Section R590-249-5 - ExamplesThe following are examples of permissible policy limitations or exclusions and are not all inclusive:
(1) a charge in connection with reconstructive or plastic surgery that may have a limited benefit, such as a chemical peel that does not alleviate a functional impairment;(2) a complication relating to services and supplies for, or in connection with:(a) gastric or intestinal bypass;(c) a similar surgical procedure to facilitate weight loss;(d) a procedure related to the reversal or revision of a procedure in Subsections (2)(a) through (2)(c); or(e) any direct complication or consequence of a procedure in Subsections (2)(a) through (2)(d);(3) a complication due to infection from a cosmetic procedure, except in a case of reconstructive surgery: (a) when the service is incidental to or follows a surgery resulting from trauma, infection, or other disease of the involved part; or(b) related to a congenital disease or anomaly of a covered dependent child that has resulted in functional defect; or(4) a complication that results from an injury or illness resulting from voluntary participation in an illegal activity described in Section R590-227-4.Utah Admin. Code R590-249-5
Amended by Utah State Bulletin Number 2023-15, effective 7/25/2023