Effective 5/14/2019 31A-22-1401. Application. (1) The requirements of this part apply to individual policies and to group policies and certificates marketed in this state on or after July 1, 2001. (2) Entities subject to this part shall comply with other applicable insurance laws and rules unless they are in conflict with this part. (3) The […]
31A-22-1403. Filing required for policies issued in another state. Group long-term care insurance coverage may not be offered to a resident of this state under a group policy issued in another state unless the policy and certificate have been filed with the commissioner. Enacted by Chapter 243, 1991 General Session
Effective 5/5/2021 31A-22-1404. Rulemaking authority. The commissioner may adopt rules that may permit or include: (1) the increase of benefits over time; (2) standards for full and fair disclosure of the manner, content, and required disclosures for the sale of long-term care insurance policies; (3) terms of renewability; (4) initial and subsequent conditions of eligibility; […]
31A-22-1405. Restrictions on terms of coverage. No long-term care insurance policy may: (1) be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; (2) contain a provision establishing a new waiting period in the event existing coverage […]
31A-22-1406. Preexisting conditions. (1) A long-term care insurance policy or certificate may not use a definition of a preexisting condition which is more restrictive than the following: “Preexisting condition means a condition for which medical advice or treatment was recommended by or received from a provider of health care services, within six months preceding the […]
31A-22-1407. Restricted conditional terms. (1) A long-term care insurance policy may not contain a provision that conditions eligibility: (a) for any benefits on a prior hospitalization requirement; (b) for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or (c) for any benefits on a prior institutionalization […]
31A-22-1408. Right of return — Notice. Individual long-term care insurance policyholders and certificate holders other than employee and labor union certificate holders have the right to return the policy within 30 days of its delivery and to have the premium refunded if the policyholder is not satisfied for any reason after examination of the policy. […]
31A-22-1409. Statements of coverage. (1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the applicant to the document and its purpose. (2) The commissioner may prescribe a standard format of an outline of coverage, […]
31A-22-1410. Report to policyholder. A monthly report shall be provided to the policyholder any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status. The report shall include: (1) any long-term care benefits paid out during the month; (2) an explanation of […]
31A-22-1411. Incontestability period. (1) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate upon a showing of misrepresentation that is material to the acceptance for coverage. (2) For a policy or certificate that has been in force for […]
31A-22-1412. Nonforfeiture benefits. (1) (a) A long-term care insurance policy or certificate may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. (b) The offer of a nonforfeiture benefit under Subsection (1)(a) may […]
31A-22-1413. Claim information. If a claim under a long-term care insurance contract is denied, within 60 days of the date a written request by the policyholder or a representative of a policyholder is filed with the insurer, the insurer shall: (1) provide a written explanation of the reason for the denial; and (2) make available […]
31A-22-1414. Marketing. A policy or rider shall comply with this part if it is advertised, marketed, or offered as: (1) long-term care insurance; or (2) nursing home insurance. Enacted by Chapter 116, 2001 General Session
Effective 5/12/2020 31A-22-1415. Living organ donor coverage. (1) For the purposes of this section, “living organ donor” means the same as that term is defined in Section 31A-22-655. (2) An insurer may not: (a) deny eligibility for coverage or limit coverage of a individual under a long-term care insurance policy or contract solely due to […]
