26B-3-1008. Statute of limitations — Survival of right of action — Insurance policy not to limit time allowed for recovery.
(1)
Terms Used In Utah Code 26B-3-1008
Claim: means :
(a)
a request or demand for payment; or
(b)
a cause of action for money or damages arising under any law. See Utah Code 26B-3-1001
Health insurance entity: means :
(a)
an insurer;
(b)
a person who administers, manages, provides, offers, sells, carries, or underwrites health insurance, as defined in Section 31A-1-301;
(c)
a self-insured plan;
(d)
a group health plan, as defined in Subsection 607(1) of the federal Employee Retirement Income Security Act of 1974;
(e)
a service benefit plan;
(f)
a managed care organization;
(g)
a pharmacy benefit manager;
(h)
an employee welfare benefit plan; or
(i)
a person who is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. See Utah Code 26B-3-1001
Medical assistance: means :
(a)
all funds expended for the benefit of a recipient under this chapter or Titles XVIII and XIX, federal Social Security Act; and
(b)
any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department. See Utah Code 26B-3-1001
Provider: means a person or entity who provides services to a recipient. See Utah Code 26B-3-1001
Recipient: means :
(a)
an individual who has applied for or received medical assistance from the state;
(b)
the guardian, conservator, or other personal representative of an individual under Subsection (11)(a) if the individual is a minor or an incapacitated person; or
(c)
the estate and survivors of an individual under Subsection (11)(a), if the individual is deceased. See Utah Code 26B-3-1001
Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
Third party: includes :
(a)
an individual, institution, corporation, public or private agency, trust, estate, insurance carrier, employee welfare benefit plan, health maintenance organization, health service organization, preferred provider organization, governmental program such as Medicare, CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by department rule; and
(b)
a spouse or a parent who:
(i)
may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order; or
(ii)
has been ordered to maintain health, dental, or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order. See Utah Code 26B-3-1001
(a)
Subject to Subsection (6), action commenced by the department under this part against a health insurance entity shall be commenced within:
(i)
subject to Subsection (7), six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based; or
(ii)
six months after the date of the last payment for medical assistance, whichever is later.
(b)
An action against any other third party, the recipient, or anyone to whom the proceeds are payable shall be commenced within:
(i)
four years after the date of the injury or onset of the illness; or
(ii)
six months after the date of the last payment for medical assistance, whichever is later.
(2)
The death of the recipient does not abate any right of action established by this part.
(3)
(a)
No insurance policy issued or renewed after June 1, 1981, may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than 24 months from the date the provider furnishes services or goods to the recipient.
(b)
No insurance policy issued or renewed after April 30, 2007, may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in Subsection (1)(a).
The provisions of this section supersede any other sections regarding the time limit in which an action shall be commenced, including Section 75-7-509.
(6)
(a)
Subsection (1)(a) extends the statute of limitations on a cause of action described in Subsection (1)(a) that was not time-barred on or before April 30, 2007.
(b)
Subsection (1)(a) does not revive a cause of action that was time-barred on or before April 30, 2007.
(7)
An action described in Subsection (1)(a) may not be commenced if the claim for recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided.
Renumbered and Amended by Chapter 306, 2023 General Session
