31A-45-403.  Essential health benefits.

(1)  The state designates the state’s own essential health benefits and does not accept a federal determination of the essential health benefits under the PPACA.

Terms Used In Utah Code 31A-45-403

  • PPACA: means the Patient Protection and Affordable Care Act, Pub. See Utah Code 31A-1-301
  • Premium: includes , however designated:
(i) an assessment;
(ii) a membership fee;
(iii) a required contribution; or
(iv) monetary consideration. See Utah Code 31A-1-301
  • State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
    • (2)  Subject to Subsections (3) and (4), the commissioner shall make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, that designate the essential health benefits for the state.

    (3)  Before the commissioner makes rules in accordance with Subsection (2):

    (a)  the commissioner shall present a summary of the commissioner’s planned rules to the Health Reform Task Force; and

    (b)  the Health Reform Task Force shall recommend whether the commissioner makes rules in accordance with the presented summary.

    (4)  The essential health benefits plan:

    (a)  may not include a state mandate if the inclusion of the state mandate would require the state to contribute to premium subsidies under the PPACA; and

    (b)  may add benefits in addition to the benefits included in a benchmark plan adopted in accordance with this section if the additional benefits are mandated under the PPACA.

    Enacted by Chapter 319, 2018 General Session

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