What is Covered Under Utah Cares

What services will be covered?

Utah Cares will cover facility and clinician charges for these Essential Health Benefits (EHBs):

● Outpatient care
● Emergency care
● Hospital stays
● Mental health and substance used disorder coverage
● Prescription drug coverage (will have limits on some)
● Rehabilitation services
● Lab and imaging services
● Preventive care
● Maternity and newborn care
● Pediatric dental and vision care

Will Home Health and Hospice Care be covered?
Yes

Will everyone have the same benefit package?
Yes, and its coverage details will be equal to, and in some cases more generous, than packages currently available to Utah’s public employees and elected policy makers.

Would the benefit package change with time?
There would be ongoing regular evaluations by the board of the details of the EHBs to assess the needs for adjustments and improvements. In doing so, the board would take input from its various advisory panels, including consumers.

Would the benefit package cover everything I need to stay healthy and all available health related treatments?
No. There is no health care system anywhere in the world that can do that. Services commonly not covered by health insurances now, such as cosmetic surgery, laser eye refraction, many alternative health treatments, and over-the-counter medications, wouldn’t be covered. The board would always have the ability to add coverage benefits, after carefully considering the costs, as needs and consumer demands arise.

Could the benefit package improve over time and cover more services
Yes, if recommended by Utah Cares advisory panels and the board can determine there is a way to pay for them.

Would new treatments and technologies be added when they become available?
Yes, if proven to be safe and effective by high quality, evidence based evaluations performed by the federal government, research institutions, or out-of-state insurers .

Could services and treatments be removed from the benefit package
Yes. If there is good evidence from multiple sources around the United States that a therapy is unsafe or totally ineffective, it could become a non covered service or treatment.

Would Primary Children’s Hospital and its affiliated clinics and facilities be covered?
Yes.

Would Huntsman Cancer and its affiliated hospital and clinics be covered?
Yes.