Terms Used In Utah Code > Title 31A > Chapter 45 > Part 4 - Access to Services for Managed Care Enrollees

• 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 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 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 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 Enrollee: includes an insured. 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)  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 insurance: means insurance providing: (i)  a health care benefit; or (ii)  payment of an incurred health care expense. 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. Land: includes :Utah Code 68-3-12.5 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 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 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 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 Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5 Quorum: The number of legislators that must be present to do business. 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 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 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