31A-22-610 - Dependent coverage from moment of birth or adoption.
31A-22-610. Dependent coverage from moment of birth or adoption.
(1) As used in this section:
(a) "Child" means, in connection with any adoption, or placement for adoption of thechild, an individual who is younger than 18 years of age as of the date of the adoption orplacement for adoption.
(b) "Placement for adoption" means the assumption and retention by a person of a legalobligation for total or partial support of a child in anticipation of the adoption of the child.
(2) (a) Except as provided in Subsection (5), if an accident and health insurance policyprovides coverage for any members of the policyholder's or certificate holder's family, the policyshall provide that any health insurance benefits applicable to dependents of the insured areapplicable on the same basis to:
(i) a newly born child from the moment of birth; and
(ii) an adopted child:
(A) beginning from the moment of birth, if placement for adoption occurs within 30 daysof the child's birth; or
(B) beginning from the date of placement, if placement for adoption occurs 30 days ormore after the child's birth.
(b) The coverage described in this Subsection (2):
(i) is not subject to any preexisting conditions; and
(ii) includes any injury or sickness, including the necessary care and treatment ofmedically diagnosed:
(A) congenital defects;
(B) birth abnormalities; or
(C) prematurity.
(c) (i) Subject to Subsection (2)(c)(ii), a claim for services for a newly born child or anadopted child may be denied until the child is enrolled.
(ii) Notwithstanding Subsection (2)(c)(i), an otherwise eligible claim denied underSubsection (2)(c)(i) is eligible for payment and may be resubmitted or reprocessed once a child isenrolled pursuant to Subsection (2)(d) or (e).
(d) If the payment of a specific premium is required to provide coverage for a child of apolicyholder or certificate holder, for there to be coverage for the child, the policyholder orcertificate holder shall enroll:
(i) a newly born child within 30 days after the date of birth of the child; or
(ii) an adopted child within 30 days after the day of placement of adoption.
(e) If the payment of a specific premium is not required to provide coverage for a child ofa policyholder or certificate holder, for the child to receive coverage the policyholder orcertificate holder shall enroll a newly born child or an adopted child no later than 30 days afterthe first notification of denial of a claim for services for that child.
(3) (a) The coverage required by Subsection (2) as to children placed for the purpose ofadoption with a policyholder or certificate holder continues in the same manner as it would withrespect to a child of the policyholder or certificate holder unless:
(i) the placement is disrupted prior to legal adoption; and
(ii) the child is removed from placement.
(b) The coverage required by Subsection (2) ends if the child is removed from placementprior to being legally adopted.
(4) The provisions of this section apply to employee welfare benefit plans as defined inSection 26-19-2.
(5) If an accident and health insurance policy that is not subject to the special enrollmentrights described in 45 C.F.R. Sec. 146.117(b) provides coverage for one individual, the insurermay choose to:
(a) provide coverage according to this section; or
(b) allow application, subject to the insurer's underwriting criteria for:
(i) a newborn;
(ii) an adopted child; or
(iii) a child placed for adoption.
Amended by Chapter 307, 2007 General Session