Utah Code 31A-22-701. Groups eligible for group or blanket insurance
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(1) A group insurance policy offering accident and health insurance may be issued to:
Terms Used In Utah Code 31A-22-701
- Accident and health insurance: means insurance to provide protection against economic losses resulting from:(1)(a)(i) a medical condition including:(1)(a)(i)(A) a medical care expense; or(1)(a)(i)(B) the risk of disability;(1)(a)(ii) accident; or(1)(a)(iii) sickness. See Utah Code 31A-1-301
- Certificate: means evidence of insurance given to:
(23)(a) an insured under a group insurance policy; or(23)(b) a third party. See Utah Code 31A-1-301- Department: means the Insurance Department. See Utah Code 31A-1-301
- Group insurance policy: means a policy covering a group of persons that is issued:
(79)(a)(i) to a policyholder on behalf of the group; and(79)(a)(ii) for the benefit of a member of the group who is selected under a procedure defined in:(79)(a)(ii)(A) the policy; or(79)(a)(ii)(B) an agreement that is collateral to the policy. See Utah Code 31A-1-301- Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. See Utah Code 31A-1-301- health insurance: means insurance providing:
(84)(a)(i) a health care benefit; or(84)(a)(ii) payment of an incurred health care expense. See Utah Code 31A-1-301- Individual: means a natural person. See Utah Code 31A-1-301
- Insurance: includes :
(96)(b)(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;(96)(b)(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(96)(b)(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:
(103)(a)(i) a policyholder;(103)(a)(ii) a subscriber;(103)(a)(iii) a member; and(103)(a)(iv) a beneficiary. See Utah Code 31A-1-301- Life insurance: means :
(114)(a)(i) insurance on a human life; and(114)(a)(ii) insurance pertaining to or connected with human life. See Utah Code 31A-1-301- Person: includes :
(146)(a) an individual;(146)(b) a partnership;(146)(c) a corporation;(146)(d) an incorporated or unincorporated association;(146)(e) a joint stock company;(146)(f) a trust;(146)(g) a limited liability company;(146)(h) a reciprocal;(146)(i) a syndicate; or(146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301- Policy: includes a service contract issued by:
(150)(b)(i) a motor club under Chapter 11, Motor Clubs;(150)(b)(ii) a service contract provided under Chapter 6a, Service Contracts; and(150)(b)(iii) a corporation licensed under:(150)(b)(iii)(A) Chapter 7, Nonprofit Health Service Insurance Corporations; or(150)(b)(iii)(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
(1)(a) a group:(1)(a)(i) to which a group life insurance policy may be issued under Section 31A-22-502, 31A-22-503, 31A-22-504, 31A-22-505, 31A-22-506, or 31A-22-507; and(1)(a)(ii) that is formed and maintained in good faith for a purpose other than obtaining insurance;(1)(b) a group specifically authorized by the commissioner, upon a finding that:(1)(b)(i) authorization is not contrary to the public interest;(1)(b)(ii) the group is actuarially sound;(1)(b)(iii) formation of the proposed group may result in economies of scale in acquisition, administrative, marketing, and brokerage costs;(1)(b)(iv) the insurance policy, insurance certificate, or other indicia of coverage that will be offered to the proposed group is substantially equivalent to insurance policies that are otherwise available to similar groups;(1)(b)(v) the group would not present hazards of adverse selection;(1)(b)(vi) the premiums for the insurance policy and any contributions by or on behalf of the insured persons are reasonable in relation to the benefits provided; and(1)(b)(vii) the group is formed and maintained in good faith for a purpose other than obtaining insurance; or(1)(c) a postsecondary educational institution covering students, upon a finding that:(1)(c)(i) the policy provides standards for financial soundness;(1)(c)(ii) the policy protects the students covered;(1)(c)(iii) the policy provides for the establishment of a financially viable alternative to traditional health care plans;(1)(c)(iv) authorization is not contrary to the public interest;(1)(c)(v) the policy would not present hazards of adverse selection; and(1)(c)(vi) the premiums for the policy and any contributions by or on behalf of the insured persons are reasonable in relation to the benefits provided.(2) A blanket insurance policy offering accident and health insurance:(2)(a) covers a defined class of persons;(2)(b) may not be offered or underwritten on an individual basis;(2)(c) shall cover only a group that is:(2)(c)(i) actuarially sound; and(2)(c)(ii) formed and maintained in good faith for a purpose other than obtaining insurance; and(2)(d) may be issued only to:(2)(d)(i) a common carrier or an operator, owner, or lessee of a means of transportation, as policyholder, covering persons who may become passengers as defined by reference to the person‘s travel status;(2)(d)(ii) an employer, as policyholder, covering any group of employees, dependents, or guests, as defined by reference to specified hazards incident to any activities of the policyholder;(2)(d)(iii) an institution of learning, including a school district, a school jurisdictional unit, or the head, principal, or governing board of a school jurisdictional unit, as policyholder, covering students, teachers, or employees;(2)(d)(iv) a religious, charitable, recreational, educational, or civic organization, or branch of one of those organizations, as policyholder, covering a group of members or participants as defined by reference to specified hazards incident to the activities sponsored or supervised by the policyholder;(2)(d)(v) a sports team, camp, or sponsor of a sports team or camp, as policyholder, covering members, campers, employees, officials, or supervisors;(2)(d)(vi) a volunteer fire department, first aid, civil defense, or other similar volunteer organization, as policyholder, covering a group of members or participants as defined by reference to specified hazards incident to activities sponsored, supervised, or participated in by the policyholder;(2)(d)(vii) a newspaper or other publisher, as policyholder, covering its carriers;(2)(d)(viii) a labor union, as a policyholder, covering a group of members or participants as defined by reference to specified hazards incident to the activities or operations sponsored or supervised by the policyholder;(2)(d)(ix) an association that has a constitution and bylaws covering a group of members or participants as defined by reference to specified hazards incident to the activities or operations sponsored or supervised by the policyholder; or(2)(d)(x) any other class of risks that, in the judgment of the commissioner, may be properly eligible for a blanket insurance policy offering accident and health insurance.(3) The judgment of the commissioner may be exercised on the basis of:(3)(a) individual risks;(3)(b) a class of risks; or(3)(c) both Subsections(3)(a) and (b).(4) A group insurance policy offering accident and health insurance issued to a group authorized under Subsection 31A-22-504(1)(b)(ii) is subject to the provisions of Section 31A-22-602. - Certificate: means evidence of insurance given to: