State Codes and Statutes

Statutes > Utah > Title-31a > Chapter-01 > 31a-1-301

31A-1-301. Definitions.
As used in this title, unless otherwise specified:
(1) (a) "Accident and health insurance" means insurance to provide protection againsteconomic losses resulting from:
(i) a medical condition including:
(A) a medical care expense; or
(B) the risk of disability;
(ii) accident; or
(iii) sickness.
(b) "Accident and health insurance":
(i) includes a contract with disability contingencies including:
(A) an income replacement contract;
(B) a health care contract;
(C) an expense reimbursement contract;
(D) a credit accident and health contract;
(E) a continuing care contract; and
(F) a long-term care contract; and
(ii) may provide:
(A) hospital coverage;
(B) surgical coverage;
(C) medical coverage;
(D) loss of income coverage;
(E) prescription drug coverage;
(F) dental coverage; or
(G) vision coverage.
(c) "Accident and health insurance" does not include workers' compensation insurance.
(2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title63G, Chapter 3, Utah Administrative Rulemaking Act.
(3) "Administrator" is defined in Subsection (159).
(4) "Adult" means an individual who has attained the age of at least 18 years.
(5) "Affiliate" means a person who controls, is controlled by, or is under common controlwith, another person. A corporation is an affiliate of another corporation, regardless ofownership, if substantially the same group of individuals manage the corporations.
(6) "Agency" means:
(a) a person other than an individual, including a sole proprietorship by which anindividual does business under an assumed name; and
(b) an insurance organization licensed or required to be licensed under Section31A-23a-301.
(7) "Alien insurer" means an insurer domiciled outside the United States.
(8) "Amendment" means an endorsement to an insurance policy or certificate.
(9) "Annuity" means an agreement to make periodical payments for a period certain orover the lifetime of one or more individuals if the making or continuance of all or some of theseries of the payments, or the amount of the payment, is dependent upon the continuance ofhuman life.
(10) "Application" means a document:

(a) (i) completed by an applicant to provide information about the risk to be insured; and
(ii) that contains information that is used by the insurer to evaluate risk and decidewhether to:
(A) insure the risk under:
(I) the coverage as originally offered; or
(II) a modification of the coverage as originally offered; or
(B) decline to insure the risk; or
(b) used by the insurer to gather information from the applicant before issuance of anannuity contract.
(11) "Articles" or "articles of incorporation" means:
(a) the original articles;
(b) a special law;
(c) a charter;
(d) an amendment;
(e) restated articles;
(f) articles of merger or consolidation;
(g) a trust instrument;
(h) another constitutive document for a trust or other entity that is not a corporation; and
(i) an amendment to an item listed in Subsections (11)(a) through (h).
(12) "Bail bond insurance" means a guarantee that a person will attend court whenrequired, up to and including surrender of the person in execution of a sentence imposed underSubsection 77-20-7(1), as a condition to the release of that person from confinement.
(13) "Binder" is defined in Section 31A-21-102.
(14) "Blanket insurance policy" means a group policy covering a defined class ofpersons:
(a) without individual underwriting or application; and
(b) that is determined by definition with or without designating each person covered.
(15) "Board," "board of trustees," or "board of directors" means the group of personswith responsibility over, or management of, a corporation, however designated.
(16) "Business entity" means:
(a) a corporation;
(b) an association;
(c) a partnership;
(d) a limited liability company;
(e) a limited liability partnership; or
(f) another legal entity.
(17) "Business of insurance" is defined in Subsection (85).
(18) "Business plan" means the information required to be supplied to the commissionerunder Subsections 31A-5-204(2)(i) and (j), including the information required when thesesubsections apply by reference under:
(a) Section 31A-7-201;
(b) Section 31A-8-205; or
(c) Subsection 31A-9-205(2).
(19) (a) "Bylaws" means the rules adopted for the regulation or management of acorporation's affairs, however designated.

(b) "Bylaws" includes comparable rules for a trust or other entity that is not acorporation.
(20) "Captive insurance company" means:
(a) an insurer:
(i) owned by another organization; and
(ii) whose exclusive purpose is to insure risks of the parent organization and an affiliatedcompany; or
(b) in the case of a group or association, an insurer:
(i) owned by the insureds; and
(ii) whose exclusive purpose is to insure risks of:
(A) a member organization;
(B) a group member; or
(C) an affiliate of:
(I) a member organization; or
(II) a group member.
(21) "Casualty insurance" means liability insurance.
(22) "Certificate" means evidence of insurance given to:
(a) an insured under a group insurance policy; or
(b) a third party.
(23) "Certificate of authority" is included within the term "license."
(24) "Claim," unless the context otherwise requires, means a request or demand on aninsurer for payment of a benefit according to the terms of an insurance policy.
(25) "Claims-made coverage" means an insurance contract or provision limiting coverageunder a policy insuring against legal liability to claims that are first made against the insuredwhile the policy is in force.
(26) (a) "Commissioner" or "commissioner of insurance" means Utah's insurancecommissioner.
(b) When appropriate, the terms listed in Subsection (26)(a) apply to the equivalentsupervisory official of another jurisdiction.
(27) (a) "Continuing care insurance" means insurance that:
(i) provides board and lodging;
(ii) provides one or more of the following:
(A) a personal service;
(B) a nursing service;
(C) a medical service; or
(D) any other health-related service; and
(iii) provides the coverage described in this Subsection (27)(a) under an agreementeffective:
(A) for the life of the insured; or
(B) for a period in excess of one year.
(b) Insurance is continuing care insurance regardless of whether or not the board andlodging are provided at the same location as a service described in Subsection (27)(a)(ii).
(28) (a) "Control," "controlling," "controlled," or "under common control" means thedirect or indirect possession of the power to direct or cause the direction of the management andpolicies of a person. This control may be:

(i) by contract;
(ii) by common management;
(iii) through the ownership of voting securities; or
(iv) by a means other than those described in Subsections (28)(a)(i) through (iii).
(b) There is no presumption that an individual holding an official position with anotherperson controls that person solely by reason of the position.
(c) A person having a contract or arrangement giving control is considered to havecontrol despite the illegality or invalidity of the contract or arrangement.
(d) There is a rebuttable presumption of control in a person who directly or indirectlyowns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the votingsecurities of another person.
(29) "Controlled insurer" means a licensed insurer that is either directly or indirectlycontrolled by a producer.
(30) "Controlling person" means a person that directly or indirectly has the power todirect or cause to be directed, the management, control, or activities of a reinsuranceintermediary.
(31) "Controlling producer" means a producer who directly or indirectly controls aninsurer.
(32) (a) "Corporation" means an insurance corporation, except when referring to:
(i) a corporation doing business:
(A) as:
(I) an insurance producer;
(II) a limited line producer;
(III) a consultant;
(IV) a managing general agent;
(V) a reinsurance intermediary;
(VI) a third party administrator; or
(VII) an adjuster; and
(B) under:
(I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, andReinsurance Intermediaries;
(II) Chapter 25, Third Party Administrators; or
(III) Chapter 26, Insurance Adjusters; or
(ii) a noninsurer that is part of a holding company system under Chapter 16, InsuranceHolding Companies.
(b) "Stock corporation" means a stock insurance corporation.
(c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
(33) (a) "Creditable coverage" has the same meaning as provided in federal regulationsadopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Pub. L.104-191, 110 Stat. 1936.
(b) "Creditable coverage" includes coverage that is offered through a public health plansuch as:
(i) the Primary Care Network Program under a Medicaid primary care networkdemonstration waiver obtained subject to Section 26-18-3;
(ii) the Children's Health Insurance Program under Section 26-40-106; or

(iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. 109-415.
(34) "Credit accident and health insurance" means insurance on a debtor to provideindemnity for payments coming due on a specific loan or other credit transaction while the debtoris disabled.
(35) (a) "Credit insurance" means insurance offered in connection with an extension ofcredit that is limited to partially or wholly extinguishing that credit obligation.
(b) "Credit insurance" includes:
(i) credit accident and health insurance;
(ii) credit life insurance;
(iii) credit property insurance;
(iv) credit unemployment insurance;
(v) guaranteed automobile protection insurance;
(vi) involuntary unemployment insurance;
(vii) mortgage accident and health insurance;
(viii) mortgage guaranty insurance; and
(ix) mortgage life insurance.
(36) "Credit life insurance" means insurance on the life of a debtor in connection with anextension of credit that pays a person if the debtor dies.
(37) "Credit property insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that protects the property until the debt is paid.
(38) "Credit unemployment insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that provides indemnity if the debtor is unemployed for payments coming due on a:
(i) specific loan; or
(ii) credit transaction.
(39) "Creditor" means a person, including an insured, having a claim, whether:
(a) matured;
(b) unmatured;
(c) liquidated;
(d) unliquidated;
(e) secured;
(f) unsecured;
(g) absolute;
(h) fixed; or
(i) contingent.
(40) (a) "Customer service representative" means a person that provides an insuranceservice and insurance product information:
(i) for the customer service representative's:
(A) producer; or
(B) consultant employer; and
(ii) to the customer service representative's employer's:
(A) customer;
(B) client; or

(C) organization.
(b) A customer service representative may only operate within the scope of authority ofthe customer service representative's producer or consultant employer.
(41) "Deadline" means a final date or time:
(a) imposed by:
(i) statute;
(ii) rule; or
(iii) order; and
(b) by which a required filing or payment must be received by the department.
(42) "Deemer clause" means a provision under this title under which upon the occurrenceof a condition precedent, the commissioner is considered to have taken a specific action. If thestatute so provides, a condition precedent may be the commissioner's failure to take a specificaction.
(43) "Degree of relationship" means the number of steps between two personsdetermined by counting the generations separating one person from a common ancestor and thencounting the generations to the other person.
(44) "Department" means the Insurance Department.
(45) "Director" means a member of the board of directors of a corporation.
(46) "Disability" means a physiological or psychological condition that partially or totallylimits an individual's ability to:
(a) perform the duties of:
(i) that individual's occupation; or
(ii) any occupation for which the individual is reasonably suited by education, training,or experience; or
(b) perform two or more of the following basic activities of daily living:
(i) eating;
(ii) toileting;
(iii) transferring;
(iv) bathing; or
(v) dressing.
(47) "Disability income insurance" is defined in Subsection (76).
(48) "Domestic insurer" means an insurer organized under the laws of this state.
(49) "Domiciliary state" means the state in which an insurer:
(a) is incorporated;
(b) is organized; or
(c) in the case of an alien insurer, enters into the United States.
(50) (a) "Eligible employee" means:
(i) an employee who:
(A) works on a full-time basis; and
(B) has a normal work week of 30 or more hours; or
(ii) a person described in Subsection (50)(b).
(b) "Eligible employee" includes, if the individual is included under a health benefit planof a small employer:
(i) a sole proprietor;
(ii) a partner in a partnership; or

(iii) an independent contractor.
(c) "Eligible employee" does not include, unless eligible under Subsection (50)(b):
(i) an individual who works on a temporary or substitute basis for a small employer;
(ii) an employer's spouse; or
(iii) a dependent of an employer.
(51) "Employee" means an individual employed by an employer.
(52) "Employee benefits" means one or more benefits or services provided to:
(a) an employee; or
(b) a dependent of an employee.
(53) (a) "Employee welfare fund" means a fund:
(i) established or maintained, whether directly or through a trustee, by:
(A) one or more employers;
(B) one or more labor organizations; or
(C) a combination of employers and labor organizations; and
(ii) that provides employee benefits paid or contracted to be paid, other than income frominvestments of the fund:
(A) by or on behalf of an employer doing business in this state; or
(B) for the benefit of a person employed in this state.
(b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or taxrevenues.
(54) "Endorsement" means a written agreement attached to a policy or certificate tomodify the policy or certificate coverage.
(55) "Enrollment date," with respect to a health benefit plan, means:
(a) the first day of coverage; or
(b) if there is a waiting period, the first day of the waiting period.
(56) (a) "Escrow" means:
(i) a real estate settlement or real estate closing conducted by a third party pursuant to therequirements of a written agreement between the parties in a real estate transaction; or
(ii) a settlement or closing involving:
(A) a mobile home;
(B) a grazing right;
(C) a water right; or
(D) other personal property authorized by the commissioner.
(b) "Escrow" includes the act of conducting a:
(i) real estate settlement; or
(ii) real estate closing.
(57) "Escrow agent" means:
(a) an insurance producer with:
(i) a title insurance line of authority; and
(ii) an escrow subline of authority; or
(b) a person defined as an escrow agent in Section 7-22-101.
(58) (a) "Excludes" is not exhaustive and does not mean that another thing is not alsoexcluded.
(b) The items listed in a list using the term "excludes" are representative examples foruse in interpretation of this title.

(59) "Exclusion" means for the purposes of accident and health insurance that an insurerdoes not provide insurance coverage, for whatever reason, for one of the following:
(a) a specific physical condition;
(b) a specific medical procedure;
(c) a specific disease or disorder; or
(d) a specific prescription drug or class of prescription drugs.
(60) "Expense reimbursement insurance" means insurance:
(a) written to provide a payment for an expense relating to hospital confinement resultingfrom illness or injury; and
(b) written:
(i) as a daily limit for a specific number of days in a hospital; and
(ii) to have a one or two day waiting period following a hospitalization.
(61) "Fidelity insurance" means insurance guaranteeing the fidelity of a person holding aposition of public or private trust.
(62) (a) "Filed" means that a filing is:
(i) submitted to the department as required by and in accordance with applicable statute,rule, or filing order;
(ii) received by the department within the time period provided in applicable statute, rule,or filing order; and
(iii) accompanied by the appropriate fee in accordance with:
(A) Section 31A-3-103; or
(B) rule.
(b) "Filed" does not include a filing that is rejected by the department because it is notsubmitted in accordance with Subsection (62)(a).
(63) "Filing," when used as a noun, means an item required to be filed with thedepartment including:
(a) a policy;
(b) a rate;
(c) a form;
(d) a document;
(e) a plan;
(f) a manual;
(g) an application;
(h) a report;
(i) a certificate;
(j) an endorsement;
(k) an actuarial certification;
(l) a licensee annual statement;
(m) a licensee renewal application;
(n) an advertisement; or
(o) an outline of coverage.
(64) "First party insurance" means an insurance policy or contract in which the insureragrees to pay a claim submitted to it by the insured for the insured's losses.
(65) "Foreign insurer" means an insurer domiciled outside of this state, including an alieninsurer.

(66) (a) "Form" means one of the following prepared for general use:
(i) a policy;
(ii) a certificate;
(iii) an application;
(iv) an outline of coverage; or
(v) an endorsement.
(b) "Form" does not include a document specially prepared for use in an individual case.
(67) "Franchise insurance" means an individual insurance policy provided through amass marketing arrangement involving a defined class of persons related in some way other thanthrough the purchase of insurance.
(68) "General lines of authority" include:
(a) the general lines of insurance in Subsection (69);
(b) title insurance under one of the following sublines of authority:
(i) search, including authority to act as a title marketing representative;
(ii) escrow, including authority to act as a title marketing representative; and
(iii) title marketing representative only;
(c) surplus lines;
(d) workers' compensation; and
(e) any other line of insurance that the commissioner considers necessary to recognize inthe public interest.
(69) "General lines of insurance" include:
(a) accident and health;
(b) casualty;
(c) life;
(d) personal lines;
(e) property; and
(f) variable contracts, including variable life and annuity.
(70) "Group health plan" means an employee welfare benefit plan to the extent that theplan provides medical care:
(a) (i) to an employee; or
(ii) to a dependent of an employee; and
(b) (i) directly;
(ii) through insurance reimbursement; or
(iii) through another method.
(71) (a) "Group insurance policy" means a policy covering a group of persons that isissued:
(i) to a policyholder on behalf of the group; and
(ii) for the benefit of a member of the group who is selected under a procedure definedin:
(A) the policy; or
(B) an agreement that is collateral to the policy.
(b) A group insurance policy may include a member of the policyholder's family or adependent.
(72) "Guaranteed automobile protection insurance" means insurance offered inconnection with an extension of credit that pays the difference in amount between the insurance

settlement and the balance of the loan if the insured automobile is a total loss.
(73) (a) Except as provided in Subsection (73)(b), "health benefit plan" means a policy orcertificate that:
(i) provides health care insurance;
(ii) provides major medical expense insurance; or
(iii) is offered as a substitute for hospital or medical expense insurance, such as:
(A) a hospital confinement indemnity; or
(B) a limited benefit plan.
(b) "Health benefit plan" does not include a policy or certificate that:
(i) provides benefits solely for:
(A) accident;
(B) dental;
(C) income replacement;
(D) long-term care;
(E) a Medicare supplement;
(F) a specified disease;
(G) vision; or
(H) a short-term limited duration; or
(ii) is offered and marketed as supplemental health insurance.
(74) "Health care" means any of the following intended for use in the diagnosis,treatment, mitigation, or prevention of a human ailment or impairment:
(a) a professional service;
(b) a personal service;
(c) a facility;
(d) equipment;
(e) a device;
(f) supplies; or
(g) medicine.
(75) (a) "Health care insurance" or "health insurance" means insurance providing:
(i) a health care benefit; or
(ii) payment of an incurred health care expense.
(b) "Health care insurance" or "health insurance" does not include accident and healthinsurance providing a benefit for:
(i) replacement of income;
(ii) short-term accident;
(iii) fixed indemnity;
(iv) credit accident and health;
(v) supplements to liability;
(vi) workers' compensation;
(vii) automobile medical payment;
(viii) no-fault automobile;
(ix) equivalent self-insurance; or
(x) a type of accident and health insurance coverage that is a part of or attached toanother type of policy.
(76) "Income replacement insurance" or "disability income insurance" means insurance

written to provide payments to replace income lost from accident or sickness.
(77) "Indemnity" means the payment of an amount to offset all or part of an insured loss.
(78) "Independent adjuster" means an insurance adjuster required to be licensed underSection 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
(79) "Independently procured insurance" means insurance procured under Section31A-15-104.
(80) "Individual" means a natural person.
(81) "Inland marine insurance" includes insurance covering:
(a) property in transit on or over land;
(b) property in transit over water by means other than boat or ship;
(c) bailee liability;
(d) fixed transportation property such as bridges, electric transmission systems, radio andtelevision transmission towers and tunnels; and
(e) personal and commercial property floaters.
(82) "Insolvency" means that:
(a) an insurer is unable to pay its debts or meet its obligations as the debts andobligations mature;
(b) an insurer's total adjusted capital is less than the insurer's mandatory control levelRBC under Subsection 31A-17-601(8)(c); or
(c) an insurer is determined to be hazardous under this title.
(83) (a) "Insurance" means:
(i) an arrangement, contract, or plan for the transfer of a risk or risks from one or morepersons to one or more other persons; or
(ii) an arrangement, contract, or plan for the distribution of a risk or risks among a groupof persons that includes the person seeking to distribute that person's risk.
(b) "Insurance" includes:
(i) a risk distributing arrangement providing for compensation or replacement fordamages or loss through the provision of a service or a benefit in kind;
(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as abusiness and not as merely incidental to a business transaction; and
(iii) a plan in which the risk does not rest upon the person who makes an arrangement,but with a class of persons who have agreed to share the risk.
(84) "Insurance adjuster" means a person who directs the investigation, negotiation, orsettlement of a claim under an insurance policy other than life insurance or an annuity, on behalfof an insurer, policyholder, or a claimant under an insurance policy.
(85) "Insurance business" or "business of insurance" includes:
(a) providing health care insurance by an organization that is or is required to be licensedunder this title;
(b) providing a benefit to an employee in the event of a contingency not within thecontrol of the employee, in which the employee is entitled to the benefit as a right, which benefitmay be provided either:
(i) by a single employer or by multiple employer groups; or
(ii) through one or more trusts, associations, or other entities;
(c) providing an annuity:
(i) including an annuity issued in return for a gift; and

(ii) except an annuity provided by a person specified in Subsections 31A-22-1305(2) and(3);
(d) providing the characteristic services of a motor club as outlined in Subsection (113);
(e) providing another person with insurance;
(f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor, orsurety, a contract or policy of title insurance;
(g) transacting or proposing to transact any phase of title insurance, including:
(i) solicitation;
(ii) negotiation preliminary to execution;
(iii) execution of a contract of title insurance;
(iv) insuring;
(v) transacting matters subsequent to the execution of the contract and arising out of thecontract, including reinsurance; and
(vi) transacting or proposing a life settlement; and
(h) doing, or proposing to do, any business in substance equivalent to Subsections (85)(a)through (g) in a manner designed to evade this title.
(86) "Insurance consultant" or "consultant" means a person who:
(a) advises another person about insurance needs and coverages;
(b) is compensated by the person advised on a basis not directly related to the insuranceplaced; and
(c) except as provided in Section 31A-23a-501, is not compensated directly or indirectlyby an insurer or producer for advice given.
(87) "Insurance holding company system" means a group of two or more affiliatedpersons, at least one of whom is an insurer.
(88) (a) "Insurance producer" or "producer" means a person licensed or required to belicensed under the laws of this state to sell, solicit, or negotiate insurance.
(b) With regards to the selling, soliciting, or negotiating of an insurance product to aninsurance customer or an insured:
(i) "producer for the insurer" means a producer who is compensated directly or indirectlyby an insurer for selling, soliciting, or negotiating a product of that insurer; and
(ii) "producer for the insured" means a producer who:
(A) is compensated directly and only by an insurance customer or an insured; and
(B) receives no compensation directly or indirectly from an insurer for selling, soliciting,or negotiating a product of that insurer to an insurance customer or insured.
(89) (a) "Insured" means a person to whom or for whose benefit an insurer makes apromise in an insurance policy and includes:
(i) a policyholder;
(ii) a subscriber;
(iii) a member; and
(iv) a beneficiary.
(b) The definition in Subsection (89)(a):
(i) applies only to this title; and
(ii) does not define the meaning of this word as used in an insurance policy or certificate.
(90) (a) "Insurer" means a person doing an insurance business as a principal including:
(i) a fraternal benefit society;

(ii) an issuer of a gift annuity other than an annuity specified in Subsections31A-22-1305(2) and (3);
(iii) a motor club;
(iv) an employee welfare plan; and
(v) a person purporting or intending to do an insurance business as a principal on thatperson's own account.
(b) "Insurer" does not include a governmental entity to the extent the governmental entityis engaged in an activity described in Section 31A-12-107.
(91) "Interinsurance exchange" is defined in Subsection (142).
(92) "Involuntary unemployment insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that provides indemnity if the debtor is involuntarily unemployed for paymentscoming due on a:
(i) specific loan; or
(ii) credit transaction.
(93) "Large employer," in connection with a health benefit plan, means an employer who,with respect to a calendar year and to a plan year:
(a) employed an average of at least 51 eligible employees on each business day duringthe preceding calendar year; and
(b) employs at least two employees on the first day of the plan year.
(94) "Late enrollee," with respect to an employer health benefit plan, means an individualwhose enrollment is a late enrollment.
(95) "Late enrollment," with respect to an employer health benefit plan, meansenrollment of an individual other than:
(a) on the earliest date on which coverage can become effective for the individual underthe terms of the plan; or
(b) through special enrollment.
(96) (a) Except for a retainer contract or legal assistance described in Section 31A-1-103,"legal expense insurance" means insurance written to indemnify or pay for a specified legalexpense.
(b) "Legal expense insurance" includes an arrangement that creates a reasonableexpectation of an enforceable right.
(c) "Legal expense insurance" does not include the provision of, or reimbursement for,legal services incidental to other insurance coverage.
(97) (a) "Liability insurance" means insurance against liability:
(i) for death, injury, or disability of a human being, or for damage to property, exclusiveof the coverages under:
(A) Subsection (107) for medical malpractice insurance;
(B) Subsection (134) for professional liability insurance; and
(C) Subsection (168) for workers' compensation insurance;
(ii) for a medical, hospital, surgical, and funeral benefit to a person other than the insuredwho is injured, irrespective of legal liability of the insured, when issued with or supplemental toinsurance against legal liability for the death, injury, or disability of a human being, exclusive ofthe coverages under:
(A) Subsection (107) for medical malpractice insurance;

(B) Subsection (134) for professional liability insurance; and
(C) Subsection (168) for workers' compensation insurance;
(iii) for loss or damage to property resulting from an accident to or explosion of a boiler,pipe, pressure container, machinery, or apparatus;
(iv) for loss or damage to property caused by:
(A) the breakage or leakage of a sprinkler, water pipe, or water container; or
(B) water entering through a leak or opening in a building; or
(v) for other loss or damage properly the subject of insurance not within another kind ofinsurance as defined in this chapter, if the insurance is not contrary to law or public policy.
(b) "Liability insurance" includes:
(i) vehicle liability insurance;
(ii) residential dwelling liability insurance; and
(iii) making inspection of, and issuing a certificate of inspection upon, an elevator,boiler, machinery, or apparatus of any kind when done in connection with insurance on theelevator, boiler, machinery, or apparatus.
(98) (a) "License" means authorization issued by the commissioner to engage in anactivity that is part of or related to the insurance business.
(b) "License" includes a certificate of authority issued to an insurer.
(99) (a) "Life insurance" means:
(i) insurance on a human life; and
(ii) insurance pertaining to or connected with human life.
(b) The business of life insurance includes:
(i) granting a death benefit;
(ii) granting an annuity benefit;
(iii) granting an endowment benefit;
(iv) granting an additional benefit in the event of death by accident;
(v) granting an additional benefit to safeguard the policy against lapse; and
(vi) providing an optional method of settlement of proceeds.
(100) "Limited license" means a license that:
(a) is issued for a specific product of insurance; and
(b) limits an individual or agency to transact only for that product or insurance.
(101) "Limited line credit insurance" includes the following forms of insurance:
(a) credit life;
(b) credit accident and health;
(c) credit property;
(d) credit unemployment;
(e) involuntary unemployment;
(f) mortgage life;
(g) mortgage guaranty;
(h) mortgage accident and health;
(i) guaranteed automobile protection; and
(j) another form of insurance offered in connection with an extension of credit that:
(i) is limited to partially or wholly extinguishing the credit obligation; and
(ii) the commissioner determines by rule should be designated as a form of limited linecredit insurance.

(102) "Limited line credit insurance producer" means a person who sells, solicits, ornegotiates one or more forms of limited line credit insurance coverage to an individual through amaster, corporate, group, or individual policy.
(103) "Limited line insurance" includes:
(a) bail bond;
(b) limited line credit insurance;
(c) legal expense insurance;
(d) motor club insurance;
(e) rental car-related insurance;
(f) travel insurance;
(g) crop insurance;
(h) self-service storage insurance; and
(i) another form of limited insurance that the commissioner determines by rule should bedesignated a form of limited line insurance.
(104) "Limited lines authority" includes:
(a) the lines of insurance listed in Subsection (103); and
(b) a customer service representative.
(105) "Limited lines producer" means a person who sells, solicits, or negotiates limitedlines insurance.
(106) (a) "Long-term care insurance" means an insurance policy or rider advertised,marketed, offered, or designated to provide coverage:
(i) in a setting other than an acute care unit of a hospital;
(ii) for not less than 12 consecutive months for a covered person on the basis of:
(A) expenses incurred;
(B) indemnity;
(C) prepayment; or
(D) another method;
(iii) for one or more necessary or medically necessary services that are:
(A) diagnostic;
(B) preventative;
(C) therapeutic;
(D) rehabilitative;
(E) maintenance; or
(F) personal care; and
(iv) that may be issued by:
(A) an insurer;
(B) a fraternal benefit society;
(C) (I) a nonprofit health hospital; and
(II) a medical service corporation;
(D) a prepaid health plan;
(E) a health maintenance organization; or
(F) an entity similar to the entities described in Subsections (106)(a)(iv)(A) through (E)to the extent that the entity is otherwise authorized to issue life or health care insurance.
(b) "Long-term care insurance" includes:
(i) any of the following that provide directly or supplement long-term care insurance:

(A) a group or individual annuity or rider; or
(B) a life insurance policy or rider;
(ii) a policy or rider that provides for payment of benefits on the basis of:
(A) cognitive impairment; or
(B) functional capacity; or
(iii) a qualified long-term care insurance contract.
(c) "Long-term care insurance" does not include:
(i) a policy that is offered primarily to provide basic Medicare supplement coverage;
(ii) basic hospital expense coverage;
(iii) basic medical/surgical expense coverage;
(iv) hospital confinement indemnity coverage;
(v) major medical expense coverage;
(vi) income replacement or related asset-protection coverage;
(vii) accident only coverage;
(viii) coverage for a specified:
(A) disease; or
(B) accident;
(ix) limited benefit health coverage; or
(x) a life insurance policy that accelerates the death benefit to provide the option of alump sum payment:
(A) if the following are not conditioned on the receipt of long-term care:
(I) benefits; or
(II) eligibility; and
(B) the coverage is for one or more the following qualifying events:
(I) terminal illness;
(II) medical conditions requiring extraordinary medical intervention; or
(III) permanent institutional confinement.
(107) "Medical malpractice insurance" means insurance against legal liability incident tothe practice and provision of a medical service other than the practice and provision of a dentalservice.
(108) "Member" means a person having membership rights in an insurance corporation.
(109) "Minimum capital" or "minimum required capital" means the capital that must beconstantly maintained by a stock insurance corporation as required by statute.
(110) "Mortgage accident and health insurance" means insurance offered in connectionwith an extension of credit that provides indemnity for payments coming due on a mortgagewhile the debtor is disabled.
(111) "Mortgage guaranty insurance" means surety insurance under which a mortgageeor other creditor is indemnified against losses caused by the default of a debtor.
(112) "Mortgage life insurance" means insurance on the life of a debtor in connectionwith an extension of credit that pays if the debtor dies.
(113) "Motor club" means a person:
(a) licensed under:
(i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
(ii) Chapter 11, Motor Clubs; or
(iii) Chapter 14, Foreign Insurers; and

(b) that promises for an advance consideration to provide for a stated period of time oneor more:
(i) legal services under Subsection 31A-11-102(1)(b);
(ii) bail services under Subsection 31A-11-102(1)(c); or
(iii) (A) trip reimbursement;
(B) towing services;
(C) emergency road services;
(D) stolen automobile services;
(E) a combination of the services listed in Subsections (113)(b)(iii)(A) through (D); or
(F) other services given in Subsections 31A-11-102(1)(b) through (f).
(114) "Mutual" means a mutual insurance corporation.
(115) "Network plan" means health care insurance:
(a) that is issued by an insurer; and
(b) under which the financing and delivery of medical care is provided, in whole or inpart, through a defined set of providers under contract with the insurer, including the financingand delivery of an item paid for as medical care.
(116) "Nonparticipating" means a plan of insurance under which the insured is notentitled to receive a dividend representing a share of the surplus of the insurer.
(117) "Ocean marine insurance" means insurance against loss of or damage to:
(a) ships or hulls of ships;
(b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money,securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia interests,or other cargoes in or awaiting transit over the oceans or inland waterways;
(c) earnings such as freight, passage money, commissions, or profits derived fromtransporting goods or people upon or across the oceans or inland waterways; or
(d) a vessel owner or operator as a result of liability to employees, passengers, bailors,owners of other vessels, owners of fixed objects, customs or other authorities, or other persons inconnection with maritime activity.
(118) "Order" means an order of the commissioner.
(119) "Outline of coverage" means a summary that explains an accident and healthinsurance policy.
(120) "Participating" means a plan of insurance under which the insured is entitled toreceive a dividend representing a share of the surplus of the insurer.
(121) "Participation," as used in a health benefit plan, means a requirement relating to theminimum percentage of eligible employees that must be enrolled in relation to the total numberof eligible employees of an employer reduced by each eligible employee who voluntarily declinescoverage under the plan because the employee:
(a) has other group health care insurance coverage; or
(b) receives:
(i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the SocialSecurity Amendments of 1965; or
(ii) another government health benefit.
(122) "Person" includes:
(a) an individual;
(b) a partnership;

(c) a corporation;
(d) an incorporated or unincorporated association;
(e) a joint stock company;
(f) a trust;
(g) a limited liability company;
(h) a reciprocal;
(i) a syndicate; or
(j) another similar entity or combination of entities acting in concert.
(123) "Personal lines insurance" means property and casualty insurance coverage sold forprimarily noncommercial purposes to:
(a) an individual; or
(b) a family.
(124) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
(125) "Plan year" means:
(a) the year that is designated as the plan year in:
(i) the plan document of a group health plan; or
(ii) a summary plan description of a group health plan;
(b) if the plan document or summary plan description does not designate a plan year orthere is no plan document or summary plan description:
(i) the year used to determine deductibles or limits;
(ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or
(iii) the employer's taxable year if:
(A) the plan does not impose deductibles or limits on a yearly basis; and
(B) (I) the plan is not insured; or
(II) the insurance policy is not renewed on an annual basis; or
(c) in a case not described in Subsection (125)(a) or (b), the calendar year.
(126) (a) "Policy" means a document, including an attached endorsement or applicationthat:
(i) purports to be an enforceable contract; and
(ii) memorializes in writing some or all of the terms of an insurance contract.
(b) "Policy" includes a service contract issued by:
(i) a motor club under Chapter 11, Motor Clubs;
(ii) a service contract provided under Chapter 6a, Service Contracts; and
(iii) a corporation licensed under:
(A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
(B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
(c) "Policy" does not include:
(i) a certificate under a group insurance contract; or
(ii) a document that does not purport to have legal effect.
(127) "Policyholder" means a person who controls a policy, binder, or oral contract byownership, premium payment, or otherwise.
(128) "Policy illustration" means a presentation or depiction that includes nonguaranteedelements of a policy of life insurance over a period of years.
(129) "Policy summary" means a synopsis describing the elements of a life insurancepolicy.

(130) "Preexisting condition," with respect to a health benefit plan:
(a) means a condition that was present before the effective date of coverage, whether ornot medical advice, diagnosis, care, or treatment was recommended or received before that day;and
(b) does not include a condition indicated by genetic information unless an actualdiagnosis of the condition by a physician has been made.
(131) (a) "Premium" means the monetary consideration for an insurance policy.
(b) "Premium" includes, however designated:
(i) an assessment;
(ii) a membership fee;
(iii) a required contribution; or
(iv) monetary consideration.
(c) (i) "Premium" does not include consideration paid to a third party administrator forthe third party administrator's services.
(ii) "Premium" includes an amount paid by a third party administrator to an insurer forinsurance on the risks administered by the third party administrator.
(132) "Principal officers" for a corporation means the officers designated underSubsection 31A-5-203(3).
(133) "Proceeding" includes an action or special statutory proceeding.
(134) "Professional liability insurance" means insurance against legal liability incident tothe practice of a profession and provision of a professional service.
(135) (a) Except as provided in Subsection (135)(b), "property insurance" meansinsurance against loss or damage to real or personal property of every kind and any interest inthat property:
(i) from all hazards or causes; and
(ii) against loss consequential upon the loss or damage including vehicle comprehensiveand vehicle physical damage coverages.
(b) "Property insurance" does not include:
(i) inland marine insurance; and
(ii) ocean marine insurance.
(136) "Qualified long-term care insurance contract" or "federally tax qualified long-termcare insurance contract" means:
(a) an individual or group insurance contract that meets the requirements of Section7702B(b), Internal Revenue Code; or
(b) the portion of a life insurance contract that provides long-term care insurance:
(i) (A) by rider; or
(B) as a part of the contract; and
(ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue Code.
(137) "Qualified United States financial institution" means an institution that:
(a) is:
(i) organized under the laws of the United States or any state; or
(ii) in the case of a United States office of a foreign banking organization, licensed underthe laws of the United States or any state;
(b) is regulated, supervised, and examined by a United States federal or state authorityhaving regulatory authority over a bank or trust company; and

(c) meets the standards of financial condition and standing that are considered necessaryand appropriate to regulate the quality of a financial institution whose letters of credit will beacceptable to the commissioner as determined by:
(i) the commissioner by rule; or
(ii) the Securities Valuation Office of the National Association of InsuranceCommissioners.
(138) (a) "Rate" means:
(i) the cost of a given unit of insurance; or
(ii) for property or casualty insurance, that cost of insurance per exposure unit eitherexpressed as:
(A) a single number; or
(B) a pure premium rate, adjusted before the application of individual risk variationsbased on loss or expense considerations to account for the treatment of:
(I) expenses;
(II) profit; and
(III) individual insurer variation in loss experience.
(b) "Rate" does not include a minimum premium.
(139) (a) Except as provided in Subsection (139)(b), "rate service organization" means aperson who assists an insurer in rate making or filing by:
(i) collecting, compiling, and furnishing loss or expense statistics;
(ii) recommending, making, or filing rates or supplementary rate information; or
(iii) advising about rate questions, except as an attorney giving legal advice.
(b) "Rate service organization" does not mean:
(i) an employee of an insurer;
(ii) a single insurer or group of insurers under common control;
(iii) a joint underwriting group; or
(iv) an individual serving as an actuarial or legal consultant.
(140) "Rating manual" means any of the following used to determine initial and renewalpolicy premiums:
(a) a manual of rates;
(b) a classification;
(c) a rate-related underwriting rule; and
(d) a rating formula that describes steps, policies, and procedures for determining initialand renewal policy premiums.
(141) "Received by the department" means:
(a) the date delivered to and stamped received by the department, if delivered in person;
(b) the post mark date, if delivered by mail;
(c) the delivery service's post mark or pickup date, if delivered by a delivery service;
(d) the received date recorded on an item delivered, if delivered by:
(i) facsimile;
(ii) email; or
(iii) another electronic method; or
(e) a date specified in:
(i) a statute;
(ii) a rule; or

(iii) an order.
(142) "Reciprocal" or "interinsurance exchange" means an unincorporated association ofpersons:
(a) operating through an attorney-in-fact common to all of the persons; and
(b) exchanging insurance contracts with one another that provide insurance coverage oneach other.
(143) "Reinsurance" means an insurance transaction where an insurer, for consideration,transfers any portion of the risk it has assumed to another insurer. In referring to reinsurancetransactions, this title sometimes refers to:
(a) the insurer transferring the risk as the "ceding insurer"; and
(b) the insurer assuming the risk as the:
(i) "assuming insurer"; or
(ii) "assuming reinsurer."
(144) "Reinsurer" means a person licensed in this state as an insurer with the authority toassume reinsurance.
(145) "Residential dwelling liability insurance" means insurance against liabilityresulting from or incident to the ownership, maintenance, or use of a residential dwelling that is adetached single family residence or multifamily residence up to four units.
(146) (a) "Retrocession" means reinsurance with another insurer of a liability assumedunder a reinsurance contract.
(b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of aliability assumed under a reinsurance contract.
(147) "Rider" means an endorsement to:
(a) an insurance policy; or
(b) an insurance certificate.
(148) (a) "Security" means a:
(i) note;
(ii) stock;
(iii) bond;
(iv) debenture;
(v) evidence of indebtedness;
(vi) certificate of interest or participation in a profit-sharing agreement;
(vii) collateral-trust certificate;
(viii) preorganization certificate or subscription;
(ix) transferable share;
(x) investment contract;
(xi) voting trust certificate;
(xii) certificate of deposit for a security;
(xiii) certificate of interest of participation in an oil, gas, or mining title or lease or inpayments out of production under such a title or lease;
(xiv) commodity contract or commodity option;
(xv) certificate of interest or participation in, temporary or interim certificate for, receiptfor, guarantee of, or warrant or right to subscribe to or purchase any of the items listed inSubsections (148)(a)(i) through (xiv); or
(xvi) another interest or instrument commonly known as a security.

(b) "Security" does not include:
(i) any of the following under which an insurance company promises to pay money in aspecific lump sum or periodically for life or some other specified period:
(A) insurance;
(B) an endowment policy; or
(C) an annuity contract; or
(ii) a burial certificate or burial contract.
(149) "Secondary medical condition" means a complication related to an exclusion fromcoverage in accident and health insurance.
(150) "Self-insurance" means an arrangement under which a person provides forspreading its own risks by a systematic plan.
(a) Except as provided in this Subsection (150), "self-insurance" does not include anarrangement under which a number of persons spread their risks among themselves.
(b) "Self-insurance" includes:
(i) an arrangement by which a governmental entity undertakes to indemnify an employeefor liability arising out of the employee's employment; and
(ii) an arrangement by which a person with a managed program of self-insurance and riskmanagement undertakes to indemnify its affiliates, subsidiaries, directors, officers, or employeesfor liability or risk that is related to the relationship or employment.
(c) "Self-insurance" does not include an arrangement with an independent contractor.
(151) "Sell" means to exchange a contract of insurance:
(a) by any means;
(b) for money or its equivalent; and
(c) on behalf of an insurance company.
(152) "Short-term care insurance" means an insurance policy or rider advertised,marketed, offered, or designed to provide coverage that is similar to long-term care insurance,but that provides coverage for less than 12 consecutive months for each covered person.
(153) "Significant break in coverage" means a period of 63 consecutive days during eachof which an individual does not have creditable coverage.
(154) "Small employer," in connection with a health benefit plan, means an employerwho, with respect to a calendar year and to a plan year:
(a) employed an average of at least two employees but not more than 50 eligibleemployees on each business day during the preceding calendar year; and
(b) employs at least two employees on the first day of the plan year.
(155) "Special enrollment period," in connection with a health benefit plan, has the samemeaning as provided in federal regulations adopted pursuant to the Health Insurance Portabilityand Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936.
(156) (a) "Subsidiary" of a person means an affiliate controlled by that person eitherdirectly or indirectly through one or more affiliates or intermediaries.
(b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the votingshares are owned by that person either alone or with its affiliates, except for the minimumnumber of shares the law of the subsidiary's domicile requires to be owned by directors or others.
(157) Subject to Subsection (83)(b), "surety insurance" includes:
(a) a guarantee against loss or damage resulting from the failure of a principal to pay orperform the principal's obligations to a creditor or other obligee;

(b) bail bond insurance; and
(c) fidelity insurance.
(158) (a) "Surplus" means the excess of assets over the sum of paid-in capital andliabilities.
(b) (i) "Permanent surplus" means the surplus of a mutual insurer that is designated bythe insurer as permanent.
(ii) Sections 31A-5-211, 31A-7-201, 31A-8-209, 31A-9-209, and 31A-14-209 requirethat mutuals doing business in this state maintain specified minimum levels of permanentsurplus.
(iii) Except for assessable mutuals, the minimum permanent surplus requirement is thesame as the minimum required capital requirement that applies to stock insurers.
(c) "Excess surplus" means:
(i) for a life insurer, accident and health insurer, health organization, or property andcasualty insurer as defined in Section 31A-17-601, the lesser of:
(A) that amount of an insurer's or health organization's total adjusted capital that exceedsthe product of:
(I) 2.5; and
(II) the sum of the insurer's or health organization's minimum capital or permanentsurplus required under Section 31A-5-211, 31A-9-209, or 31A-14-205; or
(B) that amount of an insurer's or health organization's total adjusted capital that exceedsthe product of:
(I) 3.0; and
(II) the authorized control level RBC as defined in Subsection 31A-17-601(8)(a); and
(ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurerthat amount of an insurer's paid-in-capital and surplus that exceeds the product of:
(A) 1.5; and
(B) the insurer's total adjusted capital required by Subsection 31A-17-609(1).
(159) "Third party administrator" or "administrator" means a person who collects chargesor premiums from, or who, for consideration, adjusts or settles claims of residents of the state inconnection with insurance coverage, annuities, or service insurance coverage, except:
(a) a union on behalf of its members;
(b) a person administering a:
(i) pension plan subject to the federal Employee Retirement Income Security Act of1974;
(ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
(iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
(c) an employer on behalf of the employer's employees or the employees of one or moreof the subsidiary or affiliated corporations of the employer;
(d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance forwhich the insurer holds a license in this state; or
(e) a person:
(i) licensed or exempt from licensing under:
(A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, andReinsurance Intermediaries; or
(B) Chapter 26, Insurance Adjusters; and

(ii) whose activities are limited to those authorized under the license the person holds orfor which the person is exempt.
(160) "Title insurance" means the insuring, guaranteeing, or indemnifying of an owner ofreal or personal property or the holder of liens or encumbrances on that property, or othersinterested in the property against loss or damage suffered by reason of liens or encumbrancesupon, defects in, or the unmarketability of the title to the property, or invalidity orunenforceability of any liens or encumbrances on the property.
(161) "Total adjusted capital" means the sum of an insurer's or health organization'sstatutory capital and surplus as determined in accordance with:
(a) the statutory accounting applicable to the annual financial statements required to befiled under Section 31A-4-113; and
(b) another item provided by the RBC instructions, as RBC instructions is defined inSection 31A-17-601.
(162) (a) &quo

State Codes and Statutes

Statutes > Utah > Title-31a > Chapter-01 > 31a-1-301

31A-1-301. Definitions.
As used in this title, unless otherwise specified:
(1) (a) "Accident and health insurance" means insurance to provide protection againsteconomic losses resulting from:
(i) a medical condition including:
(A) a medical care expense; or
(B) the risk of disability;
(ii) accident; or
(iii) sickness.
(b) "Accident and health insurance":
(i) includes a contract with disability contingencies including:
(A) an income replacement contract;
(B) a health care contract;
(C) an expense reimbursement contract;
(D) a credit accident and health contract;
(E) a continuing care contract; and
(F) a long-term care contract; and
(ii) may provide:
(A) hospital coverage;
(B) surgical coverage;
(C) medical coverage;
(D) loss of income coverage;
(E) prescription drug coverage;
(F) dental coverage; or
(G) vision coverage.
(c) "Accident and health insurance" does not include workers' compensation insurance.
(2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title63G, Chapter 3, Utah Administrative Rulemaking Act.
(3) "Administrator" is defined in Subsection (159).
(4) "Adult" means an individual who has attained the age of at least 18 years.
(5) "Affiliate" means a person who controls, is controlled by, or is under common controlwith, another person. A corporation is an affiliate of another corporation, regardless ofownership, if substantially the same group of individuals manage the corporations.
(6) "Agency" means:
(a) a person other than an individual, including a sole proprietorship by which anindividual does business under an assumed name; and
(b) an insurance organization licensed or required to be licensed under Section31A-23a-301.
(7) "Alien insurer" means an insurer domiciled outside the United States.
(8) "Amendment" means an endorsement to an insurance policy or certificate.
(9) "Annuity" means an agreement to make periodical payments for a period certain orover the lifetime of one or more individuals if the making or continuance of all or some of theseries of the payments, or the amount of the payment, is dependent upon the continuance ofhuman life.
(10) "Application" means a document:

(a) (i) completed by an applicant to provide information about the risk to be insured; and
(ii) that contains information that is used by the insurer to evaluate risk and decidewhether to:
(A) insure the risk under:
(I) the coverage as originally offered; or
(II) a modification of the coverage as originally offered; or
(B) decline to insure the risk; or
(b) used by the insurer to gather information from the applicant before issuance of anannuity contract.
(11) "Articles" or "articles of incorporation" means:
(a) the original articles;
(b) a special law;
(c) a charter;
(d) an amendment;
(e) restated articles;
(f) articles of merger or consolidation;
(g) a trust instrument;
(h) another constitutive document for a trust or other entity that is not a corporation; and
(i) an amendment to an item listed in Subsections (11)(a) through (h).
(12) "Bail bond insurance" means a guarantee that a person will attend court whenrequired, up to and including surrender of the person in execution of a sentence imposed underSubsection 77-20-7(1), as a condition to the release of that person from confinement.
(13) "Binder" is defined in Section 31A-21-102.
(14) "Blanket insurance policy" means a group policy covering a defined class ofpersons:
(a) without individual underwriting or application; and
(b) that is determined by definition with or without designating each person covered.
(15) "Board," "board of trustees," or "board of directors" means the group of personswith responsibility over, or management of, a corporation, however designated.
(16) "Business entity" means:
(a) a corporation;
(b) an association;
(c) a partnership;
(d) a limited liability company;
(e) a limited liability partnership; or
(f) another legal entity.
(17) "Business of insurance" is defined in Subsection (85).
(18) "Business plan" means the information required to be supplied to the commissionerunder Subsections 31A-5-204(2)(i) and (j), including the information required when thesesubsections apply by reference under:
(a) Section 31A-7-201;
(b) Section 31A-8-205; or
(c) Subsection 31A-9-205(2).
(19) (a) "Bylaws" means the rules adopted for the regulation or management of acorporation's affairs, however designated.

(b) "Bylaws" includes comparable rules for a trust or other entity that is not acorporation.
(20) "Captive insurance company" means:
(a) an insurer:
(i) owned by another organization; and
(ii) whose exclusive purpose is to insure risks of the parent organization and an affiliatedcompany; or
(b) in the case of a group or association, an insurer:
(i) owned by the insureds; and
(ii) whose exclusive purpose is to insure risks of:
(A) a member organization;
(B) a group member; or
(C) an affiliate of:
(I) a member organization; or
(II) a group member.
(21) "Casualty insurance" means liability insurance.
(22) "Certificate" means evidence of insurance given to:
(a) an insured under a group insurance policy; or
(b) a third party.
(23) "Certificate of authority" is included within the term "license."
(24) "Claim," unless the context otherwise requires, means a request or demand on aninsurer for payment of a benefit according to the terms of an insurance policy.
(25) "Claims-made coverage" means an insurance contract or provision limiting coverageunder a policy insuring against legal liability to claims that are first made against the insuredwhile the policy is in force.
(26) (a) "Commissioner" or "commissioner of insurance" means Utah's insurancecommissioner.
(b) When appropriate, the terms listed in Subsection (26)(a) apply to the equivalentsupervisory official of another jurisdiction.
(27) (a) "Continuing care insurance" means insurance that:
(i) provides board and lodging;
(ii) provides one or more of the following:
(A) a personal service;
(B) a nursing service;
(C) a medical service; or
(D) any other health-related service; and
(iii) provides the coverage described in this Subsection (27)(a) under an agreementeffective:
(A) for the life of the insured; or
(B) for a period in excess of one year.
(b) Insurance is continuing care insurance regardless of whether or not the board andlodging are provided at the same location as a service described in Subsection (27)(a)(ii).
(28) (a) "Control," "controlling," "controlled," or "under common control" means thedirect or indirect possession of the power to direct or cause the direction of the management andpolicies of a person. This control may be:

(i) by contract;
(ii) by common management;
(iii) through the ownership of voting securities; or
(iv) by a means other than those described in Subsections (28)(a)(i) through (iii).
(b) There is no presumption that an individual holding an official position with anotherperson controls that person solely by reason of the position.
(c) A person having a contract or arrangement giving control is considered to havecontrol despite the illegality or invalidity of the contract or arrangement.
(d) There is a rebuttable presumption of control in a person who directly or indirectlyowns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the votingsecurities of another person.
(29) "Controlled insurer" means a licensed insurer that is either directly or indirectlycontrolled by a producer.
(30) "Controlling person" means a person that directly or indirectly has the power todirect or cause to be directed, the management, control, or activities of a reinsuranceintermediary.
(31) "Controlling producer" means a producer who directly or indirectly controls aninsurer.
(32) (a) "Corporation" means an insurance corporation, except when referring to:
(i) a corporation doing business:
(A) as:
(I) an insurance producer;
(II) a limited line producer;
(III) a consultant;
(IV) a managing general agent;
(V) a reinsurance intermediary;
(VI) a third party administrator; or
(VII) an adjuster; and
(B) under:
(I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, andReinsurance Intermediaries;
(II) Chapter 25, Third Party Administrators; or
(III) Chapter 26, Insurance Adjusters; or
(ii) a noninsurer that is part of a holding company system under Chapter 16, InsuranceHolding Companies.
(b) "Stock corporation" means a stock insurance corporation.
(c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
(33) (a) "Creditable coverage" has the same meaning as provided in federal regulationsadopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Pub. L.104-191, 110 Stat. 1936.
(b) "Creditable coverage" includes coverage that is offered through a public health plansuch as:
(i) the Primary Care Network Program under a Medicaid primary care networkdemonstration waiver obtained subject to Section 26-18-3;
(ii) the Children's Health Insurance Program under Section 26-40-106; or

(iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. 109-415.
(34) "Credit accident and health insurance" means insurance on a debtor to provideindemnity for payments coming due on a specific loan or other credit transaction while the debtoris disabled.
(35) (a) "Credit insurance" means insurance offered in connection with an extension ofcredit that is limited to partially or wholly extinguishing that credit obligation.
(b) "Credit insurance" includes:
(i) credit accident and health insurance;
(ii) credit life insurance;
(iii) credit property insurance;
(iv) credit unemployment insurance;
(v) guaranteed automobile protection insurance;
(vi) involuntary unemployment insurance;
(vii) mortgage accident and health insurance;
(viii) mortgage guaranty insurance; and
(ix) mortgage life insurance.
(36) "Credit life insurance" means insurance on the life of a debtor in connection with anextension of credit that pays a person if the debtor dies.
(37) "Credit property insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that protects the property until the debt is paid.
(38) "Credit unemployment insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that provides indemnity if the debtor is unemployed for payments coming due on a:
(i) specific loan; or
(ii) credit transaction.
(39) "Creditor" means a person, including an insured, having a claim, whether:
(a) matured;
(b) unmatured;
(c) liquidated;
(d) unliquidated;
(e) secured;
(f) unsecured;
(g) absolute;
(h) fixed; or
(i) contingent.
(40) (a) "Customer service representative" means a person that provides an insuranceservice and insurance product information:
(i) for the customer service representative's:
(A) producer; or
(B) consultant employer; and
(ii) to the customer service representative's employer's:
(A) customer;
(B) client; or

(C) organization.
(b) A customer service representative may only operate within the scope of authority ofthe customer service representative's producer or consultant employer.
(41) "Deadline" means a final date or time:
(a) imposed by:
(i) statute;
(ii) rule; or
(iii) order; and
(b) by which a required filing or payment must be received by the department.
(42) "Deemer clause" means a provision under this title under which upon the occurrenceof a condition precedent, the commissioner is considered to have taken a specific action. If thestatute so provides, a condition precedent may be the commissioner's failure to take a specificaction.
(43) "Degree of relationship" means the number of steps between two personsdetermined by counting the generations separating one person from a common ancestor and thencounting the generations to the other person.
(44) "Department" means the Insurance Department.
(45) "Director" means a member of the board of directors of a corporation.
(46) "Disability" means a physiological or psychological condition that partially or totallylimits an individual's ability to:
(a) perform the duties of:
(i) that individual's occupation; or
(ii) any occupation for which the individual is reasonably suited by education, training,or experience; or
(b) perform two or more of the following basic activities of daily living:
(i) eating;
(ii) toileting;
(iii) transferring;
(iv) bathing; or
(v) dressing.
(47) "Disability income insurance" is defined in Subsection (76).
(48) "Domestic insurer" means an insurer organized under the laws of this state.
(49) "Domiciliary state" means the state in which an insurer:
(a) is incorporated;
(b) is organized; or
(c) in the case of an alien insurer, enters into the United States.
(50) (a) "Eligible employee" means:
(i) an employee who:
(A) works on a full-time basis; and
(B) has a normal work week of 30 or more hours; or
(ii) a person described in Subsection (50)(b).
(b) "Eligible employee" includes, if the individual is included under a health benefit planof a small employer:
(i) a sole proprietor;
(ii) a partner in a partnership; or

(iii) an independent contractor.
(c) "Eligible employee" does not include, unless eligible under Subsection (50)(b):
(i) an individual who works on a temporary or substitute basis for a small employer;
(ii) an employer's spouse; or
(iii) a dependent of an employer.
(51) "Employee" means an individual employed by an employer.
(52) "Employee benefits" means one or more benefits or services provided to:
(a) an employee; or
(b) a dependent of an employee.
(53) (a) "Employee welfare fund" means a fund:
(i) established or maintained, whether directly or through a trustee, by:
(A) one or more employers;
(B) one or more labor organizations; or
(C) a combination of employers and labor organizations; and
(ii) that provides employee benefits paid or contracted to be paid, other than income frominvestments of the fund:
(A) by or on behalf of an employer doing business in this state; or
(B) for the benefit of a person employed in this state.
(b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or taxrevenues.
(54) "Endorsement" means a written agreement attached to a policy or certificate tomodify the policy or certificate coverage.
(55) "Enrollment date," with respect to a health benefit plan, means:
(a) the first day of coverage; or
(b) if there is a waiting period, the first day of the waiting period.
(56) (a) "Escrow" means:
(i) a real estate settlement or real estate closing conducted by a third party pursuant to therequirements of a written agreement between the parties in a real estate transaction; or
(ii) a settlement or closing involving:
(A) a mobile home;
(B) a grazing right;
(C) a water right; or
(D) other personal property authorized by the commissioner.
(b) "Escrow" includes the act of conducting a:
(i) real estate settlement; or
(ii) real estate closing.
(57) "Escrow agent" means:
(a) an insurance producer with:
(i) a title insurance line of authority; and
(ii) an escrow subline of authority; or
(b) a person defined as an escrow agent in Section 7-22-101.
(58) (a) "Excludes" is not exhaustive and does not mean that another thing is not alsoexcluded.
(b) The items listed in a list using the term "excludes" are representative examples foruse in interpretation of this title.

(59) "Exclusion" means for the purposes of accident and health insurance that an insurerdoes not provide insurance coverage, for whatever reason, for one of the following:
(a) a specific physical condition;
(b) a specific medical procedure;
(c) a specific disease or disorder; or
(d) a specific prescription drug or class of prescription drugs.
(60) "Expense reimbursement insurance" means insurance:
(a) written to provide a payment for an expense relating to hospital confinement resultingfrom illness or injury; and
(b) written:
(i) as a daily limit for a specific number of days in a hospital; and
(ii) to have a one or two day waiting period following a hospitalization.
(61) "Fidelity insurance" means insurance guaranteeing the fidelity of a person holding aposition of public or private trust.
(62) (a) "Filed" means that a filing is:
(i) submitted to the department as required by and in accordance with applicable statute,rule, or filing order;
(ii) received by the department within the time period provided in applicable statute, rule,or filing order; and
(iii) accompanied by the appropriate fee in accordance with:
(A) Section 31A-3-103; or
(B) rule.
(b) "Filed" does not include a filing that is rejected by the department because it is notsubmitted in accordance with Subsection (62)(a).
(63) "Filing," when used as a noun, means an item required to be filed with thedepartment including:
(a) a policy;
(b) a rate;
(c) a form;
(d) a document;
(e) a plan;
(f) a manual;
(g) an application;
(h) a report;
(i) a certificate;
(j) an endorsement;
(k) an actuarial certification;
(l) a licensee annual statement;
(m) a licensee renewal application;
(n) an advertisement; or
(o) an outline of coverage.
(64) "First party insurance" means an insurance policy or contract in which the insureragrees to pay a claim submitted to it by the insured for the insured's losses.
(65) "Foreign insurer" means an insurer domiciled outside of this state, including an alieninsurer.

(66) (a) "Form" means one of the following prepared for general use:
(i) a policy;
(ii) a certificate;
(iii) an application;
(iv) an outline of coverage; or
(v) an endorsement.
(b) "Form" does not include a document specially prepared for use in an individual case.
(67) "Franchise insurance" means an individual insurance policy provided through amass marketing arrangement involving a defined class of persons related in some way other thanthrough the purchase of insurance.
(68) "General lines of authority" include:
(a) the general lines of insurance in Subsection (69);
(b) title insurance under one of the following sublines of authority:
(i) search, including authority to act as a title marketing representative;
(ii) escrow, including authority to act as a title marketing representative; and
(iii) title marketing representative only;
(c) surplus lines;
(d) workers' compensation; and
(e) any other line of insurance that the commissioner considers necessary to recognize inthe public interest.
(69) "General lines of insurance" include:
(a) accident and health;
(b) casualty;
(c) life;
(d) personal lines;
(e) property; and
(f) variable contracts, including variable life and annuity.
(70) "Group health plan" means an employee welfare benefit plan to the extent that theplan provides medical care:
(a) (i) to an employee; or
(ii) to a dependent of an employee; and
(b) (i) directly;
(ii) through insurance reimbursement; or
(iii) through another method.
(71) (a) "Group insurance policy" means a policy covering a group of persons that isissued:
(i) to a policyholder on behalf of the group; and
(ii) for the benefit of a member of the group who is selected under a procedure definedin:
(A) the policy; or
(B) an agreement that is collateral to the policy.
(b) A group insurance policy may include a member of the policyholder's family or adependent.
(72) "Guaranteed automobile protection insurance" means insurance offered inconnection with an extension of credit that pays the difference in amount between the insurance

settlement and the balance of the loan if the insured automobile is a total loss.
(73) (a) Except as provided in Subsection (73)(b), "health benefit plan" means a policy orcertificate that:
(i) provides health care insurance;
(ii) provides major medical expense insurance; or
(iii) is offered as a substitute for hospital or medical expense insurance, such as:
(A) a hospital confinement indemnity; or
(B) a limited benefit plan.
(b) "Health benefit plan" does not include a policy or certificate that:
(i) provides benefits solely for:
(A) accident;
(B) dental;
(C) income replacement;
(D) long-term care;
(E) a Medicare supplement;
(F) a specified disease;
(G) vision; or
(H) a short-term limited duration; or
(ii) is offered and marketed as supplemental health insurance.
(74) "Health care" means any of the following intended for use in the diagnosis,treatment, mitigation, or prevention of a human ailment or impairment:
(a) a professional service;
(b) a personal service;
(c) a facility;
(d) equipment;
(e) a device;
(f) supplies; or
(g) medicine.
(75) (a) "Health care insurance" or "health insurance" means insurance providing:
(i) a health care benefit; or
(ii) payment of an incurred health care expense.
(b) "Health care insurance" or "health insurance" does not include accident and healthinsurance providing a benefit for:
(i) replacement of income;
(ii) short-term accident;
(iii) fixed indemnity;
(iv) credit accident and health;
(v) supplements to liability;
(vi) workers' compensation;
(vii) automobile medical payment;
(viii) no-fault automobile;
(ix) equivalent self-insurance; or
(x) a type of accident and health insurance coverage that is a part of or attached toanother type of policy.
(76) "Income replacement insurance" or "disability income insurance" means insurance

written to provide payments to replace income lost from accident or sickness.
(77) "Indemnity" means the payment of an amount to offset all or part of an insured loss.
(78) "Independent adjuster" means an insurance adjuster required to be licensed underSection 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
(79) "Independently procured insurance" means insurance procured under Section31A-15-104.
(80) "Individual" means a natural person.
(81) "Inland marine insurance" includes insurance covering:
(a) property in transit on or over land;
(b) property in transit over water by means other than boat or ship;
(c) bailee liability;
(d) fixed transportation property such as bridges, electric transmission systems, radio andtelevision transmission towers and tunnels; and
(e) personal and commercial property floaters.
(82) "Insolvency" means that:
(a) an insurer is unable to pay its debts or meet its obligations as the debts andobligations mature;
(b) an insurer's total adjusted capital is less than the insurer's mandatory control levelRBC under Subsection 31A-17-601(8)(c); or
(c) an insurer is determined to be hazardous under this title.
(83) (a) "Insurance" means:
(i) an arrangement, contract, or plan for the transfer of a risk or risks from one or morepersons to one or more other persons; or
(ii) an arrangement, contract, or plan for the distribution of a risk or risks among a groupof persons that includes the person seeking to distribute that person's risk.
(b) "Insurance" includes:
(i) a risk distributing arrangement providing for compensation or replacement fordamages or loss through the provision of a service or a benefit in kind;
(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as abusiness and not as merely incidental to a business transaction; and
(iii) a plan in which the risk does not rest upon the person who makes an arrangement,but with a class of persons who have agreed to share the risk.
(84) "Insurance adjuster" means a person who directs the investigation, negotiation, orsettlement of a claim under an insurance policy other than life insurance or an annuity, on behalfof an insurer, policyholder, or a claimant under an insurance policy.
(85) "Insurance business" or "business of insurance" includes:
(a) providing health care insurance by an organization that is or is required to be licensedunder this title;
(b) providing a benefit to an employee in the event of a contingency not within thecontrol of the employee, in which the employee is entitled to the benefit as a right, which benefitmay be provided either:
(i) by a single employer or by multiple employer groups; or
(ii) through one or more trusts, associations, or other entities;
(c) providing an annuity:
(i) including an annuity issued in return for a gift; and

(ii) except an annuity provided by a person specified in Subsections 31A-22-1305(2) and(3);
(d) providing the characteristic services of a motor club as outlined in Subsection (113);
(e) providing another person with insurance;
(f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor, orsurety, a contract or policy of title insurance;
(g) transacting or proposing to transact any phase of title insurance, including:
(i) solicitation;
(ii) negotiation preliminary to execution;
(iii) execution of a contract of title insurance;
(iv) insuring;
(v) transacting matters subsequent to the execution of the contract and arising out of thecontract, including reinsurance; and
(vi) transacting or proposing a life settlement; and
(h) doing, or proposing to do, any business in substance equivalent to Subsections (85)(a)through (g) in a manner designed to evade this title.
(86) "Insurance consultant" or "consultant" means a person who:
(a) advises another person about insurance needs and coverages;
(b) is compensated by the person advised on a basis not directly related to the insuranceplaced; and
(c) except as provided in Section 31A-23a-501, is not compensated directly or indirectlyby an insurer or producer for advice given.
(87) "Insurance holding company system" means a group of two or more affiliatedpersons, at least one of whom is an insurer.
(88) (a) "Insurance producer" or "producer" means a person licensed or required to belicensed under the laws of this state to sell, solicit, or negotiate insurance.
(b) With regards to the selling, soliciting, or negotiating of an insurance product to aninsurance customer or an insured:
(i) "producer for the insurer" means a producer who is compensated directly or indirectlyby an insurer for selling, soliciting, or negotiating a product of that insurer; and
(ii) "producer for the insured" means a producer who:
(A) is compensated directly and only by an insurance customer or an insured; and
(B) receives no compensation directly or indirectly from an insurer for selling, soliciting,or negotiating a product of that insurer to an insurance customer or insured.
(89) (a) "Insured" means a person to whom or for whose benefit an insurer makes apromise in an insurance policy and includes:
(i) a policyholder;
(ii) a subscriber;
(iii) a member; and
(iv) a beneficiary.
(b) The definition in Subsection (89)(a):
(i) applies only to this title; and
(ii) does not define the meaning of this word as used in an insurance policy or certificate.
(90) (a) "Insurer" means a person doing an insurance business as a principal including:
(i) a fraternal benefit society;

(ii) an issuer of a gift annuity other than an annuity specified in Subsections31A-22-1305(2) and (3);
(iii) a motor club;
(iv) an employee welfare plan; and
(v) a person purporting or intending to do an insurance business as a principal on thatperson's own account.
(b) "Insurer" does not include a governmental entity to the extent the governmental entityis engaged in an activity described in Section 31A-12-107.
(91) "Interinsurance exchange" is defined in Subsection (142).
(92) "Involuntary unemployment insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that provides indemnity if the debtor is involuntarily unemployed for paymentscoming due on a:
(i) specific loan; or
(ii) credit transaction.
(93) "Large employer," in connection with a health benefit plan, means an employer who,with respect to a calendar year and to a plan year:
(a) employed an average of at least 51 eligible employees on each business day duringthe preceding calendar year; and
(b) employs at least two employees on the first day of the plan year.
(94) "Late enrollee," with respect to an employer health benefit plan, means an individualwhose enrollment is a late enrollment.
(95) "Late enrollment," with respect to an employer health benefit plan, meansenrollment of an individual other than:
(a) on the earliest date on which coverage can become effective for the individual underthe terms of the plan; or
(b) through special enrollment.
(96) (a) Except for a retainer contract or legal assistance described in Section 31A-1-103,"legal expense insurance" means insurance written to indemnify or pay for a specified legalexpense.
(b) "Legal expense insurance" includes an arrangement that creates a reasonableexpectation of an enforceable right.
(c) "Legal expense insurance" does not include the provision of, or reimbursement for,legal services incidental to other insurance coverage.
(97) (a) "Liability insurance" means insurance against liability:
(i) for death, injury, or disability of a human being, or for damage to property, exclusiveof the coverages under:
(A) Subsection (107) for medical malpractice insurance;
(B) Subsection (134) for professional liability insurance; and
(C) Subsection (168) for workers' compensation insurance;
(ii) for a medical, hospital, surgical, and funeral benefit to a person other than the insuredwho is injured, irrespective of legal liability of the insured, when issued with or supplemental toinsurance against legal liability for the death, injury, or disability of a human being, exclusive ofthe coverages under:
(A) Subsection (107) for medical malpractice insurance;

(B) Subsection (134) for professional liability insurance; and
(C) Subsection (168) for workers' compensation insurance;
(iii) for loss or damage to property resulting from an accident to or explosion of a boiler,pipe, pressure container, machinery, or apparatus;
(iv) for loss or damage to property caused by:
(A) the breakage or leakage of a sprinkler, water pipe, or water container; or
(B) water entering through a leak or opening in a building; or
(v) for other loss or damage properly the subject of insurance not within another kind ofinsurance as defined in this chapter, if the insurance is not contrary to law or public policy.
(b) "Liability insurance" includes:
(i) vehicle liability insurance;
(ii) residential dwelling liability insurance; and
(iii) making inspection of, and issuing a certificate of inspection upon, an elevator,boiler, machinery, or apparatus of any kind when done in connection with insurance on theelevator, boiler, machinery, or apparatus.
(98) (a) "License" means authorization issued by the commissioner to engage in anactivity that is part of or related to the insurance business.
(b) "License" includes a certificate of authority issued to an insurer.
(99) (a) "Life insurance" means:
(i) insurance on a human life; and
(ii) insurance pertaining to or connected with human life.
(b) The business of life insurance includes:
(i) granting a death benefit;
(ii) granting an annuity benefit;
(iii) granting an endowment benefit;
(iv) granting an additional benefit in the event of death by accident;
(v) granting an additional benefit to safeguard the policy against lapse; and
(vi) providing an optional method of settlement of proceeds.
(100) "Limited license" means a license that:
(a) is issued for a specific product of insurance; and
(b) limits an individual or agency to transact only for that product or insurance.
(101) "Limited line credit insurance" includes the following forms of insurance:
(a) credit life;
(b) credit accident and health;
(c) credit property;
(d) credit unemployment;
(e) involuntary unemployment;
(f) mortgage life;
(g) mortgage guaranty;
(h) mortgage accident and health;
(i) guaranteed automobile protection; and
(j) another form of insurance offered in connection with an extension of credit that:
(i) is limited to partially or wholly extinguishing the credit obligation; and
(ii) the commissioner determines by rule should be designated as a form of limited linecredit insurance.

(102) "Limited line credit insurance producer" means a person who sells, solicits, ornegotiates one or more forms of limited line credit insurance coverage to an individual through amaster, corporate, group, or individual policy.
(103) "Limited line insurance" includes:
(a) bail bond;
(b) limited line credit insurance;
(c) legal expense insurance;
(d) motor club insurance;
(e) rental car-related insurance;
(f) travel insurance;
(g) crop insurance;
(h) self-service storage insurance; and
(i) another form of limited insurance that the commissioner determines by rule should bedesignated a form of limited line insurance.
(104) "Limited lines authority" includes:
(a) the lines of insurance listed in Subsection (103); and
(b) a customer service representative.
(105) "Limited lines producer" means a person who sells, solicits, or negotiates limitedlines insurance.
(106) (a) "Long-term care insurance" means an insurance policy or rider advertised,marketed, offered, or designated to provide coverage:
(i) in a setting other than an acute care unit of a hospital;
(ii) for not less than 12 consecutive months for a covered person on the basis of:
(A) expenses incurred;
(B) indemnity;
(C) prepayment; or
(D) another method;
(iii) for one or more necessary or medically necessary services that are:
(A) diagnostic;
(B) preventative;
(C) therapeutic;
(D) rehabilitative;
(E) maintenance; or
(F) personal care; and
(iv) that may be issued by:
(A) an insurer;
(B) a fraternal benefit society;
(C) (I) a nonprofit health hospital; and
(II) a medical service corporation;
(D) a prepaid health plan;
(E) a health maintenance organization; or
(F) an entity similar to the entities described in Subsections (106)(a)(iv)(A) through (E)to the extent that the entity is otherwise authorized to issue life or health care insurance.
(b) "Long-term care insurance" includes:
(i) any of the following that provide directly or supplement long-term care insurance:

(A) a group or individual annuity or rider; or
(B) a life insurance policy or rider;
(ii) a policy or rider that provides for payment of benefits on the basis of:
(A) cognitive impairment; or
(B) functional capacity; or
(iii) a qualified long-term care insurance contract.
(c) "Long-term care insurance" does not include:
(i) a policy that is offered primarily to provide basic Medicare supplement coverage;
(ii) basic hospital expense coverage;
(iii) basic medical/surgical expense coverage;
(iv) hospital confinement indemnity coverage;
(v) major medical expense coverage;
(vi) income replacement or related asset-protection coverage;
(vii) accident only coverage;
(viii) coverage for a specified:
(A) disease; or
(B) accident;
(ix) limited benefit health coverage; or
(x) a life insurance policy that accelerates the death benefit to provide the option of alump sum payment:
(A) if the following are not conditioned on the receipt of long-term care:
(I) benefits; or
(II) eligibility; and
(B) the coverage is for one or more the following qualifying events:
(I) terminal illness;
(II) medical conditions requiring extraordinary medical intervention; or
(III) permanent institutional confinement.
(107) "Medical malpractice insurance" means insurance against legal liability incident tothe practice and provision of a medical service other than the practice and provision of a dentalservice.
(108) "Member" means a person having membership rights in an insurance corporation.
(109) "Minimum capital" or "minimum required capital" means the capital that must beconstantly maintained by a stock insurance corporation as required by statute.
(110) "Mortgage accident and health insurance" means insurance offered in connectionwith an extension of credit that provides indemnity for payments coming due on a mortgagewhile the debtor is disabled.
(111) "Mortgage guaranty insurance" means surety insurance under which a mortgageeor other creditor is indemnified against losses caused by the default of a debtor.
(112) "Mortgage life insurance" means insurance on the life of a debtor in connectionwith an extension of credit that pays if the debtor dies.
(113) "Motor club" means a person:
(a) licensed under:
(i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
(ii) Chapter 11, Motor Clubs; or
(iii) Chapter 14, Foreign Insurers; and

(b) that promises for an advance consideration to provide for a stated period of time oneor more:
(i) legal services under Subsection 31A-11-102(1)(b);
(ii) bail services under Subsection 31A-11-102(1)(c); or
(iii) (A) trip reimbursement;
(B) towing services;
(C) emergency road services;
(D) stolen automobile services;
(E) a combination of the services listed in Subsections (113)(b)(iii)(A) through (D); or
(F) other services given in Subsections 31A-11-102(1)(b) through (f).
(114) "Mutual" means a mutual insurance corporation.
(115) "Network plan" means health care insurance:
(a) that is issued by an insurer; and
(b) under which the financing and delivery of medical care is provided, in whole or inpart, through a defined set of providers under contract with the insurer, including the financingand delivery of an item paid for as medical care.
(116) "Nonparticipating" means a plan of insurance under which the insured is notentitled to receive a dividend representing a share of the surplus of the insurer.
(117) "Ocean marine insurance" means insurance against loss of or damage to:
(a) ships or hulls of ships;
(b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money,securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia interests,or other cargoes in or awaiting transit over the oceans or inland waterways;
(c) earnings such as freight, passage money, commissions, or profits derived fromtransporting goods or people upon or across the oceans or inland waterways; or
(d) a vessel owner or operator as a result of liability to employees, passengers, bailors,owners of other vessels, owners of fixed objects, customs or other authorities, or other persons inconnection with maritime activity.
(118) "Order" means an order of the commissioner.
(119) "Outline of coverage" means a summary that explains an accident and healthinsurance policy.
(120) "Participating" means a plan of insurance under which the insured is entitled toreceive a dividend representing a share of the surplus of the insurer.
(121) "Participation," as used in a health benefit plan, means a requirement relating to theminimum percentage of eligible employees that must be enrolled in relation to the total numberof eligible employees of an employer reduced by each eligible employee who voluntarily declinescoverage under the plan because the employee:
(a) has other group health care insurance coverage; or
(b) receives:
(i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the SocialSecurity Amendments of 1965; or
(ii) another government health benefit.
(122) "Person" includes:
(a) an individual;
(b) a partnership;

(c) a corporation;
(d) an incorporated or unincorporated association;
(e) a joint stock company;
(f) a trust;
(g) a limited liability company;
(h) a reciprocal;
(i) a syndicate; or
(j) another similar entity or combination of entities acting in concert.
(123) "Personal lines insurance" means property and casualty insurance coverage sold forprimarily noncommercial purposes to:
(a) an individual; or
(b) a family.
(124) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
(125) "Plan year" means:
(a) the year that is designated as the plan year in:
(i) the plan document of a group health plan; or
(ii) a summary plan description of a group health plan;
(b) if the plan document or summary plan description does not designate a plan year orthere is no plan document or summary plan description:
(i) the year used to determine deductibles or limits;
(ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or
(iii) the employer's taxable year if:
(A) the plan does not impose deductibles or limits on a yearly basis; and
(B) (I) the plan is not insured; or
(II) the insurance policy is not renewed on an annual basis; or
(c) in a case not described in Subsection (125)(a) or (b), the calendar year.
(126) (a) "Policy" means a document, including an attached endorsement or applicationthat:
(i) purports to be an enforceable contract; and
(ii) memorializes in writing some or all of the terms of an insurance contract.
(b) "Policy" includes a service contract issued by:
(i) a motor club under Chapter 11, Motor Clubs;
(ii) a service contract provided under Chapter 6a, Service Contracts; and
(iii) a corporation licensed under:
(A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
(B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
(c) "Policy" does not include:
(i) a certificate under a group insurance contract; or
(ii) a document that does not purport to have legal effect.
(127) "Policyholder" means a person who controls a policy, binder, or oral contract byownership, premium payment, or otherwise.
(128) "Policy illustration" means a presentation or depiction that includes nonguaranteedelements of a policy of life insurance over a period of years.
(129) "Policy summary" means a synopsis describing the elements of a life insurancepolicy.

(130) "Preexisting condition," with respect to a health benefit plan:
(a) means a condition that was present before the effective date of coverage, whether ornot medical advice, diagnosis, care, or treatment was recommended or received before that day;and
(b) does not include a condition indicated by genetic information unless an actualdiagnosis of the condition by a physician has been made.
(131) (a) "Premium" means the monetary consideration for an insurance policy.
(b) "Premium" includes, however designated:
(i) an assessment;
(ii) a membership fee;
(iii) a required contribution; or
(iv) monetary consideration.
(c) (i) "Premium" does not include consideration paid to a third party administrator forthe third party administrator's services.
(ii) "Premium" includes an amount paid by a third party administrator to an insurer forinsurance on the risks administered by the third party administrator.
(132) "Principal officers" for a corporation means the officers designated underSubsection 31A-5-203(3).
(133) "Proceeding" includes an action or special statutory proceeding.
(134) "Professional liability insurance" means insurance against legal liability incident tothe practice of a profession and provision of a professional service.
(135) (a) Except as provided in Subsection (135)(b), "property insurance" meansinsurance against loss or damage to real or personal property of every kind and any interest inthat property:
(i) from all hazards or causes; and
(ii) against loss consequential upon the loss or damage including vehicle comprehensiveand vehicle physical damage coverages.
(b) "Property insurance" does not include:
(i) inland marine insurance; and
(ii) ocean marine insurance.
(136) "Qualified long-term care insurance contract" or "federally tax qualified long-termcare insurance contract" means:
(a) an individual or group insurance contract that meets the requirements of Section7702B(b), Internal Revenue Code; or
(b) the portion of a life insurance contract that provides long-term care insurance:
(i) (A) by rider; or
(B) as a part of the contract; and
(ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue Code.
(137) "Qualified United States financial institution" means an institution that:
(a) is:
(i) organized under the laws of the United States or any state; or
(ii) in the case of a United States office of a foreign banking organization, licensed underthe laws of the United States or any state;
(b) is regulated, supervised, and examined by a United States federal or state authorityhaving regulatory authority over a bank or trust company; and

(c) meets the standards of financial condition and standing that are considered necessaryand appropriate to regulate the quality of a financial institution whose letters of credit will beacceptable to the commissioner as determined by:
(i) the commissioner by rule; or
(ii) the Securities Valuation Office of the National Association of InsuranceCommissioners.
(138) (a) "Rate" means:
(i) the cost of a given unit of insurance; or
(ii) for property or casualty insurance, that cost of insurance per exposure unit eitherexpressed as:
(A) a single number; or
(B) a pure premium rate, adjusted before the application of individual risk variationsbased on loss or expense considerations to account for the treatment of:
(I) expenses;
(II) profit; and
(III) individual insurer variation in loss experience.
(b) "Rate" does not include a minimum premium.
(139) (a) Except as provided in Subsection (139)(b), "rate service organization" means aperson who assists an insurer in rate making or filing by:
(i) collecting, compiling, and furnishing loss or expense statistics;
(ii) recommending, making, or filing rates or supplementary rate information; or
(iii) advising about rate questions, except as an attorney giving legal advice.
(b) "Rate service organization" does not mean:
(i) an employee of an insurer;
(ii) a single insurer or group of insurers under common control;
(iii) a joint underwriting group; or
(iv) an individual serving as an actuarial or legal consultant.
(140) "Rating manual" means any of the following used to determine initial and renewalpolicy premiums:
(a) a manual of rates;
(b) a classification;
(c) a rate-related underwriting rule; and
(d) a rating formula that describes steps, policies, and procedures for determining initialand renewal policy premiums.
(141) "Received by the department" means:
(a) the date delivered to and stamped received by the department, if delivered in person;
(b) the post mark date, if delivered by mail;
(c) the delivery service's post mark or pickup date, if delivered by a delivery service;
(d) the received date recorded on an item delivered, if delivered by:
(i) facsimile;
(ii) email; or
(iii) another electronic method; or
(e) a date specified in:
(i) a statute;
(ii) a rule; or

(iii) an order.
(142) "Reciprocal" or "interinsurance exchange" means an unincorporated association ofpersons:
(a) operating through an attorney-in-fact common to all of the persons; and
(b) exchanging insurance contracts with one another that provide insurance coverage oneach other.
(143) "Reinsurance" means an insurance transaction where an insurer, for consideration,transfers any portion of the risk it has assumed to another insurer. In referring to reinsurancetransactions, this title sometimes refers to:
(a) the insurer transferring the risk as the "ceding insurer"; and
(b) the insurer assuming the risk as the:
(i) "assuming insurer"; or
(ii) "assuming reinsurer."
(144) "Reinsurer" means a person licensed in this state as an insurer with the authority toassume reinsurance.
(145) "Residential dwelling liability insurance" means insurance against liabilityresulting from or incident to the ownership, maintenance, or use of a residential dwelling that is adetached single family residence or multifamily residence up to four units.
(146) (a) "Retrocession" means reinsurance with another insurer of a liability assumedunder a reinsurance contract.
(b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of aliability assumed under a reinsurance contract.
(147) "Rider" means an endorsement to:
(a) an insurance policy; or
(b) an insurance certificate.
(148) (a) "Security" means a:
(i) note;
(ii) stock;
(iii) bond;
(iv) debenture;
(v) evidence of indebtedness;
(vi) certificate of interest or participation in a profit-sharing agreement;
(vii) collateral-trust certificate;
(viii) preorganization certificate or subscription;
(ix) transferable share;
(x) investment contract;
(xi) voting trust certificate;
(xii) certificate of deposit for a security;
(xiii) certificate of interest of participation in an oil, gas, or mining title or lease or inpayments out of production under such a title or lease;
(xiv) commodity contract or commodity option;
(xv) certificate of interest or participation in, temporary or interim certificate for, receiptfor, guarantee of, or warrant or right to subscribe to or purchase any of the items listed inSubsections (148)(a)(i) through (xiv); or
(xvi) another interest or instrument commonly known as a security.

(b) "Security" does not include:
(i) any of the following under which an insurance company promises to pay money in aspecific lump sum or periodically for life or some other specified period:
(A) insurance;
(B) an endowment policy; or
(C) an annuity contract; or
(ii) a burial certificate or burial contract.
(149) "Secondary medical condition" means a complication related to an exclusion fromcoverage in accident and health insurance.
(150) "Self-insurance" means an arrangement under which a person provides forspreading its own risks by a systematic plan.
(a) Except as provided in this Subsection (150), "self-insurance" does not include anarrangement under which a number of persons spread their risks among themselves.
(b) "Self-insurance" includes:
(i) an arrangement by which a governmental entity undertakes to indemnify an employeefor liability arising out of the employee's employment; and
(ii) an arrangement by which a person with a managed program of self-insurance and riskmanagement undertakes to indemnify its affiliates, subsidiaries, directors, officers, or employeesfor liability or risk that is related to the relationship or employment.
(c) "Self-insurance" does not include an arrangement with an independent contractor.
(151) "Sell" means to exchange a contract of insurance:
(a) by any means;
(b) for money or its equivalent; and
(c) on behalf of an insurance company.
(152) "Short-term care insurance" means an insurance policy or rider advertised,marketed, offered, or designed to provide coverage that is similar to long-term care insurance,but that provides coverage for less than 12 consecutive months for each covered person.
(153) "Significant break in coverage" means a period of 63 consecutive days during eachof which an individual does not have creditable coverage.
(154) "Small employer," in connection with a health benefit plan, means an employerwho, with respect to a calendar year and to a plan year:
(a) employed an average of at least two employees but not more than 50 eligibleemployees on each business day during the preceding calendar year; and
(b) employs at least two employees on the first day of the plan year.
(155) "Special enrollment period," in connection with a health benefit plan, has the samemeaning as provided in federal regulations adopted pursuant to the Health Insurance Portabilityand Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936.
(156) (a) "Subsidiary" of a person means an affiliate controlled by that person eitherdirectly or indirectly through one or more affiliates or intermediaries.
(b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the votingshares are owned by that person either alone or with its affiliates, except for the minimumnumber of shares the law of the subsidiary's domicile requires to be owned by directors or others.
(157) Subject to Subsection (83)(b), "surety insurance" includes:
(a) a guarantee against loss or damage resulting from the failure of a principal to pay orperform the principal's obligations to a creditor or other obligee;

(b) bail bond insurance; and
(c) fidelity insurance.
(158) (a) "Surplus" means the excess of assets over the sum of paid-in capital andliabilities.
(b) (i) "Permanent surplus" means the surplus of a mutual insurer that is designated bythe insurer as permanent.
(ii) Sections 31A-5-211, 31A-7-201, 31A-8-209, 31A-9-209, and 31A-14-209 requirethat mutuals doing business in this state maintain specified minimum levels of permanentsurplus.
(iii) Except for assessable mutuals, the minimum permanent surplus requirement is thesame as the minimum required capital requirement that applies to stock insurers.
(c) "Excess surplus" means:
(i) for a life insurer, accident and health insurer, health organization, or property andcasualty insurer as defined in Section 31A-17-601, the lesser of:
(A) that amount of an insurer's or health organization's total adjusted capital that exceedsthe product of:
(I) 2.5; and
(II) the sum of the insurer's or health organization's minimum capital or permanentsurplus required under Section 31A-5-211, 31A-9-209, or 31A-14-205; or
(B) that amount of an insurer's or health organization's total adjusted capital that exceedsthe product of:
(I) 3.0; and
(II) the authorized control level RBC as defined in Subsection 31A-17-601(8)(a); and
(ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurerthat amount of an insurer's paid-in-capital and surplus that exceeds the product of:
(A) 1.5; and
(B) the insurer's total adjusted capital required by Subsection 31A-17-609(1).
(159) "Third party administrator" or "administrator" means a person who collects chargesor premiums from, or who, for consideration, adjusts or settles claims of residents of the state inconnection with insurance coverage, annuities, or service insurance coverage, except:
(a) a union on behalf of its members;
(b) a person administering a:
(i) pension plan subject to the federal Employee Retirement Income Security Act of1974;
(ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
(iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
(c) an employer on behalf of the employer's employees or the employees of one or moreof the subsidiary or affiliated corporations of the employer;
(d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance forwhich the insurer holds a license in this state; or
(e) a person:
(i) licensed or exempt from licensing under:
(A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, andReinsurance Intermediaries; or
(B) Chapter 26, Insurance Adjusters; and

(ii) whose activities are limited to those authorized under the license the person holds orfor which the person is exempt.
(160) "Title insurance" means the insuring, guaranteeing, or indemnifying of an owner ofreal or personal property or the holder of liens or encumbrances on that property, or othersinterested in the property against loss or damage suffered by reason of liens or encumbrancesupon, defects in, or the unmarketability of the title to the property, or invalidity orunenforceability of any liens or encumbrances on the property.
(161) "Total adjusted capital" means the sum of an insurer's or health organization'sstatutory capital and surplus as determined in accordance with:
(a) the statutory accounting applicable to the annual financial statements required to befiled under Section 31A-4-113; and
(b) another item provided by the RBC instructions, as RBC instructions is defined inSection 31A-17-601.
(162) (a) &quo

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State Codes and Statutes

Statutes > Utah > Title-31a > Chapter-01 > 31a-1-301

31A-1-301. Definitions.
As used in this title, unless otherwise specified:
(1) (a) "Accident and health insurance" means insurance to provide protection againsteconomic losses resulting from:
(i) a medical condition including:
(A) a medical care expense; or
(B) the risk of disability;
(ii) accident; or
(iii) sickness.
(b) "Accident and health insurance":
(i) includes a contract with disability contingencies including:
(A) an income replacement contract;
(B) a health care contract;
(C) an expense reimbursement contract;
(D) a credit accident and health contract;
(E) a continuing care contract; and
(F) a long-term care contract; and
(ii) may provide:
(A) hospital coverage;
(B) surgical coverage;
(C) medical coverage;
(D) loss of income coverage;
(E) prescription drug coverage;
(F) dental coverage; or
(G) vision coverage.
(c) "Accident and health insurance" does not include workers' compensation insurance.
(2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title63G, Chapter 3, Utah Administrative Rulemaking Act.
(3) "Administrator" is defined in Subsection (159).
(4) "Adult" means an individual who has attained the age of at least 18 years.
(5) "Affiliate" means a person who controls, is controlled by, or is under common controlwith, another person. A corporation is an affiliate of another corporation, regardless ofownership, if substantially the same group of individuals manage the corporations.
(6) "Agency" means:
(a) a person other than an individual, including a sole proprietorship by which anindividual does business under an assumed name; and
(b) an insurance organization licensed or required to be licensed under Section31A-23a-301.
(7) "Alien insurer" means an insurer domiciled outside the United States.
(8) "Amendment" means an endorsement to an insurance policy or certificate.
(9) "Annuity" means an agreement to make periodical payments for a period certain orover the lifetime of one or more individuals if the making or continuance of all or some of theseries of the payments, or the amount of the payment, is dependent upon the continuance ofhuman life.
(10) "Application" means a document:

(a) (i) completed by an applicant to provide information about the risk to be insured; and
(ii) that contains information that is used by the insurer to evaluate risk and decidewhether to:
(A) insure the risk under:
(I) the coverage as originally offered; or
(II) a modification of the coverage as originally offered; or
(B) decline to insure the risk; or
(b) used by the insurer to gather information from the applicant before issuance of anannuity contract.
(11) "Articles" or "articles of incorporation" means:
(a) the original articles;
(b) a special law;
(c) a charter;
(d) an amendment;
(e) restated articles;
(f) articles of merger or consolidation;
(g) a trust instrument;
(h) another constitutive document for a trust or other entity that is not a corporation; and
(i) an amendment to an item listed in Subsections (11)(a) through (h).
(12) "Bail bond insurance" means a guarantee that a person will attend court whenrequired, up to and including surrender of the person in execution of a sentence imposed underSubsection 77-20-7(1), as a condition to the release of that person from confinement.
(13) "Binder" is defined in Section 31A-21-102.
(14) "Blanket insurance policy" means a group policy covering a defined class ofpersons:
(a) without individual underwriting or application; and
(b) that is determined by definition with or without designating each person covered.
(15) "Board," "board of trustees," or "board of directors" means the group of personswith responsibility over, or management of, a corporation, however designated.
(16) "Business entity" means:
(a) a corporation;
(b) an association;
(c) a partnership;
(d) a limited liability company;
(e) a limited liability partnership; or
(f) another legal entity.
(17) "Business of insurance" is defined in Subsection (85).
(18) "Business plan" means the information required to be supplied to the commissionerunder Subsections 31A-5-204(2)(i) and (j), including the information required when thesesubsections apply by reference under:
(a) Section 31A-7-201;
(b) Section 31A-8-205; or
(c) Subsection 31A-9-205(2).
(19) (a) "Bylaws" means the rules adopted for the regulation or management of acorporation's affairs, however designated.

(b) "Bylaws" includes comparable rules for a trust or other entity that is not acorporation.
(20) "Captive insurance company" means:
(a) an insurer:
(i) owned by another organization; and
(ii) whose exclusive purpose is to insure risks of the parent organization and an affiliatedcompany; or
(b) in the case of a group or association, an insurer:
(i) owned by the insureds; and
(ii) whose exclusive purpose is to insure risks of:
(A) a member organization;
(B) a group member; or
(C) an affiliate of:
(I) a member organization; or
(II) a group member.
(21) "Casualty insurance" means liability insurance.
(22) "Certificate" means evidence of insurance given to:
(a) an insured under a group insurance policy; or
(b) a third party.
(23) "Certificate of authority" is included within the term "license."
(24) "Claim," unless the context otherwise requires, means a request or demand on aninsurer for payment of a benefit according to the terms of an insurance policy.
(25) "Claims-made coverage" means an insurance contract or provision limiting coverageunder a policy insuring against legal liability to claims that are first made against the insuredwhile the policy is in force.
(26) (a) "Commissioner" or "commissioner of insurance" means Utah's insurancecommissioner.
(b) When appropriate, the terms listed in Subsection (26)(a) apply to the equivalentsupervisory official of another jurisdiction.
(27) (a) "Continuing care insurance" means insurance that:
(i) provides board and lodging;
(ii) provides one or more of the following:
(A) a personal service;
(B) a nursing service;
(C) a medical service; or
(D) any other health-related service; and
(iii) provides the coverage described in this Subsection (27)(a) under an agreementeffective:
(A) for the life of the insured; or
(B) for a period in excess of one year.
(b) Insurance is continuing care insurance regardless of whether or not the board andlodging are provided at the same location as a service described in Subsection (27)(a)(ii).
(28) (a) "Control," "controlling," "controlled," or "under common control" means thedirect or indirect possession of the power to direct or cause the direction of the management andpolicies of a person. This control may be:

(i) by contract;
(ii) by common management;
(iii) through the ownership of voting securities; or
(iv) by a means other than those described in Subsections (28)(a)(i) through (iii).
(b) There is no presumption that an individual holding an official position with anotherperson controls that person solely by reason of the position.
(c) A person having a contract or arrangement giving control is considered to havecontrol despite the illegality or invalidity of the contract or arrangement.
(d) There is a rebuttable presumption of control in a person who directly or indirectlyowns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the votingsecurities of another person.
(29) "Controlled insurer" means a licensed insurer that is either directly or indirectlycontrolled by a producer.
(30) "Controlling person" means a person that directly or indirectly has the power todirect or cause to be directed, the management, control, or activities of a reinsuranceintermediary.
(31) "Controlling producer" means a producer who directly or indirectly controls aninsurer.
(32) (a) "Corporation" means an insurance corporation, except when referring to:
(i) a corporation doing business:
(A) as:
(I) an insurance producer;
(II) a limited line producer;
(III) a consultant;
(IV) a managing general agent;
(V) a reinsurance intermediary;
(VI) a third party administrator; or
(VII) an adjuster; and
(B) under:
(I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, andReinsurance Intermediaries;
(II) Chapter 25, Third Party Administrators; or
(III) Chapter 26, Insurance Adjusters; or
(ii) a noninsurer that is part of a holding company system under Chapter 16, InsuranceHolding Companies.
(b) "Stock corporation" means a stock insurance corporation.
(c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
(33) (a) "Creditable coverage" has the same meaning as provided in federal regulationsadopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Pub. L.104-191, 110 Stat. 1936.
(b) "Creditable coverage" includes coverage that is offered through a public health plansuch as:
(i) the Primary Care Network Program under a Medicaid primary care networkdemonstration waiver obtained subject to Section 26-18-3;
(ii) the Children's Health Insurance Program under Section 26-40-106; or

(iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. 109-415.
(34) "Credit accident and health insurance" means insurance on a debtor to provideindemnity for payments coming due on a specific loan or other credit transaction while the debtoris disabled.
(35) (a) "Credit insurance" means insurance offered in connection with an extension ofcredit that is limited to partially or wholly extinguishing that credit obligation.
(b) "Credit insurance" includes:
(i) credit accident and health insurance;
(ii) credit life insurance;
(iii) credit property insurance;
(iv) credit unemployment insurance;
(v) guaranteed automobile protection insurance;
(vi) involuntary unemployment insurance;
(vii) mortgage accident and health insurance;
(viii) mortgage guaranty insurance; and
(ix) mortgage life insurance.
(36) "Credit life insurance" means insurance on the life of a debtor in connection with anextension of credit that pays a person if the debtor dies.
(37) "Credit property insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that protects the property until the debt is paid.
(38) "Credit unemployment insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that provides indemnity if the debtor is unemployed for payments coming due on a:
(i) specific loan; or
(ii) credit transaction.
(39) "Creditor" means a person, including an insured, having a claim, whether:
(a) matured;
(b) unmatured;
(c) liquidated;
(d) unliquidated;
(e) secured;
(f) unsecured;
(g) absolute;
(h) fixed; or
(i) contingent.
(40) (a) "Customer service representative" means a person that provides an insuranceservice and insurance product information:
(i) for the customer service representative's:
(A) producer; or
(B) consultant employer; and
(ii) to the customer service representative's employer's:
(A) customer;
(B) client; or

(C) organization.
(b) A customer service representative may only operate within the scope of authority ofthe customer service representative's producer or consultant employer.
(41) "Deadline" means a final date or time:
(a) imposed by:
(i) statute;
(ii) rule; or
(iii) order; and
(b) by which a required filing or payment must be received by the department.
(42) "Deemer clause" means a provision under this title under which upon the occurrenceof a condition precedent, the commissioner is considered to have taken a specific action. If thestatute so provides, a condition precedent may be the commissioner's failure to take a specificaction.
(43) "Degree of relationship" means the number of steps between two personsdetermined by counting the generations separating one person from a common ancestor and thencounting the generations to the other person.
(44) "Department" means the Insurance Department.
(45) "Director" means a member of the board of directors of a corporation.
(46) "Disability" means a physiological or psychological condition that partially or totallylimits an individual's ability to:
(a) perform the duties of:
(i) that individual's occupation; or
(ii) any occupation for which the individual is reasonably suited by education, training,or experience; or
(b) perform two or more of the following basic activities of daily living:
(i) eating;
(ii) toileting;
(iii) transferring;
(iv) bathing; or
(v) dressing.
(47) "Disability income insurance" is defined in Subsection (76).
(48) "Domestic insurer" means an insurer organized under the laws of this state.
(49) "Domiciliary state" means the state in which an insurer:
(a) is incorporated;
(b) is organized; or
(c) in the case of an alien insurer, enters into the United States.
(50) (a) "Eligible employee" means:
(i) an employee who:
(A) works on a full-time basis; and
(B) has a normal work week of 30 or more hours; or
(ii) a person described in Subsection (50)(b).
(b) "Eligible employee" includes, if the individual is included under a health benefit planof a small employer:
(i) a sole proprietor;
(ii) a partner in a partnership; or

(iii) an independent contractor.
(c) "Eligible employee" does not include, unless eligible under Subsection (50)(b):
(i) an individual who works on a temporary or substitute basis for a small employer;
(ii) an employer's spouse; or
(iii) a dependent of an employer.
(51) "Employee" means an individual employed by an employer.
(52) "Employee benefits" means one or more benefits or services provided to:
(a) an employee; or
(b) a dependent of an employee.
(53) (a) "Employee welfare fund" means a fund:
(i) established or maintained, whether directly or through a trustee, by:
(A) one or more employers;
(B) one or more labor organizations; or
(C) a combination of employers and labor organizations; and
(ii) that provides employee benefits paid or contracted to be paid, other than income frominvestments of the fund:
(A) by or on behalf of an employer doing business in this state; or
(B) for the benefit of a person employed in this state.
(b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or taxrevenues.
(54) "Endorsement" means a written agreement attached to a policy or certificate tomodify the policy or certificate coverage.
(55) "Enrollment date," with respect to a health benefit plan, means:
(a) the first day of coverage; or
(b) if there is a waiting period, the first day of the waiting period.
(56) (a) "Escrow" means:
(i) a real estate settlement or real estate closing conducted by a third party pursuant to therequirements of a written agreement between the parties in a real estate transaction; or
(ii) a settlement or closing involving:
(A) a mobile home;
(B) a grazing right;
(C) a water right; or
(D) other personal property authorized by the commissioner.
(b) "Escrow" includes the act of conducting a:
(i) real estate settlement; or
(ii) real estate closing.
(57) "Escrow agent" means:
(a) an insurance producer with:
(i) a title insurance line of authority; and
(ii) an escrow subline of authority; or
(b) a person defined as an escrow agent in Section 7-22-101.
(58) (a) "Excludes" is not exhaustive and does not mean that another thing is not alsoexcluded.
(b) The items listed in a list using the term "excludes" are representative examples foruse in interpretation of this title.

(59) "Exclusion" means for the purposes of accident and health insurance that an insurerdoes not provide insurance coverage, for whatever reason, for one of the following:
(a) a specific physical condition;
(b) a specific medical procedure;
(c) a specific disease or disorder; or
(d) a specific prescription drug or class of prescription drugs.
(60) "Expense reimbursement insurance" means insurance:
(a) written to provide a payment for an expense relating to hospital confinement resultingfrom illness or injury; and
(b) written:
(i) as a daily limit for a specific number of days in a hospital; and
(ii) to have a one or two day waiting period following a hospitalization.
(61) "Fidelity insurance" means insurance guaranteeing the fidelity of a person holding aposition of public or private trust.
(62) (a) "Filed" means that a filing is:
(i) submitted to the department as required by and in accordance with applicable statute,rule, or filing order;
(ii) received by the department within the time period provided in applicable statute, rule,or filing order; and
(iii) accompanied by the appropriate fee in accordance with:
(A) Section 31A-3-103; or
(B) rule.
(b) "Filed" does not include a filing that is rejected by the department because it is notsubmitted in accordance with Subsection (62)(a).
(63) "Filing," when used as a noun, means an item required to be filed with thedepartment including:
(a) a policy;
(b) a rate;
(c) a form;
(d) a document;
(e) a plan;
(f) a manual;
(g) an application;
(h) a report;
(i) a certificate;
(j) an endorsement;
(k) an actuarial certification;
(l) a licensee annual statement;
(m) a licensee renewal application;
(n) an advertisement; or
(o) an outline of coverage.
(64) "First party insurance" means an insurance policy or contract in which the insureragrees to pay a claim submitted to it by the insured for the insured's losses.
(65) "Foreign insurer" means an insurer domiciled outside of this state, including an alieninsurer.

(66) (a) "Form" means one of the following prepared for general use:
(i) a policy;
(ii) a certificate;
(iii) an application;
(iv) an outline of coverage; or
(v) an endorsement.
(b) "Form" does not include a document specially prepared for use in an individual case.
(67) "Franchise insurance" means an individual insurance policy provided through amass marketing arrangement involving a defined class of persons related in some way other thanthrough the purchase of insurance.
(68) "General lines of authority" include:
(a) the general lines of insurance in Subsection (69);
(b) title insurance under one of the following sublines of authority:
(i) search, including authority to act as a title marketing representative;
(ii) escrow, including authority to act as a title marketing representative; and
(iii) title marketing representative only;
(c) surplus lines;
(d) workers' compensation; and
(e) any other line of insurance that the commissioner considers necessary to recognize inthe public interest.
(69) "General lines of insurance" include:
(a) accident and health;
(b) casualty;
(c) life;
(d) personal lines;
(e) property; and
(f) variable contracts, including variable life and annuity.
(70) "Group health plan" means an employee welfare benefit plan to the extent that theplan provides medical care:
(a) (i) to an employee; or
(ii) to a dependent of an employee; and
(b) (i) directly;
(ii) through insurance reimbursement; or
(iii) through another method.
(71) (a) "Group insurance policy" means a policy covering a group of persons that isissued:
(i) to a policyholder on behalf of the group; and
(ii) for the benefit of a member of the group who is selected under a procedure definedin:
(A) the policy; or
(B) an agreement that is collateral to the policy.
(b) A group insurance policy may include a member of the policyholder's family or adependent.
(72) "Guaranteed automobile protection insurance" means insurance offered inconnection with an extension of credit that pays the difference in amount between the insurance

settlement and the balance of the loan if the insured automobile is a total loss.
(73) (a) Except as provided in Subsection (73)(b), "health benefit plan" means a policy orcertificate that:
(i) provides health care insurance;
(ii) provides major medical expense insurance; or
(iii) is offered as a substitute for hospital or medical expense insurance, such as:
(A) a hospital confinement indemnity; or
(B) a limited benefit plan.
(b) "Health benefit plan" does not include a policy or certificate that:
(i) provides benefits solely for:
(A) accident;
(B) dental;
(C) income replacement;
(D) long-term care;
(E) a Medicare supplement;
(F) a specified disease;
(G) vision; or
(H) a short-term limited duration; or
(ii) is offered and marketed as supplemental health insurance.
(74) "Health care" means any of the following intended for use in the diagnosis,treatment, mitigation, or prevention of a human ailment or impairment:
(a) a professional service;
(b) a personal service;
(c) a facility;
(d) equipment;
(e) a device;
(f) supplies; or
(g) medicine.
(75) (a) "Health care insurance" or "health insurance" means insurance providing:
(i) a health care benefit; or
(ii) payment of an incurred health care expense.
(b) "Health care insurance" or "health insurance" does not include accident and healthinsurance providing a benefit for:
(i) replacement of income;
(ii) short-term accident;
(iii) fixed indemnity;
(iv) credit accident and health;
(v) supplements to liability;
(vi) workers' compensation;
(vii) automobile medical payment;
(viii) no-fault automobile;
(ix) equivalent self-insurance; or
(x) a type of accident and health insurance coverage that is a part of or attached toanother type of policy.
(76) "Income replacement insurance" or "disability income insurance" means insurance

written to provide payments to replace income lost from accident or sickness.
(77) "Indemnity" means the payment of an amount to offset all or part of an insured loss.
(78) "Independent adjuster" means an insurance adjuster required to be licensed underSection 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
(79) "Independently procured insurance" means insurance procured under Section31A-15-104.
(80) "Individual" means a natural person.
(81) "Inland marine insurance" includes insurance covering:
(a) property in transit on or over land;
(b) property in transit over water by means other than boat or ship;
(c) bailee liability;
(d) fixed transportation property such as bridges, electric transmission systems, radio andtelevision transmission towers and tunnels; and
(e) personal and commercial property floaters.
(82) "Insolvency" means that:
(a) an insurer is unable to pay its debts or meet its obligations as the debts andobligations mature;
(b) an insurer's total adjusted capital is less than the insurer's mandatory control levelRBC under Subsection 31A-17-601(8)(c); or
(c) an insurer is determined to be hazardous under this title.
(83) (a) "Insurance" means:
(i) an arrangement, contract, or plan for the transfer of a risk or risks from one or morepersons to one or more other persons; or
(ii) an arrangement, contract, or plan for the distribution of a risk or risks among a groupof persons that includes the person seeking to distribute that person's risk.
(b) "Insurance" includes:
(i) a risk distributing arrangement providing for compensation or replacement fordamages or loss through the provision of a service or a benefit in kind;
(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as abusiness and not as merely incidental to a business transaction; and
(iii) a plan in which the risk does not rest upon the person who makes an arrangement,but with a class of persons who have agreed to share the risk.
(84) "Insurance adjuster" means a person who directs the investigation, negotiation, orsettlement of a claim under an insurance policy other than life insurance or an annuity, on behalfof an insurer, policyholder, or a claimant under an insurance policy.
(85) "Insurance business" or "business of insurance" includes:
(a) providing health care insurance by an organization that is or is required to be licensedunder this title;
(b) providing a benefit to an employee in the event of a contingency not within thecontrol of the employee, in which the employee is entitled to the benefit as a right, which benefitmay be provided either:
(i) by a single employer or by multiple employer groups; or
(ii) through one or more trusts, associations, or other entities;
(c) providing an annuity:
(i) including an annuity issued in return for a gift; and

(ii) except an annuity provided by a person specified in Subsections 31A-22-1305(2) and(3);
(d) providing the characteristic services of a motor club as outlined in Subsection (113);
(e) providing another person with insurance;
(f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor, orsurety, a contract or policy of title insurance;
(g) transacting or proposing to transact any phase of title insurance, including:
(i) solicitation;
(ii) negotiation preliminary to execution;
(iii) execution of a contract of title insurance;
(iv) insuring;
(v) transacting matters subsequent to the execution of the contract and arising out of thecontract, including reinsurance; and
(vi) transacting or proposing a life settlement; and
(h) doing, or proposing to do, any business in substance equivalent to Subsections (85)(a)through (g) in a manner designed to evade this title.
(86) "Insurance consultant" or "consultant" means a person who:
(a) advises another person about insurance needs and coverages;
(b) is compensated by the person advised on a basis not directly related to the insuranceplaced; and
(c) except as provided in Section 31A-23a-501, is not compensated directly or indirectlyby an insurer or producer for advice given.
(87) "Insurance holding company system" means a group of two or more affiliatedpersons, at least one of whom is an insurer.
(88) (a) "Insurance producer" or "producer" means a person licensed or required to belicensed under the laws of this state to sell, solicit, or negotiate insurance.
(b) With regards to the selling, soliciting, or negotiating of an insurance product to aninsurance customer or an insured:
(i) "producer for the insurer" means a producer who is compensated directly or indirectlyby an insurer for selling, soliciting, or negotiating a product of that insurer; and
(ii) "producer for the insured" means a producer who:
(A) is compensated directly and only by an insurance customer or an insured; and
(B) receives no compensation directly or indirectly from an insurer for selling, soliciting,or negotiating a product of that insurer to an insurance customer or insured.
(89) (a) "Insured" means a person to whom or for whose benefit an insurer makes apromise in an insurance policy and includes:
(i) a policyholder;
(ii) a subscriber;
(iii) a member; and
(iv) a beneficiary.
(b) The definition in Subsection (89)(a):
(i) applies only to this title; and
(ii) does not define the meaning of this word as used in an insurance policy or certificate.
(90) (a) "Insurer" means a person doing an insurance business as a principal including:
(i) a fraternal benefit society;

(ii) an issuer of a gift annuity other than an annuity specified in Subsections31A-22-1305(2) and (3);
(iii) a motor club;
(iv) an employee welfare plan; and
(v) a person purporting or intending to do an insurance business as a principal on thatperson's own account.
(b) "Insurer" does not include a governmental entity to the extent the governmental entityis engaged in an activity described in Section 31A-12-107.
(91) "Interinsurance exchange" is defined in Subsection (142).
(92) "Involuntary unemployment insurance" means insurance:
(a) offered in connection with an extension of credit; and
(b) that provides indemnity if the debtor is involuntarily unemployed for paymentscoming due on a:
(i) specific loan; or
(ii) credit transaction.
(93) "Large employer," in connection with a health benefit plan, means an employer who,with respect to a calendar year and to a plan year:
(a) employed an average of at least 51 eligible employees on each business day duringthe preceding calendar year; and
(b) employs at least two employees on the first day of the plan year.
(94) "Late enrollee," with respect to an employer health benefit plan, means an individualwhose enrollment is a late enrollment.
(95) "Late enrollment," with respect to an employer health benefit plan, meansenrollment of an individual other than:
(a) on the earliest date on which coverage can become effective for the individual underthe terms of the plan; or
(b) through special enrollment.
(96) (a) Except for a retainer contract or legal assistance described in Section 31A-1-103,"legal expense insurance" means insurance written to indemnify or pay for a specified legalexpense.
(b) "Legal expense insurance" includes an arrangement that creates a reasonableexpectation of an enforceable right.
(c) "Legal expense insurance" does not include the provision of, or reimbursement for,legal services incidental to other insurance coverage.
(97) (a) "Liability insurance" means insurance against liability:
(i) for death, injury, or disability of a human being, or for damage to property, exclusiveof the coverages under:
(A) Subsection (107) for medical malpractice insurance;
(B) Subsection (134) for professional liability insurance; and
(C) Subsection (168) for workers' compensation insurance;
(ii) for a medical, hospital, surgical, and funeral benefit to a person other than the insuredwho is injured, irrespective of legal liability of the insured, when issued with or supplemental toinsurance against legal liability for the death, injury, or disability of a human being, exclusive ofthe coverages under:
(A) Subsection (107) for medical malpractice insurance;

(B) Subsection (134) for professional liability insurance; and
(C) Subsection (168) for workers' compensation insurance;
(iii) for loss or damage to property resulting from an accident to or explosion of a boiler,pipe, pressure container, machinery, or apparatus;
(iv) for loss or damage to property caused by:
(A) the breakage or leakage of a sprinkler, water pipe, or water container; or
(B) water entering through a leak or opening in a building; or
(v) for other loss or damage properly the subject of insurance not within another kind ofinsurance as defined in this chapter, if the insurance is not contrary to law or public policy.
(b) "Liability insurance" includes:
(i) vehicle liability insurance;
(ii) residential dwelling liability insurance; and
(iii) making inspection of, and issuing a certificate of inspection upon, an elevator,boiler, machinery, or apparatus of any kind when done in connection with insurance on theelevator, boiler, machinery, or apparatus.
(98) (a) "License" means authorization issued by the commissioner to engage in anactivity that is part of or related to the insurance business.
(b) "License" includes a certificate of authority issued to an insurer.
(99) (a) "Life insurance" means:
(i) insurance on a human life; and
(ii) insurance pertaining to or connected with human life.
(b) The business of life insurance includes:
(i) granting a death benefit;
(ii) granting an annuity benefit;
(iii) granting an endowment benefit;
(iv) granting an additional benefit in the event of death by accident;
(v) granting an additional benefit to safeguard the policy against lapse; and
(vi) providing an optional method of settlement of proceeds.
(100) "Limited license" means a license that:
(a) is issued for a specific product of insurance; and
(b) limits an individual or agency to transact only for that product or insurance.
(101) "Limited line credit insurance" includes the following forms of insurance:
(a) credit life;
(b) credit accident and health;
(c) credit property;
(d) credit unemployment;
(e) involuntary unemployment;
(f) mortgage life;
(g) mortgage guaranty;
(h) mortgage accident and health;
(i) guaranteed automobile protection; and
(j) another form of insurance offered in connection with an extension of credit that:
(i) is limited to partially or wholly extinguishing the credit obligation; and
(ii) the commissioner determines by rule should be designated as a form of limited linecredit insurance.

(102) "Limited line credit insurance producer" means a person who sells, solicits, ornegotiates one or more forms of limited line credit insurance coverage to an individual through amaster, corporate, group, or individual policy.
(103) "Limited line insurance" includes:
(a) bail bond;
(b) limited line credit insurance;
(c) legal expense insurance;
(d) motor club insurance;
(e) rental car-related insurance;
(f) travel insurance;
(g) crop insurance;
(h) self-service storage insurance; and
(i) another form of limited insurance that the commissioner determines by rule should bedesignated a form of limited line insurance.
(104) "Limited lines authority" includes:
(a) the lines of insurance listed in Subsection (103); and
(b) a customer service representative.
(105) "Limited lines producer" means a person who sells, solicits, or negotiates limitedlines insurance.
(106) (a) "Long-term care insurance" means an insurance policy or rider advertised,marketed, offered, or designated to provide coverage:
(i) in a setting other than an acute care unit of a hospital;
(ii) for not less than 12 consecutive months for a covered person on the basis of:
(A) expenses incurred;
(B) indemnity;
(C) prepayment; or
(D) another method;
(iii) for one or more necessary or medically necessary services that are:
(A) diagnostic;
(B) preventative;
(C) therapeutic;
(D) rehabilitative;
(E) maintenance; or
(F) personal care; and
(iv) that may be issued by:
(A) an insurer;
(B) a fraternal benefit society;
(C) (I) a nonprofit health hospital; and
(II) a medical service corporation;
(D) a prepaid health plan;
(E) a health maintenance organization; or
(F) an entity similar to the entities described in Subsections (106)(a)(iv)(A) through (E)to the extent that the entity is otherwise authorized to issue life or health care insurance.
(b) "Long-term care insurance" includes:
(i) any of the following that provide directly or supplement long-term care insurance:

(A) a group or individual annuity or rider; or
(B) a life insurance policy or rider;
(ii) a policy or rider that provides for payment of benefits on the basis of:
(A) cognitive impairment; or
(B) functional capacity; or
(iii) a qualified long-term care insurance contract.
(c) "Long-term care insurance" does not include:
(i) a policy that is offered primarily to provide basic Medicare supplement coverage;
(ii) basic hospital expense coverage;
(iii) basic medical/surgical expense coverage;
(iv) hospital confinement indemnity coverage;
(v) major medical expense coverage;
(vi) income replacement or related asset-protection coverage;
(vii) accident only coverage;
(viii) coverage for a specified:
(A) disease; or
(B) accident;
(ix) limited benefit health coverage; or
(x) a life insurance policy that accelerates the death benefit to provide the option of alump sum payment:
(A) if the following are not conditioned on the receipt of long-term care:
(I) benefits; or
(II) eligibility; and
(B) the coverage is for one or more the following qualifying events:
(I) terminal illness;
(II) medical conditions requiring extraordinary medical intervention; or
(III) permanent institutional confinement.
(107) "Medical malpractice insurance" means insurance against legal liability incident tothe practice and provision of a medical service other than the practice and provision of a dentalservice.
(108) "Member" means a person having membership rights in an insurance corporation.
(109) "Minimum capital" or "minimum required capital" means the capital that must beconstantly maintained by a stock insurance corporation as required by statute.
(110) "Mortgage accident and health insurance" means insurance offered in connectionwith an extension of credit that provides indemnity for payments coming due on a mortgagewhile the debtor is disabled.
(111) "Mortgage guaranty insurance" means surety insurance under which a mortgageeor other creditor is indemnified against losses caused by the default of a debtor.
(112) "Mortgage life insurance" means insurance on the life of a debtor in connectionwith an extension of credit that pays if the debtor dies.
(113) "Motor club" means a person:
(a) licensed under:
(i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
(ii) Chapter 11, Motor Clubs; or
(iii) Chapter 14, Foreign Insurers; and

(b) that promises for an advance consideration to provide for a stated period of time oneor more:
(i) legal services under Subsection 31A-11-102(1)(b);
(ii) bail services under Subsection 31A-11-102(1)(c); or
(iii) (A) trip reimbursement;
(B) towing services;
(C) emergency road services;
(D) stolen automobile services;
(E) a combination of the services listed in Subsections (113)(b)(iii)(A) through (D); or
(F) other services given in Subsections 31A-11-102(1)(b) through (f).
(114) "Mutual" means a mutual insurance corporation.
(115) "Network plan" means health care insurance:
(a) that is issued by an insurer; and
(b) under which the financing and delivery of medical care is provided, in whole or inpart, through a defined set of providers under contract with the insurer, including the financingand delivery of an item paid for as medical care.
(116) "Nonparticipating" means a plan of insurance under which the insured is notentitled to receive a dividend representing a share of the surplus of the insurer.
(117) "Ocean marine insurance" means insurance against loss of or damage to:
(a) ships or hulls of ships;
(b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money,securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia interests,or other cargoes in or awaiting transit over the oceans or inland waterways;
(c) earnings such as freight, passage money, commissions, or profits derived fromtransporting goods or people upon or across the oceans or inland waterways; or
(d) a vessel owner or operator as a result of liability to employees, passengers, bailors,owners of other vessels, owners of fixed objects, customs or other authorities, or other persons inconnection with maritime activity.
(118) "Order" means an order of the commissioner.
(119) "Outline of coverage" means a summary that explains an accident and healthinsurance policy.
(120) "Participating" means a plan of insurance under which the insured is entitled toreceive a dividend representing a share of the surplus of the insurer.
(121) "Participation," as used in a health benefit plan, means a requirement relating to theminimum percentage of eligible employees that must be enrolled in relation to the total numberof eligible employees of an employer reduced by each eligible employee who voluntarily declinescoverage under the plan because the employee:
(a) has other group health care insurance coverage; or
(b) receives:
(i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the SocialSecurity Amendments of 1965; or
(ii) another government health benefit.
(122) "Person" includes:
(a) an individual;
(b) a partnership;

(c) a corporation;
(d) an incorporated or unincorporated association;
(e) a joint stock company;
(f) a trust;
(g) a limited liability company;
(h) a reciprocal;
(i) a syndicate; or
(j) another similar entity or combination of entities acting in concert.
(123) "Personal lines insurance" means property and casualty insurance coverage sold forprimarily noncommercial purposes to:
(a) an individual; or
(b) a family.
(124) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
(125) "Plan year" means:
(a) the year that is designated as the plan year in:
(i) the plan document of a group health plan; or
(ii) a summary plan description of a group health plan;
(b) if the plan document or summary plan description does not designate a plan year orthere is no plan document or summary plan description:
(i) the year used to determine deductibles or limits;
(ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or
(iii) the employer's taxable year if:
(A) the plan does not impose deductibles or limits on a yearly basis; and
(B) (I) the plan is not insured; or
(II) the insurance policy is not renewed on an annual basis; or
(c) in a case not described in Subsection (125)(a) or (b), the calendar year.
(126) (a) "Policy" means a document, including an attached endorsement or applicationthat:
(i) purports to be an enforceable contract; and
(ii) memorializes in writing some or all of the terms of an insurance contract.
(b) "Policy" includes a service contract issued by:
(i) a motor club under Chapter 11, Motor Clubs;
(ii) a service contract provided under Chapter 6a, Service Contracts; and
(iii) a corporation licensed under:
(A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
(B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
(c) "Policy" does not include:
(i) a certificate under a group insurance contract; or
(ii) a document that does not purport to have legal effect.
(127) "Policyholder" means a person who controls a policy, binder, or oral contract byownership, premium payment, or otherwise.
(128) "Policy illustration" means a presentation or depiction that includes nonguaranteedelements of a policy of life insurance over a period of years.
(129) "Policy summary" means a synopsis describing the elements of a life insurancepolicy.

(130) "Preexisting condition," with respect to a health benefit plan:
(a) means a condition that was present before the effective date of coverage, whether ornot medical advice, diagnosis, care, or treatment was recommended or received before that day;and
(b) does not include a condition indicated by genetic information unless an actualdiagnosis of the condition by a physician has been made.
(131) (a) "Premium" means the monetary consideration for an insurance policy.
(b) "Premium" includes, however designated:
(i) an assessment;
(ii) a membership fee;
(iii) a required contribution; or
(iv) monetary consideration.
(c) (i) "Premium" does not include consideration paid to a third party administrator forthe third party administrator's services.
(ii) "Premium" includes an amount paid by a third party administrator to an insurer forinsurance on the risks administered by the third party administrator.
(132) "Principal officers" for a corporation means the officers designated underSubsection 31A-5-203(3).
(133) "Proceeding" includes an action or special statutory proceeding.
(134) "Professional liability insurance" means insurance against legal liability incident tothe practice of a profession and provision of a professional service.
(135) (a) Except as provided in Subsection (135)(b), "property insurance" meansinsurance against loss or damage to real or personal property of every kind and any interest inthat property:
(i) from all hazards or causes; and
(ii) against loss consequential upon the loss or damage including vehicle comprehensiveand vehicle physical damage coverages.
(b) "Property insurance" does not include:
(i) inland marine insurance; and
(ii) ocean marine insurance.
(136) "Qualified long-term care insurance contract" or "federally tax qualified long-termcare insurance contract" means:
(a) an individual or group insurance contract that meets the requirements of Section7702B(b), Internal Revenue Code; or
(b) the portion of a life insurance contract that provides long-term care insurance:
(i) (A) by rider; or
(B) as a part of the contract; and
(ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue Code.
(137) "Qualified United States financial institution" means an institution that:
(a) is:
(i) organized under the laws of the United States or any state; or
(ii) in the case of a United States office of a foreign banking organization, licensed underthe laws of the United States or any state;
(b) is regulated, supervised, and examined by a United States federal or state authorityhaving regulatory authority over a bank or trust company; and

(c) meets the standards of financial condition and standing that are considered necessaryand appropriate to regulate the quality of a financial institution whose letters of credit will beacceptable to the commissioner as determined by:
(i) the commissioner by rule; or
(ii) the Securities Valuation Office of the National Association of InsuranceCommissioners.
(138) (a) "Rate" means:
(i) the cost of a given unit of insurance; or
(ii) for property or casualty insurance, that cost of insurance per exposure unit eitherexpressed as:
(A) a single number; or
(B) a pure premium rate, adjusted before the application of individual risk variationsbased on loss or expense considerations to account for the treatment of:
(I) expenses;
(II) profit; and
(III) individual insurer variation in loss experience.
(b) "Rate" does not include a minimum premium.
(139) (a) Except as provided in Subsection (139)(b), "rate service organization" means aperson who assists an insurer in rate making or filing by:
(i) collecting, compiling, and furnishing loss or expense statistics;
(ii) recommending, making, or filing rates or supplementary rate information; or
(iii) advising about rate questions, except as an attorney giving legal advice.
(b) "Rate service organization" does not mean:
(i) an employee of an insurer;
(ii) a single insurer or group of insurers under common control;
(iii) a joint underwriting group; or
(iv) an individual serving as an actuarial or legal consultant.
(140) "Rating manual" means any of the following used to determine initial and renewalpolicy premiums:
(a) a manual of rates;
(b) a classification;
(c) a rate-related underwriting rule; and
(d) a rating formula that describes steps, policies, and procedures for determining initialand renewal policy premiums.
(141) "Received by the department" means:
(a) the date delivered to and stamped received by the department, if delivered in person;
(b) the post mark date, if delivered by mail;
(c) the delivery service's post mark or pickup date, if delivered by a delivery service;
(d) the received date recorded on an item delivered, if delivered by:
(i) facsimile;
(ii) email; or
(iii) another electronic method; or
(e) a date specified in:
(i) a statute;
(ii) a rule; or

(iii) an order.
(142) "Reciprocal" or "interinsurance exchange" means an unincorporated association ofpersons:
(a) operating through an attorney-in-fact common to all of the persons; and
(b) exchanging insurance contracts with one another that provide insurance coverage oneach other.
(143) "Reinsurance" means an insurance transaction where an insurer, for consideration,transfers any portion of the risk it has assumed to another insurer. In referring to reinsurancetransactions, this title sometimes refers to:
(a) the insurer transferring the risk as the "ceding insurer"; and
(b) the insurer assuming the risk as the:
(i) "assuming insurer"; or
(ii) "assuming reinsurer."
(144) "Reinsurer" means a person licensed in this state as an insurer with the authority toassume reinsurance.
(145) "Residential dwelling liability insurance" means insurance against liabilityresulting from or incident to the ownership, maintenance, or use of a residential dwelling that is adetached single family residence or multifamily residence up to four units.
(146) (a) "Retrocession" means reinsurance with another insurer of a liability assumedunder a reinsurance contract.
(b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of aliability assumed under a reinsurance contract.
(147) "Rider" means an endorsement to:
(a) an insurance policy; or
(b) an insurance certificate.
(148) (a) "Security" means a:
(i) note;
(ii) stock;
(iii) bond;
(iv) debenture;
(v) evidence of indebtedness;
(vi) certificate of interest or participation in a profit-sharing agreement;
(vii) collateral-trust certificate;
(viii) preorganization certificate or subscription;
(ix) transferable share;
(x) investment contract;
(xi) voting trust certificate;
(xii) certificate of deposit for a security;
(xiii) certificate of interest of participation in an oil, gas, or mining title or lease or inpayments out of production under such a title or lease;
(xiv) commodity contract or commodity option;
(xv) certificate of interest or participation in, temporary or interim certificate for, receiptfor, guarantee of, or warrant or right to subscribe to or purchase any of the items listed inSubsections (148)(a)(i) through (xiv); or
(xvi) another interest or instrument commonly known as a security.

(b) "Security" does not include:
(i) any of the following under which an insurance company promises to pay money in aspecific lump sum or periodically for life or some other specified period:
(A) insurance;
(B) an endowment policy; or
(C) an annuity contract; or
(ii) a burial certificate or burial contract.
(149) "Secondary medical condition" means a complication related to an exclusion fromcoverage in accident and health insurance.
(150) "Self-insurance" means an arrangement under which a person provides forspreading its own risks by a systematic plan.
(a) Except as provided in this Subsection (150), "self-insurance" does not include anarrangement under which a number of persons spread their risks among themselves.
(b) "Self-insurance" includes:
(i) an arrangement by which a governmental entity undertakes to indemnify an employeefor liability arising out of the employee's employment; and
(ii) an arrangement by which a person with a managed program of self-insurance and riskmanagement undertakes to indemnify its affiliates, subsidiaries, directors, officers, or employeesfor liability or risk that is related to the relationship or employment.
(c) "Self-insurance" does not include an arrangement with an independent contractor.
(151) "Sell" means to exchange a contract of insurance:
(a) by any means;
(b) for money or its equivalent; and
(c) on behalf of an insurance company.
(152) "Short-term care insurance" means an insurance policy or rider advertised,marketed, offered, or designed to provide coverage that is similar to long-term care insurance,but that provides coverage for less than 12 consecutive months for each covered person.
(153) "Significant break in coverage" means a period of 63 consecutive days during eachof which an individual does not have creditable coverage.
(154) "Small employer," in connection with a health benefit plan, means an employerwho, with respect to a calendar year and to a plan year:
(a) employed an average of at least two employees but not more than 50 eligibleemployees on each business day during the preceding calendar year; and
(b) employs at least two employees on the first day of the plan year.
(155) "Special enrollment period," in connection with a health benefit plan, has the samemeaning as provided in federal regulations adopted pursuant to the Health Insurance Portabilityand Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936.
(156) (a) "Subsidiary" of a person means an affiliate controlled by that person eitherdirectly or indirectly through one or more affiliates or intermediaries.
(b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the votingshares are owned by that person either alone or with its affiliates, except for the minimumnumber of shares the law of the subsidiary's domicile requires to be owned by directors or others.
(157) Subject to Subsection (83)(b), "surety insurance" includes:
(a) a guarantee against loss or damage resulting from the failure of a principal to pay orperform the principal's obligations to a creditor or other obligee;

(b) bail bond insurance; and
(c) fidelity insurance.
(158) (a) "Surplus" means the excess of assets over the sum of paid-in capital andliabilities.
(b) (i) "Permanent surplus" means the surplus of a mutual insurer that is designated bythe insurer as permanent.
(ii) Sections 31A-5-211, 31A-7-201, 31A-8-209, 31A-9-209, and 31A-14-209 requirethat mutuals doing business in this state maintain specified minimum levels of permanentsurplus.
(iii) Except for assessable mutuals, the minimum permanent surplus requirement is thesame as the minimum required capital requirement that applies to stock insurers.
(c) "Excess surplus" means:
(i) for a life insurer, accident and health insurer, health organization, or property andcasualty insurer as defined in Section 31A-17-601, the lesser of:
(A) that amount of an insurer's or health organization's total adjusted capital that exceedsthe product of:
(I) 2.5; and
(II) the sum of the insurer's or health organization's minimum capital or permanentsurplus required under Section 31A-5-211, 31A-9-209, or 31A-14-205; or
(B) that amount of an insurer's or health organization's total adjusted capital that exceedsthe product of:
(I) 3.0; and
(II) the authorized control level RBC as defined in Subsection 31A-17-601(8)(a); and
(ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurerthat amount of an insurer's paid-in-capital and surplus that exceeds the product of:
(A) 1.5; and
(B) the insurer's total adjusted capital required by Subsection 31A-17-609(1).
(159) "Third party administrator" or "administrator" means a person who collects chargesor premiums from, or who, for consideration, adjusts or settles claims of residents of the state inconnection with insurance coverage, annuities, or service insurance coverage, except:
(a) a union on behalf of its members;
(b) a person administering a:
(i) pension plan subject to the federal Employee Retirement Income Security Act of1974;
(ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
(iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
(c) an employer on behalf of the employer's employees or the employees of one or moreof the subsidiary or affiliated corporations of the employer;
(d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance forwhich the insurer holds a license in this state; or
(e) a person:
(i) licensed or exempt from licensing under:
(A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, andReinsurance Intermediaries; or
(B) Chapter 26, Insurance Adjusters; and

(ii) whose activities are limited to those authorized under the license the person holds orfor which the person is exempt.
(160) "Title insurance" means the insuring, guaranteeing, or indemnifying of an owner ofreal or personal property or the holder of liens or encumbrances on that property, or othersinterested in the property against loss or damage suffered by reason of liens or encumbrancesupon, defects in, or the unmarketability of the title to the property, or invalidity orunenforceability of any liens or encumbrances on the property.
(161) "Total adjusted capital" means the sum of an insurer's or health organization'sstatutory capital and surplus as determined in accordance with:
(a) the statutory accounting applicable to the annual financial statements required to befiled under Section 31A-4-113; and
(b) another item provided by the RBC instructions, as RBC instructions is defined inSection 31A-17-601.
(162) (a) &quo

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