Utah Code 31A-22-611. Coverage for children with a disability
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(1) For the purposes of this section:
Terms Used In Utah Code 31A-22-611
- 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
- Application: means a document:
(10)(a)(10)(a)(i) completed by an applicant to provide information about the risk to be insured; and(10)(a)(ii) that contains information that is used by the insurer to evaluate risk and decide whether to:(10)(a)(ii)(A) insure the risk under:(10)(a)(ii)(A)(I) the coverage as originally offered; or(10)(a)(ii)(A)(II) a modification of the coverage as originally offered; or(10)(a)(ii)(B) decline to insure the risk; or(10)(b) used by the insurer to gather information from the applicant before issuance of an annuity contract. 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- Contract: A legal written agreement that becomes binding when signed.
- 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:
(51)(a) perform the duties of:(51)(a)(i) that individual's occupation; or(51)(a)(ii) an occupation for which the individual is reasonably suited by education, training, or experience; or(51)(b) perform two or more of the following basic activities of daily living:(51)(b)(i) eating;(51)(b)(ii) toileting;(51)(b)(iii) transferring;(51)(b)(iv) bathing; or(51)(b)(v) dressing. 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- 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) “Dependent with a disability” means a child who is and continues to be both:(1)(a)(i) unable to engage in substantial gainful employment to the degree that the child can achieve economic independence due to a medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months; and(1)(a)(ii) chiefly dependent upon an insured for support and maintenance since the child reached the age specified in Subsection 31A-22-610.5(2).(1)(b) “Mental impairment” means a mental or psychological disorder such as:(1)(b)(i) an intellectual disability;(1)(b)(ii) organic brain syndrome;(1)(b)(iii) emotional or mental illness; or(1)(b)(iv) specific learning disabilities as determined by the insurer.(1)(c) “Physical impairment” means a physiological disorder, condition, or disfigurement, or anatomical loss affecting one or more of the following body systems:(1)(c)(i) neurological;(1)(c)(ii) musculoskeletal;(1)(c)(iii) special sense organs;(1)(c)(iv) respiratory organs;(1)(c)(v) speech organs;(1)(c)(vi) cardiovascular;(1)(c)(vii) reproductive;(1)(c)(viii) digestive;(1)(c)(ix) genito-urinary;(1)(c)(x) hemic and lymphatic;(1)(c)(xi) skin; or(1)(c)(xii) endocrine.(2) The insurer may require proof of the impairment and dependency be furnished by the person insured under the policy within 30 days of the effective date or the date the child attains the age specified in Subsection 31A-22-610.5(2), and at any time thereafter, except that the insurer may not require proof more often than annually after the two-year period immediately following attainment of the limiting age by the dependent with a disability.(3) Any individual or group accident and health insurance policy or health maintenance organization contract that provides coverage for a policyholder‘s or certificate holder’s dependent shall, upon application, provide coverage for all unmarried dependents with a disability who have been continuously covered, with no break of more than 63 days, under any accident and health insurance since the age specified in Subsection 31A-22-610.5(2).(4) Every accident and health insurance policy or contract that provides coverage of a dependent with a disability may not terminate the policy due to an age limitation. - Application: means a document: