Terms Used In Utah Code > Title 63G > Chapter 10 - State Settlement Agreements Act

• Accident and health insurance: means insurance to provide protection against economic losses resulting from:
            (1)(a)(i) a medical condition including:

                 (1)(a)(i)(A) a medical care expense; or

                 (1)(a)(i)(B) the risk of disability;
            (1)(a)(ii) accident; or
            (1)(a)(iii) sickness. See Utah Code 31A-1-301
• Action settlement agreement: includes a stipulation, consent decree, settlement agreement, or any other legally binding document or representation that resolves a threatened or pending lawsuit between the state and another party by requiring the state to take legally binding action. See Utah Code 63G-10-102
• Agency: includes the legislative branch, the judicial branch, the attorney general's office, the State Board of Education, the Utah Board of Higher Education, the institutional councils of each higher education institution, and each higher education institution. See Utah Code 63G-10-102
• Application: means a document:
       (10)(a)

            (10)(a)(i) completed by an applicant to provide information about the risk to be insured; and

            (10)(a)(ii) that contains information that is used by the insurer to evaluate risk and decide whether to:

                 (10)(a)(ii)(A) insure the risk under:

                      (10)(a)(ii)(A)(I) the coverage as originally offered; or

                      (10)(a)(ii)(A)(II) a modification of the coverage as originally offered; or

                 (10)(a)(ii)(B) decline to insure the risk; or
       (10)(b) used by the insurer to gather information from the applicant before issuance of an annuity contract. See Utah Code 31A-1-301
• Appraisal: A determination of property value.
• Certificate: means evidence of insurance given to:
       (23)(a) an insured under a group insurance policy; or
       (23)(b) a third party. See Utah Code 31A-1-301
• 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.
• Creditable coverage: includes coverage that is offered through a public health plan such as:
            (35)(b)(i) the Primary Care Network Program under a Medicaid primary care network demonstration waiver obtained subject to Section 26B-3-108;
            (35)(b)(ii) the Children's Health Insurance Program under Section 26B-3-904; or
            (35)(b)(iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. See Utah Code 31A-1-301
• Direct response insurance policy: means an insurance policy solicited and sold without the policyholder having direct contact with a natural person intermediary. See Utah Code 31A-1-301
• Employee: means :
       (57)(a) an individual employed by an employer; or
       (57)(b) an individual who meets the requirements of Subsection (55)(b). See Utah Code 31A-1-301
• 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:
       (67)(a) a specific physical condition;
       (67)(b) a specific medical procedure;
       (67)(c) a specific disease or disorder; or
       (67)(d) a specific prescription drug or class of prescription drugs. See Utah Code 31A-1-301
• Executive director: means the individual appointed under Section 63A-1-105 as the executive director of the Department of Government Operations, created in Section 63A-1-104. See Utah Code 63G-10-501
• Financial settlement agreement: includes a stipulation, consent decree, settlement agreement, and any other legally binding document or representation that resolves a dispute between the state and another party exclusively by requiring the payment of money from one party to the other. See Utah Code 63G-10-102
• Form: means one of the following prepared for general use:
            (74)(a)(i) a policy;
            (74)(a)(ii) a certificate;
            (74)(a)(iii) an application;
            (74)(a)(iv) an outline of coverage; or
            (74)(a)(v) an endorsement. See Utah Code 31A-1-301
• Government entities: means the state and its political subdivisions. See Utah Code 63G-10-102
• Group health plan: means an employee welfare benefit plan to the extent that the plan provides medical care:
       (78)(a)

            (78)(a)(i) to an employee; or

            (78)(a)(ii) to a dependent of an employee; and
       (78)(b)

            (78)(b)(i) directly;

            (78)(b)(ii) through insurance reimbursement; or

            (78)(b)(iii) through another method. 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:
       (83)(a) a professional service;
       (83)(b) a personal service;
       (83)(c) a facility;
       (83)(d) equipment;
       (83)(e) a device;
       (83)(f) supplies; or
       (83)(g) medicine. See Utah Code 31A-1-301
• health insurance: means insurance providing:
            (84)(a)(i) a health care benefit; or
            (84)(a)(ii) payment of an incurred health care expense. See Utah Code 31A-1-301
• Indemnity: means the payment of an amount to offset all or part of an insured loss. See Utah Code 31A-1-301
• Individual: means a natural person. See Utah Code 31A-1-301
• Insurance: includes :
            (96)(b)(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;
            (96)(b)(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
            (96)(b)(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:
            (103)(a)(i) a policyholder;
            (103)(a)(ii) a subscriber;
            (103)(a)(iii) a member; and
            (103)(a)(iv) a beneficiary. See Utah Code 31A-1-301
• Joint resolution: A legislative measure which requires the approval of both chambers.
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the federal Social Security Act, as then constituted or later amended. See Utah Code 31A-1-301
• Medicare supplement insurance: means health insurance coverage that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of individuals eligible for Medicare. 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.
• Outline of coverage: means a summary that explains an accident and health insurance policy. See Utah Code 31A-1-301
• Person: includes :
       (146)(a) an individual;
       (146)(b) a partnership;
       (146)(c) a corporation;
       (146)(d) an incorporated or unincorporated association;
       (146)(e) a joint stock company;
       (146)(f) a trust;
       (146)(g) a limited liability company;
       (146)(h) a reciprocal;
       (146)(i) a syndicate; or
       (146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301
• Person: means :
       (24)(a) an individual;
       (24)(b) an association;
       (24)(c) an institution;
       (24)(d) a corporation;
       (24)(e) a company;
       (24)(f) a trust;
       (24)(g) a limited liability company;
       (24)(h) a partnership;
       (24)(i) a political subdivision;
       (24)(j) a government office, department, division, bureau, or other body of government; and
       (24)(k) any other organization or entity. See Utah Code 68-3-12.5
• Policy: includes a service contract issued by:
            (150)(b)(i) a motor club under Chapter 11, Motor Clubs;
            (150)(b)(ii) a service contract provided under Chapter 6a, Service Contracts; and
            (150)(b)(iii) a corporation licensed under:

                 (150)(b)(iii)(A) Chapter 7, Nonprofit Health Service Insurance Corporations; or

                 (150)(b)(iii)(B) Chapter 8, Health Maintenance Organizations and Limited Health Plans. See Utah Code 31A-1-301
• Policyholder: means a person who controls a policy, binder, or oral contract by ownership, premium payment, or otherwise. See Utah Code 31A-1-301
• Premium: includes , however designated:
            (156)(b)(i) an assessment;
            (156)(b)(ii) a membership fee;
            (156)(b)(iii) a required contribution; or
            (156)(b)(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
• Risk management fund: means the fund created in Section 63A-4-201. See Utah Code 63G-10-501
• Risk manager: means the state risk manager appointed under Section Utah Code 63G-10-501
• Security: means a:
            (176)(a)(i) note;
            (176)(a)(ii) stock;
            (176)(a)(iii) bond;
            (176)(a)(iv) debenture;
            (176)(a)(v) evidence of indebtedness;
            (176)(a)(vi) certificate of interest or participation in a profit-sharing agreement;
            (176)(a)(vii) collateral-trust certificate;
            (176)(a)(viii) preorganization certificate or subscription;
            (176)(a)(ix) transferable share;
            (176)(a)(x) investment contract;
            (176)(a)(xi) voting trust certificate;
            (176)(a)(xii) certificate of deposit for a security;
            (176)(a)(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;
            (176)(a)(xiv) commodity contract or commodity option;
            (176)(a)(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 (176)(a)(i) through (xiv); or
            (176)(a)(xvi) another interest or instrument commonly known as a security. See Utah Code 31A-1-301
• 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.
• Settlement agreement report: means a report that:
       (5)(a) states the total amount of the settlement;
       (5)(b) states the payer of the settlement;
       (5)(c) states the recipient of the payment;
       (5)(d) summarizes the circumstances related to the settlement; and
       (5)(e) contains a copy of the settlement agreement, unless the agreement is not permitted to be disclosed due to a court order or other legal requirement. See Utah Code 63G-10-102
• Settlement amount: means the total cost to implement:
       (4)(a) an action settlement as defined in Section 63G-10-102, including the cost of the required action and any required monetary payment; or
       (4)(b) a financial settlement as defined in Section 63G-10-102. See Utah Code 63G-10-501
• Significant break in coverage: means a period of 63 consecutive days during each of which an individual does not have creditable coverage. 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.