Utah Admin. Code R590-83-4 - Availability Requirements and Prohibited Transactions

Current through Bulletin No. 2021-18, September 15, 2021

Availability of any insurance contract may not be denied to an insured or prospective insured on the basis of sex or marital status of the insured or prospective insured. The amount of benefits payable, or any term, condition or type of coverage may not be restricted, modified, excluded or reduced on the basis of the sex or marital status of the insured or prospective insured, except marital status may be considered for the purpose of defining eligibility for dependent or family coverage. An insurer may treat a polygamous relationship differently than a monogamous relationship for purposes of defining or providing dependent or family coverage provided that the treatment reflects reasonable treatment of the interests of the affected parties and safeguards the economic interests of the insurer and other policyholders or prospective policyholders. Any insurer or representative of an insurer acting in contravention of this rule shall be deemed to have engaged in an unfair or deceptive act or practice as provided by Chapter 23a, Title 31A. Examples of the practices prohibited by this section include:

(a) denying, canceling or refusing to renew coverage, or providing coverage on different terms, because the insured or prospective insured is residing with another person not related by blood or marriage;
(b) offering coverage to males gainfully employed at home, employed part-time or employed by relatives while denying or offering reduced coverage to females similarly employed;
(c) reducing disability benefits for females who become disabled while not gainfully employed full- time outside the home when a similar reduction is not applied to males;
(d) denying females waiver of premium provisions that are available to males or offering the provisions to females only for contact limits that are lower than those available to males;
(e) refusing to offer maternity benefits to insureds or prospective insureds purchasing individual contracts when comparable family coverage contracts offer maternity benefits;
(f) denying, under group contracts, dependents coverage to husbands of female employees when dependent's coverage is available to wives of male employees;
(g) offering coverage to males in certain occupations while denying coverage or offering more limited coverage to females in the same occupational categories;
(h) offering males higher benefit levels or longer benefits periods, or both, than are offered to females in the same classifications;
(i) offering contracts containing different definitions of disability for females and males in the same classifications;
(j) offering contracts containing different waiting and elimination periods for females and males;
(k) requiring female applicants to submit to medical examinations while not requiring males to submit to the examinations for the same coverage;
(l) establishing different benefit options for females and males;
(m) denying to divorced or single persons coverage available to married persons;
(n) limiting the amount of coverage available to an insured or prospective insured based upon the person's marital status;
(o) denying employees of one sex insurance benefits that are offered to dependents who are of the same sex as the employees;
(p) denying a married or separated female the right to obtain or continue coverage in her own name when the same does not apply to males;
(q) establishing different issue age requirements for females and males;
(r) establishing different occupational classifications for females and males;
(s) denying coverage to unwed persons or their dependents, or both;


Utah Admin. Code R590-83-4

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