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 may extend the employee's coverage under the current employer's grouppolicy for a period of 12 months, except as provided in Subsections (2) and 31A-22-722.5(4). 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) a disability;
(i) leave of absence; or
(j) reduction of hours.
(2) (a) Notwithstanding Subsection (1), an employee may not extend coverage under thecurrent employer's group insurance policy if the employee:
(i) fails to pay premiums or contributions in accordance with the terms of the insurancepolicy;
(ii) acquires other group coverage covering all preexisting conditions includingmaternity, if the coverage exists;
(iii) performs an act or practice that constitutes fraud in connection with the coverage;
(iv) makes an intentional misrepresentation of material fact under the terms of thecoverage;
(v) is terminated from employment for gross misconduct;
(vi) is not continuously covered under the current employer's group policy for a period ofthree months immediately before the termination of the insurance policy due to an event set forthin Subsection (1);
(vii) is eligible for an extension of coverage required by federal law;
(viii) establishes residence outside of this state;
(ix) moves out of the insurer's service area;
(x) is eligible for similar coverage under another group insurance policy;
(xi) has the employee's coverage terminated because the employer's coverage isterminated, except as provided in Subsection (8); or
(xii) elects alternative coverage under Section 31A-22-724.
(b) The right to extend coverage under Subsection (1) applies to spouse or dependentcoverage, including a surviving spouse or dependents whose coverage under the insurance policyterminates by reason of the death of the employee or member.
(3) (a) The employer shall notify the following in writing of the right to extend groupcoverage and the payment amounts required for extension of coverage, including the manner,place, and time in which the payments shall be made:
(i) a terminated insured;
(ii) an ex-spouse of an insured; or
(iii) if Subsection (2)(b) applies:
(A) a surviving spouse; and
(B) the guardian of surviving dependents, if different from a surviving spouse.
(b) The notification required in Subsection (3)(a) shall be sent first class mail within 30days 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 ifshown on the records of the employer;
(iii) the guardian of any dependents address, if different from the insured's address, and ifshown on the records of the employer; and
(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 theopportunity to extend the group coverage at the payment amount stated in Subsection (5) if:
(a) the employer policyholder does not provide the terminated insured the writtennotification required by Subsection (3)(a); and
(b) the employee or other individual eligible for extension contacts the insurer within 60days of coverage termination.
(5) A premium amount for extended group coverage may not exceed 102% of the grouprate in effect for a group member, including an employer's contribution, if any, for a groupinsurance policy.
(6) Except as provided in this Subsection (6), coverage extends without interruption for12 months and may not terminate if the terminated insured or, with respect to a minor, the parentor 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 before 12 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 insurancepolicy, 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 thecoverage;
(f) becomes eligible for similar coverage under another group insurance policy; or
(g) has the coverage terminated because the employer's coverage is terminated, except asprovided in Subsection (8).
(8) If the current employer coverage is terminated and the employer replaces coveragewith similar coverage under another group insurance policy, without interruption, the terminatedinsured, spouse, or the surviving spouse and guardian of dependents if Subsection (2)(b) applies,may obtain extension of coverage under the replacement group insurance policy:
(a) for the balance of the period the terminated insured would have extended coverageunder the replaced group insurance 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 employershall 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 anindividual conversion policy under Section 31A-22-723.
(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 ifshown on the records of the employer;
(C) the guardian of any dependents last known address as shown on the records of theemployer, 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 providethe conversion coverage.
Amended by Chapter 10, 2010 General Session