(1)  The commissioner shall issue a license to act as a third party administrator to a person who:

Terms Used In Utah Code 31A-25-203

  • Administrator: means the same as that term is defined in Subsection (182). See Utah Code 31A-1-301
  • Agency: means :
(a) a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and
(b) an insurance organization licensed or required to be licensed under Section 31A-23a-301, 31A-25-207, or 31A-26-209. 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
  • business of insurance: includes :
    (a) providing health care insurance by an organization that is or is required to be licensed under this title;
    (b) providing a benefit to an employee in the event of a contingency not within the control of the employee, in which the employee is entitled to the benefit as a right, which benefit may be provided either:
    (i) by a single employer or by multiple employer groups; or
    (ii) through one or more trusts, associations, or other entities;
    (c) providing an annuity:
    (i) including an annuity issued in return for a gift; and
    (ii) except an annuity provided by a person specified in Subsections 31A-22-1305(2) and (3);
    (d) providing the characteristic services of a motor club;
    (e) providing another person with insurance;
    (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor, or surety, a contract or policy offering 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;
    (h) transacting or proposing a life settlement; and
    (i) doing, or proposing to do, any business in substance equivalent to Subsections (95)(a) through (h) in a manner designed to evade this title. See Utah Code 31A-1-301
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Department: means the Insurance Department. See Utah Code 31A-1-301
  • Filed: means that a filing is:
    (i) submitted to the department as required by and in accordance with applicable statute, rule, or filing order;
    (ii) received by the department within the time period provided in applicable statute, rule, or filing order; and
    (iii) accompanied by the appropriate fee in accordance with:
    (A) Section 31A-3-103; or
    (B) rule. See Utah Code 31A-1-301
  • Form: means one of the following prepared for general use:
    (i) a policy;
    (ii) a certificate;
    (iii) an application;
    (iv) an outline of coverage; or
    (v) an endorsement. 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
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • License: includes a certificate of authority issued to an insurer. 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
  • 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)  satisfies the character requirements under Section 31A-25-204;

    (b)  satisfies the financial responsibility requirement under Section 31A-25-205;

    (c)  has not committed an act that is a ground for denial, suspension, or revocation provided in Section 31A-25-208;

    (d)  if a nonresident, complies with Section 31A-25-206; and

    (e)  pays the applicable fees under Section 31A-3-103.
  • (2) 

    (a)  This Subsection (2) applies to the following persons:

    (i)  an applicant for a third party administrator’s license; or

    (ii)  a licensed third party administrator.

    (b)  A person described in Subsection (2)(a) shall report to the commissioner:

    (i)  an administrative action taken against the person, including a denial of a new or renewal license application:

    (A)  in another jurisdiction; or

    (B)  by another regulatory agency in this state; and

    (ii)  a criminal prosecution taken against the person in any jurisdiction.

    (c)  The report required by Subsection (2)(b) shall:

    (i)  be filed:

    (A)  at the time the person applies for a third party administrator’s license; and

    (B)  if an action or prosecution occurs on or after the day on which the person applies for a third party administrator license:

    (I)  for an administrative action, within 30 days of the final disposition of the administrative action; or

    (II)  for a criminal prosecution, within 30 days of the initial appearance before a court; and

    (ii)  include a copy of the complaint or other relevant legal documents related to the action or prosecution described in Subsection (2)(b).

    (3) 

    (a)  The department may require a person applying for a license or for consent to engage in the business of insurance to submit to a criminal background check as a condition of receiving a license or consent.

    (b)  A person, if required to submit to a criminal background check under Subsection (3)(a), shall:

    (i)  submit a fingerprint card in a form acceptable to the department; and

    (ii)  consent to a fingerprint background check by:

    (A)  the Utah Bureau of Criminal Identification; and

    (B)  the Federal Bureau of Investigation.

    (c)  For a person who submits a fingerprint card and consents to a fingerprint background check under Subsection (3)(b), the department may request concerning a person applying for a third party administrator’s license:

    (i)  criminal background information maintained pursuant to 2, from the Bureau of Criminal Identification; and

    (ii)  complete Federal Bureau of Investigation criminal background checks through the national criminal history system.

    (d)  Information obtained by the department from the review of criminal history records received under this Subsection (3) shall be used by the department for the purposes of:

    (i)  determining if a person satisfies the character requirements under Section 31A-25-204 for issuance or renewal of a license;

    (ii)  determining if a person has failed to maintain the character requirements under Section 31A-25-204; and

    (iii)  preventing a person who violates the federal Violent Crime Control and Law Enforcement Act of 1994, 18 U.S.C. § 1033, from engaging in the business of insurance in the state.

    (e)  If the department requests the criminal background information, the department shall:

    (i)  pay to the Department of Public Safety the costs incurred by the Department of Public Safety in providing the department criminal background information under Subsection (3)(c)(i);

    (ii)  pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau of Investigation in providing the department criminal background information under Subsection (3)(c)(ii); and

    (iii)  charge the person applying for a license or for consent to engage in the business of insurance a fee equal to the aggregate of Subsections (3)(e)(i) and (ii).

    (4)  The commissioner may deny a license application to act as a third party administrator to a person who:

    (a)  fails to satisfy the requirements of this section; or

    (b)  commits an act that is a ground for denial, suspension, or revocation provided in Section 31A-25-208.

    Amended by Chapter 253, 2012 General Session