31A-22-627. Coverage of emergency medical services.

336 words·~2 min read·/ut/title-31a/chapter-22/31a-22-627

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/4/2022

(1)A health insurance policy or managed care organization contract:

(a)shall provide coverage of emergency services; and

(b)may not:

(i)require any form of preauthorization for treatment of an emergency medical condition until after the insured's condition has been stabilized;

(ii)deny a claim for any covered evaluation, covered diagnostic test, or other covered treatment considered medically necessary to stabilize the emergency medical condition of an insured; or

(iii)impose any cost-sharing requirement for out-of-network that exceeds the cost-sharing requirement imposed for in-network.

(a)A health insurance policy or managed care organization contract may require authorization for the continued treatment of an emergency medical condition after the insured's condition has been stabilized.

(b)If authorization described in Subsection (2)(a) is required, an insurer who does not accept or reject a request for authorization may not deny a claim for any evaluation, diagnostic testing, or other treatment considered medically necessary that occurred between the time the request was received and the time the insurer rejected the request for authorization.

(3)For purposes of this section:

(a)"Hospital emergency department" means that area of a hospital in which emergency services are provided on a 24-hour-a-day basis.

(b)"Stabilize" means the same as that term is defined in 42 U.S.C. Sec. 1395dd(e)(3).

(4)Nothing in this section may be construed as:

(a)altering the level or type of benefits that are provided under the terms of a contract or policy; or

(b)restricting a policy or contract from providing enhanced benefits for certain emergency medical conditions that are identified in the policy or contract.

(5)Notwithstanding Section 31A-2-308 , if the commissioner finds an insurer has violated this section, the commissioner may:

(a)work with the insurer to improve the insurer's compliance with this section; or

(b)impose the following fines:

(i)not more than $5,000; or

(ii)twice the amount of any profit gained from violations of this section.

Amended by Chapter 198 , 2022 General Session