Utah Admin. Code R590-233-5 - General Requirements
(1) A contract may
not include a definition regarding a matter defined in Section
R590-233-3 unless the definition
complies with that section.
(2) A
contract that provides coverage to a spouse of the contract holder:
(a) may not provide for termination of
coverage of the spouse solely because of the occurrence of an event specified
for termination of coverage of the contract holder, other than for nonpayment
of premium; and
(b) shall provide
that in the event of the contract holder's death, the spouse shall become the
contract holder.
(3)
(a) Termination of a contract shall be
without prejudice to any continuous loss that commenced while the contract was
in force.
(b) The continuous total
disability of the enrollee may be a condition for an extension of benefits
beyond the period the contract was in force, limited to the duration of the
benefit period, if any, or payment of the maximum benefits.
(4) If a contract includes a
status-type military service exclusion or a provision that suspends coverage
during military service, the contract shall, upon receipt of a written request,
provide for a refund of premiums, as applicable, to the enrollee on a pro-rata
basis.
(5)
(a) If an insurer cancels or refuses to renew
a contract providing pregnancy benefits, the contract shall provide an
extension of benefits for the pregnancy benefit, if:
(i) the pregnancy commenced while the
contract was in force; and
(ii) a
benefit would have been payable had the contract remained in force.
(b) Subsection (5)(a) does not
apply to a contract that is canceled due to the enrollee:
(i) failing to pay the required premium in
accordance with the contract terms;
(ii) performing an act or practice that
constitutes fraud in connection with the coverage; or
(iii) making an intentional misrepresentation
of material fact under the terms of the contract.
(6) A contract providing coverage
for the recipient in a transplant operation shall also provide reimbursement of
all medically necessary transplant expenses of a live donor, to the extent
benefits remain and are available under the recipient's contract and after
benefits for the recipient's expenses have been paid.
(7) A premium change notice shall be given no
less than 45 days before the renewal date.
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) Policy definitions. No policy subject to this rule may contain definitions respecting the matters defined in Section R590-233-3 unless such definitions comply with the requirements of that section.
(2) Rights of spouse. The following provisions apply to policies that provide coverage to a spouse of the insured:
(a) A policy may not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than for nonpayment of premium.
(b) A policy shall provide that in the event of the insured's death the spouse of the insured shall become the insured.
(3) Cancellation, Renewability, and Termination. Policy cancellation, renewability and termination provisions must comply with Sections 31A-8-402.3, 31A-8-402.5, 31A-8-402.7, 31A-22-721 and 31A-30-107, 107.1 and 107.3.
(4) Termination of the policy shall be without prejudice to a continuous loss that commenced while the policy or certificate was in force. The continuous total disability of the insured may be a condition for the extension of benefits beyond the period the policy was in force, limited to the duration of the benefit period, if any, or payment of the maximum benefits.
(5) Military service. If a policy contains a status-type military service exclusion or a provision that suspends coverage during military service, the policy shall provide, upon receipt of written request, for refund of premiums as applicable to the person on a pro rata basis.
(6) Pregnancy benefit extension. In the event the insurer cancels or refuses to renew a policy providing pregnancy benefits, the policy shall provide an extension of benefits for a pregnancy commencing while the policy is in force and for which benefits would have been payable had the policy remained in force. This requirement does not apply to a policy that is canceled for the following reasons:
(a) the insured fails to pay the required premiums in accordance with the terms of the plan; or
(b) the insured person performs an act or practice that constitutes fraud in connection with the coverage or makes an intentional misrepresentation of material fact under the terms of the coverage.
(7) Transplant donor coverage. A policy providing coverage for the recipient in a transplant operation shall also provide reimbursement of any medical expenses of a live donor to the extent that benefits remain and are available under the recipient's policy or certificate, after benefits for the recipient's own expenses have been paid.
(8) Notice of premium change. A notice of change in premium shall be given no fewer than 45 days before the renewal date.