2006 Utah Code - 31A-1-301 — Definitions.

     31A-1-301.   Definitions.
     As used in this title, unless otherwise specified:
     (1) (a) "Accident and health insurance" means insurance to provide protection against economic losses resulting from:
     (i) a medical condition including:
     (A) medical care expenses; or
     (B) the risk of disability;
     (ii) accident; or
     (iii) sickness.
     (b) "Accident and health insurance":
     (i) includes a contract with disability contingencies including:
     (A) an income replacement contract;
     (B) a health care contract;
     (C) an expense reimbursement contract;
     (D) a credit accident and health contract;
     (E) a continuing care contract; and
     (F) a long-term care contract; and
     (ii) may provide:
     (A) hospital coverage;
     (B) surgical coverage;
     (C) medical coverage; or
     (D) loss of income coverage.
     (c) "Accident and health insurance" does not include workers' compensation insurance.
     (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act.
     (3) "Administrator" is defined in Subsection (155).
     (4) "Adult" means a natural person who has attained the age of at least 18 years.
     (5) "Affiliate" means any person who controls, is controlled by, or is under common control with, another person. A corporation is an affiliate of another corporation, regardless of ownership, if substantially the same group of natural persons manages the corporations.
     (6) "Agency" means:
     (a) a person other than an individual, including a sole proprietorship by which a natural person does business under an assumed name; and
     (b) an insurance organization licensed or required to be licensed under Section 31A-23a-301.
     (7) "Alien insurer" means an insurer domiciled outside the United States.
     (8) "Amendment" means an endorsement to an insurance policy or certificate.
     (9) "Annuity" means an agreement to make periodical payments for a period certain or over the lifetime of one or more natural persons if the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life.
     (10) "Application" means a document:
     (a) (i) completed by an applicant to provide information about the risk to be insured; and
     (ii) that contains information that is used by the insurer to evaluate risk and decide whether to:

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     (A) insure the risk under:
     (I) the coverages as originally offered; or
     (II) a modification of the coverage as originally offered; or
     (B) decline to insure the risk; or
     (b) used by the insurer to gather information from the applicant before issuance of an annuity contract.
     (11) "Articles" or "articles of incorporation" means the original articles, special laws, charters, amendments, restated articles, articles of merger or consolidation, trust instruments, and other constitutive documents for trusts and other entities that are not corporations, and amendments to any of these.
     (12) "Bail bond insurance" means a guarantee that a person will attend court when required, up to and including surrender of the person in execution of any sentence imposed under Subsection 77-20-7(1), as a condition to the release of that person from confinement.
     (13) "Binder" is defined in Section 31A-21-102.
     (14) "Board," "board of trustees," or "board of directors" means the group of persons with responsibility over, or management of, a corporation, however designated.
     (15) "Business entity" means a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity.
     (16) "Business of insurance" is defined in Subsection (82).
     (17) "Business plan" means the information required to be supplied to the commissioner under Subsections 31A-5-204(2)(i) and (j), including the information required when these subsections are applicable by reference under:
     (a) Section 31A-7-201;
     (b) Section 31A-8-205; or
     (c) Subsection 31A-9-205(2).
     (18) "Bylaws" means the rules adopted for the regulation or management of a corporation's affairs, however designated and includes comparable rules for trusts and other entities that are not corporations.
     (19) "Captive insurance company" means:
     (a) an insurance company:
     (i) owned by another organization; and
     (ii) whose exclusive purpose is to insure risks of the parent organization and affiliated companies; or
     (b) in the case of groups and associations, an insurance organization:
     (i) owned by the insureds; and
     (ii) whose exclusive purpose is to insure risks of:
     (A) member organizations;
     (B) group members; and
     (C) affiliates of:
     (I) member organizations; or
     (II) group members.
     (20) "Casualty insurance" means liability insurance as defined in Subsection (94).
     (21) "Certificate" means evidence of insurance given to:
     (a) an insured under a group insurance policy; or
     (b) a third party.

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     (22) "Certificate of authority" is included within the term "license."
     (23) "Claim," unless the context otherwise requires, means a request or demand on an insurer for payment of benefits according to the terms of an insurance policy.
     (24) "Claims-made coverage" means an insurance contract or provision limiting coverage under a policy insuring against legal liability to claims that are first made against the insured while the policy is in force.
     (25) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance commissioner.
     (b) When appropriate, the terms listed in Subsection (25)(a) apply to the equivalent supervisory official of another jurisdiction.
     (26) (a) "Continuing care insurance" means insurance that:
     (i) provides board and lodging;
     (ii) provides one or more of the following services:
     (A) personal services;
     (B) nursing services;
     (C) medical services; or
     (D) other health-related services; and
     (iii) provides the coverage described in Subsection (26)(a)(i) under an agreement effective:
     (A) for the life of the insured; or
     (B) for a period in excess of one year.
     (b) Insurance is continuing care insurance regardless of whether or not the board and lodging are provided at the same location as the services described in Subsection (26)(a)(ii).
     (27) (a) "Control," "controlling," "controlled," or "under common control" means the direct or indirect possession of the power to direct or cause the direction of the management and policies of a person. This control may be:
     (i) by contract;
     (ii) by common management;
     (iii) through the ownership of voting securities; or
     (iv) by a means other than those described in Subsections (27)(a)(i) through (iii).
     (b) There is no presumption that an individual holding an official position with another person controls that person solely by reason of the position.
     (c) A person having a contract or arrangement giving control is considered to have control despite the illegality or invalidity of the contract or arrangement.
     (d) There is a rebuttable presumption of control in a person who directly or indirectly owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the voting securities of another person.
     (28) "Controlled insurer" means a licensed insurer that is either directly or indirectly controlled by a producer.
     (29) "Controlling person" means any person that directly or indirectly has the power to direct or cause to be directed, the management, control, or activities of a reinsurance intermediary.
     (30) "Controlling producer" means a producer who directly or indirectly controls an insurer.
     (31) (a) "Corporation" means an insurance corporation, except when referring to:

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     (i) a corporation doing business:
     (A) as:
     (I) an insurance producer;
     (II) a limited line producer;
     (III) a consultant;
     (IV) a managing general agent;
     (V) a reinsurance intermediary;
     (VI) a third party administrator; or
     (VII) an adjuster; and
     (B) under:
     (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries;
     (II) Chapter 25, Third Party Administrators; or
     (III) Chapter 26, Insurance Adjusters; or
     (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance Holding Companies.
     (b) "Stock corporation" means a stock insurance corporation.
     (c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
     (32) "Creditable coverage" has the same meaning as provided in federal regulations adopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936.
     (33) "Credit accident and health insurance" means insurance on a debtor to provide indemnity for payments coming due on a specific loan or other credit transaction while the debtor is disabled.
     (34) (a) "Credit insurance" means insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation.
     (b) "Credit insurance" includes:
     (i) credit accident and health insurance;
     (ii) credit life insurance;
     (iii) credit property insurance;
     (iv) credit unemployment insurance;
     (v) guaranteed automobile protection insurance;
     (vi) involuntary unemployment insurance;
     (vii) mortgage accident and health insurance;
     (viii) mortgage guaranty insurance; and
     (ix) mortgage life insurance.
     (35) "Credit life insurance" means insurance on the life of a debtor in connection with an extension of credit that pays a person if the debtor dies.
     (36) "Credit property insurance" means insurance:
     (a) offered in connection with an extension of credit; and
     (b) that protects the property until the debt is paid.
     (37) "Credit unemployment insurance" means insurance:
     (a) offered in connection with an extension of credit; and
     (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
     (i) specific loan; or

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     (ii) credit transaction.
     (38) "Creditor" means a person, including an insured, having any claim, whether:
     (a) matured;
     (b) unmatured;
     (c) liquidated;
     (d) unliquidated;
     (e) secured;
     (f) unsecured;
     (g) absolute;
     (h) fixed; or
     (i) contingent.
     (39) (a) "Customer service representative" means a person that provides insurance services and insurance product information:
     (i) for the customer service representative's:
     (A) producer; or
     (B) consultant employer; and
     (ii) to the customer service representative's employer's:
     (A) customer;
     (B) client; or
     (C) organization.
     (b) A customer service representative may only operate within the scope of authority of the customer service representative's producer or consultant employer.
     (40) "Deadline" means the final date or time:
     (a) imposed by:
     (i) statute;
     (ii) rule; or
     (iii) order; and
     (b) by which a required filing or payment must be received by the department.
     (41) "Deemer clause" means a provision under this title under which upon the occurrence of a condition precedent, the commissioner is deemed to have taken a specific action. If the statute so provides, the condition precedent may be the commissioner's failure to take a specific action.
     (42) "Degree of relationship" means the number of steps between two persons determined by counting the generations separating one person from a common ancestor and then counting the generations to the other person.
     (43) "Department" means the Insurance Department.
     (44) "Director" means a member of the board of directors of a corporation.
     (45) "Disability" means a physiological or psychological condition that partially or totally limits an individual's ability to:
     (a) perform the duties of:
     (i) that individual's occupation; or
     (ii) any occupation for which the individual is reasonably suited by education, training, or experience; or
     (b) perform two or more of the following basic activities of daily living:
     (i) eating;

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     (ii) toileting;
     (iii) transferring;
     (iv) bathing; or
     (v) dressing.
     (46) "Disability income insurance" is defined in Subsection (73).
     (47) "Domestic insurer" means an insurer organized under the laws of this state.
     (48) "Domiciliary state" means the state in which an insurer:
     (a) is incorporated;
     (b) is organized; or
     (c) in the case of an alien insurer, enters into the United States.
     (49) (a) "Eligible employee" means:
     (i) an employee who:
     (A) works on a full-time basis; and
     (B) has a normal work week of 30 or more hours; or
     (ii) a person described in Subsection (49)(b).
     (b) "Eligible employee" includes, if the individual is included under a health benefit plan of a small employer:
     (i) a sole proprietor;
     (ii) a partner in a partnership; or
     (iii) an independent contractor.
     (c) "Eligible employee" does not include, unless eligible under Subsection (49)(b):
     (i) an individual who works on a temporary or substitute basis for a small employer;
     (ii) an employer's spouse; or
     (iii) a dependent of an employer.
     (50) "Employee" means any individual employed by an employer.
     (51) "Employee benefits" means one or more benefits or services provided to:
     (a) employees; or
     (b) dependents of employees.
     (52) (a) "Employee welfare fund" means a fund:
     (i) established or maintained, whether directly or through trustees, by:
     (A) one or more employers;
     (B) one or more labor organizations; or
     (C) a combination of employers and labor organizations; and
     (ii) that provides employee benefits paid or contracted to be paid, other than income from investments of the fund, by or on behalf of an employer doing business in this state or for the benefit of any person employed in this state.
     (b) "Employee welfare fund" includes a plan funded or subsidized by user fees or tax revenues.
     (53) "Endorsement" means a written agreement attached to a policy or certificate to modify one or more of the provisions of the policy or certificate.
     (54) "Enrollment date," with respect to a health benefit plan, means the first day of coverage or, if there is a waiting period, the first day of the waiting period.
     (55) (a) "Escrow" means:
     (i) a real estate settlement or real estate closing conducted by a third party pursuant to the requirements of a written agreement between the parties in a real estate transaction; or

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     (ii) a settlement or closing involving:
     (A) a mobile home;
     (B) a grazing right;
     (C) a water right; or
     (D) other personal property authorized by the commissioner.
     (b) "Escrow" includes the act of conducting a:
     (i) real estate settlement; or
     (ii) real estate closing.
     (56) "Escrow agent" means:
     (a) an insurance producer with:
     (i) a title insurance line of authority; and
     (ii) an escrow subline of authority; or
     (b) a person defined as an escrow agent in Section 7-22-101.
     (57) "Excludes" is not exhaustive and does not mean that other things are not also excluded. The items listed are representative examples for use in interpretation of this title.
     (58) "Expense reimbursement insurance" means insurance:
     (a) written to provide payments for expenses relating to hospital confinements resulting from illness or injury; and
     (b) written:
     (i) as a daily limit for a specific number of days in a hospital; and
     (ii) to have a one or two day waiting period following a hospitalization.
     (59) "Fidelity insurance" means insurance guaranteeing the fidelity of persons holding positions of public or private trust.
     (60) (a) "Filed" means that a filing is:
     (i) submitted to the department as required by and in accordance with any applicable statute, rule, or filing order;
     (ii) received by the department within the time period provided in the applicable statute, rule, or filing order; and
     (iii) accompanied by the appropriate fee in accordance with:
     (A) Section 31A-3-103; or
     (B) rule.
     (b) "Filed" does not include a filing that is rejected by the department because it is not submitted in accordance with Subsection (60)(a).
     (61) "Filing," when used as a noun, means an item required to be filed with the department including:
     (a) a policy;
     (b) a rate;
     (c) a form;
     (d) a document;
     (e) a plan;
     (f) a manual;
     (g) an application;
     (h) a report;
     (i) a certificate;
     (j) an endorsement;

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     (k) an actuarial certification;
     (l) a licensee annual statement;
     (m) a licensee renewal application; or
     (n) an advertisement.
     (62) "First party insurance" means an insurance policy or contract in which the insurer agrees to pay claims submitted to it by the insured for the insured's losses.
     (63) "Foreign insurer" means an insurer domiciled outside of this state, including an alien insurer.
     (64) (a) "Form" means one of the following prepared for general use:
     (i) a policy;
     (ii) a certificate;
     (iii) an application; or
     (iv) an outline of coverage.
     (b) "Form" does not include a document specially prepared for use in an individual case.
     (65) "Franchise insurance" means individual insurance policies provided through a mass marketing arrangement involving a defined class of persons related in some way other than through the purchase of insurance.
     (66) "General lines of authority" include:
     (a) the general lines of insurance in Subsection (67);
     (b) title insurance under one of the following sublines of authority:
     (i) search, including authority to act as a title marketing representative;
     (ii) escrow, including authority to act as a title marketing representative;
     (iii) search and escrow, including authority to act as a title marketing representative; and
     (iv) title marketing representative only;
     (c) surplus lines;
     (d) workers' compensation; and
     (e) any other line of insurance that the commissioner considers necessary to recognize in the public interest.
     (67) "General lines of insurance" include:
     (a) accident and health;
     (b) casualty;
     (c) life;
     (d) personal lines;
     (e) property; and
     (f) variable contracts, including variable life and annuity.
     (68) "Group health plan" means an employee welfare benefit plan to the extent that the plan provides medical care:
     (a) (i) to employees; or
     (ii) to a dependent of an employee; and
     (b) (i) directly;
     (ii) through insurance reimbursement; or
     (iii) through any other method.
     (69) "Guaranteed automobile protection insurance" means insurance offered in connection with an extension of credit that pays the difference in amount between the insurance settlement and the balance of the loan if the insured automobile is a total loss.

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     (70) (a) Except as provided in Subsection (70)(b), "health benefit plan" means a policy or certificate that:
     (i) provides health care insurance;
     (ii) provides major medical expense insurance; or
     (iii) is offered as a substitute for hospital or medical expense insurance such as:
     (A) a hospital confinement indemnity; or
     (B) a limited benefit plan.
     (b) "Health benefit plan" does not include a policy or certificate that:
     (i) provides benefits solely for:
     (A) accident;
     (B) dental;
     (C) income replacement;
     (D) long-term care;
     (E) a Medicare supplement;
     (F) a specified disease;
     (G) vision; or
     (H) a short-term limited duration; or
     (ii) is offered and marketed as supplemental health insurance.
     (71) "Health care" means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
     (a) professional services;
     (b) personal services;
     (c) facilities;
     (d) equipment;
     (e) devices;
     (f) supplies; or
     (g) medicine.
     (72) (a) "Health care insurance" or "health insurance" means insurance providing:
     (i) health care benefits; or
     (ii) payment of incurred health care expenses.
     (b) "Health care insurance" or "health insurance" does not include accident and health insurance providing benefits for:
     (i) replacement of income;
     (ii) short-term accident;
     (iii) fixed indemnity;
     (iv) credit accident and health;
     (v) supplements to liability;
     (vi) workers' compensation;
     (vii) automobile medical payment;
     (viii) no-fault automobile;
     (ix) equivalent self-insurance; or
     (x) any type of accident and health insurance coverage that is a part of or attached to another type of policy.
     (73) "Income replacement insurance" or "disability income insurance" means insurance written to provide payments to replace income lost from accident or sickness.

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     (74) "Indemnity" means the payment of an amount to offset all or part of an insured loss.
     (75) "Independent adjuster" means an insurance adjuster required to be licensed under Section 31A-26-201 who engages in insurance adjusting as a representative of insurers.
     (76) "Independently procured insurance" means insurance procured under Section 31A-15-104.
     (77) "Individual" means a natural person.
     (78) "Inland marine insurance" includes insurance covering:
     (a) property in transit on or over land;
     (b) property in transit over water by means other than boat or ship;
     (c) bailee liability;
     (d) fixed transportation property such as bridges, electric transmission systems, radio and television transmission towers and tunnels; and
     (e) personal and commercial property floaters.
     (79) "Insolvency" means that:
     (a) an insurer is unable to pay its debts or meet its obligations as they mature;
     (b) an insurer's total adjusted capital is less than the insurer's mandatory control level RBC under Subsection 31A-17-601(8)(c); or
     (c) an insurer is determined to be hazardous under this title.
     (80) (a) "Insurance" means:
     (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more persons to one or more other persons; or
     (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a group of persons that includes the person seeking to distribute that person's risk.
     (b) "Insurance" includes:
     (i) risk distributing arrangements providing for compensation or replacement for damages or loss through the provision of services or benefits in kind;
     (ii) contracts of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and
     (iii) plans in which the risk does not rest upon the person who makes the arrangements, but with a class of persons who have agreed to share it.
     (81) "Insurance adjuster" means a person who directs the investigation, negotiation, or settlement of a claim under an insurance policy other than life insurance or an annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy.
     (82) "Insurance business" or "business of insurance" includes:
     (a) providing health care insurance, as defined in Subsection (72), by organizations that are or should be licensed under this title;
     (b) providing benefits to employees in the event of contingencies not within the control of the employees, in which the employees are entitled to the benefits as a right, which benefits may be provided either:
     (i) by single employers or by multiple employer groups; or
     (ii) through trusts, associations, or other entities;
     (c) providing annuities, including those issued in return for gifts, except those provided by persons specified in Subsections 31A-22-1305(2) and (3);
     (d) providing the characteristic services of motor clubs as outlined in Subsection (110);
     (e) providing other persons with insurance as defined in Subsection (80);

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     (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor, or surety, any contract or policy of title insurance;
     (g) transacting or proposing to transact any phase of title insurance, including:
     (i) solicitation;
     (ii) negotiation preliminary to execution;
     (iii) execution of a contract of title insurance;
     (iv) insuring; and
     (v) transacting matters subsequent to the execution of the contract and arising out of the contract, including reinsurance; and
     (h) doing, or proposing to do, any business in substance equivalent to Subsections (82)(a) through (g) in a manner designed to evade the provisions of this title.
     (83) "Insurance consultant" or "consultant" means a person who:
     (a) advises other persons about insurance needs and coverages;
     (b) is compensated by the person advised on a basis not directly related to the insurance placed; and
     (c) except as provided in Section 31A-23a-501, is not compensated directly or indirectly by an insurer or producer for advice given.
     (84) "Insurance holding company system" means a group of two or more affiliated persons, at least one of whom is an insurer.
     (85) (a) "Insurance producer" or "producer" means a person licensed or required to be licensed under the laws of this state to sell, solicit, or negotiate insurance.
     (b) With regards to the selling, soliciting, or negotiating of an insurance product to an insurance customer or an insured:
     (i) "producer for the insurer" means a producer who is compensated directly or indirectly by an insurer for selling, soliciting, or negotiating any product of that insurer; and
     (ii) "producer for the insured" means a producer who:
     (A) is compensated directly and only by an insurance customer or an insured; and
     (B) receives no compensation directly or indirectly from an insurer for selling, soliciting, or negotiating any product of that insurer to an insurance customer or insured.
     (86) (a) "Insured" means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
     (i) policyholders;
     (ii) subscribers;
     (iii) members; and
     (iv) beneficiaries.
     (b) The definition in Subsection (86)(a):
     (i) applies only to this title; and
     (ii) does not define the meaning of this word as used in insurance policies or certificates.
     (87) (a) (i) "Insurer" means any person doing an insurance business as a principal including:
     (A) fraternal benefit societies;
     (B) issuers of gift annuities other than those specified in Subsections 31A-22-1305(2) and (3);
     (C) motor clubs;
     (D) employee welfare plans; and

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     (E) any person purporting or intending to do an insurance business as a principal on that person's own account.
     (ii) "Insurer" does not include a governmental entity to the extent it is engaged in the activities described in Section 31A-12-107.
     (b) "Admitted insurer" is defined in Subsection (159)(b).
     (c) "Alien insurer" is defined in Subsection (7).
     (d) "Authorized insurer" is defined in Subsection (159)(b).
     (e) "Domestic insurer" is defined in Subsection (47).
     (f) "Foreign insurer" is defined in Subsection (63).
     (g) "Nonadmitted insurer" is defined in Subsection (159)(a).
     (h) "Unauthorized insurer" is defined in Subsection (159)(a).
     (88) "Interinsurance exchange" is defined in Subsection (139).
     (89) "Involuntary unemployment insurance" means insurance:
     (a) offered in connection with an extension of credit;
     (b) that provides indemnity if the debtor is involuntarily unemployed for payments coming due on a:
     (i) specific loan; or
     (ii) credit transaction.
     (90) "Large employer," in connection with a health benefit plan, means an employer who, with respect to a calendar year and to a plan year:
     (a) employed an average of at least 51 eligible employees on each business day during the preceding calendar year; and
     (b) employs at least two employees on the first day of the plan year.
     (91) "Late enrollee," with respect to an employer health benefit plan, means an individual whose enrollment is a late enrollment.
     (92) "Late enrollment," with respect to an employer health benefit plan, means enrollment of an individual other than:
     (a) on the earliest date on which coverage can become effective for the individual under the terms of the plan; or
     (b) through special enrollment.
     (93) (a) Except for a retainer contract or legal assistance described in Section 31A-1-103, "legal expense insurance" means insurance written to indemnify or pay for specified legal expenses.
     (b) "Legal expense insurance" includes arrangements that create reasonable expectations of enforceable rights.
     (c) "Legal expense insurance" does not include the provision of, or reimbursement for, legal services incidental to other insurance coverages.
     (94) (a) "Liability insurance" means insurance against liability:
     (i) for death, injury, or disability of any human being, or for damage to property, exclusive of the coverages under:
     (A) Subsection (104) for medical malpractice insurance;
     (B) Subsection (131) for professional liability insurance; and
     (C) Subsection (164) for workers' compensation insurance;
     (ii) for medical, hospital, surgical, and funeral benefits to persons other than the insured who are injured, irrespective of legal liability of the insured, when issued with or supplemental to

insurance against legal liability for the death, injury, or disability of human beings, exclusive of the coverages under:
     (A) Subsection (104) for medical malpractice insurance;
     (B) Subsection (131) for professional liability insurance; and
     (C) Subsection (164) for workers' compensation insurance;
     (iii) for loss or damage to property resulting from accidents to or explosions of boilers, pipes, pressure containers, machinery, or apparatus;
     (iv) for loss or damage to any property caused by the breakage or leakage of sprinklers, water pipes and containers, or by water entering through leaks or openings in buildings; or
     (v) for other loss or damage properly the subject of insurance not within any other kind or kinds of insurance as defined in this chapter, if such insurance is not contrary to law or public policy.
     (b) "Liability insurance" includes:
     (i) vehicle liability insurance as defined in Subsection (161);
     (ii) residential dwelling liability insurance as defined in Subsection (142); and
     (iii) making inspection of, and issuing certificates of inspection upon, elevators, boilers, machinery, and apparatus of any kind when done in connection with insurance on them.
     (95) (a) "License" means the authorization issued by the commissioner to engage in some activity that is part of or related to the insurance business.
     (b) "License" includes certificates of authority issued to insurers.
     (96) (a) "Life insurance" means insurance on human lives and insurances pertaining to or connected with human life.
     (b) The business of life insurance includes:
     (i) granting death benefits;
     (ii) granting annuity benefits;
     (iii) granting endowment benefits;
     (iv) granting additional benefits in the event of death by accident;
     (v) granting additional benefits to safeguard the policy against lapse; and
     (vi) providing optional methods of settlement of proceeds.
     (97) "Limited license" means a license that:
     (a) is issued for a specific product of insurance; and
     (b) limits an individual or agency to transact only for that product or insurance.
     (98) "Limited line credit insurance" includes the following forms of insurance:
     (a) credit life;
     (b) credit accident and health;
     (c) credit property;
     (d) credit unemployment;
     (e) involuntary unemployment;
     (f) mortgage life;
     (g) mortgage guaranty;
     (h) mortgage accident and health;
     (i) guaranteed automobile protection; and
     (j) any other form of insurance offered in connection with an extension of credit that:
     (i) is limited to partially or wholly extinguishing the credit obligation; and
     (ii) the commissioner determines by rule should be designated as a form of limited line

credit insurance.
     (99) "Limited line credit insurance producer" means a person who sells, solicits, or negotiates one or more forms of limited line credit insurance coverage to individuals through a master, corporate, group, or individual policy.
     (100) "Limited line insurance" includes:
     (a) bail bond;
     (b) limited line credit insurance;
     (c) legal expense insurance;
     (d) motor club insurance;
     (e) rental car-related insurance;
     (f) travel insurance; and
     (g) any other form of limited insurance that the commissioner determines by rule should be designated a form of limited line insurance.
     (101) "Limited lines authority" includes:
     (a) the lines of insurance listed in Subsection (100); and
     (b) a customer service representative.
     (102) "Limited lines producer" means a person who sells, solicits, or negotiates limited lines insurance.
     (103) (a) "Long-term care insurance" means an insurance policy or rider advertised, marketed, offered, or designated to provide coverage:
     (i) in a setting other than an acute care unit of a hospital;
     (ii) for not less than 12 consecutive months for each covered person on the basis of:
     (A) expenses incurred;
     (B) indemnity;
     (C) prepayment; or
     (D) another method;
     (iii) for one or more necessary or medically necessary services that are:
     (A) diagnostic;
     (B) preventative;
     (C) therapeutic;
     (D) rehabilitative;
     (E) maintenance; or
     (F) personal care; and
     (iv) that may be issued by:
     (A) an insurer;
     (B) a fraternal benefit society;
     (C) (I) a nonprofit health hospital; and
     (II) a medical service corporation;
     (D) a prepaid health plan;
     (E) a health maintenance organization; or
     (F) an entity similar to the entities described in Subsections (103)(a)(iv)(A) through (E) to the extent that the entity is otherwise authorized to issue life or health care insurance.
     (b) "Long-term care insurance" includes:
     (i) any of the following that provide directly or supplement long-term care insurance:
     (A) a group or individual annuity or rider; or

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     (B) a life insurance policy or rider;
     (ii) a policy or rider that provides for payment of benefits based on:
     (A) cognitive impairment; or
     (B) functional capacity; or
     (iii) a qualified long-term care insurance contract.
     (c) "Long-term care insurance" does not include:
     (i) a policy that is offered primarily to provide basic Medicare supplement coverage;
     (ii) basic hospital expense coverage;
     (iii) basic medical/surgical expense coverage;
     (iv) hospital confinement indemnity coverage;
     (v) major medical expense coverage;
     (vi) income replacement or related asset-protection coverage;
     (vii) accident only coverage;
     (viii) coverage for a specified:
     (A) disease; or
     (B) accident;
     (ix) limited benefit health coverage; or
     (x) a life insurance policy that accelerates the death benefit to provide the option of a lump sum payment:
     (A) if the following are not conditioned on the receipt of long-term care:
     (I) benefits; or
     (II) eligibility; and
     (B) the coverage is for one or more the following qualifying events:
     (I) terminal illness;
     (II) medical conditions requiring extraordinary medical intervention; or
     (III) permanent institutional confinement.
     (104) "Medical malpractice insurance" means insurance against legal liability incident to the practice and provision of medical services other than the practice and provision of dental services.
     (105) "Member" means a person having membership rights in an insurance corporation.
     (106) "Minimum capital" or "minimum required capital" means the capital that must be constantly maintained by a stock insurance corporation as required by statute.
     (107) "Mortgage accident and health insurance" means insurance offered in connection with an extension of credit that provides indemnity for payments coming due on a mortgage while the debtor is disabled.
     (108) "Mortgage guaranty insurance" means surety insurance under which mortgagees and other creditors are indemnified against losses caused by the default of debtors.
     (109) "Mortgage life insurance" means insurance on the life of a debtor in connection with an extension of credit that pays if the debtor dies.
     (110) "Motor club" means a person:
     (a) licensed under:
     (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
     (ii) Chapter 11, Motor Clubs; or
     (iii) Chapter 14, Foreign Insurers; and
     (b) that promises for an advance consideration to provide for a stated period of time:

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     (i) legal services under Subsection 31A-11-102(1)(b);
     (ii) bail services under Subsection 31A-11-102(1)(c); or
     (iii) (A) trip reimbursement;
     (B) towing services;
     (C) emergency road services;
     (D) stolen automobile services;
     (E) a combination of the services listed in Subsections (110)(b)(iii)(A) through (D); or
     (F) any other services given in Subsections 31A-11-102(1)(b) through (f).
     (111) "Mutual" means a mutual insurance corporation.
     (112) "Network plan" means health care insurance:
     (a) that is issued by an insurer; and
     (b) under which the financing and delivery of medical care is provided, in whole or in part, through a defined set of providers under contract with the insurer, including the financing and delivery of items paid for as medical care.
     (113) "Nonparticipating" means a plan of insurance under which the insured is not entitled to receive dividends representing shares of the surplus of the insurer.
     (114) "Ocean marine insurance" means insurance against loss of or damage to:
     (a) ships or hulls of ships;
     (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, moneys, securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
     (c) earnings such as freight, passage money, commissions, or profits derived from transporting goods or people upon or across the oceans or inland waterways; or
     (d) a vessel owner or operator as a result of liability to employees, passengers, bailors, owners of other vessels, owners of fixed objects, customs or other authorities, or other persons in connection with maritime activity.
     (115) "Order" means an order of the commissioner.
     (116) "Outline of coverage" means a summary that explains an accident and health insurance policy.
     (117) "Participating" means a plan of insurance under which the insured is entitled to receive dividends representing shares of the surplus of the insurer.
     (118) "Participation," as used in a health benefit plan, means a requirement relating to the minimum percentage of eligible employees that must be enrolled in relation to the total number of eligible employees of an employer reduced by each eligible employee who voluntarily declines coverage under the plan because the employee has other group health care insurance coverage.
     (119) "Person" includes an individual, partnership, corporation, incorporated or unincorporated association, joint stock company, trust, limited liability company, reciprocal, syndicate, or any similar entity or combination of entities acting in concert.
     (120) "Personal lines insurance" means property and casualty insurance coverage sold for primarily noncommercial purposes to:
     (a) individuals; and
     (b) families.
     (121) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
     (122) "Plan year" means:
     (a) the year that is designated as the plan year in:

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     (i) the plan document of a group health plan; or
     (ii) a summary plan description of a group health plan;
     (b) if the plan document or summary plan description does not designate a plan year or there is no plan document or summary plan description:
     (i) the year used to determine deductibles or limits;
     (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or
     (iii) the employer's taxable year if:
     (A) the plan does not impose deductibles or limits on a yearly basis; and
     (B) (I) the plan is not insured; or
     (II) the insurance policy is not renewed on an annual basis; or
     (c) in a case not described in Subsection (122)(a) or (b), the calendar year.
     (123) (a) (i) "Policy" means any document, including attached endorsements and riders, purporting to be an enforceable contract, which memorializes in writing some or all of the terms of an insurance contract.
     (ii) "Policy" includes a service contract issued by:
     (A) a motor club under Chapter 11, Motor Clubs;
     (B) a service contract provided under Chapter 6a, Service Contracts; and
     (C) a corporation licensed under:
     (I) Chapter 7, Nonprofit Health Service Insurance Corporations; or
     (II) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
     (iii) "Policy" does not include:
     (A) a certificate under a group insurance contract; or
     (B) a document that does not purport to have legal effect.
     (b) (i) "Group insurance policy" means a policy covering a group of persons that is issued:
     (A) to a policyholder on behalf of the group; and
     (B) for the benefit of group members who are selected under procedures defined in:
     (I) the policy; or
     (II) agreements which are collateral to the policy.
     (ii) A group insurance policy may include members of the policyholder's family or dependents.
     (c) "Blanket insurance policy" means a group policy covering classes of persons without individual underwriting, where the persons insured are determined by definition of the class with or without designating the persons covered.
     (124) "Policyholder" means the person who controls a policy, binder, or oral contract by ownership, premium payment, or otherwise.
     (125) "Policy illustration" means a presentation or depiction that includes nonguaranteed elements of a policy of life insurance over a period of years.
     (126) "Policy summary" means a synopsis describing the elements of a life insurance policy.
     (127) "Preexisting condition," with respect to a health benefit plan:
     (a) means a condition that was present before the effective date of coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that day; and
     (b) does not include a condition indicated by genetic information unless an actual

diagnosis of the condition by a physician has been made.
     (128) (a) "Premium" means the monetary consideration for an insurance policy.
     (b) "Premium" includes, however designated:
     (i) assessments;
     (ii) membership fees;
     (iii) required contributions; or
     (iv) monetary consideration.
     (c) (i) Consideration paid to third party administrators for their services is not "premium."
     (ii) Amounts paid by third party administrators to insurers for insurance on the risks administered by the third party administrators are "premium."
     (129) "Principal officers" of a corporation means the officers designated under Subsection 31A-5-203(3).
     (130) "Proceedings" includes actions and special statutory proceedings.
     (131) "Professional liability insurance" means insurance against legal liability incident to the practice of a profession and provision of any professional services.
     (132) (a) Except as provided in Subsection (132)(b), "property insurance" means insurance against loss or damage to real or personal property of every kind and any interest in that property:
     (i) from all hazards or causes; and
     (ii) against loss consequential upon the loss or damage including vehicle comprehensive and vehicle physical damage coverages.
     (b) "Property insurance" does not include:
     (i) inland marine insurance as defined in Subsection (78); and
     (ii) ocean marine insurance as defined under Subsection (114).
     (133) "Qualified long-term care insurance contract" or "federally tax qualified long-term care insurance contract" means:
     (a) an individual or group insurance contract that meets the requirements of Section 7702B(b), Internal Revenue Code; or
     (b) the portion of a life insurance contract that provides long-term care insurance:
     (i) (A) by rider; or
     (B) as a part of the contract; and
     (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue Code.
     (134) "Qualified United States financial institution" means an institution that:
     (a) is:
     (i) organized under the laws of the United States or any state; or
     (ii) in the case of a United States office of a foreign banking organization, licensed under the laws of the United States or any state;
     (b) is regulated, supervised, and examined by United States federal or state authorities having regulatory authority over banks and trust companies; and
     (c) meets the standards of financial condition and standing that are considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner as determined by:
     (i) the commissioner by rule; or
     (ii) the Securities Valuation Office of the National Association of Insurance

Commissioners.
     (135) (a) "Rate" means:
     (i) the cost of a given unit of insurance; or
     (ii) for property-casualty insurance, that cost of insurance per exposure unit either expressed as:
     (A) a single number; or
     (B) a pure premium rate, adjusted before any application of individual risk variations based on loss or expense considerations to account for the treatment of:
     (I) expenses;
     (II) profit; and
     (III) individual insurer variation in loss experience.
     (b) "Rate" does not include a minimum premium.
     (136) (a) Except as provided in Subsection (136)(b), "rate service organization" means any person who assists insurers in rate making or filing by:
     (i) collecting, compiling, and furnishing loss or expense statistics;
     (ii) recommending, making, or filing rates or supplementary rate information; or
     (iii) advising about rate questions, except as an attorney giving legal advice.
     (b) "Rate service organization" does not mean:
     (i) an employee of an insurer;
     (ii) a single insurer or group of insurers under common control;
     (iii) a joint underwriting group; or
     (iv) a natural person serving as an actuarial or legal consultant.
     (137) "Rating manual" means any of the following used to determine initial and renewal policy premiums:
     (a) a manual of rates;
     (b) classifications;
     (c) rate-related underwriting rules; and
     (d) rating formulas that describe steps, policies, and procedures for determining initial and renewal policy premiums.
     (138) "Received by the department" means:
     (a) except as provided in Subsection (138)(b), the date delivered to and stamped received by the department, whether delivered:
     (i) in person; or
     (ii) electronically; and
     (b) if delivered to the department by a delivery service, the delivery service's postmark date or pick-up date unless otherwise stated in:
     (i) statute;
     (ii) rule; or
     (iii) a specific filing order.
     (139) "Reciprocal" or "interinsurance exchange" means any unincorporated association of persons:
     (a) operating through an attorney-in-fact common to all of them; and
     (b) exchanging insurance contracts with one another that provide insurance coverage on each other.
     (140) "Reinsurance" means an insurance transaction where an insurer, for consideration,

transfers any portion of the risk it has assumed to another insurer. In referring to reinsurance transactions, this title sometimes refers to:
     (a) the insurer transferring the risk as the "ceding insurer"; and
     (b) the insurer assuming the risk as the:
     (i) "assuming insurer"; or
     (ii) "assuming reinsurer."
     (141) "Reinsurer" means any person licensed in this state as an insurer with the authority to assume reinsurance.
     (142) "Residential dwelling liability insurance" means insurance against liability resulting from or incident to the ownership, maintenance, or use of a residential dwelling that is a detached single family residence or multifamily residence up to four units.
     (143) "Retrocession" means reinsurance with another insurer of a liability assumed under a reinsurance contract. A reinsurer "retrocedes" when it reinsures with another insurer part of a liability assumed under a reinsurance contract.
     (144) "Rider" means an endorsement to:
     (a) an insurance policy; or
     (b) an insurance certificate.
     (145) (a) "Security" means any:
     (i) note;
     (ii) stock;
     (iii) bond;
     (iv) debenture;
     (v) evidence of indebtedness;
     (vi) certificate of interest or participation in any profit-sharing agreement;
     (vii) collateral-trust certificate;
     (viii) preorganization certificate or subscription;
     (ix) transferable share;
     (x) investment contract;
     (xi) voting trust certificate;
     (xii) certificate of deposit for a security;
     (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in payments out of production under such a title or lease;
     (xiv) commodity contract or commodity option;
     (xv) certificate of interest or participation in, temporary or interim certificate for, receipt for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed in Subsections (145)(a)(i) through (xiv); or
     (xvi) other interest or instrument commonly known as a security.
     (b) "Security" does not include:
     (i) any of the following under which an insurance company promises to pay money in a specific lump sum or periodically for life or some other specified period:
     (A) insurance;
     (B) endowment policy; or
     (C) annuity contract; or
     (ii) a burial certificate or burial contract.
     (146) "Self-insurance" means any arrangement under which a person provides for

spreading its own risks by a systematic plan.
     (a) Except as provided in this Subsection (146), "self-insurance" does not include an arrangement under which a number of persons spread their risks among themselves.
     (b) "Self-insurance" includes:
     (i) an arrangement by which a governmental entity undertakes to indemnify its employees for liability arising out of the employees' employment; and
     (ii) an arrangement by which a person with a managed program of self-insurance and risk management undertakes to indemnify its affiliates, subsidiaries, directors, officers, or employees for liability or risk which is related to the relationship or employment.
     (c) "Self-insurance" does not include any arrangement with independent contractors.
     (147) "Sell" means to exchange a contract of insurance:
     (a) by any means;
     (b) for money or its equivalent; and
     (c) on behalf of an insurance company.
     (148) "Short-term care insurance" means any insurance policy or rider advertised, marketed, offered, or designed to provide coverage that is similar to long-term care insurance but that provides coverage for less than 12 consecutive months for each covered person.
     (149) "Significant break in coverage" means a period of 63 consecutive days during each of which an individual does not have any creditable coverage.
     (150) "Small employer," in connection with a health benefit plan, means an employer who, with respect to a calendar year and to a plan year:
     (a) employed an average of at least two employees but not more than 50 eligible employees on each business day during the preceding calendar year; and
     (b) employs at least two employees on the first day of the plan year.
     (151) "Special enrollment period," in connection with a health benefit plan, has the same meaning as provided in federal regulations adopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936.
     (152) (a) "Subsidiary" of a person means an affiliate controlled by that person either directly or indirectly through one or more affiliates or intermediaries.
     (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting shares are owned by that person either alone or with its affiliates, except for the minimum number of shares the law of the subsidiary's domicile requires to be owned by directors or others.
     (153) Subject to Subsection (80)(b), "surety insurance" includes:
     (a) a guarantee against loss or damage resulting from failure of principals to pay or perform their obligations to a creditor or other obligee;
     (b) bail bond insurance; and
     (c) fidelity insurance.
     (154) (a) "Surplus" means the excess of assets over the sum of paid-in capital and liabilities.
     (b) (i) "Permanent surplus" means the surplus of a mutual insurer that has been designated by the insurer as permanent.
     (ii) Sections 31A-5-211, 31A-7-201, 31A-8-209, 31A-9-209, and 31A-14-209 require that mutuals doing business in this state maintain specified minimum levels of permanent surplus.
     (iii) Except for assessable mutuals, the minimum permanent surplus requirement is

essentially the same as the minimum required capital requirement that applies to stock insurers.
     (c) "Excess surplus" means:
     (i) for life or accident and health insurers, health organizations, and property and casualty insurers as defined in Section 31A-17-601, the lesser of:
     (A) that amount of an insurer's or health organization's total adjusted capital, as defined in Subsection (157), that exceeds the product of:
     (I) 2.5; and
     (II) the sum of the insurer's or health organization's minimum capital or permanent surplus required under Section 31A-5-211, 31A-9-209, or 31A-14-205; or
     (B) that amount of an insurer's or health organization's total adjusted capital, as defined in Subsection (157), that exceeds the product of:
     (I) 3.0; and
     (II) the authorized control level RBC as defined in Subsection 31A-17-601(8)(a); and
     (ii) for monoline mortgage guaranty insurers, financial guaranty insurers, and title insurers, that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
     (A) 1.5; and
     (B) the insurer's total adjusted capital required by Subsection 31A-17-609(1).
     (155) "Third party administrator" or "administrator" means any person who collects charges or premiums from, or who, for consideration, adjusts or settles claims of residents of the state in connection with insurance coverage, annuities, or service insurance coverage, except:
     (a) a union on behalf of its members;
     (b) a person administering any:
     (i) pension plan subject to the federal Employee Retirement Income Security Act of 1974;
     (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
     (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
     (c) an employer on behalf of the employer's employees or the employees of one or more of the subsidiary or affiliated corporations of the employer;
     (d) an insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance for which the insurer holds a license in this state; or
     (e) a person:
     (i) licensed or exempt from licensing under:
     (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries; or
     (B) Chapter 26, Insurance Adjusters; and
     (ii) whose activities are limited to those authorized under the license the person holds or for which the person is exempt.
     (156) "Title insurance" means the insuring, guaranteeing, or indemnifying of owners of real or personal property or the holders of liens or encumbrances on that property, or others interested in the property against loss or damage suffered by reason of liens or encumbrances upon, defects in, or the unmarketability of the title to the property, or invalidity or unenforceability of any liens or encumbrances on the property.
     (157) "Total adjusted capital" means the sum of an insurer's or health organization's statutory capital and surplus as determined in accordance with:
     (a) the statutory accounting applicable to the annual financial statements required to be

filed under Section 31A-4-113; and
     (b) any other items provided by the RBC instructions, as RBC instructions is defined in Section 31A-17-601.
     (158) (a) "Trustee" means "director" when referring to the board of directors of a corporation.
     (b) "Trustee," when used in reference to an employee welfare fund, means an individual, firm, association, organization, joint stock company, or corporation, whether acting individually or jointly and whether designated by that name or any other, that is charged with or has the overall management of an employee welfare fund.
     (159) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted insurer" means an insurer:
     (i) not holding a valid certificate of authority to do an insurance business in this state; or
     (ii) transacting business not authorized by a valid certificate.
     (b) "Admitted insurer" or "authorized insurer" means an insurer:
     (i) holding a valid certificate of authority to do an insurance business in this state; and
     (ii) transacting business as authorized by a valid certificate.
     (160) "Underwrite" means the authority to accept or reject risk on behalf of the insurer.
     (161) "Vehicle liability insurance" means insurance against liability resulting from or incident to ownership, maintenance, or use of any land vehicle or aircraft, exclusive of vehicle comprehensive and vehicle physical damage coverages under Subsection (132).
     (162) "Voting security" means a security with voting rights, and includes any security convertible into a security with a voting right associated with the security.
     (163) "Waiting period" for a health benefit plan means the period that must pass before coverage for an individual, who is otherwise eligible to enroll under the terms of the health benefit plan, can become effective.
     (164) "Workers' compensation insurance" means:
     (a) insurance for indemnification of employers against liability for compensation based on:
     (i) compensable accidental injuries; and
     (ii) occupational disease disability;
     (b) employer's liability insurance incidental to workers' compensation insurance and written in connection with workers' compensation insurance; and
     (c) insurance assuring to the persons entitled to workers' compensation benefits the compensation provided by law.

Amended by Chapter 332, 2006 General Session
Amended by Chapter 320, 2006 General Session