affiliated: means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, a specified person. See Utah Code 31A-30-103
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
Bona fide employer association: means an association of employers:
(i)
that meets the requirements of Section 31A-22-505;
(ii)
in which the employers of the association, either directly or indirectly, exercise control over the plan;
(iii)
that is organized:
(A)
based on a commonality of interest between the employers and their employees that participate in the plan by some common economic or representation interest or genuine organizational relationship unrelated to the provision of benefits; and
(B)
to act in the best interests of its employers to provide benefits for the employer's employees and their spouses and dependents, and other benefits relating to employment; and
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
Carrier: means a person that provides health insurance in this state including:
(a)
an insurance company;
(b)
a prepaid hospital or medical care plan;
(c)
a health maintenance organization;
(d)
a multiple employer welfare arrangement; and
(e)
another person providing a health insurance plan under this title. See Utah Code 31A-30-103
Certificate: means evidence of insurance given to:
advises another person 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. See Utah Code 31A-1-301
Contract: A legal written agreement that becomes binding when signed.
Covered carrier: means an individual carrier or small employer carrier subject to this chapter. See Utah Code 31A-30-103
Covered insureds: means small employers and individuals who are issued a health benefit plan that is subject to this chapter. See Utah Code 31A-30-103
Employee: means :
(a)
an individual employed by an employer; or
(b)
an individual who meets the requirements of Subsection (53)(b). See Utah Code 31A-1-301
Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. 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 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
Member: means a person having membership rights in an insurance corporation. See Utah Code 31A-1-301
Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
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
producer: means a person licensed or required to be licensed under the laws of this state to sell, solicit, or negotiate insurance. See Utah Code 31A-1-301
Small employer: means , in connection with a health benefit plan and with respect to a calendar year and to a plan year, an employer who:
(i)
(A)
employed at least one but not more than 50 eligible employees on business days during the preceding calendar year; or
(B)
if the employer did not exist for the entirety of the preceding calendar year, reasonably expects to employ an average of at least one but not more than 50 eligible employees on business days during the current calendar year;
(ii)
employs at least one employee on the first day of the plan year; and
(iii)
for an employer who has common ownership with one or more other employers, is treated as a single employer under 26 U. See Utah Code 31A-1-301
Small employer carrier: means a carrier that provides health benefit plans covering eligible employees of one or more small employers in this state, regardless of whether:
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)
health benefit plan that provides coverage to:
(i)
individuals;
(ii)
small employers, except as provided in Subsection (3); or
This chapter applies to a health benefit plan that provides coverage to small employers or individuals regardless of:
(a)
whether the contract is issued to:
(i)
an association, except as provided in Subsection (3);
(ii)
a trust;
(iii)
a discretionary group; or
(iv)
other similar grouping; or
(b)
the situs of delivery of the policy or contract.
(3)
This chapter does not apply to:
(a)
short-term limited duration health insurance;
(b)
federally funded or partially funded programs; or
(c)
a bona fide employer association.
(4)
(a)
Except as provided in Subsection (4)(b), for the purposes of this chapter:
(i)
carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier; and
(ii)
any restrictions or limitations imposed by this chapter or Section 31A-22-618.6 or 31A-22-618.7 shall apply as if all health benefit plans delivered or issued for delivery to covered insureds in this state by the affiliated carriers were issued by one carrier.
(b)
Upon a finding of the commissioner, an affiliated carrier that is a health maintenance organization having a certificate of authority under this title may be considered to be a separate carrier for the purposes of this chapter.
(c)
Unless otherwise authorized by the commissioner, a covered carrier may not enter into one or more ceding arrangements with respect to health benefit plans delivered or issued for delivery to covered insureds in this state if the ceding arrangements would result in less than 50% of the insurance obligation or risk for the health benefit plans being retained by the ceding carrier.
(d)
Section 31A-22-1201 applies if a covered carrier cedes or assumes all of the insurance obligation or risk with respect to one or more health benefit plans delivered or issued for delivery to covered insureds in this state.
(5)
(a)
A Taft Hartley trust created in accordance with Section 302(c)(5) of the Federal Labor Management Relations Act, or a carrier with the written authorization of such a trust, may make a written request to the commissioner for a waiver from the application of any of the provisions of Subsections 31A-30-106(1) and 31A-30-106.1(1) with respect to a health benefit plan provided to the trust.
(b)
The commissioner may grant a trust or carrier described in Subsection (5)(a) a waiver if the commissioner finds that application with respect to the trust would:
(i)
have a substantial adverse effect on the participants and beneficiaries of the trust; and
(ii)
require significant modifications to one or more collective bargaining arrangements under which the trust is established or maintained.
(c)
A waiver granted under this Subsection (5) may not apply to an individual if the person participates in a Taft Hartley trust as an associate member of any employee organization.
any insurer engaging in the business of insurance related to the risk of a small employer for medical, surgical, hospital, or ancillary health care expenses of the small employer’s employees provided as an employee benefit; and
(b)
any contract of an insurer, other than a workers’ compensation policy, related to the risk of a small employer for medical, surgical, hospital, or ancillary health care expenses of the small employer’s employees provided as an employee benefit.
(7)
The commissioner may make rules requiring that the marketing practices be consistent with this chapter for:
