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:
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. See Utah Code 31A-22-2002
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:
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)
when referring to an individual limited long-term care insurancepolicy, 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.
(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.
