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Section 301 | Definitions. |
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31A-1-301. Definitions. As used in this title, unless otherwise specified: (1) (a) "Accident and health insurance" means insurance to provide protection against economic 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 Title 63G, Chapter 3, Utah Administrative Rulemaking Act. (3) "Administrator" is defined in Subsection (161). (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 control with, another person. A corporation is an affiliate of another corporation, regardless of ownership, 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 an individual does business under an assumed name; and (b) an insurance organization licensed or required to be licensed under Section 31A-23a-301, 31A-25-207, or 31A-26-209. (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 or over the lifetime of one or more individuals if the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human 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 decide whether 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 an annuity 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 when required, up to and including surrender of the person in execution of a sentence imposed under Subsection 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 of persons: (a) without individual underwriting or application; and (b) that is determined by definition without designating each person covered. (15) "Board," "board of trustees," or "board of directors" means the group of persons with responsibility over, or management of, a corporation, however designated. (16) "Bona fide office" means a physical office in this state: (a) that is open to the public; (b) that is staffed during regular business hours on regular business days; and (c) at which the public may appear in person to obtain services. (17) "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. (18) "Business of insurance" is defined in Subsection (87). (19) "Business plan" means the information required to be supplied to the commissioner under Subsections 31A-5-204(2)(i) and (j), including the information required when these subsections apply by reference under: (a) Section 31A-7-201; (b) Section 31A-8-205; or (c) Subsection 31A-9-205(2). (20) (a) "Bylaws" means the rules adopted for the regulation or management of a corporation's affairs, however designated. (b) "Bylaws" includes comparable rules for a trust or other entity that is not a corporation. (21) "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 affiliated company; 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. (22) "Casualty insurance" means liability insurance. (23) "Certificate" means evidence of insurance given to: (a) an insured under a group insurance policy; or (b) a third party. (24) "Certificate of authority" is included within the term "license." (25) "Claim," unless the context otherwise requires, means a request or demand on an insurer for payment of a benefit according to the terms of an insurance policy. (26) "Claims-made coverage" means an insurance contract or provision limiting coverage under a policy insuring against legal liability to claims that are first made against the insured while the policy is in force. (27) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance commissioner. (b) When appropriate, the terms listed in Subsection (27)(a) apply to the equivalent supervisory official of another jurisdiction. (28) (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 (28)(a) under an agreement effective: (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 and
lodging are provided at the same location as a service described in Subsection (28)(a)(ii). (i) the Primary Care Network Program under a Medicaid primary care network demonstration 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. (35) "Credit accident and health insurance" means insurance on a debtor to provide indemnity for payments coming due on a specific loan or other credit transaction while the debtor has a disability. (36) (a) "Credit insurance" means insurance offered in connection with an extension of credit 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. (37) "Credit life insurance" means insurance on the life of a debtor in connection with an extension of credit that pays a person if the debtor dies. (38) "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. (39) "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. (40) "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. (41) (a) "Customer service representative" means a person that provides an insurance service 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 of the customer service representative's producer or consultant employer. (42) "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. (43) "Deemer clause" means a provision under this title under which upon the occurrence of a condition precedent, the commissioner is considered to have taken a specific action. If the statute so provides, a condition precedent may be the commissioner's failure to take a specific action. (44) "Degree of relationship" means the number of steps between two persons determined by counting the generations separating one person from a common ancestor and then counting the generations to the other person. (45) "Department" means the Insurance Department. (46) "Director" means a member of the board of directors of a corporation. (47) "Disability" means a physiological or psychological condition that partially or totally limits 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. (48) "Disability income insurance" is defined in Subsection (78). (49) "Domestic insurer" means an insurer organized under the laws of this state. (50) "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. (51) (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 (51)(b). (b) "Eligible employee" includes, if the individual is included under a health benefit plan
of a small employer:
excluded.
agrees to pay a claim submitted to it by the insured for the insured's losses.
dependent. (x) a type of accident and health insurance coverage that is a part of or attached to another type of policy. (77) "Health Insurance Portability and Accountability Act" means the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936, as amended. (78) "Income replacement insurance" or "disability income insurance" means insurance written to provide payments to replace income lost from accident or sickness. (79) "Indemnity" means the payment of an amount to offset all or part of an insured loss. (80) "Independent adjuster" means an insurance adjuster required to be licensed under Section 31A-26-201 who engages in insurance adjusting as a representative of an insurer. (81) "Independently procured insurance" means insurance procured under Section 31A-15-104. (82) "Individual" means a natural person. (83) "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 and television transmission towers and tunnels; and (e) personal and commercial property floaters. (84) "Insolvency" means that: (a) an insurer is unable to pay its debts or meet its obligations as the debts and obligations mature; (b) an insurer's total adjusted capital is less than the insurer's mandatory control level RBC under Subsection 31A-17-601(8)(c); or (c) an insurer is determined to be hazardous under this title. (85) (a) "Insurance" means: (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more persons to one or more other persons; or (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a group of 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 for damages 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 a business 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. (86) "Insurance adjuster" means a person who directs the investigation, negotiation, or settlement of a claim under an insurance policy other than life insurance or an annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy. (87) "Insurance business" or "business of insurance" includes: (a) providing health care insurance by an organization that is or is required to be licensed under this title; (b) providing a benefit to an employee in the event of a contingency not within the control of the employee, in which the employee is entitled to the benefit as a right, which benefit
may be provided either: (b) The definition in Subsection (91)(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. (92) (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 Subsections 31A-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 that person's own account. (b) "Insurer" does not include a governmental entity to the extent the governmental entity is engaged in an activity described in Section 31A-12-107. (93) "Interinsurance exchange" is defined in Subsection (144). (94) "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 payments coming due on a: (i) specific loan; or (ii) credit transaction. (95) "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 during the preceding calendar year; and (b) employs at least two employees on the first day of the plan year. (96) "Late enrollee," with respect to an employer health benefit plan, means an individual whose enrollment is a late enrollment. (97) "Late enrollment," with respect to an employer health benefit plan, means enrollment of an individual other than: (a) on the earliest date on which coverage can become effective for the individual under the terms of the plan; or (b) through special enrollment. (98) (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 legal expense. (b) "Legal expense insurance" includes an arrangement that creates a reasonable expectation of an enforceable right. (c) "Legal expense insurance" does not include the provision of, or reimbursement for, legal services incidental to other insurance coverage. (99) (a) "Liability insurance" means insurance against liability: (i) for death, injury, or disability of a human being, or for damage to property, exclusive of the coverages under: (A) Subsection (109) for medical malpractice insurance; (B) Subsection (136) for professional liability insurance; and (C) Subsection (170) for workers' compensation insurance; (ii) for a medical, hospital, surgical, and funeral benefit to a person other than the insured who is injured, irrespective of legal liability of the insured, when issued with or supplemental to insurance against legal liability for the death, injury, or disability of a human being, exclusive of the coverages under: (A) Subsection (109) for medical malpractice insurance; (B) Subsection (136) for professional liability insurance; and (C) Subsection (170) 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 of insurance 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 the elevator, boiler, machinery, or apparatus. (100) (a) "License" means authorization issued by the commissioner to engage in an activity that is part of or related to the insurance business. (b) "License" includes a certificate of authority issued to an insurer. (101) (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. (102) "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. (103) "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 line credit insurance. (104) "Limited line credit insurance producer" means a person who sells, solicits, or negotiates one or more forms of limited line credit insurance coverage to an individual through a master, corporate, group, or individual policy. (105) "Limited line insurance" includes: (a) bail bond; (b) limited line credit insurance; (c) legal expense insurance; (d) motor club insurance; (e) car rental related insurance; (f) travel insurance; (g) crop insurance; (h) self-service storage insurance; (i) guaranteed asset protection waiver; and (j) another form of limited insurance that the commissioner determines by rule should be designated a form of limited line insurance. (106) "Limited lines authority" includes: (a) the lines of insurance listed in Subsection (105); and (b) a customer service representative. (107) "Limited lines producer" means a person who sells, solicits, or negotiates limited lines insurance. (108) (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 (108)(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 a lump 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. (109) "Medical malpractice insurance" means insurance against legal liability incident to the practice and provision of a medical service other than the practice and provision of a dental service. (110) "Member" means a person having membership rights in an insurance corporation. (111) "Minimum capital" or "minimum required capital" means the capital that must be constantly maintained by a stock insurance corporation as required by statute. (112) "Mortgage accident and health insurance" means insurance offered in connection with an extension of credit that provides indemnity for payments coming due on a mortgage while the debtor has a disability. (113) "Mortgage guaranty insurance" means surety insurance under which a mortgagee or other creditor is indemnified against losses caused by the default of a debtor. (114) "Mortgage life insurance" means insurance on the life of a debtor in connection
with an extension of credit that pays if the debtor dies. (i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965; or (ii) another government health benefit. (124) "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. (125) "Personal lines insurance" means property and casualty insurance coverage sold for primarily noncommercial purposes to: (a) an individual; or (b) a family. (126) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B). (127) "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 or there 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 (127)(a) or (b), the calendar year. (128) (a) "Policy" means a document, including an attached endorsement or application that: (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. (129) "Policyholder" means a person who controls a policy, binder, or oral contract by ownership, premium payment, or otherwise. (130) "Policy illustration" means a presentation or depiction that includes nonguaranteed elements of a policy of life insurance over a period of years. (131) "Policy summary" means a synopsis describing the elements of a life insurance policy. (132) "Preexisting condition," with respect to a health benefit plan: (a) means a condition that was present before the effective date of coverage, whether or not 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 actual diagnosis of the condition by a physician has been made. (133) (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 for the third party administrator's services. (ii) "Premium" includes an amount paid by a third party administrator to an insurer for insurance on the risks administered by the third party administrator. (134) "Principal officers" for a corporation means the officers designated under Subsection 31A-5-203(3). (135) "Proceeding" includes an action or special statutory proceeding. (136) "Professional liability insurance" means insurance against legal liability incident to the practice of a profession and provision of a professional service. (137) (a) Except as provided in Subsection (137)(b), "property insurance" means insurance against loss or damage to real or personal property of every kind and any interest in that property: (i) from all hazards or causes; and (ii) against loss consequential upon the loss or damage including vehicle comprehensive and vehicle physical damage coverages. (b) "Property insurance" does not include: (i) inland marine insurance; and (ii) ocean marine insurance. (138) "Qualified long-term care insurance contract" or "federally tax qualified long-term care insurance contract" means: (a) an individual or group insurance contract that meets the requirements of Section 7702B(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. (139) "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 under the laws of the United States or any state; (b) is regulated, supervised, and examined by a United States federal or state authority having regulatory authority over a bank or trust company; and (c) meets the standards of financial condition and standing that are considered necessary and appropriate to regulate the quality of a financial institution whose letters of credit will be acceptable to the commissioner as determined by: (i) the commissioner by rule; or (ii) the Securities Valuation Office of the National Association of Insurance Commissioners. (140) (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 either expressed as: (A) a single number; or (B) a pure premium rate, adjusted before the application of individual risk variations based 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. (141) (a) Except as provided in Subsection (141)(b), "rate service organization" means a person 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. (142) "Rating manual" means any of the following used to determine initial and renewal policy 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 initial and renewal policy premiums. (143) "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. (144) "Reciprocal" or "interinsurance exchange" means an unincorporated association of persons: (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 on each other. (145) "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 reinsurance transactions, 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." (146) "Reinsurer" means a person licensed in this state as an insurer with the authority to assume reinsurance. (147) "Residential dwelling liability insurance" means insurance against liability resulting from or incident to the ownership, maintenance, or use of a residential dwelling that is a detached single family residence or multifamily residence up to four units. (148) (a) "Retrocession" means reinsurance with another insurer of a liability assumed under a reinsurance contract. (b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of a liability assumed under a reinsurance contract. (149) "Rider" means an endorsement to: (a) an insurance policy; or (b) an insurance certificate. (150) (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 in
payments out of production under such a title or lease; (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting shares are owned by that person either alone or with its affiliates, except for the minimum number of shares the law of the subsidiary's domicile requires to be owned by directors or others. (159) Subject to Subsection (85)(b), "surety insurance" includes: (a) a guarantee against loss or damage resulting from the failure of a principal to pay or perform the principal's obligations to a creditor or other obligee; (b) bail bond insurance; and (c) fidelity insurance. (160) (a) "Surplus" means the excess of assets over the sum of paid-in capital and liabilities. (b) (i) "Permanent surplus" means the surplus of a mutual insurer that is designated by the insurer as permanent. (ii) Sections 31A-5-211, 31A-7-201, 31A-8-209, 31A-9-209, and 31A-14-209 require that mutuals doing business in this state maintain specified minimum levels of permanent surplus. (iii) Except for assessable mutuals, the minimum permanent surplus requirement is the same 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 and casualty 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 exceeds the product of: (I) 2.5; and (II) the sum of the insurer's or health organization's minimum capital or permanent surplus 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 exceeds the 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 insurer that 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). (161) "Third party administrator" or "administrator" means a person who collects charges or premiums from, or who, for consideration, adjusts or settles claims of residents of the state in connection 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 of 1974; (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 more of the subsidiary or affiliated corporations of the employer; (d) an insurer licensed under the following, but only for a line of insurance for which the
insurer holds a license in this state:
benefit plan, can become effective.
Amended by Chapter 284, 2011 General Session |
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