Download Zipped Introduced WordPerfect HB0039S01.ZIP
[Status][Bill Documents][Fiscal Note][Bills Directory]
First Substitute H.B. 39
7 LONG TITLE
8 General Description:
9 This bill modifies the Insurance Code and related provisions to make various
11 Highlighted Provisions:
12 This bill:
13 . modifies definitions;
14 . addresses fees, nonlapsing money, and the creation of restricted accounts;
15 . removes outdated language related to reporting;
16 . allows a member of the Title and Escrow Commission to continue to serve until
18 . modifies duties of the Title and Escrow Commission;
19 . modifies provisions related to variable contract law;
20 . modifies provisions related to approval of forms;
21 . addresses requirements for purchasing groups;
22 . clarifies language related to underinsured motorist coverage;
23 . modifies provisions related to catastrophic coverage of mental health conditions;
24 . addresses issuance of group or blanket accident and health insurance;
25 . modifies Utah's mini-COBRA provisions;
26 . addresses special enrollment periods relating to Medicaid and Children's Health
27 Insurance Program;
28 . addresses provisions related to licensure and insurance adjusting;
29 . addresses licensee compensation;
30 . modifies definitions related to life settlements;
31 . provides for rulemaking and other processes related to surrender of a professional
32 employer organization license;
33 . addresses the board of directors for the Utah Defined Contribution Risk Adjuster;
35 . makes technical and conforming amendments.
36 Monies Appropriated in this Bill:
38 Other Special Clauses:
39 This bill provides an effective date.
40 Utah Code Sections Affected:
42 31A-1-301, as last amended by Laws of Utah 2009, Chapter 349
43 31A-2-403, as last amended by Laws of Utah 2008, Chapter 345
44 31A-2-404, as last amended by Laws of Utah 2008, Chapter 382
45 31A-3-103, as last amended by Laws of Utah 2009, Chapters 183 and 368
46 31A-3-104, as last amended by Laws of Utah 2006, Chapter 117
47 31A-3-304 (Superseded 07/01/10), as last amended by Laws of Utah 2009, Chapter
49 31A-3-304 (Effective 07/01/10), as last amended by Laws of Utah 2009, Chapter 183
50 31A-5-217.5, as enacted by Laws of Utah 1992, Chapter 230
51 31A-15-208, as enacted by Laws of Utah 1992, Chapter 258
52 31A-20-106, as enacted by Laws of Utah 1985, Chapter 242
53 31A-21-201, as last amended by Laws of Utah 2005, Chapter 123
54 31A-21-301, as last amended by Laws of Utah 2001, Chapter 116
55 31A-22-305.3, as last amended by Laws of Utah 2009, Chapter 231
56 31A-22-411, as last amended by Laws of Utah 1991, Chapter 74
57 31A-22-625, as last amended by Laws of Utah 2008, Chapters 345 and 382
58 31A-22-701, as last amended by Laws of Utah 2007, Chapter 307
59 31A-22-722, as last amended by Laws of Utah 2009, Chapter 12
60 31A-22-722.5, as enacted by Laws of Utah 2009, Chapter 274
61 31A-23a-415, as last amended by Laws of Utah 2007, Chapter 325
62 31A-23a-501, as last amended by Laws of Utah 2009, Chapters 12 and 274
63 31A-26-201, as last amended by Laws of Utah 2003, Chapter 298
64 31A-35-401, as last amended by Laws of Utah 2009, Chapter 183
65 31A-35-406, as last amended by Laws of Utah 2009, Chapters 183 and 349
66 31A-36-102, as last amended by Laws of Utah 2009, Chapter 355
67 31A-40-103, as enacted by Laws of Utah 2008, Chapter 318
68 31A-40-302, as enacted by Laws of Utah 2008, Chapter 318
69 31A-42-201, as enacted by Laws of Utah 2009, Chapter 12
70 63J-1-602, as enacted by Laws of Utah 2009, Chapter 368
72 31A-3-105, Utah Code Annotated 1953
73 31A-22-725, Utah Code Annotated 1953
74 31A-40-307, Utah Code Annotated 1953
75 Uncodified Material Affected:
76 ENACTS UNCODIFIED MATERIAL
78 Be it enacted by the Legislature of the state of Utah:
79 Section 1. Section 31A-1-301 is amended to read:
80 31A-1-301. Definitions.
81 As used in this title, unless otherwise specified:
82 (1) (a) "Accident and health insurance" means insurance to provide protection against
83 economic losses resulting from:
84 (i) a medical condition including:
85 (A) a medical care expense; or
86 (B) the risk of disability;
87 (ii) accident; or
88 (iii) sickness.
89 (b) "Accident and health insurance":
90 (i) includes a contract with disability contingencies including:
91 (A) an income replacement contract;
92 (B) a health care contract;
93 (C) an expense reimbursement contract;
94 (D) a credit accident and health contract;
95 (E) a continuing care contract; and
96 (F) a long-term care contract; and
97 (ii) may provide:
98 (A) hospital coverage;
99 (B) surgical coverage;
100 (C) medical coverage;
101 (D) loss of income coverage;
102 (E) prescription drug coverage;
103 (F) dental coverage; or
104 (G) vision coverage.
105 (c) "Accident and health insurance" does not include workers' compensation insurance.
106 (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title
107 63G, Chapter 3, Utah Administrative Rulemaking Act.
108 (3) "Administrator" is defined in Subsection (159).
109 (4) "Adult" means an individual who has attained the age of at least 18 years.
110 (5) "Affiliate" means a person who controls, is controlled by, or is under common
111 control with, another person. A corporation is an affiliate of another corporation, regardless of
112 ownership, if substantially the same group of individuals manage the corporations.
113 (6) "Agency" means:
114 (a) a person other than an individual, including a sole proprietorship by which an
115 individual does business under an assumed name; and
116 (b) an insurance organization licensed or required to be licensed under Section
117 31A-23a-301 .
118 (7) "Alien insurer" means an insurer domiciled outside the United States.
119 (8) "Amendment" means an endorsement to an insurance policy or certificate.
120 (9) "Annuity" means an agreement to make periodical payments for a period certain or
121 over the lifetime of one or more individuals if the making or continuance of all or some of the
122 series of the payments, or the amount of the payment, is dependent upon the continuance of
123 human life.
124 (10) "Application" means a document:
125 (a) (i) completed by an applicant to provide information about the risk to be insured;
127 (ii) that contains information that is used by the insurer to evaluate risk and decide
128 whether to:
129 (A) insure the risk under:
130 (I) the coverage as originally offered; or
131 (II) a modification of the coverage as originally offered; or
132 (B) decline to insure the risk; or
133 (b) used by the insurer to gather information from the applicant before issuance of an
134 annuity contract.
135 (11) "Articles" or "articles of incorporation" means:
136 (a) the original articles;
137 (b) a special law;
138 (c) a charter;
139 (d) an amendment;
140 (e) restated articles;
141 (f) articles of merger or consolidation;
142 (g) a trust instrument;
143 (h) another constitutive document for a trust or other entity that is not a corporation;
145 (i) an amendment to an item listed in Subsections (11)(a) through (h).
146 (12) "Bail bond insurance" means a guarantee that a person will attend court when
147 required, up to and including surrender of the person in execution of a sentence imposed under
148 Subsection 77-20-7 (1), as a condition to the release of that person from confinement.
149 (13) "Binder" is defined in Section 31A-21-102 .
150 (14) "Blanket insurance policy" means a group policy covering a defined class of
152 (a) without individual underwriting or application; and
153 (b) that is determined by definition with or without designating each person covered.
154 (15) "Board," "board of trustees," or "board of directors" means the group of persons
155 with responsibility over, or management of, a corporation, however designated.
156 (16) "Business entity" means:
157 (a) a corporation;
158 (b) an association;
159 (c) a partnership;
160 (d) a limited liability company;
161 (e) a limited liability partnership; or
162 (f) another legal entity.
163 (17) "Business of insurance" is defined in Subsection (85).
164 (18) "Business plan" means the information required to be supplied to the
165 commissioner under Subsections 31A-5-204 (2)(i) and (j), including the information required
166 when these subsections apply by reference under:
167 (a) Section 31A-7-201 ;
168 (b) Section 31A-8-205 ; or
169 (c) Subsection 31A-9-205 (2).
170 (19) (a) "Bylaws" means the rules adopted for the regulation or management of a
171 corporation's affairs, however designated.
172 (b) "Bylaws" includes comparable rules for a trust or other entity that is not a
174 (20) "Captive insurance company" means:
175 (a) an insurer:
176 (i) owned by another organization; and
177 (ii) whose exclusive purpose is to insure risks of the parent organization and an
178 affiliated company; or
179 (b) in the case of a group or association, an insurer:
180 (i) owned by the insureds; and
181 (ii) whose exclusive purpose is to insure risks of:
182 (A) a member organization;
183 (B) a group member; or
184 (C) an affiliate of:
185 (I) a member organization; or
186 (II) a group member.
187 (21) "Casualty insurance" means liability insurance.
188 (22) "Certificate" means evidence of insurance given to:
189 (a) an insured under a group insurance policy; or
190 (b) a third party.
191 (23) "Certificate of authority" is included within the term "license."
192 (24) "Claim," unless the context otherwise requires, means a request or demand on an
193 insurer for payment of a benefit according to the terms of an insurance policy.
194 (25) "Claims-made coverage" means an insurance contract or provision limiting
195 coverage under a policy insuring against legal liability to claims that are first made against the
196 insured while the policy is in force.
197 (26) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance
199 (b) When appropriate, the terms listed in Subsection (26)(a) apply to the equivalent
200 supervisory official of another jurisdiction.
201 (27) (a) "Continuing care insurance" means insurance that:
202 (i) provides board and lodging;
203 (ii) provides one or more of the following:
204 (A) a personal service;
205 (B) a nursing service;
206 (C) a medical service; or
207 (D) any other health-related service; and
208 (iii) provides the coverage described in this Subsection (27)(a) under an agreement
210 (A) for the life of the insured; or
211 (B) for a period in excess of one year.
212 (b) Insurance is continuing care insurance regardless of whether or not the board and
213 lodging are provided at the same location as a service described in Subsection (27)(a)(ii).
214 (28) (a) "Control," "controlling," "controlled," or "under common control" means the
215 direct or indirect possession of the power to direct or cause the direction of the management
216 and policies of a person. This control may be:
217 (i) by contract;
218 (ii) by common management;
219 (iii) through the ownership of voting securities; or
220 (iv) by a means other than those described in Subsections (28)(a)(i) through (iii).
221 (b) There is no presumption that an individual holding an official position with another
222 person controls that person solely by reason of the position.
223 (c) A person having a contract or arrangement giving control is considered to have
224 control despite the illegality or invalidity of the contract or arrangement.
225 (d) There is a rebuttable presumption of control in a person who directly or indirectly
226 owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the
227 voting securities of another person.
228 (29) "Controlled insurer" means a licensed insurer that is either directly or indirectly
229 controlled by a producer.
230 (30) "Controlling person" means a person that directly or indirectly has the power to
231 direct or cause to be directed, the management, control, or activities of a reinsurance
233 (31) "Controlling producer" means a producer who directly or indirectly controls an
235 (32) (a) "Corporation" means an insurance corporation, except when referring to:
236 (i) a corporation doing business:
237 (A) as:
238 (I) an insurance producer;
239 (II) a limited line producer;
240 (III) a consultant;
241 (IV) a managing general agent;
242 (V) a reinsurance intermediary;
243 (VI) a third party administrator; or
244 (VII) an adjuster; and
245 (B) under:
246 (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
247 Reinsurance Intermediaries;
248 (II) Chapter 25, Third Party Administrators; or
249 (III) Chapter 26, Insurance Adjusters; or
250 (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance
251 Holding Companies.
252 (b) "Stock corporation" means a stock insurance corporation.
253 (c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
254 (33) (a) "Creditable coverage" has the same meaning as provided in federal regulations
255 adopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Pub. L.
256 104-191, 110 Stat. 1936.
257 (b) "Creditable coverage" includes coverage that is offered through a public health plan
258 such as:
259 (i) the Primary Care Network Program under a Medicaid primary care network
260 demonstration waiver obtained subject to Section 26-18-3 ;
261 (ii) the Children's Health Insurance Program under Section 26-40-106 ; or
262 (iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.
263 101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. 109-415.
264 (34) "Credit accident and health insurance" means insurance on a debtor to provide
265 indemnity for payments coming due on a specific loan or other credit transaction while the
266 debtor is disabled.
267 (35) (a) "Credit insurance" means insurance offered in connection with an extension of
268 credit that is limited to partially or wholly extinguishing that credit obligation.
269 (b) "Credit insurance" includes:
270 (i) credit accident and health insurance;
271 (ii) credit life insurance;
272 (iii) credit property insurance;
273 (iv) credit unemployment insurance;
274 (v) guaranteed automobile protection insurance;
275 (vi) involuntary unemployment insurance;
276 (vii) mortgage accident and health insurance;
277 (viii) mortgage guaranty insurance; and
278 (ix) mortgage life insurance.
279 (36) "Credit life insurance" means insurance on the life of a debtor in connection with
280 an extension of credit that pays a person if the debtor dies.
281 (37) "Credit property insurance" means insurance:
282 (a) offered in connection with an extension of credit; and
283 (b) that protects the property until the debt is paid.
284 (38) "Credit unemployment insurance" means insurance:
285 (a) offered in connection with an extension of credit; and
286 (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
287 (i) specific loan; or
288 (ii) credit transaction.
289 (39) "Creditor" means a person, including an insured, having a claim, whether:
290 (a) matured;
291 (b) unmatured;
292 (c) liquidated;
293 (d) unliquidated;
294 (e) secured;
295 (f) unsecured;
296 (g) absolute;
297 (h) fixed; or
298 (i) contingent.
299 (40) (a) "Customer service representative" means a person that provides an insurance
300 service and insurance product information:
301 (i) for the customer service representative's:
302 (A) producer; or
303 (B) consultant employer; and
304 (ii) to the customer service representative's employer's:
305 (A) customer;
306 (B) client; or
307 (C) organization.
308 (b) A customer service representative may only operate within the scope of authority of
309 the customer service representative's producer or consultant employer.
310 (41) "Deadline" means a final date or time:
311 (a) imposed by:
312 (i) statute;
313 (ii) rule; or
314 (iii) order; and
315 (b) by which a required filing or payment must be received by the department.
316 (42) "Deemer clause" means a provision under this title under which upon the
317 occurrence of a condition precedent, the commissioner is considered to have taken a specific
318 action. If the statute so provides, a condition precedent may be the commissioner's failure to
319 take a specific action.
320 (43) "Degree of relationship" means the number of steps between two persons
321 determined by counting the generations separating one person from a common ancestor and
322 then counting the generations to the other person.
323 (44) "Department" means the Insurance Department.
324 (45) "Director" means a member of the board of directors of a corporation.
325 (46) "Disability" means a physiological or psychological condition that partially or
326 totally limits an individual's ability to:
327 (a) perform the duties of:
328 (i) that individual's occupation; or
329 (ii) any occupation for which the individual is reasonably suited by education, training,
330 or experience; or
331 (b) perform two or more of the following basic activities of daily living:
332 (i) eating;
333 (ii) toileting;
334 (iii) transferring;
335 (iv) bathing; or
336 (v) dressing.
337 (47) "Disability income insurance" is defined in Subsection (76).
338 (48) "Domestic insurer" means an insurer organized under the laws of this state.
339 (49) "Domiciliary state" means the state in which an insurer:
340 (a) is incorporated;
341 (b) is organized; or
342 (c) in the case of an alien insurer, enters into the United States.
343 (50) (a) "Eligible employee" means:
344 (i) an employee who:
345 (A) works on a full-time basis; and
346 (B) has a normal work week of 30 or more hours; or
347 (ii) a person described in Subsection (50)(b).
348 (b) "Eligible employee" includes, if the individual is included under a health benefit
349 plan of a small employer:
350 (i) a sole proprietor;
351 (ii) a partner in a partnership; or
352 (iii) an independent contractor.
353 (c) "Eligible employee" does not include, unless eligible under Subsection (50)(b):
354 (i) an individual who works on a temporary or substitute basis for a small employer;
355 (ii) an employer's spouse; or
356 (iii) a dependent of an employer.
357 (51) "Employee" means an individual employed by an employer.
358 (52) "Employee benefits" means one or more benefits or services provided to:
359 (a) an employee; or
360 (b) a dependent of an employee.
361 (53) (a) "Employee welfare fund" means a fund:
362 (i) established or maintained, whether directly or through a trustee, by:
363 (A) one or more employers;
364 (B) one or more labor organizations; or
365 (C) a combination of employers and labor organizations; and
366 (ii) that provides employee benefits paid or contracted to be paid, other than income
367 from investments of the fund:
368 (A) by or on behalf of an employer doing business in this state; or
369 (B) for the benefit of a person employed in this state.
370 (b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or tax
372 (54) "Endorsement" means a written agreement attached to a policy or certificate to
373 modify the policy or certificate coverage.
374 (55) "Enrollment date," with respect to a health benefit plan, means:
375 (a) the first day of coverage; or
376 (b) if there is a waiting period, the first day of the waiting period.
377 (56) (a) "Escrow" means:
378 (i) a real estate settlement or real estate closing conducted by a third party pursuant to
379 the requirements of a written agreement between the parties in a real estate transaction; or
380 (ii) a settlement or closing involving:
381 (A) a mobile home;
382 (B) a grazing right;
383 (C) a water right; or
384 (D) other personal property authorized by the commissioner.
385 (b) "Escrow" includes the act of conducting a:
386 (i) real estate settlement; or
387 (ii) real estate closing.
388 (57) "Escrow agent" means:
389 (a) an insurance producer with:
390 (i) a title insurance line of authority; and
391 (ii) an escrow subline of authority; or
392 (b) a person defined as an escrow agent in Section 7-22-101 .
393 (58) (a) "Excludes" is not exhaustive and does not mean that another thing is not also
395 (b) The items listed in a list using the term "excludes" are representative examples for
396 use in interpretation of this title.
397 (59) "Exclusion" means for the purposes of accident and health insurance that an
398 insurer does not provide insurance coverage, for whatever reason, for one of the following:
399 (a) a specific physical condition;
400 (b) a specific medical procedure;
401 (c) a specific disease or disorder; or
402 (d) a specific prescription drug or class of prescription drugs.
403 (60) "Expense reimbursement insurance" means insurance:
404 (a) written to provide a payment for an expense relating to hospital confinement
405 resulting from illness or injury; and
406 (b) written:
407 (i) as a daily limit for a specific number of days in a hospital; and
408 (ii) to have a one or two day waiting period following a hospitalization.
409 (61) "Fidelity insurance" means insurance guaranteeing the fidelity of a person holding
410 a position of public or private trust.
411 (62) (a) "Filed" means that a filing is:
412 (i) submitted to the department as required by and in accordance with applicable
413 statute, rule, or filing order;
414 (ii) received by the department within the time period provided in applicable statute,
415 rule, or filing order; and
416 (iii) accompanied by the appropriate fee in accordance with:
417 (A) Section 31A-3-103 ; or
418 (B) rule.
419 (b) "Filed" does not include a filing that is rejected by the department because it is not
420 submitted in accordance with Subsection (62)(a).
421 (63) "Filing," when used as a noun, means an item required to be filed with the
422 department including:
423 (a) a policy;
424 (b) a rate;
425 (c) a form;
426 (d) a document;
427 (e) a plan;
428 (f) a manual;
429 (g) an application;
430 (h) a report;
431 (i) a certificate;
432 (j) an endorsement;
433 (k) an actuarial certification;
434 (l) a licensee annual statement;
435 (m) a licensee renewal application;
436 (n) an advertisement; or
437 (o) an outline of coverage.
438 (64) "First party insurance" means an insurance policy or contract in which the insurer
439 agrees to pay a claim submitted to it by the insured for the insured's losses.
440 (65) "Foreign insurer" means an insurer domiciled outside of this state, including an
441 alien insurer.
442 (66) (a) "Form" means one of the following prepared for general use:
443 (i) a policy;
444 (ii) a certificate;
445 (iii) an application;
446 (iv) an outline of coverage; or
447 (v) an endorsement.
448 (b) "Form" does not include a document specially prepared for use in an individual
450 (67) "Franchise insurance" means an individual insurance policy provided through a
451 mass marketing arrangement involving a defined class of persons related in some way other
452 than through the purchase of insurance.
453 (68) "General lines of authority" include:
454 (a) the general lines of insurance in Subsection (69);
455 (b) title insurance under one of the following sublines of authority:
456 (i) search, including authority to act as a title marketing representative;
457 (ii) escrow, including authority to act as a title marketing representative; and
458 (iii) title marketing representative only;
459 (c) surplus lines;
460 (d) workers' compensation; and
461 (e) any other line of insurance that the commissioner considers necessary to recognize
462 in the public interest.
463 (69) "General lines of insurance" include:
464 (a) accident and health;
465 (b) casualty;
466 (c) life;
467 (d) personal lines;
468 (e) property; and
469 (f) variable contracts, including variable life and annuity.
470 (70) "Group health plan" means an employee welfare benefit plan to the extent that the
471 plan provides medical care:
472 (a) (i) to an employee; or
473 (ii) to a dependent of an employee; and
474 (b) (i) directly;
475 (ii) through insurance reimbursement; or
476 (iii) through another method.
477 (71) (a) "Group insurance policy" means a policy covering a group of persons that is
479 (i) to a policyholder on behalf of the group; and
480 (ii) for the benefit of a member of the group who is selected under a procedure defined
482 (A) the policy; or
483 (B) an agreement that is collateral to the policy.
484 (b) A group insurance policy may include a member of the policyholder's family or a
486 (72) "Guaranteed automobile protection insurance" means insurance offered in
487 connection with an extension of credit that pays the difference in amount between the
488 insurance settlement and the balance of the loan if the insured automobile is a total loss.
489 (73) (a) Except as provided in Subsection (73)(b), "health benefit plan" means a policy
490 or certificate that:
491 (i) provides health care insurance;
492 (ii) provides major medical expense insurance; or
493 (iii) is offered as a substitute for hospital or medical expense insurance, such as:
494 (A) a hospital confinement indemnity; or
495 (B) a limited benefit plan.
496 (b) "Health benefit plan" does not include a policy or certificate that:
497 (i) provides benefits solely for:
498 (A) accident;
499 (B) dental;
500 (C) income replacement;
501 (D) long-term care;
502 (E) a Medicare supplement;
503 (F) a specified disease;
504 (G) vision; or
505 (H) a short-term limited duration; or
506 (ii) is offered and marketed as supplemental health insurance.
507 (74) "Health care" means any of the following intended for use in the diagnosis,
508 treatment, mitigation, or prevention of a human ailment or impairment:
509 (a) a professional service;
510 (b) a personal service;
511 (c) a facility;
512 (d) equipment;
513 (e) a device;
514 (f) supplies; or
515 (g) medicine.
516 (75) (a) "Health care insurance" or "health insurance" means insurance providing:
517 (i) a health care benefit; or
518 (ii) payment of an incurred health care expense.
519 (b) "Health care insurance" or "health insurance" does not include accident and health
520 insurance providing a benefit for:
521 (i) replacement of income;
522 (ii) short-term accident;
523 (iii) fixed indemnity;
524 (iv) credit accident and health;
525 (v) supplements to liability;
526 (vi) workers' compensation;
527 (vii) automobile medical payment;
528 (viii) no-fault automobile;
529 (ix) equivalent self-insurance; or
530 (x) a type of accident and health insurance coverage that is a part of or attached to
531 another type of policy.
532 (76) "Income replacement insurance" or "disability income insurance" means insurance
533 written to provide payments to replace income lost from accident or sickness.
534 (77) "Indemnity" means the payment of an amount to offset all or part of an insured
536 (78) "Independent adjuster" means an insurance adjuster required to be licensed under
537 Section 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
538 (79) "Independently procured insurance" means insurance procured under Section
539 31A-15-104 .
540 (80) "Individual" means a natural person.
541 (81) "Inland marine insurance" includes insurance covering:
542 (a) property in transit on or over land;
543 (b) property in transit over water by means other than boat or ship;
544 (c) bailee liability;
545 (d) fixed transportation property such as bridges, electric transmission systems, radio
546 and television transmission towers and tunnels; and
547 (e) personal and commercial property floaters.
548 (82) "Insolvency" means that:
549 (a) an insurer is unable to pay its debts or meet its obligations as the debts and
550 obligations mature;
551 (b) an insurer's total adjusted capital is less than the insurer's mandatory control level
552 RBC under Subsection 31A-17-601 (8)(c); or
553 (c) an insurer is determined to be hazardous under this title.
554 (83) (a) "Insurance" means:
555 (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more
556 persons to one or more other persons; or
557 (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a
558 group of persons that includes the person seeking to distribute that person's risk.
559 (b) "Insurance" includes:
560 (i) a risk distributing arrangement providing for compensation or replacement for
561 damages or loss through the provision of a service or a benefit in kind;
562 (ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a
563 business and not as merely incidental to a business transaction; and
564 (iii) a plan in which the risk does not rest upon the person who makes an arrangement,
565 but with a class of persons who have agreed to share the risk.
566 (84) "Insurance adjuster" means a person who directs the investigation, negotiation, or
567 settlement of a claim under an insurance policy other than life insurance or an annuity, on
568 behalf of an insurer, policyholder, or a claimant under an insurance policy.
569 (85) "Insurance business" or "business of insurance" includes:
570 (a) providing health care insurance by an organization that is or is required to be
571 licensed under this title;
572 (b) providing a benefit to an employee in the event of a contingency not within the
573 control of the employee, in which the employee is entitled to the benefit as a right, which
574 benefit may be provided either:
575 (i) by a single employer or by multiple employer groups; or
576 (ii) through one or more trusts, associations, or other entities;
577 (c) providing an annuity:
578 (i) including an annuity issued in return for a gift; and
579 (ii) except an annuity provided by a person specified in Subsections 31A-22-1305 (2)
580 and (3);
581 (d) providing the characteristic services of a motor club as outlined in Subsection
583 (e) providing another person with insurance;
584 (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor,
585 or surety, a contract or policy of title insurance;
586 (g) transacting or proposing to transact any phase of title insurance, including:
587 (i) solicitation;
588 (ii) negotiation preliminary to execution;
589 (iii) execution of a contract of title insurance;
590 (iv) insuring; [
591 (v) transacting matters subsequent to the execution of the contract and arising out of
592 the contract, including reinsurance; and
593 (vi) transacting or proposing a life settlement; and
594 (h) doing, or proposing to do, any business in substance equivalent to Subsections
595 (85)(a) through (g) in a manner designed to evade this title.
596 (86) "Insurance consultant" or "consultant" means a person who:
597 (a) advises another person about insurance needs and coverages;
598 (b) is compensated by the person advised on a basis not directly related to the insurance
599 placed; and
600 (c) except as provided in Section 31A-23a-501 , is not compensated directly or
601 indirectly by an insurer or producer for advice given.
602 (87) "Insurance holding company system" means a group of two or more affiliated
603 persons, at least one of whom is an insurer.
604 (88) (a) "Insurance producer" or "producer" means a person licensed or required to be
605 licensed under the laws of this state to sell, solicit, or negotiate insurance.
606 (b) With regards to the selling, soliciting, or negotiating of an insurance product to an
607 insurance customer or an insured:
608 (i) "producer for the insurer" means a producer who is compensated directly or
609 indirectly by an insurer for selling, soliciting, or negotiating a product of that insurer; and
610 (ii) "producer for the insured" means a producer who:
611 (A) is compensated directly and only by an insurance customer or an insured; and
612 (B) receives no compensation directly or indirectly from an insurer for selling,
613 soliciting, or negotiating a product of that insurer to an insurance customer or insured.
614 (89) (a) "Insured" means a person to whom or for whose benefit an insurer makes a
615 promise in an insurance policy and includes:
616 (i) a policyholder;
617 (ii) a subscriber;
618 (iii) a member; and
619 (iv) a beneficiary.
620 (b) The definition in Subsection (89)(a):
621 (i) applies only to this title; and
622 (ii) does not define the meaning of this word as used in an insurance policy or
624 (90) (a) "Insurer" means a person doing an insurance business as a principal including:
625 (i) a fraternal benefit society;
626 (ii) an issuer of a gift annuity other than an annuity specified in Subsections
627 31A-22-1305 (2) and (3);
628 (iii) a motor club;
629 (iv) an employee welfare plan; and
630 (v) a person purporting or intending to do an insurance business as a principal on that
631 person's own account.
632 (b) "Insurer" does not include a governmental entity to the extent the governmental
633 entity is engaged in an activity described in Section 31A-12-107 .
634 (91) "Interinsurance exchange" is defined in Subsection (142).
635 (92) "Involuntary unemployment insurance" means insurance:
636 (a) offered in connection with an extension of credit; and
637 (b) that provides indemnity if the debtor is involuntarily unemployed for payments
638 coming due on a:
639 (i) specific loan; or
640 (ii) credit transaction.
641 (93) "Large employer," in connection with a health benefit plan, means an employer
642 who, with respect to a calendar year and to a plan year:
643 (a) employed an average of at least 51 eligible employees on each business day during
644 the preceding calendar year; and
645 (b) employs at least two employees on the first day of the plan year.
646 (94) "Late enrollee," with respect to an employer health benefit plan, means an
647 individual whose enrollment is a late enrollment.
648 (95) "Late enrollment," with respect to an employer health benefit plan, means
649 enrollment of an individual other than:
650 (a) on the earliest date on which coverage can become effective for the individual
651 under the terms of the plan; or
652 (b) through special enrollment.
653 (96) (a) Except for a retainer contract or legal assistance described in Section
654 31A-1-103 , "legal expense insurance" means insurance written to indemnify or pay for a
655 specified legal expense.
656 (b) "Legal expense insurance" includes an arrangement that creates a reasonable
657 expectation of an enforceable right.
658 (c) "Legal expense insurance" does not include the provision of, or reimbursement for,
659 legal services incidental to other insurance coverage.
660 (97) (a) "Liability insurance" means insurance against liability:
661 (i) for death, injury, or disability of a human being, or for damage to property,
662 exclusive of the coverages under:
663 (A) Subsection (107) for medical malpractice insurance;
664 (B) Subsection (134) for professional liability insurance; and
665 (C) Subsection (168) for workers' compensation insurance;
666 (ii) for a medical, hospital, surgical, and funeral benefit to a person other than the
667 insured who is injured, irrespective of legal liability of the insured, when issued with or
668 supplemental to insurance against legal liability for the death, injury, or disability of a human
669 being, exclusive of the coverages under:
670 (A) Subsection (107) for medical malpractice insurance;
671 (B) Subsection (134) for professional liability insurance; and
672 (C) Subsection (168) for workers' compensation insurance;
673 (iii) for loss or damage to property resulting from an accident to or explosion of a
674 boiler, pipe, pressure container, machinery, or apparatus;
675 (iv) for loss or damage to property caused by:
676 (A) the breakage or leakage of a sprinkler, water pipe, or water container; or
677 (B) water entering through a leak or opening in a building; or
678 (v) for other loss or damage properly the subject of insurance not within another kind
679 of insurance as defined in this chapter, if the insurance is not contrary to law or public policy.
680 (b) "Liability insurance" includes:
681 (i) vehicle liability insurance;
682 (ii) residential dwelling liability insurance; and
683 (iii) making inspection of, and issuing a certificate of inspection upon, an elevator,
684 boiler, machinery, or apparatus of any kind when done in connection with insurance on the
685 elevator, boiler, machinery, or apparatus.
686 (98) (a) "License" means authorization issued by the commissioner to engage in an
687 activity that is part of or related to the insurance business.
688 (b) "License" includes a certificate of authority issued to an insurer.
689 (99) (a) "Life insurance" means:
690 (i) insurance on a human life; and
691 (ii) insurance pertaining to or connected with human life.
692 (b) The business of life insurance includes:
693 (i) granting a death benefit;
694 (ii) granting an annuity benefit;
695 (iii) granting an endowment benefit;
696 (iv) granting an additional benefit in the event of death by accident;
697 (v) granting an additional benefit to safeguard the policy against lapse; and
698 (vi) providing an optional method of settlement of proceeds.
699 (100) "Limited license" means a license that:
700 (a) is issued for a specific product of insurance; and
701 (b) limits an individual or agency to transact only for that product or insurance.
702 (101) "Limited line credit insurance" includes the following forms of insurance:
703 (a) credit life;
704 (b) credit accident and health;
705 (c) credit property;
706 (d) credit unemployment;
707 (e) involuntary unemployment;
708 (f) mortgage life;
709 (g) mortgage guaranty;
710 (h) mortgage accident and health;
711 (i) guaranteed automobile protection; and
712 (j) another form of insurance offered in connection with an extension of credit that:
713 (i) is limited to partially or wholly extinguishing the credit obligation; and
714 (ii) the commissioner determines by rule should be designated as a form of limited line
715 credit insurance.
716 (102) "Limited line credit insurance producer" means a person who sells, solicits, or
717 negotiates one or more forms of limited line credit insurance coverage to an individual through
718 a master, corporate, group, or individual policy.
719 (103) "Limited line insurance" includes:
720 (a) bail bond;
721 (b) limited line credit insurance;
722 (c) legal expense insurance;
723 (d) motor club insurance;
724 (e) rental car-related insurance;
725 (f) travel insurance;
726 (g) crop insurance;
727 (h) self-service storage insurance; and
728 (i) another form of limited insurance that the commissioner determines by rule should
729 be designated a form of limited line insurance.
730 (104) "Limited lines authority" includes:
731 (a) the lines of insurance listed in Subsection (103); and
732 (b) a customer service representative.
733 (105) "Limited lines producer" means a person who sells, solicits, or negotiates limited
734 lines insurance.
735 (106) (a) "Long-term care insurance" means an insurance policy or rider advertised,
736 marketed, offered, or designated to provide coverage:
737 (i) in a setting other than an acute care unit of a hospital;
738 (ii) for not less than 12 consecutive months for a covered person on the basis of:
739 (A) expenses incurred;
740 (B) indemnity;
741 (C) prepayment; or
742 (D) another method;
743 (iii) for one or more necessary or medically necessary services that are:
744 (A) diagnostic;
745 (B) preventative;
746 (C) therapeutic;
747 (D) rehabilitative;
748 (E) maintenance; or
749 (F) personal care; and
750 (iv) that may be issued by:
751 (A) an insurer;
752 (B) a fraternal benefit society;
753 (C) (I) a nonprofit health hospital; and
754 (II) a medical service corporation;
755 (D) a prepaid health plan;
756 (E) a health maintenance organization; or
757 (F) an entity similar to the entities described in Subsections (106)(a)(iv)(A) through (E)
758 to the extent that the entity is otherwise authorized to issue life or health care insurance.
759 (b) "Long-term care insurance" includes:
760 (i) any of the following that provide directly or supplement long-term care insurance:
761 (A) a group or individual annuity or rider; or
762 (B) a life insurance policy or rider;
763 (ii) a policy or rider that provides for payment of benefits on the basis of:
764 (A) cognitive impairment; or
765 (B) functional capacity; or
766 (iii) a qualified long-term care insurance contract.
767 (c) "Long-term care insurance" does not include:
768 (i) a policy that is offered primarily to provide basic Medicare supplement coverage;
769 (ii) basic hospital expense coverage;
770 (iii) basic medical/surgical expense coverage;
771 (iv) hospital confinement indemnity coverage;
772 (v) major medical expense coverage;
773 (vi) income replacement or related asset-protection coverage;
774 (vii) accident only coverage;
775 (viii) coverage for a specified:
776 (A) disease; or
777 (B) accident;
778 (ix) limited benefit health coverage; or
779 (x) a life insurance policy that accelerates the death benefit to provide the option of a
780 lump sum payment:
781 (A) if the following are not conditioned on the receipt of long-term care:
782 (I) benefits; or
783 (II) eligibility; and
784 (B) the coverage is for one or more the following qualifying events:
785 (I) terminal illness;
786 (II) medical conditions requiring extraordinary medical intervention; or
787 (III) permanent institutional confinement.
788 (107) "Medical malpractice insurance" means insurance against legal liability incident
789 to the practice and provision of a medical service other than the practice and provision of a
790 dental service.
791 (108) "Member" means a person having membership rights in an insurance
793 (109) "Minimum capital" or "minimum required capital" means the capital that must be
794 constantly maintained by a stock insurance corporation as required by statute.
795 (110) "Mortgage accident and health insurance" means insurance offered in connection
796 with an extension of credit that provides indemnity for payments coming due on a mortgage
797 while the debtor is disabled.
798 (111) "Mortgage guaranty insurance" means surety insurance under which a mortgagee
799 or other creditor is indemnified against losses caused by the default of a debtor.
800 (112) "Mortgage life insurance" means insurance on the life of a debtor in connection
801 with an extension of credit that pays if the debtor dies.
802 (113) "Motor club" means a person:
803 (a) licensed under:
804 (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
805 (ii) Chapter 11, Motor Clubs; or
806 (iii) Chapter 14, Foreign Insurers; and
807 (b) that promises for an advance consideration to provide for a stated period of time
808 one or more:
809 (i) legal services under Subsection 31A-11-102 (1)(b);
810 (ii) bail services under Subsection 31A-11-102 (1)(c); or
811 (iii) (A) trip reimbursement;
812 (B) towing services;
813 (C) emergency road services;
814 (D) stolen automobile services;
815 (E) a combination of the services listed in Subsections (113)(b)(iii)(A) through (D); or
816 (F) other services given in Subsections 31A-11-102 (1)(b) through (f).
817 (114) "Mutual" means a mutual insurance corporation.
818 (115) "Network plan" means health care insurance:
819 (a) that is issued by an insurer; and
820 (b) under which the financing and delivery of medical care is provided, in whole or in
821 part, through a defined set of providers under contract with the insurer, including the financing
822 and delivery of an item paid for as medical care.
823 (116) "Nonparticipating" means a plan of insurance under which the insured is not
824 entitled to receive a dividend representing a share of the surplus of the insurer.
825 (117) "Ocean marine insurance" means insurance against loss of or damage to:
826 (a) ships or hulls of ships;
827 (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, moneys,
828 securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia
829 interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
830 (c) earnings such as freight, passage money, commissions, or profits derived from
831 transporting goods or people upon or across the oceans or inland waterways; or
832 (d) a vessel owner or operator as a result of liability to employees, passengers, bailors,
833 owners of other vessels, owners of fixed objects, customs or other authorities, or other persons
834 in connection with maritime activity.
835 (118) "Order" means an order of the commissioner.
836 (119) "Outline of coverage" means a summary that explains an accident and health
837 insurance policy.
838 (120) "Participating" means a plan of insurance under which the insured is entitled to
839 receive a dividend representing a share of the surplus of the insurer.
840 (121) "Participation," as used in a health benefit plan, means a requirement relating to
841 the minimum percentage of eligible employees that must be enrolled in relation to the total
842 number of eligible employees of an employer reduced by each eligible employee who
843 voluntarily declines coverage under the plan because the employee:
844 (a) has other group health care insurance coverage; or
845 (b) receives:
846 (i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the Social
847 Security Amendments of 1965; or
848 (ii) another government health benefit.
849 (122) "Person" includes:
850 (a) an individual;
851 (b) a partnership;
852 (c) a corporation;
853 (d) an incorporated or unincorporated association;
854 (e) a joint stock company;
855 (f) a trust;
856 (g) a limited liability company;
857 (h) a reciprocal;
858 (i) a syndicate; or
859 (j) another similar entity or combination of entities acting in concert.
860 (123) "Personal lines insurance" means property and casualty insurance coverage sold
861 for primarily noncommercial purposes to:
862 (a) an individual; or
863 (b) a family.
864 (124) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
865 (125) "Plan year" means:
866 (a) the year that is designated as the plan year in:
867 (i) the plan document of a group health plan; or
868 (ii) a summary plan description of a group health plan;
869 (b) if the plan document or summary plan description does not designate a plan year or
870 there is no plan document or summary plan description:
871 (i) the year used to determine deductibles or limits;
872 (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis;
874 (iii) the employer's taxable year if:
875 (A) the plan does not impose deductibles or limits on a yearly basis; and
876 (B) (I) the plan is not insured; or
877 (II) the insurance policy is not renewed on an annual basis; or
878 (c) in a case not described in Subsection (125)(a) or (b), the calendar year.
879 (126) (a) "Policy" means a document, including [
880 application that:
881 (i) purports to be an enforceable contract; and
882 (ii) memorializes in writing some or all of the terms of an insurance contract.
883 (b) "Policy" includes a service contract issued by:
884 (i) a motor club under Chapter 11, Motor Clubs;
885 (ii) a service contract provided under Chapter 6a, Service Contracts; and
886 (iii) a corporation licensed under:
887 (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
888 (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
889 (c) "Policy" does not include:
890 (i) a certificate under a group insurance contract; or
891 (ii) a document that does not purport to have legal effect.
892 (127) "Policyholder" means a person who controls a policy, binder, or oral contract by
893 ownership, premium payment, or otherwise.
894 (128) "Policy illustration" means a presentation or depiction that includes
895 nonguaranteed elements of a policy of life insurance over a period of years.
896 (129) "Policy summary" means a synopsis describing the elements of a life insurance
898 (130) "Preexisting condition," with respect to a health benefit plan:
899 (a) means a condition that was present before the effective date of coverage, whether or
900 not medical advice, diagnosis, care, or treatment was recommended or received before that day;
902 (b) does not include a condition indicated by genetic information unless an actual
903 diagnosis of the condition by a physician has been made.
904 (131) (a) "Premium" means the monetary consideration for an insurance policy.
905 (b) "Premium" includes, however designated:
906 (i) an assessment;
907 (ii) a membership fee;
908 (iii) a required contribution; or
909 (iv) monetary consideration.
910 (c) (i) "Premium" does not include consideration paid to a third party administrator for
911 the third party administrator's services.
912 (ii) "Premium" includes an amount paid by a third party administrator to an insurer for
913 insurance on the risks administered by the third party administrator.
914 (132) "Principal officers" for a corporation means the officers designated under
915 Subsection 31A-5-203 (3).
916 (133) "Proceeding" includes an action or special statutory proceeding.
917 (134) "Professional liability insurance" means insurance against legal liability incident
918 to the practice of a profession and provision of a professional service.
919 (135) (a) Except as provided in Subsection (135)(b), "property insurance" means
920 insurance against loss or damage to real or personal property of every kind and any interest in
921 that property:
922 (i) from all hazards or causes; and
923 (ii) against loss consequential upon the loss or damage including vehicle
924 comprehensive and vehicle physical damage coverages.
925 (b) "Property insurance" does not include:
926 (i) inland marine insurance; and
927 (ii) ocean marine insurance.
928 (136) "Qualified long-term care insurance contract" or "federally tax qualified
929 long-term care insurance contract" means:
930 (a) an individual or group insurance contract that meets the requirements of Section
931 7702B(b), Internal Revenue Code; or
932 (b) the portion of a life insurance contract that provides long-term care insurance:
933 (i) (A) by rider; or
934 (B) as a part of the contract; and
935 (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue
937 (137) "Qualified United States financial institution" means an institution that:
938 (a) is:
939 (i) organized under the laws of the United States or any state; or
940 (ii) in the case of a United States office of a foreign banking organization, licensed
941 under the laws of the United States or any state;
942 (b) is regulated, supervised, and examined by a United States federal or state authority
943 having regulatory authority over a bank or trust company; and
944 (c) meets the standards of financial condition and standing that are considered
945 necessary and appropriate to regulate the quality of a financial institution whose letters of credit
946 will be acceptable to the commissioner as determined by:
947 (i) the commissioner by rule; or
948 (ii) the Securities Valuation Office of the National Association of Insurance
950 (138) (a) "Rate" means:
951 (i) the cost of a given unit of insurance; or
952 (ii) for property or casualty insurance, that cost of insurance per exposure unit either
953 expressed as:
954 (A) a single number; or
955 (B) a pure premium rate, adjusted before the application of individual risk variations
956 based on loss or expense considerations to account for the treatment of:
957 (I) expenses;
958 (II) profit; and
959 (III) individual insurer variation in loss experience.
960 (b) "Rate" does not include a minimum premium.
961 (139) (a) Except as provided in Subsection (139)(b), "rate service organization" means
962 a person who assists an insurer in rate making or filing by:
963 (i) collecting, compiling, and furnishing loss or expense statistics;
964 (ii) recommending, making, or filing rates or supplementary rate information; or
965 (iii) advising about rate questions, except as an attorney giving legal advice.
966 (b) "Rate service organization" does not mean:
967 (i) an employee of an insurer;
968 (ii) a single insurer or group of insurers under common control;
969 (iii) a joint underwriting group; or
970 (iv) an individual serving as an actuarial or legal consultant.
971 (140) "Rating manual" means any of the following used to determine initial and
972 renewal policy premiums:
973 (a) a manual of rates;
974 (b) a classification;
975 (c) a rate-related underwriting rule; and
976 (d) a rating formula that describes steps, policies, and procedures for determining
977 initial and renewal policy premiums.
978 (141) "Received by the department" means:
979 (a) the date delivered to and stamped received by the department, if delivered in
981 (b) the post mark date, if delivered by mail;
982 (c) the delivery service's post mark or pickup date, if delivered by a delivery service;
983 (d) the received date recorded on an item delivered, if delivered by:
984 (i) facsimile;
985 (ii) email; or
986 (iii) another electronic method; or
987 (e) a date specified in:
988 (i) a statute;
989 (ii) a rule; or
990 (iii) an order.
991 (142) "Reciprocal" or "interinsurance exchange" means an unincorporated association
992 of persons:
993 (a) operating through an attorney-in-fact common to all of the persons; and
994 (b) exchanging insurance contracts with one another that provide insurance coverage
995 on each other.
996 (143) "Reinsurance" means an insurance transaction where an insurer, for
997 consideration, transfers any portion of the risk it has assumed to another insurer. In referring to
998 reinsurance transactions, this title sometimes refers to:
999 (a) the insurer transferring the risk as the "ceding insurer"; and
1000 (b) the insurer assuming the risk as the:
1001 (i) "assuming insurer"; or
1002 (ii) "assuming reinsurer."
1003 (144) "Reinsurer" means a person licensed in this state as an insurer with the authority
1004 to assume reinsurance.
1005 (145) "Residential dwelling liability insurance" means insurance against liability
1006 resulting from or incident to the ownership, maintenance, or use of a residential dwelling that is
1007 a detached single family residence or multifamily residence up to four units.
1008 (146) (a) "Retrocession" means reinsurance with another insurer of a liability assumed
1009 under a reinsurance contract.
1010 (b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of a
1011 liability assumed under a reinsurance contract.
1012 (147) "Rider" means an endorsement to:
1013 (a) an insurance policy; or
1014 (b) an insurance certificate.
1015 (148) (a) "Security" means a:
1016 (i) note;
1017 (ii) stock;
1018 (iii) bond;
1019 (iv) debenture;
1020 (v) evidence of indebtedness;
1021 (vi) certificate of interest or participation in a profit-sharing agreement;
1022 (vii) collateral-trust certificate;
1023 (viii) preorganization certificate or subscription;
1024 (ix) transferable share;
1025 (x) investment contract;
1026 (xi) voting trust certificate;
1027 (xii) certificate of deposit for a security;
1028 (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in
1029 payments out of production under such a title or lease;
1030 (xiv) commodity contract or commodity option;
1031 (xv) certificate of interest or participation in, temporary or interim certificate for,
1032 receipt for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed
1033 in Subsections (148)(a)(i) through (xiv); or
1034 (xvi) another interest or instrument commonly known as a security.
1035 (b) "Security" does not include:
1036 (i) any of the following under which an insurance company promises to pay money in a
1037 specific lump sum or periodically for life or some other specified period:
1038 (A) insurance;
1039 (B) an endowment policy; or
1040 (C) an annuity contract; or
1041 (ii) a burial certificate or burial contract.
1042 (149) "Secondary medical condition" means a complication related to an exclusion
1043 from coverage in accident and health insurance.
1044 (150) "Self-insurance" means an arrangement under which a person provides for
1045 spreading its own risks by a systematic plan.
1046 (a) Except as provided in this Subsection (150), "self-insurance" does not include an
1047 arrangement under which a number of persons spread their risks among themselves.
1048 (b) "Self-insurance" includes:
1049 (i) an arrangement by which a governmental entity undertakes to indemnify an
1050 employee for liability arising out of the employee's employment; and
1051 (ii) an arrangement by which a person with a managed program of self-insurance and
1052 risk management undertakes to indemnify its affiliates, subsidiaries, directors, officers, or
1053 employees for liability or risk that is related to the relationship or employment.
1054 (c) "Self-insurance" does not include an arrangement with an independent contractor.
1055 (151) "Sell" means to exchange a contract of insurance:
1056 (a) by any means;
1057 (b) for money or its equivalent; and
1058 (c) on behalf of an insurance company.
1059 (152) "Short-term care insurance" means an insurance policy or rider advertised,
1060 marketed, offered, or designed to provide coverage that is similar to long-term care insurance,
1061 but that provides coverage for less than 12 consecutive months for each covered person.
1062 (153) "Significant break in coverage" means a period of 63 consecutive days during
1063 each of which an individual does not have creditable coverage.
1064 (154) "Small employer," in connection with a health benefit plan, means an employer
1065 who, with respect to a calendar year and to a plan year:
1066 (a) employed an average of at least two employees but not more than 50 eligible
1067 employees on each business day during the preceding calendar year; and
1068 (b) employs at least two employees on the first day of the plan year.
1069 (155) "Special enrollment period," in connection with a health benefit plan, has the
1070 same meaning as provided in federal regulations adopted pursuant to the Health Insurance
1071 Portability and Accountability Act of 1996, Pub. L. [
1072 (156) (a) "Subsidiary" of a person means an affiliate controlled by that person either
1073 directly or indirectly through one or more affiliates or intermediaries.
1074 (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting
1075 shares are owned by that person either alone or with its affiliates, except for the minimum
1076 number of shares the law of the subsidiary's domicile requires to be owned by directors or
1078 (157) Subject to Subsection (83)(b), "surety insurance" includes:
1079 (a) a guarantee against loss or damage resulting from the failure of a principal to pay or
1080 perform the principal's obligations to a creditor or other obligee;
1081 (b) bail bond insurance; and
1082 (c) fidelity insurance.
1083 (158) (a) "Surplus" means the excess of assets over the sum of paid-in capital and
1085 (b) (i) "Permanent surplus" means the surplus of a mutual insurer that is designated by
1086 the insurer as permanent.
1087 (ii) Sections 31A-5-211 , 31A-7-201 , 31A-8-209 , 31A-9-209 , and 31A-14-209 require
1088 that mutuals doing business in this state maintain specified minimum levels of permanent
1090 (iii) Except for assessable mutuals, the minimum permanent surplus requirement is the
1091 same as the minimum required capital requirement that applies to stock insurers.
1092 (c) "Excess surplus" means:
1093 (i) for a life insurer, accident and health insurer, health organization, or property and
1094 casualty insurer as defined in Section 31A-17-601 , the lesser of:
1095 (A) that amount of an insurer's or health organization's total adjusted capital that
1096 exceeds the product of:
1097 (I) 2.5; and
1098 (II) the sum of the insurer's or health organization's minimum capital or permanent
1099 surplus required under Section 31A-5-211 , 31A-9-209 , or 31A-14-205 ; or
1100 (B) that amount of an insurer's or health organization's total adjusted capital that
1101 exceeds the product of:
1102 (I) 3.0; and
1103 (II) the authorized control level RBC as defined in Subsection 31A-17-601 (8)(a); and
1104 (ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurer
1105 that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
1106 (A) 1.5; and
1107 (B) the insurer's total adjusted capital required by Subsection 31A-17-609 (1).
1108 (159) "Third party administrator" or "administrator" means a person who collects
1109 charges or premiums from, or who, for consideration, adjusts or settles claims of residents of
1110 the state in connection with insurance coverage, annuities, or service insurance coverage,
1112 (a) a union on behalf of its members;
1113 (b) a person administering a:
1114 (i) pension plan subject to the federal Employee Retirement Income Security Act of
1116 (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
1117 (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
1118 (c) an employer on behalf of the employer's employees or the employees of one or
1119 more of the subsidiary or affiliated corporations of the employer;
1120 (d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance
1121 for which the insurer holds a license in this state; or
1122 (e) a person:
1123 (i) licensed or exempt from licensing under:
1124 (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
1125 Reinsurance Intermediaries; or
1126 (B) Chapter 26, Insurance Adjusters; and
1127 (ii) whose activities are limited to those authorized under the license the person holds
1128 or for which the person is exempt.
1129 (160) "Title insurance" means the insuring, guaranteeing, or indemnifying of an owner
1130 of real or personal property or the holder of liens or encumbrances on that property, or others
1131 interested in the property against loss or damage suffered by reason of liens or encumbrances
1132 upon, defects in, or the unmarketability of the title to the property, or invalidity or
1133 unenforceability of any liens or encumbrances on the property.
1134 (161) "Total adjusted capital" means the sum of an insurer's or health organization's
1135 statutory capital and surplus as determined in accordance with:
1136 (a) the statutory accounting applicable to the annual financial statements required to be
1137 filed under Section 31A-4-113 ; and
1138 (b) another item provided by the RBC instructions, as RBC instructions is defined in
1139 Section 31A-17-601 .
1140 (162) (a) "Trustee" means "director" when referring to the board of directors of a
1142 (b) "Trustee," when used in reference to an employee welfare fund, means an
1143 individual, firm, association, organization, joint stock company, or corporation, whether acting
1144 individually or jointly and whether designated by that name or any other, that is charged with
1145 or has the overall management of an employee welfare fund.
1146 (163) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted insurer"
1147 means an insurer:
1148 (i) not holding a valid certificate of authority to do an insurance business in this state;
1150 (ii) transacting business not authorized by a valid certificate.
1151 (b) "Admitted insurer" or "authorized insurer" means an insurer:
1152 (i) holding a valid certificate of authority to do an insurance business in this state; and
1153 (ii) transacting business as authorized by a valid certificate.
1154 (164) "Underwrite" means the authority to accept or reject risk on behalf of the insurer.
1155 (165) "Vehicle liability insurance" means insurance against liability resulting from or
1156 incident to ownership, maintenance, or use of a land vehicle or aircraft, exclusive of a vehicle
1157 comprehensive or vehicle physical damage coverage under Subsection (135).
1158 (166) "Voting security" means a security with voting rights, and includes a security
1159 convertible into a security with a voting right associated with the security.
1160 (167) "Waiting period" for a health benefit plan means the period that must pass before
1161 coverage for an individual, who is otherwise eligible to enroll under the terms of the health
1162 benefit plan, can become effective.
1163 (168) "Workers' compensation insurance" means:
1164 (a) insurance for indemnification of an employer against liability for compensation
1165 based on:
1166 (i) a compensable accidental injury; and
1167 (ii) occupational disease disability;
1168 (b) employer's liability insurance incidental to workers' compensation insurance and
1169 written in connection with workers' compensation insurance; and
1170 (c) insurance assuring to a person entitled to workers' compensation benefits the
1171 compensation provided by law.
1172 Section 2. Section 31A-2-403 is amended to read:
1173 31A-2-403. Title and Escrow Commission created.
1174 (1) (a) Subject to Subsection (1)(b), there is created within the department the Title and
1175 Escrow Commission that is comprised of five members appointed by the governor with the
1176 consent of the Senate as follows:
1177 (i) four members shall each:
1178 (A) be or have been licensed under the title insurance line of authority; [
1179 (B) as of the day on which the member is appointed, be or have been licensed with the
1180 search or escrow subline of authority for at least five years; and
1181 (C) as of the day on which the member is appointed, not be from the same county as
1182 another member appointed under this Subsection (1)(a)(i); and
1183 (ii) one member shall be a member of the general public from any county in the state.
1184 (b) No more than one commission member may be appointed from a single company.
1185 (2) (a) Subject to Subsection (2)(c), a [
1186 with the [
1187 interest that the [
1188 subject to the jurisdiction of the [
1189 (b) The disclosure statement required by this Subsection (2) shall be:
1190 (i) filed by no later than the day on which the person begins that person's appointment;
1192 (ii) amended when a significant change occurs in any matter required to be disclosed
1193 under this Subsection (2).
1194 (c) A [
1195 interest that the [
1196 part of a mutual fund, trust, or similar investment.
1197 (3) (a) Except as required by Subsection (3)(b), as terms of current commission
1198 members expire, the governor shall appoint each new commission member to a four-year term
1199 ending on June 30.
1200 (b) Notwithstanding the requirements of Subsection (3)(a), the governor shall, at the
1201 time of appointment, adjust the length of terms to ensure that the terms of the commission
1202 members are staggered so that approximately half of the commission is appointed every two
1204 (c) A commission member may not serve more than one consecutive term.
1205 (d) When a vacancy occurs in the membership for any reason, the governor, with the
1206 consent of the Senate, shall appoint a replacement for the unexpired term.
1207 (e) Notwithstanding the other provisions of this Subsection (3), a commission member
1208 serves until a successor is appointed by the governor with the consent of the Senate.
1209 (4) (a) A [
1210 benefits for the commission member's services, but may receive per diem and expenses
1211 incurred in the performance of the commission member's official duties at the rates established
1212 by the Division of Finance under Sections 63A-3-106 and 63A-3-107 .
1213 (b) A commission member may decline to receive per diem and expenses for the
1214 commission member's service.
1215 (5) Members of the commission shall annually select one commission member to serve
1216 as chair.
1217 (6) (a) The commission shall meet at least monthly.
1218 (b) The commissioner may call additional meetings:
1219 (i) at the commissioner's discretion;
1220 (ii) upon the request of the chair of the commission; or
1221 (iii) upon the written request of three or more commission members.
1222 (c) (i) Three [
1223 transaction of business.
1224 (ii) The action of a majority of the commission members when a quorum is present is
1225 the action of the commission.
1226 (7) The [
1227 Section 3. Section 31A-2-404 is amended to read:
1228 31A-2-404. Duties of the commissioner and Title and Escrow Commission.
1229 (1) Notwithstanding the other provisions of this chapter, to the extent provided in this
1230 part, the commissioner shall administer and enforce the provisions in this title related to:
1231 (a) title insurance; and
1232 (b) escrow conducted by a title licensee or title insurer.
1233 (2) The commission shall:
1234 (a) in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and
1235 subject to Subsection (3), make rules for the administration of the provisions in this title related
1236 to title insurance including rules related to:
1237 (i) rating standards and rating methods for a title [
1238 provided in Section 31A-19a-209 ;
1239 (ii) the licensing for a title licensee, including the licensing requirements of Sections
1240 31A-23a-203 and 31A-23a-204 ;
1241 (iii) continuing education requirements of Section 31A-23a-202 ;
1242 (iv) examination procedures, after consultation with the [
1243 and the [
1244 31A-23a-204 ; and
1245 (v) standards of conduct for a title licensee;
1246 (b) concur in the issuance and renewal of [
1247 Section 31A-23a-105 or 31A-26-203 ;
1248 (c) in accordance with Section 31A-3-103 , establish, with the concurrence of the
1250 (d) in accordance with Section 31A-23a-415 determine, after consulting with the
1251 commissioner, the assessment on a title insurer as defined in Section 31A-23a-415 ;
1252 (e) conduct [
1253 to an administrative law judge related to the:
1254 (i) licensing of [
1255 (ii) conduct of [
1256 (iii) approval of a continuing education [
1257 31A-23a-202 ;
1263 (i) under this title related to:
1264 (A) title insurance; or
1265 (B) escrow conducted by a title licensee;
1266 (ii) after investigation by the [
1267 Procedures and Enforcement; and
1268 (iii) that [
1272 commissioner's budget related to title insurance; and
1274 (3) The commission may make a rule under this title only if at the time the commission
1275 files its proposed rule and rule analysis with the Division of Administrative Rules in
1276 accordance with Section 63G-3-301 , the commission provides the Real Estate Commission that
1277 same information.
1278 (4) (a) The commissioner shall annually report the information described in Subsection
1279 (4)(b) in writing to:
1280 (i) the commission; and
1281 (ii) the Business and Labor Interim Committee.
1282 (b) The information required to be reported under this Subsection (4):
1283 (i) may not identify a person; and
1284 (ii) shall include:
1285 (A) the number of complaints the [
1286 transactions involving title insurance or a title licensee during the calendar year immediately
1287 proceeding the report;
1288 (B) the type of complaints described in Subsection (4)(b)(ii)(A); and
1289 (C) for each complaint described in Subsection (4)(b)(ii)(A):
1290 (I) any action taken by the [
1292 (II) the time-period beginning the day on which a complaint is made and ending the
1293 day on which the [
1294 regard to the complaint.
1295 Section 4. Section 31A-3-103 is amended to read:
1296 31A-3-103. Fees.
1297 (1) For purposes of this section[
1298 reasonable and necessary to enable the commissioner to perform the duties imposed by this title
1304 termination; and
1306 (2) Except as otherwise provided by this title:
1307 (a) the commissioner may set and collect a fee for services provided by the
1309 (b) [
1310 frequently than once each year[
1312 with Section 63J-1-504 .
1313 (3) [
1314 fee established pursuant to this section shall be deposited into the General Fund for
1315 appropriation by the Legislature.
1320 (4) (a) The commissioner shall [
1323 pursuant to this section.
1325 a fee established [
1326 Section 5. Section 31A-3-104 is amended to read:
1327 31A-3-104. Technology fees -- Restricted account.
1328 (1) The [
1330 (a) that is obtained from an electronic database of the [
1331 (b) derived from data that is generated by electronic means.
1332 (2) In addition to any fee authorized in this title, the [
1333 impose a supplemental fee on the issuance or renewal of any of the following issued by the
1335 (a) a license;
1336 (b) a registration; or
1337 (c) a certificate of authority.
1338 (3) A fee imposed under this section shall be:
1339 (a) established in accordance with [
1340 (b) deposited into the [
1342 (4) (a) There is created in the General Fund a restricted account known as the
1343 "Technology Development Restricted Account."
1344 (b) The Technology Development Restricted Account shall consist of the fees imposed
1345 by the commissioner in accordance with this section.
1346 (c) The commissioner shall administer the Technology Development Restricted
1347 Account. Subject to appropriations by the Legislature, the commissioner shall use the money
1348 deposited into the Technology Development Restricted Account to provide services through
1349 use of electronic commerce or other similar technology.
1350 (d) The money in the Technology Development Restricted Account is nonlapsing.
1351 Section 6. Section 31A-3-105 is enacted to read:
1352 31A-3-105. Criminal Background Check Restricted Account.
1353 (1) There is created in the General Fund a restricted account known as the "Criminal
1354 Background Check Restricted Account."
1355 (2) The Criminal Background Check Restricted Account shall consist of the fees
1356 imposed by the commissioner in accordance with:
1357 (a) Subsection 31A-16-103 (3);
1358 (b) Subsection 31A-23a-105 (3);
1359 (c) Subsection 31A-25-203 (3); and
1360 (d) Subsection 31A-26-203 (3).
1361 (3) The commissioner shall administer the Criminal Background Check Restricted
1362 Account. Subject to appropriations by the Legislature, the commissioner shall use the money
1363 deposited into the Criminal Background Check Restricted Account to pay the costs the
1364 department is required to pay related to obtaining criminal background information in
1365 accordance with the provisions listed in Subsection (2)(a).
1366 (4) The money in the Criminal Background Check Restricted Account is nonlapsing.
1367 Section 7. Section 31A-3-304 (Superseded 07/01/10) is amended to read:
1368 31A-3-304 (Superseded 07/01/10). Annual fees -- Other taxes or fees prohibited --
1369 Captive Insurance Restricted Account.
1370 (1) (a) A captive insurance company shall pay an annual fee imposed under this section
1371 to obtain or renew a certificate of authority.
1372 (b) The commissioner shall:
1373 (i) determine the annual fee pursuant to [
1375 (ii) consider whether the annual fee is competitive with fees imposed by other states on
1376 captive insurance companies.
1377 (2) A captive insurance company that fails to pay the fee required by this section is
1378 subject to the relevant sanctions of this title.
1379 (3) (a) Except as provided in Subsection (3)(b) and notwithstanding Title 59, Chapter
1380 9, Taxation of Admitted Insurers, the fee provided for in this section constitutes the sole tax or
1381 fee under the laws of this state that may be otherwise levied or assessed on a captive insurance
1382 company, and no other occupation tax or other tax or fee may be levied or collected from a
1383 captive insurance company by the state or a county, city, or municipality within this state.
1384 (b) Notwithstanding Subsection (3)(a), a captive insurance company is subject to real
1385 and personal property taxes.
1386 (4) A captive insurance company shall pay the fee imposed by this section to the
1390 (5) (a) Money received pursuant to Subsection (2) shall be deposited into the Captive
1391 Insurance Restricted Account.
1392 (b) There is created in the General Fund a restricted account known as the "Captive
1393 Insurance Restricted Account."
1394 (c) The Captive Insurance Restricted Account shall consist of the fees imposed by the
1395 commissioner in accordance with this section.
1396 (d) The commissioner shall administer the Captive Insurance Restricted Account.
1397 Subject to appropriations by the Legislature, the commissioner shall use the money deposited
1398 into the Captive Insurance Restricted Account to:
1399 (i) administer and enforce Chapter 37, Captive Insurance Companies Act; and
1400 (ii) promote the captive insurance industry in Utah.
1402 except that at the end of each fiscal year, [
1403 commissioner in excess of $250,000 shall be treated as free revenue in the General Fund.
1404 Section 8. Section 31A-3-304 (Effective 07/01/10) is amended to read:
1405 31A-3-304 (Effective 07/01/10). Annual fees -- Other taxes or fees prohibited --
1406 Captive Insurance Restricted Account.
1407 (1) (a) A captive insurance company shall pay an annual fee imposed under this section
1408 to obtain or renew a certificate of authority.
1409 (b) The commissioner shall:
1410 (i) determine the annual fee pursuant to [
1412 (ii) consider whether the annual fee is competitive with fees imposed by other states on
1413 captive insurance companies.
1414 (2) A captive insurance company that fails to pay the fee required by this section is
1415 subject to the relevant sanctions of this title.
1416 (3) (a) Except as provided in Subsection (3)(b) and notwithstanding Title 59, Chapter
1417 9, Taxation of Admitted Insurers, the fee provided for in this section constitutes the sole tax or
1418 fee under the laws of this state that may be otherwise levied or assessed on a captive insurance
1419 company, and no other occupation tax or other tax or fee may be levied or collected from a
1420 captive insurance company by the state or a county, city, or municipality within this state.
1421 (b) Notwithstanding Subsection (3)(a), a captive insurance company is subject to real
1422 and personal property taxes.
1423 (4) A captive insurance company shall pay the fee imposed by this section to the
1427 (5) (a) Money received pursuant to Subsection (2) shall be deposited into the Captive
1428 Insurance Restricted Account.
1429 (b) There is created in the General Fund a restricted account known as the "Captive
1430 Insurance Restricted Account."
1431 (c) The Captive Insurance Restricted Account shall consist of the fees imposed by the
1432 commissioner in accordance with this section.
1433 (d) The commissioner shall administer the Captive Insurance Restricted Account.
1434 Subject to appropriations by the Legislature, the commissioner shall use the money deposited
1435 into the Captive Insurance Restricted Account to:
1436 (i) administer and enforce Chapter 37, Captive Insurance Companies Act; and
1437 (ii) promote the captive insurance industry in Utah.
1439 except that at the end of each fiscal year, [
1440 commissioner in excess of $750,000 shall be treated as free revenue in the General Fund.
1441 Section 9. Section 31A-5-217.5 is amended to read:
1442 31A-5-217.5. Variable contract law.
1443 (1) This section applies to [
1444 support [
1445 (a) a variable life insurance [
1446 Section 817, Internal Revenue Code;
1447 (b) a variable annuity [
1448 annuity; or
1449 (c) benefits under [
1450 Security Act of 1974.
1451 (2) [
1452 section of this title as it relates to [
1453 (1), this section prevails.
1454 (3) [
1456 (i) establish one or more separate accounts[
1457 (ii) allocate to those separate accounts amounts, which include:
1458 (A) proceeds applied under optional modes of settlement or under dividend options, to
1459 provide for life insurance or annuities[
1460 (B) benefits incidental to life insurance or annuities, payable in fixed [
1461 both fixed and variable amounts [
1463 gains, and losses, realized or unrealized, from assets allocated to [
1465 of the [
1467 and funds referred to in Subsection [
1468 (i) an insurer may invest or reinvest amounts allocated to [
1469 accumulations on [
1471 investments of a life [
1472 (ii) an insurer may not take into account the investments in [
1473 account [
1474 apply to the investments of the [
1476 condition the commissioner prescribes as to investments and other matters [
1478 not maintain in a separate account reserves for:
1479 (i) benefits guaranteed as to dollar amount and duration[
1480 (ii) funds guaranteed as to principal amount or stated rate of interest [
1483 approved by the commissioner, assets allocated to a separate account shall be valued:
1484 (A) at their market value on the date of valuation[
1485 (B) if there is no readily available market, then as provided under the terms of the
1486 contract [
1488 (ii) Unless otherwise approved by the commissioner, the portion of [
1489 of [
1490 regard to the guaranteed benefits and funds referred to in Subsection [
1491 in accordance with the rules that otherwise apply to the company's assets.
1493 account in the exercise of the power granted by this section [
1495 those amounts. [
1496 (ii) To the extent provided under the applicable [
1497 insurer may not charge the portion of the assets of [
1498 reserves and other [
1503 account and one or more of its separate accounts unless[
1504 (A) in case of a transfer into a separate account, the transfer is made solely to establish
1505 the account or to support the operation of the [
1506 separate account to which the transfer is made[
1507 (B) the transfer, whether into or from a separate account, is made by:
1508 (I) a transfer of cash[
1509 (II) if the transfer of securities is approved by the commissioner, a transfer of securities
1510 having a readily determinable market value[
1512 (ii) The commissioner may approve [
1513 Subsection (2)(g)(i) among [
1514 commissioner's opinion, the [
1517 separate account, including [
1518 company or a unit investment trust, may provide for [
1519 separate account to have appropriate voting and other rights and special procedures for the
1520 conduct of the business of the separate account, including:
1521 (i) special rights and procedures relating to investment policy[
1522 (ii) investment advisory services[
1523 (iii) selection of independent public accountants[
1524 (iv) the selection of a committee, the members of which need not be otherwise
1525 affiliated with the [
1564 Section 10. Section 31A-15-208 is amended to read:
1565 31A-15-208. Purchasing groups -- Filing and registration requirements.
1566 (1) A purchasing group [
1567 doing business, furnish notice to the insurance commissioner:
1568 (a) identifying the state in which the purchasing group is domiciled;
1569 (b) identifying [
1571 (c) specifying the lines and classifications of liability insurance [
1572 purchasing group intends to purchase;
1573 (d) identifying the [
1574 purchase its insurance and the domicile of the [
1575 (e) specifying the method by which, and any persons through whom, insurance will be
1576 offered to group members whose risks are resident or located in this state;
1577 (f) identifying the principal place of business of the purchasing group; and
1578 (g) providing any other information required by the [
1579 that the purchasing group is [
1580 group," as defined in Section 31A-15-202 [
1581 (2) A purchasing group shall notify the commissioner of [
1583 (3) [
1584 pay a filing fee. [
1585 (b) A purchasing group shall designate the commissioner as its agent solely for the
1586 purpose of receiving service of legal documents or process.
1587 (c) The registration and fee requirements of this Subsection (3) do not apply to a
1588 purchasing group [
1589 Liability Risk Retention Act of 1981, and [
1596 insurer licensed in any state; or
1598 Retention Act of 1981 before October 27, 1986.
1599 (4) [
1600 also furnish information required by the commissioner to:
1601 (a) verify that the entity qualifies as a purchasing group;
1602 (b) determine where the purchasing group is located; and
1603 (c) determine appropriate tax treatment of the purchasing group.
1604 Section 11. Section 31A-20-106 is amended to read:
1605 31A-20-106. Variable contracts.
1609 (i) is licensed to do a life insurance or annuity business in this state; and
1610 (ii) satisfies the commissioner that [
1611 operation in connection with those types of [
1612 insurer's operation hazardous to the public or its policyholders in [
1613 (b) Notwithstanding any other provision of law, the commissioner has sole authority
1615 (i) regulate the issuance and sale of a variable contract; and
1616 (ii) make rules necessary and appropriate to carry out this chapter in relation to a
1617 variable contract.
1618 (2) In determining the qualification of an insurer requesting authority to deliver [
1620 commissioner shall consider:
1623 directors; and
1625 its domicile or the jurisdiction in which its head office is located provides protection to
1626 policyholders and the public substantially equal to that provided by [
1627 title and the rules issued under [
1628 (3) If an insurer is a subsidiary of an admitted life insurer, or affiliated with an admitted
1629 life insurer through common management or ownership, the commissioner may consider the
1630 insurer to have met the requirements of this section if:
1631 (a) the insurer meets the requirements of this section; or
1632 (b) the parent or the affiliated insurer meets the requirements of this section.
1633 (4) This title applies to a separate account or a contract relating to the separate account,
1635 (a) Sections 31A-22-402 , 31A-22-407 , and 31A-22-409 , in the case of a variable
1636 annuity policy;
1637 (b) Sections 31A-22-402 , 31A-22-407 , and 31A-22-408 , in the case of a variable life
1638 insurance policy; and
1639 (c) as otherwise provided in this title.
1640 Section 12. Section 31A-21-201 is amended to read:
1641 31A-21-201. Filing of forms.
1642 (1) (a) Except as exempted under Subsections 31A-21-101 (2) through (6), a form may
1643 not be used, sold, or offered for sale [
1645 (b) A form is considered filed with the commissioner when the commissioner receives:
1646 (i) the form;
1647 (ii) the applicable filing fee as prescribed under Section 31A-3-103 ; and
1648 (iii) the applicable transmittal forms as required by the commissioner.
1649 (2) In filing a form for use in this state the insurer is responsible for assuring that the
1650 form is in compliance with this title and rules adopted by the commissioner.
1651 (3) (a) The commissioner may prohibit the use of a form at any time upon a finding
1653 (i) the form [
1654 (A) is inequitable;
1655 (B) is unfairly discriminatory;
1656 (C) is misleading;
1657 (D) is deceptive;
1658 (E) is obscure;
1659 (F) is unfair;
1660 (G) encourages misrepresentation; or
1661 (H) is not in the public interest;
1662 (ii) the form provides benefits or contains [
1663 provision that endangers the solidity of the insurer;
1664 (iii) [
1665 except an application required by Section 31A-22-635 , the form is an insurance policy or
1666 application for [
1668 (A) the exact name of the insurer;
1669 (B) the state of domicile of the insurer filing the [
1670 for the [
1671 (C) for a life insurance and annuity [
1672 administrative office of the insurer filing the [
1674 (iv) the form violates a statute or a rule adopted by the commissioner; or
1675 (v) the form is otherwise contrary to law.
1676 (b) Subsection (3)(a)(iii) does not apply to [
1677 to [
1678 (c) (i) [
1679 Subsection (3)(a), the commissioner may order that, on or before a date not less than 15 days
1680 after the order, the use of the form be discontinued.
1681 (ii) Once use of a form [
1682 appropriate changes are filed with and reviewed by the commissioner.
1683 (iii) [
1684 (3)(a), the commissioner may require the insurer to disclose contract deficiencies to the
1685 existing policyholders.
1686 (d) If the commissioner prohibits use of a form under this Subsection (3), the
1687 prohibition shall:
1688 (i) be in writing;
1689 (ii) constitute an order; and
1690 (iii) state the reasons for the prohibition.
1691 (4) (a) If, after a hearing, the commissioner determines that it is in the public interest,
1692 the commissioner may require by rule or order that [
1693 commissioner's approval [
1694 (b) The rule or order described in Subsection (4)(a) shall prescribe the filing
1695 procedures for [
1696 stated in this section.
1697 (c) The [
1698 (4)(a) [
1699 (i) a form for a particular class of insurance;
1700 (ii) a form for a specific line of insurance;
1701 (iii) a specific type of form; or
1702 (iv) a form for a specific market segment.
1703 (5) (a) An insurer shall maintain a complete and accurate record of the following for
1704 the time period described in Subsection (5)(b):
1705 (i) [
1706 (A) filed under this section for use; [
1707 (B) that is in use; and
1708 (ii) [
1710 (b) The insurer shall maintain a record required under Subsection (5)(a) for the balance
1711 of the current year, plus five years from:
1712 (i) the last day on which the form is used; or
1713 (ii) the last day [
1714 Section 13. Section 31A-21-301 is amended to read:
1715 31A-21-301. Clauses required to be in a prominent position.
1716 (1) The following portions of insurance policies shall appear conspicuously in the
1718 (a) as required by Subsection 31A-21-201 (3)(a)(iii):
1719 (i) the exact name of the insurer;
1720 (ii) the state of domicile of the insurer; and
1721 (iii) for life insurance and annuity policies only, the address of the administrative office
1722 of the insurer;
1723 (b) information that two or more insurers under Subsection (1)(a) undertake only
1724 several liability, as required by Section 31A-21-306 ;
1725 (c) if a policy is assessable, a statement of that;
1726 (d) a statement that benefits are variable, as required by [
1727 31A-22-411 [
1728 (e) the right to return a life or accident and health insurance policy under Sections
1729 31A-22-423 and 31A-22-606 ; and
1730 (f) the beginning and ending dates of insurance protection.
1731 (2) Each clause listed in Subsection (1) shall be displayed conspicuously and separately
1732 from any other clause.
1733 Section 14. Section 31A-22-305.3 is amended to read:
1734 31A-22-305.3. Underinsured motorist coverage.
1735 (1) As used in this section:
1736 (a) "Covered person" has the same meaning as defined in Section 31A-22-305 .
1737 (b) (i) "Underinsured motor vehicle" includes a motor vehicle, the operation,
1738 maintenance, or use of which is covered under a liability policy at the time of an injury-causing
1739 occurrence, but which has insufficient liability coverage to compensate fully the injured party
1740 for all special and general damages.
1741 (ii) The term "underinsured motor vehicle" does not include:
1742 (A) a motor vehicle that is covered under the liability coverage of the same policy that
1743 also contains the underinsured motorist coverage;
1744 (B) an uninsured motor vehicle as defined in Subsection 31A-22-305 (2); or
1745 (C) a motor vehicle owned or leased by:
1746 (I) [
1747 (II) [
1748 (III) [
1749 (2) (a) (i) Underinsured motorist coverage under Subsection 31A-22-302 (1)(c)
1750 provides coverage for a covered [
1751 damages from [
1752 vehicle because of bodily injury, sickness, disease, or death.
1753 (ii) A covered person occupying or using a motor vehicle owned, leased, or furnished
1754 to the covered person, the covered person's spouse, or covered person's resident relative may
1755 recover underinsured benefits only if the motor vehicle is:
1756 (A) described in the policy under which a claim is made; or
1757 (B) a newly acquired or replacement motor vehicle covered under the terms of the
1759 (b) For new policies written on or after January 1, 2001, the limits of underinsured
1760 motorist coverage shall be equal to the lesser of the limits of the insured's motor vehicle
1761 liability coverage or the maximum underinsured motorist coverage limits available by the
1762 insurer under the insured's motor vehicle policy, unless the insured purchases coverage in a
1763 lesser amount by signing an acknowledgment form that:
1764 (i) is filed with the department;
1765 (ii) is provided by the insurer;
1766 (iii) waives the higher coverage;
1767 (iv) reasonably explains the purpose of underinsured motorist coverage; and
1768 (v) discloses the additional premiums required to purchase underinsured motorist
1769 coverage with limits equal to the lesser of the limits of the insured's motor vehicle liability
1770 coverage or the maximum underinsured motorist coverage limits available by the insurer under
1771 the insured's motor vehicle policy.
1772 (c) A self-insured, including a governmental entity, may elect to provide underinsured
1773 motorist coverage in an amount that is less than its maximum self-insured retention under
1774 Subsections (2)(b) and (2)(g) by issuing a declaratory memorandum or policy statement from
1775 the chief financial officer or chief risk officer that declares the:
1776 (i) self-insured entity's coverage level; and
1777 (ii) process for filing an underinsured motorist claim.
1778 (d) Underinsured motorist coverage may not be sold with limits that are less than:
1779 (i) $10,000 for one person in any one accident; and
1780 (ii) at least $20,000 for two or more persons in any one accident.
1781 (e) [
1782 underinsured motorist coverage until the insured, in writing, requests different underinsured
1783 motorist coverage from the insurer.
1784 (f) (i) The named insured's underinsured motorist coverage, as described in Subsection
1785 (2)(a), is secondary to the liability coverage of an owner or operator of an underinsured motor
1786 vehicle, as described in Subsection (1).
1787 (ii) Underinsured motorist coverage may not be set off against the liability coverage of
1788 the owner or operator of an underinsured motor vehicle, but shall be added to, combined with,
1789 or stacked upon the liability coverage of the owner or operator of the underinsured motor
1790 vehicle to determine the limit of coverage available to the injured person.
1791 (g) (i) A named insured may reject underinsured motorist coverage by an express
1792 writing to the insurer that provides liability coverage under Subsection 31A-22-302 (1)(a).
1793 (ii) [
1794 by the insurer that includes a reasonable explanation of the purpose of underinsured motorist
1795 coverage and when it would be applicable.
1796 (iii) [
1797 the liability coverage until the insured in writing requests underinsured motorist coverage from
1798 that liability insurer.
1809 (3) (a) (i) Except as provided in this Subsection (3), a covered person injured in a
1810 motor vehicle described in a policy that includes underinsured motorist benefits may not elect
1811 to collect underinsured motorist coverage benefits from [
1812 insurance policy.
1813 (ii) The limit of liability for underinsured motorist coverage for two or more motor
1814 vehicles may not be added together, combined, or stacked to determine the limit of insurance
1815 coverage available to an injured person for any one accident.
1816 (iii) Subsection (3)(a)(ii) applies to all persons except a covered person described
1817 under Subsections (3)(b)(i) and (ii).
1818 (b) (i) Except as provided in Subsection (3)(b)(ii), a covered person injured while
1819 occupying, using, or maintaining a motor vehicle that is not owned, leased, or furnished to the
1820 covered person, the covered person's spouse, or the covered person's resident parent or resident
1821 sibling, may also recover benefits under any one other policy under which [
1822 covered person is also a covered person.
1823 (ii) (A) A covered person may recover benefits from no more than two additional
1824 policies, one additional policy from each parent's household if the covered person is:
1825 (I) a dependent minor of parents who reside in separate households; and
1826 (II) injured while occupying or using a motor vehicle that is not owned, leased, or
1827 furnished to the covered person, the covered person's resident parent, or the covered person's
1828 resident sibling.
1829 (B) Each parent's policy under this Subsection (3)(b)(ii) is liable only for the
1830 percentage of the damages that the limit of liability of each parent's policy of underinsured
1831 motorist coverage bears to the total of both parents' underinsured coverage applicable to the
1833 (iii) A covered person's recovery under any available policies may not exceed the full
1834 amount of damages.
1835 (iv) Underinsured coverage on a motor vehicle occupied at the time of an accident
1837 Subsections 31A-22-305 (1)(a) and (b) [
1838 (v) The primary and the secondary coverage may not be set off against the other.
1839 (vi) A covered person as described under Subsection (3)(b)(i) is entitled to the highest
1840 limits of underinsured motorist coverage under only one additional policy per household
1841 applicable to that covered person as a named insured, spouse, or relative.
1842 (vii) A covered injured person is not barred against making subsequent elections if
1843 recovery is unavailable under previous elections.
1844 (viii) (A) As used in this section, "interpolicy stacking" means recovering benefits for a
1845 single incident of loss under more than one insurance policy.
1846 (B) Except to the extent permitted by this Subsection (3), interpolicy stacking is
1847 prohibited for underinsured motorist coverage.
1848 (c) Underinsured motorist coverage:
1849 (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
1850 Compensation Act;
1851 (ii) may not be subrogated by [
1852 (iii) may not be reduced by [
1854 (iv) may be reduced by health insurance subrogation only after the covered person [
1856 (v) may not be collected for bodily injury or death sustained by a person:
1857 (A) while committing a violation of Section 41-1a-1314 ;
1858 (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
1859 in violation of Section 41-1a-1314 ; or
1860 (C) while committing a felony; and
1861 (vi) notwithstanding Subsection (3)(c)(v), may be recovered:
1862 (A) for a person under 18 years of age who is injured within the scope of Subsection
1863 (3)(c)(v), but is limited to medical and funeral expenses; or
1864 (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
1865 within the course and scope of the law enforcement officer's duties.
1866 (4) The inception of the loss under Subsection 31A-21-313 (1) for underinsured
1867 motorist claims occurs upon the date of the last liability policy payment.
1868 (5) (a) Within five business days after notification that all liability insurers have
1869 tendered their liability policy limits, the underinsured carrier shall either:
1870 (i) waive any subrogation claim the underinsured carrier may have against the person
1871 liable for the injuries caused in the accident; or
1872 (ii) pay the insured an amount equal to the policy limits tendered by the liability carrier.
1873 (b) If neither option is exercised under Subsection (5)(a), the subrogation claim is
1874 considered to be waived by the underinsured carrier.
1875 (6) Except as otherwise provided in this section, a covered person may seek, subject to
1876 the terms and conditions of the policy, additional coverage under any policy:
1877 (a) that provides coverage for damages resulting from motor vehicle accidents; and
1878 (b) that is not required to conform to Section 31A-22-302 .
1879 (7) (a) When a claim is brought by a named insured or a person described in
1880 Subsection 31A-22-305 (1) and is asserted against the covered person's underinsured motorist
1881 carrier, the claimant may elect to resolve the claim:
1882 (i) by submitting the claim to binding arbitration; or
1883 (ii) through litigation.
1884 (b) Unless otherwise provided in the policy under which underinsured benefits are
1885 claimed, the election provided in Subsection (7)(a) is available to the claimant only.
1886 (c) Once [
1887 (7)(a)(ii), the claimant may not elect to resolve the claim through binding arbitration under this
1888 section without the written consent of the underinsured motorist coverage carrier.
1889 (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
1890 binding arbitration under Subsection (7)(a)(i) shall be resolved by a single arbitrator.
1891 (ii) All parties shall agree on the single arbitrator selected under Subsection (7)(d)(i).
1892 (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
1893 (7)(d)(ii), the parties shall select a panel of three arbitrators.
1894 (e) If the parties select a panel of three arbitrators under Subsection (7)(d)(iii):
1895 (i) each side shall select one arbitrator; and
1896 (ii) the arbitrators appointed under Subsection (7)(e)(i) shall select one additional
1897 arbitrator to be included in the panel.
1898 (f) Unless otherwise agreed to in writing:
1899 (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
1900 under Subsection (7)(d)(i); or
1901 (ii) if an arbitration panel is selected under Subsection (7)(d)(iii):
1902 (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
1903 (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
1904 under Subsection (7)(e)(ii).
1905 (g) Except as otherwise provided in this section or unless otherwise agreed to in
1906 writing by the parties, an arbitration proceeding conducted under this section [
1907 governed by Title 78B, Chapter 11, Utah Uniform Arbitration Act.
1908 (h) [
1909 54, and 68 of the Utah Rules of Civil Procedure.
1910 (i) [
1911 arbitration panel.
1912 (j) A written decision by a single arbitrator or by a majority of the arbitration panel
1914 (k) (i) The amount of an arbitration award may not exceed the underinsured motorist
1915 policy limits of all applicable underinsured motorist policies, including applicable underinsured
1916 motorist umbrella policies.
1917 (ii) If the initial arbitration award exceeds the underinsured motorist policy limits of all
1918 applicable underinsured motorist policies, the arbitration award shall be reduced to an amount
1919 equal to the combined underinsured motorist policy limits of all applicable underinsured
1920 motorist policies.
1921 (l) The arbitrator or arbitration panel may not decide [
1922 or extra-contractual damages, including:
1923 (i) whether the claimant is a covered person;
1924 (ii) whether the policy extends coverage to the loss; or
1925 (iii) [
1926 or bad faith liability.
1927 (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
1928 class-representative basis.
1929 (n) If the arbitrator or arbitration panel finds that the [
1930 brought, pursued, or defended in good faith, the arbitrator or arbitration panel may award
1931 reasonable attorney fees and costs against the party that failed to bring, pursue, or defend the
1933 (o) An arbitration award issued under this section shall be the final resolution of all
1934 claims not excluded by Subsection (7)(l) between the parties unless:
1935 (i) the award [
1936 (ii) either party, within 20 days after service of the arbitration award:
1937 (A) files a complaint requesting a trial de novo in the district court; and
1938 (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
1939 under Subsection (7)(o)(ii)(A).
1940 (p) (i) Upon filing a complaint for a trial de novo under Subsection (7)(o), [
1941 shall proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules
1942 of Evidence in the district court.
1943 (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
1944 request a jury trial with a complaint requesting a trial de novo under Subsection (7)(o)(ii)(A).
1945 (q) (i) If the claimant, as the moving party in a trial de novo requested under
1946 Subsection (7)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater
1947 than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
1948 (ii) If the underinsured motorist carrier, as the moving party in a trial de novo requested
1949 under Subsection (7)(o), does not obtain a verdict that is at least 20% less than the arbitration
1950 award, the underinsured motorist carrier is responsible for all of the nonmoving party's costs.
1951 (iii) Except as provided in Subsection (7)(q)(iv), the costs under this Subsection (7)(q)
1952 shall include:
1953 (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
1954 (B) the costs of expert witnesses and depositions.
1955 (iv) An award of costs under this Subsection (7)(q) may not exceed $2,500.
1956 (r) For purposes of determining whether a party's verdict is greater or less than the
1957 arbitration award under Subsection (7)(q), a court may not consider any recovery or other relief
1958 granted on a claim for damages if the claim for damages:
1959 (i) was not fully disclosed in writing prior to the arbitration proceeding; or
1960 (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil
1962 (s) If a district court determines, upon a motion of the nonmoving party, that [
1963 moving party's use of the trial de novo process [
1964 Section 78B-5-825 , the district court may award reasonable attorney fees to the nonmoving
1966 (t) Nothing in this section is intended to limit [
1967 portion of an applicable insurance policy.
1968 (u) If there are multiple underinsured motorist policies, as set forth in Subsection (3),
1969 the claimant may elect to arbitrate in one hearing the claims against all the underinsured
1970 motorist carriers.
1971 Section 15. Section 31A-22-411 is amended to read:
1972 31A-22-411. Contracts providing variable benefits.
1973 (1) [
1975 features of the procedure to be followed by the insurer in determining the dollar amount of the
1976 variable benefits. [
1977 (2) A variable insurance policy shall contain:
1979 either Section 31A-22-408 or 31A-22-409 ;
1981 by Section 31A-22-407 ; and
1983 insurance policy in lieu of those required by Section 31A-22-402 .
1985 under a group [
1986 page that:
1987 (a) the dollar amount may decrease or increase [
1989 experience; and
1990 (b) a benefit under the insurance policy is payable on a variable basis[
1994 insurance policy, state that the insurer's liabilities with respect to a variable [
1995 under the insurance policy are subject to satisfaction only out of the insurer's variable account
1998 (5)(a) A variable insurance policy shall state whether it may be amended as to:
1999 (i) investment policy[
2000 (ii) voting rights[
2001 (iii) conduct of the business and affairs of [
2002 (b) Subject to any preemptive provision of federal law, [
2003 the type described in this Subsection (5) is subject to:
2004 (i) filing under Section 31A-21-201 ; and
2005 (ii) approval by a majority of the policyholders in the [
2006 Section 16. Section 31A-22-625 is amended to read:
2007 31A-22-625. Catastrophic coverage of mental health conditions.
2008 (1) As used in this section:
2009 (a) (i) "Catastrophic mental health coverage" means coverage in a health benefit plan
2011 payment limit, episodic limit, inpatient or outpatient service limit, or maximum out-of-pocket
2012 limit that places a greater financial burden on an insured for the evaluation and treatment of a
2013 mental health condition than for the evaluation and treatment of a physical health condition.
2014 (ii) "Catastrophic mental health coverage" may include a restriction on cost sharing
2015 factors, such as deductibles, copayments, or coinsurance, [
2016 maximum out-of-pocket limit.
2017 (iii) "Catastrophic mental health coverage" may include one maximum out-of-pocket
2018 limit for physical health conditions and another maximum out-of-pocket limit for mental health
2019 conditions, [
2020 out-of-pocket limit for mental health conditions may not exceed the out-of-pocket limit for
2021 physical health conditions.
2022 (b) (i) "50/50 mental health coverage" means coverage in a health benefit plan [
2024 diagnosis and treatment of mental health conditions.
2025 (ii) "50/50 mental health coverage" may include a restriction on:
2026 (A) episodic limits[
2027 (B) inpatient or outpatient service limits[
2028 (C) maximum out-of-pocket limits.
2029 (c) "Large employer," [
2030 Sec. 300gg-91.
2031 (d) (i) "Mental health condition" means [
2032 illness that falls under [
2033 and Statistical Manual, as periodically revised.
2034 (ii) "Mental health condition" does not include the following when diagnosed as the
2035 primary or substantial reason or need for treatment:
2036 (A) a marital or family problem;
2037 (B) a social, occupational, religious, or other social maladjustment;
2038 (C) a conduct disorder;
2039 (D) a chronic adjustment disorder;
2040 (E) a psychosexual disorder;
2041 (F) a chronic organic brain syndrome;
2042 (G) a personality disorder;
2043 (H) a specific developmental disorder or learning disability; or
2044 (I) mental retardation.
2045 (e) "Small employer" is as defined in [
2046 (2) (a) At the time of purchase and renewal, an insurer shall offer to [
2047 employer that it insures or seeks to insure a choice between catastrophic mental health
2048 coverage and 50/50 mental health coverage.
2049 (b) In addition to complying with Subsection (2)(a), an insurer may offer to provide:
2050 (i) catastrophic mental health coverage, 50/50 mental health coverage, or both at levels
2051 that exceed the minimum requirements of this section; or
2052 (ii) coverage that excludes benefits for mental health conditions.
2053 (c) A small employer may, at its option, choose either catastrophic mental health
2054 coverage, 50/50 mental health coverage, or coverage offered under Subsection (2)(b),
2055 regardless of the employer's previous coverage for mental health conditions.
2056 (d) An insurer is exempt from the 30% index rating restriction in Subsection
2057 31A-30-106 (1)(b) and, for the first year only that catastrophic mental health coverage is
2058 chosen, the 15% annual adjustment restriction in Subsection 31A-30-106 (1)(c)(ii), for any
2059 small employer with 20 or less enrolled employees who chooses coverage that meets or
2060 exceeds catastrophic mental health coverage.
2069 (3) An insurer shall offer a large employer mental health and substance use disorder
2070 benefit in compliance with Section 2705 of the Public Health Service Act, 42 U.S.C. Sec.
2071 300gg-5, and federal regulations adopted pursuant to that act.
2072 (4) (a) An insurer may provide catastrophic mental health coverage to a small employer
2073 through a managed care organization or system in a manner consistent with [
2074 Chapter 8, Health Maintenance Organizations and Limited Health Plans, regardless of whether
2075 the insurance policy [
2076 of physical health conditions.
2077 (b) (i) Notwithstanding any other provision of this title, an insurer may:
2078 (A) establish a closed panel of providers for catastrophic mental health coverage; and
2079 (B) refuse to provide [
2080 provider unless:
2081 (I) the insured is referred to a nonpanel provider with the prior authorization of the
2082 insurer; and
2083 (II) the nonpanel provider agrees to follow the insurer's protocols and treatment
2085 (ii) If an insured receives services from a nonpanel provider in the manner permitted by
2086 Subsection (4)(b)(i)(B), the insurer shall reimburse the insured for not less than 75% of the
2087 average amount paid by the insurer for comparable services of panel providers under a
2088 noncapitated arrangement who are members of the same class of health care providers.
2089 (iii) [
2090 insurer to authorize a referral to a nonpanel provider.
2091 (c) To be eligible for catastrophic mental health coverage, a diagnosis or treatment of a
2092 mental health condition must be rendered:
2093 (i) by a mental health therapist as defined in Section 58-60-102 ; or
2094 (ii) in a health care facility:
2095 (A) licensed or otherwise authorized to provide mental health services pursuant to:
2096 (I) Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act[
2097 (II) Title 62A, Chapter 2, Licensure of Programs and Facilities[
2098 (B) that provides a program for the treatment of a mental health condition pursuant to a
2099 written plan.
2100 (5) The commissioner may prohibit [
2101 mental health coverage in a manner that is inconsistent with this section.
2102 (6) The commissioner shall:
2103 (a) adopt rules, in accordance with Title 63G, Chapter 3, Utah Administrative
2104 Rulemaking Act, as necessary to ensure compliance with this section; and
2105 (b) provide general figures on the percentage of [
2107 (i) no mental health coverage[
2108 (ii) 50/50 mental health coverage[
2109 (iii) catastrophic mental health coverage[
2110 (iv) coverage that exceeds the minimum requirements of this section.
2126 (7) This section may not be construed as discouraging or otherwise preventing
2128 connection with an individual insurance policy [
2130 Section 17. Section 31A-22-701 is amended to read:
2131 31A-22-701. Groups eligible for group or blanket insurance.
2132 (1) As used in this section, "association group" means a lawfully formed association of
2133 individuals or business entities that:
2134 (a) purchases insurance on a group basis on behalf of members; and
2135 (b) is formed and maintained in good faith for purposes other than obtaining insurance.
2137 (a) [
2138 (i) to which a group life insurance policy may be issued under Sections 31A-22-502
2140 (ii) that is formed for a reason other than the purchase of insurance; [
2141 (b) an association group that:
2142 (i) has been actively in existence for at least five years;
2143 (ii) has a constitution and bylaws;
2144 (iii) is formed and maintained in good faith for purposes other than obtaining
2146 (iv) does not condition membership in the association group on any health
2147 status-related factor relating to an individual, including an employee of an employer or a
2148 dependent of an employee;
2149 (v) makes accident and health insurance coverage offered through the association
2150 group available to all members regardless of any health status-related factor relating to the
2151 members or individuals eligible for coverage through a member; and
2152 (vi) does not make accident and health insurance coverage offered through the
2153 association group available other than in connection with a member of the association group; or
2155 31A-22-509 , upon a finding that:
2156 (i) authorization is not contrary to the public interest;
2157 (ii) the proposed group is actuarially sound;
2158 (iii) formation of the proposed group may result in economies of scale in acquisition,
2159 administrative, marketing, and brokerage costs;
2160 (iv) the [
2161 will be offered to the proposed group is substantially equivalent to insurance policies that are
2162 otherwise available to similar groups; [
2164 (v) the group would not present hazards of adverse selection; and
2165 (vi) the premiums for the insurance policy and any contributions by or on behalf of the
2166 insured persons are reasonable in relation to the benefits provided.
2168 (a) [
2169 transportation, as policyholder, covering persons who may become passengers as defined by
2170 reference to their travel status;
2171 (b) an employer, as policyholder, covering any group of employees, dependents, or
2172 guests, as defined by reference to specified hazards incident to any activities of the
2174 (c) an institution of learning, including a school district, school jurisdictional units, or
2175 the head, principal, or governing board of any of those units, as policyholder, covering
2176 students, teachers, or employees;
2177 (d) [
2178 branch of those organizations, as policyholder, covering any group of members or participants
2179 as defined by reference to specified hazards incident to the activities sponsored or supervised
2180 by the policyholder;
2181 (e) a sports team, camp, or sponsor of the team or camp, as policyholder, covering
2182 members, campers, employees, officials, or supervisors;
2183 (f) [
2184 organization, as policyholder, covering any group of members or participants as defined by
2185 reference to specified hazards incident to activities sponsored, supervised, or participated in by
2186 the policyholder;
2187 (g) a newspaper or other publisher, as policyholder, covering its carriers;
2188 (h) an association, including a labor union, which has a constitution and bylaws and
2189 which has been organized in good faith for purposes other than that of obtaining insurance, as
2190 policyholder, covering any group of members or participants as defined by reference to
2191 specified hazards incident to the activities or operations sponsored or supervised by the
2193 (i) a health insurance purchasing association, as defined in Section 31A-34-103 ,
2194 organized and controlled solely by participating employers; and
2195 (j) any other class of risks [
2196 properly eligible for blanket accident and health insurance.
2198 (a) individual risks;
2199 (b) a class of risks; or
2200 (c) both Subsections [
2201 Section 18. Section 31A-22-722 is amended to read:
2202 31A-22-722. Utah mini-COBRA benefits for employer group coverage.
2203 (1) An insured [
2204 employer's group policy for a period of 12 months, except as provided in [
2205 Subsections (2) and 31A-22-722.5 (4). The right to extend coverage includes:
2206 (a) voluntary termination;
2207 (b) involuntary termination;
2208 (c) retirement;
2209 (d) death;
2210 (e) divorce or legal separation;
2211 (f) loss of dependent status;
2212 (g) sabbatical;
2213 (h) [
2214 (i) leave of absence; or
2215 (j) reduction of hours.
2216 (2) (a) Notwithstanding [
2218 the employee:
2219 (i) [
2220 contributions in accordance with the terms of the insurance policy;
2221 (ii) acquires other group coverage covering all preexisting conditions including
2222 maternity, if the coverage exists;
2223 (iii) [
2224 the coverage;
2225 (iv) [
2226 the coverage;
2227 (v) [
2228 (vi) [
2229 policy for a period of three months immediately [
2230 insurance policy due to [
2231 (vii) is eligible for [
2232 (viii) establishes residence outside of this state;
2233 (ix) moves out of the insurer's service area;
2234 (x) is eligible for similar coverage under another group insurance policy;
2235 (xi) has the employee's coverage terminated because the employer's coverage is
2236 terminated, except as provided in Subsection (8); or
2238 (b) The right to extend coverage under Subsection (1) applies to [
2239 dependent [
2240 under the insurance policy terminates by reason of the death of the employee or member.
2241 (3) (a) The employer shall [
2242 of the right to extend group coverage and the payment amounts required for extension of
2243 coverage, including the manner, place, and time in which the payments shall be made [
2244 (i) [
2245 (ii) [
2246 (iii) if Subsection (2)(b) applies:
2247 (A) [
2248 (B) the guardian of surviving dependents, if different from a surviving spouse.
2249 (b) The notification required in Subsection (3)(a) shall be sent first class mail within 30
2250 days after the termination date of the group coverage to:
2251 (i) the terminated insured's home address as shown on the records of the employer;
2252 (ii) the address of the surviving spouse, if different from the insured's address and if
2253 shown on the records of the employer;
2254 (iii) the guardian of any dependents address, if different from the insured's address, and
2255 if shown on the records of the employer; and
2256 (iv) the address of the ex-spouse, if shown on the records of the employer.
2257 (4) The insurer shall provide the employee, spouse, or any eligible dependent the
2258 opportunity to extend the group coverage at the payment amount stated in Subsection (5) if:
2259 (a) the employer policyholder does not provide the terminated insured the written
2260 notification required by Subsection (3)(a); and
2261 (b) the employee or other individual eligible for extension contacts the insurer within
2262 60 days of coverage termination.
2263 (5) [
2264 the group rate in effect for a group member, including an employer's contribution, if any, for a
2265 group insurance policy.
2266 (6) Except as provided in this Subsection (6), [
2267 interruption for 12 months and may not terminate if the terminated insured or, with respect to a
2268 minor, the parent or guardian of the terminated insured:
2269 (a) elects to extend group coverage within 60 days of losing group coverage; and
2270 (b) tenders the amount required to the employer or insurer.
2271 (7) The insured's coverage may be terminated [
2272 terminated insured:
2273 (a) establishes residence outside of this state;
2274 (b) moves out of the insurer's service area;
2275 (c) fails to pay premiums or contributions in accordance with the terms of the insurance
2276 policy, including any timeliness requirements;
2277 (d) performs an act or practice that constitutes fraud in connection with the coverage;
2278 (e) makes an intentional misrepresentation of material fact under the terms of the
2280 (f) becomes eligible for similar coverage under another group insurance policy; or
2281 (g) has the coverage terminated because the employer's coverage is terminated, except
2282 as provided in Subsection (8).
2283 (8) If the current employer coverage is terminated and the employer replaces coverage
2284 with similar coverage under another group insurance policy, without interruption, the
2285 terminated insured, spouse, or the surviving spouse and guardian of dependents if Subsection
2286 (2)(b) applies, [
2287 group insurance policy:
2288 (a) for the balance of the period the terminated insured would have extended coverage
2289 under the replaced group insurance policy; and
2290 (b) if the terminated insured is otherwise eligible for extension of coverage.
2291 (9) (a) Within 30 days of the insured's exhaustion of extension of coverage, the
2292 employer shall provide the terminated insured and the ex-spouse, or, in the case of the death of
2293 the insured, the surviving spouse, or guardian of any dependents, written notification of the
2294 right to an individual conversion policy under Section 31A-22-723 .
2295 (b) The notification required by Subsection (9)(a):
2296 (i) shall be sent first class mail to:
2297 (A) the insured's last-known address as shown on the records of the employer;
2298 (B) the address of the surviving spouse, if different from the insured's address, and if
2299 shown on the records of the employer;
2300 (C) the guardian of any dependents last known address as shown on the records of the
2301 employer, if different from the address of the surviving spouse; and
2302 (D) the address of the ex-spouse as shown on the records of the employer, if
2303 applicable; and
2304 (ii) shall contain the name, address, and telephone number of the insurer that will
2305 provide the conversion coverage.
2306 Section 19. Section 31A-22-722.5 is amended to read:
2307 31A-22-722.5. Mini-COBRA election -- American Recovery and Reinvestment
2309 (1) An individual has a right, until [
2310 individual's employer or the insurer for the employer to participate in a second election period
2311 for mini-COBRA benefits under Section 31A-22-722 in accordance with Section 3001 of the
2312 American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5), as amended, if the
2314 (a) was involuntarily terminated from employment between [
2316 American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5), as amended;
2317 (b) is eligible for COBRA premium assistance under Section 3001 of the American
2318 Recovery and Reinvestment Act of 2009 (Pub. S. 111-5), as amended; [
2319 (c) was eligible for Utah mini-COBRA as provided in Section 31A-22-722 at the time
2320 of termination[
2321 (d) elected Utah mini-COBRA; and
2322 (e) coverage was terminated between December 1, 2009 through February 1,2010, for
2323 reasons other than those identified in Subsection 31A-22-722 (7).
2324 (2) (a) An individual or the employer of the individual shall contact the insurer and
2325 inform the insurer that the individual wants to take advantage of the second election period for
2326 mini-COBRA coverage under the provisions of Section 3001 of the American Recovery and
2327 Reinvestment Act of 2009 (Pub. S. 111-5), as amended.
2328 (b) An individual or an employer on behalf of an eligible individual must submit the
2329 enrollment forms for coverage under Subsection (1) to the insurer [
2330 before March 1, 2010.
2331 (3) The provision regarding the application of pre-existing condition waivers to the
2332 extended second election period for federal COBRA under Section 3001 of the American
2333 Recovery and Reinvestment Act of 2009 (Pub. S. 111-5), as amended, shall apply to the
2334 extended second election for state mini-COBRA under this section.
2335 (4) An insured has the right to extend the employee's coverage under the current
2336 employer's group policy beyond 12 months to the period of time the insured is eligible to
2337 receive assistance in accordance with Section 3001 of the American Recovery and
2338 Reinvestment Act of 2009 (Pub. S. 111-5), as amended.
2340 Section 31A-2-308 .
2341 Section 20. Section 31A-22-725 is enacted to read:
2342 31A-22-725. Special enrollment periods relating to Medicaid and Children's
2343 Health Insurance Program.
2344 (1) A person is eligible to enroll for coverage under the terms of an employer's group
2345 health benefit plan if:
2346 (a) the person is:
2347 (i) an employee who is eligible, but not enrolled, for coverage under the terms of the
2348 employer's group health benefit plan; or
2349 (ii) a dependent of an employee, if the dependent is eligible, but not enrolled, for
2350 coverage under the terms of the employer's group health benefit plan; and
2351 (b) the conditions of either Subsection (2) or (3) are met.
2352 (2) Subsection (1) applies if:
2353 (a) the employee or dependent is covered under:
2354 (i) a Medicaid health benefit plan under Title XIX of the Social Security Act; or
2355 (ii) a state child health benefit plan under Title XXI of the Social Security Act;
2356 (b) coverage of the employee or dependent described in Subsection (2)(a) is terminated
2357 as a result of loss of eligibility for the coverage; and
2358 (c) the employee requests coverage under the employer's group health plan no later
2359 than 60 days after the date of termination of the coverage described in Subsection (2)(a).
2360 (3) Subsection (1) applies if:
2361 (a) the employee or dependent becomes eligible for assistance, with respect to coverage
2362 under the employer's group health plan under a plan described in Subsection (2)(a), including
2363 under a waiver or demonstration project conducted under or in relation to a plan described in
2364 Subsection (2)(a); and
2365 (b) the employee requests coverage under the employer's group health plan no later
2366 than 60 days after the date the employee or dependent is determined to be eligible for the
2367 assistance described in Subsection (3)(a).
2368 Section 21. Section 31A-23a-415 is amended to read:
2369 31A-23a-415. Assessment on title insurance agencies or title insurers -- Account
2371 (1) For purposes of this section:
2372 (a) "Premium" is as defined in Subsection 59-9-101 (3).
2373 (b) "Title insurer" means a person:
2374 (i) making any contract or policy of title insurance as:
2375 (A) insurer;
2376 (B) guarantor; or
2377 (C) surety;
2378 (ii) proposing to make any contract or policy of title insurance as:
2379 (A) insurer;
2380 (B) guarantor; or
2381 (C) surety; or
2382 (iii) transacting or proposing to transact any phase of title insurance, including:
2383 (A) soliciting;
2384 (B) negotiating preliminary to execution;
2385 (C) executing of a contract of title insurance;
2386 (D) insuring; and
2387 (E) transacting matters subsequent to the execution of the contract and arising out of
2388 the contract.
2389 (c) "Utah risks" means insuring, guaranteeing, or indemnifying with regard to real or
2390 personal property located in Utah, an owner of real or personal property, the holders of liens or
2391 encumbrances on that property, or others interested in the property against loss or damage
2392 suffered by reason of:
2393 (i) liens or encumbrances upon, defects in, or the unmarketability of the title to the
2394 property; or
2395 (ii) invalidity or unenforceability of any liens or encumbrances on the property.
2396 (2) (a) [
2397 and each title insurance agency an annual assessment:
2398 (i) determined by the Title and Escrow Commission:
2399 (A) after consultation with the commissioner; and
2400 (B) in accordance with this Subsection (2); and
2401 (ii) to be used for the purposes described in Subsection (3).
2402 (b) A title insurance agency shall be assessed up to:
2403 (i) $200 for the first office in each county in which the title insurance agency maintains
2404 an office; and
2405 (ii) $100 for each additional office the title insurance agency maintains in the county
2406 described in Subsection (2)(b)(i).
2407 (c) A title insurer shall be assessed up to:
2408 (i) $200 for the first office in each county in which the title insurer maintains an office;
2409 (ii) $100 for each additional office the title insurer maintains in the county described in
2410 Subsection (2)(c)(i); and
2411 (iii) an amount calculated by:
2412 (A) aggregating the assessments imposed on:
2413 (I) title insurance agencies under Subsection (2)(b); and
2414 (II) title insurers under Subsections (2)(c)(i) and (2)(c)(ii);
2415 (B) subtracting the amount determined under Subsection (2)(c)(iii)(A) from the total
2416 costs and expenses determined under Subsection (2)(d); and
2417 (C) multiplying:
2418 (I) the amount calculated under Subsection (2)(c)(iii)(B); and
2419 (II) the percentage of total premiums for title insurance on Utah risk that are premiums
2420 of the title insurer.
2421 (d) Notwithstanding Section 31A-3-103 and subject to Section 31A-2-404 , the Title
2422 and Escrow Commission by rule shall establish the amount of costs and expenses described
2423 under Subsection (3) that will be covered by the assessment, except the costs or expenses to be
2424 covered by the assessment may not exceed $75,000 annually.
2425 (3) (a) [
2429 (b) There is created in the General Fund a restricted account known as the "Title
2430 Licensee Enforcement Restricted Account."
2431 (c) The Title Licensee Enforcement Restricted Account shall consist of the money
2432 received by the state under this section.
2433 (d) The commissioner shall administer the Title Licensee Enforcement Restricted
2434 Account. Subject to appropriations by the Legislature, the commissioner shall use the money
2435 deposited into the Title Licensee Enforcement Restricted Account only to pay for [
2436 or expense incurred by the department in the administration, investigation, and enforcement of
2437 this part and Part 5, Compensation of Producers and Consultants, related to:
2438 (i) the marketing of title insurance; and
2439 (ii) audits of agencies.
2440 (e) The money in the Title Licensee Enforcement Restricted Account is nonlapsing.
2441 (4) The assessment imposed by this section shall be in addition to any premium
2442 assessment imposed under Subsection 59-9-101 (3).
2443 Section 22. Section 31A-23a-501 is amended to read:
2444 31A-23a-501. Licensee compensation.
2445 (1) As used in this section:
2446 (a) "Commission compensation" includes funds paid to or credited for the benefit of a
2447 licensee from:
2448 (i) commission amounts deducted from insurance premiums on insurance sold by or
2449 placed through the licensee; or
2450 (ii) commission amounts received from an insurer or another licensee as a result of the
2451 sale or placement of insurance.
2452 (b) (i) "Compensation from an insurer or third party administrator" means
2453 commissions, fees, awards, overrides, bonuses, contingent commissions, loans, stock options,
2454 gifts, prizes, or any other form of valuable consideration:
2455 (A) whether or not payable pursuant to a written agreement; and
2456 (B) received from:
2457 (I) an insurer; or
2458 (II) a third party to the transaction for the sale or placement of insurance.
2459 (ii) "Compensation from an insurer or third party administrator" does not mean
2460 compensation from a customer that is:
2461 (A) a fee or pass-through costs as provided in Subsection (1)(e); or
2462 (B) a fee or amount collected by or paid to the producer that does not exceed an
2463 amount established by the commissioner by administrative rule.
2464 (c) (i) "Customer" means:
2465 (A) the person signing the application or submission for insurance; or
2466 (B) the authorized representative of the insured actually negotiating the placement of
2467 insurance with the producer.
2468 (ii) "Customer" does not mean a person who is a participant or beneficiary of:
2469 (A) an employee benefit plan; or
2470 (B) a group or blanket insurance policy or group annuity contract sold, solicited, or
2471 negotiated by the producer or affiliate.
2472 (d) (i) "Noncommission compensation" includes all funds paid to or credited for the
2473 benefit of a licensee other than commission compensation.
2474 (ii) "Noncommission compensation" does not include charges for pass-through costs
2475 incurred by the licensee in connection with obtaining, placing, or servicing an insurance policy.
2476 (e) "Pass-through costs" include:
2477 (i) costs for copying documents to be submitted to the insurer; and
2478 (ii) bank costs for processing cash or credit card payments.
2479 (2) A licensee may receive from an insured or from a person purchasing an insurance
2480 policy, noncommission compensation if the noncommission compensation is stated on a
2481 separate, written disclosure.
2482 (a) The disclosure required by this Subsection (2) shall:
2483 (i) include the signature of the insured or prospective insured acknowledging the
2484 noncommission compensation;
2485 (ii) clearly specify the amount or extent of the noncommission compensation; and
2486 (iii) be provided to the insured or prospective insured before the performance of the
2488 (b) Noncommission compensation shall be:
2489 (i) limited to actual or reasonable expenses incurred for services; and
2490 (ii) uniformly applied to all insureds or prospective insureds in a class or classes of
2491 business or for a specific service or services.
2492 (c) A copy of the signed disclosure required by this Subsection (2) must be maintained
2493 by any licensee who collects or receives the noncommission compensation or any portion of
2494 the noncommission compensation.
2495 (d) All accounting records relating to noncommission compensation shall be
2496 maintained by the person described in Subsection (2)(c) in a manner that facilitates an audit.
2497 (3) (a) A licensee may receive noncommission compensation when acting as a
2498 producer for the insured in connection with the actual sale or placement of insurance if:
2499 (i) the producer and the insured have agreed on the producer's noncommission
2500 compensation; and
2501 (ii) the producer has disclosed to the insured the existence and source of any other
2502 compensation that accrues to the producer as a result of the transaction.
2503 (b) The disclosure required by this Subsection (3) shall:
2504 (i) include the signature of the insured or prospective insured acknowledging the
2505 noncommission compensation;
2506 (ii) clearly specify the amount or extent of the noncommission compensation and the
2507 existence and source of any other compensation; and
2508 (iii) be provided to the insured or prospective insured before the performance of the
2510 (c) The following additional noncommission compensation is authorized:
2511 (i) compensation received by a producer of a compensated corporate surety who under
2512 procedures approved by a rule or order of the commissioner is paid by surety bond principal
2513 debtors for extra services;
2514 (ii) compensation received by an insurance producer who is also licensed as a public
2515 adjuster under Section 31A-26-203 , for services performed for an insured in connection with a
2516 claim adjustment, so long as the producer does not receive or is not promised compensation for
2517 aiding in the claim adjustment prior to the occurrence of the claim;
2518 (iii) compensation received by a consultant as a consulting fee, provided the consultant
2519 complies with the requirements of Section 31A-23a-401 ; or
2520 (iv) other compensation arrangements approved by the commissioner after a finding
2521 that they do not violate Section 31A-23a-401 and are not harmful to the public.
2522 (4) (a) For purposes of this Subsection (4), "producer" includes:
2523 (i) a producer;
2524 (ii) an affiliate of a producer; or
2525 (iii) a consultant.
2526 (b) Beginning January 1, 2010, in addition to any other disclosures required by this
2527 section, a producer may not accept or receive any compensation from an insurer or third party
2528 administrator for the placement of a health benefit plan, other than a hospital confinement
2529 indemnity policy, unless prior to the customer's purchase of the health benefit plan the
2531 (i) except as provided in Subsection (4)(c), discloses in writing to the customer that the
2532 producer will receive compensation from the insurer or third party administrator for the
2533 placement of insurance, including the amount or type of compensation known to the producer
2534 at the time of the disclosure; and
2535 (ii) except as provided in Subsection (4)(c):
2536 (A) obtains the customer's signed acknowledgment that the disclosure under
2537 Subsection (4)(b)(i) was made to the customer; or
2538 (B) [
2539 Subsection (4)(b)(i) was made to the customer[
2540 (II) keeps the signed statement on file in the producer's office while the health benefit
2541 plan placed with the customer is in force.
2542 (c) If the compensation to the producer from an insurer or third party administrator is
2543 for the renewal of a health benefit plan, once the producer has made an initial disclosure that
2544 complies with Subsection (4)(b), the producer does not have to disclose compensation received
2545 for the subsequent yearly renewals in accordance with Subsection (4)(b) until the renewal
2546 period immediately following 36 months after the initial disclosure.
2547 (d) (i) [
2549 insurer or third party administrator in a manner that facilitates an audit[
2550 benefit plan placed with the customer is in force, maintain a copy of:
2551 (A) the signed acknowledgment described in Subsection (4)(b)(i); or
2552 (B) the signed statement described in Subsection (4)(b)(ii).
2553 (ii) The standard application developed in accordance with Section 31A-22-635 shall
2554 include a place for a producer to provide the disclosure required by this Subsection (4), and if
2555 completed, shall satisfy the requirement of Subsection (4)(d)(i).
2556 (e) Subsection (4)(b)(ii) does not apply to:
2557 (i) a person licensed as a producer who acts only as an intermediary between an insurer
2558 and the customer's producer, including a managing general agent; or
2559 (ii) the placement of insurance in a secondary or residual market.
2560 (5) This section does not alter the right of any licensee to recover from an insured the
2561 amount of any premium due for insurance effected by or through that licensee or to charge a
2562 reasonable rate of interest upon past-due accounts.
2563 (6) This section does not apply to bail bond producers or bail enforcement agents as
2564 defined in Section 31A-35-102 .
2565 Section 23. Section 31A-26-201 is amended to read:
2566 31A-26-201. Requirement of license.
2567 (1) Except as provided in Subsection (2)[
2568 (a) a person may not perform, offer to perform, or solicit the opportunity to perform
2570 (b) a person may not use the insurance adjusting services of another if the person
2571 knows or should know that the one providing these services does not have a license as required
2572 by law.
2573 (2) The following are exempt from the license requirement of Subsection (1), when
2574 acting in the indicated [
2575 (a) [
2576 employee of, and not an independent contractor for, an insurer;
2577 (b) an arbitrator or an umpire selected by the claimant and insurer to decide, alone or
2578 with others, whether a claim should be paid and how much should be paid;
2579 (c) an attorney at law acting in an attorney-client relationship;
2580 (d) an insurance producer, but only as to [
2581 (i) a class of insurance for which [
2582 31A-23a-106 ; and [
2583 (ii) a claim adjusted on the request of an insurer for which [
2584 is a producer;
2585 (e) a regular salaried employee of, and not an independent contractor for, a
2586 policyholder or claimant under an insurance policy;
2587 (f) an employee of a licensed insurance adjuster who provides only administrative or
2588 clerical assistance;
2589 (g) [
2590 31A-26-102 , but who is specially employed to obtain facts about a loss for or furnish technical
2591 assistance to a licensed adjuster or a company adjuster, including:
2592 (i) a photographer[
2593 (ii) an estimator [
2594 (iii) an appraiser[
2595 (iv) a marine surveyor[
2596 (v) a private detective[
2597 (vi) an engineer[
2598 (vii) a handwriting expert;
2599 (h) a holder of a group insurance policy, with respect to administrative activities in
2600 connection with that insurance policy, who receives no compensation for [
2601 policyholder's services beyond the actual expenses estimated on a reasonable basis;
2602 (i) [
2603 employee of, and not an independent contractor for, an administrator licensed under Chapter
2605 (j) a person who gives advice or assistance without compensation or expectation of
2606 compensation, direct or indirect.
2607 (3) [
2608 insurance [
2610 Section 24. Section 31A-35-401 is amended to read:
2611 31A-35-401. Requirement for license or certificate of authority -- Process -- Fees
2612 -- Limitations.
2613 (1) (a) A person may not engage in the bail bond surety insurance business unless that
2615 (i) is a bail bond surety company licensed under this chapter;
2616 (ii) is a surety insurer that is granted a certificate under this section in the same manner
2617 as other insurers doing business in this state are granted certificates of authority under this title;
2619 (iii) is a bail bond producer licensed in accordance with this section.
2620 (b) A bail bond surety company shall be licensed under this chapter as an agency.
2621 (c) A bail bond producer shall be licensed under Chapter 23a, Insurance Marketing -
2622 Licensing Producers, Consultants, and Reinsurance Intermediaries, as a limited lines producer.
2623 (2) A person applying for a bail bond surety company license under this chapter shall
2624 submit to the commissioner:
2625 (a) a completed application form as prescribed by the commissioner;
2626 (b) a fee as determined by the commissioner in accordance with Section [
2627 31A-3-103 ; and
2628 (c) any additional information required by rule.
2629 (3) [
2630 (4) [
2631 restricted account created in Section 31A-35-407 .
2632 (5) (a) A bail bond surety company shall be domiciled in Utah.
2633 (b) A bail bond producer shall be a resident of Utah.
2634 (c) A foreign surety insurer that is granted a certificate to issue bail bonds may only
2635 issue bail bonds through a bail bond surety company licensed under this chapter.
2636 Section 25. Section 31A-35-406 is amended to read:
2637 31A-35-406. Renewal and reinstatement.
2638 (1) (a) To renew its license under this chapter, on or before the last day of the month in
2639 which the license expires a bail bond surety company shall:
2640 (i) complete and submit a renewal application to the department; and
2641 (ii) pay the department the applicable renewal fee established in accordance with
2642 Section [
2643 (b) A bail bond surety company shall renew its license under this chapter annually as
2644 established by department rule, regardless of when the license is issued.
2645 (2) A bail bond surety company may apply for reinstatement of an expired bail bond
2646 surety company license within one year following the expiration of the license under
2647 Subsection (1) by:
2648 (a) submitting the renewal application required by Subsection (1); and
2649 (b) paying a license reinstatement fee established in accordance with Section
2651 (3) If a bail bond surety company license has been expired for more than one year, the
2652 person applying for reinstatement of the bail bond surety license shall:
2653 (a) submit a new application form to the commissioner; and
2654 (b) pay the application fee established in accordance with Section [
2655 31A-3-103 .
2656 (4) If a bail bond surety company license is suspended, the applicant may not submit an
2657 application for a bail bond surety company license until after the end of the period of
2659 (5) [
2660 created in Section 31A-35-407 .
2661 Section 26. Section 31A-36-102 is amended to read:
2662 31A-36-102. Definitions.
2663 As used in this chapter:
2664 (1) (a) "Advertising" means a communication placed before the public to:
2665 (i) create an interest in a life settlement; or
2666 (ii) induce a person pursuant to a life settlement to sell, assign, devise, bequest, or
2667 transfer the death benefit or ownership of:
2668 (A) a policy; or
2669 (B) an interest in a policy.
2670 (b) "Advertising" includes the following, if the requirements of Subsection (1)(a) are
2672 (i) a written, electronic, or printed communication;
2673 (ii) a communication by means of a recorded telephone message;
2674 (iii) a communication transmitted on radio, television, the Internet, or similar
2675 communications media; and
2676 (iv) a film strip, motion picture, or video.
2677 (2) "Business of life settlements" includes the following:
2678 (a) offering a life settlement;
2679 (b) soliciting a life settlement;
2680 (c) negotiating a life settlement;
2681 (d) procuring a life settlement;
2682 (e) effectuating a life settlement;
2683 (f) purchasing a life settlement;
2684 (g) investing in a life settlement;
2685 (h) financing a life settlement;
2686 (i) monitoring a life settlement;
2687 (j) tracking a life settlement;
2688 (k) underwriting a life settlement;
2689 (l) selling a life settlement;
2690 (m) transferring a life settlement;
2691 (n) assigning a life settlement;
2692 (o) pledging a life settlement;
2693 (p) hypothecating a life settlement; or
2694 (q) in any other manner acquiring an interest in [
2695 life settlement.
2696 (3) "Chronically ill" means:
2697 (a) being unable to perform at least two activities of daily living, such as eating,
2698 toileting, moving from one place to another, bathing, dressing, or continence;
2699 (b) requiring substantial supervision for protection from threats to health and safety
2700 because of severe cognitive impairment; or
2701 (c) having a level of disability similar to that described in Subsection (3)(a).
2702 (4) "Depository institution" is as defined in Section 7-1-103 .
2703 (5) (a) "Financing entity" means a person:
2704 (i) who has direct ownership in a policy that is the subject of a life settlement;
2705 (ii) whose principal activity related to a life settlement is providing money to effect the
2706 life settlement or the purchase of one or more settled policies; and
2707 (iii) who has an agreement in writing with one or more licensed life settlement
2708 providers to finance the acquisition of one or more life settlements.
2709 (b) "Financing entity" includes, if the requirements of Subsection (5)(a) are met, the
2711 (i) an underwriter;
2712 (ii) a placement agent;
2713 (iii) an enhancer of credit;
2714 (iv) a lender;
2715 (v) a purchaser of securities; and
2716 (vi) a purchaser of a policy from a life settlement provider.
2717 (c) "Financing entity" does not include:
2718 (i) a nonaccredited investor; or
2719 (ii) a life settlement purchaser.
2720 (6) "Form" means, in addition to a form as defined in Section 31A-1-301 :
2721 (a) a life settlement;
2722 (b) a disclosure to an owner;
2723 (c) a notice of intent to settle; or
2724 (d) a verification of coverage.
2725 (7) "Life expectancy" means the mean number of months an individual insured under a
2726 policy to be settled can be expected to live considering medical records and appropriate
2727 experiential data.
2728 (8) (a) "Life settlement" means a written agreement:
2729 (i) between an owner and a life settlement provider; and
2730 (ii) [
2732 transferring, devising, releasing, or bequeathing, at the time of or after the exchange, the death
2733 benefit or ownership of:
2734 (A) any portion of a policy; or
2735 (B) a beneficial interest in the policy.
2736 (b) "Life settlement" includes:
2737 (i) the transfer for compensation or value of ownership or beneficial interest in a trust
2738 or other entity that owns a policy if the trust or other entity is formed or operated for the
2739 principal purpose of acquiring one or more policies; or
2740 (ii) a premium finance loan made for a policy by a lender to an owner on, before, or
2741 after the date of issuance of the policy if the owner:
2742 (A) receives on the date of the premium finance loan a guarantee of a future life
2743 settlement value of the policy; or
2744 (B) agrees on the date of the premium finance loan to sell the policy or any portion of
2745 the policy's death benefit on a date following the issuance of the policy.
2746 (c) An agreement described in Subsection (8)(a) is a "life settlement" even if it is
2747 referred to by a different name, including:
2748 (i) a [
2749 (ii) a "senior settlement."
2750 (d) "Life settlement" does not include:
2751 (i) a loan or accelerated death benefit by an insurer pursuant to the terms of a policy;
2752 (ii) loan proceeds that are used solely to pay:
2753 (A) premiums for a policy; and
2754 (B) the loan costs or other expenses incurred by the lender, including:
2755 (I) interest;
2756 (II) an arrangement fee;
2757 (III) a use fee;
2758 (IV) closing costs;
2759 (V) attorney fees and expenses;
2760 (VI) trustee fees and expenses; and
2761 (VII) third party collateral provider fees and expenses, including fees payable to a letter
2762 of credit issuer;
2763 (iii) (A) a loan made by a licensed lender in which the licensed lender takes an interest
2764 in a policy solely to secure repayment of a loan; or
2765 (B) the transfer of a policy by a lender, if:
2766 (I) the loan is:
2767 (Aa) a loan described in Subsection (8)(d)(iii)(A); or
2768 (Bb) a premium finance loan that is not a life settlement;
2769 (II) the loan is defaulted on;
2770 (III) the policy is transferred; and
2771 (IV) neither the default itself nor the transfer of the policy in connection with the
2772 default is pursuant to an agreement with any other person for the purpose of evading regulation
2773 under this chapter;
2774 (iv) an agreement where all the participants in the agreement:
2775 (A) (I) are closely related to the insured by blood or law; or
2776 (II) have a lawful substantial economic interest in the continued life, health, and bodily
2777 safety of the person insured; and
2778 (B) are trusts established primarily for the benefit of the participants in the agreement;
2779 (v) a designation, consent, or agreement by an insured who is an employee of an
2780 employer in connection with the purchase by the employer, or trust established by the
2781 employer, of life insurance on the life of the employee; or
2782 (vi) a business succession planning arrangement not made for the purpose of evading
2783 regulation under this chapter:
2784 (A) (I) between one or more shareholders in a corporation; or
2785 (II) between a corporation and:
2786 (Aa) one or more of its shareholders; or
2787 (Bb) one or more trusts established by its shareholders;
2788 (B) (I) between one or more partners in a partnership; or
2789 (II) between a partnership and:
2790 (Aa) one or more of its partners; or
2791 (Bb) one or more trusts established by its partners; or
2792 (C) (I) between one or more members in a limited liability company; or
2793 (II) between a limited liability company and:
2794 (Aa) one or more of its members; or
2795 (Bb) one or more trusts established by its members.
2796 (9) (a) "Life settlement producer" means a person licensed in the state as a life
2797 insurance producer that on behalf of an owner and for consideration offers or attempts to
2798 negotiate a life settlement between the owner and one or more life settlement providers.
2799 (b) "Life settlement producer" does not include an attorney licensed to practice law in
2800 any state, a certified public accountant, or a financial planner accredited by a nationally
2801 recognized accrediting agency:
2802 (i) that is retained to represent an owner; and
2803 (ii) whose compensation is not paid directly or indirectly by:
2804 (A) a life settlement provider; or
2805 (B) a life settlement purchaser.
2806 (10) (a) "Life settlement provider" means a person other than an owner that enters into
2807 or effectuates a life settlement.
2808 (b) "Life settlement provider" does not include:
2809 (i) a licensed lender that takes an assignment of a policy as security for a loan,
2810 including a:
2811 (A) depository institution; or
2812 (B) lender that makes a premium finance loan that is not described in Subsection
2814 (ii) the issuer of a policy;
2815 (iii) an authorized or eligible insurer that provides stop-loss coverage to:
2816 (A) a life settlement provider;
2817 (B) a life settlement purchaser;
2818 (C) a financing entity;
2819 (D) a special purpose entity; or
2820 (E) a related provider trust;
2821 (iv) a financing entity;
2822 (v) a special purpose entity;
2823 (vi) a related provider trust;
2824 (vii) a life settlement purchaser; or
2825 (viii) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A
2826 that purchases a settled policy from a life settlement provider.
2827 (11) (a) "Life settlement purchaser" means a person that, to derive an economic benefit:
2828 (i) provides a sum of money as consideration for a policy or an interest in the death
2829 benefits of a policy; or
2830 (ii) owns, acquires, or is entitled to a beneficial interest in a trust that:
2831 (A) owns a life settlement; or
2832 (B) is the beneficiary of a policy that has been or will be the subject of a life settlement.
2833 (b) "Life settlement purchaser" does not include:
2834 (i) a life settlement provider;
2835 (ii) a life settlement producer;
2836 (iii) an accredited investor as defined in Regulation D, Rule 501, 17 C.F.R. Sec.
2838 (iv) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A;
2839 (v) a financing entity;
2840 (vi) a special purpose entity; or
2841 (vii) a related provider trust.
2842 (12) (a) "Owner" means any of the following who resides in this state and seeks to
2843 enter into a life settlement:
2844 (i) the owner of a policy; or
2845 (ii) the holder of a certificate of [
2846 (b) "Owner" is not limited to [
2847 chronically ill except when the limitation is expressly provided in this chapter.
2848 (c) "Owner" does not include:
2849 (i) a life settlement provider;
2850 (ii) a life settlement producer;
2851 (iii) a qualified institutional buyer as defined in Rule 144A, 17 C.F.R. Sec. 230.144A;
2852 (iv) a financing entity;
2853 (v) a special purpose entity; or
2854 (vi) a related provider trust.
2855 (13) "Policy" means:
2856 (a) an individual or group life insurance policy;
2857 (b) an individual or group annuity policy;
2859 (d) a group annuity certificate; or
2861 whether or not delivered or issued for delivery in Utah:
2862 (i) affecting the rights of a resident of Utah; or
2863 (ii) bearing a reasonable relation to Utah.
2864 (14) "Premium finance loan" is a loan made primarily for the purpose of making
2865 premium payments on a policy if the loan is secured by an interest in the policy.
2866 (15) "Related provider trust" means a trust established by a licensed life settlement
2867 provider or a financing entity solely to hold the ownership of or beneficial interests in
2868 purchased policies in connection with financing.
2869 (16) "Settled policy" means a policy that is acquired by a life settlement provider
2870 pursuant to a life settlement.
2871 (17) "Special purpose entity" means an entity formed by a licensed life settlement
2872 provider solely to enable the life settlement provider to gain access to institutional markets for
2874 (18) (a) "Stranger-originated life insurance" means an act, practice, or arrangement to
2875 initiate a policy for the benefit of a third party investor or other person who has no insurable
2876 interest in the insured resulting in the requirements of Section 31A-21-104 not being met.
2877 (b) "Stranger-originated life insurance" includes when:
2878 (i) a policy is purchased with resources or guarantees from or through a person who, at
2879 the time of policy origination, could not lawfully initiate the policy itself; and
2880 (ii) at the time of policy origination, there is an agreement, whether oral or written, to
2881 directly or indirectly transfer to a third party the ownership of a policy, policy benefits, or both.
2882 (c) "Stranger-originated life insurance" does not include:
2883 (i) a life settlement that complies with:
2884 (A) this chapter; and
2885 (B) Section 31A-21-104 ; or
2886 (ii) an act, practice, or arrangement described in Subsection (8)(d).
2887 (19) "Terminally ill" means having a condition that reasonably may be expected to
2888 result in death within 24 months.
2889 Section 27. Section 31A-40-103 is amended to read:
2890 31A-40-103. Duties of the commissioner.
2891 (1) (a) The commissioner shall maintain a list of professional employer organizations
2892 that are licensed under this chapter.
2893 (b) The commissioner shall make the list required by this Subsection (1) available to
2894 the public by electronic or other means.
2895 (2) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
2897 (a) shall make rules to prescribe the requirements for forms required under this chapter;
2899 (b) may make rules to prescribe the requirements and process for correcting under
2900 Section 31A-40-205 :
2901 (i) a deficiency in working capital; or
2902 (ii) negative working capital;
2904 a financial statement under Section 31A-40-305 :
2905 (i) that are consistent with generally accepted accounting principles; and
2906 (ii) including the timeliness of a financial statement[
2907 (d) may make rules to prescribe the requirements and process for when a professional
2908 employer organization license is terminated by:
2909 (i) voluntary surrender of the professional organization license; or
2910 (ii) involuntary surrender of the professional organization license.
2911 (3) A rule in effect on May 5, 2008 under the repealed Title 58, Chapter 59,
2912 Professional Employer Organization Registration Act, [
2914 modifies or repeals the rule.
2918 Section 28. Section 31A-40-302 is amended to read:
2919 31A-40-302. Licensing process.
2920 (1) To apply for an initial or renewal license under this chapter, a person shall:
2921 (a) (i) [
2922 the commissioner shall determine by rule made in accordance with Title 63G, Chapter 3, Utah
2923 Administrative Rulemaking Act; and
2924 (ii) pay a license fee determined in accordance with Section 31A-3-103 that is not
2925 refunded if the application:
2926 (A) is denied; [
2927 (B) does not comply with Section 31A-40-303 ; or
2929 (b) comply with Section 31A-40-303 .
2930 (2) In the application described in Subsection (1)(a), the person shall provide:
2931 (a) any name under which the professional employer organization will engage in a
2932 professional employer service;
2933 (b) the address of the principal place of business of the professional employer
2935 (c) the address of each location the professional employer organization maintains in
2936 this state;
2937 (d) the professional employer organization's federal taxpayer or employer identification
2939 (e) the following information by jurisdiction of each name under which the
2940 professional employer organization operated in the five years preceding the day on which the
2941 person [
2942 (i) the name;
2943 (ii) an alternative name, if any;
2944 (iii) a name of a predecessor; and
2945 (iv) if known, a successor business entity;
2946 (f) a statement of ownership that includes the name and evidence of the business
2947 experience of a person that, individually or acting in concert with one or more other persons,
2948 owns or controls, directly or indirectly, 10% or more of the equity interests of the professional
2949 employer organization;
2950 (g) a statement of management that includes the name and evidence of the business
2951 experience of [
2952 (i) serves as president of the professional employer organization;
2953 (ii) serves as chief executive officer of the professional employer organization; or
2954 (iii) may act as a senior executive officer of the professional employer organization;
2956 (h) a financial statement that:
2957 (i) sets forth the financial condition of:
2958 (A) the professional employer organization; or
2959 (B) a professional employer organization group in which the professional employer
2960 organization is a member;
2961 (ii) states whether or not the professional employer organization complies with Section
2962 31A-40-205 ; and
2963 (iii) complies with Section 31A-40-305 .
2971 (3) A professional employer organization shall renew its license [
2973 Section 29. Section 31A-40-307 is enacted to read:
2974 31A-40-307. Voluntary surrender of professional employer organization license.
2975 (1) When a professional employer organization wants to voluntarily surrender its
2976 professional employer organization license, the professional employer organization shall:
2977 (a) notify in writing each coemployer regarding the impending loss of the following
2978 provided under the professional employer agreement:
2979 (i) workers' compensation insurance coverage;
2980 (ii) health care benefits, if a coemployers' employee welfare plan includes fully insured
2981 or partially insured health insurance benefits; and
2982 (iii) any other insurance benefit provided to coemployers by the professional employer
2983 organization; and
2984 (b) submit a letter of intent to voluntarily surrender the license to the commissioner:
2985 (i) after providing the notice to coemployers under Subsection (1)(a); and
2986 (ii) not less than 45 days before the day on which the professional employer
2987 organization surrenders its professional employer organization license.
2988 (2) The letter of intent to voluntarily surrender a professional employer organization
2989 license shall include the following:
2990 (a) the reason the professional employer organization license is being surrendered;
2991 (b) a discussion of each process or plan to handle the obligations to coemployers and
2993 (c) a list of coemployers as of the date of the letter;
2994 (d) a copy of the notice sent to the coemployers under Subsection (1)(a);
2995 (e) certification that the professional employer organization has notified the
2996 coemployers located in Utah of the professional employer organization's intent to cease doing
2997 business in Utah; and
2998 (f) the signature of the professional employer organization's chief executive officer or
2999 controlling individual.
3000 Section 30. Section 31A-42-201 is amended to read:
3001 31A-42-201. Creation of defined contribution market risk adjuster mechanism --
3002 Board of directors -- Appointment -- Terms -- Quorum -- Plan preparation.
3003 (1) There is created the "Utah Defined Contribution Risk Adjuster," a nonprofit entity
3004 within the [
3005 (2) (a) The risk adjuster [
3006 composed of up to nine members described in Subsection (2)(b).
3007 (b) The board of directors shall consist of:
3009 consent of the Senate:
3013 contribution arrangement market in the state; and
3015 insurer that has a small percentage of lives in the defined contribution market;
3017 participant in the defined contribution market;
3019 Office of Consumer Health Services within the Governor's Office of Economic Development;
3021 with actuarial experience, [
3025 (A) is appointed by the commissioner; and
3026 (B) has actuarial experience.
3027 (c) The commissioner or a representative appointed by the commissioner[
3029 (3) (a) Except as required by Subsection (3)(b), as terms of current board members
3030 appointed by the governor expire, the governor shall appoint each new member or reappointed
3031 member to a four-year term.
3032 (b) Notwithstanding the requirements of Subsection (3)(a), the governor shall, at the
3033 time of appointment or reappointment, adjust the length of terms to ensure that the terms of
3034 board members are staggered so that approximately half of the board is appointed every two
3036 (c) Notwithstanding the requirements of Subsection (3)(a), a board member shall
3037 continue to serve until the board member is reappointed or replaced by another individual in
3038 accordance with this section.
3039 (4) When a vacancy occurs in the membership for any reason, the replacement shall be
3040 appointed for the unexpired term in the same manner as the original appointment was made.
3041 (5) (a) [
3042 member who is not a government employee may not receive compensation or benefits for the
3044 (b) A state government member who is a board member because of the board member's
3045 state government position may not receive per diem or expenses for the member's service.
3046 (6) The board shall elect annually a chair and vice chair from its membership.
3047 (7) [