Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 138 First Substitute (2016GS)

Sponsor

Sen. Mayne, K.

Final action

Governor Signed 3/25/2016

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• requires a health insurer to, at a minimum, provide coverage for emergency care that is medically necessary to stabilize an emergency medical condition; and
• authorizes the insurance commissioner to impose fines if an insurer violates the emergency care coverage standards.

Every vote on this bill

Bill text

HEALTH INSURANCE COVERAGE FOR EMERGENCY CARE
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Karen Mayne
House Sponsor: 
Mike K. McKell
LONG TITLE
General Description:
This bill amends the Insurance Code related to health insurance coverage for emergency
care. 
Highlighted Provisions:
This bill:
▸ requires a health insurer to, at a minimum, provide coverage for emergency care that
is medically necessary to stabilize an emergency medical condition; and
▸ authorizes the insurance commissioner to impose fines if an insurer violates the
emergency care coverage standards. 
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
31A-22-627
, as last amended by Laws of Utah 2006, Chapter 188
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
31A-22-627
 is amended to read:
31A-22-627.
Coverage of emergency medical services.
(1) A health insurance policy or health maintenance organization contract
:
(a) shall provide, at a minimum, coverage of emergency services as required in 29
C.F.R. Sec. 2590.715-2719A; and
(b)
 may not:
[
(a)
] 
(i)
 require any form of preauthorization for treatment of an emergency medical
condition until after the insured's condition has been stabilized; or
[
(b)
] 
(ii)
 deny a claim for any covered evaluation, covered diagnostic test, or other
covered treatment considered medically necessary to stabilize the emergency medical condition
of an insured.
(2) A health insurance policy or health maintenance organization contract may require
authorization for the continued treatment of an emergency medical condition after the insured's
condition has been stabilized. If such authorization is required, an insurer who does not accept
or reject a request for authorization may not deny a claim for any evaluation, diagnostic testing,
or other treatment considered medically necessary that occurred between the time the request
was received 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
acute symptoms of sufficient severity, including severe pain, such that a prudent layperson,
who possesses an average knowledge of medicine and health, would reasonably expect the
absence of immediate 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 the
woman 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 emergency
services 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
or policy; or
(b) restricting a policy or contract from providing enhanced benefits for certain
emergency medical conditions that are identified in the policy or contract.
(5) Notwithstanding Section 
31A-2-308
, if the commissioner finds an insurer has
violated this section, the commissioner may:
(a) work with the insurer to improve the insurer's compliance with this section; or
(b) impose the following fines:
(i) not more than $5,000; or
(ii) twice the amount of any profit gained from violations of this section.