Utah Admin. Code 590-286-6

Current through Bulletin 2024-19, October 1, 2024

Section R590-286-6 - Minimum Policy Standards

(1) The duration of a short-term limited duration health insurance policy shall specify that the contract is less than 12 months after the first issuance of the policy or certificate.

(a) The maximum duration, considering any extensions, has an expiration date which is not more than 36 months after the first issuance of the policy or certificate.

(b) Subject to Subsection R590-286-6(1)(a), a short-term limited duration health insurance policy cannot be renewed.

(2) Short-term limited duration health insurance provides medical coverage that includes, at a minimum, the following benefits:

(a) hospital, surgical, and medical expense coverage, to an aggregate maximum of not less than:

(i) $1,000,000; and

(ii) copayment or coinsurance not to exceed 50% of covered charges;

(b) hospital services, including:

(i) inpatient services; and

(ii) other miscellaneous services associated with admission to a hospital for diagnosis and treatment of a covered condition, including medically necessary services delivered in a hospital setting, including:

(A) professional services;

(B) anesthesia;

(C) facility fees;

(D) supplies;

(E) imaging;

(F) laboratory;

(G) pharmacy services and prescription drugs;

(H) treatments;

(I) therapy; and

(J) other services delivered on an inpatient basis;

(c) outpatient services, including medically necessary services ordered by the insured's attending health care practitioner and rendered on an ambulatory basis for diagnosis and treatment of a covered condition, including:

(i) office and clinic visits;

(ii) diagnostic imaging;

(iii) laboratory services;

(iv) radiation therapy;

(v) physical therapy;

(vi) speech therapy;

(vii) occupational therapy; and

(viii) hemodialysis;

(d) surgical services for diagnosis and treatment of a covered condition must include:

(i) inpatient and outpatient surgical services at a hospital, ambulatory surgical facility, surgical suite, or provider's office; and

(ii) medically necessary services delivered in a hospital, ambulatory surgical facility, surgical suite, or provider's office related to provision of a surgical service, including:

(A) professional services;

(B) anesthesiology;

(C) facility fees;

(D) supplies;

(E) laboratory; and

(F) pharmacy services and prescription drugs related to, or required as a result of, the surgical procedure; and

(e) medical services for diagnosis and treatment of a covered condition including;

(i) office visits;

(ii) benefits for inborn metabolic errors as required by Section 31A-22-623 and Rule R590-194;

(iii) benefits for diabetes as required by Section 31A-22-626 and Rule R590-220; and

(iv) telehealth services and telemedicine services as appropriate.

Utah Admin. Code R590-286-6

Adopted by Utah State Bulletin Number 2021-07, effective 3/11/2021