Utah Admin. Code 590-286-7

Current through Bulletin 2024-19, October 1, 2024

Section R590-286-7 - Outline of Coverage and Disclosure Requirements

(1) An insurer shall deliver to an applicant the Short-Term Limited Duration Health Insurance Disclosure at application.

(2)

(a) Outline of Coverage. The items included in the outline of coverage must appear in the sequence prescribed:

TABLE

(INSERT COMPANY NAME)

SHORT-TERM LIMITED DURATION HEALTH INSURANCE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS.

BENEFITS ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!

Short-term limited duration health insurance coverage is designed to provide, to persons insured, limited or supplemental coverage.

A brief specific description of the benefits, including dollar amounts.

A description of any provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.

A description of provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(b) an insurer shall deliver an outline of coverage to an applicant prior to or upon the sale of a short-term limited duration health insurance policy as required by this rule; and

(c) a policy delivered to persons eligible for Medicare by reason of age shall contain the following language, which shall be printed on or attached to the first page of the outline of coverage:

"THIS IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for Medicare, review the Guide to Health Insurance for People With Medicare available from the company."

(3) Every application for short-term limited duration health insurance shall contain a statement by the applicant attesting and acknowledging the following:

(a) the insured has received the Short-Term Limited Duration Health Insurance Disclosure;

(b) coverage does not meet minimum essential coverage;

(c) benefits do not comply with the Patient Protection and Affordable Care Act;

(d) exclusions or limitations, including preexisting exclusions or limitations, may apply;

(e) lifetime dollar limits may apply on health benefits; and

(f) annual dollar limits may apply on health benefits.

(4) An insurer shall, upon specific request from the commissioner, file for use a copy of any short-term limited duration health insurance advertisement intended for use in this state whether through written, radio, electronic, or television medium.

Utah Admin. Code R590-286-7

Adopted by Utah State Bulletin Number 2021-07, effective 3/11/2021