a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
(ii)
a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and
(iii)
a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(a)
An insurer issuing an individual or group life insurance policy or an accident and health insurance policy shall deliver a copy of the policy to the policyholder as soon as practicable but no later than 90 days after the day on which the coverage is effective.
(b)
The policy described in this Subsection (1) shall:
(i)
provide the exact name of the insurer; and
(ii)
state the state of domicile of the insurer.
(2)
(a)
(i)
Except under Subsection (2)(d), an insurer issuing a group insurance policy other than a blanket insurance policy shall, as soon as practicable after the coverage is effective, but no later than 90 days after the day on which the coverage is effective, provide a certificate for each member of the insured group, except that only one certificate need be provided for the members of a family unit.
(ii)
The certificate described in this Subsection (2) shall:
(A)
provide the exact name of the insurer;
(B)
state the state of domicile of the insurer; and
(C)
contain a summary of the essential features of the insurance coverage, including:
(I)
any rights of conversion to an individual policy;
(II)
in the case of group life insurance, any continuation of coverage during total disability; and
(III)
in the case of group life insurance, the incontestability provision.
(iii)
Upon receiving a written request, the insurer shall inform any insured how the insured may inspect, during normal business hours at a place reasonably convenient to the insured:
(A)
a copy of the policy; or
(B)
a summary of the policy containing all the details that are relevant to the certificate holder.
(b)
The commissioner may by rule impose a requirement similar to Subsection (2)(a) on any class of blanket insurance policies for which the commissioner finds that the group of persons covered is constant enough for that type of action to be practicable and not unreasonably expensive.
(c)
(i)
A certificate shall be provided in a manner reasonably calculated to bring the certificate to the attention of the certificate holder.
(ii)
The insurer may deliver or mail a certificate:
(A)
directly to the certificate holders; or
(B)
in bulk to the policyholder to transmit to certificate holders.
(iii)
An affidavit by the insurer that the insurer mailed the certificates in the usual course of business creates a rebuttable presumption that the insurer has mailed the certificate to:
(A)
a certificate holder; or
(B)
a policyholder as provided in Subsection (2)(c)(ii)(B).
(d)
The commissioner may by rule or order prescribe substitutes for delivery or mailing of certificates that are reasonably calculated to inform a certificate holder of the certificate holder’s rights, including:
(i)
booklets describing the coverage;
(ii)
the posting of notices in the place of business; or
(iii)
publication in a house organ.
(3)
Unless a policy, certificate or an authorized substitute has been made available to the policyholder or certificate holder, as applicable, when required by this section, an act or omission forbidden to or required of the policyholder or certificate holder by the policy or certificate after the coverage has become effective as to the policyholder or certificate holder, other than intentionally causing the loss insured against or failing to make required contributory premium payments, may not affect the insurer’s obligations under the insurance contract.
