(1) The purpose of this section is to increase the range of health benefit plans available in the small group, small employer group, large group, and individual insurance markets.
(2) A health maintenance organization that is subject to Chapter 8, Health Maintenance Organizations and Limited Health Plans: (a) shall offer to potential purchasers at least one health benefit plan that is subject to the requirements of Chapter 8, Health Maintenance Organizations and Limited Health Plans; and (b) may offer to a potential purchaser one or more health benefit plans that: (i) are not subject to one or more of the following: (A) the limitations on insured indemnity benefits in Subsection 31A-8-105(4); (B) except as provided in Subsection (2)(b)(ii), basic health care services as defined in Section 31A-8-101; or (C) coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that the insurer offers one plan under Subsection (2)(a) that covers the mandate enacted after January 1, 2009; and (ii) when offering a health plan under this section, provide coverage for an emergency medical condition as required by Section 31A-22-627.
(a) shall offer to potential purchasers at least one health benefit plan that is subject to the requirements of Chapter 8, Health Maintenance Organizations and Limited Health Plans; and
(b) may offer to a potential purchaser one or more health benefit plans that: (i) are not subject to one or more of the following: (A) the limitations on insured indemnity benefits in Subsection 31A-8-105(4); (B) except as provided in Subsection (2)(b)(ii), basic health care services as defined in Section 31A-8-101; or (C) coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that the insurer offers one plan under Subsection (2)(a) that covers the mandate enacted after January 1, 2009; and (ii) when offering a health plan under this section, provide coverage for an emergency medical condition as required by Section 31A-22-627.
(i) are not subject to one or more of the following: (A) the limitations on insured indemnity benefits in Subsection 31A-8-105(4); (B) except as provided in Subsection (2)(b)(ii), basic health care services as defined in Section 31A-8-101; or (C) coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that the insurer offers one plan under Subsection (2)(a) that covers the mandate enacted after January 1, 2009; and
(A) the limitations on insured indemnity benefits in Subsection 31A-8-105(4);
(B) except as provided in Subsection (2)(b)(ii), basic health care services as defined in Section 31A-8-101; or
(C) coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that the insurer offers one plan under Subsection (2)(a) that covers the mandate enacted after January 1, 2009; and
(ii) when offering a health plan under this section, provide coverage for an emergency medical condition as required by Section 31A-22-627.
(3) An insurer that offers a health benefit plan that is not subject to Chapter 8, Health Maintenance Organizations and Limited Health Plans: (a) may offer a health benefit plan that is not subject to Section 31A-22-618 and Subsection 31A-45-303(3)(b)(iii); (b) when offering a health plan under this Subsection (3), shall provide coverage of emergency care services as required by Section 31A-22-627; and (c) is not subject to coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that an insurer offers one plan that covers a mandate enacted after January 1, 2009.
(a) may offer a health benefit plan that is not subject to Section 31A-22-618 and Subsection 31A-45-303(3)(b)(iii);
(b) when offering a health plan under this Subsection (3), shall provide coverage of emergency care services as required by Section 31A-22-627; and
(c) is not subject to coverage mandates enacted after January 1, 2009 that are not required by federal law, provided that an insurer offers one plan that covers a mandate enacted after January 1, 2009.
(4) Section 31A-8-106 does not prohibit the offer of a health benefit plan under Subsection (2)(b).
(5) (a) Any difference in price between a health benefit plan offered under Subsections (2)(a) and (b) shall be based on actuarially sound data. (b) Any difference in price between a health benefit plan offered under Subsection (3)(a) shall be based on actuarially sound data.
(a) Any difference in price between a health benefit plan offered under Subsections (2)(a) and (b) shall be based on actuarially sound data.
(b) Any difference in price between a health benefit plan offered under Subsection (3)(a) shall be based on actuarially sound data.
(6) Nothing in this section limits the number of health benefit plans that an insurer may offer.
Copyright ©2024 LegalFix. All rights reserved. LegalFix is not a law firm, is not licensed to practice law, and does not provide legal advice, services, or representation. The information on this website is an overview of the legal plans you can purchase—or that may be provided by your employer as an employee benefit or by your credit union or other membership group as a membership benefit.
LegalFix provides its members with easy access to affordable legal services through a network of independent law firms. LegalFix, its corporate entity, and its officers, directors, employees, agents, and contractors do not provide legal advice, services, or representation—directly or indirectly.
The articles and information on the site are not legal advice and should not be relied upon—they are for information purposes only. You should become a LegalFix member to get legal services from one of our network law firms.
You should not disclose confidential or potentially incriminating information to LegalFix—you should only communicate such information to your network law firm.
The benefits and legal services described in the LegalFix legal plans are not always available in all states or with all plans. See the legal plan Benefit Overview and the more comprehensive legal plan contract during checkout for coverage details in your state.
Use of this website, the purchase of legal plans, and access to the LegalFix networks of law firms are subject to the LegalFix Terms of Service and Privacy Policy.