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H.B. 295 Enrolled

             1     

INSURANCE LAW AMENDMENTS

             2     
2007 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: James A. Dunnigan

             5     
Senate Sponsor: Michael G. Waddoups

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill modifies the Insurance Code.
             10      Highlighted Provisions:
             11          This bill:
             12          .    addresses definitions;
             13          .    addresses examinations and costs of examinations;
             14          .    clarifies laws applicable to executive compensation;
             15          .    clarifies that certain acknowledgment forms are to be filed with the department;
             16          .    modifies certain policy and annuity examination periods;
             17          .    addresses accident and health insurance coverage related to birth or adoption;
             18          .    addresses requirements for the commissioner's adoption of a Basic Health Care
             19      Plan;
             20          .    addresses independent review organizations;
             21          .    addresses groups eligible for group or blanket insurance;
             22          .    removes certain references to a federal employer identification number;
             23          .    clarifies application of special requirements to title insurance producers which are
             24      agencies;
             25          .    allows for an insurer to provide incentives to participate in programs or activities
             26      designed to reduce claims or claims expenses;
             27          .    clarifies provisions related to sharing of commissions;
             28          .    addresses health care claims practices;
             29          .    modifies the Individual, Small Employer, and Group Health Insurance Act;


             30          .    addresses appointments to the Bail Bond Surety Oversight Board;
             31          .    addresses provisions applicable to a viatical settlement provider or viatical
             32      settlement producer;
             33          .    clarifies provisions related to examinations of captive insurance companies; and
             34          .    makes technical changes including correcting citations.
             35      Monies Appropriated in this Bill:
             36          None
             37      Other Special Clauses:
             38          This bill coordinates with H.B. 340, Insurer Receivership Act, to make technical
             39      changes.
             40      Utah Code Sections Affected:
             41      AMENDS:
             42          31A-1-301, as last amended by Chapters 320 and 332, Laws of Utah 2006
             43          31A-2-205, as last amended by Chapter 2, Laws of Utah 2004
             44          31A-5-416, as last amended by Chapter 277, Laws of Utah 1992
             45          31A-21-104, as last amended by Chapter 81, Laws of Utah 2003
             46          31A-21-503, as last amended by Chapter 116, Laws of Utah 2001
             47          31A-22-305, as last amended by Chapter 69, Laws of Utah 2006
             48          31A-22-305.3, as enacted by Chapter 69, Laws of Utah 2006
             49          31A-22-423, as last amended by Chapter 252, Laws of Utah 2003
             50          31A-22-610, as last amended by Chapter 252, Laws of Utah 2003
             51          31A-22-613.5, as last amended by Chapter 114, Laws of Utah 2002
             52          31A-22-629, as last amended by Chapter 78, Laws of Utah 2005
             53          31A-22-701, as last amended by Chapters 90 and 108, Laws of Utah 2004
             54          31A-23a-104, as last amended by Chapter 173, Laws of Utah 2004
             55          31A-23a-105, as last amended by Chapter 312, Laws of Utah 2006
             56          31A-23a-117, as last amended by Chapter 312, Laws of Utah 2006
             57          31A-23a-204, as last amended by Chapter 312, Laws of Utah 2006


             58          31A-23a-401, as renumbered and amended by Chapter 298, Laws of Utah 2003
             59          31A-23a-402, as last amended by Chapters 123 and 185, Laws of Utah 2005
             60          31A-23a-504, as renumbered and amended by Chapter 298, Laws of Utah 2003
             61          31A-25-202, as last amended by Chapter 90, Laws of Utah 2004
             62          31A-26-202, as last amended by Chapter 252, Laws of Utah 2003
             63          31A-26-301.6, as last amended by Chapter 308, Laws of Utah 2002
             64          31A-27-331, as enacted by Chapter 242, Laws of Utah 1985
             65          31A-30-103, as last amended by Chapters 2 and 90, Laws of Utah 2004
             66          31A-30-107.3, as last amended by Chapter 329, Laws of Utah 2004
             67          31A-30-107.5, as last amended by Chapter 188, Laws of Utah 2006
             68          31A-30-112, as enacted by Chapter 321, Laws of Utah 1995
             69          31A-35-201, as last amended by Chapter 131, Laws of Utah 1999
             70          31A-36-102, as enacted by Chapter 81, Laws of Utah 2003
             71          31A-36-104, as last amended by Chapter 106, Laws of Utah 2004
             72          31A-36-105, as enacted by Chapter 81, Laws of Utah 2003
             73          31A-36-106, as enacted by Chapter 81, Laws of Utah 2003
             74          31A-36-107, as enacted by Chapter 81, Laws of Utah 2003
             75          31A-36-108, as enacted by Chapter 81, Laws of Utah 2003
             76          31A-36-109, as enacted by Chapter 81, Laws of Utah 2003
             77          31A-36-110, as enacted by Chapter 81, Laws of Utah 2003
             78          31A-36-111, as enacted by Chapter 81, Laws of Utah 2003
             79          31A-36-112, as enacted by Chapter 81, Laws of Utah 2003
             80          31A-36-113, as enacted by Chapter 81, Laws of Utah 2003
             81          31A-36-117, as enacted by Chapter 81, Laws of Utah 2003
             82          31A-36-119, as last amended by Chapter 106, Laws of Utah 2004
             83          31A-37-502, as enacted by Chapter 251, Laws of Utah 2003
             84          61-1-13, as last amended by Chapter 4, Laws of Utah 2006, Third Special Session
             85     


             86      Be it enacted by the Legislature of the state of Utah:
             87          Section 1. Section 31A-1-301 is amended to read:
             88           31A-1-301. Definitions.
             89          As used in this title, unless otherwise specified:
             90          (1) (a) "Accident and health insurance" means insurance to provide protection against
             91      economic losses resulting from:
             92          (i) a medical condition including:
             93          (A) medical care expenses; or
             94          (B) the risk of disability;
             95          (ii) accident; or
             96          (iii) sickness.
             97          (b) "Accident and health insurance":
             98          (i) includes a contract with disability contingencies including:
             99          (A) an income replacement contract;
             100          (B) a health care contract;
             101          (C) an expense reimbursement contract;
             102          (D) a credit accident and health contract;
             103          (E) a continuing care contract; and
             104          (F) a long-term care contract; and
             105          (ii) may provide:
             106          (A) hospital coverage;
             107          (B) surgical coverage;
             108          (C) medical coverage; or
             109          (D) loss of income coverage.
             110          (c) "Accident and health insurance" does not include workers' compensation insurance.
             111          (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title
             112      63, Chapter 46a, Utah Administrative Rulemaking Act.
             113          (3) "Administrator" is defined in Subsection [(155)] (157).


             114          (4) "Adult" means a natural person who has attained the age of at least 18 years.
             115          (5) "Affiliate" means any person who controls, is controlled by, or is under common
             116      control with, another person. A corporation is an affiliate of another corporation, regardless of
             117      ownership, if substantially the same group of natural persons manages the corporations.
             118          (6) "Agency" means:
             119          (a) a person other than an individual, including a sole proprietorship by which a natural
             120      person does business under an assumed name; and
             121          (b) an insurance organization licensed or required to be licensed under Section
             122      31A-23a-301 .
             123          (7) "Alien insurer" means an insurer domiciled outside the United States.
             124          (8) "Amendment" means an endorsement to an insurance policy or certificate.
             125          (9) "Annuity" means an agreement to make periodical payments for a period certain or
             126      over the lifetime of one or more natural persons if the making or continuance of all or some of
             127      the series of the payments, or the amount of the payment, is dependent upon the continuance of
             128      human life.
             129          (10) "Application" means a document:
             130          (a) (i) completed by an applicant to provide information about the risk to be insured;
             131      and
             132          (ii) that contains information that is used by the insurer to evaluate risk and decide
             133      whether to:
             134          (A) insure the risk under:
             135          (I) the coverages as originally offered; or
             136          (II) a modification of the coverage as originally offered; or
             137          (B) decline to insure the risk; or
             138          (b) used by the insurer to gather information from the applicant before issuance of an
             139      annuity contract.
             140          (11) "Articles" or "articles of incorporation" means the original articles, special laws,
             141      charters, amendments, restated articles, articles of merger or consolidation, trust instruments,


             142      and other constitutive documents for trusts and other entities that are not corporations, and
             143      amendments to any of these.
             144          (12) "Bail bond insurance" means a guarantee that a person will attend court when
             145      required, up to and including surrender of the person in execution of any sentence imposed
             146      under Subsection 77-20-7 (1), as a condition to the release of that person from confinement.
             147          (13) "Binder" is defined in Section 31A-21-102 .
             148          (14) "Blanket insurance policy" means a group policy covering classes of persons
             149      without individual underwriting, where the persons insured are determined by definition of the
             150      class with or without designating the persons covered.
             151          [(14)] (15) "Board," "board of trustees," or "board of directors" means the group of
             152      persons with responsibility over, or management of, a corporation, however designated.
             153          [(15)] (16) "Business entity" means a corporation, association, partnership, limited
             154      liability company, limited liability partnership, or other legal entity.
             155          [(16)] (17) "Business of insurance" is defined in Subsection [(82)] (84).
             156          [(17)] (18) "Business plan" means the information required to be supplied to the
             157      commissioner under Subsections 31A-5-204 (2)(i) and (j), including the information required
             158      when these subsections are applicable by reference under:
             159          (a) Section 31A-7-201 ;
             160          (b) Section 31A-8-205 ; or
             161          (c) Subsection 31A-9-205 (2).
             162          [(18)] (19) "Bylaws" means the rules adopted for the regulation or management of a
             163      corporation's affairs, however designated and includes comparable rules for trusts and other
             164      entities that are not corporations.
             165          [(19)] (20) "Captive insurance company" means:
             166          (a) an insurance company:
             167          (i) owned by another organization; and
             168          (ii) whose exclusive purpose is to insure risks of the parent organization and affiliated
             169      companies; or


             170          (b) in the case of groups and associations, an insurance organization:
             171          (i) owned by the insureds; and
             172          (ii) whose exclusive purpose is to insure risks of:
             173          (A) member organizations;
             174          (B) group members; and
             175          (C) affiliates of:
             176          (I) member organizations; or
             177          (II) group members.
             178          [(20)] (21) "Casualty insurance" means liability insurance as defined in Subsection
             179      [(94)] (96).
             180          [(21)] (22) "Certificate" means evidence of insurance given to:
             181          (a) an insured under a group insurance policy; or
             182          (b) a third party.
             183          [(22)] (23) "Certificate of authority" is included within the term "license."
             184          [(23)] (24) "Claim," unless the context otherwise requires, means a request or demand
             185      on an insurer for payment of benefits according to the terms of an insurance policy.
             186          [(24)] (25) "Claims-made coverage" means an insurance contract or provision limiting
             187      coverage under a policy insuring against legal liability to claims that are first made against the
             188      insured while the policy is in force.
             189          [(25)] (26) (a) "Commissioner" or "commissioner of insurance" means Utah's
             190      insurance commissioner.
             191          (b) When appropriate, the terms listed in Subsection [(25)] (26)(a) apply to the
             192      equivalent supervisory official of another jurisdiction.
             193          [(26)] (27) (a) "Continuing care insurance" means insurance that:
             194          (i) provides board and lodging;
             195          (ii) provides one or more of the following services:
             196          (A) personal services;
             197          (B) nursing services;


             198          (C) medical services; or
             199          (D) other health-related services; and
             200          (iii) provides the coverage described in Subsection [(26)] (27)(a)(i) under an agreement
             201      effective:
             202          (A) for the life of the insured; or
             203          (B) for a period in excess of one year.
             204          (b) Insurance is continuing care insurance regardless of whether or not the board and
             205      lodging are provided at the same location as the services described in Subsection [(26)]
             206      (27)(a)(ii).
             207          [(27)] (28) (a) "Control," "controlling," "controlled," or "under common control"
             208      means the direct or indirect possession of the power to direct or cause the direction of the
             209      management and policies of a person. This control may be:
             210          (i) by contract;
             211          (ii) by common management;
             212          (iii) through the ownership of voting securities; or
             213          (iv) by a means other than those described in Subsections [(27)] (28)(a)(i) through (iii).
             214          (b) There is no presumption that an individual holding an official position with another
             215      person controls that person solely by reason of the position.
             216          (c) A person having a contract or arrangement giving control is considered to have
             217      control despite the illegality or invalidity of the contract or arrangement.
             218          (d) There is a rebuttable presumption of control in a person who directly or indirectly
             219      owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the
             220      voting securities of another person.
             221          [(28)] (29) "Controlled insurer" means a licensed insurer that is either directly or
             222      indirectly controlled by a producer.
             223          [(29)] (30) "Controlling person" means any person that directly or indirectly has the
             224      power to direct or cause to be directed, the management, control, or activities of a reinsurance
             225      intermediary.


             226          [(30)] (31) "Controlling producer" means a producer who directly or indirectly controls
             227      an insurer.
             228          [(31)] (32) (a) "Corporation" means an insurance corporation, except when referring to:
             229          (i) a corporation doing business:
             230          (A) as:
             231          (I) an insurance producer;
             232          (II) a limited line producer;
             233          (III) a consultant;
             234          (IV) a managing general agent;
             235          (V) a reinsurance intermediary;
             236          (VI) a third party administrator; or
             237          (VII) an adjuster; and
             238          (B) under:
             239          (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
             240      Reinsurance Intermediaries;
             241          (II) Chapter 25, Third Party Administrators; or
             242          (III) Chapter 26, Insurance Adjusters; or
             243          (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance
             244      Holding Companies.
             245          (b) "Stock corporation" means a stock insurance corporation.
             246          (c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
             247          [(32)] (33) "Creditable coverage" has the same meaning as provided in federal
             248      regulations adopted pursuant to the Health Insurance Portability and Accountability Act of
             249      1996, Pub. L. 104-191, 110 Stat. 1936.
             250          [(33)] (34) "Credit accident and health insurance" means insurance on a debtor to
             251      provide indemnity for payments coming due on a specific loan or other credit transaction while
             252      the debtor is disabled.
             253          [(34)] (35) (a) "Credit insurance" means insurance offered in connection with an


             254      extension of credit that is limited to partially or wholly extinguishing that credit obligation.
             255          (b) "Credit insurance" includes:
             256          (i) credit accident and health insurance;
             257          (ii) credit life insurance;
             258          (iii) credit property insurance;
             259          (iv) credit unemployment insurance;
             260          (v) guaranteed automobile protection insurance;
             261          (vi) involuntary unemployment insurance;
             262          (vii) mortgage accident and health insurance;
             263          (viii) mortgage guaranty insurance; and
             264          (ix) mortgage life insurance.
             265          [(35)] (36) "Credit life insurance" means insurance on the life of a debtor in connection
             266      with an extension of credit that pays a person if the debtor dies.
             267          [(36)] (37) "Credit property insurance" means insurance:
             268          (a) offered in connection with an extension of credit; and
             269          (b) that protects the property until the debt is paid.
             270          [(37)] (38) "Credit unemployment insurance" means insurance:
             271          (a) offered in connection with an extension of credit; and
             272          (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
             273          (i) specific loan; or
             274          (ii) credit transaction.
             275          [(38)] (39) "Creditor" means a person, including an insured, having any claim,
             276      whether:
             277          (a) matured;
             278          (b) unmatured;
             279          (c) liquidated;
             280          (d) unliquidated;
             281          (e) secured;


             282          (f) unsecured;
             283          (g) absolute;
             284          (h) fixed; or
             285          (i) contingent.
             286          [(39)] (40) (a) "Customer service representative" means a person that provides
             287      insurance services and insurance product information:
             288          (i) for the customer service representative's:
             289          (A) producer; or
             290          (B) consultant employer; and
             291          (ii) to the customer service representative's employer's:
             292          (A) customer;
             293          (B) client; or
             294          (C) organization.
             295          (b) A customer service representative may only operate within the scope of authority of
             296      the customer service representative's producer or consultant employer.
             297          [(40)] (41) "Deadline" means the final date or time:
             298          (a) imposed by:
             299          (i) statute;
             300          (ii) rule; or
             301          (iii) order; and
             302          (b) by which a required filing or payment must be received by the department.
             303          [(41)] (42) "Deemer clause" means a provision under this title under which upon the
             304      occurrence of a condition precedent, the commissioner is deemed to have taken a specific
             305      action. If the statute so provides, the condition precedent may be the commissioner's failure to
             306      take a specific action.
             307          [(42)] (43) "Degree of relationship" means the number of steps between two persons
             308      determined by counting the generations separating one person from a common ancestor and
             309      then counting the generations to the other person.


             310          [(43)] (44) "Department" means the Insurance Department.
             311          [(44)] (45) "Director" means a member of the board of directors of a corporation.
             312          [(45)] (46) "Disability" means a physiological or psychological condition that partially
             313      or totally limits an individual's ability to:
             314          (a) perform the duties of:
             315          (i) that individual's occupation; or
             316          (ii) any occupation for which the individual is reasonably suited by education, training,
             317      or experience; or
             318          (b) perform two or more of the following basic activities of daily living:
             319          (i) eating;
             320          (ii) toileting;
             321          (iii) transferring;
             322          (iv) bathing; or
             323          (v) dressing.
             324          [(46)] (47) "Disability income insurance" is defined in Subsection [(73)] (75).
             325          [(47)] (48) "Domestic insurer" means an insurer organized under the laws of this state.
             326          [(48)] (49) "Domiciliary state" means the state in which an insurer:
             327          (a) is incorporated;
             328          (b) is organized; or
             329          (c) in the case of an alien insurer, enters into the United States.
             330          [(49)] (50) (a) "Eligible employee" means:
             331          (i) an employee who:
             332          (A) works on a full-time basis; and
             333          (B) has a normal work week of 30 or more hours; or
             334          (ii) a person described in Subsection [(49)] (50)(b).
             335          (b) "Eligible employee" includes, if the individual is included under a health benefit
             336      plan of a small employer:
             337          (i) a sole proprietor;


             338          (ii) a partner in a partnership; or
             339          (iii) an independent contractor.
             340          (c) "Eligible employee" does not include, unless eligible under Subsection [(49)]
             341      (50)(b):
             342          (i) an individual who works on a temporary or substitute basis for a small employer;
             343          (ii) an employer's spouse; or
             344          (iii) a dependent of an employer.
             345          [(50)] (51) "Employee" means any individual employed by an employer.
             346          [(51)] (52) "Employee benefits" means one or more benefits or services provided to:
             347          (a) employees; or
             348          (b) dependents of employees.
             349          [(52)] (53) (a) "Employee welfare fund" means a fund:
             350          (i) established or maintained, whether directly or through trustees, by:
             351          (A) one or more employers;
             352          (B) one or more labor organizations; or
             353          (C) a combination of employers and labor organizations; and
             354          (ii) that provides employee benefits paid or contracted to be paid, other than income
             355      from investments of the fund, by or on behalf of an employer doing business in this state or for
             356      the benefit of any person employed in this state.
             357          (b) "Employee welfare fund" includes a plan funded or subsidized by user fees or tax
             358      revenues.
             359          [(53)] (54) "Endorsement" means a written agreement attached to a policy or certificate
             360      to modify one or more of the provisions of the policy or certificate.
             361          [(54)] (55) "Enrollment date," with respect to a health benefit plan, means the first day
             362      of coverage or, if there is a waiting period, the first day of the waiting period.
             363          [(55)] (56) (a) "Escrow" means:
             364          (i) a real estate settlement or real estate closing conducted by a third party pursuant to
             365      the requirements of a written agreement between the parties in a real estate transaction; or


             366          (ii) a settlement or closing involving:
             367          (A) a mobile home;
             368          (B) a grazing right;
             369          (C) a water right; or
             370          (D) other personal property authorized by the commissioner.
             371          (b) "Escrow" includes the act of conducting a:
             372          (i) real estate settlement; or
             373          (ii) real estate closing.
             374          [(56)] (57) "Escrow agent" means:
             375          (a) an insurance producer with:
             376          (i) a title insurance line of authority; and
             377          (ii) an escrow subline of authority; or
             378          (b) a person defined as an escrow agent in Section 7-22-101 .
             379          [(57)] (58) "Excludes" is not exhaustive and does not mean that other things are not
             380      also excluded. The items listed are representative examples for use in interpretation of this
             381      title.
             382          [(58)] (59) "Expense reimbursement insurance" means insurance:
             383          (a) written to provide payments for expenses relating to hospital confinements resulting
             384      from illness or injury; and
             385          (b) written:
             386          (i) as a daily limit for a specific number of days in a hospital; and
             387          (ii) to have a one or two day waiting period following a hospitalization.
             388          [(59)] (60) "Fidelity insurance" means insurance guaranteeing the fidelity of persons
             389      holding positions of public or private trust.
             390          [(60)] (61) (a) "Filed" means that a filing is:
             391          (i) submitted to the department as required by and in accordance with any applicable
             392      statute, rule, or filing order;
             393          (ii) received by the department within the time period provided in the applicable


             394      statute, rule, or filing order; and
             395          (iii) accompanied by the appropriate fee in accordance with:
             396          (A) Section 31A-3-103 ; or
             397          (B) rule.
             398          (b) "Filed" does not include a filing that is rejected by the department because it is not
             399      submitted in accordance with Subsection [(60)] (61)(a).
             400          [(61)] (62) "Filing," when used as a noun, means an item required to be filed with the
             401      department including:
             402          (a) a policy;
             403          (b) a rate;
             404          (c) a form;
             405          (d) a document;
             406          (e) a plan;
             407          (f) a manual;
             408          (g) an application;
             409          (h) a report;
             410          (i) a certificate;
             411          (j) an endorsement;
             412          (k) an actuarial certification;
             413          (l) a licensee annual statement;
             414          (m) a licensee renewal application; or
             415          (n) an advertisement.
             416          [(62)] (63) "First party insurance" means an insurance policy or contract in which the
             417      insurer agrees to pay claims submitted to it by the insured for the insured's losses.
             418          [(63)] (64) "Foreign insurer" means an insurer domiciled outside of this state, including
             419      an alien insurer.
             420          [(64)] (65) (a) "Form" means one of the following prepared for general use:
             421          (i) a policy;


             422          (ii) a certificate;
             423          (iii) an application; or
             424          (iv) an outline of coverage.
             425          (b) "Form" does not include a document specially prepared for use in an individual
             426      case.
             427          [(65)] (66) "Franchise insurance" means individual insurance policies provided through
             428      a mass marketing arrangement involving a defined class of persons related in some way other
             429      than through the purchase of insurance.
             430          [(66)] (67) "General lines of authority" include:
             431          (a) the general lines of insurance in Subsection [(67)] (68);
             432          (b) title insurance under one of the following sublines of authority:
             433          (i) search, including authority to act as a title marketing representative;
             434          (ii) escrow, including authority to act as a title marketing representative;
             435          (iii) search and escrow, including authority to act as a title marketing representative;
             436      and
             437          (iv) title marketing representative only;
             438          (c) surplus lines;
             439          (d) workers' compensation; and
             440          (e) any other line of insurance that the commissioner considers necessary to recognize
             441      in the public interest.
             442          [(67)] (68) "General lines of insurance" include:
             443          (a) accident and health;
             444          (b) casualty;
             445          (c) life;
             446          (d) personal lines;
             447          (e) property; and
             448          (f) variable contracts, including variable life and annuity.
             449          [(68)] (69) "Group health plan" means an employee welfare benefit plan to the extent


             450      that the plan provides medical care:
             451          (a) (i) to employees; or
             452          (ii) to a dependent of an employee; and
             453          (b) (i) directly;
             454          (ii) through insurance reimbursement; or
             455          (iii) through any other method.
             456          (70) (a) "Group insurance policy" means a policy covering a group of persons that is
             457      issued:
             458          (i) to a policyholder on behalf of the group; and
             459          (ii) for the benefit of group members who are selected under procedures defined in:
             460          (A) the policy; or
             461          (B) agreements which are collateral to the policy.
             462          (b) A group insurance policy may include members of the policyholder's family or
             463      dependents.
             464          [(69)] (71) "Guaranteed automobile protection insurance" means insurance offered in
             465      connection with an extension of credit that pays the difference in amount between the
             466      insurance settlement and the balance of the loan if the insured automobile is a total loss.
             467          [(70)] (72) (a) Except as provided in Subsection [(70)] (72)(b), "health benefit plan"
             468      means a policy or certificate that:
             469          (i) provides health care insurance;
             470          (ii) provides major medical expense insurance; or
             471          (iii) is offered as a substitute for hospital or medical expense insurance such as:
             472          (A) a hospital confinement indemnity; or
             473          (B) a limited benefit plan.
             474          (b) "Health benefit plan" does not include a policy or certificate that:
             475          (i) provides benefits solely for:
             476          (A) accident;
             477          (B) dental;


             478          (C) income replacement;
             479          (D) long-term care;
             480          (E) a Medicare supplement;
             481          (F) a specified disease;
             482          (G) vision; or
             483          (H) a short-term limited duration; or
             484          (ii) is offered and marketed as supplemental health insurance.
             485          [(71)] (73) "Health care" means any of the following intended for use in the diagnosis,
             486      treatment, mitigation, or prevention of a human ailment or impairment:
             487          (a) professional services;
             488          (b) personal services;
             489          (c) facilities;
             490          (d) equipment;
             491          (e) devices;
             492          (f) supplies; or
             493          (g) medicine.
             494          [(72)] (74) (a) "Health care insurance" or "health insurance" means insurance
             495      providing:
             496          (i) health care benefits; or
             497          (ii) payment of incurred health care expenses.
             498          (b) "Health care insurance" or "health insurance" does not include accident and health
             499      insurance providing benefits for:
             500          (i) replacement of income;
             501          (ii) short-term accident;
             502          (iii) fixed indemnity;
             503          (iv) credit accident and health;
             504          (v) supplements to liability;
             505          (vi) workers' compensation;


             506          (vii) automobile medical payment;
             507          (viii) no-fault automobile;
             508          (ix) equivalent self-insurance; or
             509          (x) any type of accident and health insurance coverage that is a part of or attached to
             510      another type of policy.
             511          [(73)] (75) "Income replacement insurance" or "disability income insurance" means
             512      insurance written to provide payments to replace income lost from accident or sickness.
             513          [(74)] (76) "Indemnity" means the payment of an amount to offset all or part of an
             514      insured loss.
             515          [(75)] (77) "Independent adjuster" means an insurance adjuster required to be licensed
             516      under Section 31A-26-201 who engages in insurance adjusting as a representative of insurers.
             517          [(76)] (78) "Independently procured insurance" means insurance procured under
             518      Section 31A-15-104 .
             519          [(77)] (79) "Individual" means a natural person.
             520          [(78)] (80) "Inland marine insurance" includes insurance covering:
             521          (a) property in transit on or over land;
             522          (b) property in transit over water by means other than boat or ship;
             523          (c) bailee liability;
             524          (d) fixed transportation property such as bridges, electric transmission systems, radio
             525      and television transmission towers and tunnels; and
             526          (e) personal and commercial property floaters.
             527          [(79)] (81) "Insolvency" means that:
             528          (a) an insurer is unable to pay its debts or meet its obligations as they mature;
             529          (b) an insurer's total adjusted capital is less than the insurer's mandatory control level
             530      RBC under Subsection 31A-17-601 (8)(c); or
             531          (c) an insurer is determined to be hazardous under this title.
             532          [(80)] (82) (a) "Insurance" means:
             533          (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more


             534      persons to one or more other persons; or
             535          (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a
             536      group of persons that includes the person seeking to distribute that person's risk.
             537          (b) "Insurance" includes:
             538          (i) risk distributing arrangements providing for compensation or replacement for
             539      damages or loss through the provision of services or benefits in kind;
             540          (ii) contracts of guaranty or suretyship entered into by the guarantor or surety as a
             541      business and not as merely incidental to a business transaction; and
             542          (iii) plans in which the risk does not rest upon the person who makes the arrangements,
             543      but with a class of persons who have agreed to share it.
             544          [(81)] (83) "Insurance adjuster" means a person who directs the investigation,
             545      negotiation, or settlement of a claim under an insurance policy other than life insurance or an
             546      annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy.
             547          [(82)] (84) "Insurance business" or "business of insurance" includes:
             548          (a) providing health care insurance, as defined in Subsection [(72)] (74), by
             549      organizations that are or should be licensed under this title;
             550          (b) providing benefits to employees in the event of contingencies not within the control
             551      of the employees, in which the employees are entitled to the benefits as a right, which benefits
             552      may be provided either:
             553          (i) by single employers or by multiple employer groups; or
             554          (ii) through trusts, associations, or other entities;
             555          (c) providing annuities, including those issued in return for gifts, except those provided
             556      by persons specified in Subsections 31A-22-1305 (2) and (3);
             557          (d) providing the characteristic services of motor clubs as outlined in Subsection
             558      [(110)] (112);
             559          (e) providing other persons with insurance as defined in Subsection [(80)] (82);
             560          (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor,
             561      or surety, any contract or policy of title insurance;


             562          (g) transacting or proposing to transact any phase of title insurance, including:
             563          (i) solicitation;
             564          (ii) negotiation preliminary to execution;
             565          (iii) execution of a contract of title insurance;
             566          (iv) insuring; and
             567          (v) transacting matters subsequent to the execution of the contract and arising out of
             568      the contract, including reinsurance; and
             569          (h) doing, or proposing to do, any business in substance equivalent to Subsections
             570      [(82)] (84)(a) through (g) in a manner designed to evade the provisions of this title.
             571          [(83)] (85) "Insurance consultant" or "consultant" means a person who:
             572          (a) advises other persons about insurance needs and coverages;
             573          (b) is compensated by the person advised on a basis not directly related to the insurance
             574      placed; and
             575          (c) except as provided in Section 31A-23a-501 , is not compensated directly or
             576      indirectly by an insurer or producer for advice given.
             577          [(84)] (86) "Insurance holding company system" means a group of two or more
             578      affiliated persons, at least one of whom is an insurer.
             579          [(85)] (87) (a) "Insurance producer" or "producer" means a person licensed or required
             580      to be licensed under the laws of this state to sell, solicit, or negotiate insurance.
             581          (b) With regards to the selling, soliciting, or negotiating of an insurance product to an
             582      insurance customer or an insured:
             583          (i) "producer for the insurer" means a producer who is compensated directly or
             584      indirectly by an insurer for selling, soliciting, or negotiating any product of that insurer; and
             585          (ii) "producer for the insured" means a producer who:
             586          (A) is compensated directly and only by an insurance customer or an insured; and
             587          (B) receives no compensation directly or indirectly from an insurer for selling,
             588      soliciting, or negotiating any product of that insurer to an insurance customer or insured.
             589          [(86)] (88) (a) "Insured" means a person to whom or for whose benefit an insurer


             590      makes a promise in an insurance policy and includes:
             591          (i) policyholders;
             592          (ii) subscribers;
             593          (iii) members; and
             594          (iv) beneficiaries.
             595          (b) The definition in Subsection [(86)] (88)(a):
             596          (i) applies only to this title; and
             597          (ii) does not define the meaning of this word as used in insurance policies or
             598      certificates.
             599          [(87)] (89) (a) (i) "Insurer" means any person doing an insurance business as a
             600      principal including:
             601          (A) fraternal benefit societies;
             602          (B) issuers of gift annuities other than those specified in Subsections 31A-22-1305 (2)
             603      and (3);
             604          (C) motor clubs;
             605          (D) employee welfare plans; and
             606          (E) any person purporting or intending to do an insurance business as a principal on
             607      that person's own account.
             608          (ii) "Insurer" does not include a governmental entity to the extent it is engaged in the
             609      activities described in Section 31A-12-107 .
             610          (b) "Admitted insurer" is defined in Subsection [(159)] (161)(b).
             611          (c) "Alien insurer" is defined in Subsection (7).
             612          (d) "Authorized insurer" is defined in Subsection [(159)] (161)(b).
             613          (e) "Domestic insurer" is defined in Subsection [(47)] (48).
             614          (f) "Foreign insurer" is defined in Subsection [(63)] (64).
             615          (g) "Nonadmitted insurer" is defined in Subsection [(159)] (161)(a).
             616          (h) "Unauthorized insurer" is defined in Subsection [(159)] (161)(a).
             617          [(88)] (90) "Interinsurance exchange" is defined in Subsection [(139)] (141).


             618          [(89)] (91) "Involuntary unemployment insurance" means insurance:
             619          (a) offered in connection with an extension of credit;
             620          (b) that provides indemnity if the debtor is involuntarily unemployed for payments
             621      coming due on a:
             622          (i) specific loan; or
             623          (ii) credit transaction.
             624          [(90)] (92) "Large employer," in connection with a health benefit plan, means an
             625      employer who, with respect to a calendar year and to a plan year:
             626          (a) employed an average of at least 51 eligible employees on each business day during
             627      the preceding calendar year; and
             628          (b) employs at least two employees on the first day of the plan year.
             629          [(91)] (93) "Late enrollee," with respect to an employer health benefit plan, means an
             630      individual whose enrollment is a late enrollment.
             631          [(92)] (94) "Late enrollment," with respect to an employer health benefit plan, means
             632      enrollment of an individual other than:
             633          (a) on the earliest date on which coverage can become effective for the individual
             634      under the terms of the plan; or
             635          (b) through special enrollment.
             636          [(93)] (95) (a) Except for a retainer contract or legal assistance described in Section
             637      31A-1-103 , "legal expense insurance" means insurance written to indemnify or pay for
             638      specified legal expenses.
             639          (b) "Legal expense insurance" includes arrangements that create reasonable
             640      expectations of enforceable rights.
             641          (c) "Legal expense insurance" does not include the provision of, or reimbursement for,
             642      legal services incidental to other insurance coverages.
             643          [(94)] (96) (a) "Liability insurance" means insurance against liability:
             644          (i) for death, injury, or disability of any human being, or for damage to property,
             645      exclusive of the coverages under:


             646          (A) Subsection [(104)] (106) for medical malpractice insurance;
             647          (B) Subsection [(131)] (133) for professional liability insurance; and
             648          (C) Subsection [(164)] (166) for workers' compensation insurance;
             649          (ii) for medical, hospital, surgical, and funeral benefits to persons other than the
             650      insured who are injured, irrespective of legal liability of the insured, when issued with or
             651      supplemental to insurance against legal liability for the death, injury, or disability of human
             652      beings, exclusive of the coverages under:
             653          (A) Subsection [(104)] (106) for medical malpractice insurance;
             654          (B) Subsection [(131)] (133) for professional liability insurance; and
             655          (C) Subsection [(164)] (166) for workers' compensation insurance;
             656          (iii) for loss or damage to property resulting from accidents to or explosions of boilers,
             657      pipes, pressure containers, machinery, or apparatus;
             658          (iv) for loss or damage to any property caused by the breakage or leakage of sprinklers,
             659      water pipes and containers, or by water entering through leaks or openings in buildings; or
             660          (v) for other loss or damage properly the subject of insurance not within any other kind
             661      or kinds of insurance as defined in this chapter, if such insurance is not contrary to law or
             662      public policy.
             663          (b) "Liability insurance" includes:
             664          (i) vehicle liability insurance as defined in Subsection [(161)] (163);
             665          (ii) residential dwelling liability insurance as defined in Subsection [(142)] (144); and
             666          (iii) making inspection of, and issuing certificates of inspection upon, elevators,
             667      boilers, machinery, and apparatus of any kind when done in connection with insurance on
             668      them.
             669          [(95)] (97) (a) "License" means the authorization issued by the commissioner to engage
             670      in some activity that is part of or related to the insurance business.
             671          (b) "License" includes certificates of authority issued to insurers.
             672          [(96)] (98) (a) "Life insurance" means insurance on human lives and insurances
             673      pertaining to or connected with human life.


             674          (b) The business of life insurance includes:
             675          (i) granting death benefits;
             676          (ii) granting annuity benefits;
             677          (iii) granting endowment benefits;
             678          (iv) granting additional benefits in the event of death by accident;
             679          (v) granting additional benefits to safeguard the policy against lapse; and
             680          (vi) providing optional methods of settlement of proceeds.
             681          [(97)] (99) "Limited license" means a license that:
             682          (a) is issued for a specific product of insurance; and
             683          (b) limits an individual or agency to transact only for that product or insurance.
             684          [(98)] (100) "Limited line credit insurance" includes the following forms of insurance:
             685          (a) credit life;
             686          (b) credit accident and health;
             687          (c) credit property;
             688          (d) credit unemployment;
             689          (e) involuntary unemployment;
             690          (f) mortgage life;
             691          (g) mortgage guaranty;
             692          (h) mortgage accident and health;
             693          (i) guaranteed automobile protection; and
             694          (j) any other form of insurance offered in connection with an extension of credit that:
             695          (i) is limited to partially or wholly extinguishing the credit obligation; and
             696          (ii) the commissioner determines by rule should be designated as a form of limited line
             697      credit insurance.
             698          [(99)] (101) "Limited line credit insurance producer" means a person who sells,
             699      solicits, or negotiates one or more forms of limited line credit insurance coverage to individuals
             700      through a master, corporate, group, or individual policy.
             701          [(100)] (102) "Limited line insurance" includes:


             702          (a) bail bond;
             703          (b) limited line credit insurance;
             704          (c) legal expense insurance;
             705          (d) motor club insurance;
             706          (e) rental car-related insurance;
             707          (f) travel insurance; and
             708          (g) any other form of limited insurance that the commissioner determines by rule
             709      should be designated a form of limited line insurance.
             710          [(101)] (103) "Limited lines authority" includes:
             711          (a) the lines of insurance listed in Subsection [(100)] (102); and
             712          (b) a customer service representative.
             713          [(102)] (104) "Limited lines producer" means a person who sells, solicits, or negotiates
             714      limited lines insurance.
             715          [(103)] (105) (a) "Long-term care insurance" means an insurance policy or rider
             716      advertised, marketed, offered, or designated to provide coverage:
             717          (i) in a setting other than an acute care unit of a hospital;
             718          (ii) for not less than 12 consecutive months for each covered person on the basis of:
             719          (A) expenses incurred;
             720          (B) indemnity;
             721          (C) prepayment; or
             722          (D) another method;
             723          (iii) for one or more necessary or medically necessary services that are:
             724          (A) diagnostic;
             725          (B) preventative;
             726          (C) therapeutic;
             727          (D) rehabilitative;
             728          (E) maintenance; or
             729          (F) personal care; and


             730          (iv) that may be issued by:
             731          (A) an insurer;
             732          (B) a fraternal benefit society;
             733          (C) (I) a nonprofit health hospital; and
             734          (II) a medical service corporation;
             735          (D) a prepaid health plan;
             736          (E) a health maintenance organization; or
             737          (F) an entity similar to the entities described in Subsections [(103)] (105)(a)(iv)(A)
             738      through (E) to the extent that the entity is otherwise authorized to issue life or health care
             739      insurance.
             740          (b) "Long-term care insurance" includes:
             741          (i) any of the following that provide directly or supplement long-term care insurance:
             742          (A) a group or individual annuity or rider; or
             743          (B) a life insurance policy or rider;
             744          (ii) a policy or rider that provides for payment of benefits based on:
             745          (A) cognitive impairment; or
             746          (B) functional capacity; or
             747          (iii) a qualified long-term care insurance contract.
             748          (c) "Long-term care insurance" does not include:
             749          (i) a policy that is offered primarily to provide basic Medicare supplement coverage;
             750          (ii) basic hospital expense coverage;
             751          (iii) basic medical/surgical expense coverage;
             752          (iv) hospital confinement indemnity coverage;
             753          (v) major medical expense coverage;
             754          (vi) income replacement or related asset-protection coverage;
             755          (vii) accident only coverage;
             756          (viii) coverage for a specified:
             757          (A) disease; or


             758          (B) accident;
             759          (ix) limited benefit health coverage; or
             760          (x) a life insurance policy that accelerates the death benefit to provide the option of a
             761      lump sum payment:
             762          (A) if the following are not conditioned on the receipt of long-term care:
             763          (I) benefits; or
             764          (II) eligibility; and
             765          (B) the coverage is for one or more the following qualifying events:
             766          (I) terminal illness;
             767          (II) medical conditions requiring extraordinary medical intervention; or
             768          (III) permanent institutional confinement.
             769          [(104)] (106) "Medical malpractice insurance" means insurance against legal liability
             770      incident to the practice and provision of medical services other than the practice and provision
             771      of dental services.
             772          [(105)] (107) "Member" means a person having membership rights in an insurance
             773      corporation.
             774          [(106)] (108) "Minimum capital" or "minimum required capital" means the capital that
             775      must be constantly maintained by a stock insurance corporation as required by statute.
             776          [(107)] (109) "Mortgage accident and health insurance" means insurance offered in
             777      connection with an extension of credit that provides indemnity for payments coming due on a
             778      mortgage while the debtor is disabled.
             779          [(108)] (110) "Mortgage guaranty insurance" means surety insurance under which
             780      mortgagees and other creditors are indemnified against losses caused by the default of debtors.
             781          [(109)] (111) "Mortgage life insurance" means insurance on the life of a debtor in
             782      connection with an extension of credit that pays if the debtor dies.
             783          [(110)] (112) "Motor club" means a person:
             784          (a) licensed under:
             785          (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;


             786          (ii) Chapter 11, Motor Clubs; or
             787          (iii) Chapter 14, Foreign Insurers; and
             788          (b) that promises for an advance consideration to provide for a stated period of time:
             789          (i) legal services under Subsection 31A-11-102 (1)(b);
             790          (ii) bail services under Subsection 31A-11-102 (1)(c); or
             791          (iii) (A) trip reimbursement;
             792          (B) towing services;
             793          (C) emergency road services;
             794          (D) stolen automobile services;
             795          (E) a combination of the services listed in Subsections [(110)] (112)(b)(iii)(A) through
             796      (D); or
             797          (F) any other services given in Subsections 31A-11-102 (1)(b) through (f).
             798          [(111)] (113) "Mutual" means a mutual insurance corporation.
             799          [(112)] (114) "Network plan" means health care insurance:
             800          (a) that is issued by an insurer; and
             801          (b) under which the financing and delivery of medical care is provided, in whole or in
             802      part, through a defined set of providers under contract with the insurer, including the financing
             803      and delivery of items paid for as medical care.
             804          [(113)] (115) "Nonparticipating" means a plan of insurance under which the insured is
             805      not entitled to receive dividends representing shares of the surplus of the insurer.
             806          [(114)] (116) "Ocean marine insurance" means insurance against loss of or damage to:
             807          (a) ships or hulls of ships;
             808          (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, moneys,
             809      securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia
             810      interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
             811          (c) earnings such as freight, passage money, commissions, or profits derived from
             812      transporting goods or people upon or across the oceans or inland waterways; or
             813          (d) a vessel owner or operator as a result of liability to employees, passengers, bailors,


             814      owners of other vessels, owners of fixed objects, customs or other authorities, or other persons
             815      in connection with maritime activity.
             816          [(115)] (117) "Order" means an order of the commissioner.
             817          [(116)] (118) "Outline of coverage" means a summary that explains an accident and
             818      health insurance policy.
             819          [(117)] (119) "Participating" means a plan of insurance under which the insured is
             820      entitled to receive dividends representing shares of the surplus of the insurer.
             821          [(118)] (120) "Participation," as used in a health benefit plan, means a requirement
             822      relating to the minimum percentage of eligible employees that must be enrolled in relation to
             823      the total number of eligible employees of an employer reduced by each eligible employee who
             824      voluntarily declines coverage under the plan because the employee has other group health care
             825      insurance coverage.
             826          [(119)] (121) "Person" includes an individual, partnership, corporation, incorporated or
             827      unincorporated association, joint stock company, trust, limited liability company, reciprocal,
             828      syndicate, or any similar entity or combination of entities acting in concert.
             829          [(120)] (122) "Personal lines insurance" means property and casualty insurance
             830      coverage sold for primarily noncommercial purposes to:
             831          (a) individuals; and
             832          (b) families.
             833          [(121)] (123) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
             834          [(122)] (124) "Plan year" means:
             835          (a) the year that is designated as the plan year in:
             836          (i) the plan document of a group health plan; or
             837          (ii) a summary plan description of a group health plan;
             838          (b) if the plan document or summary plan description does not designate a plan year or
             839      there is no plan document or summary plan description:
             840          (i) the year used to determine deductibles or limits;
             841          (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis;


             842      or
             843          (iii) the employer's taxable year if:
             844          (A) the plan does not impose deductibles or limits on a yearly basis; and
             845          (B) (I) the plan is not insured; or
             846          (II) the insurance policy is not renewed on an annual basis; or
             847          (c) in a case not described in Subsection [(122)] (124)(a) or (b), the calendar year.
             848          [(123)] (125) (a) [(i)] "Policy" means any document, including attached endorsements
             849      and riders, purporting to be an enforceable contract, which memorializes in writing some or all
             850      of the terms of an insurance contract.
             851          [(ii)] (b) "Policy" includes a service contract issued by:
             852          [(A)] (i) a motor club under Chapter 11, Motor Clubs;
             853          [(B)] (ii) a service contract provided under Chapter 6a, Service Contracts; and
             854          [(C)] (iii) a corporation licensed under:
             855          [(I)] (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
             856          [(II)] (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
             857          [(iii)] (c) "Policy" does not include:
             858          [(A)] (i) a certificate under a group insurance contract; or
             859          [(B)] (ii) a document that does not purport to have legal effect.
             860          [(b) (i) "Group insurance policy" means a policy covering a group of persons that is
             861      issued:]
             862          [(A) to a policyholder on behalf of the group; and]
             863          [(B) for the benefit of group members who are selected under procedures defined in:]
             864          [(I) the policy; or]
             865          [(II) agreements which are collateral to the policy.]
             866          [(ii) A group insurance policy may include members of the policyholder's family or
             867      dependents.]
             868          [(c) "Blanket insurance policy" means a group policy covering classes of persons
             869      without individual underwriting, where the persons insured are determined by definition of the


             870      class with or without designating the persons covered.]
             871          [(124)] (126) "Policyholder" means the person who controls a policy, binder, or oral
             872      contract by ownership, premium payment, or otherwise.
             873          [(125)] (127) "Policy illustration" means a presentation or depiction that includes
             874      nonguaranteed elements of a policy of life insurance over a period of years.
             875          [(126)] (128) "Policy summary" means a synopsis describing the elements of a life
             876      insurance policy.
             877          [(127)] (129) "Preexisting condition," with respect to a health benefit plan:
             878          (a) means a condition that was present before the effective date of coverage, whether or
             879      not any medical advice, diagnosis, care, or treatment was recommended or received before that
             880      day; and
             881          (b) does not include a condition indicated by genetic information unless an actual
             882      diagnosis of the condition by a physician has been made.
             883          [(128)] (130) (a) "Premium" means the monetary consideration for an insurance policy.
             884          (b) "Premium" includes, however designated:
             885          (i) assessments;
             886          (ii) membership fees;
             887          (iii) required contributions; or
             888          (iv) monetary consideration.
             889          (c) (i) Consideration paid to third party administrators for their services is not
             890      "premium."
             891          (ii) Amounts paid by third party administrators to insurers for insurance on the risks
             892      administered by the third party administrators are "premium."
             893          [(129)] (131) "Principal officers" of a corporation means the officers designated under
             894      Subsection 31A-5-203 (3).
             895          [(130)] (132) "Proceedings" includes actions and special statutory proceedings.
             896          [(131)] (133) "Professional liability insurance" means insurance against legal liability
             897      incident to the practice of a profession and provision of any professional services.


             898          [(132)] (134) (a) Except as provided in Subsection [(132)] (134)(b), "property
             899      insurance" means insurance against loss or damage to real or personal property of every kind
             900      and any interest in that property:
             901          (i) from all hazards or causes; and
             902          (ii) against loss consequential upon the loss or damage including vehicle
             903      comprehensive and vehicle physical damage coverages.
             904          (b) "Property insurance" does not include:
             905          (i) inland marine insurance as defined in Subsection [(78)] (80); and
             906          (ii) ocean marine insurance as defined under Subsection [(114)] (116).
             907          [(133)] (135) "Qualified long-term care insurance contract" or "federally tax qualified
             908      long-term care insurance contract" means:
             909          (a) an individual or group insurance contract that meets the requirements of Section
             910      7702B(b), Internal Revenue Code; or
             911          (b) the portion of a life insurance contract that provides long-term care insurance:
             912          (i) (A) by rider; or
             913          (B) as a part of the contract; and
             914          (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue
             915      Code.
             916          [(134)] (136) "Qualified United States financial institution" means an institution that:
             917          (a) is:
             918          (i) organized under the laws of the United States or any state; or
             919          (ii) in the case of a United States office of a foreign banking organization, licensed
             920      under the laws of the United States or any state;
             921          (b) is regulated, supervised, and examined by United States federal or state authorities
             922      having regulatory authority over banks and trust companies; and
             923          (c) meets the standards of financial condition and standing that are considered
             924      necessary and appropriate to regulate the quality of financial institutions whose letters of credit
             925      will be acceptable to the commissioner as determined by:


             926          (i) the commissioner by rule; or
             927          (ii) the Securities Valuation Office of the National Association of Insurance
             928      Commissioners.
             929          [(135)] (137) (a) "Rate" means:
             930          (i) the cost of a given unit of insurance; or
             931          (ii) for property-casualty insurance, that cost of insurance per exposure unit either
             932      expressed as:
             933          (A) a single number; or
             934          (B) a pure premium rate, adjusted before any application of individual risk variations
             935      based on loss or expense considerations to account for the treatment of:
             936          (I) expenses;
             937          (II) profit; and
             938          (III) individual insurer variation in loss experience.
             939          (b) "Rate" does not include a minimum premium.
             940          [(136)] (138) (a) Except as provided in Subsection [(136)] (138)(b), "rate service
             941      organization" means any person who assists insurers in rate making or filing by:
             942          (i) collecting, compiling, and furnishing loss or expense statistics;
             943          (ii) recommending, making, or filing rates or supplementary rate information; or
             944          (iii) advising about rate questions, except as an attorney giving legal advice.
             945          (b) "Rate service organization" does not mean:
             946          (i) an employee of an insurer;
             947          (ii) a single insurer or group of insurers under common control;
             948          (iii) a joint underwriting group; or
             949          (iv) a natural person serving as an actuarial or legal consultant.
             950          [(137)] (139) "Rating manual" means any of the following used to determine initial and
             951      renewal policy premiums:
             952          (a) a manual of rates;
             953          (b) classifications;


             954          (c) rate-related underwriting rules; and
             955          (d) rating formulas that describe steps, policies, and procedures for determining initial
             956      and renewal policy premiums.
             957          [(138)] (140) "Received by the department" means:
             958          (a) except as provided in Subsection [(138)] (140)(b), the date delivered to and
             959      stamped received by the department, whether delivered:
             960          (i) in person; or
             961          (ii) electronically; and
             962          (b) if delivered to the department by a delivery service, the delivery service's postmark
             963      date or pick-up date unless otherwise stated in:
             964          (i) statute;
             965          (ii) rule; or
             966          (iii) a specific filing order.
             967          [(139)] (141) "Reciprocal" or "interinsurance exchange" means any unincorporated
             968      association of persons:
             969          (a) operating through an attorney-in-fact common to all of them; and
             970          (b) exchanging insurance contracts with one another that provide insurance coverage
             971      on each other.
             972          [(140)] (142) "Reinsurance" means an insurance transaction where an insurer, for
             973      consideration, transfers any portion of the risk it has assumed to another insurer. In referring to
             974      reinsurance transactions, this title sometimes refers to:
             975          (a) the insurer transferring the risk as the "ceding insurer"; and
             976          (b) the insurer assuming the risk as the:
             977          (i) "assuming insurer"; or
             978          (ii) "assuming reinsurer."
             979          [(141)] (143) "Reinsurer" means any person licensed in this state as an insurer with the
             980      authority to assume reinsurance.
             981          [(142)] (144) "Residential dwelling liability insurance" means insurance against


             982      liability resulting from or incident to the ownership, maintenance, or use of a residential
             983      dwelling that is a detached single family residence or multifamily residence up to four units.
             984          [(143)] (145) "Retrocession" means reinsurance with another insurer of a liability
             985      assumed under a reinsurance contract. A reinsurer "retrocedes" when it reinsures with another
             986      insurer part of a liability assumed under a reinsurance contract.
             987          [(144)] (146) "Rider" means an endorsement to:
             988          (a) an insurance policy; or
             989          (b) an insurance certificate.
             990          [(145)] (147) (a) "Security" means any:
             991          (i) note;
             992          (ii) stock;
             993          (iii) bond;
             994          (iv) debenture;
             995          (v) evidence of indebtedness;
             996          (vi) certificate of interest or participation in any profit-sharing agreement;
             997          (vii) collateral-trust certificate;
             998          (viii) preorganization certificate or subscription;
             999          (ix) transferable share;
             1000          (x) investment contract;
             1001          (xi) voting trust certificate;
             1002          (xii) certificate of deposit for a security;
             1003          (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in
             1004      payments out of production under such a title or lease;
             1005          (xiv) commodity contract or commodity option;
             1006          (xv) certificate of interest or participation in, temporary or interim certificate for, receipt
             1007      for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed in
             1008      Subsections [(145)] (147)(a)(i) through (xiv); or
             1009          (xvi) other interest or instrument commonly known as a security.


             1010          (b) "Security" does not include:
             1011          (i) any of the following under which an insurance company promises to pay money in a
             1012      specific lump sum or periodically for life or some other specified period:
             1013          (A) insurance;
             1014          (B) endowment policy; or
             1015          (C) annuity contract; or
             1016          (ii) a burial certificate or burial contract.
             1017          [(146)] (148) "Self-insurance" means any arrangement under which a person provides
             1018      for spreading its own risks by a systematic plan.
             1019          (a) Except as provided in this Subsection [(146)] (148), "self-insurance" does not
             1020      include an arrangement under which a number of persons spread their risks among themselves.
             1021          (b) "Self-insurance" includes:
             1022          (i) an arrangement by which a governmental entity undertakes to indemnify its
             1023      employees for liability arising out of the employees' employment; and
             1024          (ii) an arrangement by which a person with a managed program of self-insurance and
             1025      risk management undertakes to indemnify its affiliates, subsidiaries, directors, officers, or
             1026      employees for liability or risk which is related to the relationship or employment.
             1027          (c) "Self-insurance" does not include any arrangement with independent contractors.
             1028          [(147)] (149) "Sell" means to exchange a contract of insurance:
             1029          (a) by any means;
             1030          (b) for money or its equivalent; and
             1031          (c) on behalf of an insurance company.
             1032          [(148)] (150) "Short-term care insurance" means any insurance policy or rider
             1033      advertised, marketed, offered, or designed to provide coverage that is similar to long-term care
             1034      insurance but that provides coverage for less than 12 consecutive months for each covered
             1035      person.
             1036          [(149)] (151) "Significant break in coverage" means a period of 63 consecutive days
             1037      during each of which an individual does not have any creditable coverage.


             1038          [(150)] (152) "Small employer," in connection with a health benefit plan, means an
             1039      employer who, with respect to a calendar year and to a plan year:
             1040          (a) employed an average of at least two employees but not more than 50 eligible
             1041      employees on each business day during the preceding calendar year; and
             1042          (b) employs at least two employees on the first day of the plan year.
             1043          [(151)] (153) "Special enrollment period," in connection with a health benefit plan, has
             1044      the same meaning as provided in federal regulations adopted pursuant to the Health Insurance
             1045      Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936.
             1046          [(152)] (154) (a) "Subsidiary" of a person means an affiliate controlled by that person
             1047      either directly or indirectly through one or more affiliates or intermediaries.
             1048          (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting
             1049      shares are owned by that person either alone or with its affiliates, except for the minimum
             1050      number of shares the law of the subsidiary's domicile requires to be owned by directors or
             1051      others.
             1052          [(153)] (155) Subject to Subsection [(80)] (82)(b), "surety insurance" includes:
             1053          (a) a guarantee against loss or damage resulting from failure of principals to pay or
             1054      perform their obligations to a creditor or other obligee;
             1055          (b) bail bond insurance; and
             1056          (c) fidelity insurance.
             1057          [(154)] (156) (a) "Surplus" means the excess of assets over the sum of paid-in capital
             1058      and liabilities.
             1059          (b) (i) "Permanent surplus" means the surplus of a mutual insurer that has been
             1060      designated by the insurer as permanent.
             1061          (ii) Sections 31A-5-211 , 31A-7-201 , 31A-8-209 , 31A-9-209 , and 31A-14-209 require
             1062      that mutuals doing business in this state maintain specified minimum levels of permanent
             1063      surplus.
             1064          (iii) Except for assessable mutuals, the minimum permanent surplus requirement is
             1065      essentially the same as the minimum required capital requirement that applies to stock insurers.


             1066          (c) "Excess surplus" means:
             1067          (i) for life or accident and health insurers, health organizations, and property and
             1068      casualty insurers as defined in Section 31A-17-601 , the lesser of:
             1069          (A) that amount of an insurer's or health organization's total adjusted capital, as defined
             1070      in Subsection [(157)] (159), that exceeds the product of:
             1071          (I) 2.5; and
             1072          (II) the sum of the insurer's or health organization's minimum capital or permanent
             1073      surplus required under Section 31A-5-211 , 31A-9-209 , or 31A-14-205 ; or
             1074          (B) that amount of an insurer's or health organization's total adjusted capital, as defined
             1075      in Subsection [(157)] (159), that exceeds the product of:
             1076          (I) 3.0; and
             1077          (II) the authorized control level RBC as defined in Subsection 31A-17-601 (8)(a); and
             1078          (ii) for monoline mortgage guaranty insurers, financial guaranty insurers, and title
             1079      insurers, that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
             1080          (A) 1.5; and
             1081          (B) the insurer's total adjusted capital required by Subsection 31A-17-609 (1).
             1082          [(155)] (157) "Third party administrator" or "administrator" means any person who
             1083      collects charges or premiums from, or who, for consideration, adjusts or settles claims of
             1084      residents of the state in connection with insurance coverage, annuities, or service insurance
             1085      coverage, except:
             1086          (a) a union on behalf of its members;
             1087          (b) a person administering any:
             1088          (i) pension plan subject to the federal Employee Retirement Income Security Act of
             1089      1974;
             1090          (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
             1091          (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
             1092          (c) an employer on behalf of the employer's employees or the employees of one or
             1093      more of the subsidiary or affiliated corporations of the employer;


             1094          (d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance
             1095      for which the insurer holds a license in this state; or
             1096          (e) a person:
             1097          (i) licensed or exempt from licensing under:
             1098          (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
             1099      Reinsurance Intermediaries; or
             1100          (B) Chapter 26, Insurance Adjusters; and
             1101          (ii) whose activities are limited to those authorized under the license the person holds
             1102      or for which the person is exempt.
             1103          [(156)] (158) "Title insurance" means the insuring, guaranteeing, or indemnifying of
             1104      owners of real or personal property or the holders of liens or encumbrances on that property, or
             1105      others interested in the property against loss or damage suffered by reason of liens or
             1106      encumbrances upon, defects in, or the unmarketability of the title to the property, or invalidity
             1107      or unenforceability of any liens or encumbrances on the property.
             1108          [(157)] (159) "Total adjusted capital" means the sum of an insurer's or health
             1109      organization's statutory capital and surplus as determined in accordance with:
             1110          (a) the statutory accounting applicable to the annual financial statements required to be
             1111      filed under Section 31A-4-113 ; and
             1112          (b) any other items provided by the RBC instructions, as RBC instructions is defined in
             1113      Section 31A-17-601 .
             1114          [(158)] (160) (a) "Trustee" means "director" when referring to the board of directors of
             1115      a corporation.
             1116          (b) "Trustee," when used in reference to an employee welfare fund, means an
             1117      individual, firm, association, organization, joint stock company, or corporation, whether acting
             1118      individually or jointly and whether designated by that name or any other, that is charged with
             1119      or has the overall management of an employee welfare fund.
             1120          [(159)] (161) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted
             1121      insurer" means an insurer:


             1122          (i) not holding a valid certificate of authority to do an insurance business in this state;
             1123      or
             1124          (ii) transacting business not authorized by a valid certificate.
             1125          (b) "Admitted insurer" or "authorized insurer" means an insurer:
             1126          (i) holding a valid certificate of authority to do an insurance business in this state; and
             1127          (ii) transacting business as authorized by a valid certificate.
             1128          [(160)] (162) "Underwrite" means the authority to accept or reject risk on behalf of the
             1129      insurer.
             1130          [(161)] (163) "Vehicle liability insurance" means insurance against liability resulting
             1131      from or incident to ownership, maintenance, or use of any land vehicle or aircraft, exclusive of
             1132      vehicle comprehensive and vehicle physical damage coverages under Subsection [(132)] (134).
             1133          [(162)] (164) "Voting security" means a security with voting rights, and includes any
             1134      security convertible into a security with a voting right associated with the security.
             1135          [(163)] (165) "Waiting period" for a health benefit plan means the period that must
             1136      pass before coverage for an individual, who is otherwise eligible to enroll under the terms of
             1137      the health benefit plan, can become effective.
             1138          [(164)] (166) "Workers' compensation insurance" means:
             1139          (a) insurance for indemnification of employers against liability for compensation based
             1140      on:
             1141          (i) compensable accidental injuries; and
             1142          (ii) occupational disease disability;
             1143          (b) employer's liability insurance incidental to workers' compensation insurance and
             1144      written in connection with workers' compensation insurance; and
             1145          (c) insurance assuring to the persons entitled to workers' compensation benefits the
             1146      compensation provided by law.
             1147          Section 2. Section 31A-2-205 is amended to read:
             1148           31A-2-205. Examination costs.
             1149          (1) (a) Except as provided in Subsection (3), an examinee that is [an insurer, rate


             1150      service organization, or the subsidiary of either] one of the following shall reimburse the
             1151      department for the reasonable costs of examinations made under Sections 31A-2-203 and
             1152      31A-2-204 [.]:
             1153          (i) an insurer;
             1154          (ii) a rate service organization;
             1155          (iii) a subsidiary of an insurer or rate service organization; or
             1156          (iv) a viatical settlement provider.
             1157          (b) The following costs shall be reimbursed under this Subsection (1):
             1158          (i) actual travel expenses;
             1159          (ii) reasonable living expense allowance;
             1160          (iii) compensation at reasonable rates for all professionals reasonably employed for the
             1161      examination under Subsection (4);
             1162          (iv) the administration and supervisory expense of:
             1163          (A) the department; and
             1164          (B) the attorney general's office; and
             1165          (v) an amount necessary to cover fringe benefits authorized by the commissioner or
             1166      provided by law.
             1167          [(b)] (c) In determining rates, the commissioner shall consider the rates recommended
             1168      and outlined in the examination manual sponsored by the National Association of Insurance
             1169      Commissioners.
             1170          [(c)] (d) This Subsection (1) applies to a surplus lines producer to the extent that the
             1171      examinations are of the surplus line producer's surplus lines business.
             1172          (2) An insurer requesting the examination of one of its producers shall pay the cost of
             1173      the examination. Otherwise, the department shall pay the cost of examining a licensee other
             1174      than those specified under Subsection (1).
             1175          (3) (a) On the examinee's request or at the commissioner's discretion, the department
             1176      may pay all or part of the costs of an examination whenever the commissioner finds that
             1177      because of the frequency of examinations or the financial condition of the examinee,


             1178      imposition of the costs would place an unreasonable burden on the examinee.
             1179          (b) The commissioner shall include in the commissioner's annual report information
             1180      about any instance in which the commissioner has applied this Subsection (3).
             1181          (4) (a) A technical expert employed under Subsection 31A-2-203 (3) shall present to the
             1182      commissioner a statement of all expenses incurred by the technical expert in conjunction with
             1183      an examination.
             1184          (b) The examined insurer shall, at the commissioner's direction, pay to [the] a technical
             1185      [experts or specialists the] expert:
             1186          (i) (A) actual travel expenses;
             1187          [(ii)] (B) reasonable living expenses; and
             1188          [(iii)] (C) compensation [at customary rates]; and
             1189          (ii) for expenses necessarily incurred as approved by the commissioner.
             1190          (c) The examined insurer shall reimburse the department for:
             1191          (i) a department [examiners for their] examiner's:
             1192          (A) actual travel expenses; and
             1193          (B) reasonable living expenses; and
             1194          (ii) [the department for] the compensation of department examiners involved in the
             1195      examination.
             1196          (d) (i) The examined insurer shall certify the consolidated account of all charges and
             1197      expenses for the examination.
             1198          (ii) The examined insurer shall:
             1199          (A) retain a copy of the consolidated account; and
             1200          (B) file a copy of the consolidated account with the department as a public record.
             1201          (e) An annual report of examination charges paid by examined insurers directly to
             1202      persons employed under Subsection 31A-2-203 (3) or to department examiners shall be
             1203      included with the department's budget request.
             1204          (f) Amounts paid directly by examined insurers to persons employed under Subsection
             1205      31A-2-203 (3) or to department examiners may not be deducted from the department's


             1206      appropriation.
             1207          (5) (a) The amount payable under Subsection (1) is due ten days after the day on which
             1208      the examinee [has been] is served with a detailed account of the costs.
             1209          (b) Payments received by the department under this Subsection (5) shall be handled as
             1210      provided by Section 31A-3-101 .
             1211          (6) (a) The commissioner may require an examinee under Subsection (1), or an insurer
             1212      requesting an examination under Subsection (2), either before or during an examination, to
             1213      make deposits with the state treasurer to pay the costs of examination.
             1214          (b) Any deposit made under this Subsection (6) shall be held in trust by the state
             1215      treasurer until applied to pay the department the costs payable under this section.
             1216          (c) If a deposit made under this Subsection (6) exceeds examination costs, the state
             1217      treasurer shall refund the surplus.
             1218          (7) A domestic insurer may offset the examination expenses paid under this section
             1219      against premium taxes under Subsection 59-9-102 (2).
             1220          Section 3. Section 31A-5-416 is amended to read:
             1221           31A-5-416. Compensation of director, officer, employee, person with investment
             1222      authority, or others.
             1223          (1) Subject to this section, [Section 16-10a-302 , except Subsection 16-10a-302 (13),
             1224      applies to stock and mutual corporations.] Subsections 16-10a-302 (11) and (12) apply to:
             1225          (a) a stock corporation; and
             1226          (b) a mutual corporation.
             1227          (2) Shareholders' approval is required:
             1228          (a) of any benefit or payment to a director or officer for services rendered to a stock
             1229      corporation more than 90 days before the agreement or decision to give the benefit or make the
             1230      payment, unless the benefit or payment is made under a plan approved by the shareholders[.
             1231      Shareholder approval is also required]; and
             1232          (b) for a new pension plan, profit-sharing plan, stock option plan, or an amendment to
             1233      an existing plan which, so far as it pertains to any director or officer, substantially increases the


             1234      financial burden on the stock corporation.
             1235          (3) An action taken by the board of a mutual on the compensation of officers, directors,
             1236      or employees, other than setting individual salaries or standards for salaries of classes of
             1237      employees, shall be reported to the commissioner within 30 days.
             1238          (4) The annual [report to the commissioner] statement of a stock or mutual corporation
             1239      shall include the amount of all direct and indirect remuneration for services, including
             1240      retirement and other deferred compensation benefits and stock options[,] paid [or accrued] each
             1241      year:
             1242          (a) for the benefit of each [director, each officer, and employee] of the following whose
             1243      remuneration exceeds an amount established by the commissioner by rule[;]:
             1244          (i) a director;
             1245          (ii) an officer; or
             1246          (iii) an employee;
             1247          (b) for all directors and officers as a group; and
             1248          (c) (i) for the five most highly compensated officers[,];
             1249          (ii) for the five most highly compensated directors[,]; and
             1250          (iii) for the five most highly compensated employees.
             1251          (5) [No] An arrangement for compensation or other employment benefits for any
             1252      director, officer, or employee with decision-making power may not be made if it would:
             1253          (a) measure the compensation or other benefits in whole or in part by any criteria that
             1254      would create a financial inducement to act contrary to the best interests of the stock or mutual
             1255      corporation; or
             1256          (b) have a tendency to make the stock or mutual corporation depend for continuance or
             1257      soundness of operation upon the continuation of any director, officer, or employee in [his] the
             1258      position of director, officer, or employee.
             1259          (6) Except for the insurer, [no] a person having any authority in the investment or
             1260      disposition of the funds of a domestic insurer may not:
             1261          (a) accept any fee, brokerage, gift, or other emolument because of any investment,


             1262      loan, deposit, purchase, sale, payment, or exchange made by or for the insurer[, nor may that
             1263      person]; or
             1264          (b) be financially interested in the investment or disposition of funds in any capacity.
             1265          (7) Unless the commissioner, acting in the corporation's best interests, orders
             1266      otherwise, if an order of rehabilitation or liquidation is issued under Section 31A-27-303 or
             1267      Section 31A-27-310 , the contractual obligations of the insurer for unperformed services of any
             1268      director, principal officer, or person performing similar functions or having similar powers are
             1269      terminated. This Subsection (7) does not apply to obligations vested before July 1, 1986.
             1270          Section 4. Section 31A-21-104 is amended to read:
             1271           31A-21-104. Insurable interest and consent.
             1272          (1) (a) An insurer may not knowingly provide insurance to a person who does not have
             1273      or expect to have an insurable interest in the subject of the insurance.
             1274          (b) A person may not knowingly procure, directly, by assignment, or otherwise, an
             1275      interest in the proceeds of an insurance policy unless that person has or expects to have an
             1276      insurable interest in the subject of the insurance.
             1277          (c) Except as provided in Subsections (6), (7), and (8), any insurance provided in
             1278      violation of this Subsection (1) is subject to Subsection (5).
             1279          (2) As used in this chapter:
             1280          (a) (i) "Insurable interest" in a person means:
             1281          (A) for persons closely related by blood or by law, a substantial interest engendered by
             1282      love and affection; or
             1283          (B) in the case of other persons, a lawful and substantial interest in having the life,
             1284      health, and bodily safety of the person insured continue.
             1285          (ii) Policyholders in group insurance contracts do not need an insurable interest if
             1286      certificate holders or persons other than group policyholders who are specified by the
             1287      certificate holders are the recipients of the proceeds of the policies.
             1288          (iii) Each person has an unlimited insurable interest in the person's own life and health.
             1289          (iv) A shareholder or partner has an insurable interest in the life of other shareholders


             1290      or partners for purposes of insurance contracts that are an integral part of a legitimate buy-sell
             1291      agreement respecting shares or a partnership interest in the business.
             1292          (v) Subject to Subsection (9), an employer or an employer sponsored trust for the
             1293      benefit of the employer's employees:
             1294          (A) has an insurable interest in the lives of the employer's:
             1295          (I) directors;
             1296          (II) officers;
             1297          (III) managers;
             1298          (IV) nonmanagement employees; and
             1299          (V) retired employees; and
             1300          (B) may insure the lives listed in Subsection (2)(a)(v)(A):
             1301          (I) on an individual or group basis; and
             1302          (II) with the written consent of the insured.
             1303          (b) "Insurable interest" in property or liability means any lawful and substantial
             1304      economic interest in the nonoccurrence of the event insured against.
             1305          (c) "Viatical settlement" is as defined in Section 31A-36-102 .
             1306          (3) (a) Except as provided in Subsection (4), an insurer may not knowingly issue an
             1307      individual life or accident and health insurance policy to a person other than the one whose life
             1308      or health is at risk unless that person, who is 18 years of age or older and not under
             1309      guardianship under Title 75, Chapter 5, Protection of Persons Under Disability and Their
             1310      Property, has given written consent to the issuance of the policy.
             1311          (b) A person shall express consent:
             1312          (i) by signing an application for the insurance with knowledge of the nature of the
             1313      document; or
             1314          (ii) in any other reasonable way.
             1315          (c) Any insurance provided in violation of this Subsection (3) is subject to Subsection
             1316      (5).
             1317          (4) (a) A life or accident and health insurance policy may be taken out without consent


             1318      in a circumstance described in this Subsection (4)(a).
             1319          (i) A person may obtain insurance on a dependent who does not have legal capacity.
             1320          (ii) A creditor may, at the creditor's expense, obtain insurance on the debtor in an
             1321      amount reasonably related to the amount of the debt.
             1322          (iii) A person may obtain life and accident and health insurance on an immediate
             1323      family member who is living with or dependent on the person.
             1324          (iv) A person may obtain an accident and health insurance policy on others that would
             1325      merely indemnify the policyholder against expenses the person would be legally or morally
             1326      obligated to pay.
             1327          (v) The commissioner may adopt rules permitting issuance of insurance for a limited
             1328      term on the life or health of a person serving outside the continental United States who is in the
             1329      public service of the United States, if the policyholder is related within the second degree by
             1330      blood or by marriage to the person whose life or health is insured.
             1331          (b) Consent may be given by another in a circumstance described in this Subsection
             1332      (4)(b).
             1333          (i) A parent, a person having legal custody of a minor, or a guardian of a person under
             1334      Title 75, Chapter 5, Protection of Persons Under Disability and Their Property, may consent to
             1335      the issuance of a policy on a dependent child or on a person under guardianship under Title 75,
             1336      Chapter 5, Protection of Persons Under Disability and Their Property.
             1337          (ii) A grandparent may consent to the issuance of life or accident and health insurance
             1338      on a grandchild.
             1339          (iii) A court of general jurisdiction may give consent to the issuance of a life or
             1340      accident and health insurance policy on an ex parte application showing facts the court
             1341      considers sufficient to justify the issuance of that insurance.
             1342          (5) (a) An insurance policy is not invalid because the policyholder lacks insurable
             1343      interest or because consent has not been given.
             1344          (b) Notwithstanding Subsection (5)(a), a court with appropriate jurisdiction may:
             1345          (i) order the proceeds to be paid to some person who is equitably entitled to the


             1346      proceeds, other than the one to whom the policy is designated to be payable; or
             1347          (ii) create a constructive trust in the proceeds or a part of the proceeds on behalf of
             1348      such a person, subject to all the valid terms and conditions of the policy other than those
             1349      relating to insurable interest or consent.
             1350          (6) This section does not prevent any organization described under 26 U.S.C. Sec.
             1351      501(c)(3), (e), or (f), as amended, and the regulations made under this section, and which is
             1352      regulated under Title 13, Chapter 22, Charitable Solicitations Act, from soliciting and
             1353      procuring, by assignment or designation as beneficiary, a gift or assignment of an interest in
             1354      life insurance on the life of the donor or assignor or from enforcing payment of proceeds from
             1355      that interest.
             1356          (7) An insurance policy transferred pursuant to Chapter 36, Viatical Settlements Act, is
             1357      not subject to Subsection (5)(b) and nothing else in this section shall prevent:
             1358          (a) any policyholder of life insurance, whether or not the policyholder is also the
             1359      subject of the insurance, from entering into a viatical settlement;
             1360          (b) any person from soliciting a person to enter into a viatical settlement;
             1361          (c) a person from enforcing payment of proceeds from the interest obtained under a
             1362      viatical settlement; or
             1363          (d) a viatical settlement provider [of viatical settlements], a viatical settlement
             1364      purchaser [of a viatical settlement], a financing entity, a related provider trust, or a special
             1365      purpose entity from executing any of the following with respect to the death benefit or
             1366      ownership of any portion of a viaticated policy as provided for in Section 31A-36-109 :
             1367          (i) an assignment;
             1368          (ii) a sale;
             1369          (iii) a transfer;
             1370          (iv) a devise; or
             1371          (v) a bequest.
             1372          (8) Notwithstanding Subsection (1), an insurer authorized under this title to issue a
             1373      workers' compensation policy may issue a workers' compensation policy to a sole


             1374      proprietorship, corporation, or partnership that elects not to include any owner, corporate
             1375      officer, or partner as an employee under the policy even if at the time the policy is issued the
             1376      sole proprietorship, corporation, or partnership has no employees.
             1377          (9) The extent of an employer's or employer sponsored trust's insurable interest for a
             1378      nonmanagement and retired employee under Subsection (2)(a)(v) is limited to an amount
             1379      commensurate with the employer's unfunded liabilities.
             1380          Section 5. Section 31A-21-503 is amended to read:
             1381           31A-21-503. Discrimination based on domestic violence or child abuse
             1382      prohibited.
             1383          (1) Except as provided in Subsection (2), an insurer of life or accident and health
             1384      insurance may not consider whether an insured or applicant is the subject of domestic abuse as
             1385      a factor to:
             1386          (a) refuse to insure the applicant;
             1387          (b) refuse to continue to insure the insured;
             1388          (c) refuse to renew or reissue a policy to insure the insured or applicant;
             1389          (d) limit the amount, extent, or kind of coverage available to the insured or applicant;
             1390          (e) charge a different rate for coverage to the insured or applicant;
             1391          (f) exclude or limit benefits or coverage under an insurance policy or contract for
             1392      losses incurred;
             1393          (g) deny a claim; or
             1394          (h) terminate coverage or fail to provide conversion privileges in violation of Sections
             1395      31A-22-612 and [ 31A-22-710 ] 31A-22-723 under a group accident and health policy for the
             1396      insured because the coverage was issued in the name of the perpetrator of the domestic
             1397      violence or abuse.
             1398          (2) (a) Notwithstanding Subsection (1), an insurer may underwrite [based] on the basis
             1399      of the physical or mental condition of an insured or applicant if the underwriting is [based] on
             1400      the basis of a determination that there is a correlation between the medical or mental condition
             1401      and a material increase in insurance risk.


             1402          (b) For purposes of Subsection (2)(a), the fact that an insured or applicant is a subject
             1403      of domestic abuse is not a mental or physical condition.
             1404          (c) The determination required by Subsection (2)(a) shall be made in conformance with
             1405      sound actuarial principles.
             1406          (d) Within 30 days after receiving an oral or written request from an insured or
             1407      applicant, an insurer shall disclose in writing:
             1408          (i) the basis of an action permitted under Subsection (2)(a); and
             1409          (ii) if the policy has been issued or modified, the extent the action taken will impact the
             1410      amount, extent, or kind of coverage or benefits available to the insured.
             1411          Section 6. Section 31A-22-305 is amended to read:
             1412           31A-22-305. Uninsured motorist coverage.
             1413          (1) As used in this section, "covered persons" includes:
             1414          (a) the named insured;
             1415          (b) persons related to the named insured by blood, marriage, adoption, or guardianship,
             1416      who are residents of the named insured's household, including those who usually make their
             1417      home in the same household but temporarily live elsewhere;
             1418          (c) any person occupying or using a motor vehicle:
             1419          (i) referred to in the policy; or
             1420          (ii) owned by a self-insured; and
             1421          (d) any person who is entitled to recover damages against the owner or operator of the
             1422      uninsured or underinsured motor vehicle because of bodily injury to or death of persons under
             1423      Subsection (1)(a), (b), or (c).
             1424          (2) As used in this section, "uninsured motor vehicle" includes:
             1425          (a) (i) a motor vehicle, the operation, maintenance, or use of which is not covered
             1426      under a liability policy at the time of an injury-causing occurrence; or
             1427          (ii) (A) a motor vehicle covered with lower liability limits than required by Section
             1428      31A-22-304 ; and
             1429          (B) the motor vehicle described in Subsection (2)(a)(ii)(A) is uninsured to the extent of


             1430      the deficiency;
             1431          (b) an unidentified motor vehicle that left the scene of an accident proximately caused
             1432      by the motor vehicle operator;
             1433          (c) a motor vehicle covered by a liability policy, but coverage for an accident is
             1434      disputed by the liability insurer for more than 60 days or continues to be disputed for more than
             1435      60 days; or
             1436          (d) (i) an insured motor vehicle if, before or after the accident, the liability insurer of
             1437      the motor vehicle is declared insolvent by a court of competent jurisdiction; and
             1438          (ii) the motor vehicle described in Subsection (2)(d)(i) is uninsured only to the extent
             1439      that the claim against the insolvent insurer is not paid by a guaranty association or fund.
             1440          (3) (a) Uninsured motorist coverage under Subsection 31A-22-302 (1)(b) provides
             1441      coverage for covered persons who are legally entitled to recover damages from owners or
             1442      operators of uninsured motor vehicles because of bodily injury, sickness, disease, or death.
             1443          (b) For new policies written on or after January 1, 2001, the limits of uninsured
             1444      motorist coverage shall be equal to the lesser of the limits of the insured's motor vehicle
             1445      liability coverage or the maximum uninsured motorist coverage limits available by the insurer
             1446      under the insured's motor vehicle policy, unless the insured purchases coverage in a lesser
             1447      amount by signing an acknowledgment form that:
             1448          (i) is filed with the department;
             1449          (ii) is provided by the insurer [that:];
             1450          [(i)] (iii) waives the higher coverage;
             1451          [(ii)] (iv) reasonably explains the purpose of uninsured motorist coverage; and
             1452          [(iii)] (v) discloses the additional premiums required to purchase uninsured motorist
             1453      coverage with limits equal to the lesser of the limits of the insured's motor vehicle liability
             1454      coverage or the maximum uninsured motorist coverage limits available by the insurer under the
             1455      insured's motor vehicle policy.
             1456          (c) A self-insured, including a governmental entity, may elect to provide uninsured
             1457      motorist coverage in an amount that is less than its maximum self-insured retention under


             1458      Subsections (3)(b) and (4)(a) by issuing a declaratory memorandum or policy statement from
             1459      the chief financial officer or chief risk officer that declares the:
             1460          (i) self-insured entity's coverage level; and
             1461          (ii) process for filing an uninsured motorist claim.
             1462          (d) Uninsured motorist coverage may not be sold with limits that are less than the
             1463      minimum bodily injury limits for motor vehicle liability policies under Section 31A-22-304 .
             1464          (e) The acknowledgment under Subsection (3)(b) continues for that issuer of the
             1465      uninsured motorist coverage until the insured, in writing, requests different uninsured motorist
             1466      coverage from the insurer.
             1467          (f) (i) In conjunction with the first two renewal notices sent after January 1, 2001, for
             1468      policies existing on that date, the insurer shall disclose in the same medium as the premium
             1469      renewal notice, an explanation of:
             1470          (A) the purpose of uninsured motorist coverage; and
             1471          (B) the costs associated with increasing the coverage in amounts up to and including
             1472      the maximum amount available by the insurer under the insured's motor vehicle policy.
             1473          (ii) The disclosure required under this Subsection (3)(f) shall be sent to all insureds that
             1474      carry uninsured motorist coverage limits in an amount less than the insured's motor vehicle
             1475      liability policy limits or the maximum uninsured motorist coverage limits available by the
             1476      insurer under the insured's motor vehicle policy.
             1477          (4) (a) (i) Except as provided in Subsection (4)(b), the named insured may reject
             1478      uninsured motorist coverage by an express writing to the insurer that provides liability
             1479      coverage under Subsection 31A-22-302 (1)(a).
             1480          (ii) This rejection shall be on a form provided by the insurer that includes a reasonable
             1481      explanation of the purpose of uninsured motorist coverage.
             1482          (iii) This rejection continues for that issuer of the liability coverage until the insured in
             1483      writing requests uninsured motorist coverage from that liability insurer.
             1484          (b) (i) All persons, including governmental entities, that are engaged in the business of,
             1485      or that accept payment for, transporting natural persons by motor vehicle, and all school


             1486      districts that provide transportation services for their students, shall provide coverage for all
             1487      motor vehicles used for that purpose, by purchase of a policy of insurance or by self-insurance,
             1488      uninsured motorist coverage of at least $25,000 per person and $500,000 per accident.
             1489          (ii) This coverage is secondary to any other insurance covering an injured covered
             1490      person.
             1491          (c) Uninsured motorist coverage:
             1492          (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
             1493      Compensation Act;
             1494          (ii) may not be subrogated by the workers' compensation insurance carrier;
             1495          (iii) may not be reduced by any benefits provided by workers' compensation insurance;
             1496          (iv) may be reduced by health insurance subrogation only after the covered person has
             1497      been made whole;
             1498          (v) may not be collected for bodily injury or death sustained by a person:
             1499          (A) while committing a violation of Section 41-1a-1314 ;
             1500          (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
             1501      in violation of Section 41-1a-1314 ; or
             1502          (C) while committing a felony; and
             1503          (vi) notwithstanding Subsection (4)(c)(v), may be recovered:
             1504          (A) for a person under 18 years of age who is injured within the scope of Subsection
             1505      (4)(c)(v) but limited to medical and funeral expenses; or
             1506          (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
             1507      within the course and scope of the law enforcement officer's duties.
             1508          (d) As used in this Subsection (4), "motor vehicle" has the same meaning as under
             1509      Section 41-1a-102 .
             1510          (5) When a covered person alleges that an uninsured motor vehicle under Subsection
             1511      (2)(b) proximately caused an accident without touching the covered person or the motor
             1512      vehicle occupied by the covered person, the covered person must show the existence of the
             1513      uninsured motor vehicle by clear and convincing evidence consisting of more than the covered


             1514      person's testimony.
             1515          (6) (a) The limit of liability for uninsured motorist coverage for two or more motor
             1516      vehicles may not be added together, combined, or stacked to determine the limit of insurance
             1517      coverage available to an injured person for any one accident.
             1518          (b) (i) Subsection (6)(a) applies to all persons except a covered person as defined under
             1519      Subsection (7)(b)(ii).
             1520          (ii) A covered person as defined under Subsection (7)(b)(ii) is entitled to the highest
             1521      limits of uninsured motorist coverage afforded for any one motor vehicle that the covered
             1522      person is the named insured or an insured family member.
             1523          (iii) This coverage shall be in addition to the coverage on the motor vehicle the covered
             1524      person is occupying.
             1525          (iv) Neither the primary nor the secondary coverage may be set off against the other.
             1526          (c) Coverage on a motor vehicle occupied at the time of an accident shall be primary
             1527      coverage, and the coverage elected by a person described under Subsections (1)(a) and (b) shall
             1528      be secondary coverage.
             1529          (7) (a) Uninsured motorist coverage under this section applies to bodily injury,
             1530      sickness, disease, or death of covered persons while occupying or using a motor vehicle only if
             1531      the motor vehicle is described in the policy under which a claim is made, or if the motor
             1532      vehicle is a newly acquired or replacement motor vehicle covered under the terms of the policy.
             1533      Except as provided in Subsection (6) or this Subsection (7), a covered person injured in a
             1534      motor vehicle described in a policy that includes uninsured motorist benefits may not elect to
             1535      collect uninsured motorist coverage benefits from any other motor vehicle insurance policy
             1536      under which the person is a covered person.
             1537          (b) Each of the following persons may also recover uninsured motorist benefits under
             1538      any one other policy in which they are described as a "covered person" as defined in Subsection
             1539      (1):
             1540          (i) a covered person injured as a pedestrian by an uninsured motor vehicle; and
             1541          (ii) except as provided in Subsection (7)(c), a covered person injured while occupying


             1542      or using a motor vehicle that is not owned, leased, or furnished:
             1543          (A) to the covered person;
             1544          (B) to the covered person's spouse; or
             1545          (C) to the covered person's resident parent or resident sibling.
             1546          (c) (i) A covered person may recover benefits from no more than two additional
             1547      policies, one additional policy from each parent's household if the covered person is:
             1548          (A) a dependent minor of parents who reside in separate households; and
             1549          (B) injured while occupying or using a motor vehicle that is not owned, leased, or
             1550      furnished:
             1551          (I) to the covered person;
             1552          (II) to the covered person's resident parent; or
             1553          (III) to the covered person's resident sibling.
             1554          (ii) Each parent's policy under this Subsection (7)(c) is liable only for the percentage of
             1555      the damages that the limit of liability of each parent's policy of uninsured motorist coverage
             1556      bears to the total of both parents' uninsured coverage applicable to the accident.
             1557          (d) A covered person's recovery under any available policies may not exceed the full
             1558      amount of damages.
             1559          (e) A covered person in Subsection (7)(b) is not barred against making subsequent
             1560      elections if recovery is unavailable under previous elections.
             1561          (f) (i) As used in this section, "interpolicy stacking" means recovering benefits for a
             1562      single incident of loss under more than one insurance policy.
             1563          (ii) Except to the extent permitted by Subsection (6) and this Subsection (7),
             1564      interpolicy stacking is prohibited for uninsured motorist coverage.
             1565          (8) (a) When a claim is brought by a named insured or a person described in
             1566      Subsection (1) and is asserted against the covered person's uninsured motorist carrier, the
             1567      claimant may elect to resolve the claim:
             1568          (i) by submitting the claim to binding arbitration; or
             1569          (ii) through litigation.


             1570          (b) Unless otherwise provided in the policy under which uninsured benefits are
             1571      claimed, the election provided in Subsection (8)(a) is available to the claimant only.
             1572          (c) Once the claimant has elected to commence litigation under Subsection (8)(a)(ii),
             1573      the claimant may not elect to resolve the claim through binding arbitration under this section
             1574      without the written consent of the uninsured motorist carrier.
             1575          (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
             1576      binding arbitration under Subsection (8)(a)(i) shall be resolved by a single arbitrator.
             1577          (ii) All parties shall agree on the single arbitrator selected under Subsection (8)(d)(i).
             1578          (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
             1579      (8)(d)(ii), the parties shall select a panel of three arbitrators.
             1580          (e) If the parties select a panel of three arbitrators under Subsection (8)(d)(iii):
             1581          (i) each side shall select one arbitrator; and
             1582          (ii) the arbitrators appointed under Subsection (8)(e)(i) shall select one additional
             1583      arbitrator to be included in the panel.
             1584          (f) Unless otherwise agreed to in writing:
             1585          (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
             1586      under Subsection (8)(d)(i); or
             1587          (ii) if an arbitration panel is selected under Subsection (8)(d)(iii):
             1588          (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
             1589          (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
             1590      under Subsection (8)(e)(ii).
             1591          (g) Except as otherwise provided in this section or unless otherwise agreed to in
             1592      writing by the parties, an arbitration proceeding conducted under this section shall be governed
             1593      by Title 78, Chapter 31a, Utah Uniform Arbitration Act.
             1594          (h) The arbitration shall be conducted in accordance with Rules 26 through 37, 54, and
             1595      68 of the Utah Rules of Civil Procedure.
             1596          (i) All issues of discovery shall be resolved by the arbitrator or the arbitration panel.
             1597          (j) A written decision by a single arbitrator or by a majority of the arbitration panel


             1598      shall constitute a final decision.
             1599          (k) (i) The amount of an arbitration award may not exceed the uninsured motorist
             1600      policy limits of all applicable uninsured motorist policies, including applicable uninsured
             1601      motorist umbrella policies.
             1602          (ii) If the initial arbitration award exceeds the uninsured motorist policy limits of all
             1603      applicable uninsured motorist policies, the arbitration award shall be reduced to an amount
             1604      equal to the combined uninsured motorist policy limits of all applicable uninsured motorist
             1605      policies.
             1606          (l) The arbitrator or arbitration panel may not decide the issues of coverage or
             1607      extra-contractual damages, including:
             1608          (i) whether the claimant is a covered person;
             1609          (ii) whether the policy extends coverage to the loss; or
             1610          (iii) any allegations or claims asserting consequential damages or bad faith liability.
             1611          (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
             1612      class-representative basis.
             1613          (n) If the arbitrator or arbitration panel finds that the action was not brought, pursued,
             1614      or defended in good faith, the arbitrator or arbitration panel may award reasonable attorney fees
             1615      and costs against the party that failed to bring, pursue, or defend the claim in good faith.
             1616          (o) An arbitration award issued under this section shall be the final resolution of all
             1617      claims not excluded by Subsection (8)(l) between the parties unless:
             1618          (i) the award was procured by corruption, fraud, or other undue means; or
             1619          (ii) either party, within 20 days after service of the arbitration award:
             1620          (A) files a complaint requesting a trial de novo in the district court; and
             1621          (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
             1622      under Subsection (8)(o)(ii)(A).
             1623          (p) (i) Upon filing a complaint for a trial de novo under Subsection (8)(o), the claim
             1624      shall proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules
             1625      of Evidence in the district court.


             1626          (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
             1627      request a jury trial with a complaint requesting a trial de novo under Subsection (8)(o)(ii)(A).
             1628          (q) (i) If the claimant, as the moving party in a trial de novo requested under
             1629      Subsection (8)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater
             1630      than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
             1631          (ii) If the uninsured motorist carrier, as the moving party in a trial de novo requested
             1632      under Subsection (8)(o), does not obtain a verdict that is at least 20% less than the arbitration
             1633      award, the uninsured motorist carrier is responsible for all of the nonmoving party's costs.
             1634          (iii) Except as provided in Subsection (8)(q)(iv), the costs under this Subsection (8)(q)
             1635      shall include:
             1636          (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
             1637          (B) the costs of expert witnesses and depositions.
             1638          (iv) An award of costs under this Subsection (8)(q) may not exceed $2,500.
             1639          (r) For purposes of determining whether a party's verdict is greater or less than the
             1640      arbitration award under Subsection (8)(q), a court may not consider any recovery or other relief
             1641      granted on a claim for damages if the claim for damages:
             1642          (i) was not fully disclosed in writing prior to the arbitration proceeding; or
             1643          (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil
             1644      Procedure.
             1645          (s) If a district court determines, upon a motion of the nonmoving party, that the
             1646      moving party's use of the trial de novo process was filed in bad faith in accordance with
             1647      Section 78-27-56 , the district court may award reasonable attorney fees to the nonmoving
             1648      party.
             1649          (t) Nothing in this section is intended to limit any claim under any other portion of an
             1650      applicable insurance policy.
             1651          (u) If there are multiple uninsured motorist policies, as set forth in Subsection (7), the
             1652      claimant may elect to arbitrate in one hearing the claims against all the uninsured motorist
             1653      carriers.


             1654          Section 7. Section 31A-22-305.3 is amended to read:
             1655           31A-22-305.3. Underinsured motorist coverage.
             1656          (1) As used in this section:
             1657          (a) "Covered person" has the same meaning as defined in Section 31A-22-305 .
             1658          (b) (i) "Underinsured motor vehicle" includes a motor vehicle, the operation,
             1659      maintenance, or use of which is covered under a liability policy at the time of an injury-causing
             1660      occurrence, but which has insufficient liability coverage to compensate fully the injured party
             1661      for all special and general damages.
             1662          (ii) The term "underinsured motor vehicle" does not include:
             1663          (A) a motor vehicle that is covered under the liability coverage of the same policy that
             1664      also contains the underinsured motorist coverage;
             1665          (B) an uninsured motor vehicle as defined in Subsection 31A-22-305 (2); or
             1666          (C) a motor vehicle owned or leased by:
             1667          (I) the named insured;
             1668          (II) the named insured's spouse; or
             1669          (III) any dependent of the named insured.
             1670          (2) (a) (i) Underinsured motorist coverage under Subsection 31A-22-302 (1)(c)
             1671      provides coverage for covered persons who are legally entitled to recover damages from
             1672      owners or operators of underinsured motor vehicles because of bodily injury, sickness, disease,
             1673      or death.
             1674          (ii) A covered person occupying or using a motor vehicle owned, leased, or furnished
             1675      to the covered person, the covered person's spouse, or covered person's resident relative may
             1676      recover underinsured benefits only if the motor vehicle is:
             1677          (A) described in the policy under which a claim is made; or
             1678          (B) a newly acquired or replacement motor vehicle covered under the terms of the
             1679      policy.
             1680          (b) For new policies written on or after January 1, 2001, the limits of underinsured
             1681      motorist coverage shall be equal to the lesser of the limits of the insured's motor vehicle


             1682      liability coverage or the maximum underinsured motorist coverage limits available by the
             1683      insurer under the insured's motor vehicle policy, unless the insured purchases coverage in a
             1684      lesser amount by signing an acknowledgment form that:
             1685          (i) is filed with the department;
             1686          (ii) is provided by the insurer [that:];
             1687          [(i)] (iii) waives the higher coverage;
             1688          [(ii)] (iv) reasonably explains the purpose of underinsured motorist coverage; and
             1689          [(iii)] (v) discloses the additional premiums required to purchase underinsured motorist
             1690      coverage with limits equal to the lesser of the limits of the insured's motor vehicle liability
             1691      coverage or the maximum underinsured motorist coverage limits available by the insurer under
             1692      the insured's motor vehicle policy.
             1693          (c) A self-insured, including a governmental entity, may elect to provide underinsured
             1694      motorist coverage in an amount that is less than its maximum self-insured retention under
             1695      Subsections (2)(b) and (2)(g) by issuing a declaratory memorandum or policy statement from
             1696      the chief financial officer or chief risk officer that declares the:
             1697          (i) self-insured entity's coverage level; and
             1698          (ii) process for filing an underinsured motorist claim.
             1699          (d) Underinsured motorist coverage may not be sold with limits that are less than:
             1700          (i) $10,000 for one person in any one accident; and
             1701          (ii) at least $20,000 for two or more persons in any one accident.
             1702          (e) The acknowledgment under Subsection (2)(b) continues for that issuer of the
             1703      underinsured motorist coverage until the insured, in writing, requests different underinsured
             1704      motorist coverage from the insurer.
             1705          (f) (i) The named insured's underinsured motorist coverage, as described in Subsection
             1706      (2)(a), is secondary to the liability coverage of an owner or operator of an underinsured motor
             1707      vehicle, as described in Subsection (1).
             1708          (ii) Underinsured motorist coverage may not be set off against the liability coverage of
             1709      the owner or operator of an underinsured motor vehicle, but shall be added to, combined with,


             1710      or stacked upon the liability coverage of the owner or operator of the underinsured motor
             1711      vehicle to determine the limit of coverage available to the injured person.
             1712          (g) (i) A named insured may reject underinsured motorist coverage by an express
             1713      writing to the insurer that provides liability coverage under Subsection 31A-22-302 (1)(a).
             1714          (ii) This written rejection shall be on a form provided by the insurer that includes a
             1715      reasonable explanation of the purpose of underinsured motorist coverage and when it would be
             1716      applicable.
             1717          (iii) This rejection continues for that issuer of the liability coverage until the insured in
             1718      writing requests underinsured motorist coverage from that liability insurer.
             1719          (h) (i) In conjunction with the first two renewal notices sent after January 1, 2001, for
             1720      policies existing on that date, the insurer shall disclose in the same medium as the premium
             1721      renewal notice, an explanation of:
             1722          (A) the purpose of underinsured motorist coverage; and
             1723          (B) the costs associated with increasing the coverage in amounts up to and including
             1724      the maximum amount available by the insurer under the insured's motor vehicle policy.
             1725          (ii) The disclosure required by this Subsection (2)(h) shall be sent to all insureds that
             1726      carry underinsured motorist coverage limits in an amount less than the insured's motor vehicle
             1727      liability policy limits or the maximum underinsured motorist coverage limits available by the
             1728      insurer under the insured's motor vehicle policy.
             1729          (3) (a) (i) Except as provided in this Subsection (3), a covered person injured in a
             1730      motor vehicle described in a policy that includes underinsured motorist benefits may not elect
             1731      to collect underinsured motorist coverage benefits from any other motor vehicle insurance
             1732      policy.
             1733          (ii) The limit of liability for underinsured motorist coverage for two or more motor
             1734      vehicles may not be added together, combined, or stacked to determine the limit of insurance
             1735      coverage available to an injured person for any one accident.
             1736          (iii) Subsection (3)(a)(ii) applies to all persons except a covered person described
             1737      under Subsections (3)(b)(i) and (ii).


             1738          (b) (i) Except as provided in Subsection (3)(b)(ii), a covered person injured while
             1739      occupying, using, or maintaining a motor vehicle that is not owned, leased, or furnished to the
             1740      covered person, the covered person's spouse, or the covered person's resident parent or resident
             1741      sibling, may also recover benefits under any one other policy under which they are a covered
             1742      person.
             1743          (ii) (A) A covered person may recover benefits from no more than two additional
             1744      policies, one additional policy from each parent's household if the covered person is:
             1745          (I) a dependent minor of parents who reside in separate households; and
             1746          (II) injured while occupying or using a motor vehicle that is not owned, leased, or
             1747      furnished to the covered person, the covered person's resident parent, or the covered person's
             1748      resident sibling.
             1749          (B) Each parent's policy under this Subsection (3)(b)(ii) is liable only for the
             1750      percentage of the damages that the limit of liability of each parent's policy of underinsured
             1751      motorist coverage bears to the total of both parents' underinsured coverage applicable to the
             1752      accident.
             1753          (iii) A covered person's recovery under any available policies may not exceed the full
             1754      amount of damages.
             1755          (iv) Underinsured coverage on a motor vehicle occupied at the time of an accident shall
             1756      be primary coverage, and the coverage elected by a person described under Subsections
             1757      31A-22-305 (1)(a) and (b) shall be secondary coverage.
             1758          (v) The primary and the secondary coverage may not be set off against the other.
             1759          (vi) A covered person as described under Subsection (3)(b)(i) is entitled to the highest
             1760      limits of underinsured motorist coverage under only one additional policy per household
             1761      applicable to that covered person as a named insured, spouse, or relative.
             1762          (vii) A covered injured person is not barred against making subsequent elections if
             1763      recovery is unavailable under previous elections.
             1764          (viii) (A) As used in this section, "interpolicy stacking" means recovering benefits for a
             1765      single incident of loss under more than one insurance policy.


             1766          (B) Except to the extent permitted by this Subsection (3), interpolicy stacking is
             1767      prohibited for underinsured motorist coverage.
             1768          (c) Underinsured motorist coverage:
             1769          (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
             1770      Compensation Act;
             1771          (ii) may not be subrogated by the workers' compensation insurance carrier;
             1772          (iii) may not be reduced by any benefits provided by workers' compensation insurance;
             1773          (iv) may be reduced by health insurance subrogation only after the covered person has
             1774      been made whole;
             1775          (v) may not be collected for bodily injury or death sustained by a person:
             1776          (A) while committing a violation of Section 41-1a-1314 ;
             1777          (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
             1778      in violation of Section 41-1a-1314 ; or
             1779          (C) while committing a felony; and
             1780          (vi) notwithstanding Subsection (3)(c)(v), may be recovered:
             1781          (A) for a person under 18 years of age who is injured within the scope of Subsection
             1782      (3)(c)(v) but limited to medical and funeral expenses; or
             1783          (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
             1784      within the course and scope of the law enforcement officer's duties.
             1785          (4) The inception of the loss under Subsection 31A-21-313 (1) for underinsured
             1786      motorist claims occurs upon the date of the last liability policy payment.
             1787          (5) (a) Within five business days after notification in a manner specified by the
             1788      department that all liability insurers have tendered their liability policy limits, the underinsured
             1789      carrier shall either:
             1790          (i) waive any subrogation claim the underinsured carrier may have against the person
             1791      liable for the injuries caused in the accident; or
             1792          (ii) pay the insured an amount equal to the policy limits tendered by the liability carrier.
             1793          (b) If neither option is exercised under Subsection (5)(a), the subrogation claim is


             1794      considered to be waived by the underinsured carrier.
             1795          (6) Except as otherwise provided in this section, a covered person may seek, subject to
             1796      the terms and conditions of the policy, additional coverage under any policy:
             1797          (a) that provides coverage for damages resulting from motor vehicle accidents; and
             1798          (b) that is not required to conform to Section 31A-22-302 .
             1799          (7) (a) When a claim is brought by a named insured or a person described in
             1800      Subsection 31A-22-305 (1) and is asserted against the covered person's underinsured motorist
             1801      carrier, the claimant may elect to resolve the claim:
             1802          (i) by submitting the claim to binding arbitration; or
             1803          (ii) through litigation.
             1804          (b) Unless otherwise provided in the policy under which underinsured benefits are
             1805      claimed, the election provided in Subsection (7)(a) is available to the claimant only.
             1806          (c) Once the claimant has elected to commence litigation under Subsection (7)(a)(ii),
             1807      the claimant may not elect to resolve the claim through binding arbitration under this section
             1808      without the written consent of the underinsured motorist coverage carrier.
             1809          (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
             1810      binding arbitration under Subsection (7)(a)(i) shall be resolved by a single arbitrator.
             1811          (ii) All parties shall agree on the single arbitrator selected under Subsection (7)(d)(i).
             1812          (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
             1813      (7)(d)(ii), the parties shall select a panel of three arbitrators.
             1814          (e) If the parties select a panel of three arbitrators under Subsection (7)(d)(iii):
             1815          (i) each side shall select one arbitrator; and
             1816          (ii) the arbitrators appointed under Subsection (7)(e)(i) shall select one additional
             1817      arbitrator to be included in the panel.
             1818          (f) Unless otherwise agreed to in writing:
             1819          (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
             1820      under Subsection (7)(d)(i); or
             1821          (ii) if an arbitration panel is selected under Subsection (7)(d)(iii):


             1822          (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
             1823          (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
             1824      under Subsection (7)(e)(ii).
             1825          (g) Except as otherwise provided in this section or unless otherwise agreed to in
             1826      writing by the parties, an arbitration proceeding conducted under this section shall be governed
             1827      by Title 78, Chapter 31a, Utah Uniform Arbitration Act.
             1828          (h) The arbitration shall be conducted in accordance with Rules 26 through 37, 54, and
             1829      68 of the Utah Rules of Civil Procedure.
             1830          (i) All issues of discovery shall be resolved by the arbitrator or the arbitration panel.
             1831          (j) A written decision by a single arbitrator or by a majority of the arbitration panel
             1832      shall constitute a final decision.
             1833          (k) (i) The amount of an arbitration award may not exceed the underinsured motorist
             1834      policy limits of all applicable underinsured motorist policies, including applicable underinsured
             1835      motorist umbrella policies.
             1836          (ii) If the initial arbitration award exceeds the underinsured motorist policy limits of all
             1837      applicable underinsured motorist policies, the arbitration award shall be reduced to an amount
             1838      equal to the combined underinsured motorist policy limits of all applicable underinsured
             1839      motorist policies.
             1840          (l) The arbitrator or arbitration panel may not decide the issues of coverage or
             1841      extra-contractual damages, including:
             1842          (i) whether the claimant is a covered person;
             1843          (ii) whether the policy extends coverage to the loss; or
             1844          (iii) any allegations or claims asserting consequential damages or bad faith liability.
             1845          (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
             1846      class-representative basis.
             1847          (n) If the arbitrator or arbitration panel finds that the action was not brought, pursued,
             1848      or defended in good faith, the arbitrator or arbitration panel may award reasonable attorney fees
             1849      and costs against the party that failed to bring, pursue, or defend the claim in good faith.


             1850          (o) An arbitration award issued under this section shall be the final resolution of all
             1851      claims not excluded by Subsection (7)(l) between the parties unless:
             1852          (i) the award was procured by corruption, fraud, or other undue means; or
             1853          (ii) either party, within 20 days after service of the arbitration award:
             1854          (A) files a complaint requesting a trial de novo in the district court; and
             1855          (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
             1856      under Subsection (7)(o)(ii)(A).
             1857          (p) (i) Upon filing a complaint for a trial de novo under Subsection (7)(o), the claim
             1858      shall proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules
             1859      of Evidence in the district court.
             1860          (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
             1861      request a jury trial with a complaint requesting a trial de novo under Subsection (7)(o)(ii)(A).
             1862          (q) (i) If the claimant, as the moving party in a trial de novo requested under
             1863      Subsection (7)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater
             1864      than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
             1865          (ii) If the underinsured motorist carrier, as the moving party in a trial de novo requested
             1866      under Subsection (7)(o), does not obtain a verdict that is at least 20% less than the arbitration
             1867      award, the underinsured motorist carrier is responsible for all of the nonmoving party's costs.
             1868          (iii) Except as provided in Subsection (7)(q)(iv), the costs under this Subsection (7)(q)
             1869      shall include:
             1870          (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
             1871          (B) the costs of expert witnesses and depositions.
             1872          (iv) An award of costs under this Subsection (7)(q) may not exceed $2,500.
             1873          (r) For purposes of determining whether a party's verdict is greater or less than the
             1874      arbitration award under Subsection (7)(q), a court may not consider any recovery or other relief
             1875      granted on a claim for damages if the claim for damages:
             1876          (i) was not fully disclosed in writing prior to the arbitration proceeding; or
             1877          (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil


             1878      Procedure.
             1879          (s) If a district court determines, upon a motion of the nonmoving party, that the
             1880      moving party's use of the trial de novo process was filed in bad faith in accordance with
             1881      Section 78-27-56 , the district court may award reasonable attorney fees to the nonmoving
             1882      party.
             1883          (t) Nothing in this section is intended to limit any claim under any other portion of an
             1884      applicable insurance policy.
             1885          (u) If there are multiple underinsured motorist policies, as set forth in Subsection (3),
             1886      the claimant may elect to arbitrate in one hearing the claims against all the underinsured
             1887      motorist carriers.
             1888          Section 8. Section 31A-22-423 is amended to read:
             1889           31A-22-423. Policy and annuity examination period.
             1890          (1) (a) Except as provided under Subsection (2), [all] a life insurance [policies] policy,
             1891      life insurance [certificates, annuities, and annuities certificates] certificate, annuity contract, or
             1892      annuity certificate shall contain a notice prominently printed on or attached to the cover or
             1893      front page of the policy, contract, or certificate stating that the policyholder, contract holder, or
             1894      certificate holder has the right to return the policy, contract, or certificate for any reason on or
             1895      before:
             1896          (i) ten days after [delivery] the day on which the policy, contract, or certificate is
             1897      delivered; or
             1898          (ii) in case of a replacement policy, contract, or certificate, [20] 30 days after the day
             1899      on which the replacement policy, contract, or certificate is delivered.
             1900          (b) For purposes of this section, "return" means a writing that:
             1901          (i) the policy, contract, or certificate is being returned for termination of coverage;
             1902          (ii) is:
             1903          (A) a written statement on the policy, contract, or certificate; or
             1904          (B) a writing that accompanies the policy, contract, or certificate; and
             1905          (iii) is delivered to or mailed first class to the insurer or the insurer's agent.


             1906          (c) A policy, contract, or certificate returned under this section is void from the date of
             1907      issuance.
             1908          (d) A policyholder, contract holder, or certificate holder returning a policy or certificate
             1909      is entitled to a refund of any premium paid.
             1910          (2) This section does not apply to:
             1911          (a) group term life insurance issued under Section 31A-22-502 ;
             1912          (b) a group master policy;
             1913          (c) a noncontributory certificate;
             1914          (d) a credit life insurance certificate; and
             1915          (e) other classes of life insurance policies that the commissioner specifies by rule after
             1916      finding that a right to return those life insurance policies would be impracticable or
             1917      unnecessary to protect the policyholder's interests.
             1918          Section 9. Section 31A-22-610 is amended to read:
             1919           31A-22-610. Dependent coverage from moment of birth or adoption.
             1920          (1) As used in this section:
             1921          (a) "Child" means, in connection with any adoption, or placement for adoption of the
             1922      child, an individual who is younger than 18 years of age as of the date of the adoption or
             1923      placement for adoption.
             1924          (b) "Placement for adoption" means the assumption and retention by a person of a legal
             1925      obligation for total or partial support of a child in anticipation of the adoption of the child.
             1926          (2) (a) [If any] Except as provided in Subsection (5), if an accident and health
             1927      insurance policy provides coverage for any members of the policyholder's or certificate holder's
             1928      family, the policy shall provide that any health insurance benefits applicable to dependents of
             1929      the insured are applicable on the same basis to:
             1930          (i) a newly born child from the moment of birth; and
             1931          (ii) an adopted child:
             1932          (A) beginning from the moment of birth, if placement for adoption occurs within 30
             1933      days of the child's birth; or


             1934          (B) beginning from the date of placement, if placement for adoption occurs 30 days or
             1935      more after the child's birth.
             1936          (b) The coverage described in this Subsection (2):
             1937          (i) is not subject to any preexisting conditions; and
             1938          (ii) includes any injury or sickness, including the necessary care and treatment of
             1939      medically diagnosed:
             1940          (A) congenital defects;
             1941          (B) birth abnormalities; or
             1942          (C) prematurity.
             1943          (c) (i) Subject to Subsection (2)(c)(ii), a claim for services for a newly born child or an
             1944      adopted child may be denied until the child is enrolled.
             1945          (ii) Notwithstanding Subsection (2)(c)(i), an otherwise eligible claim denied under
             1946      Subsection (2)(c)(i) is eligible for payment and may be resubmitted or reprocessed once a child
             1947      is enrolled pursuant to Subsection (2)(d) or (e).
             1948          (d) If the payment of a specific premium is required to provide coverage for a child of a
             1949      policyholder or certificate holder, for there to be coverage for the child, the policyholder or
             1950      certificate holder shall enroll:
             1951          (i) a newly born child within 30 days after the date of birth of the child; or
             1952          (ii) an adopted child within 30 days after the day of placement of adoption.
             1953          (e) If the payment of a specific premium is not required to provide coverage for a child
             1954      of a policyholder or certificate holder, for the child to receive coverage the policyholder or
             1955      certificate holder shall enroll a newly born child or an adopted child no later than 30 days after
             1956      the first notification of denial of a claim for services for that child.
             1957          (3) (a) The coverage required by Subsection (2) as to children placed for the purpose of
             1958      adoption with a policyholder or certificate holder continues in the same manner as it would
             1959      with respect to a child of the policyholder or certificate holder unless:
             1960          (i) the placement is disrupted prior to legal adoption; and
             1961          (ii) the child is removed from placement.


             1962          (b) The coverage required by Subsection (2) ends if the child is removed from
             1963      placement prior to being legally adopted.
             1964          (4) The provisions of this section apply to employee welfare benefit plans as defined in
             1965      Section 26-19-2 .
             1966          (5) If an accident and health insurance policy that is not subject to the special
             1967      enrollment rights described in 45 C.F.R. Sec. 146.117(b) provides coverage for one individual,
             1968      the insurer may choose to:
             1969          (a) provide coverage according to this section; or
             1970          (b) allow application, subject to the insurer's underwriting criteria for:
             1971          (i) a newborn;
             1972          (ii) an adopted child; or
             1973          (iii) a child placed for adoption.
             1974          Section 10. Section 31A-22-613.5 is amended to read:
             1975           31A-22-613.5. Price and value comparisons of health insurance -- Basic Health
             1976      Care Plan.
             1977          (1) This section applies generally to all health insurance policies and health
             1978      maintenance organization contracts.
             1979          (2) [(a)] The commissioner shall adopt a Basic Health Care Plan consistent with this
             1980      section to be offered under the open enrollment provisions of Chapter 30, Individual, Small
             1981      Employer, and Group Health Insurance Act.
             1982          [(b) (i) Before adoption of a plan under Subsection (2)(a), the commissioner shall
             1983      submit the proposed Basic Health Care Plan to the Health and Human Services Interim
             1984      Committee for review and recommendations.]
             1985          [(ii) After the commissioner adopts the Basic Health Care Plan, the Health and Human
             1986      Services Interim Committee:]
             1987          [(A) shall provide legislative oversight of the Basic Health Care Plan; and]
             1988          [(B) may recommend legislation to modify the Basic Health Care Plan adopted by the
             1989      commissioner.]


             1990          (3) (a) The commissioner shall promote informed consumer behavior and responsible
             1991      health insurance and health plans by requiring an insurer issuing health insurance policies or
             1992      health maintenance organization contracts to provide to all enrollees, prior to enrollment in the
             1993      health benefit plan or health insurance policy, written disclosure of:
             1994          (i) restrictions or limitations on prescription drugs and biologics including the use of a
             1995      formulary and generic substitution; and
             1996          (ii) coverage limits under the plan.
             1997          (b) In addition to the requirements of Subsections (3)(a) and (d), an insurer described in
             1998      Subsection (3)(a) shall submit the written disclosure required by this Subsection (3) to the
             1999      commissioner:
             2000          (i) upon commencement of operations in the state; and
             2001          (ii) anytime the insurer amends any of the following described in Subsection (3)(a):
             2002          (A) treatment policies;
             2003          (B) practice standards;
             2004          (C) restrictions; or
             2005          (D) coverage limits of the insurer's health benefit plan or health insurance policy.
             2006          (c) The commissioner may adopt rules to implement the disclosure requirements of this
             2007      Subsection (3), taking into account:
             2008          (i) business confidentiality of the insurer;
             2009          (ii) definitions of terms; and
             2010          (iii) the method of disclosure to enrollees.
             2011          (d) If under Subsection (3)(a)(i) a formulary is used, the insurer shall make available to
             2012      prospective enrollees and maintain evidence of the fact of the disclosure of:
             2013          (i) the drugs included;
             2014          (ii) the patented drugs not included; and
             2015          (iii) any conditions that exist as a precedent to coverage.
             2016          (4) The Basic Health Care Plan adopted by the commissioner under this section shall
             2017      provide for:


             2018          (a) a lifetime maximum benefit per person not to exceed $1,000,000;
             2019          (b) an annual maximum benefit per person not to exceed $300,000;
             2020          (c) an out-of-pocket maximum per person not to exceed $5,000, including the
             2021      deductible;
             2022          (d) in relation to its cost-sharing features:
             2023          (i) a deductible of not less than $1,500 for major medical expenses; and
             2024          (ii) (A) a copayment of not less than:
             2025          (I) $25 per visit for office services; and
             2026          (II) $150 per visit to an emergency room; or
             2027          (B) coinsurance of not less than:
             2028          (I) 20% per visit for office services; and
             2029          (II) 20% per visit for an emergency room; and
             2030          (e) in relation to cost-sharing features for prescription drugs:
             2031          (i) a deductible of not less than $500; and
             2032          (ii) (A) a copayment of not less than:
             2033          (I) the lesser of the cost of the prescription drug or $15 for the lowest level of cost for
             2034      prescription drugs;
             2035          (II) the lesser of the cost of the prescription drug or $30 for the second level of cost for
             2036      prescription drugs; and
             2037          (III) the lesser of the cost of the prescription drug or $60 for the highest level of cost
             2038      for prescription drugs; or
             2039          (B) coinsurance of not less than:
             2040          (I) the lesser of the cost of the prescription drug or 25% for the lowest level of cost for
             2041      prescription drugs;
             2042          (II) the lesser of the cost of the prescription drug or 40% for the second level of cost for
             2043      prescription drugs; and
             2044          (III) the lesser of the cost of the prescription drug or 60% for the highest level of cost
             2045      for prescription drugs.


             2046          Section 11. Section 31A-22-629 is amended to read:
             2047           31A-22-629. Adverse benefit determination review process.
             2048          (1) As used in this section:
             2049          (a) (i) "Adverse benefit determination" means the:
             2050          (A) denial of a benefit;
             2051          (B) reduction of a benefit;
             2052          (C) termination of a benefit; or
             2053          (D) failure to provide or make payment, in whole or in part, for a benefit.
             2054          (ii) "Adverse benefit determination" includes:
             2055          (A) denial, reduction, termination, or failure to provide or make payment that is based
             2056      on a determination of an insured's or a beneficiary's eligibility to participate in a plan;
             2057          (B) with respect to individual or group health plans, and income replacement or
             2058      disability income policies, a denial, reduction, or termination of, or a failure to provide or make
             2059      payment, in whole or in part, for, a benefit resulting from the application of a utilization
             2060      review; and
             2061          (C) failure to cover an item or service for which benefits are otherwise provided
             2062      because it is determined to be:
             2063          (I) experimental;
             2064          (II) investigational; or
             2065          (III) not medically necessary or appropriate.
             2066          (b) "Independent review" means a process that:
             2067          (i) is a voluntary option for the resolution of an adverse benefit determination;
             2068          (ii) is conducted at the discretion of the claimant;
             2069          (iii) is conducted by an independent review organization designated by the insurer;
             2070          (iv) renders an independent and impartial decision on an adverse benefit determination
             2071      submitted by an insured; and
             2072          (v) may not require the insured to pay a fee for requesting the independent review.
             2073          (c) "Independent review organization" means a person, subject to Subsection (6), who


             2074      conducts an independent external review of adverse determinations.
             2075          [(c)] (d) "Insured" is as defined in Section 31A-1-301 and includes a person who is
             2076      authorized to act on the insured's behalf.
             2077          [(d)] (e) "Insurer" is as defined in Section 31A-1-301 and includes:
             2078          (i) a health maintenance organization; and
             2079          (ii) a third party administrator that offers, sells, manages, or administers a health
             2080      insurance policy or health maintenance organization contract that is subject to this title.
             2081          [(e)] (f) "Internal review" means the process an insurer uses to review an insured's
             2082      adverse benefit determination before the adverse benefit determination is submitted for
             2083      independent review.
             2084          (2) This section applies generally to health insurance policies, health maintenance
             2085      organization contracts, and income replacement or disability income policies.
             2086          (3) (a) An insured may submit an adverse benefit determination to the insurer.
             2087          (b) The insurer shall conduct an internal review of the insured's adverse benefit
             2088      determination.
             2089          (c) An insured who disagrees with the results of an internal review may submit the
             2090      adverse benefit determination for an independent review if the adverse benefit determination
             2091      involves:
             2092          (i) payment of a claim regarding medical necessity; or
             2093          (ii) denial of a claim regarding medical necessity.
             2094          (4) [Before October 1, 2000, the] The commissioner shall adopt rules that establish
             2095      minimum standards for:
             2096          (a) internal reviews;
             2097          (b) independent reviews to ensure independence and impartiality;
             2098          (c) the types of adverse benefit determinations that may be submitted to an independent
             2099      review; and
             2100          (d) the timing of the review process, including an expedited review when medically
             2101      necessary.


             2102          (5) Nothing in this section may be construed as:
             2103          (a) expanding, extending, or modifying the terms of a policy or contract with respect to
             2104      benefits or coverage;
             2105          (b) permitting an insurer to charge an insured for the internal review of an adverse
             2106      benefit determination;
             2107          (c) restricting the use of arbitration in connection with or subsequent to an independent
             2108      review; or
             2109          (d) altering the legal rights of any party to seek court or other redress in connection
             2110      with:
             2111          (i) an adverse decision resulting from an independent review, except that if the insurer
             2112      is the party seeking legal redress, the insurer shall pay for the reasonable [attorneys'] attorney
             2113      fees of the insured related to the action and court costs; or
             2114          (ii) an adverse benefit determination or other claim that is not eligible for submission
             2115      to independent review.
             2116          (6) (a) An independent review organization in relation to the insurer may not be:
             2117          (i) the insurer;
             2118          (ii) the health plan;
             2119          (iii) the health plan's fiduciary;
             2120          (iv) the employer; or
             2121          (v) an employee or agent of any one listed in Subsections (6)(a)(i) through (iv).
             2122          (b) An independent review organization may not have a material professional, familial,
             2123      or financial conflict of interest with:
             2124          (i) the health plan;
             2125          (ii) an officer, director, or management employee of the health plan;
             2126          (iii) the enrollee;
             2127          (iv) the enrollee's health care provider;
             2128          (v) the health care provider's medical group or independent practice association;
             2129          (vi) a health care facility where service would be provided; or


             2130          (vii) the developer or manufacturer of the service that would be provided.
             2131          Section 12. Section 31A-22-701 is amended to read:
             2132           31A-22-701. Groups eligible for group or blanket insurance.
             2133          (1) A group or blanket accident and health insurance policy may be issued to:
             2134          (a) any group:
             2135          (i) to which a group life insurance policy may be issued under Sections 31A-22-502
             2136      through 31A-22-507 ; and
             2137          (ii) that is formed for a reason other than the purchase of insurance; or
             2138          (b) [a] any group specifically authorized by the commissioner under Section
             2139      31A-22-509 , upon a finding that:
             2140          (i) authorization is not contrary to the public interest;
             2141          (ii) the proposed group is actuarially sound;
             2142          (iii) formation of the proposed group may result in economies of scale in
             2143      administrative, marketing, and brokerage costs; [and]
             2144          (iv) the health insurance policy, certificate, or other indicia of coverage that will be
             2145      offered to the proposed group is substantially equivalent to policies that are otherwise available
             2146      to similar groups[.]; and
             2147          [(2) Blanket policies]
             2148          (v) the proposed group is formed for a reason other than the purchase of insurance.
             2149          (2) A blanket policy may also be issued to:
             2150          (a) any common carrier or any operator, owner, or lessee of a means of transportation,
             2151      as policyholder, covering persons who may become passengers as defined by reference to their
             2152      travel status;
             2153          (b) an employer, as policyholder, covering any group of employees, dependents, or
             2154      guests, as defined by reference to specified hazards incident to any activities of the
             2155      policyholder;
             2156          (c) an institution of learning, including a school district, school jurisdictional units, or
             2157      the head, principal, or governing board of any of those units, as policyholder, covering


             2158      students, teachers, or employees;
             2159          (d) any religious, charitable, recreational, educational, or civic organization, or branch
             2160      of those organizations, as policyholder, covering any group of members or participants as
             2161      defined by reference to specified hazards incident to the activities sponsored or supervised by
             2162      the policyholder;
             2163          (e) a sports team, camp, or sponsor of the team or camp, as policyholder, covering
             2164      members, campers, employees, officials, or supervisors;
             2165          (f) any volunteer fire department, first aid, civil defense, or other similar volunteer
             2166      organization, as policyholder, covering any group of members or participants as defined by
             2167      reference to specified hazards incident to activities sponsored, supervised, or participated in by
             2168      the policyholder;
             2169          (g) a newspaper or other publisher, as policyholder, covering its carriers;
             2170          (h) an association, including a labor union, which has a constitution and bylaws and
             2171      which has been organized in good faith for purposes other than that of obtaining insurance, as
             2172      policyholder, covering any group of members or participants as defined by reference to
             2173      specified hazards incident to the activities or operations sponsored or supervised by the
             2174      policyholder;
             2175          (i) a health insurance purchasing association, as defined in Section 31A-34-103 ,
             2176      organized and controlled solely by participating employers [as defined in Section 31A-34-103 ];
             2177      and
             2178          (j) any other class of risks which, in the judgment of the commissioner, may be
             2179      properly eligible for blanket accident and health insurance.
             2180          (3) The judgment of the commissioner may be exercised on the basis of:
             2181          (a) individual risks;
             2182          (b) class of risks; or
             2183          (c) both Subsections (3)(a) and (b).
             2184          Section 13. Section 31A-23a-104 is amended to read:
             2185           31A-23a-104. Application for individual license -- Application for agency license.


             2186          (1) [Subject to Subsection (2), an application for] This section applies to an initial or
             2187      renewal [individual] license as a:
             2188          (a) producer[,];
             2189          (b) limited line producer[,];
             2190          (c) customer service representative[,];
             2191          (d) consultant[,];
             2192          (e) managing general agent[,]; or
             2193          (f) reinsurance intermediary.
             2194          (2) (a) Subject to Subsection (2)(b), an initial or renewal individual license shall be:
             2195          [(a)] (i) made to the commissioner on forms and in a manner the commissioner
             2196      prescribes; and
             2197          [(b)] (ii) accompanied by a license fee that is not refunded if the application:
             2198          [(i)] (A) is denied; or
             2199          [(ii)] (B) if incomplete, is never completed by the applicant.
             2200          [(2)] (b) An application described in this Subsection [(1)] (2) shall provide:
             2201          [(a)] (i) information about the applicant's identity;
             2202          [(b)] (ii) the applicant's Social Security number;
             2203          [(c)] (iii) the applicant's personal history, experience, education, and business record;
             2204          [(d)] (iv) whether the applicant is 18 years of age or older;
             2205          [(e)] (v) whether the applicant has committed an act that is a ground for denial,
             2206      suspension, or revocation as set forth in Section 31A-23a-105 or 31A-23a-111 ; and
             2207          [(f)] (vi) any other information the commissioner reasonably requires.
             2208          (3) The commissioner may require any documents reasonably necessary to verify the
             2209      information contained in an application filed under this section.
             2210          (4) [The following information] An applicant's Social Security number contained in an
             2211      application filed under this section is a private record under [Title 63, Chapter 2, Government
             2212      Records Access and Management Act:] Section 63-2-302 .
             2213          [(a) an applicant's Social Security number; or]


             2214          [(b) an applicant's federal employer identification number.]
             2215          (5) (a) Subject to Subsection (5)(b), an application for an initial or renewal agency
             2216      license [as a producer, limited line producer, customer service representative, consultant,
             2217      managing general agent, or reinsurance intermediary] shall be:
             2218          (i) made to the commissioner on forms and in a manner the commissioner prescribes;
             2219      and
             2220          (ii) accompanied by a license fee that is not refunded if the application:
             2221          (A) is denied; or
             2222          (B) if incomplete, is never completed by the applicant.
             2223          (b) An application described in Subsection (5)(a) shall provide:
             2224          (i) information about the applicant's identity;
             2225          (ii) the applicant's federal employer identification number;
             2226          (iii) the designated responsible licensed producer;
             2227          (iv) the identity of all owners, partners, officers, and directors;
             2228          (v) whether the applicant has committed an act that is a ground for denial, suspension,
             2229      or revocation as set forth in Section 31A-23a-105 or 31A-23a-111 ; and
             2230          (vi) any other information the commissioner reasonably requires.
             2231          Section 14. Section 31A-23a-105 is amended to read:
             2232           31A-23a-105. General requirements for individual and agency license issuance
             2233      and renewal.
             2234          (1) The commissioner shall issue or renew a license to act as a producer, limited line
             2235      producer, customer service representative, consultant, managing general agent, or reinsurance
             2236      intermediary to any person who, as to the license type and line of authority classification
             2237      applied for under Section 31A-23a-106 :
             2238          (a) has satisfied the application requirements under Section 31A-23a-104 ;
             2239          (b) has satisfied the character requirements under Section 31A-23a-107 ;
             2240          (c) has satisfied any applicable continuing education requirements under Section
             2241      31A-23a-202 ;


             2242          (d) has satisfied any applicable examination requirements under Section 31A-23a-108 ;
             2243          (e) has satisfied any applicable training period requirements under Section
             2244      31A-23a-203 ;
             2245          (f) if a nonresident:
             2246          (i) has complied with Section 31A-23a-109 ; and
             2247          (ii) holds an active similar license in that person's state of residence;
             2248          (g) if an applicant for a title insurance producer license, has satisfied the requirements
             2249      of Sections 31A-23a-203 and 31A-23a-204 ;
             2250          (h) if an applicant for a license to act as a viatical settlement provider or viatical
             2251      settlement producer [of viatical settlements], has satisfied the requirements of Section
             2252      31A-23a-117 ; and
             2253          (i) has paid the applicable fees under Section 31A-3-103 .
             2254          (2) (a) This Subsection (2) applies to the following persons:
             2255          (i) an applicant for a pending:
             2256          (A) individual or agency producer license;
             2257          (B) limited line producer license;
             2258          (C) customer service representative license;
             2259          (D) consultant license;
             2260          (E) managing general agent license; or
             2261          (F) reinsurance intermediary license; or
             2262          (ii) a licensed:
             2263          (A) individual or agency producer;
             2264          (B) limited line producer;
             2265          (C) customer service representative;
             2266          (D) consultant;
             2267          (E) managing general agent; or
             2268          (F) reinsurance intermediary.
             2269          (b) A person described in Subsection (2)(a) shall report to the commissioner:


             2270          (i) any administrative action taken against the person:
             2271          (A) in another jurisdiction; or
             2272          (B) by another regulatory agency in this state; and
             2273          (ii) any criminal prosecution taken against the person in any jurisdiction.
             2274          (c) The report required by Subsection (2)(b) shall:
             2275          (i) be filed:
             2276          (A) at the time the person files the application for an individual or agency license; and
             2277          (B) for an action or prosecution that occurs on or after the day on which the person
             2278      files the application:
             2279          (I) for an administrative action, within 30 days of the final disposition of the
             2280      administrative action; or
             2281          (II) for a criminal prosecution, within 30 days of the initial pretrial hearing date; and
             2282          (ii) include a copy of the complaint or other relevant legal documents related to the
             2283      action or prosecution described in Subsection (2)(b).
             2284          (3) (a) The department may request:
             2285          (i) criminal background information maintained pursuant to Title 53, Chapter 10, Part
             2286      2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
             2287          (ii) complete Federal Bureau of Investigation criminal background checks through the
             2288      national criminal history system.
             2289          (b) Information obtained by the department from the review of criminal history records
             2290      received under Subsection (3)(a) shall be used by the department for the purposes of:
             2291          (i) determining if a person satisfies the character requirements under Section
             2292      31A-23a-107 for issuance or renewal of a license;
             2293          (ii) determining if a person has failed to maintain the character requirements under
             2294      Section 31A-23a-107 ; and
             2295          (iii) preventing persons who violate the federal Violent Crime Control and Law
             2296      Enforcement Act of 1994, 18 U.S.C. Secs. 1033 and 1034, from engaging in the business of
             2297      insurance in the state.


             2298          (c) If the department requests the criminal background information, the department
             2299      shall:
             2300          (i) pay to the Department of Public Safety the costs incurred by the Department of
             2301      Public Safety in providing the department criminal background information under Subsection
             2302      (3)(a)(i);
             2303          (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
             2304      of Investigation in providing the department criminal background information under
             2305      Subsection (3)(a)(ii); and
             2306          (iii) charge the person applying for a license or for renewal of a license a fee equal to
             2307      the aggregate of Subsections (3)(c)(i) and (ii).
             2308          (4) To become a resident licensee in accordance with Section 31A-23a-104 and this
             2309      section, a person licensed as one of the following in another state who moves to this state shall
             2310      apply within 90 days of establishing legal residence in this state:
             2311          (a) insurance producer;
             2312          (b) limited line producer;
             2313          (c) customer service representative;
             2314          (d) consultant;
             2315          (e) managing general agent; or
             2316          (f) reinsurance intermediary.
             2317          (5) Notwithstanding the other provisions of this section, the commissioner may:
             2318          (a) issue a license to an applicant for a license for a title insurance line of authority only
             2319      with the concurrence of the Title and Escrow Commission; and
             2320          (b) renew a license for a title insurance line of authority only with the concurrence of
             2321      the Title and Escrow Commission.
             2322          Section 15. Section 31A-23a-117 is amended to read:
             2323           31A-23a-117. Special requirements for viatical settlement providers and
             2324      producers.
             2325          (1) A viatical settlement provider or viatical settlement producer [of viatical


             2326      settlements] shall be licensed in accordance with this title, with the additional requirements
             2327      listed in this section.
             2328          (2) A viatical settlement provider [of viatical settlements] shall provide to the
             2329      commissioner:
             2330          (a) a detailed plan of operation with the viatical settlement provider's:
             2331          (i) initial license application; and
             2332          (ii) renewal application;
             2333          (b) a copy of the viatical settlement provider's most current audited financial statement;
             2334      and
             2335          (c) an antifraud plan that meets the requirements of Section 31A-36-117 .
             2336          (3) A viatical settlement provider [or producer of viatical settlements] shall provide
             2337      with the viatical settlement provider's [or producer's] initial license application information
             2338      describing the viatical settlement provider's [or producer's] viatical settlement experience,
             2339      training, and education.
             2340          (4) A viatical settlement provider [or producer of viatical settlements] shall provide to
             2341      the commissioner, within 30 days after a change occurs, new or revised information concerning
             2342      any of the following:
             2343          (a) officers;
             2344          (b) holders of more than 10% of its stock;
             2345          (c) partners;
             2346          (d) directors;
             2347          (e) members; and
             2348          (f) designated employees.
             2349          Section 16. Section 31A-23a-204 is amended to read:
             2350           31A-23a-204. Special requirements for title insurance producers including
             2351      agencies.
             2352          Title insurance producers, including agencies, shall be licensed in accordance with this
             2353      chapter, with the additional requirements listed in this section.


             2354          (1) (a) A person that receives a new license under this title on or after July 1, 2007 as a
             2355      title insurance agency, shall at the time of licensure be owned or managed by one or more
             2356      natural persons who are licensed with the following lines of authority for at least three of the
             2357      five years immediately proceeding the date on which the title insurance agency applies for a
             2358      license:
             2359          (i) both a:
             2360          (A) search line of authority; and
             2361          (B) escrow line of authority; or
             2362          (ii) a search and escrow line of authority.
             2363          (b) A title insurance agency subject to Subsection (1)(a) may comply with Subsection
             2364      (1)(a) by having the title insurance agency owned or managed by:
             2365          (i) one or more natural persons who are licensed with the search line of authority for
             2366      the time period provided in Subsection (1)(a); and
             2367          (ii) one or more natural persons who are licensed with the escrow line of authority for
             2368      the time period provided in Subsection (1)(a).
             2369          (c) The Title and Escrow Commission may by rule made in accordance with Title 63,
             2370      Chapter 46a, Utah Administrative Rulemaking Act, exempt an attorney with real estate
             2371      experience from the experience requirements in Subsection (1)(a).
             2372          (2) (a) Every title insurance agency or producer appointed by an insurer shall maintain:
             2373          (i) a fidelity bond;
             2374          (ii) a professional liability insurance policy; or
             2375          (iii) a financial protection:
             2376          (A) equivalent to that described in Subsection (2)(a)(i) or (ii); and
             2377          (B) that the commissioner considers adequate.
             2378          (b) The bond [or], insurance, or financial protection required by this Subsection (2):
             2379          (i) shall be supplied under a contract approved by the commissioner to provide
             2380      protection against the improper performance of any service in conjunction with the issuance of
             2381      a contract or policy of title insurance; and


             2382          (ii) be in a face amount no less than $50,000.
             2383          (c) The Title and Escrow Commission may by rule made in accordance with Title 63,
             2384      Chapter 46a, Utah Administrative Rulemaking Act, exempt title insurance producers from the
             2385      requirements of this Subsection (2) upon a finding that, and only so long as, the required policy
             2386      or bond is generally unavailable at reasonable rates.
             2387          (3) (a) (i) Every title insurance agency or producer appointed by an insurer shall
             2388      maintain a reserve fund.
             2389          (ii) The reserve fund required by this Subsection (3) shall be:
             2390          (A) (I) composed of assets approved by the commissioner and the Title and Escrow
             2391      Commission;
             2392          (II) maintained as a separate trust account; and
             2393          (III) charged as a reserve liability of the title insurance producer in determining the
             2394      producer's financial condition; and
             2395          (B) accumulated by segregating 1% of all gross income received from the title
             2396      insurance business.
             2397          (iii) The reserve fund shall contain the accumulated assets for the immediately
             2398      preceding ten years as defined in Subsection (3)(a)(ii).
             2399          (iv) That portion of the assets held in the reserve fund over ten years may be:
             2400          (A) withdrawn from the reserve fund; and
             2401          (B) restored to the income of the title insurance producer.
             2402          (v) The title insurance producer may withdraw interest from the reserve fund related to
             2403      the principal amount as it accrues.
             2404          (b) (i) A disbursement may not be made from the reserve fund except as provided in
             2405      Subsection (3)(a) unless the title insurance producer ceases doing business as a result of:
             2406          (A) sale of assets;
             2407          (B) merger of the producer with another producer;
             2408          (C) termination of the producer's license;
             2409          (D) insolvency; or


             2410          (E) any cessation of business by the producer.
             2411          (ii) Any disbursements from the reserve fund may be made only to settle claims arising
             2412      from the improper performance of the title insurance producer in providing services defined in
             2413      Section 31A-23a-406 .
             2414          (iii) The commissioner shall be notified ten days before any disbursements from the
             2415      reserve fund.
             2416          (iv) The notice required by this Subsection (3)(b) shall contain:
             2417          (A) the amount of claim;
             2418          (B) the nature of the claim; and
             2419          (C) the name of the payee.
             2420          (c) (i) The reserve fund shall be maintained by the title insurance producer or the title
             2421      insurance producer's representative for a period of two years after the day on which the title
             2422      insurance producer ceases doing business.
             2423          (ii) Any assets remaining in the reserve fund at the end of the two years specified in
             2424      Subsection (3)(c)(i) may be withdrawn and restored to the former title insurance producer.
             2425          (4) Any examination for licensure shall include questions regarding the search and
             2426      examination of title to real property.
             2427          (5) A title insurance producer may not perform the functions of escrow unless the title
             2428      insurance producer has been examined on the fiduciary duties and procedures involved in those
             2429      functions.
             2430          (6) The Title and Escrow Commission shall adopt rules, in accordance with Title 63,
             2431      Chapter 46a, Utah Administrative Rulemaking Act, after consulting with the department and
             2432      the department's test administrator, establishing an examination for a license that will satisfy
             2433      this section.
             2434          (7) A license may be issued to a title insurance producer who has qualified:
             2435          (a) to perform only searches and examinations of title as specified in Subsection (4);
             2436          (b) to handle only escrow arrangements as specified in Subsection (5); or
             2437          (c) to act as a title marketing representative.


             2438          (8) (a) A person licensed to practice law in Utah is exempt from the requirements of
             2439      Subsections (2) and (3) if that person issues 12 or less policies in any 12-month period.
             2440          (b) In determining the number of policies issued by a person licensed to practice law in
             2441      Utah for purposes of Subsection (8)(a), if the person licensed to practice law in Utah issues a
             2442      policy to more than one party to the same closing, the person is considered to have issued only
             2443      one policy.
             2444          (9) A person licensed to practice law in Utah, whether exempt under Subsection (8) or
             2445      not, shall maintain a trust account separate from a law firm trust account for all title and real
             2446      estate escrow transactions.
             2447          Section 17. Section 31A-23a-401 is amended to read:
             2448           31A-23a-401. Disclosure of conflicting interests.
             2449          (1) (a) Except as provided under Subsection (1)(b)[, no]:
             2450          (i) a licensee under this chapter may not act in the same or any directly related
             2451      transaction as:
             2452          (A) a producer for the insured or consultant; and
             2453          (B) producer for the insurer; [nor may] and
             2454          (ii) a producer for the insured or consultant may not recommend or encourage the
             2455      purchase of insurance from or through an insurer or other producer:
             2456          (A) of which the producer for the insured or consultant or producer for the insured's or
             2457      consultant's spouse is an owner, executive, or employee; or
             2458          (B) to which [he] the producer for the insured or consultant has the type of relation that
             2459      a material benefit would accrue to the producer for the insured or consultant or spouse as a
             2460      result of the purchase.
             2461          (b) Subsection (1)(a) does not apply if the following three conditions are met:
             2462          (i) Prior to performing the consulting services, the producer for the insured or
             2463      consultant [discloses] shall disclose to the client, prominently, in writing[,]:
             2464          (A) the producer for the insured's or consultant's interest as a producer for the insurer,
             2465      or the relationship to an insurer or other producer[,]; and


             2466          (B) that as a result of those interests, the producer for the insured's or the consultant's
             2467      recommendations should be given appropriate scrutiny.
             2468          (ii) The producer for the insured's or consultant's fee [is] shall be agreed upon, in
             2469      writing, after the disclosure required under Subsection (1)(b)(i), but [prior to] before
             2470      performing the requested services.
             2471          (iii) Any report resulting from requested services [contains] shall contain a copy of the
             2472      disclosure made under Subsection (1)(b)(i).
             2473          (2) [No] A licensee under this chapter may not act as to the same client as both a
             2474      producer for the insurer and a producer for the insured without the client's prior written consent
             2475      based on full disclosure.
             2476          (3) Whenever a person applies for insurance coverage through a producer for the
             2477      insured, the producer for the insured shall disclose to the applicant, in writing, that the producer
             2478      for the insured is not the producer for the insurer [of] or the potential insurer. This disclosure
             2479      shall also inform the applicant that the applicant likely does not have the benefit of an insurer
             2480      being financially responsible for the conduct of the producer for the [insured's conduct]
             2481      insured.
             2482          Section 18. Section 31A-23a-402 is amended to read:
             2483           31A-23a-402. Unfair marketing practices -- Communication -- Inducement --
             2484      Unfair discrimination -- Coercion or intimidation -- Restriction on choice.
             2485          (1) (a) (i) Any of the following may not make or cause to be made any communication
             2486      that contains false or misleading information, relating to an insurance product or contract, any
             2487      insurer, or any licensee under this title, including information that is false or misleading
             2488      because it is incomplete:
             2489          (A) a person who is or should be licensed under this title;
             2490          (B) an employee or producer of a person described in Subsection (1)(a)(i)(A);
             2491          (C) a person whose primary interest is as a competitor of a person licensed under this
             2492      title; and
             2493          (D) a person on behalf of any of the persons listed in this Subsection (1)(a)(i).


             2494          (ii) As used in this Subsection (1), "false or misleading information" includes:
             2495          (A) assuring the nonobligatory payment of future dividends or refunds of unused
             2496      premiums in any specific or approximate amounts, but reporting fully and accurately past
             2497      experience is not false or misleading information; and
             2498          (B) with intent to deceive a person examining it:
             2499          (I) filing a report;
             2500          (II) making a false entry in a record; or
             2501          (III) wilfully refraining from making a proper entry in a record.
             2502          (iii) A licensee under this title may not:
             2503          (A) use any business name, slogan, emblem, or related device that is misleading or
             2504      likely to cause the insurer or other licensee to be mistaken for another insurer or other licensee
             2505      already in business; or
             2506          (B) use any advertisement or other insurance promotional material that would cause a
             2507      reasonable person to mistakenly believe that a state or federal government agency:
             2508          (I) is responsible for the insurance sales activities of the person;
             2509          (II) stands behind the credit of the person;
             2510          (III) guarantees any returns on insurance products of or sold by the person; or
             2511          (IV) is a source of payment of any insurance obligation of or sold by the person.
             2512          (iv) A person who is not an insurer may not assume or use any name that deceptively
             2513      implies or suggests that person is an insurer.
             2514          (v) A person other than persons licensed as health maintenance organizations under
             2515      Chapter 8 may not use the term "Health Maintenance Organization" or "HMO" in referring to
             2516      itself.
             2517          (b) A licensee's violation creates a rebuttable presumption that the violation was also
             2518      committed by the insurer if:
             2519          (i) the licensee under this title distributes cards or documents, exhibits a sign, or
             2520      publishes an advertisement that violates Subsection (1)(a), with reference to a particular
             2521      insurer:


             2522          (A) that the licensee represents; or
             2523          (B) for whom the licensee processes claims; and
             2524          (ii) the cards, documents, signs, or advertisements are supplied or approved by that
             2525      insurer.
             2526          (2) (a) (i) A licensee under this title, or an officer or employee of a licensee may not
             2527      induce any person to enter into or continue an insurance contract or to terminate an existing
             2528      insurance contract by offering benefits not specified in the policy to be issued or continued,
             2529      including premium or commission rebates.
             2530          (ii) An insurer may not make or knowingly allow any agreement of insurance that is
             2531      not clearly expressed in the policy to be issued or renewed.
             2532          (iii) This Subsection (2)(a) does not preclude:
             2533          (A) [insurers] an insurer from reducing premiums because of expense savings;
             2534          (B) an insurer from providing to a policyholder or insured one or more incentives to
             2535      participate in programs or activities designed to reduce claims or claim expenses;
             2536          [(B)] (C) the usual kinds of social courtesies not related to particular transactions; or
             2537          [(C)] (D) an insurer from receiving premiums under an installment payment plan.
             2538          (iv) The commissioner may adopt rules in accordance with Title 63, Chapter 46a, Utah
             2539      Administrative Rulemaking Act, to define what constitutes an incentive described in
             2540      Subsection (2)(a)(iii)(B).
             2541          (b) A licensee under this title may not absorb the tax under Section 31A-3-301 .
             2542          (c) (i) A title insurer or producer or any officer or employee of either may not pay,
             2543      allow, give, or offer to pay, allow, or give, directly or indirectly, as an inducement to obtaining
             2544      any title insurance business:
             2545          (A) any rebate, reduction, or abatement of any rate or charge made incident to the
             2546      issuance of the title insurance;
             2547          (B) any special favor or advantage not generally available to others; or
             2548          (C) any money or other consideration or material inducement.
             2549          (ii) "Charge made incident to the issuance of the title insurance" includes escrow


             2550      charges, and any other services that are prescribed in rule by the Title and Escrow Commission
             2551      after consultation with the commissioner.
             2552          (iii) An insured or any other person connected, directly or indirectly, with the
             2553      transaction, including a mortgage lender, real estate broker, builder, attorney, or any officer,
             2554      employee, or agent of any of them, may not knowingly receive or accept, directly or indirectly,
             2555      any benefit referred to in Subsection (2)(c)(i).
             2556          (3) (a) An insurer may not unfairly discriminate among policyholders by charging
             2557      different premiums or by offering different terms of coverage, except on the basis of
             2558      classifications related to the nature and the degree of the risk covered or the expenses involved.
             2559          (b) Rates are not unfairly discriminatory if they are averaged broadly among persons
             2560      insured under a group, blanket, or franchise policy, and the terms of those policies are not
             2561      unfairly discriminatory merely because they are more favorable than in similar individual
             2562      policies.
             2563          (4) (a) This Subsection (4) applies to:
             2564          (i) a person who is or should be licensed under this title;
             2565          (ii) an employee of that licensee or person who should be licensed;
             2566          (iii) a person whose primary interest is as a competitor of a person licensed under this
             2567      title; and
             2568          (iv) one acting on behalf of any person described in Subsections (4)(a)(i) through (iii).
             2569          (b) A person described in Subsection (4)(a) may not commit or enter into any
             2570      agreement to participate in any act of boycott, coercion, or intimidation that:
             2571          (i) tends to produce:
             2572          (A) an unreasonable restraint of the business of insurance; or
             2573          (B) a monopoly in that business; or
             2574          (ii) results in an applicant purchasing or replacing an insurance contract.
             2575          (5) (a) (i) Subject to Subsection (5)(a)(ii), a person may not restrict in the choice of an
             2576      insurer or licensee under this chapter, another person who is required to pay for insurance as a
             2577      condition for the conclusion of a contract or other transaction or for the exercise of any right


             2578      under a contract.
             2579          (ii) A person requiring coverage may reserve the right to disapprove the insurer or the
             2580      coverage selected on reasonable grounds.
             2581          (b) The form of corporate organization of an insurer authorized to do business in this
             2582      state is not a reasonable ground for disapproval, and the commissioner may by rule specify
             2583      additional grounds that are not reasonable. This Subsection (5) does not bar an insurer from
             2584      declining an application for insurance.
             2585          (6) A person may not make any charge other than insurance premiums and premium
             2586      financing charges for the protection of property or of a security interest in property, as a
             2587      condition for obtaining, renewing, or continuing the financing of a purchase of the property or
             2588      the lending of money on the security of an interest in the property.
             2589          (7) (a) A licensee under this title may not refuse or fail to return promptly all indicia of
             2590      agency to the principal on demand.
             2591          (b) A licensee whose license is suspended, limited, or revoked under Section
             2592      31A-2-308 , 31A-23a-111 , or 31A-23a-112 may not refuse or fail to return the license to the
             2593      commissioner on demand.
             2594          (8) (a) A person may not engage in any other unfair method of competition or any other
             2595      unfair or deceptive act or practice in the business of insurance, as defined by the commissioner
             2596      by rule, after a finding that they:
             2597          (i) are misleading;
             2598          (ii) are deceptive;
             2599          (iii) are unfairly discriminatory;
             2600          (iv) provide an unfair inducement; or
             2601          (v) unreasonably restrain competition.
             2602          (b) Notwithstanding Subsection (8)(a), for purpose of the title insurance industry, the
             2603      Title and Escrow Commission shall make rules, in accordance with Title 63, Chapter 46a, Utah
             2604      Administrative Rulemaking Act, that define any other unfair method of competition or any
             2605      other unfair or deceptive act or practice after a finding that they:


             2606          (i) are misleading;
             2607          (ii) are deceptive;
             2608          (iii) are unfairly discriminatory;
             2609          (iv) provide an unfair inducement; or
             2610          (v) unreasonably restrain competition.
             2611          Section 19. Section 31A-23a-504 is amended to read:
             2612           31A-23a-504. Sharing commissions.
             2613          (1) (a) Except as provided in Subsection 31A-15-103 (3), a licensee under this chapter
             2614      or an insurer may only pay consideration or reimburse out-of-pocket expenses to a person if the
             2615      licensee knows that the person is licensed under this chapter as to the particular type of
             2616      insurance to act in Utah as:
             2617          (i) a producer[,];
             2618          (ii) a limited line producer[,];
             2619          (iii) a customer service representative[,];
             2620          (iv) a consultant[,];
             2621          (v) a managing general agent[,]; or
             2622          (vi) a reinsurance intermediary [in Utah as to the particular type of insurance].
             2623          (b) A person may only accept commission compensation or other compensation as [a
             2624      producer, limited line producer, customer service representative, consultant, managing general
             2625      agent, or reinsurance intermediary] a person described in Subsections (1)(a)(i) through (vi) that
             2626      is directly or indirectly the result of any insurance transaction if that person is licensed under
             2627      this chapter to act [as a producer, limited line producer, customer service representative,
             2628      consultant, managing general agent, or reinsurance intermediary as to the particular type of
             2629      insurance] as described in Subsection (1)(a).
             2630          (2) (a) Except as provided in Section 31A-23a-501 , a consultant may not pay or receive
             2631      any commission or other compensation that is directly or indirectly the result of any insurance
             2632      transaction.
             2633          (b) A consultant may share a consultant fee or other compensation received for


             2634      consulting services performed within Utah only:
             2635          (i) with another consultant licensed under this chapter[,]; and [only]
             2636          (ii) to the extent that the other consultant contributed to the services performed.
             2637          (3) This section does not prohibit the payment of renewal commissions to former
             2638      licensees under this chapter, former Title 31, Chapter 17, or their successors in interest under a
             2639      deferred compensation or agency sales agreement.
             2640          (4) This section does not prohibit compensation paid to or received by a person for
             2641      referral of a potential customer that seeks to purchase or obtain an opinion or advice on an
             2642      insurance product if:
             2643          (a) the person is not licensed to sell insurance;
             2644          (b) the person [sells or provides] does not sell or provide opinions or advice on the
             2645      product; and
             2646          (c) the compensation does not depend on whether the referral results in a purchase or
             2647      sale.
             2648          (5) (a) In selling [any] a policy of title insurance, [no] sharing of commissions under
             2649      Subsection (1) may not occur if it will result in:
             2650          (i) an unlawful rebate[, or in];
             2651          (ii) compensation in connection with controlled business[,]; or [in]
             2652          (iii) payment of a forwarding fee or finder's fee.
             2653          (b) A person may share compensation for the issuance of a title insurance policy only
             2654      to the extent that [he] the person contributed to the search and examination of the title or other
             2655      services connected with [it] the title insurance policy.
             2656          (6) This section does not apply to bail bond producers or bail enforcement agents as
             2657      defined in Section 31A-35-102 .
             2658          Section 20. Section 31A-25-202 is amended to read:
             2659           31A-25-202. Application for license.
             2660          (1) (a) An application for a license as a third party administrator shall be:
             2661          (i) made to the commissioner on forms and in a manner the commissioner prescribes;


             2662      and
             2663          (ii) accompanied by the applicable fee, which is not refundable if the application is
             2664      denied.
             2665          (b) The application for a license as a third party administrator shall:
             2666          (i) state the applicant's:
             2667          (A) Social Security number; or
             2668          (B) federal employer identification number;
             2669          (ii) provide information about:
             2670          (A) the applicant's identity;
             2671          (B) the applicant's personal history, experience, education, and business record;
             2672          (C) if the applicant is a natural person, whether the applicant is 18 years of age or
             2673      older; and
             2674          (D) whether the applicant has committed an act that is a ground for denial, suspension,
             2675      or revocation as set forth in Section 31A-25-208 ; and
             2676          (iii) any other information as the commissioner reasonably requires.
             2677          (2) The commissioner may require documents reasonably necessary to verify the
             2678      information contained in the application.
             2679          [(3) The following are private records under Subsection 63-2-302 (1)(h):]
             2680          [(a) an applicant's Social Security number; and]
             2681          [(b) an applicant's federal employer identification number.]
             2682          (3) An applicant's Social Security number contained in an application filed under this
             2683      section is a private record under Section 63-2-302 .
             2684          Section 21. Section 31A-26-202 is amended to read:
             2685           31A-26-202. Application for license.
             2686          (1) (a) The application for a license as an independent adjuster or public adjuster shall
             2687      be:
             2688          (i) made to the commissioner on forms and in a manner the commissioner prescribes;
             2689      and


             2690          (ii) accompanied by the applicable fee, which is not refunded if the application is
             2691      denied.
             2692          (b) The application shall provide:
             2693          (i) information about the applicant's identity, including:
             2694          (A) the applicant's:
             2695          (I) Social Security number; or
             2696          (II) federal employer identification number;
             2697          (B) the applicant's personal history, experience, education, and business record;
             2698          (C) if the applicant is a natural person, whether the applicant is 18 years of age or
             2699      older; and
             2700          (D) whether the applicant has committed an act that is a ground for denial, suspension,
             2701      or revocation as set forth in Section 31A-25-208 ; and
             2702          (ii) any other information as the commissioner reasonably requires.
             2703          (2) The commissioner may require documents reasonably necessary to verify the
             2704      information contained in the application.
             2705          (3) [The following information] An applicant's Social Security number contained in an
             2706      application filed under this section is a private record under [Title 63, Chapter 2, Government
             2707      Records Access and Management Act:] Section 63-2-302 .
             2708          [(a) an applicant's Social Security number; or]
             2709          [(b) an applicant's federal employer identification number.]
             2710          Section 22. Section 31A-26-301.6 is amended to read:
             2711           31A-26-301.6. Health care claims practices.
             2712          (1) As used in this section:
             2713          (a) "Articulable reason" may include a determination regarding:
             2714          (i) eligibility for coverage;
             2715          (ii) preexisting conditions;
             2716          (iii) applicability of other public or private insurance;
             2717          (iv) medical necessity; and


             2718          (v) any other reason that would justify an extension of the time to investigate a claim.
             2719          (b) "Health care provider" means a person licensed to provide health care under:
             2720          (i) Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act; or
             2721          (ii) Title 58, Occupations and Professions.
             2722          (c) "Insurer" means an admitted or authorized insurer, as defined in Section
             2723      31A-1-301 , and includes:
             2724          (i) a health maintenance organization; and
             2725          (ii) a [third-party] third party administrator that is subject to this title, provided that
             2726      nothing in this section may be construed as requiring a third party administrator to use its own
             2727      funds to pay claims that have not been funded by the entity for which the third party
             2728      administrator is paying claims.
             2729          (d) "Provider" means a health care provider to whom an insurer is obligated to pay
             2730      directly in connection with a claim by virtue of:
             2731          (i) an agreement between the insurer and the provider;
             2732          (ii) a health insurance policy or contract of the insurer; or
             2733          (iii) state or federal law.
             2734          (2) An insurer shall timely pay every valid insurance claim submitted by a provider in
             2735      accordance with this section.
             2736          (3) (a) [Within] Except as provided in Subsection (4), within 30 days of [receiving] the
             2737      day on which the insurer receives a written claim, an insurer shall [do one of the following]:
             2738          (i) pay the claim [unless Subsection (3)(a)(ii), (iii), (iv), or (v) applies]; or
             2739          (ii) deny the claim and provide a written explanation [if the claim is denied;] for the
             2740      denial.
             2741          [(iii) specifically describe and request any additional information from the provider that
             2742      is necessary to process the claim;]
             2743          [(iv) inform the provider, pursuant to Subsection (4), of the 30-day extension of the
             2744      insurer's investigation of the claim; or]
             2745          [(v) request additional information and inform the provider of the 30-day extension if


             2746      both Subsections (3)(a)(iii) and (iv) apply.]
             2747          [(b) A provider shall respond to each request by an insurer for additional necessary
             2748      information made under Subsection (3)(a)(iii) or (v) within 30 days of receipt of the request by
             2749      providing the requested information that is in the possession of the provider, unless:]
             2750          [(i) the provider has requested and received the permission of the insurer to extend the
             2751      30-day period; or]
             2752          [(ii) the provider explains to the insurer in writing that additional time, which may not
             2753      exceed 30 days, is necessary to comply with the request for information.]
             2754          [(c) Subsection (7) shall apply after an insurer has received the information requested.]
             2755          [(4) The time to investigate a claim may be extended by the insurer for an additional
             2756      30-days if:]
             2757          [(a) the investigation of the claim cannot reasonably be completed within the initial
             2758      30-day period of Subsection (3)(a);]
             2759          [(b) before the end of the 30-day period in Subsection (3)(a), the insurer informs the
             2760      provider in writing of the reason for the payment delay, the nature of the investigation, the
             2761      timelines for investigations established in this section, and the anticipated completion date.]
             2762          [(5) Notwithstanding Subsection (4), the time to investigate a claim may be extended
             2763      beyond the initial 30-day period and the extended 30-day period if:]
             2764          [(a) due to matters beyond the control of the insurer, the investigation cannot
             2765      reasonably be completed within 60 days as to some part or all of the claim;]
             2766          [(b) before the end of the combined 60-day period, the insurer makes a written request
             2767      to the commissioner for an extension, including the reason for the delay, the nature of the
             2768      investigation, the anticipated completion date, and the amount of any partial payment of the
             2769      claim made pursuant to Subsection (5)(d);]
             2770          [(c) before the end of the combined 60-day period, the commissioner informs the
             2771      insurer that the request for an extension has been granted, based on a finding that:]
             2772          [(i) there is a good faith and articulable reason to believe that the insurer is not
             2773      obligated to pay some part or all of the claim; and]


             2774          [(ii) the investigation cannot reasonably be completed within 60 days; and]
             2775          [(d) the insurer identifies and pays all sums the insurer is obligated to pay on the claim
             2776      and which are not subject to the extension requested under this Subsection (5).]
             2777          [(6) An extension granted by the commissioner under Subsection (5)(c) shall include
             2778      the completion date for the investigation.]
             2779          (b) (i) Subject to Subsection (3)(b)(ii), the time period described in Subsection (3)(a)
             2780      may be extended by 15 days if the insurer:
             2781          (A) determines that the extension is necessary due to matters beyond the control of the
             2782      insurer; and
             2783          (B) before the end of the 30-day period described in Subsection (3)(a), notifies the
             2784      provider and insured in writing of:
             2785          (I) the circumstances requiring the extension of time; and
             2786          (II) the date by which the insurer expects to pay the claim or deny the claim with a
             2787      written explanation for the denial.
             2788          (ii) If an extension is necessary due to a failure of the provider or insured to submit the
             2789      information necessary to decide the claim:
             2790          (A) the notice of extension required by this Subsection (3)(b) shall specifically describe
             2791      the required information; and
             2792          (B) the insurer shall give the provider or insured at least 45 days from the day on which
             2793      the provider or insured receives the notice before the insurer denies the claim for failure to
             2794      provide the information requested in Subsection (3)(b)(ii)(A).
             2795          (4) (a) In the case of a claim for income replacement benefits, within 45 days of the day
             2796      on which the insurer receives a written claim, an insurer shall:
             2797          (i) pay the claim; or
             2798          (ii) deny the claim and provide a written explanation of the denial.
             2799          (b) Subject to Subsections (4)(d) and (e), the time period described in Subsection (4)(a)
             2800      may be extended for 30 days if the insurer:
             2801          (i) determines that the extension is necessary due to matters beyond the control of the


             2802      insurer; and
             2803          (ii) before the expiration of the 45-day period described in Subsection (4)(a), notifies
             2804      the insured of:
             2805          (A) the circumstances requiring the extension of time; and
             2806          (B) the date by which the insurer expects to pay the claim or deny the claim with a
             2807      written explanation for the denial.
             2808          (c) Subject to Subsections (4)(d) and (e), the time period for complying with
             2809      Subsection (4)(a) may be extended for up to an additional 30 days from the day on which the
             2810      30-day extension period provided in Subsection (4)(b) ends if before the day on which the
             2811      30-day extension period ends, the insurer:
             2812          (i) determines that due to matters beyond the control of the insurer a decision cannot be
             2813      rendered within the 30-day extension period; and
             2814          (ii) notifies the insured of:
             2815          (A) the circumstances requiring the extension; and
             2816          (B) the date as of which the insurer expects to pay the claim or deny the claim with a
             2817      written explanation for the denial.
             2818          (d) A notice of extension under this Subsection (4) shall specifically explain:
             2819          (i) the standards on which entitlement to a benefit is based; and
             2820          (ii) the unresolved issues that prevent a decision on the claim.
             2821          (e) If an extension allowed by Subsection (4)(b) or (c) is necessary due to a failure of
             2822      the insured to submit the information necessary to decide the claim:
             2823          (i) the notice of extension required by Subsection (4)(b) or (c) shall specifically
             2824      describe the necessary information; and
             2825          (ii) the insurer shall give the insured at least 45 days from the day on which the insured
             2826      receives the notice before the insurer denies the claim for failure to provide the information
             2827      requested in Subsection (4)(b) or (c).
             2828          (5) If a period of time is extended as permitted under Subsection (3)(b), (4)(b), or
             2829      (4)(c), due to an insured or provider failing to submit information necessary to decide a claim,


             2830      the period for making the benefit determination shall be tolled from the date on which the
             2831      notification of the extension is sent to the insured or provider until the date on which the
             2832      insured or provider responds to the request for additional information.
             2833          [(7) (a)] (6) An insurer shall pay all sums to the provider or insured that the insurer is
             2834      obligated to pay on the claim, and provide a written explanation of the insurer's decision
             2835      regarding any part of the claim that is denied within 20 days of[: (i)] receiving the information
             2836      requested under Subsection (3)[(a)(iii);](b), (4)(b), or (4)(c).
             2837          [(ii) completing an investigation under Subsection (4) or (5); or]
             2838          [(iii) the latter of Subsection (3)(a)(iii) or (iv), if Subsection (3)(a)(v) applies.]
             2839          [(b) (i) Except as provided in Subsection (7)(c), an insurer may send a follow-up
             2840      request for additional information within the 20-day time period in Subsection (7)(a) if the
             2841      previous response of the provider was not sufficient for the insurer to make a decision on the
             2842      claim.]
             2843          [(ii) A follow-up request for additional necessary information shall state with
             2844      specificity:]
             2845          [(A) the reason why the previous response was insufficient;]
             2846          [(B) the information that is necessary to comply with the request for information; and]
             2847          [(C) the reason why the requested information is necessary to process the claim.]
             2848          [(c) Unless an insurer has an extension for an investigation pursuant to Subsection (4)
             2849      or (5), the insurer shall pay all sums it is obligated to pay on a claim and provide a written
             2850      explanation of any part of the claim that is denied within 20 days of receiving a notice from the
             2851      provider that the provider has submitted all requested information in the provider's possession
             2852      that is related to the claim.]
             2853          [(8)] (7) (a) Whenever an insurer makes a payment to a provider on any part of a claim
             2854      under this section, the insurer shall also send to the insured an explanation of benefits paid.
             2855          (b) Whenever an insurer denies any part of a claim under this section, the insurer shall
             2856      also send to the insured:
             2857          (i) a written explanation of the part of the claim that was denied; and


             2858          (ii) notice of the adverse benefit determination review process established under
             2859      Section 31A-22-629 .
             2860          (c) This Subsection [(8)] (7) does not apply to a person receiving benefits under the
             2861      state Medicaid program as defined in Section 26-18-2 , unless required by the Department of
             2862      Health or federal law.
             2863          [(9)] (8) (a) Beginning with health care claims submitted on or after January 1, 2002, a
             2864      late fee shall be imposed on:
             2865          (i) an insurer that fails to timely pay a claim in accordance with this section; and
             2866          (ii) a provider that fails to timely provide information on a claim in accordance with
             2867      this section.
             2868          (b) For the first 90 days that a claim payment or a provider response to a request for
             2869      information is late, the late fee shall be determined by multiplying together:
             2870          (i) the total amount of the claim;
             2871          (ii) the total number of days the response or the payment is late; and
             2872          (iii) .1%.
             2873          (c) For a claim payment or a provider response to a request for information that is 91 or
             2874      more days late, the late fee shall be determined by adding together:
             2875          (i) the late fee for a 90-day period under Subsection [(9)] (8)(b); and
             2876          (ii) the following multiplied together:
             2877          (A) the total amount of the claim;
             2878          (B) the total number of days the response or payment was late beyond the initial 90-day
             2879      period; and
             2880          (C) the rate of interest set in accordance with Section 15-1-1 .
             2881          (d) Any late fee paid or collected under this section shall be separately identified on the
             2882      documentation used by the insurer to pay the claim.
             2883          (e) For purposes of this Subsection [(9)] (8), "late fee" does not include an amount that
             2884      is less than $1.
             2885          [(10)] (9) Each insurer shall establish a review process to resolve claims-related


             2886      disputes between the insurer and providers.
             2887          [(11) No] (10) An insurer or person representing an insurer may not engage in any
             2888      unfair claim settlement practice with respect to a provider. Unfair claim settlement practices
             2889      include:
             2890          (a) knowingly misrepresenting a material fact or the contents of an insurance policy in
             2891      connection with a claim;
             2892          (b) failing to acknowledge and substantively respond within 15 days to any written
             2893      communication from a provider relating to a pending claim;
             2894          (c) denying or threatening to deny the payment of a claim for any reason that is not
             2895      clearly described in the insured's policy;
             2896          (d) failing to maintain a payment process sufficient to comply with this section;
             2897          (e) failing to maintain claims documentation sufficient to demonstrate compliance with
             2898      this section;
             2899          (f) failing, upon request, to give to the provider written information regarding the
             2900      specific rate and terms under which the provider will be paid for health care services;
             2901          (g) failing to timely pay a valid claim in accordance with this section as a means of
             2902      influencing, intimidating, retaliating, or gaining an advantage over the provider with respect to
             2903      an unrelated claim, an undisputed part of a pending claim, or some other aspect of the
             2904      contractual relationship;
             2905          (h) failing to pay the sum when required and as required under Subsection [(9)] (8)
             2906      when a violation has occurred;
             2907          (i) threatening to retaliate or actual retaliation against a provider for [availing himself
             2908      of the provisions of] the provider applying this section;
             2909          (j) any material violation of this section; and
             2910          (k) any other unfair claim settlement practice established in rule or law.
             2911          [(12)] (11) (a) The provisions of this section shall apply to each contract between an
             2912      insurer and a provider for the duration of the contract.
             2913          (b) Notwithstanding Subsection [(12)] (11)(a), this section may not be the basis for a


             2914      bad faith insurance claim.
             2915          (c) Nothing in Subsection [(12)] (11)(a) may be construed as limiting the ability of an
             2916      insurer and a provider from including provisions in their contract that are more stringent than
             2917      the provisions of this section.
             2918          [(13)] (12) (a) Pursuant to Chapter 2, Part 2, Duties and Powers of Commissioner, and
             2919      beginning January 1, 2002, the commissioner may conduct examinations to determine an
             2920      insurer's level of compliance with this section and impose sanctions for each violation.
             2921          (b) The commissioner may adopt rules only as necessary to implement this section.
             2922          (c) [After December 31, 2002, the] The commissioner may establish rules to facilitate
             2923      the exchange of electronic confirmations when claims-related information has been received.
             2924          (d) Notwithstanding [the provisions of] Subsection [(13)] (12)(b), the commissioner
             2925      may not adopt rules regarding the review process required by Subsection [(10)] (9).
             2926          [(14)] (13) Nothing in this section may be construed as limiting the collection rights of
             2927      a provider under Section 31A-26-301.5 .
             2928          [(15)] (14) Nothing in this section may be construed as limiting the ability of an insurer
             2929      to:
             2930          (a) recover any amount improperly paid to a provider or an insured:
             2931          (i) in accordance with Section 31A-31-103 or any other provision of state or federal
             2932      law;
             2933          (ii) within 36 months for a coordination of benefits error; or
             2934          (iii) within 18 months for any other reason not identified in Subsection [(15)] (14)(a)(i)
             2935      or (ii);
             2936          (b) take any action against a provider that is permitted under the terms of the provider
             2937      contract and not prohibited by this section;
             2938          (c) report the provider to a state or federal agency with regulatory authority over the
             2939      provider for unprofessional, unlawful, or fraudulent conduct; or
             2940          (d) enter into a mutual agreement with a provider to resolve alleged violations of this
             2941      section through mediation or binding arbitration.


             2942          Section 23. Section 31A-27-331 is amended to read:
             2943           31A-27-331. Special provisions for third party claims.
             2944          (1) This section does not apply to a claim that is or may be covered by one of the Utah
             2945      insurance guaranty associations or a corresponding association or fund of another state.
             2946          (2) Whenever any third party asserts a cause of action against an insured of an insurer
             2947      which is in liquidation for which the insurance might indemnify the insured, the third party
             2948      may file a claim with the liquidator.
             2949          (3) Whether or not the third party files a claim, the insured may file a claim on [his] the
             2950      insured's own behalf in the liquidation. An insured who fails to file a claim by the date for
             2951      filing claims specified in the order of liquidation or within 60 days after mailing of the notice
             2952      required by Subsection 31A-27-315 (1) (b), whichever is later, is an unexcused late filer.
             2953          (4) (a) The liquidator shall make recommendations to the court under Section
             2954      31A-27-336 for the allowance of an insured's claim under Subsection (3) after consideration of
             2955      the probable outcome of any pending action against the insured on which the claim is based,
             2956      the probable damages recoverable in the action, and the probable costs and expenses of
             2957      defense.
             2958          (b) After allowance of the claim by the court, the liquidator shall withhold any
             2959      distributions payable on the claim, pending the outcome of the litigation and negotiation with
             2960      the insured.
             2961          (c) Whenever it seems appropriate, the liquidator may reconsider the claim on the basis
             2962      of additional information and amend the recommendations to the court. The insured shall be
             2963      afforded the same notice and opportunity to be heard on all changes in the recommendation as
             2964      in its initial determination.
             2965          (d) The court may amend [its] the court's allowance as it determines is appropriate.
             2966          (e) (i) As claims against the insured are settled or barred, the insured shall be paid from
             2967      the amount withheld the same percentage distribution as was paid on other claims of like
             2968      priority, based on the lesser of:
             2969          [(a)] (A) the amount actually recovered from the insured by the action or paid by the


             2970      agreement, plus the reasonable costs and expenses of defense; and
             2971          [(b)] (B) the amount allowed on the claims by the court.
             2972          (ii) After all claims are settled or barred, any sum remaining from the amount withheld
             2973      shall revert to the undistributed assets of the insurer. Delay in final payment under this
             2974      subsection is not a reason for unreasonable delay of final distribution and discharge of the
             2975      liquidator.
             2976          (5) If several claims founded upon one policy are filed, whether by third parties or as
             2977      claims by the insured under this section, and the aggregate allowed amount of the claims to
             2978      which the same limit of liability in the policy is applicable exceeds that limit, each claim as
             2979      allowed shall be reduced in the same proportion so that the total equals the policy limit.
             2980      Claims by the insured are evaluated as in Subsection (4). If any insured's claim is subsequently
             2981      reduced under Subsection (4), the amount thus freed shall be apportioned ratably among the
             2982      claims which have been reduced under this Subsection (5).
             2983          Section 24. Section 31A-30-103 is amended to read:
             2984           31A-30-103. Definitions.
             2985          As used in this chapter:
             2986          (1) "Actuarial certification" means a written statement by a member of the American
             2987      Academy of Actuaries or other individual approved by the commissioner that a covered carrier
             2988      is in compliance with Section 31A-30-106 , based upon the examination of the covered carrier,
             2989      including review of the appropriate records and of the actuarial assumptions and methods used
             2990      by the covered carrier in establishing premium rates for applicable health benefit plans.
             2991          (2) "Affiliate" or "affiliated" means any entity or person who directly or indirectly
             2992      through one or more intermediaries, controls or is controlled by, or is under common control
             2993      with, a specified entity or person.
             2994          (3) "Base premium rate" means, for each class of business as to a rating period, the
             2995      lowest premium rate charged or that could have been charged under a rating system for that
             2996      class of business by the covered carrier to covered insureds with similar case characteristics for
             2997      health benefit plans with the same or similar coverage.


             2998          (4) "Basic coverage" means the coverage provided in the Basic Health Care Plan under
             2999      Subsection 31A-22-613.5 (2).
             3000          (5) "Carrier" means any person or entity that provides health insurance in this state
             3001      including:
             3002          (a) an insurance company;
             3003          (b) a prepaid hospital or medical care plan;
             3004          (c) a health maintenance organization;
             3005          (d) a multiple employer welfare arrangement; and
             3006          (e) any other person or entity providing a health insurance plan under this title.
             3007          (6) (a) Except as provided in Subsection (6)(b), "case characteristics" means
             3008      demographic or other objective characteristics of a covered insured that are considered by the
             3009      carrier in determining premium rates for the covered insured.
             3010          (b) "Case characteristics" [does] do not include:
             3011          (i) duration of coverage since the policy was issued;
             3012          (ii) claim experience; and
             3013          (iii) health status.
             3014          (7) "Class of business" means all or a separate grouping of covered insureds
             3015      established under Section 31A-30-105 .
             3016          (8) "Conversion policy" means a policy providing coverage under the conversion
             3017      provisions required in Chapter 22, Part 7, Group Accident and Health Insurance.
             3018          (9) "Covered carrier" means any individual carrier or small employer carrier subject to
             3019      this chapter.
             3020          (10) "Covered individual" means any individual who is covered under a health benefit
             3021      plan subject to this chapter.
             3022          (11) "Covered insureds" means small employers and individuals who are issued a
             3023      health benefit plan that is subject to this chapter.
             3024          (12) "Dependent" means an individual to the extent that the individual is defined to be
             3025      a dependent by:


             3026          (a) the health benefit plan covering the covered individual; and
             3027          (b) Chapter 22, Part 6, Accident and Health Insurance.
             3028          (13) "Established geographic service area" means a geographical area approved by the
             3029      commissioner within which the carrier is authorized to provide coverage.
             3030          (14) "Index rate" means, for each class of business as to a rating period for covered
             3031      insureds with similar case characteristics, the arithmetic average of the applicable base
             3032      premium rate and the corresponding highest premium rate.
             3033          (15) "Individual carrier" means a carrier that provides coverage on an individual basis
             3034      through a health benefit plan regardless of whether:
             3035          (a) coverage is offered through:
             3036          (i) an association;
             3037          (ii) a trust;
             3038          (iii) a discretionary group; or
             3039          (iv) other similar groups; or
             3040          (b) the policy or contract is situated out-of-state.
             3041          (16) "Individual conversion policy" means a conversion policy issued to:
             3042          (a) an individual; or
             3043          (b) an individual with a family.
             3044          (17) "Individual coverage count" means the number of natural persons covered under a
             3045      carrier's health benefit products that are individual policies.
             3046          (18) "Individual enrollment cap" means the percentage set by the commissioner in
             3047      accordance with Section 31A-30-110 .
             3048          (19) "New business premium rate" means, for each class of business as to a rating
             3049      period, the lowest premium rate charged or offered, or that could have been charged or offered,
             3050      by the carrier to covered insureds with similar case characteristics for newly issued health
             3051      benefit plans with the same or similar coverage.
             3052          (20) "Plan year" means the year that is designated as the plan year in the plan document
             3053      of a group health plan, except that if the plan document does not designate a plan year or if


             3054      there is not a plan document, the plan year is:
             3055          (a) the deductible or limit year used under the plan;
             3056          (b) if the plan does not impose a deductible or limit on a yearly basis, the policy year;
             3057          (c) if the plan does not impose a deductible or limit on a yearly basis and either the
             3058      plan is not insured or the insurance policy is not renewed on an annual basis, the employer's
             3059      taxable year; or
             3060          (d) in any case not described in Subsections (20)(a) through (c), the calendar year.
             3061          [(20)] (21) "Preexisting condition" is as defined in Section 31A-1-301 .
             3062          [(21)] (22) "Premium" means all monies paid by covered insureds and covered
             3063      individuals as a condition of receiving coverage from a covered carrier, including any fees or
             3064      other contributions associated with the health benefit plan.
             3065          [(22)] (23) (a) "Rating period" means the calendar period for which premium rates
             3066      established by a covered carrier are assumed to be in effect, as determined by the carrier.
             3067          (b) A covered carrier may not have:
             3068          (i) more than one rating period in any calendar month; and
             3069          (ii) no more than 12 rating periods in any calendar year.
             3070          [(23)] (24) "Resident" means an individual who has resided in this state for at least 12
             3071      consecutive months immediately preceding the date of application.
             3072          [(24)] (25) "Short-term limited duration insurance" means a health benefit product that:
             3073          (a) is not renewable; and
             3074          (b) has an expiration date specified in the contract that is less than 364 days after the
             3075      date the plan became effective.
             3076          [(25)] (26) "Small employer carrier" means a carrier that provides health benefit plans
             3077      covering eligible employees of one or more small employers in this state, regardless of
             3078      whether:
             3079          (a) coverage is offered through:
             3080          (i) an association;
             3081          (ii) a trust;


             3082          (iii) a discretionary group; or
             3083          (iv) other similar grouping; or
             3084          (b) the policy or contract is situated out-of-state.
             3085          [(26)] (27) "Uninsurable" means an individual who:
             3086          (a) is eligible for the Comprehensive Health Insurance Pool coverage under the
             3087      underwriting criteria established in Subsection 31A-29-111 (5); or
             3088          (b) (i) is issued a certificate for coverage under Subsection 31A-30-108 (3); and
             3089          (ii) has a condition of health that does not meet consistently applied underwriting
             3090      criteria as established by the commissioner in accordance with Subsections 31A-30-106 (1)(i)
             3091      and (j) for which coverage the applicant is applying.
             3092          [(27)] (28) "Uninsurable percentage" for a given calendar year equals UC/CI where, for
             3093      purposes of this formula:
             3094          (a) "CI" means the carrier's individual coverage count as of December 31 of the
             3095      preceding year; and
             3096          (b) "UC" means the number of uninsurable individuals who were issued an individual
             3097      policy on or after July 1, 1997.
             3098          Section 25. Section 31A-30-107.3 is amended to read:
             3099           31A-30-107.3. Discontinuance and nonrenewal limitations and conditions.
             3100          (1) (a) A carrier that elects to discontinue offering a health benefit plan under
             3101      Subsection 31A-30-107 (3)(e) or 31A-30-107.1 (3)(e) is prohibited from writing new business:
             3102          (i) in the small employer and individual market in this state; and
             3103          (ii) for a period of five years beginning on the date of discontinuation of the last
             3104      coverage that is discontinued.
             3105          (b) The prohibition described in Subsection (1)(a) may be waived if the commissioner
             3106      finds that waiver is in the public interest:
             3107          (i) to promote competition; or
             3108          (ii) to resolve inequity in the marketplace.
             3109          (2) (a) If the Comprehensive Health Insurance Pool as set forth under Title 31A,


             3110      Chapter 29, is dissolved or discontinued, or if enrollment is capped or suspended, an individual
             3111      carrier:
             3112          (i) may elect to discontinue offering new individual health benefit plans, except to
             3113      HIPAA eligibles, but must keep existing individual health benefit plans in effect, except those
             3114      individual plans that are not renewed under the provisions of Subsection 31A-30-107 (2) or
             3115      31A-30-107.1 (2);
             3116          (ii) may elect to continue to offer new individual and small employer health benefit
             3117      plans; or
             3118          (iii) may elect to discontinue all of the covered carrier's health benefit plans in the
             3119      individual or small group market under the provisions of Subsection 31A-30-107 (3)(e) or
             3120      31A-30-107.1 (3)(e).
             3121          (b) A carrier that makes an election under Subsection (2)(a)(i):
             3122          (i) is prohibited from writing new business:
             3123          (A) in the individual market in this state; and
             3124          (B) for a period of five years beginning on the date of discontinuation;
             3125          (ii) may continue to write new business in the small employer market; and
             3126          (iii) must provide written notice of the election under Subsection (2)(a)(i) within two
             3127      calendar days of the election to the Utah Insurance Department.
             3128          (c) The prohibition described in Subsection (2)(b)(i) may be waived if the
             3129      commissioner finds that waiver is in the public interest:
             3130          (i) to promote competition; or
             3131          (ii) to resolve inequity in the marketplace.
             3132          (d) A carrier that makes an election under Subsection (2)(a)(iii) is subject to the
             3133      provisions of Subsection (1).
             3134          (3) If a carrier is doing business in one established geographic service area of the state,
             3135      Sections 31A-30-107 and 31A-30-107.1 apply only to the carrier's operations in that
             3136      geographic service area.
             3137          (4) If a small employer employs less than two eligible employees, a carrier may not


             3138      discontinue or not renew the health benefit plan until the first renewal date following the
             3139      beginning of a new plan year, even if the carrier knows as of the beginning of the plan year that
             3140      the employer no longer has at least two current employees.
             3141          Section 26. Section 31A-30-107.5 is amended to read:
             3142           31A-30-107.5. Preexisting condition exclusion -- Condition-specific exclusion
             3143      riders -- Limitation periods.
             3144          (1) A health benefit plan may impose a preexisting condition exclusion only if the
             3145      provision complies with Subsection 31A-22-605.1 (4).
             3146          (2) (a) In accordance with Subsection (2)(b), an individual carrier:
             3147          (i) may, when the individual carrier and the insured mutually agree in writing to a
             3148      condition-specific exclusion rider, offer to issue an individual policy that excludes all treatment
             3149      and prescription drugs related to:
             3150          (A) a specific physical condition;
             3151          (B) a specific disease or disorder; and
             3152          (C) any specific or class of prescription drugs; and
             3153          (ii) may offer an individual policy that may establish separate cost sharing
             3154      requirements including, deductibles and maximum limits that are specific to covered services
             3155      and supplies, including drugs, when utilized for the treatment and care of the conditions,
             3156      diseases, or disorders listed in Subsection (2)(b).
             3157          (b) (i) Except as provided in Section 31A-22-630 and [except for the treatment of
             3158      asthma or when the condition is due to cancer] Subsection (2)(b)(ii), the following may be the
             3159      subject of a condition-specific exclusion rider:
             3160          (A) conditions, diseases, and disorders of the bones or joints of the ankle, arm, elbow,
             3161      fingers, foot, hand, hip, knee, leg, mandible, mastoid, wrist, shoulder, spine, and toes, including
             3162      bone spurs, bunions, carpal tunnel syndrome, club foot, cubital tunnel syndrome, hammertoe,
             3163      syndactylism, and treatment and prosthetic devices related to amputation;
             3164          (B) anal fistula, anal fissure, anal stricture, breast implants, breast reduction, chronic
             3165      cystitis, chronic prostatitis, cystocele, rectocele, enuresis, hemorrhoids, hydrocele, hypospadius,


             3166      interstitial cystitis, kidney stones, uterine leiomyoma, varicocele, spermatocele, endometriosis;
             3167          (C) allergic rhinitis, nonallergic rhinitis, hay fever, dust allergies, pollen allergies,
             3168      deviated nasal septum, and sinus related conditions, diseases, and disorders;
             3169          (D) hemangioma, keloids, scar revisions, and other skin related conditions, diseases,
             3170      and disorders;
             3171          (E) goiter and other thyroid related conditions, diseases, or disorders;
             3172          (F) cataracts, cornea transplant, detached retina, glaucoma, keratoconus, macular
             3173      degeneration, strabismus and other eye related conditions, diseases, and disorders;
             3174          (G) otitis media, cholesteatoma, otosclerosis, and other internal/external ear conditions,
             3175      diseases, and disorders;
             3176          (H) Baker's cyst, ganglion cyst;
             3177          (I) abdominoplasty, esophageal reflux, hernia, Meniere's disease, migraines, TIC
             3178      Doulourex, varicose veins, vestibular disorders;
             3179          (J) sleep disorders and speech disorders; and
             3180          (K) any specific or class of prescription drugs.
             3181          (ii) Subsection (2)(b)(i) does not apply:
             3182          (A) for the treatment of asthma; or
             3183          (B) when the condition is due to cancer.
             3184          [(ii)] (iii) A condition-specific exclusion rider:
             3185          (A) shall be limited to the excluded condition, disease, or disorder and any
             3186      complications from that condition, disease, or disorder;
             3187          (B) may not extend to any secondary medical condition; and
             3188          (C) must include the following informed consent paragraph: "I agree by signing below,
             3189      to the terms of this rider, which excludes coverage for all treatment, including medications,
             3190      related to the specific condition(s), disease(s), and/or disorder(s) stated herein and that if
             3191      treatment or medications are received that I have the responsibility for payment for those
             3192      services and items. I further understand that this rider does not extend to any secondary
             3193      medical condition, disease, or disorder."


             3194          (c) If an individual carrier issues a condition-specific exclusion rider, the
             3195      condition-specific exclusion rider shall remain in effect for the duration of the policy at the
             3196      individual carrier's option.
             3197          (d) An individual policy issued in accordance with this Subsection (2) is not subject to
             3198      Subsection 31A-26-301.6 [(9)](7).
             3199          (3) Notwithstanding the other provisions of this section, a health benefit plan may
             3200      impose a limitation period if:
             3201          (a) each policy that imposes a limitation period under the health benefit plan specifies
             3202      the physical condition, disease, or disorder that is excluded from coverage during the limitation
             3203      period;
             3204          (b) the limitation period does not exceed 12 months;
             3205          (c) the limitation period is applied uniformly; and
             3206          (d) the limitation period is reduced in compliance with Subsections
             3207      31A-22-605.1 (4)(a) and (4)(b).
             3208          Section 27. Section 31A-30-112 is amended to read:
             3209           31A-30-112. Employee participation levels.
             3210          (1) Except as provided in Subsection (2), requirements used by a covered carrier in
             3211      determining whether to provide coverage to a small employer, including requirements for
             3212      minimum participation of eligible employees and minimum employer contributions shall be
             3213      applied uniformly among all small employers with the same number of eligible employees
             3214      applying for coverage or receiving coverage from the covered carrier. In addition to applying
             3215      Subsection 31A-1-301 (120), a covered carrier may require that a small employer have a
             3216      minimum of two eligible employees to meet participation requirements.
             3217          (2) A covered carrier may not increase any requirement for minimum employee
             3218      participation or any requirement for minimum employer contribution applicable to a small
             3219      employer at any time after the small employer has been accepted for coverage.
             3220          Section 28. Section 31A-35-201 is amended to read:
             3221           31A-35-201. Bail Bond Surety Oversight Board.


             3222          (1) There is created a Bail Bond Surety Oversight Board within the department,
             3223      consisting of:
             3224          (a) the following seven voting members to be appointed by the commissioner:
             3225          (i) one representative each from four licensed bail bond surety companies;
             3226          (ii) two members of the general public who do not have any financial interest in or
             3227      professional affiliation with any bail bond surety company; and
             3228          (iii) one attorney in good standing licensed to practice law in Utah; and
             3229          (b) a nonvoting member who is a staff member of the insurance department appointed
             3230      by the commissioner.
             3231          (2) (a) The appointments are for terms of four years. A board member may not serve
             3232      more than two consecutive terms.
             3233          [(b) Except as required by Subsection (2)(c), the members as of May 5, 1998, of the
             3234      Bail Bond Surety Licensing Board created under Section 77-20-11 shall serve the remainder of
             3235      their terms as members of the board. Upon expiration of their terms they are eligible for
             3236      appointment to another term.]
             3237          [(c)] (b) The insurance commissioner shall, at the time of [initial appointments]
             3238      appointment or reappointment of a board member described in Subsection (1)(a), adjust the
             3239      length of terms to ensure that the terms of board members are staggered so approximately half
             3240      of the board is appointed every two years.
             3241          (3) A board member serves until:
             3242          (a) removed by the insurance commissioner;
             3243          (b) the member's resignation; or
             3244          (c) for a member described in Subsection (1)(a), the expiration of the member's term
             3245      and the appointment of a successor.
             3246          (4) When a vacancy occurs in the membership of a board member described in
             3247      Subsection (1)(a) for any reason, the replacement shall be appointed for the remainder of the
             3248      unexpired term.
             3249          (5) The board shall annually elect one of its members as chair.


             3250          (6) Four voting members constitute a quorum for the transaction of business.
             3251          (7) (a) [Members do] A member described in Subsection (1)(a) does not receive
             3252      compensation or benefits for [their] the member's services, but may receive per diem and
             3253      expenses incurred in the performance of official duties at the rates established by the Division
             3254      of Finance under Sections 63A-3-106 and 63A-3-107 .
             3255          (b) [Members] A member described in Subsection (1)(a) may decline to receive per
             3256      diem and expenses for [their] the member's services.
             3257          (8) (a) The commissioner, with a majority vote of the board, may remove any member
             3258      of the board described in Subsection (1)(a) for misconduct, incompetency, or neglect of duty.
             3259          (b) The board shall conduct a hearing if requested by the board member described in
             3260      Subsection (1)(a) that is to be removed.
             3261          (9) Members of the board are immune from suit with respect to all acts done and
             3262      actions taken in good faith in carrying out the purposes of this chapter.
             3263          Section 29. Section 31A-36-102 is amended to read:
             3264           31A-36-102. Definitions.
             3265          As used in this chapter:
             3266          (1) (a) "Advertising" means any communication placed before the public to:
             3267          (i) create an interest in viatical settlements; or
             3268          (ii) induce a person to sell a policy or an interest in a policy pursuant to a viatical
             3269      settlement.
             3270          (b) "Advertising" includes the following, if the requirements of Subsection (1)(a) are
             3271      met:
             3272          (i) any written, electronic, or printed communication;
             3273          (ii) any communication by means of recorded telephone messages;
             3274          (iii) any communication transmitted on radio, television, the Internet, or similar
             3275      communications media; and
             3276          (iv) film strips, motion pictures, and videos.
             3277          (2) "Business of viatical settlements" includes the following:


             3278          (a) offering a viatical settlement;
             3279          (b) [solicitation of] soliciting a viatical settlement;
             3280          (c) [negotiation of] negotiating a viatical settlement;
             3281          (d) [procurement of] procuring a viatical settlement;
             3282          (e) [effectuation of] effectuating a viatical settlement;
             3283          (f) purchasing a viatical settlement;
             3284          (g) investing in a viatical settlement;
             3285          (h) financing a viatical settlement;
             3286          (i) monitoring a viatical settlement;
             3287          (j) tracking a viatical settlement;
             3288          (k) underwriting a viatical settlement;
             3289          (l) selling a viatical settlement;
             3290          (m) transferring a viatical settlement;
             3291          (n) assigning a viatical settlement;
             3292          (o) pledging a viatical settlement; and
             3293          (p) otherwise hypothecating a viatical [settlements] settlement.
             3294          (3) "Chronically ill" means:
             3295          (a) being unable to perform at least two activities of daily living, such as eating,
             3296      toileting, moving from one place to another, bathing, dressing, or continence;
             3297          (b) requiring substantial supervision for protection from threats to health and safety
             3298      because of severe cognitive impairment; or
             3299          (c) having a level of disability similar to that described in Subsection (3)(a).
             3300          (4) (a) "Financing entity" means a person:
             3301          (i) [that] who has direct ownership in a policy that is the subject of [the] a viatical
             3302      settlement;
             3303          (ii) whose principal activity related to [the transaction] a viatical settlement is
             3304      providing money to effect the viatical settlement; and
             3305          (iii) [that] who has an agreement in writing with one or more licensed viatical


             3306      settlement providers [of viatical settlements] to finance the acquisition of one or more viatical
             3307      settlements.
             3308          (b) "Financing entity" includes, if the requirements of Subsection (4)(a) are met, the
             3309      following:
             3310          (i) an underwriter;
             3311          (ii) a placement agent;
             3312          (iii) an enhancer of credit;
             3313          (iv) a lender;
             3314          (v) a purchaser of securities; and
             3315          (vi) a purchaser of a policy from a viatical settlement provider [of viatical settlements].
             3316          (c) "Financing entity" does not include:
             3317          (i) a nonaccredited investor [or a purchaser of]; or
             3318          (ii) a viatical [settlements] settlement purchaser.
             3319          (5) "Form" means, in addition to a form as defined in Section 31A-1-301 :
             3320          (a) a viatical settlement;
             3321          (b) a disclosure to a viator;
             3322          (c) a notice of intent to viaticate; or
             3323          (d) a verification of coverage.
             3324          [(5)] (6) "Policy" means:
             3325          (a) an individual or group policy;
             3326          (b) a group certificate; or
             3327          (c) a contract or arrangement of life insurance, whether or not delivered or issued for
             3328      delivery in Utah:
             3329          (i) affecting the rights of a resident of Utah; or
             3330          (ii) bearing a reasonable relation to Utah.
             3331          [(6) (a) "Producer of viatical settlements" means a person that on behalf of a viator and
             3332      for consideration offers or attempts to negotiate a viatical settlement between the viator and
             3333      one or more providers of viatical settlements.]


             3334          [(b) "Producer of viatical settlements" does not include an attorney licensed to practice
             3335      law in any state, certified public accountant, or financial planner accredited by a nationally
             3336      recognized accrediting agency:]
             3337          [(i) that is retained by the viator; and]
             3338          [(ii) whose compensation is not paid directly or indirectly by a provider or purchaser of
             3339      viatical settlements.]
             3340          [(7) (a) "Provider of viatical settlements" means a person other than a viator that enters
             3341      into or effectuates a viatical settlement.]
             3342          [(b) "Provider of viatical settlements" does not include:]
             3343          [(i) a licensed lender that takes an assignment of a policy as security for a loan,
             3344      including a:]
             3345          [(A) bank;]
             3346          [(B) savings bank;]
             3347          [(C) savings and loan association;]
             3348          [(D) credit union; or]
             3349          [(E) other licensed lender;]
             3350          [(ii) the issuer of a policy providing accelerated benefits pursuant to the policy;]
             3351          [(iii) an authorized or eligible insurer that provides stop-loss coverage to:]
             3352          [(A) a provider of viatical settlements;]
             3353          [(B) a purchaser of viatical settlements;]
             3354          [(C) a financing entity;]
             3355          [(D) a special purpose entity; or]
             3356          [(E) a related provider trust;]
             3357          [(iv) a natural person that enters or effectuates no more than one agreement in a
             3358      calendar year for the transfer of policies for a value less than the expected death benefit;]
             3359          [(v) a financing entity;]
             3360          [(vi) a special purpose entity;]
             3361          [(vii) a related provider trust;]


             3362          [(viii) a purchaser of viatical settlements; or]
             3363          [(ix) any of the following that purchases a viaticated policy from a provider of viatical
             3364      settlements:]
             3365          [(A) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
             3366      230.501; or]
             3367          [(B) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A.]
             3368          [(8) (a) "Purchaser of viatical settlements" means a person that, to derive an economic
             3369      benefit:]
             3370          [(i) gives a sum of money as consideration for a policy or an interest in the death
             3371      benefits of a policy; or]
             3372          [(ii) owns, acquires, or is entitled to a beneficial interest in a trust that:]
             3373          [(A) owns a viatical settlement contract; or]
             3374          [(B) is the beneficiary of a policy that has been or will be the subject of a viatical
             3375      settlement.]
             3376          [(b) "Purchaser of viatical settlements" does not include:]
             3377          [(i) a licensee under this chapter;]
             3378          [(ii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
             3379      230.501;]
             3380          [(iii) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec.
             3381      230.144A;]
             3382          [(iv) a financing entity;]
             3383          [(v) a special purpose entity; or]
             3384          [(vi) a related provider trust.]
             3385          [(9)] (7) "Related provider trust" means a trust established by a licensed viatical
             3386      settlement provider [of viatical settlements] or a financing entity solely to hold the ownership
             3387      of or beneficial interests in purchased policies in connection with financing.
             3388          [(10)] (8) "Special purpose entity" means an organization formed by a licensed viatical
             3389      settlement provider [of viatical settlements] solely to enable the provider to gain access to


             3390      institutional markets for capital.
             3391          [(11)] (9) "Terminally ill" means having a condition that reasonably may be expected
             3392      to result in death within 24 months.
             3393          [(13)] (10) "Viaticated policy" means a policy that has been acquired by a viatical
             3394      settlement provider [of viatical settlements] pursuant to a viatical settlement.
             3395          [(12)] (11) (a) "Viatical settlement" means a written agreement for the payment of
             3396      anything of value, which is less than the expected death benefit of the policy, in exchange for
             3397      the viator's assignment, sale, transfer, devise, or bequest of the death benefit or ownership of
             3398      any portion of a policy.
             3399          (b) "Viatical settlement" includes:
             3400          (i) an agreement with a viator for a loan or other financing secured primarily by a
             3401      policy; and
             3402          (ii) an agreement with a viator to transfer ownership or change the beneficiary in the
             3403      future, regardless of the date of payment to the viator.
             3404          (c) "Viatical settlement" does not include:
             3405          (i) a loan by an insurer pursuant to the terms of a policy; or
             3406          (ii) a loan secured by the cash value of a policy.
             3407          (12) (a) "Viatical settlement producer" means a person that on behalf of a viator and for
             3408      consideration offers or attempts to negotiate a viatical settlement between the viator and one or
             3409      more viatical settlement providers.
             3410          (b) "Viatical settlement producer" does not include an attorney licensed to practice law
             3411      in any state, a certified public accountant, or a financial planner accredited by a nationally
             3412      recognized accrediting agency:
             3413          (i) that is retained by the viator; and
             3414          (ii) whose compensation is not paid directly or indirectly by:
             3415          (A) a viatical settlement provider; or
             3416          (B) a viatical settlement purchaser.
             3417          (13) (a) "Viatical settlement provider" means a person other than a viator that enters


             3418      into or effectuates a viatical settlement.
             3419          (b) "Viatical settlement provider" does not include:
             3420          (i) a licensed lender that takes an assignment of a policy as security for a loan,
             3421      including a:
             3422          (A) bank;
             3423          (B) savings bank;
             3424          (C) savings and loan association;
             3425          (D) credit union; or
             3426          (E) other licensed lender;
             3427          (ii) the issuer of a policy providing accelerated benefits pursuant to the policy;
             3428          (iii) an authorized or eligible insurer that provides stop-loss coverage to:
             3429          (A) a viatical settlement provider;
             3430          (B) a viatical settlement purchaser;
             3431          (C) a financing entity;
             3432          (D) a special purpose entity; or
             3433          (E) a related provider trust;
             3434          (iv) a natural person that enters or effectuates no more than one agreement in a
             3435      calendar year for the transfer of policies for a value less than the expected death benefit;
             3436          (v) a financing entity;
             3437          (vi) a special purpose entity;
             3438          (vii) a related provider trust;
             3439          (viii) a viatical settlement purchaser; or
             3440          (ix) any of the following that purchases a viaticated policy from a viatical settlement
             3441      provider:
             3442          (A) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
             3443      230.501; or
             3444          (B) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A.
             3445          (14) (a) "Viatical settlement purchaser" means a person that, to derive an economic


             3446      benefit:
             3447          (i) gives a sum of money as consideration for a policy or an interest in the death
             3448      benefits of a policy; or
             3449          (ii) owns, acquires, or is entitled to a beneficial interest in a trust that:
             3450          (A) owns a viatical settlement contract; or
             3451          (B) is the beneficiary of a policy that has been or will be the subject of a viatical
             3452      settlement.
             3453          (b) "Viatical settlement purchaser" does not include:
             3454          (i) a viatical settlement provider;
             3455          (ii) a viatical settlement producer;
             3456          (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
             3457      230.501;
             3458          (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A;
             3459          (v) a financing entity;
             3460          (vi) a special purpose entity; or
             3461          (vii) a related provider trust.
             3462          [(14)] (15) (a) "Viator" means any of the following that seeks to enter into a viatical
             3463      settlement:
             3464          (i) the owner of a policy; or
             3465          (ii) the holder of a certificate of insurance under a policy of group insurance.
             3466          (b) "Viator" is not limited to a person that is terminally ill or chronically ill except
             3467      where that limitation is expressly provided.
             3468          (c) "Viator" does not include:
             3469          [(i) a licensee under this chapter;]
             3470          (i) a viatical settlement provider;
             3471          (ii) a viatical settlement producer;
             3472          [(ii)] (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
             3473      230.501;


             3474          [(iii)] (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec.
             3475      230.144A;
             3476          [(iv)] (v) a financing entity;
             3477          [(v)] (vi) a special purpose entity; or
             3478          [(vi)] (vii) a related provider trust.
             3479          Section 30. Section 31A-36-104 is amended to read:
             3480           31A-36-104. License requirements, revocation, and denial.
             3481          (1) (a) A person may not, without first obtaining a license from the commissioner,
             3482      operate in or from this state as:
             3483          (i) a viatical settlement provider [of viatical settlements]; or
             3484          (ii) a viatical settlement producer [of viatical settlements].
             3485          (b) Viatical settlements are included within the scope of the life insurance producer
             3486      line of authority.
             3487          (2) (a) To obtain a license as a viatical settlement provider [of viatical settlements], an
             3488      applicant shall:
             3489          (i) comply with Section 31A-23a-117 ;
             3490          (ii) file an application; and
             3491          (iii) pay the license fee.
             3492          (b) If an applicant complies with Subsection (2)(a), the commissioner shall investigate
             3493      the applicant and issue a license if the commissioner finds that the applicant is competent and
             3494      trustworthy to engage in the business of providing viatical settlements by experience, training,
             3495      or education.
             3496          (3) In addition to the requirements in Sections 31A-23a-111 , 31A-23a-112 and
             3497      31A-23a-113 , the commissioner may refuse to issue, suspend, revoke, or refuse to renew the
             3498      license of a viatical settlement provider [of viatical settlements] or viatical settlement producer
             3499      [of viatical settlements] if the commissioner finds that:
             3500          (a) a viatical settlement provider [of viatical settlements] demonstrates a pattern of
             3501      unreasonable payments to viators;


             3502          (b) the applicant [or], the licensee, [or] an officer, partner, or member, or key
             3503      management personnel:
             3504          (i) has, whether or not a judgment of conviction has been entered by the court, been
             3505      found guilty of, or pleaded guilty or nolo contendere to:
             3506          (A) a felony; or
             3507          (B) a misdemeanor involving fraud or moral turpitude;
             3508          (ii) violated any provision of this chapter; or
             3509          (iii) has been subject to a final administrative action by another state or federal
             3510      jurisdiction.
             3511          (c) a viatical settlement provider [of viatical settlements] has entered into a viatical
             3512      settlement not approved under this chapter;
             3513          (d) a viatical settlement provider [of viatical settlements] has failed to honor
             3514      obligations of a viatical settlement;
             3515          (e) a viatical settlement provider [of viatical settlements] has assigned, transferred, or
             3516      pledged a viaticated policy to a person other than:
             3517          (i) a viatical settlement provider [of viatical settlements] licensed under this chapter;
             3518          (ii) a viatical settlement purchaser [of the viatical settlement];
             3519          (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
             3520      230.501;
             3521          (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A;
             3522          (v) a financing entity;
             3523          (vi) a special purpose entity; or
             3524          (vii) a related provider trust; or
             3525          (f) a viatical settlement provider [of viatical settlements] has failed to maintain a
             3526      standard set forth in Subsection (2)(b).
             3527          (4) If the commissioner denies a license application or suspends, revokes, or refuses to
             3528      renew the license of a viatical settlement provider [of viatical settlements] or viatical settlement
             3529      producer [of viatical settlements], the commissioner shall conduct an adjudicative proceeding


             3530      under Title 63, Chapter 46b, Administrative Procedures Act.
             3531          Section 31. Section 31A-36-105 is amended to read:
             3532           31A-36-105. Filing and use of forms for viatical settlement and disclosure.
             3533          (1) [Unless] A person may not use a form unless the form has been filed with the
             3534      commissioner under Subsection 31A-21-201 (1)[, a person may not use a form for a:].
             3535          [(a) viatical settlement;]
             3536          [(b) disclosure to the viator;]
             3537          [(c) notice of intent to viaticate;]
             3538          [(d) verification of coverage; or]
             3539          [(e) application.]
             3540          (2) The commissioner may prohibit the use of a form submitted under Subsection (1)
             3541      pursuant to Subsection 31A-21-201 (3).
             3542          (3) The commissioner may require the submission of advertising material before its
             3543      use.
             3544          Section 32. Section 31A-36-106 is amended to read:
             3545           31A-36-106. Reporting requirements and privacy.
             3546          (1) (a) [Each licensee under this chapter] Subject to Subsection (1)(b), each viatical
             3547      settlement provider shall file with the commissioner on or before March 1 of each year an
             3548      annual statement containing [such] the information [as] the commissioner prescribes under
             3549      Section 31A-36-119 [, provided, however, that].
             3550          (b) Notwithstanding Subsection (1)(a), the commissioner shall only require the
             3551      information [shall be limited to] for those transactions where the viator is a resident of Utah.
             3552          (2) Except as otherwise allowed or required by law, the following may not disclose the
             3553      identity, financial information, or medical information of an insured to any other person:
             3554          (a) a viatical settlement provider [of viatical settlements];
             3555          (b) a viatical settlement producer [of viatical settlements];
             3556          (c) a producer of insurance;
             3557          (d) an information bureau;


             3558          (e) a rating agency or company; or
             3559          (f) any other person knowing the identity of an insured.
             3560          (3) Notwithstanding Subsection (2), a person may disclose the identity of an insured if
             3561      the disclosure is:
             3562          (a) necessary to effect a viatical settlement between the viator and a viatical settlement
             3563      provider [of viatical settlements] and both the viator and the insured have given prior written
             3564      consent to the disclosure;
             3565          (b) furnished in response to an investigation or examination by the commissioner or
             3566      another governmental officer or agency;
             3567          (c) furnished pursuant to Section 31A-36-114 ;
             3568          (d) a term of or condition to the transfer of a policy by one viatical settlement provider
             3569      [of viatical settlements] to another viatical settlement provider;
             3570          (e) necessary to permit a financing entity, related provider trust, or special purpose
             3571      entity to finance the purchase of a policy by a viatical settlement provider [of viatical
             3572      settlements] and the insured has given prior written consent to the disclosure;
             3573          (f) necessary to allow the viatical settlement provider or viatical settlement producer
             3574      [of viatical settlements] or [their] the viatical settlement provider's or viatical settlement
             3575      producer's authorized representatives to make contacts to determine the health status of the
             3576      viator; or
             3577          (g) required to purchase stop-loss coverage.
             3578          Section 33. Section 31A-36-107 is amended to read:
             3579           31A-36-107. Examinations and retention of records.
             3580          (1) The commissioner may conduct an examination of a [licensee under this chapter]
             3581      viatical settlement provider or viatical settlement producer in accordance with Sections
             3582      31A-2-203 , 31A-2-203.5 , 31A-2-204 , and 31A-2-205 .
             3583          (2) A [person required to be licensed under this chapter] viatical settlement provider or
             3584      viatical settlement producer shall retain for five years copies of all:
             3585          (a) the following records, whether proposed, offered, or executed, from the later of the


             3586      date of the proposal, offer, or execution[, whichever is later]:
             3587          (i) contracts;
             3588          (ii) purchase agreements;
             3589          (iii) underwriting documents;
             3590          (iv) policy forms; and
             3591          (v) applications;
             3592          (b) checks, drafts, and other evidence or documentation relating to the payment,
             3593      transfer, or release of money, from the date of the transaction; and
             3594          (c) records and documents related to the requirements of this chapter.
             3595          (3) This section does not relieve a person of the obligation to produce a document
             3596      described in Subsection (2) to the commissioner after the expiration of the relevant period if
             3597      the person has retained the document.
             3598          (4) Records required by this section to be retained must be legible and complete. They
             3599      may be retained in any form or by any process that accurately reproduces or is a durable
             3600      medium for the reproduction of the record.
             3601          (5) An examiner may not be appointed by the commissioner if the examiner, either
             3602      directly or indirectly, has a conflict of interest or is affiliated with the management of or owns a
             3603      pecuniary interest in any person subject to examination under this chapter. This [section]
             3604      Subsection (5) does not automatically preclude an examiner from being:
             3605          (a) a viator;
             3606          (b) an insured in a viaticated policy; or
             3607          (c) a beneficiary in a policy that is proposed to be viaticated.
             3608          (6) (a) Examinees under this section shall reimburse the cost of any examination to the
             3609      department consistent with Section 31A-2-205 .
             3610          (b) Notwithstanding Subsection (6)(a), an individual [producers of viatical settlements
             3611      are] viatical settlement producer is not subject to Section 31A-2-205 .
             3612          Section 34. Section 31A-36-108 is amended to read:
             3613           31A-36-108. Required disclosures.


             3614          (1) With each application for a viatical settlement, a viatical settlement provider or
             3615      viatical settlement producer [of viatical settlements] shall furnish to the viator any disclosures
             3616      the commissioner may require under Section 31A-36-119 , in a separate document signed by the
             3617      viator and the viatical settlement provider or viatical settlement producer, no later than the time
             3618      the application for the viatical settlement is signed by all the parties.
             3619          (2) A viatical settlement provider [of viatical settlements] shall furnish to the viator any
             3620      disclosures the commissioner may require under Section 31A-36-119 , conspicuously displayed
             3621      in the viatical settlement or in a separate document signed by the viator and the viatical
             3622      settlement provider [of viatical settlements], no later than the time the viatical settlement is
             3623      signed by all parties.
             3624          Section 35. Section 31A-36-109 is amended to read:
             3625           31A-36-109. General requirements.
             3626          (1) If a viatical settlement provider [of viatical settlements] transfers ownership or
             3627      changes the beneficiary of a viaticated policy, the viatical settlement provider shall inform the
             3628      insured of the transfer or change within 20 calendar days.
             3629          (2) A viatical settlement provider [of viatical settlements] that enters a viatical
             3630      settlement shall first obtain:
             3631          (a) if the viator is the insured, a written statement from a licensed attending physician
             3632      that the viator is of sound mind and under no constraint or undue influence to enter a viatical
             3633      settlement;
             3634          (b) a witnessed document in which the viator represents that:
             3635          (i) the viator has a full and complete understanding of the viatical settlement and the
             3636      benefits of the policy;
             3637          (ii) the viator has entered the viatical settlement freely and voluntarily; and
             3638          (iii) if applicable, the insured is terminally ill or chronically ill and that the illness was
             3639      diagnosed after the policy was issued; and
             3640          (c) a document in which the insured consents to the release of the insured's medical
             3641      records to:


             3642          (i) a viatical settlement provider [of viatical settlements];
             3643          (ii) a viatical settlement producer [of viatical settlements]; and
             3644          (iii) the insurer that issued the policy covering the insured.
             3645          (3) Within 20 calendar days after a viator executes documents necessary to transfer
             3646      rights under a policy, or enters into an agreement in any form, express or implied, to viaticate
             3647      the policy, the viatical settlement provider [of viatical settlements] shall give written notice to
             3648      the issuer of the policy that the policy has or will become viaticated. The notice must be
             3649      accompanied by a copy of the documents required by Subsection (4).
             3650          (4) The viatical settlement provider [of viatical settlements] shall deliver a copy of the
             3651      following to the insurer that issued the policy that is the subject of the viatical settlement:
             3652          (a) the medical release required under Subsection (2)(c);
             3653          (b) a copy of the viator's application for the viatical settlement; and
             3654          (c) the notice required under Subsection (3).
             3655          (5) The insurer shall complete and return a request for verification of coverage not later
             3656      than 30 calendar days after the date the request is received. In its response, the insurer shall
             3657      indicate whether the insurer intends to pursue an investigation regarding the validity of the
             3658      insurance contract.
             3659          (6) All medical information solicited or obtained by a [licensee under this chapter]
             3660      viatical settlement provider or viatical settlement producer is subject to:
             3661          (a) other laws of this state relating to the confidentiality of the information; and
             3662          (b) a rule relating to privacy of medical or personal information promulgated by the
             3663      commissioner under Title V, Section 505 of the Gramm-Leach-Bliley Act of 1999, 15 U.S.C.
             3664      Sec. 6805.
             3665          (7) A viatical settlement entered into in this state must reserve to the viator an
             3666      unconditional right to terminate the viatical settlement within 15 calendar days after the viator
             3667      receives the proceeds of the viatical settlement. If the insured dies during that period, the
             3668      viatical settlement is terminated and all proceeds, premiums, loans, and loan interest that have
             3669      been paid by the viatical settlement provider or viatical settlement purchaser [of the viatical


             3670      settlement] must be repaid to the viatical settlement provider or viatical settlement purchaser
             3671      [of the viatical settlement].
             3672          (8) (a) Contact with an insured to determine the health status of the insured after a
             3673      viatical settlement may be made only by a viatical settlement provider or viatical settlement
             3674      producer [of viatical settlements] that is licensed in this state, or its authorized representative,
             3675      and no more than:
             3676          (i) once every three months if the insured has a life expectancy of one year or more; or
             3677          (ii) once every month if the insured has a life expectancy of less than one year.
             3678          (b) The viatical settlement provider or viatical settlement producer [of viatical
             3679      settlements] shall explain the procedure for the contacts allowed under this Subsection (8) to
             3680      the viator when the application for the viatical settlement is signed by all parties.
             3681          (c) The limitations of this Subsection (8) do not apply to contacts for purposes other
             3682      than determining health status.
             3683          (d) A viatical settlement provider or viatical settlement producer [of viatical
             3684      settlements] is responsible for the acts of its authorized representative in violation of this
             3685      Subsection (8).
             3686          (9) The trustee of a related provider trust must agree in writing with the viatical
             3687      settlement provider [of viatical settlements] that:
             3688          (a) the viatical settlement provider is responsible for ensuring compliance with all
             3689      statutory and regulatory requirements; and
             3690          (b) the trustee will make all records and files related to viatical settlements available to
             3691      the commissioner as if those records and files were maintained directly by the viatical
             3692      settlement provider.
             3693          (10) Regardless of the method of compensation, a viatical settlement producer [of
             3694      viatical settlements]:
             3695          (a) represents only the viator; and
             3696          (b) owes a fiduciary duty to the viator to act according to the viator's instructions and in
             3697      the best interest of the viator.


             3698          Section 36. Section 31A-36-110 is amended to read:
             3699           31A-36-110. Payment and document requirements.
             3700          (1) (a) A viatical settlement provider [of viatical settlements] shall instruct the viator to
             3701      send the executed documents required to effect the change in ownership or assignment or
             3702      change of beneficiary of the affected policy to a designated independent escrow agent.
             3703          (b) Within three business days after the [date] day on which the escrow agent receives
             3704      the documents, or within three business days after the day on which the viatical settlement
             3705      provider [of viatical settlements] receives the documents if by mistake they are sent directly to
             3706      the viatical settlement provider [of viatical settlements], the escrow agent shall deposit the
             3707      proceeds of the settlement into an escrow or trust account maintained in a regulated financial
             3708      institution whose deposits are insured by a federal deposit insurer.
             3709          (2) (a) Upon completion of the requirements of Subsection (1), the escrow agent shall
             3710      deliver to the viatical settlement provider [of viatical settlements] the original documents
             3711      executed by the viator.
             3712          (b) Upon the viatical settlement provider's receipt from the insurer of an
             3713      acknowledgment of the change in ownership or assignment or change of beneficiary of the
             3714      affected policy, the viatical settlement provider [of viatical settlements] shall instruct the
             3715      escrow agent to pay the proceeds of the settlement to the viator.
             3716          (3) Payment to the viator must be made within three business days after the [date] day
             3717      on which the viatical settlement provider [of viatical settlements received] receives the
             3718      acknowledgment from the insurer. Failure to make the payment within that time makes the
             3719      viatical settlement voidable by the viator for lack of consideration until payment is tendered to
             3720      and accepted by the viator.
             3721          Section 37. Section 31A-36-111 is amended to read:
             3722           31A-36-111. Prohibited acts.
             3723          (1) A viator may not enter into a viatical settlement within two years after the date of
             3724      issuance of the policy to which the settlement relates unless the viator certifies to the viatical
             3725      settlement provider [of viatical settlements] that one of the following is satisfied:


             3726          (a) the policy was issued upon the viator's exercise of conversion rights arising out of a
             3727      group or individual policy, provided:
             3728          (i) the total time covered under the conversion policy plus the time covered under the
             3729      prior policy is at least 24 months; and
             3730          (ii) the time covered under a group policy, calculated without regard to any change in
             3731      insurance carriers, has been continuous and under the same group sponsorship;
             3732          (b) the viator is a charitable organization exempt from taxation under 26 U.S.C. Sec.
             3733      501(c)(3);
             3734          (c) the viator is not a natural person; or
             3735          (d) the viator submits to the viatical settlement provider [of viatical settlements]
             3736      independent evidence that within the two-year period:
             3737          (i) the viator or insured is terminally ill;
             3738          (ii) the viator or insured is chronically ill;
             3739          (iii) the spouse of the viator has died;
             3740          (iv) the viator has divorced the viator's spouse;
             3741          (v) the viator has retired from full-time employment;
             3742          (vi) the viator has become physically or mentally disabled and a physician determines
             3743      that the disability precludes the viator from maintaining full-time employment;
             3744          (vii) (A) the viator was the employer of the insured when the policy or certificate was
             3745      issued; and
             3746          (B) the employment relationship has terminated;
             3747          (viii) a final judgment or order has been entered or issued by a court of competent
             3748      jurisdiction, on the application of a creditor of the viator:
             3749          (A) adjudging the viator bankrupt or insolvent;
             3750          (B) approving a petition for reorganization of the viator; or
             3751          (C) appointing a receiver, trustee, or liquidator for all or a substantial part of the
             3752      viator's assets;
             3753          (ix) the viator experiences a significant decrease in income that is unexpected and


             3754      impairs the viator's reasonable ability to pay the policy premium;
             3755          (x) the viator disposes of the viator's ownership in a closely held corporation; or
             3756          (xi) the insured disposes of the insured's ownership in a closely held corporation.
             3757          (2) When the viatical settlement provider [of viatical settlements] submits a request to
             3758      the insurer to verify coverage, the viatical settlement provider [of viatical settlements] shall
             3759      submit to the insurer the following:
             3760          (a) copies of the independent evidence required under Subsection (1)(d); and
             3761          (b) documents required under Subsection 31A-36-109 (2).
             3762          (3) If a viatical settlement provider [of viatical settlements] submits to an insurer a
             3763      copy of the owner's or insured's certification that one of the events described in Subsection
             3764      (1)(d) has occurred, the certification conclusively establishes that the viatical settlement
             3765      satisfies the requirements of this section, and the insurer shall timely respond to the viatical
             3766      settlement provider's request to effect a transfer of the policy.
             3767          Section 38. Section 31A-36-112 is amended to read:
             3768           31A-36-112. Advertising regulations.
             3769          (1) (a) Each [licensee under this chapter] viatical settlement provider or viatical
             3770      settlement producer shall establish and continuously maintain a system of control over the
             3771      content, form, and method of dissemination of all advertisements of [its] the viatical settlement
             3772      provider's or viatical settlement producer's contracts and services.
             3773          (b) Each advertisement is the responsibility of the [licensee] viatical settlement
             3774      provider or viatical settlement producer as well as the person that creates or presents [it] the
             3775      advertisement.
             3776          (c) A system of control must include at least annual notification to persons authorized
             3777      by the [licensee] viatical settlement provider or viatical settlement producer that disseminate
             3778      advertisements of the requirements and procedures for approval before use of any
             3779      advertisements not furnished by the [licensee] viatical settlement provider or viatical settlement
             3780      producer.
             3781          (2) An advertisement must be truthful and not misleading in fact or by implication, as


             3782      determined by the commissioner from the overall impression it may reasonably be expected to
             3783      create upon a person of average education or intelligence in the segment of the public to which
             3784      it is directed.
             3785          (3) False or misleading statements are not remedied by:
             3786          (a) making a viatical settlement available for inspection before it is consummated; or
             3787          (b) offering to refund payment if the viator is not satisfied within the period prescribed
             3788      in Subsection 31A-36-109 (7).
             3789          Section 39. Section 31A-36-113 is amended to read:
             3790           31A-36-113. Fraud.
             3791          (1) As used in this section, "recklessly" means engaging in conduct:
             3792          (a) where a person knows or should have known of a substantial likelihood of the
             3793      existence of the relevant facts or risks; and
             3794          (b) involving a significant deviation from acceptable standards of conduct.
             3795          (2) A person may not, knowingly or with intent to defraud, to deprive another of
             3796      property or for pecuniary gain, do or permit its employees or agents to engage in any of the
             3797      following acts:
             3798          (a) present, cause to be presented or prepare with knowledge or belief that it will be
             3799      presented, false information to or by a viatical settlement provider or viatical settlement
             3800      producer [of viatical settlements], a financing entity, an insurer, a provider of insurance or any
             3801      other person, or to conceal information, as part of, in support of or concerning a fact material
             3802      to:
             3803          (i) an application for the issuance of a policy or viatical settlement;
             3804          (ii) the underwriting of a policy or viatical settlement;
             3805          (iii) a claim for payment or other benefit under a policy or viatical settlement;
             3806          (iv) a premium paid on a policy;
             3807          (v) a payment or change of beneficiary or ownership pursuant to a policy or viatical
             3808      settlement;
             3809          (vi) the reinstatement or conversion of a policy;


             3810          (vii) the solicitation, offer, effectuation, or sale of a policy or viatical settlement;
             3811          (viii) the issuance of written evidence of a policy or viatical settlement; or
             3812          (ix) a financing transaction;
             3813          (b) in furtherance of a fraud or to prevent detection of a fraud:
             3814          (i) remove, conceal, alter, destroy, or sequester from the commissioner assets or
             3815      records of a [licensee under this chapter or other] person engaged in the business of viatical
             3816      settlements;
             3817          (ii) misrepresent or conceal the financial condition of a licensee, a financing entity, an
             3818      insurer, or other person;
             3819          (iii) transact the business of viatical settlements in violation of this chapter; or
             3820          (iv) file with the commissioner or analogous officer of another jurisdiction a document
             3821      containing false information or otherwise conceal information about a material fact from the
             3822      commissioner or analogous officer;
             3823          (c) embezzle, steal, misappropriate, or convert money, premiums, credits, or other
             3824      property of a viatical settlement provider [of viatical settlements], a viator, an insurer, an
             3825      insured, an owner of a policy, or other person engaged in the business of viatical settlements or
             3826      insurance;
             3827          (d) recklessly enter into, negotiate, or otherwise deal in a viatical settlement, the
             3828      subject of which is a policy obtained where the viator or the viator's agent intended to defraud
             3829      the policy's issuer by:
             3830          (i) presenting false information concerning any fact material to the policy; or
             3831          (ii) concealing, to mislead another, information concerning any fact material to the
             3832      policy; or
             3833          (e) attempt to commit, assist, aid, abet, or conspire to commit an act or omission
             3834      described in this Subsection (2).
             3835          (3) A person may not knowingly or intentionally interfere with the enforcement of [the
             3836      provisions of] this chapter or an investigation of a possible violation of this chapter.
             3837          (4) A person engaged in the business of viatical settlements may not knowingly or


             3838      intentionally permit any person convicted of a felony involving dishonesty or breach of trust to
             3839      participate in the business of viatical settlements.
             3840          (5) (a) An application or contract for a viatical settlement, however transmitted, shall
             3841      contain the following or a substantially similar statement: "A person that knowingly presents
             3842      false information in an application for insurance or a viatical settlement is guilty of a crime and
             3843      may be subject to fines and confinement in prison."
             3844          (b) The lack of [such a] the statement described in Subsection (5)(a) is not a defense in
             3845      a prosecution for violation of this section.
             3846          Section 40. Section 31A-36-117 is amended to read:
             3847           31A-36-117. Antifraud initiatives.
             3848          (1) The following shall establish and maintain antifraud initiatives which are
             3849      reasonably calculated to prevent, detect, and assist in the prosecution of violations of Section
             3850      31A-36-113 :
             3851          (a) a viatical settlement provider [of viatical settlements]; and
             3852          (b) an agency that is a viatical settlement producer [of viatical settlements].
             3853          (2) The commissioner may order, or a licensee may request and the commissioner may
             3854      approve, modifications of the measures otherwise required under this section, more or less
             3855      restrictive than those measures, as necessary to protect against fraud.
             3856          (3) Antifraud initiatives shall include:
             3857          (a) fraud investigators, that may be either:
             3858          (i) employees of a viatical settlement provider or viatical settlement producer [of
             3859      viatical settlements]; or
             3860          (ii) independent contractors;
             3861          (b) an antifraud plan submitted to the commissioner, which shall include:
             3862          (i) a description of the procedures for:
             3863          (A) detecting and investigating possible violations of Section 31A-36-113 ; and
             3864          (B) resolving material inconsistencies between medical records and applications for
             3865      insurance;


             3866          (ii) a description of the procedures for reporting possible violations to the
             3867      commissioner;
             3868          (iii) a description of the plan for educating and training underwriters and other
             3869      personnel against fraud; and
             3870          (iv) a description or chart of the organizational arrangement of the personnel
             3871      responsible for detecting and investigating possible violations of Section 31A-36-113 and for
             3872      resolving material inconsistencies between medical records and applications for insurance.
             3873          (4) A plan submitted to the commissioner shall be classified as a protected record
             3874      under Title 63, Chapter 2, Government Records Access and Management Act.
             3875          Section 41. Section 31A-36-119 is amended to read:
             3876           31A-36-119. Authority to make rules.
             3877          In accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act, the
             3878      commissioner may adopt rules to:
             3879          (1) establish the requirements for the annual statement required under Section
             3880      31A-36-106 ;
             3881          (2) establish standards for evaluating the reasonableness of payments under viatical
             3882      settlements;
             3883          (3) establish appropriate licensing requirements, fees, and standards for continued
             3884      licensure for:
             3885          (a) [providers of] a viatical [settlements] settlement provider; and
             3886          (b) [producers of] a viatical [settlements] settlement producer;
             3887          (4) require a bond or otherwise ensure financial accountability of:
             3888          (a) [providers of] a viatical [settlements] settlement provider; and
             3889          (b) [producers of] a viatical [settlements] settlement producer;
             3890          (5) govern the relationship of insurers with [providers of viatical settlements and
             3891      producers of viatical settlements] a viatical settlement provider or viatical settlement producer
             3892      during the viatication of a policy;
             3893          (6) determine the specific disclosures required under Section 31A-36-108 ;


             3894          (7) determine whether advertising for viatical settlements violates Section 31A-36-112 ;
             3895          (8) determine the information to be provided to the commissioner under Section
             3896      31A-36-114 and the manner of providing the information;
             3897          (9) determine additional acts or practices that are prohibited under Section
             3898      31A-36-111 ;
             3899          (10) establish payment requirements for the payments in Section 31A-36-110 ; and
             3900          (11) establish the filing procedure for the forms listed in Subsection 31A-36-105 (1).
             3901          Section 42. Section 31A-37-502 is amended to read:
             3902           31A-37-502. Examination.
             3903          (1) (a) [At least once in three years, and whenever the commissioner determines it to be
             3904      prudent, the department,] As provided in this section, the commissioner or a person appointed
             3905      by the commissioner, shall [visit] examine each captive insurance company [and] in each
             3906      three-year period.
             3907          (b) The three-year period described in Subsection (1)(a) shall be determined on the
             3908      basis of three full annual accounting periods of operation.
             3909          (c) The examination is to be made as of:
             3910          (i) December 31 of the full three-year period; or
             3911          (ii) the last day of the month of an annual accounting period authorized for a captive
             3912      insurance company under this section.
             3913          (d) In addition to an examination required under this Subsection (1), the commissioner,
             3914      or a person appointed by the commissioner may examine a captive insurance company
             3915      whenever the commissioner determines it to be prudent.
             3916          (2) During an examination under this section the commissioner, or a person appointed
             3917      by the commissioner, shall thoroughly inspect and examine the affairs of the captive insurance
             3918      company to ascertain:
             3919          (a) the financial condition of the captive insurance company;
             3920          (b) the ability of the captive insurance company to fulfill the obligations of the captive
             3921      insurance company; and


             3922          (c) whether the captive insurance company has complied with this chapter.
             3923          [(2)] (3) The commissioner upon application may enlarge the three-year period
             3924      described in Subsection (1) to five years, if a captive insurance company is subject to a
             3925      comprehensive annual audit during that period:
             3926          (a) of a scope satisfactory to the commissioner; and
             3927          (b) performed by independent auditors approved by the commissioner.
             3928          [(3)] (4) A captive insurance company that is inspected and examined under this
             3929      section shall pay, as provided in Subsection 31A-37-202 (5)(b), the expenses and charges of an
             3930      inspection and examination.
             3931          Section 43. Section 61-1-13 is amended to read:
             3932           61-1-13. Definitions.
             3933          (1) As used in this chapter:
             3934          (a) "Affiliate" means a person that, directly or indirectly, through one or more
             3935      intermediaries, controls or is controlled by, or is under common control with a person
             3936      specified.
             3937          (b) (i) "Agent" means any individual other than a broker-dealer who represents a
             3938      broker-dealer or issuer in effecting or attempting to effect purchases or sales of securities.
             3939          (ii) "Agent" does not include an individual who represents:
             3940          (A) an issuer, who receives no commission or other remuneration, directly or
             3941      indirectly, for effecting or attempting to effect purchases or sales of securities in this state, and
             3942      who effects transactions:
             3943          (I) in securities exempted by Subsection 61-1-14 (1)(a), (b), (c), (i), or (j);
             3944          (II) exempted by Subsection 61-1-14 (2);
             3945          (III) in a covered security as described in Sections 18(b)(3) and 18(b)(4)(D) of the
             3946      Securities Act of 1933; or
             3947          (IV) with existing employees, partners, officers, or directors of the issuer; or
             3948          (B) a broker-dealer in effecting transactions in this state limited to those transactions
             3949      described in Section 15(h)(2) of the Securities Exchange Act of 1934.


             3950          (iii) A partner, officer, or director of a broker-dealer or issuer, or a person occupying a
             3951      similar status or performing similar functions, is an agent only if the partner, officer, director,
             3952      or person otherwise comes within the definition of "agent."
             3953          (iv) "Agent" does not include a person described in Subsection (3).
             3954          (c) (i) "Broker-dealer" means any person engaged in the business of effecting
             3955      transactions in securities for the account of others or for the person's own account.
             3956          (ii) "Broker-dealer" does not include:
             3957          (A) an agent;
             3958          (B) an issuer;
             3959          (C) a bank, savings institution, or trust company;
             3960          (D) a person who has no place of business in this state if:
             3961          (I) the person effects transactions in this state exclusively with or through:
             3962          (Aa) the issuers of the securities involved in the transactions;
             3963          (Bb) other broker-dealers; or
             3964          (Cc) banks, savings institutions, trust companies, insurance companies, investment
             3965      companies as defined in the Investment Company Act of 1940, pension or profit-sharing trusts,
             3966      or other financial institutions or institutional buyers, whether acting for themselves or as
             3967      trustees; or
             3968          (II) during any period of 12 consecutive months the person does not direct more than
             3969      15 offers to sell or buy into this state in any manner to persons other than those specified in
             3970      Subsection (1)(c)(ii)(D)(I), whether or not the offeror or any of the offerees is then present in
             3971      this state;
             3972          (E) a general partner who organizes and effects transactions in securities of three or
             3973      fewer limited partnerships, of which the person is the general partner, in any period of 12
             3974      consecutive months;
             3975          (F) a person whose participation in transactions in securities is confined to those
             3976      transactions made by or through a broker-dealer licensed in this state;
             3977          (G) a person who is a real estate broker licensed in this state and who effects


             3978      transactions in a bond or other evidence of indebtedness secured by a real or chattel mortgage
             3979      or deed of trust, or by an agreement for the sale of real estate or chattels, if the entire mortgage,
             3980      deed or trust, or agreement, together with all the bonds or other evidences of indebtedness
             3981      secured thereby, is offered and sold as a unit;
             3982          (H) a person effecting transactions in commodity contracts or commodity options;
             3983          (I) a person described in Subsection (3); or
             3984          (J) other persons as the division, by rule or order, may designate, consistent with the
             3985      public interest and protection of investors, as not within the intent of this Subsection (1)(c).
             3986          (d) "Buy" or "purchase" means every contract for purchase of, contract to buy, or
             3987      acquisition of a security or interest in a security for value.
             3988          (e) "Commodity" means, except as otherwise specified by the division by rule:
             3989          (i) any agricultural, grain, or livestock product or byproduct, except real property or
             3990      any timber, agricultural, or livestock product grown or raised on real property and offered or
             3991      sold by the owner or lessee of the real property;
             3992          (ii) any metal or mineral, including a precious metal, except a numismatic coin whose
             3993      fair market value is at least 15% greater than the value of the metal it contains;
             3994          (iii) any gem or gemstone, whether characterized as precious, semi-precious, or
             3995      otherwise;
             3996          (iv) any fuel, whether liquid, gaseous, or otherwise;
             3997          (v) any foreign currency; and
             3998          (vi) all other goods, articles, products, or items of any kind, except any work of art
             3999      offered or sold by art dealers, at public auction or offered or sold through a private sale by the
             4000      owner of the work.
             4001          (f) (i) "Commodity contract" means any account, agreement, or contract for the
             4002      purchase or sale, primarily for speculation or investment purposes and not for use or
             4003      consumption by the offeree or purchaser, of one or more commodities, whether for immediate
             4004      or subsequent delivery or whether delivery is intended by the parties, and whether characterized
             4005      as a cash contract, deferred shipment or deferred delivery contract, forward contract, futures


             4006      contract, installment or margin contract, leverage contract, or otherwise.
             4007          (ii) Any commodity contract offered or sold shall, in the absence of evidence to the
             4008      contrary, be presumed to be offered or sold for speculation or investment purposes.
             4009          (iii) (A) A commodity contract shall not include any contract or agreement which
             4010      requires, and under which the purchaser receives, within 28 calendar days from the payment in
             4011      good funds any portion of the purchase price, physical delivery of the total amount of each
             4012      commodity to be purchased under the contract or agreement.
             4013          (B) The purchaser is not considered to have received physical delivery of the total
             4014      amount of each commodity to be purchased under the contract or agreement when the
             4015      commodity or commodities are held as collateral for a loan or are subject to a lien of any
             4016      person when the loan or lien arises in connection with the purchase of each commodity or
             4017      commodities.
             4018          (g) (i) "Commodity option" means any account, agreement, or contract giving a party
             4019      to the option the right but not the obligation to purchase or sell one or more commodities or
             4020      one or more commodity contracts, or both whether characterized as an option, privilege,
             4021      indemnity, bid, offer, put, call, advance guaranty, decline guaranty, or otherwise.
             4022          (ii) "Commodity option" does not include an option traded on a national securities
             4023      exchange registered:
             4024          (A) with the United States Securities and Exchange Commission; or
             4025          (B) on a board of trade designated as a contract market by the Commodity Futures
             4026      Trading Commission.
             4027          (h) "Director" means the director of the Division of Securities charged with the
             4028      administration and enforcement of this chapter.
             4029          (i) "Division" means the Division of Securities established by Section 61-1-18 .
             4030          (j) "Executive director" means the executive director of the Department of Commerce.
             4031          (k) "Federal covered adviser" means a person who:
             4032          (i) is registered under Section 203 of the Investment Advisers Act of 1940; or
             4033          (ii) is excluded from the definition of "investment adviser" under Section 202(a)(11) of


             4034      the Investment Advisers Act of 1940.
             4035          (l) "Federal covered security" means any security that is a covered security under
             4036      Section 18(b) of the Securities Act of 1933 or rules or regulations promulgated under Section
             4037      18(b) of the Securities Act of 1933.
             4038          (m) "Fraud," "deceit," and "defraud" are not limited to their common-law meanings.
             4039          (n) "Guaranteed" means guaranteed as to payment of principal or interest as to debt
             4040      securities, or dividends as to equity securities.
             4041          (o) (i) "Investment adviser" means any person who:
             4042          (A) for compensation, engages in the business of advising others, either directly or
             4043      through publications or writings, as to the value of securities or as to the advisability of
             4044      investing in, purchasing, or selling securities; or
             4045          (B) for compensation and as a part of a regular business, issues or promulgates
             4046      analyses or reports concerning securities.
             4047          (ii) "Investment adviser" includes financial planners and other persons who:
             4048          (A) as an integral component of other financially related services, provide the
             4049      investment advisory services described in Subsection (1)(o)(i) to others for compensation and
             4050      as part of a business; or
             4051          (B) hold themselves out as providing the investment advisory services described in
             4052      Subsection (1)(o)(i) to others for compensation.
             4053          (iii) "Investment adviser" does not include:
             4054          (A) an investment adviser representative;
             4055          (B) a bank, savings institution, or trust company;
             4056          (C) a lawyer, accountant, engineer, or teacher whose performance of these services is
             4057      solely incidental to the practice of his profession;
             4058          (D) a broker-dealer or its agent whose performance of these services is solely
             4059      incidental to the conduct of its business as a broker-dealer and who receives no special
             4060      compensation for the services;
             4061          (E) a publisher of any bona fide newspaper, news column, news letter, news magazine,


             4062      or business or financial publication or service, of general, regular, and paid circulation, whether
             4063      communicated in hard copy form, or by electronic means, or otherwise, that does not consist of
             4064      the rendering of advice on the basis of the specific investment situation of each client;
             4065          (F) any person who is a federal covered adviser;
             4066          (G) a person described in Subsection (3); or
             4067          (H) such other persons not within the intent of this Subsection (1)(o) as the division
             4068      may by rule or order designate.
             4069          (p) (i) "Investment adviser representative" means any partner, officer, director of, or a
             4070      person occupying a similar status or performing similar functions, or other individual, except
             4071      clerical or ministerial personnel, who:
             4072          (A) (I) is employed by or associated with an investment adviser who is licensed or
             4073      required to be licensed under this chapter; or
             4074          (II) has a place of business located in this state and is employed by or associated with a
             4075      federal covered adviser; and
             4076          (B) does any of the following:
             4077          (I) makes any recommendations or otherwise renders advice regarding securities;
             4078          (II) manages accounts or portfolios of clients;
             4079          (III) determines which recommendation or advice regarding securities should be given;
             4080          (IV) solicits, offers, or negotiates for the sale of or sells investment advisory services;
             4081      or
             4082          (V) supervises employees who perform any of the acts described in this Subsection
             4083      (1)(p)(i)(B).
             4084          (ii) "Investment advisor representative" does not include a person described in
             4085      Subsection (3).
             4086          (q) (i) "Issuer" means any person who issues or proposes to issue any security or has
             4087      outstanding a security that it has issued.
             4088          (ii) With respect to a preorganization certificate or subscription, "issuer" means the
             4089      promoter or the promoters of the person to be organized.


             4090          (iii) "Issuer" means the person or persons performing the acts and assuming duties of a
             4091      depositor or manager under the provisions of the trust or other agreement or instrument under
             4092      which the security is issued with respect to:
             4093          (A) interests in trusts, including collateral trust certificates, voting trust certificates, and
             4094      certificates of deposit for securities; or
             4095          (B) shares in an investment company without a board of directors.
             4096          (iv) With respect to an equipment trust certificate, a conditional sales contract, or
             4097      similar securities serving the same purpose, "issuer" means the person by whom the equipment
             4098      or property is to be used.
             4099          (v) With respect to interests in partnerships, general or limited, "issuer" means the
             4100      partnership itself and not the general partner or partners.
             4101          (vi) With respect to certificates of interest or participation in oil, gas, or mining titles or
             4102      leases or in payment out of production under the titles or leases, "issuer" means the owner of
             4103      the title or lease or right of production, whether whole or fractional, who creates fractional
             4104      interests therein for the purpose of sale.
             4105          (r) "Nonissuer" means not directly or indirectly for the benefit of the issuer.
             4106          (s) "Person" means:
             4107          (i) an individual;
             4108          (ii) a corporation;
             4109          (iii) a partnership;
             4110          (iv) a limited liability company;
             4111          (v) an association;
             4112          (vi) a joint-stock company;
             4113          (vii) a joint venture;
             4114          (viii) a trust where the interests of the beneficiaries are evidenced by a security;
             4115          (ix) an unincorporated organization;
             4116          (x) a government; or
             4117          (xi) a political subdivision of a government.


             4118          (t) "Precious metal" means the following, whether in coin, bullion, or other form:
             4119          (i) silver;
             4120          (ii) gold;
             4121          (iii) platinum;
             4122          (iv) palladium;
             4123          (v) copper; and
             4124          (vi) such other substances as the division may specify by rule.
             4125          (u) "Promoter" means any person who, acting alone or in concert with one or more
             4126      persons, takes initiative in founding or organizing the business or enterprise of a person.
             4127          (v) (i) "Sale" or "sell" includes every contract for sale of, contract to sell, or disposition
             4128      of, a security or interest in a security for value.
             4129          (ii) "Offer" or "offer to sell" includes every attempt or offer to dispose of, or
             4130      solicitation of an offer to buy, a security or interest in a security for value.
             4131          (iii) The following are examples of the definitions in Subsection (1)(v)(i) or (ii):
             4132          (A) any security given or delivered with or as a bonus on account of any purchase of a
             4133      security or any other thing, is part of the subject of the purchase, and has been offered and sold
             4134      for value;
             4135          (B) a purported gift of assessable stock is an offer or sale as is each assessment levied
             4136      on the stock;
             4137          (C) an offer or sale of a security that is convertible into, or entitles its holder to acquire
             4138      or subscribe to another security of the same or another issuer is an offer or sale of that security,
             4139      and also an offer of the other security, whether the right to convert or acquire is exercisable
             4140      immediately or in the future;
             4141          (D) any conversion or exchange of one security for another shall constitute an offer or
             4142      sale of the security received in a conversion or exchange, and the offer to buy or the purchase
             4143      of the security converted or exchanged;
             4144          (E) securities distributed as a dividend wherein the person receiving the dividend
             4145      surrenders the right, or the alternative right, to receive a cash or property dividend is an offer or


             4146      sale;
             4147          (F) a dividend of a security of another issuer is an offer or sale; or
             4148          (G) the issuance of a security under a merger, consolidation, reorganization,
             4149      recapitalization, reclassification, or acquisition of assets shall constitute the offer or sale of the
             4150      security issued as well as the offer to buy or the purchase of any security surrendered in
             4151      connection therewith, unless the sole purpose of the transaction is to change the issuer's
             4152      domicile.
             4153          (iv) The terms defined in Subsections (1)(v)(i) and (ii) do not include:
             4154          (A) a good faith gift;
             4155          (B) a transfer by death;
             4156          (C) a transfer by termination of a trust or of a beneficial interest in a trust;
             4157          (D) a security dividend not within Subsection (1)(v)(iii)(E) or (F);
             4158          (E) a securities split or reverse split; or
             4159          (F) any act incident to a judicially approved reorganization in which a security is issued
             4160      in exchange for one or more outstanding securities, claims, or property interests, or partly in
             4161      such exchange and partly for cash.
             4162          (w) "Securities Act of 1933," "Securities Exchange Act of 1934," "Public Utility
             4163      Holding Company Act of 1935," and "Investment Company Act of 1940" mean the federal
             4164      statutes of those names as amended before or after the effective date of this chapter.
             4165          (x) (i) "Security" means any:
             4166          (A) note;
             4167          (B) stock;
             4168          (C) treasury stock;
             4169          (D) bond;
             4170          (E) debenture;
             4171          (F) evidence of indebtedness;
             4172          (G) certificate of interest or participation in any profit-sharing agreement;
             4173          (H) collateral-trust certificate;


             4174          (I) preorganization certificate or subscription;
             4175          (J) transferable share;
             4176          (K) investment contract;
             4177          (L) burial certificate or burial contract;
             4178          (M) voting-trust certificate;
             4179          (N) certificate of deposit for a security;
             4180          (O) certificate of interest or participation in an oil, gas, or mining title or lease or in
             4181      payments out of production under such a title or lease;
             4182          (P) commodity contract or commodity option;
             4183          (Q) interest in a limited liability company;
             4184          (R) viatical settlement interest; or
             4185          (S) in general, any interest or instrument commonly known as a "security," or any
             4186      certificate of interest or participation in, temporary or interim certificate for, receipt for,
             4187      guarantee of, or warrant or right to subscribe to or purchase any of the foregoing.
             4188          (ii) "Security" does not include any:
             4189          (A) insurance or endowment policy or annuity contract under which an insurance
             4190      company promises to pay money in a lump sum or periodically for life or some other specified
             4191      period;
             4192          (B) interest in a limited liability company in which the limited liability company is
             4193      formed as part of an estate plan where all of the members are related by blood or marriage,
             4194      there are five or fewer members, or the person claiming this exception can prove that all of the
             4195      members are actively engaged in the management of the limited liability company; or
             4196          (C) (I) a whole long-term estate in real property;
             4197          (II) an undivided fractionalized long-term estate in real property that consists of ten or
             4198      fewer owners; or
             4199          (III) an undivided fractionalized long-term estate in real property that consists of more
             4200      than ten owners if, when the real property estate is subject to a management agreement:
             4201          (Aa) the management agreement permits a simple majority of owners of the real


             4202      property estate to not renew or to terminate the management agreement at the earlier of the end
             4203      of the management agreement's current term, or 180 days after the day on which the owners
             4204      give notice of termination to the manager;
             4205          (Bb) the management agreement prohibits, directly or indirectly, the lending of the
             4206      proceeds earned from the real property estate or the use or pledge of its assets to any person or
             4207      entity affiliated with or under common control of the manager; and
             4208          (Cc) the management agreement complies with any other requirement imposed by rule
             4209      by the Real Estate Commission under Section 61-2-26 .
             4210          (iii) For purposes of Subsection (1)(x)(ii)(B), evidence that members vote or have the
             4211      right to vote, or the right to information concerning the business and affairs of the limited
             4212      liability company, or the right to participate in management, shall not establish, without more,
             4213      that all members are actively engaged in the management of the limited liability company.
             4214          (y) "State" means any state, territory, or possession of the United States, the District of
             4215      Columbia, and Puerto Rico.
             4216          (z) "Threshold security" means a security that is a threshold security under Regulation
             4217      SHO, 17 C.F.R. 242.200 et seq.
             4218          (aa) (i) "Undivided fractionalized long-term estate" means an ownership interest in real
             4219      property by two or more persons that is a:
             4220          (A) tenancy in common; or
             4221          (B) any other legal form of undivided estate in real property including:
             4222          (I) a fee estate;
             4223          (II) a life estate; or
             4224          (III) other long-term estate.
             4225          (ii) "Undivided fractionalized long-term estate" does not include a joint tenancy.
             4226          (bb) (i) "Viatical settlement interest" means the entire interest or any fractional interest
             4227      in any of the following that is the subject of a viatical settlement:
             4228          (A) a life insurance policy; or
             4229          (B) the death benefit under a life insurance policy.


             4230          (ii) "Viatical settlement interest" does not include the initial purchase from the viator
             4231      by a viatical settlement provider [of viatical settlements].
             4232          (cc) "Whole long-term estate" means a person or persons through joint tenancy owns
             4233      real property through:
             4234          (i) a fee estate;
             4235          (ii) a life estate; or
             4236          (iii) other long-term estate.
             4237          (dd) "Working days" means 8 a.m. to 5 p.m., Monday through Friday, exclusive of
             4238      legal holidays listed in Section 63-13-2 .
             4239          (2) A term not defined in this section shall have the meaning as established by division
             4240      rule. The meaning of a term neither defined in this section nor by rule of the division shall be
             4241      the meaning commonly accepted in the business community.
             4242          (3) (a) This Subsection (3) applies to:
             4243          (i) the offer or sale of a real property estate exempted from the definition of security
             4244      under Subsection (1)(x)(ii)(C); or
             4245          (ii) the offer or sale of an undivided fractionalized long-term estate that is the offer of a
             4246      security.
             4247          (b) A person who, directly or indirectly receives compensation in connection with the
             4248      offer or sale as provided in this Subsection (3) of a real property estate is not an agent,
             4249      broker-dealer, investment adviser, or investor adviser representative under this chapter if that
             4250      person is licensed under Chapter 2, Division of Real Estate, as:
             4251          (i) a principal real estate broker;
             4252          (ii) an associate real estate broker; or
             4253          (iii) a real estate sales agent.
             4254          (4) The list of real property estates excluded from the definition of securities under
             4255      Subsection (1)(x)(ii)(C) is not an exclusive list of real property estates or interests that are not a
             4256      security.
             4257          Section 44. Coordinating this H.B. 295 with H.B. 340 -- Technical changes.


             4258          If this H.B. 295 and H.B. 340, Insurer Receivership Act, both pass, it is the intent of the
             4259      Legislature that in preparing the Utah Code database for publication, the Office of the
             4260      Legislative Research and General Counsel, modify Subsections 31A-27a-104 (2)(k) and (l) to
             4261      read:
             4262          "(k) viatical settlement provider; or
             4263          (l) viatical settlement producer."


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