31A-23b-102.  Definitions.
     As used in this chapter:

(1)  “Enroll” and “enrollment” mean to:

Terms Used In Utah Code 31A-23b-102

  • Accident and health insurance: means insurance to provide protection against economic losses resulting from:
(i) a medical condition including:
(A) a medical care expense; or
(B) the risk of disability;
(ii) accident; or
(iii) sickness. See Utah Code 31A-1-301
  • 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:
    (A) insure the risk under:
    (I) the coverage 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. See Utah Code 31A-1-301
  • Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
    (a) a professional service;
    (b) a personal service;
    (c) a facility;
    (d) equipment;
    (e) a device;
    (f) supplies; or
    (g) medicine. See Utah Code 31A-1-301
  • Individual: means a natural person. See Utah Code 31A-1-301
  • Insurance: includes :
    (i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
    (ii) a contract 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) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
  • Person: includes :
    (a) an individual;
    (b) a partnership;
    (c) a corporation;
    (d) an incorporated or unincorporated association;
    (e) a joint stock company;
    (f) a trust;
    (g) a limited liability company;
    (h) a reciprocal;
    (i) a syndicate; or
    (j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301
  • Personally identifiable information: is a s defined in 45 C. See Utah Code 31A-23b-102
  • PPACA: means the Patient Protection and Affordable Care Act, Pub. See Utah Code 31A-1-301
  • Premium: includes , however designated:
    (i) an assessment;
    (ii) a membership fee;
    (iii) a required contribution; or
    (iv) monetary consideration. See Utah Code 31A-1-301
  • Public programs: means the state Medicaid program in Title 26B, Chapter 3, Health Care - Administration and Assistance, and 9. See Utah Code 31A-23b-102
  • State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
  • (a) 

    (i)  obtain personally identifiable information about an individual; and

    (ii)  inform an individual about accident and health insurance plans or public programs offered on an exchange;

    (b)  solicit insurance; or

    (c)  submit to the exchange:

    (i)  personally identifiable information about an individual; and

    (ii)  an individual’s selection of a particular accident and health insurance plan or public program offered on the exchange.
  • (2)  “Navigator”:

    (a)  means a person who facilitates enrollment in an exchange by offering to assist, or who advertises any services to assist, with:

    (i)  the selection of and enrollment in a qualified health plan or a public program offered on an exchange; or

    (ii)  applying for premium subsidies through an exchange; and

    (b)  includes a person who is an in-person assister or a certified application counselor as described in federal regulations or guidance issued under PPACA.

    (3)  “Personally identifiable information” is as defined in 45 C.F.R. § 155.260.

    (4)  “Public programs” means the state Medicaid program in Title 26B, Chapter 3, Health Care – Administration and Assistance, and 9.

    (5)  “Resident” is as defined by rule made by the commissioner in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.

    (6)  “Solicit” means the same as that term is defined in Section 31A-23a-102.

    Amended by Chapter 328, 2023 General Session