2006 Utah Code - 31A-22-722 — Utah mini-COBRA benefits for employer group coverage.

     31A-22-722.   Utah mini-COBRA benefits for employer group coverage.
     (1) An insured has the right to extend the employee's coverage under the current employer's group policy for a period of six months, except as provided in Subsection (2). The right to extend coverage includes:
     (a) voluntary termination;
     (b) involuntary termination;
     (c) retirement;
     (d) death;
     (e) divorce or legal separation;
     (f) loss of dependent status;
     (g) sabbatical;
     (h) any disability;
     (i) leave of absence; or
     (j) reduction of hours.
     (2) (a) Notwithstanding the provisions of Subsection (1), an employee does not have the right to extend coverage under the current employer's group policy if the employee:
     (i) failed to pay any required individual contribution;
     (ii) acquires other group coverage covering all preexisting conditions including maternity, if the coverage exists;
     (iii) performed an act or practice that constitutes fraud in connection with the coverage;
     (iv) made an intentional misrepresentation of material fact under the terms of the coverage;
     (v) was terminated for gross misconduct;
     (vi) has not been continuously covered under the current employer's group policy for a period of six months immediately prior to the termination of the policy due to the events set forth in Subsection (1); or
     (vii) is eligible for any extension of coverage required by federal law.
     (b) The right to extend coverage under Subsection (1) applies to any spouse or dependent coverages, including a surviving spouse or dependents whose coverage under the policy terminates by reason of the death of the employee or member.
     (3) (a) The employer shall provide written notification of the right to extend group coverage and the payment amounts required for extension of coverage, including the manner, place, and time in which the payments shall be made to:
     (i) the terminated insured;
     (ii) the ex-spouse; or
     (iii) if Subsection (2)(b) applies:
     (A) to a surviving spouse; and
     (B) the guardian of surviving dependents, if different from a surviving spouse.
     (b) The notification shall be sent first class mail within 30 days after the termination date of the group coverage to:
     (i) the terminated insured's home address as shown on the records of the employer;
     (ii) the address of the surviving spouse, if different from the insured's address and if shown on the records of the employer;
     (iii) the guardian of any dependents address, if different from the insured's address, and if shown on the records of the employer; and

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     (iv) the address of the ex-spouse, if shown on the records of the employer.
     (4) The insurer shall provide the employee, spouse, or any eligible dependent the opportunity to extend the group coverage at the payment amount stated in this Subsection (3) if:
     (a) the employer policyholder does not provide the terminated insured the written notification required by Subsection (3)(a); and
     (b) the employee or other individual eligible for extension contacts the insurer within 60 days of coverage termination.
     (5) The premium amount for extended group coverage may not exceed 102% of the group rate in effect for a group member, including an employer's contribution, if any, for a group insurance policy.
     (6) Except as provided in this Subsection (6), the coverage extends without interruption for six months and may not terminate if the terminated insured or, with respect to a minor, the parent or guardian of the terminated insured:
     (a) elects to extend group coverage within 60 days of losing group coverage; and
     (b) tenders the amount required to the employer or insurer.
     (7) The insured's coverage may be terminated prior to six months if the terminated insured:
     (a) establishes residence outside of this state;
     (b) moves out of the insurer's service area;
     (c) fails to pay premiums or contributions in accordance with the terms of the policy, including any timeliness requirements;
     (d) performs an act or practice that constitutes fraud in connection with the coverage;
     (e) makes an intentional misrepresentation of material fact under the terms of the coverage;
     (f) becomes eligible for similar coverage under another group policy; or
     (g) employer's coverage is terminated, except as provided in Subsection (8).
     (8) If the current employer coverage is terminated and the employer replaces coverage with similar coverage under another group policy, without interruption, the terminated insured, spouse, or the surviving spouse and guardian of dependents if Subsection (2)(b) applies, have the right to obtain extension of coverage under the replacement group policy:
     (a) for the balance of the period the terminated insured would have extended coverage under the replaced group policy; and
     (b) if the terminated insured is otherwise eligible for extension of coverage.
     (9) (a) Within 30 days of the insured's exhaustion of extension of coverage, the employer shall provide the terminated insured and the ex-spouse, or, in the case of the death of the insured, the surviving spouse, or guardian of any dependents, written notification of the right to an individual conversion policy.
     (b) The notification required by Subsection (9)(a):
     (i) shall be sent first class mail to:
     (A) the insured's last-known address as shown on the records of the employer;
     (B) the address of the surviving spouse, if different from the insured's address, and if shown on the records of the employer;
     (C) the guardian of any dependents last known address as shown on the records of the employer, if different from the address of the surviving spouse; and
     (D) the address of the ex-spouse as shown on the records of the employer, if applicable;

and
     (ii) shall contain the name, address, and telephone number of the insurer that will provide the conversion coverage.

Amended by Chapter 188, 2006 General Session