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H.B. 22





Chief Sponsor: Paul Ray

Senate Sponsor: ____________

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

             28          .    provides specified exemptions regarding coverage by an inmate's health or dental
             29      insurance policy, including injuries to the insured caused by physical violence.
             30      Monies Appropriated in this Bill:
             31          None
             32      Other Special Clauses:
             33          None
             34      Utah Code Sections Affected:
             35      AMENDS:
             36          31A-22-613, as last amended by Laws of Utah 2005, Chapter 78
             37          31A-22-619, as last amended by Laws of Utah 2009, Chapter 11
             38          64-13-30, as last amended by Laws of Utah 2009, Chapter 258
             40      Be it enacted by the Legislature of the state of Utah:
             41          Section 1. Section 31A-22-613 is amended to read:
             42           31A-22-613. Permitted provisions for accident, health, and dental insurance
             43      policies.
             44          The following provisions may be contained in an accident [and], health, and dental
             45      insurance policy, but if they are in that policy, they shall conform to at least the minimum
             46      requirements for the policyholder in this section.
             47          (1) Any provision respecting change of occupation may provide only for a lower
             48      maximum benefit payment and for reduction of loss payments proportionate to the change in
             49      appropriate premium rates, if the change is to a higher rated occupation, and this provision
             50      shall provide for retroactive reduction of premium rates from the date of change of occupation
             51      or the last policy anniversary date, whichever is the more recent, if the change is to a lower
             52      rated occupation.
             53          (2) Section 31A-22-405 applies to misstatement of age in accident and health policies,
             54      with the appropriate modifications of terminology.
             55          (3) (a) Any policy which contains a provision establishing, as an age limit or otherwise,
             56      a date after which the coverage provided by the policy is not effective, and if that date falls
             57      within a period for which a premium is accepted by the insurer or if the insurer accepts a
             58      premium after that date, the coverage provided by the policy continues in force, subject to any

             59      right of cancellation, until the end of the period for which the premium was accepted.
             60          (b) This Subsection (3) does not apply if the acceptance of premium would not have
             61      occurred but for a misstatement of age by the insured.
             62          (4) (a) (i) If an insured is otherwise eligible for maternity benefits, a policy may not
             63      contain language which requires an insured to obtain any additional preauthorization or
             64      preapproval for customary and reasonable maternity care expenses or for the delivery of the
             65      child after an initial preauthorization or preapproval has been obtained from the insurer for
             66      prenatal care.
             67          (ii) A requirement for notice of admission for delivery is not a requirement for
             68      preauthorization or preapproval, however, the maternity benefit may not be denied or
             69      diminished for failure to provide admission notice. The policy may not require the provision of
             70      admission notice by only the insured patient.
             71          (b) This Subsection (4) does not prohibit an insurer from:
             72          (i) requiring a referral before maternity care can be obtained;
             73          (ii) specifying a group of providers or a particular location from which an insured is
             74      required to obtain maternity care; or
             75          (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
             76      terms and conditions of the insurance contract so long as [such] the terms do not conflict with
             77      Subsection (4)(a).
             78          (5) An insurer may only represent that a policy:
             79          (a) offers a vision benefit if the policy:
             80          (i) charges a premium for the benefit; and
             81          (ii) provides reimbursement for materials or services provided under the policy; and
             82          (b) covers laser vision correction, whether photorefractive keratectomy, laser assisted
             83      in-situ keratomelusis, or related procedure, if the policy:
             84          (i) charges a premium for the benefit; and
             85          (ii) the procedure is at least a partially covered benefit.
             86          (6) If an insured is otherwise eligible for benefits under a health or dental policy, the
             87      insurer may not exclude coverage if the insured is an:
             88          (a) inmate housed in a correctional facility as defined in Section 64-13-1 ; or
             89          (b) offender in the custody of the Department of Corrections.

             90          Section 2. Section 31A-22-619 is amended to read:
             91           31A-22-619. Coordination of benefits.
             92          (1) The commissioner shall:
             93          (a) convene a group of health insurers and health care providers for the purpose of
             94      making recommendations to the Legislature regarding an efficient method of coordination of
             95      benefits to increase the timeliness and accuracy of coordination of benefits;
             96          (b) report to the Legislature's Health Reform Task Force before November 15, 2009
             97      regarding legislation to enact the recommendations developed under Subsection (1)(a); and
             98          (c) adopt rules concerning the coordination of benefits between accident and health
             99      insurance policies.
             100          (2) Rules adopted by the commissioner under Subsection (1):
             101          (a) may not prohibit coordination of benefits with individual accident and health
             102      insurance policies; [and]
             103          (b) shall apply equally to all accident and health insurance policies without regard to
             104      whether the policies are group or individual policies[.]; and
             105          (c) shall require a health or dental insurer to coordinate benefits for an insured who is
             106      an:
             107          (i) inmate housed in a correctional facility as defined in Section 64-13-1 ; or
             108          (ii) offender in the custody of the Department of Corrections.
             109          Section 3. Section 64-13-30 is amended to read:
             110           64-13-30. Expenses incurred by offenders -- Payment to department or county
             111      jail -- Medical care and copayments.
             112          (1) (a) The department shall establish and collect from each offender on a work release
             113      program the reasonable costs of the offender's maintenance, transportation, and incidental
             114      expenses incurred by the department on behalf of the offender.
             115          (b) Priority shall be given to restitution and family support obligations.
             116          (c) The offender's reimbursement to the department for the cost of obtaining the
             117      offender's DNA specimen, under Section 53-10-404 is the next priority after Subsection (1)(b).
             118          (2) The department, under its rules, may advance funds to any offender as necessary to
             119      establish the offender in a work release program.
             120          (3) (a) The department or county jail may require an inmate to make a copayment for

             121      medical and dental services provided by the department or county jail.
             122          (b) For services provided while in the custody of the department, the copayment by the
             123      inmate is $5 for primary medical care, $5 for dental care, and $2 for prescription medication.
             124          (c) For services provided outside of a prison facility while in the custody of the
             125      department, the [offender] inmate is responsible for 10% of the costs associated with hospital
             126      care with a cap on an inmate's share of hospital care expenses not to exceed $2,000 per fiscal
             127      year.
             128          (4) (a) An inmate who has assets exceeding $200,000, as determined by the department
             129      upon entry into the department's custody, is responsible [to pay] for paying the costs of all
             130      medical and dental care up to 20% of the inmate's total determined asset value.
             131          (b) After an inmate has received medical and dental care equal to 20% of the inmate's
             132      total asset value, the inmate [will be] is subject to the copayments provided in Subsection (3).
             133          (5) The department shall turn over to the Office of State Debt Collection any debt
             134      under this section that is unpaid at the time the offender is released from parole.
             135          (6) An inmate may not be denied medical treatment if the inmate is unable to pay for
             136      the treatment because of inadequate financial resources.
             137          (7) (a) An inmate who, upon entering into the department's custody, has health
             138      insurance or dental insurance coverage shall use that coverage as the primary payer for health
             139      and dental costs incurred while in the custody of the department, except as limited under
             140      Subsection (7)(b).
             141          (b) Any insurance policy held by an inmate for health or dental care is not required
             142      under Subsection (7)(a) to provide coverage for:
             143          (i) incidents of inmate self harm;
             144          (ii) injuries sustained by the inmate as a result of an act of physical violence committed
             145      either upon or by the inmate; or
             146          (iii) situations where the department has reason to believe, based on a medical
             147      evaluation of the inmate, that the inmate sought the health or dental care knowing that an
             148      underlying medical or dental need did not exist.

Legislative Review Note
    as of 9-23-09 10:56 AM

Office of Legislative Research and General Counsel

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