Utah Code 31A-22-654. Study of coverage for in vitro fertilization and genetic testing — Reporting — Coverage requirements
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(1) As used in this section:
Terms Used In Utah Code 31A-22-654
- Department: means the Insurance Department. See Utah Code 31A-1-301
- Enrollee: includes an insured. See Utah Code 31A-1-301
- 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
- Plan year: means :(149)(a) the year that is designated as the plan year in:(149)(a)(i) the plan document of a group health plan; or(149)(a)(ii) a summary plan description of a group health plan;(149)(b) if the plan document or summary plan description does not designate a plan year or there is no plan document or summary plan description:(149)(b)(i) the year used to determine deductibles or limits;(149)(b)(ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or(149)(b)(iii) the employer's taxable year if:(149)(b)(iii)(A) the plan does not impose deductibles or limits on a yearly basis; and(149)(b)(iii)(B)(149)(b)(iii)(B)(I) the plan is not insured; or(149)(b)(iii)(B)(II) the insurance policy is not renewed on an annual basis; or(149)(c) in a case not described in Subsection (149)(a) or (b), the calendar year. See Utah Code 31A-1-301
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(1)(a) “Qualified condition” means the same as that term is defined in Section 49-20-420.(1)(b) “Qualified insurer” means an insurer that provides a health benefit plan as defined in Section 31A-1-301 to more than 25,000 enrollees in the state as of December 31 of the preceding reporting year.(1)(c) “Qualified enrollee” means an enrollee of a qualified insurer who:(1)(c)(i) has been diagnosed by a physician as having a genetic trait associated with a qualified condition; and(1)(c)(ii) intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the enrollee.
(2)
(2)(a) A qualified insurer shall submit the information described in this Subsection (2) to the department for a plan year beginning:
(2)(a)(i) on or after January 1, 2022, but before December 31, 2022; and
(2)(a)(ii) on or after January 1, 2025, but before December 31, 2025.
(2)(b) A qualified insurer shall study whether providing the coverage for the services described in Subsections (3)(a) and (b) for qualified enrollees will result in cost savings for the qualified insurer.
(2)(c)
(2)(c)(i) If a qualified insurer determines that providing the coverage described in Subsection (3) for qualified enrollees will result in cost savings for the qualified insurer, the qualified insurer shall submit a summary of the results of the study described in Subsection (2)(b), and:
(2)(c)(i)(A) describe how the qualified insurer intends to provide the coverage described in Subsection (3); or
(2)(c)(i)(B) submit an explanation of why the insurer will not provide the coverage described in Subsection (3).
(2)(c)(ii) If a qualified insurer determines that providing the coverage described in Subsection (3) will not result in cost savings to the qualified insurer, the qualified insurer shall submit a summary of the results of the study described in Subsection (2)(b).
(2)(d) A qualified insurer shall provide the information required under this Subsection (2) to the department no later than:
(2)(d)(i) January 1, 2022, for a plan year beginning on or after January 1, 2022, but before December 31, 2022; and
(2)(d)(ii) January 1, 2025, for a plan year beginning on or after January 1, 2025, but before December 31, 2025.
(3) A qualified insurer shall consider coverage for:
(3)(a) in vitro fertilization services for a qualified enrollee; and
(3)(b) genetic testing of a qualified enrollee who received in vitro fertilization services under Subsection (3)(a).
(4) The department shall report the information received under Subsection (2) to the Health and Human Services Interim Committee on or before:
(4)(a) for information submitted under Subsection (2)(a)(i), November 1, 2022; and
(4)(b) for information submitted under Subsection (2)(a)(ii), November 1, 2025.