Bill > HB0495

This bill makes several amendments to health care practices and insurance regulations in Utah. The first section updates health care claims practices, requiring insurers to timely pay valid claims within specific timeframes, provide written explanations for denials, and establish clear communication processes with providers. The bill introduces a late fee mechanism for delayed claim payments or responses, with a daily interest rate of 0.033%. It also prohibits insurers from engaging in unfair claim settlement practices, such as misrepresenting policy details or denying claims without clear justification. The second section focuses on dental claim transparency, mandating that insurers provide detailed policy information to dental providers, limit downcoding and bundling practices, and ensure explanation of benefits include reasons for claim adjustments. The third and fourth sections expand definitions and regulations for dispensing practitioners, notably adding dentists to the list of professionals who can dispense certain medications and allowing dentists to dispense prescription fluoride medication regardless of treatment duration. Specific changes include allowing dentists to be considered dispensing practitioners and removing previous restrictions on certain medications. The bill is set to take effect on May 7, 2025, and aims to improve transparency, fairness, and clarity in health care claims processing and medication dispensing.

Business and Industry, Health and Social Services

https://le.utah.gov/~2025/bills/static/HB0495.html