49-20-422.  Coverage of pregnancy and childbirth services, including doula, direct- entry midwife, and birthing center services.

(1)  As used in this section:

Terms Used In Utah Code 49-20-422

  • Covered individual: means an employee and the employee's dependents eligible for coverage under this chapter. See Utah Code 49-20-102
  • Plan: means the Utah Governors' and Legislators' Retirement Plan created by Chapter 19, Utah Governors' and Legislators' Retirement Act, the New Public Employees' Tier II Defined Contribution Plan created by 4, the New Public Safety and Firefighter Tier II Defined Contribution Plan created by 4, or the defined contribution plans created under Section 49-11-801. See Utah Code 49-11-102
  • Program: means the Public Employees' Benefit and Insurance Program. See Utah Code 49-20-102
  • 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
(a)  “Doula” means an individual who:

(i)  provides information and physical and emotional support:

(A)  to a pregnant or postpartum individual; and

(B)  related to the pregnant or postpartum individual’s pregnancy; and

(ii)  is certified by one or more organizations approved by the program.

(b)  “Pregnancy and childbirth services” means services provided to a pregnant individual before, during, or shortly after childbirth:

(i)  by a doula for the services described in Subsections (1)(a)(i) and (ii); and

(ii)  at a birthing center that:

(A)  is licensed under Title 26B, Chapter 2, Health Care Facility Licensing and Inspection Act, or accredited by the Commission for the Accreditation of Birth Centers; and

(B)  may include services by a direct-entry midwife licensed under Title 58, Chapter 77, Direct-Entry Midwife Act, if the direct-entry midwife is engaged in the practice of direct-entry midwifery, as defined in Section 58-77-102.

(c)  “Qualified individual” means a covered individual who is:

(i)  within the state employees’ risk pool; and

(ii) 

(A)  is pregnant; or

(B)  was pregnant within the past six months.

(2)  For a plan year that begins on or after July 1, 2023, and before July 1, 2026, the program shall cover pregnancy and childbirth services to a qualified individual.

(3)  The program may establish limits for coverage under Subsection (2), including limits based on:

(a)  the type or number of services provided;

(b)  a qualified individual’s physical or emotional condition; and

(c)  conditions for provider participation.

(4)  The program shall report to the Health and Human Services Interim Committee on or before October 1 of each year regarding coverage provided under Subsection (2), including:

(a)  covered providers;

(b)  covered services;

(c)  provider payment rates;

(d)  covered-individual cost sharing;

(e)  total provider payments and covered-individual cost sharing; and

(f)  any indicators of whether pregnancy and childbirth services covered under Subsection (2) have:

(i)  reduced pregnancy or postpartum coverage costs; or

(ii)  improved pregnancy or postpartum care.

Enacted by Chapter 292, 2023 General Session

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