31A-22-627 - Coverage of emergency medical services. - Utah Statutes

31A-22-627. Coverage of emergency medical services.
(1) A health insurance policy or health maintenance organization contract may not:
(a) require any form of preauthorization for treatment of an emergency medical conditionuntil after the insured's condition has been stabilized; or
(b) deny a claim for any covered evaluation, covered diagnostic test, or other coveredtreatment considered medically necessary to stabilize the emergency medical condition of aninsured.
(2) A health insurance policy or health maintenance organization contract may requireauthorization for the continued treatment of an emergency medical condition after the insured'scondition has been stabilized. If such authorization is required, an insurer who does not accept orreject a request for authorization may not deny a claim for any evaluation, diagnostic testing, orother treatment considered medically necessary that occurred between the time the request wasreceived and the time the insurer rejected the request for authorization.
(3) For purposes of this section:
(a) "emergency medical condition" means a medical condition manifesting itself by acutesymptoms of sufficient severity, including severe pain, such that a prudent layperson, whopossesses an average knowledge of medicine and health, would reasonably expect the absence ofimmediate medical attention at a hospital emergency department to result in:
(i) placing the insured's health, or with respect to a pregnant woman, the health of thewoman or her unborn child, in serious jeopardy;
(ii) serious impairment to bodily functions; or
(iii) serious dysfunction of any bodily organ or part; and
(b) "hospital emergency department" means that area of a hospital in which emergencyservices are provided on a 24-hour-a-day basis.
(4) Nothing in this section may be construed as:
(a) altering the level or type of benefits that are provided under the terms of a contract orpolicy; or
(b) restricting a policy or contract from providing enhanced benefits for certainemergency medical conditions that are identified in the policy or contract.

Amended by Chapter 188, 2006 General Session