Utah Admin. Code R590-277-5 - General Requirements
(1) A contract
may not include a definition regarding a matter defined in Section
R590-277-3 unless the definition
complies with that section.
(2)
Except for an employer-sponsored health benefit plan, a contract:
(a) may not provide for termination of
coverage of the spouse or a dependent 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 contract providing coverage for the
recipient in a transplant operation shall also provide reimbursement of
medically necessary transplant expenses of a live donor.
(4) A premium change notice shall be given no
less than 45 days before the renewal date.
(5)
(a)
Except under Subsection (5)(b), a completed application:
(i) is made part of the contract;
and
(ii) shall be provided to the
applicant before, or at delivery, of the contract.
(b) Subsection (5)(a) does not apply to:
(i) an employer-sponsored health benefit
plan; or
(ii) an individual if the
application was submitted through the health insurance exchange.
(6) A managed care
organization offering an individual health benefit plan shall issue with an
individual policy:
(a)
(i) an outline of coverage; or
(ii) a benefit summary; and
(b) a summary of benefits and
coverage.
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 R590-277-3 unless such definitions comply with the requirements of that section.
(2) Rights of spouse and dependents. Except for an employer sponsored health plan, a policy;
(a) may not provide for termination of coverage of the spouse or a dependent solely because of the occurrence of an event specified for termination of coverage of the policyholder, other than for nonpayment of premium; and
(b) shall provide that in the event of the policyholder's death the spouse of the insured shall become the insured.
(3) Cancellation, renewability, and termination. A policy cancellation, renewability and termination provision shall comply with Sections 31A-22-618.6 or 31A-22-618.7.
(4) Transplant donor coverage. A policy providing coverage for the recipient in a transplant operation shall also provide reimbursement of any medically necessary transplant expenses of a live donor.
(5) Notice of premium change. A notice of change in premium shall be given no fewer than 45 days before the renewal date.
(6)
(a) Except as provided in Subsection (b), a completed application shall be made part of the policy. A copy of the completed application shall be provided to the applicant prior to, or upon delivery, of the policy.
(b) Subsection (6)(a) does not apply to:
(i) an employer sponsored health benefit plan; or
(ii) an individual policy where application was effectuated directly through heathcare.gov.
(7) A managed care organization offering a health benefit plan to an individual or small employer:
(a) shall offer coverage to all individuals and eligible employees on a guaranteed basis without regard to health status;
(b) may modify coverage at the time of renewal to the extent that such modification is consistent with federal and state law and effective on a uniform basis among all individuals in the health benefit plan; and
(c) must renew or continue coverage at the option of the policyholder, subject to Subsections 31A-22-618.6 and 618.7.