31A-22-611 - Coverage for children with a disability.
31A-22-611. Coverage for children with a disability.
(1) For the purposes of this section:
(a) "Disabled dependent" means a child who is and continues to be both:
(i) unable to engage in substantial gainful employment to the degree that the child canachieve economic independence due to a medically determinable physical or mental impairmentwhich can be expected to result in death, or which has lasted or can be expected to last for acontinuous period of not less than 12 months; and
(ii) chiefly dependent upon an insured for support and maintenance since the childreached the age specified in Subsection 31A-22-610.5(2).
(b) "Physical impairment" means a physiological disorder, condition, or disfigurement,or anatomical loss affecting one or more of the following body systems:
(i) neurological;
(ii) musculoskeletal;
(iii) special sense organs;
(iv) respiratory organs;
(v) speech organs;
(vi) cardiovascular;
(vii) reproductive;
(viii) digestive;
(ix) genito-urinary;
(x) hemic and lymphatic;
(xi) skin; or
(xii) endocrine.
(c) "Mental impairment" means a mental or psychological disorder such as:
(i) mental retardation;
(ii) organic brain syndrome;
(iii) emotional or mental illness; or
(iv) specific learning disabilities as determined by the insurer.
(2) The insurer may require proof of the incapacity and dependency be furnished by theperson insured under the policy within 30 days of the effective date or the date the child attainsthe age specified in Subsection 31A-22-610.5(2), and at any time thereafter, except that theinsurer may not require proof more often than annually after the two-year period immediatelyfollowing attainment of the limiting age by the disabled dependent.
(3) Any individual or group accident and health insurance policy or health maintenanceorganization contract that provides coverage for a policyholder's or certificate holder's dependentshall, upon application, provide coverage for all unmarried disabled dependents who have beencontinuously covered, with no break of more than 63 days, under any accident and healthinsurance since the age specified in Subsection 31A-22-610.5(2).
(4) Every accident and health insurance policy or contract that provides coverage of adisabled dependent shall not terminate the policy due to an age limitation.
Amended by Chapter 188, 2006 General Session