Utah Health Study Guide

Start with the name, because Utah is particular about it. §31A-23a-106 calls this line accident and health — not “health,” not “accident and health or sickness,” not “life and health.” Prometric’s exam name mirrors the statute exactly. When a question says the accident and health line of authority, that’s Utah’s own phrasing, not a distractor.

Then set aside what you know about grace periods, because this is the line where Utah’s numbers diverge from the national template most sharply — and where the divergence is doing real work, not just renumbering.

Grace periods — 15 and 30, and a question about coverage

Nearly every national manual teaches the same triad for accident and health: 7 days weekly, 10 days monthly, 31 days all other. Utah uses none of those numbers.

Under §31A-22-607, an individual or franchise A&H policy carries a grace period of at least 15 days if premiums are payable weekly or monthly, and 30 days for anything else. A group or blanket policy carries at least 30 days.

Now the part that catches people who got the numbers right. On an individual or franchise policy, the policy is not in force during the grace period. Coverage continues without a gap if the premium arrives before the period expires — but the grace period itself buys continuity, not protection. On a group or blanket policy, the policy is in force throughout, and terminates as of the last day of the grace period if the premium never comes.

Two policy types, opposite answers to “was the insured covered on day twelve?”, both in the same statute.

Claim deadlines — 20 days, then 90

Notice of claim: 20 days. §31A-22-614(2) requires written notice of claim within 20 days after the occurrence or commencement of any loss covered by the policy. Thirty days is the answer nearly everywhere else, and it will be sitting in the answer choices.

Proof of loss: 180 days. §31A-22-614(3) — within 180 days after the termination of the period the insurer is liable for on a periodic-payment claim, or within 180 days after the date of the loss on any other claim. Ninety days is the national default; Utah gives twice that.

So the two deadlines move in opposite directions from the national baseline — notice is shorter, proof of loss is longer. That is the whole trap. A candidate who decides “Utah is stricter” answers the first correctly and the second wrongly, and a candidate who decides “Utah is more generous” does the reverse.

Free look, incontestability, and the 30-day products

The ordinary A&H free look is 10 days after delivery (§31A-22-606). Group policies are excluded, as are single-premium nonrenewable policies for terms of 60 days or less, and accident-only or accidental-bodily-injury-only coverage.

Two health-family products get 30 days instead. Medicare-related coverage carries a 30-day right of return. So does long-term care — and note the cite, because it surprises people: §31A-22-1408, the LTC statute itself, not the LTC rule. R590-148 has thirty sections and none of them is a free-look section. The LTC policy must print a prominent notice of that 30-day right on its first page or attached to it.

Incontestability is two years (§31A-22-609): after coverage has been in effect two years, a statement in the application may not be used to avoid coverage, and a claim arising more than two years from issue may not be reduced for a preexisting condition.

Prompt pay — the insurer’s clocks

Utah puts hard deadlines on insurers in §31A-26-301.6, and they show up on the exam as a set:

• 30 days from receipt of a written claim to pay or deny it, extendable by 15 days where the insurer determines the extension is necessary.
• 45 days for an income replacement benefits determination, with up to two 30-day extensions.
• 20 days to act after receiving information the insurer requested.
• 15 days to acknowledge and substantively respond to a written communication from a provider.

Miss the deadline and a late fee accrues: the claim amount × the days late × a 0.033% daily interest rate. There are no tiers and no cutoff — the same rate runs for as long as the payment is late — and a computed late fee of less than $1 is disregarded.

Continuation coverage, stated precisely

Utah’s §31A-22-722 extends group coverage for 12 months, elected within 60 days of losing it, at a premium not exceeding 102% of the group rate including any employer contribution. Qualifying events run wide: voluntary or involuntary termination, retirement, death, divorce, loss of dependent status, sabbatical, disability, leave of absence, reduction of hours.

One precision point. Study material routinely describes this as applying to employers with 2 to 19 employees, and in practice that’s exactly who uses it. But the statute contains no employee-count range. It simply drops out where the person “is eligible for an extension of coverage required by federal law” — the federal COBRA exclusion is what confines it. Accurate description, not statutory text.