Utah Admin. Code R590-266-4 - Utah Essential Health Benefits
(1)
(a) The
commissioner hereby designates the PEHP Utah Basic Plus plan as the Utah
Essential Health Benefits Package for purposes of the PPACA in Utah.
(b) The PEHP Utah Basic Plus 2013 Plan as
incorporated herein and available at
http://insurance.utah.gov/health/healthreform.html.
(c) The PEHP Utah Basic Plus 2013 Plan was
issued on July 1, 2013. Some of the benchmark plan benefits may not comply with
current state or federal requirements.
(2)
(a)
Except as provided in Subsection (b) and (c), an individual or small employer
carrier who issues or renews a non-grandfathered plan on or after January 1,
2014, must include at a minimum the benefits of the Utah Essential Health
Benefits Package.
(b) A carrier may
substitute coverage provided in the Utah Essential Health Benefits Package as
long as substitutions are actuarially equivalent and complies with the
standards set forth in
42 CFR
457.431.
(c) A health benefit plan may exclude the
pediatric dental essential health benefit if there is at least one carrier
offering a certified stand-alone dental plan that provides the pediatric dental
essential health benefit in the PEHP Utah Basic Plus 2013 Plan.
(3) This rule does not prohibit an
individual or small employer carrier from offering a non-grandfathered plan
with benefits in addition to the Utah Essential Health Benefits
Package.
Notes
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