2006 Utah Code - 31A-22-633 — Exemptions from standards.

     31A-22-633.   Exemptions from standards.
     Notwithstanding the provisions of Title 31A, Insurance Code, any accident and health insurer or health maintenance organization may offer a choice of coverage that is less or different than is otherwise required by applicable state law if:
     (1) the Department of Health offers a choice of coverage as part of a Medicaid waiver under Title 26, Chapter 18, Medical Assistance Act, which includes:
     (a) less or different coverage than the basic coverage;
     (b) less or different coverage than is otherwise required in an insurance policy or health maintenance organization contract under applicable state law; or
     (c) less or different coverage than required by Subsection 31A-22-605(4)(b); and
     (2) the choice of coverage offered by the carrier:
     (a) is the same or similar coverage as the coverage offered by the Department of Health under Subsection (1);
     (b) is offered to the same or similar population as the coverage offered by the Department of Health under Subsection (1); and
     (c) contains an explanation for each insured of coverage exclusions and limitations;
     (3) the commissioner and the executive director of the Department of Health shall report to the Health and Human Services Interim Committee prior to November 15 of each year concerning:
     (a) the number of lives covered under any policy offered under the provisions of this section or under the Medicaid waiver described in Subsection (1);
     (b) the claims experienced under the policies or Medicaid programs described in Subsection (3)(a);
     (c) any cost shifting to the private sector for care not covered under the programs or policies described in Subsection (3)(a); and
     (d) efforts or agreements between the Department of Health, the commissioner, insurers regulated under this chapter, and health care providers regarding combining publicly funded coverage with private, employer-based coverage to increase benefits and health care coverage.

Amended by Chapter 123, 2005 General Session

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