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S.B. 9

             1     

EQUITY IN PRESCRIPTION COVERAGE

             2     
2000 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Sponsor: Paula F. Julander

             5      AN ACT RELATING TO INSURANCE; REQUIRING HEALTH INSURANCE POLICIES
             6      THAT COVER PRESCRIPTION DRUGS TO COVER FDA-APPROVED PRESCRIPTION
             7      CONTRACEPTIVE ARTICLES AND RELATED OUTPATIENT SERVICES; CREATING AN
             8      EXEMPTION FOR RELIGIOUS ORGANIZATIONS; AND PROVIDING AN EFFECTIVE
             9      DATE.
             10      This act affects sections of Utah Code Annotated 1953 as follows:
             11      AMENDS:
             12          31A-22-613, as last amended by Chapter 38, Laws of Utah 1996
             13      Be it enacted by the Legislature of the state of Utah:
             14          Section 1. Section 31A-22-613 is amended to read:
             15           31A-22-613. Permitted provisions for disability insurance policies.
             16          The following provisions may be contained in a disability insurance policy, but if they are
             17      in that policy, they shall conform to at least the following minimum requirements for the
             18      policyholder:
             19          (1) Any provision respecting change of occupation may provide only for a lower maximum
             20      benefit payment and for reduction of loss payments proportionate to the change in appropriate
             21      premium rates, if the change is to a higher rated occupation, and this provision shall provide for
             22      retroactive reduction of premium rates from the date of change of occupation or the last policy
             23      anniversary date, whichever is the more recent, if the change is to a lower rated occupation.
             24          (2) Section 31A-22-405 applies to misstatement of age in disability policies, with the
             25      appropriate modifications of terminology.
             26          (3) Any policy which contains a provision establishing, as an age limit or otherwise, a date
             27      after which the coverage provided by the policy is not effective, and if that date falls within a


             28      period for which a premium is accepted by the insurer or if the insurer accepts a premium after that
             29      date, the coverage provided by the policy continues in force, subject to any right of cancellation,
             30      until the end of the period for which the premium was accepted. This subsection does not apply
             31      if the acceptance of premium would not have occurred but for a misstatement of age by the
             32      insured.
             33          (4) Any provision dealing with preexisting conditions shall be consistent with Subsections
             34      31A-22-605 (9)(a) and 31A-22-609 (2), and any applicable rule adopted by the commissioner.
             35          (5) (a) If an insured is otherwise eligible for maternity benefits, a policy may not contain
             36      language which requires an insured to obtain any additional preauthorization or preapproval for
             37      customary and reasonable maternity care expenses or for the delivery of the child after an initial
             38      preauthorization or preapproval has been obtained from the insurer for prenatal care. A
             39      requirement for notice of admission for delivery is not a requirement for preauthorization or
             40      preapproval, however, the maternity benefit may not be denied or diminished for failure to provide
             41      admission notice. The policy may not require the provision of admission notice by only the
             42      insured patient.
             43          (b) This Subsection (5) does not prohibit an insurer from:
             44          (i) requiring a referral before maternity care can be obtained;
             45          (ii) specifying a group of providers or a particular location from which an insured is
             46      required to obtain maternity care; or
             47          (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
             48      terms and conditions of the insurance contract so long as such terms do not conflict with
             49      Subsection (5)(a).
             50          (6) (a) Except as provided in Subsection (6)(b), a health insurance policy or health
             51      maintenance organization contract that provides coverage for outpatient prescription drugs shall
             52      cover to the same extent and subject to the same policy or contract terms:
             53          (i) contraceptive articles; and
             54          (ii) outpatient services for contraceptive articles.
             55          (b) A religious organization may, at its option, request that the coverage required by
             56      Subsection (6)(a) be excluded from a policy or contract purchased by or otherwise offered through
             57      the organization for the benefit of the organization's employees.
             58          (c) The commissioner shall adopt rules as necessary to ensure that health insurance


             59      policies and health maintenance organization contracts are in compliance with this Subsection (6).
             60          (d) As used in this Subsection (6):
             61          (i) "Contraceptive article" means:
             62          (A) any drug, medicine, mixture, preparation, instrument, article, or device of any nature
             63      that is:
             64          (I) approved by the federal Food and Drug Administration to prevent a pregnancy; and
             65          (II) prescribed by a licensed health care provider for use to prevent a pregnancy; or
             66          (B) any hormonal compound that is taken orally and that is approved by the federal Food
             67      and Drug Administration for use to prevent a pregnancy.
             68          (ii) "Contraceptive article" does not include any drug, medicine, mixture, preparation,
             69      instrument, article, or device of any nature that is prescribed by a licensed health care professional
             70      for use in terminating a pregnancy.
             71          Section 2. Effective date.
             72          This act takes effect on July 1, 2000.




Legislative Review Note
    as of 12-13-99 3:03 PM


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

Office of Legislative Research and General Counsel


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