Terms Used In Utah Code > Title 31A > Chapter 45 - Managed Care Organizations

• Accessory dwelling unit: means a habitable living unit added to, created within, or detached from a primary single-family dwelling and contained on one lot. See Utah Code 17-27a-103
• 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 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 Allegation: something that someone says happened. Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant. Appeal authority: means the person, board, commission, agency, or other body designated by ordinance to decide an appeal of a decision of a land use application or a variance. See Utah Code 17-27a-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 Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization benefit: means the health care services to which a covered person is entitled under the terms of a health care insurance plan offered by a managed care organization. See Utah Code 31A-45-102 Billboard: means a freestanding ground sign located on industrial, commercial, or residential property if the sign is designed or intended to direct attention to a business, product, or service that is not sold, offered, or existing on the property where the sign is located. See Utah Code 17-27a-103 board of directors: means the group of persons with responsibility over, or management of, a corporation, however designated. See Utah Code 31A-1-301 Charter school: means : (i)  an operating charter school; (ii)  a charter school applicant that a charter school authorizer approves in accordance with 3; or (iii)  an entity that is working on behalf of a charter school or approved charter applicant to develop or construct a charter school building. See Utah Code 17-27a-103 City: includes , depending on population, a metro township as defined in Section 10-3c-102. See Utah Code 68-3-12.5 Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant. Contract: A legal written agreement that becomes binding when signed. Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name. Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries. Department: means the Insurance Department. See Utah Code 31A-1-301 Director: means a member of the board of directors of a corporation. See Utah Code 31A-1-301 Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial. Enrollee: includes an insured. See Utah Code 31A-1-301 Escheat: Reversion of real or personal property to the state when 1) a person dies without leaving a will and has no heirs, or 2) when the property (such as a bank account) has been inactive for a certain period of time. Source: OCC Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other. Exclusion: means for the purposes of accident and health insurance that an insurer does not provide insurance coverage, for whatever reason, for one of the following: (a)  a specific physical condition; (b)  a specific medical procedure; (c)  a specific disease or disorder; or (d)  a specific prescription drug or class of prescription drugs. 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 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; (k)  an actuarial certification; (l)  a licensee annual statement; (m)  a licensee renewal application; (n)  an advertisement; (o)  a binder; or (p)  an outline of coverage. See Utah Code 31A-1-301 Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006. 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)  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 Health care provider: means the same as that term is defined in Section 78B-3-403. See Utah Code 31A-1-301 health insurance: means insurance providing: (i)  a health care benefit; or (ii)  payment of an incurred health care expense. See Utah Code 31A-1-301 Individual: means a natural person. See Utah Code 31A-1-301 insolvent: means that: (a)  an insurer is unable to pay the insurer's obligations as the obligations are due; (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's admitted assets are less than the insurer's liabilities. 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 Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes: (i)  a policyholder; (ii)  a subscriber; (iii)  a member; and (iv)  a beneficiary. 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. Land: includes :Utah Code 68-3-12.5 Land use authority: means : (a)  a person, board, commission, agency, or body, including the local legislative body, designated by the local legislative body to act upon a land use application; or (b)  if the local legislative body has not designated a person, board, commission, agency, or body, the local legislative body. See Utah Code 17-27a-103 Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC Legal tender: coins, dollar bills, or other currency issued by a government as official money. Source: U.S. Mint Legislative: when used to describe the powers, duties, or functions of a county commission or council, refers to: (a)  the power and duty to enact ordinances, levy taxes, and establish budgets; and (b)  those powers, duties, and functions that, under constitutional and statutory provisions and through long usage and accepted practice and custom at the federal and state level, have come to be regarded as belonging to the legislative branch of government. See Utah Code 17-50-101 Maintain custody: means to direct the safekeeping and investment of state funds. See Utah Code 67-4-2 Managed care organization: means : (a)  a managed care organization as that term is defined in Section 31A-1-301; and (b)  a third party administrator as that term is defined in Section 31A-1-301. See Utah Code 31A-45-102 Member: means a person having membership rights in an insurance corporation. See Utah Code 31A-1-301 Mutual: means a mutual insurance corporation. See Utah Code 31A-1-301 Network provider: means a health care provider who has an agreement with a managed care organization to provide health care services to an enrollee with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly from the managed care organization. See Utah Code 31A-1-301 Noncomplying structure: means a structure that: (a)  legally existed before the structure's current land use designation; and (b)  because of one or more subsequent land use ordinance changes, does not conform to the setback, height restrictions, or other regulations, excluding those regulations that govern the use of land. See Utah Code 17-27a-103 Nonconforming use: means a use of land that: (a)  legally existed before the current land use designation; (b)  has been maintained continuously since the time the land use ordinance regulation governing the land changed; and (c)  because of one or more subsequent land use ordinance changes, does not conform to the regulations that now govern the use of the land. See Utah Code 17-27a-103 Order: means an order of the commissioner. See Utah Code 31A-1-301 Oversight: Committee review of the activities of a Federal agency or program. Person: means :Utah Code 68-3-12.5 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 Policy: includes a service contract issued by: (i)  a motor club under Chapter 11, Motor Clubs; (ii)  a service contract provided under Chapter 6a, Service Contracts; and (iii)  a corporation licensed under: (A)  Chapter 7, Nonprofit Health Service Insurance Corporations; or (B)  Chapter 8, Health Maintenance Organizations and Limited Health Plans. See Utah Code 31A-1-301 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 Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed. Proceeding: includes an action or special statutory proceeding. See Utah Code 31A-1-301 Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5 Property: includes both real and personal property. See Utah Code 68-3-12.5 Quorum: The number of legislators that must be present to do business. Rate: means : (i)  the cost of a given unit of insurance; or (ii)  for property or casualty insurance, that cost of insurance per exposure unit either expressed as: (A)  a single number; or (B)  a pure premium rate, adjusted before the 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. See Utah Code 31A-1-301 Receiving zone: means an unincorporated area of a county that the county designates, by ordinance, as an area in which an owner of land may receive a transferable development right. See Utah Code 17-27a-103 Road: includes :Utah Code 68-3-12.5 Security: means a: (i)  note; (ii)  stock; (iii)  bond; (iv)  debenture; (v)  evidence of indebtedness; (vi)  certificate of interest or participation in a 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 (171)(a)(i) through (xiv); or (xvi)  another interest or instrument commonly known as a security. See Utah Code 31A-1-301 Sending zone: means an unincorporated area of a county that the county designates, by ordinance, as an area from which an owner of land may transfer a transferable development right. See Utah Code 17-27a-103 Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims. 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 State: includes any department, division, or agency of the state. See Utah Code 17-27a-103 State entity: includes independent state agencies and public corporations. See Utah Code 67-4-2 State funds: includes funds of independent state agencies or public corporations, regardless of the source of funds. See Utah Code 67-4-2 Statute: A law passed by a legislature. Subdivision: includes : (i)  the division or development of land, whether by deed, metes and bounds description, devise and testacy, map, plat, or other recorded instrument, regardless of whether the division includes all or a portion of a parcel or lot; and (ii)  except as provided in Subsection (70)(c), divisions of land for residential and nonresidential uses, including land used or to be used for commercial, agricultural, and industrial purposes. See Utah Code 17-27a-103 Town: includes , depending on population, a metro township as defined in Section 10-3c-102. See Utah Code 68-3-12.5 Transferable development right: means a right to develop and use land that originates by an ordinance that authorizes a land owner in a designated sending zone to transfer land use rights from a designated sending zone to a designated receiving zone. See Utah Code 17-27a-103 Unincorporated: means the area outside of the incorporated area of a municipality. See Utah Code 17-27a-103 United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5 Warrant: means an order in a specific amount drawn upon the treasurer by the Division of Finance or another state agency. See Utah Code 67-4-2 Writing: includes :Utah Code 68-3-12.5