Title 31A Chapter 8 Section 103

Insurance Code
Health Maintenance Organizations and Limited Health Plans
Section 103
Applicability to other provisions of law.

            

31A-8-103.   Applicability to other provisions of law.

            (1) (a) Except for exemptions specifically granted under this title, an organization is subject to regulation under all of the provisions of this title.

            (b) Notwithstanding any provision of this title, an organization licensed under this chapter:

            (i) is wholly exempt from:

            (A) Chapter 7, Nonprofit Health Service Insurance Corporations;

            (B) Chapter 9, Insurance Fraternals;

            (C) Chapter 10, Annuities;

            (D) Chapter 11, Motor Clubs;

            (E) Chapter 12, State Risk Management Fund;

            (F) Chapter 13, Employee Welfare Funds and Plans;

            (G) Chapter 19a, Utah Rate Regulation Act; and

            (H) Chapter 28, Guaranty Associations; and

            (ii) is not subject to:

            (A) Chapter 3, Department Funding, Fees, and Taxes, except for Part 1, Funding the Insurance Department;

            (B) Section 31A-4-107;

            (C) Chapter 5, Domestic Stock and Mutual Insurance Corporations, except for provisions specifically made applicable by this chapter;

            (D) Chapter 14, Foreign Insurers, except for provisions specifically made applicable by this chapter;

            (E) Chapter 17, Determination of Financial Condition, except:

            (I) Part 2, Qualified Assets, and Part 6, Risk-Based Capital; or

            (II) as made applicable by the commissioner by rule consistent with this chapter;

            (F) Chapter 18, Investments, except as made applicable by the commissioner by rule consistent with this chapter; and

            (G) Chapter 22, Contracts in Specific Lines, except for Part 6, Accident and Health Insurance, Part 7, Group Accident and Health Insurance, and Part 12, Reinsurance.

            (2) The commissioner may by rule waive other specific provisions of this title that the commissioner considers inapplicable to health maintenance organizations or limited health plans, upon a finding that the waiver will not endanger the interests of:

            (a) enrollees;

            (b) investors; or

            (c) the public.

            (3) Title 16, Chapter 6a, Utah Revised Nonprofit Corporation Act, and Title 16, Chapter 10a, Utah Revised Business Corporation Act, do not apply to an organization except as specifically made applicable by:

            (a) this chapter;

            (b) a provision referenced under this chapter; or

            (c) a rule adopted by the commissioner to deal with corporate law issues of health maintenance organizations that are not settled under this chapter.

            (4) (a) Whenever in this chapter, Chapter 5, Domestic Stock and Mutual Insurance Corporations, or Chapter 14, Foreign Insurers, is made applicable to an organization, the application is:

            (i) of those provisions that apply to a mutual corporation if the organization is nonprofit; and

            (ii) of those that apply to a stock corporation if the organization is for profit.

            (b) When Chapter 5, Domestic Stock and Mutual Insurance Corporations, or Chapter 14, Foreign Insurers, is made applicable to an organization under this chapter, "mutual" means nonprofit organization.

            (5) Solicitation of enrollees by an organization is not a violation of any provision of law relating to solicitation or advertising by health professionals if that solicitation is made in accordance with:

            (a) this chapter; and

            (b) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries.

            (6) This title does not prohibit any health maintenance organization from meeting the requirements of any federal law that enables the health maintenance organization to:

            (a) receive federal funds; or

            (b) obtain or maintain federal qualification status.

            (7) Except as provided in Section 31A-8-501, an organization is exempt from statutes in this title or department rules that restrict or limit the organization's freedom of choice in contracting with or selecting health care providers, including Section 31A-22-618.

            (8) An organization is exempt from the assessment or payment of premium taxes imposed by Sections 59-9-101 through 59-9-104.


Amended by Chapter 324, 2010 General Session