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S.B. 42





Sponsor: Paula F. Julander

             5      This act modifies the Insurance Code to require health insurance policies that cover
             6      prescription drugs to cover FDA-approved prescription contraceptive articles and related
             7      outpatient services. This act creates an exemption for religious organizations. This act takes
             8      effect on July 1, 2001.
             9      This act affects sections of Utah Code Annotated 1953 as follows:
             10      AMENDS:
             11          31A-22-613, as last amended by Chapter 160, Laws of Utah 2000
             12      Be it enacted by the Legislature of the state of Utah:
             13          Section 1. Section 31A-22-613 is amended to read:
             14           31A-22-613. Permitted provisions for disability insurance policies.
             15          The following provisions may be contained in a disability insurance policy, but if they are
             16      in that policy, they shall conform to at least the following minimum requirements for the
             17      policyholder:
             18          (1) Any provision respecting change of occupation may provide only for a lower maximum
             19      benefit payment and for reduction of loss payments proportionate to the change in appropriate
             20      premium rates, if the change is to a higher rated occupation, and this provision shall provide for
             21      retroactive reduction of premium rates from the date of change of occupation or the last policy
             22      anniversary date, whichever is the more recent, if the change is to a lower rated occupation.
             23          (2) Section 31A-22-405 applies to misstatement of age in disability policies, with the
             24      appropriate modifications of terminology.
             25          (3) Any policy which contains a provision establishing, as an age limit or otherwise, a date
             26      after which the coverage provided by the policy is not effective, and if that date falls within a
             27      period for which a premium is accepted by the insurer or if the insurer accepts a premium after that

             28      date, the coverage provided by the policy continues in force, subject to any right of cancellation,
             29      until the end of the period for which the premium was accepted. This Subsection (3) does not
             30      apply if the acceptance of premium would not have occurred but for a misstatement of age by the
             31      insured.
             32          (4) Any provision dealing with preexisting conditions shall be consistent with Subsections
             33      31A-22-605 (9)(a) and 31A-22-609 (2), and any applicable rule adopted by the commissioner.
             34          (5) (a) If an insured is otherwise eligible for maternity benefits, a policy may not contain
             35      language which requires an insured to obtain any additional preauthorization or preapproval for
             36      customary and reasonable maternity care expenses or for the delivery of the child after an initial
             37      preauthorization or preapproval has been obtained from the insurer for prenatal care. A
             38      requirement for notice of admission for delivery is not a requirement for preauthorization or
             39      preapproval, however, the maternity benefit may not be denied or diminished for failure to provide
             40      admission notice. The policy may not require the provision of admission notice by only the
             41      insured patient.
             42          (b) This Subsection (5) does not prohibit an insurer from:
             43          (i) requiring a referral before maternity care can be obtained;
             44          (ii) specifying a group of providers or a particular location from which an insured is
             45      required to obtain maternity care; or
             46          (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
             47      terms and conditions of the insurance contract so long as such terms do not conflict with
             48      Subsection (5)(a).
             49          (6) An insurer may only represent that a policy:
             50          (a) offers a vision benefit if the policy:
             51          (i) charges a premium for the benefit; and
             52          (ii) provides reimbursement for materials or services provided under the policy; and
             53          (b) covers laser vision correction, whether photorefractive keratectomy, laser assisted
             54      in-situ keratomelusis, or related procedure, if the policy:
             55          (i) charges a premium for the benefit; and
             56          (ii) the procedure is at least a partially covered benefit.
             57          (7) (a) Except as provided in Subsection (7)(b), a health insurance policy or health
             58      maintenance organization contract that provides coverage for outpatient prescription drugs shall

             59      cover to the same extent and subject to the same policy or contract terms:
             60          (i) contraceptive articles; and
             61          (ii) outpatient services for contraceptive articles.
             62          (b) A religious organization may, at its option, request that the coverage required by
             63      Subsection (7)(a) be excluded from a policy or contract purchased by or otherwise offered through
             64      the organization for the benefit of the organization's employees.
             65          (c) The commissioner shall adopt rules as necessary to ensure that health insurance
             66      policies and health maintenance organization contracts are in compliance with this Subsection (7).
             67          (d) As used in this Subsection (7):
             68          (i) "Contraceptive article" means:
             69          (A) any drug, medicine, mixture, preparation, instrument, article, or device of any nature
             70      that is:
             71          (I) approved by the federal Food and Drug Administration to prevent a pregnancy; and
             72          (II) prescribed by a licensed health care provider for use to prevent a pregnancy; or
             73          (B) any hormonal compound that is taken orally and that is approved by the federal Food
             74      and Drug Administration for use to prevent a pregnancy.
             75          (ii) "Contraceptive article" does not include any drug, medicine, mixture, preparation,
             76      instrument, article, or device of any nature that is prescribed by a licensed health care professional
             77      for use in terminating a pregnancy.
             78          Section 2. Effective date.
             79          This act takes effect on July 1, 2001.

Legislative Review Note
    as of 11-30-00 9:23 AM

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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