H.B. 76 Enrolled

             1     

INSURANCE RELATED REVISIONS

             2     
2014 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Jim Bird

             5     
Senate Sponsor: Wayne A. Harper

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill modifies Title 31A, Insurance Code, and other related provisions, to address
             10      the regulation of insurance.
             11      Highlighted Provisions:
             12          This bill:
             13          .    amends definition provisions;
             14          .    provides for insurance fraud investigators being designated as law enforcement
             15      officers;
             16          .    changes the date captive insurance companies are to pay a fee;
             17          .    addresses what constitutes a qualified insurer;
             18          .    modifies requirements for a plan of orderly withdrawal from writing a line of
             19      insurance;
             20          .    addresses notice requirements related to a request for a hearing;
             21          .    modifies calculations related to interest payable on life insurance proceeds;
             22          .    addresses uninsured and underinsured motorist coverage;
             23          .    addresses preferred provider contract provisions;
             24          .    addresses coverage of mental health and substance use disorders;
             25          .    modifies requirements for the uniform application form and the uniform waiver of
             26      coverage form;
             27          .    amends language regarding the health benefit plan on the Health Insurance
             28      Exchange;
             29          .    amends language regarding open enrollment provisions;


             30          .    modifies language regarding dental and vision policies being offered on the Health
             31      Insurance Exchange;
             32          .    clarifies language related to the designated responsible licensed individual;
             33          .    clarifies references to the Violent Crime Control and Law Enforcement Act;
             34          .    modifies references to state of residence to home state;
             35          .    addresses requirements related to licensing when a person establishes legal
             36      residence in the state;
             37          .    changes requirements related to the commissioner placing a licensee on probation;
             38          .    repeals language related to a voluntarily surrendered license that is reinstated upon
             39      completion of continuing education requirements;
             40          .    modifies certain exemptions from continuing education requirements;
             41          .    clarifies training period requirements;
             42          .    changes a navigator license term to one year;
             43          .    provides for training periods for a navigator license;
             44          .    modifies continuing education requirements for a navigator;
             45          .    repeals the requirement that the commissioner publish a list of professional
             46      designations whose continuing education requirements could be used for certain
             47      circumstances related to navigators;
             48          .    modifies provisions related to inducements;
             49          .    addresses license compensation provisions;
             50          .    makes navigator licensees subject to unfair marketing practice restrictions;
             51          .    amends definitions specific to insurance adjusters' chapter;
             52          .    exempts an applicant for the crop insurance license class from certain requirements;
             53          .    modifies the definition of receiver;
             54          .    addresses the provisions related to the receivership court's seizure order;
             55          .    amends the purpose statement, definition, and applicability and scope provisions for
             56      the Individual, Small Employer, and Group Health Insurance Act;
             57          .    addresses the surcharge for groups changing carriers;


             58          .    addresses eligibility for the small employer and individual market;
             59          .    modifies the provisions related to appointment of insurance producers and the
             60      Health Insurance Exchange;
             61          .    modifies Health Insurance Exchange disclosure requirements;
             62          .    requires a captive insurance company, rather than an association captive insurance
             63      company or industrial insured group, to file a specified report;
             64          .    corrects a reference to a covered employee;
             65          .    changes reference to a multiple coordinated policy to a master policy;
             66          .    includes reference to the defined contribution arrangement market into the Defined
             67      Contribution Risk Adjuster Act;
             68          .    modifies definitions in the Small Employer Stop-Loss Insurance Act;
             69          .    addresses stop-loss insurance coverage standards, stop-loss restrictions, filing
             70      requirements, and stop-loss insurance disclosure;
             71          .    modifies commissioner's rulemaking authority under the Small Employer Stop-Loss
             72      Insurance Act; and
             73          .    makes technical and conforming amendments.
             74      Money Appropriated in this Bill:
             75          None
             76      Other Special Clauses:
             77          This bill provides an effective date.
             78          This bill coordinates with H.B. 141, Health Reform Amendments, by providing
             79      superseding and substantive amendments.
             80          This bill provides revisor instructions.
             81      Utah Code Sections Affected:
             82      AMENDS:
             83           31A-1-301 , as last amended by Laws of Utah 2013, Chapter 319
             84           31A-2-104 , as last amended by Laws of Utah 1999, Chapter 21
             85           31A-3-304 (Superseded 07/01/15), as last amended by Laws of Utah 2011, Chapter


             86      284
             87           31A-3-304 (Effective 07/01/15), as last amended by Laws of Utah 2013, Chapter 319
             88           31A-4-102 , as last amended by Laws of Utah 2008, Chapter 345
             89           31A-4-115 , as last amended by Laws of Utah 2002, Chapter 308
             90           31A-8-402.3 , as last amended by Laws of Utah 2004, Chapter 329
             91           31A-16-103 , as last amended by Laws of Utah 2004, Chapter 2
             92           31A-17-607 , as last amended by Laws of Utah 2001, Chapter 116
             93           31A-22-305 , as last amended by Laws of Utah 2013, Chapter 460
             94           31A-22-305.3 , as last amended by Laws of Utah 2013, Chapter 460
             95           31A-22-428 , as enacted by Laws of Utah 2008, Chapter 345
             96           31A-22-617 , as last amended by Laws of Utah 2013, Chapters 104 and 319
             97           31A-22-618.5 , as last amended by Laws of Utah 2013, Chapter 319
             98           31A-22-625 , as last amended by Laws of Utah 2012, Chapter 253
             99           31A-22-635 , as last amended by Laws of Utah 2012, Chapters 253 and 279
             100           31A-22-721 , as last amended by Laws of Utah 2011, Chapter 284
             101           31A-23a-102 , as last amended by Laws of Utah 2013, Chapter 319
             102           31A-23a-104 , as last amended by Laws of Utah 2012, Chapter 253
             103           31A-23a-105 , as last amended by Laws of Utah 2013, Chapter 319
             104           31A-23a-108 , as last amended by Laws of Utah 2012, Chapter 253
             105           31A-23a-112 , as last amended by Laws of Utah 2008, Chapter 382
             106           31A-23a-113 , as last amended by Laws of Utah 2012, Chapter 253
             107           31A-23a-202 , as last amended by Laws of Utah 2013, Chapter 319
             108           31A-23a-203 , as last amended by Laws of Utah 2012, Chapter 253
             109           31A-23a-402.5 , as last amended by Laws of Utah 2013, Chapter 319
             110           31A-23a-501 , as last amended by Laws of Utah 2013, Chapter 341
             111           31A-23b-102 , as enacted by Laws of Utah 2013, Chapter 341
             112           31A-23b-202 , as enacted by Laws of Utah 2013, Chapter 341
             113           31A-23b-205 , as enacted by Laws of Utah 2013, Chapter 341


             114           31A-23b-206 , as enacted by Laws of Utah 2013, Chapter 341
             115           31A-23b-301 , as enacted by Laws of Utah 2013, Chapter 341
             116           31A-23b-402 , as enacted by Laws of Utah 2013, Chapter 341
             117           31A-25-208 , as last amended by Laws of Utah 2011, Chapter 284
             118           31A-25-209 , as last amended by Laws of Utah 2008, Chapter 382
             119           31A-26-102 , as last amended by Laws of Utah 2012, Chapter 151
             120           31A-26-206 , as last amended by Laws of Utah 2011, Chapter 284
             121           31A-26-207 , as last amended by Laws of Utah 2001, Chapter 116
             122           31A-26-213 , as last amended by Laws of Utah 2011, Chapter 284
             123           31A-26-214 , as last amended by Laws of Utah 2008, Chapter 382
             124           31A-26-214.5 , as last amended by Laws of Utah 2009, Chapter 349
             125           31A-27a-102 , as last amended by Laws of Utah 2008, Chapter 382
             126           31A-27a-107 , as enacted by Laws of Utah 2007, Chapter 309
             127           31A-27a-201 , as enacted by Laws of Utah 2007, Chapter 309
             128           31A-27a-701 , as last amended by Laws of Utah 2011, Chapter 297
             129           31A-29-106 , as last amended by Laws of Utah 2013, Chapter 319
             130           31A-29-111 , as last amended by Laws of Utah 2012, Chapters 158 and 347
             131           31A-29-115 , as last amended by Laws of Utah 2004, Chapter 2
             132           31A-30-102 , as last amended by Laws of Utah 2009, Chapter 12
             133           31A-30-103 , as last amended by Laws of Utah 2013, Chapter 168
             134           31A-30-104 , as last amended by Laws of Utah 2013, Chapters 168 and 341
             135           31A-30-106 , as last amended by Laws of Utah 2011, Chapter 284
             136           31A-30-106.7 , as last amended by Laws of Utah 2008, Chapter 382
             137           31A-30-107 , as last amended by Laws of Utah 2009, Chapter 12
             138           31A-30-108 , as last amended by Laws of Utah 2011, Chapter 284
             139           31A-30-207 , as last amended by Laws of Utah 2011, Second Special Session, Chapter 5
             140           31A-30-209 , as last amended by Laws of Utah 2011, Chapter 400
             141           31A-30-211 , as last amended by Laws of Utah 2011, Second Special Session, Chapter 5


             142           31A-37-501 , as last amended by Laws of Utah 2008, Chapter 302
             143           31A-40-203 , as enacted by Laws of Utah 2008, Chapter 318
             144           31A-40-209 , as enacted by Laws of Utah 2008, Chapter 318
             145           31A-42-202 , as last amended by Laws of Utah 2011, Chapter 400
             146           31A-43-102 , as enacted by Laws of Utah 2013, Chapter 341
             147           31A-43-301 , as enacted by Laws of Utah 2013, Chapter 341
             148           31A-43-302 , as enacted by Laws of Utah 2013, Chapter 341
             149           31A-43-303 , as enacted by Laws of Utah 2013, Chapter 341
             150           31A-43-304 , as enacted by Laws of Utah 2013, Chapter 341
             151           53-13-103 , as last amended by Laws of Utah 2011, Chapter 58
             152      REPEALS:
             153           31A-30-110 , as last amended by Laws of Utah 2011, Chapters 284 and 297
             154           31A-30-111 , as last amended by Laws of Utah 2002, Chapter 308
             155      Utah Code Sections Affected by Coordination Clause:
             156           31A-23b-205 , as enacted by Laws of Utah 2013, Chapter 341
             157           31A-23b-206 , as enacted by Laws of Utah 2013, Chapter 341
             158      Utah Code Sections Affected by Revisor Instructions:
             159           31A-22-305 , as last amended by Laws of Utah 2013, Chapter 460
             160           31A-22-305.3 , as last amended by Laws of Utah 2013, Chapter 460
             161     
             162      Be it enacted by the Legislature of the state of Utah:
             163          Section 1. Section 31A-1-301 is amended to read:
             164           31A-1-301. Definitions.
             165          As used in this title, unless otherwise specified:
             166          (1) (a) "Accident and health insurance" means insurance to provide protection against
             167      economic losses resulting from:
             168          (i) a medical condition including:
             169          (A) a medical care expense; or


             170          (B) the risk of disability;
             171          (ii) accident; or
             172          (iii) sickness.
             173          (b) "Accident and health insurance":
             174          (i) includes a contract with disability contingencies including:
             175          (A) an income replacement contract;
             176          (B) a health care contract;
             177          (C) an expense reimbursement contract;
             178          (D) a credit accident and health contract;
             179          (E) a continuing care contract; and
             180          (F) a long-term care contract; and
             181          (ii) may provide:
             182          (A) hospital coverage;
             183          (B) surgical coverage;
             184          (C) medical coverage;
             185          (D) loss of income coverage;
             186          (E) prescription drug coverage;
             187          (F) dental coverage; or
             188          (G) vision coverage.
             189          (c) "Accident and health insurance" does not include workers' compensation insurance.
             190          (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title
             191      63G, Chapter 3, Utah Administrative Rulemaking Act.
             192          (3) "Administrator" is defined in Subsection [(163)] (164).
             193          (4) "Adult" means an individual who has attained the age of at least 18 years.
             194          (5) "Affiliate" means a person who controls, is controlled by, or is under common
             195      control with, another person. A corporation is an affiliate of another corporation, regardless of
             196      ownership, if substantially the same group of individuals manage the corporations.
             197          (6) "Agency" means:


             198          (a) a person other than an individual, including a sole proprietorship by which an
             199      individual does business under an assumed name; and
             200          (b) an insurance organization licensed or required to be licensed under Section
             201      31A-23a-301 , 31A-25-207 , or 31A-26-209 .
             202          (7) "Alien insurer" means an insurer domiciled outside the United States.
             203          (8) "Amendment" means an endorsement to an insurance policy or certificate.
             204          (9) "Annuity" means an agreement to make periodical payments for a period certain or
             205      over the lifetime of one or more individuals if the making or continuance of all or some of the
             206      series of the payments, or the amount of the payment, is dependent upon the continuance of
             207      human life.
             208          (10) "Application" means a document:
             209          (a) (i) completed by an applicant to provide information about the risk to be insured;
             210      and
             211          (ii) that contains information that is used by the insurer to evaluate risk and decide
             212      whether to:
             213          (A) insure the risk under:
             214          (I) the coverage as originally offered; or
             215          (II) a modification of the coverage as originally offered; or
             216          (B) decline to insure the risk; or
             217          (b) used by the insurer to gather information from the applicant before issuance of an
             218      annuity contract.
             219          (11) "Articles" or "articles of incorporation" means:
             220          (a) the original articles;
             221          (b) a special law;
             222          (c) a charter;
             223          (d) an amendment;
             224          (e) restated articles;
             225          (f) articles of merger or consolidation;


             226          (g) a trust instrument;
             227          (h) another constitutive document for a trust or other entity that is not a corporation;
             228      and
             229          (i) an amendment to an item listed in Subsections (11)(a) through (h).
             230          (12) "Bail bond insurance" means a guarantee that a person will attend court when
             231      required, up to and including surrender of the person in execution of a sentence imposed under
             232      Subsection 77-20-7 (1), as a condition to the release of that person from confinement.
             233          (13) "Binder" is defined in Section 31A-21-102 .
             234          (14) "Blanket insurance policy" means a group policy covering a defined class of
             235      persons:
             236          (a) without individual underwriting or application; and
             237          (b) that is determined by definition without designating each person covered.
             238          (15) "Board," "board of trustees," or "board of directors" means the group of persons
             239      with responsibility over, or management of, a corporation, however designated.
             240          (16) "Bona fide office" means a physical office in this state:
             241          (a) that is open to the public;
             242          (b) that is staffed during regular business hours on regular business days; and
             243          (c) at which the public may appear in person to obtain services.
             244          (17) "Business entity" means:
             245          (a) a corporation;
             246          (b) an association;
             247          (c) a partnership;
             248          (d) a limited liability company;
             249          (e) a limited liability partnership; or
             250          (f) another legal entity.
             251          (18) "Business of insurance" is defined in Subsection (88).
             252          (19) "Business plan" means the information required to be supplied to the
             253      commissioner under Subsections 31A-5-204 (2)(i) and (j), including the information required


             254      when these subsections apply by reference under:
             255          (a) Section 31A-7-201 ;
             256          (b) Section 31A-8-205 ; or
             257          (c) Subsection 31A-9-205 (2).
             258          (20) (a) "Bylaws" means the rules adopted for the regulation or management of a
             259      corporation's affairs, however designated.
             260          (b) "Bylaws" includes comparable rules for a trust or other entity that is not a
             261      corporation.
             262          (21) "Captive insurance company" means:
             263          (a) an insurer:
             264          (i) owned by another organization; and
             265          (ii) whose exclusive purpose is to insure risks of the parent organization and an
             266      affiliated company; or
             267          (b) in the case of a group or association, an insurer:
             268          (i) owned by the insureds; and
             269          (ii) whose exclusive purpose is to insure risks of:
             270          (A) a member organization;
             271          (B) a group member; or
             272          (C) an affiliate of:
             273          (I) a member organization; or
             274          (II) a group member.
             275          (22) "Casualty insurance" means liability insurance.
             276          (23) "Certificate" means evidence of insurance given to:
             277          (a) an insured under a group insurance policy; or
             278          (b) a third party.
             279          (24) "Certificate of authority" is included within the term "license."
             280          (25) "Claim," unless the context otherwise requires, means a request or demand on an
             281      insurer for payment of a benefit according to the terms of an insurance policy.


             282          (26) "Claims-made coverage" means an insurance contract or provision limiting
             283      coverage under a policy insuring against legal liability to claims that are first made against the
             284      insured while the policy is in force.
             285          (27) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance
             286      commissioner.
             287          (b) When appropriate, the terms listed in Subsection (27)(a) apply to the equivalent
             288      supervisory official of another jurisdiction.
             289          (28) (a) "Continuing care insurance" means insurance that:
             290          (i) provides board and lodging;
             291          (ii) provides one or more of the following:
             292          (A) a personal service;
             293          (B) a nursing service;
             294          (C) a medical service; or
             295          (D) any other health-related service; and
             296          (iii) provides the coverage described in this Subsection (28)(a) under an agreement
             297      effective:
             298          (A) for the life of the insured; or
             299          (B) for a period in excess of one year.
             300          (b) Insurance is continuing care insurance regardless of whether or not the board and
             301      lodging are provided at the same location as a service described in Subsection (28)(a)(ii).
             302          (29) (a) "Control," "controlling," "controlled," or "under common control" means the
             303      direct or indirect possession of the power to direct or cause the direction of the management
             304      and policies of a person. This control may be:
             305          (i) by contract;
             306          (ii) by common management;
             307          (iii) through the ownership of voting securities; or
             308          (iv) by a means other than those described in Subsections (29)(a)(i) through (iii).
             309          (b) There is no presumption that an individual holding an official position with another


             310      person controls that person solely by reason of the position.
             311          (c) A person having a contract or arrangement giving control is considered to have
             312      control despite the illegality or invalidity of the contract or arrangement.
             313          (d) There is a rebuttable presumption of control in a person who directly or indirectly
             314      owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the
             315      voting securities of another person.
             316          (30) "Controlled insurer" means a licensed insurer that is either directly or indirectly
             317      controlled by a producer.
             318          (31) "Controlling person" means a person that directly or indirectly has the power to
             319      direct or cause to be directed, the management, control, or activities of a reinsurance
             320      intermediary.
             321          (32) "Controlling producer" means a producer who directly or indirectly controls an
             322      insurer.
             323          (33) (a) "Corporation" means an insurance corporation, except when referring to:
             324          (i) a corporation doing business:
             325          (A) as:
             326          (I) an insurance producer;
             327          (II) a surplus lines producer;
             328          (III) a limited line producer;
             329          (IV) a consultant;
             330          (V) a managing general agent;
             331          (VI) a reinsurance intermediary;
             332          (VII) a third party administrator; or
             333          (VIII) an adjuster; and
             334          (B) under:
             335          (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
             336      Reinsurance Intermediaries;
             337          (II) Chapter 25, Third Party Administrators; or


             338          (III) Chapter 26, Insurance Adjusters; or
             339          (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance
             340      Holding Companies.
             341          (b) "Stock corporation" means a stock insurance corporation.
             342          (c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
             343          (34) (a) "Creditable coverage" has the same meaning as provided in federal regulations
             344      adopted pursuant to the Health Insurance Portability and Accountability Act.
             345          (b) "Creditable coverage" includes coverage that is offered through a public health plan
             346      such as:
             347          (i) the Primary Care Network Program under a Medicaid primary care network
             348      demonstration waiver obtained subject to Section 26-18-3 ;
             349          (ii) the Children's Health Insurance Program under Section 26-40-106 ; or
             350          (iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.
             351      101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. 109-415.
             352          (35) "Credit accident and health insurance" means insurance on a debtor to provide
             353      indemnity for payments coming due on a specific loan or other credit transaction while the
             354      debtor has a disability.
             355          (36) (a) "Credit insurance" means insurance offered in connection with an extension of
             356      credit that is limited to partially or wholly extinguishing that credit obligation.
             357          (b) "Credit insurance" includes:
             358          (i) credit accident and health insurance;
             359          (ii) credit life insurance;
             360          (iii) credit property insurance;
             361          (iv) credit unemployment insurance;
             362          (v) guaranteed automobile protection insurance;
             363          (vi) involuntary unemployment insurance;
             364          (vii) mortgage accident and health insurance;
             365          (viii) mortgage guaranty insurance; and


             366          (ix) mortgage life insurance.
             367          (37) "Credit life insurance" means insurance on the life of a debtor in connection with
             368      an extension of credit that pays a person if the debtor dies.
             369          (38) "Credit property insurance" means insurance:
             370          (a) offered in connection with an extension of credit; and
             371          (b) that protects the property until the debt is paid.
             372          (39) "Credit unemployment insurance" means insurance:
             373          (a) offered in connection with an extension of credit; and
             374          (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
             375          (i) specific loan; or
             376          (ii) credit transaction.
             377          (40) "Creditor" means a person, including an insured, having a claim, whether:
             378          (a) matured;
             379          (b) unmatured;
             380          (c) liquidated;
             381          (d) unliquidated;
             382          (e) secured;
             383          (f) unsecured;
             384          (g) absolute;
             385          (h) fixed; or
             386          (i) contingent.
             387          (41) (a) "Crop insurance" means insurance providing protection against damage to
             388      crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation,
             389      disease, or other yield-reducing conditions or perils that is:
             390          (i) provided by the private insurance market; or
             391          (ii) subsidized by the Federal Crop Insurance Corporation.
             392          (b) "Crop insurance" includes multiperil crop insurance.
             393          (42) (a) "Customer service representative" means a person that provides an insurance


             394      service and insurance product information:
             395          (i) for the customer service representative's:
             396          (A) producer;
             397          (B) surplus lines producer; or
             398          (C) consultant employer; and
             399          (ii) to the customer service representative's employer's:
             400          (A) customer;
             401          (B) client; or
             402          (C) organization.
             403          (b) A customer service representative may only operate within the scope of authority of
             404      the customer service representative's producer, surplus lines producer, or consultant employer.
             405          (43) "Deadline" means a final date or time:
             406          (a) imposed by:
             407          (i) statute;
             408          (ii) rule; or
             409          (iii) order; and
             410          (b) by which a required filing or payment must be received by the department.
             411          (44) "Deemer clause" means a provision under this title under which upon the
             412      occurrence of a condition precedent, the commissioner is considered to have taken a specific
             413      action. If the statute so provides, a condition precedent may be the commissioner's failure to
             414      take a specific action.
             415          (45) "Degree of relationship" means the number of steps between two persons
             416      determined by counting the generations separating one person from a common ancestor and
             417      then counting the generations to the other person.
             418          (46) "Department" means the Insurance Department.
             419          (47) "Director" means a member of the board of directors of a corporation.
             420          (48) "Disability" means a physiological or psychological condition that partially or
             421      totally limits an individual's ability to:


             422          (a) perform the duties of:
             423          (i) that individual's occupation; or
             424          (ii) [any] an occupation for which the individual is reasonably suited by education,
             425      training, or experience; or
             426          (b) perform two or more of the following basic activities of daily living:
             427          (i) eating;
             428          (ii) toileting;
             429          (iii) transferring;
             430          (iv) bathing; or
             431          (v) dressing.
             432          (49) "Disability income insurance" is defined in Subsection (79).
             433          (50) "Domestic insurer" means an insurer organized under the laws of this state.
             434          (51) "Domiciliary state" means the state in which an insurer:
             435          (a) is incorporated;
             436          (b) is organized; or
             437          (c) in the case of an alien insurer, enters into the United States.
             438          (52) (a) "Eligible employee" means:
             439          (i) an employee who:
             440          (A) works on a full-time basis; and
             441          (B) has a normal work week of 30 or more hours; or
             442          (ii) a person described in Subsection (52)(b).
             443          (b) "Eligible employee" includes, if the individual is included under a health benefit
             444      plan of a small employer:
             445          (i) a sole proprietor;
             446          (ii) a partner in a partnership; or
             447          (iii) an independent contractor.
             448          (c) "Eligible employee" does not include, unless eligible under Subsection (52)(b):
             449          (i) an individual who works on a temporary or substitute basis for a small employer;


             450          (ii) an employer's spouse; or
             451          (iii) a dependent of an employer.
             452          (53) "Employee" means an individual employed by an employer.
             453          (54) "Employee benefits" means one or more benefits or services provided to:
             454          (a) an employee; or
             455          (b) a dependent of an employee.
             456          (55) (a) "Employee welfare fund" means a fund:
             457          (i) established or maintained, whether directly or through a trustee, by:
             458          (A) one or more employers;
             459          (B) one or more labor organizations; or
             460          (C) a combination of employers and labor organizations; and
             461          (ii) that provides employee benefits paid or contracted to be paid, other than income
             462      from investments of the fund:
             463          (A) by or on behalf of an employer doing business in this state; or
             464          (B) for the benefit of a person employed in this state.
             465          (b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or tax
             466      revenues.
             467          (56) "Endorsement" means a written agreement attached to a policy or certificate to
             468      modify the policy or certificate coverage.
             469          (57) "Enrollment date," with respect to a health benefit plan, means:
             470          (a) the first day of coverage; or
             471          (b) if there is a waiting period, the first day of the waiting period.
             472          (58) (a) "Escrow" means:
             473          (i) a transaction that effects the sale, transfer, encumbering, or leasing of real property,
             474      when a person not a party to the transaction, and neither having nor acquiring an interest in the
             475      title, performs, in accordance with the written instructions or terms of the written agreement
             476      between the parties to the transaction, any of the following actions:
             477          (A) the explanation, holding, or creation of a document; or


             478          (B) the receipt, deposit, and disbursement of money;
             479          (ii) a settlement or closing involving:
             480          (A) a mobile home;
             481          (B) a grazing right;
             482          (C) a water right; or
             483          (D) other personal property authorized by the commissioner.
             484          (b) "Escrow" does not include:
             485          (i) the following notarial acts performed by a notary within the state:
             486          (A) an acknowledgment;
             487          (B) a copy certification;
             488          (C) jurat; and
             489          (D) an oath or affirmation;
             490          (ii) the receipt or delivery of a document; or
             491          (iii) the receipt of money for delivery to the escrow agent.
             492          (59) "Escrow agent" means an agency title insurance producer meeting the
             493      requirements of Sections 31A-4-107 , 31A-14-211 , and 31A-23a-204 , who is acting through an
             494      individual title insurance producer licensed with an escrow subline of authority.
             495          (60) (a) "Excludes" is not exhaustive and does not mean that another thing is not also
             496      excluded.
             497          (b) The items listed in a list using the term "excludes" are representative examples for
             498      use in interpretation of this title.
             499          (61) "Exclusion" means for the purposes of accident and health insurance that an
             500      insurer does not provide insurance coverage, for whatever reason, for one of the following:
             501          (a) a specific physical condition;
             502          (b) a specific medical procedure;
             503          (c) a specific disease or disorder; or
             504          (d) a specific prescription drug or class of prescription drugs.
             505          (62) "Expense reimbursement insurance" means insurance:


             506          (a) written to provide a payment for an expense relating to hospital confinement
             507      resulting from illness or injury; and
             508          (b) written:
             509          (i) as a daily limit for a specific number of days in a hospital; and
             510          (ii) to have a one or two day waiting period following a hospitalization.
             511          (63) "Fidelity insurance" means insurance guaranteeing the fidelity of a person holding
             512      a position of public or private trust.
             513          (64) (a) "Filed" means that a filing is:
             514          (i) submitted to the department as required by and in accordance with applicable
             515      statute, rule, or filing order;
             516          (ii) received by the department within the time period provided in applicable statute,
             517      rule, or filing order; and
             518          (iii) accompanied by the appropriate fee in accordance with:
             519          (A) Section 31A-3-103 ; or
             520          (B) rule.
             521          (b) "Filed" does not include a filing that is rejected by the department because it is not
             522      submitted in accordance with Subsection (64)(a).
             523          (65) "Filing," when used as a noun, means an item required to be filed with the
             524      department including:
             525          (a) a policy;
             526          (b) a rate;
             527          (c) a form;
             528          (d) a document;
             529          (e) a plan;
             530          (f) a manual;
             531          (g) an application;
             532          (h) a report;
             533          (i) a certificate;


             534          (j) an endorsement;
             535          (k) an actuarial certification;
             536          (l) a licensee annual statement;
             537          (m) a licensee renewal application;
             538          (n) an advertisement; or
             539          (o) an outline of coverage.
             540          (66) "First party insurance" means an insurance policy or contract in which the insurer
             541      agrees to pay a claim submitted to it by the insured for the insured's losses.
             542          (67) "Foreign insurer" means an insurer domiciled outside of this state, including an
             543      alien insurer.
             544          (68) (a) "Form" means one of the following prepared for general use:
             545          (i) a policy;
             546          (ii) a certificate;
             547          (iii) an application;
             548          (iv) an outline of coverage; or
             549          (v) an endorsement.
             550          (b) "Form" does not include a document specially prepared for use in an individual
             551      case.
             552          (69) "Franchise insurance" means an individual insurance policy provided through a
             553      mass marketing arrangement involving a defined class of persons related in some way other
             554      than through the purchase of insurance.
             555          (70) "General lines of authority" include:
             556          (a) the general lines of insurance in Subsection (71);
             557          (b) title insurance under one of the following sublines of authority:
             558          (i) search, including authority to act as a title marketing representative;
             559          (ii) escrow, including authority to act as a title marketing representative; and
             560          (iii) title marketing representative only;
             561          (c) surplus lines;


             562          (d) workers' compensation; and
             563          (e) [any other] another line of insurance that the commissioner considers necessary to
             564      recognize in the public interest.
             565          (71) "General lines of insurance" include:
             566          (a) accident and health;
             567          (b) casualty;
             568          (c) life;
             569          (d) personal lines;
             570          (e) property; and
             571          (f) variable contracts, including variable life and annuity.
             572          (72) "Group health plan" means an employee welfare benefit plan to the extent that the
             573      plan provides medical care:
             574          (a) (i) to an employee; or
             575          (ii) to a dependent of an employee; and
             576          (b) (i) directly;
             577          (ii) through insurance reimbursement; or
             578          (iii) through another method.
             579          (73) (a) "Group insurance policy" means a policy covering a group of persons that is
             580      issued:
             581          (i) to a policyholder on behalf of the group; and
             582          (ii) for the benefit of a member of the group who is selected under a procedure defined
             583      in:
             584          (A) the policy; or
             585          (B) an agreement that is collateral to the policy.
             586          (b) A group insurance policy may include a member of the policyholder's family or a
             587      dependent.
             588          (74) "Guaranteed automobile protection insurance" means insurance offered in
             589      connection with an extension of credit that pays the difference in amount between the


             590      insurance settlement and the balance of the loan if the insured automobile is a total loss.
             591          (75) (a) Except as provided in Subsection (75)(b), "health benefit plan" means a policy
             592      or certificate that:
             593          (i) provides health care insurance;
             594          (ii) provides major medical expense insurance; or
             595          (iii) is offered as a substitute for hospital or medical expense insurance, such as:
             596          (A) a hospital confinement indemnity; or
             597          (B) a limited benefit plan.
             598          (b) "Health benefit plan" does not include a policy or certificate that:
             599          (i) provides benefits solely for:
             600          (A) accident;
             601          (B) dental;
             602          (C) income replacement;
             603          (D) long-term care;
             604          (E) a Medicare supplement;
             605          (F) a specified disease;
             606          (G) vision; or
             607          (H) a short-term limited duration; or
             608          (ii) is offered and marketed as supplemental health insurance.
             609          (76) "Health care" means any of the following intended for use in the diagnosis,
             610      treatment, mitigation, or prevention of a human ailment or impairment:
             611          (a) a professional service;
             612          (b) a personal service;
             613          (c) a facility;
             614          (d) equipment;
             615          (e) a device;
             616          (f) supplies; or
             617          (g) medicine.


             618          (77) (a) "Health care insurance" or "health insurance" means insurance providing:
             619          (i) a health care benefit; or
             620          (ii) payment of an incurred health care expense.
             621          (b) "Health care insurance" or "health insurance" does not include accident and health
             622      insurance providing a benefit for:
             623          (i) replacement of income;
             624          (ii) short-term accident;
             625          (iii) fixed indemnity;
             626          (iv) credit accident and health;
             627          (v) supplements to liability;
             628          (vi) workers' compensation;
             629          (vii) automobile medical payment;
             630          (viii) no-fault automobile;
             631          (ix) equivalent self-insurance; or
             632          (x) a type of accident and health insurance coverage that is a part of or attached to
             633      another type of policy.
             634          (78) "Health Insurance Portability and Accountability Act" means the Health Insurance
             635      Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936, as amended.
             636          (79) "Income replacement insurance" or "disability income insurance" means insurance
             637      written to provide payments to replace income lost from accident or sickness.
             638          (80) "Indemnity" means the payment of an amount to offset all or part of an insured
             639      loss.
             640          (81) "Independent adjuster" means an insurance adjuster required to be licensed under
             641      Section 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
             642          (82) "Independently procured insurance" means insurance procured under Section
             643      31A-15-104 .
             644          (83) "Individual" means a natural person.
             645          (84) "Inland marine insurance" includes insurance covering:


             646          (a) property in transit on or over land;
             647          (b) property in transit over water by means other than boat or ship;
             648          (c) bailee liability;
             649          (d) fixed transportation property such as bridges, electric transmission systems, radio
             650      and television transmission towers and tunnels; and
             651          (e) personal and commercial property floaters.
             652          (85) "Insolvency" means that:
             653          (a) an insurer is unable to pay its debts or meet its obligations as the debts and
             654      obligations mature;
             655          (b) an insurer's total adjusted capital is less than the insurer's mandatory control level
             656      RBC under Subsection 31A-17-601 (8)(c); or
             657          (c) an insurer is determined to be hazardous under this title.
             658          (86) (a) "Insurance" means:
             659          (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more
             660      persons to one or more other persons; or
             661          (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a
             662      group of persons that includes the person seeking to distribute that person's risk.
             663          (b) "Insurance" includes:
             664          (i) a risk distributing arrangement providing for compensation or replacement for
             665      damages or loss through the provision of a service or a benefit in kind;
             666          (ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a
             667      business and not as merely incidental to a business transaction; and
             668          (iii) a plan in which the risk does not rest upon the person who makes an arrangement,
             669      but with a class of persons who have agreed to share the risk.
             670          (87) "Insurance adjuster" means a person who directs or conducts the investigation,
             671      negotiation, or settlement of a claim under an insurance policy other than life insurance or an
             672      annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy.
             673          (88) "Insurance business" or "business of insurance" includes:


             674          (a) providing health care insurance by an organization that is or is required to be
             675      licensed under this title;
             676          (b) providing a benefit to an employee in the event of a contingency not within the
             677      control of the employee, in which the employee is entitled to the benefit as a right, which
             678      benefit may be provided either:
             679          (i) by a single employer or by multiple employer groups; or
             680          (ii) through one or more trusts, associations, or other entities;
             681          (c) providing an annuity:
             682          (i) including an annuity issued in return for a gift; and
             683          (ii) except an annuity provided by a person specified in Subsections 31A-22-1305 (2)
             684      and (3);
             685          (d) providing the characteristic services of a motor club as outlined in Subsection
             686      (116);
             687          (e) providing another person with insurance;
             688          (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor,
             689      or surety, a contract or policy of title insurance;
             690          (g) transacting or proposing to transact any phase of title insurance, including:
             691          (i) solicitation;
             692          (ii) negotiation preliminary to execution;
             693          (iii) execution of a contract of title insurance;
             694          (iv) insuring; and
             695          (v) transacting matters subsequent to the execution of the contract and arising out of
             696      the contract, including reinsurance;
             697          (h) transacting or proposing a life settlement; and
             698          (i) doing, or proposing to do, any business in substance equivalent to Subsections
             699      (88)(a) through (h) in a manner designed to evade this title.
             700          (89) "Insurance consultant" or "consultant" means a person who:
             701          (a) advises another person about insurance needs and coverages;


             702          (b) is compensated by the person advised on a basis not directly related to the insurance
             703      placed; and
             704          (c) except as provided in Section 31A-23a-501 , is not compensated directly or
             705      indirectly by an insurer or producer for advice given.
             706          (90) "Insurance holding company system" means a group of two or more affiliated
             707      persons, at least one of whom is an insurer.
             708          (91) (a) "Insurance producer" or "producer" means a person licensed or required to be
             709      licensed under the laws of this state to sell, solicit, or negotiate insurance.
             710          (b) (i) "Producer for the insurer" means a producer who is compensated directly or
             711      indirectly by an insurer for selling, soliciting, or negotiating an insurance product of that
             712      insurer.
             713          (ii) "Producer for the insurer" may be referred to as an "agent."
             714          (c) (i) "Producer for the insured" means a producer who:
             715          (A) is compensated directly and only by an insurance customer or an insured; and
             716          (B) receives no compensation directly or indirectly from an insurer for selling,
             717      soliciting, or negotiating an insurance product of that insurer to an insurance customer or
             718      insured.
             719          (ii) "Producer for the insured" may be referred to as a "broker."
             720          (92) (a) "Insured" means a person to whom or for whose benefit an insurer makes a
             721      promise in an insurance policy and includes:
             722          (i) a policyholder;
             723          (ii) a subscriber;
             724          (iii) a member; and
             725          (iv) a beneficiary.
             726          (b) The definition in Subsection (92)(a):
             727          (i) applies only to this title; and
             728          (ii) does not define the meaning of this word as used in an insurance policy or
             729      certificate.


             730          (93) (a) "Insurer" means a person doing an insurance business as a principal including:
             731          (i) a fraternal benefit society;
             732          (ii) an issuer of a gift annuity other than an annuity specified in Subsections
             733      31A-22-1305 (2) and (3);
             734          (iii) a motor club;
             735          (iv) an employee welfare plan; and
             736          (v) a person purporting or intending to do an insurance business as a principal on that
             737      person's own account.
             738          (b) "Insurer" does not include a governmental entity to the extent the governmental
             739      entity is engaged in an activity described in Section 31A-12-107 .
             740          (94) "Interinsurance exchange" is defined in Subsection [(146)] (147).
             741          (95) "Involuntary unemployment insurance" means insurance:
             742          (a) offered in connection with an extension of credit; and
             743          (b) that provides indemnity if the debtor is involuntarily unemployed for payments
             744      coming due on a:
             745          (i) specific loan; or
             746          (ii) credit transaction.
             747          (96) "Large employer," in connection with a health benefit plan, means an employer
             748      who, with respect to a calendar year and to a plan year:
             749          (a) employed an average of at least 51 eligible employees on each business day during
             750      the preceding calendar year; and
             751          (b) employs at least two employees on the first day of the plan year.
             752          (97) "Late enrollee," with respect to an employer health benefit plan, means an
             753      individual whose enrollment is a late enrollment.
             754          (98) "Late enrollment," with respect to an employer health benefit plan, means
             755      enrollment of an individual other than:
             756          (a) on the earliest date on which coverage can become effective for the individual
             757      under the terms of the plan; or


             758          (b) through special enrollment.
             759          (99) (a) Except for a retainer contract or legal assistance described in Section
             760      31A-1-103 , "legal expense insurance" means insurance written to indemnify or pay for a
             761      specified legal expense.
             762          (b) "Legal expense insurance" includes an arrangement that creates a reasonable
             763      expectation of an enforceable right.
             764          (c) "Legal expense insurance" does not include the provision of, or reimbursement for,
             765      legal services incidental to other insurance coverage.
             766          (100) (a) "Liability insurance" means insurance against liability:
             767          (i) for death, injury, or disability of a human being, or for damage to property,
             768      exclusive of the coverages under:
             769          (A) Subsection (110) for medical malpractice insurance;
             770          (B) Subsection (138) for professional liability insurance; and
             771          (C) Subsection [(172)] (173) for workers' compensation insurance;
             772          (ii) for a medical, hospital, surgical, and funeral benefit to a person other than the
             773      insured who is injured, irrespective of legal liability of the insured, when issued with or
             774      supplemental to insurance against legal liability for the death, injury, or disability of a human
             775      being, exclusive of the coverages under:
             776          (A) Subsection (110) for medical malpractice insurance;
             777          (B) Subsection (138) for professional liability insurance; and
             778          (C) Subsection [(172)] (173) for workers' compensation insurance;
             779          (iii) for loss or damage to property resulting from an accident to or explosion of a
             780      boiler, pipe, pressure container, machinery, or apparatus;
             781          (iv) for loss or damage to property caused by:
             782          (A) the breakage or leakage of a sprinkler, water pipe, or water container; or
             783          (B) water entering through a leak or opening in a building; or
             784          (v) for other loss or damage properly the subject of insurance not within another kind
             785      of insurance as defined in this chapter, if the insurance is not contrary to law or public policy.


             786          (b) "Liability insurance" includes:
             787          (i) vehicle liability insurance;
             788          (ii) residential dwelling liability insurance; and
             789          (iii) making inspection of, and issuing a certificate of inspection upon, an elevator,
             790      boiler, machinery, or apparatus of any kind when done in connection with insurance on the
             791      elevator, boiler, machinery, or apparatus.
             792          (101) (a) "License" means authorization issued by the commissioner to engage in an
             793      activity that is part of or related to the insurance business.
             794          (b) "License" includes a certificate of authority issued to an insurer.
             795          (102) (a) "Life insurance" means:
             796          (i) insurance on a human life; and
             797          (ii) insurance pertaining to or connected with human life.
             798          (b) The business of life insurance includes:
             799          (i) granting a death benefit;
             800          (ii) granting an annuity benefit;
             801          (iii) granting an endowment benefit;
             802          (iv) granting an additional benefit in the event of death by accident;
             803          (v) granting an additional benefit to safeguard the policy against lapse; and
             804          (vi) providing an optional method of settlement of proceeds.
             805          (103) "Limited license" means a license that:
             806          (a) is issued for a specific product of insurance; and
             807          (b) limits an individual or agency to transact only for that product or insurance.
             808          (104) "Limited line credit insurance" includes the following forms of insurance:
             809          (a) credit life;
             810          (b) credit accident and health;
             811          (c) credit property;
             812          (d) credit unemployment;
             813          (e) involuntary unemployment;


             814          (f) mortgage life;
             815          (g) mortgage guaranty;
             816          (h) mortgage accident and health;
             817          (i) guaranteed automobile protection; and
             818          (j) another form of insurance offered in connection with an extension of credit that:
             819          (i) is limited to partially or wholly extinguishing the credit obligation; and
             820          (ii) the commissioner determines by rule should be designated as a form of limited line
             821      credit insurance.
             822          (105) "Limited line credit insurance producer" means a person who sells, solicits, or
             823      negotiates one or more forms of limited line credit insurance coverage to an individual through
             824      a master, corporate, group, or individual policy.
             825          (106) "Limited line insurance" includes:
             826          (a) bail bond;
             827          (b) limited line credit insurance;
             828          (c) legal expense insurance;
             829          (d) motor club insurance;
             830          (e) car rental related insurance;
             831          (f) travel insurance;
             832          (g) crop insurance;
             833          (h) self-service storage insurance;
             834          (i) guaranteed asset protection waiver;
             835          (j) portable electronics insurance; and
             836          (k) another form of limited insurance that the commissioner determines by rule should
             837      be designated a form of limited line insurance.
             838          (107) "Limited lines authority" includes[: (a)] the lines of insurance listed in
             839      Subsection (106)[; and].
             840          [(b) a customer service representative.]
             841          (108) "Limited lines producer" means a person who sells, solicits, or negotiates limited


             842      lines insurance.
             843          (109) (a) "Long-term care insurance" means an insurance policy or rider advertised,
             844      marketed, offered, or designated to provide coverage:
             845          (i) in a setting other than an acute care unit of a hospital;
             846          (ii) for not less than 12 consecutive months for a covered person on the basis of:
             847          (A) expenses incurred;
             848          (B) indemnity;
             849          (C) prepayment; or
             850          (D) another method;
             851          (iii) for one or more necessary or medically necessary services that are:
             852          (A) diagnostic;
             853          (B) preventative;
             854          (C) therapeutic;
             855          (D) rehabilitative;
             856          (E) maintenance; or
             857          (F) personal care; and
             858          (iv) that may be issued by:
             859          (A) an insurer;
             860          (B) a fraternal benefit society;
             861          (C) (I) a nonprofit health hospital; and
             862          (II) a medical service corporation;
             863          (D) a prepaid health plan;
             864          (E) a health maintenance organization; or
             865          (F) an entity similar to the entities described in Subsections (109)(a)(iv)(A) through (E)
             866      to the extent that the entity is otherwise authorized to issue life or health care insurance.
             867          (b) "Long-term care insurance" includes:
             868          (i) any of the following that provide directly or supplement long-term care insurance:
             869          (A) a group or individual annuity or rider; or


             870          (B) a life insurance policy or rider;
             871          (ii) a policy or rider that provides for payment of benefits on the basis of:
             872          (A) cognitive impairment; or
             873          (B) functional capacity; or
             874          (iii) a qualified long-term care insurance contract.
             875          (c) "Long-term care insurance" does not include:
             876          (i) a policy that is offered primarily to provide basic Medicare supplement coverage;
             877          (ii) basic hospital expense coverage;
             878          (iii) basic medical/surgical expense coverage;
             879          (iv) hospital confinement indemnity coverage;
             880          (v) major medical expense coverage;
             881          (vi) income replacement or related asset-protection coverage;
             882          (vii) accident only coverage;
             883          (viii) coverage for a specified:
             884          (A) disease; or
             885          (B) accident;
             886          (ix) limited benefit health coverage; or
             887          (x) a life insurance policy that accelerates the death benefit to provide the option of a
             888      lump sum payment:
             889          (A) if the following are not conditioned on the receipt of long-term care:
             890          (I) benefits; or
             891          (II) eligibility; and
             892          (B) the coverage is for one or more the following qualifying events:
             893          (I) terminal illness;
             894          (II) medical conditions requiring extraordinary medical intervention; or
             895          (III) permanent institutional confinement.
             896          (110) "Medical malpractice insurance" means insurance against legal liability incident
             897      to the practice and provision of a medical service other than the practice and provision of a


             898      dental service.
             899          (111) "Member" means a person having membership rights in an insurance
             900      corporation.
             901          (112) "Minimum capital" or "minimum required capital" means the capital that must be
             902      constantly maintained by a stock insurance corporation as required by statute.
             903          (113) "Mortgage accident and health insurance" means insurance offered in connection
             904      with an extension of credit that provides indemnity for payments coming due on a mortgage
             905      while the debtor has a disability.
             906          (114) "Mortgage guaranty insurance" means surety insurance under which a mortgagee
             907      or other creditor is indemnified against losses caused by the default of a debtor.
             908          (115) "Mortgage life insurance" means insurance on the life of a debtor in connection
             909      with an extension of credit that pays if the debtor dies.
             910          (116) "Motor club" means a person:
             911          (a) licensed under:
             912          (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
             913          (ii) Chapter 11, Motor Clubs; or
             914          (iii) Chapter 14, Foreign Insurers; and
             915          (b) that promises for an advance consideration to provide for a stated period of time
             916      one or more:
             917          (i) legal services under Subsection 31A-11-102 (1)(b);
             918          (ii) bail services under Subsection 31A-11-102 (1)(c); or
             919          (iii) (A) trip reimbursement;
             920          (B) towing services;
             921          (C) emergency road services;
             922          (D) stolen automobile services;
             923          (E) a combination of the services listed in Subsections (116)(b)(iii)(A) through (D); or
             924          (F) other services given in Subsections 31A-11-102 (1)(b) through (f).
             925          (117) "Mutual" means a mutual insurance corporation.


             926          (118) "Network plan" means health care insurance:
             927          (a) that is issued by an insurer; and
             928          (b) under which the financing and delivery of medical care is provided, in whole or in
             929      part, through a defined set of providers under contract with the insurer, including the financing
             930      and delivery of an item paid for as medical care.
             931          (119) "Nonparticipating" means a plan of insurance under which the insured is not
             932      entitled to receive a dividend representing a share of the surplus of the insurer.
             933          (120) "Ocean marine insurance" means insurance against loss of or damage to:
             934          (a) ships or hulls of ships;
             935          (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money,
             936      securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia
             937      interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
             938          (c) earnings such as freight, passage money, commissions, or profits derived from
             939      transporting goods or people upon or across the oceans or inland waterways; or
             940          (d) a vessel owner or operator as a result of liability to employees, passengers, bailors,
             941      owners of other vessels, owners of fixed objects, customs or other authorities, or other persons
             942      in connection with maritime activity.
             943          (121) "Order" means an order of the commissioner.
             944          (122) "Outline of coverage" means a summary that explains an accident and health
             945      insurance policy.
             946          (123) "Participating" means a plan of insurance under which the insured is entitled to
             947      receive a dividend representing a share of the surplus of the insurer.
             948          (124) "Participation," as used in a health benefit plan, means a requirement relating to
             949      the minimum percentage of eligible employees that must be enrolled in relation to the total
             950      number of eligible employees of an employer reduced by each eligible employee who
             951      voluntarily declines coverage under the plan because the employee:
             952          (a) has other group health care insurance coverage; or
             953          (b) receives:


             954          (i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the Social
             955      Security Amendments of 1965; or
             956          (ii) another government health benefit.
             957          (125) "Person" includes:
             958          (a) an individual;
             959          (b) a partnership;
             960          (c) a corporation;
             961          (d) an incorporated or unincorporated association;
             962          (e) a joint stock company;
             963          (f) a trust;
             964          (g) a limited liability company;
             965          (h) a reciprocal;
             966          (i) a syndicate; or
             967          (j) another similar entity or combination of entities acting in concert.
             968          (126) "Personal lines insurance" means property and casualty insurance coverage sold
             969      for primarily noncommercial purposes to:
             970          (a) an individual; or
             971          (b) a family.
             972          (127) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
             973          (128) "Plan year" means:
             974          (a) the year that is designated as the plan year in:
             975          (i) the plan document of a group health plan; or
             976          (ii) a summary plan description of a group health plan;
             977          (b) if the plan document or summary plan description does not designate a plan year or
             978      there is no plan document or summary plan description:
             979          (i) the year used to determine deductibles or limits;
             980          (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis;
             981      or


             982          (iii) the employer's taxable year if:
             983          (A) the plan does not impose deductibles or limits on a yearly basis; and
             984          (B) (I) the plan is not insured; or
             985          (II) the insurance policy is not renewed on an annual basis; or
             986          (c) in a case not described in Subsection (128)(a) or (b), the calendar year.
             987          (129) (a) "Policy" means a document, including an attached endorsement or application
             988      that:
             989          (i) purports to be an enforceable contract; and
             990          (ii) memorializes in writing some or all of the terms of an insurance contract.
             991          (b) "Policy" includes a service contract issued by:
             992          (i) a motor club under Chapter 11, Motor Clubs;
             993          (ii) a service contract provided under Chapter 6a, Service Contracts; and
             994          (iii) a corporation licensed under:
             995          (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
             996          (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
             997          (c) "Policy" does not include:
             998          (i) a certificate under a group insurance contract; or
             999          (ii) a document that does not purport to have legal effect.
             1000          (130) "Policyholder" means a person who controls a policy, binder, or oral contract by
             1001      ownership, premium payment, or otherwise.
             1002          (131) "Policy illustration" means a presentation or depiction that includes
             1003      nonguaranteed elements of a policy of life insurance over a period of years.
             1004          (132) "Policy summary" means a synopsis describing the elements of a life insurance
             1005      policy.
             1006          (133) "PPACA" means the Patient Protection and Affordable Care Act, Pub. L. No.
             1007      111-148 and the Health Care Education Reconciliation Act of 2010, Pub. L. No. 111-152, and
             1008      related federal regulations and guidance.
             1009          (134) "Preexisting condition," with respect to a health benefit plan:


             1010          (a) means a condition that was present before the effective date of coverage, whether or
             1011      not medical advice, diagnosis, care, or treatment was recommended or received before that day;
             1012      and
             1013          (b) does not include a condition indicated by genetic information unless an actual
             1014      diagnosis of the condition by a physician has been made.
             1015          (135) (a) "Premium" means the monetary consideration for an insurance policy.
             1016          (b) "Premium" includes, however designated:
             1017          (i) an assessment;
             1018          (ii) a membership fee;
             1019          (iii) a required contribution; or
             1020          (iv) monetary consideration.
             1021          (c) (i) "Premium" does not include consideration paid to a third party administrator for
             1022      the third party administrator's services.
             1023          (ii) "Premium" includes an amount paid by a third party administrator to an insurer for
             1024      insurance on the risks administered by the third party administrator.
             1025          (136) "Principal officers" for a corporation means the officers designated under
             1026      Subsection 31A-5-203 (3).
             1027          (137) "Proceeding" includes an action or special statutory proceeding.
             1028          (138) "Professional liability insurance" means insurance against legal liability incident
             1029      to the practice of a profession and provision of a professional service.
             1030          (139) (a) Except as provided in Subsection (139)(b), "property insurance" means
             1031      insurance against loss or damage to real or personal property of every kind and any interest in
             1032      that property:
             1033          (i) from all hazards or causes; and
             1034          (ii) against loss consequential upon the loss or damage including vehicle
             1035      comprehensive and vehicle physical damage coverages.
             1036          (b) "Property insurance" does not include:
             1037          (i) inland marine insurance; and


             1038          (ii) ocean marine insurance.
             1039          (140) "Qualified long-term care insurance contract" or "federally tax qualified
             1040      long-term care insurance contract" means:
             1041          (a) an individual or group insurance contract that meets the requirements of Section
             1042      7702B(b), Internal Revenue Code; or
             1043          (b) the portion of a life insurance contract that provides long-term care insurance:
             1044          (i) (A) by rider; or
             1045          (B) as a part of the contract; and
             1046          (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue
             1047      Code.
             1048          (141) "Qualified United States financial institution" means an institution that:
             1049          (a) is:
             1050          (i) organized under the laws of the United States or any state; or
             1051          (ii) in the case of a United States office of a foreign banking organization, licensed
             1052      under the laws of the United States or any state;
             1053          (b) is regulated, supervised, and examined by a United States federal or state authority
             1054      having regulatory authority over a bank or trust company; and
             1055          (c) meets the standards of financial condition and standing that are considered
             1056      necessary and appropriate to regulate the quality of a financial institution whose letters of credit
             1057      will be acceptable to the commissioner as determined by:
             1058          (i) the commissioner by rule; or
             1059          (ii) the Securities Valuation Office of the National Association of Insurance
             1060      Commissioners.
             1061          (142) (a) "Rate" means:
             1062          (i) the cost of a given unit of insurance; or
             1063          (ii) for property or casualty insurance, that cost of insurance per exposure unit either
             1064      expressed as:
             1065          (A) a single number; or


             1066          (B) a pure premium rate, adjusted before the application of individual risk variations
             1067      based on loss or expense considerations to account for the treatment of:
             1068          (I) expenses;
             1069          (II) profit; and
             1070          (III) individual insurer variation in loss experience.
             1071          (b) "Rate" does not include a minimum premium.
             1072          (143) (a) Except as provided in Subsection (143)(b), "rate service organization" means
             1073      a person who assists an insurer in rate making or filing by:
             1074          (i) collecting, compiling, and furnishing loss or expense statistics;
             1075          (ii) recommending, making, or filing rates or supplementary rate information; or
             1076          (iii) advising about rate questions, except as an attorney giving legal advice.
             1077          (b) "Rate service organization" does not mean:
             1078          (i) an employee of an insurer;
             1079          (ii) a single insurer or group of insurers under common control;
             1080          (iii) a joint underwriting group; or
             1081          (iv) an individual serving as an actuarial or legal consultant.
             1082          (144) "Rating manual" means any of the following used to determine initial and
             1083      renewal policy premiums:
             1084          (a) a manual of rates;
             1085          (b) a classification;
             1086          (c) a rate-related underwriting rule; and
             1087          (d) a rating formula that describes steps, policies, and procedures for determining
             1088      initial and renewal policy premiums.
             1089          (145) (a) "Rebate" means a licensee paying, allowing, giving, or offering to pay, allow,
             1090      or give, directly or indirectly:
             1091          (i) a refund of premium or portion of premium;
             1092          (ii) a refund of commission or portion of commission;
             1093          (iii) a refund of all or a portion of a consultant fee; or


             1094          (iv) providing services or other benefits not specified in an insurance or annuity
             1095      contract.
             1096          (b) "Rebate" does not include:
             1097          (i) a refund due to termination or changes in coverage;
             1098          (ii) a refund due to overcharges made in error by the licensee; or
             1099          (iii) savings or wellness benefits as provided in the contract by the licensee.
             1100          [(145)] (146) "Received by the department" means:
             1101          (a) the date delivered to and stamped received by the department, if delivered in
             1102      person;
             1103          (b) the post mark date, if delivered by mail;
             1104          (c) the delivery service's post mark or pickup date, if delivered by a delivery service;
             1105          (d) the received date recorded on an item delivered, if delivered by:
             1106          (i) facsimile;
             1107          (ii) email; or
             1108          (iii) another electronic method; or
             1109          (e) a date specified in:
             1110          (i) a statute;
             1111          (ii) a rule; or
             1112          (iii) an order.
             1113          [(146)] (147) "Reciprocal" or "interinsurance exchange" means an unincorporated
             1114      association of persons:
             1115          (a) operating through an attorney-in-fact common to all of the persons; and
             1116          (b) exchanging insurance contracts with one another that provide insurance coverage
             1117      on each other.
             1118          [(147)] (148) "Reinsurance" means an insurance transaction where an insurer, for
             1119      consideration, transfers any portion of the risk it has assumed to another insurer. In referring to
             1120      reinsurance transactions, this title sometimes refers to:
             1121          (a) the insurer transferring the risk as the "ceding insurer"; and


             1122          (b) the insurer assuming the risk as the:
             1123          (i) "assuming insurer"; or
             1124          (ii) "assuming reinsurer."
             1125          [(148)] (149) "Reinsurer" means a person licensed in this state as an insurer with the
             1126      authority to assume reinsurance.
             1127          [(149)] (150) "Residential dwelling liability insurance" means insurance against
             1128      liability resulting from or incident to the ownership, maintenance, or use of a residential
             1129      dwelling that is a detached single family residence or multifamily residence up to four units.
             1130          [(150)] (151) (a) "Retrocession" means reinsurance with another insurer of a liability
             1131      assumed under a reinsurance contract.
             1132          (b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of a
             1133      liability assumed under a reinsurance contract.
             1134          [(151)] (152) "Rider" means an endorsement to:
             1135          (a) an insurance policy; or
             1136          (b) an insurance certificate.
             1137          [(152)] (153) (a) "Security" means a:
             1138          (i) note;
             1139          (ii) stock;
             1140          (iii) bond;
             1141          (iv) debenture;
             1142          (v) evidence of indebtedness;
             1143          (vi) certificate of interest or participation in a profit-sharing agreement;
             1144          (vii) collateral-trust certificate;
             1145          (viii) preorganization certificate or subscription;
             1146          (ix) transferable share;
             1147          (x) investment contract;
             1148          (xi) voting trust certificate;
             1149          (xii) certificate of deposit for a security;


             1150          (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in
             1151      payments out of production under such a title or lease;
             1152          (xiv) commodity contract or commodity option;
             1153          (xv) certificate of interest or participation in, temporary or interim certificate for,
             1154      receipt for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed
             1155      in Subsections [(152)] (153)(a)(i) through (xiv); or
             1156          (xvi) another interest or instrument commonly known as a security.
             1157          (b) "Security" does not include:
             1158          (i) any of the following under which an insurance company promises to pay money in a
             1159      specific lump sum or periodically for life or some other specified period:
             1160          (A) insurance;
             1161          (B) an endowment policy; or
             1162          (C) an annuity contract; or
             1163          (ii) a burial certificate or burial contract.
             1164          [(153)] (154) "Secondary medical condition" means a complication related to an
             1165      exclusion from coverage in accident and health insurance.
             1166          [(154)] (155) (a) "Self-insurance" means an arrangement under which a person
             1167      provides for spreading its own risks by a systematic plan.
             1168          (b) Except as provided in this Subsection [(154)] (155), "self-insurance" does not
             1169      include an arrangement under which a number of persons spread their risks among themselves.
             1170          (c) "Self-insurance" includes:
             1171          (i) an arrangement by which a governmental entity undertakes to indemnify an
             1172      employee for liability arising out of the employee's employment; and
             1173          (ii) an arrangement by which a person with a managed program of self-insurance and
             1174      risk management undertakes to indemnify its affiliates, subsidiaries, directors, officers, or
             1175      employees for liability or risk that is related to the relationship or employment.
             1176          (d) "Self-insurance" does not include an arrangement with an independent contractor.
             1177          [(155)] (156) "Sell" means to exchange a contract of insurance:


             1178          (a) by any means;
             1179          (b) for money or its equivalent; and
             1180          (c) on behalf of an insurance company.
             1181          [(156)] (157) "Short-term care insurance" means an insurance policy or rider
             1182      advertised, marketed, offered, or designed to provide coverage that is similar to long-term care
             1183      insurance, but that provides coverage for less than 12 consecutive months for each covered
             1184      person.
             1185          [(157)] (158) "Significant break in coverage" means a period of 63 consecutive days
             1186      during each of which an individual does not have creditable coverage.
             1187          [(158)] (159) "Small employer[,]" means, in connection with a health benefit plan[,
             1188      means an employer who,] and with respect to a calendar year and to a plan year, an employer
             1189      who:
             1190          (a) employed [an average of] at least [two employees] one employee but not more than
             1191      an average of 50 eligible employees on [each] business [day] days during the preceding
             1192      calendar year; and
             1193          (b) employs at least [two employees] one employee on the first day of the plan year.
             1194          [(159)] (160) "Special enrollment period," in connection with a health benefit plan, has
             1195      the same meaning as provided in federal regulations adopted pursuant to the Health Insurance
             1196      Portability and Accountability Act.
             1197          [(160)] (161) (a) "Subsidiary" of a person means an affiliate controlled by that person
             1198      either directly or indirectly through one or more affiliates or intermediaries.
             1199          (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting
             1200      shares are owned by that person either alone or with its affiliates, except for the minimum
             1201      number of shares the law of the subsidiary's domicile requires to be owned by directors or
             1202      others.
             1203          [(161)] (162) Subject to Subsection (86)(b), "surety insurance" includes:
             1204          (a) a guarantee against loss or damage resulting from the failure of a principal to pay or
             1205      perform the principal's obligations to a creditor or other obligee;


             1206          (b) bail bond insurance; and
             1207          (c) fidelity insurance.
             1208          [(162)] (163) (a) "Surplus" means the excess of assets over the sum of paid-in capital
             1209      and liabilities.
             1210          (b) (i) "Permanent surplus" means the surplus of an insurer or organization that is
             1211      designated by the insurer or organization as permanent.
             1212          (ii) Sections 31A-5-211 , 31A-7-201 , 31A-8-209 , 31A-9-209 , and 31A-14-205 require
             1213      that insurers or organizations doing business in this state maintain specified minimum levels of
             1214      permanent surplus.
             1215          (iii) Except for assessable mutuals, the minimum permanent surplus requirement is the
             1216      same as the minimum required capital requirement that applies to stock insurers.
             1217          (c) "Excess surplus" means:
             1218          (i) for a life insurer, accident and health insurer, health organization, or property and
             1219      casualty insurer as defined in Section 31A-17-601 , the lesser of:
             1220          (A) that amount of an insurer's or health organization's total adjusted capital that
             1221      exceeds the product of:
             1222          (I) 2.5; and
             1223          (II) the sum of the insurer's or health organization's minimum capital or permanent
             1224      surplus required under Section 31A-5-211 , 31A-9-209 , or 31A-14-205 ; or
             1225          (B) that amount of an insurer's or health organization's total adjusted capital that
             1226      exceeds the product of:
             1227          (I) 3.0; and
             1228          (II) the authorized control level RBC as defined in Subsection 31A-17-601 (8)(a); and
             1229          (ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurer
             1230      that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
             1231          (A) 1.5; and
             1232          (B) the insurer's total adjusted capital required by Subsection 31A-17-609 (1).
             1233          [(163)] (164) "Third party administrator" or "administrator" means a person who


             1234      collects charges or premiums from, or who, for consideration, adjusts or settles claims of
             1235      residents of the state in connection with insurance coverage, annuities, or service insurance
             1236      coverage, except:
             1237          (a) a union on behalf of its members;
             1238          (b) a person administering a:
             1239          (i) pension plan subject to the federal Employee Retirement Income Security Act of
             1240      1974;
             1241          (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
             1242          (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
             1243          (c) an employer on behalf of the employer's employees or the employees of one or
             1244      more of the subsidiary or affiliated corporations of the employer;
             1245          (d) an insurer licensed under the following, but only for a line of insurance for which
             1246      the insurer holds a license in this state:
             1247          (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
             1248          (ii) Chapter 7, Nonprofit Health Service Insurance Corporations;
             1249          (iii) Chapter 8, Health Maintenance Organizations and Limited Health Plans;
             1250          (iv) Chapter 9, Insurance Fraternals; or
             1251          (v) Chapter 14, Foreign Insurers;
             1252          (e) a person:
             1253          (i) licensed or exempt from licensing under:
             1254          (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
             1255      Reinsurance Intermediaries; or
             1256          (B) Chapter 26, Insurance Adjusters; and
             1257          (ii) whose activities are limited to those authorized under the license the person holds
             1258      or for which the person is exempt; or
             1259          (f) an institution, bank, or financial institution:
             1260          (i) that is:
             1261          (A) an institution whose deposits and accounts are to any extent insured by a federal


             1262      deposit insurance agency, including the Federal Deposit Insurance Corporation or National
             1263      Credit Union Administration; or
             1264          (B) a bank or other financial institution that is subject to supervision or examination by
             1265      a federal or state banking authority; and
             1266          (ii) that does not adjust claims without a third party administrator license.
             1267          [(164)] (165) "Title insurance" means the insuring, guaranteeing, or indemnifying of an
             1268      owner of real or personal property or the holder of liens or encumbrances on that property, or
             1269      others interested in the property against loss or damage suffered by reason of liens or
             1270      encumbrances upon, defects in, or the unmarketability of the title to the property, or invalidity
             1271      or unenforceability of any liens or encumbrances on the property.
             1272          [(165)] (166) "Total adjusted capital" means the sum of an insurer's or health
             1273      organization's statutory capital and surplus as determined in accordance with:
             1274          (a) the statutory accounting applicable to the annual financial statements required to be
             1275      filed under Section 31A-4-113 ; and
             1276          (b) another item provided by the RBC instructions, as RBC instructions is defined in
             1277      Section 31A-17-601 .
             1278          [(166)] (167) (a) "Trustee" means "director" when referring to the board of directors of
             1279      a corporation.
             1280          (b) "Trustee," when used in reference to an employee welfare fund, means an
             1281      individual, firm, association, organization, joint stock company, or corporation, whether acting
             1282      individually or jointly and whether designated by that name or any other, that is charged with
             1283      or has the overall management of an employee welfare fund.
             1284          [(167)] (168) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted
             1285      insurer" means an insurer:
             1286          (i) not holding a valid certificate of authority to do an insurance business in this state;
             1287      or
             1288          (ii) transacting business not authorized by a valid certificate.
             1289          (b) "Admitted insurer" or "authorized insurer" means an insurer:


             1290          (i) holding a valid certificate of authority to do an insurance business in this state; and
             1291          (ii) transacting business as authorized by a valid certificate.
             1292          [(168)] (169) "Underwrite" means the authority to accept or reject risk on behalf of the
             1293      insurer.
             1294          [(169)] (170) "Vehicle liability insurance" means insurance against liability resulting
             1295      from or incident to ownership, maintenance, or use of a land vehicle or aircraft, exclusive of a
             1296      vehicle comprehensive or vehicle physical damage coverage under Subsection (139).
             1297          [(170)] (171) "Voting security" means a security with voting rights, and includes a
             1298      security convertible into a security with a voting right associated with the security.
             1299          [(171)] (172) "Waiting period" for a health benefit plan means the period that must
             1300      pass before coverage for an individual, who is otherwise eligible to enroll under the terms of
             1301      the health benefit plan, can become effective.
             1302          [(172)] (173) "Workers' compensation insurance" means:
             1303          (a) insurance for indemnification of an employer against liability for compensation
             1304      based on:
             1305          (i) a compensable accidental injury; and
             1306          (ii) occupational disease disability;
             1307          (b) employer's liability insurance incidental to workers' compensation insurance and
             1308      written in connection with workers' compensation insurance; and
             1309          (c) insurance assuring to a person entitled to workers' compensation benefits the
             1310      compensation provided by law.
             1311          Section 2. Section 31A-2-104 is amended to read:
             1312           31A-2-104. Other employees -- Insurance fraud investigators.
             1313          (1) The department shall employ a chief examiner and such other professional,
             1314      technical, and clerical employees as necessary to carry out the duties of the department.
             1315          (2) An insurance fraud investigator employed pursuant to Subsection (1) may as
             1316      approved by the commissioner:
             1317          (a) be designated a [special function] law enforcement officer, as defined in Section


             1318      [53-13-105 , by the commissioner, but is not] 53-13-103 ; and
             1319          (b) be eligible for retirement benefits under the Public Safety Employee's Retirement
             1320      System.
             1321          Section 3. Section 31A-3-304 (Superseded 07/01/15) is amended to read:
             1322           31A-3-304 (Superseded 07/01/15). Annual fees -- Other taxes or fees prohibited --
             1323      Captive Insurance Restricted Account.
             1324          (1) (a) A captive insurance company shall pay an annual fee imposed under this section
             1325      to obtain or renew a certificate of authority.
             1326          (b) The commissioner shall:
             1327          (i) determine the annual fee pursuant to Section 31A-3-103 ; and
             1328          (ii) consider whether the annual fee is competitive with fees imposed by other states on
             1329      captive insurance companies.
             1330          (2) A captive insurance company that fails to pay the fee required by this section is
             1331      subject to the relevant sanctions of this title.
             1332          (3) (a) Except as provided in Subsection (3)(d) and notwithstanding Title 59, Chapter
             1333      9, Taxation of Admitted Insurers, the following constitute the sole taxes, fees, or charges under
             1334      the laws of this state that may be levied or assessed on a captive insurance company:
             1335          (i) a fee under this section;
             1336          (ii) a fee under Chapter 37, Captive Insurance Companies Act; and
             1337          (iii) a fee under Chapter 37a, Special Purpose Financial Captive Insurance Company
             1338      Act.
             1339          (b) The state or a county, city, or town within the state may not levy or collect an
             1340      occupation tax or other tax, fee, or charge not described in Subsections (3)(a)(i) through (iii)
             1341      against a captive insurance company.
             1342          (c) The state may not levy, assess, or collect a withdrawal fee under Section 31A-4-115
             1343      against a captive insurance company.
             1344          (d) A captive insurance company is subject to real and personal property taxes.
             1345          (4) A captive insurance company shall pay the fee imposed by this section to the


             1346      commissioner by June [20] 1 of each year.
             1347          (5) (a) Money received pursuant to a fee described in Subsection (3)(a) shall be
             1348      deposited into the Captive Insurance Restricted Account.
             1349          (b) There is created in the General Fund a restricted account known as the "Captive
             1350      Insurance Restricted Account."
             1351          (c) The Captive Insurance Restricted Account shall consist of the fees described in
             1352      Subsection (3)(a).
             1353          (d) The commissioner shall administer the Captive Insurance Restricted Account.
             1354      Subject to appropriations by the Legislature, the commissioner shall use the money deposited
             1355      into the Captive Insurance Restricted Account to:
             1356          (i) administer and enforce:
             1357          (A) Chapter 37, Captive Insurance Companies Act; and
             1358          (B) Chapter 37a, Special Purpose Financial Captive Insurance Company Act; and
             1359          (ii) promote the captive insurance industry in Utah.
             1360          (e) An appropriation from the Captive Insurance Restricted Account is nonlapsing,
             1361      except that at the end of each fiscal year, money received by the commissioner in excess of
             1362      $950,000 shall be treated as free revenue in the General Fund.
             1363          Section 4. Section 31A-3-304 (Effective 07/01/15) is amended to read:
             1364           31A-3-304 (Effective 07/01/15). Annual fees -- Other taxes or fees prohibited --
             1365      Captive Insurance Restricted Account.
             1366          (1) (a) A captive insurance company shall pay an annual fee imposed under this section
             1367      to obtain or renew a certificate of authority.
             1368          (b) The commissioner shall:
             1369          (i) determine the annual fee pursuant to Section 31A-3-103 ; and
             1370          (ii) consider whether the annual fee is competitive with fees imposed by other states on
             1371      captive insurance companies.
             1372          (2) A captive insurance company that fails to pay the fee required by this section is
             1373      subject to the relevant sanctions of this title.


             1374          (3) (a) Except as provided in Subsection (3)(d) and notwithstanding Title 59, Chapter
             1375      9, Taxation of Admitted Insurers, the following constitute the sole taxes, fees, or charges under
             1376      the laws of this state that may be levied or assessed on a captive insurance company:
             1377          (i) a fee under this section;
             1378          (ii) a fee under Chapter 37, Captive Insurance Companies Act; and
             1379          (iii) a fee under Chapter 37a, Special Purpose Financial Captive Insurance Company
             1380      Act.
             1381          (b) The state or a county, city, or town within the state may not levy or collect an
             1382      occupation tax or other tax, fee, or charge not described in Subsections (3)(a)(i) through (iii)
             1383      against a captive insurance company.
             1384          (c) The state may not levy, assess, or collect a withdrawal fee under Section 31A-4-115
             1385      against a captive insurance company.
             1386          (d) A captive insurance company is subject to real and personal property taxes.
             1387          (4) A captive insurance company shall pay the fee imposed by this section to the
             1388      commissioner by June [20] 1 of each year.
             1389          (5) (a) Money received pursuant to a fee described in Subsection (3)(a) shall be
             1390      deposited into the Captive Insurance Restricted Account.
             1391          (b) There is created in the General Fund a restricted account known as the "Captive
             1392      Insurance Restricted Account."
             1393          (c) The Captive Insurance Restricted Account shall consist of the fees described in
             1394      Subsection (3)(a).
             1395          (d) The commissioner shall administer the Captive Insurance Restricted Account.
             1396      Subject to appropriations by the Legislature, the commissioner shall use the money deposited
             1397      into the Captive Insurance Restricted Account to:
             1398          (i) administer and enforce:
             1399          (A) Chapter 37, Captive Insurance Companies Act; and
             1400          (B) Chapter 37a, Special Purpose Financial Captive Insurance Company Act; and
             1401          (ii) promote the captive insurance industry in Utah.


             1402          (e) An appropriation from the Captive Insurance Restricted Account is nonlapsing,
             1403      except that at the end of each fiscal year, money received by the commissioner in excess of
             1404      $1,250,000 shall be treated as free revenue in the General Fund.
             1405          Section 5. Section 31A-4-102 is amended to read:
             1406           31A-4-102. Qualified insurers.
             1407          (1) A person may not conduct an insurance business in Utah in person, through an
             1408      agent, through a broker, through the mail, or through another method of communication,
             1409      except:
             1410          (a) an insurer:
             1411          (i) authorized to do business in Utah under [Chapter 5, 7, 8, 9, 10, 11, 13, or 14; and]:
             1412          (A) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
             1413          (B) Chapter 7, Nonprofit Health Service Insurance Corporations;
             1414          (C) Chapter 8, Health Maintenance Organizations and Limited Health Plans;
             1415          (D) Chapter 9, Insurance Fraternals;
             1416          (E) Chapter 10, Annuities;
             1417          (F) Chapter 11, Motor Clubs;
             1418          (G) Chapter 13, Employee Welfare Funds and Plans;
             1419          (H) Chapter 14, Foreign Insurers;
             1420          (I) Chapter 37, Captive Insurance Companies Act; or
             1421          (J) Chapter 37a, Special Purpose Financial Captive Insurance Company Act; and
             1422          (ii) within the limits of its certificate of authority;
             1423          (b) a joint underwriting group under Section 31A-2-214 or 31A-20-102 ;
             1424          (c) an insurer doing business under Section 31A-15-103 ;
             1425          (d) a person who submits to the commissioner a certificate from the United States
             1426      Department of Labor, or such other evidence as satisfies the commissioner, that the laws of
             1427      Utah are preempted with respect to specified activities of that person by Section 514 of the
             1428      Employee Retirement Income Security Act of 1974 or other federal law; or
             1429          (e) a person exempt from this title under Section 31A-1-103 or another applicable


             1430      statute.
             1431          (2) As used in this section, "insurer" includes a bail bond surety company, as defined in
             1432      Section 31A-35-102 .
             1433          Section 6. Section 31A-4-115 is amended to read:
             1434           31A-4-115. Plan of orderly withdrawal.
             1435          (1) (a) When an insurer intends to withdraw from writing a line of insurance in this
             1436      state or to reduce its total annual premium volume by 75% or more, the insurer shall file with
             1437      the commissioner a plan of orderly withdrawal.
             1438          (b) For purposes of this section, a discontinuance of a health benefit plan pursuant to
             1439      one of the following provisions is a withdrawal from a line of insurance:
             1440          (i) Subsection 31A-30-107 (3)(e); or
             1441          (ii) Subsection 31A-30-107.1 (3)(e).
             1442          (2) An insurer's plan of orderly withdrawal shall:
             1443          (a) indicate the date the insurer intends to begin and complete its withdrawal plan; and
             1444          (b) include provisions for:
             1445          (i) meeting the insurer's contractual obligations;
             1446          (ii) providing services to its Utah policyholders and claimants;
             1447          (iii) meeting [any] applicable statutory obligations; and
             1448          (iv) [(A)] the payment of a withdrawal fee of $50,000 to the [Utah Comprehensive
             1449      Health Insurance Pool if: (I) the insurer is an accident and health insurer; and (II) the insurer's
             1450      line of business is not assumed or placed with another insurer approved by the commissioner;
             1451      or (B) the payment of a withdrawal fee of $50,000 to the department if: (I) the insurer is not
             1452      an accident and health insurer; and (II)] department if the insurer's line of business is not
             1453      assumed or placed with another insurer approved by the commissioner.
             1454          (3) The commissioner shall approve a plan of orderly withdrawal if the plan of orderly
             1455      withdrawal adequately demonstrates that the insurer will:
             1456          (a) protect the interests of the people of the state;
             1457          (b) meet the insurer's contractual obligations;


             1458          (c) provide service to the insurer's Utah policyholders and claimants; and
             1459          (d) meet [any] applicable statutory obligations.
             1460          (4) Section 31A-2-302 governs the commissioner's approval or disapproval of a plan for
             1461      orderly withdrawal.
             1462          (5) The commissioner may require an insurer to increase the deposit maintained in
             1463      accordance with Section 31A-4-105 or Section 31A-4-105.5 and place the deposit in trust in
             1464      the name of the commissioner upon finding, after an adjudicative proceeding that:
             1465          (a) there is reasonable cause to conclude that the interests of the people of the state are
             1466      best served by such action; and
             1467          (b) the insurer:
             1468          (i) has filed a plan of orderly withdrawal; or
             1469          (ii) intends to:
             1470          (A) withdraw from writing a line of insurance in this state; or
             1471          (B) reduce the insurer's total annual premium volume by 75% or more.
             1472          (6) An insurer is subject to the civil penalties under Section 31A-2-308 , if the insurer:
             1473          (a) withdraws from writing insurance in this state without receiving the commissioner's
             1474      approval of a plan of orderly withdrawal; or
             1475          (b) reduces its total annual premium volume by 75% or more in any year without
             1476      [having submitted a plan or receiving the commissioner's approval] receiving the
             1477      commissioner's approval of a plan of orderly withdrawal.
             1478          (7) An insurer that withdraws from writing all lines of insurance in this state may not
             1479      resume writing insurance in this state for five years unless[: (a)] the commissioner finds that
             1480      the prohibition should be waived because the waiver is:
             1481          [(i)] (a) in the public interest to promote competition; or
             1482          [(ii)] (b) to resolve inequity in the marketplace[; and].
             1483          [(b) the insurer complies with Subsection 31A-30-108 (5), if applicable.]
             1484          (8) The commissioner shall adopt rules necessary to implement this section.
             1485          Section 7. Section 31A-8-402.3 is amended to read:


             1486           31A-8-402.3. Discontinuance, nonrenewal, or changes to group health benefit
             1487      plans.
             1488          (1) Except as otherwise provided in this section, a group health benefit plan for a plan
             1489      sponsor is renewable and continues in force:
             1490          (a) with respect to all eligible employees and dependents; and
             1491          (b) at the option of the plan sponsor.
             1492          (2) A health benefit plan for a plan sponsor may be discontinued or nonrenewed:
             1493          (a) for a network plan, if[: (i)] there is no longer any enrollee under the group health
             1494      plan who lives, resides, or works in:
             1495          [(A)] (i) the service area of the insurer; or
             1496          [(B)] (ii) the area for which the insurer is authorized to do business; [and] or
             1497          [(ii) in the case of the small employer market, the insurer applies the same criteria the
             1498      insurer would apply in denying enrollment in the plan under Subsection 31A-30-108 (7); or]
             1499          (b) for coverage made available in the small or large employer market only through an
             1500      association, if:
             1501          (i) the employer's membership in the association ceases; and
             1502          (ii) the coverage is terminated uniformly without regard to any health status-related
             1503      factor relating to any covered individual.
             1504          (3) A health benefit plan for a plan sponsor may be discontinued if:
             1505          (a) a condition described in Subsection (2) exists;
             1506          (b) the plan sponsor fails to pay premiums or contributions in accordance with the
             1507      terms of the contract;
             1508          (c) the plan sponsor:
             1509          (i) performs an act or practice that constitutes fraud; or
             1510          (ii) makes an intentional misrepresentation of material fact under the terms of the
             1511      coverage;
             1512          (d) the insurer:
             1513          (i) elects to discontinue offering a particular health benefit product delivered or issued


             1514      for delivery in this state; and
             1515          (ii) (A) provides notice of the discontinuation in writing:
             1516          (I) to each plan sponsor, employee, or dependent of a plan sponsor or an employee; and
             1517          (II) at least 90 days before the date the coverage will be discontinued;
             1518          (B) provides notice of the discontinuation in writing:
             1519          (I) to the commissioner; and
             1520          (II) at least three working days prior to the date the notice is sent to the affected plan
             1521      sponsors, employees, and dependents of the plan sponsors or employees;
             1522          (C) offers to each plan sponsor, on a guaranteed issue basis, the option to purchase:
             1523          (I) all other health benefit products currently being offered by the insurer in the market;
             1524      or
             1525          (II) in the case of a large employer, any other health benefit product currently being
             1526      offered in that market; and
             1527          (D) in exercising the option to discontinue that product and in offering the option of
             1528      coverage in this section, acts uniformly without regard to:
             1529          (I) the claims experience of a plan sponsor;
             1530          (II) any health status-related factor relating to any covered participant or beneficiary; or
             1531          (III) any health status-related factor relating to any new participant or beneficiary who
             1532      may become eligible for the coverage; or
             1533          (e) the insurer:
             1534          (i) elects to discontinue all of the insurer's health benefit plans in:
             1535          (A) the small employer market;
             1536          (B) the large employer market; or
             1537          (C) both the small employer and large employer markets; and
             1538          (ii) (A) provides notice of the discontinuation in writing:
             1539          (I) to each plan sponsor, employee, or dependent of a plan sponsor or an employee; and
             1540          (II) at least 180 days before the date the coverage will be discontinued;
             1541          (B) provides notice of the discontinuation in writing:


             1542          (I) to the commissioner in each state in which an affected insured individual is known
             1543      to reside; and
             1544          (II) at least 30 working days prior to the date the notice is sent to the affected plan
             1545      sponsors, employees, and the dependents of the plan sponsors or employees;
             1546          (C) discontinues and nonrenews all plans issued or delivered for issuance in the
             1547      market; and
             1548          (D) provides a plan of orderly withdrawal as required by Section 31A-4-115 .
             1549          (4) A large employer health benefit plan may be discontinued or nonrenewed:
             1550          (a) if a condition described in Subsection (2) exists; or
             1551          (b) for noncompliance with the insurer's:
             1552          (i) minimum participation requirements; or
             1553          (ii) employer contribution requirements.
             1554          (5) A small employer health benefit plan may be discontinued or nonrenewed:
             1555          (a) if a condition described in Subsection (2) exists; or
             1556          (b) for noncompliance with the insurer's employer contribution requirements.
             1557          (6) A small employer health benefit plan may be nonrenewed:
             1558          (a) if a condition described in Subsection (2) exists; or
             1559          (b) for noncompliance with the insurer's minimum participation requirements.
             1560          (7) (a) Except as provided in Subsection (7)(d), an eligible employee may be
             1561      discontinued if after issuance of coverage the eligible employee:
             1562          (i) engages in an act or practice in connection with the coverage that constitutes fraud;
             1563      or
             1564          (ii) makes an intentional misrepresentation of material fact in connection with the
             1565      coverage.
             1566          (b) An eligible employee that is discontinued under Subsection (7)(a) may reenroll:
             1567          (i) 12 months after the date of discontinuance; and
             1568          (ii) if the plan sponsor's coverage is in effect at the time the eligible employee applies
             1569      to reenroll.


             1570          (c) At the time the eligible employee's coverage is discontinued under Subsection
             1571      (7)(a), the insurer shall notify the eligible employee of the right to reenroll when coverage is
             1572      discontinued.
             1573          (d) An eligible employee may not be discontinued under this Subsection (7) because of
             1574      a fraud or misrepresentation that relates to health status.
             1575          (8) For purposes of this section, a reference to "plan sponsor" includes a reference to
             1576      the employer:
             1577          (a) with respect to coverage provided to an employer member of the association; and
             1578          (b) if the health benefit plan is made available by an insurer in the employer market
             1579      only through:
             1580          (i) an association;
             1581          (ii) a trust; or
             1582          (iii) a discretionary group.
             1583          (9) An insurer may modify a health benefit plan for a plan sponsor only:
             1584          (a) at the time of coverage renewal; and
             1585          (b) if the modification is effective uniformly among all plans with that product.
             1586          Section 8. Section 31A-16-103 is amended to read:
             1587           31A-16-103. Acquisition of control of or merger with domestic insurer.
             1588          (1) (a) A person may not take the actions described in Subsections (1)(b) or (c) unless,
             1589      at the time any offer, request, or invitation is made or any such agreement is entered into, or
             1590      prior to the acquisition of securities if no offer or agreement is involved:
             1591          (i) the person files with the commissioner a statement containing the information
             1592      required by this section;
             1593          (ii) the person provides a copy of the statement described in Subsection (1)(a)(i) to the
             1594      insurer; and
             1595          (iii) the commissioner approves the offer, request, invitation, agreement, or acquisition.
             1596          (b) Unless the person complies with Subsection (1)(a), a person other than the issuer
             1597      may not make a tender offer for, a request or invitation for tenders of, or enter into any


             1598      agreement to exchange securities, or seek to acquire or acquire in the open market or otherwise,
             1599      any voting security of a domestic insurer if after the acquisition, the person would directly,
             1600      indirectly, by conversion, or by exercise of any right to acquire be in control of the insurer.
             1601          (c) Unless the person complies with Subsection (1)(a), a person may not enter into an
             1602      agreement to merge with or otherwise to acquire control of:
             1603          (i) a domestic insurer; or
             1604          (ii) any person controlling a domestic insurer.
             1605          (d) (i) For purposes of this section, a domestic insurer includes any person controlling a
             1606      domestic insurer unless the person as determined by the commissioner is either directly or
             1607      through its affiliates primarily engaged in business other than the business of insurance.
             1608          (ii) The controlling person described in Subsection (1)(d)(i) shall file with the
             1609      commissioner a preacquisition notification containing the information required in Subsection
             1610      (2) 30 calendar days before the proposed effective date of the acquisition.
             1611          (iii) For the purposes of this section, "person" does not include any securities broker
             1612      that in the usual and customary brokers function holds less than 20% of:
             1613          (A) the voting securities of an insurance company; or
             1614          (B) any person that controls an insurance company.
             1615          (iv) This section applies to all domestic insurers and other entities licensed under
             1616      Chapters 5, 7, 8, 9, and 11.
             1617          (e) (i) An agreement for acquisition of control or merger as contemplated by this
             1618      Subsection (1) is not valid or enforceable unless the agreement:
             1619          (A) is in writing; and
             1620          (B) includes a provision that the agreement is subject to the approval of the
             1621      commissioner upon the filing of any applicable statement required under this chapter.
             1622          (ii) A written agreement for acquisition or control that includes the provision described
             1623      in Subsection (1)(e)(i) satisfies the requirements of this Subsection (1).
             1624          (2) The statement to be filed with the commissioner under Subsection (1) shall be
             1625      made under oath or affirmation and shall contain the following information:


             1626          (a) the name and address of the "acquiring party," which means each person by whom
             1627      or on whose behalf the merger or other acquisition of control referred to in Subsection (1) is to
             1628      be effected; and
             1629          (i) if the person is an individual:
             1630          (A) the person's principal occupation;
             1631          (B) a listing of all offices and positions held by the person during the past five years;
             1632      and
             1633          (C) any conviction of crimes other than minor traffic violations during the past 10
             1634      years; and
             1635          (ii) if the person is not an individual:
             1636          (A) a report of the nature of its business operations during:
             1637          (I) the past five years; or
             1638          (II) for any lesser period as the person and any of its predecessors has been in
             1639      existence;
             1640          (B) an informative description of the business intended to be done by the person and
             1641      the person's subsidiaries;
             1642          (C) a list of all individuals who are or who have been selected to become directors or
             1643      executive officers of the person, or individuals who perform, or who will perform functions
             1644      appropriate to such positions; and
             1645          (D) for each individual described in Subsection (2)(a)(ii)(C), the information required
             1646      by Subsection (2)(a)(i) for each individual;
             1647          (b) (i) the source, nature, and amount of the consideration used or to be used in
             1648      effecting the merger or acquisition of control;
             1649          (ii) a description of any transaction in which funds were or are to be obtained for the
             1650      purpose of effecting the merger or acquisition of control, including any pledge of:
             1651          (A) the insurer's stock; or
             1652          (B) the stock of any of the insurer's subsidiaries or controlling affiliates; and
             1653          (iii) the identity of persons furnishing the consideration;


             1654          (c) (i) fully audited financial information, or other financial information considered
             1655      acceptable by the commissioner, of the earnings and financial condition of each acquiring party
             1656      for:
             1657          (A) the preceding five fiscal years of each acquiring party; or
             1658          (B) any lesser period the acquiring party and any of its predecessors shall have been in
             1659      existence; and
             1660          (ii) unaudited information:
             1661          (A) similar to the information described in Subsection (2)(c)(i); and
             1662          (B) prepared within the 90 days prior to the filing of the statement;
             1663          (d) any plans or proposals which each acquiring party may have to:
             1664          (i) liquidate the insurer;
             1665          (ii) sell its assets;
             1666          (iii) merge or consolidate the insurer with any person; or
             1667          (iv) make any other material change in the insurer's:
             1668          (A) business;
             1669          (B) corporate structure; or
             1670          (C) management;
             1671          (e) (i) the number of shares of any security referred to in Subsection (1) that each
             1672      acquiring party proposes to acquire;
             1673          (ii) the terms of the offer, request, invitation, agreement, or acquisition referred to in
             1674      Subsection (1); and
             1675          (iii) a statement as to the method by which the fairness of the proposal was arrived at;
             1676          (f) the amount of each class of any security referred to in Subsection (1) that:
             1677          (i) is beneficially owned; or
             1678          (ii) concerning which there is a right to acquire beneficial ownership by each acquiring
             1679      party;
             1680          (g) a full description of any contract, arrangement, or understanding with respect to any
             1681      security referred to in Subsection (1) in which any acquiring party is involved, including:


             1682          (i) the transfer of any of the securities;
             1683          (ii) joint ventures;
             1684          (iii) loan or option arrangements;
             1685          (iv) puts or calls;
             1686          (v) guarantees of loans;
             1687          (vi) guarantees against loss or guarantees of profits;
             1688          (vii) division of losses or profits; or
             1689          (viii) the giving or withholding of proxies;
             1690          (h) a description of the purchase by any acquiring party of any security referred to in
             1691      Subsection (1) during the 12 calendar months preceding the filing of the statement including:
             1692          (i) the dates of purchase;
             1693          (ii) the names of the purchasers; and
             1694          (iii) the consideration paid or agreed to be paid for the purchase;
             1695          (i) a description of:
             1696          (i) any recommendations to purchase by any acquiring party any security referred to in
             1697      Subsection (1) made during the 12 calendar months preceding the filing of the statement; or
             1698          (ii) any recommendations made by anyone based upon interviews or at the suggestion
             1699      of the acquiring party;
             1700          (j) (i) copies of all tender offers for, requests for, or invitations for tenders of, exchange
             1701      offers for, and agreements to acquire or exchange any securities referred to in Subsection (1);
             1702      and
             1703          (ii) if distributed, copies of additional soliciting material relating to the transactions
             1704      described in Subsection (2)(j)(i);
             1705          (k) (i) the term of any agreement, contract, or understanding made with, or proposed to
             1706      be made with, any broker-dealer as to solicitation of securities referred to in Subsection (1) for
             1707      tender; and
             1708          (ii) the amount of any fees, commissions, or other compensation to be paid to
             1709      broker-dealers with regard to any agreement, contract, or understanding described in


             1710      Subsection (2)(k)(i); and
             1711          (l) any additional information the commissioner requires by rule, which the
             1712      commissioner determines to be:
             1713          (i) necessary or appropriate for the protection of policyholders of the insurer; or
             1714          (ii) in the public interest.
             1715          (3) The department may request:
             1716          (a) (i) criminal background information maintained pursuant to Title 53, Chapter 10,
             1717      Part 2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
             1718          (ii) complete Federal Bureau of Investigation criminal background checks through the
             1719      national criminal history system.
             1720          (b) Information obtained by the department from the review of criminal history records
             1721      received under Subsection (3)(a) shall be used by the department for the purpose of:
             1722          (i) verifying the information in Subsection (2)(a)(i);
             1723          (ii) determining the integrity of persons who would control the operation of an insurer;
             1724      and
             1725          (iii) preventing persons who violate 18 U.S.C. [Sections] Sec. 1033 [and 1034] from
             1726      engaging in the business of insurance in the state.
             1727          (c) If the department requests the criminal background information, the department
             1728      shall:
             1729          (i) pay to the Department of Public Safety the costs incurred by the Department of
             1730      Public Safety in providing the department criminal background information under Subsection
             1731      (3)(a)(i);
             1732          (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
             1733      of Investigation in providing the department criminal background information under
             1734      Subsection (3)(a)(ii); and
             1735          (iii) charge the person required to file the statement referred to in Subsection (1) a fee
             1736      equal to the aggregate of Subsections (3)(c)(i) and (ii).
             1737          (4) (a) If the source of the consideration under Subsection (2)(b)(i) is a loan made in


             1738      the lender's ordinary course of business, the identity of the lender shall remain confidential, if
             1739      the person filing the statement so requests.
             1740          (b) (i) Under Subsection (2)(e), the commissioner may require a statement of the
             1741      adjusted book value assigned by the acquiring party to each security in arriving at the terms of
             1742      the offer.
             1743          (ii) For purposes of this Subsection (4)(b), "adjusted book value" means each security's
             1744      proportional interest in the capital and surplus of the insurer with adjustments that reflect:
             1745          (A) market conditions;
             1746          (B) business in force; and
             1747          (C) other intangible assets or liabilities of the insurer.
             1748          (c) The description required by Subsection (2)(g) shall identify the persons with whom
             1749      the contracts, arrangements, or understandings have been entered into.
             1750          (5) (a) If the person required to file the statement referred to in Subsection (1) is a
             1751      partnership, limited partnership, syndicate, or other group, the commissioner may require that
             1752      all the information called for by Subsections (2), (3), or (4) shall be given with respect to each:
             1753          (i) partner of the partnership or limited partnership;
             1754          (ii) member of the syndicate or group; and
             1755          (iii) person who controls the partner or member.
             1756          (b) If any partner, member, or person referred to in Subsection (5)(a) is a corporation,
             1757      or if the person required to file the statement referred to in Subsection (1) is a corporation, the
             1758      commissioner may require that the information called for by Subsection (2) shall be given with
             1759      respect to:
             1760          (i) the corporation;
             1761          (ii) each officer and director of the corporation; and
             1762          (iii) each person who is directly or indirectly the beneficial owner of more than 10% of
             1763      the outstanding voting securities of the corporation.
             1764          (6) If any material change occurs in the facts set forth in the statement filed with the
             1765      commissioner and sent to the insurer pursuant to Subsection (2), an amendment setting forth


             1766      the change, together with copies of all documents and other material relevant to the change,
             1767      shall be filed with the commissioner and sent to the insurer within two business days after the
             1768      filing person learns of such change.
             1769          (7) If any offer, request, invitation, agreement, or acquisition referred to in Subsection
             1770      (1) is proposed to be made by means of a registration statement under the Securities Act of
             1771      1933, or under circumstances requiring the disclosure of similar information under the
             1772      Securities Exchange Act of 1934, or under a state law requiring similar registration or
             1773      disclosure, a person required to file the statement referred to in Subsection (1) may use copies
             1774      of any registration or disclosure documents in furnishing the information called for by the
             1775      statement.
             1776          (8) (a) The commissioner shall approve any merger or other acquisition of control
             1777      referred to in Subsection (1) unless, after a public hearing on the merger or acquisition, the
             1778      commissioner finds that:
             1779          (i) after the change of control, the domestic insurer referred to in Subsection (1) would
             1780      not be able to satisfy the requirements for the issuance of a license to write the line or lines of
             1781      insurance for which it is presently licensed;
             1782          (ii) the effect of the merger or other acquisition of control would:
             1783          (A) substantially lessen competition in insurance in this state; or
             1784          (B) tend to create a monopoly in insurance;
             1785          (iii) the financial condition of any acquiring party might:
             1786          (A) jeopardize the financial stability of the insurer; or
             1787          (B) prejudice the interest of:
             1788          (I) its policyholders; or
             1789          (II) any remaining securityholders who are unaffiliated with the acquiring party;
             1790          (iv) the terms of the offer, request, invitation, agreement, or acquisition referred to in
             1791      Subsection (1) are unfair and unreasonable to the securityholders of the insurer;
             1792          (v) the plans or proposals which the acquiring party has to liquidate the insurer, sell its
             1793      assets, or consolidate or merge it with any person, or to make any other material change in its


             1794      business or corporate structure or management, are:
             1795          (A) unfair and unreasonable to policyholders of the insurer; and
             1796          (B) not in the public interest; or
             1797          (vi) the competence, experience, and integrity of those persons who would control the
             1798      operation of the insurer are such that it would not be in the interest of the policyholders of the
             1799      insurer and the public to permit the merger or other acquisition of control.
             1800          (b) For purposes of Subsection (8)(a)(iv), the offering price for each security may not
             1801      be considered unfair if the adjusted book values under Subsection (2)(e):
             1802          (i) are disclosed to the securityholders; and
             1803          (ii) determined by the commissioner to be reasonable.
             1804          (9) (a) The public hearing referred to in Subsection (8) shall be held within 30 days
             1805      after the statement required by Subsection (1) is filed.
             1806          (b) (i) At least 20 days notice of the hearing shall be given by the commissioner to the
             1807      person filing the statement.
             1808          (ii) Affected parties may waive the notice required by this Subsection (9)(b).
             1809          (iii) Not less than seven days notice of the public hearing shall be given by the person
             1810      filing the statement to:
             1811          (A) the insurer; and
             1812          (B) any person designated by the commissioner.
             1813          (c) The commissioner shall make a determination within 30 days after the conclusion
             1814      of the hearing.
             1815          (d) At the hearing, the person filing the statement, the insurer, any person to whom
             1816      notice of hearing was sent, and any other person whose interest may be affected by the hearing
             1817      may:
             1818          (i) present evidence;
             1819          (ii) examine and cross-examine witnesses; and
             1820          (iii) offer oral and written arguments.
             1821          (e) (i) A person or insurer described in Subsection (9)(d) may conduct discovery


             1822      proceedings in the same manner as is presently allowed in the district courts of this state.
             1823          (ii) All discovery proceedings shall be concluded not later than three days before the
             1824      commencement of the public hearing.
             1825          (10) (a) The commissioner may retain technical experts to assist in reviewing all, or a
             1826      portion of, information filed in connection with a proposed merger or other acquisition of
             1827      control referred to in Subsection (1).
             1828          (b) In determining whether any of the conditions in Subsection (8) exist, the
             1829      commissioner may consider the findings of technical experts employed to review applicable
             1830      filings.
             1831          (c) (i) A technical expert employed under Subsection (10)(a) shall present to the
             1832      commissioner a statement of all expenses incurred by the technical expert in conjunction with
             1833      the technical expert's review of a proposed merger or other acquisition of control.
             1834          (ii) At the commissioner's direction the acquiring person shall compensate the technical
             1835      expert at customary rates for time and expenses:
             1836          (A) necessarily incurred; and
             1837          (B) approved by the commissioner.
             1838          (iii) The acquiring person shall:
             1839          (A) certify the consolidated account of all charges and expenses incurred for the review
             1840      by technical experts;
             1841          (B) retain a copy of the consolidated account described in Subsection (10)(c)(iii)(A);
             1842      and
             1843          (C) file with the department as a public record a copy of the consolidated account
             1844      described in Subsection (10)(c)(iii)(A).
             1845          (11) (a) (i) If a domestic insurer proposes to merge into another insurer, any
             1846      securityholder electing to exercise a right of dissent may file with the insurer a written request
             1847      for payment of the adjusted book value given in the statement required by Subsection (1) and
             1848      approved under Subsection (8), in return for the surrender of the security holder's securities.
             1849          (ii) The request described in Subsection (11)(a)(i) shall be filed not later than 10 days


             1850      after the day of the securityholders' meeting where the corporate action is approved.
             1851          (b) The dissenting securityholder is entitled to and the insurer is required to pay to the
             1852      dissenting securityholder the specified value within 60 days of receipt of the dissenting security
             1853      holder's security.
             1854          (c) Persons electing under this Subsection (11) to receive cash for their securities waive
             1855      the dissenting shareholder and appraisal rights otherwise applicable under Title 16, Chapter
             1856      10a, Part 13, Dissenters' Rights.
             1857          (d) (i) This Subsection (11) provides an elective procedure for dissenting
             1858      securityholders to resolve their objections to the plan of merger.
             1859          (ii) This section does not restrict the rights of dissenting securityholders under Title 16,
             1860      Chapter 10a, Utah Revised Business Corporation Act, unless this election is made under this
             1861      Subsection (11).
             1862          (12) (a) All statements, amendments, or other material filed under Subsection (1), and
             1863      all notices of public hearings held under Subsection (8), shall be mailed by the insurer to its
             1864      securityholders within five business days after the insurer has received the statements,
             1865      amendments, other material, or notices.
             1866          (b) (i) Mailing expenses shall be paid by the person making the filing.
             1867          (ii) As security for the payment of mailing expenses, that person shall file with the
             1868      commissioner an acceptable bond or other deposit in an amount determined by the
             1869      commissioner.
             1870          (13) This section does not apply to any offer, request, invitation, agreement, or
             1871      acquisition that the commissioner by order exempts from the requirements of this section as:
             1872          (a) not having been made or entered into for the purpose of, and not having the effect
             1873      of, changing or influencing the control of a domestic insurer; or
             1874          (b) [as] otherwise not comprehended within the purposes of this section.
             1875          (14) The following are violations of this section:
             1876          (a) the failure to file any statement, amendment, or other material required to be filed
             1877      pursuant to Subsections (1), (2), and (5); or


             1878          (b) the effectuation, or any attempt to effectuate, an acquisition of control of or merger
             1879      with a domestic insurer unless the commissioner has given the commissioner's approval to the
             1880      acquisition or merger.
             1881          (15) (a) The courts of this state are vested with jurisdiction over:
             1882          (i) a person who:
             1883          (A) files a statement with the commissioner under this section; and
             1884          (B) is not resident, domiciled, or authorized to do business in this state; and
             1885          (ii) overall actions involving persons described in Subsection (15)(a)(i) arising out of a
             1886      violation of this section.
             1887          (b) A person described in Subsection (15)(a) is considered to have performed acts
             1888      equivalent to and constituting an appointment of the commissioner by that person, to be that
             1889      person's lawful agent upon whom may be served all lawful process in any action, suit, or
             1890      proceeding arising out of a violation of this section.
             1891          (c) A copy of a lawful process described in Subsection (15)(b) shall be:
             1892          (i) served on the commissioner; and
             1893          (ii) transmitted by registered or certified mail by the commissioner to the person at that
             1894      person's last-known address.
             1895          Section 9. Section 31A-17-607 is amended to read:
             1896           31A-17-607. Hearings.
             1897          (1) (a) Following receipt of a notice described in Subsection (2), the insurer or health
             1898      organization shall have the right to a confidential departmental hearing at which the insurer or
             1899      health organization may challenge [any] a determination or action by the commissioner.
             1900          (b) The insurer or health organization shall notify the commissioner of its request for a
             1901      hearing within five days after the notification by the commissioner under [Subsections
             1902      31A-17-604 (1), (2), and (3)] Subsection (2).
             1903          (c) Upon receipt of the insurer's or health organization's request for a hearing, the
             1904      commissioner shall set a date for the hearing, which date shall be no less than 10 nor more than
             1905      30 days after the date of the insurer's or health organization's request.


             1906          (2) An insurer or health organization has the right to a hearing under Subsection (1)
             1907      after:
             1908          (a) notification to an insurer or health organization by the commissioner of an adjusted
             1909      RBC report;
             1910          (b) notification to an insurer or health organization by the commissioner that:
             1911          (i) the insurer's or health organization's RBC plan or revised RBC plan is
             1912      unsatisfactory; and
             1913          (ii) the notification constitutes a regulatory action level event with respect to the
             1914      insurer or health organization;
             1915          (c) notification to any insurer or health organization by the commissioner that the
             1916      insurer or health organization has failed to adhere to its RBC plan or revised RBC plan and that
             1917      the failure has substantial adverse effect on the ability of the insurer or health organization to
             1918      eliminate the company action level event with respect to the insurer or health organization in
             1919      accordance with its RBC plan or revised RBC plan; or
             1920          (d) notification to an insurer or health organization by the commissioner of a corrective
             1921      order with respect to the insurer or health organization.
             1922          Section 10. Section 31A-22-305 is amended to read:
             1923           31A-22-305. Uninsured motorist coverage.
             1924          (1) As used in this section, "covered persons" includes:
             1925          (a) the named insured;
             1926          (b) for a claim arising on or after May 13, 2014, the named insured's dependent minor
             1927      children;
             1928          [(b)] (c) persons related to the named insured by blood, marriage, adoption, or
             1929      guardianship, who are residents of the named insured's household, including those who usually
             1930      make their home in the same household but temporarily live elsewhere;
             1931          [(c)] (d) any person occupying or using a motor vehicle:
             1932          (i) referred to in the policy; or
             1933          (ii) owned by a self-insured; and


             1934          [(d)] (e) any person who is entitled to recover damages against the owner or operator of
             1935      the uninsured or underinsured motor vehicle because of bodily injury to or death of persons
             1936      under Subsection (1)(a), (b), [or] (c), or (d).
             1937          (2) As used in this section, "uninsured motor vehicle" includes:
             1938          (a) (i) a motor vehicle, the operation, maintenance, or use of which is not covered
             1939      under a liability policy at the time of an injury-causing occurrence; or
             1940          (ii) (A) a motor vehicle covered with lower liability limits than required by Section
             1941      31A-22-304 ; and
             1942          (B) the motor vehicle described in Subsection (2)(a)(ii)(A) is uninsured to the extent of
             1943      the deficiency;
             1944          (b) an unidentified motor vehicle that left the scene of an accident proximately caused
             1945      by the motor vehicle operator;
             1946          (c) a motor vehicle covered by a liability policy, but coverage for an accident is
             1947      disputed by the liability insurer for more than 60 days or continues to be disputed for more than
             1948      60 days; or
             1949          (d) (i) an insured motor vehicle if, before or after the accident, the liability insurer of
             1950      the motor vehicle is declared insolvent by a court of competent jurisdiction; and
             1951          (ii) the motor vehicle described in Subsection (2)(d)(i) is uninsured only to the extent
             1952      that the claim against the insolvent insurer is not paid by a guaranty association or fund.
             1953          (3) Uninsured motorist coverage under Subsection 31A-22-302 (1)(b) provides
             1954      coverage for covered persons who are legally entitled to recover damages from owners or
             1955      operators of uninsured motor vehicles because of bodily injury, sickness, disease, or death.
             1956          (4) (a) For new policies written on or after January 1, 2001, the limits of uninsured
             1957      motorist coverage shall be equal to the lesser of the limits of the named insured's motor vehicle
             1958      liability coverage or the maximum uninsured motorist coverage limits available by the insurer
             1959      under the named insured's motor vehicle policy, unless a named insured rejects or purchases
             1960      coverage in a lesser amount by signing an acknowledgment form that:
             1961          (i) is filed with the department;


             1962          (ii) is provided by the insurer;
             1963          (iii) waives the higher coverage;
             1964          (iv) need only state in this or similar language that uninsured motorist coverage
             1965      provides benefits or protection to you and other covered persons for bodily injury resulting
             1966      from an accident caused by the fault of another party where the other party has no liability
             1967      insurance; and
             1968          (v) discloses the additional premiums required to purchase uninsured motorist
             1969      coverage with limits equal to the lesser of the limits of the named insured's motor vehicle
             1970      liability coverage or the maximum uninsured motorist coverage limits available by the insurer
             1971      under the named insured's motor vehicle policy.
             1972          (b) Any selection or rejection under this Subsection (4) continues for that issuer of the
             1973      liability coverage until the insured requests, in writing, a change of uninsured motorist
             1974      coverage from that liability insurer.
             1975          (c) (i) Subsections (4)(a) and (b) apply retroactively to any claim arising on or after
             1976      January 1, 2001, for which, as of May 14, 2013, an insured has not made a written demand for
             1977      arbitration or filed a complaint in a court of competent jurisdiction.
             1978          (ii) The Legislature finds that the retroactive application of Subsections (4)(a) and (b)
             1979      clarifies legislative intent and does not enlarge, eliminate, or destroy vested rights.
             1980          (d) For purposes of this Subsection (4), "new policy" means:
             1981          (i) any policy that is issued which does not include a renewal or reinstatement of an
             1982      existing policy; or
             1983          (ii) a change to an existing policy that results in:
             1984          (A) a named insured being added to or deleted from the policy; or
             1985          (B) a change in the limits of the named insured's motor vehicle liability coverage.
             1986          (e) (i) As used in this Subsection (4)(e), "additional motor vehicle" means a change
             1987      that increases the total number of vehicles insured by the policy, and does not include
             1988      replacement, substitute, or temporary vehicles.
             1989          (ii) The adding of an additional motor vehicle to an existing personal lines or


             1990      commercial lines policy does not constitute a new policy for purposes of Subsection (4)(d).
             1991          (iii) If an additional motor vehicle is added to a personal lines policy where uninsured
             1992      motorist coverage has been rejected, or where uninsured motorist limits are lower than the
             1993      named insured's motor vehicle liability limits, the insurer shall provide a notice to a named
             1994      insured within 30 days that:
             1995          (A) in the same manner as described in Subsection (4)(a)(iv), explains the purpose of
             1996      uninsured motorist coverage; and
             1997          (B) encourages the named insured to contact the insurance company or insurance
             1998      producer for quotes as to the additional premiums required to purchase uninsured motorist
             1999      coverage with limits equal to the lesser of the limits of the named insured's motor vehicle
             2000      liability coverage or the maximum uninsured motorist coverage limits available by the insurer
             2001      under the named insured's motor vehicle policy.
             2002          (f) A change in policy number resulting from any policy change not identified under
             2003      Subsection (4)(d)(ii) does not constitute a new policy.
             2004          (g) (i) Subsection (4)(d) applies retroactively to any claim arising on or after January 1,
             2005      2001, for which, as of May 1, 2012, an insured has not made a written demand for arbitration
             2006      or filed a complaint in a court of competent jurisdiction.
             2007          (ii) The Legislature finds that the retroactive application of Subsection (4):
             2008          (A) does not enlarge, eliminate, or destroy vested rights; and
             2009          (B) clarifies legislative intent.
             2010          (h) A self-insured, including a governmental entity, may elect to provide uninsured
             2011      motorist coverage in an amount that is less than its maximum self-insured retention under
             2012      Subsections (4)(a) and (5)(a) by issuing a declaratory memorandum or policy statement from
             2013      the chief financial officer or chief risk officer that declares the:
             2014          (i) self-insured entity's coverage level; and
             2015          (ii) process for filing an uninsured motorist claim.
             2016          (i) Uninsured motorist coverage may not be sold with limits that are less than the
             2017      minimum bodily injury limits for motor vehicle liability policies under Section 31A-22-304 .


             2018          (j) The acknowledgment under Subsection (4)(a) continues for that issuer of the
             2019      uninsured motorist coverage until the named insured requests, in writing, different uninsured
             2020      motorist coverage from the insurer.
             2021          (k) (i) In conjunction with the first two renewal notices sent after January 1, 2001, for
             2022      policies existing on that date, the insurer shall disclose in the same medium as the premium
             2023      renewal notice, an explanation of:
             2024          (A) the purpose of uninsured motorist coverage in the same manner as described in
             2025      Subsection (4)(a)(iv); and
             2026          (B) a disclosure of the additional premiums required to purchase uninsured motorist
             2027      coverage with limits equal to the lesser of the limits of the named insured's motor vehicle
             2028      liability coverage or the maximum uninsured motorist coverage limits available by the insurer
             2029      under the named insured's motor vehicle policy.
             2030          (ii) The disclosure required under Subsection (4)(k)(i) shall be sent to all named
             2031      insureds that carry uninsured motorist coverage limits in an amount less than the named
             2032      insured's motor vehicle liability policy limits or the maximum uninsured motorist coverage
             2033      limits available by the insurer under the named insured's motor vehicle policy.
             2034          (l) For purposes of this Subsection (4), a notice or disclosure sent to a named insured in
             2035      a household constitutes notice or disclosure to all insureds within the household.
             2036          (5) (a) (i) Except as provided in Subsection (5)(b), the named insured may reject
             2037      uninsured motorist coverage by an express writing to the insurer that provides liability
             2038      coverage under Subsection 31A-22-302 (1)(a).
             2039          (ii) This rejection shall be on a form provided by the insurer that includes a reasonable
             2040      explanation of the purpose of uninsured motorist coverage.
             2041          (iii) This rejection continues for that issuer of the liability coverage until the insured in
             2042      writing requests uninsured motorist coverage from that liability insurer.
             2043          (b) (i) All persons, including governmental entities, that are engaged in the business of,
             2044      or that accept payment for, transporting natural persons by motor vehicle, and all school
             2045      districts that provide transportation services for their students, shall provide coverage for all


             2046      motor vehicles used for that purpose, by purchase of a policy of insurance or by self-insurance,
             2047      uninsured motorist coverage of at least $25,000 per person and $500,000 per accident.
             2048          (ii) This coverage is secondary to any other insurance covering an injured covered
             2049      person.
             2050          (c) Uninsured motorist coverage:
             2051          (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
             2052      Compensation Act;
             2053          (ii) may not be subrogated by the workers' compensation insurance carrier;
             2054          (iii) may not be reduced by any benefits provided by workers' compensation insurance;
             2055          (iv) may be reduced by health insurance subrogation only after the covered person has
             2056      been made whole;
             2057          (v) may not be collected for bodily injury or death sustained by a person:
             2058          (A) while committing a violation of Section 41-1a-1314 ;
             2059          (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
             2060      in violation of Section 41-1a-1314 ; or
             2061          (C) while committing a felony; and
             2062          (vi) notwithstanding Subsection (5)(c)(v), may be recovered:
             2063          (A) for a person under 18 years of age who is injured within the scope of Subsection
             2064      (5)(c)(v) but limited to medical and funeral expenses; or
             2065          (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
             2066      within the course and scope of the law enforcement officer's duties.
             2067          (d) As used in this Subsection (5), "motor vehicle" has the same meaning as under
             2068      Section 41-1a-102 .
             2069          (6) When a covered person alleges that an uninsured motor vehicle under Subsection
             2070      (2)(b) proximately caused an accident without touching the covered person or the motor
             2071      vehicle occupied by the covered person, the covered person shall show the existence of the
             2072      uninsured motor vehicle by clear and convincing evidence consisting of more than the covered
             2073      person's testimony.


             2074          (7) (a) The limit of liability for uninsured motorist coverage for two or more motor
             2075      vehicles may not be added together, combined, or stacked to determine the limit of insurance
             2076      coverage available to an injured person for any one accident.
             2077          (b) (i) Subsection (7)(a) applies to all persons except a covered person as defined under
             2078      Subsection (8)(b)(ii).
             2079          (ii) A covered person as defined under Subsection (8)(b)(ii) is entitled to the highest
             2080      limits of uninsured motorist coverage afforded for any one motor vehicle that the covered
             2081      person is the named insured or an insured family member.
             2082          (iii) This coverage shall be in addition to the coverage on the motor vehicle the covered
             2083      person is occupying.
             2084          (iv) Neither the primary nor the secondary coverage may be set off against the other.
             2085          (c) Coverage on a motor vehicle occupied at the time of an accident shall be primary
             2086      coverage, and the coverage elected by a person described under Subsections (1)(a) [and], (b),
             2087      and (c) shall be secondary coverage.
             2088          (8) (a) Uninsured motorist coverage under this section applies to bodily injury,
             2089      sickness, disease, or death of covered persons while occupying or using a motor vehicle only if
             2090      the motor vehicle is described in the policy under which a claim is made, or if the motor
             2091      vehicle is a newly acquired or replacement motor vehicle covered under the terms of the policy.
             2092      Except as provided in Subsection (7) or this Subsection (8), a covered person injured in a
             2093      motor vehicle described in a policy that includes uninsured motorist benefits may not elect to
             2094      collect uninsured motorist coverage benefits from any other motor vehicle insurance policy
             2095      under which the person is a covered person.
             2096          (b) Each of the following persons may also recover uninsured motorist benefits under
             2097      any one other policy in which they are described as a "covered person" as defined in Subsection
             2098      (1):
             2099          (i) a covered person injured as a pedestrian by an uninsured motor vehicle; and
             2100          (ii) except as provided in Subsection (8)(c), a covered person injured while occupying
             2101      or using a motor vehicle that is not owned, leased, or furnished:


             2102          (A) to the covered person;
             2103          (B) to the covered person's spouse; or
             2104          (C) to the covered person's resident parent or resident sibling.
             2105          (c) (i) A covered person may recover benefits from no more than two additional
             2106      policies, one additional policy from each parent's household if the covered person is:
             2107          (A) a dependent minor of parents who reside in separate households; and
             2108          (B) injured while occupying or using a motor vehicle that is not owned, leased, or
             2109      furnished:
             2110          (I) to the covered person;
             2111          (II) to the covered person's resident parent; or
             2112          (III) to the covered person's resident sibling.
             2113          (ii) Each parent's policy under this Subsection (8)(c) is liable only for the percentage of
             2114      the damages that the limit of liability of each parent's policy of uninsured motorist coverage
             2115      bears to the total of both parents' uninsured coverage applicable to the accident.
             2116          (d) A covered person's recovery under any available policies may not exceed the full
             2117      amount of damages.
             2118          (e) A covered person in Subsection (8)(b) is not barred against making subsequent
             2119      elections if recovery is unavailable under previous elections.
             2120          (f) (i) As used in this section, "interpolicy stacking" means recovering benefits for a
             2121      single incident of loss under more than one insurance policy.
             2122          (ii) Except to the extent permitted by Subsection (7) and this Subsection (8),
             2123      interpolicy stacking is prohibited for uninsured motorist coverage.
             2124          (9) (a) When a claim is brought by a named insured or a person described in
             2125      Subsection (1) and is asserted against the covered person's uninsured motorist carrier, the
             2126      claimant may elect to resolve the claim:
             2127          (i) by submitting the claim to binding arbitration; or
             2128          (ii) through litigation.
             2129          (b) Unless otherwise provided in the policy under which uninsured benefits are


             2130      claimed, the election provided in Subsection (9)(a) is available to the claimant only, except that
             2131      if the policy under which insured benefits are claimed provides that either an insured or the
             2132      insurer may elect arbitration, the insured or the insurer may elect arbitration and that election to
             2133      arbitrate shall stay the litigation of the claim under Subsection (9)(a)(ii).
             2134          (c) Once the claimant has elected to commence litigation under Subsection (9)(a)(ii),
             2135      the claimant may not elect to resolve the claim through binding arbitration under this section
             2136      without the written consent of the uninsured motorist carrier.
             2137          (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
             2138      binding arbitration under Subsection (9)(a)(i) shall be resolved by a single arbitrator.
             2139          (ii) All parties shall agree on the single arbitrator selected under Subsection (9)(d)(i).
             2140          (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
             2141      (9)(d)(ii), the parties shall select a panel of three arbitrators.
             2142          (e) If the parties select a panel of three arbitrators under Subsection (9)(d)(iii):
             2143          (i) each side shall select one arbitrator; and
             2144          (ii) the arbitrators appointed under Subsection (9)(e)(i) shall select one additional
             2145      arbitrator to be included in the panel.
             2146          (f) Unless otherwise agreed to in writing:
             2147          (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
             2148      under Subsection (9)(d)(i); or
             2149          (ii) if an arbitration panel is selected under Subsection (9)(d)(iii):
             2150          (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
             2151          (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
             2152      under Subsection (9)(e)(ii).
             2153          (g) Except as otherwise provided in this section or unless otherwise agreed to in
             2154      writing by the parties, an arbitration proceeding conducted under this section shall be governed
             2155      by Title 78B, Chapter 11, Utah Uniform Arbitration Act.
             2156          (h) (i) The arbitration shall be conducted in accordance with Rules 26(a)(4) through (f),
             2157      27 through 37, 54, and 68 of the Utah Rules of Civil Procedure, once the requirements of


             2158      Subsections (10)(a) through (c) are satisfied.
             2159          (ii) The specified tier as defined by Rule 26(c)(3) of the Utah Rules of Civil Procedure
             2160      shall be determined based on the claimant's specific monetary amount in the written demand
             2161      for payment of uninsured motorist coverage benefits as required in Subsection (10)(a)(i)(A).
             2162          (iii) Rules 26.1 and 26.2 of the Utah Rules of Civil Procedure do not apply to
             2163      arbitration claims under this part.
             2164          (i) All issues of discovery shall be resolved by the arbitrator or the arbitration panel.
             2165          (j) A written decision by a single arbitrator or by a majority of the arbitration panel
             2166      shall constitute a final decision.
             2167          (k) (i) Except as provided in Subsection (10), the amount of an arbitration award may
             2168      not exceed the uninsured motorist policy limits of all applicable uninsured motorist policies,
             2169      including applicable uninsured motorist umbrella policies.
             2170          (ii) If the initial arbitration award exceeds the uninsured motorist policy limits of all
             2171      applicable uninsured motorist policies, the arbitration award shall be reduced to an amount
             2172      equal to the combined uninsured motorist policy limits of all applicable uninsured motorist
             2173      policies.
             2174          (l) The arbitrator or arbitration panel may not decide the issues of coverage or
             2175      extra-contractual damages, including:
             2176          (i) whether the claimant is a covered person;
             2177          (ii) whether the policy extends coverage to the loss; or
             2178          (iii) any allegations or claims asserting consequential damages or bad faith liability.
             2179          (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
             2180      class-representative basis.
             2181          (n) If the arbitrator or arbitration panel finds that the action was not brought, pursued,
             2182      or defended in good faith, the arbitrator or arbitration panel may award reasonable attorney fees
             2183      and costs against the party that failed to bring, pursue, or defend the claim in good faith.
             2184          (o) An arbitration award issued under this section shall be the final resolution of all
             2185      claims not excluded by Subsection (9)(l) between the parties unless:


             2186          (i) the award was procured by corruption, fraud, or other undue means;
             2187          (ii) either party, within 20 days after service of the arbitration award:
             2188          (A) files a complaint requesting a trial de novo in the district court; and
             2189          (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
             2190      under Subsection (9)(o)(ii)(A).
             2191          (p) (i) Upon filing a complaint for a trial de novo under Subsection (9)(o), the claim
             2192      shall proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules
             2193      of Evidence in the district court.
             2194          (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
             2195      request a jury trial with a complaint requesting a trial de novo under Subsection (9)(o)(ii)(A).
             2196          (q) (i) If the claimant, as the moving party in a trial de novo requested under
             2197      Subsection (9)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater
             2198      than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
             2199          (ii) If the uninsured motorist carrier, as the moving party in a trial de novo requested
             2200      under Subsection (9)(o), does not obtain a verdict that is at least 20% less than the arbitration
             2201      award, the uninsured motorist carrier is responsible for all of the nonmoving party's costs.
             2202          (iii) Except as provided in Subsection (9)(q)(iv), the costs under this Subsection (9)(q)
             2203      shall include:
             2204          (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
             2205          (B) the costs of expert witnesses and depositions.
             2206          (iv) An award of costs under this Subsection (9)(q) may not exceed $2,500 unless
             2207      Subsection (10)(h)(iii) applies.
             2208          (r) For purposes of determining whether a party's verdict is greater or less than the
             2209      arbitration award under Subsection (9)(q), a court may not consider any recovery or other relief
             2210      granted on a claim for damages if the claim for damages:
             2211          (i) was not fully disclosed in writing prior to the arbitration proceeding; or
             2212          (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil
             2213      Procedure.


             2214          (s) If a district court determines, upon a motion of the nonmoving party, that the
             2215      moving party's use of the trial de novo process was filed in bad faith in accordance with
             2216      Section 78B-5-825 , the district court may award reasonable attorney fees to the nonmoving
             2217      party.
             2218          (t) Nothing in this section is intended to limit any claim under any other portion of an
             2219      applicable insurance policy.
             2220          (u) If there are multiple uninsured motorist policies, as set forth in Subsection (8), the
             2221      claimant may elect to arbitrate in one hearing the claims against all the uninsured motorist
             2222      carriers.
             2223          (10) (a) Within 30 days after a covered person elects to submit a claim for uninsured
             2224      motorist benefits to binding arbitration or files litigation, the covered person shall provide to
             2225      the uninsured motorist carrier:
             2226          (i) a written demand for payment of uninsured motorist coverage benefits, setting forth:
             2227          (A) subject to Subsection (10)(l), the specific monetary amount of the demand,
             2228      including a computation of the covered person's claimed past medical expenses, claimed past
             2229      lost wages, and the other claimed past economic damages; and
             2230          (B) the factual and legal basis and any supporting documentation for the demand;
             2231          (ii) a written statement under oath disclosing:
             2232          (A) (I) the names and last known addresses of all health care providers who have
             2233      rendered health care services to the covered person that are material to the claims for which
             2234      uninsured motorist benefits are sought for a period of five years preceding the date of the event
             2235      giving rise to the claim for uninsured motorist benefits up to the time the election for
             2236      arbitration or litigation has been exercised; and
             2237          (II) [whether the covered person has seen other] the names and last known addresses of
             2238      the health care providers who have rendered health care services to the covered person, which
             2239      the covered person claims are immaterial to the claims for which uninsured motorist benefits
             2240      are sought, for a period of five years preceding the date of the event giving rise to the claim for
             2241      uninsured motorist benefits up to the time the election for arbitration or litigation has been


             2242      exercised that have not been disclosed under Subsection (10)(a)(ii)(A)(I);
             2243          (B) (I) the names and last known addresses of all health insurers or other entities to
             2244      whom the covered person has submitted claims for health care services or benefits material to
             2245      the claims for which uninsured motorist benefits are sought, for a period of five years
             2246      preceding the date of the event giving rise to the claim for uninsured motorist benefits up to the
             2247      time the election for arbitration or litigation has been exercised; and
             2248          (II) [whether the identity of any] the names and last known addresses of the health
             2249      insurers or other entities to whom the covered person has submitted claims for health care
             2250      services or benefits, which the covered person claims are immaterial to the claims for which
             2251      uninsured motorist benefits are sought, for a period of five years preceding the date of the event
             2252      giving rise to the claim for uninsured motorist benefits up to the time the election for
             2253      arbitration or litigation have not been disclosed;
             2254          (C) if lost wages, diminished earning capacity, or similar damages are claimed, all
             2255      employers of the covered person for a period of five years preceding the date of the event
             2256      giving rise to the claim for uninsured motorist benefits up to the time the election for
             2257      arbitration or litigation has been exercised;
             2258          (D) other documents to reasonably support the claims being asserted; and
             2259          (E) all state and federal statutory lienholders including a statement as to whether the
             2260      covered person is a recipient of Medicare or Medicaid benefits or Utah Children's Health
             2261      Insurance Program benefits under Title 26, Chapter 40, Utah Children's Health Insurance Act,
             2262      or if the claim is subject to any other state or federal statutory liens; and
             2263          (iii) signed authorizations to allow the uninsured motorist carrier to only obtain records
             2264      and billings from the individuals or entities disclosed under Subsections (10)(a)(ii)(A)(I),
             2265      (B)(I), and (C).
             2266          (b) (i) If the uninsured motorist carrier determines that the disclosure of undisclosed
             2267      health care providers or health care insurers under Subsection (10)(a)(ii) is reasonably
             2268      necessary, the uninsured motorist carrier may:
             2269          (A) make a request for the disclosure of the identity of the health care providers or


             2270      health care insurers; and
             2271          (B) make a request for authorizations to allow the uninsured motorist carrier to only
             2272      obtain records and billings from the individuals or entities not disclosed.
             2273          (ii) If the covered person does not provide the requested information within 10 days:
             2274          (A) the covered person shall disclose, in writing, the legal or factual basis for the
             2275      failure to disclose the health care providers or health care insurers; and
             2276          (B) either the covered person or the uninsured motorist carrier may request the
             2277      arbitrator or arbitration panel to resolve the issue of whether the identities or records are to be
             2278      provided if the covered person has elected arbitration.
             2279          (iii) The time periods imposed by Subsection (10)(c)(i) are tolled pending resolution of
             2280      the dispute concerning the disclosure and production of records of the health care providers or
             2281      health care insurers.
             2282          (c) (i) An uninsured motorist carrier that receives an election for arbitration or a notice
             2283      of filing litigation and the demand for payment of uninsured motorist benefits under Subsection
             2284      (10)(a)(i) shall have a reasonable time, not to exceed 60 days from the date of the demand and
             2285      receipt of the items specified in Subsections (10)(a)(i) through (iii), to:
             2286          (A) provide a written response to the written demand for payment provided for in
             2287      Subsection (10)(a)(i);
             2288          (B) except as provided in Subsection (10)(c)(i)(C), tender the amount, if any, of the
             2289      uninsured motorist carrier's determination of the amount owed to the covered person; and
             2290          (C) if the covered person is a recipient of Medicare or Medicaid benefits or Utah
             2291      Children's Health Insurance Program benefits under Title 26, Chapter 40, Utah Children's
             2292      Health Insurance Act, or if the claim is subject to any other state or federal statutory liens,
             2293      tender the amount, if any, of the uninsured motorist carrier's determination of the amount owed
             2294      to the covered person less:
             2295          (I) if the amount of the state or federal statutory lien is established, the amount of the
             2296      lien; or
             2297          (II) if the amount of the state or federal statutory lien is not established, two times the


             2298      amount of the medical expenses subject to the state or federal statutory lien until such time as
             2299      the amount of the state or federal statutory lien is established.
             2300          (ii) If the amount tendered by the uninsured motorist carrier under Subsection (10)(c)(i)
             2301      is the total amount of the uninsured motorist policy limits, the tendered amount shall be
             2302      accepted by the covered person.
             2303          (d) A covered person who receives a written response from an uninsured motorist
             2304      carrier as provided for in Subsection (10)(c)(i), may:
             2305          (i) elect to accept the amount tendered in Subsection (10)(c)(i) as payment in full of all
             2306      uninsured motorist claims; or
             2307          (ii) elect to:
             2308          (A) accept the amount tendered in Subsection (10)(c)(i) as partial payment of all
             2309      uninsured motorist claims; and
             2310          (B) continue to litigate or arbitrate the remaining claim in accordance with the election
             2311      made under Subsections (9)(a), (b), and (c).
             2312          (e) If a covered person elects to accept the amount tendered under Subsection (10)(c)(i)
             2313      as partial payment of all uninsured motorist claims, the final award obtained through
             2314      arbitration, litigation, or later settlement shall be reduced by any payment made by the
             2315      uninsured motorist carrier under Subsection (10)(c)(i).
             2316          (f) In an arbitration proceeding on the remaining uninsured claims:
             2317          (i) the parties may not disclose to the arbitrator or arbitration panel the amount paid
             2318      under Subsection (10)(c)(i) until after the arbitration award has been rendered; and
             2319          (ii) the parties may not disclose the amount of the limits of uninsured motorist benefits
             2320      provided by the policy.
             2321          (g) If the final award obtained through arbitration or litigation is greater than the
             2322      average of the covered person's initial written demand for payment provided for in Subsection
             2323      (10)(a)(i) and the uninsured motorist carrier's initial written response provided for in
             2324      Subsection (10)(c)(i), the uninsured motorist carrier shall pay:
             2325          (i) the final award obtained through arbitration or litigation, except that if the award


             2326      exceeds the policy limits of the subject uninsured motorist policy by more than $15,000, the
             2327      amount shall be reduced to an amount equal to the policy limits plus $15,000; and
             2328          (ii) any of the following applicable costs:
             2329          (A) any costs as set forth in Rule 54(d), Utah Rules of Civil Procedure;
             2330          (B) the arbitrator or arbitration panel's fee; and
             2331          (C) the reasonable costs of expert witnesses and depositions used in the presentation of
             2332      evidence during arbitration or litigation.
             2333          (h) (i) The covered person shall provide an affidavit of costs within five days of an
             2334      arbitration award.
             2335          (ii) (A) Objection to the affidavit of costs shall specify with particularity the costs to
             2336      which the uninsured motorist carrier objects.
             2337          (B) The objection shall be resolved by the arbitrator or arbitration panel.
             2338          (iii) The award of costs by the arbitrator or arbitration panel under Subsection
             2339      (10)(g)(ii) may not exceed $5,000.
             2340          (i) (i) A covered person shall disclose all material information, other than rebuttal
             2341      evidence, within 30 days after a covered person elects to submit a claim for uninsured motorist
             2342      coverage benefits to binding arbitration or files litigation as specified in Subsection (10)(a).
             2343          (ii) If the information under Subsection (10)(i)(i) is not disclosed, the covered person
             2344      may not recover costs or any amounts in excess of the policy under Subsection (10)(g).
             2345          (j) This Subsection (10) does not limit any other cause of action that arose or may arise
             2346      against the uninsured motorist carrier from the same dispute.
             2347          (k) The provisions of this Subsection (10) only apply to motor vehicle accidents that
             2348      occur on or after March 30, 2010.
             2349          (l) (i) The written demand requirement in Subsection (10)(a)(i)(A) does not affect the
             2350      covered person's requirement to provide a computation of any other economic damages
             2351      claimed, and the one or more respondents shall have a reasonable time after the receipt of the
             2352      computation of any other economic damages claimed to conduct fact and expert discovery as to
             2353      any additional damages claimed. The changes made by this bill to this Subsection (10)(l) and


             2354      Subsection (10)(a)(i)(A) apply to a claim submitted to binding arbitration or through litigation
             2355      on or after May 13, 2014.
             2356          (ii) The changes made by this bill to Subsections (10)(a)(ii)(A)(II) and (B)(II) apply to
             2357      any claim submitted to binding arbitration or through litigation on or after May 13, 2014.
             2358          Section 11. Section 31A-22-305.3 is amended to read:
             2359           31A-22-305.3. Underinsured motorist coverage.
             2360          (1) As used in this section:
             2361          (a) "Covered person" has the same meaning as defined in Section 31A-22-305 .
             2362          (b) (i) "Underinsured motor vehicle" includes a motor vehicle, the operation,
             2363      maintenance, or use of which is covered under a liability policy at the time of an injury-causing
             2364      occurrence, but which has insufficient liability coverage to compensate fully the injured party
             2365      for all special and general damages.
             2366          (ii) The term "underinsured motor vehicle" does not include:
             2367          (A) a motor vehicle that is covered under the liability coverage of the same policy that
             2368      also contains the underinsured motorist coverage;
             2369          (B) an uninsured motor vehicle as defined in Subsection 31A-22-305 (2); or
             2370          (C) a motor vehicle owned or leased by:
             2371          (I) a named insured;
             2372          (II) a named insured's spouse; or
             2373          (III) a dependent of a named insured.
             2374          (2) (a) Underinsured motorist coverage under Subsection 31A-22-302 (1)(c) provides
             2375      coverage for a covered person who is legally entitled to recover damages from an owner or
             2376      operator of an underinsured motor vehicle because of bodily injury, sickness, disease, or death.
             2377          (b) A covered person occupying or using a motor vehicle owned, leased, or furnished
             2378      to the covered person, the covered person's spouse, or covered person's resident relative may
             2379      recover underinsured benefits only if the motor vehicle is:
             2380          (i) described in the policy under which a claim is made; or
             2381          (ii) a newly acquired or replacement motor vehicle covered under the terms of the


             2382      policy.
             2383          (3) (a) For new policies written on or after January 1, 2001, the limits of underinsured
             2384      motorist coverage shall be equal to the lesser of the limits of the named insured's motor vehicle
             2385      liability coverage or the maximum underinsured motorist coverage limits available by the
             2386      insurer under the named insured's motor vehicle policy, unless a named insured rejects or
             2387      purchases coverage in a lesser amount by signing an acknowledgment form that:
             2388          (i) is filed with the department;
             2389          (ii) is provided by the insurer;
             2390          (iii) waives the higher coverage;
             2391          (iv) need only state in this or similar language that underinsured motorist coverage
             2392      provides benefits or protection to you and other covered persons for bodily injury resulting
             2393      from an accident caused by the fault of another party where the other party has insufficient
             2394      liability insurance; and
             2395          (v) discloses the additional premiums required to purchase underinsured motorist
             2396      coverage with limits equal to the lesser of the limits of the named insured's motor vehicle
             2397      liability coverage or the maximum underinsured motorist coverage limits available by the
             2398      insurer under the named insured's motor vehicle policy.
             2399          (b) Any selection or rejection under Subsection (3)(a) continues for that issuer of the
             2400      liability coverage until the insured requests, in writing, a change of underinsured motorist
             2401      coverage from that liability insurer.
             2402          (c) (i) Subsections (3)(a) and (b) apply retroactively to any claim arising on or after
             2403      January 1, 2001, for which, as of May 14, 2013, an insured has not made a written demand for
             2404      arbitration or filed a complaint in a court of competent jurisdiction.
             2405          (ii) The Legislature finds that the retroactive application of Subsections (3)(a) and (b)
             2406      clarifies legislative intent and does not enlarge, eliminate, or destroy vested rights.
             2407          (d) For purposes of this Subsection (3), "new policy" means:
             2408          (i) any policy that is issued which does not include a renewal or reinstatement of an
             2409      existing policy; or


             2410          (ii) a change to an existing policy that results in:
             2411          (A) a named insured being added to or deleted from the policy; or
             2412          (B) a change in the limits of the named insured's motor vehicle liability coverage.
             2413          (e) (i) As used in this Subsection (3)(e), "additional motor vehicle" means a change
             2414      that increases the total number of vehicles insured by the policy, and does not include
             2415      replacement, substitute, or temporary vehicles.
             2416          (ii) The adding of an additional motor vehicle to an existing personal lines or
             2417      commercial lines policy does not constitute a new policy for purposes of Subsection (3)(d).
             2418          (iii) If an additional motor vehicle is added to a personal lines policy where
             2419      underinsured motorist coverage has been rejected, or where underinsured motorist limits are
             2420      lower than the named insured's motor vehicle liability limits, the insurer shall provide a notice
             2421      to a named insured within 30 days that:
             2422          (A) in the same manner described in Subsection (3)(a)(iv), explains the purpose of
             2423      underinsured motorist coverage; and
             2424          (B) encourages the named insured to contact the insurance company or insurance
             2425      producer for quotes as to the additional premiums required to purchase underinsured motorist
             2426      coverage with limits equal to the lesser of the limits of the named insured's motor vehicle
             2427      liability coverage or the maximum underinsured motorist coverage limits available by the
             2428      insurer under the named insured's motor vehicle policy.
             2429          (f) A change in policy number resulting from any policy change not identified under
             2430      Subsection (3)(d)(ii) does not constitute a new policy.
             2431          (g) (i) Subsection (3)(d) applies retroactively to any claim arising on or after January 1,
             2432      2001 for which, as of May 1, 2012, an insured has not made a written demand for arbitration or
             2433      filed a complaint in a court of competent jurisdiction.
             2434          (ii) The Legislature finds that the retroactive application of Subsection (3)(d):
             2435          (A) does not enlarge, eliminate, or destroy vested rights; and
             2436          (B) clarifies legislative intent.
             2437          (h) A self-insured, including a governmental entity, may elect to provide underinsured


             2438      motorist coverage in an amount that is less than its maximum self-insured retention under
             2439      Subsections (3)(a) and (l) by issuing a declaratory memorandum or policy statement from the
             2440      chief financial officer or chief risk officer that declares the:
             2441          (i) self-insured entity's coverage level; and
             2442          (ii) process for filing an underinsured motorist claim.
             2443          (i) Underinsured motorist coverage may not be sold with limits that are less than:
             2444          (i) $10,000 for one person in any one accident; and
             2445          (ii) at least $20,000 for two or more persons in any one accident.
             2446          (j) An acknowledgment under Subsection (3)(a) continues for that issuer of the
             2447      underinsured motorist coverage until the named insured, in writing, requests different
             2448      underinsured motorist coverage from the insurer.
             2449          (k) (i) The named insured's underinsured motorist coverage, as described in Subsection
             2450      (2), is secondary to the liability coverage of an owner or operator of an underinsured motor
             2451      vehicle, as described in Subsection (1).
             2452          (ii) Underinsured motorist coverage may not be set off against the liability coverage of
             2453      the owner or operator of an underinsured motor vehicle, but shall be added to, combined with,
             2454      or stacked upon the liability coverage of the owner or operator of the underinsured motor
             2455      vehicle to determine the limit of coverage available to the injured person.
             2456          (l) (i) In conjunction with the first two renewal notices sent after January 1, 2001, for
             2457      policies existing on that date, the insurer shall disclose in the same medium as the premium
             2458      renewal notice, an explanation of:
             2459          (A) the purpose of underinsured motorist coverage in the same manner as described in
             2460      Subsection (3)(a)(iv); and
             2461          (B) a disclosure of the additional premiums required to purchase underinsured motorist
             2462      coverage with limits equal to the lesser of the limits of the named insured's motor vehicle
             2463      liability coverage or the maximum underinsured motorist coverage limits available by the
             2464      insurer under the named insured's motor vehicle policy.
             2465          (ii) The disclosure required under this Subsection (3)(l) shall be sent to all named


             2466      insureds that carry underinsured motorist coverage limits in an amount less than the named
             2467      insured's motor vehicle liability policy limits or the maximum underinsured motorist coverage
             2468      limits available by the insurer under the named insured's motor vehicle policy.
             2469          (m) For purposes of this Subsection (3), a notice or disclosure sent to a named insured
             2470      in a household constitutes notice or disclosure to all insureds within the household.
             2471          (4) (a) (i) Except as provided in this Subsection (4), a covered person injured in a
             2472      motor vehicle described in a policy that includes underinsured motorist benefits may not elect
             2473      to collect underinsured motorist coverage benefits from another motor vehicle insurance policy.
             2474          (ii) The limit of liability for underinsured motorist coverage for two or more motor
             2475      vehicles may not be added together, combined, or stacked to determine the limit of insurance
             2476      coverage available to an injured person for any one accident.
             2477          (iii) Subsection (4)(a)(ii) applies to all persons except a covered person described
             2478      under Subsections (4)(b)(i) and (ii).
             2479          (b) (i) Except as provided in Subsection (4)(b)(ii), a covered person injured while
             2480      occupying, using, or maintaining a motor vehicle that is not owned, leased, or furnished to the
             2481      covered person, the covered person's spouse, or the covered person's resident parent or resident
             2482      sibling, may also recover benefits under any one other policy under which the covered person is
             2483      also a covered person.
             2484          (ii) (A) A covered person may recover benefits from no more than two additional
             2485      policies, one additional policy from each parent's household if the covered person is:
             2486          (I) a dependent minor of parents who reside in separate households; and
             2487          (II) injured while occupying or using a motor vehicle that is not owned, leased, or
             2488      furnished to the covered person, the covered person's resident parent, or the covered person's
             2489      resident sibling.
             2490          (B) Each parent's policy under this Subsection (4)(b)(ii) is liable only for the
             2491      percentage of the damages that the limit of liability of each parent's policy of underinsured
             2492      motorist coverage bears to the total of both parents' underinsured coverage applicable to the
             2493      accident.


             2494          (iii) A covered person's recovery under any available policies may not exceed the full
             2495      amount of damages.
             2496          (iv) Underinsured coverage on a motor vehicle occupied at the time of an accident is
             2497      primary coverage, and the coverage elected by a person described under Subsections
             2498      31A-22-305 (1)(a) [and], (b), and (c) is secondary coverage.
             2499          (v) The primary and the secondary coverage may not be set off against the other.
             2500          (vi) A covered person as described under Subsection (4)(b)(i) is entitled to the highest
             2501      limits of underinsured motorist coverage under only one additional policy per household
             2502      applicable to that covered person as a named insured, spouse, or relative.
             2503          (vii) A covered injured person is not barred against making subsequent elections if
             2504      recovery is unavailable under previous elections.
             2505          (viii) (A) As used in this section, "interpolicy stacking" means recovering benefits for a
             2506      single incident of loss under more than one insurance policy.
             2507          (B) Except to the extent permitted by this Subsection (4), interpolicy stacking is
             2508      prohibited for underinsured motorist coverage.
             2509          (c) Underinsured motorist coverage:
             2510          (i) is secondary to the benefits provided by Title 34A, Chapter 2, Workers'
             2511      Compensation Act;
             2512          (ii) may not be subrogated by a workers' compensation insurance carrier;
             2513          (iii) may not be reduced by benefits provided by workers' compensation insurance;
             2514          (iv) may be reduced by health insurance subrogation only after the covered person is
             2515      made whole;
             2516          (v) may not be collected for bodily injury or death sustained by a person:
             2517          (A) while committing a violation of Section 41-1a-1314 ;
             2518          (B) who, as a passenger in a vehicle, has knowledge that the vehicle is being operated
             2519      in violation of Section 41-1a-1314 ; or
             2520          (C) while committing a felony; and
             2521          (vi) notwithstanding Subsection (4)(c)(v), may be recovered:


             2522          (A) for a person under 18 years of age who is injured within the scope of Subsection
             2523      (4)(c)(v), but is limited to medical and funeral expenses; or
             2524          (B) by a law enforcement officer as defined in Section 53-13-103 , who is injured
             2525      within the course and scope of the law enforcement officer's duties.
             2526          (5) The inception of the loss under Subsection 31A-21-313 (1) for underinsured
             2527      motorist claims occurs upon the date of the last liability policy payment.
             2528          (6) (a) Within five business days after notification that all liability insurers have
             2529      tendered their liability policy limits, the underinsured carrier shall either:
             2530          (i) waive any subrogation claim the underinsured carrier may have against the person
             2531      liable for the injuries caused in the accident; or
             2532          (ii) pay the insured an amount equal to the policy limits tendered by the liability carrier.
             2533          (b) If neither option is exercised under Subsection (6)(a), the subrogation claim is
             2534      considered to be waived by the underinsured carrier.
             2535          (c) The notification under Subsection (6)(a) shall include:
             2536          (i) the name, address, and phone number for all liability insurers;
             2537          (ii) the liability insurers' liability policy limits; and
             2538          (iii) the claim number associated with each liability insurer.
             2539          (7) Except as otherwise provided in this section, a covered person may seek, subject to
             2540      the terms and conditions of the policy, additional coverage under any policy:
             2541          (a) that provides coverage for damages resulting from motor vehicle accidents; and
             2542          (b) that is not required to conform to Section 31A-22-302 .
             2543          (8) (a) When a claim is brought by a named insured or a person described in
             2544      Subsection 31A-22-305 (1) and is asserted against the covered person's underinsured motorist
             2545      carrier, the claimant may elect to resolve the claim:
             2546          (i) by submitting the claim to binding arbitration; or
             2547          (ii) through litigation.
             2548          (b) Unless otherwise provided in the policy under which underinsured benefits are
             2549      claimed, the election provided in Subsection (8)(a) is available to the claimant only, except that


             2550      if the policy under which insured benefits are claimed provides that either an insured or the
             2551      insurer may elect arbitration, the insured or the insurer may elect arbitration and that election to
             2552      arbitrate shall stay the litigation of the claim under Subsection (8)(a)(ii).
             2553          (c) Once a claimant elects to commence litigation under Subsection (8)(a)(ii), the
             2554      claimant may not elect to resolve the claim through binding arbitration under this section
             2555      without the written consent of the underinsured motorist coverage carrier.
             2556          (d) (i) Unless otherwise agreed to in writing by the parties, a claim that is submitted to
             2557      binding arbitration under Subsection (8)(a)(i) shall be resolved by a single arbitrator.
             2558          (ii) All parties shall agree on the single arbitrator selected under Subsection (8)(d)(i).
             2559          (iii) If the parties are unable to agree on a single arbitrator as required under Subsection
             2560      (8)(d)(ii), the parties shall select a panel of three arbitrators.
             2561          (e) If the parties select a panel of three arbitrators under Subsection (8)(d)(iii):
             2562          (i) each side shall select one arbitrator; and
             2563          (ii) the arbitrators appointed under Subsection (8)(e)(i) shall select one additional
             2564      arbitrator to be included in the panel.
             2565          (f) Unless otherwise agreed to in writing:
             2566          (i) each party shall pay an equal share of the fees and costs of the arbitrator selected
             2567      under Subsection (8)(d)(i); or
             2568          (ii) if an arbitration panel is selected under Subsection (8)(d)(iii):
             2569          (A) each party shall pay the fees and costs of the arbitrator selected by that party; and
             2570          (B) each party shall pay an equal share of the fees and costs of the arbitrator selected
             2571      under Subsection (8)(e)(ii).
             2572          (g) Except as otherwise provided in this section or unless otherwise agreed to in
             2573      writing by the parties, an arbitration proceeding conducted under this section is governed by
             2574      Title 78B, Chapter 11, Utah Uniform Arbitration Act.
             2575          (h) (i) The arbitration shall be conducted in accordance with Rules 26(a)(4) through (f),
             2576      27 through 37, 54, and 68 of the Utah Rules of Civil Procedure, once the requirements of
             2577      Subsections (9)(a) through (c) are satisfied.


             2578          (ii) The specified tier as defined by Rule 26(c)(3) of the Utah Rules of Civil Procedure
             2579      shall be determined based on the claimant's specific monetary amount in the written demand
             2580      for payment of uninsured motorist coverage benefits as required in Subsection (9)(a)(i)(A).
             2581          (iii) Rules 26.1 and 26.2 of the Utah Rules of Civil Procedure do not apply to
             2582      arbitration claims under this part.
             2583          (i) An issue of discovery shall be resolved by the arbitrator or the arbitration panel.
             2584          (j) A written decision by a single arbitrator or by a majority of the arbitration panel
             2585      constitutes a final decision.
             2586          (k) (i) Except as provided in Subsection (9), the amount of an arbitration award may
             2587      not exceed the underinsured motorist policy limits of all applicable underinsured motorist
             2588      policies, including applicable underinsured motorist umbrella policies.
             2589          (ii) If the initial arbitration award exceeds the underinsured motorist policy limits of all
             2590      applicable underinsured motorist policies, the arbitration award shall be reduced to an amount
             2591      equal to the combined underinsured motorist policy limits of all applicable underinsured
             2592      motorist policies.
             2593          (l) The arbitrator or arbitration panel may not decide an issue of coverage or
             2594      extra-contractual damages, including:
             2595          (i) whether the claimant is a covered person;
             2596          (ii) whether the policy extends coverage to the loss; or
             2597          (iii) an allegation or claim asserting consequential damages or bad faith liability.
             2598          (m) The arbitrator or arbitration panel may not conduct arbitration on a class-wide or
             2599      class-representative basis.
             2600          (n) If the arbitrator or arbitration panel finds that the arbitration is not brought, pursued,
             2601      or defended in good faith, the arbitrator or arbitration panel may award reasonable attorney fees
             2602      and costs against the party that failed to bring, pursue, or defend the arbitration in good faith.
             2603          (o) An arbitration award issued under this section shall be the final resolution of all
             2604      claims not excluded by Subsection (8)(l) between the parties unless:
             2605          (i) the award is procured by corruption, fraud, or other undue means;


             2606          (ii) either party, within 20 days after service of the arbitration award:
             2607          (A) files a complaint requesting a trial de novo in the district court; and
             2608          (B) serves the nonmoving party with a copy of the complaint requesting a trial de novo
             2609      under Subsection (8)(o)(ii)(A).
             2610          (p) (i) Upon filing a complaint for a trial de novo under Subsection (8)(o), a claim shall
             2611      proceed through litigation pursuant to the Utah Rules of Civil Procedure and Utah Rules of
             2612      Evidence in the district court.
             2613          (ii) In accordance with Rule 38, Utah Rules of Civil Procedure, either party may
             2614      request a jury trial with a complaint requesting a trial de novo under Subsection (8)(o)(ii)(A).
             2615          (q) (i) If the claimant, as the moving party in a trial de novo requested under
             2616      Subsection (8)(o), does not obtain a verdict that is at least $5,000 and is at least 20% greater
             2617      than the arbitration award, the claimant is responsible for all of the nonmoving party's costs.
             2618          (ii) If the underinsured motorist carrier, as the moving party in a trial de novo requested
             2619      under Subsection (8)(o), does not obtain a verdict that is at least 20% less than the arbitration
             2620      award, the underinsured motorist carrier is responsible for all of the nonmoving party's costs.
             2621          (iii) Except as provided in Subsection (8)(q)(iv), the costs under this Subsection (8)(q)
             2622      shall include:
             2623          (A) any costs set forth in Rule 54(d), Utah Rules of Civil Procedure; and
             2624          (B) the costs of expert witnesses and depositions.
             2625          (iv) An award of costs under this Subsection (8)(q) may not exceed $2,500 unless
             2626      Subsection (9)(h)(iii) applies.
             2627          (r) For purposes of determining whether a party's verdict is greater or less than the
             2628      arbitration award under Subsection (8)(q), a court may not consider any recovery or other relief
             2629      granted on a claim for damages if the claim for damages:
             2630          (i) was not fully disclosed in writing prior to the arbitration proceeding; or
             2631          (ii) was not disclosed in response to discovery contrary to the Utah Rules of Civil
             2632      Procedure.
             2633          (s) If a district court determines, upon a motion of the nonmoving party, that a moving


             2634      party's use of the trial de novo process is filed in bad faith in accordance with Section
             2635      78B-5-825 , the district court may award reasonable attorney fees to the nonmoving party.
             2636          (t) Nothing in this section is intended to limit a claim under another portion of an
             2637      applicable insurance policy.
             2638          (u) If there are multiple underinsured motorist policies, as set forth in Subsection (4),
             2639      the claimant may elect to arbitrate in one hearing the claims against all the underinsured
             2640      motorist carriers.
             2641          (9) (a) Within 30 days after a covered person elects to submit a claim for underinsured
             2642      motorist benefits to binding arbitration or files litigation, the covered person shall provide to
             2643      the underinsured motorist carrier:
             2644          (i) a written demand for payment of underinsured motorist coverage benefits, setting
             2645      forth:
             2646          (A) subject to Subsection (9)(l), the specific monetary amount of the demand,
             2647      including a computation of the covered person's claimed past medical expenses, claimed past
             2648      lost wages, and all other claimed past economic damages; and
             2649          (B) the factual and legal basis and any supporting documentation for the demand;
             2650          (ii) a written statement under oath disclosing:
             2651          (A) (I) the names and last known addresses of all health care providers who have
             2652      rendered health care services to the covered person that are material to the claims for which the
             2653      underinsured motorist benefits are sought for a period of five years preceding the date of the
             2654      event giving rise to the claim for underinsured motorist benefits up to the time the election for
             2655      arbitration or litigation has been exercised; and
             2656          (II) [whether the covered person has seen other] the names and last know addresses of
             2657      the health care providers who have rendered health care services to the covered person, which
             2658      the covered person claims are immaterial to the claims for which underinsured motorist
             2659      benefits are sought, for a period of five years preceding the date of the event giving rise to the
             2660      claim for underinsured motorist benefits up to the time the election for arbitration or litigation
             2661      has been exercised that have not been disclosed under Subsection (9)(a)(ii)(A)(I);


             2662          (B) (I) the names and last known addresses of all health insurers or other entities to
             2663      whom the covered person has submitted claims for health care services or benefits material to
             2664      the claims for which underinsured motorist benefits are sought, for a period of five years
             2665      preceding the date of the event giving rise to the claim for underinsured motorist benefits up to
             2666      the time the election for arbitration or litigation has been exercised; and
             2667          (II) [whether the identity of any] the names and last known addresses of the health
             2668      insurers or other entities to whom the covered person has submitted claims for health care
             2669      services or benefits, which the covered person claims are immaterial to the claims for which
             2670      underinsured motorist benefits are sought, for a period of five years preceding the date of the
             2671      event giving rise to the claim for underinsured motorist benefits up to the time the election for
             2672      arbitration or litigation have not been disclosed;
             2673          (C) if lost wages, diminished earning capacity, or similar damages are claimed, all
             2674      employers of the covered person for a period of five years preceding the date of the event
             2675      giving rise to the claim for underinsured motorist benefits up to the time the election for
             2676      arbitration or litigation has been exercised;
             2677          (D) other documents to reasonably support the claims being asserted; and
             2678          (E) all state and federal statutory lienholders including a statement as to whether the
             2679      covered person is a recipient of Medicare or Medicaid benefits or Utah Children's Health
             2680      Insurance Program benefits under Title 26, Chapter 40, Utah Children's Health Insurance Act,
             2681      or if the claim is subject to any other state or federal statutory liens; and
             2682          (iii) signed authorizations to allow the underinsured motorist carrier to only obtain
             2683      records and billings from the individuals or entities disclosed under Subsections
             2684      (9)(a)(ii)(A)(I), (B)(I), and (C).
             2685          (b) (i) If the underinsured motorist carrier determines that the disclosure of undisclosed
             2686      health care providers or health care insurers under Subsection (9)(a)(ii) is reasonably necessary,
             2687      the underinsured motorist carrier may:
             2688          (A) make a request for the disclosure of the identity of the health care providers or
             2689      health care insurers; and


             2690          (B) make a request for authorizations to allow the underinsured motorist carrier to only
             2691      obtain records and billings from the individuals or entities not disclosed.
             2692          (ii) If the covered person does not provide the requested information within 10 days:
             2693          (A) the covered person shall disclose, in writing, the legal or factual basis for the
             2694      failure to disclose the health care providers or health care insurers; and
             2695          (B) either the covered person or the underinsured motorist carrier may request the
             2696      arbitrator or arbitration panel to resolve the issue of whether the identities or records are to be
             2697      provided if the covered person has elected arbitration.
             2698          (iii) The time periods imposed by Subsection (9)(c)(i) are tolled pending resolution of
             2699      the dispute concerning the disclosure and production of records of the health care providers or
             2700      health care insurers.
             2701          (c) (i) An underinsured motorist carrier that receives an election for arbitration or a
             2702      notice of filing litigation and the demand for payment of underinsured motorist benefits under
             2703      Subsection (9)(a)(i) shall have a reasonable time, not to exceed 60 days from the date of the
             2704      demand and receipt of the items specified in Subsections (9)(a)(i) through (iii), to:
             2705          (A) provide a written response to the written demand for payment provided for in
             2706      Subsection (9)(a)(i);
             2707          (B) except as provided in Subsection (9)(c)(i)(C), tender the amount, if any, of the
             2708      underinsured motorist carrier's determination of the amount owed to the covered person; and
             2709          (C) if the covered person is a recipient of Medicare or Medicaid benefits or Utah
             2710      Children's Health Insurance Program benefits under Title 26, Chapter 40, Utah Children's
             2711      Health Insurance Act, or if the claim is subject to any other state or federal statutory liens,
             2712      tender the amount, if any, of the underinsured motorist carrier's determination of the amount
             2713      owed to the covered person less:
             2714          (I) if the amount of the state or federal statutory lien is established, the amount of the
             2715      lien; or
             2716          (II) if the amount of the state or federal statutory lien is not established, two times the
             2717      amount of the medical expenses subject to the state or federal statutory lien until such time as


             2718      the amount of the state or federal statutory lien is established.
             2719          (ii) If the amount tendered by the underinsured motorist carrier under Subsection
             2720      (9)(c)(i) is the total amount of the underinsured motorist policy limits, the tendered amount
             2721      shall be accepted by the covered person.
             2722          (d) A covered person who receives a written response from an underinsured motorist
             2723      carrier as provided for in Subsection (9)(c)(i), may:
             2724          (i) elect to accept the amount tendered in Subsection (9)(c)(i) as payment in full of all
             2725      underinsured motorist claims; or
             2726          (ii) elect to:
             2727          (A) accept the amount tendered in Subsection (9)(c)(i) as partial payment of all
             2728      underinsured motorist claims; and
             2729          (B) continue to litigate or arbitrate the remaining claim in accordance with the election
             2730      made under Subsections (8)(a), (b), and (c).
             2731          (e) If a covered person elects to accept the amount tendered under Subsection (9)(c)(i)
             2732      as partial payment of all underinsured motorist claims, the final award obtained through
             2733      arbitration, litigation, or later settlement shall be reduced by any payment made by the
             2734      underinsured motorist carrier under Subsection (9)(c)(i).
             2735          (f) In an arbitration proceeding on the remaining underinsured claims:
             2736          (i) the parties may not disclose to the arbitrator or arbitration panel the amount paid
             2737      under Subsection (9)(c)(i) until after the arbitration award has been rendered; and
             2738          (ii) the parties may not disclose the amount of the limits of underinsured motorist
             2739      benefits provided by the policy.
             2740          (g) If the final award obtained through arbitration or litigation is greater than the
             2741      average of the covered person's initial written demand for payment provided for in Subsection
             2742      (9)(a)(i) and the underinsured motorist carrier's initial written response provided for in
             2743      Subsection (9)(c)(i), the underinsured motorist carrier shall pay:
             2744          (i) the final award obtained through arbitration or litigation, except that if the award
             2745      exceeds the policy limits of the subject underinsured motorist policy by more than $15,000, the


             2746      amount shall be reduced to an amount equal to the policy limits plus $15,000; and
             2747          (ii) any of the following applicable costs:
             2748          (A) any costs as set forth in Rule 54(d), Utah Rules of Civil Procedure;
             2749          (B) the arbitrator or arbitration panel's fee; and
             2750          (C) the reasonable costs of expert witnesses and depositions used in the presentation of
             2751      evidence during arbitration or litigation.
             2752          (h) (i) The covered person shall provide an affidavit of costs within five days of an
             2753      arbitration award.
             2754          (ii) (A) Objection to the affidavit of costs shall specify with particularity the costs to
             2755      which the underinsured motorist carrier objects.
             2756          (B) The objection shall be resolved by the arbitrator or arbitration panel.
             2757          (iii) The award of costs by the arbitrator or arbitration panel under Subsection (9)(g)(ii)
             2758      may not exceed $5,000.
             2759          (i) (i) A covered person shall disclose all material information, other than rebuttal
             2760      evidence, within 30 days after a covered person elects to submit a claim for underinsured
             2761      motorist coverage benefits to binding arbitration or files litigation as specified in Subsection
             2762      (9)(a).
             2763          (ii) If the information under Subsection (9)(i)(i) is not disclosed, the covered person
             2764      may not recover costs or any amounts in excess of the policy under Subsection (9)(g).
             2765          (j) This Subsection (9) does not limit any other cause of action that arose or may arise
             2766      against the underinsured motorist carrier from the same dispute.
             2767          (k) The provisions of this Subsection (9) only apply to motor vehicle accidents that
             2768      occur on or after March 30, 2010.
             2769          (l) (i) The written demand requirement in Subsection (9)(a)(i)(A) does not affect the
             2770      covered person's requirement to provide a computation of any other economic damages
             2771      claimed, and the one or more respondents shall have a reasonable time after the receipt of the
             2772      computation of any other economic damages claimed to conduct fact and expert discovery as to
             2773      any additional damages claimed. The changes made by this bill to this Subsection (9)(l) and


             2774      Subsection (9)(a)(i)(A) apply to a claim submitted to binding arbitration or through litigation
             2775      on or after May 13, 2014.
             2776          (ii) The changes made by this bill under Subsections (9)(a)(ii)(A)(II) and (B)(II) apply
             2777      to a claim submitted to binding arbitration or through litigation on or after May 13, 2014.
             2778          Section 12. Section 31A-22-428 is amended to read:
             2779           31A-22-428. Interest payable on life insurance proceeds.
             2780          (1) For a life insurance policy delivered or issued for delivery in this state on or after
             2781      May 5, 2008, the insurer shall pay interest on the death proceeds payable upon the death of the
             2782      insured.
             2783          (2) (a) Except as provided in Subsection (4), for the period beginning on the date of
             2784      death and ending the day before the day described in Subsection (3)(b), interest under
             2785      Subsection (1) shall accrue at a rate no less than the greater of:
             2786          (i) the rate applicable to policy funds left on deposit; [or] and
             2787          (ii) [if there is no rate described in Subsection (2)(a)(i), at] the Two Year Treasury
             2788      Constant Maturity Rate as published by the Federal Reserve.
             2789          (b) If there is no rate applicable to policy funds on deposit as stated in Subsection
             2790      (2)(a)(i), then the Two Year Treasury Constant Maturity Rates as published by the Federal
             2791      Reserve applies.
             2792          [(b)] (c) The rate described in Subsection (2)(a) or (b) is the rate in effect on the day on
             2793      which the death occurs.
             2794          [(c)] (d) Interest is payable until the day on which the claim is paid.
             2795          (3) (a) Unless the claim is paid and except as provided in Subsection (4), beginning on
             2796      the day described in Subsection (3)(b) and ending the day on which the claim is paid, interest
             2797      shall accrue at the rate in Subsection (2) plus additional interest at the rate of 10% annually.
             2798          (b) Interest accrues under Subsection (3)(a) beginning with the day that is 31 days from
             2799      the latest of:
             2800          (i) the day on which the insurer receives proof of death;
             2801          (ii) the day on which the insurer receives sufficient information to determine:


             2802          (A) liability;
             2803          (B) the extent of the liability; and
             2804          (C) the appropriate payee legally entitled to the proceeds; and
             2805          (iii) the day on which:
             2806          (A) legal impediments to payment of proceeds that depend on the action of parties
             2807      other than the insurer are resolved; and
             2808          (B) the insurer receives sufficient evidence of the resolution of the legal impediments
             2809      described in Subsection (3)(b)(iii)(A).
             2810          (4) A court of competent jurisdiction may require payment of interest from the date of
             2811      death to the day on which a claim is paid at a rate equal to the sum of:
             2812          (a) the rate specified in Subsection (2); and
             2813          (b) the legal rate identified in Subsection 15-1-1 (2).
             2814          Section 13. Section 31A-22-617 is amended to read:
             2815           31A-22-617. Preferred provider contract provisions.
             2816          Health insurance policies may provide for insureds to receive services or
             2817      reimbursement under the policies in accordance with preferred health care provider contracts as
             2818      follows:
             2819          (1) Subject to restrictions under this section, [any] an insurer or third party
             2820      administrator may enter into contracts with health care providers as defined in Section
             2821      78B-3-403 under which the health care providers agree to supply services, at prices specified in
             2822      the contracts, to persons insured by an insurer.
             2823          (a) (i) A health care provider contract may require the health care provider to accept the
             2824      specified payment in this Subsection (1) as payment in full, relinquishing the right to collect
             2825      additional amounts from the insured person.
             2826          (ii) In [any] a dispute involving a provider's claim for reimbursement, the same shall be
             2827      determined in accordance with applicable law, the provider contract, the subscriber contract,
             2828      and the insurer's written payment policies in effect at the time services were rendered.
             2829          (iii) If the parties are unable to resolve their dispute, the matter shall be subject to


             2830      binding arbitration by a jointly selected arbitrator. Each party is to bear its own expense except
             2831      the cost of the jointly selected arbitrator shall be equally shared. This Subsection (1)(a)(iii)
             2832      does not apply to the claim of a general acute hospital to the extent it is inconsistent with the
             2833      hospital's provider agreement.
             2834          (iv) An organization may not penalize a provider solely for pursuing a claims dispute
             2835      or otherwise demanding payment for a sum believed owing.
             2836          (v) If an insurer permits another entity with which it does not share common ownership
             2837      or control to use or otherwise lease one or more of the organization's networks of participating
             2838      providers, the organization shall ensure, at a minimum, that the entity pays participating
             2839      providers in accordance with the same fee schedule and general payment policies as the
             2840      organization would for that network.
             2841          (b) The insurance contract may reward the insured for selection of preferred health care
             2842      providers by:
             2843          (i) reducing premium rates;
             2844          (ii) reducing deductibles;
             2845          (iii) coinsurance;
             2846          (iv) other copayments; or
             2847          (v) any other reasonable manner.
             2848          (c) If the insurer is a managed care organization, as defined in Subsection
             2849      31A-27a-403 (1)(f):
             2850          (i) the insurance contract and the health care provider contract shall provide that in the
             2851      event the managed care organization becomes insolvent, the rehabilitator or liquidator may:
             2852          (A) require the health care provider to continue to provide health care services under
             2853      the contract until the earlier of:
             2854          (I) 90 days after the date of the filing of a petition for rehabilitation or the petition for
             2855      liquidation; or
             2856          (II) the date the term of the contract ends; and
             2857          (B) subject to Subsection (1)(c)(v), reduce the fees the provider is otherwise entitled to


             2858      receive from the managed care organization during the time period described in Subsection
             2859      (1)(c)(i)(A);
             2860          (ii) the provider is required to:
             2861          (A) accept the reduced payment under Subsection (1)(c)(i)(B) as payment in full; and
             2862          (B) relinquish the right to collect additional amounts from the insolvent managed care
             2863      organization's enrollee, as defined in Subsection 31A-27a-403 (1)(b);
             2864          (iii) if the contract between the health care provider and the managed care organization
             2865      has not been reduced to writing, or the contract fails to contain the [language required by]
             2866      requirements described in Subsection (1)(c)(i), the provider may not collect or attempt to
             2867      collect from the enrollee:
             2868          (A) sums owed by the insolvent managed care organization; or
             2869          (B) the amount of the regular fee reduction authorized under Subsection (1)(c)(i)(B);
             2870          (iv) the following may not bill or maintain [any] an action at law against an enrollee to
             2871      collect sums owed by the insolvent managed care organization or the amount of the regular fee
             2872      reduction authorized under Subsection (1)(c)(i)(B):
             2873          (A) a provider;
             2874          (B) an agent;
             2875          (C) a trustee; or
             2876          (D) an assignee of a person described in Subsections (1)(c)(iv)(A) through (C); and
             2877          (v) notwithstanding Subsection (1)(c)(i):
             2878          (A) a rehabilitator or liquidator may not reduce a fee by less than 75% of the provider's
             2879      regular fee set forth in the contract; and
             2880          (B) the enrollee shall continue to pay the copayments, deductibles, and other payments
             2881      for services received from the provider that the enrollee was required to pay before the filing
             2882      of:
             2883          (I) a petition for rehabilitation; or
             2884          (II) a petition for liquidation.
             2885          (2) (a) Subject to Subsections (2)(b) through (2)(e), an insurer using preferred health


             2886      care provider contracts is subject to the reimbursement requirements in Section 31A-8-501 on
             2887      or after January 1, 2014.
             2888          (b) When reimbursing for services of health care providers not under contract, the
             2889      insurer may make direct payment to the insured.
             2890          (c) An insurer using preferred health care provider contracts may impose a deductible
             2891      on coverage of health care providers not under contract.
             2892          (d) When selecting health care providers with whom to contract under Subsection (1),
             2893      an insurer may not unfairly discriminate between classes of health care providers, but may
             2894      discriminate within a class of health care providers, subject to Subsection (7).
             2895          (e) For purposes of this section, unfair discrimination between classes of health care
             2896      providers includes:
             2897          (i) refusal to contract with class members in reasonable proportion to the number of
             2898      insureds covered by the insurer and the expected demand for services from class members; and
             2899          (ii) refusal to cover procedures for one class of providers that are:
             2900          (A) commonly used by members of the class of health care providers for the treatment
             2901      of illnesses, injuries, or conditions;
             2902          (B) otherwise covered by the insurer; and
             2903          (C) within the scope of practice of the class of health care providers.
             2904          (3) Before the insured consents to the insurance contract, the insurer shall fully disclose
             2905      to the insured that it has entered into preferred health care provider contracts. The insurer shall
             2906      provide sufficient detail on the preferred health care provider contracts to permit the insured to
             2907      agree to the terms of the insurance contract. The insurer shall provide at least the following
             2908      information:
             2909          (a) a list of the health care providers under contract, and if requested their business
             2910      locations and specialties;
             2911          (b) a description of the insured benefits, including [any] deductibles, coinsurance, or
             2912      other copayments;
             2913          (c) a description of the quality assurance program required under Subsection (4); and


             2914          (d) a description of the adverse benefit determination procedures required under
             2915      Subsection (5).
             2916          (4) (a) An insurer using preferred health care provider contracts shall maintain a quality
             2917      assurance program for assuring that the care provided by the health care providers under
             2918      contract meets prevailing standards in the state.
             2919          (b) The commissioner in consultation with the executive director of the Department of
             2920      Health may designate qualified persons to perform an audit of the quality assurance program.
             2921      The auditors shall have full access to all records of the organization and its health care
             2922      providers, including medical records of individual patients.
             2923          (c) The information contained in the medical records of individual patients shall
             2924      remain confidential. All information, interviews, reports, statements, memoranda, or other data
             2925      furnished for purposes of the audit and any findings or conclusions of the auditors are
             2926      privileged. The information is not subject to discovery, use, or receipt in evidence in any legal
             2927      proceeding except hearings before the commissioner concerning alleged violations of this
             2928      section.
             2929          (5) An insurer using preferred health care provider contracts shall provide a reasonable
             2930      procedure for resolving complaints and adverse benefit determinations initiated by the insureds
             2931      and health care providers.
             2932          (6) An insurer may not contract with a health care provider for treatment of illness or
             2933      injury unless the health care provider is licensed to perform that treatment.
             2934          (7) (a) A health care provider or insurer may not discriminate against a preferred health
             2935      care provider for agreeing to a contract under Subsection (1).
             2936          (b) [Any] A health care provider licensed to treat [any] an illness or injury within the
             2937      scope of the health care provider's practice, who is willing and able to meet the terms and
             2938      conditions established by the insurer for designation as a preferred health care provider, shall
             2939      be able to apply for and receive the designation as a preferred health care provider. Contract
             2940      terms and conditions may include reasonable limitations on the number of designated preferred
             2941      health care providers based upon substantial objective and economic grounds, or expected use


             2942      of particular services based upon prior provider-patient profiles.
             2943          (8) Upon the written request of a provider excluded from a provider contract, the
             2944      commissioner may hold a hearing to determine if the insurer's exclusion of the provider is
             2945      based on the criteria set forth in Subsection (7)(b).
             2946          [(9) Except as provided in Subsection 31A-22-618.5 (3)(a), insurers are subject to
             2947      Sections 31A-22-613.5 , 31A-22-614.5 , and 31A-22-618 .]
             2948          [(10)] (9) Nothing in this section is to be construed as to require an insurer to offer a
             2949      certain benefit or service as part of a health benefit plan.
             2950          [(11)] (10) This section does not apply to catastrophic mental health coverage provided
             2951      in accordance with Section 31A-22-625 .
             2952          [(12)] (11) Notwithstanding [the provisions of] Subsection (1), Subsection (7)(b), and
             2953      Section 31A-22-618 , an insurer or third party administrator is not required to, but may, enter
             2954      into [contracts] a contract with a licensed athletic [trainers] trainer, licensed under Title 58,
             2955      Chapter 40a, Athletic Trainer Licensing Act.
             2956          Section 14. Section 31A-22-618.5 is amended to read:
             2957           31A-22-618.5. Health benefit plan offerings.
             2958          (1) The purpose of this section is to increase the range of health benefit plans available
             2959      in the small group, small employer group, large group, and individual insurance markets.
             2960          (2) A health maintenance organization that is subject to Chapter 8, Health Maintenance
             2961      Organizations and Limited Health Plans:
             2962          (a) shall offer to potential purchasers at least one health benefit plan that is subject to
             2963      the requirements of Chapter 8, Health Maintenance Organizations and Limited Health Plans;
             2964      and
             2965          (b) may offer to a potential purchaser one or more health benefit plans that:
             2966          (i) are not subject to one or more of the following:
             2967          (A) the limitations on insured indemnity benefits in Subsection 31A-8-105 (4);
             2968          (B) the limitation on point of service products in Subsections 31A-8-408 (3) through
             2969      (6);


             2970          (C) except as provided in Subsection (2)(b)(ii), basic health care services as defined in
             2971      Section 31A-8-101 ; or
             2972          (D) coverage mandates enacted after January 1, 2009 that are not required by federal
             2973      law, provided that the insurer offers one plan under Subsection (2)(a) that covers the mandate
             2974      enacted after January 1, 2009; and
             2975          (ii) when offering a health plan under this section, provide coverage for an emergency
             2976      medical condition as required by Section 31A-22-627 as follows:
             2977          (A) within the organization's service area, covered services shall include health care
             2978      services from nonaffiliated providers when medically necessary to stabilize an emergency
             2979      medical condition; and
             2980          (B) outside the organization's service area, covered services shall include medically
             2981      necessary health care services for the treatment of an emergency medical condition that are
             2982      immediately required while the enrollee is outside the geographic limits of the organization's
             2983      service area.
             2984          (3) An insurer that offers a health benefit plan that is not subject to Chapter 8, Health
             2985      Maintenance Organizations and Limited Health Plans:
             2986          (a) [notwithstanding Subsection 31A-22-617 (9),] may offer a health benefit plan that is
             2987      not subject to Section 31A-22-618 ;
             2988          (b) when offering a health plan under this Subsection (3), shall provide coverage of
             2989      emergency care services as required by Section 31A-22-627 ; and
             2990          (c) is not subject to coverage mandates enacted after January 1, 2009 that are not
             2991      required by federal law, provided that an insurer offers one plan that covers a mandate enacted
             2992      after January 1, 2009.
             2993          (4) Section 31A-8-106 does not prohibit the offer of a health benefit plan under
             2994      Subsection (2)(b).
             2995          (5) (a) Any difference in price between a health benefit plan offered under Subsections
             2996      (2)(a) and (b) shall be based on actuarially sound data.
             2997          (b) Any difference in price between a health benefit plan offered under Subsection


             2998      (3)(a) shall be based on actuarially sound data.
             2999          (6) Nothing in this section limits the number of health benefit plans that an insurer may
             3000      offer.
             3001          Section 15. Section 31A-22-625 is amended to read:
             3002           31A-22-625. Catastrophic coverage of mental health conditions.
             3003          (1) As used in this section:
             3004          (a) (i) "Catastrophic mental health coverage" means coverage in a health benefit plan
             3005      that does not impose a lifetime limit, annual payment limit, episodic limit, inpatient or
             3006      outpatient service limit, or maximum out-of-pocket limit that places a greater financial burden
             3007      on an insured for the evaluation and treatment of a mental health condition than for the
             3008      evaluation and treatment of a physical health condition.
             3009          (ii) "Catastrophic mental health coverage" may include a restriction on cost sharing
             3010      factors, such as deductibles, copayments, or coinsurance, before reaching a maximum
             3011      out-of-pocket limit.
             3012          (iii) "Catastrophic mental health coverage" may include one maximum out-of-pocket
             3013      limit for physical health conditions and another maximum out-of-pocket limit for mental health
             3014      conditions, except that if separate out-of-pocket limits are established, the out-of-pocket limit
             3015      for mental health conditions may not exceed the out-of-pocket limit for physical health
             3016      conditions.
             3017          (b) (i) "50/50 mental health coverage" means coverage in a health benefit plan that
             3018      pays for at least 50% of covered services for the diagnosis and treatment of mental health
             3019      conditions.
             3020          (ii) "50/50 mental health coverage" may include a restriction on:
             3021          (A) episodic limits;
             3022          (B) inpatient or outpatient service limits; or
             3023          (C) maximum out-of-pocket limits.
             3024          (c) "Large employer" is as defined in 42 U.S.C. Sec. 300gg-91.
             3025          (d) (i) "Mental health condition" means a condition or disorder involving mental illness


             3026      that falls under a diagnostic category listed in the Diagnostic and Statistical Manual, as