Section 10. Section 31A-22-613.5 is amended to read:
31A-22-613.5. Price and value comparisons of health insurance.
(1) This section applies generally to all health insurance policies and health
maintenance organization contracts.
(2) [(a)] The commissioner shall adopt a Basic Health Care Plan consistent with
this section to be offered under the open enrollment provisions of Chapter 30 ,
Individual, Small Employer, and Group Health Insurance Act .
[(b) (i) Before adoption of a plan under Subsection (2)(a), the commissioner shall
submit the proposed Basic Health Care Plan to the Health and Human Services Interim
Committee for review and recommendations.
(ii) After the commissioner adopts the Basic Health Care Plan, the Health and
Human Services Interim Committee:
(A) shall provide legislative oversight of the Basic Health Care Plan; and
(B) may recommend legislation to modify the Basic Health Care Plan adopted by
the commissioner.]
(3) (a) The commissioner shall promote informed consumer behavior and
responsible health insurance and health plans by requiring an insurer issuing health
insurance policies or health maintenance organization contracts to provide to all
enrollees, prior to enrollment in the health benefit plan or health insurance policy, written
disclosure of:
(i) restrictions or limitations on prescription drugs and biologics including the use of
a formulary and generic substitution; and
(ii) coverage limits under the plan.
(b) In addition to the requirements of Subsections (3)(a) and (d), an insurer described
in Subsection (3)(a) shall submit the written disclosure required by this Subsection (3) to
the commissioner:
(i) upon commencement of operations in the state; and
(ii) anytime the insurer amends any of the following described in Subsection (3)(a):
(A) treatment policies;
(B) practice standards;
(C) restrictions; or
(D) coverage limits of the insurer's health benefit plan or health insurance policy.
(c) The commissioner may adopt rules to implement the disclosure requirements of
this Subsection (3), taking into account:
(i) business confidentiality of the insurer;
(ii) definitions of terms; and
(iii) the method of disclosure to enrollees.
(d) If under Subsection (3)(a)(i) a formulary is used, the insurer shall make available
to prospective enrollees and maintain evidence of the fact of the disclosure of:
(i) the drugs included;
(ii) the patented drugs not included; and
(iii) any conditions that exist as a precedent to coverage.
(4) The Basic Health Care Plan adopted by the commissioner under this section
shall provide for:
(a) a lifetime maximum benefit per person not to exceed $1,000,000;
(b) an annual maximum benefit per person not to exceed $300,000;
(c) an out-of-pocket maximum per person not to exceed $5,000, including the
deductible;
(d) in relation to its cost-sharing features:
(i) a deductible of not less than $1,500 for major medical expenses; and
(ii)(A) a copayment of not less than:
(I) $25 per visit for office services; and
(II) $150 per visit to an emergency room; or
(B) coinsurance of not less than:
(I) 20% per visit for office services; and
(II) 20% per visit for an emergency room; and
(e) in relation to cost sharing features for prescription drugs:
(i) a deductible of not less than $500; and
(ii)(A) a copayment of not less than:
(I) $15 for the lowest level of cost for prescription drugs;
(II) $30 for the second level of cost for prescription drugs; and
(III) $60 for the highest level of cost for prescription drugs; or
(B) coinsurance of not less than:
(I) 25% for the lowest level of cost for prescription drugs;
(II) 40% for the second level of cost for prescription drugs; and
(III) 60% for the highest level of cost for prescription drugs.
Renumber remaining sections accordingly.
The motion to amend passed unanimously, with Rep. D. Clark and Rep. Ferry absent for the
vote.
MOTION: Rep. Kiser moved to pass the bill out favorably as amended. The motion passed
unanimously, with Rep. Biskupski and Rep. D. Clark absent for the vote.
H.B. 277 Construction Amendments (Rep. M. Morley)
MOTION: Rep. Morley moved to delete in title and body H.B. 277 and replace it with 1st
Substitute H.B. 277. The motion passed unanimously.
Rep. Morley introduced the bill to the committee.
Spoke to the bill: John T. Nielsen, Utah State Bar Association
Spoke against the bill: Paul Newton, President, Utah Land Title Association
Spoke for the bill: Craig Moody, Utah Construction Suppliers Association
Taz Biesinger, Utah Home Builders Association
MOTION: Rep. Ferry moved to pass the substitute bill out favorably. The motion passed
with Rep. Biskupski voting in opposition.
H.B. 261 Expiration of Gift Certificates (Rep. W. Harper)
Rep. Harper introduced the bill to the committee.
MOTION: Rep. Neuenschwander moved to amend the bill as follows:
1. Page
5, Lines 136 through 140
:
136
(4) (a) A gift certificate, instrument, or other record that does not print an expiration
137
date in accordance with Subsection (2)(v) does not expire.
138
(b) A gift certificate, instrument, or other record that does not include printed
139
information concerning a fee to be charged and deducted from the balance of the gift
140
certificate, instrument, or other record is not subject to the charging and deduction of the
fee.
(c) Subsections (2)(v) and (4)(b) do not apply to a gift certificate, instrument, or
other record useable at multiple, unaffiliated sellers of goods or services if an
expiration date is printed on the gift certificate, instrument, or other record.
The motion to amend passed unanimously, with Rep. Morley absent for the vote.
Spoke to the bill: Jim Olsen, President, Utah Retail Merchants Association
Howard Headlee, President, Utah Bankers Association
MOTION: Rep. Ferry moved to pass the bill out favorably as amended. The motion passed
unanimously, with Rep. Froerer absent for the vote.
H.B. 258 Continuing Education Requirements for Architects (Rep. B. Dee)
This bill was not heard in this meeting.
MOTION: Rep. Kiser moved to adjourn the meeting. The motion passed unanimously, with
Rep. Froerer absent for the vote.
Chair Clark adjourned the meeting at 3:35 p.m.
_________________________
Rep. Stephen D. Clark, Chair