Employers have no obligation under Utah law to offer long-term care insurance to their employees. However, if long-term care insurance is among the benefits offered, certain state law requirements limit how the plan may be designed.
A long-term care insurance policy may not limit or exclude coverage by type of illness, treatment, medical condition, or accident, except for:
• Preexisting conditions or diseases;
• Mental or nervous disorders (but not Alzheimer's disease or any other mental or nervous disorder of organic origin);
• Alcoholism and drug addiction;
• Illness, treatment, or medical condition arising out of war or act of war (whether declared or undeclared); participation in a felony, riot, or insurrection; service in the armed forces or auxiliary units; suicide, attempted suicide, or an intentional self-inflicted injury; or aviation as a non-fare-paying passenger;
• Treatment provided in a government facility (unless required by law);
• Services for which benefits are available under Medicare or other governmental program (except Medicaid); any state or federal workers' compensation, employer's liability, or occupational disease law; or any motor vehicle no-fault law;
• Services provided by a member of the covered person's immediate family; and
• Services for which no charge is normally made in the absence of insurance (U.A.C. Sec. R590-148-6).
A “preexisting condition” cannot be defined more restrictively than as a condition for which medical advice or treatment was recommended by or received from a healthcare services provider within six months before the effective date of coverage (UT Code Sec. 31A-22-1406). Additionally, ...