In 1991, the state established the Utah Comprehensive Health Insurance Pool (HIPUtah), 31A-29-101 et. seq., to specifically address the problem of people with serious medical conditions, such as cancer, diabetes, heart disease, and other chronic illnesses that made them medically uninsurable and, as a result, unable to obtain health insurance at any price. This program is managed by a volunteer Board of Directors (“Board”) and administered privately by SelectHealth, pursuant to a competitively bid contract. HIPUtah also serves as the state’s Health Insurance Portability and Accountability Act (HIPAA) alternative, which is required by Federal Legislation.
HIPUtah is managed by a Board of Directors under Legislative and Insurance Department authority. The Board is voluntary, appointed by the Governor and serves without compensation. The Board has rule-making authority to set premium rates and define underwriting and program management guidelines. The Board members and key staff are identified in Addendum I; an Organizational Chart is attached as Addendum II and outlines HIPUtah’s interaction with State Government.
Additionally, the Board chooses administrative support for the program. This includes a contracted executive director, a consulting actuary, and an underwriting auditor. The State of Utah provides accounting, legal, audit and program evaluation support. As of July 1, 2005 SelectHealth has provided administrative services for HIPUtah.
HIPUtah currently provides insurance coverage to approximately 3,500 Utah residents that without this coverage may be exposed to catastrophic medical expenses.
The Primary Care Network (PCN) is health plan offered by the Utah Department of Health. It covers services administered by a primary care provider.
Applications are only accepted during open enrollment periods, which are held when resources are available to cover more people. The federal government requires PCN to enroll more parents than people without children. Because of this, PCN may schedule separate enrollment times for parents and those without children. To qualify as a parent, you must have children age 18 or younger living at home with you.
PCN covers primary care services:
• Visits to a primary care provider
• Four prescriptions per month
• Dental exams, dental X-rays, cleanings, and fillings
• Eye exam; no glasses or contacts
• Routine lab services and x-rays
• Emergency room visits (restrictions apply; see PCN Member Guide)
• Emergency medical transportation
• Birth control methods
The Children's Health Insurance Program, or CHIP is a state health insurance plan for children. Depending on income and family size, working Utah families who do not have other health insurance may qualify for CHIP.