provisions for accident and health insurance policies.
30 The following provisions may be contained in an accident and health insurance policy,
31 but if they are in that policy, they shall conform to at least the minimum requirements for the
32 policyholder in this section.
33 (1) Any provision respecting change of occupation may provide only for a lower
34 maximum benefit payment and for reduction of loss payments proportionate to the change in
35 appropriate premium rates, if the change is to a higher rated occupation, and this provision
36 shall provide for retroactive reduction of premium rates from the date of change of occupation
37 or the last policy anniversary date, whichever is the more recent, if the change is to a lower
38 rated occupation.
39 (2) Section 31A-22-405 applies to misstatement of age in accident and health policies,
40 with the appropriate modifications of terminology.
41 (3) Any policy which contains a provision establishing, as an age limit or otherwise, a
42 date after which the coverage provided by the policy is not effective, and if that date falls
43 within a period for which a premium is accepted by the insurer or if the insurer accepts a
44 premium after that date, the coverage provided by the policy continues in force, subject to any
45 right of cancellation, until the end of the period for which the premium was accepted. This
46 Subsection (3) does not apply if the acceptance of premium would not have occurred but for a
47 misstatement of age by the insured.
48 (4) (a) If an insured is otherwise eligible for maternity benefits, a policy may not
49 contain language which requires an insured to obtain any additional preauthorization or
50 preapproval for customary and reasonable maternity care expenses or for the delivery of the
51 child after an initial preauthorization or preapproval has been obtained from the insurer for
52 prenatal care. A requirement for notice of admission for delivery is not a requirement for
53 preauthorization or preapproval, however, the maternity benefit may not be denied or
54 diminished for failure to provide admission notice. The policy may not require the provision of
55 admission notice by only the insured patient.
56 (b) This Subsection (4) does not prohibit an insurer from:
57 (i) requiring a referral before maternity care can be obtained;
58 (ii) specifying a group of providers or a particular location from which an insured is
59 required to obtain maternity care; or
60 (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
61 terms and conditions of the insurance contract so long as such terms do not conflict with
62 Subsection (4)(a).
63 (5) An insurer may only represent that a policy:
64 (a) offers a vision benefit if the policy:
65 (i) charges a premium for the benefit; and
66 (ii) provides reimbursement for materials or services provided under the policy; and
67 (b) covers laser vision correction, whether photorefractive keratectomy, laser assisted
68 in-situ keratomelusis, or related procedure, if the policy:
69 (i) charges a premium for the benefit; and
70 (ii) the procedure is at least a partially covered benefit.
71 (6) (a) For purposes of this Subsection (6):
72 (i) "Contraceptive article" means:
73 (A) any prescription drug, medicine, mixture, preparation, instrument, article, or device
74 of any nature that is:
75 (I) approved by the Federal Food and Drug Administration to prevent a pregnancy; and
76 (II) prescribed by a licensed health care provider for use to prevent a pregnancy; or
77 (B) any hormonal compound that is taken orally and that is approved by the Federal
78 Food and Drug Administration for use to prevent a pregnancy.
79 (ii) "Contraceptive article" does not include any drug, medicine, mixture, preparation,
80 instrument, article, or device of any nature that is prescribed by a licensed health care
81 professional for use in terminating a pregnancy.
82 (b) Except as provided in Subsection (6)(c), all health insurance policies or health
83 maintenance organization contracts that provide coverage for outpatient prescription drugs
84 shall cover to the same extent and subject to the same policy or contract terms:
85 (i) contraceptive articles; and
86 (ii) outpatient services for contraceptive articles.
87 (c) Notwithstanding any other provision of this section, a religious employer may
88 request a health insurance policy or health maintenance organization contract without coverage
89 for prescriptive contraceptive articles or methods that are contrary to the religious employer's
90 religious tenets. If requested, a health insurance policy or health maintenance organization
91 contract shall be provided without coverage for contraceptive articles or methods.
92 (i) For purposes of this Subsection (6)(c), a "religious employer" is an entity for which
93 each of the following is true:
94 (A) the inculcation of religious values is the purpose of the entity;
95 (B) the entity primarily employs persons who share the religious tenets of the entity;
96 (C) the entity serves primarily persons who share the religious tenets of the entity; and
97 (D) the entity is a nonprofit organization as described in Section 6033(a)(2)(A)i or iii,
98 of the Internal Revenue Code of 1986, as amended.
99 (ii) Every religious employer that invokes the exemption provided under this
100 Subsection (6)(c) shall provide written notice to prospective enrollees prior to enrollment with
101 the plan, listing the contraceptive articles or methods the employer refuses to cover for
102 religious reasons.
103 (d) Nothing in this Subsection (6) shall be construed to:
104 (i) exclude coverage for prescriptive contraceptive articles or methods ordered by a
105 health care provider with prescriptive authority for reasons other than contraceptive purposes,
106 such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for
107 prescription contraception that is necessary to preserve the life or health of an enrollee;
108 (ii) deny or restrict in any way any existing right or benefit provided under law or by
109 contract; or
110 (iii) require an individual or group health insurance policy or health maintenance
111 organization contract to cover experimental or investigational treatments.
112 Section 2. Effective date.
113 This bill takes effect on July 1, 2007.
Legislative Review Note
as of 1-17-07 6:43 AM