State Codes and Statutes

Statutes > Utah > Title-31a > Chapter-08 > 31a-8-502

31A-8-502. Court ordered coverage for minor children who reside outside theservice area.
(1) (a) The requirements of Subsection (2) apply to a health maintenance organization ifthe health maintenance organization plan:
(i) restricts coverage for nonemergency services to services provided by contractedproviders within the organization's service area; and
(ii) does not offer a benefit that permits members the option of obtaining coveredservices from a non-contracted provider.
(b) The requirements of Subsection (2) do not apply to a health maintenance organizationif:
(i) the child that is the subject of a court or administrative support order is over the age of18 and is no longer enrolled in high school; or
(ii) a parent's employer offers the parent a choice to select health insurance coverage thatis not a health maintenance organization plan either at the time of the court or administrativesupport order, or at a subsequent open enrollment period. This exemption from Subsection (2)applies even if the parent ultimately chooses the health maintenance organization plan.
(2) If a parent is required by a court or administrative support order to provide healthinsurance coverage for a child who resides outside of a health maintenance organization's servicearea, the health maintenance organization shall:
(a) comply with the provisions of Section 31A-22-610.5;
(b) allow the enrollee parent to enroll the child on the organization plan;
(c) pay for otherwise covered health care services rendered to the child outside of theservice area by a noncontracted provider:
(i) if the child, noncustodial parent, or custodial parent has complied with priorauthorization or utilization review otherwise required by the organization; and
(ii) in an amount equal to the dollar amount the organization pays under a noncapitatedarrangement for comparable services to a contracting provider in the same class of health careproviders as the provider who rendered the services; and
(d) make payments on claims submitted in accordance with Subsection (2)(c) directly tothe provider, custodial parent, the child who obtained benefits, or state Medicaid agency.
(3) (a) The parents of the child who is the subject of the court or administrative supportorder are responsible for any charges billed by the provider in excess of those paid by theorganization.
(b) This section does not affect any court or administrative order regarding theresponsibilities between the parents to pay any medical expenses not covered by accident andhealth insurance or a health maintenance organization plan.
(4) The commissioner shall adopt rules as necessary to administer this section andSection 31A-22-610.5.

Enacted by Chapter 178, 2004 General Session