S.B. 39 Enrolled

1

HEALTH INSURANCE PRIOR
2 AUTHORIZATION AMENDMENTS
3 2010 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: Karen Mayne
6 House Sponsor: Merlynn T. Newbold
7
8 LONG TITLE
9 General Description:
10 This bill amends the Accident and Health Insurance part of the Insurance Code.
11 Highlighted Provisions:
12 This bill:
13 . requires an accident and health insurer to provide an enrollee with a statement of
14 preauthorization for a medical procedure in certain circumstances; and
15 . clarifies that a statement of preauthorization is not a guarantee of payment by an
16 insurer.
17 Monies Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 ENACTS:
23 31A-22-638, Utah Code Annotated 1953
24
25 Be it enacted by the Legislature of the state of Utah:
26 Section 1. Section 31A-22-638 is enacted to read:
27 31A-22-638. Statement of preauthorization.
28 (1) An insurer who requires preauthorization or preapproval for coverage under
29 accident and health insurance shall, beginning January 1, 2011, provide an enrollee with a

30 statement of preauthorization if:
31 (a) the applicable CPT codes have been submitted to the insurer to determine whether
32 a particular procedure is covered under the terms of the accident and health insurance policy;
33 (b) the enrollee has met the requirements for preauthorization of the procedure or
34 encounter; and
35 (c) the enrollee requests a statement of preauthorization.
36 (2) A statement of preauthorization under Subsection (1) may be sent:
37 (a) by mail; or
38 (b) electronically.
39 (3) A statement of preauthorization shall include a statement that the preauthorization
40 is:
41 (a) not a guarantee of payment by an insurer; and
42 (b) subject to the policy and contract provisions of the accident and health insurance
43 contract.