2006 Utah Code - 31A-8-402.5 — Individual discontinuance and nonrenewal.

     31A-8-402.5.   Individual discontinuance and nonrenewal.
     (1) (a) Except as otherwise provided in this section, a health benefit plan offered on an individual basis is renewable and continues in force:
     (i) with respect to all individuals or dependents; and
     (ii) at the option of the individual.
     (b) Subsection (1)(a) applies regardless of:
     (i) whether the contract is issued through:
     (A) a trust;
     (B) an association;
     (C) a discretionary group; or
     (D) other similar grouping; or
     (ii) the situs of delivery of the policy or contract.
     (2) A health benefit plan may be discontinued or nonrenewed:
     (a) for a network plan, if:
     (i) the individual no longer lives, resides, or works in:
     (A) the service area of the insurer; or
     (B) the area for which the insurer is authorized to do business; and
     (ii) coverage is terminated uniformly without regard to any health status-related factor relating to any covered individual; or
     (b) for coverage made available through an association, if:
     (i) the individual's membership in the association ceases; and
     (ii) the coverage is terminated uniformly without regard to any health status-related factor relating to any covered individual.
     (3) A health benefit plan may be discontinued if:
     (a) a condition described in Subsection (2) exists;
     (b) the individual fails to pay premiums or contributions in accordance with the terms of the health benefit plan, including any timeliness requirements;
     (c) the individual:
     (i) performs an act or practice in connection with the coverage that constitutes fraud; or
     (ii) makes an intentional misrepresentation of material fact under the terms of the coverage;
     (d) the insurer:
     (i) elects to discontinue offering a particular health benefit product delivered or issued for delivery in this state; and
     (ii) (A) provides notice of the discontinuation in writing:
     (I) to each individual provided coverage; and
     (II) at least 90 days before the date the coverage will be discontinued;
     (B) provides notice of the discontinuation in writing:
     (I) to the commissioner; and
     (II) at least three working days prior to the date the notice is sent to the affected individuals;
     (C) offers to each covered individual on a guaranteed issue basis, the option to purchase all other individual health benefit products currently being offered by the insurer for individuals in that market; and
     (D) acts uniformly without regard to any health status-related factor of covered

individuals or dependents of covered individuals who may become eligible for coverage; or
     (e) the insurer:
     (i) elects to discontinue all of the insurer's health benefit plans in the individual market; and
     (ii) (A) provides notice of the discontinuation in writing:
     (I) to each individual provided coverage; and
     (II) at least 180 days before the date the coverage will be discontinued;
     (B) provides notice of the discontinuation in writing:
     (I) to the commissioner in each state in which an affected insured individual is known to reside; and
     (II) at least 30 working days prior to the date the notice is sent to the affected individuals;
     (C) discontinues and nonrenews all health benefit plans the insurer issues or delivers for issuance in the individual market; and
     (D) acts uniformly without regard to any health status-related factor of covered individuals or dependents of covered individuals who may become eligible for coverage.

Amended by Chapter 252, 2003 General Session