(1) (a) This section applies to all health benefit plans. (b) Subsection (2) applies to: (i) all health benefit plans; and (ii) coverage offered to state employees under Subsection 49-20-202(1)(a). (2) The commissioner shall promote informed consumer behavior and responsible health benefit plans by requiring an insurer issuing a health benefit plan to provide to all enrollees, before enrollment in the health benefit plan, written disclosure of: (a) restrictions or limitations on prescription drugs and biologics, including: (i) the use of a formulary; (ii) co-payments and deductibles for prescription drugs; and (iii) requirements for generic substitution; (b) coverage limits under the plan; (c) any limitation or exclusion of coverage, including: (i) a limitation or exclusion for a secondary medical condition related to a limitation or exclusion from coverage; and (ii) easily understood examples of a limitation or exclusion of coverage for a secondary medical condition; (d) (i) (A) each drug, device, and covered service that is subject to a preauthorization requirement as defined in Section 31A-22-650; or (B) if listing each device or covered service in accordance with Subsection (2)(d)(i)(A) is too numerous to list separately, all devices or covered services in a particular category where all devices or covered services have the same preauthorization requirement; (ii) each requirement for authorization as defined in Section 31A-22-650 for: (A) each drug, device, or covered service described in Subsection (2)(d)(i)(A); and (B) each category of devices or covered services described in Subsection (2)(d)(i)(B); and (iii) sufficient information to allow a network provider or enrollee to submit all of the information to the insurer necessary to meet each requirement for authorization described in Subsection (2)(d)(ii); (e) whether the insurer permits an exchange of the adoption indemnity benefit in Section
‹ Prev All Utah sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.