31A-22-610.5 - Dependent coverage. - Utah Statutes

31A-22-610.5. Dependent coverage.
(1) As used in this section, "child" has the same meaning as defined in Section78B-12-102.
(2) (a) Any individual or group accident and health insurance policy or healthmaintenance organization contract that provides coverage for a policyholder's or certificateholder's dependent may not terminate coverage of an unmarried dependent by reason of thedependent's age before the dependent's 26th birthday and shall, upon application, providecoverage for all unmarried dependents up to age 26.
(b) The cost of coverage for unmarried dependents 19 to 26 years of age shall beincluded in the premium on the same basis as other dependent coverage.
(c) This section does not prohibit the employer from requiring the employee to pay all orpart of the cost of coverage for unmarried dependents.
(d) An individual health insurance policy, group health insurance policy, or healthmaintenance organization shall continue in force coverage for a dependent through the last day ofthe month in which the dependent ceases to be a dependent:
(i) if premiums are paid; and
(ii) notwithstanding Section 31A-8-402.3, 31A-8-402.5, 31A-22-721, 31A-30-107.1, or31A-30-107.3.
(3) An individual or group accident and health insurance policy or health maintenanceorganization contract shall reinstate dependent coverage, and for purposes of all exclusions andlimitations, shall treat the dependent as if the coverage had been in force since it was terminated;if:
(a) the dependent has not reached the age of 26 by July 1, 1995;
(b) the dependent had coverage prior to July 1, 1994;
(c) prior to July 1, 1994, the dependent's coverage was terminated solely due to the age ofthe dependent; and
(d) the policy has not been terminated since the dependent's coverage was terminated.
(4) (a) When a parent is required by a court or administrative order to provide healthinsurance coverage for a child, an accident and health insurer may not deny enrollment of a childunder the accident and health insurance plan of the child's parent on the grounds the child:
(i) was born out of wedlock and is entitled to coverage under Subsection (5);
(ii) was born out of wedlock and the custodial parent seeks enrollment for the child underthe custodial parent's policy;
(iii) is not claimed as a dependent on the parent's federal tax return; or
(iv) does not reside with the parent or in the insurer's service area.
(b) A child enrolled as required under Subsection (4)(a)(iv) is subject to the terms of theaccident and health insurance plan contract pertaining to services received outside of an insurer'sservice area. A health maintenance organization must comply with Section 31A-8-502.
(5) When a child has accident and health coverage through an insurer of a noncustodialparent, and when requested by the noncustodial or custodial parent, the insurer shall:
(a) provide information to the custodial parent as necessary for the child to obtainbenefits through that coverage, but the insurer or employer, or the agents or employees of eitherof them, are not civilly or criminally liable for providing information in compliance with thisSubsection (5)(a), whether the information is provided pursuant to a verbal or written request;
(b) permit the custodial parent or the service provider, with the custodial parent's

approval, to submit claims for covered services without the approval of the noncustodial parent;and
(c) make payments on claims submitted in accordance with Subsection (5)(b) directly tothe custodial parent, the child who obtained benefits, the provider, or the state Medicaid agency.
(6) When a parent is required by a court or administrative order to provide healthcoverage for a child, and the parent is eligible for family health coverage, the insurer shall:
(a) permit the parent to enroll, under the family coverage, a child who is otherwiseeligible for the coverage without regard to an enrollment season restrictions;
(b) if the parent is enrolled but fails to make application to obtain coverage for the child,enroll the child under family coverage upon application of the child's other parent, the stateagency administering the Medicaid program, or the state agency administering 42 U.S.C. Sec.651 through 669, the child support enforcement program; and
(c) (i) when the child is covered by an individual policy, not disenroll or eliminatecoverage of the child unless the insurer is provided satisfactory written evidence that:
(A) the court or administrative order is no longer in effect; or
(B) the child is or will be enrolled in comparable accident and health coverage throughanother insurer which will take effect not later than the effective date of disenrollment; or
(ii) when the child is covered by a group policy, not disenroll or eliminate coverage ofthe child unless the employer is provided with satisfactory written evidence, which evidence isalso provided to the insurer, that Subsection (9)(c)(i), (ii) or (iii) has happened.
(7) An insurer may not impose requirements on a state agency that has been assigned therights of an individual eligible for medical assistance under Medicaid and covered for accidentand health benefits from the insurer that are different from requirements applicable to an agent orassignee of any other individual so covered.
(8) Insurers may not reduce their coverage of pediatric vaccines below the benefit levelin effect on May 1, 1993.
(9) When a parent is required by a court or administrative order to provide healthcoverage, which is available through an employer doing business in this state, the employer shall:
(a) permit the parent to enroll under family coverage any child who is otherwise eligiblefor coverage without regard to any enrollment season restrictions;
(b) if the parent is enrolled but fails to make application to obtain coverage of the child,enroll the child under family coverage upon application by the child's other parent, by the stateagency administering the Medicaid program, or the state agency administering 42 U.S.C. Sec.651 through 669, the child support enforcement program;
(c) not disenroll or eliminate coverage of the child unless the employer is providedsatisfactory written evidence that:
(i) the court order is no longer in effect;
(ii) the child is or will be enrolled in comparable coverage which will take effect no laterthan the effective date of disenrollment; or
(iii) the employer has eliminated family health coverage for all of its employees; and
(d) withhold from the employee's compensation the employee's share, if any, ofpremiums for health coverage and to pay this amount to the insurer.
(10) An order issued under Section 62A-11-326.1 may be considered a "qualifiedmedical support order" for the purpose of enrolling a dependent child in a group accident and

health insurance plan as defined in Section 609(a), Federal Employee Retirement IncomeSecurity Act of 1974.
(11) This section does not affect any insurer's ability to require as a precondition of anychild being covered under any policy of insurance that:
(a) the parent continues to be eligible for coverage;
(b) the child shall be identified to the insurer with adequate information to comply withthis section; and
(c) the premium shall be paid when due.
(12) The provisions of this section apply to employee welfare benefit plans as defined inSection 26-19-2.
(13) The commissioner shall adopt rules interpreting and implementing this section withregard to out-of-area court ordered dependent coverage.

Amended by Chapter 10, 2010 General Session