H.B. 347
This document includes House Committee Amendments incorporated into the bill on Fri, Feb 21, 2014 at 12:27 PM by jeyring. --> 1
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7 LONG TITLE
8 General Description:
9 This bill permits an accident and health insurer to offer a limited benefit plan for
10 infertility treatment coverage.
11 Highlighted Provisions:
12 This bill:
13 . defines terms;
14 . requires the commissioner to allow limited benefit accident and health insurance
15 benefits for infertility treatment;
16 . establishes some limitations and requirements for the infertility treatment coverage;
17 and
18 . authorizes, at the discretion of the insurer and the enrollee, the use of the value of
19 the adoption indemnity benefit for infertility treatment.
20 Money Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 None
24 Utah Code Sections Affected:
25 AMENDS:
26 31A-22-610.1 , as last amended by Laws of Utah 2006, Chapter 94
27 ENACTS:
28 31A-22-642 , Utah Code Annotated 1953
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30 Be it enacted by the Legislature of the state of Utah:
31 Section 1. Section 31A-22-610.1 is amended to read:
32 31A-22-610.1. Adoption indemnity benefit.
33 (1) (a) (i) If an insured has coverage for maternity benefits on the date of an adoptive
34 placement, the insured's policy shall provide an adoption indemnity benefit payable to the
35 insured, if a child is placed for adoption with the insured within 90 days of the child's birth. If
36 more than one child from the same birth is placed for adoption with the insured, only one
37 adoption indemnity benefit is required.
38 (ii) This section does not prevent an accident and health insurer from:
39 (A) adjusting the benefit payable under this section for cost sharing measures imposed
40 under the policy or contract for maternity benefit coverage; or
41 (B) providing additional adoption indemnity benefits including:
42 (I) extending the period of time after birth in which a child must be placed with an
43 insured; or
44 (II) providing a benefit in excess of the amount specified in Subsection (1)(c).
45 (b) An insurer that has paid the adoption indemnity benefit under Subsection (1)(a)
46 may seek reimbursement of the benefit if:
47 (i) the postplacement evaluation disapproves the adoption placement; and
48 (ii) a court rules the adoption may not be finalized because of an act or omission of an
49 adoptive parent or parents that affects the child's health or safety.
50 (c) (i) The amount of the adoption indemnity benefit provided under Subsection (1) is
51 $4,000 subject to the adjustments permitted by Subsection (1)(a)(ii).
52 (ii) An insurer may comply with the provisions of this section by providing the $4,000
53 adoption indemnity benefit to an enrollee to be used for the purpose of the enrollee obtaining
54 infertility treatments rather than seeking reimbursement for an adoption in accordance with
55 terms H. [
56 (d) Each insurer shall pay its pro rata share of the adoption indemnity benefit if each
57 adoptive parent:
58 (i) has coverage for maternity benefits with a different insurer; and
59 (ii) makes a claim for the adoption indemnity benefit provided in Subsection (1)(a).
60 (2) If a policy offers optional maternity benefits, it shall also offer coverage for
61 adoption indemnity benefits if:
62 (a) a child is placed for adoption with the insured within 90 days of the child's birth;
63 and
64 (b) the adoption is finalized within one year of the child's birth.
65 (3) If an insured qualifies for the adoption indemnity benefit under this section and
66 receives services from a health care provider under contract with his insurer, the contracting
67 health care provider may only collect from the insured the amount that the contracting health
68 care provider is entitled to receive for such services under the contract, including any
69 applicable copayment.
70 (4) For purposes of this section, "contracting health care provider" means:
71 (a) a "participating provider" as defined in Section 31A-8-101 ; or
72 (b) a "preferred health care provider" as described in Section 31A-22-617 .
73 Section 2. Section 31A-22-642 is enacted to read:
74 31A-22-642. Infertility treatment limited benefit plans.
75 (1) As used in this section:
76 (a) "Infertility" is as defined by the American Society for Reproductive Medicine.
77 (b) (i) "Infertility treatment" includes:
78 (A) the diagnosis of infertility; and
79 (B) except as provided in Subsection (1)(b)(ii), treatment of infertility, including in
80 vitro fertilization that is performed at a medical facility that conforms to American Society for
81 Reproductive Medicine guidelines.
82 (ii) "Infertility treatment" may exclude in vitro fertilization if the insurer offers at least
83 one limited benefit plan under this section that includes coverage for in vitro fertilization
84 treatment in accordance with Subsection (4).
85 (c) "Patient" means a woman who:
86 (i) is married;
87 (ii) is the policyholder or the spouse of the policyholder;
88 (iii) is at least 21 years old but less than 44 years old; and
89 (iv) has been covered by the infertility treatment limited benefit plan for at least 12
90 continuous months prior to receiving infertility treatment under the policy.
91 (2) The commissioner shall permit an accident and health insurer to offer, and shall
92 permit an individual or employer group to enroll in, a limited benefit plan for infertility
93 treatment in accordance with this section.
94 (3) (a) An accident and health insurer may offer a limited benefit plan for infertility
95 treatment to a patient if the accident and health insurer offers:
96 (i) a limited benefit plan that covers infertility treatment, including in vitro fertilization;
97 or
98 (ii) two or more limited benefit plans:
99 (A) one of which covers infertility treatment, including in vitro fertilization; and
100 (B) one of which covers infertility treatment, but excludes coverage for in vitro
101 fertilization.
102 (b) A health insurer may offer to provide the value of the adoption indemnity benefit to
103 an enrollee to be used for infertility treatment in accordance with Subsection 31A-22-610.1 (1).
104 (4) Infertility treatment coverage under Subsection (3)(a) shall:
105 (a) have a minimum actuarial value of 75%;
106 (b) have a lifetime maximum benefit of not less than $ H. [
107 (c) if in vitro fertilization is covered:
108 (i) only offer in vitro fertilization to a patient who has not been able to obtain a viable
109 pregnancy through a procedure less costly than in vitro fertilization; and
110 (ii) limit embryos transferred per in vitro cycle to:
111 (A) one embryo for a patient who is at least 21 years old but less than 34 years old; and
112 (B) two embryos per cycle for a patient who is at least 34 years old but less than 44
113 years old.
Legislative Review Note
as of 2-12-14 10:20 AM