Key Takeaways
- Utah Insurance Department regulates health insurance
- Utah uses the federally-facilitated exchange (HealthCare.gov)
- Pre-existing condition exclusions are prohibited in ACA-compliant plans
- Essential health benefits are required in individual and small group markets
- Utah has expanded Medicaid coverage
Last updated: January 2026
Utah Health Insurance Policy Requirements
Utah has health insurance regulations under Title 31A of the Utah Code.
Regulatory Structure
Utah health coverage is regulated by:
| Agency | Responsibility |
|---|---|
| Utah Insurance Department | Regulates all insurance |
| HealthCare.gov | Federal marketplace for individual enrollment |
Utah Insurance Department
The Department:
- Reviews and approves policy forms and rates
- Licenses insurance producers and companies
- Handles consumer complaints
- Enforces insurance laws and regulations
Health Insurance Marketplace
Utah uses the federally-facilitated exchange (HealthCare.gov):
Key Features
- Federal marketplace for individual health insurance
- Premium tax credits available for qualifying applicants
- Qualified Health Plans (QHPs) certified by federal government
- Multiple private insurers participate
Enrollment Periods
- Annual open enrollment each fall
- Special enrollment for qualifying life events
- Financial assistance based on income
State Health Programs
Utah Medicaid
Utah has expanded Medicaid coverage:
- Covers adults up to 138% FPL
- Covers children through CHIP
- Managed care delivery system available
Required Coverage
Utah ACA-compliant plans must cover Essential Health Benefits:
Essential Health Benefits
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Pre-Existing Condition Protections
For ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited |
Guaranteed Issue and Renewal
ACA requirements provide:
Guaranteed Issue
- Insurers must accept all applicants during open enrollment
- Cannot deny coverage based on health status
Guaranteed Renewal
- Cannot cancel coverage except for non-payment or fraud
- Plan discontinuation requires advance notice
Mental Health Parity
Utah and federal mental health parity requirements apply:
- Mental health benefits must equal medical benefits
- Same copays, deductibles, and limits
- Coverage for substance use disorders required
Test Your Knowledge
Which marketplace does Utah use for individual health insurance enrollment?
A
B
C
D
Test Your Knowledge
Are pre-existing condition exclusions prohibited in Utah ACA-compliant individual health plans?
A
B
C
D