Effective 5/5/2021 31A-22-600. Scope of Part 6. (1) Except where a provision’s application is otherwise specifically limited, this part applies to all: (a) accident and health insurance contracts, including credit accident and health; (b) franchise; (c) group contracts; and (d) life insurance and annuity policies that directly or through a rider provide: (i) accident and […]
31A-22-601. Applicability of life insurance provisions. Sections 31A-22-412 through 31A-22-417 apply to death benefits in accident and health insurance policies. Amended by Chapter 116, 2001 General Session
Effective 5/4/2022 31A-22-602. Premium rates. (1) Except as provided in Subsection 31A-22-701(4), this section does not apply to group accident and health insurance. (2) The benefits in an accident and health insurance policy shall be reasonable in relation to the premiums charged. (3) The commissioner shall prohibit the use of an accident and health insurance […]
Effective 5/10/2016 31A-22-603. Persons insured under an individual accident and health policy. A policy of individual accident and health insurance may insure only one person, except that originally or by subsequent amendment, upon the application of an adult policyholder, a policy may insure any two or more eligible members of the policyholder’s family, including spouse, […]
31A-22-604. Reimbursement by insurers of Medicaid benefits. (1) As used in this section, “Medicaid” means the program under Title XIX of the federal Social Security Act. (2) Any accident and health insurer, including a group accident and health insurance plan, as defined in Section 607(1), Federal Employee Retirement Income Security Act of 1974, or health […]
Effective 5/9/2017 31A-22-605. Accident and health insurance standards. (1) The purposes of this section include: (a) reasonable standardization and simplification of terms and coverages of individual and franchise accident and health insurance policies, including accident and health insurance contracts of insurers licensed under Chapter 7, Nonprofit Health Service Insurance Corporations, and Chapter 8, Health Maintenance […]
Effective 5/14/2019 31A-22-605.1. Preexisting condition limitations. (1) Any provision dealing with preexisting conditions shall be consistent with this section, Section 31A-22-609, and rules adopted by the commissioner. (2) Except as provided in this section, an insurer that elects to use an application form without questions concerning the insured’s health or medical treatment history shall provide […]
31A-22-605.5. Application. (1) For purposes of this section “insurance mandate”: (a) means a mandatory obligation with respect to coverage, benefits, or the number or types of providers imposed on policies of accident and health insurance; and (b) does not mean: (i) an administrative rule imposing a mandatory obligation with respect to coverage, benefits, or providers […]
31A-22-606. Policy examination period. (1) (a) Except as provided in Subsection (2), all accident and health policies shall contain a notice prominently printed on or attached to the cover or front page stating that the policyholder has the right to return the policy for any reason within 10 days after its delivery. (b) “Return” means […]
Effective 5/5/2021 31A-22-607. Grace period. (1) (a) An individual or franchise accident and health insurance policy shall contain one or more clauses providing for a grace period for premium payment only of: (i) at least 15 days for a weekly or monthly premium policy; and (ii) 30 days for a policy that is not a […]
Effective 5/5/2021 31A-22-608. Reinstatement of individual or franchise accident and health insurance policies. (1) Every individual or franchise accident and health insurance policy shall contain a provision which reads substantially as follows: “REINSTATEMENT: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the […]
31A-22-609. Incontestability for accident and health insurance. (1) (a) A statement made by an applicant relating to the person’s insurability, except fraudulent misrepresentation, may not be a basis for avoidance of a policy, coverage, or denial of a claim for loss incurred or disability commencing after the coverage has been in effect for two years. […]
Effective 5/8/2018 31A-22-610. Dependent coverage from moment of birth or adoption. (1) As used in this section: (a) “Child” means, in connection with any adoption, or placement for adoption of the child, an individual who is younger than 18 years of age as of the date of the adoption or placement for adoption. (b) “Placement […]
Effective 1/1/2018 31A-22-610.1. Indemnity benefit for adoption or infertility treatments. (1) (a) (i) If an insured has coverage for maternity benefits on the date of an adoptive placement, the insured’s policy shall provide an adoption indemnity benefit payable to the insured, if a child is placed for adoption with the insured within 90 days of […]
31A-22-610.2. Maternity stay minimum limits. (1) (a) If an insured has coverage for maternity benefits, the policy may not be limited to a less than a 48-hour benefit for both mother and newborn with a normal vaginal delivery. (b) If an insured has coverage for maternity benefits, the policy may not be limited to a […]
Effective 5/12/2020 31A-22-610.5. Dependent coverage. (1) As used in this section, “child” has the same meaning as defined in Section 78B-12-102. (2) (a) Any individual or group accident and health insurance policy or managed care organization contract that provides coverage for a policyholder’s or certificate holder’s dependent: (i) may not terminate coverage of an unmarried […]
31A-22-610.6. Special enrollment for individuals receiving premium assistance. (1) As used in this section: (a) “Premium assistance” means assistance under Title 26, Chapter 18, Medical Assistance Act, in the payment of premium. (b) “Qualified beneficiary” means an individual who is approved to receive premium assistance. (2) Subject to the other provisions in this section, an […]
Effective 5/14/2019 31A-22-611. Coverage for children with a disability. (1) For the purposes of this section: (a) “Dependent with a disability” means a child who is and continues to be both: (i) unable to engage in substantial gainful employment to the degree that the child can achieve economic independence due to a medically determinable physical […]
Effective 5/5/2021 31A-22-612. Conversion privileges for insured former spouse. (1) An accident and health insurance policy, that in addition to covering the insured also provides coverage to the spouse of the insured, may not contain a provision for termination of coverage of a spouse covered under the policy, except by entry of a valid decree […]
31A-22-613. Permitted provisions for accident and health insurance policies. The following provisions may be contained in an accident and health insurance policy, but if they are in that policy, they shall conform to at least the minimum requirements for the policyholder in this section. (1) Any provision respecting change of occupation may provide only for […]
