1     
HEALTH CARE SHARING MINISTRY AMENDMENTS

2     
2016 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Michael S. Kennedy

5     
Senate Sponsor: Todd Weiler

6     

7     LONG TITLE
8     General Description:
9          This bill amends exemptions from the Insurance Code.
10     Highlighted Provisions:
11          This bill:
12          ▸      exempts certain health care sharing ministries from regulation by the Utah Insurance
13     Department; and
14          ▸     requires an exempt health care sharing ministry to disclose to an individual applying
15     for participation in the health care sharing ministry:
16               •     that the health care sharing ministry is not health insurance and does not
17     guarantee or promise that medical bills will be paid; and
18               •     the conditions under which the health care sharing ministry may refuse to pay
19     medical bills or cancel an individual's participation in the health care sharing
20     ministry.
21     Money Appropriated in this Bill:
22          None
23     Other Special Clauses:
24          None
25     Utah Code Sections Affected:
26     AMENDS:
27          31A-1-103, as last amended by Laws of Utah 2010, Chapter 274

28     

29     Be it enacted by the Legislature of the state of Utah:
30          Section 1. Section 31A-1-103 is amended to read:
31          31A-1-103. Scope and applicability of title.
32          (1) This title does not apply to:
33          (a) a retainer contract made by an attorney-at-law:
34          (i) with an individual client; and
35          (ii) under which fees are based on estimates of the nature and amount of services to be
36     provided to the specific client;
37          (b) a contract similar to a contract described in Subsection (1)(a) made with a group of
38     clients involved in the same or closely related legal matters;
39          (c) an arrangement for providing benefits that do not exceed a limited amount of
40     consultations, advice on simple legal matters, either alone or in combination with referral
41     services, or the promise of fee discounts for handling other legal matters;
42          (d) limited legal assistance on an informal basis involving neither an express
43     contractual obligation nor reasonable expectations, in the context of an employment,
44     membership, educational, or similar relationship;
45          (e) legal assistance by employee organizations to their members in matters relating to
46     employment; or
47          (f) death, accident, health, or disability benefits provided to a person by an organization
48     or its affiliate if:
49          (i) the organization is tax exempt under Section 501(c)(3) of the Internal Revenue
50     Code and has had its principal place of business in Utah for at least five years;
51          (ii) the person is not an employee of the organization; and
52          (iii) (A) substantially all the person's time in the organization is spent providing
53     voluntary services:
54          (I) in furtherance of the organization's purposes;
55          (II) for a designated period of time; and
56          (III) for which no compensation, other than expenses, is paid; or
57          (B) the time since the service under Subsection (1)(f)(iii)(A) was completed is no more
58     than 18 months.

59          (2) (a) This title restricts otherwise legitimate business activity.
60          (b) What this title does not prohibit is permitted unless contrary to other provisions of
61     Utah law.
62          (3) Except as otherwise expressly provided, this title does not apply to:
63          (a) those activities of an insurer where state jurisdiction is preempted by Section 514 of
64     the federal Employee Retirement Income Security Act of 1974, as amended;
65          (b) ocean marine insurance;
66          (c) death, accident, health, or disability benefits provided by an organization if the
67     organization:
68          (i) has as its principal purpose to achieve charitable, educational, social, or religious
69     objectives rather than to provide death, accident, health, or disability benefits;
70          (ii) does not incur a legal obligation to pay a specified amount; and
71          (iii) does not create reasonable expectations of receiving a specified amount on the part
72     of an insured person;
73          (d) other business specified in rules adopted by the commissioner on a finding that:
74          (i) the transaction of the business in this state does not require regulation for the
75     protection of the interests of the residents of this state; or
76          (ii) it would be impracticable to require compliance with this title;
77          (e) except as provided in Subsection (4), a transaction independently procured through
78     negotiations under Section 31A-15-104;
79          (f) self-insurance;
80          (g) reinsurance;
81          (h) subject to Subsection (5), employee and labor union group or blanket insurance
82     covering risks in this state if:
83          (i) the policyholder exists primarily for purposes other than to procure insurance;
84          (ii) the policyholder:
85          (A) is not a resident of this state;
86          (B) is not a domestic corporation; or
87          (C) does not have its principal office in this state;
88          (iii) no more than 25% of the certificate holders or insureds are residents of this state;
89          (iv) on request of the commissioner, the insurer files with the department a copy of the

90     policy and a copy of each form or certificate; and
91          (v) (A) the insurer agrees to pay premium taxes on the Utah portion of its business, as
92     if it were authorized to do business in this state; and
93          (B) the insurer provides the commissioner with the security the commissioner
94     considers necessary for the payment of premium taxes under Title 59, Chapter 9, Taxation of
95     Admitted Insurers;
96          (i) to the extent provided in Subsection (6):
97          (i) a manufacturer's or seller's warranty; and
98          (ii) a manufacturer's or seller's service contract;
99          (j) except to the extent provided in Subsection (7), a public agency insurance mutual;
100     [or]
101          (k) except as provided in Chapter 6b, Guaranteed Asset Protection Waiver Act, a
102     guaranteed asset protection waiver[.]; or
103          (l) a health care sharing ministry that:
104          (i) (A) meets the requirements for a health care sharing ministry under 26 U.S.C. Sec.
105     5000A(d)(2)(B)(ii);
106          (B) provides reimbursement for expenses incurred by an individual for health care as
107     that term is defined in Section 31A-1-301; and
108          (C) provides the disclosures required in Subsection (8); and
109          (ii) does not limit reimbursement solely for the benefits described in Subsection
110     31A-1-301(76)(b).
111          (4) A transaction described in Subsection (3)(e) is subject to taxation under Section
112     31A-3-301.
113          (5) (a) After a hearing, the commissioner may order an insurer of certain group or
114     blanket contracts to transfer the Utah portion of the business otherwise exempted under
115     Subsection (3)(h) to an authorized insurer if the contracts have been written by an unauthorized
116     insurer.
117          (b) If the commissioner finds that the conditions required for the exemption of a group
118     or blanket insurer are not satisfied or that adequate protection to residents of this state is not
119     provided, the commissioner may require:
120          (i) the insurer to be authorized to do business in this state; or

121          (ii) that any of the insurer's transactions be subject to this title.
122          (6) (a) As used in Subsection (3)(i) and this Subsection (6):
123          (i) "manufacturer's or seller's service contract" means a service contract:
124          (A) made available by:
125          (I) a manufacturer of a product;
126          (II) a seller of a product; or
127          (III) an affiliate of a manufacturer or seller of a product;
128          (B) made available:
129          (I) on one or more specific products; or
130          (II) on products that are components of a system; and
131          (C) under which the person described in Subsection (6)(a)(i)(A) is liable for services to
132     be provided under the service contract including, if the manufacturer's or seller's service
133     contract designates, providing parts and labor;
134          (ii) "manufacturer's or seller's warranty" means the guaranty of:
135          (A) (I) the manufacturer of a product;
136          (II) a seller of a product; or
137          (III) an affiliate of a manufacturer or seller of a product;
138          (B) (I) on one or more specific products; or
139          (II) on products that are components of a system; and
140          (C) under which the person described in Subsection (6)(a)(ii)(A) is liable for services
141     to be provided under the warranty, including, if the manufacturer's or seller's warranty
142     designates, providing parts and labor; and
143          (iii) "service contract" is as defined in Section 31A-6a-101.
144          (b) A manufacturer's or seller's warranty may be designated as:
145          (i) a warranty;
146          (ii) a guaranty; or
147          (iii) a term similar to a term described in Subsection (6)(b)(i) or (ii).
148          (c) This title does not apply to:
149          (i) a manufacturer's or seller's warranty;
150          (ii) a manufacturer's or seller's service contract paid for with consideration that is in
151     addition to the consideration paid for the product itself; and

152          (iii) a service contract that is not a manufacturer's or seller's warranty or manufacturer's
153     or seller's service contract if:
154          (A) the service contract is paid for with consideration that is in addition to the
155     consideration paid for the product itself;
156          (B) the service contract is for the repair or maintenance of goods;
157          (C) the cost of the product is equal to an amount determined in accordance with
158     Subsection (6)(e); and
159          (D) the product is not a motor vehicle.
160          (d) This title does not apply to a manufacturer's or seller's warranty or service contract
161     paid for with consideration that is in addition to the consideration paid for the product itself
162     regardless of whether the manufacturer's or seller's warranty or service contract is sold:
163          (i) at the time of the purchase of the product; or
164          (ii) at a time other than the time of the purchase of the product.
165          (e) (i) For fiscal year 2001-02, the amount described in Subsection (6)(c)(iii)(C) shall
166     be equal to $3,700 or less.
167          (ii) For each fiscal year after fiscal year 2001-02, the commissioner shall annually
168     determine whether the amount described in Subsection (6)(c)(iii)(C) should be adjusted in
169     accordance with changes in the Consumer Price Index published by the United States Bureau
170     of Labor Statistics selected by the commissioner by rule, between:
171          (A) the Consumer Price Index for the February immediately preceding the adjustment;
172     and
173          (B) the Consumer Price Index for February 2001.
174          (iii) If under Subsection (6)(e)(ii) the commissioner determines that an adjustment
175     should be made, the commissioner shall make the adjustment by rule.
176          (7) (a) For purposes of this Subsection (7), "public agency insurance mutual" means an
177     entity formed by two or more political subdivisions or public agencies of the state:
178          (i) under Title 11, Chapter 13, Interlocal Cooperation Act; and
179          (ii) for the purpose of providing for the political subdivisions or public agencies:
180          (A) subject to Subsection (7)(b), insurance coverage; or
181          (B) risk management.
182          (b) Notwithstanding Subsection (7)(a)(ii)(A), a public agency insurance mutual may

183     not provide health insurance unless the public agency insurance mutual provides the health
184     insurance using:
185          (i) a third party administrator licensed under Chapter 25, Third Party Administrators;
186          (ii) an admitted insurer; or
187          (iii) a program authorized by Title 49, Chapter 20, Public Employees' Benefit and
188     Insurance Program Act.
189          (c) Except for this Subsection (7), a public agency insurance mutual is exempt from
190     this title.
191          (d) A public agency insurance mutual is considered to be a governmental entity and
192     political subdivision of the state with all of the rights, privileges, and immunities of a
193     governmental entity or political subdivision of the state including all the rights and benefits of
194     Title 63G, Chapter 7, Governmental Immunity Act of Utah.
195          (8) (a) A health care sharing ministry exempt from regulation under Subsection (3)(l)
196     shall provide the disclosure in Subsection (8)(b) to an individual, in writing, in at least 14-point
197     bold font prominently displayed on the health care sharing ministry application form, directly
198     above the signature line.
199          (b) The written disclosure required under Subsection (8)(a) shall:
200          (i) be signed by the individual prior to enrollment in the health care sharing ministry;
201          (ii) include the following statement:
202          "__________ is not an insurance company and___________ does not guarantee
203     payment of health care expenses. Our role is to enable self-pay patients to help fellow members
204     through voluntary financial gifts. This program is not health insurance nor is it offered through
205     an insurance company. This program does not guarantee or promise that your health care bills
206     will be paid or assigned to others for payment. Whether anyone chooses to pay your health care
207     bills will be totally voluntary. As such, this program should never be considered as a substitute
208     for a health insurance policy. Whether you receive any payments for health care expenses and
209     whether or not this program continues to operate, you are always liable for any unpaid bills.";
210     and
211          (iii) include:
212          (A) disclosure of any application fees, membership dues or fees, or other
213     administrative expenses for which the member may be required to pay, or for which the

214     member's benefits may be reduced;
215          (B) notification to the individual that if the individual leaves the health care sharing
216     ministry, the individual may not enroll in other health insurance coverage in the individual
217     market until the next federal open enrollment period;
218          (C) a description of circumstances that may result in cancellation of the individual's
219     membership in the health care sharing ministry, or reasons for which the health care sharing
220     ministry may refuse to provide reimbursement to the individual for health care expenses
221     incurred by the individual; and
222          (D) a declaration that the health care sharing ministry meets the requirements of 26
223     U.S.C. Sec. 5000A(d)(2)(B)(ii).






Legislative Review Note
Office of Legislative Research and General Counsel