H.B. 295

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 independent review organizations;
19 . addresses groups eligible for group or blanket insurance;
20 . removes certain references to a federal employer identification number;
21 . clarifies application of special requirements to title insurance producers which are
22 agencies;
23 . allows for an insurer to provide incentives to participate in programs or activities
24 designed to reduce claims or claims expenses;
25 . clarifies provisions related to sharing of commissions;
26 . addresses health care provider claims practices;
27 . addresses appointments to the Bail Bond Surety Oversight Board;

28 . addresses provisions applicable to a viatical settlement provider or viatical
29 settlement producer;
30 . clarifies provisions related to examinations of captive insurance companies; and
31 . makes technical changes including correcting citations.
32 Monies Appropriated in this Bill:
33 None
34 Other Special Clauses:
35 None
36 Utah Code Sections Affected:
37 AMENDS:
38 31A-1-301, as last amended by Chapters 320 and 332, Laws of Utah 2006
39 31A-2-205, as last amended by Chapter 2, Laws of Utah 2004
40 31A-5-416, as last amended by Chapter 277, Laws of Utah 1992
41 31A-21-104, as last amended by Chapter 81, Laws of Utah 2003
42 31A-21-503, as last amended by Chapter 116, Laws of Utah 2001
43 31A-22-305, as last amended by Chapter 69, Laws of Utah 2006
44 31A-22-305.3, as enacted by Chapter 69, Laws of Utah 2006
45 31A-22-423, as last amended by Chapter 252, Laws of Utah 2003
46 31A-22-610, as last amended by Chapter 252, Laws of Utah 2003
47 31A-22-629, as last amended by Chapter 78, Laws of Utah 2005
48 31A-22-701, as last amended by Chapters 90 and 108, Laws of Utah 2004
49 31A-23a-104, as last amended by Chapter 173, Laws of Utah 2004
50 31A-23a-105, as last amended by Chapter 312, Laws of Utah 2006
51 31A-23a-117, as last amended by Chapter 312, Laws of Utah 2006
52 31A-23a-204, as last amended by Chapter 312, Laws of Utah 2006
53 31A-23a-401, as renumbered and amended by Chapter 298, Laws of Utah 2003
54 31A-23a-402, as last amended by Chapters 123 and 185, Laws of Utah 2005
55 31A-23a-504, as renumbered and amended by Chapter 298, Laws of Utah 2003
56 31A-25-202, as last amended by Chapter 90, Laws of Utah 2004
57 31A-26-202, as last amended by Chapter 252, Laws of Utah 2003
58 31A-26-301.6, as last amended by Chapter 308, Laws of Utah 2002

59 31A-27-331, as enacted by Chapter 242, Laws of Utah 1985
60 31A-30-103, as last amended by Chapters 2 and 90, Laws of Utah 2004
61 31A-30-107.5, as last amended by Chapter 188, Laws of Utah 2006
62 31A-35-201, as last amended by Chapter 131, Laws of Utah 1999
63 31A-36-102, as enacted by Chapter 81, Laws of Utah 2003
64 31A-36-104, as last amended by Chapter 106, Laws of Utah 2004
65 31A-36-105, as enacted by Chapter 81, Laws of Utah 2003
66 31A-36-106, as enacted by Chapter 81, Laws of Utah 2003
67 31A-36-107, as enacted by Chapter 81, Laws of Utah 2003
68 31A-36-108, as enacted by Chapter 81, Laws of Utah 2003
69 31A-36-109, as enacted by Chapter 81, Laws of Utah 2003
70 31A-36-110, as enacted by Chapter 81, Laws of Utah 2003
71 31A-36-111, as enacted by Chapter 81, Laws of Utah 2003
72 31A-36-112, as enacted by Chapter 81, Laws of Utah 2003
73 31A-36-113, as enacted by Chapter 81, Laws of Utah 2003
74 31A-36-117, as enacted by Chapter 81, Laws of Utah 2003
75 31A-36-119, as last amended by Chapter 106, Laws of Utah 2004
76 31A-37-502, as enacted by Chapter 251, Laws of Utah 2003
77 61-1-13, as last amended by Chapter 4, Laws of Utah 2006, Third Special Session
78
79 Be it enacted by the Legislature of the state of Utah:
80 Section 1. Section 31A-1-301 is amended to read:
81 31A-1-301. Definitions.
82 As used in this title, unless otherwise specified:
83 (1) (a) "Accident and health insurance" means insurance to provide protection against
84 economic losses resulting from:
85 (i) a medical condition including:
86 (A) medical care expenses; or
87 (B) the risk of disability;
88 (ii) accident; or
89 (iii) sickness.

90 (b) "Accident and health insurance":
91 (i) includes a contract with disability contingencies including:
92 (A) an income replacement contract;
93 (B) a health care contract;
94 (C) an expense reimbursement contract;
95 (D) a credit accident and health contract;
96 (E) a continuing care contract; and
97 (F) a long-term care contract; and
98 (ii) may provide:
99 (A) hospital coverage;
100 (B) surgical coverage;
101 (C) medical coverage; or
102 (D) loss of income coverage.
103 (c) "Accident and health insurance" does not include workers' compensation insurance.
104 (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title
105 63, Chapter 46a, Utah Administrative Rulemaking Act.
106 (3) "Administrator" is defined in Subsection [(155)] (157).
107 (4) "Adult" means a natural person who has attained the age of at least 18 years.
108 (5) "Affiliate" means any person who controls, is controlled by, or is under common
109 control with, another person. A corporation is an affiliate of another corporation, regardless of
110 ownership, if substantially the same group of natural persons manages the corporations.
111 (6) "Agency" means:
112 (a) a person other than an individual, including a sole proprietorship by which a natural
113 person does business under an assumed name; and
114 (b) an insurance organization licensed or required to be licensed under Section
115 31A-23a-301 .
116 (7) "Alien insurer" means an insurer domiciled outside the United States.
117 (8) "Amendment" means an endorsement to an insurance policy or certificate.
118 (9) "Annuity" means an agreement to make periodical payments for a period certain or
119 over the lifetime of one or more natural persons if the making or continuance of all or some of
120 the series of the payments, or the amount of the payment, is dependent upon the continuance of

121 human life.
122 (10) "Application" means a document:
123 (a) (i) completed by an applicant to provide information about the risk to be insured;
124 and
125 (ii) that contains information that is used by the insurer to evaluate risk and decide
126 whether to:
127 (A) insure the risk under:
128 (I) the coverages as originally offered; or
129 (II) a modification of the coverage as originally offered; or
130 (B) decline to insure the risk; or
131 (b) used by the insurer to gather information from the applicant before issuance of an
132 annuity contract.
133 (11) "Articles" or "articles of incorporation" means the original articles, special laws,
134 charters, amendments, restated articles, articles of merger or consolidation, trust instruments,
135 and other constitutive documents for trusts and other entities that are not corporations, and
136 amendments to any of these.
137 (12) "Bail bond insurance" means a guarantee that a person will attend court when
138 required, up to and including surrender of the person in execution of any sentence imposed
139 under Subsection 77-20-7 (1), as a condition to the release of that person from confinement.
140 (13) "Binder" is defined in Section 31A-21-102 .
141 (14) "Blanket insurance policy" means a group policy covering classes of persons
142 without individual underwriting, where the persons insured are determined by definition of the
143 class with or without designating the persons covered.
144 [(14)] (15) "Board," "board of trustees," or "board of directors" means the group of
145 persons with responsibility over, or management of, a corporation, however designated.
146 [(15)] (16) "Business entity" means a corporation, association, partnership, limited
147 liability company, limited liability partnership, or other legal entity.
148 [(16)] (17) "Business of insurance" is defined in Subsection [(82)] (84).
149 [(17)] (18) "Business plan" means the information required to be supplied to the
150 commissioner under Subsections 31A-5-204 (2)(i) and (j), including the information required
151 when these subsections are applicable by reference under:

152 (a) Section 31A-7-201 ;
153 (b) Section 31A-8-205 ; or
154 (c) Subsection 31A-9-205 (2).
155 [(18)] (19) "Bylaws" means the rules adopted for the regulation or management of a
156 corporation's affairs, however designated and includes comparable rules for trusts and other
157 entities that are not corporations.
158 [(19)] (20) "Captive insurance company" means:
159 (a) an insurance company:
160 (i) owned by another organization; and
161 (ii) whose exclusive purpose is to insure risks of the parent organization and affiliated
162 companies; or
163 (b) in the case of groups and associations, an insurance organization:
164 (i) owned by the insureds; and
165 (ii) whose exclusive purpose is to insure risks of:
166 (A) member organizations;
167 (B) group members; and
168 (C) affiliates of:
169 (I) member organizations; or
170 (II) group members.
171 [(20)] (21) "Casualty insurance" means liability insurance as defined in Subsection
172 [(94)] (96).
173 [(21)] (22) "Certificate" means evidence of insurance given to:
174 (a) an insured under a group insurance policy; or
175 (b) a third party.
176 [(22)] (23) "Certificate of authority" is included within the term "license."
177 [(23)] (24) "Claim," unless the context otherwise requires, means a request or demand
178 on an insurer for payment of benefits according to the terms of an insurance policy.
179 [(24)] (25) "Claims-made coverage" means an insurance contract or provision limiting
180 coverage under a policy insuring against legal liability to claims that are first made against the
181 insured while the policy is in force.
182 [(25)] (26) (a) "Commissioner" or "commissioner of insurance" means Utah's

183 insurance commissioner.
184 (b) When appropriate, the terms listed in Subsection [(25)] (26)(a) apply to the
185 equivalent supervisory official of another jurisdiction.
186 [(26)] (27) (a) "Continuing care insurance" means insurance that:
187 (i) provides board and lodging;
188 (ii) provides one or more of the following services:
189 (A) personal services;
190 (B) nursing services;
191 (C) medical services; or
192 (D) other health-related services; and
193 (iii) provides the coverage described in Subsection [(26)] (27)(a)(i) under an agreement
194 effective:
195 (A) for the life of the insured; or
196 (B) for a period in excess of one year.
197 (b) Insurance is continuing care insurance regardless of whether or not the board and
198 lodging are provided at the same location as the services described in Subsection [(26)]
199 (27)(a)(ii).
200 [(27)] (28) (a) "Control," "controlling," "controlled," or "under common control"
201 means the direct or indirect possession of the power to direct or cause the direction of the
202 management and policies of a person. This control may be:
203 (i) by contract;
204 (ii) by common management;
205 (iii) through the ownership of voting securities; or
206 (iv) by a means other than those described in Subsections [(27)] (28)(a)(i) through (iii).
207 (b) There is no presumption that an individual holding an official position with another
208 person controls that person solely by reason of the position.
209 (c) A person having a contract or arrangement giving control is considered to have
210 control despite the illegality or invalidity of the contract or arrangement.
211 (d) There is a rebuttable presumption of control in a person who directly or indirectly
212 owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the
213 voting securities of another person.

214 [(28)] (29) "Controlled insurer" means a licensed insurer that is either directly or
215 indirectly controlled by a producer.
216 [(29)] (30) "Controlling person" means any person that directly or indirectly has the
217 power to direct or cause to be directed, the management, control, or activities of a reinsurance
218 intermediary.
219 [(30)] (31) "Controlling producer" means a producer who directly or indirectly controls
220 an insurer.
221 [(31)] (32) (a) "Corporation" means an insurance corporation, except when referring to:
222 (i) a corporation doing business:
223 (A) as:
224 (I) an insurance producer;
225 (II) a limited line producer;
226 (III) a consultant;
227 (IV) a managing general agent;
228 (V) a reinsurance intermediary;
229 (VI) a third party administrator; or
230 (VII) an adjuster; and
231 (B) under:
232 (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
233 Reinsurance Intermediaries;
234 (II) Chapter 25, Third Party Administrators; or
235 (III) Chapter 26, Insurance Adjusters; or
236 (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance
237 Holding Companies.
238 (b) "Stock corporation" means a stock insurance corporation.
239 (c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
240 [(32)] (33) "Creditable coverage" has the same meaning as provided in federal
241 regulations adopted pursuant to the Health Insurance Portability and Accountability Act of
242 1996, Pub. L. 104-191, 110 Stat. 1936.
243 [(33)] (34) "Credit accident and health insurance" means insurance on a debtor to
244 provide indemnity for payments coming due on a specific loan or other credit transaction while

245 the debtor is disabled.
246 [(34)] (35) (a) "Credit insurance" means insurance offered in connection with an
247 extension of credit that is limited to partially or wholly extinguishing that credit obligation.
248 (b) "Credit insurance" includes:
249 (i) credit accident and health insurance;
250 (ii) credit life insurance;
251 (iii) credit property insurance;
252 (iv) credit unemployment insurance;
253 (v) guaranteed automobile protection insurance;
254 (vi) involuntary unemployment insurance;
255 (vii) mortgage accident and health insurance;
256 (viii) mortgage guaranty insurance; and
257 (ix) mortgage life insurance.
258 [(35)] (36) "Credit life insurance" means insurance on the life of a debtor in connection
259 with an extension of credit that pays a person if the debtor dies.
260 [(36)] (37) "Credit property insurance" means insurance:
261 (a) offered in connection with an extension of credit; and
262 (b) that protects the property until the debt is paid.
263 [(37)] (38) "Credit unemployment insurance" means insurance:
264 (a) offered in connection with an extension of credit; and
265 (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
266 (i) specific loan; or
267 (ii) credit transaction.
268 [(38)] (39) "Creditor" means a person, including an insured, having any claim,
269 whether:
270 (a) matured;
271 (b) unmatured;
272 (c) liquidated;
273 (d) unliquidated;
274 (e) secured;
275 (f) unsecured;

276 (g) absolute;
277 (h) fixed; or
278 (i) contingent.
279 [(39)] (40) (a) "Customer service representative" means a person that provides
280 insurance services and insurance product information:
281 (i) for the customer service representative's:
282 (A) producer; or
283 (B) consultant employer; and
284 (ii) to the customer service representative's employer's:
285 (A) customer;
286 (B) client; or
287 (C) organization.
288 (b) A customer service representative may only operate within the scope of authority of
289 the customer service representative's producer or consultant employer.
290 [(40)] (41) "Deadline" means the final date or time:
291 (a) imposed by:
292 (i) statute;
293 (ii) rule; or
294 (iii) order; and
295 (b) by which a required filing or payment must be received by the department.
296 [(41)] (42) "Deemer clause" means a provision under this title under which upon the
297 occurrence of a condition precedent, the commissioner is deemed to have taken a specific
298 action. If the statute so provides, the condition precedent may be the commissioner's failure to
299 take a specific action.
300 [(42)] (43) "Degree of relationship" means the number of steps between two persons
301 determined by counting the generations separating one person from a common ancestor and
302 then counting the generations to the other person.
303 [(43)] (44) "Department" means the Insurance Department.
304 [(44)] (45) "Director" means a member of the board of directors of a corporation.
305 [(45)] (46) "Disability" means a physiological or psychological condition that partially
306 or totally limits an individual's ability to:

307 (a) perform the duties of:
308 (i) that individual's occupation; or
309 (ii) any occupation for which the individual is reasonably suited by education, training,
310 or experience; or
311 (b) perform two or more of the following basic activities of daily living:
312 (i) eating;
313 (ii) toileting;
314 (iii) transferring;
315 (iv) bathing; or
316 (v) dressing.
317 [(46)] (47) "Disability income insurance" is defined in Subsection [(73)] (75).
318 [(47)] (48) "Domestic insurer" means an insurer organized under the laws of this state.
319 [(48)] (49) "Domiciliary state" means the state in which an insurer:
320 (a) is incorporated;
321 (b) is organized; or
322 (c) in the case of an alien insurer, enters into the United States.
323 [(49)] (50) (a) "Eligible employee" means:
324 (i) an employee who:
325 (A) works on a full-time basis; and
326 (B) has a normal work week of 30 or more hours; or
327 (ii) a person described in Subsection [(49)] (50)(b).
328 (b) "Eligible employee" includes, if the individual is included under a health benefit
329 plan of a small employer:
330 (i) a sole proprietor;
331 (ii) a partner in a partnership; or
332 (iii) an independent contractor.
333 (c) "Eligible employee" does not include, unless eligible under Subsection [(49)]
334 (50)(b):
335 (i) an individual who works on a temporary or substitute basis for a small employer;
336 (ii) an employer's spouse; or
337 (iii) a dependent of an employer.

338 [(50)] (51) "Employee" means any individual employed by an employer.
339 [(51)] (52) "Employee benefits" means one or more benefits or services provided to:
340 (a) employees; or
341 (b) dependents of employees.
342 [(52)] (53) (a) "Employee welfare fund" means a fund:
343 (i) established or maintained, whether directly or through trustees, by:
344 (A) one or more employers;
345 (B) one or more labor organizations; or
346 (C) a combination of employers and labor organizations; and
347 (ii) that provides employee benefits paid or contracted to be paid, other than income
348 from investments of the fund, by or on behalf of an employer doing business in this state or for
349 the benefit of any person employed in this state.
350 (b) "Employee welfare fund" includes a plan funded or subsidized by user fees or tax
351 revenues.
352 [(53)] (54) "Endorsement" means a written agreement attached to a policy or certificate
353 to modify one or more of the provisions of the policy or certificate.
354 [(54)] (55) "Enrollment date," with respect to a health benefit plan, means the first day
355 of coverage or, if there is a waiting period, the first day of the waiting period.
356 [(55)] (56) (a) "Escrow" means:
357 (i) a real estate settlement or real estate closing conducted by a third party pursuant to
358 the requirements of a written agreement between the parties in a real estate transaction; or
359 (ii) a settlement or closing involving:
360 (A) a mobile home;
361 (B) a grazing right;
362 (C) a water right; or
363 (D) other personal property authorized by the commissioner.
364 (b) "Escrow" includes the act of conducting a:
365 (i) real estate settlement; or
366 (ii) real estate closing.
367 [(56)] (57) "Escrow agent" means:
368 (a) an insurance producer with:

369 (i) a title insurance line of authority; and
370 (ii) an escrow subline of authority; or
371 (b) a person defined as an escrow agent in Section 7-22-101 .
372 [(57)] (58) "Excludes" is not exhaustive and does not mean that other things are not
373 also excluded. The items listed are representative examples for use in interpretation of this
374 title.
375 [(58)] (59) "Expense reimbursement insurance" means insurance:
376 (a) written to provide payments for expenses relating to hospital confinements resulting
377 from illness or injury; and
378 (b) written:
379 (i) as a daily limit for a specific number of days in a hospital; and
380 (ii) to have a one or two day waiting period following a hospitalization.
381 [(59)] (60) "Fidelity insurance" means insurance guaranteeing the fidelity of persons
382 holding positions of public or private trust.
383 [(60)] (61) (a) "Filed" means that a filing is:
384 (i) submitted to the department as required by and in accordance with any applicable
385 statute, rule, or filing order;
386 (ii) received by the department within the time period provided in the applicable
387 statute, rule, or filing order; and
388 (iii) accompanied by the appropriate fee in accordance with:
389 (A) Section 31A-3-103 ; or
390 (B) rule.
391 (b) "Filed" does not include a filing that is rejected by the department because it is not
392 submitted in accordance with Subsection [(60)] (61)(a).
393 [(61)] (62) "Filing," when used as a noun, means an item required to be filed with the
394 department including:
395 (a) a policy;
396 (b) a rate;
397 (c) a form;
398 (d) a document;
399 (e) a plan;

400 (f) a manual;
401 (g) an application;
402 (h) a report;
403 (i) a certificate;
404 (j) an endorsement;
405 (k) an actuarial certification;
406 (l) a licensee annual statement;
407 (m) a licensee renewal application; or
408 (n) an advertisement.
409 [(62)] (63) "First party insurance" means an insurance policy or contract in which the
410 insurer agrees to pay claims submitted to it by the insured for the insured's losses.
411 [(63)] (64) "Foreign insurer" means an insurer domiciled outside of this state, including
412 an alien insurer.
413 [(64)] (65) (a) "Form" means one of the following prepared for general use:
414 (i) a policy;
415 (ii) a certificate;
416 (iii) an application; or
417 (iv) an outline of coverage.
418 (b) "Form" does not include a document specially prepared for use in an individual
419 case.
420 [(65)] (66) "Franchise insurance" means individual insurance policies provided through
421 a mass marketing arrangement involving a defined class of persons related in some way other
422 than through the purchase of insurance.
423 [(66)] (67) "General lines of authority" include:
424 (a) the general lines of insurance in Subsection [(67)] (68);
425 (b) title insurance under one of the following sublines of authority:
426 (i) search, including authority to act as a title marketing representative;
427 (ii) escrow, including authority to act as a title marketing representative;
428 (iii) search and escrow, including authority to act as a title marketing representative;
429 and
430 (iv) title marketing representative only;

431 (c) surplus lines;
432 (d) workers' compensation; and
433 (e) any other line of insurance that the commissioner considers necessary to recognize
434 in the public interest.
435 [(67)] (68) "General lines of insurance" include:
436 (a) accident and health;
437 (b) casualty;
438 (c) life;
439 (d) personal lines;
440 (e) property; and
441 (f) variable contracts, including variable life and annuity.
442 [(68)] (69) "Group health plan" means an employee welfare benefit plan to the extent
443 that the plan provides medical care:
444 (a) (i) to employees; or
445 (ii) to a dependent of an employee; and
446 (b) (i) directly;
447 (ii) through insurance reimbursement; or
448 (iii) through any other method.
449 (70) (a) "Group insurance policy" means a policy covering a group of persons that is
450 issued:
451 (i) to a policyholder on behalf of the group; and
452 (ii) for the benefit of group members who are selected under procedures defined in:
453 (A) the policy; or
454 (B) agreements which are collateral to the policy.
455 (b) A group insurance policy may include members of the policyholder's family or
456 dependents.
457 [(69)] (71) "Guaranteed automobile protection insurance" means insurance offered in
458 connection with an extension of credit that pays the difference in amount between the
459 insurance settlement and the balance of the loan if the insured automobile is a total loss.
460 [(70)] (72) (a) Except as provided in Subsection [(70)] (72)(b), "health benefit plan"
461 means a policy or certificate that:

462 (i) provides health care insurance;
463 (ii) provides major medical expense insurance; or
464 (iii) is offered as a substitute for hospital or medical expense insurance such as:
465 (A) a hospital confinement indemnity; or
466 (B) a limited benefit plan.
467 (b) "Health benefit plan" does not include a policy or certificate that:
468 (i) provides benefits solely for:
469 (A) accident;
470 (B) dental;
471 (C) income replacement;
472 (D) long-term care;
473 (E) a Medicare supplement;
474 (F) a specified disease;
475 (G) vision; or
476 (H) a short-term limited duration; or
477 (ii) is offered and marketed as supplemental health insurance.
478 [(71)] (73) "Health care" means any of the following intended for use in the diagnosis,
479 treatment, mitigation, or prevention of a human ailment or impairment:
480 (a) professional services;
481 (b) personal services;
482 (c) facilities;
483 (d) equipment;
484 (e) devices;
485 (f) supplies; or
486 (g) medicine.
487 [(72)] (74) (a) "Health care insurance" or "health insurance" means insurance
488 providing:
489 (i) health care benefits; or
490 (ii) payment of incurred health care expenses.
491 (b) "Health care insurance" or "health insurance" does not include accident and health
492 insurance providing benefits for:

493 (i) replacement of income;
494 (ii) short-term accident;
495 (iii) fixed indemnity;
496 (iv) credit accident and health;
497 (v) supplements to liability;
498 (vi) workers' compensation;
499 (vii) automobile medical payment;
500 (viii) no-fault automobile;
501 (ix) equivalent self-insurance; or
502 (x) any type of accident and health insurance coverage that is a part of or attached to
503 another type of policy.
504 [(73)] (75) "Income replacement insurance" or "disability income insurance" means
505 insurance written to provide payments to replace income lost from accident or sickness.
506 [(74)] (76) "Indemnity" means the payment of an amount to offset all or part of an
507 insured loss.
508 [(75)] (77) "Independent adjuster" means an insurance adjuster required to be licensed
509 under Section 31A-26-201 who engages in insurance adjusting as a representative of insurers.
510 [(76)] (78) "Independently procured insurance" means insurance procured under
511 Section 31A-15-104 .
512 [(77)] (79) "Individual" means a natural person.
513 [(78)] (80) "Inland marine insurance" includes insurance covering:
514 (a) property in transit on or over land;
515 (b) property in transit over water by means other than boat or ship;
516 (c) bailee liability;
517 (d) fixed transportation property such as bridges, electric transmission systems, radio
518 and television transmission towers and tunnels; and
519 (e) personal and commercial property floaters.
520 [(79)] (81) "Insolvency" means that:
521 (a) an insurer is unable to pay its debts or meet its obligations as they mature;
522 (b) an insurer's total adjusted capital is less than the insurer's mandatory control level
523 RBC under Subsection 31A-17-601 (8)(c); or

524 (c) an insurer is determined to be hazardous under this title.
525 [(80)] (82) (a) "Insurance" means:
526 (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more
527 persons to one or more other persons; or
528 (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a
529 group of persons that includes the person seeking to distribute that person's risk.
530 (b) "Insurance" includes:
531 (i) risk distributing arrangements providing for compensation or replacement for
532 damages or loss through the provision of services or benefits in kind;
533 (ii) contracts of guaranty or suretyship entered into by the guarantor or surety as a
534 business and not as merely incidental to a business transaction; and
535 (iii) plans in which the risk does not rest upon the person who makes the arrangements,
536 but with a class of persons who have agreed to share it.
537 [(81)] (83) "Insurance adjuster" means a person who directs the investigation,
538 negotiation, or settlement of a claim under an insurance policy other than life insurance or an
539 annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy.
540 [(82)] (84) "Insurance business" or "business of insurance" includes:
541 (a) providing health care insurance, as defined in Subsection [(72)] (74), by
542 organizations that are or should be licensed under this title;
543 (b) providing benefits to employees in the event of contingencies not within the control
544 of the employees, in which the employees are entitled to the benefits as a right, which benefits
545 may be provided either:
546 (i) by single employers or by multiple employer groups; or
547 (ii) through trusts, associations, or other entities;
548 (c) providing annuities, including those issued in return for gifts, except those provided
549 by persons specified in Subsections 31A-22-1305 (2) and (3);
550 (d) providing the characteristic services of motor clubs as outlined in Subsection
551 [(110)] (112);
552 (e) providing other persons with insurance as defined in Subsection [(80)] (82);
553 (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor,
554 or surety, any contract or policy of title insurance;

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

586 (iii) members; and
587 (iv) beneficiaries.
588 (b) The definition in Subsection [(86)] (88)(a):
589 (i) applies only to this title; and
590 (ii) does not define the meaning of this word as used in insurance policies or
591 certificates.
592 [(87)] (89) (a) (i) "Insurer" means any person doing an insurance business as a
593 principal including:
594 (A) fraternal benefit societies;
595 (B) issuers of gift annuities other than those specified in Subsections 31A-22-1305 (2)
596 and (3);
597 (C) motor clubs;
598 (D) employee welfare plans; and
599 (E) any person purporting or intending to do an insurance business as a principal on
600 that person's own account.
601 (ii) "Insurer" does not include a governmental entity to the extent it is engaged in the
602 activities described in Section 31A-12-107 .
603 (b) "Admitted insurer" is defined in Subsection [(159)] (161)(b).
604 (c) "Alien insurer" is defined in Subsection (7).
605 (d) "Authorized insurer" is defined in Subsection [(159)] (161)(b).
606 (e) "Domestic insurer" is defined in Subsection [(47)] (48).
607 (f) "Foreign insurer" is defined in Subsection [(63)] (64).
608 (g) "Nonadmitted insurer" is defined in Subsection [(159)] (161)(a).
609 (h) "Unauthorized insurer" is defined in Subsection [(159)] (161)(a).
610 [(88)] (90) "Interinsurance exchange" is defined in Subsection [(139)] (141).
611 [(89)] (91) "Involuntary unemployment insurance" means insurance:
612 (a) offered in connection with an extension of credit;
613 (b) that provides indemnity if the debtor is involuntarily unemployed for payments
614 coming due on a:
615 (i) specific loan; or
616 (ii) credit transaction.

617 [(90)] (92) "Large employer," in connection with a health benefit plan, means an
618 employer who, with respect to a calendar year and to a plan year:
619 (a) employed an average of at least 51 eligible employees on each business day during
620 the preceding calendar year; and
621 (b) employs at least two employees on the first day of the plan year.
622 [(91)] (93) "Late enrollee," with respect to an employer health benefit plan, means an
623 individual whose enrollment is a late enrollment.
624 [(92)] (94) "Late enrollment," with respect to an employer health benefit plan, means
625 enrollment of an individual other than:
626 (a) on the earliest date on which coverage can become effective for the individual
627 under the terms of the plan; or
628 (b) through special enrollment.
629 [(93)] (95) (a) Except for a retainer contract or legal assistance described in Section
630 31A-1-103 , "legal expense insurance" means insurance written to indemnify or pay for
631 specified legal expenses.
632 (b) "Legal expense insurance" includes arrangements that create reasonable
633 expectations of enforceable rights.
634 (c) "Legal expense insurance" does not include the provision of, or reimbursement for,
635 legal services incidental to other insurance coverages.
636 [(94)] (96) (a) "Liability insurance" means insurance against liability:
637 (i) for death, injury, or disability of any human being, or for damage to property,
638 exclusive of the coverages under:
639 (A) Subsection [(104)] (106) for medical malpractice insurance;
640 (B) Subsection [(131)] (133) for professional liability insurance; and
641 (C) Subsection [(164)] (166) for workers' compensation insurance;
642 (ii) for medical, hospital, surgical, and funeral benefits to persons other than the
643 insured who are injured, irrespective of legal liability of the insured, when issued with or
644 supplemental to insurance against legal liability for the death, injury, or disability of human
645 beings, 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 (iii) for loss or damage to property resulting from accidents to or explosions of boilers,
650 pipes, pressure containers, machinery, or apparatus;
651 (iv) for loss or damage to any property caused by the breakage or leakage of sprinklers,
652 water pipes and containers, or by water entering through leaks or openings in buildings; or
653 (v) for other loss or damage properly the subject of insurance not within any other kind
654 or kinds of insurance as defined in this chapter, if such insurance is not contrary to law or
655 public policy.
656 (b) "Liability insurance" includes:
657 (i) vehicle liability insurance as defined in Subsection [(161)] (163);
658 (ii) residential dwelling liability insurance as defined in Subsection [(142)] (144); and
659 (iii) making inspection of, and issuing certificates of inspection upon, elevators,
660 boilers, machinery, and apparatus of any kind when done in connection with insurance on
661 them.
662 [(95)] (97) (a) "License" means the authorization issued by the commissioner to engage
663 in some activity that is part of or related to the insurance business.
664 (b) "License" includes certificates of authority issued to insurers.
665 [(96)] (98) (a) "Life insurance" means insurance on human lives and insurances
666 pertaining to or connected with human life.
667 (b) The business of life insurance includes:
668 (i) granting death benefits;
669 (ii) granting annuity benefits;
670 (iii) granting endowment benefits;
671 (iv) granting additional benefits in the event of death by accident;
672 (v) granting additional benefits to safeguard the policy against lapse; and
673 (vi) providing optional methods of settlement of proceeds.
674 [(97)] (99) "Limited license" means a license that:
675 (a) is issued for a specific product of insurance; and
676 (b) limits an individual or agency to transact only for that product or insurance.
677 [(98)] (100) "Limited line credit insurance" includes the following forms of insurance:
678 (a) credit life;

679 (b) credit accident and health;
680 (c) credit property;
681 (d) credit unemployment;
682 (e) involuntary unemployment;
683 (f) mortgage life;
684 (g) mortgage guaranty;
685 (h) mortgage accident and health;
686 (i) guaranteed automobile protection; and
687 (j) any other form of insurance offered in connection with an extension of credit that:
688 (i) is limited to partially or wholly extinguishing the credit obligation; and
689 (ii) the commissioner determines by rule should be designated as a form of limited line
690 credit insurance.
691 [(99)] (101) "Limited line credit insurance producer" means a person who sells,
692 solicits, or negotiates one or more forms of limited line credit insurance coverage to individuals
693 through a master, corporate, group, or individual policy.
694 [(100)] (102) "Limited line insurance" includes:
695 (a) bail bond;
696 (b) limited line credit insurance;
697 (c) legal expense insurance;
698 (d) motor club insurance;
699 (e) rental car-related insurance;
700 (f) travel insurance; and
701 (g) any other form of limited insurance that the commissioner determines by rule
702 should be designated a form of limited line insurance.
703 [(101)] (103) "Limited lines authority" includes:
704 (a) the lines of insurance listed in Subsection [(100)] (102); and
705 (b) a customer service representative.
706 [(102)] (104) "Limited lines producer" means a person who sells, solicits, or negotiates
707 limited lines insurance.
708 [(103)] (105) (a) "Long-term care insurance" means an insurance policy or rider
709 advertised, marketed, offered, or designated to provide coverage:

710 (i) in a setting other than an acute care unit of a hospital;
711 (ii) for not less than 12 consecutive months for each covered person on the basis of:
712 (A) expenses incurred;
713 (B) indemnity;
714 (C) prepayment; or
715 (D) another method;
716 (iii) for one or more necessary or medically necessary services that are:
717 (A) diagnostic;
718 (B) preventative;
719 (C) therapeutic;
720 (D) rehabilitative;
721 (E) maintenance; or
722 (F) personal care; and
723 (iv) that may be issued by:
724 (A) an insurer;
725 (B) a fraternal benefit society;
726 (C) (I) a nonprofit health hospital; and
727 (II) a medical service corporation;
728 (D) a prepaid health plan;
729 (E) a health maintenance organization; or
730 (F) an entity similar to the entities described in Subsections [(103)] (105)(a)(iv)(A)
731 through (E) to the extent that the entity is otherwise authorized to issue life or health care
732 insurance.
733 (b) "Long-term care insurance" includes:
734 (i) any of the following that provide directly or supplement long-term care insurance:
735 (A) a group or individual annuity or rider; or
736 (B) a life insurance policy or rider;
737 (ii) a policy or rider that provides for payment of benefits based on:
738 (A) cognitive impairment; or
739 (B) functional capacity; or
740 (iii) a qualified long-term care insurance contract.

741 (c) "Long-term care insurance" does not include:
742 (i) a policy that is offered primarily to provide basic Medicare supplement coverage;
743 (ii) basic hospital expense coverage;
744 (iii) basic medical/surgical expense coverage;
745 (iv) hospital confinement indemnity coverage;
746 (v) major medical expense coverage;
747 (vi) income replacement or related asset-protection coverage;
748 (vii) accident only coverage;
749 (viii) coverage for a specified:
750 (A) disease; or
751 (B) accident;
752 (ix) limited benefit health coverage; or
753 (x) a life insurance policy that accelerates the death benefit to provide the option of a
754 lump sum payment:
755 (A) if the following are not conditioned on the receipt of long-term care:
756 (I) benefits; or
757 (II) eligibility; and
758 (B) the coverage is for one or more the following qualifying events:
759 (I) terminal illness;
760 (II) medical conditions requiring extraordinary medical intervention; or
761 (III) permanent institutional confinement.
762 [(104)] (106) "Medical malpractice insurance" means insurance against legal liability
763 incident to the practice and provision of medical services other than the practice and provision
764 of dental services.
765 [(105)] (107) "Member" means a person having membership rights in an insurance
766 corporation.
767 [(106)] (108) "Minimum capital" or "minimum required capital" means the capital that
768 must be constantly maintained by a stock insurance corporation as required by statute.
769 [(107)] (109) "Mortgage accident and health insurance" means insurance offered in
770 connection with an extension of credit that provides indemnity for payments coming due on a
771 mortgage while the debtor is disabled.

772 [(108)] (110) "Mortgage guaranty insurance" means surety insurance under which
773 mortgagees and other creditors are indemnified against losses caused by the default of debtors.
774 [(109)] (111) "Mortgage life insurance" means insurance on the life of a debtor in
775 connection with an extension of credit that pays if the debtor dies.
776 [(110)] (112) "Motor club" means a person:
777 (a) licensed under:
778 (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
779 (ii) Chapter 11, Motor Clubs; or
780 (iii) Chapter 14, Foreign Insurers; and
781 (b) that promises for an advance consideration to provide for a stated period of time:
782 (i) legal services under Subsection 31A-11-102 (1)(b);
783 (ii) bail services under Subsection 31A-11-102 (1)(c); or
784 (iii) (A) trip reimbursement;
785 (B) towing services;
786 (C) emergency road services;
787 (D) stolen automobile services;
788 (E) a combination of the services listed in Subsections [(110)] (112)(b)(iii)(A) through
789 (D); or
790 (F) any other services given in Subsections 31A-11-102 (1)(b) through (f).
791 [(111)] (113) "Mutual" means a mutual insurance corporation.
792 [(112)] (114) "Network plan" means health care insurance:
793 (a) that is issued by an insurer; and
794 (b) under which the financing and delivery of medical care is provided, in whole or in
795 part, through a defined set of providers under contract with the insurer, including the financing
796 and delivery of items paid for as medical care.
797 [(113)] (115) "Nonparticipating" means a plan of insurance under which the insured is
798 not entitled to receive dividends representing shares of the surplus of the insurer.
799 [(114)] (116) "Ocean marine insurance" means insurance against loss of or damage to:
800 (a) ships or hulls of ships;
801 (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, moneys,
802 securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia

803 interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
804 (c) earnings such as freight, passage money, commissions, or profits derived from
805 transporting goods or people upon or across the oceans or inland waterways; or
806 (d) a vessel owner or operator as a result of liability to employees, passengers, bailors,
807 owners of other vessels, owners of fixed objects, customs or other authorities, or other persons
808 in connection with maritime activity.
809 [(115)] (117) "Order" means an order of the commissioner.
810 [(116)] (118) "Outline of coverage" means a summary that explains an accident and
811 health insurance policy.
812 [(117)] (119) "Participating" means a plan of insurance under which the insured is
813 entitled to receive dividends representing shares of the surplus of the insurer.
814 [(118)] (120) "Participation," as used in a health benefit plan, means a requirement
815 relating to the minimum percentage of eligible employees that must be enrolled in relation to
816 the total number of eligible employees of an employer reduced by each eligible employee who
817 voluntarily declines coverage under the plan because the employee has other group health care
818 insurance coverage.
819 [(119)] (121) "Person" includes an individual, partnership, corporation, incorporated or
820 unincorporated association, joint stock company, trust, limited liability company, reciprocal,
821 syndicate, or any similar entity or combination of entities acting in concert.
822 [(120)] (122) "Personal lines insurance" means property and casualty insurance
823 coverage sold for primarily noncommercial purposes to:
824 (a) individuals; and
825 (b) families.
826 [(121)] (123) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
827 [(122)] (124) "Plan year" means:
828 (a) the year that is designated as the plan year in:
829 (i) the plan document of a group health plan; or
830 (ii) a summary plan description of a group health plan;
831 (b) if the plan document or summary plan description does not designate a plan year or
832 there is no plan document or summary plan description:
833 (i) the year used to determine deductibles or limits;

834 (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis;
835 or
836 (iii) the employer's taxable year if:
837 (A) the plan does not impose deductibles or limits on a yearly basis; and
838 (B) (I) the plan is not insured; or
839 (II) the insurance policy is not renewed on an annual basis; or
840 (c) in a case not described in Subsection [(122)] (124)(a) or (b), the calendar year.
841 [(123)] (125) (a) [(i)] "Policy" means any document, including attached endorsements
842 and riders, purporting to be an enforceable contract, which memorializes in writing some or all
843 of the terms of an insurance contract.
844 [(ii)] (b) "Policy" includes a service contract issued by:
845 [(A)] (i) a motor club under Chapter 11, Motor Clubs;
846 [(B)] (ii) a service contract provided under Chapter 6a, Service Contracts; and
847 [(C)] (iii) a corporation licensed under:
848 [(I)] (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
849 [(II)] (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
850 [(iii)] (c) "Policy" does not include:
851 [(A)] (i) a certificate under a group insurance contract; or
852 [(B)] (ii) a document that does not purport to have legal effect.
853 [(b) (i) "Group insurance policy" means a policy covering a group of persons that is
854 issued:]
855 [(A) to a policyholder on behalf of the group; and]
856 [(B) for the benefit of group members who are selected under procedures defined in:]
857 [(I) the policy; or]
858 [(II) agreements which are collateral to the policy.]
859 [(ii) A group insurance policy may include members of the policyholder's family or
860 dependents.]
861 [(c) "Blanket insurance policy" means a group policy covering classes of persons
862 without individual underwriting, where the persons insured are determined by definition of the
863 class with or without designating the persons covered.]
864 [(124)] (126) "Policyholder" means the person who controls a policy, binder, or oral

865 contract by ownership, premium payment, or otherwise.
866 [(125)] (127) "Policy illustration" means a presentation or depiction that includes
867 nonguaranteed elements of a policy of life insurance over a period of years.
868 [(126)] (128) "Policy summary" means a synopsis describing the elements of a life
869 insurance policy.
870 [(127)] (129) "Preexisting condition," with respect to a health benefit plan:
871 (a) means a condition that was present before the effective date of coverage, whether or
872 not any medical advice, diagnosis, care, or treatment was recommended or received before that
873 day; and
874 (b) does not include a condition indicated by genetic information unless an actual
875 diagnosis of the condition by a physician has been made.
876 [(128)] (130) (a) "Premium" means the monetary consideration for an insurance policy.
877 (b) "Premium" includes, however designated:
878 (i) assessments;
879 (ii) membership fees;
880 (iii) required contributions; or
881 (iv) monetary consideration.
882 (c) (i) Consideration paid to third party administrators for their services is not
883 "premium."
884 (ii) Amounts paid by third party administrators to insurers for insurance on the risks
885 administered by the third party administrators are "premium."
886 [(129)] (131) "Principal officers" of a corporation means the officers designated under
887 Subsection 31A-5-203 (3).
888 [(130)] (132) "Proceedings" includes actions and special statutory proceedings.
889 [(131)] (133) "Professional liability insurance" means insurance against legal liability
890 incident to the practice of a profession and provision of any professional services.
891 [(132)] (134) (a) Except as provided in Subsection [(132)] (134)(b), "property
892 insurance" means insurance against loss or damage to real or personal property of every kind
893 and any interest in that property:
894 (i) from all hazards or causes; and
895 (ii) against loss consequential upon the loss or damage including vehicle

896 comprehensive and vehicle physical damage coverages.
897 (b) "Property insurance" does not include:
898 (i) inland marine insurance as defined in Subsection [(78)] (80); and
899 (ii) ocean marine insurance as defined under Subsection [(114)] (116).
900 [(133)] (135) "Qualified long-term care insurance contract" or "federally tax qualified
901 long-term care insurance contract" means:
902 (a) an individual or group insurance contract that meets the requirements of Section
903 7702B(b), Internal Revenue Code; or
904 (b) the portion of a life insurance contract that provides long-term care insurance:
905 (i) (A) by rider; or
906 (B) as a part of the contract; and
907 (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue
908 Code.
909 [(134)] (136) "Qualified United States financial institution" means an institution that:
910 (a) is:
911 (i) organized under the laws of the United States or any state; or
912 (ii) in the case of a United States office of a foreign banking organization, licensed
913 under the laws of the United States or any state;
914 (b) is regulated, supervised, and examined by United States federal or state authorities
915 having regulatory authority over banks and trust companies; and
916 (c) meets the standards of financial condition and standing that are considered
917 necessary and appropriate to regulate the quality of financial institutions whose letters of credit
918 will be acceptable to the commissioner as determined by:
919 (i) the commissioner by rule; or
920 (ii) the Securities Valuation Office of the National Association of Insurance
921 Commissioners.
922 [(135)] (137) (a) "Rate" means:
923 (i) the cost of a given unit of insurance; or
924 (ii) for property-casualty insurance, that cost of insurance per exposure unit either
925 expressed as:
926 (A) a single number; or

927 (B) a pure premium rate, adjusted before any application of individual risk variations
928 based on loss or expense considerations to account for the treatment of:
929 (I) expenses;
930 (II) profit; and
931 (III) individual insurer variation in loss experience.
932 (b) "Rate" does not include a minimum premium.
933 [(136)] (138) (a) Except as provided in Subsection [(136)] (138)(b), "rate service
934 organization" means any person who assists insurers in rate making or filing by:
935 (i) collecting, compiling, and furnishing loss or expense statistics;
936 (ii) recommending, making, or filing rates or supplementary rate information; or
937 (iii) advising about rate questions, except as an attorney giving legal advice.
938 (b) "Rate service organization" does not mean:
939 (i) an employee of an insurer;
940 (ii) a single insurer or group of insurers under common control;
941 (iii) a joint underwriting group; or
942 (iv) a natural person serving as an actuarial or legal consultant.
943 [(137)] (139) "Rating manual" means any of the following used to determine initial and
944 renewal policy premiums:
945 (a) a manual of rates;
946 (b) classifications;
947 (c) rate-related underwriting rules; and
948 (d) rating formulas that describe steps, policies, and procedures for determining initial
949 and renewal policy premiums.
950 [(138)] (140) "Received by the department" means:
951 (a) except as provided in Subsection [(138)] (140)(b), the date delivered to and
952 stamped received by the department, whether delivered:
953 (i) in person; or
954 (ii) electronically; and
955 (b) if delivered to the department by a delivery service, the delivery service's postmark
956 date or pick-up date unless otherwise stated in:
957 (i) statute;

958 (ii) rule; or
959 (iii) a specific filing order.
960 [(139)] (141) "Reciprocal" or "interinsurance exchange" means any unincorporated
961 association of persons:
962 (a) operating through an attorney-in-fact common to all of them; and
963 (b) exchanging insurance contracts with one another that provide insurance coverage
964 on each other.
965 [(140)] (142) "Reinsurance" means an insurance transaction where an insurer, for
966 consideration, transfers any portion of the risk it has assumed to another insurer. In referring to
967 reinsurance transactions, this title sometimes refers to:
968 (a) the insurer transferring the risk as the "ceding insurer"; and
969 (b) the insurer assuming the risk as the:
970 (i) "assuming insurer"; or
971 (ii) "assuming reinsurer."
972 [(141)] (143) "Reinsurer" means any person licensed in this state as an insurer with the
973 authority to assume reinsurance.
974 [(142)] (144) "Residential dwelling liability insurance" means insurance against
975 liability resulting from or incident to the ownership, maintenance, or use of a residential
976 dwelling that is a detached single family residence or multifamily residence up to four units.
977 [(143)] (145) "Retrocession" means reinsurance with another insurer of a liability
978 assumed under a reinsurance contract. A reinsurer "retrocedes" when it reinsures with another
979 insurer part of a liability assumed under a reinsurance contract.
980 [(144)] (146) "Rider" means an endorsement to:
981 (a) an insurance policy; or
982 (b) an insurance certificate.
983 [(145)] (147) (a) "Security" means any:
984 (i) note;
985 (ii) stock;
986 (iii) bond;
987 (iv) debenture;
988 (v) evidence of indebtedness;

989 (vi) certificate of interest or participation in any profit-sharing agreement;
990 (vii) collateral-trust certificate;
991 (viii) preorganization certificate or subscription;
992 (ix) transferable share;
993 (x) investment contract;
994 (xi) voting trust certificate;
995 (xii) certificate of deposit for a security;
996 (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in
997 payments out of production under such a title or lease;
998 (xiv) commodity contract or commodity option;
999 (xv) certificate of interest or participation in, temporary or interim certificate for, receipt
1000 for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed in
1001 Subsections [(145)] (147)(a)(i) through (xiv); or
1002 (xvi) other interest or instrument commonly known as a security.
1003 (b) "Security" does not include:
1004 (i) any of the following under which an insurance company promises to pay money in a
1005 specific lump sum or periodically for life or some other specified period:
1006 (A) insurance;
1007 (B) endowment policy; or
1008 (C) annuity contract; or
1009 (ii) a burial certificate or burial contract.
1010 [(146)] (148) "Self-insurance" means any arrangement under which a person provides
1011 for spreading its own risks by a systematic plan.
1012 (a) Except as provided in this Subsection [(146)] (148), "self-insurance" does not
1013 include an arrangement under which a number of persons spread their risks among themselves.
1014 (b) "Self-insurance" includes:
1015 (i) an arrangement by which a governmental entity undertakes to indemnify its
1016 employees for liability arising out of the employees' employment; and
1017 (ii) an arrangement by which a person with a managed program of self-insurance and
1018 risk management undertakes to indemnify its affiliates, subsidiaries, directors, officers, or
1019 employees for liability or risk which is related to the relationship or employment.

1020 (c) "Self-insurance" does not include any arrangement with independent contractors.
1021 [(147)] (149) "Sell" means to exchange a contract of insurance:
1022 (a) by any means;
1023 (b) for money or its equivalent; and
1024 (c) on behalf of an insurance company.
1025 [(148)] (150) "Short-term care insurance" means any insurance policy or rider
1026 advertised, marketed, offered, or designed to provide coverage that is similar to long-term care
1027 insurance but that provides coverage for less than 12 consecutive months for each covered
1028 person.
1029 [(149)] (151) "Significant break in coverage" means a period of 63 consecutive days
1030 during each of which an individual does not have any creditable coverage.
1031 [(150)] (152) "Small employer," in connection with a health benefit plan, means an
1032 employer who, with respect to a calendar year and to a plan year:
1033 (a) employed an average of at least two employees but not more than 50 eligible
1034 employees on each business day during the preceding calendar year; and
1035 (b) employs at least two employees on the first day of the plan year.
1036 [(151)] (153) "Special enrollment period," in connection with a health benefit plan, has
1037 the same meaning as provided in federal regulations adopted pursuant to the Health Insurance
1038 Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936.
1039 [(152)] (154) (a) "Subsidiary" of a person means an affiliate controlled by that person
1040 either directly or indirectly through one or more affiliates or intermediaries.
1041 (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting
1042 shares are owned by that person either alone or with its affiliates, except for the minimum
1043 number of shares the law of the subsidiary's domicile requires to be owned by directors or
1044 others.
1045 [(153)] (155) Subject to Subsection [(80)] (82)(b), "surety insurance" includes:
1046 (a) a guarantee against loss or damage resulting from failure of principals to pay or
1047 perform their obligations to a creditor or other obligee;
1048 (b) bail bond insurance; and
1049 (c) fidelity insurance.
1050 [(154)] (156) (a) "Surplus" means the excess of assets over the sum of paid-in capital

1051 and liabilities.
1052 (b) (i) "Permanent surplus" means the surplus of a mutual insurer that has been
1053 designated by the insurer as permanent.
1054 (ii) Sections 31A-5-211 , 31A-7-201 , 31A-8-209 , 31A-9-209 , and 31A-14-209 require
1055 that mutuals doing business in this state maintain specified minimum levels of permanent
1056 surplus.
1057 (iii) Except for assessable mutuals, the minimum permanent surplus requirement is
1058 essentially the same as the minimum required capital requirement that applies to stock insurers.
1059 (c) "Excess surplus" means:
1060 (i) for life or accident and health insurers, health organizations, and property and
1061 casualty insurers as defined in Section 31A-17-601 , the lesser of:
1062 (A) that amount of an insurer's or health organization's total adjusted capital, as defined
1063 in Subsection [(157)] (159), that exceeds the product of:
1064 (I) 2.5; and
1065 (II) the sum of the insurer's or health organization's minimum capital or permanent
1066 surplus required under Section 31A-5-211 , 31A-9-209 , or 31A-14-205 ; or
1067 (B) that amount of an insurer's or health organization's total adjusted capital, as defined
1068 in Subsection [(157)] (159), that exceeds the product of:
1069 (I) 3.0; and
1070 (II) the authorized control level RBC as defined in Subsection 31A-17-601 (8)(a); and
1071 (ii) for monoline mortgage guaranty insurers, financial guaranty insurers, and title
1072 insurers, that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
1073 (A) 1.5; and
1074 (B) the insurer's total adjusted capital required by Subsection 31A-17-609 (1).
1075 [(155)] (157) "Third party administrator" or "administrator" means any person who
1076 collects charges or premiums from, or who, for consideration, adjusts or settles claims of
1077 residents of the state in connection with insurance coverage, annuities, or service insurance
1078 coverage, except:
1079 (a) a union on behalf of its members;
1080 (b) a person administering any:
1081 (i) pension plan subject to the federal Employee Retirement Income Security Act of

1082 1974;
1083 (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
1084 (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
1085 (c) an employer on behalf of the employer's employees or the employees of one or
1086 more of the subsidiary or affiliated corporations of the employer;
1087 (d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance
1088 for which the insurer holds a license in this state; or
1089 (e) a person:
1090 (i) licensed or exempt from licensing under:
1091 (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
1092 Reinsurance Intermediaries; or
1093 (B) Chapter 26, Insurance Adjusters; and
1094 (ii) whose activities are limited to those authorized under the license the person holds
1095 or for which the person is exempt.
1096 [(156)] (158) "Title insurance" means the insuring, guaranteeing, or indemnifying of
1097 owners of real or personal property or the holders of liens or encumbrances on that property, or
1098 others interested in the property against loss or damage suffered by reason of liens or
1099 encumbrances upon, defects in, or the unmarketability of the title to the property, or invalidity
1100 or unenforceability of any liens or encumbrances on the property.
1101 [(157)] (159) "Total adjusted capital" means the sum of an insurer's or health
1102 organization's statutory capital and surplus as determined in accordance with:
1103 (a) the statutory accounting applicable to the annual financial statements required to be
1104 filed under Section 31A-4-113 ; and
1105 (b) any other items provided by the RBC instructions, as RBC instructions is defined in
1106 Section 31A-17-601 .
1107 [(158)] (160) (a) "Trustee" means "director" when referring to the board of directors of
1108 a corporation.
1109 (b) "Trustee," when used in reference to an employee welfare fund, means an
1110 individual, firm, association, organization, joint stock company, or corporation, whether acting
1111 individually or jointly and whether designated by that name or any other, that is charged with
1112 or has the overall management of an employee welfare fund.

1113 [(159)] (161) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted
1114 insurer" means an insurer:
1115 (i) not holding a valid certificate of authority to do an insurance business in this state;
1116 or
1117 (ii) transacting business not authorized by a valid certificate.
1118 (b) "Admitted insurer" or "authorized insurer" means an insurer:
1119 (i) holding a valid certificate of authority to do an insurance business in this state; and
1120 (ii) transacting business as authorized by a valid certificate.
1121 [(160)] (162) "Underwrite" means the authority to accept or reject risk on behalf of the
1122 insurer.
1123 [(161)] (163) "Vehicle liability insurance" means insurance against liability resulting
1124 from or incident to ownership, maintenance, or use of any land vehicle or aircraft, exclusive of
1125 vehicle comprehensive and vehicle physical damage coverages under Subsection [(132)] (134).
1126 [(162)] (164) "Voting security" means a security with voting rights, and includes any
1127 security convertible into a security with a voting right associated with the security.
1128 [(163)] (165) "Waiting period" for a health benefit plan means the period that must
1129 pass before coverage for an individual, who is otherwise eligible to enroll under the terms of
1130 the health benefit plan, can become effective.
1131 [(164)] (166) "Workers' compensation insurance" means:
1132 (a) insurance for indemnification of employers against liability for compensation based
1133 on:
1134 (i) compensable accidental injuries; and
1135 (ii) occupational disease disability;
1136 (b) employer's liability insurance incidental to workers' compensation insurance and
1137 written in connection with workers' compensation insurance; and
1138 (c) insurance assuring to the persons entitled to workers' compensation benefits the
1139 compensation provided by law.
1140 Section 2. Section 31A-2-205 is amended to read:
1141 31A-2-205. Examination costs.
1142 (1) (a) Except as provided in Subsection (3), an examinee that is [an insurer, rate
1143 service organization, or the subsidiary of either] one of the following shall reimburse the

1144 department for the reasonable costs of examinations made under Sections 31A-2-203 and
1145 31A-2-204 [.]:
1146 (i) an insurer;
1147 (ii) a rate service organization;
1148 (iii) a subsidiary of an insurer or rate service organization; or
1149 (iv) a viatical settlement provider.
1150 (b) The following costs shall be reimbursed under this Subsection (1):
1151 (i) actual travel expenses;
1152 (ii) reasonable living expense allowance;
1153 (iii) compensation at reasonable rates for all professionals reasonably employed for the
1154 examination under Subsection (4);
1155 (iv) the administration and supervisory expense of:
1156 (A) the department; and
1157 (B) the attorney general's office; and
1158 (v) an amount necessary to cover fringe benefits authorized by the commissioner or
1159 provided by law.
1160 [(b)] (c) In determining rates, the commissioner shall consider the rates recommended
1161 and outlined in the examination manual sponsored by the National Association of Insurance
1162 Commissioners.
1163 [(c)] (d) This Subsection (1) applies to a surplus lines producer to the extent that the
1164 examinations are of the surplus line producer's surplus lines business.
1165 (2) An insurer requesting the examination of one of its producers shall pay the cost of
1166 the examination. Otherwise, the department shall pay the cost of examining a licensee other
1167 than those specified under Subsection (1).
1168 (3) (a) On the examinee's request or at the commissioner's discretion, the department
1169 may pay all or part of the costs of an examination whenever the commissioner finds that
1170 because of the frequency of examinations or the financial condition of the examinee,
1171 imposition of the costs would place an unreasonable burden on the examinee.
1172 (b) The commissioner shall include in the commissioner's annual report information
1173 about any instance in which the commissioner has applied this Subsection (3).
1174 (4) (a) A technical expert employed under Subsection 31A-2-203 (3) shall present to the

1175 commissioner a statement of all expenses incurred by the technical expert in conjunction with
1176 an examination.
1177 (b) The examined insurer shall, at the commissioner's direction, pay to [the] a technical
1178 [experts or specialists the] expert:
1179 (i) (A) actual travel expenses;
1180 [(ii)] (B) reasonable living expenses; and
1181 [(iii)] (C) compensation [at customary rates]; and
1182 (ii) for expenses necessarily incurred as approved by the commissioner.
1183 (c) The examined insurer shall reimburse the department for:
1184 (i) a department [examiners for their] examiner's:
1185 (A) actual travel expenses; and
1186 (B) reasonable living expenses; and
1187 (ii) [the department for] the compensation of department examiners involved in the
1188 examination.
1189 (d) (i) The examined insurer shall certify the consolidated account of all charges and
1190 expenses for the examination.
1191 (ii) The examined insurer shall:
1192 (A) retain a copy of the consolidated account; and
1193 (B) file a copy of the consolidated account with the department as a public record.
1194 (e) An annual report of examination charges paid by examined insurers directly to
1195 persons employed under Subsection 31A-2-203 (3) or to department examiners shall be
1196 included with the department's budget request.
1197 (f) Amounts paid directly by examined insurers to persons employed under Subsection
1198 31A-2-203 (3) or to department examiners may not be deducted from the department's
1199 appropriation.
1200 (5) (a) The amount payable under Subsection (1) is due ten days after the day on which
1201 the examinee [has been] is served with a detailed account of the costs.
1202 (b) Payments received by the department under this Subsection (5) shall be handled as
1203 provided by Section 31A-3-101 .
1204 (6) (a) The commissioner may require an examinee under Subsection (1), or an insurer
1205 requesting an examination under Subsection (2), either before or during an examination, to

1206 make deposits with the state treasurer to pay the costs of examination.
1207 (b) Any deposit made under this Subsection (6) shall be held in trust by the state
1208 treasurer until applied to pay the department the costs payable under this section.
1209 (c) If a deposit made under this Subsection (6) exceeds examination costs, the state
1210 treasurer shall refund the surplus.
1211 (7) A domestic insurer may offset the examination expenses paid under this section
1212 against premium taxes under Subsection 59-9-102 (2).
1213 Section 3. Section 31A-5-416 is amended to read:
1214 31A-5-416. Compensation of director, officer, employee, person with investment
1215 authority, or others.
1216 (1) Subject to this section, [Section 16-10a-302 , except Subsection 16-10a-302 (13),
1217 applies to stock and mutual corporations.] Subsections 16-10a-302 (11) and (12) apply to:
1218 (a) a stock corporation; and
1219 (b) a mutual corporation.
1220 (2) Shareholders' approval is required:
1221 (a) of any benefit or payment to a director or officer for services rendered to a stock
1222 corporation more than 90 days before the agreement or decision to give the benefit or make the
1223 payment, unless the benefit or payment is made under a plan approved by the shareholders[.
1224 Shareholder approval is also required]; and
1225 (b) for a new pension plan, profit-sharing plan, stock option plan, or an amendment to
1226 an existing plan which, so far as it pertains to any director or officer, substantially increases the
1227 financial burden on the stock corporation.
1228 (3) An action taken by the board of a mutual on the compensation of officers, directors,
1229 or employees, other than setting individual salaries or standards for salaries of classes of
1230 employees, shall be reported to the commissioner within 30 days.
1231 (4) The annual [report to the commissioner] statement of a stock or mutual corporation
1232 shall include the amount of all direct and indirect remuneration for services, including
1233 retirement and other deferred compensation benefits and stock options[,] paid [or accrued] each
1234 year:
1235 (a) for the benefit of each [director, each officer, and employee] of the following whose
1236 remuneration exceeds an amount established by the commissioner by rule[;]:

1237 (i) a director;
1238 (ii) an officer; or
1239 (iii) an employee;
1240 (b) for all directors and officers as a group; and
1241 (c) (i) for the five most highly compensated officers[,];
1242 (ii) for the five most highly compensated directors[,]; and
1243 (iii) for the five most highly compensated employees.
1244 (5) [No] An arrangement for compensation or other employment benefits for any
1245 director, officer, or employee with decision-making power may not be made if it would:
1246 (a) measure the compensation or other benefits in whole or in part by any criteria that
1247 would create a financial inducement to act contrary to the best interests of the stock or mutual
1248 corporation; or
1249 (b) have a tendency to make the stock or mutual corporation depend for continuance or
1250 soundness of operation upon the continuation of any director, officer, or employee in [his] the
1251 position of director, officer, or employee.
1252 (6) Except for the insurer, [no] a person having any authority in the investment or
1253 disposition of the funds of a domestic insurer may not:
1254 (a) accept any fee, brokerage, gift, or other emolument because of any investment,
1255 loan, deposit, purchase, sale, payment, or exchange made by or for the insurer[, nor may that
1256 person]; or
1257 (b) be financially interested in the investment or disposition of funds in any capacity.
1258 (7) Unless the commissioner, acting in the corporation's best interests, orders
1259 otherwise, if an order of rehabilitation or liquidation is issued under Section 31A-27-303 or
1260 Section 31A-27-310 , the contractual obligations of the insurer for unperformed services of any
1261 director, principal officer, or person performing similar functions or having similar powers are
1262 terminated. This Subsection (7) does not apply to obligations vested before July 1, 1986.
1263 Section 4. Section 31A-21-104 is amended to read:
1264 31A-21-104. Insurable interest and consent.
1265 (1) (a) An insurer may not knowingly provide insurance to a person who does not have
1266 or expect to have an insurable interest in the subject of the insurance.
1267 (b) A person may not knowingly procure, directly, by assignment, or otherwise, an

1268 interest in the proceeds of an insurance policy unless that person has or expects to have an
1269 insurable interest in the subject of the insurance.
1270 (c) Except as provided in Subsections (6), (7), and (8), any insurance provided in
1271 violation of this Subsection (1) is subject to Subsection (5).
1272 (2) As used in this chapter:
1273 (a) (i) "Insurable interest" in a person means:
1274 (A) for persons closely related by blood or by law, a substantial interest engendered by
1275 love and affection; or
1276 (B) in the case of other persons, a lawful and substantial interest in having the life,
1277 health, and bodily safety of the person insured continue.
1278 (ii) Policyholders in group insurance contracts do not need an insurable interest if
1279 certificate holders or persons other than group policyholders who are specified by the
1280 certificate holders are the recipients of the proceeds of the policies.
1281 (iii) Each person has an unlimited insurable interest in the person's own life and health.
1282 (iv) A shareholder or partner has an insurable interest in the life of other shareholders
1283 or partners for purposes of insurance contracts that are an integral part of a legitimate buy-sell
1284 agreement respecting shares or a partnership interest in the business.
1285 (v) Subject to Subsection (9), an employer or an employer sponsored trust for the
1286 benefit of the employer's employees:
1287 (A) has an insurable interest in the lives of the employer's:
1288 (I) directors;
1289 (II) officers;
1290 (III) managers;
1291 (IV) nonmanagement employees; and
1292 (V) retired employees; and
1293 (B) may insure the lives listed in Subsection (2)(a)(v)(A):
1294 (I) on an individual or group basis; and
1295 (II) with the written consent of the insured.
1296 (b) "Insurable interest" in property or liability means any lawful and substantial
1297 economic interest in the nonoccurrence of the event insured against.
1298 (c) "Viatical settlement" is as defined in Section 31A-36-102 .

1299 (3) (a) Except as provided in Subsection (4), an insurer may not knowingly issue an
1300 individual life or accident and health insurance policy to a person other than the one whose life
1301 or health is at risk unless that person, who is 18 years of age or older and not under
1302 guardianship under Title 75, Chapter 5, Protection of Persons Under Disability and Their
1303 Property, has given written consent to the issuance of the policy.
1304 (b) A person shall express consent:
1305 (i) by signing an application for the insurance with knowledge of the nature of the
1306 document; or
1307 (ii) in any other reasonable way.
1308 (c) Any insurance provided in violation of this Subsection (3) is subject to Subsection
1309 (5).
1310 (4) (a) A life or accident and health insurance policy may be taken out without consent
1311 in a circumstance described in this Subsection (4)(a).
1312 (i) A person may obtain insurance on a dependent who does not have legal capacity.
1313 (ii) A creditor may, at the creditor's expense, obtain insurance on the debtor in an
1314 amount reasonably related to the amount of the debt.
1315 (iii) A person may obtain life and accident and health insurance on an immediate
1316 family member who is living with or dependent on the person.
1317 (iv) A person may obtain an accident and health insurance policy on others that would
1318 merely indemnify the policyholder against expenses the person would be legally or morally
1319 obligated to pay.
1320 (v) The commissioner may adopt rules permitting issuance of insurance for a limited
1321 term on the life or health of a person serving outside the continental United States who is in the
1322 public service of the United States, if the policyholder is related within the second degree by
1323 blood or by marriage to the person whose life or health is insured.
1324 (b) Consent may be given by another in a circumstance described in this Subsection
1325 (4)(b).
1326 (i) A parent, a person having legal custody of a minor, or a guardian of a person under
1327 Title 75, Chapter 5, Protection of Persons Under Disability and Their Property, may consent to
1328 the issuance of a policy on a dependent child or on a person under guardianship under Title 75,
1329 Chapter 5, Protection of Persons Under Disability and Their Property.

1330 (ii) A grandparent may consent to the issuance of life or accident and health insurance
1331 on a grandchild.
1332 (iii) A court of general jurisdiction may give consent to the issuance of a life or
1333 accident and health insurance policy on an ex parte application showing facts the court
1334 considers sufficient to justify the issuance of that insurance.
1335 (5) (a) An insurance policy is not invalid because the policyholder lacks insurable
1336 interest or because consent has not been given.
1337 (b) Notwithstanding Subsection (5)(a), a court with appropriate jurisdiction may:
1338 (i) order the proceeds to be paid to some person who is equitably entitled to the
1339 proceeds, other than the one to whom the policy is designated to be payable; or
1340 (ii) create a constructive trust in the proceeds or a part of the proceeds on behalf of
1341 such a person, subject to all the valid terms and conditions of the policy other than those
1342 relating to insurable interest or consent.
1343 (6) This section does not prevent any organization described under 26 U.S.C. Sec.
1344 501(c)(3), (e), or (f), as amended, and the regulations made under this section, and which is
1345 regulated under Title 13, Chapter 22, Charitable Solicitations Act, from soliciting and
1346 procuring, by assignment or designation as beneficiary, a gift or assignment of an interest in
1347 life insurance on the life of the donor or assignor or from enforcing payment of proceeds from
1348 that interest.
1349 (7) An insurance policy transferred pursuant to Chapter 36, Viatical Settlements Act, is
1350 not subject to Subsection (5)(b) and nothing else in this section shall prevent:
1351 (a) any policyholder of life insurance, whether or not the policyholder is also the
1352 subject of the insurance, from entering into a viatical settlement;
1353 (b) any person from soliciting a person to enter into a viatical settlement;
1354 (c) a person from enforcing payment of proceeds from the interest obtained under a
1355 viatical settlement; or
1356 (d) a viatical settlement provider [of viatical settlements], a viatical settlement
1357 purchaser [of a viatical settlement], a financing entity, a related provider trust, or a special
1358 purpose entity from executing any of the following with respect to the death benefit or
1359 ownership of any portion of a viaticated policy as provided for in Section 31A-36-109 :
1360 (i) an assignment;

1361 (ii) a sale;
1362 (iii) a transfer;
1363 (iv) a devise; or
1364 (v) a bequest.
1365 (8) Notwithstanding Subsection (1), an insurer authorized under this title to issue a
1366 workers' compensation policy may issue a workers' compensation policy to a sole
1367 proprietorship, corporation, or partnership that elects not to include any owner, corporate
1368 officer, or partner as an employee under the policy even if at the time the policy is issued the
1369 sole proprietorship, corporation, or partnership has no employees.
1370 (9) The extent of an employer's or employer sponsored trust's insurable interest for a
1371 nonmanagement and retired employee under Subsection (2)(a)(v) is limited to an amount
1372 commensurate with the employer's unfunded liabilities.
1373 Section 5. Section 31A-21-503 is amended to read:
1374 31A-21-503. Discrimination based on domestic violence or child abuse
1375 prohibited.
1376 (1) Except as provided in Subsection (2), an insurer of life or accident and health
1377 insurance may not consider whether an insured or applicant is the subject of domestic abuse as
1378 a factor to:
1379 (a) refuse to insure the applicant;
1380 (b) refuse to continue to insure the insured;
1381 (c) refuse to renew or reissue a policy to insure the insured or applicant;
1382 (d) limit the amount, extent, or kind of coverage available to the insured or applicant;
1383 (e) charge a different rate for coverage to the insured or applicant;
1384 (f) exclude or limit benefits or coverage under an insurance policy or contract for
1385 losses incurred;
1386 (g) deny a claim; or
1387 (h) terminate coverage or fail to provide conversion privileges in violation of Sections
1388 31A-22-612 and [ 31A-22-710 ] 31A-22-723 under a group accident and health policy for the
1389 insured because the coverage was issued in the name of the perpetrator of the domestic
1390 violence or abuse.
1391 (2) (a) Notwithstanding Subsection (1), an insurer may underwrite [based] on the basis

1392 of the physical or mental condition of an insured or applicant if the underwriting is [based] on
1393 the basis of a determination that there is a correlation between the medical or mental condition
1394 and a material increase in insurance risk.
1395 (b) For purposes of Subsection (2)(a), the fact that an insured or applicant is a subject
1396 of domestic abuse is not a mental or physical condition.
1397 (c) The determination required by Subsection (2)(a) shall be made in conformance with
1398 sound actuarial principles.
1399 (d) Within 30 days after receiving an oral or written request from an insured or
1400 applicant, an insurer shall disclose in writing:
1401 (i) the basis of an action permitted under Subsection (2)(a); and
1402 (ii) if the policy has been issued or modified, the extent the action taken will impact the
1403 amount, extent, or kind of coverage or benefits available to the insured.
1404 Section 6. Section 31A-22-305 is amended to read:
1405 31A-22-305. Uninsured motorist coverage.
1406 (1) As used in this section, "covered persons" includes:
1407 (a) the named insured;
1408 (b) persons related to the named insured by blood, marriage, adoption, or guardianship,
1409 who are residents of the named insured's household, including those who usually make their
1410 home in the same household but temporarily live elsewhere;
1411 (c) any person occupying or using a motor vehicle:
1412 (i) referred to in the policy; or
1413 (ii) owned by a self-insured; and
1414 (d) any person who is entitled to recover damages against the owner or operator of the
1415 uninsured or underinsured motor vehicle because of bodily injury to or death of persons under
1416 Subsection (1)(a), (b), or (c).
1417 (2) As used in this section, "uninsured motor vehicle" includes:
1418 (a) (i) a motor vehicle, the operation, maintenance, or use of which is not covered
1419 under a liability policy at the time of an injury-causing occurrence; or
1420 (ii) (A) a motor vehicle covered with lower liability limits than required by Section
1421 31A-22-304 ; and
1422 (B) the motor vehicle described in Subsection (2)(a)(ii)(A) is uninsured to the extent of

1423 the deficiency;
1424 (b) an unidentified motor vehicle that left the scene of an accident proximately caused
1425 by the motor vehicle operator;
1426 (c) a motor vehicle covered by a liability policy, but coverage for an accident is
1427 disputed by the liability insurer for more than 60 days or continues to be disputed for more than
1428 60 days; or
1429 (d) (i) an insured motor vehicle if, before or after the accident, the liability insurer of
1430 the motor vehicle is declared insolvent by a court of competent jurisdiction; and
1431 (ii) the motor vehicle described in Subsection (2)(d)(i) is uninsured only to the extent
1432 that the claim against the insolvent insurer is not paid by a guaranty association or fund.
1433 (3) (a) Uninsured motorist coverage under Subsection 31A-22-302 (1)(b) provides
1434 coverage for covered persons who are legally entitled to recover damages from owners or
1435 operators of uninsured motor vehicles because of bodily injury, sickness, disease, or death.
1436 (b) For new policies written on or after January 1, 2001, the limits of uninsured
1437 motorist coverage shall be equal to the lesser of the limits of the insured's motor vehicle
1438 liability coverage or the maximum uninsured motorist coverage limits available by the insurer
1439 under the insured's motor vehicle policy, unless the insured purchases coverage in a lesser
1440 amount by signing an acknowledgment form that:
1441 (i) is filed with the department;
1442 (ii) is provided by the insurer [that:];
1443 [(i)] (iii) waives the higher coverage;
1444 [(ii)] (iv) reasonably explains the purpose of uninsured motorist coverage; and
1445 [(iii)] (v) discloses the additional premiums required to purchase uninsured motorist
1446 coverage with limits equal to the lesser of the limits of the insured's motor vehicle liability
1447 coverage or the maximum uninsured motorist coverage limits available by the insurer under the
1448 insured's motor vehicle policy.
1449 (c) A self-insured, including a governmental entity, may elect to provide uninsured
1450 motorist coverage in an amount that is less than its maximum self-insured retention under
1451 Subsections (3)(b) and (4)(a) by issuing a declaratory memorandum or policy statement from
1452 the chief financial officer or chief risk officer that declares the:
1453 (i) self-insured entity's coverage level; and

1454 (ii) process for filing an uninsured motorist claim.
1455 (d) Uninsured motorist coverage may not be sold with limits that are less than the
1456 minimum bodily injury limits for motor vehicle liability policies under Section 31A-22-304 .
1457 (e) The acknowledgment under Subsection (3)(b) continues for that issuer of the
1458 uninsured motorist coverage until the insured, in writing, requests different uninsured motorist
1459 coverage from the insurer.
1460 (f) (i) In conjunction with the first two renewal notices sent after January 1, 2001, for
1461 policies existing on that date, the insurer shall disclose in the same medium as the premium
1462 renewal notice, an explanation of:
1463 (A) the purpose of uninsured motorist coverage; and
1464 (B) the costs associated with increasing the coverage in amounts up to and including
1465 the maximum amount available by the insurer under the insured's motor vehicle policy.
1466 (ii) The disclosure required under this Subsection (3)(f) shall be sent to all insureds that
1467 carry uninsured motorist coverage limits in an amount less than the insured's motor vehicle
1468 liability policy limits or the maximum uninsured motorist coverage limits available by the
1469 insurer under the insured's motor vehicle policy.
1470 (4) (a) (i) Except as provided in Subsection (4)(b), the named insured may reject
1471 uninsured motorist coverage by an express writing to the insurer that provides liability
1472 coverage under Subsection 31A-22-302 (1)(a).
1473 (ii) This rejection shall be on a form provided by the insurer that includes a reasonable
1474 explanation of the purpose of uninsured motorist coverage.
1475 (iii) This rejection continues for that issuer of the liability coverage until the insured in
1476 writing requests uninsured motorist coverage from that liability insurer.
1477 (b) (i) All persons, including governmental entities, that are engaged in the business of,
1478 or that accept payment for, transporting natural persons by motor vehicle, and all school
1479 districts that provide transportation services for their students, shall provide coverage for all
1480 motor vehicles used for that purpose, by purchase of a policy of insurance or by self-insurance,
1481 uninsured motorist coverage of at least $25,000 per person and $500,000 per accident.
1482 (ii) This coverage is secondary to any other insurance covering an injured covered
1483 person.
1484 (c) Uninsured motorist coverage:

1485 (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
1486 Compensation Act;
1487 (ii) may not be subrogated by the workers' compensation insurance carrier;
1488 (iii) may not be reduced by any benefits provided by workers' compensation insurance;
1489 (iv) may be reduced by health insurance subrogation only after the covered person has
1490 been made whole;
1491 (v) may not be collected for bodily injury or death sustained by a person:
1492 (A) while committing a violation of Section 41-1a-1314 ;
1493 (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
1494 in violation of Section 41-1a-1314 ; or
1495 (C) while committing a felony; and
1496 (vi) notwithstanding Subsection (4)(c)(v), may be recovered:
1497 (A) for a person under 18 years of age who is injured within the scope of Subsection
1498 (4)(c)(v) but limited to medical and funeral expenses; or
1499 (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
1500 within the course and scope of the law enforcement officer's duties.
1501 (d) As used in this Subsection (4), "motor vehicle" has the same meaning as under
1502 Section 41-1a-102 .
1503 (5) When a covered person alleges that an uninsured motor vehicle under Subsection
1504 (2)(b) proximately caused an accident without touching the covered person or the motor
1505 vehicle occupied by the covered person, the covered person must show the existence of the
1506 uninsured motor vehicle by clear and convincing evidence consisting of more than the covered
1507 person's testimony.
1508 (6) (a) The limit of liability for uninsured motorist coverage for two or more motor
1509 vehicles may not be added together, combined, or stacked to determine the limit of insurance
1510 coverage available to an injured person for any one accident.
1511 (b) (i) Subsection (6)(a) applies to all persons except a covered person as defined under
1512 Subsection (7)(b)(ii).
1513 (ii) A covered person as defined under Subsection (7)(b)(ii) is entitled to the highest
1514 limits of uninsured motorist coverage afforded for any one motor vehicle that the covered
1515 person is the named insured or an insured family member.

1516 (iii) This coverage shall be in addition to the coverage on the motor vehicle the covered
1517 person is occupying.
1518 (iv) Neither the primary nor the secondary coverage may be set off against the other.
1519 (c) Coverage on a motor vehicle occupied at the time of an accident shall be primary
1520 coverage, and the coverage elected by a person described under Subsections (1)(a) and (b) shall
1521 be secondary coverage.
1522 (7) (a) Uninsured motorist coverage under this section applies to bodily injury,
1523 sickness, disease, or death of covered persons while occupying or using a motor vehicle only if
1524 the motor vehicle is described in the policy under which a claim is made, or if the motor
1525 vehicle is a newly acquired or replacement motor vehicle covered under the terms of the policy.
1526 Except as provided in Subsection (6) or this Subsection (7), a covered person injured in a
1527 motor vehicle described in a policy that includes uninsured motorist benefits may not elect to
1528 collect uninsured motorist coverage benefits from any other motor vehicle insurance policy
1529 under which the person is a covered person.
1530 (b) Each of the following persons may also recover uninsured motorist benefits under
1531 any one other policy in which they are described as a "covered person" as defined in Subsection
1532 (1):
1533 (i) a covered person injured as a pedestrian by an uninsured motor vehicle; and
1534 (ii) except as provided in Subsection (7)(c), a covered person injured while occupying
1535 or using a motor vehicle that is not owned, leased, or furnished:
1536 (A) to the covered person;
1537 (B) to the covered person's spouse; or
1538 (C) to the covered person's resident parent or resident sibling.
1539 (c) (i) A covered person may recover benefits from no more than two additional
1540 policies, one additional policy from each parent's household if the covered person is:
1541 (A) a dependent minor of parents who reside in separate households; and
1542 (B) injured while occupying or using a motor vehicle that is not owned, leased, or
1543 furnished:
1544 (I) to the covered person;
1545 (II) to the covered person's resident parent; or
1546 (III) to the covered person's resident sibling.

1547 (ii) Each parent's policy under this Subsection (7)(c) is liable only for the percentage of
1548 the damages that the limit of liability of each parent's policy of uninsured motorist coverage
1549 bears to the total of both parents' uninsured coverage applicable to the accident.
1550 (d) A covered person's recovery under any available policies may not exceed the full
1551 amount of damages.
1552 (e) A covered person in Subsection (7)(b) is not barred against making subsequent
1553 elections if recovery is unavailable under previous elections.
1554 (f) (i) As used in this section, "interpolicy stacking" means recovering benefits for a
1555 single incident of loss under more than one insurance policy.
1556 (ii) Except to the extent permitted by Subsection (6) and this Subsection (7),
1557 interpolicy stacking is prohibited for uninsured motorist coverage.
1558 (8) (a) When a claim is brought by a named insured or a person described in
1559 Subsection (1) and is asserted against the covered person's uninsured motorist carrier, the
1560 claimant may elect to resolve the claim:
1561 (i) by submitting the claim to binding arbitration; or
1562 (ii) through litigation.
1563 (b) Unless otherwise provided in the policy under which uninsured benefits are
1564 claimed, the election provided in Subsection (8)(a) is available to the claimant only.
1565 (c) Once the claimant has elected to commence litigation under Subsection (8)(a)(ii),
1566 the claimant may not elect to resolve the claim through binding arbitration under this section
1567 without the written consent of the uninsured motorist carrier.
1568 (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
1569 binding arbitration under Subsection (8)(a)(i) shall be resolved by a single arbitrator.
1570 (ii) All parties shall agree on the single arbitrator selected under Subsection (8)(d)(i).
1571 (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
1572 (8)(d)(ii), the parties shall select a panel of three arbitrators.
1573 (e) If the parties select a panel of three arbitrators under Subsection (8)(d)(iii):
1574 (i) each side shall select one arbitrator; and
1575 (ii) the arbitrators appointed under Subsection (8)(e)(i) shall select one additional
1576 arbitrator to be included in the panel.
1577 (f) Unless otherwise agreed to in writing:

1578 (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
1579 under Subsection (8)(d)(i); or
1580 (ii) if an arbitration panel is selected under Subsection (8)(d)(iii):
1581 (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
1582 (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
1583 under Subsection (8)(e)(ii).
1584 (g) Except as otherwise provided in this section or unless otherwise agreed to in
1585 writing by the parties, an arbitration proceeding conducted under this section shall be governed
1586 by Title 78, Chapter 31a, Utah Uniform Arbitration Act.
1587 (h) The arbitration shall be conducted in accordance with Rules 26 through 37, 54, and
1588 68 of the Utah Rules of Civil Procedure.
1589 (i) All issues of discovery shall be resolved by the arbitrator or the arbitration panel.
1590 (j) A written decision by a single arbitrator or by a majority of the arbitration panel
1591 shall constitute a final decision.
1592 (k) (i) The amount of an arbitration award may not exceed the uninsured motorist
1593 policy limits of all applicable uninsured motorist policies, including applicable uninsured
1594 motorist umbrella policies.
1595 (ii) If the initial arbitration award exceeds the uninsured motorist policy limits of all
1596 applicable uninsured motorist policies, the arbitration award shall be reduced to an amount
1597 equal to the combined uninsured motorist policy limits of all applicable uninsured motorist
1598 policies.
1599 (l) The arbitrator or arbitration panel may not decide the issues of coverage or
1600 extra-contractual damages, including:
1601 (i) whether the claimant is a covered person;
1602 (ii) whether the policy extends coverage to the loss; or
1603 (iii) any allegations or claims asserting consequential damages or bad faith liability.
1604 (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
1605 class-representative basis.
1606 (n) If the arbitrator or arbitration panel finds that the action was not brought, pursued,
1607 or defended in good faith, the arbitrator or arbitration panel may award reasonable attorney fees
1608 and costs against the party that failed to bring, pursue, or defend the claim in good faith.

1609 (o) An arbitration award issued under this section shall be the final resolution of all
1610 claims not excluded by Subsection (8)(l) between the parties unless:
1611 (i) the award was procured by corruption, fraud, or other undue means; or
1612 (ii) either party, within 20 days after service of the arbitration award:
1613 (A) files a complaint requesting a trial de novo in the district court; and
1614 (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
1615 under Subsection (8)(o)(ii)(A).
1616 (p) (i) Upon filing a complaint for a trial de novo under Subsection (8)(o), the claim
1617 shall proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules
1618 of Evidence in the district court.
1619 (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
1620 request a jury trial with a complaint requesting a trial de novo under Subsection (8)(o)(ii)(A).
1621 (q) (i) If the claimant, as the moving party in a trial de novo requested under
1622 Subsection (8)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater
1623 than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
1624 (ii) If the uninsured motorist carrier, as the moving party in a trial de novo requested
1625 under Subsection (8)(o), does not obtain a verdict that is at least 20% less than the arbitration
1626 award, the uninsured motorist carrier is responsible for all of the nonmoving party's costs.
1627 (iii) Except as provided in Subsection (8)(q)(iv), the costs under this Subsection (8)(q)
1628 shall include:
1629 (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
1630 (B) the costs of expert witnesses and depositions.
1631 (iv) An award of costs under this Subsection (8)(q) may not exceed $2,500.
1632 (r) For purposes of determining whether a party's verdict is greater or less than the
1633 arbitration award under Subsection (8)(q), a court may not consider any recovery or other relief
1634 granted on a claim for damages if the claim for damages:
1635 (i) was not fully disclosed in writing prior to the arbitration proceeding; or
1636 (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil
1637 Procedure.
1638 (s) If a district court determines, upon a motion of the nonmoving party, that the
1639 moving party's use of the trial de novo process was filed in bad faith in accordance with

1640 Section 78-27-56 , the district court may award reasonable attorney fees to the nonmoving
1641 party.
1642 (t) Nothing in this section is intended to limit any claim under any other portion of an
1643 applicable insurance policy.
1644 (u) If there are multiple uninsured motorist policies, as set forth in Subsection (7), the
1645 claimant may elect to arbitrate in one hearing the claims against all the uninsured motorist
1646 carriers.
1647 Section 7. Section 31A-22-305.3 is amended to read:
1648 31A-22-305.3. Underinsured motorist coverage.
1649 (1) As used in this section:
1650 (a) "Covered person" has the same meaning as defined in Section 31A-22-305 .
1651 (b) (i) "Underinsured motor vehicle" includes a motor vehicle, the operation,
1652 maintenance, or use of which is covered under a liability policy at the time of an injury-causing
1653 occurrence, but which has insufficient liability coverage to compensate fully the injured party
1654 for all special and general damages.
1655 (ii) The term "underinsured motor vehicle" does not include:
1656 (A) a motor vehicle that is covered under the liability coverage of the same policy that
1657 also contains the underinsured motorist coverage;
1658 (B) an uninsured motor vehicle as defined in Subsection 31A-22-305 (2); or
1659 (C) a motor vehicle owned or leased by:
1660 (I) the named insured;
1661 (II) the named insured's spouse; or
1662 (III) any dependent of the named insured.
1663 (2) (a) (i) Underinsured motorist coverage under Subsection 31A-22-302 (1)(c)
1664 provides coverage for covered persons who are legally entitled to recover damages from
1665 owners or operators of underinsured motor vehicles because of bodily injury, sickness, disease,
1666 or death.
1667 (ii) A covered person occupying or using a motor vehicle owned, leased, or furnished
1668 to the covered person, the covered person's spouse, or covered person's resident relative may
1669 recover underinsured benefits only if the motor vehicle is:
1670 (A) described in the policy under which a claim is made; or

1671 (B) a newly acquired or replacement motor vehicle covered under the terms of the
1672 policy.
1673 (b) For new policies written on or after January 1, 2001, the limits of underinsured
1674 motorist coverage shall be equal to the lesser of the limits of the insured's motor vehicle
1675 liability coverage or the maximum underinsured motorist coverage limits available by the
1676 insurer under the insured's motor vehicle policy, unless the insured purchases coverage in a
1677 lesser amount by signing an acknowledgment form that:
1678 (i) is filed with the department;
1679 (ii) is provided by the insurer [that:];
1680 [(i)] (iii) waives the higher coverage;
1681 [(ii)] (iv) reasonably explains the purpose of underinsured motorist coverage; and
1682 [(iii)] (v) discloses the additional premiums required to purchase underinsured motorist
1683 coverage with limits equal to the lesser of the limits of the insured's motor vehicle liability
1684 coverage or the maximum underinsured motorist coverage limits available by the insurer under
1685 the insured's motor vehicle policy.
1686 (c) A self-insured, including a governmental entity, may elect to provide underinsured
1687 motorist coverage in an amount that is less than its maximum self-insured retention under
1688 Subsections (2)(b) and (2)(g) by issuing a declaratory memorandum or policy statement from
1689 the chief financial officer or chief risk officer that declares the:
1690 (i) self-insured entity's coverage level; and
1691 (ii) process for filing an underinsured motorist claim.
1692 (d) Underinsured motorist coverage may not be sold with limits that are less than:
1693 (i) $10,000 for one person in any one accident; and
1694 (ii) at least $20,000 for two or more persons in any one accident.
1695 (e) The acknowledgment under Subsection (2)(b) continues for that issuer of the
1696 underinsured motorist coverage until the insured, in writing, requests different underinsured
1697 motorist coverage from the insurer.
1698 (f) (i) The named insured's underinsured motorist coverage, as described in Subsection
1699 (2)(a), is secondary to the liability coverage of an owner or operator of an underinsured motor
1700 vehicle, as described in Subsection (1).
1701 (ii) Underinsured motorist coverage may not be set off against the liability coverage of

1702 the owner or operator of an underinsured motor vehicle, but shall be added to, combined with,
1703 or stacked upon the liability coverage of the owner or operator of the underinsured motor
1704 vehicle to determine the limit of coverage available to the injured person.
1705 (g) (i) A named insured may reject underinsured motorist coverage by an express
1706 writing to the insurer that provides liability coverage under Subsection 31A-22-302 (1)(a).
1707 (ii) This written rejection shall be on a form provided by the insurer that includes a
1708 reasonable explanation of the purpose of underinsured motorist coverage and when it would be
1709 applicable.
1710 (iii) This rejection continues for that issuer of the liability coverage until the insured in
1711 writing requests underinsured motorist coverage from that liability insurer.
1712 (h) (i) In conjunction with the first two renewal notices sent after January 1, 2001, for
1713 policies existing on that date, the insurer shall disclose in the same medium as the premium
1714 renewal notice, an explanation of:
1715 (A) the purpose of underinsured motorist coverage; and
1716 (B) the costs associated with increasing the coverage in amounts up to and including
1717 the maximum amount available by the insurer under the insured's motor vehicle policy.
1718 (ii) The disclosure required by this Subsection (2)(h) shall be sent to all insureds that
1719 carry underinsured motorist coverage limits in an amount less than the insured's motor vehicle
1720 liability policy limits or the maximum underinsured motorist coverage limits available by the
1721 insurer under the insured's motor vehicle policy.
1722 (3) (a) (i) Except as provided in this Subsection (3), a covered person injured in a
1723 motor vehicle described in a policy that includes underinsured motorist benefits may not elect
1724 to collect underinsured motorist coverage benefits from any other motor vehicle insurance
1725 policy.
1726 (ii) The limit of liability for underinsured motorist coverage for two or more motor
1727 vehicles may not be added together, combined, or stacked to determine the limit of insurance
1728 coverage available to an injured person for any one accident.
1729 (iii) Subsection (3)(a)(ii) applies to all persons except a covered person described
1730 under Subsections (3)(b)(i) and (ii).
1731 (b) (i) Except as provided in Subsection (3)(b)(ii), a covered person injured while
1732 occupying, using, or maintaining a motor vehicle that is not owned, leased, or furnished to the

1733 covered person, the covered person's spouse, or the covered person's resident parent or resident
1734 sibling, may also recover benefits under any one other policy under which they are a covered
1735 person.
1736 (ii) (A) A covered person may recover benefits from no more than two additional
1737 policies, one additional policy from each parent's household if the covered person is:
1738 (I) a dependent minor of parents who reside in separate households; and
1739 (II) injured while occupying or using a motor vehicle that is not owned, leased, or
1740 furnished to the covered person, the covered person's resident parent, or the covered person's
1741 resident sibling.
1742 (B) Each parent's policy under this Subsection (3)(b)(ii) is liable only for the
1743 percentage of the damages that the limit of liability of each parent's policy of underinsured
1744 motorist coverage bears to the total of both parents' underinsured coverage applicable to the
1745 accident.
1746 (iii) A covered person's recovery under any available policies may not exceed the full
1747 amount of damages.
1748 (iv) Underinsured coverage on a motor vehicle occupied at the time of an accident shall
1749 be primary coverage, and the coverage elected by a person described under Subsections
1750 31A-22-305 (1)(a) and (b) shall be secondary coverage.
1751 (v) The primary and the secondary coverage may not be set off against the other.
1752 (vi) A covered person as described under Subsection (3)(b)(i) is entitled to the highest
1753 limits of underinsured motorist coverage under only one additional policy per household
1754 applicable to that covered person as a named insured, spouse, or relative.
1755 (vii) A covered injured person is not barred against making subsequent elections if
1756 recovery is unavailable under previous elections.
1757 (viii) (A) As used in this section, "interpolicy stacking" means recovering benefits for a
1758 single incident of loss under more than one insurance policy.
1759 (B) Except to the extent permitted by this Subsection (3), interpolicy stacking is
1760 prohibited for underinsured motorist coverage.
1761 (c) Underinsured motorist coverage:
1762 (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
1763 Compensation Act;

1764 (ii) may not be subrogated by the workers' compensation insurance carrier;
1765 (iii) may not be reduced by any benefits provided by workers' compensation insurance;
1766 (iv) may be reduced by health insurance subrogation only after the covered person has
1767 been made whole;
1768 (v) may not be collected for bodily injury or death sustained by a person:
1769 (A) while committing a violation of Section 41-1a-1314 ;
1770 (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
1771 in violation of Section 41-1a-1314 ; or
1772 (C) while committing a felony; and
1773 (vi) notwithstanding Subsection (3)(c)(v), may be recovered:
1774 (A) for a person under 18 years of age who is injured within the scope of Subsection
1775 (3)(c)(v) but limited to medical and funeral expenses; or
1776 (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
1777 within the course and scope of the law enforcement officer's duties.
1778 (4) The inception of the loss under Subsection 31A-21-313 (1) for underinsured
1779 motorist claims occurs upon the date of the last liability policy payment.
1780 (5) (a) Within five business days after notification in a manner specified by the
1781 department that all liability insurers have tendered their liability policy limits, the underinsured
1782 carrier shall either:
1783 (i) waive any subrogation claim the underinsured carrier may have against the person
1784 liable for the injuries caused in the accident; or
1785 (ii) pay the insured an amount equal to the policy limits tendered by the liability carrier.
1786 (b) If neither option is exercised under Subsection (5)(a), the subrogation claim is
1787 considered to be waived by the underinsured carrier.
1788 (6) Except as otherwise provided in this section, a covered person may seek, subject to
1789 the terms and conditions of the policy, additional coverage under any policy:
1790 (a) that provides coverage for damages resulting from motor vehicle accidents; and
1791 (b) that is not required to conform to Section 31A-22-302 .
1792 (7) (a) When a claim is brought by a named insured or a person described in
1793 Subsection 31A-22-305 (1) and is asserted against the covered person's underinsured motorist
1794 carrier, the claimant may elect to resolve the claim:

1795 (i) by submitting the claim to binding arbitration; or
1796 (ii) through litigation.
1797 (b) Unless otherwise provided in the policy under which underinsured benefits are
1798 claimed, the election provided in Subsection (7)(a) is available to the claimant only.
1799 (c) Once the claimant has elected to commence litigation under Subsection (7)(a)(ii),
1800 the claimant may not elect to resolve the claim through binding arbitration under this section
1801 without the written consent of the underinsured motorist coverage carrier.
1802 (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
1803 binding arbitration under Subsection (7)(a)(i) shall be resolved by a single arbitrator.
1804 (ii) All parties shall agree on the single arbitrator selected under Subsection (7)(d)(i).
1805 (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
1806 (7)(d)(ii), the parties shall select a panel of three arbitrators.
1807 (e) If the parties select a panel of three arbitrators under Subsection (7)(d)(iii):
1808 (i) each side shall select one arbitrator; and
1809 (ii) the arbitrators appointed under Subsection (7)(e)(i) shall select one additional
1810 arbitrator to be included in the panel.
1811 (f) Unless otherwise agreed to in writing:
1812 (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
1813 under Subsection (7)(d)(i); or
1814 (ii) if an arbitration panel is selected under Subsection (7)(d)(iii):
1815 (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
1816 (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
1817 under Subsection (7)(e)(ii).
1818 (g) Except as otherwise provided in this section or unless otherwise agreed to in
1819 writing by the parties, an arbitration proceeding conducted under this section shall be governed
1820 by Title 78, Chapter 31a, Utah Uniform Arbitration Act.
1821 (h) The arbitration shall be conducted in accordance with Rules 26 through 37, 54, and
1822 68 of the Utah Rules of Civil Procedure.
1823 (i) All issues of discovery shall be resolved by the arbitrator or the arbitration panel.
1824 (j) A written decision by a single arbitrator or by a majority of the arbitration panel
1825 shall constitute a final decision.

1826 (k) (i) The amount of an arbitration award may not exceed the underinsured motorist
1827 policy limits of all applicable underinsured motorist policies, including applicable underinsured
1828 motorist umbrella policies.
1829 (ii) If the initial arbitration award exceeds the underinsured motorist policy limits of all
1830 applicable underinsured motorist policies, the arbitration award shall be reduced to an amount
1831 equal to the combined underinsured motorist policy limits of all applicable underinsured
1832 motorist policies.
1833 (l) The arbitrator or arbitration panel may not decide the issues of coverage or
1834 extra-contractual damages, including:
1835 (i) whether the claimant is a covered person;
1836 (ii) whether the policy extends coverage to the loss; or
1837 (iii) any allegations or claims asserting consequential damages or bad faith liability.
1838 (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
1839 class-representative basis.
1840 (n) If the arbitrator or arbitration panel finds that the action was not brought, pursued,
1841 or defended in good faith, the arbitrator or arbitration panel may award reasonable attorney fees
1842 and costs against the party that failed to bring, pursue, or defend the claim in good faith.
1843 (o) An arbitration award issued under this section shall be the final resolution of all
1844 claims not excluded by Subsection (7)(l) between the parties unless:
1845 (i) the award was procured by corruption, fraud, or other undue means; or
1846 (ii) either party, within 20 days after service of the arbitration award:
1847 (A) files a complaint requesting a trial de novo in the district court; and
1848 (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
1849 under Subsection (7)(o)(ii)(A).
1850 (p) (i) Upon filing a complaint for a trial de novo under Subsection (7)(o), the claim
1851 shall proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules
1852 of Evidence in the district court.
1853 (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
1854 request a jury trial with a complaint requesting a trial de novo under Subsection (7)(o)(ii)(A).
1855 (q) (i) If the claimant, as the moving party in a trial de novo requested under
1856 Subsection (7)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater

1857 than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
1858 (ii) If the underinsured motorist carrier, as the moving party in a trial de novo requested
1859 under Subsection (7)(o), does not obtain a verdict that is at least 20% less than the arbitration
1860 award, the underinsured motorist carrier is responsible for all of the nonmoving party's costs.
1861 (iii) Except as provided in Subsection (7)(q)(iv), the costs under this Subsection (7)(q)
1862 shall include:
1863 (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
1864 (B) the costs of expert witnesses and depositions.
1865 (iv) An award of costs under this Subsection (7)(q) may not exceed $2,500.
1866 (r) For purposes of determining whether a party's verdict is greater or less than the
1867 arbitration award under Subsection (7)(q), a court may not consider any recovery or other relief
1868 granted on a claim for damages if the claim for damages:
1869 (i) was not fully disclosed in writing prior to the arbitration proceeding; or
1870 (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil
1871 Procedure.
1872 (s) If a district court determines, upon a motion of the nonmoving party, that the
1873 moving party's use of the trial de novo process was filed in bad faith in accordance with
1874 Section 78-27-56 , the district court may award reasonable attorney fees to the nonmoving
1875 party.
1876 (t) Nothing in this section is intended to limit any claim under any other portion of an
1877 applicable insurance policy.
1878 (u) If there are multiple underinsured motorist policies, as set forth in Subsection (3),
1879 the claimant may elect to arbitrate in one hearing the claims against all the underinsured
1880 motorist carriers.
1881 Section 8. Section 31A-22-423 is amended to read:
1882 31A-22-423. Policy and annuity examination period.
1883 (1) (a) Except as provided under Subsection (2), [all] a life insurance [policies] policy,
1884 life insurance [certificates, annuities, and annuities certificates] certificate, annuity contract, or
1885 annuity certificate shall contain a notice prominently printed on or attached to the cover or
1886 front page of the policy, contract, or certificate stating that the policyholder, contract holder, or
1887 certificate holder has the right to return the policy, contract, or certificate for any reason on or

1888 before:
1889 (i) ten days after [delivery] the day on which the policy, contract, or certificate is
1890 delivered; or
1891 (ii) in case of a replacement policy, contract, or certificate, [20] 30 days after the day
1892 on which the replacement policy, contract, or certificate is delivered.
1893 (b) For purposes of this section, "return" means a writing that:
1894 (i) the policy, contract, or certificate is being returned for termination of coverage;
1895 (ii) is:
1896 (A) a written statement on the policy, contract, or certificate; or
1897 (B) a writing that accompanies the policy, contract, or certificate; and
1898 (iii) is delivered to or mailed first class to the insurer or the insurer's agent.
1899 (c) A policy, contract, or certificate returned under this section is void from the date of
1900 issuance.
1901 (d) A policyholder, contract holder, or certificate holder returning a policy or certificate
1902 is entitled to a refund of any premium paid.
1903 (2) This section does not apply to:
1904 (a) group term life insurance issued under Section 31A-22-502 ;
1905 (b) a group master policy;
1906 (c) a noncontributory certificate;
1907 (d) a credit life insurance certificate; and
1908 (e) other classes of life insurance policies that the commissioner specifies by rule after
1909 finding that a right to return those life insurance policies would be impracticable or
1910 unnecessary to protect the policyholder's interests.
1911 Section 9. Section 31A-22-610 is amended to read:
1912 31A-22-610. Dependent coverage from moment of birth or adoption.
1913 (1) As used in this section:
1914 (a) "Child" means, in connection with any adoption, or placement for adoption of the
1915 child, an individual who is younger than 18 years of age as of the date of the adoption or
1916 placement for adoption.
1917 (b) "Placement for adoption" means the assumption and retention by a person of a legal
1918 obligation for total or partial support of a child in anticipation of the adoption of the child.

1919 (2) (a) [If any] Except as provided in Subsection (5), if an accident and health
1920 insurance policy provides coverage for any members of the policyholder's or certificate holder's
1921 family, the policy shall provide that any health insurance benefits applicable to dependents of
1922 the insured are applicable on the same basis to:
1923 (i) a newly born child from the moment of birth; and
1924 (ii) an adopted child:
1925 (A) beginning from the moment of birth, if placement for adoption occurs within 30
1926 days of the child's birth; or
1927 (B) beginning from the date of placement, if placement for adoption occurs 30 days or
1928 more after the child's birth.
1929 (b) The coverage described in this Subsection (2):
1930 (i) is not subject to any preexisting conditions; and
1931 (ii) includes any injury or sickness, including the necessary care and treatment of
1932 medically diagnosed:
1933 (A) congenital defects;
1934 (B) birth abnormalities; or
1935 (C) prematurity.
1936 (c) (i) Subject to Subsection (2)(c)(ii), a claim for services for a newly born child or an
1937 adopted child may be denied until the child is enrolled.
1938 (ii) Notwithstanding Subsection (2)(c)(i), an otherwise eligible claim denied under
1939 Subsection (2)(c)(i) is eligible for payment and may be resubmitted or reprocessed once a child
1940 is enrolled pursuant to Subsection (2)(d) or (e).
1941 (d) If the payment of a specific premium is required to provide coverage for a child of a
1942 policyholder or certificate holder, for there to be coverage for the child, the policyholder or
1943 certificate holder shall enroll:
1944 (i) a newly born child within 30 days after the date of birth of the child; or
1945 (ii) an adopted child within 30 days after the day of placement of adoption.
1946 (e) If the payment of a specific premium is not required to provide coverage for a child
1947 of a policyholder or certificate holder, for the child to receive coverage the policyholder or
1948 certificate holder shall enroll a newly born child or an adopted child no later than 30 days after
1949 the first notification of denial of a claim for services for that child.

1950 (3) (a) The coverage required by Subsection (2) as to children placed for the purpose of
1951 adoption with a policyholder or certificate holder continues in the same manner as it would
1952 with respect to a child of the policyholder or certificate holder unless:
1953 (i) the placement is disrupted prior to legal adoption; and
1954 (ii) the child is removed from placement.
1955 (b) The coverage required by Subsection (2) ends if the child is removed from
1956 placement prior to being legally adopted.
1957 (4) The provisions of this section apply to employee welfare benefit plans as defined in
1958 Section 26-19-2 .
1959 (5) If an accident and health insurance policy that is not subject to the special
1960 enrollment rights described in 45 C.F.R. Sec. 146.117(b) provides coverage for one individual,
1961 the insurer may choose to:
1962 (a) provide coverage according to this section; or
1963 (b) allow application, subject to the insurer's underwriting criteria for:
1964 (i) a newborn;
1965 (ii) an adopted child; or
1966 (iii) a child placed for adoption.
1967 Section 10. Section 31A-22-629 is amended to read:
1968 31A-22-629. Adverse benefit determination review process.
1969 (1) As used in this section:
1970 (a) (i) "Adverse benefit determination" means the:
1971 (A) denial of a benefit;
1972 (B) reduction of a benefit;
1973 (C) termination of a benefit; or
1974 (D) failure to provide or make payment, in whole or in part, for a benefit.
1975 (ii) "Adverse benefit determination" includes:
1976 (A) denial, reduction, termination, or failure to provide or make payment that is based
1977 on a determination of an insured's or a beneficiary's eligibility to participate in a plan;
1978 (B) with respect to individual or group health plans, and income replacement or
1979 disability income policies, a denial, reduction, or termination of, or a failure to provide or make
1980 payment, in whole or in part, for, a benefit resulting from the application of a utilization

1981 review; and
1982 (C) failure to cover an item or service for which benefits are otherwise provided
1983 because it is determined to be:
1984 (I) experimental;
1985 (II) investigational; or
1986 (III) not medically necessary or appropriate.
1987 (b) "Independent review" means a process that:
1988 (i) is a voluntary option for the resolution of an adverse benefit determination;
1989 (ii) is conducted at the discretion of the claimant;
1990 (iii) is conducted by an independent review organization designated by the insurer;
1991 (iv) renders an independent and impartial decision on an adverse benefit determination
1992 submitted by an insured; and
1993 (v) may not require the insured to pay a fee for requesting the independent review.
1994 (c) "Independent review organization" means a person, subject to Subsection (6), who
1995 conducts an independent external review of adverse determinations.
1996 [(c)] (d) "Insured" is as defined in Section 31A-1-301 and includes a person who is
1997 authorized to act on the insured's behalf.
1998 [(d)] (e) "Insurer" is as defined in Section 31A-1-301 and includes:
1999 (i) a health maintenance organization; and
2000 (ii) a third party administrator that offers, sells, manages, or administers a health
2001 insurance policy or health maintenance organization contract that is subject to this title.
2002 [(e)] (f) "Internal review" means the process an insurer uses to review an insured's
2003 adverse benefit determination before the adverse benefit determination is submitted for
2004 independent review.
2005 (2) This section applies generally to health insurance policies, health maintenance
2006 organization contracts, and income replacement or disability income policies.
2007 (3) (a) An insured may submit an adverse benefit determination to the insurer.
2008 (b) The insurer shall conduct an internal review of the insured's adverse benefit
2009 determination.
2010 (c) An insured who disagrees with the results of an internal review may submit the
2011 adverse benefit determination for an independent review if the adverse benefit determination

2012 involves:
2013 (i) payment of a claim regarding medical necessity; or
2014 (ii) denial of a claim regarding medical necessity.
2015 (4) [Before October 1, 2000, the] The commissioner shall adopt rules that establish
2016 minimum standards for:
2017 (a) internal reviews;
2018 (b) independent reviews to ensure independence and impartiality;
2019 (c) the types of adverse benefit determinations that may be submitted to an independent
2020 review; and
2021 (d) the timing of the review process, including an expedited review when medically
2022 necessary.
2023 (5) Nothing in this section may be construed as:
2024 (a) expanding, extending, or modifying the terms of a policy or contract with respect to
2025 benefits or coverage;
2026 (b) permitting an insurer to charge an insured for the internal review of an adverse
2027 benefit determination;
2028 (c) restricting the use of arbitration in connection with or subsequent to an independent
2029 review; or
2030 (d) altering the legal rights of any party to seek court or other redress in connection
2031 with:
2032 (i) an adverse decision resulting from an independent review, except that if the insurer
2033 is the party seeking legal redress, the insurer shall pay for the reasonable [attorneys'] attorney
2034 fees of the insured related to the action and court costs; or
2035 (ii) an adverse benefit determination or other claim that is not eligible for submission
2036 to independent review.
2037 (6) (a) An independent review organization in relation to the insurer may not be:
2038 (i) the insurer;
2039 (ii) the health plan;
2040 (iii) the health plan's fiduciary;
2041 (iv) the employer; or
2042 (v) an employee or agent of any one listed in Subsections (6)(a)(i) through (iv).

2043 (b) An independent review organization may not have a material professional, familial,
2044 or financial conflict of interest with:
2045 (i) the health plan;
2046 (ii) an officer, director, or management employee of the health plan;
2047 (iii) the enrollee;
2048 (iv) the enrollee's health care provider;
2049 (v) the health care provider's medical group or independent practice association;
2050 (vi) a health care facility where service would be provided; or
2051 (vii) the developer or manufacturer of the service that would be provided.
2052 Section 11. Section 31A-22-701 is amended to read:
2053 31A-22-701. Title -- Definitions -- Groups eligible for group or blanket insurance.
2054 (1) A group or blanket accident and health insurance policy may be issued to:
2055 (a) any group:
2056 (i) to which a group life insurance policy may be issued under Sections 31A-22-502
2057 through 31A-22-507 ; and
2058 (ii) that is formed for a reason other than the purchase of insurance; or
2059 (b) [a] any group specifically authorized by the commissioner under Section
2060 31A-22-509 , upon a finding that:
2061 (i) authorization is not contrary to the public interest;
2062 (ii) the proposed group is actuarially sound;
2063 (iii) formation of the proposed group may result in economies of scale in
2064 administrative, marketing, and brokerage costs; [and]
2065 (iv) the health insurance policy, certificate, or other indicia of coverage that will be
2066 offered to the proposed group is substantially equivalent to policies that are otherwise available
2067 to similar groups[.]; and
2068 [(2) Blanket policies]
2069 (v) the proposed group is formed for a reason other than the purchase of insurance.
2070 (2) A blanket policy may also be issued to:
2071 (a) any common carrier or any operator, owner, or lessee of a means of transportation,
2072 as policyholder, covering persons who may become passengers as defined by reference to their
2073 travel status;

2074 (b) an employer, as policyholder, covering any group of employees, dependents, or
2075 guests, as defined by reference to specified hazards incident to any activities of the
2076 policyholder;
2077 (c) an institution of learning, including a school district, school jurisdictional units, or
2078 the head, principal, or governing board of any of those units, as policyholder, covering
2079 students, teachers, or employees;
2080 (d) any religious, charitable, recreational, educational, or civic organization, or branch
2081 of those organizations, as policyholder, covering any group of members or participants as
2082 defined by reference to specified hazards incident to the activities sponsored or supervised by
2083 the policyholder;
2084 (e) a sports team, camp, or sponsor of the team or camp, as policyholder, covering
2085 members, campers, employees, officials, or supervisors;
2086 (f) any volunteer fire department, first aid, civil defense, or other similar volunteer
2087 organization, as policyholder, covering any group of members or participants as defined by
2088 reference to specified hazards incident to activities sponsored, supervised, or participated in by
2089 the policyholder;
2090 (g) a newspaper or other publisher, as policyholder, covering its carriers;
2091 (h) an association, including a labor union, which has a constitution and bylaws and
2092 which has been organized in good faith for purposes other than that of obtaining insurance, as
2093 policyholder, covering any group of members or participants as defined by reference to
2094 specified hazards incident to the activities or operations sponsored or supervised by the
2095 policyholder;
2096 (i) a health insurance purchasing association, as defined in Section 31A-34-103 ,
2097 organized and controlled solely by participating employers [as defined in Section 31A-34-103 ];
2098 and
2099 (j) any other class of risks which, in the judgment of the commissioner, may be
2100 properly eligible for blanket accident and health insurance.
2101 (3) The judgment of the commissioner may be exercised on the basis of:
2102 (a) individual risks;
2103 (b) class of risks; or
2104 (c) both Subsections (3)(a) and (b).

2105 Section 12. Section 31A-23a-104 is amended to read:
2106 31A-23a-104. Application for individual license -- Application for agency license.
2107 (1) [Subject to Subsection (2), an application for] This section applies to an initial or
2108 renewal [individual] license as a:
2109 (a) producer[,];
2110 (b) limited line producer[,];
2111 (c) customer service representative[,];
2112 (d) consultant[,];
2113 (e) managing general agent[,]; or
2114 (f) reinsurance intermediary.
2115 (2) (a) Subject to Subsection (2)(b), an initial or renewal individual license shall be:
2116 [(a)] (i) made to the commissioner on forms and in a manner the commissioner
2117 prescribes; and
2118 [(b)] (ii) accompanied by a license fee that is not refunded if the application:
2119 [(i)] (A) is denied; or
2120 [(ii)] (B) if incomplete, is never completed by the applicant.
2121 [(2)] (b) An application described in this Subsection [(1)] (2) shall provide:
2122 [(a)] (i) information about the applicant's identity;
2123 [(b)] (ii) the applicant's Social Security number;
2124 [(c)] (iii) the applicant's personal history, experience, education, and business record;
2125 [(d)] (iv) whether the applicant is 18 years of age or older;
2126 [(e)] (v) whether the applicant has committed an act that is a ground for denial,
2127 suspension, or revocation as set forth in Section 31A-23a-105 or 31A-23a-111 ; and
2128 [(f)] (vi) any other information the commissioner reasonably requires.
2129 (3) The commissioner may require any documents reasonably necessary to verify the
2130 information contained in an application filed under this section.
2131 (4) [The following information] An applicant's Social Security number contained in an
2132 application filed under this section is a private record under [Title 63, Chapter 2, Government
2133 Records Access and Management Act:] Section 63-2-302 .
2134 [(a) an applicant's Social Security number; or]
2135 [(b) an applicant's federal employer identification number.]

2136 (5) (a) Subject to Subsection (5)(b), an application for an initial or renewal agency
2137 license [as a producer, limited line producer, customer service representative, consultant,
2138 managing general agent, or reinsurance intermediary] shall be:
2139 (i) made to the commissioner on forms and in a manner the commissioner prescribes;
2140 and
2141 (ii) accompanied by a license fee that is not refunded if the application:
2142 (A) is denied; or
2143 (B) if incomplete, is never completed by the applicant.
2144 (b) An application described in Subsection (5)(a) shall provide:
2145 (i) information about the applicant's identity;
2146 (ii) the applicant's federal employer identification number;
2147 (iii) the designated responsible licensed producer;
2148 (iv) the identity of all owners, partners, officers, and directors;
2149 (v) whether the applicant has committed an act that is a ground for denial, suspension,
2150 or revocation as set forth in Section 31A-23a-105 or 31A-23a-111 ; and
2151 (vi) any other information the commissioner reasonably requires.
2152 Section 13. Section 31A-23a-105 is amended to read:
2153 31A-23a-105. General requirements for individual and agency license issuance
2154 and renewal.
2155 (1) The commissioner shall issue or renew a license to act as a producer, limited line
2156 producer, customer service representative, consultant, managing general agent, or reinsurance
2157 intermediary to any person who, as to the license type and line of authority classification
2158 applied for under Section 31A-23a-106 :
2159 (a) has satisfied the application requirements under Section 31A-23a-104 ;
2160 (b) has satisfied the character requirements under Section 31A-23a-107 ;
2161 (c) has satisfied any applicable continuing education requirements under Section
2162 31A-23a-202 ;
2163 (d) has satisfied any applicable examination requirements under Section 31A-23a-108 ;
2164 (e) has satisfied any applicable training period requirements under Section
2165 31A-23a-203 ;
2166 (f) if a nonresident:

2167 (i) has complied with Section 31A-23a-109 ; and
2168 (ii) holds an active similar license in that person's state of residence;
2169 (g) if an applicant for a title insurance producer license, has satisfied the requirements
2170 of Sections 31A-23a-203 and 31A-23a-204 ;
2171 (h) if an applicant for a license to act as a viatical settlement provider or viatical
2172 settlement producer [of viatical settlements], has satisfied the requirements of Section
2173 31A-23a-117 ; and
2174 (i) has paid the applicable fees under Section 31A-3-103 .
2175 (2) (a) This Subsection (2) applies to the following persons:
2176 (i) an applicant for a pending:
2177 (A) individual or agency producer license;
2178 (B) limited line producer license;
2179 (C) customer service representative license;
2180 (D) consultant license;
2181 (E) managing general agent license; or
2182 (F) reinsurance intermediary license; or
2183 (ii) a licensed:
2184 (A) individual or agency producer;
2185 (B) limited line producer;
2186 (C) customer service representative;
2187 (D) consultant;
2188 (E) managing general agent; or
2189 (F) reinsurance intermediary.
2190 (b) A person described in Subsection (2)(a) shall report to the commissioner:
2191 (i) any administrative action taken against the person:
2192 (A) in another jurisdiction; or
2193 (B) by another regulatory agency in this state; and
2194 (ii) any criminal prosecution taken against the person in any jurisdiction.
2195 (c) The report required by Subsection (2)(b) shall:
2196 (i) be filed:
2197 (A) at the time the person files the application for an individual or agency license; and

2198 (B) for an action or prosecution that occurs on or after the day on which the person
2199 files the application:
2200 (I) for an administrative action, within 30 days of the final disposition of the
2201 administrative action; or
2202 (II) for a criminal prosecution, within 30 days of the initial pretrial hearing date; and
2203 (ii) include a copy of the complaint or other relevant legal documents related to the
2204 action or prosecution described in Subsection (2)(b).
2205 (3) (a) The department may request:
2206 (i) criminal background information maintained pursuant to Title 53, Chapter 10, Part
2207 2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
2208 (ii) complete Federal Bureau of Investigation criminal background checks through the
2209 national criminal history system.
2210 (b) Information obtained by the department from the review of criminal history records
2211 received under Subsection (3)(a) shall be used by the department for the purposes of:
2212 (i) determining if a person satisfies the character requirements under Section
2213 31A-23a-107 for issuance or renewal of a license;
2214 (ii) determining if a person has failed to maintain the character requirements under
2215 Section 31A-23a-107 ; and
2216 (iii) preventing persons who violate the federal Violent Crime Control and Law
2217 Enforcement Act of 1994, 18 U.S.C. Secs. 1033 and 1034, from engaging in the business of
2218 insurance in the state.
2219 (c) If the department requests the criminal background information, the department
2220 shall:
2221 (i) pay to the Department of Public Safety the costs incurred by the Department of
2222 Public Safety in providing the department criminal background information under Subsection
2223 (3)(a)(i);
2224 (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
2225 of Investigation in providing the department criminal background information under
2226 Subsection (3)(a)(ii); and
2227 (iii) charge the person applying for a license or for renewal of a license a fee equal to
2228 the aggregate of Subsections (3)(c)(i) and (ii).

2229 (4) To become a resident licensee in accordance with Section 31A-23a-104 and this
2230 section, a person licensed as one of the following in another state who moves to this state shall
2231 apply within 90 days of establishing legal residence in this state:
2232 (a) insurance producer;
2233 (b) limited line producer;
2234 (c) customer service representative;
2235 (d) consultant;
2236 (e) managing general agent; or
2237 (f) reinsurance intermediary.
2238 (5) Notwithstanding the other provisions of this section, the commissioner may:
2239 (a) issue a license to an applicant for a license for a title insurance line of authority only
2240 with the concurrence of the Title and Escrow Commission; and
2241 (b) renew a license for a title insurance line of authority only with the concurrence of
2242 the Title and Escrow Commission.
2243 Section 14. Section 31A-23a-117 is amended to read:
2244 31A-23a-117. Special requirements for viatical settlement providers and
2245 producers.
2246 (1) A viatical settlement provider or viatical settlement producer [of viatical
2247 settlements] shall be licensed in accordance with this title, with the additional requirements
2248 listed in this section.
2249 (2) A viatical settlement provider [of viatical settlements] shall provide to the
2250 commissioner:
2251 (a) a detailed plan of operation with the viatical settlement provider's:
2252 (i) initial license application; and
2253 (ii) renewal application;
2254 (b) a copy of the viatical settlement provider's most current audited financial statement;
2255 and
2256 (c) an antifraud plan that meets the requirements of Section 31A-36-117 .
2257 (3) A viatical settlement provider [or producer of viatical settlements] shall provide
2258 with the viatical settlement provider's [or producer's] initial license application information
2259 describing the viatical settlement provider's [or producer's] viatical settlement experience,

2260 training, and education.
2261 (4) A viatical settlement provider [or producer of viatical settlements] shall provide to
2262 the commissioner, within 30 days after a change occurs, new or revised information concerning
2263 any of the following:
2264 (a) officers;
2265 (b) holders of more than 10% of its stock;
2266 (c) partners;
2267 (d) directors;
2268 (e) members; and
2269 (f) designated employees.
2270 Section 15. Section 31A-23a-204 is amended to read:
2271 31A-23a-204. Special requirements for title insurance producers and agencies.
2272 Title insurance producers, including agencies, shall be licensed in accordance with this
2273 chapter, with the additional requirements listed in this section.
2274 (1) (a) A person that receives a new license under this title on or after July 1, 2007 as a
2275 title insurance agency, shall at the time of licensure be owned or managed by one or more
2276 natural persons who are licensed with the following lines of authority for at least three of the
2277 five years immediately proceeding the date on which the title insurance agency applies for a
2278 license:
2279 (i) both a:
2280 (A) search line of authority; and
2281 (B) escrow line of authority; or
2282 (ii) a search and escrow line of authority.
2283 (b) A title insurance agency subject to Subsection (1)(a) may comply with Subsection
2284 (1)(a) by having the title insurance agency owned or managed by:
2285 (i) one or more natural persons who are licensed with the search line of authority for
2286 the time period provided in Subsection (1)(a); and
2287 (ii) one or more natural persons who are licensed with the escrow line of authority for
2288 the time period provided in Subsection (1)(a).
2289 (c) The Title and Escrow Commission may by rule made in accordance with Title 63,
2290 Chapter 46a, Utah Administrative Rulemaking Act, exempt an attorney with real estate

2291 experience from the experience requirements in Subsection (1)(a).
2292 (2) (a) Every title insurance agency or producer appointed by an insurer shall maintain:
2293 (i) a fidelity bond;
2294 (ii) a professional liability insurance policy; or
2295 (iii) a financial protection:
2296 (A) equivalent to that described in Subsection (2)(a)(i) or (ii); and
2297 (B) that the commissioner considers adequate.
2298 (b) The bond [or], insurance, or financial protection required by this Subsection (2):
2299 (i) shall be supplied under a contract approved by the commissioner to provide
2300 protection against the improper performance of any service in conjunction with the issuance of
2301 a contract or policy of title insurance; and
2302 (ii) be in a face amount no less than $50,000.
2303 (c) The Title and Escrow Commission may by rule made in accordance with Title 63,
2304 Chapter 46a, Utah Administrative Rulemaking Act, exempt title insurance producers from the
2305 requirements of this Subsection (2) upon a finding that, and only so long as, the required policy
2306 or bond is generally unavailable at reasonable rates.
2307 (3) (a) (i) Every title insurance agency or producer appointed by an insurer shall
2308 maintain a reserve fund.
2309 (ii) The reserve fund required by this Subsection (3) shall be:
2310 (A) (I) composed of assets approved by the commissioner and the Title and Escrow
2311 Commission;
2312 (II) maintained as a separate trust account; and
2313 (III) charged as a reserve liability of the title insurance producer in determining the
2314 producer's financial condition; and
2315 (B) accumulated by segregating 1% of all gross income received from the title
2316 insurance business.
2317 (iii) The reserve fund shall contain the accumulated assets for the immediately
2318 preceding ten years as defined in Subsection (3)(a)(ii).
2319 (iv) That portion of the assets held in the reserve fund over ten years may be:
2320 (A) withdrawn from the reserve fund; and
2321 (B) restored to the income of the title insurance producer.

2322 (v) The title insurance producer may withdraw interest from the reserve fund related to
2323 the principal amount as it accrues.
2324 (b) (i) A disbursement may not be made from the reserve fund except as provided in
2325 Subsection (3)(a) unless the title insurance producer ceases doing business as a result of:
2326 (A) sale of assets;
2327 (B) merger of the producer with another producer;
2328 (C) termination of the producer's license;
2329 (D) insolvency; or
2330 (E) any cessation of business by the producer.
2331 (ii) Any disbursements from the reserve fund may be made only to settle claims arising
2332 from the improper performance of the title insurance producer in providing services defined in
2333 Section 31A-23a-406 .
2334 (iii) The commissioner shall be notified ten days before any disbursements from the
2335 reserve fund.
2336 (iv) The notice required by this Subsection (3)(b) shall contain:
2337 (A) the amount of claim;
2338 (B) the nature of the claim; and
2339 (C) the name of the payee.
2340 (c) (i) The reserve fund shall be maintained by the title insurance producer or the title
2341 insurance producer's representative for a period of two years after the day on which the title
2342 insurance producer ceases doing business.
2343 (ii) Any assets remaining in the reserve fund at the end of the two years specified in
2344 Subsection (3)(c)(i) may be withdrawn and restored to the former title insurance producer.
2345 (4) Any examination for licensure shall include questions regarding the search and
2346 examination of title to real property.
2347 (5) A title insurance producer may not perform the functions of escrow unless the title
2348 insurance producer has been examined on the fiduciary duties and procedures involved in those
2349 functions.
2350 (6) The Title and Escrow Commission shall adopt rules, in accordance with Title 63,
2351 Chapter 46a, Utah Administrative Rulemaking Act, after consulting with the department and
2352 the department's test administrator, establishing an examination for a license that will satisfy

2353 this section.
2354 (7) A license may be issued to a title insurance producer who has qualified:
2355 (a) to perform only searches and examinations of title as specified in Subsection (4);
2356 (b) to handle only escrow arrangements as specified in Subsection (5); or
2357 (c) to act as a title marketing representative.
2358 (8) (a) A person licensed to practice law in Utah is exempt from the requirements of
2359 Subsections (2) and (3) if that person issues 12 or less policies in any 12-month period.
2360 (b) In determining the number of policies issued by a person licensed to practice law in
2361 Utah for purposes of Subsection (8)(a), if the person licensed to practice law in Utah issues a
2362 policy to more than one party to the same closing, the person is considered to have issued only
2363 one policy.
2364 (9) A person licensed to practice law in Utah, whether exempt under Subsection (8) or
2365 not, shall maintain a trust account separate from a law firm trust account for all title and real
2366 estate escrow transactions.
2367 Section 16. Section 31A-23a-401 is amended to read:
2368 31A-23a-401. Disclosure of conflicting interests.
2369 (1) (a) Except as provided under Subsection (1)(b)[, no]:
2370 (i) a licensee under this chapter may not act in the same or any directly related
2371 transaction as:
2372 (A) a producer for the insured; or
2373 (B) a consultant and producer for the insurer; [nor may] and
2374 (ii) a producer for the insured or consultant may not recommend or encourage the
2375 purchase of insurance from or through an insurer or other producer:
2376 (A) of which the producer for the insured or consultant or producer for the insured's or
2377 consultant's spouse is an owner, executive, or employee; or
2378 (B) to which [he] the producer for the insured or consultant has the type of relation that
2379 a material benefit would accrue to the producer for the insured or consultant or spouse as a
2380 result of the purchase.
2381 (b) Subsection (1)(a) does not apply if the following three conditions are met:
2382 (i) Prior to performing the consulting services, the producer for the insured or
2383 consultant [discloses] shall disclose to the client, prominently, in writing[,]:

2384 (A) the producer for the insured's or consultant's interest as a producer for the insurer,
2385 or the relationship to an insurer or other producer[,]; and
2386 (B) that as a result of those interests the producer's for the insured or the consultant's
2387 recommendations should be given appropriate scrutiny.
2388 (ii) The producer for the insured's or consultant's fee [is] shall be agreed upon, in
2389 writing, after the disclosure required under Subsection (1)(b)(i), but [prior to] before
2390 performing the requested services.
2391 (iii) Any report resulting from requested services [contains] shall contain a copy of the
2392 disclosure made under Subsection (1)(b)(i).
2393 (2) [No] A licensee under this chapter may not act as to the same client as both a
2394 producer for the insurer and a producer for the insured without the client's prior written consent
2395 based on full disclosure.
2396 (3) Whenever a person applies for insurance coverage through a producer for the
2397 insured, the producer for the insured shall disclose to the applicant, in writing, that the producer
2398 for the insured is not the producer for the insurer [of] or the potential insurer. This disclosure
2399 shall also inform the applicant that the applicant likely does not have the benefit of an insurer
2400 being financially responsible for the conduct of the producer for the [insured's conduct]
2401 insured.
2402 Section 17. Section 31A-23a-402 is amended to read:
2403 31A-23a-402. Unfair marketing practices -- Communication -- Inducement --
2404 Unfair discrimination -- Coercion or intimidation -- Restriction on choice.
2405 (1) (a) (i) Any of the following may not make or cause to be made any communication
2406 that contains false or misleading information, relating to an insurance product or contract, any
2407 insurer, or any licensee under this title, including information that is false or misleading
2408 because it is incomplete:
2409 (A) a person who is or should be licensed under this title;
2410 (B) an employee or producer of a person described in Subsection (1)(a)(i)(A);
2411 (C) a person whose primary interest is as a competitor of a person licensed under this
2412 title; and
2413 (D) a person on behalf of any of the persons listed in this Subsection (1)(a)(i).
2414 (ii) As used in this Subsection (1), "false or misleading information" includes:

2415 (A) assuring the nonobligatory payment of future dividends or refunds of unused
2416 premiums in any specific or approximate amounts, but reporting fully and accurately past
2417 experience is not false or misleading information; and
2418 (B) with intent to deceive a person examining it:
2419 (I) filing a report;
2420 (II) making a false entry in a record; or
2421 (III) wilfully refraining from making a proper entry in a record.
2422 (iii) A licensee under this title may not:
2423 (A) use any business name, slogan, emblem, or related device that is misleading or
2424 likely to cause the insurer or other licensee to be mistaken for another insurer or other licensee
2425 already in business; or
2426 (B) use any advertisement or other insurance promotional material that would cause a
2427 reasonable person to mistakenly believe that a state or federal government agency:
2428 (I) is responsible for the insurance sales activities of the person;
2429 (II) stands behind the credit of the person;
2430 (III) guarantees any returns on insurance products of or sold by the person; or
2431 (IV) is a source of payment of any insurance obligation of or sold by the person.
2432 (iv) A person who is not an insurer may not assume or use any name that deceptively
2433 implies or suggests that person is an insurer.
2434 (v) A person other than persons licensed as health maintenance organizations under
2435 Chapter 8 may not use the term "Health Maintenance Organization" or "HMO" in referring to
2436 itself.
2437 (b) A licensee's violation creates a rebuttable presumption that the violation was also
2438 committed by the insurer if:
2439 (i) the licensee under this title distributes cards or documents, exhibits a sign, or
2440 publishes an advertisement that violates Subsection (1)(a), with reference to a particular
2441 insurer:
2442 (A) that the licensee represents; or
2443 (B) for whom the licensee processes claims; and
2444 (ii) the cards, documents, signs, or advertisements are supplied or approved by that
2445 insurer.

2446 (2) (a) (i) A licensee under this title, or an officer or employee of a licensee may not
2447 induce any person to enter into or continue an insurance contract or to terminate an existing
2448 insurance contract by offering benefits not specified in the policy to be issued or continued,
2449 including premium or commission rebates.
2450 (ii) An insurer may not make or knowingly allow any agreement of insurance that is
2451 not clearly expressed in the policy to be issued or renewed.
2452 (iii) This Subsection (2)(a) does not preclude:
2453 (A) [insurers] an insurer from reducing premiums because of expense savings;
2454 (B) an insurer from providing to a policyholder or insured one or more incentives to
2455 participate in programs or activities designed to reduce claims or claim expenses;
2456 [(B)] (C) the usual kinds of social courtesies not related to particular transactions; or
2457 [(C)] (D) an insurer from receiving premiums under an installment payment plan.
2458 (iv) The commissioner may adopt rules in accordance with Title 63, Chapter 46a, Utah
2459 Administrative Rulemaking Act, to define what constitutes an incentive described in
2460 Subsection (2)(a)(iii)(B).
2461 (b) A licensee under this title may not absorb the tax under Section 31A-3-301 .
2462 (c) (i) A title insurer or producer or any officer or employee of either may not pay,
2463 allow, give, or offer to pay, allow, or give, directly or indirectly, as an inducement to obtaining
2464 any title insurance business:
2465 (A) any rebate, reduction, or abatement of any rate or charge made incident to the
2466 issuance of the title insurance;
2467 (B) any special favor or advantage not generally available to others; or
2468 (C) any money or other consideration or material inducement.
2469 (ii) "Charge made incident to the issuance of the title insurance" includes escrow
2470 charges, and any other services that are prescribed in rule by the Title and Escrow Commission
2471 after consultation with the commissioner.
2472 (iii) An insured or any other person connected, directly or indirectly, with the
2473 transaction, including a mortgage lender, real estate broker, builder, attorney, or any officer,
2474 employee, or agent of any of them, may not knowingly receive or accept, directly or indirectly,
2475 any benefit referred to in Subsection (2)(c)(i).
2476 (3) (a) An insurer may not unfairly discriminate among policyholders by charging

2477 different premiums or by offering different terms of coverage, except on the basis of
2478 classifications related to the nature and the degree of the risk covered or the expenses involved.
2479 (b) Rates are not unfairly discriminatory if they are averaged broadly among persons
2480 insured under a group, blanket, or franchise policy, and the terms of those policies are not
2481 unfairly discriminatory merely because they are more favorable than in similar individual
2482 policies.
2483 (4) (a) This Subsection (4) applies to:
2484 (i) a person who is or should be licensed under this title;
2485 (ii) an employee of that licensee or person who should be licensed;
2486 (iii) a person whose primary interest is as a competitor of a person licensed under this
2487 title; and
2488 (iv) one acting on behalf of any person described in Subsections (4)(a)(i) through (iii).
2489 (b) A person described in Subsection (4)(a) may not commit or enter into any
2490 agreement to participate in any act of boycott, coercion, or intimidation that:
2491 (i) tends to produce:
2492 (A) an unreasonable restraint of the business of insurance; or
2493 (B) a monopoly in that business; or
2494 (ii) results in an applicant purchasing or replacing an insurance contract.
2495 (5) (a) (i) Subject to Subsection (5)(a)(ii), a person may not restrict in the choice of an
2496 insurer or licensee under this chapter, another person who is required to pay for insurance as a
2497 condition for the conclusion of a contract or other transaction or for the exercise of any right
2498 under a contract.
2499 (ii) A person requiring coverage may reserve the right to disapprove the insurer or the
2500 coverage selected on reasonable grounds.
2501 (b) The form of corporate organization of an insurer authorized to do business in this
2502 state is not a reasonable ground for disapproval, and the commissioner may by rule specify
2503 additional grounds that are not reasonable. This Subsection (5) does not bar an insurer from
2504 declining an application for insurance.
2505 (6) A person may not make any charge other than insurance premiums and premium
2506 financing charges for the protection of property or of a security interest in property, as a
2507 condition for obtaining, renewing, or continuing the financing of a purchase of the property or

2508 the lending of money on the security of an interest in the property.
2509 (7) (a) A licensee under this title may not refuse or fail to return promptly all indicia of
2510 agency to the principal on demand.
2511 (b) A licensee whose license is suspended, limited, or revoked under Section
2512 31A-2-308 , 31A-23a-111 , or 31A-23a-112 may not refuse or fail to return the license to the
2513 commissioner on demand.
2514 (8) (a) A person may not engage in any other unfair method of competition or any other
2515 unfair or deceptive act or practice in the business of insurance, as defined by the commissioner
2516 by rule, after a finding that they:
2517 (i) are misleading;
2518 (ii) are deceptive;
2519 (iii) are unfairly discriminatory;
2520 (iv) provide an unfair inducement; or
2521 (v) unreasonably restrain competition.
2522 (b) Notwithstanding Subsection (8)(a), for purpose of the title insurance industry, the
2523 Title and Escrow Commission shall make rules, in accordance with Title 63, Chapter 46a, Utah
2524 Administrative Rulemaking Act, that define any other unfair method of competition or any
2525 other unfair or deceptive act or practice after a finding that they:
2526 (i) are misleading;
2527 (ii) are deceptive;
2528 (iii) are unfairly discriminatory;
2529 (iv) provide an unfair inducement; or
2530 (v) unreasonably restrain competition.
2531 Section 18. Section 31A-23a-504 is amended to read:
2532 31A-23a-504. Sharing commissions.
2533 (1) (a) Except as provided in Subsection 31A-15-103 (3), a licensee under this chapter
2534 or an insurer may only pay consideration or reimburse out-of-pocket expenses to a person if the
2535 licensee knows that the person is licensed under this chapter as to the particular type of
2536 insurance to act in Utah as:
2537 (i) a producer[,];
2538 (ii) a limited line producer[,];

2539 (iii) a customer service representative[,];
2540 (iv) a consultant[,];
2541 (v) a managing general agent[,]; or
2542 (vi) a reinsurance intermediary [in Utah as to the particular type of insurance].
2543 (b) A person may only accept commission compensation or other compensation as [a
2544 producer, limited line producer, customer service representative, consultant, managing general
2545 agent, or reinsurance intermediary] a person described in Subsections (1)(a)(i) through (vi) that
2546 is directly or indirectly the result of any insurance transaction if that person is licensed under
2547 this chapter to act [as a producer, limited line producer, customer service representative,
2548 consultant, managing general agent, or reinsurance intermediary as to the particular type of
2549 insurance] as described in Subsection (1)(a).
2550 (2) (a) Except as provided in Section 31A-23a-501 , a consultant may not pay or receive
2551 any commission or other compensation that is directly or indirectly the result of any insurance
2552 transaction.
2553 (b) A consultant may share a consultant fee or other compensation received for
2554 consulting services performed within Utah only:
2555 (i) with another consultant licensed under this chapter[,]; and [only]
2556 (ii) to the extent that the other consultant contributed to the services performed.
2557 (3) This section does not prohibit the payment of renewal commissions to former
2558 licensees under this chapter, former Title 31, Chapter 17, or their successors in interest under a
2559 deferred compensation or agency sales agreement.
2560 (4) This section does not prohibit compensation paid to or received by a person for
2561 referral of a potential customer that seeks to purchase or obtain an opinion or advice on an
2562 insurance product if:
2563 (a) the person is not licensed to sell insurance;
2564 (b) the person [sells or provides] does not sell or provide opinions or advice on the
2565 product; and
2566 (c) the compensation does not depend on whether the referral results in a purchase or
2567 sale.
2568 (5) (a) In selling [any] a policy of title insurance, [no] sharing of commissions under
2569 Subsection (1) may not occur if it will result in:

2570 (i) an unlawful rebate[, or];
2571 (ii) in compensation in connection with controlled business[,]; or
2572 (iii) in payment of a forwarding fee or finder's fee.
2573 (b) A person may share compensation for the issuance of a title insurance policy only
2574 to the extent that [he] the person contributed to the search and examination of the title or other
2575 services connected with [it] the title insurance policy.
2576 (6) This section does not apply to bail bond producers or bail enforcement agents as
2577 defined in Section 31A-35-102 .
2578 Section 19. Section 31A-25-202 is amended to read:
2579 31A-25-202. Application for license.
2580 (1) (a) An application for a license as a third party administrator shall be:
2581 (i) made to the commissioner on forms and in a manner the commissioner prescribes;
2582 and
2583 (ii) accompanied by the applicable fee, which is not refundable if the application is
2584 denied.
2585 (b) The application for a license as a third party administrator shall:
2586 (i) state the applicant's:
2587 (A) Social Security number; or
2588 (B) federal employer identification number;
2589 (ii) provide information about:
2590 (A) the applicant's identity;
2591 (B) the applicant's personal history, experience, education, and business record;
2592 (C) if the applicant is a natural person, whether the applicant is 18 years of age or
2593 older; and
2594 (D) whether the applicant has committed an act that is a ground for denial, suspension,
2595 or revocation as set forth in Section 31A-25-208 ; and
2596 (iii) any other information as the commissioner reasonably requires.
2597 (2) The commissioner may require documents reasonably necessary to verify the
2598 information contained in the application.
2599 [(3) The following are private records under Subsection 63-2-302 (1)(h):]
2600 [(a) an applicant's Social Security number; and]

2601 [(b) an applicant's federal employer identification number.]
2602 (3) An applicant's Social Security number contained in an application filed under this
2603 section is a private record under Section 63-2-302 .
2604 Section 20. Section 31A-26-202 is amended to read:
2605 31A-26-202. Application for license.
2606 (1) (a) The application for a license as an independent adjuster or public adjuster shall
2607 be:
2608 (i) made to the commissioner on forms and in a manner the commissioner prescribes;
2609 and
2610 (ii) accompanied by the applicable fee, which is not refunded if the application is
2611 denied.
2612 (b) The application shall provide:
2613 (i) information about the applicant's identity, including:
2614 (A) the applicant's:
2615 (I) Social Security number; or
2616 (II) federal employer identification number;
2617 (B) the applicant's personal history, experience, education, and business record;
2618 (C) if the applicant is a natural person, whether the applicant is 18 years of age or
2619 older; and
2620 (D) whether the applicant has committed an act that is a ground for denial, suspension,
2621 or revocation as set forth in Section 31A-25-208 ; and
2622 (ii) any other information as the commissioner reasonably requires.
2623 (2) The commissioner may require documents reasonably necessary to verify the
2624 information contained in the application.
2625 (3) [The following information] An applicant's Social Security number contained in an
2626 application filed under this section is a private record under [Title 63, Chapter 2, Government
2627 Records Access and Management Act:] Section 63-2-302 .
2628 [(a) an applicant's Social Security number; or]
2629 [(b) an applicant's federal employer identification number.]
2630 Section 21. Section 31A-26-301.6 is amended to read:
2631 31A-26-301.6. Health care provider claims practices.

2632 (1) As used in this section:
2633 (a) "Articulable reason" may include a determination regarding:
2634 (i) eligibility for coverage;
2635 (ii) preexisting conditions;
2636 (iii) applicability of other public or private insurance;
2637 (iv) medical necessity; and
2638 (v) any other reason that would justify an extension of the time to investigate a claim.
2639 (b) "Health care provider" means a person licensed to provide health care under:
2640 (i) Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act; or
2641 (ii) Title 58, Occupations and Professions.
2642 (c) "Insurer" means an admitted or authorized insurer, as defined in Section
2643 31A-1-301 , and includes:
2644 (i) a health maintenance organization; and
2645 (ii) a [third-party] third party administrator that is subject to this title, provided that
2646 nothing in this section may be construed as requiring a third party administrator to use its own
2647 funds to pay claims that have not been funded by the entity for which the third party
2648 administrator is paying claims.
2649 (d) "Provider" means a health care provider to whom an insurer is obligated to pay
2650 directly in connection with a claim by virtue of:
2651 (i) an agreement between the insurer and the provider;
2652 (ii) a health insurance policy or contract of the insurer; or
2653 (iii) state or federal law.
2654 (2) An insurer shall timely pay every valid insurance claim submitted by a provider in
2655 accordance with this section.
2656 (3) (a) [Within] Except as provided in Subsection (4), within 30 days of [receiving] the
2657 day on which the insurer receives a written claim, an insurer shall [do one of the following]:
2658 (i) pay the claim [unless Subsection (3)(a)(ii), (iii), (iv), or (v) applies]; or
2659 (ii) deny the claim and provide a written explanation [if the claim is denied;] for the
2660 denial.
2661 [(iii) specifically describe and request any additional information from the provider that
2662 is necessary to process the claim;]

2663 [(iv) inform the provider, pursuant to Subsection (4), of the 30-day extension of the
2664 insurer's investigation of the claim; or]
2665 [(v) request additional information and inform the provider of the 30-day extension if
2666 both Subsections (3)(a)(iii) and (iv) apply.]
2667 [(b) A provider shall respond to each request by an insurer for additional necessary
2668 information made under Subsection (3)(a)(iii) or (v) within 30 days of receipt of the request by
2669 providing the requested information that is in the possession of the provider, unless:]
2670 [(i) the provider has requested and received the permission of the insurer to extend the
2671 30-day period; or]
2672 [(ii) the provider explains to the insurer in writing that additional time, which may not
2673 exceed 30 days, is necessary to comply with the request for information.]
2674 [(c) Subsection (7) shall apply after an insurer has received the information requested.]
2675 [(4) The time to investigate a claim may be extended by the insurer for an additional
2676 30-days if:]
2677 [(a) the investigation of the claim cannot reasonably be completed within the initial
2678 30-day period of Subsection (3)(a);]
2679 [(b) before the end of the 30-day period in Subsection (3)(a), the insurer informs the
2680 provider in writing of the reason for the payment delay, the nature of the investigation, the
2681 timelines for investigations established in this section, and the anticipated completion date.]
2682 [(5) Notwithstanding Subsection (4), the time to investigate a claim may be extended
2683 beyond the initial 30-day period and the extended 30-day period if:]
2684 [(a) due to matters beyond the control of the insurer, the investigation cannot
2685 reasonably be completed within 60 days as to some part or all of the claim;]
2686 [(b) before the end of the combined 60-day period, the insurer makes a written request
2687 to the commissioner for an extension, including the reason for the delay, the nature of the
2688 investigation, the anticipated completion date, and the amount of any partial payment of the
2689 claim made pursuant to Subsection (5)(d);]
2690 [(c) before the end of the combined 60-day period, the commissioner informs the
2691 insurer that the request for an extension has been granted, based on a finding that:]
2692 [(i) there is a good faith and articulable reason to believe that the insurer is not
2693 obligated to pay some part or all of the claim; and]

2694 [(ii) the investigation cannot reasonably be completed within 60 days; and]
2695 [(d) the insurer identifies and pays all sums the insurer is obligated to pay on the claim
2696 and which are not subject to the extension requested under this Subsection (5).]
2697 [(6) An extension granted by the commissioner under Subsection (5)(c) shall include
2698 the completion date for the investigation.]
2699 (b) (i) Subject to Subsection (3)(b)(ii), the time period described in Subsection (3)(a)
2700 may be extended by 15 days if the insurer:
2701 (A) determines that the extension is necessary due to matters beyond the control of the
2702 insurer; and
2703 (B) before the end of the 30-day period described in Subsection (3)(a), notifies the
2704 provider and insured in writing of:
2705 (I) the circumstances requiring the extension of time; and
2706 (II) the date by which the insurer expects to pay the claim or deny the claim with a
2707 written explanation for the denial.
2708 (ii) If an extension is necessary due to a failure of the provider or insured to submit the
2709 information necessary to decide the claim:
2710 (A) the notice of extension required by this Subsection (3)(b) shall specifically describe
2711 the required information; and
2712 (B) the insurer shall give the provider or insured at least 45 days from the day on which
2713 the provider or insured receives the notice before the insurer denies the claim for failure to
2714 provide the information requested in Subsection (3)(b)(ii)(A).
2715 (4) (a) In the case of a claim for income replacement benefits, within 45 days of the day
2716 on which the insurer receives a written claim, an insurer shall:
2717 (i) pay the claim; or
2718 (ii) deny the claim and provide a written explanation of the denial.
2719 (b) Subject to Subsections (4)(d) and (e), the time period described in Subsection (4)(a)
2720 may be extended for 30 days if the insurer:
2721 (i) determines that the extension is necessary due to matters beyond the control of the
2722 insurer; and
2723 (ii) before the expiration of the 45-day period described in Subsection (4)(a), notifies
2724 the insured of:

2725 (A) the circumstances requiring the extension of time; and
2726 (B) the date by which the insurer expects to pay the claim or deny the claim with a
2727 written explanation for the denial.
2728 (c) Subject to Subsections (4)(d) and (e), the time period for complying with
2729 Subsection (4)(a) may be extended for up to an additional 30 days from the day on which the
2730 30-day extension period provided in Subsection (4)(b) ends if before the day on which the
2731 30-day extension period ends, the insurer:
2732 (i) determines that due to matters beyond the control of the insurer a decision cannot be
2733 rendered within the 30-day extension period; and
2734 (ii) notifies the insured of:
2735 (A) the circumstances requiring the extension; and
2736 (B) the date as of which the insurer expects to pay the claim or deny the claim with a
2737 written explanation for the denial.
2738 (d) A notice of extension under this Subsection (4) shall specifically explain:
2739 (i) the standards on which entitlement to a benefit is based; and
2740 (ii) the unresolved issues that prevent a decision on the claim.
2741 (e) If an extension allowed by Subsection (4)(b) or (c) is necessary due to a failure of
2742 the insured to submit the information necessary to decide the claim:
2743 (i) the notice of extension required by Subsection (4)(b) or (c) shall specifically
2744 describe the necessary information; and
2745 (ii) the insurer shall give the insured at least 45 days from the day on which the insured
2746 receives the notice before the insurer denies the claim for failure to provide the information
2747 requested in Subsection (4)(b) or (c).
2748 (5) If a period of time is extended as permitted under Subsection (3)(b), (4)(b), or
2749 (4)(c), due to an insured or provider failing to submit information necessary to decide a claim,
2750 the period for making the benefit determination shall be tolled from the date on which the
2751 notification of the extension is sent to the insured or provider until the date on which the
2752 insured or provider responds to the request for additional information.
2753 [(7) (a)] (6) An insurer shall pay all sums to the provider or insured that the insurer is
2754 obligated to pay on the claim, and provide a written explanation of the insurer's decision
2755 regarding any part of the claim that is denied within 20 days of[: (i)] receiving the information

2756 requested under Subsection (3)[(a)(iii);](b), (4)(b), or (4)(c).
2757 [(ii) completing an investigation under Subsection (4) or (5); or]
2758 [(iii) the latter of Subsection (3)(a)(iii) or (iv), if Subsection (3)(a)(v) applies.]
2759 [(b) (i) Except as provided in Subsection (7)(c), an insurer may send a follow-up
2760 request for additional information within the 20-day time period in Subsection (7)(a) if the
2761 previous response of the provider was not sufficient for the insurer to make a decision on the
2762 claim.]
2763 [(ii) A follow-up request for additional necessary information shall state with
2764 specificity:]
2765 [(A) the reason why the previous response was insufficient;]
2766 [(B) the information that is necessary to comply with the request for information; and]
2767 [(C) the reason why the requested information is necessary to process the claim.]
2768 [(c) Unless an insurer has an extension for an investigation pursuant to Subsection (4)
2769 or (5), the insurer shall pay all sums it is obligated to pay on a claim and provide a written
2770 explanation of any part of the claim that is denied within 20 days of receiving a notice from the
2771 provider that the provider has submitted all requested information in the provider's possession
2772 that is related to the claim.]
2773 [(8)] (7) (a) Whenever an insurer makes a payment to a provider on any part of a claim
2774 under this section, the insurer shall also send to the insured an explanation of benefits paid.
2775 (b) Whenever an insurer denies any part of a claim under this section, the insurer shall
2776 also send to the insured:
2777 (i) a written explanation of the part of the claim that was denied; and
2778 (ii) notice of the adverse benefit determination review process established under
2779 Section 31A-22-629 .
2780 (c) This Subsection [(8)] (7) does not apply to a person receiving benefits under the
2781 state Medicaid program as defined in Section 26-18-2 , unless required by the Department of
2782 Health or federal law.
2783 [(9)] (8) (a) Beginning with health care claims submitted on or after January 1, 2002, a
2784 late fee shall be imposed on:
2785 (i) an insurer that fails to timely pay a claim in accordance with this section; and
2786 (ii) a provider that fails to timely provide information on a claim in accordance with

2787 this section.
2788 (b) For the first 90 days that a claim payment or a provider response to a request for
2789 information is late, the late fee shall be determined by multiplying together:
2790 (i) the total amount of the claim;
2791 (ii) the total number of days the response or the payment is late; and
2792 (iii) .1%.
2793 (c) For a claim payment or a provider response to a request for information that is 91 or
2794 more days late, the late fee shall be determined by adding together:
2795 (i) the late fee for a 90-day period under Subsection [(9)] (8)(b); and
2796 (ii) the following multiplied together:
2797 (A) the total amount of the claim;
2798 (B) the total number of days the response or payment was late beyond the initial 90-day
2799 period; and
2800 (C) the rate of interest set in accordance with Section 15-1-1 .
2801 (d) Any late fee paid or collected under this section shall be separately identified on the
2802 documentation used by the insurer to pay the claim.
2803 (e) For purposes of this Subsection [(9)] (8), "late fee" does not include an amount that
2804 is less than $1.
2805 [(10)] (9) Each insurer shall establish a review process to resolve claims-related
2806 disputes between the insurer and providers.
2807 [(11) No] (10) An insurer or person representing an insurer may not engage in any
2808 unfair claim settlement practice with respect to a provider. Unfair claim settlement practices
2809 include:
2810 (a) knowingly misrepresenting a material fact or the contents of an insurance policy in
2811 connection with a claim;
2812 (b) failing to acknowledge and substantively respond within 15 days to any written
2813 communication from a provider relating to a pending claim;
2814 (c) denying or threatening to deny the payment of a claim for any reason that is not
2815 clearly described in the insured's policy;
2816 (d) failing to maintain a payment process sufficient to comply with this section;
2817 (e) failing to maintain claims documentation sufficient to demonstrate compliance with

2818 this section;
2819 (f) failing, upon request, to give to the provider written information regarding the
2820 specific rate and terms under which the provider will be paid for health care services;
2821 (g) failing to timely pay a valid claim in accordance with this section as a means of
2822 influencing, intimidating, retaliating, or gaining an advantage over the provider with respect to
2823 an unrelated claim, an undisputed part of a pending claim, or some other aspect of the
2824 contractual relationship;
2825 (h) failing to pay the sum when required and as required under Subsection [(9)] (8)
2826 when a violation has occurred;
2827 (i) threatening to retaliate or actual retaliation against a provider for [availing himself
2828 of the provisions of] the provider applying this section;
2829 (j) any material violation of this section; and
2830 (k) any other unfair claim settlement practice established in rule or law.
2831 [(12)] (11) (a) The provisions of this section shall apply to each contract between an
2832 insurer and a provider for the duration of the contract.
2833 (b) Notwithstanding Subsection [(12)] (11)(a), this section may not be the basis for a
2834 bad faith insurance claim.
2835 (c) Nothing in Subsection [(12)] (11)(a) may be construed as limiting the ability of an
2836 insurer and a provider from including provisions in their contract that are more stringent than
2837 the provisions of this section.
2838 [(13)] (12) (a) Pursuant to Chapter 2, Part 2, Duties and Powers of Commissioner, and
2839 beginning January 1, 2002, the commissioner may conduct examinations to determine an
2840 insurer's level of compliance with this section and impose sanctions for each violation.
2841 (b) The commissioner may adopt rules only as necessary to implement this section.
2842 (c) [After December 31, 2002, the] The commissioner may establish rules to facilitate
2843 the exchange of electronic confirmations when claims-related information has been received.
2844 (d) Notwithstanding [the provisions of] Subsection [(13)] (12)(b), the commissioner
2845 may not adopt rules regarding the review process required by Subsection [(10)] (9).
2846 [(14)] (13) Nothing in this section may be construed as limiting the collection rights of
2847 a provider under Section 31A-26-301.5 .
2848 [(15)] (14) Nothing in this section may be construed as limiting the ability of an insurer

2849 to:
2850 (a) recover any amount improperly paid to a provider or an insured:
2851 (i) in accordance with Section 31A-31-103 or any other provision of state or federal
2852 law;
2853 (ii) within 36 months for a coordination of benefits error; or
2854 (iii) within 18 months for any other reason not identified in Subsection [(15)] (14)(a)(i)
2855 or (ii);
2856 (b) take any action against a provider that is permitted under the terms of the provider
2857 contract and not prohibited by this section;
2858 (c) report the provider to a state or federal agency with regulatory authority over the
2859 provider for unprofessional, unlawful, or fraudulent conduct; or
2860 (d) enter into a mutual agreement with a provider to resolve alleged violations of this
2861 section through mediation or binding arbitration.
2862 Section 22. Section 31A-27-331 is amended to read:
2863 31A-27-331. Special provisions for third party claims.
2864 (1) This section does not apply to a claim that is or may be covered by one of the Utah
2865 insurance guaranty associations or a corresponding association or fund of another state.
2866 (2) Whenever any third party asserts a cause of action against an insured of an insurer
2867 which is in liquidation for which the insurance might indemnify the insured, the third party
2868 may file a claim with the liquidator.
2869 (3) Whether or not the third party files a claim, the insured may file a claim on [his] the
2870 insured's own behalf in the liquidation. An insured who fails to file a claim by the date for
2871 filing claims specified in the order of liquidation or within 60 days after mailing of the notice
2872 required by Subsection 31A-27-315 (1) (b), whichever is later, is an unexcused late filer.
2873 (4) (a) The liquidator shall make recommendations to the court under Section
2874 31A-27-336 for the allowance of an insured's claim under Subsection (3) after consideration of
2875 the probable outcome of any pending action against the insured on which the claim is based,
2876 the probable damages recoverable in the action, and the probable costs and expenses of
2877 defense.
2878 (b) After allowance of the claim by the court, the liquidator shall withhold any
2879 distributions payable on the claim, pending the outcome of the litigation and negotiation with

2880 the insured.
2881 (c) Whenever it seems appropriate, the liquidator may reconsider the claim on the basis
2882 of additional information and amend the recommendations to the court. The insured shall be
2883 afforded the same notice and opportunity to be heard on all changes in the recommendation as
2884 in its initial determination.
2885 (d) The court may amend [its] the court's allowance as it determines is appropriate.
2886 (e) (i) As claims against the insured are settled or barred, the insured shall be paid from
2887 the amount withheld the same percentage distribution as was paid on other claims of like
2888 priority, based on the lesser of:
2889 [(a)] (A) the amount actually recovered from the insured by the action or paid by the
2890 agreement, plus the reasonable costs and expenses of defense; and
2891 [(b)] (B) the amount allowed on the claims by the court.
2892 (ii) After all claims are settled or barred, any sum remaining from the amount withheld
2893 shall revert to the undistributed assets of the insurer. Delay in final payment under this
2894 subsection is not a reason for unreasonable delay of final distribution and discharge of the
2895 liquidator.
2896 (5) If several claims founded upon one policy are filed, whether by third parties or as
2897 claims by the insured under this section, and the aggregate allowed amount of the claims to
2898 which the same limit of liability in the policy is applicable exceeds that limit, each claim as
2899 allowed shall be reduced in the same proportion so that the total equals the policy limit.
2900 Claims by the insured are evaluated as in Subsection (4). If any insured's claim is subsequently
2901 reduced under Subsection (4), the amount thus freed shall be apportioned ratably among the
2902 claims which have been reduced under this Subsection (5).
2903 Section 23. Section 31A-30-103 is amended to read:
2904 31A-30-103. Definitions.
2905 As used in this chapter:
2906 (1) "Actuarial certification" means a written statement by a member of the American
2907 Academy of Actuaries or other individual approved by the commissioner that a covered carrier
2908 is in compliance with Section 31A-30-106 , based upon the examination of the covered carrier,
2909 including review of the appropriate records and of the actuarial assumptions and methods used
2910 by the covered carrier in establishing premium rates for applicable health benefit plans.

2911 (2) "Affiliate" or "affiliated" means any entity or person who directly or indirectly
2912 through one or more intermediaries, controls or is controlled by, or is under common control
2913 with, a specified entity or person.
2914 (3) "Base premium rate" means, for each class of business as to a rating period, the
2915 lowest premium rate charged or that could have been charged under a rating system for that
2916 class of business by the covered carrier to covered insureds with similar case characteristics for
2917 health benefit plans with the same or similar coverage.
2918 (4) "Basic coverage" means the coverage provided in the Basic Health Care Plan under
2919 Subsection 31A-22-613.5 (2).
2920 (5) "Carrier" means any person or entity that provides health insurance in this state
2921 including:
2922 (a) an insurance company;
2923 (b) a prepaid hospital or medical care plan;
2924 (c) a health maintenance organization;
2925 (d) a multiple employer welfare arrangement; and
2926 (e) any other person or entity providing a health insurance plan under this title.
2927 (6) (a) Except as provided in Subsection (6)(b), "case characteristics" means
2928 demographic or other objective characteristics of a covered insured that are considered by the
2929 carrier in determining premium rates for the covered insured.
2930 (b) "Case characteristics" [does] do not include:
2931 (i) duration of coverage since the policy was issued;
2932 (ii) claim experience; and
2933 (iii) health status.
2934 (7) "Class of business" means all or a separate grouping of covered insureds
2935 established under Section 31A-30-105 .
2936 (8) "Conversion policy" means a policy providing coverage under the conversion
2937 provisions required in Chapter 22, Part 7, Group Accident and Health Insurance.
2938 (9) "Covered carrier" means any individual carrier or small employer carrier subject to
2939 this chapter.
2940 (10) "Covered individual" means any individual who is covered under a health benefit
2941 plan subject to this chapter.

2942 (11) "Covered insureds" means small employers and individuals who are issued a
2943 health benefit plan that is subject to this chapter.
2944 (12) "Dependent" means an individual to the extent that the individual is defined to be
2945 a dependent by:
2946 (a) the health benefit plan covering the covered individual; and
2947 (b) Chapter 22, Part 6, Accident and Health Insurance.
2948 (13) "Established geographic service area" means a geographical area approved by the
2949 commissioner within which the carrier is authorized to provide coverage.
2950 (14) "Index rate" means, for each class of business as to a rating period for covered
2951 insureds with similar case characteristics, the arithmetic average of the applicable base
2952 premium rate and the corresponding highest premium rate.
2953 (15) "Individual carrier" means a carrier that provides coverage on an individual basis
2954 through a health benefit plan regardless of whether:
2955 (a) coverage is offered through:
2956 (i) an association;
2957 (ii) a trust;
2958 (iii) a discretionary group; or
2959 (iv) other similar groups; or
2960 (b) the policy or contract is situated out-of-state.
2961 (16) "Individual conversion policy" means a conversion policy issued to:
2962 (a) an individual; or
2963 (b) an individual with a family.
2964 (17) "Individual coverage count" means the number of natural persons covered under a
2965 carrier's health benefit products that are individual policies.
2966 (18) "Individual enrollment cap" means the percentage set by the commissioner in
2967 accordance with Section 31A-30-110 .
2968 (19) "New business premium rate" means, for each class of business as to a rating
2969 period, the lowest premium rate charged or offered, or that could have been charged or offered,
2970 by the carrier to covered insureds with similar case characteristics for newly issued health
2971 benefit plans with the same or similar coverage.
2972 (20) "Plan year" means the year that is designated as the plan year in the plan document

2973 of a group health plan, except that if the plan document does not designate a plan year or if
2974 there is not a plan document, the plan year is:
2975 (a) the deductible or limit year used under the plan;
2976 (b) if the plan does not impose a deductible or limit on a yearly basis, the policy year;
2977 (c) if the plan does not impose a deductible or limit on a yearly basis and either the
2978 plan is not insured or the insurance policy is not renewed on an annual basis, the employer's
2979 taxable year; or
2980 (d) in any case not described in Subsections (20)(a) through (c), the calendar year.
2981 [(20)] (21) "Preexisting condition" is as defined in Section 31A-1-301 .
2982 [(21)] (22) "Premium" means all monies paid by covered insureds and covered
2983 individuals as a condition of receiving coverage from a covered carrier, including any fees or
2984 other contributions associated with the health benefit plan.
2985 [(22)] (23) (a) "Rating period" means the calendar period for which premium rates
2986 established by a covered carrier are assumed to be in effect, as determined by the carrier.
2987 (b) A covered carrier may not have:
2988 (i) more than one rating period in any calendar month; and
2989 (ii) no more than 12 rating periods in any calendar year.
2990 [(23)] (24) "Resident" means an individual who has resided in this state for at least 12
2991 consecutive months immediately preceding the date of application.
2992 [(24)] (25) "Short-term limited duration insurance" means a health benefit product that:
2993 (a) is not renewable; and
2994 (b) has an expiration date specified in the contract that is less than 364 days after the
2995 date the plan became effective.
2996 [(25)] (26) "Small employer carrier" means a carrier that provides health benefit plans
2997 covering eligible employees of one or more small employers in this state, regardless of
2998 whether:
2999 (a) coverage is offered through:
3000 (i) an association;
3001 (ii) a trust;
3002 (iii) a discretionary group; or
3003 (iv) other similar grouping; or

3004 (b) the policy or contract is situated out-of-state.
3005 [(26)] (27) "Uninsurable" means an individual who:
3006 (a) is eligible for the Comprehensive Health Insurance Pool coverage under the
3007 underwriting criteria established in Subsection 31A-29-111 (5); or
3008 (b) (i) is issued a certificate for coverage under Subsection 31A-30-108 (3); and
3009 (ii) has a condition of health that does not meet consistently applied underwriting
3010 criteria as established by the commissioner in accordance with Subsections 31A-30-106 (1)(i)
3011 and (j) for which coverage the applicant is applying.
3012 [(27)] (28) "Uninsurable percentage" for a given calendar year equals UC/CI where, for
3013 purposes of this formula:
3014 (a) "CI" means the carrier's individual coverage count as of December 31 of the
3015 preceding year; and
3016 (b) "UC" means the number of uninsurable individuals who were issued an individual
3017 policy on or after July 1, 1997.
3018 Section 24. Section 31A-30-107.5 is amended to read:
3019 31A-30-107.5. Preexisting condition exclusion -- Condition-specific exclusion
3020 riders -- Limitation periods.
3021 (1) A health benefit plan may impose a preexisting condition exclusion only if the
3022 provision complies with Subsection 31A-22-605.1 (4).
3023 (2) (a) In accordance with Subsection (2)(b), an individual carrier:
3024 (i) may, when the individual carrier and the insured mutually agree in writing to a
3025 condition-specific exclusion rider, offer to issue an individual policy that excludes all treatment
3026 and prescription drugs related to:
3027 (A) a specific physical condition;
3028 (B) a specific disease or disorder; and
3029 (C) any specific or class of prescription drugs; and
3030 (ii) may offer an individual policy that may establish separate cost sharing
3031 requirements including, deductibles and maximum limits that are specific to covered services
3032 and supplies, including drugs, when utilized for the treatment and care of the conditions,
3033 diseases, or disorders listed in Subsection (2)(b).
3034 (b) (i) Except as provided in Section 31A-22-630 and [except for the treatment of

3035 asthma or when the condition is due to cancer] Subsection (2)(b)(ii), the following may be the
3036 subject of a condition-specific exclusion rider:
3037 (A) conditions, diseases, and disorders of the bones or joints of the ankle, arm, elbow,
3038 fingers, foot, hand, hip, knee, leg, mandible, mastoid, wrist, shoulder, spine, and toes, including
3039 bone spurs, bunions, carpal tunnel syndrome, club foot, cubital tunnel syndrome, hammertoe,
3040 syndactylism, and treatment and prosthetic devices related to amputation;
3041 (B) anal fistula, anal fissure, anal stricture, breast implants, breast reduction, chronic
3042 cystitis, chronic prostatitis, cystocele, rectocele, enuresis, hemorrhoids, hydrocele, hypospadius,
3043 interstitial cystitis, kidney stones, uterine leiomyoma, varicocele, spermatocele, endometriosis;
3044 (C) allergic rhinitis, nonallergic rhinitis, hay fever, dust allergies, pollen allergies,
3045 deviated nasal septum, and sinus related conditions, diseases, and disorders;
3046 (D) hemangioma, keloids, scar revisions, and other skin related conditions, diseases,
3047 and disorders;
3048 (E) goiter and other thyroid related conditions, diseases, or disorders;
3049 (F) cataracts, cornea transplant, detached retina, glaucoma, keratoconus, macular
3050 degeneration, strabismus and other eye related conditions, diseases, and disorders;
3051 (G) otitis media, cholesteatoma, otosclerosis, and other internal/external ear conditions,
3052 diseases, and disorders;
3053 (H) Baker's cyst, ganglion cyst;
3054 (I) abdominoplasty, esophageal reflux, hernia, Meniere's disease, migraines, TIC
3055 Doulourex, varicose veins, vestibular disorders;
3056 (J) sleep disorders and speech disorders; and
3057 (K) any specific or class of prescription drugs.
3058 (ii) Subsection (2)(b)(i) does not apply:
3059 (A) for the treatment of asthma; or
3060 (B) when the condition is due to cancer.
3061 [(ii)] (iii) A condition-specific exclusion rider:
3062 (A) shall be limited to the excluded condition, disease, or disorder and any
3063 complications from that condition, disease, or disorder;
3064 (B) may not extend to any secondary medical condition; and
3065 (C) must include the following informed consent paragraph: "I agree by signing below,

3066 to the terms of this rider, which excludes coverage for all treatment, including medications,
3067 related to the specific condition(s), disease(s), and/or disorder(s) stated herein and that if
3068 treatment or medications are received that I have the responsibility for payment for those
3069 services and items. I further understand that this rider does not extend to any secondary
3070 medical condition, disease, or disorder."
3071 (c) If an individual carrier issues a condition-specific exclusion rider, the
3072 condition-specific exclusion rider shall remain in effect for the duration of the policy at the
3073 individual carrier's option.
3074 (d) An individual policy issued in accordance with this Subsection (2) is not subject to
3075 Subsection 31A-26-301.6 [(9)](7).
3076 (3) Notwithstanding the other provisions of this section, a health benefit plan may
3077 impose a limitation period if:
3078 (a) each policy that imposes a limitation period under the health benefit plan specifies
3079 the physical condition, disease, or disorder that is excluded from coverage during the limitation
3080 period;
3081 (b) the limitation period does not exceed 12 months;
3082 (c) the limitation period is applied uniformly; and
3083 (d) the limitation period is reduced in compliance with Subsections
3084 31A-22-605.1 (4)(a) and (4)(b).
3085 Section 25. Section 31A-35-201 is amended to read:
3086 31A-35-201. Bail Bond Surety Oversight Board creation -- Membership.
3087 (1) There is created a Bail Bond Surety Oversight Board within the department,
3088 consisting of:
3089 (a) the following seven voting members to be appointed by the commissioner:
3090 (i) one representative each from four licensed bail bond surety companies;
3091 (ii) two members of the general public who do not have any financial interest in or
3092 professional affiliation with any bail bond surety company; and
3093 (iii) one attorney in good standing licensed to practice law in Utah; and
3094 (b) a nonvoting member who is a staff member of the insurance department appointed
3095 by the commissioner.
3096 (2) (a) The appointments are for terms of four years. A board member may not serve

3097 more than two consecutive terms.
3098 [(b) Except as required by Subsection (2)(c), the members as of May 5, 1998, of the
3099 Bail Bond Surety Licensing Board created under Section 77-20-11 shall serve the remainder of
3100 their terms as members of the board. Upon expiration of their terms they are eligible for
3101 appointment to another term.]
3102 [(c)] (b) The insurance commissioner shall, at the time of [initial appointments]
3103 appointment or reappointment of a board member described in Subsection (1)(a), adjust the
3104 length of terms to ensure that the terms of board members are staggered so approximately half
3105 of the board is appointed every two years.
3106 (3) A board member serves until:
3107 (a) removed by the insurance commissioner;
3108 (b) the member's resignation; or
3109 (c) for a member described in Subsection (1)(a), the expiration of the member's term
3110 and the appointment of a successor.
3111 (4) When a vacancy occurs in the membership of a board member described in
3112 Subsection (1)(a) for any reason, the replacement shall be appointed for the remainder of the
3113 unexpired term.
3114 (5) The board shall annually elect one of its members as chair.
3115 (6) Four voting members constitute a quorum for the transaction of business.
3116 (7) (a) [Members do] A member described in Subsection (1)(a) does not receive
3117 compensation or benefits for [their] the member's services, but may receive per diem and
3118 expenses incurred in the performance of official duties at the rates established by the Division
3119 of Finance under Sections 63A-3-106 and 63A-3-107 .
3120 (b) [Members] A member described in Subsection (1)(a) may decline to receive per
3121 diem and expenses for [their] the member's services.
3122 (8) (a) The commissioner, with a majority vote of the board, may remove any member
3123 of the board described in Subsection (1)(a) for misconduct, incompetency, or neglect of duty.
3124 (b) The board shall conduct a hearing if requested by the board member described in
3125 Subsection (1)(a) that is to be removed.
3126 (9) Members of the board are immune from suit with respect to all acts done and
3127 actions taken in good faith in carrying out the purposes of this chapter.

3128 Section 26. Section 31A-36-102 is amended to read:
3129 31A-36-102. Definitions.
3130 As used in this chapter:
3131 (1) (a) "Advertising" means any communication placed before the public to:
3132 (i) create an interest in viatical settlements; or
3133 (ii) induce a person to sell a policy or an interest in a policy pursuant to a viatical
3134 settlement.
3135 (b) "Advertising" includes the following, if the requirements of Subsection (1)(a) are
3136 met:
3137 (i) any written, electronic, or printed communication;
3138 (ii) any communication by means of recorded telephone messages;
3139 (iii) any communication transmitted on radio, television, the Internet, or similar
3140 communications media; and
3141 (iv) film strips, motion pictures, and videos.
3142 (2) "Business of viatical settlements" includes the following:
3143 (a) offering a viatical settlement;
3144 (b) [solicitation of] soliciting a viatical settlement;
3145 (c) [negotiation of] negotiating a viatical settlement;
3146 (d) [procurement of] procuring a viatical settlement;
3147 (e) [effectuation of] effectuating a viatical settlement;
3148 (f) purchasing a viatical settlement;
3149 (g) investing in a viatical settlement;
3150 (h) financing a viatical settlement;
3151 (i) monitoring a viatical settlement;
3152 (j) tracking a viatical settlement;
3153 (k) underwriting a viatical settlement;
3154 (l) selling a viatical settlement;
3155 (m) transferring a viatical settlement;
3156 (n) assigning a viatical settlement;
3157 (o) pledging a viatical settlement; and
3158 (p) otherwise hypothecating a viatical [settlements] settlement.

3159 (3) "Chronically ill" means:
3160 (a) being unable to perform at least two activities of daily living, such as eating,
3161 toileting, moving from one place to another, bathing, dressing, or continence;
3162 (b) requiring substantial supervision for protection from threats to health and safety
3163 because of severe cognitive impairment; or
3164 (c) having a level of disability similar to that described in Subsection (3)(a).
3165 (4) (a) "Financing entity" means a person:
3166 (i) [that] who has direct ownership in a policy that is the subject of [the] a viatical
3167 settlement;
3168 (ii) whose principal activity related to [the transaction] a viatical settlement is
3169 providing money to effect the viatical settlement; and
3170 (iii) [that] who has an agreement in writing with one or more licensed viatical
3171 settlement providers [of viatical settlements] to finance the acquisition of one or more viatical
3172 settlements.
3173 (b) "Financing entity" includes, if the requirements of Subsection (4)(a) are met, the
3174 following:
3175 (i) an underwriter;
3176 (ii) a placement agent;
3177 (iii) an enhancer of credit;
3178 (iv) a lender;
3179 (v) a purchaser of securities; and
3180 (vi) a purchaser of a policy from a viatical settlement provider [of viatical settlements].
3181 (c) "Financing entity" does not include:
3182 (i) a nonaccredited investor [or a purchaser of]; or
3183 (ii) a viatical [settlements] settlement purchaser.
3184 (5) "Form" means, in addition to a form as defined in Section 31A-1-301 :
3185 (a) a viatical settlement;
3186 (b) a disclosure to a viator;
3187 (c) a notice of intent to viaticate; or
3188 (d) a verification of coverage.
3189 [(5)] (6) "Policy" means:

3190 (a) an individual or group policy;
3191 (b) a group certificate; or
3192 (c) a contract or arrangement of life insurance, whether or not delivered or issued for
3193 delivery in Utah:
3194 (i) affecting the rights of a resident of Utah; or
3195 (ii) bearing a reasonable relation to Utah.
3196 [(6) (a) "Producer of viatical settlements" means a person that on behalf of a viator and
3197 for consideration offers or attempts to negotiate a viatical settlement between the viator and
3198 one or more providers of viatical settlements.]
3199 [(b) "Producer of viatical settlements" does not include an attorney licensed to practice
3200 law in any state, certified public accountant, or financial planner accredited by a nationally
3201 recognized accrediting agency:]
3202 [(i) that is retained by the viator; and]
3203 [(ii) whose compensation is not paid directly or indirectly by a provider or purchaser of
3204 viatical settlements.]
3205 [(7) (a) "Provider of viatical settlements" means a person other than a viator that enters
3206 into or effectuates a viatical settlement.]
3207 [(b) "Provider of viatical settlements" does not include:]
3208 [(i) a licensed lender that takes an assignment of a policy as security for a loan,
3209 including a:]
3210 [(A) bank;]
3211 [(B) savings bank;]
3212 [(C) savings and loan association;]
3213 [(D) credit union; or]
3214 [(E) other licensed lender;]
3215 [(ii) the issuer of a policy providing accelerated benefits pursuant to the policy;]
3216 [(iii) an authorized or eligible insurer that provides stop-loss coverage to:]
3217 [(A) a provider of viatical settlements;]
3218 [(B) a purchaser of viatical settlements;]
3219 [(C) a financing entity;]
3220 [(D) a special purpose entity; or]

3221 [(E) a related provider trust;]
3222 [(iv) a natural person that enters or effectuates no more than one agreement in a
3223 calendar year for the transfer of policies for a value less than the expected death benefit;]
3224 [(v) a financing entity;]
3225 [(vi) a special purpose entity;]
3226 [(vii) a related provider trust;]
3227 [(viii) a purchaser of viatical settlements; or]
3228 [(ix) any of the following that purchases a viaticated policy from a provider of viatical
3229 settlements:]
3230 [(A) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
3231 230.501; or]
3232 [(B) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A.]
3233 [(8) (a) "Purchaser of viatical settlements" means a person that, to derive an economic
3234 benefit:]
3235 [(i) gives a sum of money as consideration for a policy or an interest in the death
3236 benefits of a policy; or]
3237 [(ii) owns, acquires, or is entitled to a beneficial interest in a trust that:]
3238 [(A) owns a viatical settlement contract; or]
3239 [(B) is the beneficiary of a policy that has been or will be the subject of a viatical
3240 settlement.]
3241 [(b) "Purchaser of viatical settlements" does not include:]
3242 [(i) a licensee under this chapter;]
3243 [(ii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
3244 230.501;]
3245 [(iii) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec.
3246 230.144A;]
3247 [(iv) a financing entity;]
3248 [(v) a special purpose entity; or]
3249 [(vi) a related provider trust.]
3250 [(9)] (7) "Related provider trust" means a trust established by a licensed viatical
3251 settlement provider [of viatical settlements] or a financing entity solely to hold the ownership

3252 of or beneficial interests in purchased policies in connection with financing.
3253 [(10)] (8) "Special purpose entity" means an organization formed by a licensed viatical
3254 settlement provider [of viatical settlements] solely to enable the provider to gain access to
3255 institutional markets for capital.
3256 [(11)] (9) "Terminally ill" means having a condition that reasonably may be expected
3257 to result in death within 24 months.
3258 [(13)] (10) "Viaticated policy" means a policy that has been acquired by a viatical
3259 settlement provider [of viatical settlements] pursuant to a viatical settlement.
3260 [(12)] (11) (a) "Viatical settlement" means a written agreement for the payment of
3261 anything of value, which is less than the expected death benefit of the policy, in exchange for
3262 the viator's assignment, sale, transfer, devise, or bequest of the death benefit or ownership of
3263 any portion of a policy.
3264 (b) "Viatical settlement" includes:
3265 (i) an agreement with a viator for a loan or other financing secured primarily by a
3266 policy; and
3267 (ii) an agreement with a viator to transfer ownership or change the beneficiary in the
3268 future, regardless of the date of payment to the viator.
3269 (c) "Viatical settlement" does not include:
3270 (i) a loan by an insurer pursuant to the terms of a policy; [or]
3271 (ii) a loan secured by the cash value of a policy[.]; or
3272 (iii) the purchase of a policy by the life insurer pursuant to Section 31A-22-419 .
3273 (12) (a) "Viatical settlement producer" means a person that on behalf of a viator and for
3274 consideration offers or attempts to negotiate a viatical settlement between the viator and one or
3275 more viatical settlement providers.
3276 (b) "Viatical settlement producer" does not include an attorney licensed to practice law
3277 in any state, a certified public accountant, or a financial planner accredited by a nationally
3278 recognized accrediting agency:
3279 (i) that is retained by the viator; and
3280 (ii) whose compensation is not paid directly or indirectly by:
3281 (A) a viatical settlement provider; or
3282 (B) a viatical settlement purchaser.

3283 (13) (a) "Viatical settlement provider" means a person other than a viator that enters
3284 into or effectuates a viatical settlement.
3285 (b) "Viatical settlement provider" does not include:
3286 (i) a licensed lender that takes an assignment of a policy as security for a loan,
3287 including a:
3288 (A) bank;
3289 (B) savings bank;
3290 (C) savings and loan association;
3291 (D) credit union; or
3292 (E) other licensed lender;
3293 (ii) the issuer of a policy providing accelerated benefits pursuant to the policy;
3294 (iii) an authorized or eligible insurer that provides stop-loss coverage to:
3295 (A) a viatical settlement provider;
3296 (B) a viatical settlement purchaser;
3297 (C) a financing entity;
3298 (D) a special purpose entity; or
3299 (E) a related provider trust;
3300 (iv) a natural person that enters or effectuates no more than one agreement in a
3301 calendar year for the transfer of policies for a value less than the expected death benefit;
3302 (v) a financing entity;
3303 (vi) a special purpose entity;
3304 (vii) a related provider trust;
3305 (viii) a viatical settlement purchaser; or
3306 (ix) any of the following that purchases a viaticated policy from a viatical settlement
3307 provider:
3308 (A) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
3309 230.501; or
3310 (B) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A.
3311 (14) (a) "Viatical settlement purchaser" means a person that, to derive an economic
3312 benefit:
3313 (i) gives a sum of money as consideration for a policy or an interest in the death

3314 benefits of a policy; or
3315 (ii) owns, acquires, or is entitled to a beneficial interest in a trust that:
3316 (A) owns a viatical settlement contract; or
3317 (B) is the beneficiary of a policy that has been or will be the subject of a viatical
3318 settlement.
3319 (b) "Viatical settlement purchaser" does not include:
3320 (i) a viatical settlement provider;
3321 (ii) a viatical settlement producer;
3322 (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
3323 230.501;
3324 (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A;
3325 (v) a financing entity;
3326 (vi) a special purpose entity; or
3327 (vii) a related provider trust.
3328 [(14)] (15) (a) "Viator" means any of the following that seeks to enter into a viatical
3329 settlement:
3330 (i) the owner of a policy; or
3331 (ii) the holder of a certificate of insurance under a policy of group insurance.
3332 (b) "Viator" is not limited to a person that is terminally ill or chronically ill except
3333 where that limitation is expressly provided.
3334 (c) "Viator" does not include:
3335 [(i) a licensee under this chapter;]
3336 (i) a viatical settlement provider;
3337 (ii) a viatical settlement producer;
3338 [(ii)] (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
3339 230.501;
3340 [(iii)] (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec.
3341 230.144A;
3342 [(iv)] (v) a financing entity;
3343 [(v)] (vi) a special purpose entity; or
3344 [(vi)] (vii) a related provider trust.

3345 Section 27. Section 31A-36-104 is amended to read:
3346 31A-36-104. License requirements, revocation, and denial.
3347 (1) (a) A person may not, without first obtaining a license from the commissioner,
3348 operate in or from this state as:
3349 (i) a viatical settlement provider [of viatical settlements]; or
3350 (ii) a viatical settlement producer [of viatical settlements].
3351 (b) Viatical settlements are included within the scope of the life insurance producer
3352 line of authority.
3353 (2) (a) To obtain a license as a viatical settlement provider [of viatical settlements], an
3354 applicant shall:
3355 (i) comply with Section 31A-23a-117 ;
3356 (ii) file an application; and
3357 (iii) pay the license fee.
3358 (b) If an applicant complies with Subsection (2)(a), the commissioner shall investigate
3359 the applicant and issue a license if the commissioner finds that the applicant is competent and
3360 trustworthy to engage in the business of providing viatical settlements by experience, training,
3361 or education.
3362 (3) In addition to the requirements in Sections 31A-23a-111 , 31A-23a-112 and
3363 31A-23a-113 , the commissioner may refuse to issue, suspend, revoke, or refuse to renew the
3364 license of a viatical settlement provider [of viatical settlements] or viatical settlement producer
3365 [of viatical settlements] if the commissioner finds that:
3366 (a) a viatical settlement provider [of viatical settlements] demonstrates a pattern of
3367 unreasonable payments to viators;
3368 (b) the applicant [or], the licensee, [or] an officer, partner, or member, or key
3369 management personnel:
3370 (i) has, whether or not a judgment of conviction has been entered by the court, been
3371 found guilty of, or pleaded guilty or nolo contendere to:
3372 (A) a felony; or
3373 (B) a misdemeanor involving fraud or moral turpitude;
3374 (ii) violated any provision of this chapter; or
3375 (iii) has been subject to a final administrative action by another state or federal

3376 jurisdiction.
3377 (c) a viatical settlement provider [of viatical settlements] has entered into a viatical
3378 settlement not approved under this chapter;
3379 (d) a viatical settlement provider [of viatical settlements] has failed to honor
3380 obligations of a viatical settlement;
3381 (e) a viatical settlement provider [of viatical settlements] has assigned, transferred, or
3382 pledged a viaticated policy to a person other than:
3383 (i) a viatical settlement provider [of viatical settlements] licensed under this chapter;
3384 (ii) a viatical settlement purchaser [of the viatical settlement];
3385 (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
3386 230.501;
3387 (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A;
3388 (v) a financing entity;
3389 (vi) a special purpose entity; or
3390 (vii) a related provider trust; or
3391 (f) a viatical settlement provider [of viatical settlements] has failed to maintain a
3392 standard set forth in Subsection (2)(b).
3393 (4) If the commissioner denies a license application or suspends, revokes, or refuses to
3394 renew the license of a viatical settlement provider [of viatical settlements] or viatical settlement
3395 producer [of viatical settlements], the commissioner shall conduct an adjudicative proceeding
3396 under Title 63, Chapter 46b, Administrative Procedures Act.
3397 Section 28. Section 31A-36-105 is amended to read:
3398 31A-36-105. Filing and use of forms for viatical settlement and disclosure.
3399 (1) [Unless] A person may not use a form unless the form has been filed with the
3400 commissioner under Subsection 31A-21-201 (1)[, a person may not use a form for a:].
3401 [(a) viatical settlement;]
3402 [(b) disclosure to the viator;]
3403 [(c) notice of intent to viaticate;]
3404 [(d) verification of coverage; or]
3405 [(e) application.]
3406 (2) The commissioner may prohibit the use of a form submitted under Subsection (1)

3407 pursuant to Subsection 31A-21-201 (3).
3408 (3) The commissioner may require the submission of advertising material before its
3409 use.
3410 Section 29. Section 31A-36-106 is amended to read:
3411 31A-36-106. Reporting requirements and privacy.
3412 (1) (a) [Each licensee under this chapter] Subject to Subsection (1)(b), each viatical
3413 settlement provider shall file with the commissioner on or before March 1 of each year an
3414 annual statement containing [such] the information [as] the commissioner prescribes under
3415 Section 31A-36-119 [, provided, however, that].
3416 (b) Notwithstanding Subsection (1)(a), the commissioner shall only require the
3417 information [shall be limited to] for those transactions where the viator is a resident of Utah.
3418 (2) Except as otherwise allowed or required by law, the following may not disclose the
3419 identity, financial information, or medical information of an insured to any other person:
3420 (a) a viatical settlement provider [of viatical settlements];
3421 (b) a viatical settlement producer [of viatical settlements];
3422 (c) a producer of insurance;
3423 (d) an information bureau;
3424 (e) a rating agency or company; or
3425 (f) any other person knowing the identity of an insured.
3426 (3) Notwithstanding Subsection (2), a person may disclose the identity of an insured if
3427 the disclosure is:
3428 (a) necessary to effect a viatical settlement between the viator and a viatical settlement
3429 provider [of viatical settlements] and both the viator and the insured have given prior written
3430 consent to the disclosure;
3431 (b) furnished in response to an investigation or examination by the commissioner or
3432 another governmental officer or agency;
3433 (c) furnished pursuant to Section 31A-36-114 ;
3434 (d) a term of or condition to the transfer of a policy by one viatical settlement provider
3435 [of viatical settlements] to another viatical settlement provider;
3436 (e) necessary to permit a financing entity, related provider trust, or special purpose
3437 entity to finance the purchase of a policy by a viatical settlement provider [of viatical

3438 settlements] and the insured has given prior written consent to the disclosure;
3439 (f) necessary to allow the viatical settlement provider or viatical settlement producer
3440 [of viatical settlements] or [their] the viatical settlement provider's or viatical settlement
3441 producer's authorized representatives to make contacts to determine the health status of the
3442 viator; or
3443 (g) required to purchase stop-loss coverage.
3444 Section 30. Section 31A-36-107 is amended to read:
3445 31A-36-107. Examinations and retention of records.
3446 (1) The commissioner may conduct an examination of a [licensee under this chapter]
3447 viatical settlement provider or viatical settlement producer in accordance with Sections
3448 31A-2-203 , 31A-2-203.5 , 31A-2-204 , and 31A-2-205 .
3449 (2) A [person required to be licensed under this chapter] viatical settlement provider or
3450 viatical settlement producer shall retain for five years copies of all:
3451 (a) the following records, whether proposed, offered, or executed, from the later of the
3452 date of the proposal, offer, or execution[, whichever is later]:
3453 (i) contracts;
3454 (ii) purchase agreements;
3455 (iii) underwriting documents;
3456 (iv) policy forms; and
3457 (v) applications;
3458 (b) checks, drafts, and other evidence or documentation relating to the payment,
3459 transfer, or release of money, from the date of the transaction; and
3460 (c) records and documents related to the requirements of this chapter.
3461 (3) This section does not relieve a person of the obligation to produce a document
3462 described in Subsection (2) to the commissioner after the expiration of the relevant period if
3463 the person has retained the document.
3464 (4) Records required by this section to be retained must be legible and complete. They
3465 may be retained in any form or by any process that accurately reproduces or is a durable
3466 medium for the reproduction of the record.
3467 (5) An examiner may not be appointed by the commissioner if the examiner, either
3468 directly or indirectly, has a conflict of interest or is affiliated with the management of or owns a

3469 pecuniary interest in any person subject to examination under this chapter. This [section]
3470 Subsection (5) does not automatically preclude an examiner from being:
3471 (a) a viator;
3472 (b) an insured in a viaticated policy; or
3473 (c) a beneficiary in a policy that is proposed to be viaticated.
3474 (6) (a) Examinees under this section shall reimburse the cost of any examination to the
3475 department consistent with Section 31A-2-205 .
3476 (b) Notwithstanding Subsection (6)(a), an individual [producers of viatical settlements
3477 are] viatical settlement producer is not subject to Section 31A-2-205 .
3478 Section 31. Section 31A-36-108 is amended to read:
3479 31A-36-108. Required disclosures.
3480 (1) With each application for a viatical settlement, a viatical settlement provider or
3481 viatical settlement producer [of viatical settlements] shall furnish to the viator any disclosures
3482 the commissioner may require under Section 31A-36-119 , in a separate document signed by the
3483 viator and the viatical settlement provider or viatical settlement producer, no later than the time
3484 the application for the viatical settlement is signed by all the parties.
3485 (2) A viatical settlement provider [of viatical settlements] shall furnish to the viator any
3486 disclosures the commissioner may require under Section 31A-36-119 , conspicuously displayed
3487 in the viatical settlement or in a separate document signed by the viator and the viatical
3488 settlement provider [of viatical settlements], no later than the time the viatical settlement is
3489 signed by all parties.
3490 Section 32. Section 31A-36-109 is amended to read:
3491 31A-36-109. General requirements.
3492 (1) If a viatical settlement provider [of viatical settlements] transfers ownership or
3493 changes the beneficiary of a viaticated policy, the viatical settlement provider shall inform the
3494 insured of the transfer or change within 20 calendar days.
3495 (2) A viatical settlement provider [of viatical settlements] that enters a viatical
3496 settlement shall first obtain:
3497 (a) if the viator is the insured, a written statement from a licensed attending physician
3498 that the viator is of sound mind and under no constraint or undue influence to enter a viatical
3499 settlement;

3500 (b) a witnessed document in which the viator represents that:
3501 (i) the viator has a full and complete understanding of the viatical settlement and the
3502 benefits of the policy;
3503 (ii) the viator has entered the viatical settlement freely and voluntarily; and
3504 (iii) if applicable, the insured is terminally ill or chronically ill and that the illness was
3505 diagnosed after the policy was issued; and
3506 (c) a document in which the insured consents to the release of the insured's medical
3507 records to:
3508 (i) a viatical settlement provider [of viatical settlements];
3509 (ii) a viatical settlement producer [of viatical settlements]; and
3510 (iii) the insurer that issued the policy covering the insured.
3511 (3) Within 20 calendar days after a viator executes documents necessary to transfer
3512 rights under a policy, or enters into an agreement in any form, express or implied, to viaticate
3513 the policy, the viatical settlement provider [of viatical settlements] shall give written notice to
3514 the issuer of the policy that the policy has or will become viaticated. The notice must be
3515 accompanied by a copy of the documents required by Subsection (4).
3516 (4) The viatical settlement provider [of viatical settlements] shall deliver a copy of the
3517 following to the insurer that issued the policy that is the subject of the viatical settlement:
3518 (a) the medical release required under Subsection (2)(c);
3519 (b) a copy of the viator's application for the viatical settlement; and
3520 (c) the notice required under Subsection (3).
3521 (5) The insurer shall complete and return a request for verification of coverage not later
3522 than 30 calendar days after the date the request is received. In its response, the insurer shall
3523 indicate whether the insurer intends to pursue an investigation regarding the validity of the
3524 insurance contract.
3525 (6) All medical information solicited or obtained by a [licensee under this chapter]
3526 viatical settlement provider or viatical settlement producer is subject to:
3527 (a) other laws of this state relating to the confidentiality of the information; and
3528 (b) a rule relating to privacy of medical or personal information promulgated by the
3529 commissioner under Title V, Section 505 of the Gramm-Leach-Bliley Act of 1999, 15 U.S.C.
3530 Sec. 6805.

3531 (7) A viatical settlement entered into in this state must reserve to the viator an
3532 unconditional right to terminate the viatical settlement within 15 calendar days after the viator
3533 receives the proceeds of the viatical settlement. If the insured dies during that period, the
3534 viatical settlement is terminated and all proceeds, premiums, loans, and loan interest that have
3535 been paid by the viatical settlement provider or viatical settlement purchaser [of the viatical
3536 settlement] must be repaid to the viatical settlement provider or viatical settlement purchaser
3537 [of the viatical settlement].
3538 (8) (a) Contact with an insured to determine the health status of the insured after a
3539 viatical settlement may be made only by a viatical settlement provider or viatical settlement
3540 producer [of viatical settlements] that is licensed in this state, or its authorized representative,
3541 and no more than:
3542 (i) once every three months if the insured has a life expectancy of one year or more; or
3543 (ii) once every month if the insured has a life expectancy of less than one year.
3544 (b) The viatical settlement provider or viatical settlement producer [of viatical
3545 settlements] shall explain the procedure for the contacts allowed under this Subsection (8) to
3546 the viator when the application for the viatical settlement is signed by all parties.
3547 (c) The limitations of this Subsection (8) do not apply to contacts for purposes other
3548 than determining health status.
3549 (d) A viatical settlement provider or viatical settlement producer [of viatical
3550 settlements] is responsible for the acts of its authorized representative in violation of this
3551 Subsection (8).
3552 (9) The trustee of a related provider trust must agree in writing with the viatical
3553 settlement provider [of viatical settlements] that:
3554 (a) the viatical settlement provider is responsible for ensuring compliance with all
3555 statutory and regulatory requirements; and
3556 (b) the trustee will make all records and files related to viatical settlements available to
3557 the commissioner as if those records and files were maintained directly by the viatical
3558 settlement provider.
3559 (10) Regardless of the method of compensation, a viatical settlement producer [of
3560 viatical settlements]:
3561 (a) represents only the viator; and

3562 (b) owes a fiduciary duty to the viator to act according to the viator's instructions and in
3563 the best interest of the viator.
3564 Section 33. Section 31A-36-110 is amended to read:
3565 31A-36-110. Payment and document requirements.
3566 (1) (a) A viatical settlement provider [of viatical settlements] shall instruct the viator to
3567 send the executed documents required to effect the change in ownership or assignment or
3568 change of beneficiary of the affected policy to a designated independent escrow agent.
3569 (b) Within three business days after the [date] day on which the escrow agent receives
3570 the documents, or within three business days after the day on which the viatical settlement
3571 provider [of viatical settlements] receives the documents if by mistake they are sent directly to
3572 the viatical settlement provider [of viatical settlements], the escrow agent shall deposit the
3573 proceeds of the settlement into an escrow or trust account maintained in a regulated financial
3574 institution whose deposits are insured by a federal deposit insurer.
3575 (2) (a) Upon completion of the requirements of Subsection (1), the escrow agent shall
3576 deliver to the viatical settlement provider [of viatical settlements] the original documents
3577 executed by the viator.
3578 (b) Upon the viatical settlement provider's receipt from the insurer of an
3579 acknowledgment of the change in ownership or assignment or change of beneficiary of the
3580 affected policy, the viatical settlement provider [of viatical settlements] shall instruct the
3581 escrow agent to pay the proceeds of the settlement to the viator.
3582 (3) Payment to the viator must be made within three business days after the [date] day
3583 on which the viatical settlement provider [of viatical settlements received] receives the
3584 acknowledgment from the insurer. Failure to make the payment within that time makes the
3585 viatical settlement voidable by the viator for lack of consideration until payment is tendered to
3586 and accepted by the viator.
3587 Section 34. Section 31A-36-111 is amended to read:
3588 31A-36-111. Prohibited acts.
3589 (1) A viator may not enter into a viatical settlement within two years after the date of
3590 issuance of the policy to which the settlement relates unless the viator certifies to the viatical
3591 settlement provider [of viatical settlements] that one of the following is satisfied:
3592 (a) the policy was issued upon the viator's exercise of conversion rights arising out of a

3593 group or individual policy, provided:
3594 (i) the total time covered under the conversion policy plus the time covered under the
3595 prior policy is at least 24 months; and
3596 (ii) the time covered under a group policy, calculated without regard to any change in
3597 insurance carriers, has been continuous and under the same group sponsorship;
3598 (b) the viator is a charitable organization exempt from taxation under 26 U.S.C. Sec.
3599 501(c)(3);
3600 (c) the viator is not a natural person; or
3601 (d) the viator submits to the viatical settlement provider [of viatical settlements]
3602 independent evidence that within the two-year period:
3603 (i) the viator or insured is terminally ill;
3604 (ii) the viator or insured is chronically ill;
3605 (iii) the spouse of the viator has died;
3606 (iv) the viator has divorced the viator's spouse;
3607 (v) the viator has retired from full-time employment;
3608 (vi) the viator has become physically or mentally disabled and a physician determines
3609 that the disability precludes the viator from maintaining full-time employment;
3610 (vii) (A) the viator was the employer of the insured when the policy or certificate was
3611 issued; and
3612 (B) the employment relationship has terminated;
3613 (viii) a final judgment or order has been entered or issued by a court of competent
3614 jurisdiction, on the application of a creditor of the viator:
3615 (A) adjudging the viator bankrupt or insolvent;
3616 (B) approving a petition for reorganization of the viator; or
3617 (C) appointing a receiver, trustee, or liquidator for all or a substantial part of the
3618 viator's assets;
3619 (ix) the viator experiences a significant decrease in income that is unexpected and
3620 impairs the viator's reasonable ability to pay the policy premium;
3621 (x) the viator disposes of the viator's ownership in a closely held corporation; or
3622 (xi) the insured disposes of the insured's ownership in a closely held corporation.
3623 (2) When the viatical settlement provider [of viatical settlements] submits a request to

3624 the insurer to verify coverage, the viatical settlement provider [of viatical settlements] shall
3625 submit to the insurer the following:
3626 (a) copies of the independent evidence required under Subsection (1)(d); and
3627 (b) documents required under Subsection 31A-36-109 (2).
3628 (3) If a viatical settlement provider [of viatical settlements] submits to an insurer a
3629 copy of the owner's or insured's certification that one of the events described in Subsection
3630 (1)(d) has occurred, the certification conclusively establishes that the viatical settlement
3631 satisfies the requirements of this section, and the insurer shall timely respond to the viatical
3632 settlement provider's request to effect a transfer of the policy.
3633 Section 35. Section 31A-36-112 is amended to read:
3634 31A-36-112. Advertising regulations.
3635 (1) (a) Each [licensee under this chapter] viatical settlement provider or viatical
3636 settlement producer shall establish and continuously maintain a system of control over the
3637 content, form, and method of dissemination of all advertisements of [its] the viatical settlement
3638 provider's or viatical settlement producer's contracts and services.
3639 (b) Each advertisement is the responsibility of the [licensee] viatical settlement
3640 provider or viatical settlement producer as well as the person that creates or presents [it] the
3641 advertisement.
3642 (c) A system of control must include at least annual notification to persons authorized
3643 by the [licensee] viatical settlement provider or viatical settlement producer that disseminate
3644 advertisements of the requirements and procedures for approval before use of any
3645 advertisements not furnished by the [licensee] viatical settlement provider or viatical settlement
3646 producer.
3647 (2) An advertisement must be truthful and not misleading in fact or by implication, as
3648 determined by the commissioner from the overall impression it may reasonably be expected to
3649 create upon a person of average education or intelligence in the segment of the public to which
3650 it is directed.
3651 (3) False or misleading statements are not remedied by:
3652 (a) making a viatical settlement available for inspection before it is consummated; or
3653 (b) offering to refund payment if the viator is not satisfied within the period prescribed
3654 in Subsection 31A-36-109 (7).

3655 Section 36. Section 31A-36-113 is amended to read:
3656 31A-36-113. Fraud.
3657 (1) As used in this section, "recklessly" means engaging in conduct:
3658 (a) where a person knows or should have known of a substantial likelihood of the
3659 existence of the relevant facts or risks; and
3660 (b) involving a significant deviation from acceptable standards of conduct.
3661 (2) A person may not, knowingly or with intent to defraud, to deprive another of
3662 property or for pecuniary gain, do or permit its employees or agents to engage in any of the
3663 following acts:
3664 (a) present, cause to be presented or prepare with knowledge or belief that it will be
3665 presented, false information to or by a viatical settlement provider or viatical settlement
3666 producer [of viatical settlements], a financing entity, an insurer, a provider of insurance or any
3667 other person, or to conceal information, as part of, in support of or concerning a fact material
3668 to:
3669 (i) an application for the issuance of a policy or viatical settlement;
3670 (ii) the underwriting of a policy or viatical settlement;
3671 (iii) a claim for payment or other benefit under a policy or viatical settlement;
3672 (iv) a premium paid on a policy;
3673 (v) a payment or change of beneficiary or ownership pursuant to a policy or viatical
3674 settlement;
3675 (vi) the reinstatement or conversion of a policy;
3676 (vii) the solicitation, offer, effectuation, or sale of a policy or viatical settlement;
3677 (viii) the issuance of written evidence of a policy or viatical settlement; or
3678 (ix) a financing transaction;
3679 (b) in furtherance of a fraud or to prevent detection of a fraud:
3680 (i) remove, conceal, alter, destroy, or sequester from the commissioner assets or
3681 records of a [licensee under this chapter or other] person engaged in the business of viatical
3682 settlements;
3683 (ii) misrepresent or conceal the financial condition of a licensee, a financing entity, an
3684 insurer, or other person;
3685 (iii) transact the business of viatical settlements in violation of this chapter; or

3686 (iv) file with the commissioner or analogous officer of another jurisdiction a document
3687 containing false information or otherwise conceal information about a material fact from the
3688 commissioner or analogous officer;
3689 (c) embezzle, steal, misappropriate, or convert money, premiums, credits, or other
3690 property of a viatical settlement provider [of viatical settlements], a viator, an insurer, an
3691 insured, an owner of a policy, or other person engaged in the business of viatical settlements or
3692 insurance;
3693 (d) recklessly enter into, negotiate, or otherwise deal in a viatical settlement, the
3694 subject of which is a policy obtained where the viator or the viator's agent intended to defraud
3695 the policy's issuer by:
3696 (i) presenting false information concerning any fact material to the policy; or
3697 (ii) concealing, to mislead another, information concerning any fact material to the
3698 policy; or
3699 (e) attempt to commit, assist, aid, abet, or conspire to commit an act or omission
3700 described in this Subsection (2).
3701 (3) A person may not knowingly or intentionally interfere with the enforcement of [the
3702 provisions of] this chapter or an investigation of a possible violation of this chapter.
3703 (4) A person engaged in the business of viatical settlements may not knowingly or
3704 intentionally permit any person convicted of a felony involving dishonesty or breach of trust to
3705 participate in the business of viatical settlements.
3706 (5) (a) An application or contract for a viatical settlement, however transmitted, shall
3707 contain the following or a substantially similar statement: "A person that knowingly presents
3708 false information in an application for insurance or a viatical settlement is guilty of a crime and
3709 may be subject to fines and confinement in prison."
3710 (b) The lack of [such a] the statement described in Subsection (5)(a) is not a defense in
3711 a prosecution for violation of this section.
3712 Section 37. Section 31A-36-117 is amended to read:
3713 31A-36-117. Antifraud initiatives.
3714 (1) The following shall establish and maintain antifraud initiatives which are
3715 reasonably calculated to prevent, detect, and assist in the prosecution of violations of Section
3716 31A-36-113 :

3717 (a) a viatical settlement provider [of viatical settlements]; and
3718 (b) an agency that is a viatical settlement producer [of viatical settlements].
3719 (2) The commissioner may order, or a licensee may request and the commissioner may
3720 approve, modifications of the measures otherwise required under this section, more or less
3721 restrictive than those measures, as necessary to protect against fraud.
3722 (3) Antifraud initiatives shall include:
3723 (a) fraud investigators, that may be either:
3724 (i) employees of a viatical settlement provider or viatical settlement producer [of
3725 viatical settlements]; or
3726 (ii) independent contractors;
3727 (b) an antifraud plan submitted to the commissioner, which shall include:
3728 (i) a description of the procedures for:
3729 (A) detecting and investigating possible violations of Section 31A-36-113 ; and
3730 (B) resolving material inconsistencies between medical records and applications for
3731 insurance;
3732 (ii) a description of the procedures for reporting possible violations to the
3733 commissioner;
3734 (iii) a description of the plan for educating and training underwriters and other
3735 personnel against fraud; and
3736 (iv) a description or chart of the organizational arrangement of the personnel
3737 responsible for detecting and investigating possible violations of Section 31A-36-113 and for
3738 resolving material inconsistencies between medical records and applications for insurance.
3739 (4) A plan submitted to the commissioner shall be classified as a protected record
3740 under Title 63, Chapter 2, Government Records Access and Management Act.
3741 Section 38. Section 31A-36-119 is amended to read:
3742 31A-36-119. Authority to make rules.
3743 In accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act, the
3744 commissioner may adopt rules to:
3745 (1) establish the requirements for the annual statement required under Section
3746 31A-36-106 ;
3747 (2) establish standards for evaluating the reasonableness of payments under viatical

3748 settlements;
3749 (3) establish appropriate licensing requirements, fees, and standards for continued
3750 licensure for:
3751 (a) [providers of] a viatical [settlements] settlement provider; and
3752 (b) [producers of] a viatical [settlements] settlement producer;
3753 (4) require a bond or otherwise ensure financial accountability of:
3754 (a) [providers of] a viatical [settlements] settlement provider; and
3755 (b) [producers of] a viatical [settlements] settlement producer;
3756 (5) govern the relationship of insurers with [providers of viatical settlements and
3757 producers of viatical settlements] a viatical settlement provider or viatical settlement producer
3758 during the viatication of a policy;
3759 (6) determine the specific disclosures required under Section 31A-36-108 ;
3760 (7) determine whether advertising for viatical settlements violates Section 31A-36-112 ;
3761 (8) determine the information to be provided to the commissioner under Section
3762 31A-36-114 and the manner of providing the information;
3763 (9) determine additional acts or practices that are prohibited under Section
3764 31A-36-111 ;
3765 (10) establish payment requirements for the payments in Section 31A-36-110 ; and
3766 (11) establish the filing procedure for the forms listed in Subsection 31A-36-105 (1).
3767 Section 39. Section 31A-37-502 is amended to read:
3768 31A-37-502. Examination.
3769 (1) (a) [At least once in three years, and whenever the commissioner determines it to be
3770 prudent, the department,] As provided in this section, the commissioner or a person appointed
3771 by the commissioner, shall [visit] examine each captive insurance company [and] in each
3772 three-year period.
3773 (b) The three-year period described in Subsection (1)(a) shall be determined on the
3774 basis of three full annual accounting periods of operation.
3775 (c) The examination is to be made as of:
3776 (i) December 31 of the full three-year period; or
3777 (ii) the last day of the month of an annual accounting period authorized for a captive
3778 insurance company under this section.

3779 (d) In addition to an examination required under this Subsection (1), the commissioner,
3780 or a person appointed by the commissioner may examine a captive insurance company
3781 whenever the commissioner determines it to be prudent.
3782 (2) During an examination under this section the commissioner, or a person appointed
3783 by the commissioner, shall thoroughly inspect and examine the affairs of the captive insurance
3784 company to ascertain:
3785 (a) the financial condition of the captive insurance company;
3786 (b) the ability of the captive insurance company to fulfill the obligations of the captive
3787 insurance company; and
3788 (c) whether the captive insurance company has complied with this chapter.
3789 [(2)] (3) The commissioner upon application may enlarge the three-year period
3790 described in Subsection (1) to five years, if a captive insurance company is subject to a
3791 comprehensive annual audit during that period:
3792 (a) of a scope satisfactory to the commissioner; and
3793 (b) performed by independent auditors approved by the commissioner.
3794 [(3)] (4) A captive insurance company that is inspected and examined under this
3795 section shall pay, as provided in Subsection 31A-37-202 (5)(b), the expenses and charges of an
3796 inspection and examination.
3797 Section 40. Section 61-1-13 is amended to read:
3798 61-1-13. Definitions.
3799 (1) As used in this chapter:
3800 (a) "Affiliate" means a person that, directly or indirectly, through one or more
3801 intermediaries, controls or is controlled by, or is under common control with a person
3802 specified.
3803 (b) (i) "Agent" means any individual other than a broker-dealer who represents a
3804 broker-dealer or issuer in effecting or attempting to effect purchases or sales of securities.
3805 (ii) "Agent" does not include an individual who represents:
3806 (A) an issuer, who receives no commission or other remuneration, directly or
3807 indirectly, for effecting or attempting to effect purchases or sales of securities in this state, and
3808 who effects transactions:
3809 (I) in securities exempted by Subsection 61-1-14 (1)(a), (b), (c), (i), or (j);

3810 (II) exempted by Subsection 61-1-14 (2);
3811 (III) in a covered security as described in Sections 18(b)(3) and 18(b)(4)(D) of the
3812 Securities Act of 1933; or
3813 (IV) with existing employees, partners, officers, or directors of the issuer; or
3814 (B) a broker-dealer in effecting transactions in this state limited to those transactions
3815 described in Section 15(h)(2) of the Securities Exchange Act of 1934.
3816 (iii) A partner, officer, or director of a broker-dealer or issuer, or a person occupying a
3817 similar status or performing similar functions, is an agent only if the partner, officer, director,
3818 or person otherwise comes within the definition of "agent."
3819 (iv) "Agent" does not include a person described in Subsection (3).
3820 (c) (i) "Broker-dealer" means any person engaged in the business of effecting
3821 transactions in securities for the account of others or for the person's own account.
3822 (ii) "Broker-dealer" does not include:
3823 (A) an agent;
3824 (B) an issuer;
3825 (C) a bank, savings institution, or trust company;
3826 (D) a person who has no place of business in this state if:
3827 (I) the person effects transactions in this state exclusively with or through:
3828 (Aa) the issuers of the securities involved in the transactions;
3829 (Bb) other broker-dealers; or
3830 (Cc) banks, savings institutions, trust companies, insurance companies, investment
3831 companies as defined in the Investment Company Act of 1940, pension or profit-sharing trusts,
3832 or other financial institutions or institutional buyers, whether acting for themselves or as
3833 trustees; or
3834 (II) during any period of 12 consecutive months the person does not direct more than
3835 15 offers to sell or buy into this state in any manner to persons other than those specified in
3836 Subsection (1)(c)(ii)(D)(I), whether or not the offeror or any of the offerees is then present in
3837 this state;
3838 (E) a general partner who organizes and effects transactions in securities of three or
3839 fewer limited partnerships, of which the person is the general partner, in any period of 12
3840 consecutive months;

3841 (F) a person whose participation in transactions in securities is confined to those
3842 transactions made by or through a broker-dealer licensed in this state;
3843 (G) a person who is a real estate broker licensed in this state and who effects
3844 transactions in a bond or other evidence of indebtedness secured by a real or chattel mortgage
3845 or deed of trust, or by an agreement for the sale of real estate or chattels, if the entire mortgage,
3846 deed or trust, or agreement, together with all the bonds or other evidences of indebtedness
3847 secured thereby, is offered and sold as a unit;
3848 (H) a person effecting transactions in commodity contracts or commodity options;
3849 (I) a person described in Subsection (3); or
3850 (J) other persons as the division, by rule or order, may designate, consistent with the
3851 public interest and protection of investors, as not within the intent of this Subsection (1)(c).
3852 (d) "Buy" or "purchase" means every contract for purchase of, contract to buy, or
3853 acquisition of a security or interest in a security for value.
3854 (e) "Commodity" means, except as otherwise specified by the division by rule:
3855 (i) any agricultural, grain, or livestock product or byproduct, except real property or
3856 any timber, agricultural, or livestock product grown or raised on real property and offered or
3857 sold by the owner or lessee of the real property;
3858 (ii) any metal or mineral, including a precious metal, except a numismatic coin whose
3859 fair market value is at least 15% greater than the value of the metal it contains;
3860 (iii) any gem or gemstone, whether characterized as precious, semi-precious, or
3861 otherwise;
3862 (iv) any fuel, whether liquid, gaseous, or otherwise;
3863 (v) any foreign currency; and
3864 (vi) all other goods, articles, products, or items of any kind, except any work of art
3865 offered or sold by art dealers, at public auction or offered or sold through a private sale by the
3866 owner of the work.
3867 (f) (i) "Commodity contract" means any account, agreement, or contract for the
3868 purchase or sale, primarily for speculation or investment purposes and not for use or
3869 consumption by the offeree or purchaser, of one or more commodities, whether for immediate
3870 or subsequent delivery or whether delivery is intended by the parties, and whether characterized
3871 as a cash contract, deferred shipment or deferred delivery contract, forward contract, futures

3872 contract, installment or margin contract, leverage contract, or otherwise.
3873 (ii) Any commodity contract offered or sold shall, in the absence of evidence to the
3874 contrary, be presumed to be offered or sold for speculation or investment purposes.
3875 (iii) (A) A commodity contract shall not include any contract or agreement which
3876 requires, and under which the purchaser receives, within 28 calendar days from the payment in
3877 good funds any portion of the purchase price, physical delivery of the total amount of each
3878 commodity to be purchased under the contract or agreement.
3879 (B) The purchaser is not considered to have received physical delivery of the total
3880 amount of each commodity to be purchased under the contract or agreement when the
3881 commodity or commodities are held as collateral for a loan or are subject to a lien of any
3882 person when the loan or lien arises in connection with the purchase of each commodity or
3883 commodities.
3884 (g) (i) "Commodity option" means any account, agreement, or contract giving a party
3885 to the option the right but not the obligation to purchase or sell one or more commodities or
3886 one or more commodity contracts, or both whether characterized as an option, privilege,
3887 indemnity, bid, offer, put, call, advance guaranty, decline guaranty, or otherwise.
3888 (ii) "Commodity option" does not include an option traded on a national securities
3889 exchange registered:
3890 (A) with the United States Securities and Exchange Commission; or
3891 (B) on a board of trade designated as a contract market by the Commodity Futures
3892 Trading Commission.
3893 (h) "Director" means the director of the Division of Securities charged with the
3894 administration and enforcement of this chapter.
3895 (i) "Division" means the Division of Securities established by Section 61-1-18 .
3896 (j) "Executive director" means the executive director of the Department of Commerce.
3897 (k) "Federal covered adviser" means a person who:
3898 (i) is registered under Section 203 of the Investment Advisers Act of 1940; or
3899 (ii) is excluded from the definition of "investment adviser" under Section 202(a)(11) of
3900 the Investment Advisers Act of 1940.
3901 (l) "Federal covered security" means any security that is a covered security under
3902 Section 18(b) of the Securities Act of 1933 or rules or regulations promulgated under Section

3903 18(b) of the Securities Act of 1933.
3904 (m) "Fraud," "deceit," and "defraud" are not limited to their common-law meanings.
3905 (n) "Guaranteed" means guaranteed as to payment of principal or interest as to debt
3906 securities, or dividends as to equity securities.
3907 (o) (i) "Investment adviser" means any person who:
3908 (A) for compensation, engages in the business of advising others, either directly or
3909 through publications or writings, as to the value of securities or as to the advisability of
3910 investing in, purchasing, or selling securities; or
3911 (B) for compensation and as a part of a regular business, issues or promulgates
3912 analyses or reports concerning securities.
3913 (ii) "Investment adviser" includes financial planners and other persons who:
3914 (A) as an integral component of other financially related services, provide the
3915 investment advisory services described in Subsection (1)(o)(i) to others for compensation and
3916 as part of a business; or
3917 (B) hold themselves out as providing the investment advisory services described in
3918 Subsection (1)(o)(i) to others for compensation.
3919 (iii) "Investment adviser" does not include:
3920 (A) an investment adviser representative;
3921 (B) a bank, savings institution, or trust company;
3922 (C) a lawyer, accountant, engineer, or teacher whose performance of these services is
3923 solely incidental to the practice of his profession;
3924 (D) a broker-dealer or its agent whose performance of these services is solely
3925 incidental to the conduct of its business as a broker-dealer and who receives no special
3926 compensation for the services;
3927 (E) a publisher of any bona fide newspaper, news column, news letter, news magazine,
3928 or business or financial publication or service, of general, regular, and paid circulation, whether
3929 communicated in hard copy form, or by electronic means, or otherwise, that does not consist of
3930 the rendering of advice on the basis of the specific investment situation of each client;
3931 (F) any person who is a federal covered adviser;
3932 (G) a person described in Subsection (3); or
3933 (H) such other persons not within the intent of this Subsection (1)(o) as the division

3934 may by rule or order designate.
3935 (p) (i) "Investment adviser representative" means any partner, officer, director of, or a
3936 person occupying a similar status or performing similar functions, or other individual, except
3937 clerical or ministerial personnel, who:
3938 (A) (I) is employed by or associated with an investment adviser who is licensed or
3939 required to be licensed under this chapter; or
3940 (II) has a place of business located in this state and is employed by or associated with a
3941 federal covered adviser; and
3942 (B) does any of the following:
3943 (I) makes any recommendations or otherwise renders advice regarding securities;
3944 (II) manages accounts or portfolios of clients;
3945 (III) determines which recommendation or advice regarding securities should be given;
3946 (IV) solicits, offers, or negotiates for the sale of or sells investment advisory services;
3947 or
3948 (V) supervises employees who perform any of the acts described in this Subsection
3949 (1)(p)(i)(B).
3950 (ii) "Investment advisor representative" does not include a person described in
3951 Subsection (3).
3952 (q) (i) "Issuer" means any person who issues or proposes to issue any security or has
3953 outstanding a security that it has issued.
3954 (ii) With respect to a preorganization certificate or subscription, "issuer" means the
3955 promoter or the promoters of the person to be organized.
3956 (iii) "Issuer" means the person or persons performing the acts and assuming duties of a
3957 depositor or manager under the provisions of the trust or other agreement or instrument under
3958 which the security is issued with respect to:
3959 (A) interests in trusts, including collateral trust certificates, voting trust certificates, and
3960 certificates of deposit for securities; or
3961 (B) shares in an investment company without a board of directors.
3962 (iv) With respect to an equipment trust certificate, a conditional sales contract, or
3963 similar securities serving the same purpose, "issuer" means the person by whom the equipment
3964 or property is to be used.

3965 (v) With respect to interests in partnerships, general or limited, "issuer" means the
3966 partnership itself and not the general partner or partners.
3967 (vi) With respect to certificates of interest or participation in oil, gas, or mining titles or
3968 leases or in payment out of production under the titles or leases, "issuer" means the owner of
3969 the title or lease or right of production, whether whole or fractional, who creates fractional
3970 interests therein for the purpose of sale.
3971 (r) "Nonissuer" means not directly or indirectly for the benefit of the issuer.
3972 (s) "Person" means:
3973 (i) an individual;
3974 (ii) a corporation;
3975 (iii) a partnership;
3976 (iv) a limited liability company;
3977 (v) an association;
3978 (vi) a joint-stock company;
3979 (vii) a joint venture;
3980 (viii) a trust where the interests of the beneficiaries are evidenced by a security;
3981 (ix) an unincorporated organization;
3982 (x) a government; or
3983 (xi) a political subdivision of a government.
3984 (t) "Precious metal" means the following, whether in coin, bullion, or other form:
3985 (i) silver;
3986 (ii) gold;
3987 (iii) platinum;
3988 (iv) palladium;
3989 (v) copper; and
3990 (vi) such other substances as the division may specify by rule.
3991 (u) "Promoter" means any person who, acting alone or in concert with one or more
3992 persons, takes initiative in founding or organizing the business or enterprise of a person.
3993 (v) (i) "Sale" or "sell" includes every contract for sale of, contract to sell, or disposition
3994 of, a security or interest in a security for value.
3995 (ii) "Offer" or "offer to sell" includes every attempt or offer to dispose of, or

3996 solicitation of an offer to buy, a security or interest in a security for value.
3997 (iii) The following are examples of the definitions in Subsection (1)(v)(i) or (ii):
3998 (A) any security given or delivered with or as a bonus on account of any purchase of a
3999 security or any other thing, is part of the subject of the purchase, and has been offered and sold
4000 for value;
4001 (B) a purported gift of assessable stock is an offer or sale as is each assessment levied
4002 on the stock;
4003 (C) an offer or sale of a security that is convertible into, or entitles its holder to acquire
4004 or subscribe to another security of the same or another issuer is an offer or sale of that security,
4005 and also an offer of the other security, whether the right to convert or acquire is exercisable
4006 immediately or in the future;
4007 (D) any conversion or exchange of one security for another shall constitute an offer or
4008 sale of the security received in a conversion or exchange, and the offer to buy or the purchase
4009 of the security converted or exchanged;
4010 (E) securities distributed as a dividend wherein the person receiving the dividend
4011 surrenders the right, or the alternative right, to receive a cash or property dividend is an offer or
4012 sale;
4013 (F) a dividend of a security of another issuer is an offer or sale; or
4014 (G) the issuance of a security under a merger, consolidation, reorganization,
4015 recapitalization, reclassification, or acquisition of assets shall constitute the offer or sale of the
4016 security issued as well as the offer to buy or the purchase of any security surrendered in
4017 connection therewith, unless the sole purpose of the transaction is to change the issuer's
4018 domicile.
4019 (iv) The terms defined in Subsections (1)(v)(i) and (ii) do not include:
4020 (A) a good faith gift;
4021 (B) a transfer by death;
4022 (C) a transfer by termination of a trust or of a beneficial interest in a trust;
4023 (D) a security dividend not within Subsection (1)(v)(iii)(E) or (F);
4024 (E) a securities split or reverse split; or
4025 (F) any act incident to a judicially approved reorganization in which a security is issued
4026 in exchange for one or more outstanding securities, claims, or property interests, or partly in

4027 such exchange and partly for cash.
4028 (w) "Securities Act of 1933," "Securities Exchange Act of 1934," "Public Utility
4029 Holding Company Act of 1935," and "Investment Company Act of 1940" mean the federal
4030 statutes of those names as amended before or after the effective date of this chapter.
4031 (x) (i) "Security" means any:
4032 (A) note;
4033 (B) stock;
4034 (C) treasury stock;
4035 (D) bond;
4036 (E) debenture;
4037 (F) evidence of indebtedness;
4038 (G) certificate of interest or participation in any profit-sharing agreement;
4039 (H) collateral-trust certificate;
4040 (I) preorganization certificate or subscription;
4041 (J) transferable share;
4042 (K) investment contract;
4043 (L) burial certificate or burial contract;
4044 (M) voting-trust certificate;
4045 (N) certificate of deposit for a security;
4046 (O) certificate of interest or participation in an oil, gas, or mining title or lease or in
4047 payments out of production under such a title or lease;
4048 (P) commodity contract or commodity option;
4049 (Q) interest in a limited liability company;
4050 (R) viatical settlement interest; or
4051 (S) in general, any interest or instrument commonly known as a "security," or any
4052 certificate of interest or participation in, temporary or interim certificate for, receipt for,
4053 guarantee of, or warrant or right to subscribe to or purchase any of the foregoing.
4054 (ii) "Security" does not include any:
4055 (A) insurance or endowment policy or annuity contract under which an insurance
4056 company promises to pay money in a lump sum or periodically for life or some other specified
4057 period;

4058 (B) interest in a limited liability company in which the limited liability company is
4059 formed as part of an estate plan where all of the members are related by blood or marriage,
4060 there are five or fewer members, or the person claiming this exception can prove that all of the
4061 members are actively engaged in the management of the limited liability company; or
4062 (C) (I) a whole long-term estate in real property;
4063 (II) an undivided fractionalized long-term estate in real property that consists of ten or
4064 fewer owners; or
4065 (III) an undivided fractionalized long-term estate in real property that consists of more
4066 than ten owners if, when the real property estate is subject to a management agreement:
4067 (Aa) the management agreement permits a simple majority of owners of the real
4068 property estate to not renew or to terminate the management agreement at the earlier of the end
4069 of the management agreement's current term, or 180 days after the day on which the owners
4070 give notice of termination to the manager;
4071 (Bb) the management agreement prohibits, directly or indirectly, the lending of the
4072 proceeds earned from the real property estate or the use or pledge of its assets to any person or
4073 entity affiliated with or under common control of the manager; and
4074 (Cc) the management agreement complies with any other requirement imposed by rule
4075 by the Real Estate Commission under Section 61-2-26 .
4076 (iii) For purposes of Subsection (1)(x)(ii)(B), evidence that members vote or have the
4077 right to vote, or the right to information concerning the business and affairs of the limited
4078 liability company, or the right to participate in management, shall not establish, without more,
4079 that all members are actively engaged in the management of the limited liability company.
4080 (y) "State" means any state, territory, or possession of the United States, the District of
4081 Columbia, and Puerto Rico.
4082 (z) "Threshold security" means a security that is a threshold security under Regulation
4083 SHO, 17 C.F.R. 242.200 et seq.
4084 (aa) (i) "Undivided fractionalized long-term estate" means an ownership interest in real
4085 property by two or more persons that is a:
4086 (A) tenancy in common; or
4087 (B) any other legal form of undivided estate in real property including:
4088 (I) a fee estate;

4089 (II) a life estate; or
4090 (III) other long-term estate.
4091 (ii) "Undivided fractionalized long-term estate" does not include a joint tenancy.
4092 (bb) (i) "Viatical settlement interest" means the entire interest or any fractional interest
4093 in any of the following that is the subject of a viatical settlement:
4094 (A) a life insurance policy; or
4095 (B) the death benefit under a life insurance policy.
4096 (ii) "Viatical settlement interest" does not include the initial purchase from the viator
4097 by a viatical settlement provider [of viatical settlements].
4098 (cc) "Whole long-term estate" means a person or persons through joint tenancy owns
4099 real property through:
4100 (i) a fee estate;
4101 (ii) a life estate; or
4102 (iii) other long-term estate.
4103 (dd) "Working days" means 8 a.m. to 5 p.m., Monday through Friday, exclusive of
4104 legal holidays listed in Section 63-13-2 .
4105 (2) A term not defined in this section shall have the meaning as established by division
4106 rule. The meaning of a term neither defined in this section nor by rule of the division shall be
4107 the meaning commonly accepted in the business community.
4108 (3) (a) This Subsection (3) applies to:
4109 (i) the offer or sale of a real property estate exempted from the definition of security
4110 under Subsection (1)(x)(ii)(C); or
4111 (ii) the offer or sale of an undivided fractionalized long-term estate that is the offer of a
4112 security.
4113 (b) A person who, directly or indirectly receives compensation in connection with the
4114 offer or sale as provided in this Subsection (3) of a real property estate is not an agent,
4115 broker-dealer, investment adviser, or investor adviser representative under this chapter if that
4116 person is licensed under Chapter 2, Division of Real Estate, as:
4117 (i) a principal real estate broker;
4118 (ii) an associate real estate broker; or
4119 (iii) a real estate sales agent.

4120 (4) The list of real property estates excluded from the definition of securities under
4121 Subsection (1)(x)(ii)(C) is not an exclusive list of real property estates or interests that are not a
4122 security.




Legislative Review Note
as of 1-17-07 1:29 PM

Office of Legislative Research and General Counsel