Utah Administrative Code
Topic - Insurance
Title R590 - Administration
Rule R590-249 - Secondary Medical Condition Exclusion
Section R590-249-5 - Examples
Universal Citation: UT Admin Code R 590-249-5
Current through Bulletin 2024-06, March 15, 2024
The following are examples of permissible policy limitations or exclusions and are not all inclusive:
(1) a charge in connection with reconstructive or plastic surgery that may have a limited benefit, such as a chemical peel that does not alleviate a functional impairment;
(2) a complication relating to services and supplies for, or in connection with:
(a)
gastric or intestinal bypass;
(b)
gastric stapling;
(c) a similar
surgical procedure to facilitate weight loss;
(d) a procedure related to the reversal or
revision of a procedure in Subsections (2)(a) through (2)(c); or
(e) any direct complication or consequence of
a procedure in Subsections (2)(a) through (2)(d);
(3) a complication due to infection from a cosmetic procedure, except in a case of reconstructive surgery:
(a) when the service is incidental to or
follows a surgery resulting from trauma, infection, or other disease of the
involved part; or
(b) related to a
congenital disease or anomaly of a covered dependent child that has resulted in
functional defect; or
(4) a complication that results from an injury or illness resulting from voluntary participation in an illegal activity described in Section R590-227-4.
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