Utah Admin. Code R590-285-7 - Required Disclosure Provisions

(1) An individual policy shall contain a renewability provision.

(a) The provision in this Subsection (1) shall:

(i) be appropriately captioned;

(ii) appear on the first page of the policy; and

(iii) clearly state that the coverage is guaranteed renewable or noncancellable.

(b) A policy or certificate, other than a policy or certificate where the insurer does not have the right to change the premium, shall include a statement that premium rates may change.

(2)

(a) A rider or endorsement added to a policy after the date of issue or at reinstatement or renewal that reduces or eliminates a benefit or coverage in the policy shall require a signed acceptance by the insured, unless the insurer:

(i) is effectuating a request made in writing by the insured; or

(ii) is exercising a specifically reserved right under a policy.

(b) After the date of policy issue, any rider or endorsement that increases a benefit or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing and signed by the insured, except if the increased benefit or coverage is required by law.

(c) When a separate additional premium is charged for a benefit provided in connection with a rider or an endorsement, the premium charge shall be set forth in the policy, rider, or endorsement.

(3) A policy providing payment of benefits based on a standard described as "usual and customary," "reasonable and customary," or similar language, shall include a definition of the term and an explanation of the term in the outline of coverage.

(4) If a policy or certificate contains a preexisting condition limitation, the limitation shall appear as a separate paragraph of the policy or certificate and be labeled as "Preexisting Condition Limitations."

(5) If a policy or certificate contains a limitation or condition for eligibility, the limitation, including any required number of days of confinement, shall appear in a separate paragraph of the policy or certificate and be labeled "Limitations or Conditions on Eligibility for Benefits."

(6) Activities of daily living and cognitive impairment shall be used to measure an insured's need for limited long-term care benefits and shall be described in a policy or certificate in a separate paragraph, including any additional benefit triggers, and be labeled "Eligibility for the Payment of Benefits."

(a) If the triggers differ for different benefits, an explanation of each trigger shall accompany each benefit description.

(b) If an attending physician or other specified person is required to certify a certain level of functional dependency to qualify for benefits, the requirements shall be specified.

Notes

Utah Admin. Code R590-285-7

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