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2020 Utah Code
Title 26 - Utah Health Code
Chapter 40 - Utah Children's Health Insurance Act
Section 106 - Program benefits.
Universal Citation: UT Code § 26-40-106 (2020)
Effective 5/12/2020
26-40-106. Program benefits.
Amended by Chapter 225, 2020 General Session
26-40-106. Program benefits.
- (1) Except as provided in Subsection (3), medical and dental program benefits shall be benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows:
- (a) medical program benefits, including behavioral health care benefits, shall be benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to:
- (i) be substantially equal to a health benefit plan with the largest insured commercial enrollment offered by a health maintenance organization in the state; and
- (ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No. 110-343; and
- (b) dental program benefits shall be benchmarked effective July 1, 2019, and on July 1 every third year thereafter in accordance with the Children's Health Insurance Program Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the state, except that the utilization review mechanism for orthodontia shall be based on medical necessity.
- (a) medical program benefits, including behavioral health care benefits, shall be benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to:
- (2) On or before July 1 of each year, the department shall publish the benchmark for dental program benefits established under Subsection (1)(b).
- (3) The program benefits for enrollees who are at or below 100% of the federal poverty level are exempt from the benchmark requirements of Subsections (1) and (2).
Amended by Chapter 225, 2020 General Session
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