Utah Admin. Code R590-285-6 - Unintentional Lapse, Notice, and Reinstatement

(1)

(a) An applicant may designate at least one person to receive the notice of lapse and termination, in addition to the applicant.

(i) Designation of an additional person does not constitute acceptance of any liability on the third party for services provided to the insured.

(ii) The form used for the written designation shall provide space clearly designated for listing at least one additional person, including each person's full name and home address.

(iii) A policy or certificate may not be issued until the insurer receives from the applicant:

(A) a written designation of at least one person, in addition to the applicant, to receive notice of lapse and termination of the policy or certificate for nonpayment of premium; or

(B) a written waiver dated and signed by the applicant electing not to designate an additional person to receive notice of lapse and termination.

(iv) If an applicant elects not to designate an additional person, the waiver shall state, "Protection against unintended lapse. I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this limited long-term care insurance policy for nonpayment of premium. I understand that notice will not be given until 30 days after a premium is due and unpaid. I elect NOT to designate a person to receive this notice."

(v) The insurer shall notify the insured of the right to change their written designation at least once every two years.

(b)

(i) If a policyholder or certificate holder pays a premium through a payroll or pension deduction plan, the insurer shall meet the requirements of this subsection within 60 days after the policyholder or certificate holder is no longer on the payment plan.

(ii) The application or enrollment form shall clearly indicate the payment plan selected by the applicant.

(c)

(i) A policy or certificate may not lapse or be terminated for nonpayment of premium unless the insurer, at least 30 days before the effective date of the lapse or termination, gives notice to the insured and each person designated under this Subsection (1), at the address provided by the insured for purposes of receiving notice of lapse or termination.

(ii) The notice in Subsection (1)(c)(i):

(A) shall be given by postage prepaid first-class United States mail;

(B) may not be given until 30 days after a premium is due and unpaid; and

(C) is considered given five days after the date of mailing.

(2) A policy or certificate shall include a provision providing for reinstatement of coverage in the event of lapse if the insurer is provided proof that the policyholder or certificate holder was cognitively impaired or had a loss of functional capacity before the grace period expired.

(a) The option in this Subsection (2) shall be available to the insured if requested within five months after termination and shall allow for the collection of past due premium, when appropriate.

(b) The standard of proof of cognitive impairment or loss of functional capacity may not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy or certificate.

Notes

Utah Admin. Code R590-285-6

Adopted by Utah State Bulletin Number 2021-05, effective 2/23/2021 Adopted by Utah State Bulletin Number 2024-21, effective 10/22/2024