Section R590-266-4 - Utah Essential Health Benefits(1)(a) The PEHP Utah Basic Plus 2013 plan is designated as the Utah essential health benefits package.(c) The PEHP Utah Basic Plus 2013 Plan was issued on July 1, 2013, and some of the benchmark plan benefits may not comply with current state or federal requirements.(2)(a) Except as provided in Subsections (2)(b) and (2)(c), an individual or small employer insurer who issues or renews a non-grandfathered plan on or after January 1, 2014, must include at least the benefits of the Utah essential health benefits package.(b) An insurer may substitute coverage provided in the Utah essential health benefits package if the substitution is actuarially equivalent and complies with 42 CFR 457.431.(c) A health benefit plan may exclude the pediatric dental essential health benefit if there is at least one insurer offering a certified stand-alone dental plan that provides the pediatric dental essential health benefit in the PEHP Utah Basic Plus 2013 Plan.(3) An individual or small employer insurer may offer a non-grandfathered plan with benefits in addition to the Utah essential health benefits package.Utah Admin. Code R590-266-4
Amended by Utah State Bulletin Number 2016-12, effective 5/23/2016Amended by Utah State Bulletin Number 2023-12, effective 6/9/2023