Utah Admin. Code R590-126-2 - Purpose and Scope
(1) The purpose of
this rule is to:
(a) standardize and simplify
the terms and coverage of an accident and health insurance contract;
(b) facilitate public understanding and
comparison of coverage;
(c)
prohibit use of a provision that is misleading or confusing in connection with
the purchase of coverage or the settlement of a claim;
(d) set minimum coverage requirements;
and
(e) provide for full disclosure
in the sale of insurance.
(2) This rule applies to an accident and
health insurance contract that is not specifically exempted from this rule,
regardless of:
(a) whether the contract is
issued to an association, a trust, a discretionary group, or another similar
group; or
(b) the situs of delivery
of the contract.
(3) This
rule does not apply to:
(a) an accident and
health insurance contract issued to an employee group under Section
31A-22-502;
(b) a contract issued to an employee or
member as an addition to a franchise plan in existence on January 1,
2006;
(c) a Medicare supplement
contract subject to Section
31A-22-620;
(d) a TRICARE policy, formerly known as a
Civilian Health and Medical Program of the Uniformed Services, 10 U.S.C. 55,
CHAMPUS settlement insurance policy;
(e) a health benefit plan subject to Title
31A, Chapter 45, Managed Care Organizations;
(f) a short-term limited duration health
insurance contract subject to Rule R590-286;
(g) a long-term care insurance contract
subject to Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards;
or
(h) a limited long-term care
insurance contract subject to Title 31A, Chapter 22, Part 20, Limited Long-Term
Care Insurance Act.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Purpose. The purpose of this rule is to provide reasonable standardization and simplification of terms and coverages of insurance policies in order to facilitate public understanding and comparison and to prohibit provisions which may be misleading or confusing in connection either with the purchase of such coverages or with the settlement of claims, and to provide for full disclosure in the sale of such insurance.
(2) Scope.
(a) This regulation applies to:
(i) all individual accident and health insurance policies and group supplemental health policies and certificates, delivered or issued for delivery in this state on and after January 1, 2006, that are not specifically exempted from this regulation, regardless of:
(A) whether the policy is issued to an association; a trust; a discretionary group; or other similar grouping; or
(B) the situs of delivery of the policy or contract; and (ii) all dental plans and vision plans.
(b) This rule shall not apply to:
(i) employer accident and health insurance, as defined in Section 31A-22-502;
(ii) policies issued to employees or members as additions to franchise plans in existence on the effective date of this regulation;
(iii) Medicare supplement policies subject to Section 31A-22-620;
(iv) civilian Health and Medical Program of the Uniformed Services, Chapter 55, title 10 of the United States Code, CHAMPUS supplement insurance policies; or
(v) a health benefit plan that complies with R590-277, Managed Care Health Benefit Plan Policy Standards.
(3) The requirements contained in this regulation shall be in addition to any other applicable regulations previously adopted.