2006 Utah Code - 31A-22-613.5 — Price and value comparisons of health insurance.

     31A-22-613.5.   Price and value comparisons of health insurance.
     (1) This section applies generally to all health insurance policies and health maintenance organization contracts.
     (2) (a) The commissioner shall adopt a Basic Health Care Plan to be offered under the open enrollment provisions of Chapter 30.
     (b) (i) Before adoption of a plan under Subsection (2)(a), the commissioner shall submit the proposed Basic Health Care Plan to the Health and Human Services Interim Committee for review and recommendations.
     (ii) After the commissioner adopts the Basic Health Care Plan, the Health and Human Services Interim Committee:
     (A) shall provide legislative oversight of the Basic Health Care Plan; and
     (B) may recommend legislation to modify the Basic Health Care Plan adopted by the commissioner.
     (3) (a) The commissioner shall promote informed consumer behavior and responsible health insurance and health plans by requiring an insurer issuing health insurance policies or health maintenance organization contracts to provide to all enrollees, prior to enrollment in the health benefit plan or health insurance policy, written disclosure of:
     (i) restrictions or limitations on prescription drugs and biologics including the use of a formulary and generic substitution; and
     (ii) coverage limits under the plan.
     (b) In addition to the requirements of Subsections (3)(a) and (d), an insurer described in Subsection (3)(a) shall submit the written disclosure required by this Subsection (3) to the commissioner:
     (i) upon commencement of operations in the state; and
     (ii) anytime the insurer amends any of the following described in Subsection (3)(a):
     (A) treatment policies;
     (B) practice standards;
     (C) restrictions; or
     (D) coverage limits of the insurer's health benefit plan or health insurance policy.
     (c) The commissioner may adopt rules to implement the disclosure requirements of this Subsection (3), taking into account:
     (i) business confidentiality of the insurer;
     (ii) definitions of terms; and
     (iii) the method of disclosure to enrollees.
     (d) If under Subsection (3)(a)(i) a formulary is used, the insurer shall make available to prospective enrollees and maintain evidence of the fact of the disclosure of:
     (i) the drugs included;
     (ii) the patented drugs not included; and
     (iii) any conditions that exist as a precedent to coverage.

Amended by Chapter 114, 2002 General Session