31A-22-654. Study of coverage for in vitro fertilization and genetic testing -- Reporting -- Coverage requirements.

479 words·~2 min read·/ut/title-31a/chapter-22/31a-22-654

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Effective 5/5/2021

(1)As used in this section:

(a)"Qualified condition" means the same as that term is defined in Section 49-20-420 .

(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.

(c)"Qualified enrollee" means an enrollee of a qualified insurer who:

(i)has been diagnosed by a physician as having a genetic trait associated with a qualified condition; and

(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.

(a)A qualified insurer shall submit the information described in this Subsection

(2)to the department for a plan year beginning:

(i)on or after January 1, 2022, but before December 31, 2022; and

(ii)on or after January 1, 2025, but before December 31, 2025.

(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.

(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:

(A)describe how the qualified insurer intends to provide the coverage described in Subsection

(3); or

(B)submit an explanation of why the insurer will not provide the coverage described in Subsection

(3).

(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) .

(d)A qualified insurer shall provide the information required under this Subsection

(2)to the department no later than:

(i)January 1, 2022, for a plan year beginning on or after January 1, 2022, but before December 31, 2022; and

(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:

(a)in vitro fertilization services for a qualified enrollee; and

(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:

(a)for information submitted under Subsection (2)(a)(i) , November 1, 2022; and

(b)for information submitted under Subsection (2)(a)(ii) , November 1, 2025.

Amended by Chapter 252 , 2021 General Session