R590. Insurance, Administration.R590-240. Procedure to Obtain Exemption of Student Health Programs From Title 31A, Insurance Code.
R590-240-1. Authority.
This rule is promulgated by the commissioner pursuant to Sections 31A-1-103 and 31A-2-201.
R590-240-2. Purpose and Scope.
(1) The purpose of this rule is to create a procedure for a student health program established by an institution of higher education to obtain an exemption from regulation under Title 31A, Insurance Code.
(2)(a) This rule applies to a student health program established by an institution of higher education.
(b) This rule does not exempt from Title 31A, Insurance Code, health insurance from an insurer made available by an institution to its students, even if:
(i) the insurer's policy is integrated into the overall student health program offered by the institution to its students; or
(ii) use of the institution's student health center is an integral, or mandatory, part of health care coverage under the insurer's policy.
R590-240-3. Definitions.
Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:
(1) "Board" means the Utah Board of Higher Education established in Section 53B-1-402.
(2) "Eligible member" means:
(a) an eligible student;
(b) a spouse of an eligible student; or
(c) a child of, dependent of, or child placed for adoption with, an eligible student.
(3) "Eligible recipient" means:
(a) an eligible member;
(b) an officer of the institution, a faculty member, or an employee; or
(c) upon application by the institution or the institution's student health center, a person approved by written order of the commissioner.
(4) "Eligible student" is as defined by each institution, but shall, at a minimum, require that the student be enrolled with the institution.
(5) "Institution" means an institution of higher education or postsecondary educational institute that consists of the following:
(a) an institution described in Section 53B-1-102; or
(b) an institution of higher education that has been accredited by the Northwest Commission on Colleges and Universities.
(6) "Student health center" means a facility that:
(a) is operated to provide health care services to an eligible recipient by an institution or pursuant to a contract with that institution;
(b) employs a health care provider, or contracts with a health care provider, which may make a referral to another health care provider;
(c) is funded, at least in part, by payment from one of the following sources, which payment grants access to the student health center during the period the eligible student is registered:
(i) a fee assessed to and paid by each eligible student at registration; or
(ii) the tuition paid by the eligible student;
(d) may accept insurance payments, or assist a user in completing a claim form for an insurance claim; and
(e) may require an eligible recipient to pay an additional fee for:
(i) each time the student health center is visited;
(ii) a specialty service;
(iii) medical equipment; or
(iv) medication received at the student health center.
(7)(a) "Student health program" means a plan organized, established, or adopted by an institution to provide or arrange for health care services for eligible members.
(b) "Student health program" may include coverage for:
(i) limited health care services;
(ii) health care services on an emergency basis; or
(iii) health care services by an out-of-area health care provider under the following situations:
(A) on an emergency basis, where a prudent layperson would expect the absence of immediate medical attention to result in placing the eligible member's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part;
(B) during a period when the individual is not enrolled in any classes at the institution but is still matriculated with the institution, including time between semesters or quarters, traditional breaks for the summer, or time away from the institution while attending another higher education institution under a plan approved by the institution; and
