Utah Admin. Code R590-233-8
(1) The outline of coverage in Table 1 shall be issued with a major medical expense insurance contract.
TABLE 1Major Medical Expense Insurance Outline of Coverage(COMPANY NAME)MAJOR MEDICAL EXPENSE COVERAGEOUTLINE OF COVERAGERead Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!Major medical expense coverage is designed to provide, to persons insured, comprehensive coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, inpatient medical services, and out-of-hospital care, subject to any deductible, copayment provisions, or other limitations that may be set forth in the policy.A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; surgical services; anesthesia services; inpatient medical services; outpatient care; maximum dollar amount for covered charges; and other benefits, if any.A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.
(2) The outline of coverage in Table 2 shall be issued with a basic medical expense insurance contract.
TABLE 2Basic Medical Expense Insurance Outline of Coverage(COMPANY NAME)BASIC MEDICAL EXPENSE COVERAGETHIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITSOUTLINE OF COVERAGERead Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself
sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!Basic medical expense coverage is designed to provide, to persons insured, limited coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, inpatient medical services, and outpatient care, subject to any limitations, deductibles and copayment requirements set forth in the policy.A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; hospital outpatient services; surgical services; anesthesia services; in hospital medical services; and other benefits, if any.A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.
(3) The outline of coverage in Table 3 shall be issued with a catastrophic expense insurance contract.
TABLE 3Catastrophic Expense Insurance Outline of Coverage(COMPANY NAME)CATASTROPHIC EXPENSE COVERAGEOUTLINE OF COVERAGERead Your (Policy)(Certificate) Carefully - This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR (POLICY)(CERTIFICATE) CAREFULLY!Catastrophic coverage is designed to provide benefits for medical expenses incurred by the insured. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, inpatient medical services, and outpatient care, subject to any deductibles with no separate internal dollar limits.A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order: daily hospital room and board; miscellaneous hospital services; surgical services; anesthesia services; in hospital medical services; outpatient care; and other benefits, if any.A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits.
A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.
KEY: health insurance
Date of Last Change: March 24, 2025
Notice of Continuation: November 25, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-22-605; 31A-22-623; 31A-22-626; 31A-23a-402; 31A-23a-412; 31A-26-301