(1) A long-term care insurance policy may not contain a provision that conditions eligibility:

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Terms Used In Utah Code 31A-22-1407

  • 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
  • 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
  • Long-term care insurance: includes :
              (121)(b)(i) any of the following that provide directly or supplement long-term care insurance:
                   (121)(b)(i)(A) a group or individual annuity or rider; or
                   (121)(b)(i)(B) a life insurance policy or rider;
              (121)(b)(ii) a policy or rider that provides for payment of benefits on the basis of:
                   (121)(b)(ii)(A) cognitive impairment; or
                   (121)(b)(ii)(B) functional capacity; or
              (121)(b)(iii) a qualified long-term care insurance contract. 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
  • Premium: includes , however designated:
              (156)(b)(i) an assessment;
              (156)(b)(ii) a membership fee;
              (156)(b)(iii) a required contribution; or
              (156)(b)(iv) monetary consideration. See Utah Code 31A-1-301
  • Rider: means an endorsement to:
         (173)(a) an insurance policy; or
         (173)(b) an insurance certificate. See Utah Code 31A-1-301
     (1)(a) for any benefits on a prior hospitalization requirement;
     (1)(b) for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
     (1)(c) for any benefits on a prior institutionalization requirement except for eligibility for:

          (1)(c)(i) waiver of premium;
          (1)(c)(ii) post confinement;
          (1)(c)(iii) post-acute care; or
          (1)(c)(iv) recuperative benefits.
(2) A long-term care insurance policy containing post confinement, post-acute care, or recuperative benefits shall clearly label the limitations or conditions, including any required number of days of confinement in a separate paragraph of the policy or certificate that is entitled “Limitations or Conditions on Eligibility for Benefits.”
(3) A long-term care insurance policy or rider that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days.