Utah Admin. Code R590-146-11 - Open Enrollment
(1)
(a) An issuer may not deny or condition the
issuance or effectiveness of a policy or certificate available for sale in this
state, nor discriminate in the pricing of a policy or certificate because of
the health status, claims experience, receipt of health care, or medical
condition of an applicant in the case of an application for a policy or
certificate that is submitted prior to or during the six month period beginning
with the first day of the first month in which an individual is both 65 years
of age or older and is enrolled for benefits under Medicare Part B.
(b) Each policy or certificate currently
available from an issuer shall be available to an applicant who qualifies under
this section regardless of age.
(c)
During an applicant's open enrollment period, an issuer shall offer the lowest
rate available to an applicant without regard to health or smoker
status.
(2)
(a) An issuer may not exclude benefits based
on a preexisting condition if an applicant described in Subsection (1) has had
a continuous period of creditable coverage of at least six months.
(b) An issuer shall reduce the period of a
preexisting condition exclusion by the aggregate of the period of creditable
coverage if an applicant, described in Subsection (1), as of the date of
application, has had a continuous period of creditable coverage that is less
than six months. The Secretary shall specify the manner of the reduction under
this subsection.
(3)
Except as provided in Subsection (2) and Sections R590-146-12 and R590-146-13,
Subsection (1) may not be construed as preventing the exclusion of benefits
under a policy, during the first six months, for a preexisting
condition.
Notes
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