Utah Code 31A-22-608. Reinstatement of individual or franchise accident and health insurance policies

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 insurer or by any agent duly authorized by the insurer to accept the premium, without also requiring an application for reinstatement, shall reinstate the policy. However, if the insurer or agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy shall be reinstated upon approval of this application from the insurer or, lacking this approval, upon the 45th day following the date of the conditional receipt, unless the insurer has previously notified the insured in writing of its disapproval of the application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than 10 days after that date. In all other respects the insured and insurer have the same rights under the reinstated policy as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed on or attached to this policy in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than 60 days prior to the date of reinstatement.”

Terms Used In Utah Code 31A-22-608

Accident and health insurance: means insurance to provide protection against economic losses resulting from:

(i)

a medical condition including:

(A)	a medical care expense; or

(B)	the risk of disability;

(ii)	accident; or

(iii)

sickness. See Utah Code 31A-1-301

Application: means a document:

(a)

(i)	completed by an applicant to provide information about the risk to be insured; and

(ii)

that contains information that is used by the insurer to evaluate risk and decide whether to:

(A)

insure the risk under:

(I)	the coverage as originally offered; or

(II)	a modification of the coverage as originally offered; or

(B)	decline to insure the risk; or

(b)

used by the insurer to gather information from the applicant before issuance of an annuity contract. See Utah Code 31A-1-301

Individual: means a natural person. 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

Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:

(i)	a policyholder;

(ii)	a subscriber;

(iii)

a member; and

(iv)

a beneficiary. 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 Writing: includes :Utah Code 68-3-12.5
(2)	The last sentence of the provision described in Subsection (1) may be omitted from any policy that the insured has the right to continue in force subject to the policy’s terms by the timely payment of premiums until at least age 50, or in the case of a policy issued after age 44, for at least five years from the day on which the insurer issues the policy.

Amended by Chapter 252, 2021 General Session

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