This document includes House Floor Amendments incorporated into the bill on Thu, Feb 29, 2024 at 6:34 PM by housengrossing.
Representative James A. Dunnigan proposes the following substitute bill:


1     
INSURANCE AMENDMENTS

2     
2024 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Curtis S. Bramble

5     
House Sponsor: James A. Dunnigan

6     

7     LONG TITLE
8     General Description:
9          This bill updates the Insurance Code.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     exempts a health care sharing ministry from regulation under the Insurance Code,
14     provided the health care sharing ministry makes certain disclosures to participants;
15          ▸     requires that the commissioner evaluate annually the state's health insurance market
16     and provide that evaluation to the Health and Human Services Interim Committee;
17          ▸     removes provisions relating to the commissioner declaring a rule in effect during a
18     transition period;
19          ▸     clarifies the scope of the consumer assistance that the commissioner provides;
20          ▸     authorizes an insurer to electronically deliver a policy document to an insured under
21     certain conditions;
22          ▸     expands the list of prohibited life insurance policy provisions;
23          ▸     updates the duties of the Office of Consumer Health Assistance;
24          ▸     modifies the commissioner's enforcement authority to allow the commissioner to
25     accept or compromise a forfeiture after the filing of a complaint;

26          ▸     amends provisions relating to mutual insurance holding companies;
27          ▸     amends the enforcement provisions under this chapter;
28          ▸     removes the filing fee for a rate filing;
29          ▸     addresses the allowable amount of a rate or other charge used by a title insurer;
30          ▸     allows a licensee to make installment payments on a judgment if the payments are
31     not more than 60 days overdue;
32          ▸     requires that certain licensees and prospective licensees report to the commissioner
33     any civil action that is filed against the licensee or prospective licensee and involves
34     conduct related to a professional or occupational license;
35          ▸     institutes new capital and net worth requirements for title insurance producers;
36          ▸     removes the requirement that an individual title insurance producer file an annual
37     report with the commissioner;
38          ▸     allows a federal home loan bank to obtain collateral pledged by an insurer-member
39     when the member-insurer is in receivership;
40          ▸     requires that the commissioner conduct a study and produce a report relating to
41     lowering health benefit plan insurance premiums and market stabilization;
42          ▸     increases the fee that the commissioner may assess certain admitted and
43     nonadmitted insurers;
44          ▸     authorizes an association captive insurance company to provide homeowners'
45     insurance, subject to commissioner approval; and
46          ▸     makes technical changes.
47     Money Appropriated in this Bill:
48          This bill appropriates in fiscal year 2025:
49          ▸     to Insurance Department - Insurance Department Administration as a one-time
50     appropriation:
51               •     from the General Fund Restricted - Relative Value Study Account, One-time,
52     $400,000
53     Other Special Clauses:
54          This bill provides a special effective date.
55     Utah Code Sections Affected:
56     AMENDS:

57          31A-1-103, as last amended by Laws of Utah 2021, Chapter 252
58          31A-1-301, as last amended by Laws of Utah 2023, Chapter 327
59          31A-2-201.2, as last amended by Laws of Utah 2019, Chapters 241, 439
60          31A-2-211, as last amended by Laws of Utah 1987, Chapter 161
61          31A-2-215, as last amended by Laws of Utah 2002, Chapter 308
62          31A-2-216, as last amended by Laws of Utah 2002, Chapter 308
63          31A-2-308, as last amended by Laws of Utah 2019, Chapter 193
64          31A-4-113.5, as last amended by Laws of Utah 2023, Chapter 194
65          31A-6a-109, as enacted by Laws of Utah 1992, Chapter 203
66          31A-16-102.6, as enacted by Laws of Utah 2022, Chapter 198
67          31A-19a-203, as last amended by Laws of Utah 2004, Chapter 117
68          31A-19a-209, as last amended by Laws of Utah 2023, Chapter 194
69          31A-20-108, as last amended by Laws of Utah 2009, Chapter 349
70          31A-21-316, as enacted by Laws of Utah 2014, Chapter 77
71          31A-21-402, as last amended by Laws of Utah 2021, Chapter 252
72          31A-22-401, as last amended by Laws of Utah 1986, Chapter 204
73          31A-22-605, as last amended by Laws of Utah 2017, Chapter 168
74          31A-22-614, as last amended by Laws of Utah 2011, Chapter 366
75          31A-22-620, as last amended by Laws of Utah 2015, Chapter 244
76          31A-22-802, as last amended by Laws of Utah 2011, Chapter 366
77          31A-22-2002, as last amended by Laws of Utah 2021, Chapter 252
78          31A-23a-105, as last amended by Laws of Utah 2014, Chapters 290, 300
79          31A-23a-111, as last amended by Laws of Utah 2023, Chapter 194
80          31A-23a-406, as last amended by Laws of Utah 2023, Chapter 194
81          31A-23a-413, as last amended by Laws of Utah 2015, Chapter 312
82          31A-26-301.6, as last amended by Laws of Utah 2023, Chapter 328
83          31A-28-113, as last amended by Laws of Utah 2018, Chapter 391
84          31A-31-108, as last amended by Laws of Utah 2013, Chapter 319
85          31A-35-202, as last amended by Laws of Utah 2016, Chapter 234
86          31A-35-406, as last amended by Laws of Utah 2021, Chapter 252
87          31A-37-202, as last amended by Laws of Utah 2023, Chapter 194

88          31A-37-204, as last amended by Laws of Utah 2023, Chapter 194
89          31A-37-502, as last amended by Laws of Utah 2019, Chapter 193
90     ENACTS:
91          31A-2-218.1, Utah Code Annotated 1953
92          31A-23a-119, Utah Code Annotated 1953
93          31A-27a-108.1, Utah Code Annotated 1953
94     REPEALS:
95          31A-2-303, as last amended by Laws of Utah 2009, Chapter 388
96     

97     Be it enacted by the Legislature of the state of Utah:
98          Section 1. Section 31A-1-103 is amended to read:
99          31A-1-103. Scope and applicability of title.
100          (1) This title does not apply to:
101          (a) a retainer contract made by an attorney-at-law:
102          (i) with an individual client; and
103          (ii) under which fees are based on estimates of the nature and amount of services to be
104     provided to the specific client;
105          (b) a contract similar to a contract described in Subsection (1)(a) made with a group of
106     clients involved in the same or closely related legal matters;
107          (c) an arrangement for providing benefits that do not exceed a limited amount of
108     consultations, advice on simple legal matters, either alone or in combination with referral
109     services, or the promise of fee discounts for handling other legal matters;
110          (d) limited legal assistance on an informal basis involving neither an express
111     contractual obligation nor reasonable expectations, in the context of an employment,
112     membership, educational, or similar relationship;
113          (e) legal assistance by employee organizations to their members in matters relating to
114     employment;
115          (f) death, accident, health, or disability benefits provided to a person by an organization
116     or its affiliate if:
117          (i) the organization is tax exempt under Section 501(c)(3) of the Internal Revenue
118     Code and has had its principal place of business in Utah for at least five years;

119          (ii) the person is not an employee of the organization; and
120          (iii) (A) substantially all the person's time in the organization is spent providing
121     voluntary services:
122          (I) in furtherance of the organization's purposes;
123          (II) for a designated period of time; and
124          (III) for which no compensation, other than expenses, is paid; or
125          (B) the time since the service under Subsection (1)(f)(iii)(A) was completed is no more
126     than 18 months; or
127          (g) a prepaid contract of limited duration that provides for scheduled maintenance only.
128          (2) (a) This title restricts otherwise legitimate business activity.
129          (b) What this title does not prohibit is permitted unless contrary to other provisions of
130     Utah law.
131          (3) Except as otherwise expressly provided, this title does not apply to:
132          (a) those activities of an insurer where state jurisdiction is preempted by Section 514 of
133     the federal Employee Retirement Income Security Act of 1974, as amended;
134          (b) ocean marine insurance;
135          (c) death, accident, health, or disability benefits provided by an organization [if the
136     organization:] that:
137          (i) has as the organization's principal purpose to achieve charitable, educational, social,
138     or religious objectives rather than to provide death, accident, health, or disability benefits;
139          (ii) does not incur a legal obligation to pay a specified amount; [and]
140          (iii) does not create reasonable expectations of receiving a specified amount on the part
141     of an insured person; and
142          (iv) is not a health care sharing ministry that provides that a participant make a
143     contribution to pay another participant's qualified expenses with no assumption of risk or
144     promise to pay.
145          (d) other business specified in rules adopted by the commissioner on a finding that:
146          (i) the transaction of the business in this state does not require regulation for the
147     protection of the interests of the residents of this state; or
148          (ii) it would be impracticable to require compliance with this title;
149          (e) except as provided in Subsection (4), a transaction independently procured through

150     negotiations under Section 31A-15-104;
151          (f) self-insurance;
152          (g) reinsurance;
153          (h) subject to Subsection (5), an employee or labor union group insurance policy
154     covering risks in this state or an employee or labor union blanket insurance policy covering
155     risks in this state, if:
156          (i) the policyholder exists primarily for purposes other than to procure insurance;
157          (ii) the policyholder:
158          (A) is not a resident of this state;
159          (B) is not a domestic corporation; or
160          (C) does not have the policyholder's principal office in this state;
161          (iii) no more than 25% of the certificate holders or insureds are residents of this state;
162          (iv) on request of the commissioner, the insurer files with the department a copy of the
163     policy and a copy of each form or certificate; and
164          (v) (A) the insurer agrees to pay premium taxes on the Utah portion of the insurer's
165     business, as if the insurer were authorized to do business in this state; and
166          (B) the insurer provides the commissioner with the security the commissioner
167     considers necessary for the payment of premium taxes under Title 59, Chapter 9, Taxation of
168     Admitted Insurers;
169          (i) to the extent provided in Subsection (6):
170          (i) a manufacturer's or seller's warranty; and
171          (ii) a manufacturer's or seller's service contract;
172          (j) except to the extent provided in Subsection (7), a public agency insurance mutual;
173     [or]
174          (k) except as provided in Chapter 6b, Guaranteed Asset Protection Waiver Act, a
175     guaranteed asset protection waiver[.]; or
176          (l) a health care sharing ministry, if the health care sharing ministry:
177          (i) provides to each participant upon enrollment and annually thereafter a written
178     statement of nationwide data from the preceding calendar year that lists the total dollar amount
179     of contributions provided to participants toward qualified expenses; and
180          (ii) includes a written disclaimer, titled "Notice", on or with each application and all

181     guideline materials that states:
182          (A) the health care sharing ministry is not an insurance company;
183          (B) nothing the health care sharing ministry offers or provides is an insurance policy,
184     including the health care sharing ministry's guidelines or plan of operations;
185          (C) participation in the health care sharing ministry is entirely voluntary and no
186     participant is compelled by law to contribute to another participant's expenses;
187          (D) participation in the health care sharing ministry or subscription to any of the health
188     care sharing ministry's services is not insurance; and
189          (E) each participant is always personally responsible for the participant's expenses
190     regardless of whether the participant receives payment for the expenses through the health care
191     sharing ministry or whether this health care sharing ministry continues to operate.
192          (4) A transaction described in Subsection (3)(e) is subject to taxation under Section
193     31A-3-301.
194          (5) (a) After a hearing, the commissioner may order an insurer of certain group
195     insurance policies or blanket insurance policies to transfer the Utah portion of the business
196     otherwise exempted under Subsection (3)(h) to an authorized insurer if the contracts have been
197     written by an unauthorized insurer.
198          (b) If the commissioner finds that the conditions required for the exemption of a group
199     or blanket insurer are not satisfied or that adequate protection to residents of this state is not
200     provided, the commissioner may require:
201          (i) the insurer to be authorized to do business in this state; or
202          (ii) that any of the insurer's transactions be subject to this title.
203          (c) Subsection (3)(h) does not apply to a blanket insurance policy offering accident and
204     health insurance.
205          (6) (a) As used in Subsection (3)(i) and this Subsection (6):
206          (i) "manufacturer's or seller's service contract" means a service contract:
207          (A) made available by:
208          (I) a manufacturer of a product;
209          (II) a seller of a product; or
210          (III) an affiliate of a manufacturer or seller of a product;
211          (B) made available:

212          (I) on one or more specific products; or
213          (II) on products that are components of a system; and
214          (C) under which the person described in Subsection (6)(a)(i)(A) is liable for services to
215     be provided under the service contract including, if the manufacturer's or seller's service
216     contract designates, providing parts and labor;
217          (ii) "manufacturer's or seller's warranty" means the guaranty of:
218          (A) (I) the manufacturer of a product;
219          (II) a seller of a product; or
220          (III) an affiliate of a manufacturer or seller of a product;
221          (B) (I) on one or more specific products; or
222          (II) on products that are components of a system; and
223          (C) under which the person described in Subsection (6)(a)(ii)(A) is liable for services
224     to be provided under the warranty, including, if the manufacturer's or seller's warranty
225     designates, providing parts and labor; and
226          (iii) "service contract" means the same as that term is defined in Section 31A-6a-101.
227          (b) A manufacturer's or seller's warranty may be designated as:
228          (i) a warranty;
229          (ii) a guaranty; or
230          (iii) a term similar to a term described in Subsection (6)(b)(i) or (ii).
231          (c) This title does not apply to:
232          (i) a manufacturer's or seller's warranty;
233          (ii) a manufacturer's or seller's service contract paid for with consideration that is in
234     addition to the consideration paid for the product itself; and
235          (iii) a service contract that is not a manufacturer's or seller's warranty or manufacturer's
236     or seller's service contract if:
237          (A) the service contract is paid for with consideration that is in addition to the
238     consideration paid for the product itself;
239          (B) the service contract is for the repair or maintenance of goods;
240          (C) the purchase price of the product is $3,700 or less;
241          (D) the product is not a motor vehicle; and
242          (E) the product is not the subject of a home warranty service contract.

243          (d) This title does not apply to a manufacturer's or seller's warranty or service contract
244     paid for with consideration that is in addition to the consideration paid for the product itself
245     regardless of whether the manufacturer's or seller's warranty or service contract is sold:
246          (i) at the time of the purchase of the product; or
247          (ii) at a time other than the time of the purchase of the product.
248          (7) (a) For purposes of this Subsection (7), "public agency insurance mutual" means an
249     entity formed by two or more political subdivisions or public agencies of the state:
250          (i) under Title 11, Chapter 13, Interlocal Cooperation Act; and
251          (ii) for the purpose of providing for the political subdivisions or public agencies:
252          (A) subject to Subsection (7)(b), insurance coverage; or
253          (B) risk management.
254          (b) Notwithstanding Subsection (7)(a)(ii)(A), a public agency insurance mutual may
255     not provide health insurance unless the public agency insurance mutual provides the health
256     insurance using:
257          (i) a third party administrator licensed under Chapter 25, Third Party Administrators;
258          (ii) an admitted insurer; or
259          (iii) a program authorized by Title 49, Chapter 20, Public Employees' Benefit and
260     Insurance Program Act.
261          (c) Except for this Subsection (7), a public agency insurance mutual is exempt from
262     this title.
263          (d) A public agency insurance mutual is considered to be a governmental entity and
264     political subdivision of the state with all of the rights, privileges, and immunities of a
265     governmental entity or political subdivision of the state including all the rights and benefits of
266     Title 63G, Chapter 7, Governmental Immunity Act of Utah.
267          Section 2. Section 31A-1-301 is amended to read:
268          31A-1-301. Definitions.
269          As used in this title, unless otherwise specified:
270          (1) (a) "Accident and health insurance" means insurance to provide protection against
271     economic losses resulting from:
272          (i) a medical condition including:
273          (A) a medical care expense; or

274          (B) the risk of disability;
275          (ii) accident; or
276          (iii) sickness.
277          (b) "Accident and health insurance":
278          (i) includes a contract with disability contingencies including:
279          (A) an income replacement contract;
280          (B) a health care contract;
281          (C) a fixed indemnity contract;
282          (D) a credit accident and health contract;
283          (E) a continuing care contract; and
284          (F) a long-term care contract; and
285          (ii) may provide:
286          (A) hospital coverage;
287          (B) surgical coverage;
288          (C) medical coverage;
289          (D) loss of income coverage;
290          (E) prescription drug coverage;
291          (F) dental coverage; or
292          (G) vision coverage.
293          (c) "Accident and health insurance" does not include workers' compensation insurance.
294          (d) For purposes of a national licensing registry, "accident and health insurance" is the
295     same as "accident and health or sickness insurance."
296          (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title
297     63G, Chapter 3, Utah Administrative Rulemaking Act.
298          (3) "Administrator" means the same as that term is defined in Subsection [(182).]
299     (187).
300          (4) "Adult" means an individual who is 18 years old or older.
301          (5) "Affiliate" means a person who controls, is controlled by, or is under common
302     control with, another person. A corporation is an affiliate of another corporation, regardless of
303     ownership, if substantially the same group of individuals manage the corporations.
304          (6) "Agency" means:

305          (a) a person other than an individual, including a sole proprietorship by which an
306     individual does business under an assumed name; and
307          (b) an insurance organization licensed or required to be licensed under Section
308     31A-23a-301, 31A-25-207, or 31A-26-209.
309          (7) "Alien insurer" means an insurer domiciled outside the United States.
310          (8) "Amendment" means an endorsement to an insurance policy or certificate.
311          (9) "Annuity" means an agreement to make periodical payments for a period certain or
312     over the lifetime of one or more individuals if the making or continuance of all or some of the
313     series of the payments, or the amount of the payment, is dependent upon the continuance of
314     human life.
315          (10) "Application" means a document:
316          (a) (i) completed by an applicant to provide information about the risk to be insured;
317     and
318          (ii) that contains information that is used by the insurer to evaluate risk and decide
319     whether to:
320          (A) insure the risk under:
321          (I) the coverage as originally offered; or
322          (II) a modification of the coverage as originally offered; or
323          (B) decline to insure the risk; or
324          (b) used by the insurer to gather information from the applicant before issuance of an
325     annuity contract.
326          (11) "Articles" or "articles of incorporation" means:
327          (a) the original articles;
328          (b) a special law;
329          (c) a charter;
330          (d) an amendment;
331          (e) restated articles;
332          (f) articles of merger or consolidation;
333          (g) a trust instrument;
334          (h) another constitutive document for a trust or other entity that is not a corporation;
335     and

336          (i) an amendment to an item listed in Subsections (11)(a) through (h).
337          (12) "Bail bond insurance" means a guarantee that a person will attend court when
338     required, up to and including surrender of the person in execution of a sentence imposed under
339     Subsection 77-20-501(1), as a condition to the release of that person from confinement.
340          (13) "Binder" means the same as that term is defined in Section 31A-21-102.
341          (14) "Blanket insurance policy" or "blanket contract" means a group insurance policy
342     covering a defined class of persons:
343          (a) without individual underwriting or application; and
344          (b) that is determined by definition without designating each person covered.
345          (15) "Board," "board of trustees," or "board of directors" means the group of persons
346     with responsibility over, or management of, a corporation, however designated.
347          (16) "Bona fide office" means a physical office in this state:
348          (a) that is open to the public;
349          (b) that is staffed during regular business hours on regular business days; and
350          (c) at which the public may appear in person to obtain services.
351          (17) "Business entity" means:
352          (a) a corporation;
353          (b) an association;
354          (c) a partnership;
355          (d) a limited liability company;
356          (e) a limited liability partnership; or
357          (f) another legal entity.
358          (18) "Business of insurance" means the same as that term is defined in Subsection
359     [(95).] (98).
360          (19) "Business plan" means the information required to be supplied to the
361     commissioner under Subsections 31A-5-204(2)(i) and (j), including the information required
362     when these subsections apply by reference under:
363          (a) Section 31A-8-205; or
364          (b) Subsection 31A-9-205(2).
365          (20) (a) "Bylaws" means the rules adopted for the regulation or management of a
366     corporation's affairs, however designated.

367          (b) "Bylaws" includes comparable rules for a trust or other entity that is not a
368     corporation.
369          (21) "Captive insurance company" means:
370          (a) an insurer:
371          (i) owned by a parent organization; and
372          (ii) whose purpose is to insure risks of the parent organization and other risks as
373     authorized under:
374          (A) Chapter 37, Captive Insurance Companies Act; and
375          (B) Chapter 37a, Special Purpose Financial Captive Insurance Company Act; or
376          (b) in the case of a group or association, an insurer:
377          (i) owned by the insureds; and
378          (ii) whose purpose is to insure risks of:
379          (A) a member organization;
380          (B) a group member; or
381          (C) an affiliate of:
382          (I) a member organization; or
383          (II) a group member.
384          (22) "Casualty insurance" means liability insurance.
385          (23) "Certificate" means evidence of insurance given to:
386          (a) an insured under a group insurance policy; or
387          (b) a third party.
388          (24) "Certificate of authority" is included within the term "license."
389          (25) "Claim," unless the context otherwise requires, means a request or demand on an
390     insurer for payment of a benefit according to the terms of an insurance policy.
391          (26) "Claims-made coverage" means an insurance contract or provision limiting
392     coverage under a policy insuring against legal liability to claims that are first made against the
393     insured while the policy is in force.
394          (27) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance
395     commissioner.
396          (b) When appropriate, the terms listed in Subsection (27)(a) apply to the equivalent
397     supervisory official of another jurisdiction.

398          (28) (a) "Continuing care insurance" means insurance that:
399          (i) provides board and lodging;
400          (ii) provides one or more of the following:
401          (A) a personal service;
402          (B) a nursing service;
403          (C) a medical service; or
404          (D) any other health-related service; and
405          (iii) provides the coverage described in this Subsection (28)(a) under an agreement
406     effective:
407          (A) for the life of the insured; or
408          (B) for a period in excess of one year.
409          (b) Insurance is continuing care insurance regardless of whether or not the board and
410     lodging are provided at the same location as a service described in Subsection (28)(a)(ii).
411          (29) (a) "Control," "controlling," "controlled," or "under common control" means the
412     direct or indirect possession of the power to direct or cause the direction of the management
413     and policies of a person. This control may be:
414          (i) by contract;
415          (ii) by common management;
416          (iii) through the ownership of voting securities; or
417          (iv) by a means other than those described in Subsections (29)(a)(i) through (iii).
418          (b) There is no presumption that an individual holding an official position with another
419     person controls that person solely by reason of the position.
420          (c) A person having a contract or arrangement giving control is considered to have
421     control despite the illegality or invalidity of the contract or arrangement.
422          (d) There is a rebuttable presumption of control in a person who directly or indirectly
423     owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the
424     voting securities of another person.
425          (30) "Controlled insurer" means a licensed insurer that is either directly or indirectly
426     controlled by a producer.
427          (31) "Controlling person" means a person that directly or indirectly has the power to
428     direct or cause to be directed, the management, control, or activities of a reinsurance

429     intermediary.
430          (32) "Controlling producer" means a producer who directly or indirectly controls an
431     insurer.
432          (33) "Corporate governance annual disclosure" means a report an insurer or insurance
433     group files in accordance with the requirements of Chapter 16b, Corporate Governance Annual
434     Disclosure Act.
435          (34) (a) "Corporation" means an insurance corporation, except when referring to:
436          (i) a corporation doing business:
437          (A) as:
438          (I) an insurance producer;
439          (II) a surplus lines producer;
440          (III) a limited line producer;
441          (IV) a consultant;
442          (V) a managing general agent;
443          (VI) a reinsurance intermediary;
444          (VII) a third party administrator; or
445          (VIII) an adjuster; and
446          (B) under:
447          (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
448     Reinsurance Intermediaries;
449          (II) Chapter 25, Third Party Administrators; or
450          (III) Chapter 26, Insurance Adjusters; or
451          (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance
452     Holding Companies.
453          (b) "Mutual" or "mutual corporation" means a mutual insurance corporation.
454          (c) "Stock corporation" means a stock insurance corporation.
455          (35) (a) "Creditable coverage" has the same meaning as provided in federal regulations
456     adopted pursuant to the Health Insurance Portability and Accountability Act.
457          (b) "Creditable coverage" includes coverage that is offered through a public health plan
458     such as:
459          (i) the Primary Care Network Program under a Medicaid primary care network

460     demonstration waiver obtained subject to Section 26B-3-108;
461          (ii) the Children's Health Insurance Program under Section 26B-3-904; or
462          (iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.
463     No. 101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. No.
464     109-415.
465          (36) "Credit accident and health insurance" means insurance on a debtor to provide
466     indemnity for payments coming due on a specific loan or other credit transaction while the
467     debtor has a disability.
468          (37) (a) "Credit insurance" means insurance offered in connection with an extension of
469     credit that is limited to partially or wholly extinguishing that credit obligation.
470          (b) "Credit insurance" includes:
471          (i) credit accident and health insurance;
472          (ii) credit life insurance;
473          (iii) credit property insurance;
474          (iv) credit unemployment insurance;
475          (v) guaranteed automobile protection insurance;
476          (vi) involuntary unemployment insurance;
477          (vii) mortgage accident and health insurance;
478          (viii) mortgage guaranty insurance; and
479          (ix) mortgage life insurance.
480          (38) "Credit life insurance" means insurance on the life of a debtor in connection with
481     an extension of credit that pays a person if the debtor dies.
482          (39) "Creditor" means a person, including an insured, having a claim, whether:
483          (a) matured;
484          (b) unmatured;
485          (c) liquidated;
486          (d) unliquidated;
487          (e) secured;
488          (f) unsecured;
489          (g) absolute;
490          (h) fixed; or

491          (i) contingent.
492          (40) "Credit property insurance" means insurance:
493          (a) offered in connection with an extension of credit; and
494          (b) that protects the property until the debt is paid.
495          (41) "Credit unemployment insurance" means insurance:
496          (a) offered in connection with an extension of credit; and
497          (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
498          (i) specific loan; or
499          (ii) credit transaction.
500          (42) (a) "Crop insurance" means insurance providing protection against damage to
501     crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation,
502     disease, or other yield-reducing conditions or perils that is:
503          (i) provided by the private insurance market; or
504          (ii) subsidized by the Federal Crop Insurance Corporation.
505          (b) "Crop insurance" includes multiperil crop insurance.
506          (43) (a) "Customer service representative" means a person that provides an insurance
507     service and insurance product information:
508          (i) for the customer service representative's:
509          (A) producer;
510          (B) surplus lines producer; or
511          (C) consultant employer; and
512          (ii) to the customer service representative's employer's:
513          (A) customer;
514          (B) client; or
515          (C) organization.
516          (b) A customer service representative may only operate within the scope of authority of
517     the customer service representative's producer, surplus lines producer, or consultant employer.
518          (44) "Deadline" means a final date or time:
519          (a) imposed by:
520          (i) statute;
521          (ii) rule; or

522          (iii) order; and
523          (b) by which a required filing or payment must be received by the department.
524          (45) "Deemer clause" means a provision under this title under which upon the
525     occurrence of a condition precedent, the commissioner is considered to have taken a specific
526     action. If the statute so provides, a condition precedent may be the commissioner's failure to
527     take a specific action.
528          (46) "Degree of relationship" means the number of steps between two persons
529     determined by counting the generations separating one person from a common ancestor and
530     then counting the generations to the other person.
531          (47) "Department" means the Insurance Department.
532          (48) (a) "Direct response solicitation" means an offer for life or accident and health
533     insurance coverage that allows the individual to apply for or enroll in the insurance coverage
534     on the basis of the offer.
535          (b) "Direct response solicitation" does not include an offer for:
536          (i) insurance through an employee benefit plan that is exempt from state regulation
537     under federal law; or
538          (ii) credit life insurance or credit accident and health insurance through a individual's
539     creditor.
540          (49) "Direct response insurance policy" means an insurance policy solicited and sold
541     without the policyholder having direct contact with a natural person intermediary.
542          [(48)] (50) "Director" means a member of the board of directors of a corporation.
543          [(49)] (51) "Disability" means a physiological or psychological condition that partially
544     or totally limits an individual's ability to:
545          (a) perform the duties of:
546          (i) that individual's occupation; or
547          (ii) an occupation for which the individual is reasonably suited by education, training,
548     or experience; or
549          (b) perform two or more of the following basic activities of daily living:
550          (i) eating;
551          (ii) toileting;
552          (iii) transferring;

553          (iv) bathing; or
554          (v) dressing.
555          [(50)] (52) "Disability income insurance" means the same as that term is defined in
556     Subsection [(86).] (89).
557          [(51)] (53) "Domestic insurer" means an insurer organized under the laws of this state.
558          [(52)] (54) "Domiciliary state" means the state in which an insurer:
559          (a) is incorporated;
560          (b) is organized; or
561          (c) in the case of an alien insurer, enters into the United States.
562          [(53)] (55) (a) "Eligible employee" means:
563          (i) an employee who:
564          (A) works on a full-time basis; and
565          (B) has a normal work week of 30 or more hours; or
566          (ii) a person described in Subsection [(53)(b).] (55)(b).
567          (b) "Eligible employee" includes:
568          (i) an owner, sole proprietor, or partner who:
569          (A) works on a full-time basis;
570          (B) has a normal work week of 30 or more hours; and
571          (C) employs at least one common employee; and
572          (ii) an independent contractor if the individual is included under a health benefit plan
573     of a small employer.
574          (c) "Eligible employee" does not include, unless eligible under Subsection [(53)(b):]
575     (55)(b):
576          (i) an individual who works on a temporary or substitute basis for a small employer;
577          (ii) an employer's spouse who does not meet the requirements of Subsection
578     [(53)(a)(i);] (55)(a)(i); or
579          (iii) a dependent of an employer who does not meet the requirements of Subsection
580     [(53)(a)(i).] (55)(a)(i).
581          [(54)] (56) "Emergency medical condition" means a medical condition that:
582          (a) manifests itself by acute symptoms, including severe pain; and
583          (b) would cause a prudent layperson possessing an average knowledge of medicine and

584     health to reasonably expect the absence of immediate medical attention through a hospital
585     emergency department to result in:
586          (i) placing the layperson's health or the layperson's unborn child's health in serious
587     jeopardy;
588          (ii) serious impairment to bodily functions; or
589          (iii) serious dysfunction of any bodily organ or part.
590          [(55)] (57) "Employee" means:
591          (a) an individual employed by an employer; or
592          (b) an individual who meets the requirements of Subsection [(53)(b).] (55)(b).
593          [(56)] (58) "Employee benefits" means one or more benefits or services provided to:
594          (a) an employee; or
595          (b) a dependent of an employee.
596          [(57)] (59) (a) "Employee welfare fund" means a fund:
597          (i) established or maintained, whether directly or through a trustee, by:
598          (A) one or more employers;
599          (B) one or more labor organizations; or
600          (C) a combination of employers and labor organizations; and
601          (ii) that provides employee benefits paid or contracted to be paid, other than income
602     from investments of the fund:
603          (A) by or on behalf of an employer doing business in this state; or
604          (B) for the benefit of a person employed in this state.
605          (b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or tax
606     revenues.
607          [(58)] (60) "Endorsement" means a written agreement attached to a policy or certificate
608     to modify the policy or certificate coverage.
609          [(59)] (61) (a) "Enrollee" means:
610          (i) a policyholder;
611          (ii) a certificate holder;
612          (iii) a subscriber; or
613          (iv) a covered individual:
614          (A) who has entered into a contract with an organization for health care; or

615          (B) on whose behalf an arrangement for health care has been made.
616          (b) "Enrollee" includes an insured.
617          [(60)] (62) "Enrollment date," with respect to a health benefit plan, means:
618          (a) the first day of coverage; or
619          (b) if there is a waiting period, the first day of the waiting period.
620          [(61)] (63) "Enterprise risk" means an activity, circumstance, event, or series of events
621     involving one or more affiliates of an insurer that, if not remedied promptly, is likely to have a
622     material adverse effect upon the financial condition or liquidity of the insurer or its insurance
623     holding company system as a whole, including anything that would cause:
624          (a) the insurer's risk-based capital to fall into an action or control level as set forth in
625     Sections 31A-17-601 through 31A-17-613; or
626          (b) the insurer to be in hazardous financial condition set forth in Section 31A-27a-101.
627          [(62)] (64) (a) "Escrow" means:
628          (i) a transaction that effects the sale, transfer, encumbering, or leasing of real property,
629     when a person not a party to the transaction, and neither having nor acquiring an interest in the
630     title, performs, in accordance with the written instructions or terms of the written agreement
631     between the parties to the transaction, any of the following actions:
632          (A) the explanation, holding, or creation of a document; or
633          (B) the receipt, deposit, and disbursement of money; or
634          (ii) a settlement or closing involving:
635          (A) a mobile home;
636          (B) a grazing right;
637          (C) a water right; or
638          (D) other personal property authorized by the commissioner.
639          (b) "Escrow" does not include:
640          (i) the following notarial acts performed by a notary within the state:
641          (A) an acknowledgment;
642          (B) a copy certification;
643          (C) jurat; and
644          (D) an oath or affirmation;
645          (ii) the receipt or delivery of a document; or

646          (iii) the receipt of money for delivery to the escrow agent.
647          [(63)] (65) "Escrow agent" means an agency title insurance producer meeting the
648     requirements of Sections 31A-4-107, 31A-14-211, and 31A-23a-204, who is acting through an
649     individual title insurance producer licensed with an escrow subline of authority.
650          [(64)] (66) (a) "Excludes" is not exhaustive and does not mean that another thing is not
651     also excluded.
652          (b) The items listed in a list using the term "excludes" are representative examples for
653     use in interpretation of this title.
654          [(65)] (67) "Exclusion" means for the purposes of accident and health insurance that an
655     insurer does not provide insurance coverage, for whatever reason, for one of the following:
656          (a) a specific physical condition;
657          (b) a specific medical procedure;
658          (c) a specific disease or disorder; or
659          (d) a specific prescription drug or class of prescription drugs.
660          [(66)] (68) "Fidelity insurance" means insurance guaranteeing the fidelity of a person
661     holding a position of public or private trust.
662          [(67)] (69) (a) "Filed" means that a filing is:
663          (i) submitted to the department as required by and in accordance with applicable
664     statute, rule, or filing order;
665          (ii) received by the department within the time period provided in applicable statute,
666     rule, or filing order; and
667          (iii) accompanied by the appropriate fee in accordance with:
668          (A) Section 31A-3-103; or
669          (B) rule.
670          (b) "Filed" does not include a filing that is rejected by the department because it is not
671     submitted in accordance with Subsection [(67)(a).] (69)(a).
672          [(68)] (70) "Filing," when used as a noun, means an item required to be filed with the
673     department including:
674          (a) a policy;
675          (b) a rate;
676          (c) a form;

677          (d) a document;
678          (e) a plan;
679          (f) a manual;
680          (g) an application;
681          (h) a report;
682          (i) a certificate;
683          (j) an endorsement;
684          (k) an actuarial certification;
685          (l) a licensee annual statement;
686          (m) a licensee renewal application;
687          (n) an advertisement;
688          (o) a binder; or
689          (p) an outline of coverage.
690          [(69)] (71) "First party insurance" means an insurance policy or contract in which the
691     insurer agrees to pay a claim submitted to it by the insured for the insured's losses.
692          [(70)] (72) (a) "Fixed indemnity insurance" means accident and health insurance
693     written to provide a fixed amount for a specified event relating to or resulting from an illness or
694     injury.
695          (b) "Fixed indemnity insurance" includes hospital confinement indemnity insurance.
696          [(71)] (73) "Foreign insurer" means an insurer domiciled outside of this state, including
697     an alien insurer.
698          [(72)] (74) (a) "Form" means one of the following prepared for general use:
699          (i) a policy;
700          (ii) a certificate;
701          (iii) an application;
702          (iv) an outline of coverage; or
703          (v) an endorsement.
704          (b) "Form" does not include a document specially prepared for use in an individual
705     case.
706          [(73)] (75) "Franchise insurance" means an individual insurance policy provided
707     through a mass marketing arrangement involving a defined class of persons related in some

708     way other than through the purchase of insurance.
709          [(74)] (76) "General lines of authority" include:
710          (a) the general lines of insurance in Subsection [(75);] (77);
711          (b) title insurance under one of the following sublines of authority:
712          (i) title examination, including authority to act as a title marketing representative;
713          (ii) escrow, including authority to act as a title marketing representative; and
714          (iii) title marketing representative only;
715          (c) surplus lines;
716          (d) workers' compensation; and
717          (e) another line of insurance that the commissioner considers necessary to recognize in
718     the public interest.
719          [(75)] (77) "General lines of insurance" include:
720          (a) accident and health;
721          (b) casualty;
722          (c) life;
723          (d) personal lines;
724          (e) property; and
725          (f) variable contracts, including variable life and annuity.
726          [(76)] (78) "Group health plan" means an employee welfare benefit plan to the extent
727     that the plan provides medical care:
728          (a) (i) to an employee; or
729          (ii) to a dependent of an employee; and
730          (b) (i) directly;
731          (ii) through insurance reimbursement; or
732          (iii) through another method.
733          [(77)] (79) (a) "Group insurance policy" means a policy covering a group of persons
734     that is issued:
735          (i) to a policyholder on behalf of the group; and
736          (ii) for the benefit of a member of the group who is selected under a procedure defined
737     in:
738          (A) the policy; or

739          (B) an agreement that is collateral to the policy.
740          (b) A group insurance policy may include a member of the policyholder's family or a
741     dependent.
742          [(78)] (80) "Group-wide supervisor" means the commissioner or other regulatory
743     official designated as the group-wide supervisor for an internationally active insurance group
744     under Section 31A-16-108.6.
745          [(79)] (81) "Guaranteed automobile protection insurance" means insurance offered in
746     connection with an extension of credit that pays the difference in amount between the
747     insurance settlement and the balance of the loan if the insured automobile is a total loss.
748          [(80)] (82) (a) "Health benefit plan" means a policy, contract, certificate, or agreement
749     offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the
750     costs of health care, including major medical expense coverage.
751          (b) "Health benefit plan" does not include:
752          (i) coverage only for accident or disability income insurance, or any combination
753     thereof;
754          (ii) coverage issued as a supplement to liability insurance;
755          (iii) liability insurance, including general liability insurance and automobile liability
756     insurance;
757          (iv) workers' compensation or similar insurance;
758          (v) automobile medical payment insurance;
759          (vi) credit-only insurance;
760          (vii) coverage for on-site medical clinics;
761          (viii) other similar insurance coverage, specified in federal regulations issued pursuant
762     to Pub. L. No. 104-191, under which benefits for health care services are secondary or
763     incidental to other insurance benefits;
764          (ix) the following benefits if they are provided under a separate policy, certificate, or
765     contract of insurance or are otherwise not an integral part of the plan:
766          (A) limited scope dental or vision benefits;
767          (B) benefits for long-term care, nursing home care, home health care,
768     community-based care, or any combination thereof; or
769          (C) other similar limited benefits, specified in federal regulations issued pursuant to

770     Pub. L. No. 104-191;
771          (x) the following benefits if the benefits are provided under a separate policy,
772     certificate, or contract of insurance, there is no coordination between the provision of benefits
773     and any exclusion of benefits under any health plan, and the benefits are paid with respect to an
774     event without regard to whether benefits are provided under any health plan:
775          (A) coverage only for specified disease or illness; or
776          (B) fixed indemnity insurance;
777          (xi) the following if offered as a separate policy, certificate, or contract of insurance:
778          (A) Medicare [supplemental health insurance as defined under the Social Security Act,
779     42 U.S.C. Sec. 1395ss(g)(1);] supplement insurance;
780          (B) coverage supplemental to the coverage provided under United States Code,
781     Title 10, Chapter 55, Civilian Health and Medical Program of the Uniformed Services
782     (CHAMPUS); or
783          (C) similar supplemental coverage provided to coverage under a group health insurance
784     plan;
785          (xii) short-term limited duration health insurance; and
786          (xiii) student health insurance, except as required under 45 C.F.R. Sec. 147.145.
787          [(81)] (83) "Health care" means any of the following intended for use in the diagnosis,
788     treatment, mitigation, or prevention of a human ailment or impairment:
789          (a) a professional service;
790          (b) a personal service;
791          (c) a facility;
792          (d) equipment;
793          (e) a device;
794          (f) supplies; or
795          (g) medicine.
796          [(82)] (84) (a) "Health care insurance" or "health insurance" means insurance
797     providing:
798          (i) a health care benefit; or
799          (ii) payment of an incurred health care expense.
800          (b) "Health care insurance" or "health insurance" does not include accident and health

801     insurance providing a benefit for:
802          (i) replacement of income;
803          (ii) short-term accident;
804          (iii) fixed indemnity;
805          (iv) credit accident and health;
806          (v) supplements to liability;
807          (vi) workers' compensation;
808          (vii) automobile medical payment;
809          (viii) no-fault automobile;
810          (ix) equivalent self-insurance; or
811          (x) a type of accident and health insurance coverage that is a part of or attached to
812     another type of policy.
813          [(83)] (85) "Health care provider" means the same as that term is defined in Section
814     78B-3-403.
815          (86) "Health care sharing ministry" means an entity that:
816          (a) is a tax-exempt nonprofit entity under the Internal Revenue Code;
817          (b) limits participants to those who are of a similar faith;
818          (c) facilitates the sharing of a participant's qualified expenses, as defined by the entity,
819     among other participants by:
820          (i) matching a participant who has qualified expenses with one or more participants
821     who are able to contribute to paying for the qualified expenses; and
822          (ii) arranging, directly or indirectly, for each contributing participant's contribution to
823     be used to pay for the qualified expenses;
824          (d) requires an individual to make one or more minimum payments or contributions as
825     a condition of one or more of the following:
826          (i) becoming a participant;
827          (ii) remaining a participant; or
828          (iii) receiving a contribution to pay qualified expenses; and
829          (e) in carrying out the functions described in this Subsection (86), makes no
830     assumption of risk or promise to pay any qualified expenses.
831          [(84)] (87) "Health insurance exchange" means an exchange as defined in 45 C.F.R.

832     Sec. 155.20.
833          [(85)] (88) "Health Insurance Portability and Accountability Act" means the Health
834     Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as
835     amended.
836          [(86)] (89) "Income replacement insurance" or "disability income insurance" means
837     insurance written to provide payments to replace income lost from accident or sickness.
838          [(87)] (90) "Indemnity" means the payment of an amount to offset all or part of an
839     insured loss.
840          [(88)] (91) "Independent adjuster" means an insurance adjuster required to be licensed
841     under Section 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
842          [(89)] (92) "Independently procured insurance" means insurance procured under
843     Section 31A-15-104.
844          [(90)] (93) "Individual" means a natural person.
845          [(91)] (94) "Inland marine insurance" includes insurance covering:
846          (a) property in transit on or over land;
847          (b) property in transit over water by means other than boat or ship;
848          (c) bailee liability;
849          (d) fixed transportation property such as bridges, electric transmission systems, radio
850     and television transmission towers and tunnels; and
851          (e) personal and commercial property floaters.
852          [(92)] (95) "Insolvency" or "insolvent" means that:
853          (a) an insurer is unable to pay the insurer's obligations as the obligations are due;
854          (b) an insurer's total adjusted capital is less than the insurer's mandatory control level
855     RBC under Subsection 31A-17-601(8)(c); or
856          (c) an insurer's admitted assets are less than the insurer's liabilities.
857          [(93)] (96) (a) "Insurance" means:
858          (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more
859     persons to one or more other persons; or
860          (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a
861     group of persons that includes the person seeking to distribute that person's risk.
862          (b) "Insurance" includes:

863          (i) a risk distributing arrangement providing for compensation or replacement for
864     damages or loss through the provision of a service or a benefit in kind;
865          (ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a
866     business and not as merely incidental to a business transaction; and
867          (iii) a plan in which the risk does not rest upon the person who makes an arrangement,
868     but with a class of persons who have agreed to share the risk.
869          [(94)] (97) "Insurance adjuster" means a person who directs or conducts the
870     investigation, negotiation, or settlement of a claim under an insurance policy other than life
871     insurance or an annuity, on behalf of an insurer, policyholder, or a claimant under an insurance
872     policy.
873          [(95)] (98) "Insurance business" or "business of insurance" includes:
874          (a) providing health care insurance by an organization that is or is required to be
875     licensed under this title;
876          (b) providing a benefit to an employee in the event of a contingency not within the
877     control of the employee, in which the employee is entitled to the benefit as a right, which
878     benefit may be provided either:
879          (i) by a single employer or by multiple employer groups; or
880          (ii) through one or more trusts, associations, or other entities;
881          (c) providing an annuity:
882          (i) including an annuity issued in return for a gift; and
883          (ii) except an annuity provided by a person specified in Subsections 31A-22-1305(2)
884     and (3);
885          (d) providing the characteristic services of a motor club;
886          (e) providing another person with insurance;
887          (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor,
888     or surety, a contract or policy offering title insurance;
889          (g) transacting or proposing to transact any phase of title insurance, including:
890          (i) solicitation;
891          (ii) negotiation preliminary to execution;
892          (iii) execution of a contract of title insurance;
893          (iv) insuring; and

894          (v) transacting matters subsequent to the execution of the contract and arising out of
895     the contract, including reinsurance;
896          (h) transacting or proposing a life settlement; and
897          (i) doing, or proposing to do, any business in substance equivalent to Subsections
898     [(95)(a)] (98)(a) through (h) in a manner designed to evade this title.
899          [(96)] (99) "Insurance consultant" or "consultant" means a person who:
900          (a) advises another person about insurance needs and coverages;
901          (b) is compensated by the person advised on a basis not directly related to the insurance
902     placed; and
903          (c) except as provided in Section 31A-23a-501, is not compensated directly or
904     indirectly by an insurer or producer for advice given.
905          [(97)] (100) "Insurance group" means the persons that comprise an insurance holding
906     company system.
907          [(98)] (101) "Insurance holding company system" means a group of two or more
908     affiliated persons, at least one of whom is an insurer.
909          [(99)] (102) (a) "Insurance producer" or "producer" means a person licensed or
910     required to be licensed under the laws of this state to sell, solicit, or negotiate insurance.
911          (b) (i) "Producer for the insurer" means a producer who is compensated directly or
912     indirectly by an insurer for selling, soliciting, or negotiating an insurance product of that
913     insurer.
914          (ii) "Producer for the insurer" may be referred to as an "agent."
915          (c) (i) "Producer for the insured" means a producer who:
916          (A) is compensated directly and only by an insurance customer or an insured; and
917          (B) receives no compensation directly or indirectly from an insurer for selling,
918     soliciting, or negotiating an insurance product of that insurer to an insurance customer or
919     insured.
920          (ii) "Producer for the insured" may be referred to as a "broker."
921          [(100)] (103) (a) "Insured" means a person to whom or for whose benefit an insurer
922     makes a promise in an insurance policy and includes:
923          (i) a policyholder;
924          (ii) a subscriber;

925          (iii) a member; and
926          (iv) a beneficiary.
927          (b) The definition in Subsection [(100)(a):] (103)(a):
928          (i) applies only to this title;
929          (ii) does not define the meaning of "insured" as used in an insurance policy or
930     certificate; and
931          (iii) includes an enrollee.
932          [(101)] (104) (a) "Insurer," "carrier," "insurance carrier," or "insurance company"
933     means a person doing an insurance business as a principal including:
934          (i) a fraternal benefit society;
935          (ii) an issuer of a gift annuity other than an annuity specified in Subsections
936     31A-22-1305(2) and (3);
937          (iii) a motor club;
938          (iv) an employee welfare plan;
939          (v) a person purporting or intending to do an insurance business as a principal on that
940     person's own account; and
941          (vi) a health maintenance organization.
942          (b) "Insurer," "carrier," "insurance carrier," or "insurance company" does not include a
943     governmental entity.
944          [(102)] (105) "Interinsurance exchange" means the same as that term is defined in
945     Subsection [(163).] (168).
946          [(103)] (106) "Internationally active insurance group" means an insurance holding
947     company system:
948          (a) that includes an insurer registered under Section 31A-16-105;
949          (b) that has premiums written in at least three countries;
950          (c) whose percentage of gross premiums written outside the United States is at least
951     10% of its total gross written premiums; and
952          (d) that, based on a three-year rolling average, has:
953          (i) total assets of at least $50,000,000,000; or
954          (ii) total gross written premiums of at least $10,000,000,000.
955          [(104)] (107) "Involuntary unemployment insurance" means insurance:

956          (a) offered in connection with an extension of credit; and
957          (b) that provides indemnity if the debtor is involuntarily unemployed for payments
958     coming due on a:
959          (i) specific loan; or
960          (ii) credit transaction.
961          [(105)] (108) "Large employer," in connection with a health benefit plan, means an
962     employer who, with respect to a calendar year and to a plan year:
963          (a) employed an average of at least 51 employees on business days during the
964     preceding calendar year; and
965          (b) employs at least one employee on the first day of the plan year.
966          [(106)] (109) "Late enrollee," with respect to an employer health benefit plan, means
967     an individual whose enrollment is a late enrollment.
968          [(107)] (110) "Late enrollment," with respect to an employer health benefit plan, means
969     enrollment of an individual other than:
970          (a) on the earliest date on which coverage can become effective for the individual
971     under the terms of the plan; or
972          (b) through special enrollment.
973          [(108)] (111) (a) Except for a retainer contract or legal assistance described in Section
974     31A-1-103, "legal expense insurance" means insurance written to indemnify or pay for a
975     specified legal expense.
976          (b) "Legal expense insurance" includes an arrangement that creates a reasonable
977     expectation of an enforceable right.
978          (c) "Legal expense insurance" does not include the provision of, or reimbursement for,
979     legal services incidental to other insurance coverage.
980          [(109)] (112) (a) "Liability insurance" means insurance against liability:
981          (i) for death, injury, or disability of a human being, or for damage to property,
982     exclusive of the coverages under:
983          (A) medical malpractice insurance;
984          (B) professional liability insurance; and
985          (C) workers' compensation insurance;
986          (ii) for a medical, hospital, surgical, and funeral benefit to a person other than the

987     insured who is injured, irrespective of legal liability of the insured, when issued with or
988     supplemental to insurance against legal liability for the death, injury, or disability of a human
989     being, exclusive of the coverages under:
990          (A) medical malpractice insurance;
991          (B) professional liability insurance; and
992          (C) workers' compensation insurance;
993          (iii) for loss or damage to property resulting from an accident to or explosion of a
994     boiler, pipe, pressure container, machinery, or apparatus;
995          (iv) for loss or damage to property caused by:
996          (A) the breakage or leakage of a sprinkler, water pipe, or water container; or
997          (B) water entering through a leak or opening in a building; or
998          (v) for other loss or damage properly the subject of insurance not within another kind
999     of insurance as defined in this chapter, if the insurance is not contrary to law or public policy.
1000          (b) "Liability insurance" includes:
1001          (i) vehicle liability insurance;
1002          (ii) residential dwelling liability insurance; and
1003          (iii) making inspection of, and issuing a certificate of inspection upon, an elevator,
1004     boiler, machinery, or apparatus of any kind when done in connection with insurance on the
1005     elevator, boiler, machinery, or apparatus.
1006          [(110)] (113) (a) "License" means authorization issued by the commissioner to engage
1007     in an activity that is part of or related to the insurance business.
1008          (b) "License" includes a certificate of authority issued to an insurer.
1009          [(111)] (114) (a) "Life insurance" means:
1010          (i) insurance on a human life; and
1011          (ii) insurance pertaining to or connected with human life.
1012          (b) The business of life insurance includes:
1013          (i) granting a death benefit;
1014          (ii) granting an annuity benefit;
1015          (iii) granting an endowment benefit;
1016          (iv) granting an additional benefit in the event of death by accident;
1017          (v) granting an additional benefit to safeguard the policy against lapse; and

1018          (vi) providing an optional method of settlement of proceeds.
1019          [(112)] (115) "Limited license" means a license that:
1020          (a) is issued for a specific product of insurance; and
1021          (b) limits an individual or agency to transact only for that product or insurance.
1022          [(113)] (116) "Limited line credit insurance" includes the following forms of
1023     insurance:
1024          (a) credit life;
1025          (b) credit accident and health;
1026          (c) credit property;
1027          (d) credit unemployment;
1028          (e) involuntary unemployment;
1029          (f) mortgage life;
1030          (g) mortgage guaranty;
1031          (h) mortgage accident and health;
1032          (i) guaranteed automobile protection; and
1033          (j) another form of insurance offered in connection with an extension of credit that:
1034          (i) is limited to partially or wholly extinguishing the credit obligation; and
1035          (ii) the commissioner determines by rule should be designated as a form of limited line
1036     credit insurance.
1037          [(114)] (117) "Limited line credit insurance producer" means a person who sells,
1038     solicits, or negotiates one or more forms of limited line credit insurance coverage to an
1039     individual through a master, corporate, group, or individual policy.
1040          [(115)] (118) "Limited line insurance" includes:
1041          (a) bail bond;
1042          (b) limited line credit insurance;
1043          (c) legal expense insurance;
1044          (d) motor club insurance;
1045          (e) car rental related insurance;
1046          (f) travel insurance;
1047          (g) crop insurance;
1048          (h) self-service storage insurance;

1049          (i) guaranteed asset protection waiver;
1050          (j) portable electronics insurance; and
1051          (k) another form of limited insurance that the commissioner determines by rule should
1052     be designated a form of limited line insurance.
1053          [(116)] (119) "Limited lines authority" includes the lines of insurance listed in
1054     Subsection [(115).] (118).
1055          [(117)] (120) "Limited lines producer" means a person who sells, solicits, or negotiates
1056     limited lines insurance.
1057          [(118)] (121) (a) "Long-term care insurance" means an insurance policy or rider
1058     advertised, marketed, offered, or designated to provide coverage:
1059          (i) in a setting other than an acute care unit of a hospital;
1060          (ii) for not less than 12 consecutive months for a covered person on the basis of:
1061          (A) expenses incurred;
1062          (B) indemnity;
1063          (C) prepayment; or
1064          (D) another method;
1065          (iii) for one or more necessary or medically necessary services that are:
1066          (A) diagnostic;
1067          (B) preventative;
1068          (C) therapeutic;
1069          (D) rehabilitative;
1070          (E) maintenance; or
1071          (F) personal care; and
1072          (iv) that may be issued by:
1073          (A) an insurer;
1074          (B) a fraternal benefit society;
1075          (C) (I) a nonprofit health hospital; and
1076          (II) a medical service corporation;
1077          (D) a prepaid health plan;
1078          (E) a health maintenance organization; or
1079          (F) an entity similar to the entities described in Subsections [(118)(a)(iv)(A)]

1080     (121)(a)(iv)(A) through (E) to the extent that the entity is otherwise authorized to issue life or
1081     health care insurance.
1082          (b) "Long-term care insurance" includes:
1083          (i) any of the following that provide directly or supplement long-term care insurance:
1084          (A) a group or individual annuity or rider; or
1085          (B) a life insurance policy or rider;
1086          (ii) a policy or rider that provides for payment of benefits on the basis of:
1087          (A) cognitive impairment; or
1088          (B) functional capacity; or
1089          (iii) a qualified long-term care insurance contract.
1090          (c) "Long-term care insurance" does not include:
1091          (i) a policy that is offered primarily to provide basic Medicare supplement [coverage]
1092     insurance;
1093          (ii) basic hospital expense coverage;
1094          (iii) basic medical/surgical expense coverage;
1095          (iv) hospital confinement indemnity coverage;
1096          (v) major medical expense coverage;
1097          (vi) income replacement or related asset-protection coverage;
1098          (vii) accident only coverage;
1099          (viii) coverage for a specified:
1100          (A) disease; or
1101          (B) accident;
1102          (ix) limited benefit health coverage;
1103          (x) a life insurance policy that accelerates the death benefit to provide the option of a
1104     lump sum payment:
1105          (A) if the following are not conditioned on the receipt of long-term care:
1106          (I) benefits; or
1107          (II) eligibility; and
1108          (B) the coverage is for one or more the following qualifying events:
1109          (I) terminal illness;
1110          (II) medical conditions requiring extraordinary medical intervention; or

1111          (III) permanent institutional confinement; or
1112          (xi) limited long-term care as defined in Section 31A-22-2002.
1113          [(119)] (122) "Managed care organization" means a person:
1114          (a) licensed as a health maintenance organization under Chapter 8, Health Maintenance
1115     Organizations and Limited Health Plans; or
1116          (b) (i) licensed under:
1117          (A) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
1118          (B) Chapter 7, Nonprofit Health Service Insurance Corporations; or
1119          (C) Chapter 14, Foreign Insurers; and
1120          (ii) that requires an enrollee to use, or offers incentives, including financial incentives,
1121     for an enrollee to use, network providers.
1122          [(120)] (123) "Medical malpractice insurance" means insurance against legal liability
1123     incident to the practice and provision of a medical service other than the practice and provision
1124     of a dental service.
1125          (124) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the
1126     federal Social Security Act, as then constituted or later amended.
1127          (125) (a) "Medicare supplement insurance" means health insurance coverage that is
1128     advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare
1129     for the hospital, medical, or surgical expenses of individuals eligible for Medicare.
1130          (b) "Medicare supplement insurance" does not include:
1131          (i) a policy issued pursuant to a contract under Section 1876 of the federal Social
1132     Security Act;
1133          (ii) a policy issued under a demonstration project specified in 42 U.S.C. Sec.
1134     1395ss(g)(1);
1135          (iii) a Medicare Advantage plan established under Medicare Part C;
1136          (iv) an outpatient prescription drug plan established under Medicare Part D; or
1137          (v) any health care prepayment plan that provides benefits pursuant to an agreement
1138     under Section 1833(a)(1)(A) of the Social Security Act.
1139          [(121)] (126) "Member" means a person having membership rights in an insurance
1140     corporation.
1141          [(122)] (127) "Minimum capital" or "minimum required capital" means the capital that

1142     must be constantly maintained by a stock insurance corporation as required by statute.
1143          [(123)] (128) "Mortgage accident and health insurance" means insurance offered in
1144     connection with an extension of credit that provides indemnity for payments coming due on a
1145     mortgage while the debtor has a disability.
1146          [(124)] (129) "Mortgage guaranty insurance" means surety insurance under which a
1147     mortgagee or other creditor is indemnified against losses caused by the default of a debtor.
1148          [(125)] (130) "Mortgage life insurance" means insurance on the life of a debtor in
1149     connection with an extension of credit that pays if the debtor dies.
1150          [(126)] (131) "Motor club" means a person:
1151          (a) licensed under:
1152          (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
1153          (ii) Chapter 11, Motor Clubs; or
1154          (iii) Chapter 14, Foreign Insurers; and
1155          (b) that promises for an advance consideration to provide for a stated period of time
1156     one or more:
1157          (i) legal services under Subsection 31A-11-102(1)(b);
1158          (ii) bail services under Subsection 31A-11-102(1)(c); or
1159          (iii) (A) trip reimbursement;
1160          (B) towing services;
1161          (C) emergency road services;
1162          (D) stolen automobile services;
1163          (E) a combination of the services listed in Subsections [(126)(b)(iii)(A)]
1164     (131)(b)(iii)(A) through (D); or
1165          (F) other services given in Subsections 31A-11-102(1)(b) through (f).
1166          [(127)] (132) "Mutual" means a mutual insurance corporation.
1167          [(128)] (133) "NAIC" means the National Association of Insurance Commissioners.
1168          [(129)] (134) "NAIC liquidity stress test framework" means a NAIC publication that
1169     includes:
1170          (a) a history of the NAIC's development of regulatory liquidity stress testing;
1171          (b) the scope criteria applicable for a specific data year; and
1172          (c) the liquidity stress test instructions and reporting templates for a specific data year,

1173     as adopted by the NAIC and as amended by the NAIC in accordance with NAIC procedures.
1174          [(130)] (135) "Network plan" means health care insurance:
1175          (a) that is issued by an insurer; and
1176          (b) under which the financing and delivery of medical care is provided, in whole or in
1177     part, through a defined set of providers under contract with the insurer, including the financing
1178     and delivery of an item paid for as medical care.
1179          [(131)] (136) "Network provider" means a health care provider who has an agreement
1180     with a managed care organization to provide health care services to an enrollee with an
1181     expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly
1182     from the managed care organization.
1183          [(132)] (137) "Nonparticipating" means a plan of insurance under which the insured is
1184     not entitled to receive a dividend representing a share of the surplus of the insurer.
1185          [(133)] (138) "Ocean marine insurance" means insurance against loss of or damage to:
1186          (a) ships or hulls of ships;
1187          (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money,
1188     securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia
1189     interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
1190          (c) earnings such as freight, passage money, commissions, or profits derived from
1191     transporting goods or people upon or across the oceans or inland waterways; or
1192          (d) a vessel owner or operator as a result of liability to employees, passengers, bailors,
1193     owners of other vessels, owners of fixed objects, customs or other authorities, or other persons
1194     in connection with maritime activity.
1195          [(134)] (139) "Order" means an order of the commissioner.
1196          [(135)] (140) "ORSA guidance manual" means the current version of the Own Risk
1197     and Solvency Assessment Guidance Manual developed and adopted by the National
1198     Association of Insurance Commissioners and as amended from time to time.
1199          [(136)] (141) "ORSA summary report" means a confidential high-level summary of an
1200     insurer or insurance group's own risk and solvency assessment.
1201          [(137)] (142) "Outline of coverage" means a summary that explains an accident and
1202     health insurance policy.
1203          [(138)] (143) "Own risk and solvency assessment" means an insurer or insurance

1204     group's confidential internal assessment:
1205          (a) (i) of each material and relevant risk associated with the insurer or insurance group;
1206          (ii) of the insurer or insurance group's current business plan to support each risk
1207     described in Subsection [(138)(a)(i);] (143)(a)(i); and
1208          (iii) of the sufficiency of capital resources to support each risk described in Subsection
1209     [(138)(a)(i);] (143)(a)(i); and
1210          (b) that is appropriate to the nature, scale, and complexity of an insurer or insurance
1211     group.
1212          [(139)] (144) "Participating" means a plan of insurance under which the insured is
1213     entitled to receive a dividend representing a share of the surplus of the insurer.
1214          [(140)] (145) "Participation," as used in a health benefit plan, means a requirement
1215     relating to the minimum percentage of eligible employees that must be enrolled in relation to
1216     the total number of eligible employees of an employer reduced by each eligible employee who
1217     voluntarily declines coverage under the plan because the employee:
1218          (a) has other group health care insurance coverage; or
1219          (b) receives:
1220          (i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the Social
1221     Security Amendments of 1965; or
1222          (ii) another government health benefit.
1223          [(141)] (146) "Person" includes:
1224          (a) an individual;
1225          (b) a partnership;
1226          (c) a corporation;
1227          (d) an incorporated or unincorporated association;
1228          (e) a joint stock company;
1229          (f) a trust;
1230          (g) a limited liability company;
1231          (h) a reciprocal;
1232          (i) a syndicate; or
1233          (j) another similar entity or combination of entities acting in concert.
1234          [(142)] (147) "Personal lines insurance" means property and casualty insurance

1235     coverage sold for primarily noncommercial purposes to:
1236          (a) an individual; or
1237          (b) a family.
1238          [(143)] (148) "Plan sponsor" means the same as that term is defined in 29 U.S.C. Sec.
1239     1002(16)(B).
1240          [(144)] (149) "Plan year" means:
1241          (a) the year that is designated as the plan year in:
1242          (i) the plan document of a group health plan; or
1243          (ii) a summary plan description of a group health plan;
1244          (b) if the plan document or summary plan description does not designate a plan year or
1245     there is no plan document or summary plan description:
1246          (i) the year used to determine deductibles or limits;
1247          (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis;
1248     or
1249          (iii) the employer's taxable year if:
1250          (A) the plan does not impose deductibles or limits on a yearly basis; and
1251          (B) (I) the plan is not insured; or
1252          (II) the insurance policy is not renewed on an annual basis; or
1253          (c) in a case not described in Subsection [(144)(a)] (149)(a) or (b), the calendar year.
1254          [(145)] (150) (a) "Policy" means a document, including an attached endorsement or
1255     application that:
1256          (i) purports to be an enforceable contract; and
1257          (ii) memorializes in writing some or all of the terms of an insurance contract.
1258          (b) "Policy" includes a service contract issued by:
1259          (i) a motor club under Chapter 11, Motor Clubs;
1260          (ii) a service contract provided under Chapter 6a, Service Contracts; and
1261          (iii) a corporation licensed under:
1262          (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
1263          (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
1264          (c) "Policy" does not include:
1265          (i) a certificate under a group insurance contract; or

1266          (ii) a document that does not purport to have legal effect.
1267          [(146)] (151) "Policyholder" means a person who controls a policy, binder, or oral
1268     contract by ownership, premium payment, or otherwise.
1269          [(147)] (152) "Policy illustration" means a presentation or depiction that includes
1270     nonguaranteed elements of a policy offering life insurance over a period of years.
1271          [(148)] (153) "Policy summary" means a synopsis describing the elements of a life
1272     insurance policy.
1273          [(149)] (154) "PPACA" means the Patient Protection and Affordable Care Act, Pub. L.
1274     No. 111-148 and the Health Care Education Reconciliation Act of 2010, Pub. L. No. 111-152,
1275     and related federal regulations and guidance.
1276          [(150)] (155) "Preexisting condition," with respect to health care insurance:
1277          (a) means a condition that was present before the effective date of coverage, whether or
1278     not medical advice, diagnosis, care, or treatment was recommended or received before that day;
1279     and
1280          (b) does not include a condition indicated by genetic information unless an actual
1281     diagnosis of the condition by a physician has been made.
1282          [(151)] (156) (a) "Premium" means the monetary consideration for an insurance policy.
1283          (b) "Premium" includes, however designated:
1284          (i) an assessment;
1285          (ii) a membership fee;
1286          (iii) a required contribution; or
1287          (iv) monetary consideration.
1288          (c) (i) "Premium" does not include consideration paid to a third party administrator for
1289     the third party administrator's services.
1290          (ii) "Premium" includes an amount paid by a third party administrator to an insurer for
1291     insurance on the risks administered by the third party administrator.
1292          [(152)] (157) "Principal officers" for a corporation means the officers designated under
1293     Subsection 31A-5-203(3).
1294          [(153)] (158) "Proceeding" includes an action or special statutory proceeding.
1295          [(154)] (159) "Professional liability insurance" means insurance against legal liability
1296     incident to the practice of a profession and provision of a professional service.

1297          [(155)] (160) (a) "Property insurance" means insurance against loss or damage to real
1298     or personal property of every kind and any interest in that property:
1299          (i) from all hazards or causes; and
1300          (ii) against loss consequential upon the loss or damage including vehicle
1301     comprehensive and vehicle physical damage coverages.
1302          (b) "Property insurance" does not include:
1303          (i) inland marine insurance; and
1304          (ii) ocean marine insurance.
1305          [(156)] (161) "Qualified long-term care insurance contract" or "federally tax qualified
1306     long-term care insurance contract" means:
1307          (a) an individual or group insurance contract that meets the requirements of Section
1308     7702B(b), Internal Revenue Code; or
1309          (b) the portion of a life insurance contract that provides long-term care insurance:
1310          (i) (A) by rider; or
1311          (B) as a part of the contract; and
1312          (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue
1313     Code.
1314          [(157)] (162) "Qualified United States financial institution" means an institution that:
1315          (a) is:
1316          (i) organized under the laws of the United States or any state; or
1317          (ii) in the case of a United States office of a foreign banking organization, licensed
1318     under the laws of the United States or any state;
1319          (b) is regulated, supervised, and examined by a United States federal or state authority
1320     having regulatory authority over a bank or trust company; and
1321          (c) meets the standards of financial condition and standing that are considered
1322     necessary and appropriate to regulate the quality of a financial institution whose letters of credit
1323     will be acceptable to the commissioner as determined by:
1324          (i) the commissioner by rule; or
1325          (ii) the Securities Valuation Office of the National Association of Insurance
1326     Commissioners.
1327          [(158)] (163) (a) "Rate" means:

1328          (i) the cost of a given unit of insurance; or
1329          (ii) for property or casualty insurance, that cost of insurance per exposure unit either
1330     expressed as:
1331          (A) a single number; or
1332          (B) a pure premium rate, adjusted before the application of individual risk variations
1333     based on loss or expense considerations to account for the treatment of:
1334          (I) expenses;
1335          (II) profit; and
1336          (III) individual insurer variation in loss experience.
1337          (b) "Rate" does not include a minimum premium.
1338          [(159)] (164) (a) "Rate service organization" means a person who assists an insurer in
1339     rate making or filing by:
1340          (i) collecting, compiling, and furnishing loss or expense statistics;
1341          (ii) recommending, making, or filing rates or supplementary rate information; or
1342          (iii) advising about rate questions, except as an attorney giving legal advice.
1343          (b) "Rate service organization" does not include:
1344          (i) an employee of an insurer;
1345          (ii) a single insurer or group of insurers under common control;
1346          (iii) a joint underwriting group; or
1347          (iv) an individual serving as an actuarial or legal consultant.
1348          [(160)] (165) "Rating manual" means any of the following used to determine initial and
1349     renewal policy premiums:
1350          (a) a manual of rates;
1351          (b) a classification;
1352          (c) a rate-related underwriting rule; and
1353          (d) a rating formula that describes steps, policies, and procedures for determining
1354     initial and renewal policy premiums.
1355          [(161)] (166) (a) "Rebate" means a licensee paying, allowing, giving, or offering to
1356     pay, allow, or give, directly or indirectly:
1357          (i) a refund of premium or portion of premium;
1358          (ii) a refund of commission or portion of commission;

1359          (iii) a refund of all or a portion of a consultant fee; or
1360          (iv) providing services or other benefits not specified in an insurance or annuity
1361     contract.
1362          (b) "Rebate" does not include:
1363          (i) a refund due to termination or changes in coverage;
1364          (ii) a refund due to overcharges made in error by the licensee; or
1365          (iii) savings or wellness benefits as provided in the contract by the licensee.
1366          [(162)] (167) "Received by the department" means:
1367          (a) the date delivered to and stamped received by the department, if delivered in
1368     person;
1369          (b) the post mark date, if delivered by mail;
1370          (c) the delivery service's post mark or pickup date, if delivered by a delivery service;
1371          (d) the received date recorded on an item delivered, if delivered by:
1372          (i) facsimile;
1373          (ii) email; or
1374          (iii) another electronic method; or
1375          (e) a date specified in:
1376          (i) a statute;
1377          (ii) a rule; or
1378          (iii) an order.
1379          [(163)] (168) "Reciprocal" or "interinsurance exchange" means an unincorporated
1380     association of persons:
1381          (a) operating through an attorney-in-fact common to all of the persons; and
1382          (b) exchanging insurance contracts with one another that provide insurance coverage
1383     on each other.
1384          [(164)] (169) "Reinsurance" means an insurance transaction where an insurer, for
1385     consideration, transfers any portion of the risk it has assumed to another insurer. In referring to
1386     reinsurance transactions, this title sometimes refers to:
1387          (a) the insurer transferring the risk as the "ceding insurer"; and
1388          (b) the insurer assuming the risk as the:
1389          (i) "assuming insurer"; or

1390          (ii) "assuming reinsurer."
1391          [(165)] (170) "Reinsurer" means a person licensed in this state as an insurer with the
1392     authority to assume reinsurance.
1393          [(166)] (171) "Residential dwelling liability insurance" means insurance against
1394     liability resulting from or incident to the ownership, maintenance, or use of a residential
1395     dwelling that is a detached single family residence or multifamily residence up to four units.
1396          [(167)] (172) (a) "Retrocession" means reinsurance with another insurer of a liability
1397     assumed under a reinsurance contract.
1398          (b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of a
1399     liability assumed under a reinsurance contract.
1400          [(168)] (173) "Rider" means an endorsement to:
1401          (a) an insurance policy; or
1402          (b) an insurance certificate.
1403          [(169)] (174) "Scope criteria" means the designated exposure bases and minimum
1404     magnitudes for a specified data year that are used to establish a preliminary list of insurers
1405     considered scoped into the NAIC liquidity stress test framework for that data year.
1406          [(170)] (175) "Secondary medical condition" means a complication related to an
1407     exclusion from coverage in accident and health insurance.
1408          [(171)] (176) (a) "Security" means a:
1409          (i) note;
1410          (ii) stock;
1411          (iii) bond;
1412          (iv) debenture;
1413          (v) evidence of indebtedness;
1414          (vi) certificate of interest or participation in a profit-sharing agreement;
1415          (vii) collateral-trust certificate;
1416          (viii) preorganization certificate or subscription;
1417          (ix) transferable share;
1418          (x) investment contract;
1419          (xi) voting trust certificate;
1420          (xii) certificate of deposit for a security;

1421          (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in
1422     payments out of production under such a title or lease;
1423          (xiv) commodity contract or commodity option;
1424          (xv) certificate of interest or participation in, temporary or interim certificate for,
1425     receipt for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed
1426     in Subsections [(171)(a)(i)] (176)(a)(i) through (xiv); or
1427          (xvi) another interest or instrument commonly known as a security.
1428          (b) "Security" does not include:
1429          (i) any of the following under which an insurance company promises to pay money in a
1430     specific lump sum or periodically for life or some other specified period:
1431          (A) insurance;
1432          (B) an endowment policy; or
1433          (C) an annuity contract; or
1434          (ii) a burial certificate or burial contract.
1435          [(172)] (177) "Securityholder" means a specified person who owns a security of a
1436     person, including:
1437          (a) common stock;
1438          (b) preferred stock;
1439          (c) debt obligations; and
1440          (d) any other security convertible into or evidencing the right of any of the items listed
1441     in this Subsection [(172).] (177).
1442          [(173)] (178) (a) "Self-insurance" means an arrangement under which a person
1443     provides for spreading the person's own risks by a systematic plan.
1444          (b) "Self-insurance" includes:
1445          (i) an arrangement under which a governmental entity undertakes to indemnify an
1446     employee for liability arising out of the employee's employment; and
1447          (ii) an arrangement under which a person with a managed program of self-insurance
1448     and risk management undertakes to indemnify the person's affiliate, subsidiary, director,
1449     officer, or employee for liability or risk that arises out of the person's relationship with the
1450     affiliate, subsidiary, director, officer, or employee.
1451          (c) "Self-insurance" does not include:

1452          (i) an arrangement under which a number of persons spread their risks among
1453     themselves; or
1454          (ii) an arrangement with an independent contractor.
1455          [(174)] (179) "Sell" means to exchange a contract of insurance:
1456          (a) by any means;
1457          (b) for money or its equivalent; and
1458          (c) on behalf of an insurance company.
1459          [(175)] (180) "Short-term limited duration health insurance" means a health benefit
1460     product that:
1461          (a) after taking into account any renewals or extensions, has a total duration of no more
1462     than 36 months; and
1463          (b) has an expiration date specified in the contract that is less than 12 months after the
1464     original effective date of coverage under the health benefit product.
1465          [(176)] (181) "Significant break in coverage" means a period of 63 consecutive days
1466     during each of which an individual does not have creditable coverage.
1467          [(177)] (182) (a) "Small employer" means, in connection with a health benefit plan and
1468     with respect to a calendar year and to a plan year, an employer who:
1469          (i) (A) employed at least one but not more than 50 eligible employees on business days
1470     during the preceding calendar year; or
1471          (B) if the employer did not exist for the entirety of the preceding calendar year,
1472     reasonably expects to employ an average of at least one but not more than 50 eligible
1473     employees on business days during the current calendar year;
1474          (ii) employs at least one employee on the first day of the plan year; and
1475          (iii) for an employer who has common ownership with one or more other employers, is
1476     treated as a single employer under 26 U.S.C. Sec. 414(b), (c), (m), or (o).
1477          (b) "Small employer" does not include an owner or a sole proprietor that does not
1478     employ at least one employee.
1479          [(178)] (183) "Special enrollment period," in connection with a health benefit plan, has
1480     the same meaning as provided in federal regulations adopted pursuant to the Health Insurance
1481     Portability and Accountability Act.
1482          [(179)] (184) (a) "Subsidiary" of a person means an affiliate controlled by that person

1483     either directly or indirectly through one or more affiliates or intermediaries.
1484          (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting
1485     shares are owned by that person either alone or with its affiliates, except for the minimum
1486     number of shares the law of the subsidiary's domicile requires to be owned by directors or
1487     others.
1488          [(180)] (185) Subject to Subsection [(92)(b),] (95)(b), "surety insurance" includes:
1489          (a) a guarantee against loss or damage resulting from the failure of a principal to pay or
1490     perform the principal's obligations to a creditor or other obligee;
1491          (b) bail bond insurance; and
1492          (c) fidelity insurance.
1493          [(181)] (186) (a) "Surplus" means the excess of assets over the sum of paid-in capital
1494     and liabilities.
1495          (b) (i) "Permanent surplus" means the surplus of an insurer or organization that is
1496     designated by the insurer or organization as permanent.
1497          (ii) Sections 31A-5-211, 31A-7-201, 31A-8-209, 31A-9-209, and 31A-14-205 require
1498     that insurers or organizations doing business in this state maintain specified minimum levels of
1499     permanent surplus.
1500          (iii) Except for assessable mutuals, the minimum permanent surplus requirement is the
1501     same as the minimum required capital requirement that applies to stock insurers.
1502          (c) "Excess surplus" means:
1503          (i) for a life insurer, accident and health insurer, health organization, or property and
1504     casualty insurer as defined in Section 31A-17-601, the lesser of:
1505          (A) that amount of an insurer's or health organization's total adjusted capital that
1506     exceeds the product of:
1507          (I) 2.5; and
1508          (II) the sum of the insurer's or health organization's minimum capital or permanent
1509     surplus required under Section 31A-5-211, 31A-9-209, or 31A-14-205; or
1510          (B) that amount of an insurer's or health organization's total adjusted capital that
1511     exceeds the product of:
1512          (I) 3.0; and
1513          (II) the authorized control level RBC as defined in Subsection 31A-17-601(8)(a); and

1514          (ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurer
1515     that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
1516          (A) 1.5; and
1517          (B) the insurer's total adjusted capital required by Subsection 31A-17-609(1).
1518          [(182)] (187) "Third party administrator" or "administrator" means a person who
1519     collects charges or premiums from, or who, for consideration, adjusts or settles claims of
1520     residents of the state in connection with insurance coverage, annuities, or service insurance
1521     coverage, except:
1522          (a) a union on behalf of its members;
1523          (b) a person administering a:
1524          (i) pension plan subject to the federal Employee Retirement Income Security Act of
1525     1974;
1526          (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
1527          (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
1528          (c) an employer on behalf of the employer's employees or the employees of one or
1529     more of the subsidiary or affiliated corporations of the employer;
1530          (d) an insurer licensed under the following, but only for a line of insurance for which
1531     the insurer holds a license in this state:
1532          (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
1533          (ii) Chapter 7, Nonprofit Health Service Insurance Corporations;
1534          (iii) Chapter 8, Health Maintenance Organizations and Limited Health Plans;
1535          (iv) Chapter 9, Insurance Fraternals; or
1536          (v) Chapter 14, Foreign Insurers;
1537          (e) a person:
1538          (i) licensed or exempt from licensing under:
1539          (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
1540     Reinsurance Intermediaries; or
1541          (B) Chapter 26, Insurance Adjusters; and
1542          (ii) whose activities are limited to those authorized under the license the person holds
1543     or for which the person is exempt; or
1544          (f) an institution, bank, or financial institution:

1545          (i) that is:
1546          (A) an institution whose deposits and accounts are to any extent insured by a federal
1547     deposit insurance agency, including the Federal Deposit Insurance Corporation or National
1548     Credit Union Administration; or
1549          (B) a bank or other financial institution that is subject to supervision or examination by
1550     a federal or state banking authority; and
1551          (ii) that does not adjust claims without a third party administrator license.
1552          [(183)] (188) "Title insurance" means the insuring, guaranteeing, or indemnifying of an
1553     owner of real or personal property or the holder of liens or encumbrances on that property, or
1554     others interested in the property against loss or damage suffered by reason of liens or
1555     encumbrances upon, defects in, or the unmarketability of the title to the property, or invalidity
1556     or unenforceability of any liens or encumbrances on the property.
1557          [(184)] (189) "Total adjusted capital" means the sum of an insurer's or health
1558     organization's statutory capital and surplus as determined in accordance with:
1559          (a) the statutory accounting applicable to the annual financial statements required to be
1560     filed under Section 31A-4-113; and
1561          (b) another item provided by the RBC instructions, as RBC instructions is defined in
1562     Section 31A-17-601.
1563          [(185)] (190) (a) "Trustee" means "director" when referring to the board of directors of
1564     a corporation.
1565          (b) "Trustee," when used in reference to an employee welfare fund, means an
1566     individual, firm, association, organization, joint stock company, or corporation, whether acting
1567     individually or jointly and whether designated by that name or any other, that is charged with
1568     or has the overall management of an employee welfare fund.
1569          [(186)] (191) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted
1570     insurer" means an insurer:
1571          (i) not holding a valid certificate of authority to do an insurance business in this state;
1572     or
1573          (ii) transacting business not authorized by a valid certificate.
1574          (b) "Admitted insurer" or "authorized insurer" means an insurer:
1575          (i) holding a valid certificate of authority to do an insurance business in this state; and

1576          (ii) transacting business as authorized by a valid certificate.
1577          [(187)] (192) "Underwrite" means the authority to accept or reject risk on behalf of the
1578     insurer.
1579          [(188)] (193) "Vehicle liability insurance" means insurance against liability resulting
1580     from or incident to ownership, maintenance, or use of a land vehicle or aircraft, exclusive of a
1581     vehicle comprehensive or vehicle physical damage coverage described in Subsection [(155).]
1582     (160).
1583          [(189)] (194) "Voting security" means a security with voting rights, and includes a
1584     security convertible into a security with a voting right associated with the security.
1585          [(190)] (195) "Waiting period" for a health benefit plan means the period that must
1586     pass before coverage for an individual, who is otherwise eligible to enroll under the terms of
1587     the health benefit plan, can become effective.
1588          [(191)] (196) "Workers' compensation insurance" means:
1589          (a) insurance for indemnification of an employer against liability for compensation
1590     based on:
1591          (i) a compensable accidental injury; and
1592          (ii) occupational disease disability;
1593          (b) employer's liability insurance incidental to workers' compensation insurance and
1594     written in connection with workers' compensation insurance; and
1595          (c) insurance assuring to a person entitled to workers' compensation benefits the
1596     compensation provided by law.
1597          Section 3. Section 31A-2-201.2 is amended to read:
1598          31A-2-201.2. Evaluation of health insurance market.
1599          (1) (a) Each year the commissioner shall:
1600          [(a)] (i) conduct an evaluation of the state's health insurance market;
1601          [(b)] (ii) report the findings of the evaluation to the [Health and Human Services
1602     Interim Committee] Office of Legislative Research and General Counsel before [December 1]
1603     February 1 of each year; and
1604          [(c)] (iii) publish the findings of the evaluation on the department website.
1605          (b) After the president of the Senate and the speaker of the House of Representatives
1606     appoint members to the Health and Human Services Interim Committee for the year in which

1607     the Office of Legislative Research and General Counsel receives a report under this subsection,
1608     the Office of Legislative Research and General Counsel shall provide a copy of the report to
1609     each member of the committee.
1610          (2) The evaluation required by this section shall:
1611          (a) analyze the effectiveness of the insurance regulations and statutes in promoting a
1612     healthy, competitive health insurance market that meets the needs of the state, and includes an
1613     analysis of:
1614          (i) the availability and marketing of individual and group products;
1615          (ii) rate changes;
1616          (iii) coverage and demographic changes;
1617          (iv) benefit trends;
1618          (v) market share changes; and
1619          (vi) accessibility;
1620          (b) assess complaint ratios and trends within the health insurance market, which
1621     assessment shall include complaint data from the Office of Consumer Health Assistance within
1622     the department;
1623          (c) contain recommendations for action to improve the overall effectiveness of the
1624     health insurance market, administrative rules, and statutes;
1625          (d) include claims loss ratio data for each health insurance company doing business in
1626     the state;
1627          (e) include information about pharmacy benefit managers collected under Section
1628     31A-46-301; and
1629          (f) include information, for each health insurance company doing business in the state,
1630     regarding:
1631          (i) preauthorization determinations; and
1632          (ii) adverse benefit determinations.
1633          (3) When preparing the evaluation and report required by this section, the
1634     commissioner may seek the input of insurers, employers, insured persons, providers, and others
1635     with an interest in the health insurance market.
1636          (4) The commissioner may adopt administrative rules for the purpose of collecting the
1637     data required by this section, taking into account the business confidentiality of the insurers.

1638          (5) Records submitted to the commissioner under this section shall be maintained by
1639     the commissioner as protected records under Title 63G, Chapter 2, Government Records
1640     Access and Management Act.
1641          Section 4. Section 31A-2-211 is amended to read:
1642          31A-2-211. Rules and forms during transition period.
1643          (1) The commissioner's rules adopted under former Title 31 are rescinded unless
1644     continued under Subsection (3).
1645          (2) Between May 1, 1985, and July 1, 1986, the commissioner may prepare and adopt
1646     rules to implement or supplement provisions under Title 31A, Insurance Code. These rules are
1647     effective on July 1, 1986, or on the effective date of the particular provision, if that is later than
1648     July 1, 1986.
1649          [(3) The commissioner may issue orders declaring that all or part of a rule in effect
1650     under former Title 31 remains in effect until a date specified under the order, which date may
1651     not be later than June 30, 1989. No rule continued under this subsection may be inconsistent
1652     with other provisions under Title 31A, Insurance Code. Notice of the order shall be given under
1653     Section 31A-2-303.]
1654          [(4)] (3) Every form used, issued, or required by the Insurance Department and
1655     approved by the commissioner or otherwise legitimately in use immediately prior to the
1656     effective date of this title may continue to be used until replaced in accordance with the
1657     provisions of this title.
1658          Section 5. Section 31A-2-215 is amended to read:
1659          31A-2-215. Consumer education.
1660          (1) In furtherance of the purposes in Section 31A-1-102, the commissioner may
1661     educate consumers about insurance and provide consumer assistance.
1662          (2) Consumer education may include:
1663          (a) outreach activities; and
1664          (b) the production or collection and dissemination of educational materials.
1665          (3) [(a)] Consumer assistance may include [explaining]:
1666          (a) explaining:
1667          (i) the terms of a policy;
1668          (ii) a policy's complaint, grievance, or adverse benefit determination procedure; and

1669          (iii) the fundamentals of self-advocacy[.]; and
1670          (b) informal efforts to negotiate a resolution of a dispute between a consumer and a
1671     licensee.
1672          (4) (a) Notwithstanding Subsection [(3)(a),] (3) and Section 31A-2-216, consumer
1673     assistance may not include:
1674          (i) commencing an administrative, judicial, or other proceeding against a licensee to
1675     obtain specific relief from the licensee for a specific consumer; or
1676          (ii) [testifying or representing a consumer in any grievance or adverse benefit
1677     determination, arbitration, judicial, or related proceeding, unless the proceeding is in
1678     connection with an enforcement action brought under Section 31A-2-308.] otherwise
1679     representing a consumer in any administrative, judicial, or other proceeding.
1680          (5) Nothing in this section prohibits the commissioner from taking enforcement action
1681     for violations under Section 31A-2-308.
1682          [(4)] (6) The commissioner may adopt rules necessary to implement the requirements
1683     of this section.
1684          Section 6. Section 31A-2-216 is amended to read:
1685          31A-2-216. Office of Consumer Health Assistance.
1686          (1) The commissioner shall establish[:]
1687          [(a)] an Office of Consumer Health Assistance before July 1, 1999[; and].
1688          [(b) a committee to advise the commissioner on consumer assistance rendered under
1689     this section.]
1690          (2) The office shall:
1691          (a) be a resource for health [care] insurance consumers concerning health [care]
1692     insurance coverage or the need for such coverage;
1693          (b) help health [care] insurance consumers understand:
1694          (i) contractual rights and responsibilities;
1695          (ii) statutory protections; and
1696          (iii) available remedies, including adverse benefit determination processes;
1697          (c) educate health [care] insurance consumers:
1698          (i) by producing or collecting and disseminating educational materials to consumers[,]
1699     and health insurers[, and health benefit plans]; and

1700          (ii) through outreach and other educational activities;
1701          (d) for health [care] insurance consumers that have difficulty in accessing their health
1702     insurance policies because of language, disability, age, or ethnicity, provide information and
1703     services, directly or through referral[, such as:];
1704          [(i) information and referral; and]
1705          [(ii) adverse benefit determination process initiation;]
1706          (e) analyze and monitor federal and state consumer health[-related] insurance statutes,
1707     rules, and regulations; and
1708          (f) summarize information gathered under this section and make the summaries
1709     available to the public, government agencies, and the Legislature.
1710          (3) The office may:
1711          (a) obtain data from health [care] insurance consumers as necessary to further the
1712     office's duties under this section;
1713          (b) investigate complaints and attempt to resolve complaints at the lowest possible
1714     level; and
1715          (c) assist, but not testify or represent, a consumer in an adverse benefit determination,
1716     arbitration, judicial, or related proceeding, unless the proceeding is in connection with an
1717     enforcement action [brought] under Section 31A-2-308.
1718          (4) The commissioner may adopt rules necessary to implement the requirements of this
1719     section.
1720          Section 7. Section 31A-2-218.1 is enacted to read:
1721          31A-2-218.1. Section 1332 Waiver Study.
1722          (1) As used in this section:
1723          (a) "Secretary" means the secretary of the United States Department of Health and
1724     Human Services.
1725          (b) "Section 1332 waiver" means a waiver for state innovation under 45 C.F.R. Part
1726     155, Subpart N.
1727          (2) The commissioner shall conduct a study to determine the feasibility of a state-based
1728     program designed to:
1729          (a) lower health benefit plan insurance premiums; and
1730          (b) increase stabilization in the market.

1731          (3) The commissioner, in the study described in Subsection (2), shall create a proposal
1732     for a Section 1332 waiver that includes:
1733          (a) a list of provisions the state should seek to waive and the rationale for waiving each
1734     provision;
1735          (b) data, assumptions, targets, and other information sufficient to determine that the
1736     proposed waiver will provide coverage at least as comprehensive as coverage that would be
1737     provided absent the waiver;
1738          (c) coverage and cost sharing protections that keep premiums at least as affordable as
1739     would be provided absent the Section 1332 waiver;
1740          (d) actuarial analyses, actuarial certifications, and financial modeling that:
1741          (i) support the estimates that the proposal will comply with the comprehensive
1742     coverage requirements, the affordability requirement, the scope of coverage requirement, and
1743     the federal deficit requirement; and
1744          (ii) include:
1745          (A) a detailed 10-year budget plan that is deficit-neutral to the federal government;
1746          (B) all costs to the state, including administrative costs, and other costs to the federal
1747     government; and
1748          (C) a detailed analysis regarding the estimated impact of the Section 1332 waiver on
1749     health insurance coverage in the state;
1750          (e) proposed legislative changes to provide the state authority to implement the
1751     proposed waiver;
1752          (f) implementation plans with a timeline;
1753          (g) categories of covered individuals with high-cost medical conditions who may be
1754     reinsured through the proposed waiver, including a recommendation for a multi-year phased-in
1755     approach;
1756          (h) reinsurance parameters, including co-insurance, attachment points, or limits;
1757          (i) set premium reduction targets;
1758          (j) a detailed plan for a budget and program implementation; and
1759          (k) a complete application for submission to the secretary.
1760          (4) To carry out the requirements in Subsections (2) and (3) the commissioner may
1761     partner or contract with a person that the commissioner determines is appropriate, subject to

1762     Title 63G, Chapter 6a, Utah Procurement Code.
1763          (5) On or before November 1, 2024, the commissioner shall submit to the Business and
1764     Labor Interim Committee a final written report describing the study described in this section.
1765          Section 8. Section 31A-2-308 is amended to read:
1766          31A-2-308. Enforcement penalties and procedures.
1767          (1) (a) A person who violates any insurance statute or rule or any order issued under
1768     Subsection 31A-2-201(4) shall forfeit to the state up to twice the amount of any profit gained
1769     from the violation, in addition to any other forfeiture or penalty imposed.
1770          (b) (i) The commissioner may order an individual producer, surplus line producer,
1771     limited line producer, managing general agent, reinsurance intermediary, adjuster, third party
1772     administrator, navigator, or insurance consultant who violates an insurance statute or rule to
1773     forfeit to the state not more than $2,500 for each violation.
1774          (ii) The commissioner may order any other person who violates an insurance statute or
1775     rule to forfeit to the state not more than $5,000 for each violation.
1776          (c) (i) The commissioner may order an individual producer, surplus line producer,
1777     limited line producer, managing general agent, reinsurance intermediary, adjuster, third party
1778     administrator, navigator, or insurance consultant who violates an order issued under Subsection
1779     31A-2-201(4) to forfeit to the state not more than $2,500 for each violation. Each day the
1780     violation continues is a separate violation.
1781          (ii) The commissioner may order any other person who violates an order issued under
1782     Subsection 31A-2-201(4) to forfeit to the state not more than $5,000 for each violation. Each
1783     day the violation continues is a separate violation.
1784          (d) The commissioner may accept or compromise any forfeiture [under this Subsection
1785     (1) until after a complaint is filed under Subsection (2). After the filing of the complaint, only
1786     the attorney general may compromise the forfeiture].
1787          (2) When a person fails to comply with an order issued under Subsection
1788     31A-2-201(4), including a forfeiture order, the commissioner may file an action in any court of
1789     competent jurisdiction or obtain a court order or judgment:
1790          (a) enforcing the commissioner's order;
1791          (b) (i) directing compliance with the commissioner's order and restraining further
1792     violation of the order; and

1793          (ii) subjecting the person ordered to the procedures and sanctions available to the court
1794     for punishing contempt if the failure to comply continues; or
1795          (c) imposing a forfeiture in an amount the court considers just, up to $10,000 for each
1796     day the failure to comply continues after the filing of the complaint until judgment is rendered.
1797          (3) (a) The Utah Rules of Civil Procedure govern actions brought under Subsection (2),
1798     except that the commissioner may file a complaint seeking a court-ordered forfeiture under
1799     Subsection (2)(c) no sooner than two weeks after giving written notice of the commissioner's
1800     intention to proceed under Subsection (2)(c).
1801          (b) The commissioner's order issued under Subsection 31A-2-201(4) may contain a
1802     notice of intention to seek a court-ordered forfeiture if the commissioner's order is disobeyed.
1803          (4) If, after a court order is issued under Subsection (2), the person fails to comply with
1804     the commissioner's order or judgment:
1805          (a) the commissioner may certify the fact of the failure to the court by affidavit; and
1806          (b) the court may, after a hearing following at least five days written notice to the
1807     parties subject to the order or judgment, amend the order or judgment to add the forfeiture or
1808     forfeitures, as prescribed in Subsection (2)(c), until the person complies.
1809          (5) (a) The proceeds of the forfeitures under this section, including collection expenses,
1810     shall be paid into the General Fund.
1811          (b) The expenses of collection shall be credited to the department's budget.
1812          (c) The attorney general's budget shall be credited to the extent the department
1813     reimburses the attorney general's office for its collection expenses under this section.
1814          (6) (a) Forfeitures and judgments under this section bear interest at the rate charged by
1815     the United States Internal Revenue Service for past due taxes on the:
1816          (i) date of entry of the commissioner's order under Subsection (1); or
1817          (ii) date of judgment under Subsection (2).
1818          (b) Interest accrues from the later of the dates described in Subsection (6)(a) until the
1819     forfeiture and accrued interest are fully paid.
1820          (7) A forfeiture may not be imposed under Subsection (2)(c) if:
1821          (a) at the time the forfeiture action is commenced, the person was in compliance with
1822     the commissioner's order; or
1823          (b) the violation of the order occurred during the order's suspension.

1824          (8) The commissioner may seek an injunction as an alternative to issuing an order
1825     under Subsection 31A-2-201(4).
1826          (9) (a) A person is guilty of a class B misdemeanor if that person:
1827          (i) intentionally violates:
1828          (A) an insurance statute of this state; or
1829          (B) an order issued under Subsection 31A-2-201(4);
1830          (ii) intentionally permits a person over whom that person has authority to violate:
1831          (A) an insurance statute of this state; or
1832          (B) an order issued under Subsection 31A-2-201(4); or
1833          (iii) intentionally aids any person in violating:
1834          (A) an insurance statute of this state; or
1835          (B) an order issued under Subsection 31A-2-201(4).
1836          (b) Unless a specific criminal penalty is provided elsewhere in this title, the person may
1837     be fined not more than:
1838          (i) $10,000 if a corporation; or
1839          (ii) $5,000 if a person other than a corporation.
1840          (c) If the person is an individual, the person may, in addition, be imprisoned for up to
1841     one year.
1842          (d) As used in this Subsection (9), "intentionally" has the same meaning as under
1843     Subsection 76-2-103(1).
1844          (10) (a) A person who knowingly and intentionally violates Section 31A-4-102,
1845     31A-8a-208, 31A-15-105, 31A-23a-116, or 31A-31-111 is guilty of a felony as provided in this
1846     Subsection (10).
1847          (b) When the value of the property, money, or other things obtained or sought to be
1848     obtained in violation of Subsection (10)(a):
1849          (i) is less than $5,000, a person is guilty of a third degree felony; or
1850          (ii) is or exceeds $5,000, a person is guilty of a second degree felony.
1851          (11) (a) After a hearing, the commissioner may, in whole or in part, revoke, suspend,
1852     place on probation, limit, or refuse to renew the licensee's license or certificate of authority:
1853          (i) when a licensee of the department, other than a domestic insurer:
1854          (A) persistently or substantially violates the insurance law; or

1855          (B) violates an order of the commissioner under Subsection 31A-2-201(4);
1856          (ii) if there are grounds for delinquency proceedings against the licensee under Section
1857     31A-27a-207; or
1858          (iii) if the licensee's methods and practices in the conduct of the licensee's business
1859     endanger, or the licensee's financial resources are inadequate to safeguard, the legitimate
1860     interests of the licensee's customers and the public.
1861          (b) Additional license termination or probation provisions for licensees other than
1862     insurers are set forth in Sections 31A-19a-303, 31A-19a-304, 31A-23a-111, 31A-23a-112,
1863     31A-25-208, 31A-25-209, 31A-26-213, 31A-26-214, 31A-35-501, and 31A-35-503.
1864          (12) The enforcement penalties and procedures set forth in this section are not
1865     exclusive, but are cumulative of other rights and remedies the commissioner has pursuant to
1866     applicable law.
1867          Section 9. Section 31A-4-113.5 is amended to read:
1868          31A-4-113.5. Filing requirements -- National Association of Insurance
1869     Commissioners.
1870          (1) (a) Each domestic, foreign, and alien insurer who is authorized to transact insurance
1871     business in this state shall annually file with the NAIC a copy of the insurer's:
1872          (i) annual statement convention blank on or before March 1;
1873          (ii) market conduct annual statements[:] on or before the applicable date determined by
1874     the NAIC; and
1875          [(A) on or before April 30, for all lines of business except health; and]
1876          [(B) on or before June 30, for the health line of business; and]
1877          (iii) any additional filings required by the commissioner for the preceding year.
1878          (b) (i) The information filed with the NAIC under Subsection (1)(a)(i) shall:
1879          (A) be prepared in accordance with the NAIC's:
1880          (I) annual statement instructions; and
1881          (II) Accounting Practices and Procedures Manual; and
1882          (B) include:
1883          (I) the signed jurat page; and
1884          (II) the actuarial certification.
1885          (ii) An insurer shall file with the NAIC amendments and addenda to information filed

1886     with the commissioner under Subsection (1)(a)(i).
1887          (c) The information filed with the NAIC under Subsection (1)(a)(ii) shall be prepared
1888     in accordance with the NAIC's Market Conduct Annual Statement Industry User Guide.
1889          (d) At the time an insurer makes a filing under this Subsection (1), the insurer shall pay
1890     any filing fees assessed by the NAIC.
1891          (e) A foreign insurer that is domiciled in a state that has a law substantially similar to
1892     this section shall be considered to be in compliance with this section.
1893          (2) All financial analysis ratios and examination synopses concerning insurance
1894     companies that are submitted to the department by the Insurance Regulatory Information
1895     System are confidential and may not be disclosed by the department.
1896          (3) The commissioner may suspend, revoke, or refuse to renew the certificate of
1897     authority of any insurer failing to:
1898          (a) submit the filings under Subsection (1)(a) when due or within any extension of time
1899     granted for good cause by:
1900          (i) the commissioner; or
1901          (ii) the NAIC; or
1902          (b) pay by the time specified in Subsection (3)(a) a fee the insurer is required to pay
1903     under this section to:
1904          (i) the commissioner; or
1905          (ii) the NAIC.
1906          Section 10. Section 31A-6a-109 is amended to read:
1907          31A-6a-109. Enforcement provisions.
1908          [Anyone violating of any of the provisions of this chapter or any rule made pursuant to
1909     the grant of rulemaking authority under this title may be assessed an administrative forfeiture
1910     equal to two times the amount of any profit gained from the violation. In addition an
1911     administrative forfeiture may be assessed for each violation not to exceed $1,000 per
1912     violation.]
1913          (1) If the commissioner finds, as part of an adjudicative proceeding under Title 63G,
1914     Chapter 4, Administrative Procedures Act, that a person has violated any provision of this
1915     chapter, the commissioner may take one or more of the following actions:
1916          (a) revoke a registration issued under this chapter;

1917          (b) suspend, for a specified period of 12 months or less, a registration issued under this
1918     chapter;
1919          (c) deny an application for a registration under this chapter;
1920          (d) assess a forfeiture equal to two times the amount of any profit gained from the
1921     violation; or
1922          (e) assess an additional forfeiture not to exceed $1,000 per violation.
1923          (2) If the violations are continuing, or are of a serious nature, or a person's business
1924     practices in connection with the solicitation, sale, offering for sale, or performance under a
1925     service contract subject to this chapter, constitute a danger to the legitimate interests of
1926     consumers or the public, the commissioner may enjoin the person from soliciting, selling, or
1927     offering to sell service contracts in this state either permanently or for a stated period of time.
1928          Section 11. Section 31A-16-102.6 is amended to read:
1929          31A-16-102.6. Mutual insurance holding companies.
1930          (1) As used in this section:
1931          (a) "Intermediate holding company" means a holding company that:
1932          (i) is a subsidiary of a mutual insurance holding company;
1933          (ii) directly or through a subsidiary of the holding company, holds one or more
1934     subsidiary insurers, including a reorganized mutual insurer; and
1935          (iii) if the subsidiary insurers were not held by the holding company, a majority of the
1936     voting shares of the subsidy insurers' capital stock would be required under this section to be
1937     owned by the mutual insurance holding company.
1938          (b) "Majority of the voting shares" means the shares of a reorganized mutual insurer's
1939     capital stock that carry the right to cast a majority of the votes entitled to be cast by all of the
1940     outstanding shares of the reorganized mutual insurer's capital stock for the election of directors
1941     and other matters submitted to a vote of the reorganized mutual insurer's shareholders.
1942          (2) (a) With the commissioner's approval, a domestic mutual insurer may reorganize by
1943     forming a mutual insurance holding company in which:
1944          (i) in accordance with the mutual insurance holding company's articles of incorporation
1945     and bylaws, the membership interests of the domestic mutual insurer's policyholders become
1946     membership interests in the mutual insurance holding company; and
1947          (ii) the domestic mutual insurer is reorganized as a domestic stock insurance company.

1948          (b) The commissioner may approve a domestic mutual insurer's reorganization under
1949     this Subsection (2) if:
1950          (i) the domestic mutual insurer's reorganization plan:
1951          (A) properly protects the interests of the domestic mutual insurer's policyholders;
1952          (B) is fair and equitable to the domestic mutual insurer's policyholders; [and]
1953          (C) is approved by a majority of the domestic mutual insurer's policyholders present at
1954     any regular or special meeting of the policyholders at which a quorum is present; and
1955          [(C)] (D) satisfies the requirements of Subsections 31A-16-103(8) through (10);
1956          (ii) the initial shares of the reorganized domestic mutual insurer's capital stock are
1957     issued to the mutual insurance holding company or intermediate holding company; and
1958          (iii) at all times, the mutual insurance holding company or intermediate holding
1959     company owns a majority of the voting shares of the reorganized domestic mutual insurer's
1960     capital stock.
1961          (c) With the commissioner's approval, the mutual insurance holding company may
1962     allow in the mutual insurance holding company's articles and bylaws that a policyholder of a
1963     stock insurer that is or becomes a subsidiary of the mutual insurance holding company to be a
1964     member of the mutual insurance holding company.
1965          (d) The domestic mutual insurer:
1966          (i) shall provide the domestic mutual insurer's policyholders notice of the
1967     reorganization plan and the related member meeting by first-class mail;
1968          (ii) shall include in a notice described in Subsection (2)(d)(i), a copy of the full
1969     reorganization plan and all related plan materials;
1970          (iii) may satisfy the requirement in Subsection (2)(d)(ii) by including with the notice of
1971     reorganization a URL link at which the policyholders can access the full reorganization plan
1972     and any related materials electronically; and
1973          (iv) shall provide a physical copy of the reorganization plan and all related plan
1974     materials to a policyholder upon request.
1975          (3) (a) With the commissioner's approval, a domestic mutual insurer may reorganize by
1976     merging the domestic mutual insurer's policyholders' membership interests into an existing
1977     domestic mutual insurance holding company formed under Subsection (2), if:
1978          (i) in accordance with the mutual insurance holding company's articles of incorporation

1979     and bylaws, the membership interests of the domestic mutual insurer's policyholders become
1980     membership interests in the mutual insurance holding company; and
1981          (ii) the domestic mutual insurer is reorganized as a domestic stock insurance company
1982     subsidiary of the existing domestic mutual insurance holding company or intermediate holding
1983     company.
1984          (b) The commissioner may approve a domestic mutual insurance company's
1985     reorganization under this Subsection (3) if:
1986          (i) the domestic mutual insurer's reorganization plan:
1987          (A) properly protects the interests of the domestic mutual insurer's policyholders;
1988          (B) is fair and equitable to the domestic mutual insurer's policyholders; and
1989          (C) satisfies the requirements of Subsections 31A-16-103(8) through (10);
1990          (ii) all of the initial shares of the capital stock of the reorganized insurance company
1991     are issued to the mutual insurance holding company or intermediate holding company; and
1992          (iii) at all times, the mutual insurance holding company or intermediate holding
1993     company owns a majority of the voting shares of the reorganized domestic mutual insurer's
1994     capital stock.
1995          (c) The commissioner may require, as a condition of approval, any modifications to the
1996     proposed merger the commissioner finds necessary for the protection of the policyholders'
1997     interests.
1998          [(3)] (4) (a) With the commissioner's approval, a foreign mutual insurer organized
1999     under the laws of any other state that would qualify to become a domestic insurer organized
2000     under the laws of this state may reorganize by [forming a] merging the foreign mutual insurer's
2001     policyholders' membership interests into an existing domestic mutual insurance holding
2002     company [system] formed under Subsection (2) in which:
2003          (i) in accordance with the mutual insurance holding company's articles of incorporation
2004     and bylaws, the membership interests of the foreign mutual insurer's policyholders become
2005     membership interests in the mutual insurance holding company; and
2006          (ii) the foreign mutual insurer is reorganized as a foreign stock insurance company
2007     subsidiary of the existing domestic mutual insurance holding company or intermediate holding
2008     company.
2009          (b) The commissioner may approve a foreign mutual insurer's reorganization under this

2010     Subsection (4) if:
2011          (i) the foreign mutual insurer's reorganization plan:
2012          (A) complies with any other law or rule applicable to the foreign mutual insurer;
2013          (B) properly protects the interests of the foreign mutual insurer's policyholders;
2014          (C) is fair and equitable to the foreign mutual insurer's policyholders; and
2015          (D) satisfies the requirements of Subsections 31A-16-103(8) through (10);
2016          (ii) all of the initial shares of the reorganized foreign mutual insurer's capital stock are
2017     issued to the mutual insurance holding company or intermediate holding company; and
2018          (iii) at all times, the mutual insurance holding company or intermediate holding
2019     company owns a majority of the voting shares of the reorganized foreign mutual insurer's
2020     capital stock.
2021          (c) After a [merger] reorganization contemplated by this Subsection (4), the
2022     reorganized foreign mutual insurer may:
2023          (i) remain a foreign corporation; and
2024          (ii) with the commissioner's approval, be admitted to conduct business in this state.
2025          (d) A foreign mutual insurer that is a party to a reorganization plan may redomesticate
2026     in this state by complying with the applicable requirements of this state and the foreign mutual
2027     insurer's state of domicile.
2028          [(4)] (5) (a) As a condition of approval, the commissioner may require a mutual insurer
2029     to modify the mutual insurer's reorganization plan to protect the interests of the mutual insurer's
2030     policyholders.
2031          (b) If the commissioner determines reasonably necessary, at the reorganizing mutual
2032     insurer's expense, the commissioner may retain a third-party consultant to assist the
2033     commissioner in reviewing the mutual insurer's reorganization plan.
2034          (c) The commissioner has jurisdiction over a mutual insurance holding company or
2035     intermediate holding company organized in accordance with this section.
2036          (d) Subject to the commissioner's approval, a reorganized mutual insurer or a stock
2037     insurance subsidiary within a mutual insurance company may issue a dividend or distribution
2038     to the mutual insurance holding company or intermediate holding company.
2039          [(5)] (6) (a) Subject to the provisions of this section, a mutual insurance holding
2040     company resulting from the reorganization of a domestic mutual insurer shall be incorporated

2041     in accordance with and is subject to the provisions of Chapter 5, Domestic Stock and Mutual
2042     Insurance Corporations as if it were a mutual insurer.
2043          (b) A mutual insurance holding company's articles of incorporation and bylaws are
2044     subject to commissioner's approval in the same manner as an insurance company's articles of
2045     incorporation and bylaws.
2046          [(6)] (7) (a) A mutual insurance holding company is:
2047          (i) subject to Chapter 27a, Insurer Receivership Act; and
2048          (ii) a party to any proceeding under Chapter 27a, Insurer Receivership Act, involving
2049     an insurer that is a subsidiary of the mutual insurance holding company as a result of a
2050     reorganization in accordance with this section.
2051          (b) In a proceeding under Chapter 27a, Insurer Receivership Act, involving a
2052     reorganized mutual insurer, the assets of the mutual insurance holding company are assets of
2053     the estate of the reorganized mutual insurer for the purpose of satisfying the claims of the
2054     reorganized mutual insurer's policyholders.
2055          (c) A mutual insurance holding company may be dissolved or liquidated only by:
2056          (i) prior approval of the commissioner; or
2057          (ii) court order in accordance with Chapter 27a, Insurer Receivership Act.
2058          [(7)] (8) (a) Section 31A-5-506 does not apply to a mutual insurer's reorganization or
2059     merger under this section.
2060          (b) Section 31A-5-506 applies to demutualization of a mutual insurance holding
2061     company.
2062          (c) The following sections do not apply to a mutual insurance holding company:
2063          (i) Sections 31A-5-204 through 31A-5-217.5;
2064          (ii) Sections 31A-5-301 through 31A-5-307;
2065          (iii) Section 31A-5-505; and
2066          (iv) Section 31A-5-509.
2067          (d) Notwithstanding Section 31A-5-203, a mutual insurance holding company is not
2068     required to include "insurance" in the mutual insurance holding company's name.
2069          [(8)] (9) A membership interest in a domestic mutual insurance holding company is not
2070     a security under Utah law.
2071          [(9)] (10) (a) The ownership of a majority of the voting shares of a reorganized mutual

2072     insurer's capital stock includes indirect ownership through one or more intermediate holding
2073     companies in a corporate structure approved by the commissioner.
2074          (b) The indirect ownership described in [Subsection (9)(a)] Subsection (10)(a) may not
2075     result in the mutual insurance holding company owning less than the equivalent of the majority
2076     of the voting shares of the reorganized mutual insurer's capital stock.
2077          [(10)] (11) (a) A mutual insurance holding company or intermediate holding company
2078     may not sell, transfer, assign, pledge, encumber, hypothecate, alienate, or subject to a security
2079     interest or lien the majority of the voting shares of the reorganized mutual insurer's capital
2080     stock.
2081          (b) An act that violates [Subsection (10)(a)] Subsection (11)(a) is void in reverse
2082     chronological order of the date the act occurred.
2083          (c) The majority of the voting shares of the reorganized mutual insurer's capital stock
2084     are not subject to execution and levy under Utah law.
2085          (d) The shares of the capital stock of the surviving or new company resulting from a
2086     merger or consolidation of two or more reorganized mutual insurers, or two or more
2087     intermediate holding companies that were subsidiaries of the same mutual insurance holding
2088     company, are subject to the same requirements, restrictions, and limitations described in this
2089     section that applied to the shares of the merging or consolidating reorganized mutual insurers
2090     or intermediate holding companies before the merger or consolidation.
2091          [(11)] (12) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
2092     Act, the commissioner may make rules to implement the provisions of this section.
2093          Section 12. Section 31A-19a-203 is amended to read:
2094          31A-19a-203. Rate filings.
2095          (1) (a) Except as provided in Subsections (4) and (5), every authorized insurer and
2096     every rate service organization licensed under Section 31A-19a-301 that has been designated
2097     by any insurer for the filing of pure premium rates under Subsection 31A-19a-205(2) shall file
2098     with the commissioner the following for use in this state:
2099          (i) all rates;
2100          (ii) all supplementary information; and
2101          (iii) all changes and amendments to rates and supplementary information.
2102          (b) An insurer shall file its rates by filing:

2103          (i) its final rates; or
2104          (ii) either of the following to be applied to pure premium rates that have been filed by a
2105     rate service organization on behalf of the insurer as permitted by Section 31A-19a-205:
2106          (A) a multiplier; or
2107          (B) (I) a multiplier; and
2108          (II) an expense constant adjustment.
2109          (c) Every filing under this Subsection (1) shall state:
2110          (i) the effective date of the rates; and
2111          (ii) the character and extent of the coverage contemplated.
2112          (d) Except for workers' compensation rates filed under Sections 31A-19a-405 and
2113     31A-19a-406, each filing shall be within 30 days after the rates and supplementary information,
2114     changes, and amendments are effective.
2115          (e) A rate filing is considered filed when it has been received[:]
2116          [(i) with the applicable filing fee as prescribed under Section 31A-3-103; and]
2117          [(ii)] pursuant to procedures established by the commissioner.
2118          (f) The commissioner may by rule prescribe procedures for submitting rate filings by
2119     electronic means.
2120          (2) (a) To show compliance with Section 31A-19a-201, at the same time as the filing
2121     of the rate and supplementary rate information, an insurer shall file all supporting information
2122     to be used in support of or in conjunction with a rate.
2123          (b) If the rate filing provides for a modification or revision of a previously filed rate,
2124     the insurer is required to file only the supporting information that supports the modification or
2125     revision.
2126          (c) If the commissioner determines that the insurer did not file sufficient supporting
2127     information, the commissioner shall inform the insurer in writing of the lack of sufficient
2128     supporting information.
2129          (d) If the insurer does not provide the necessary supporting information within 45
2130     calendar days of the date on which the commissioner mailed notice under Subsection (2)(c), the
2131     rate filing may be:
2132          (i) considered incomplete and unfiled; and
2133          (ii) returned to the insurer as:

2134          (A) not filed; and
2135          (B) not available for use.
2136          (e) Notwithstanding Subsection (2)(d), the commissioner may extend the time period
2137     for filing supporting information.
2138          (f) If a rate filing is returned to an insurer as not filed and not available for use under
2139     Subsection (2)(d), the insurer may not use the rate filing for any policy issued or renewed on or
2140     after 60 calendar days from the date the rate filing was returned.
2141          (3) At the request of the commissioner, an insurer using the services of a rate service
2142     organization shall provide a description of the rationale for using the services of the rate service
2143     organization, including the insurer's:
2144          (a) own information; and
2145          (b) method of use of the rate service organization's information.
2146          (4) (a) An insurer may not make or issue a contract or policy except in accordance with
2147     the rate filings that are in effect for the insurer as provided in this chapter.
2148          (b) Subsection (4)(a) does not apply to contracts or policies for inland marine risks for
2149     which filings are not required.
2150          (5) Subsection (1) does not apply to inland marine risks, which, by general custom, are
2151     not written according to standardized manual rules or rating plans.
2152          (6) (a) The insurer may file a written application, stating the insurer's reasons for using
2153     a higher rate than that otherwise applicable to a specific risk.
2154          (b) If the application described in Subsection (6)(a) is filed with and not disapproved
2155     by the commissioner within 10 days after filing, the higher rate may be applied to the specific
2156     risk.
2157          (c) The rate described in this Subsection (6) may be disapproved without a hearing.
2158          (d) If disapproved, the rate otherwise applicable applies from the effective date of the
2159     policy, but the insurer may cancel the policy pro rata on 10 days' notice to the policyholder.
2160          (e) If the insurer does not cancel the policy under Subsection (6)(d), the insurer shall
2161     refund any excess premium from the effective date of the policy.
2162          (7) (a) Agreements may be made between insurers on the use of reasonable rate
2163     modifications for insurance provided under Section 31A-22-310.
2164          (b) The rate modifications described in Subsection (7)(a) shall be filed immediately

2165     upon agreement by the insurers.
2166          Section 13. Section 31A-19a-209 is amended to read:
2167          31A-19a-209. Special provisions for title insurance.
2168          (1) (a) (i) The Title and Escrow Commission may make rules, in accordance with Title
2169     63G, Chapter 3, Utah Administrative Rulemaking Act, and subject to Section 31A-2-404,
2170     establishing rate standards and rating methods.
2171          (ii) The commissioner shall determine compliance with rate standards and rating
2172     methods for title insurers, individual title insurance producers, and agency title insurance
2173     producers.
2174          (b) In addition to the considerations in determining compliance with rate standards and
2175     rating methods as set forth in Sections 31A-19a-201 and 31A-19a-202, including for title
2176     insurers, the commissioner and the Title and Escrow Commission shall consider the costs and
2177     expenses incurred by title insurers, individual title insurance producers, and agency title
2178     insurance producers pertaining to the business of title insurance including:
2179          (i) the maintenance of title plants; and
2180          (ii) the examining of public records to determine insurability of title to real property.
2181          (2) A title insurer[, individual title insurance producer, or agency title insurance
2182     producer] may not use any rate or other charge relating to the business of title insurance[,
2183     including rates or charges for escrow] that would cause the title [insurance company, individual
2184     title insurance producer, or agency title insurance producer to:] insurer to fail to adequately
2185     underwrite a title insurance policy.
2186          [(a) operate at less than the cost of doing]
2187          [the insurance business; or]
2188          [(b) fail to adequately underwrite a title insurance policy.]
2189          Section 14. Section 31A-20-108 is amended to read:
2190          31A-20-108. Single risk limitation.
2191          (1) This section applies to all lines of insurance, including ocean marine and
2192     reinsurance, except:
2193          (a) title insurance;
2194          (b) workers' compensation insurance;
2195          (c) occupational disease insurance;

2196          (d) employers' liability insurance; and
2197          (e) health insurance.
2198          (2) (a) Except as provided under Subsections (3) and (4) and under Section
2199     31A-20-109, an insurer authorized to do an insurance business in Utah may not expose itself to
2200     loss on a single risk in an amount exceeding 10% of its capital and surplus.
2201          (b) The commissioner may adopt rules to calculate surplus under this section.
2202          (c) An insurer may deduct the portion of a risk reinsured by a reinsurance contract
2203     worthy of a reserve credit under Sections 31A-17-404 through 31A-17-404.4 in determining
2204     the limitation of risk under this section.
2205          (3) (a) The commissioner may adopt rules, after hearings held with notice [provided
2206     under Section 31A-2-303] as required by law, to specify the maximum exposure to which an
2207     assessable mutual may subject itself.
2208          (b) The rules described in Subsection (3)(a) may provide for classifications of
2209     insurance and insurers to preserve the solidity of insurers.
2210          (4) As used in this section, a "single risk" includes all losses reasonably expected as a
2211     result of the same event.
2212          (5) A company transacting fidelity or surety insurance may expose itself to a risk or
2213     hazard in excess of the amount prescribed in Subsection (2), if the commissioner, after
2214     considering all the facts and circumstances, approves the risk.
2215          Section 15. Section 31A-21-316 is amended to read:
2216          31A-21-316. Electronic notices and documents.
2217          (1) As used in this section:
2218          (a) "Delivered by electronic means" includes:
2219          (i) delivery to an electronic mail address at which a party has consented to receive a
2220     notice or document; or
2221          (ii) posting on an electronic network or site accessible by way of the Internet, a mobile
2222     application, a computer, a mobile device, a tablet, or any other electronic device, together with
2223     separate notice of the posting that is provided by:
2224          (A) electronic mail to the address at which the party has consented to receive notice; or
2225          (B) any other delivery method that has been consented to by the party.
2226          (b) (i) "Party" means a recipient of a notice or document required as part of an

2227     insurance transaction.
2228          (ii) "Party" includes an applicant, an insured, or a policyholder.
2229          (c) "Policy document" means a policy, certificate, amendment, or endorsement.
2230          (2) Subject to [Subsection (4)] Subsections (4) and (5), a notice to a party or another
2231     document required under applicable law in an insurance transaction or that serves as evidence
2232     of insurance coverage may be delivered, stored, and presented by electronic means if it meets
2233     the requirements of Title 46, Chapter 4, Uniform Electronic Transactions Act.
2234          (3) Delivery of a notice or document in accordance with this section is considered
2235     equivalent to any delivery method required under applicable law.
2236          (4) [Subject to Subsection (5), a] A notice or document may be delivered by electronic
2237     means by an insurer to a party under this section if:
2238          (a) the party has affirmatively consented to that method of delivery and has not
2239     withdrawn the consent;
2240          (b) the party, before giving consent, is provided with a clear and conspicuous statement
2241     informing the party of:
2242          (i) any right or option of the party to have the notice or document provided or made
2243     available in paper or another nonelectronic form;
2244          (ii) the right of the party to withdraw consent to have a notice or document delivered
2245     by electronic means, including:
2246          (A) a condition or consequence imposed if consent is withdrawn;
2247          (B) when the insurer will make the party's withdrawal effective, during or at the
2248     conclusion of the policy term; and
2249          (C) the procedure a party is to follow to withdraw consent to have a notice or document
2250     delivered by electronic means;
2251          (iii) whether the party's consent applies:
2252          (A) only to the particular transaction as to which the notice or document must be given;
2253     or
2254          (B) to identified categories of notices or documents that may be delivered by electronic
2255     means during the course of the party's relationship with the insured; and
2256          (iv) the means, after consent is given, by which a party may obtain a paper copy of a
2257     notice or document delivered by electronic means; and

2258          (c) the party:
2259          (i) before giving consent, is provided with a statement of the electronic delivery and
2260     retrieval method requirements for access to and retention of a notice or document delivered by
2261     electronic means;
2262          (ii) consents electronically, or confirms consent electronically, in a manner that
2263     reasonably demonstrates that the party can access information in the electronic form that will
2264     be used for a notice or document delivered by electronic means as to which the party has given
2265     consent; and
2266          (iii) is provided a process to update information needed to contact the party
2267     electronically[.];
2268          (d) [(5) (a) After] after consent of the party is given and if a change in the electronic
2269     delivery or retrieval methods creates a substantial risk that the party will not be able to access
2270     or retain a subsequent notice or document to which the consent applies, the insurer [shall]:
2271          (i) [provide] provides the party with a statement of:
2272          (A) the revised electronic delivery or retrieval methods; and
2273          (B) the right of the party to withdraw consent without the imposition of any condition
2274     or consequence that was not disclosed under Subsection (4)(b)(ii); [and]
2275          (ii) [comply] complies with Subsection (4)(b)[.]; and
2276          [(b) Failure by an insurer to comply with this Subsection (5) is treated, at the election
2277     of the party, as a withdrawal of consent for purposes of this section.]
2278          [(c) When an electronic mail address provided by the party to facilitate delivery by
2279     electronic means is returned with a message as undeliverable each time electronic delivery is
2280     attempted over a period not to exceed two business days, the party is presumed to have
2281     withdrawn consent for the purposes of this section.]
2282          [(d)]
2283          [(i)] (e) [An] an insurer [shall file] files with the department the consent statement
2284     described under Subsection (4)(b), which includes conditions or consequences for a party to
2285     revoke the party's consent to conduct an insurance transaction, electronically.
2286          [(ii)] (i) An insurer shall file the consent statement described in [Subsection (5)(d)(i)]
2287     Subsection (4)(b) before the insurer uses the consent statement.
2288          [(iii)] (ii) The insurer shall communicate to the party in accordance with Subsection

2289     (4)(b) the conditions or consequences for a party to revoke the party's consent.
2290          (5) (a) An insurer may deliver a policy document to a party, by electronic means and
2291     without the party's consent to receive the policy document by electronic means, if:
2292          (i) the party has not withdrawn the consent described in this Subsection (5);
2293          (ii) the insurer provides a clear and conspicuous statement in paper form, to the party,
2294     informing the party of:
2295          (A) the party's right or option to have the policy document provided or made available
2296     in paper or another nonelectronic form;
2297          (B) the party's right to withdraw consent to the electronic delivery of a policy
2298     document, including the procedure a party must follow to withdraw consent to electronic
2299     delivery of a policy document;
2300          (C) policy documents that the insurer may deliver electronically;
2301          (D) the means by which a party may obtain a paper copy of a policy document that the
2302     insurer delivered electronically;
2303          (E) the electronic delivery and retrieval method requirements for access to and
2304     retention of a policy document delivered electronically; and
2305          (F) the process to update the party's electronic contact information; and
2306          (iii) the party demonstrates the ability to electronically access the information
2307     contained in the policy document.
2308          (b) This Subsection (5) does not apply to a life insurance policy document.
2309          (6) A withdrawal of consent by a party does not affect the legal effectiveness, validity,
2310     or enforceability of a notice or document delivered by electronic means to the party before the
2311     withdrawal of consent is effective.
2312          (7) This section does not affect requirements related to content or timing of any notice
2313     or document required under applicable law.
2314          (8) If a provision of this title or applicable law requiring a notice or document to be
2315     provided to a party expressly requires verification or acknowledgment of receipt of the notice
2316     or document, the notice or document may be delivered by electronic means only if the method
2317     used provides for verification or acknowledgment of receipt.
2318          (9) The legal effectiveness, validity, or enforceability of a contract or policy of
2319     insurance executed by a party may not be denied solely because of the failure to obtain

2320     electronic consent or confirmation of consent of the party in accordance with Subsection
2321     (4)(c)(ii).
2322          (10) This section does not apply to or affect a notice or document delivered by an
2323     insurer in an electronic form before July 1, 2014, to a party who, before July 1, 2014, has
2324     consented to receive the notice or document in an electronic form otherwise allowed by law.
2325          (11) If the consent of a party to receive certain notices or documents in an electronic
2326     form is on file with an insurer before July 1, 2014, and pursuant to this section, an insurer
2327     intends to deliver an additional notice or document to the party in an electronic form, then
2328     before delivering the additional notices or documents electronically, the insurer shall notify the
2329     party of:
2330          (a) the notices or documents that may be delivered by electronic means under this
2331     section that were not previously delivered electronically; and
2332          (b) the party's right to withdraw consent to have notices or documents delivered by
2333     electronic means.
2334          (12) (a) Except as otherwise provided by Section 31A-21-102, if an oral
2335     communication or a recording of an oral communication from a party can be reliably stored and
2336     reproduced by an insurer, the oral communication or recording may qualify as a notice or
2337     document delivered by electronic means for purposes of this section.
2338          (b) If a provision of this title or applicable law requires a signature, notice, or
2339     document to be notarized, acknowledged, verified, or made under oath, the requirement is
2340     satisfied if the electronic signature of the party authorized to perform those acts, together with
2341     all other information required to be included by the provision, is attached to or logically
2342     associated with the signature, notice, or document.
2343          (13) For purposes of this section, an insurer's failure to comply with Subsection (4) or
2344     (5) constitutes a withdrawal of the party's consent.
2345          (14) A party is presumed to have withdrawn consent under this section if the email
2346     address the party provides to receive a policy document returns a message stating that the
2347     message is undeliverable each time the insurer attempts electronic delivery over a period of up
2348     to two business days.
2349          [(13)] (15) This section may not be construed to modify, limit, or supersede the federal
2350     Electronic Signatures in Global and National Commerce Act, P. Law 106-229, as amended.

2351          Section 16. Section 31A-21-402 is amended to read:
2352          31A-21-402. Definitions.
2353          [As used in this part:]
2354          [(1) (a) "Direct response solicitation" means any offer an insurer makes to persons in
2355     this state, either directly or through a third party, to effect life or accident and health insurance
2356     coverage which enables the individual to apply or enroll for the insurance on the basis of the
2357     offer.]
2358          [(b) "Direct response solicitation" does not include:]
2359          [(i) solicitations for insurance through an employee benefit plan exempt from state
2360     regulation under preemptive federal law; or]
2361          [(ii) solicitations through an individual's creditor with respect to credit life or credit
2362     accident and health insurance. (2) "Mass] As used in this part, "mass marketed life or accident
2363     and health insurance" means the insurance under any individual, franchise, group, or blanket
2364     insurance policy offering life or accident and health insurance:
2365          [(a)] (1) that is offered by means of direct response solicitation through:
2366          [(i)] (a) a sponsoring organization; or
2367          [(ii)] (b) the mails or other mass communications media; and
2368          [(b)] (2) under which the person insured pays all or substantially all of the cost of the
2369     person's insurance.
2370          Section 17. Section 31A-22-401 is amended to read:
2371          31A-22-401. Prohibited life insurance policy provisions.
2372          No life insurance company may issue or deliver any life insurance policy subject to this
2373     chapter under Section 31A-21-101 which contains any provision:
2374          (1) forfeiting the policy for failure to repay any loan on the policy or to pay interest on
2375     the loan while the total indebtedness on the policy is less than its loan value, and in
2376     ascertaining the indebtedness due upon policy loans, the interest, if not paid when due, may be
2377     added to the principal of those loans and may bear interest at the same rate as the principal;
2378          (2) claiming that the policy was issued or became effective more than one year before
2379     the original application for the insurance is executed, if the insured would then be rated at an
2380     age more than one year younger than his age at the date of his application, unless the aggregate
2381     amount of the annual premiums for the whole term of the back-dated period is paid in cash;

2382     [or]
2383          (3) allowing assessments or calls to be made upon policyholders[.]; or
2384          (4) allowing an insurer to cancel or terminate a policy for a reason other than:
2385          (a) nonpayment of a premium when due; or
2386          (b) as allowed pursuant to Subsection 31A-21-105(2).
2387          Section 18. Section 31A-22-605 is amended to read:
2388          31A-22-605. Accident and health insurance standards.
2389          (1) The purposes of this section include:
2390          (a) reasonable standardization and simplification of terms and coverages of individual
2391     and franchise accident and health insurance policies, including accident and health insurance
2392     contracts of insurers licensed under Chapter 7, Nonprofit Health Service Insurance
2393     Corporations, and Chapter 8, Health Maintenance Organizations and Limited Health Plans, to
2394     facilitate public understanding and comparison in purchasing;
2395          (b) elimination of provisions contained in individual and franchise accident and health
2396     insurance contracts that may be misleading or confusing in connection with either the purchase
2397     of those types of coverages or the settlement of claims; and
2398          (c) full disclosure in the sale of individual and franchise accident and health insurance
2399     contracts.
2400          [(2) As used in this section:]
2401          [(a) "Direct response insurance policy" means an individual insurance policy solicited
2402     and sold without the policyholder having direct contact with a natural person intermediary.]
2403          [(b) "Medicare" means the same as that term is defined in Subsection
2404     31A-22-620(1)(e).]
2405          [(c) "Medicare supplement policy" means the same as that term is defined in
2406     Subsection 31A-22-620(1)(f).]
2407          [(3)] (2) This section applies to all individual and franchise accident and health
2408     policies.
2409          [(4)] (3) The commissioner shall adopt rules, made in accordance with Title 63G,
2410     Chapter 3, Utah Administrative Rulemaking Act, relating to the following matters:
2411          (a) standards for the manner and content of policy provisions, and disclosures to be
2412     made in connection with the sale of policies covered by this section, dealing with at least the

2413     following matters:
2414          (i) terms of renewability;
2415          (ii) initial and subsequent conditions of eligibility;
2416          (iii) nonduplication of coverage provisions;
2417          (iv) coverage of dependents;
2418          (v) preexisting conditions;
2419          (vi) termination of insurance;
2420          (vii) probationary periods;
2421          (viii) limitations;
2422          (ix) exceptions;
2423          (x) reductions;
2424          (xi) elimination periods;
2425          (xii) requirements for replacement;
2426          (xiii) recurrent conditions;
2427          (xiv) coverage of persons eligible for Medicare; and
2428          (xv) definition of terms;
2429          (b) minimum standards for benefits under each of the following categories of coverage
2430     in policies covered in this section:
2431          (i) basic hospital expense coverage;
2432          (ii) basic medical-surgical expense coverage;
2433          (iii) hospital confinement indemnity coverage;
2434          (iv) major medical expense coverage;
2435          (v) income replacement coverage;
2436          (vi) accident only coverage;
2437          (vii) specified disease or specified accident coverage;
2438          (viii) limited benefit health coverage; and
2439          (ix) nursing home and long-term care coverage;
2440          (c) the content and format of the outline of coverage, in addition to that required under
2441     Subsection [(6);] (5);
2442          (d) the method of identification of policies and contracts based upon coverages
2443     provided; and

2444          (e) rating practices.
2445          [(5)] (4) Nothing in Subsection [(4)(b)] (3)(b) precludes the issuance of policies that
2446     combine categories of coverage in Subsection [(4)(b)] (3)(b) provided that any combination of
2447     categories meets the standards of a component category of coverage.
2448          [(6)] (5) The commissioner may adopt rules, made in accordance with Title 63G,
2449     Chapter 3, Utah Administrative Rulemaking Act, relating to the following matters:
2450          (a) establishing disclosure requirements for insurance policies covered in this section,
2451     designed to adequately inform the prospective insured of the need for and extent of the
2452     coverage offered, and requiring that this disclosure be furnished to the prospective insured with
2453     the application form, unless it is a direct response insurance policy;
2454          (b) (i) prescribing caption or notice requirements designed to inform prospective
2455     insureds that particular insurance coverages are not [Medicare Supplement coverages]
2456     Medicare supplement insurance; and
2457          (ii) applying the requirements of Subsection [(6)(b)(i) apply] (5)(b)(i) to all insurance
2458     policies and certificates sold to persons eligible for Medicare; and
2459          (c) requiring the disclosures or information brochures to be furnished to the
2460     prospective insured on direct response insurance policies, upon his request or, in any event, no
2461     later than the time of the policy delivery.
2462          [(7)] (6) A policy covered by this section may be issued only if it meets the minimum
2463     standards established by the commissioner under Subsection [(4),] (3), an outline of coverage
2464     accompanies the policy or is delivered to the applicant at the time of the application, and,
2465     except with respect to direct response insurance policies, an acknowledged receipt is provided
2466     to the insurer. The outline of coverage shall include:
2467          (a) a statement identifying the applicable categories of coverage provided by the policy
2468     as prescribed under Subsection [(4);] (3);
2469          (b) a description of the principal benefits and coverage;
2470          (c) a statement of the exceptions, reductions, and limitations contained in the policy;
2471          (d) a statement of the renewal provisions, including any reservation by the insurer of a
2472     right to change premiums;
2473          (e) a statement that the outline is a summary of the policy issued or applied for and that
2474     the policy should be consulted to determine governing contractual provisions; and

2475          (f) any other contents the commissioner prescribes.
2476          [(8)] (7) If a policy is issued on a basis other than that applied for, the outline of
2477     coverage shall accompany the policy when it is delivered and it shall clearly state that it is not
2478     the policy for which application was made.
2479          [(9)] (8) (a) Notwithstanding Subsection 31A-22-606(1), limited accident and health
2480     policies or certificates issued to persons eligible for Medicare shall contain a notice
2481     prominently printed on or attached to the cover or front page which states that the policyholder
2482     or certificate holder has the right to return the policy for any reason within 30 days after its
2483     delivery and to have the premium refunded.
2484          (b) This Subsection [(9)] (8) does not apply to a policy issued to an employer group.
2485          Section 19. Section 31A-22-614 is amended to read:
2486          31A-22-614. Claims under accident and health policies.
2487          (1) Section 31A-21-312 applies generally to claims under accident and health policies.
2488          (2) (a) Subject to Subsection (1), an accident and health insurance policy may not
2489     contain a claim notice requirement less favorable to the insured, or an insured's Ĥ→ [
designee]
2489a     network provider ←Ĥ , than
2490     one which requires written notice of the claim within 20 days after the occurrence or
2491     commencement of any loss covered by the policy. The policy shall specify to whom claim
2492     notices may be given.
2493          (b) If a loss of time benefit under a policy may be paid for a period of at least two
2494     years, an insurer may require periodic notices that the insured continues to have a disability,
2495     unless the insured is legally incapacitated. The insured's, or the insured's Ĥ→ [
designee's] network
2495a     provider's ←Ĥ , delay in
2496     giving that notice does not impair the insured's, the insured's Ĥ→ [
designee's] network provider's
2496a     ←Ĥ , or beneficiary's right to
2497     any indemnity which would otherwise have accrued during the six months preceding the date
2498     on which that notice is actually given.
2499          (3) An accident and health insurance policy may not contain a time limit on proof of
2500     loss which is more restrictive to the insured, or the insured's Ĥ→ [
designee] network provider ←Ĥ ,
2500a     than a provision
2501     requiring written proof of loss, delivered to the insurer, within the following time:
2502          (a) for a claim where periodic payments are contingent upon continuing loss, within
2503     [90] 120 days after the termination of the period for which the insurer is liable; or
2504          (b) for any other claim, within [90] 120 days after the date of the loss.
2505          (4) (a) (i) Section 31A-26-301 applies generally to the payment of claims.

2506          (ii) Indemnity for loss of life is paid in accordance with the beneficiary designation
2507     effective at the time of payment. If no valid beneficiary designation exists, the indemnity is
2508     paid to the insured's estate. Any other accrued indemnities unpaid at the insured's death are
2509     paid to the insured's estate.
2510          (b) Reasonable facility of payment clauses, specified by the commissioner by rule or in
2511     approving the policy form, are permitted. Payment made in good faith and in accordance with
2512     those clauses discharges the insurer's obligation to pay those claims.
2513          (c) All or a portion of any indemnities provided under an accident and health policy on
2514     account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid
2515     directly to the hospital or person rendering the services.
2516          Section 20. Section 31A-22-620 is amended to read:
2517          31A-22-620. Medicare Supplement Insurance Minimum Standards Act.
2518          (1) As used in this section:
2519          (a) "Applicant" means:
2520          (i) in the case of an individual Medicare supplement insurance policy, the person who
2521     seeks to contract for insurance benefits; and
2522          (ii) in the case of a group Medicare supplement insurance policy, the proposed
2523     certificate holder.
2524          (b) "Certificate" means any certificate delivered or issued for delivery in this state
2525     under a group Medicare supplement insurance policy.
2526          (c) "Certificate form" means the form on which the certificate is delivered or issued for
2527     delivery by the issuer.
2528          (d) "Issuer" includes insurance companies, fraternal benefit societies, health care
2529     service plans, health maintenance organizations, and any other entity delivering, or issuing for
2530     delivery in this state, Medicare supplement insurance policies or certificates.
2531          [(e) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the
2532     Social Security Amendments of 1965, as then constituted or later amended.]
2533          [(f) "Medicare Supplement Policy":]
2534          [(i) means a group or individual policy of health insurance, other than a policy issued
2535     pursuant to a contract under Section 1876 of the federal Social Security Act, 42 U.S.C. Sec.
2536     1395 et seq., or an issued policy under a demonstration project specified in 42 U.S.C. Sec.

2537     1395ss(g)(1), that is advertised, marketed, or designed primarily as a supplement to
2538     reimbursements under Medicare for the hospital, medical, or surgical expenses of persons
2539     eligible for Medicare; and]
2540          [(ii) does not include Medicare Advantage plans established under Medicare Part C,
2541     outpatient prescription drug plans established under Medicare Part D, or any health care
2542     prepayment plan that provides benefits pursuant to an agreement under Section 1833(a)(1)(A)
2543     of the Social Security Act.]
2544          [(g)] (e) "Policy form" means the form on which the policy is delivered or issued for
2545     delivery by the issuer.
2546          (2) (a) Except as otherwise specifically provided, this section applies to:
2547          (i) all Medicare supplement insurance policies delivered or issued for delivery in this
2548     state on or after the effective date of this section;
2549          (ii) all certificates issued under group Medicare supplement insurance policies, that
2550     have been delivered or issued for delivery in this state on or after the effective date of this
2551     section; and
2552          (iii) policies or certificates that were in force prior to the effective date of this section,
2553     with respect to requirements for benefits, claims payment, and policy reporting practice under
2554     Subsection (3)(d), and loss ratios under Subsection (4).
2555          (b) This section does not apply to a policy of one or more employers or labor
2556     organizations, or of the trustees of a fund established by one or more employers or labor
2557     organizations, or a combination of employers and labor unions, for employees or former
2558     employees or a combination of employees and former employees, or for members or former
2559     members of the labor organizations, or a combination of members and former members of
2560     labor organizations.
2561          (c) This section does not prohibit, nor does it apply to insurance policies or health care
2562     benefit plans, including group conversion policies, provided to Medicare eligible persons that
2563     are not marketed or held out to be Medicare supplement insurance policies or benefit plans.
2564          (3) (a) A Medicare supplement insurance policy or certificate in force in the state may
2565     not contain benefits that duplicate benefits provided by Medicare.
2566          (b) Notwithstanding any other provision of law of this state, a Medicare supplement
2567     policy or certificate may not exclude or limit benefits for loss incurred more than six months

2568     from the effective date of coverage because it involved a preexisting condition. The policy or
2569     certificate may not define a preexisting condition more restrictively than: "A condition for
2570     which medical advice was given or treatment was recommended by or received from a
2571     physician within six months before the effective date of coverage."
2572          (c) The commissioner shall adopt rules to establish specific standards for policy
2573     provisions of Medicare supplement insurance policies and certificates. The standards adopted
2574     shall be in addition to and in accordance with applicable laws of this state. A requirement of
2575     this title relating to minimum required policy benefits, other than the minimum standards
2576     contained in this section, may not apply to Medicare supplement insurance policies and
2577     certificates. The standards may include:
2578          (i) terms of renewability;
2579          (ii) initial and subsequent conditions of eligibility;
2580          (iii) nonduplication of coverage;
2581          (iv) probationary periods;
2582          (v) benefit limitations, exceptions, and reductions;
2583          (vi) elimination periods;
2584          (vii) requirements for replacement;
2585          (viii) recurrent conditions; and
2586          (ix) definitions of terms.
2587          (d) The commissioner shall adopt rules establishing minimum standards for benefits,
2588     claims payment, marketing practices, compensation arrangements, and reporting practices for
2589     Medicare supplement insurance policies and certificates.
2590          (e) The commissioner may adopt rules to conform Medicare supplement insurance
2591     policies and certificates to the requirements of federal law and regulations, including:
2592          (i) requiring refunds or credits if the policies do not meet loss ratio requirements;
2593          (ii) establishing a uniform methodology for calculating and reporting loss ratios;
2594          (iii) assuring public access to policies, premiums, and loss ratio information of issuers
2595     of Medicare supplement insurance;
2596          (iv) establishing a process for approving or disapproving policy forms and certificate
2597     forms and proposed premium increases;
2598          (v) establishing a policy for holding public hearings prior to approval of premium

2599     increases;
2600          (vi) establishing standards for Medicare select policies and certificates; and
2601          (vii) nondiscrimination for genetic testing or genetic information.
2602          (f) The commissioner may adopt rules that prohibit policy provisions not otherwise
2603     specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair, or
2604     unfairly discriminatory to any person insured or proposed to be insured under a Medicare
2605     supplement insurance policy or certificate.
2606          (4) Medicare supplement insurance policies shall return to policyholders benefits that
2607     are reasonable in relation to the premium charged. The commissioner shall make rules to
2608     establish minimum standards for loss ratios of Medicare supplement insurance policies on the
2609     basis of incurred claims experience, or incurred health care expenses where coverage is
2610     provided by a health maintenance organization on a service basis rather than on a
2611     reimbursement basis, and earned premiums in accordance with accepted actuarial principles
2612     and practices.
2613          (5) (a) To provide for full and fair disclosure in the sale of [Medicare supplement
2614     policies, a Medicare supplement policy] Medicare supplement insurance, a Medicare
2615     supplement insurance policy or certificate may not be delivered in this state unless an outline of
2616     coverage is delivered to the applicant at the time application is made.
2617          (b) The commissioner shall prescribe the format and content of the outline of coverage
2618     required by Subsection (5)(a).
2619          (c) For purposes of this section, "format" means style arrangements and overall
2620     appearance, including such items as the size, color, and prominence of type and arrangement of
2621     text and captions. The outline of coverage shall include:
2622          (i) a description of the principal benefits and coverage provided in the policy;
2623          (ii) a statement of the renewal provisions, including any reservation by the issuer of a
2624     right to change premiums; and disclosure of the existence of any automatic renewal premium
2625     increases based on the policyholder's age; and
2626          (iii) a statement that the outline of coverage is a summary of the policy issued or
2627     applied for and that the policy should be consulted to determine governing contractual
2628     provisions.
2629          (d) The commissioner may make rules for captions or notice if the commissioner finds

2630     that the rules are:
2631          (i) in the public interest; and
2632          (ii) designed to inform prospective insureds that particular insurance coverages are not
2633     Medicare supplement coverages, for all accident and health insurance policies sold to persons
2634     eligible for Medicare, other than:
2635          (A) a [medicare] Medicare supplement insurance policy; or
2636          (B) a disability income policy.
2637          (e) The commissioner may prescribe by rule a standard form and the contents of an
2638     informational brochure for persons eligible for Medicare, that is intended to improve the
2639     buyer's ability to select the most appropriate coverage and improve the buyer's understanding of
2640     Medicare. Except in the case of direct response insurance policies, the commissioner may
2641     require by rule that the informational brochure be provided concurrently with delivery of the
2642     outline of coverage to any prospective insureds eligible for Medicare. With respect to direct
2643     response insurance policies, the commissioner may require by rule that the prescribed brochure
2644     be provided upon request to any prospective insureds eligible for Medicare, but in no event
2645     later than the time of policy delivery.
2646          (f) The commissioner may adopt reasonable rules to govern the full and fair disclosure
2647     of the information in connection with the replacement of accident and health policies,
2648     subscriber contracts, or certificates by persons eligible for Medicare.
2649          (6) Notwithstanding Subsection (1), Medicare supplement insurance policies and
2650     certificates shall have a notice prominently printed on the first page of the policy or certificate,
2651     or attached to the front page, stating in substance that the applicant has the right to return the
2652     policy or certificate within 30 days of its delivery and to have the premium refunded if, after
2653     examination of the policy or certificate, the applicant is not satisfied for any reason. Any
2654     refund made pursuant to this section shall be paid directly to the applicant by the issuer in a
2655     timely manner.
2656          (7) Every issuer of Medicare supplement insurance policies or certificates in this state
2657     shall provide a copy of any Medicare supplement insurance advertisement intended for use in
2658     this state, whether through written or broadcast medium, to the commissioner for review.
2659          (8) The commissioner may adopt rules to conform Medicare and Medicare supplement
2660     insurance policies and certificates to the marketing requirements of federal law and regulation.

2661          Section 21. Section 31A-22-802 is amended to read:
2662          31A-22-802. Definitions.
2663          As used in this part:
2664          [(1) "Credit accident and health insurance" means insurance on a debtor to provide
2665     indemnity for payments coming due on a specific loan or other credit transaction while the
2666     debtor has a disability.]
2667          [(2) "Credit life insurance" means life insurance on the life of a debtor in connection
2668     with a specific loan or credit transaction.]
2669          [(3)] (1) "Credit transaction" means any transaction under which the payment for
2670     money loaned or for goods, services, or properties sold or leased is to be made on future dates.
2671          [(4)] (2) "Creditor" means the lender of money or the vendor or lessor of goods,
2672     services, or property, for which payment is arranged through a credit transaction, or any
2673     successor to the right, title, or interest of any lender or vendor.
2674          [(5)] (3) "Debtor" means a borrower of money or a purchaser, including a lessee under
2675     a lease intended as security, of goods, services, or property, for which payment is arranged
2676     through a credit transaction.
2677          [(6)] (4) "Indebtedness" means the total amount payable by a debtor to a creditor in
2678     connection with a credit transaction, including principal finance charges and interest.
2679          [(7)] (5) "Net indebtedness" means the total amount required to liquidate the
2680     indebtedness, exclusive of any unearned interest, any insurance on the monthly outstanding
2681     balance coverage, or any finance charge.
2682          [(8)] (6) "Net written premiums" means gross written premiums minus refunds on
2683     termination.
2684          Section 22. Section 31A-22-2002 is amended to read:
2685          31A-22-2002. Definitions.
2686          As used in this part:
2687          (1) "Applicant" means:
2688          (a) when referring to an individual limited long-term care insurance policy, the person
2689     who seeks to contract for benefits; and
2690          (b) when referring to a group limited long-term care insurance policy, the proposed
2691     certificate holder.

2692          (2) "Elimination period" means the length of time between meeting the eligibility for
2693     benefit payment and receiving benefit payments from an insurer.
2694          (3) "Group limited long-term care insurance" means a limited long-term care insurance
2695     policy that is delivered or issued for delivery:
2696          (a) in this state; and
2697          (b) to an eligible group, as described under Subsection [31A-22-701(2)]
2698     31A-22-701(1).
2699          (4) (a) "Limited long-term care insurance" means an insurance policy, endorsement, or
2700     rider that is advertised, marketed, offered, or designed to provide coverage:
2701          (i) for less than 12 consecutive months for each covered person;
2702          (ii) on an expense-incurred, indemnity, prepaid or other basis; and
2703          (iii) for one or more necessary or medically necessary diagnostic, preventative,
2704     therapeutic, rehabilitative, maintenance, or personal care services that is provided in a setting
2705     other than an acute care unit of a hospital.
2706          (b) "Limited long-term care insurance" includes a policy or rider described in
2707     Subsection (4)(a) that provides for payment of benefits based on cognitive impairment or the
2708     loss of functional capacity.
2709          (c) "Limited long-term care insurance" does not include an insurance policy that is
2710     offered primarily to provide:
2711          (i) basic Medicare supplement insurance coverage;
2712          (ii) basic hospital expense coverage;
2713          (iii) basic medical-surgical expense coverage;
2714          (iv) hospital confinement indemnity coverage;
2715          (v) major medical expense coverage;
2716          (vi) disability income or related asset-protection coverage;
2717          (vii) accidental only coverage;
2718          (viii) specified disease or specified accident coverage; or
2719          (ix) limited benefit health coverage.
2720          (5) "Preexisting condition" means a condition for which medical advice or treatment is
2721     recommended:
2722          (a) by, or received from, a provider of health care services; and

2723          (b) within six months before the day on which the coverage of an insured person
2724     becomes effective.
2725          (6) "Waiting period" means the time an insured waits before some or all of the
2726     insured's coverage becomes effective.
2727          Section 23. Section 31A-23a-105 is amended to read:
2728          31A-23a-105. General requirements for individual and agency license issuance
2729     and renewal.
2730          (1) (a) The commissioner shall issue or renew a license to a person described in
2731     Subsection (1)(b) to act as:
2732          (i) a producer;
2733          (ii) a surplus lines producer;
2734          (iii) a limited line producer;
2735          (iv) a consultant;
2736          (v) a managing general agent; or
2737          (vi) a reinsurance intermediary.
2738          (b) The commissioner shall issue or renew a license under Subsection (1)(a) to a
2739     person who, as to the license type and line of authority classification applied for under Section
2740     31A-23a-106:
2741          (i) satisfies the application requirements under Section 31A-23a-104;
2742          (ii) satisfies the character requirements under Section 31A-23a-107;
2743          (iii) satisfies applicable continuing education requirements under Section
2744     31A-23a-202;
2745          (iv) satisfies applicable examination requirements under Section 31A-23a-108;
2746          (v) satisfies applicable training period requirements under Section 31A-23a-203;
2747          (vi) if an applicant for a resident individual producer license, certifies that, to the extent
2748     applicable, the applicant:
2749          (A) is in compliance with Section 31A-23a-203.5; and
2750          (B) will maintain compliance with Section 31A-23a-203.5 during the period for which
2751     the license is issued or renewed;
2752          (vii) has not committed an act that is a ground for denial, suspension, or revocation as
2753     provided in Section 31A-23a-111;

2754          (viii) if a nonresident:
2755          (A) complies with Section 31A-23a-109; and
2756          (B) holds an active similar license in that person's home state;
2757          (ix) if an applicant for an individual title insurance producer or agency title insurance
2758     producer license, satisfies the requirements of Section 31A-23a-204;
2759          (x) if an applicant for a license to act as a life settlement provider or life settlement
2760     producer, satisfies the requirements of Section 31A-23a-117; and
2761          (xi) pays the applicable fees under Section 31A-3-103.
2762          (2) (a) This Subsection (2) applies to the following persons:
2763          (i) an applicant for a pending:
2764          (A) individual or agency producer license;
2765          (B) surplus lines producer license;
2766          (C) limited line producer license;
2767          (D) consultant license;
2768          (E) managing general agent license; or
2769          (F) reinsurance intermediary license; or
2770          (ii) a licensed:
2771          (A) individual or agency producer;
2772          (B) surplus lines producer;
2773          (C) limited line producer;
2774          (D) consultant;
2775          (E) managing general agent; or
2776          (F) reinsurance intermediary.
2777          (b) A person described in Subsection (2)(a) shall report to the commissioner:
2778          (i) an administrative action taken against the person, including a denial of a new or
2779     renewal license application:
2780          (A) in another jurisdiction; or
2781          (B) by another regulatory agency in this state; [and]
2782          (ii) a criminal prosecution taken against the person in any jurisdiction[.]; and
2783          (iii) a civil action filed against the person in any jurisdiction if the action involves
2784     conduct related to a professional or occupational license, certification, authorization, or

2785     registration, regardless of whether the person held the license, certification, authorization, or
2786     registration.
2787          (c) The report required by Subsection (2)(b) shall:
2788          (i) be filed:
2789          (A) at the time the person files the application for an individual or agency license; and
2790          (B) for an action or prosecution that occurs on or after the day on which the person
2791     files the application:
2792          (I) for an administrative action, within 30 days of the final disposition of the
2793     administrative action; or
2794          (II) for a criminal prosecution or civil action, within 30 days of the initial appearance
2795     before a court; and
2796          (ii) include a copy of the complaint or other relevant legal documents related to the
2797     action or prosecution described in Subsection (2)(b).
2798          (3) (a) The department may require a person applying for a license or for consent to
2799     engage in the business of insurance to submit to a criminal background check as a condition of
2800     receiving a license or consent.
2801          (b) A person, if required to submit to a criminal background check under Subsection
2802     (3)(a), shall:
2803          (i) submit a fingerprint card in a form acceptable to the department; and
2804          (ii) consent to a fingerprint background check by:
2805          (A) the Utah Bureau of Criminal Identification; and
2806          (B) the Federal Bureau of Investigation.
2807          (c) For a person who submits a fingerprint card and consents to a fingerprint
2808     background check under Subsection (3)(b), the department may request:
2809          (i) criminal background information maintained pursuant to Title 53, Chapter 10, Part
2810     2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
2811          (ii) complete Federal Bureau of Investigation criminal background checks through the
2812     national criminal history system.
2813          (d) Information obtained by the department from the review of criminal history records
2814     received under this Subsection (3) shall be used by the department for the purposes of:
2815          (i) determining if a person satisfies the character requirements under Section

2816     31A-23a-107 for issuance or renewal of a license;
2817          (ii) determining if a person has failed to maintain the character requirements under
2818     Section 31A-23a-107; and
2819          (iii) preventing a person who violates the federal Violent Crime Control and Law
2820     Enforcement Act of 1994, 18 U.S.C. Sec. 1033, from engaging in the business of insurance in
2821     the state.
2822          (e) If the department requests the criminal background information, the department
2823     shall:
2824          (i) pay to the Department of Public Safety the costs incurred by the Department of
2825     Public Safety in providing the department criminal background information under Subsection
2826     (3)(c)(i);
2827          (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
2828     of Investigation in providing the department criminal background information under
2829     Subsection (3)(c)(ii); and
2830          (iii) charge the person applying for a license or for consent to engage in the business of
2831     insurance a fee equal to the aggregate of Subsections (3)(e)(i) and (ii).
2832          (4) To become a resident licensee in accordance with Section 31A-23a-104 and this
2833     section, a person licensed as one of the following in another state who moves to this state shall
2834     apply within 90 days of establishing legal residence in this state:
2835          (a) insurance producer;
2836          (b) surplus lines producer;
2837          (c) limited line producer;
2838          (d) consultant;
2839          (e) managing general agent; or
2840          (f) reinsurance intermediary.
2841          (5) (a) The commissioner may deny a license application for a license listed in
2842     Subsection (5)(b) if the person applying for the license, as to the license type and line of
2843     authority classification applied for under Section 31A-23a-106:
2844          (i) fails to satisfy the requirements as set forth in this section; or
2845          (ii) commits an act that is grounds for denial, suspension, or revocation as set forth in
2846     Section 31A-23a-111.

2847          (b) This Subsection (5) applies to the following licenses:
2848          (i) producer;
2849          (ii) surplus lines producer;
2850          (iii) limited line producer;
2851          (iv) consultant;
2852          (v) managing general agent; or
2853          (vi) reinsurance intermediary.
2854          (6) Notwithstanding the other provisions of this section, the commissioner may:
2855          (a) issue a license to an applicant for a license for a title insurance line of authority only
2856     with the concurrence of the Title and Escrow Commission; and
2857          (b) renew a license for a title insurance line of authority only with the concurrence of
2858     the Title and Escrow Commission.
2859          Section 24. Section 31A-23a-111 is amended to read:
2860          31A-23a-111. Revoking, suspending, surrendering, lapsing, limiting, or otherwise
2861     terminating a license -- Forfeiture -- Rulemaking for renewal or reinstatement.
2862          (1) A license type issued under this chapter remains in force until:
2863          (a) revoked or suspended under Subsection (5);
2864          (b) surrendered to the commissioner and accepted by the commissioner in lieu of
2865     administrative action;
2866          (c) the licensee dies or is adjudicated incompetent as defined under:
2867          (i) Title 75, Chapter 5, Part 3, Guardians of Incapacitated Persons; or
2868          (ii) Title 75, Chapter 5, Part 4, Protection of Property of Persons Under Disability and
2869     Minors;
2870          (d) lapsed under Section 31A-23a-113; or
2871          (e) voluntarily surrendered.
2872          (2) The following may be reinstated within one year after the day on which the license
2873     is no longer in force:
2874          (a) a lapsed license; or
2875          (b) a voluntarily surrendered license, except that a voluntarily surrendered license may
2876     not be reinstated after the license period in which the license is voluntarily surrendered.
2877          (3) Unless otherwise stated in a written agreement for the voluntary surrender of a

2878     license, submission and acceptance of a voluntary surrender of a license does not prevent the
2879     department from pursuing additional disciplinary or other action authorized under:
2880          (a) this title; or
2881          (b) rules made under this title in accordance with Title 63G, Chapter 3, Utah
2882     Administrative Rulemaking Act.
2883          (4) A line of authority issued under this chapter remains in force until:
2884          (a) the qualifications pertaining to a line of authority are no longer met by the licensee;
2885          (b) the supporting license type:
2886          (i) is revoked or suspended under Subsection (5);
2887          (ii) is surrendered to the commissioner and accepted by the commissioner in lieu of
2888     administrative action;
2889          (iii) lapses under Section 31A-23a-113; or
2890          (iv) is voluntarily surrendered; or
2891          (c) the licensee dies or is adjudicated incompetent as defined under:
2892          (i) Title 75, Chapter 5, Part 3, Guardians of Incapacitated Persons; or
2893          (ii) Title 75, Chapter 5, Part 4, Protection of Property of Persons Under Disability and
2894     Minors.
2895          (5) (a) If the commissioner makes a finding under Subsection (5)(b), as part of an
2896     adjudicative proceeding under Title 63G, Chapter 4, Administrative Procedures Act, the
2897     commissioner may:
2898          (i) revoke:
2899          (A) a license; or
2900          (B) a line of authority;
2901          (ii) suspend for a specified period of 12 months or less:
2902          (A) a license; or
2903          (B) a line of authority;
2904          (iii) limit in whole or in part:
2905          (A) a license; or
2906          (B) a line of authority;
2907          (iv) deny a license application;
2908          (v) assess a forfeiture under Subsection 31A-2-308(1)(b)(i) or (1)(c)(i); or

2909          (vi) take a combination of actions under Subsections (5)(a)(i) through (iv) and
2910     Subsection (5)(a)(v).
2911          (b) The commissioner may take an action described in Subsection (5)(a) if the
2912     commissioner finds that the licensee or license applicant:
2913          (i) is unqualified for a license or line of authority under Section 31A-23a-104,
2914     31A-23a-105, or 31A-23a-107;
2915          (ii) violates:
2916          (A) an insurance statute;
2917          (B) a rule that is valid under Subsection 31A-2-201(3); or
2918          (C) an order that is valid under Subsection 31A-2-201(4);
2919          (iii) is insolvent or the subject of receivership, conservatorship, rehabilitation, or other
2920     delinquency proceedings in any state;
2921          (iv) [fails to pay a final judgment rendered against the person within 60 days after the
2922     day on which the judgment became final] is more than 60 days past due on an enforceable final
2923     judgment;
2924          (v) fails to meet the same good faith obligations in claims settlement that is required of
2925     admitted insurers;
2926          (vi) is affiliated with and under the same general management or interlocking
2927     directorate or ownership as another insurance producer that transacts business in this state
2928     without a license;
2929          (vii) refuses:
2930          (A) to be examined; or
2931          (B) to produce its accounts, records, and files for examination;
2932          (viii) has an officer who refuses to:
2933          (A) give information with respect to the insurance producer's affairs; or
2934          (B) perform any other legal obligation as to an examination;
2935          (ix) provides information in the license application that is:
2936          (A) incorrect;
2937          (B) misleading;
2938          (C) incomplete; or
2939          (D) materially untrue;

2940          (x) violates an insurance law, valid rule, or valid order of another regulatory agency in
2941     any jurisdiction;
2942          (xi) obtains or attempts to obtain a license through misrepresentation or fraud;
2943          (xii) improperly withholds, misappropriates, or converts money or properties received
2944     in the course of doing insurance business;
2945          (xiii) intentionally misrepresents the terms of an actual or proposed:
2946          (A) insurance contract;
2947          (B) application for insurance; or
2948          (C) life settlement;
2949          (xiv) has been convicted of, or has entered a plea in abeyance as defined in Section
2950     77-2a-1 to:
2951          (A) a felony; or
2952          (B) a misdemeanor involving fraud, misrepresentation, theft, or dishonesty;
2953          (xv) admits or is found to have committed an insurance unfair trade practice or fraud;
2954          (xvi) in the conduct of business in this state or elsewhere:
2955          (A) uses fraudulent, coercive, or dishonest practices; or
2956          (B) demonstrates incompetence, untrustworthiness, or financial irresponsibility;
2957          (xvii) has had an insurance license or other professional or occupational license, or an
2958     equivalent to an insurance license or registration, or other professional or occupational license
2959     or registration:
2960          (A) denied;
2961          (B) suspended;
2962          (C) revoked; or
2963          (D) surrendered to resolve an administrative action;
2964          (xviii) forges another's name to:
2965          (A) an application for insurance; or
2966          (B) a document related to an insurance transaction;
2967          (xix) improperly uses notes or another reference material to complete an examination
2968     for an insurance license;
2969          (xx) knowingly accepts insurance business from an individual who is not licensed;
2970          (xxi) fails to comply with an administrative or court order imposing a child support

2971     obligation;
2972          (xxii) fails to:
2973          (A) pay state income tax; or
2974          (B) comply with an administrative or court order directing payment of state income
2975     tax;
2976          (xxiii) has been convicted of violating the federal Violent Crime Control and Law
2977     Enforcement Act of 1994, 18 U.S.C. Sec. 1033 and has not obtained written consent to engage
2978     in the business of insurance or participate in such business as required by 18 U.S.C. Sec. 1033;
2979          (xxiv) engages in a method or practice in the conduct of business that endangers the
2980     legitimate interests of customers and the public; or
2981          (xxv) has been convicted of any criminal felony involving dishonesty or breach of trust
2982     and has not obtained written consent to engage in the business of insurance or participate in
2983     such business as required by 18 U.S.C. Sec. 1033.
2984          (c) For purposes of this section, if a license is held by an agency, both the agency itself
2985     and any individual designated under the license are considered to be the holders of the license.
2986          (d) If an individual designated under the agency license commits an act or fails to
2987     perform a duty that is a ground for suspending, revoking, or limiting the individual's license,
2988     the commissioner may suspend, revoke, or limit the license of:
2989          (i) the individual;
2990          (ii) the agency, if the agency:
2991          (A) is reckless or negligent in its supervision of the individual; or
2992          (B) knowingly participates in the act or failure to act that is the ground for suspending,
2993     revoking, or limiting the license; or
2994          (iii) (A) the individual; and
2995          (B) the agency if the agency meets the requirements of Subsection (5)(d)(ii).
2996          (6) A licensee under this chapter is subject to the penalties for acting as a licensee
2997     without a license if:
2998          (a) the licensee's license is:
2999          (i) revoked;
3000          (ii) suspended;
3001          (iii) limited;

3002          (iv) surrendered in lieu of administrative action;
3003          (v) lapsed; or
3004          (vi) voluntarily surrendered; and
3005          (b) the licensee:
3006          (i) continues to act as a licensee; or
3007          (ii) violates the terms of the license limitation.
3008          (7) A licensee under this chapter shall immediately report to the commissioner:
3009          (a) a revocation, suspension, or limitation of the person's license in another state, the
3010     District of Columbia, or a territory of the United States;
3011          (b) the imposition of a disciplinary sanction imposed on that person by another state,
3012     the District of Columbia, or a territory of the United States; or
3013          (c) a judgment or injunction entered against that person on the basis of conduct
3014     involving:
3015          (i) fraud;
3016          (ii) deceit;
3017          (iii) misrepresentation; or
3018          (iv) a violation of an insurance law or rule.
3019          (8) (a) An order revoking a license under Subsection (5) or an agreement to surrender a
3020     license in lieu of administrative action may specify a time, not to exceed five years, within
3021     which the former licensee may not apply for a new license.
3022          (b) If no time is specified in an order or agreement described in Subsection (8)(a), the
3023     former licensee may not apply for a new license for five years from the day on which the order
3024     or agreement is made without the express approval by the commissioner.
3025          (9) The commissioner shall promptly withhold, suspend, restrict, or reinstate the use of
3026     a license issued under this part if so ordered by a court.
3027          (10) The commissioner shall by rule prescribe the license renewal and reinstatement
3028     procedures in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
3029          Section 25. Section 31A-23a-119 is enacted to read:
3030          31A-23a-119. Special requirements for agency title insurance producers.
3031          (1) As used in this section:
3032          (a) "Applicable percentage" means:

3033          (i) on February 1, 2024, through January 31, 2025, 2.5%;
3034          (ii) on February 1, 2025, through January 31, 2026, 3%;
3035          (iii) on February 1, 2026, through January 31, 2027, 3.5%;
3036          (iv) on February 1, 2027, through January 31, 2028, 4%; and
3037          (v) on February 1, 2028, through January 31, 2029, 4.5%.
3038          (b) "Sufficient capital and net worth" means:
3039          (i) for a new title entity:
3040          (A) $100,000 for the first five years after becoming a new agency title insurance
3041     producer; or
3042          (B) after the first five years after becoming a new agency title insurance producer, the
3043     greater of $50,000, or on February 1 of each year, an amount equal to 5% of the title entity's
3044     average annual gross revenue over the preceding two calendar years, up to $150,000; or
3045          (ii) for a title entity licensed before May 14, 2019:
3046          (A) for the time period beginning on February 1, 2020, and ending on January 31,
3047     2029, the lesser of an amount equal to the applicable percentage of the title entity's average
3048     annual gross revenue over the two calendar years immediately preceding the February 1 on
3049     which the applicable percentage applies or $150,000; and
3050          (B) beginning on February 1, 2029, the greater of $50,000 or an amount equal to 5% of
3051     the title entity's average annual gross revenue over the preceding two calendar years, up to
3052     $150,000.
3053          (2) Before May 1 of each year, each agency title insurance producer shall submit a
3054     report to the commissioner containing proof satisfactory to the commissioner that the agency
3055     title insurance producer had sufficient capital and net worth for the preceding calendar year.
3056          Section 26. Section 31A-23a-406 is amended to read:
3057          31A-23a-406. Title insurance producer's business.
3058          (1) As used in this section:
3059          (a) "Automated clearing house network" or "ACH network" means a national
3060     electronic funds transfer system regulated by the Federal Reserve and the Office of the
3061     Comptroller of the Currency.
3062          (b) "Depository institution" means the same as that term is defined in Section 7-1-103.
3063          (c) "Funds transfer system" means the same as that term is defined in Section

3064     [7-1-103.] 70A-4a-105.
3065          (2) An individual title insurance producer or agency title insurance producer may do
3066     escrow involving real property transactions if all of the following exist:
3067          (a) the individual title insurance producer or agency title insurance producer is licensed
3068     with:
3069          (i) the title line of authority; and
3070          (ii) the escrow subline of authority;
3071          (b) the individual title insurance producer or agency title insurance producer is
3072     appointed by a title insurer authorized to do business in the state;
3073          (c) except as provided in Subsection (4), the individual title insurance producer or
3074     agency title insurance producer issues one or more of the following as part of the transaction:
3075          (i) an owner's policy offering title insurance;
3076          (ii) a lender's policy offering title insurance; or
3077          (iii) if the transaction does not involve a transfer of ownership, an endorsement to an
3078     owner's or a lender's policy offering title insurance;
3079          (d) money deposited with the individual title insurance producer or agency title
3080     insurance producer in connection with any escrow is deposited:
3081          (i) in a federally insured depository institution, as defined in Section 7-1-103, that:
3082          (A) has a branch in this state, if the individual title insurance producer or agency title
3083     insurance producer depositing the money is a resident licensee; and
3084          (B) is authorized by the depository institution's primary regulator to engage in trust
3085     business, as defined in Section 7-5-1, in this state; and
3086          (ii) in a trust account that is separate from all other trust account money that is not
3087     related to real estate transactions;
3088          (e) money deposited with the individual title insurance producer or agency title
3089     insurance producer in connection with any escrow is the property of the one or more persons
3090     entitled to the money under the provisions of the escrow;
3091          (f) money deposited with the individual title insurance producer or agency title
3092     insurance producer in connection with an escrow is segregated escrow by escrow in the records
3093     of the individual title insurance producer or agency title insurance producer;
3094          (g) earnings on money held in escrow may be paid out of the [escrow] trust account to

3095     any person in accordance with the conditions of the escrow;
3096          (h) the escrow does not require the individual title insurance producer or agency title
3097     insurance producer to hold:
3098          (i) construction money; or
3099          (ii) money held for exchange under Section 1031, Internal Revenue Code; and
3100          (i) the individual title insurance producer or agency title insurance producer shall
3101     maintain a physical office in Utah staffed by a person with an escrow subline of authority who
3102     processes the escrow.
3103          (3) Notwithstanding Subsection (2), an individual title insurance producer or agency
3104     title insurance producer may engage in the escrow business if:
3105          (a) the escrow involves:
3106          (i) a mobile home;
3107          (ii) a grazing right;
3108          (iii) a water right; or
3109          (iv) other personal property authorized by the commissioner; and
3110          (b) the individual title insurance producer or agency title insurance producer complies
3111     with this section except for Subsection (2)(c).
3112          (4) (a) Subsection (2)(c) does not apply if the transaction is for the transfer of real
3113     property from the School and Institutional Trust Lands Administration.
3114          (b) This subsection does not prohibit an individual title insurance producer or agency
3115     title insurance producer from issuing a policy described in Subsection (2)(c) as part of a
3116     transaction described in Subsection (4)(a).
3117          (5) Money held in escrow:
3118          (a) is not subject to any debts of the individual title insurance producer or agency title
3119     insurance producer;
3120          (b) may only be used to fulfill the terms of the individual escrow under which the
3121     money is accepted; and
3122          (c) may not be used until the conditions of the escrow are met.
3123          (6) Assets or property other than escrow money received by an individual title
3124     insurance producer or agency title insurance producer in accordance with an escrow shall be
3125     maintained in a manner that will:

3126          (a) reasonably preserve and protect the asset or property from loss, theft, or damages;
3127     and
3128          (b) otherwise comply with the general duties and responsibilities of a fiduciary or
3129     bailee.
3130          (7) (a) A check from the trust account described in Subsection (2)(d) may not be
3131     drawn, executed, or dated, or money otherwise disbursed unless the segregated [escrow] trust
3132     account from which money is to be disbursed contains a sufficient credit balance consisting of
3133     collected and cleared money at the time the check is drawn, executed, or dated, or money is
3134     otherwise disbursed.
3135          (b) As used in this Subsection (7), money is considered to be "collected and cleared,"
3136     and may be disbursed as follows:
3137          (i) cash may be disbursed on the same day the cash is deposited;
3138          (ii) a wire transfer may be disbursed on the same day the wire transfer is deposited;
3139          (iii) the proceeds of one or more of the following financial instruments may be
3140     disbursed on the same day the financial instruments are deposited if received from a single
3141     party to the real estate transaction and if the aggregate of the financial instruments for the real
3142     estate transaction is less than $10,000:
3143          (A) a cashier's check, certified check, or official check that is drawn on an existing
3144     account at a federally insured financial institution;
3145          (B) a check drawn on the trust account of a principal broker or associate broker
3146     licensed under Title 61, Chapter 2f, Real Estate Licensing and Practices Act, if the individual
3147     title insurance producer or agency title insurance producer has reasonable and prudent grounds
3148     to believe sufficient money will be available from the trust account on which the check is
3149     drawn at the time of disbursement of proceeds from the individual title insurance producer or
3150     agency title insurance producer's [escrow] trust account;
3151          (C) a personal check not to exceed $500 per closing; or
3152          (D) a check drawn on the [escrow] trust account of another individual title insurance
3153     producer or agency title insurance producer, if the individual title insurance producer or agency
3154     title insurance producer in the escrow transaction has reasonable and prudent grounds to
3155     believe that sufficient money will be available for withdrawal from the account upon which the
3156     check is drawn at the time of disbursement of money from the [escrow] trust account of the

3157     individual title insurance producer or agency title insurance producer in the escrow transaction;
3158          (iv) deposits made through the ACH network may be disbursed on the same day the
3159     deposit is made if:
3160          (A) the transferred funds remain uniquely designated and traceable throughout the
3161     entire ACH network transfer process;
3162          (B) except as a function of the ACH network process, the transferred funds are not
3163     subject to comingling or third party access during the transfer process;
3164          (C) the transferred funds are deposited into the title insurance producer's [escrow] trust
3165     account and are available for disbursement; and
3166          (D) either the ACH network payment type or the title insurance producer's systems
3167     prevent the transaction from being unilaterally canceled or reversed by the consumer once the
3168     transferred funds are deposited to the individual title insurance producer or agency title
3169     producer; or
3170          (v) deposits may be disbursed on the same day the deposit is made if the deposit is
3171     made via:
3172          (A) the Federal Reserve Bank through the Federal Reserve's Fedwire funds transfer
3173     system; or
3174          (B) a funds transfer system provided by an association of [banks] federally insured
3175     depository institutions.
3176          (c) A check or deposit not described in Subsection (7)(b) may be disbursed:
3177          (i) within the time limits provided under the Expedited Funds Availability Act, 12
3178     U.S.C. Sec. 4001 et seq., as amended, and related regulations of the Federal Reserve System; or
3179          (ii) upon notification from the financial institution to which the money has been
3180     deposited that final settlement has occurred on the deposited financial instrument.
3181          (8) An individual title insurance producer or agency title insurance producer shall
3182     maintain a record of a receipt or disbursement of escrow money.
3183          (9) An individual title insurance producer or agency title insurance producer shall
3184     comply with:
3185          (a) Section 31A-23a-409;
3186          (b) Title 46, Chapter 1, Notaries Public Reform Act; and
3187          (c) any rules adopted by the Title and Escrow Commission, subject to Section

3188     31A-2-404, that govern escrows.
3189          (10) If an individual title insurance producer or agency title insurance producer
3190     conducts a search for real estate located in the state, the individual title insurance producer or
3191     agency title insurance producer shall conduct a reasonable search of the public records.
3192          Section 27. Section 31A-23a-413 is amended to read:
3193          31A-23a-413. Title insurance producer's annual report.
3194          An agency title insurance producer [and an individual title insurance producer who is
3195     not an employee of a title insurer or who has not been designated by an agency title insurance
3196     producer] shall annually file with the commissioner, by a date and in a form the commissioner
3197     specifies by rule, a verified statement of the agency title insurance producer's [or individual
3198     title insurance producer's] financial condition, transactions, and affairs as of the end of the
3199     preceding calendar year.
3200          Section 28. Section 31A-26-301.6 is amended to read:
3201          31A-26-301.6. Health care claims practices.
3202          (1) As used in this section:
3203          Ĥ→ [
[] (a) "Health care provider" means a person licensed to provide health care
3203a     under: [
]] ←Ĥ
3204          Ĥ→ [
[] (i) Title 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection;
3204a     or [
]] ←Ĥ
3205          Ĥ→ [
[] (ii) Title 58, Occupations and Professions. []] ←Ĥ
3206          Ĥ→ [
[] (b) []] [(a)] ←Ĥ "Insurer" means an admitted or authorized insurer, as defined in
3206a     Section
3207     31A-1-301, and includes:
3208          (i) a health maintenance organization; and
3209          (ii) a third party administrator that is subject to this title, provided that nothing in this
3210     section may be construed as requiring a third party administrator to use its own funds to pay
3211     claims that have not been funded by the entity for which the third party administrator is paying
3212     claims.
3213          Ĥ→ [
[] (c) []] [(b)] ←Ĥ "Provider" means a health care provider to whom an insurer is
3213a     obligated to pay
3214     directly in connection with a claim by virtue of:
3215          (i) an agreement between the insurer and the provider;
3216          (ii) [a] an accident and health insurance policy or contract of the insurer; or
3217          (iii) state or federal law.
3218          (2) An insurer shall timely pay every valid insurance claim submitted by a provider in
3219     accordance with this section.
3220          (3) (a) Except as provided in Subsection (4), within 30 days of the day on which the
3221     insurer receives a written claim, an insurer shall:
3222          (i) pay the claim; or
3223          (ii) deny the claim and provide a written explanation for the denial.
3224          (b) (i) Subject to Subsection (3)(b)(ii), the time period described in Subsection (3)(a)
3225     may be extended by 15 days if the insurer:
3226          (A) determines that the extension is necessary due to matters beyond the control of the
3227     insurer; and
3228          (B) before the end of the 30-day period described in Subsection (3)(a), notifies the
3229     provider and insured in writing of:
3230          (I) the circumstances requiring the extension of time; and
3231          (II) the date by which the insurer expects to pay the claim or deny the claim with a
3232     written explanation for the denial.
3233          (ii) If an extension is necessary due to a failure of the provider or insured to submit the
3234     information necessary to decide the claim:
3235          (A) the notice of extension required by this Subsection (3)(b) shall specifically describe
3236     the required information; and
3237          (B) the insurer shall give the provider or insured at least 45 days from the day on which
3238     the provider or insured receives the notice before the insurer denies the claim for failure to
3239     provide the information requested in Subsection (3)(b)(ii)(A).
3240          (4) (a) In the case of a claim for income replacement benefits, within 45 days of the day
3241     on which the insurer receives a written claim, an insurer shall:
3242          (i) pay the claim; or
3243          (ii) deny the claim and provide a written explanation of the denial.
3244          (b) Subject to Subsections (4)(d) and (e), the time period described in Subsection (4)(a)
3245     may be extended for 30 days if the insurer:
3246          (i) determines that the extension is necessary due to matters beyond the control of the
3247     insurer; and
3248          (ii) before the expiration of the 45-day period described in Subsection (4)(a), notifies
3249     the insured of:

3250          (A) the circumstances requiring the extension of time; and
3251          (B) the date by which the insurer expects to pay the claim or deny the claim with a
3252     written explanation for the denial.
3253          (c) Subject to Subsections (4)(d) and (e), the time period for complying with
3254     Subsection (4)(a) may be extended for up to an additional 30 days from the day on which the
3255     30-day extension period provided in Subsection (4)(b) ends if before the day on which the
3256     30-day extension period ends, the insurer:
3257          (i) determines that due to matters beyond the control of the insurer a decision cannot be
3258     rendered within the 30-day extension period; and
3259          (ii) notifies the insured of:
3260          (A) the circumstances requiring the extension; and
3261          (B) the date as of which the insurer expects to pay the claim or deny the claim with a
3262     written explanation for the denial.
3263          (d) A notice of extension under this Subsection (4) shall specifically explain:
3264          (i) the standards on which entitlement to a benefit is based; and
3265          (ii) the unresolved issues that prevent a decision on the claim.
3266          (e) If an extension allowed by Subsection (4)(b) or (c) is necessary due to a failure of
3267     the insured to submit the information necessary to decide the claim:
3268          (i) the notice of extension required by Subsection (4)(b) or (c) shall specifically
3269     describe the necessary information; and
3270          (ii) the insurer shall give the insured at least 45 days from the day on which the insured
3271     receives the notice before the insurer denies the claim for failure to provide the information
3272     requested in Subsection (4)(b) or (c).
3273          (5) If a period of time is extended as permitted under Subsection (3)(b), (4)(b), or
3274     (4)(c), due to an insured or provider failing to submit information necessary to decide a claim,
3275     the period for making the benefit determination shall be tolled from the date on which the
3276     notification of the extension is sent to the insured or provider until the date on which the
3277     insured or provider responds to the request for additional information.
3278          (6) An insurer shall pay all sums to the provider or insured that the insurer is obligated
3279     to pay on the claim, and provide a written explanation of the insurer's decision regarding any
3280     part of the claim that is denied within 20 days of receiving the information requested under

3281     Subsection (3)(b), (4)(b), or (4)(c).
3282          (7) (a) Whenever an insurer makes a payment to a provider on any part of a claim
3283     under this section, the insurer shall also send to the insured an explanation of benefits paid.
3284          (b) Whenever an insurer denies any part of a claim under this section, the insurer shall
3285     also send to the insured:
3286          (i) a written explanation of the part of the claim that was denied; and
3287          (ii) notice of the adverse benefit determination review process established under
3288     Section 31A-22-629.
3289          (c) This Subsection (7) does not apply to a person receiving benefits under the state
3290     Medicaid program as defined in Section 26B-3-101, unless required by the Department of
3291     Health and Human Services or federal law.
3292          (8) (a) A late fee shall be imposed on:
3293          (i) an insurer that fails to timely pay a claim in accordance with this section; and
3294          (ii) a provider that fails to timely provide information on a claim in accordance with
3295     this section.
3296          (b) The late fee described in Subsection (8)(a) shall be determined by multiplying
3297     together:
3298          (i) the total amount of the claim the insurer is obliged to pay;
3299          (ii) the total number of days the response or the payment is late; and
3300          (iii) 0.033% daily interest rate.
3301          (c) Any late fee paid or collected under this Subsection (8) shall be separately
3302     identified on the documentation used by the insurer to pay the claim.
3303          (d) For purposes of this Subsection (8), "late fee" does not include an amount that is
3304     less than $1.
3305          (9) Each insurer shall establish a review process to resolve claims-related disputes
3306     between the insurer and providers.
3307          (10) An insurer or person representing an insurer may not engage in any unfair claim
3308     settlement practice with respect to a provider. Unfair claim settlement practices include:
3309          (a) knowingly misrepresenting a material fact or the contents of an insurance policy in
3310     connection with a claim;
3311          (b) failing to acknowledge and substantively respond within 15 days to any written

3312     communication from a provider relating to a pending claim;
3313          (c) denying or threatening to deny the payment of a claim for any reason that is not
3314     clearly described in the insured's policy;
3315          (d) failing to maintain a payment process sufficient to comply with this section;
3316          (e) failing to maintain claims documentation sufficient to demonstrate compliance with
3317     this section;
3318          (f) failing, upon request, to give to the provider written information regarding the
3319     specific rate and terms under which the provider will be paid for health care services;
3320          (g) failing to timely pay a valid claim in accordance with this section as a means of
3321     influencing, intimidating, retaliating, or gaining an advantage over the provider with respect to
3322     an unrelated claim, an undisputed part of a pending claim, or some other aspect of the
3323     contractual relationship;
3324          (h) failing to pay the sum when required and as required under Subsection (8) when a
3325     violation has occurred;
3326          (i) threatening to retaliate or actual retaliation against a provider for the provider
3327     applying this section;
3328          (j) any material violation of this section; and
3329          (k) any other unfair claim settlement practice established in rule or law.
3330          (11) (a) The provisions of this section shall apply to each contract between an insurer
3331     and a provider for the duration of the contract.
3332          (b) Notwithstanding Subsection (11)(a), this section may not be the basis for a bad
3333     faith insurance claim.
3334          (c) Nothing in Subsection (11)(a) may be construed as limiting the ability of an insurer
3335     and a provider from including provisions in their contract that are more stringent than the
3336     provisions of this section.
3337          (12) (a) Pursuant to Chapter 2, Part 2, Duties and Powers of Commissioner, the
3338     commissioner may conduct examinations to determine an insurer's level of compliance with
3339     this section and impose sanctions for each violation.
3340          (b) The commissioner may adopt rules only as necessary to implement this section.
3341          (c) The commissioner may establish rules to facilitate the exchange of electronic
3342     confirmations when claims-related information has been received.

3343          (d) Notwithstanding Subsection (12)(b), the commissioner may not adopt rules
3344     regarding the review process required by Subsection (9).
3345          (13) Nothing in this section may be construed as limiting the collection rights of a
3346     provider under Section 31A-26-301.5.
3347          (14) Nothing in this section may be construed as limiting the ability of an insurer to:
3348          (a) recover any amount improperly paid to a provider or an insured:
3349          (i) in accordance with Section 31A-31-103 or any other provision of state or federal
3350     law;
3351          (ii) within 24 months of the amount improperly paid for a coordination of benefits
3352     error;
3353          (iii) within 12 months of the amount improperly paid for any other reason not
3354     identified in Subsection (14)(a)(i) or (ii); or
3355          (iv) within 36 months of the amount improperly paid when the improper payment was
3356     due to a recovery by Medicaid, Medicare, the Children's Health Insurance Program, or any
3357     other state or federal health care program;
3358          (b) take any action against a provider that is permitted under the terms of the provider
3359     contract and not prohibited by this section;
3360          (c) report the provider to a state or federal agency with regulatory authority over the
3361     provider for unprofessional, unlawful, or fraudulent conduct; or
3362          (d) enter into a mutual agreement with a provider to resolve alleged violations of this
3363     section through mediation or binding arbitration.
3364          (15) A [health care] provider may only seek recovery from the insurer for an amount
3365     improperly paid by the insurer within the same time frames as Subsections (14)(a) and (b).
3366          (16) (a) An insurer may offer the remittance of payment through a credit card or other
3367     similar arrangement.
3368          (b) (i) A [health care] provider may elect not to receive remittance through a credit card
3369     or other similar arrangement.
3370          (ii) An insurer:
3371          (A) shall permit a [health care] provider's election described in Subsection (16)(b)(i) to
3372     apply to the [health care] provider's entire practice; and
3373          (B) may not require a [health care] provider's election described in Subsection

3374     (16)(b)(i) to be made on a patient-by-patient basis.
3375          (c) An insurer may not require a [health care] provider or insured to accept remittance
3376     through a credit card or other similar arrangement.
3377          Section 29. Section 31A-27a-108.1 is enacted to read:
3378          31A-27a-108.1. Injunctions and orders applicable to a federal home loan bank.
3379          (1) As used in this section:
3380          (a) "Federal home loan bank" means the same as that term is defined in 12 U.S.C. Sec.
3381     1422.
3382          (b) "Insurer-member" means an insurer that is a member as defined in 12 U.S.C. Sec.
3383     1422.
3384          (2) (a) Notwithstanding any other provision of this chapter, after the seventh day
3385     following the filing of a delinquency proceeding, a state court may not stay or prohibit a federal
3386     home loan bank from exercising its rights regarding collateral pledged by an insurer-member.
3387          (b) A federal home loan bank may repurchase any outstanding capital stock that is in
3388     excess of the amount of federal home loan bank stock that the federal loan bank requires the
3389     insurer-member to hold as a minimum investment if:
3390          (i) the insurer-member is subject to a delinquency proceeding;
3391          (ii) the federal home loan bank exercises the federal home loan bank's rights regarding
3392     collateral pledged by the insurer-member;
3393          (iii) the federal home loan bank, in good faith, determines the repurchase is permissible
3394     under applicable laws, regulations, regulatory obligations, and the federal home loan bank's
3395     capital plan; and
3396          (iv) the repurchase is consistent with the federal home loan bank's current capital stock
3397     practices that apply to the federal home loan bank's entire membership.
3398          (c) Subject to Subsection (2)(d), after a court appoints a receiver for an
3399     insurer-member, a federal home loan bank shall provide the receiver a process, and establish a
3400     timeline, for the following:
3401          (i) the release of collateral that exceeds the amount required to support secured
3402     obligations remaining after any repayment of loans as determined in accordance with the
3403     applicable agreements between the federal home loan bank and the insurer-member;
3404          (ii) the release of any of the insurer-member's collateral remaining in the federal home

3405     loan bank's possession following full repayment of all outstanding secured obligations of the
3406     insurer-member;
3407          (iii) the payment of fees owed by the insurer-member and the operation of deposits and
3408     other accounts of the insurer-member with the federal home loan bank; and
3409          (iv) the possible redemption or repurchase of federal home loan bank stock or excess
3410     stock of any class that an insurer-member is required to own.
3411          (d) An insurer-member shall provide the information described in Subsection (2)(c)
3412     within 10 business days after the day on which the receiver requests the information.
3413          (e) Upon request from a receiver, a federal home loan bank shall provide any available
3414     options for an insurer-member subject to a delinquency proceeding to renew or restructure a
3415     loan to defer associated prepayment fees, subject to:
3416          (i) market conditions;
3417          (ii) the terms of any loan outstanding to the insurer-member;
3418          (iii) the applicable policies of the federal home loan bank; and
3419          (iv) the federal home loan bank's compliance with federal laws and regulations.
3420          (3) (a) Notwithstanding any other provision of this chapter, the receiver for an
3421     insurer-member may not void any transfer of, or any obligation to transfer, money or any other
3422     property arising under or in connection with:
3423          (i) any federal home loan bank security agreement;
3424          (ii) any pledge, security, collateral, or guarantee agreement; or
3425          (iii) any other similar arrangement or credit enhancement relating to a federal home
3426     loan bank security agreement made in the ordinary course of business and in compliance with
3427     the applicable federal home loan bank agreement.
3428          (b) Notwithstanding Subsection (3)(a), an insurer-member may avoid a transfer if a
3429     party to the transfer made the transfer with intent to hinder, delay, or defraud the
3430     insurer-member, the receiver for the insurer-member, or an existing or future creditor.
3431          (c) This subsection shall not affect a receiver's rights regarding advances to an
3432     insurer-member in a delinquency proceeding pursuant to 12 C.F.R. Sec. 1266.4.
3433          Section 30. Section 31A-28-113 is amended to read:
3434          31A-28-113. Credit for assessments paid.
3435          (1) (a) A member insurer may offset against its premium tax, income tax, or franchise

3436     tax liability to this state an assessment described in Subsection 31A-28-109(2)(b) to the extent
3437     of 20% of the amount of the assessment for each of the five calendar years following the year
3438     in which the assessment was paid.
3439          (b) To the extent that the offsets described in Subsection (1)(a) exceed [premium] tax
3440     liability, the offsets may be carried forward and used to offset [premium] tax liability in future
3441     years.
3442          (c) If a member insurer ceases doing business, all uncredited assessments may be
3443     credited against its [premium] tax liability for the year it ceases doing business.
3444          (2) (a) A member insurer that is exempt from taxes described in Subsection (1) may
3445     recoup the member insurer's assessment by a surcharge on premiums in a sum reasonably
3446     calculated to recoup the assessments over a reasonable period of time, as approved by the
3447     commissioner.
3448          (b) Amounts recouped shall not be considered premiums for any other purpose,
3449     including the computation of gross premium tax, income tax, franchise tax, producer
3450     commission, or, to the extent allowed under federal law, medical loss ratio.
3451          (c) If a member insurer collects excess surcharges, the member insurer shall remit the
3452     excess amount to the association, and the excess amount shall be applied to reduce future
3453     assessments in the appropriate account.
3454          (3) (a) Money shall be paid by the member insurers to the state in a manner required by
3455     the State Tax Commission if the money:
3456          (i) is acquired by refund in accordance with Subsection 31A-28-109(6) from the
3457     association by member insurers; and
3458          (ii) has been offset against [premium] taxes as provided in Subsection (1).
3459          (b) The association shall notify the commissioner that the refunds described in
3460     Subsection (3)(a) have been made.
3461          Section 31. Section 31A-31-108 is amended to read:
3462          31A-31-108. Assessment of insurers.
3463          (1) For purposes of this section:
3464          (a) The commissioner shall by rule made in accordance with Title 63G, Chapter 3,
3465     Utah Administrative Rulemaking Act, define:
3466          (i) "annuity consideration";

3467          (ii) "membership fees";
3468          (iii) "other fees";
3469          (iv) "deposit-type contract funds"; and
3470          (v) "other considerations in Utah."
3471          (b) "Insurance fraud provisions" means:
3472          (i) this chapter;
3473          (ii) Section 34A-2-110; and
3474          (iii) Section 76-6-521.
3475          (c) "Utah consideration" means:
3476          (i) the total premiums written for Utah risks;
3477          (ii) annuity consideration;
3478          (iii) membership fees collected by the insurer;
3479          (iv) other fees collected by the insurer;
3480          (v) deposit-type contract funds; and
3481          (vi) other considerations in Utah.
3482          (d) "Utah risks" means insurance coverage on the lives, health, or against the liability
3483     of persons residing in Utah, or on property located in Utah, other than property temporarily in
3484     transit through Utah.
3485          (2) To implement insurance fraud provisions, the commissioner may assess an
3486     admitted insurer and a nonadmitted insurer transacting insurance under Chapter 15, Part 1,
3487     Unauthorized Insurers and Surplus Lines, and Chapter 15, Part 2, Risk Retention Groups Act,
3488     an annual fee as follows:
3489          (a) [$200] $225 for an insurer for which the sum of the Utah consideration is less than
3490     or equal to $1,000,000;
3491          (b) [$450] $525 for an insurer for which the sum of the Utah consideration is greater
3492     than $1,000,000 but is less than or equal to $2,500,000;
3493          (c) [$800] $925 for an insurer for which the sum of the Utah consideration is greater
3494     than $2,500,000 but is less than or equal to $5,000,000;
3495          (d) [$1,600] $1,850 for an insurer for which the sum of the Utah consideration is
3496     greater than $5,000,000 but less than or equal to $10,000,000;
3497          (e) [$6,100] $7,000 for an insurer for which the sum of the Utah consideration is

3498     greater than $10,000,000 but less than $50,000,000; and
3499          (f) [$15,000] $17,250 for an insurer for which the sum of the Utah consideration equals
3500     or exceeds $50,000,000.
3501          (3) Money received by the state under this section shall be deposited into the Insurance
3502     Fraud Investigation Restricted Account created in Subsection (4).
3503          (4) (a) There is created in the General Fund a restricted account known as the
3504     "Insurance Fraud Investigation Restricted Account."
3505          (b) The Insurance Fraud Investigation Restricted Account shall consist of the money
3506     received by the commissioner under this section and Subsections 31A-31-109(1)(a)(ii), (1)(b),
3507     (2)(b)(i), (2)(c), and (3)(a). Money ordered paid under Subsections 31A-31-109(1)(a)(i) and
3508     (2)(a) shall be deposited in the Insurance Fraud Victim Restitution Fund pursuant to Section
3509     31A-31-108.5.
3510          (c) The commissioner shall administer the Insurance Fraud Investigation Restricted
3511     Account. Subject to appropriations by the Legislature, the commissioner shall use the money
3512     deposited into the Insurance Fraud Investigation Restricted Account to pay for a cost or
3513     expense incurred by the commissioner in the administration, investigation, and enforcement of
3514     insurance fraud provisions.
3515          Section 32. Section 31A-35-202 is amended to read:
3516          31A-35-202. Board responsibilities.
3517          (1) The board shall:
3518          (a) meet:
3519          (i) at least quarterly; and
3520          (ii) at the call of the chair;
3521          (b) make written recommendations to the commissioner for rules governing the
3522     following aspects of the bail bond insurance business:
3523          (i) qualifications, applications, and fees for obtaining:
3524          (A) a license required by this Section 31A-35-401; or
3525          (B) a certificate;
3526          (ii) limits on the aggregate amounts of bail bonds;
3527          (iii) unprofessional conduct;
3528          (iv) procedures for hearing and resolving allegations of unprofessional conduct; and

3529          (v) sanctions for unprofessional conduct;
3530          (c) screen:
3531          (i) bail bond agency license applications; and
3532          (ii) persons applying for a bail bond agency license; and
3533          (d) recommend to the commissioner action regarding the granting, [renewing,]
3534     suspending, revoking, and reinstating of bail bond agency license.
3535          (2) Nothing in Subsection (1)(d) precludes the commissioner from suspending a license
3536     under Section 31A-35-504.
3537          [(2)] (3) The board may:
3538          (a) conduct investigations of allegations of unprofessional conduct on the part of
3539     persons or bail bond agencies involved in the business of bail bond insurance; and
3540          (b) provide the results of the investigations described in Subsection [(2)(a)] (3)(a) to
3541     the commissioner with recommendations for:
3542          (i) action; and
3543          (ii) any appropriate sanctions.
3544          Section 33. Section 31A-35-406 is amended to read:
3545          31A-35-406. Initial licensing, license renewal, and license reinstatement.
3546          (1) An applicant for an initial bail bond agency license shall:
3547          (a) complete and submit to the department an application;
3548          (b) submit to the department, as applicable, a copy of the applicant's:
3549          (i) irrevocable letter of credit, as required under Subsection 31A-35-404(1);
3550          (ii) verified financial statement, as required under Subsection 31A-35-404(2); or
3551          (iii) qualifying power of attorney, as required under Subsection 31A-35-404(3); and
3552          (c) pay the department the applicable renewal fee established in accordance with
3553     Section 31A-3-103.
3554          (2) (a) A license under this chapter expires annually effective at midnight on August
3555     [14] 31.
3556          (b) To renew a bail bond agency license issued under this chapter, on or before [July
3557     15] August 31, the bail bond agency shall:
3558          (i) complete and submit to the department a renewal application that includes
3559     certification that:

3560          (A) a principal of the agency attended or participated by telephone in at least one entire
3561     board meeting during the 12-month period before [July 15] August 31; and
3562          (B) as of May 1, the agency complies with aggregate bond limits established by rule
3563     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;
3564          (ii) submit to the department, as applicable, a copy of the applicant's:
3565          (A) irrevocable letter of credit, as required under Subsection 31A-35-404(1);
3566          (B) verified financial statement, as required under Subsection 31A-35-404(2); or
3567          (C) qualifying power of attorney, as required under Subsection 31A-35-404(3); and
3568          (iii) pay the department the applicable renewal fee established in accordance with
3569     Section 31A-3-103.
3570          (c) A bail bond agency shall renew the bail bond agency's license under this chapter
3571     annually as established by department rule, regardless of when the license is issued.
3572          (3) (a) A bail bond agency may apply for reinstatement of an expired bail bond agency
3573     license within one year after the day on which the license expires by complying with the
3574     renewal requirements described in Subsection (2).
3575          (b) If a bail bond agency license has been expired for more than one year, the person
3576     applying for reinstatement of the bail bond agency license shall comply with the initial
3577     licensing requirements described in Subsection (1).
3578          (4) If a bail bond agency license is suspended, the applicant may not submit an
3579     application for a bail bond agency license until after the day on which the period of suspension
3580     ends.
3581          (5) The department shall deposit a fee collected under this section in the restricted
3582     account created in Section 31A-35-407.
3583          Section 34. Section 31A-37-202 is amended to read:
3584          31A-37-202. Permissive areas of insurance.
3585          (1) Except as provided in Subsections (2) and (3), a captive insurance company may
3586     not directly insure a risk other than the risk of the captive insurance company's parent or
3587     affiliated company.
3588          (2) In addition to the risks described in Subsection (1), an association captive insurance
3589     company may insure the risk of:
3590          (a) a member organization of the association captive insurance company's association;

3591     or
3592          (b) an affiliate of a member organization of the association captive insurance
3593     company's association.
3594          (3) The following may insure a risk of a controlled unaffiliated business:
3595          (a) an industrial insured captive insurance company;
3596          (b) a protected cell;
3597          (c) a pure captive insurance company; or
3598          (d) a sponsored captive insurance company.
3599          (4) To the extent allowed by a captive insurance company's organizational charter, a
3600     captive insurance company may provide any type of insurance described in this title, except:
3601          (a) workers' compensation insurance;
3602          (b) personal motor vehicle insurance;
3603          (c) homeowners' insurance; and
3604          (d) any component of the types of insurance described in Subsections (4)(a) through
3605     (c).
3606          (5) A captive insurance company may not provide coverage for:
3607          (a) a wager or gaming risk;
3608          (b) loss of an election; or
3609          (c) the penal consequences of a crime.
3610          (6) Unless the punitive damages award arises out of a criminal act of an insured, a
3611     captive insurance company may provide coverage for punitive damages awarded, including
3612     through adjudication or compromise, against the captive insurance company's:
3613          (a) parent; or
3614          (b) affiliated company.
3615          (7) Notwithstanding Subsection (4), if approved by the commissioner[,]:
3616          (a) a captive insurance company may insure as a reimbursement a limited layer or
3617     deductible of workers' compensation coverage[.]; and
3618          (b) an association captive insurance company that satisfies the requirements of this
3619     chapter may provide homeowners' insurance.
3620          Section 35. Section 31A-37-204 is amended to read:
3621          31A-37-204. Paid-in capital -- Other capital.

3622          (1) (a) The commissioner may not issue a certificate of authority to a company
3623     described in Subsection (1)(c) unless the company possesses and thereafter maintains
3624     unimpaired paid-in capital and unimpaired paid-in surplus of:
3625          (i) in the case of a pure captive insurance company:
3626          (A) except as provided in Subsection (1)(a)(i)(B), not less than $250,000; or
3627          (B) if the pure captive insurance company is not acting as a pool that facilitates risk
3628     distribution for other captive insurers, an amount that is the greater of:
3629          (I) not less than 20% of the company's total aggregate risk; or
3630          (II) $50,000;
3631          (ii) in the case of an association captive insurance company, not less than $750,000;
3632          (iii) in the case of an industrial insured captive insurance company incorporated as a
3633     stock insurer, not less than $700,000;
3634          (iv) in the case of a sponsored captive insurance company, not less than [$500,000,]
3635     $250,000 of which a minimum of [$200,000] $50,000 is provided by the sponsor; or
3636          (v) in the case of a special purpose captive insurance company, an amount determined
3637     by the commissioner after giving due consideration to the company's business plan, feasibility
3638     study, and pro-formas, including the nature of the risks to be insured.
3639          (b) The paid-in capital and surplus required under this Subsection (1) may be in the
3640     form of:
3641          (i) (A) cash; or
3642          (B) cash equivalent;
3643          (ii) an irrevocable letter of credit:
3644          (A) issued by:
3645          (I) a bank chartered by this state;
3646          (II) a member bank of the Federal Reserve System; or
3647          (III) a member bank of the Federal Deposit Insurance Corporation;
3648          (B) approved by the commissioner;
3649          (iii) marketable securities as determined by Subsection (5); or
3650          (iv) some other thing of value approved by the commissioner, for a period not to
3651     exceed 45 days, to facilitate the formation of a captive insurance company in this state pursuant
3652     to an approved plan of liquidation and reorganization of another captive insurance company or

3653     alien captive insurance company in another jurisdiction.
3654          (c) This Subsection (1) applies to:
3655          (i) a pure captive insurance company;
3656          (ii) a sponsored captive insurance company;
3657          (iii) a special purpose captive insurance company;
3658          (iv) an association captive insurance company; or
3659          (v) an industrial insured captive insurance company.
3660          (2) (a) The commissioner may, under Section 31A-37-106, prescribe additional capital
3661     based on the type, volume, and nature of insurance business transacted.
3662          (b) The capital prescribed by the commissioner under this Subsection (2) may be in the
3663     form of:
3664          (i) cash;
3665          (ii) an irrevocable letter of credit issued by:
3666          (A) a bank chartered by this state; or
3667          (B) a member bank of the Federal Reserve System; or
3668          (iii) marketable securities as determined by Subsection (5).
3669          (3) (a) Except as provided in Subsection (3)(c), a branch captive insurance company, as
3670     security for the payment of liabilities attributable to branch operations, shall, through its branch
3671     operations, establish and maintain a trust fund:
3672          (i) funded by an irrevocable letter of credit or other acceptable asset; and
3673          (ii) in the United States for the benefit of:
3674          (A) United States policyholders; and
3675          (B) United States ceding insurers under:
3676          (I) insurance policies issued; or
3677          (II) reinsurance contracts issued or assumed.
3678          (b) The amount of the security required under this Subsection (3) shall be no less than:
3679          (i) the capital and surplus required by this chapter; and
3680          (ii) the reserves on the insurance policies or reinsurance contracts, including:
3681          (A) reserves for losses;
3682          (B) allocated loss adjustment expenses;
3683          (C) incurred but not reported losses; and

3684          (D) unearned premiums with regard to business written through branch operations.
3685          (c) Notwithstanding the other provisions of this Subsection (3):
3686          (i) the commissioner may permit a branch captive insurance company that is required
3687     to post security for loss reserves on branch business by its reinsurer to reduce the funds in the
3688     trust account required by this section by the same amount as the security posted if the security
3689     remains posted with the reinsurer; and
3690          (ii) a branch captive insurance company that is the result of the licensure of an alien
3691     captive insurance company that is not formed in an alien jurisdiction is not subject to the
3692     requirements of this Subsection (3).
3693          (4) (a) A captive insurance company may not pay the following without the prior
3694     approval of the commissioner:
3695          (i) a dividend out of capital or surplus in excess of the limits under Section
3696     16-10a-640; or
3697          (ii) a distribution with respect to capital or surplus in excess of the limits under Section
3698     16-10a-640.
3699          (b) The commissioner shall condition approval of an ongoing plan for the payment of
3700     dividends or other distributions on the retention, at the time of each payment, of capital or
3701     surplus in excess of:
3702          (i) amounts specified by the commissioner under Section 31A-37-106; or
3703          (ii) determined in accordance with formulas approved by the commissioner under
3704     Section 31A-37-106.
3705          (5) For purposes of this section, marketable securities means:
3706          (a) a bond or other evidence of indebtedness of a governmental unit in the United
3707     States or Canada or any instrumentality of the United States or Canada; or
3708          (b) securities:
3709          (i) traded on one or more of the following exchanges in the United States:
3710          (A) New York;
3711          (B) American; or
3712          (C) NASDAQ;
3713          (ii) when no particular security, or a substantially related security, applied toward the
3714     required minimum capital and surplus requirement of Subsection (1) represents more than 50%

3715     of the minimum capital and surplus requirement; and
3716          (iii) when no group of up to four particular securities, consolidating substantially
3717     related securities, applied toward the required minimum capital and surplus requirement of
3718     Subsection (1) represents more than 90% of the minimum capital and surplus requirement.
3719          (6) Notwithstanding Subsection (5), to protect the solvency and liquidity of a captive
3720     insurance company, the commissioner may reject the application of specific assets or amounts
3721     of specific assets to satisfying the requirement of Subsection (1).
3722          Section 36. Section 31A-37-502 is amended to read:
3723          31A-37-502. Examination.
3724          (1) (a) As provided in this section, the commissioner, or a person appointed by the
3725     commissioner, [shall] may examine each captive insurance company [in each five-year period.]
3726     at least once every five years, or more frequently if the commissioner determines a more
3727     frequent examination is prudent.
3728          (b) The five-year period described in Subsection (1)(a) shall be determined on the basis
3729     of five full annual accounting periods of operation.
3730          (c) The examination is to be made as of:
3731          (i) December 31 of the full five-year period; or
3732          (ii) the last day of the month of an annual accounting period authorized for a captive
3733     insurance company under this section.
3734          [(d) In addition to an examination required under this Subsection (1), the
3735     commissioner, or a person appointed by the commissioner may examine a captive insurance
3736     company whenever the commissioner determines it to be prudent.]
3737          (2) During an examination under this section the commissioner, or a person appointed
3738     by the commissioner, shall thoroughly inspect and examine the affairs of the captive insurance
3739     company to ascertain all or any combination of the following:
3740          (a) the financial condition of the captive insurance company;
3741          (b) the ability of the captive insurance company to fulfill the insurance policy
3742     obligations of the captive insurance company; and
3743          (c) whether the captive insurance company has complied with this chapter.
3744          [(3) The commissioner may accept a comprehensive annual independent audit in lieu
3745     of an examination:]

3746          [(a) of a scope satisfactory to the commissioner; and]
3747          [(b) performed by an independent auditor approved by the commissioner.]
3748          [(4)] (3) A captive insurance company that is inspected and examined under this
3749     section shall pay, as provided in Subsection 31A-37-201(6)(b), the expenses and charges of an
3750     inspection and examination.
3751          Section 37. Repealer.
3752          This bill repeals:
3753          Section 31A-2-303, Notice.
3754          Section 38. FY 2025 Appropriation.
3755          The following sums of money are appropriated for the fiscal year beginning July 1,
3756     2024, and ending June 30, 2025. These are additions to amounts previously appropriated for
3757     fiscal year 2025.
3758          Subsection 38(a). Restricted Fund and Account Transfers.
3759          The Legislature authorizes the State Division of Finance to transfer the following
3760     amounts between the following funds or accounts as indicated. Expenditures and outlays from
3761     the funds to which the money is transferred must be authorized by an appropriation.
3762     
ITEM 1
     To Insurance Department Administration
3763      From General Fund Restricted - Relative Value Study Account,
One-time
$400,000
3764      Schedule of Programs:
3765      Administration$400,000
3766     The Legislature intends that the appropriation under this item be used for the study described in
3767     Section 31A-2-218.1.
3768          Section 39. Effective date.
3769          (1) Except as provided in Ĥ→ [
Subsection (2)] Subsections (2) and (3) ←Ĥ , this bill takes
3769a     effect on May 1, 2024.
3770          (2) (a) Except as provided in Subsection (2)(b), the actions affecting Section
3771     31A-2-218.1 take effect upon approval by the governor, or the day following the constitutional
3772     time limit of Utah Constitution, Article VII, Section 8, without the governor's signature, or in
3773     the case of a veto, the date of veto override.
3774          (b) If this bill is not approved by two-thirds of all members elected to each house, the

3775     actions affecting Section 31A-2-218.1 take effect May 1, 2024.
3775a      Ĥ→ (3) The actions affecting Section 31A-22-614 take effect July 1, 2024. ←Ĥ