Effective 5/5/2021
31A-22-2002. Definitions.
As used in this part:
31A-22-2002. Definitions.
As used in this part:
- (1) “Applicant” means:
- (a) when referring to an individual limited long-term care insurance policy, the person who seeks to contract for benefits; and
- (b) when referring to a group limited long-term care insurance policy, the proposed certificate holder.
- (2) “Elimination period” means the length of time between meeting the eligibility for benefit payment and receiving benefit payments from an insurer.
- (3) “Group limited long-term care insurance” means a limited long-term care insurance policy that is delivered or issued for delivery:
- (a) in this state; and
- (b) to an eligible group, as described under Subsection 31A-22-701(2).
- (4)
- (a) “Limited long-term care insurance” means an insurance policy, endorsement, or rider that is advertised, marketed, offered, or designed to provide coverage:
- (i) for less than 12 consecutive months for each covered person;
- (ii) on an expense-incurred, indemnity, prepaid or other basis; and
- (iii) for one or more necessary or medically necessary diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services that is provided in a setting other than an acute care unit of a hospital.
- (b) “Limited long-term care insurance” includes a policy or rider described in Subsection (4)(a) that provides for payment of benefits based on cognitive impairment or the loss of functional capacity.
- (c) “Limited long-term care insurance” does not include an insurance policy that is offered primarily to provide:
- (i) basic Medicare supplement coverage;
- (ii) basic hospital expense coverage;
- (iii) basic medical-surgical expense coverage;
- (iv) hospital confinement indemnity coverage;
- (v) major medical expense coverage;
- (vi) disability income or related asset-protection coverage;
- (vii) accidental only coverage;
- (viii) specified disease or specified accident coverage; or
- (ix) limited benefit health coverage.
- (a) “Limited long-term care insurance” means an insurance policy, endorsement, or rider that is advertised, marketed, offered, or designed to provide coverage:
- (5) “Preexisting condition” means a condition for which medical advice or treatment is recommended:
- (a) by, or received from, a provider of health care services; and
- (b) within six months before the day on which the coverage of an insured person becomes effective.
- (6) “Waiting period” means the time an insured waits before some or all of the insured’s coverage becomes effective.
Amended by Chapter 252, 2021 General Session