Utah Code 31A-22-618.7. Discontinuance, nonrenewal, and modification for individual health benefit plans
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Terms Used In Utah Code 31A-22-618.7
- Affiliate: means a person who controls, is controlled by, or is under common control with, another person. See Utah Code 31A-1-301
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: includes an insured. See Utah Code 31A-1-301
- Fraud: Intentional deception resulting in injury to another.
- Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
- Individual: means a natural person. 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
- 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
- Writing: includes :
(48)(a) printing;(48)(b) handwriting; and(48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5(1)(a) Except as otherwise provided in this section, a health benefit plan offered on an individual basis is renewable and continues in force:(1)(a)(i) with respect to all enrollees or dependents; and(1)(a)(ii) at the option of the enrollee.(1)(b) Subsection (1)(a) applies regardless of:(1)(b)(i) whether the contract is issued through:(1)(b)(i)(A) a trust;(1)(b)(i)(B) an association;(1)(b)(i)(C) a discretionary group; or(1)(b)(i)(D) other similar grouping; or(1)(b)(ii) the situs of delivery of the policy or contract.(2) An individual health benefit plan may be discontinued or nonrenewed:(2)(a) if:(2)(a)(i) there is no longer an enrollee under the individual health benefit plan who lives, resides, or works in:(2)(a)(i)(A) the service area of the insurer; or(2)(a)(i)(B) the area for which the insurer is authorized to do business; and(2)(a)(ii) coverage is discontinued or nonrenewed uniformly without regard to any health status-related factor relating to any covered enrollee; or(2)(b) for coverage made available through an association, if:(2)(b)(i) the enrollee’s membership in the association ceases; and(2)(b)(ii) the coverage is discontinued or nonrenewed uniformly without regard to any health status-related factor relating to any covered enrollee.(3) An individual health benefit plan may be discontinued or nonrenewed if:(3)(a) a condition described in Subsection (2) exists;(3)(b) the enrollee fails to pay premiums or contributions in accordance with the terms of the health benefit plan, including any timeliness requirements;(3)(c) the enrollee:(3)(c)(i) performs an act or practice in connection with the coverage that constitutes fraud; or(3)(c)(ii) makes an intentional misrepresentation of material fact under the terms of the coverage;(3)(d) the insurer:(3)(d)(i) elects to discontinue offering a particular individual health benefit plan delivered or issued for delivery in this state; and(3)(d)(ii)(3)(d)(ii)(A) provides notice of the discontinuation in writing to each enrollee provided coverage at least 90 days before the day on which the coverage discontinues;(3)(d)(ii)(B) provides notice of the discontinuation in writing to the commissioner and, at least three working days before the day on which the notice is sent, to each affected enrollee;(3)(d)(ii)(C) offers to each covered enrollee on a guaranteed issue basis the option to purchase all other individual health benefit plans currently being offered by the insurer for individuals in that market; and(3)(d)(ii)(D) acts uniformly without regard to any health status-related factor of covered enrollees or dependents of covered enrollees who may become eligible for coverage; or(3)(e) the insurer:(3)(e)(i) elects to discontinue offering all of the insurer’s individual health benefit plans in the individual market;(3)(e)(ii) provides notice of the discontinuation in writing to each enrollee provided coverage at least 180 days before the day on which the coverage discontinues;(3)(e)(iii) provides notice of the discontinuation in writing to the commissioner in each state in which an affected enrollee is known to reside and, at least 30 working days before the day on which the insurer sends the notice, to each affected enrollee;(3)(e)(iv) discontinues and nonrenews all individual health benefit plans the insurer issues or delivers for issuance in the individual market;(3)(e)(v) acts uniformly without regard to any health status-related factor of covered enrollees or dependents of covered enrollees who may become eligible for coverage; and(3)(e)(vi)(3)(e)(vi)(A) provides a plan of orderly withdrawal in accordance with Section 31A-4-115; or(3)(e)(vi)(B) places the plan with an affiliate of the insurer with a plan of the same or similar coverage.(4) An insurer may modify an individual health benefit plan only:(4)(a) at the time of coverage renewal; and(4)(b) if the modification is effective uniformly among all individual health benefit plans.