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:
Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
Person: includes :
(a)
an individual;
(b)
a partnership;
(c)
a corporation;
(d)
an incorporated or unincorporated association;
(e)
a joint stock company;
(f)
a trust;
(g)
a limited liability company;
(h)
a reciprocal;
(i)
a syndicate; or
(j)
another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301
“Child” means, in connection with any adoption, or placement for adoption of the child, an individual who is younger than 18 years old as of the date of the adoption or placement for adoption.
(b)
“Placement for adoption” means the assumption and retention by a person of a legal obligation for total or partial support of a child in anticipation of the adoption of the child.
(2)
(a)
Except as provided in Subsection (5), if an accident and health insurancepolicy provides coverage for any members of the policyholder‘s or certificate holder’s family, the policy shall provide that any health insurance benefits applicable to dependents of the insured are applicable on the same basis to:
(i)
a newly born child from the moment of birth; and
(ii)
an adopted child:
(A)
beginning from the moment of birth, if placement for adoption occurs within 30 days of the child’s birth; or
(B)
beginning from the date of placement, if placement for adoption occurs 30 days or more after the child’s birth.
(b)
The coverage described in this Subsection (2):
(i)
is not subject to any preexisting conditions; and
(ii)
includes any injury or sickness, including the necessary care and treatment of medically diagnosed:
(A)
congenital defects;
(B)
birth abnormalities; or
(C)
prematurity.
(c)
(i)
Subject to Subsection (2)(c)(ii), a claim for services for a newly born child or an adopted child may be denied until the child is enrolled.
(ii)
Notwithstanding Subsection (2)(c)(i), an otherwise eligible claim denied under Subsection (2)(c)(i) is eligible for payment and may be resubmitted or reprocessed once a child is enrolled pursuant to Subsection (2)(d) or (e).
(d)
If the payment of a specific premium is required to provide coverage for a child of a policyholder or certificate holder, for there to be coverage for the child, the policyholder or certificate holder shall enroll:
(i)
a newly born child within 30 days after the date of birth of the child; or
(ii)
an adopted child within 30 days after the day of placement of adoption.
(e)
If the payment of a specific premium is not required to provide coverage for a child of a policyholder or certificate holder, for the child to receive coverage the policyholder or certificate holder shall enroll a newly born child or an adopted child no later than 30 days after the first notification of denial of a claim for services for that child.
(3)
(a)
The coverage required by Subsection (2) as to children placed for the purpose of adoption with a policyholder or certificate holder continues in the same manner as it would with respect to a child of the policyholder or certificate holder unless:
(i)
the placement is disrupted prior to legal adoption; and
(ii)
the child is removed from placement.
(b)
The coverage required by Subsection (2) ends if the child is removed from placement prior to being legally adopted.
(4)
The provisions of this section apply to employee welfare benefit plans as defined in Section 26B-3-1001.
(5)
If an accident and health insurance policy that is not subject to the special enrollment rights described in 45 C.F.R. § 146.117(b) provides coverage for one individual, the insurer may choose to:
(a)
provide coverage according to this section; or
(b)
allow application, subject to the insurer’s underwriting criteria for:
