Terms Used In Utah Code > Title 31A > Chapter 45 > Part 3 - Relationships with Providers

• Administrator: means the same as that term is defined in Subsection (182). See Utah Code 31A-1-301
• 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.
• 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 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 City: includes , depending on population, a metro township as defined in Section 10-3c-102. See Utah Code 68-3-12.5 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. 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 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 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 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 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 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 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 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 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 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 Statute: A law passed by a legislature. Writing: includes :Utah Code 68-3-12.5