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S.B. 39

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




Legislative Review Note
    as of 12-22-09 7:44 AM


Office of Legislative Research and General Counsel


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