As used in this title, unless otherwise specified: (1) (a) "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. (b) "Accident and health insurance": (i) includes a contract with disability contingencies including: (A) an income replacement contract; (B) a health care contract; (C) a fixed indemnity contract; (D) a credit accident and health contract; (E) a continuing care contract; and (F) a long-term care contract; and (ii) may provide: (A) hospital coverage; (B) surgical coverage; (C) medical coverage; (D) loss of income coverage; (E) prescription drug coverage; (F) dental coverage; or (G) vision coverage. (c) "Accident and health insurance" does not include workers' compensation insurance. (d) For purposes of a national licensing registry, "accident and health insurance" is the same as "accident and health or sickness insurance." (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act. (3) "Administrator" means the same as that term is defined in Subsection (187). (4) "Adult" means an individual who is 18 years old or older. (5) "Affiliate" means a person who controls, is controlled by, or is under common control with, another person. A corporation is an affiliate of another corporation, regardless of ownership, if substantially the same group of individuals manage the corporations. (6) "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. (7) "Alien insurer" means an insurer domiciled outside the United States. (8) "Amendment" means an endorsement to an insurance policy or certificate. (9) "Annuity" means an agreement to make periodical payments for a period certain or over the lifetime of one or more individuals if the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life. (10) "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. (11) "Articles" or "articles of incorporation" means: (a) the original articles; (b) a special law; (c) a charter; (d) an amendment; (e) restated articles; (f) articles of merger or consolidation; (g) a trust instrument; (h) another constitutive document for a trust or other entity that is not a corporation; and (i) an amendment to an item listed in Subsections (11)(a) through (h). (12) "Bail bond insurance" means a guarantee that a person will attend court when required, up to and including surrender of the person in execution of a sentence imposed under Subsection 77-20-501(1), as a condition to the release of that person from confinement. (13) "Binder" means the same as that term is defined in Section 31A-21-102. (14) "Blanket insurance policy" or "blanket contract" means a group insurance policy covering a defined class of persons: (a) without individual underwriting or application; and (b) that is determined by definition without designating each person covered. (15) "Board," "board of trustees," or "board of directors" means the group of persons with responsibility over, or management of, a corporation, however designated. (16) "Bona fide office" means a physical office in this state: (a) that is open to the public; (b) that is staffed during regular business hours on regular business days; and (c) at which the public may appear in person to obtain services. (17) "Business entity" means: (a) a corporation; (b) an association; (c) a partnership; (d) a limited liability company; (e) a limited liability partnership; or (f) another legal entity. (18) "Business of insurance" means the same as that term is defined in Subsection (98). (19) "Business plan" means the information required to be supplied to the commissioner under Subsections 31A-5-204(2)(i) and (j), including the information required when these subsections apply by reference under: (a) Section 31A-8-205; or (b) Subsection 31A-9-205(2). (20) (a) "Bylaws" means the rules adopted for the regulation or management of a corporation's affairs, however designated. (b) "Bylaws" includes comparable rules for a trust or other entity that is not a corporation. (21) "Captive insurance company" means: (a) an insurer: (i) owned by a parent organization; and (ii) whose purpose is to insure risks of the parent organization and other risks as authorized under: (A) Chapter 37, Captive Insurance Companies Act; and (B) Chapter 37a, Special Purpose Financial Captive Insurance Company Act; or (b) in the case of a group or association, an insurer: (i) owned by the insureds; and (ii) whose purpose is to insure risks of: (A) a member organization; (B) a group member; or (C) an affiliate of: (I) a member organization; or (II) a group member. (22) "Casualty insurance" means liability insurance. (23) "Certificate" means evidence of insurance given to: (a) an insured under a group insurance policy; or (b) a third party. (24) "Certificate of authority" is included within the term "license." (25) "Claim," unless the context otherwise requires, means a request or demand on an insurer for payment of a benefit according to the terms of an insurance policy. (26) "Claims-made coverage" means an insurance contract or provision limiting coverage under a policy insuring against legal liability to claims that are first made against the insured while the policy is in force. (27) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance commissioner. (b) When appropriate, the terms listed in Subsection (27)(a) apply to the equivalent supervisory official of another jurisdiction. (28) (a) "Continuing care insurance" means insurance that: (i) provides board and lodging; (ii) provides one or more of the following: (A) a personal service; (B) a nursing service; (C) a medical service; or (D) any other health-related service; and (iii) provides the coverage described in this Subsection (28)(a) under an agreement effective: (A) for the life of the insured; or (B) for a period in excess of one year. (b) Insurance is continuing care insurance regardless of whether or not the board and lodging are provided at the same location as a service described in Subsection (28)(a)(ii). (29) (a) "Control," "controlling," "controlled," or "under common control" means the direct or indirect possession of the power to direct or cause the direction of the management and policies of a person. This control may be: (i) by contract; (ii) by common management; (iii) through the ownership of voting securities; or (iv) by a means other than those described in Subsections (29)(a)(i) through (iii). (b) There is no presumption that an individual holding an official position with another person controls that person solely by reason of the position. (c) A person having a contract or arrangement giving control is considered to have control despite the illegality or invalidity of the contract or arrangement. (d) There is a rebuttable presumption of control in a person who directly or indirectly owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the voting securities of another person. (30) "Controlled insurer" means a licensed insurer that is either directly or indirectly controlled by a producer. (31) "Controlling person" means a person that directly or indirectly has the power to direct or cause to be directed, the management, control, or activities of a reinsurance intermediary. (32) "Controlling producer" means a producer who directly or indirectly controls an insurer. (33) "Corporate governance annual disclosure" means a report an insurer or insurance group files in accordance with the requirements of Chapter 16b, Corporate Governance Annual Disclosure Act. (34) (a) "Corporation" means an insurance corporation, except when referring to: (i) a corporation doing business: (A) as: (I) an insurance producer; (II) a surplus lines producer; (III) a limited line producer; (IV) a consultant; (V) a managing general agent; (VI) a reinsurance intermediary; (VII) a third party administrator; or (VIII) an adjuster; and (B) under: (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries; (II) Chapter 25, Third Party Administrators; or (III) Chapter 26, Insurance Adjusters; or (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance Holding Companies. (b) "Mutual" or "mutual corporation" means a mutual insurance corporation. (c) "Stock corporation" means a stock insurance corporation. (35) (a) "Creditable coverage" has the same meaning as provided in federal regulations adopted pursuant to the Health Insurance Portability and Accountability Act. (b) "Creditable coverage" includes coverage that is offered through a public health plan such as: (i) the Primary Care Network Program under a Medicaid primary care network demonstration waiver obtained subject to Section 26B-3-108; (ii) the Children's Health Insurance Program under Section 26B-3-904; or (iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L. No. 101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. No. 109-415. (36) "Credit accident and health insurance" means insurance on a debtor to provide indemnity for payments coming due on a specific loan or other credit transaction while the debtor has a disability. (37) (a) "Credit insurance" means insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation. (b) "Credit insurance" includes: (i) credit accident and health insurance; (ii) credit life insurance; (iii) credit property insurance; (iv) credit unemployment insurance; (v) guaranteed automobile protection insurance; (vi) involuntary unemployment insurance; (vii) mortgage accident and health insurance; (viii) mortgage guaranty insurance; and (ix) mortgage life insurance. (38) "Credit life insurance" means insurance on the life of a debtor in connection with an extension of credit that pays a person if the debtor dies. (39) "Creditor" means a person, including an insured, having a claim, whether: (a) matured; (b) unmatured; (c) liquidated; (d) unliquidated; (e) secured; (f) unsecured; (g) absolute; (h) fixed; or (i) contingent. (40) "Credit property insurance" means insurance: (a) offered in connection with an extension of credit; and (b) that protects the property until the debt is paid. (41) "Credit unemployment insurance" means insurance: (a) offered in connection with an extension of credit; and (b) that provides indemnity if the debtor is unemployed for payments coming due on a: (i) specific loan; or (ii) credit transaction. (42) (a) "Crop insurance" means insurance providing protection against damage to crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation, disease, or other yield-reducing conditions or perils that is: (i) provided by the private insurance market; or (ii) subsidized by the Federal Crop Insurance Corporation. (b) "Crop insurance" includes multiperil crop insurance. (43) (a) "Customer service representative" means a person that provides an insurance service and insurance product information: (i) for the customer service representative's: (A) producer; (B) surplus lines producer; or (C) consultant employer; and (ii) to the customer service representative's employer's: (A) customer; (B) client; or (C) organization. (b) A customer service representative may only operate within the scope of authority of the customer service representative's producer, surplus lines producer, or consultant employer. (44) "Deadline" means a final date or time: (a) imposed by: (i) statute; (ii) rule; or (iii) order; and (b) by which a required filing or payment must be received by the department. (45) "Deemer clause" means a provision under this title under which upon the occurrence of a condition precedent, the commissioner is considered to have taken a specific action. If the statute so provides, a condition precedent may be the commissioner's failure to take a specific action. (46) "Degree of relationship" means the number of steps between two persons determined by counting the generations separating one person from a common ancestor and then counting the generations to the other person. (47) "Department" means the Insurance Department. (48) (a) "Direct response solicitation" means an offer for life or accident and health insurance coverage that allows the individual to apply for or enroll in the insurance coverage on the basis of the offer. (b) "Direct response solicitation" does not include an offer for: (i) insurance through an employee benefit plan that is exempt from state regulation under federal law; or (ii) credit life insurance or credit accident and health insurance through a individual's creditor. (49) "Direct response insurance policy" means an insurance policy solicited and sold without the policyholder having direct contact with a natural person intermediary. (50) "Director" means a member of the board of directors of a corporation. (51) "Disability" means a physiological or psychological condition that partially or totally limits an individual's ability to: (a) perform the duties of: (i) that individual's occupation; or (ii) an occupation for which the individual is reasonably suited by education, training, or experience; or (b) perform two or more of the following basic activities of daily living: (i) eating; (ii) toileting; (iii) transferring; (iv) bathing; or (v) dressing. (52) "Disability income insurance" means the same as that term is defined in Subsection (89). (53) "Domestic insurer" means an insurer organized under the laws of this state. (54) "Domiciliary state" means the state in which an insurer: (a) is incorporated; (b) is organized; or (c) in the case of an alien insurer, enters into the United States. (55) (a) "Eligible employee" means: (i) an employee who: (A) works on a full-time basis; and (B) has a normal work week of 30 or more hours; or (ii) a person described in Subsection (55)(b). (b) "Eligible employee" includes: (i) an owner, sole proprietor, or partner who: (A) works on a full-time basis; (B) has a normal work week of 30 or more hours; and (C) employs at least one common employee; and (ii) an independent contractor if the individual is included under a health benefit plan of a small employer. (c) "Eligible employee" does not include, unless eligible under Subsection (55)(b): (i) an individual who works on a temporary or substitute basis for a small employer; (ii) an employer's spouse who does not meet the requirements of Subsection (55)(a)(i); or (iii) a dependent of an employer who does not meet the requirements of Subsection (55)(a)(i). (56) "Emergency medical condition" means a medical condition that: (a) manifests itself by acute symptoms, including severe pain; and (b) would cause a prudent layperson possessing an average knowledge of medicine and health to reasonably expect the absence of immediate medical attention through a hospital emergency department to result in: (i) placing the layperson's health or the layperson's unborn child's health in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ or part. (57) "Employee" means: (a) an individual employed by an employer; or (b) an individual who meets the requirements of Subsection (55)(b). (58) "Employee benefits" means one or more benefits or services provided to: (a) an employee; or (b) a dependent of an employee. (59) (a) "Employee welfare fund" means a fund: (i) established or maintained, whether directly or through a trustee, by: (A) one or more employers; (B) one or more labor organizations; or (C) a combination of employers and labor organizations; and (ii) that provides employee benefits paid or contracted to be paid, other than income from investments of the fund: (A) by or on behalf of an employer doing business in this state; or (B) for the benefit of a person employed in this state. (b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or tax revenues. (60) "Endorsement" means a written agreement attached to a policy or certificate to modify the policy or certificate coverage. (61) (a) "Enrollee" means: (i) a policyholder; (ii) a certificate holder; (iii) a subscriber; or (iv) a covered individual: (A) who has entered into a contract with an organization for health care; or (B) on whose behalf an arrangement for health care has been made. (b) "Enrollee" includes an insured. (62) "Enrollment date," with respect to a health benefit plan, means: (a) the first day of coverage; or (b) if there is a waiting period, the first day of the waiting period. (63) "Enterprise risk" means an activity, circumstance, event, or series of events involving one or more affiliates of an insurer that, if not remedied promptly, is likely to have a material adverse effect upon the financial condition or liquidity of the insurer or its insurance holding company system as a whole, including anything that would cause: (a) the insurer's risk-based capital to fall into an action or control level as set forth in Sections
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