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Utah Health Insurance
Health insurance is the key to insuring your financial future and your family’s basic medical care needs. Protecting your family against the occurrence of illness or injury is difficult; however a suitable health policy can relieve your financial burden caused by these events. When purchasing health coverage, your top priority should be evaluation of all potential risks and its influence on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, often become the casualty of high financial costs due to the absence of proper health insurance. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.
Utah holds the 5th position in the healthiest states list according to United Health Foundation’s 2008 Health Rankings. The state climbed one spot from its 6th position in 2007 and 2006 respectively. The strong features of the state include low infant mortality, low violent crime rate and low prevalence of binge drinking. The state of Utah, with a population of more than two million residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Utah who meet specific eligibility requirements of age and income.
The Utah Insurance Department manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, due to the state’s low public health funding, approximately 15.1% of Utah residents are surviving without health insurance. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 37.6% of Utah’s uninsured residents come under the above 200% FPL category.
Buying health coverage is not easy and requires the help of a licensed health insurance agent/broker to choose a proper health insurance plan with benefits that are ideal for your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Utah. These regulations apply to all insurance companies offering individual or family health insurance in Utah:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 6 months |
Look Back Standard | Objective |
Mandatory Benefits | Reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as Primary Care Providers, eating disorder parity |
Market Rate Restrictions | Yes |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Utah. These regulations apply to all insurance companies offering small group health insurance in Utah:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for coverage; owner can count as an employee |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate bands |
Rate Adjustment Factors | 30% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Utah. For employer groups of more than 20 employees, refer to the federal COBRA guidelines;
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 6 months |
Extension of Benefits Period - Disabled | 6 months |
Maximum Premium Increase | 102% |
State Legislation Reference | Utah Continuation Law |
Additional Notes | To be eligible for the continuation coverage, the individual should they have been covered under a group insurance plan for at least six months prior. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Utah to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Utah is summarized in the chart below:
| Plan Name | The Comprehensive Health Insurance Pool of Utah (HIPUtah) |
Website | |
Phone Number | 800-705-9173 |
HIPPA Eligibility Required? | Yes |
Available Carriers | SelectHealth |
Pre-Existing Condition Waiting Period | 6 months |
Enrollment Periods | Currently Open to New Enrollment |
Premium Limits | No more than 200% of standard risk |
Lifetime Maximum Benefit | $1.5 million |
Special Notes | To qualify, you should have at least 18 months of prior coverage, the most recent prior coverage being under a group health plan, government plan, or church plan, and have elected and exhausted COBRA or a state continuation plan; you should apply for HIPUtah coverage within 63 days of termination from prior coverage |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Utah provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | Children’s Health Insurance Program |
Website | |
Phone Number | 877-543-7669 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | Molina, Public Employees Health Program (PEHP) |
Length of Coverage | 12 months |
Residency Requirements | Utah residents, U.S. citizen, legal immigrants |
Other Eligibility Requirements | The child should not have been covered by any other insurance |
Pre-Existing Condition Exclusions | None |
Cost | Depending on your income you will either pay $0, $30 a quarter, or $75 per quarter and co-pays. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Utah.
| Governing Agency | Utah Department of Health |
Website | |
Phone Number | 801-538-6155, 800-662-9651 |
Residency Requirements | Utah resident, U.S. citizen |
Federal Poverty Line Income Limits | Parents: 70% FPL |
Additional Resources
Utah Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Utah’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Utah: At-A-Glance
Provides exclusive health data of Utah. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
