This document includes Senate Committee Amendments incorporated into the bill on Mon, Mar 2, 2015 at 1:56 PM by lpoole.
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7 LONG TITLE
8 General Description:
9 This bill addresses provisions related to a health benefit plan.
10 Highlighted Provisions:
11 This bill:
12 ▸ defines terms;
13 ▸ prohibits denial of coverage under a health benefit plan because of life expectancy
14 or a terminal condition under certain circumstances;
15 ▸ provides that the prohibition may not be interpreted to require an insurer to offer a
16 particular benefit or service as part of a health benefit plan Ŝ→ or alter certain policies of a health
16a benefit plan ←Ŝ ;
17 ▸ provides that the prohibition provisions do not create a new or additional private
18 right of action; and
19 ▸ makes technical and conforming changes.
20 Money Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 None
24 Utah Code Sections Affected:
25 ENACTS:
26 31A-22-644, Utah Code Annotated 1953
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28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 31A-22-644 is enacted to read:
30 31A-22-644. Denial of coverage under a health benefit plan because of life
31 expectancy or terminal condition.
32 (1) As used in this section:
33 (a) "Health benefit plan" means the same as that term is defined in Section 31A-1-301.
34 (b) "Terminal condition" means an irreversible condition:
35 (i) caused by disease, illness, or injury; and
36 (ii) if:
37 (A) the irreversible condition will result in imminent death within a six-month period
38 after the date the condition is diagnosed; and
39 (B) the application of life-sustaining treatment only prolongs the process of dying.
40 (2) This section applies to a health benefit plan under:
41 (a) this part; or
42 (b) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
43 (3) Except as provided by law, and subject to the other provisions of this section, a
44 health benefit plan may not deny coverage for medically necessary treatment if the medically
45 necessary treatment is:
46 (a) prescribed by a physician;
47 (b) agreed to:
48 (i) by a person who is:
49 (A) insured under the health benefit plan; and
50 (B) fully informed regarding the person's life expectancy or diagnosis with a terminal
51 condition; or
52 (ii) if the person described in Subsection (3)(b)(i) lacks legal capacity to consent, by
53 another person who:
54 (A) has legal authority to consent on behalf of the person described in Subsection
55 (3)(b)(i); and
56 (B) is fully informed regarding the life expectancy or diagnosis with a terminal
57 condition of the person described in Subsection (3)(b)(i); and
58 (c) denied solely because:
59 (i) of the life expectancy of the person described in Subsection (3)(b)(i); or
60 (ii) the person has been diagnosed with a terminal condition.
61 (4) A denial of coverage described in Subsection (3) for medically necessary treatment
62 is a violation of this section.
63 (5) Whether treatment is considered to be medically necessary treatment is determined
64 by the defined standards and policies of the health benefit plan.
65 (6) This section may not be interpreted to Ŝ→ :
65a (a) ←Ŝ require an insurer to offer a particular benefit
66 or service as part of a health benefit plan Ŝ→ [
66a (b) alter the clinical policies of a health benefit plan regarding the appropriate location
66b for services. ←Ŝ
67 (7) This section does not create a new or additional private right of action.
Legislative Review Note
as of 2-25-15 11:04 AM
Office of Legislative Research and General Counsel