Utah Admin. Code R590-277-6 - Required Provisions
(1)
(a) A contract shall include a renewal,
continuation, and nonrenewal provision.
(b) Each provision shall:
(i) appear on the first page of the
contract;
(ii) be appropriately
captioned; and
(iii) clearly state
the renewability of coverage.
(2)
(a)
Except for an endorsement by which the managed care organization effectuates a
written request by the policyholder or exercises a specifically reserved right
under the contract, signed acceptance by the policyholder is required for an
endorsement that reduces or eliminates a benefit or coverage and is added to a
contract after the date of issue, at reinstatement, or at renewal.
(b) After the contract issue date, an
endorsement that increases a benefit or coverage with a concurrent increase in
premium during the contract term shall be agreed to in writing and signed by
the policyholder, except if the increased benefit or coverage is required by
law.
(3) If a separate
additional premium is charged for a benefit provided in connection with an
endorsement, the premium charge shall be set forth in the contract.
(4) A contract that provides for the payment
of a benefit based on a standard described as usual and customary, reasonable
and customary, or similar words, shall include a definition and explanation of
the term in the accompanying outline of coverage or benefit summary.
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) A policy and certificate shall include a renewal, continuation, and nonrenewal provision. The provision shall be appropriately captioned, appear on the first page of the policy and certificate, and clearly state the duration of coverage.
(2) Endorsement acceptance.
(a) Except for an endorsement by which the insurer effectuates a request made in writing by the policyholder or exercises a specifically reserved right under the policy, an endorsement added to a policy after date of issue or at reinstatement or renewal that reduces or eliminates benefits or coverage in the policy shall require signed acceptance by the policyholder.
(b) After the date of policy issue, an endorsement that increases benefits or coverage with a concurrent increase in premium during the policy term, must be agreed to in writing signed by the policyholder, except if the increased benefits or coverage is required by law.
(3) Additional premium. Where a separate additional premium is charged for benefits provided in connection with an endorsement, the premium charge shall be set forth in the policy or certificate.
(4) Benefit payment standard. A policy or certificate that provides for the payment of benefits based on standards described as usual and customary, reasonable and customary, or words of similar import, shall include a definition of the terms and an explanation of the terms in its accompanying outline of coverage or certificate.