2023 Utah Code › Title 31A - Insurance Code › Chapter 22 - Contracts in Specific Lines › Part 7 - Group Accident and Health Insurance › Section 701 - Groups eligible for group or blanket insurance.

Effective 5/5/2021
31A-22-701.
Groups eligible for group or blanket insurance.
(1) A group insurance policy offering accident and health insurance may be issued to:
(a) a group:
(i) to which a group life insurance policy may be issued under Section 31A-22-502, 31A-22-503, 31A-22-504, 31A-22-505, 31A-22-506, or 31A-22-507; and
(ii) that is formed and maintained in good faith for a purpose other than obtaining insurance;
(b) a group specifically authorized by the commissioner, upon a finding that:
(i) authorization is not contrary to the public interest;
(ii) the group is actuarially sound;
(iii) formation of the proposed group may result in economies of scale in acquisition, administrative, marketing, and brokerage costs;
(iv) the insurance policy, insurance certificate, or other indicia of coverage that will be offered to the proposed group is substantially equivalent to insurance policies that are otherwise available to similar groups;
(v) the group would not present hazards of adverse selection;
(vi) the premiums for the insurance policy and any contributions by or on behalf of the insured persons are reasonable in relation to the benefits provided; and
(vii) the group is formed and maintained in good faith for a purpose other than obtaining insurance; or
(c) a postsecondary educational institution covering students, upon a finding that:
(i) the policy provides standards for financial soundness;
(ii) the policy protects the students covered;
(iii) the policy provides for the establishment of a financially viable alternative to traditional health care plans;
(iv) authorization is not contrary to the public interest;
(v) the policy would not present hazards of adverse selection; and
(vi) the premiums for the policy and any contributions by or on behalf of the insured persons are reasonable in relation to the benefits provided.
(2) A blanket insurance policy offering accident and health insurance:
(a) covers a defined class of persons;
(b) may not be offered or underwritten on an individual basis;
(c) shall cover only a group that is:
(i) actuarially sound; and
(ii) formed and maintained in good faith for a purpose other than obtaining insurance; and
(d) may be issued only to:
(i) a common carrier or an operator, owner, or lessee of a means of transportation, as policyholder, covering persons who may become passengers as defined by reference to the person's travel status;
(ii) an employer, as policyholder, covering any group of employees, dependents, or guests, as defined by reference to specified hazards incident to any activities of the policyholder;
(iii) an institution of learning, including a school district, a school jurisdictional unit, or the head, principal, or governing board of a school jurisdictional unit, as policyholder, covering students, teachers, or employees;
(iv) a religious, charitable, recreational, educational, or civic organization, or branch of one of those organizations, as policyholder, covering a group of members or participants as defined by reference to specified hazards incident to the activities sponsored or supervised by the policyholder;
(v) a sports team, camp, or sponsor of a sports team or camp, as policyholder, covering members, campers, employees, officials, or supervisors;
(vi) a volunteer fire department, first aid, civil defense, or other similar volunteer organization, as policyholder, covering a group of members or participants as defined by reference to specified hazards incident to activities sponsored, supervised, or participated in by the policyholder;
(vii) a newspaper or other publisher, as policyholder, covering its carriers;
(viii) a labor union, as a policyholder, covering a group of members or participants as defined by reference to specified hazards incident to the activities or operations sponsored or supervised by the policyholder;
(ix) an association that has a constitution and bylaws covering a group of members or participants as defined by reference to specified hazards incident to the activities or operations sponsored or supervised by the policyholder; or
(x) any other class of risks that, in the judgment of the commissioner, may be properly eligible for a blanket insurance policy offering accident and health insurance.
(3) The judgment of the commissioner may be exercised on the basis of:
(a) individual risks;
(b) a class of risks; or
(c) both Subsections(3)(a) and (b).
(4) A group insurance policy offering accident and health insurance issued to a group authorized under Subsection 31A-22-504(1)(b)(ii) is subject to the provisions of Section 31A-22-602.
Amended by Chapter 252, 2021 General Session