S.B. 112

1

INSURANCE COVERAGE OF
2 CONTRACEPTIVES
3 2002 GENERAL SESSION
4 STATE OF UTAH
5 Sponsor: L. Steven Poulton
6 This act modifies the Insurance Code to require health insurance policies that cover
7 prescription drugs to also offer to cover, subject to the same conditions or contract terms and
8 any additional premiums, FDA-approved prescription contraceptive articles and related
9 outpatient services. This act creates an exemption for religious organizations. This act takes
10 effect on July 1, 2002.
11 This act affects sections of Utah Code Annotated 1953 as follows:
12 AMENDS:
13 31A-22-613, as last amended by Chapter 116, Laws of Utah 2001
14 Be it enacted by the Legislature of the state of Utah:
15 Section 1. Section 31A-22-613 is amended to read:
16 31A-22-613. Permitted provisions for accident and health insurance policies.
17 The following provisions may be contained in an accident and health insurance policy, but
18 if they are in that policy, they shall conform to at least the minimum requirements for the
19 policyholder in this section.
20 (1) Any provision respecting change of occupation may provide only for a lower maximum
21 benefit payment and for reduction of loss payments proportionate to the change in appropriate
22 premium rates, if the change is to a higher rated occupation, and this provision shall provide for
23 retroactive reduction of premium rates from the date of change of occupation or the last policy
24 anniversary date, whichever is the more recent, if the change is to a lower rated occupation.
25 (2) Section 31A-22-405 applies to misstatement of age in accident and health policies,
26 with the appropriate modifications of terminology.
27 (3) Any policy which contains a provision establishing, as an age limit or otherwise, a date

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

59 (7) (a) Except as provided in Subsection (7)(b), a health insurance policy or health
60 maintenance organization contract that provides coverage for outpatient prescription drugs shall
61 also offer to cover, subject to the same policy conditions or contract terms and any additional
62 premiums:
63 (i) contraceptive articles; and
64 (ii) outpatient services for contraceptive articles.
65 (b) A religious organization may, at its option, request that the coverage required by
66 Subsection (7)(a) be excluded from a policy or contract purchased by or otherwise offered through
67 the organization for the benefit of the organization's employees.
68 (c) As used in this Subsection (7):
69 (i) "Contraceptive article" means:
70 (A) any prescription drug, medicine, mixture, preparation, instrument, article, or device
71 of any nature that is:
72 (I) approved by the federal Food and Drug Administration to prevent a pregnancy; and
73 (II) prescribed by a licensed health care provider for use to prevent a pregnancy; or
74 (B) any hormonal compound that is taken orally and that is approved by the federal Food
75 and Drug Administration for use to prevent a pregnancy.
76 (ii) "Contraceptive article" does not include any drug, medicine, mixture, preparation,
77 instrument, article, or device of any nature that is prescribed by a licensed health care professional
78 for use in terminating a pregnancy.
79 Section 2. Effective date.
80 This act takes effect on July 1, 2002.




Legislative Review Note
as of 7-26-01 8:08 AM

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

Office of Legislative Research and General Counsel