(1)  A long-term care insurance policy may not contain a provision that conditions eligibility:

Terms Used In Utah Code 31A-22-1407

  • Certificate: means evidence of insurance given to:
(a) an insured under a group insurance policy; or
(b) a third party. See Utah Code 31A-1-301
  • Insurance: includes :
    (i) 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
  • Long-term care insurance: includes :
    (i) any of the following that provide directly or supplement long-term care insurance:
    (A) a group or individual annuity or rider; or
    (B) a life insurance policy or rider;
    (ii) a policy or rider that provides for payment of benefits on the basis of:
    (A) cognitive impairment; or
    (B) functional capacity; or
    (iii) a qualified long-term care insurance contract. See Utah Code 31A-1-301
  • Policy: includes a service contract issued by:
    (i) a motor club under Chapter 11, Motor Clubs;
    (ii) a service contract provided under Chapter 6a, Service Contracts; and
    (iii) a corporation licensed under:
    (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
    (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans. See Utah Code 31A-1-301
  • Premium: includes , however designated:
    (i) an assessment;
    (ii) a membership fee;
    (iii) a required contribution; or
    (iv) monetary consideration. See Utah Code 31A-1-301
  • Rider: means an endorsement to:
    (a) an insurance policy; or
    (b) an insurance certificate. See Utah Code 31A-1-301
    (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 requirement except for eligibility for:

    (i)  waiver of premium;

    (ii)  post confinement;

    (iii)  post-acute care; or

    (iv)  recuperative benefits.
  • (2)  A long-term care insurance policy containing post confinement, post-acute care, or recuperative benefits shall clearly label the limitations or conditions, including any required number of days of confinement in a separate paragraph of the policy or certificate that is entitled “Limitations or Conditions on Eligibility for Benefits.”

    (3)  A long-term care insurance policy or rider that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days.

    Amended by Chapter 116, 2001 General Session