March 25, 2025
In March 2025, Gov. Cox signed the following bills into law:
- SB 196 Physical Therapist Practice Amendments: The new legislation expands the definition of primary healthcare to include services provided by physical therapists. It also prohibits insurers from charging higher premiums or copays if a patient selects a physical therapist (or other qualified provider) as the primary care provider, including where an accident or health insurance policy requires a primary care provider or physician to be selected. The law takes effect May 7, 2025.
- HB 301 Ambulance Provider Payment Amendments: The new legislation regulates and standardizes billing practices for ground ambulance services in Utah. The law sets fixed base rates, requires direct billing to insurers or workers' compensation (including for out-of-network services), mandates direct payment to providers by insurers/carriers, and prohibits balance billing for covered services. These state-level protections are separate from the federal No Surprises Act. The law is effective on May 7, 2025.
- HB 23 Insurance Modifications: The law modifies small employer stop-loss contract standards, including specific and annual aggregate attachment points. It also prohibits a stop-loss insurer or reinsurer from entering into a stop-loss contract with a small employer with less than 10 enrolled employees. The stop-loss provisions do not apply to small employer contracts entered into before July 1, 2025, unless the insurance provider changes under the small employer’s health plan during the contract period.
- SB 256 General Government and Appropriations Amendments: The new legislation requires the insurance commissioner to update the state’s essential health benefits (EHB) benchmark plan for plan years beginning on or after January 1, 2027, to include any state-mandated health insurance benefit that applied to a health benefit plans effective on or after January 1, 2012, through January 1, 2025, and additional benefits mandated by the federal Patient Protection and Affordable Care Act (PPACA). It also permits the commissioner to expand the state's EHB plan if additional benefits are mandated by the PPACA. The law takes effect on May 7, 2025.
- SB 274 Health Insurance Preauthorization Revisions: The new legislation requires health insurers to give 30 days’ notice on their website before changing preauthorization requirements. Separately, if a drug is removed from the formulary midyear, patients on active treatment must receive 30 days' notice and can request an exemption. These requirements take effect on May 7, 2025. Related, HB 23 Insurance Modifications aligns Utah state law with federal rules relating to preexisting condition limitations.
On March 24, 2025, the Utah Insurance Department updated three regulations: R590-126 Accident and Health Insurance Standards, R590-233 Health Benefit Plan Insurance Standards, and R590-286 for Minimum Standards for Short-Term Limited Duration Health Insurance. Each substantially repeals and reenacts existing administrative code to align with current rulemaking standards. While these updates do not introduce new requirements or eliminate existing ones, they clarify, modernize, and recite key rules in Utah employee benefits law. All three rules became effective on March 24, 2025.
- R590-126 addresses accident and health insurance contracts. It contains provisions on definitions, prohibited clauses, general contract standards, benefit requirements, and expectations for outlines of coverage governed by Utah law.
- R590-233 pertains to health benefit plan insurance standards, focusing on the terms and coverage of these contracts.
- R590-286 sets minimum standards for short-term limited duration health insurance, including rules on maximum policy durations, required disclosures, and baseline benefit levels.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier or third-party administrator for further details.
- SB 196 Physical Therapist Practice Amendment
- HB 301 Ambulance Provider Payment Amendments
- HB 23 Insurance Modifications
- SB 256 General Government and Appropriations Amendments
- SB 274 Health Insurance Preauthorization Revision
- R590-126, Accident and Health Insurance Standards
- R590-233, Health Benefit Plan Insurance Standards
- R590-286, Minimum Standards for Short-Term Limited Duration Health Insurance