31A-22-633 - Exemptions from standards.
31A-22-633. Exemptions from standards.
Notwithstanding the provisions of Title 31A, Insurance Code, any accident and healthinsurer or health maintenance organization may offer a choice of coverage that is less or differentthan is otherwise required by applicable state law if:
(1) the Department of Health offers a choice of coverage as part of a Medicaid waiverunder Title 26, Chapter 18, Medical Assistance Act, which includes:
(a) less or different coverage than the basic coverage;
(b) less or different coverage than is otherwise required in an insurance policy or healthmaintenance organization contract under applicable state law; or
(c) less or different coverage than required by Subsection 31A-22-605(4)(b); and
(2) the choice of coverage offered by the carrier:
(a) is the same or similar coverage as the coverage offered by the Department of Healthunder Subsection (1);
(b) is offered to the same or similar population as the coverage offered by theDepartment of Health under Subsection (1); and
(c) contains an explanation for each insured of coverage exclusions and limitations;
(3) the commissioner and the executive director of the Department of Health shall reportto the Health and Human Services Interim Committee prior to November 15 of each yearconcerning:
(a) the number of lives covered under any policy offered under the provisions of thissection or under the Medicaid waiver described in Subsection (1);
(b) the claims experienced under the policies or Medicaid programs described inSubsection (3)(a);
(c) any cost shifting to the private sector for care not covered under the programs orpolicies described in Subsection (3)(a); and
(d) efforts or agreements between the Department of Health, the commissioner, insurersregulated under this chapter, and health care providers regarding combining publicly fundedcoverage with private, employer-based coverage to increase benefits and health care coverage.
Amended by Chapter 123, 2005 General Session