State Codes and Statutes

Statutes > Utah > Title-31a > Chapter-22 > 31a-22-613

31A-22-613. Permitted provisions for accident and health insurance policies.
The following provisions may be contained in an accident and health insurance policy,but if they are in that policy, they shall conform to at least the minimum requirements for thepolicyholder in this section.
(1) Any provision respecting change of occupation may provide only for a lowermaximum benefit payment and for reduction of loss payments proportionate to the change inappropriate premium rates, if the change is to a higher rated occupation, and this provision shallprovide for retroactive reduction of premium rates from the date of change of occupation or thelast policy anniversary date, whichever is the more recent, if the change is to a lower ratedoccupation.
(2) Section 31A-22-405 applies to misstatement of age in accident and health policies,with the appropriate modifications of terminology.
(3) Any policy which contains a provision establishing, as an age limit or otherwise, adate after which the coverage provided by the policy is not effective, and if that date falls withina period for which a premium is accepted by the insurer or if the insurer accepts a premium afterthat date, the coverage provided by the policy continues in force, subject to any right ofcancellation, until the end of the period for which the premium was accepted. This Subsection(3) does not apply if the acceptance of premium would not have occurred but for a misstatementof age by the insured.
(4) (a) If an insured is otherwise eligible for maternity benefits, a policy may not containlanguage which requires an insured to obtain any additional preauthorization or preapproval forcustomary and reasonable maternity care expenses or for the delivery of the child after an initialpreauthorization or preapproval has been obtained from the insurer for prenatal care. Arequirement for notice of admission for delivery is not a requirement for preauthorization orpreapproval, however, the maternity benefit may not be denied or diminished for failure toprovide admission notice. The policy may not require the provision of admission notice by onlythe insured patient.
(b) This Subsection (4) does not prohibit an insurer from:
(i) requiring a referral before maternity care can be obtained;
(ii) specifying a group of providers or a particular location from which an insured isrequired to obtain maternity care; or
(iii) limiting reimbursement for maternity expenses and benefits in accordance with theterms and conditions of the insurance contract so long as such terms do not conflict withSubsection (4)(a).
(5) An insurer may only represent that a policy:
(a) offers a vision benefit if the policy:
(i) charges a premium for the benefit; and
(ii) provides reimbursement for materials or services provided under the policy; and
(b) covers laser vision correction, whether photorefractive keratectomy, laser assistedin-situ keratomelusis, or related procedure, if the policy:
(i) charges a premium for the benefit; and
(ii) the procedure is at least a partially covered benefit.

Amended by Chapter 78, 2005 General Session