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Utah Health Insurance

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Facts and Figures

  • Place in State
    Health Report Card
  • Insured 2,382,802
  • Uninsured 389,400
  • Insurance
  • Number of
    Primary Care Physicians
    No Data
  • Number of
  • Average Cost of
    Health Insurance*

Breakdown of Insureds

  • Employer-sponsored health insurance 63%
  • Private plans 5%
  • Medicaid 15%
  • Medicare 17%

Insurance Carriers

State Health Report Card

In the past year, the rate of preventable hospitalizations decreased from 39.9 to 36.7 discharges per 1,000 Medicare enrollees. In the past five years, diabetes increased from 5.5 percent to 6.5 percent of adults. Now 123,000 Utah adults have diabetes. While smoking decreased from 12.9 percent to 9.1 percent of adults in the last ten years, 172,000 adults still smoke in Utah. In the past ten years, obesity increased from 19.1 percent to 23.0 percent of adults, with 435,000 obese adults in the state.

Utah Health Insurance Laws and Regulations

Utah health insurance laws provide certain protections for you as you shop for health insurance. For example, Utah health insurance companies are required to offer standardized health plans that cover a certain set of medical services. Once you are accepted into a Utah health insurance plan, an insurer is not allowed to cancel your coverage if you get sick or are injured – as long as you pay your premiums. But Utah health insurance companies will look at pre-existing health conditions and health status before they accept applicants into coverage and set premiums. If a resident is turned down for coverage because of his or her health status, that person can purchase coverage through Utah’s high-risk health insurance pool, HIPUtah. This pool offers four kinds of plans with different deductible levels. Learn more about HIPUtah here.

Individual Health Insurance in Utah (UT) There are some regulations governing individual health insurance in Utah which are different from other states. If you are not eligible for individual insurance through your employment, membership in an association, COBRA, Utah’s continuation coverage, conversion coverage, Medicaid, Medicare, or HIPUtah program, insurers are required to provide individual insurance coverage. For all others, the individual insurers can deny coverage based on medical problems you may have. Utah also requires standardized policies which contain specific benefits from all individual insurers, as well as additional policies that they choose to offer. In the presence of a pre-existing condition, individual insurers may attach an elimination rider to your policy or an exclusion period with a maximum of 12 months. Creditable coverage is allowed for individual insurance. Pregnancy is considered a pre-existing condition in Utah. For HIPAA eligible individuals who cannot buy HIPUtah, you cannot be required to fulfill an exclusion period. The premiums for individual insurance are based on the average of small group health insurance, with limits placed because of health problems. For renewal, there are no limitations because of age and health. Your individual coverage cannot be cancelled if you get sick. Regence Blue Cross Blue Shield administers Utah’s Comprehensive Health Insurance Pool for those who are unable to buy individual health insurance. Group Health Insurance in Utah (UT) For Utah residents who qualify, group health insurance cannot be refused, and the people cannot be charge more, because of a health problem. Certain life changes relating to family or job loss may entitle you to special opportunities for group coverage. A new employer is allowed a waiting period before offering group insurance; also, a new HMO is allowed to impose an affiliation period. In the presence of a pre-existing condition, group insurers can require an exclusion period of no more than 12 months. They are allowed to look back at your medical history for the prior six months before coverage to determine pre-existing conditions. If you had continuous coverage, without a lapse of more than 63 days, you are protected from exclusion periods with creditable coverage. Small Business Health Insurance in Utah (UT) For small businesses with two to 50 employees, they cannot be refused small group health insurance, nor can it be cancelled due to illness within the employee group. The state requires insurance companies offer standardized plans. For small group insurance, there are limits placed on the premiums. A small business with two to 50 employees can join a statewide and approved purchasing alliance for group health insurance coverage. For all regulations that cover associations with group coverage, it is recommended you contact the Utah Insurance Department.

Heath Care Reform

Immediate Benefits for Utah

Small business tax credits. 40,500 small businesses in Utah could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 22,400 Medicare beneficiaries in Utah hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Utah who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.

Support for health coverage for early retirees. An estimated 38,500 people from Utah retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 1.6 million Utah residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 186,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Utah peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 1.5 million residents of Utah with health insurance from their employer, along with anyone who signs up with a new insurance plan in Utah.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 11,600 individuals in Utah who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $40.1 million federal dollars are available to Utah starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 47 Community Health Centers in Utah but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 11% of Utah’s population who live in an underserved area.

New Medicaid options for states. For the first time, Utah has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

State Government Insurance Programs Offered


800-662-9651 801-538-6155 Covers Inpatient hospital, Outpatient hospital services, Prenatal care, Vaccines for children, Physician, Nursing facility services, Family planning, Rural health clinic services, Home health care for persons eligible for skilled nursing services, Laboratory and x-ray services, Pediatric and family nurse practitioner services, Nurse-midwife services and more. Eligibility: Income limits: Aged, blind or disabled: 100% FPL for singles and couples with asset limit of $2,000 for singles and $3,000 for couples. Pregnant women and children ages 0–5: 133% FPL. Children ages 6–18: 100% FPL. Parents/caretakers living with their children ages 0–18: 4% to 60% FPL.

Children’s Health Insurance Program (CHIP)

877-543-7669 866-435-7414

CHIP: Well-child exams, Immunizations, Health care provider visits, Prescriptions, Hearing and eye exams, Mental health services, Dental services for prevention and treatment of tooth decay. Must be a U.S. citizen or legal alien and Utah resident, under 19 years old, not covered by health insurance (including Medicaid), with income up to 200% FPL

Primary Care Network


PCN: Primary care services, Prescriptions drugs, Dental benefits, Immunizations, Eye exams (no glasses or contact lenses), Lab and x-rays services, Emergency room visits, (restrictions apply), Emergency medical transportation, Birth control, Insulin, Lancets, Test strips, Syringes (for diabetes control and management) PCN: Must be 19–64 years old, uninsured, ineligible for Medicaid, not have access to student health insurance, Medicare or Veterans’ Benefits. Income limit of 150% FPL.

Premium Partnership For Health Insurance

UPP is a program for adults and children who do not currently have health insurance or COBRA coverage. UPP will help pay for monthly insurance premiums for individuals enrolled in their employer’s health insurance plan or COBRA

Utah Medicare


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

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