Utah Code 31A-22-649.5. Insurance parity for telemedicine services — Method of technology used
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(1) As used in this section:
Terms Used In Utah Code 31A-22-649.5
- Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
- Individual: means a natural person. See Utah Code 31A-1-301
- Insurance: includes :(96)(b)(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;(96)(b)(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and(96)(b)(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
- Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the federal Social Security Act, as then constituted or later amended. See Utah Code 31A-1-301
- Network provider: means a health care provider who has an agreement with a managed care organization to provide health care services to an enrollee with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly from the managed care organization. See Utah Code 31A-1-301
- Rate: means :
(163)(a)(i) the cost of a given unit of insurance; or(163)(a)(ii) for property or casualty insurance, that cost of insurance per exposure unit either expressed as:(163)(a)(ii)(A) a single number; or(163)(a)(ii)(B) a pure premium rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:(163)(a)(ii)(B)(I) expenses;(163)(a)(ii)(B)(II) profit; and(163)(a)(ii)(B)(III) individual insurer variation in loss experience. See Utah Code 31A-1-301(1)(a) “Mental health condition” means a mental disorder or a substance-related disorder that falls under a diagnostic category listed in the Diagnostic and Statistical Manual, as periodically revised.(1)(b) “Telemedicine services” means the same as that term is defined in Section 26B-4-704.(2) Notwithstanding the provisions of Section 31A-22-618.5, a health benefit plan offered in the individual market, the small group market, or the large group market shall:(2)(a) provide coverage for:(2)(a)(i) telemedicine services that are covered by Medicare; and(2)(a)(ii) treatment of a mental health condition through telemedicine services if:(2)(a)(ii)(A) the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and(2)(a)(ii)(B) the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and(2)(b) reimburse a network provider that provides the telemedicine services described in Subsection (2)(a) at a negotiated commercially reasonable rate.(3)(3)(a) Notwithstanding Section 31A-45-303, a health benefit plan providing coverage under Subsection (2)(a) may not impose originating site restrictions, geographic restrictions, or distance-based restrictions.(3)(b) A network provider that provides the telemedicine services described in Subsection (2)(a) may utilize any synchronous audiovisual technology for the telemedicine services that is compliant with the federal Health Insurance Portability and Accountability Act of 1996.