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H.B. 372

             1     

INSURANCE PROVISIONS REGARDING

             2     
OFFENDERS

             3     
2009 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Paul Ray

             6     
Senate Sponsor: ____________

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill modifies the Insurance Code by requiring an insurance company providing
             11      health or accident policies to coordinate benefits for an insured individual housed in a
             12      correctional facility or offenders in the custody of the Department of Corrections.
             13      Highlighted Provisions:
             14          This bill:
             15          .    provides that, if an insured is otherwise eligible for benefits under a policy, an
             16      accident and health insurer may not exclude coverage for:
             17              .    an inmate housed in a correctional facility; or
             18              .    an offender in the custody of the Department of Corrections;
             19          .    requires that an accident and health insurer coordinate benefits for an insured who
             20      is:
             21              .    an inmate housed in a correctional facility; or
             22              .    an offender in the custody of the Department of Corrections; and
             23          .    requires an inmate who has medical or dental insurance coverage, upon entering
             24      into the Department of Correction's custody, to use that coverage as primary payer
             25      for medical and dental costs incurred while in the custody of the Department of
             26      Corrections.
             27      Monies Appropriated in this Bill:


             28          None
             29      Other Special Clauses:
             30          None
             31      Utah Code Sections Affected:
             32      AMENDS:
             33          31A-22-613, as last amended by Laws of Utah 2005, Chapter 78
             34          31A-22-619, as last amended by Laws of Utah 2001, Chapter 116
             35          64-13-30, as last amended by Laws of Utah 2002, Chapter 140
             36     
             37      Be it enacted by the Legislature of the state of Utah:
             38          Section 1. Section 31A-22-613 is amended to read:
             39           31A-22-613. Permitted provisions for accident and health insurance policies.
             40          The following provisions may be contained in an accident and health insurance policy,
             41      but if they are in that policy, they shall conform to at least the minimum requirements for the
             42      policyholder in this section.
             43          (1) Any provision respecting change of occupation may provide only for a lower
             44      maximum benefit payment and for reduction of loss payments proportionate to the change in
             45      appropriate premium rates, if the change is to a higher rated occupation, and this provision
             46      shall provide for retroactive reduction of premium rates from the date of change of occupation
             47      or the last policy anniversary date, whichever is the more recent, if the change is to a lower
             48      rated occupation.
             49          (2) Section 31A-22-405 applies to misstatement of age in accident and health policies,
             50      with the appropriate modifications of terminology.
             51          (3) Any policy which contains a provision establishing, as an age limit or otherwise, a
             52      date after which the coverage provided by the policy is not effective, and if that date falls
             53      within a period for which a premium is accepted by the insurer or if the insurer accepts a
             54      premium after that date, the coverage provided by the policy continues in force, subject to any
             55      right of cancellation, until the end of the period for which the premium was accepted. This
             56      Subsection (3) does not apply if the acceptance of premium would not have occurred but for a
             57      misstatement of age by the insured.
             58          (4) (a) If an insured is otherwise eligible for maternity benefits, a policy may not


             59      contain language which requires an insured to obtain any additional preauthorization or
             60      preapproval for customary and reasonable maternity care expenses or for the delivery of the
             61      child after an initial preauthorization or preapproval has been obtained from the insurer for
             62      prenatal care. A requirement for notice of admission for delivery is not a requirement for
             63      preauthorization or preapproval, however, the maternity benefit may not be denied or
             64      diminished for failure to provide admission notice. The policy may not require the provision of
             65      admission notice by only the insured patient.
             66          (b) This Subsection (4) does not prohibit an insurer from:
             67          (i) requiring a referral before maternity care can be obtained;
             68          (ii) specifying a group of providers or a particular location from which an insured is
             69      required to obtain maternity care; or
             70          (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
             71      terms and conditions of the insurance contract so long as such terms do not conflict with
             72      Subsection (4)(a).
             73          (5) An insurer may only represent that a policy:
             74          (a) offers a vision benefit if the policy:
             75          (i) charges a premium for the benefit; and
             76          (ii) provides reimbursement for materials or services provided under the policy; and
             77          (b) covers laser vision correction, whether photorefractive keratectomy, laser assisted
             78      in-situ keratomelusis, or related procedure, if the policy:
             79          (i) charges a premium for the benefit; and
             80          (ii) the procedure is at least a partially covered benefit.
             81          (6) If an insured is otherwise eligible for benefits under a policy, an accident and health
             82      insurer may not exclude coverage if the insured is an:
             83          (a) inmate housed in a correctional facility as defined in Section 64-13-1 ; or
             84          (b) offender in the custody of the Department of Corrections.
             85          Section 2. Section 31A-22-619 is amended to read:
             86           31A-22-619. Coordination of benefits.
             87          (1) The commissioner shall adopt rules concerning the coordination of benefits
             88      between accident and health insurance policies.
             89          (2) Rules adopted by the commissioner under Subsection (1):


             90          (a) may not prohibit coordination of benefits with individual accident and health
             91      insurance policies; [and]
             92          (b) shall apply equally to all accident and health insurance policies without regard to
             93      whether the policies are group or individual policies[.]; and
             94          (c) shall require an accident and health insurer to coordinate benefits for an insured
             95      who is an:
             96          (i) inmate housed in a correctional facility as defined in Section 63-13-1 ; or
             97          (ii) offender in the custody of the Department of Corrections.
             98          Section 3. Section 64-13-30 is amended to read:
             99           64-13-30. Expenses incurred by offenders -- Payment to department or county
             100      jail.
             101          (1) (a) The department shall establish and collect from [offenders] each offender on a
             102      work release [programs] program the reasonable costs of the offender's maintenance,
             103      transportation, and incidental expenses incurred by the department on behalf of the [offenders]
             104      offender.
             105          (b) Priority shall be given to restitution and family support obligations.
             106          (c) The offender's reimbursement to the department for the cost of obtaining the
             107      offender's DNA specimen, under Section 53-10-404 is the next priority after Subsection (1)(b).
             108          (2) The department, under its rules, may advance funds to any offender as necessary to
             109      establish the offender in a work release program.
             110          (3) (a) The department or county jail may require an inmate to make a [reasonable]
             111      copayment for medical and dental services provided by the department or county jail.
             112          (b) An inmate may not be denied medical treatment if he is unable to pay the
             113      copayment because of inadequate financial resources.
             114          (4) An inmate who, upon entering into the department's custody, has medical insurance
             115      or dental insurance coverage shall use that coverage as the primary payer for medical and
             116      dental costs incurred while in the custody of the department.





Legislative Review Note
    as of 2-13-09 2:51 PM


Office of Legislative Research and General Counsel


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