(1) 

Terms Used In Utah Code 31A-22-1412

  • 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
  • Form: means one of the following prepared for general use:
    (i) a policy;
    (ii) a certificate;
    (iii) an application;
    (iv) an outline of coverage; or
    (v) an endorsement. 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
  • Policyholder: means a person who controls a policy, binder, or oral contract by ownership, premium payment, or otherwise. 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
  • Rate: means :
    (i) the cost of a given unit of insurance; or
    (ii) for property or casualty insurance, that cost of insurance per exposure unit either expressed as:
    (A) a single number; or
    (B) a pure premium rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:
    (I) expenses;
    (II) profit; and
    (III) individual insurer variation in loss experience. 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
  • 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)  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 be in the form of a rider that is attached to the policy.

    (c)  If the policyholder or certificate holder declines the nonforfeiture benefit offered under this Subsection (1), the insurer shall provide a contingent benefit upon lapse of the policy or certificate that is available for a specified period of time following a substantial increase in premium rates.

    (d) 

    (i)  Except as provided in Subsection (1)(d)(ii), if a group long-term care insurance policy is issued, the offer required in this Subsection (1) shall be made to the group policyholder.

    (ii)  If the policy is issued to a group authorized under Section 31A-22-509, the offer required under this Subsection (1) shall be made to each proposed certificate holder.
  • (2)  The commissioner shall make rules:

    (a)  specifying the types of nonforfeiture benefits to be offered as part of a long-term care insurance policy or certificate;

    (b)  specifying the standards for nonforfeiture benefits; and

    (c)  regarding contingent benefits upon lapse, including a determination of:

    (i)  the specified period of time during which a contingent benefit upon lapse will be available as provided in Subsection (1); and

    (ii)  the substantial premium rate increase that triggers a contingent benefit upon lapse as provided in Subsection (1).

    Amended by Chapter 116, 2001 General Session