Utah Health Insurance Guide
Utah Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a resident of Utah you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Utah State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Utah is not a guarantee issue state for individuals, unless the insurer selling individual policies has failed to meet enrollment caps. In that case, the insurer must guarantee issue at least one individual policy if you are not eligible for any other type of health coverage. Otherwise, by law, private insurance companies that sell individual policies can medically underwrite them and are not required to sell you an individual health insurance policy if you do not meet their criteria. You can be turned down for any number of reasons including your past or current health and lifestyle habits. In Utah, insurers are permitted a 12-month exclusionary period and a six-month look-back period for pre-existing conditions, unless you have proof of prior creditable coverage. Pregnancy can be considered a pre-existing condition. Utah also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions. Insurers in Utah can base premiums for individual policies on your health, your age and lifestyle factors. However, there is a cap that limits what you can reasonably be charged; the variance is plus or minus 30% of the state’s individual market rate. Utah requires insurers to offer standardized policies for individuals. Your options will include an HMO and a PPO, and the choice of a low, medium or high deductible plan.
Utah is a guarantee issue state for group health plans issued to small businesses. If your Utah health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. The insurer can impose a 12-month exclusionary period and a six-month look-back period for pre-existing medical conditions, but must give credit for prior creditable coverage if there has been no more than a 63-day break in coverage. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 30% of its index rate if your group has a history of unfavorable health.
Utah is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
Utah Mandated Health Benefits
Utah laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Breast Reconstruction
- Cleft Palate
- Diabetes Supplies
- Drug Abuse Treatment
- Emergency Services
- HPV Vaccine
- Maternity Stays
- General and Parity Mental Health
- PKU/Formula
- Well-Child Care
- Coverage for newborns under their parent's policy
- Coverage for adopted children under their parent's policy
- Coverage for handicapped children under their parent's policy
- Coverage for continuation/dependents under their guardian's policy
- Coverage for dependent students under their guardian's policy
- Coverage for non-custodial children under their guardian’s policy
- Coverage for continuation/employees
- Coverageconversion to non-group.
Types Health Insurance Plans Available in Utah
The following major medical health insurance plans are generally available in Utah. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Utah
Utah Comprehensive Health Insurance Pool
HIPUtah is the state-sponsored high-risk pool that offers health insurance if you are a Utah resident and cannot obtain private health insurance because of a pre-existing condition. Other eligibility requirements apply. Three HMO plans and one High Deductible Health Plan to be used with a Health Savings Account are offered, with three different deductable levels ranging from $500 to $2,500. The plan is also available as a Health Savings Account Plan. Coinsurance for most treatments is 20%. Maximum out-of-pocket includes the deductible and varies depending on deductible level selected. After deductible is satisfied, plans pay 100% of covered services. Premiums are based on the plan you select and your age. but are capped at 200% of the average rate charged for similar coverage in Utah. Enrollment is open. There may be a six-month waiting period for pre-existing conditions.
Utah Children’s Health Insurance Program
Utah CHIP provides comprehensive free or low-cost health care for resident children up to age 19, whose families meet income requirements and other eligibility requirements. There are two plans to select from. Modest premiums and co-pays are charged may be charged for most covered services but can’t exceed 5% of family income. There may be a waiting period but it can be waived in certain circumstances. Enrollment is open but is subject to review and renewal every 12 months.
Regulating Agency
The Utah Insurance Department is responsible for regulating Utah’s health insurance industry.
Get access to Utah health insurance quotes from http://www.einsurance.com/health-insurance.
Utah Insurance Department
3110 State Office Building
Salt Lake City, UT 84114
(801) 53-3800
http://www.insurance.utah.gov
Utah Comprehensive Health Insurance Pool
3009 S Rio Grande St
Salt Lake City, UT 84101-1106
(801) 442-6660
http://www.insurance.utah.gov/hiputah/index.html
Utah Children’s Health Insurance Program
PO Box 144102
Salt Lake City, UT 84114-4102
(877) KIDS-NOW
http://health.utah.gov/chip
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/