Utah Admin. Code R590-285-10 - Prohibition Against Post-Claims Underwriting

(1) An application or enrollment form, except one that is guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(2)

(a) If an application or enrollment form contains a question that asks whether the applicant has had medication prescribed by a physician, it shall also ask the applicant to list the prescribed medication.

(b) If the medications listed in the application or enrollment form were known by the insurer, or should have been known at the time of application or enrollment, to be directly related to a medical condition for which coverage would otherwise be denied, then the policy or certificate may not be rescinded for that condition.

(3)

(a) Except for a policy or a certificate that is guaranteed issue:

(i) the following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a policy or a certificate: "Caution: If your answers on this application are incorrect or untrue, (insert name of insurer) has the right to deny benefits or rescind your policy."; and

(ii) the following language, or language substantially similar to the following, shall be set out conspicuously on the policy or certificate at the time of delivery: "Caution: The issuance of this limited long-term care insurance (insert either policy or certificate) is based upon your responses to the questions on your application. A copy of your (insert either application or enrollment form) (insert either is enclosed or was retained by you when you applied). If your answers are incorrect or untrue, the insurer has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: (insert address)."

(b) The insurer shall deliver to the insured a copy of the completed application or enrollment form no later than at the time of delivery of the policy or certificate unless it was retained by the insured at the time of application or enrollment.

Notes

Utah Admin. Code R590-285-10

Adopted by Utah State Bulletin Number 2021-05, effective 2/23/2021 Adopted by Utah State Bulletin Number 2024-21, effective 10/22/2024