Utah Admin. Code R590-285-20 - Availability of New Services or Providers

(1) This section applies to a policy issued on or after July 1, 2021.

(2)

(a) An insurer shall notify a policyholder of the availability of a new policy series that provides coverage not previously available to the general public for new providers or new limited long-term care services.

(b) The insurer shall provide the notice within 12 months of the date the new policy series is made available in this state.

(3)

(a) A notice is not required for:

(i) a policy issued before July 1, 2021; or

(ii) a policyholder or certificate holder who:

(A) is currently eligible for benefits;

(B) is within an elimination period or on a claim;

(C) previously had been in claim status; or

(D) is not eligible to apply for coverage due to issue age limitations under the new policy.

(b) The insurer may require that a policyholder meet each eligibility requirement, including underwriting and payment of the required premium, to add the new services or providers.

(4) The insurer shall make the new coverage available by:

(a) adding a rider to the existing policy and charging a separate premium for the new rider based on the insured's attained age;

(b) exchanging the existing policy or certificate for one with an issue age based on the present age of the insured by:

(i) recognizing past insured status by granting premium credits toward the premiums for the new policy or certificate; and

(ii) basing premium credits on premiums paid or reserves held for the prior policy or certificate;

(c) exchanging the existing policy or certificate for a new policy or certificate where:

(i) consideration for past insured status shall be recognized by setting the premium for the new policy or certificate at the issue age of the policy or certificate being exchanged; and

(ii) the cost for the new policy or certificate may recognize the difference in reserves between the new policy or certificate and the original policy or certificate; or

(d) an alternative program developed by the insurer that meets the intent of this section.

(5)

(a) An insurer is not required to notify a policyholder of a new proprietary policy series created for use in a limited distribution channel.

(b) An insurer shall notify a policyholder who purchased a proprietary policy through a limited distribution channel of a new policy series that provides coverage for new providers or limited long-term care services not previously available to that limited distribution channel.

(6) A new policy issued pursuant to this section:

(a) is an exchange;

(b) is not a replacement; and

(c) is not subject to Section R590-285-13 or R590-285-19, or Subsection R590-285-14(1).

(7)

(a) If the policy is offered through an employer, a labor organization, or an occupational, professional, or trade association, the required notification in Subsection (2) shall be made to the policyholder.

(b) If the policy is issued to a group under Section 31A-22-504, 31A-22-505, or 31A-22-507, or Subsection 31A-22-701(1)(b), the notification shall be made to each certificate holder.

(8)

(a) This section does not prohibit an insurer from offering a policy, rider, certificate, or coverage change to any policyholder or certificate holder.

(b)

(i) Upon request, a policyholder may apply for currently available coverage that includes the new services or providers.

(ii) The insurer may require that a policyholder meet each eligibility requirement, including underwriting and payment of the required premium, to add the new services or providers.

(9) This section does not apply to a life insurance policy or rider containing accelerated limited long-term care benefits.

Notes

Utah Admin. Code R590-285-20

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