31A-22-701 (Effective 01/01/11) - Groups eligible for group or blanket insurance.
31A-22-701 (Effective 01/01/11). Groups eligible for group or blanket insurance.
(1) As used in this section, "association group" means a lawfully formed association ofindividuals or business entities that:
(a) purchases insurance on a group basis on behalf of members; and
(b) is formed and maintained in good faith for purposes other than obtaining insurance.
(2) A group or blanket accident and health insurance policy may be issued to:
(a) a group:
(i) to which a group life insurance policy may be issued under Sections 31A-22-502,31A-22-503, 31A-22-504, 31A-22-506, 31A-22-507, and 31A-22-509; and
(ii) that is formed for a reason other than the purchase of insurance;
(b) an association group that:
(i) has been actively in existence for at least five years;
(ii) has a constitution and bylaws;
(iii) is formed and maintained in good faith for purposes other than obtaining insurance;
(iv) does not condition membership in the association group on any health status-relatedfactor relating to an individual, including an employee of an employer or a dependent of anemployee;
(v) makes accident and health insurance coverage offered through the association groupavailable to all members regardless of any health status-related factor relating to the members orindividuals eligible for coverage through a member; and
(vi) does not make accident and health insurance coverage offered through theassociation group available other than in connection with a member of the association group; or
(c) a group specifically authorized by the commissioner under Section 31A-22-509, upona finding that:
(i) authorization is not contrary to the public interest;
(ii) the proposed 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 beoffered to the proposed group is substantially equivalent to insurance policies that are otherwiseavailable to similar groups;
(v) the group would not present hazards of adverse selection; and
(vi) the premiums for the insurance policy and any contributions by or on behalf of theinsured persons are reasonable in relation to the benefits provided.
(3) A blanket insurance policy may also be issued to:
(a) a common carrier or an operator, owner, or lessee of a means of transportation, aspolicyholder, covering persons who may become passengers as defined by reference to theirtravel status;
(b) an employer, as policyholder, covering any group of employees, dependents, orguests, as defined by reference to specified hazards incident to any activities of the policyholder;
(c) an institution of learning, including a school district, school jurisdictional units, or thehead, principal, or governing board of any of those units, as policyholder, covering students,teachers, or employees;
(d) a religious, charitable, recreational, educational, or civic organization, or branch ofthose organizations, as policyholder, covering any group of members or participants as defined
by reference to specified hazards incident to the activities sponsored or supervised by thepolicyholder;
(e) a sports team, camp, or sponsor of the team or camp, as policyholder, coveringmembers, campers, employees, officials, or supervisors;
(f) a volunteer fire department, first aid, civil defense, or other similar volunteerorganization, as policyholder, covering any group of members or participants as defined byreference to specified hazards incident to activities sponsored, supervised, or participated in bythe policyholder;
(g) a newspaper or other publisher, as policyholder, covering its carriers;
(h) an association, including a labor union, which has a constitution and bylaws andwhich has been organized in good faith for purposes other than that of obtaining insurance, aspolicyholder, covering any group of members or participants as defined by reference to specifiedhazards incident to the activities or operations sponsored or supervised by the policyholder;
(i) a health insurance purchasing association, as defined in Section 31A-34-103,organized and controlled solely by participating employers; and
(j) any other class of risks that, in the judgment of the commissioner, may be properlyeligible for blanket accident and health insurance.
(4) The judgment of the commissioner may be exercised on the basis of:
(a) individual risks;
(b) a class of risks; or
(c) both Subsections (4)(a) and (b).
Amended by Chapter 10, 2010 General Session