Utah Code 31A-22-644. Denial of coverage under a health benefit plan because of life expectancy or terminal condition
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(1) As used in this section:
Terms Used In Utah Code 31A-22-644
- Application: means a document:(10)(a)(10)(a)(i) completed by an applicant to provide information about the risk to be insured; and(10)(a)(ii) that contains information that is used by the insurer to evaluate risk and decide whether to:(10)(a)(ii)(A) insure the risk under:(10)(a)(ii)(A)(I) the coverage as originally offered; or(10)(a)(ii)(A)(II) a modification of the coverage as originally offered; or(10)(a)(ii)(B) decline to insure the risk; or(10)(b) used by the insurer to gather information from the applicant before issuance of an annuity contract. 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
- Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
(103)(a)(i) a policyholder;(103)(a)(ii) a subscriber;(103)(a)(iii) a member; and(103)(a)(iv) a beneficiary. See Utah Code 31A-1-301- Person: includes :
(146)(a) an individual;(146)(b) a partnership;(146)(c) a corporation;(146)(d) an incorporated or unincorporated association;(146)(e) a joint stock company;(146)(f) a trust;(146)(g) a limited liability company;(146)(h) a reciprocal;(146)(i) a syndicate; or(146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301- Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
(1)(a) “Health benefit plan” means the same as that term is defined in Section 31A-1-301.(1)(b) “Terminal condition” means an irreversible condition:(1)(b)(i) caused by disease, illness, or injury; and(1)(b)(ii) if:(1)(b)(ii)(A) the irreversible condition will result in imminent death within a six-month period after the date the condition is diagnosed; and(1)(b)(ii)(B) the application of life-sustaining treatment only prolongs the process of dying.(2) This section applies to a health benefit plan under:(2)(a) this part; or(3) Except as provided by law, and subject to the other provisions of this section, a health benefit plan may not deny coverage for medically necessary treatment if the medically necessary treatment is:(3)(a) prescribed by a physician;(3)(b) agreed to:(3)(b)(i) by a person who is:(3)(b)(i)(A) insured under the health benefit plan; and(3)(b)(i)(B) fully informed regarding the person’s life expectancy or diagnosis with a terminal condition; or(3)(b)(ii) if the person described in Subsection (3)(b)(i) lacks legal capacity to consent, by another person who:(3)(b)(ii)(A) has legal authority to consent on behalf of the person described in Subsection (3)(b)(i); and(3)(b)(ii)(B) is fully informed regarding the life expectancy or diagnosis with a terminal condition of the person described in Subsection (3)(b)(i); and(3)(c) denied solely because:(3)(c)(i) of the life expectancy of the person described in Subsection (3)(b)(i); or(3)(c)(ii) the person has been diagnosed with a terminal condition.(4) A denial of coverage described in Subsection (3) for medically necessary treatment is a violation of this section.(5) Whether treatment is considered to be medically necessary treatment is determined by the defined standards and policies of the health benefit plan.(6) This section may not be interpreted to:(6)(a) require an insurer to offer a particular benefit or service as part of a health benefit plan; or(6)(b) alter the clinical policies of a health benefit plan regarding the appropriate location for services.(7) This section does not create a new or additional private right of action.