H.B. 105

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PRESCRIPTION COVERAGE
2 1998 GENERAL SESSION
3 STATE OF UTAH
4 Sponsor: Sheryl L. Allen
5 Susan J. Koehn
6 Mary Carlson
7 Patrice Arent
8 Patricia B. Larson
Trisha S. Beck
Loretta Baca
Marda Dillree
Afton B. Bradshaw
Beverly Ann Evans
Judy Ann Buffmire
Christine R. Fox-Finlinson
Loraine T. Pace

9 AN ACT RELATING TO INSURANCE; REQUIRING HEALTH INSURANCE POLICIES
10 THAT COVER PRESCRIPTION DRUGS TO COVER PRESCRIPTION CONTRACEPTIVE
11 METHODS AND RELATED OUTPATIENT SERVICES; AND PROVIDING AN
12 EFFECTIVE DATE.
13 This act affects sections of Utah Code Annotated 1953 as follows:
14 AMENDS:
15 31A-22-613, as last amended by Chapter 38, Laws of Utah 1996
16 Be it enacted by the Legislature of the state of Utah:
17 Section 1. Section 31A-22-613 is amended to read:
18 31A-22-613. Permitted provisions for disability insurance policies.
19 The following provisions may be contained in a disability insurance policy, but if they are
20 in that policy, they shall conform to at least the following minimum requirements for the
21 policyholder:
22 (1) Any provision respecting change of occupation may provide only for a lower
23 maximum benefit payment and for reduction of loss payments proportionate to the change in
24 appropriate premium rates, if the change is to a higher rated occupation, and this provision shall
25 provide for retroactive reduction of premium rates from the date of change of occupation or the
26 last policy anniversary date, whichever is the more recent, if the change is to a lower rated
27 occupation.
28 (2) Section 31A-22-405 applies to misstatement of age in disability policies, with the

1 appropriate modifications of terminology.
2 (3) Any policy which contains a provision establishing, as an age limit or otherwise, a date
3 after which the coverage provided by the policy is not effective, and if that date falls within a
4 period for which a premium is accepted by the insurer or if the insurer accepts a premium after that
5 date, the coverage provided by the policy continues in force, subject to any right of cancellation,
6 until the end of the period for which the premium was accepted. This subsection does not apply
7 if the acceptance of premium would not have occurred but for a misstatement of age by the
8 insured.
9 (4) Any provision dealing with preexisting conditions shall be consistent with Subsections
10 31A-22-605(9)(a) and 31A-22-609(2), and any applicable rule adopted by the commissioner.
11 (5) (a) If an insured is otherwise eligible for maternity benefits, a policy may not contain
12 language which requires an insured to obtain any additional preauthorization or preapproval for
13 customary and reasonable maternity care expenses or for the delivery of the child after an initial
14 preauthorization or preapproval has been obtained from the insurer for prenatal care. A
15 requirement for notice of admission for delivery is not a requirement for preauthorization or
16 preapproval, however, the maternity benefit may not be denied or diminished for failure to provide
17 admission notice. The policy may not require the provision of admission notice by only the
18 insured patient.
19 (b) This subsection does not prohibit an insurer from:
20 (i) requiring a referral before maternity care can be obtained;
21 (ii) specifying a group of providers or a particular location from which an insured is
22 required to obtain maternity care; or
23 (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
24 terms and conditions of the insurance contract so long as such terms do not conflict with
25 Subsection (5)(a).
26 (6) A disability policy that provides coverage for outpatient prescription drugs shall cover:
27 (a) to the same extent and subject to the same contract terms, prescription contraceptive
28 methods approved by the federal Food and Drug Administration; and
29 (b) outpatient services for prescription contraceptive methods approved by the federal
30 Food and Drug Administration to the same extent and subject to the same contract terms as other
31 covered outpatient services.

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1 Section 2. Effective date.
2 This act takes effect on July 1, 1998.




Legislative Review Note
as of 1-21-98 2:14 PM

A limited legal review of this bill raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel

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