31A-22-722. Utah mini-COBRA benefits for employer group coverage.
(1)
An employer’s group policy shall offer an employee‘s coverage to be extended under the current employer’s group policy for a period of 12 months, except as provided in Subsection (2). The right to extend coverage includes:
Terms Used In Utah Code 31A-22-722
Dependent: A person dependent for support upon another.
Disability: means a physiological or psychological condition that partially or totally limits an individual's ability to:
(a)
perform the duties of:
(i)
that individual's occupation; or
(ii)
an occupation for which the individual is reasonably suited by education, training, or experience; or
(b)
perform two or more of the following basic activities of daily living:
Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
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:
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:
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
Notwithstanding Subsection (1), an employee may not extend coverage under the current employer’s group insurance policy if the employee:
(i)
fails to pay premiums or contributions in accordance with the terms of the insurance policy;
(ii)
acquires other group coverage covering all preexisting conditions including maternity, if the coverage exists;
(iii)
performs an act or practice that constitutes fraud in connection with the coverage;
(iv)
makes an intentional misrepresentation of material fact under the terms of the coverage;
(v)
is terminated from employment for gross misconduct;
(vi)
is not continuously covered under the current employer’s group policy for a period of three months immediately before the termination of the insurance policy due to an event set forth in Subsection (1);
(vii)
is eligible for an extension of coverage required by federal law;
(viii)
establishes residence outside of this state;
(ix)
moves out of the insurer’s service area;
(x)
is eligible for similar coverage under another group insurance policy; or
(xi)
has the employee’s coverage terminated because the employer’s coverage is terminated, except as provided in Subsection (8).
(b)
The right to extend coverage under Subsection (1) applies to spouse or dependent coverage, including a surviving spouse or dependents whose coverage under the insurance policy terminates by reason of the death of the employee or member.
(3)
(a)
The employer shall notify the following in writing of the right to extend group coverage and the payment amounts required for extension of coverage, including the manner, place, and time in which the payments shall be made:
the guardian of surviving dependents, if different from a surviving spouse.
(b)
The notification required in Subsection (3)(a) shall be sent first class mail within 30 days after the termination date of the group coverage to:
(i)
the terminated insured’s home address as shown on the records of the employer;
(ii)
the address of the surviving spouse, if different from the insured’s address and if shown on the records of the employer;
(iii)
the guardian of any dependents address, if different from the insured’s address, and if shown on the records of the employer; and
(iv)
the address of the ex-spouse, if shown on the records of the employer.
(4)
The insurer shall provide the employee, spouse, or any eligible dependent the opportunity to extend the group coverage at the payment amount stated in Subsection (5) if:
(a)
the employer policyholder does not provide the terminated insured the written notification required by Subsection (3)(a); and
(b)
the employee or other individual eligible for extension contacts the insurer within 60 days of coverage termination.
(5)
(a)
A premium amount for extended group coverage may not exceed 102% of the group rate in effect for a group member, including an employer’s contribution, if any, for a group insurance policy.
(b)
Except as provided in Subsection (5)(a), an insurer may not charge an insured an additional fee, an additional premium, interest, or any similar charge for electing extended group coverage.
(6)
Except as provided in this Subsection (6), coverage extends without interruption for 12 months and may not terminate if the terminated insured or, with respect to a minor, the parent or guardian of the terminated insured:
(a)
elects to extend group coverage within 60 days of losing group coverage; and
(b)
tenders the amount required to the employer or insurer.
(7)
The insured’s coverage may be terminated before 12 months if the terminated insured:
(a)
establishes residence outside of this state;
(b)
moves out of the insurer’s service area;
(c)
fails to pay premiums or contributions in accordance with the terms of the insurance policy, including any timeliness requirements;
(d)
performs an act or practice that constitutes fraud in connection with the coverage;
(e)
makes an intentional misrepresentation of material fact under the terms of the coverage;
(f)
becomes eligible for similar coverage under another group insurance policy; or
(g)
has the coverage terminated because the employer’s coverage is terminated, except as provided in Subsection (8).
(8)
If the current employer coverage is terminated and the employer replaces coverage with similar coverage under another group insurance policy, without interruption, the terminated insured, spouse, or the surviving spouse and guardian of dependents if Subsection (2)(b) applies, may obtain extension of coverage under the replacement group insurance policy:
(a)
for the balance of the period the terminated insured would have extended coverage under the replaced group insurance policy; and
(b)
if the terminated insured is otherwise eligible for extension of coverage.
(9)
An insurer shall require an insured employer to offer to the following individuals an open enrollment period at the same time as other regular employees:
(a)
an individual who extends group coverage and is current on payment; and
(b)
during the applicable grace period described in Subsection (3) or (4), an individual who is eligible to elect to extend group coverage.
