1. (1)(a) A short-term limited duration health insurance contract shall specify that the initial term is less than 12 months.

   1. (b) The maximum duration, including any extensions, has an expiration date that is not more than 36 months after the first issuance of the policy or certificate.
   2. (c) Subject to Subsection R590-286-6(1)(b), a policy may not be renewed.

2. (2) A contract shall provide medical coverage that includes, at a minimum, the following benefits:

   1. (a) hospital, surgical, and medical expense coverage, to an aggregate maximum of not less than:

      1. (i) $1,000,000; and
      2. (ii) copayment or coinsurance not to exceed 50% of covered charges;

   2. (b) hospital services, including:

      1. (i) inpatient services; and

      2. (ii) other miscellaneous services associated with admission to a hospital for diagnosis and treatment of a covered condition, including medically necessary services delivered in a hospital setting, including:

         1. (A) professional services;
         2. (B) anesthesia;
         3. (C) facility fees;
         4. (D) supplies;
         5. (E) imaging;
         6. (F) laboratory;
         7. (G) pharmacy services and prescription drugs;
         8. (H) treatments;
         9. (I) therapy; and
         10. (J) other services delivered on an inpatient basis;

   3. (c) outpatient services, including medically necessary services ordered by the enrollee's attending health care practitioner and provided on an ambulatory basis for the diagnosis and treatment of a covered condition, including:

      1. (i) office and clinic visits;
      2. (ii) diagnostic imaging;
      3. (iii) laboratory services;
      4. (iv) radiation therapy;
      5. (v) physical therapy;
      6. (vi) speech therapy;
      7. (vii) occupational therapy; and
      8. (viii) hemodialysis;

   4. (d) surgical services for the diagnosis and treatment of a covered condition, which must include:

      1. (i) inpatient and outpatient surgical services at a hospital, ambulatory surgical facility, surgical suite, or a provider's office; and

      2. (ii) medically necessary services related to a surgical service delivered in a hospital, ambulatory surgical facility, surgical suite, or a provider's office, including:

         1. (A) a professional service;
         2. (B) anesthesiology;
         3. (C) facility fees;
         4. (D) a supply;
         5. (E) laboratory; and
         6. (F) a pharmaceutical service or prescription drug related to, or required as a result of, the surgical procedure; and

   5. (e) a medical service for the diagnosis and treatment of a covered condition, including:

      1. (i) an office visit;
      2. (ii) a benefit for inborn metabolic errors as required under Section 31A-22-623 and Rule R590-194;
      3. (iii) a benefit for diabetes as required under Section 31A-22-626 and Rule R590-220; and
      4. (iv) telehealth services and telemedicine services as appropriate.

KEY: insurance, health, short-term limited duration

Date of Last Change: March 24, 2025

Notice of Continuation: March 9, 2026

Authorizing, and Implemented or Interpreted Law: 31A-2-201(3)(a); 31A-2-202; 31A-22-605(4); 31A-22-605(6); 31A-22-605.1(1); 31A-45-103