§ 31A-8-401 Enrollee participation
§ 31A-8-403 Examination of organization and providers
§ 31A-8-404 Annual audit of internal quality control
§ 31A-8-405 Confidentiality of medical records and audits
§ 31A-8-406 Distribution by nonprofit organizations
§ 31A-8-407 Written contracts — Limited liability of enrollee — Provider claim disputes — Leased networks
§ 31A-8-408 Organizations offering point of service or point of sales products
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Terms Used In Utah Code > Title 31A > Chapter 8 > Part 4 - Operations

  • Adjudicative proceeding: means :
         (2)(a) an action by a board, commission, department, officer, or other administrative unit of the state that determines the legal rights, duties, privileges, immunities, or other legal interests of one or more identifiable persons, including an action to grant, deny, revoke, suspend, modify, annul, withdraw, or amend an authority, right, or license; and
         (2)(b) judicial review of an action described in Subsection (2)(a). See Utah Code 68-3-12.5
  • Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Analysis assignment: means an unbiased analysis, opinion, or conclusion that relates to the nature, quality, or utility of identified real estate or identified real property. See Utah Code 61-2g-102
  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • 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.
  • Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
  • Appraisal: A determination of property value.
  • Appraisal: means an analysis, opinion, or conclusion relating to the nature, quality, value, or utility of a specified interest in, or aspect of, identified real estate or identified real property. See Utah Code 61-2g-102
  • Appraisal Foundation: means the Appraisal Foundation that was incorporated as an Illinois not-for-profit corporation on November 30, 1987. See Utah Code 61-2g-102
  • Appraisal report: means a communication, written or oral, of an appraisal. See Utah Code 61-2g-102
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Associate broker: means an individual who is:
         (1)(a) employed or engaged as an independent contractor by or on behalf of a principal broker to perform an act described in Subsection (20) for valuable consideration; and
         (1)(b) licensed under this chapter as an associate broker. See Utah Code 61-2f-102
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Board: means the Real Estate Appraiser Licensing and Certification Board that is established in Section 61-2g-204. See Utah Code 61-2g-102
  • Branch broker: means an associate broker who manages a principal broker's branch office under the supervision of the principal broker. See Utah Code 61-2f-102
  • Branch office: means a principal broker's real estate brokerage office that is not the principal broker's main office. See Utah Code 61-2f-102
  • Certified appraisal report: means a written or oral appraisal report that is certified by a state-certified general appraiser or state-certified residential appraiser. See Utah Code 61-2g-102
  • Commission: means the Real Estate Commission established under this chapter. See Utah Code 61-2f-102
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Concurrence: means the entities given a concurring role must jointly agree for action to be taken. See Utah Code 61-2f-102
  • Concurrence: means that the entities that are given a concurring role jointly agree to an action. See Utah Code 61-2g-102
  • Consultation service: means an engagement to provide a real estate valuation service analysis, opinion, conclusion, or other service that does not fall within the definition of appraisal. See Utah Code 61-2g-102
  • Contingent fee: means a fee or other form of compensation, payment of which is dependent on or conditioned by:
              (1)(i)(i) the reporting of a predetermined analysis, opinion, or conclusion by the person performing the analysis, opinion, or conclusion; or
              (1)(i)(ii) achieving a result specified by the person requesting the analysis, opinion, or conclusion. See Utah Code 61-2g-102
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • 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.
  • Credential: means a state-issued registration, license, or certification that allows an individual to perform any act or service that requires licensure or certification under this chapter. See Utah Code 61-2g-102
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
  • Department: means the Insurance Department. See Utah Code 31A-1-301
  • Dependent: A person dependent for support upon another.
  • Director: means a member of the board of directors of a corporation. See Utah Code 31A-1-301
  • Director: means the director of the Division of Real Estate. See Utah Code 61-2f-102
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Division: means the Division of Real Estate. See Utah Code 61-2f-102
  • Division: means the Division of Real Estate of the Department of Commerce. See Utah Code 61-2g-102
  • Enrollee: includes an insured. See Utah Code 31A-1-301
  • Entity: means :
         (14)(a) a corporation;
         (14)(b) a partnership;
         (14)(c) a limited liability company;
         (14)(d) a company;
         (14)(e) an association;
         (14)(f) a joint venture;
         (14)(g) a business trust;
         (14)(h) a trust; or
         (14)(i) any organization similar to an entity described in Subsections (14)(a) through (h). See Utah Code 61-2f-102
  • Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
  • Evaluation: means an opinion on the market value of real property or real estate that:
              (1)(l)(i) is made in accordance with the Interagency Appraisal and Evaluation Guidelines; and
              (1)(l)(ii) is provided to a financial institution for use in a real estate related transaction for which the regulations of the federal financial institutions regulatory agencies do not require an appraisal. See Utah Code 61-2g-102
  • 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.
  • Executive director: means the director of the Department of Commerce. See Utah Code 61-2f-102
  • Executive director: means the executive director of the Department of Commerce. See Utah Code 61-2g-102
  • Federal financial institutions regulatory agencies: means :
              (1)(n)(i) the Board of Governors of the Federal Reserve System;
              (1)(n)(ii) the Federal Deposit Insurance Corporation;
              (1)(n)(iii) the Office of the Comptroller of the Currency; and
              (1)(n)(iv) the National Credit Union Administration. See Utah Code 61-2g-102
  • Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. Source: OCC
  • Fiduciary: A trustee, executor, or administrator.
  • Filing: when used as a noun, means an item required to be filed with the department including:
         (70)(a) a policy;
         (70)(b) a rate;
         (70)(c) a form;
         (70)(d) a document;
         (70)(e) a plan;
         (70)(f) a manual;
         (70)(g) an application;
         (70)(h) a report;
         (70)(i) a certificate;
         (70)(j) an endorsement;
         (70)(k) an actuarial certification;
         (70)(l) a licensee annual statement;
         (70)(m) a licensee renewal application;
         (70)(n) an advertisement;
         (70)(o) a binder; or
         (70)(p) an outline of coverage. See Utah Code 31A-1-301
  • Financial institution: means an insured:
              (1)(p)(i) depository as defined in Utah Code 61-2g-102
  • 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.
  • Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
  • Foreclosure rescue: means , for compensation or with the expectation of receiving valuable consideration, to:
         (16)(a) engage, or offer to engage, in an act that:
              (16)(a)(i) the person represents will assist a borrower in preventing a foreclosure; and
              (16)(a)(ii) relates to a transaction involving the transfer of title to residential real property; or
         (16)(b) as an employee or agent of another person:
              (16)(b)(i) solicit, or offer that the other person will engage in an act described in Subsection (16)(a); or
              (16)(b)(ii) negotiate terms in relationship to an act described in Subsection (16)(a). See Utah Code 61-2f-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
  • Fraud: Intentional deception resulting in injury to another.
  • 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
  • Individual: means a natural person. See Utah Code 31A-1-301
  • Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
  • insolvent: means that:
         (95)(a) an insurer is unable to pay the insurer's obligations as the obligations are due;
         (95)(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
         (95)(c) an insurer's admitted assets are less than the insurer's liabilities. 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
  • Interagency Appraisal and Evaluation Guidelines: means the guidelines published as Interagency Appraisal and Evaluation Guidelines, 75 Fed. See Utah Code 61-2g-102
  • 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 :
         (18)(a) land;
         (18)(b) a tenement;
         (18)(c) a hereditament;
         (18)(d) a water right;
         (18)(e) a possessory right; and
         (18)(f) a claim. See Utah Code 68-3-12.5
  • 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.
  • 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
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Loan modification assistance: means , for compensation or with the expectation of receiving valuable consideration, to:
         (17)(a) act, or offer to act, on behalf of a person to:
              (17)(a)(i) obtain a loan term of a residential mortgage loan that is different from an existing loan term including:
                   (17)(a)(i)(A) an increase or decrease in an interest rate;
                   (17)(a)(i)(B) a change to the type of interest rate;
                   (17)(a)(i)(C) an increase or decrease in the principal amount of the residential mortgage loan;
                   (17)(a)(i)(D) a change in the number of required period payments;
                   (17)(a)(i)(E) an addition of collateral;
                   (17)(a)(i)(F) a change to, or addition of, a prepayment penalty;
                   (17)(a)(i)(G) an addition of a cosigner; or
                   (17)(a)(i)(H) a change in persons obligated under the existing residential mortgage loan; or
              (17)(a)(ii) substitute a new residential mortgage loan for an existing residential mortgage loan; or
         (17)(b) as an employee or agent of another person:
              (17)(b)(i) solicit, or offer that the other person will engage in an act described in Subsection (17)(a); or
              (17)(b)(ii) negotiate terms in relationship to an act described in Subsection (17)(a). See Utah Code 61-2f-102
  • Main office: means the address which a principal broker designates with the division as the principal broker's primary brokerage office. See Utah Code 61-2f-102
  • Member: means a person having membership rights in an insurance corporation. See Utah Code 31A-1-301
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • National Credit Union Administration: The federal regulatory agency that charters and supervises federal credit unions. (NCUA also administers the National Credit Union Share Insurance Fund, which insures the deposits of federal credit unions.) Source: OCC
  • Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
  • Oath: A promise to tell the truth.
  • Oath: includes "affirmation. See Utah Code 68-3-12.5
  • Participating: means a plan of insurance under which the insured is entitled to receive a dividend representing a share of the surplus of the insurer. See Utah Code 31A-1-301
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • 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 an individual or entity. See Utah Code 61-2f-102
  • 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
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
  • 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
  • Principal broker: means an individual who is licensed or required to be licensed as a principal broker under this chapter who:
         (20)(a) sells or lists for sale real estate, including real estate being sold as part of a foreclosure rescue, or a business opportunity with the expectation of receiving valuable consideration;
         (20)(b) buys, exchanges, or auctions real estate, an option on real estate, a business opportunity, or an improvement on real estate with the expectation of receiving valuable consideration;
         (20)(c) advertises, offers, attempts, or otherwise holds the individual out to be engaged in the business described in Subsection (20)(a) or (b);
         (20)(d) is employed by or on behalf of the owner of real estate or by a prospective purchaser of real estate and performs an act described in Subsection (20)(a), whether the individual's compensation is at a stated salary, a commission basis, upon a salary and commission basis, or otherwise;
         (20)(e) with the expectation of receiving valuable consideration, manages property owned by another person;
         (20)(f) advertises or otherwise holds the individual out to be engaged in property management;
         (20)(g) with the expectation of receiving valuable consideration, assists or directs in the procurement of prospects for or the negotiation of a transaction listed in Subsections (20)(a) and (e);
         (20)(h) except for a mortgage lender, title insurance producer, or an employee of a mortgage lender or title insurance producer, assists or directs in the closing of a real estate transaction with the expectation of receiving valuable consideration;
         (20)(i) engages in foreclosure rescue; or
         (20)(j) advertises, offers, attempts, or otherwise holds the person out as being engaged in foreclosure rescue. See Utah Code 61-2f-102
  • 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.
  • Real estate: includes leaseholds and business opportunities involving real property. See Utah Code 61-2f-102
  • Real estate: means an identified parcel or tract of land including improvements if any. See Utah Code 61-2g-102
  • Real estate related transaction: means :
              (1)(t)(i) the sale, lease, purchase, investment in, or exchange of real property or an interest in real property, or the financing of such a transaction;
              (1)(t)(ii) the refinancing of real property or an interest in real property; or
              (1)(t)(iii) the use of real property or an interest in real property as security for a loan or investment, including mortgage-backed securities. See Utah Code 61-2g-102
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Real property: means one or more defined interests, benefits, or rights inherent in the ownership of real estate. See Utah Code 61-2g-102
  • real property: includes :
         (31)(a) land;
         (31)(b) a tenement;
         (31)(c) a hereditament;
         (31)(d) a water right;
         (31)(e) a possessory right; and
         (31)(f) a claim. See Utah Code 68-3-12.5
  • Reinstatement: means restoring a license that has expired or has been suspended. See Utah Code 61-2f-102
  • Renewal: means extending a license for an additional licensing period on or before the date the license expires. See Utah Code 61-2f-102
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • Review assignment: means an unbiased analysis, opinion, or conclusion that forms an opinion as to the adequacy and appropriateness of a valuation appraisal or an analysis assignment. See Utah Code 61-2g-102
  • Sales agent: means an individual who is:
         (28)(a) affiliated with a principal broker, either as an independent contractor or an employee as provided in Section 61-2f-303, to perform for valuable consideration an act described in Subsection (20); and
         (28)(b) licensed under this chapter as a sales agent. See Utah Code 61-2f-102
  • Sell: means to exchange a contract of insurance:
         (179)(a) by any means;
         (179)(b) for money or its equivalent; and
         (179)(c) on behalf of an insurance company. See Utah Code 31A-1-301
  • Service of process: The service of writs or summonses to the appropriate party.
  • 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.
  • Signature: includes a name, mark, or sign written with the intent to authenticate an instrument or writing. See Utah Code 68-3-12.5
  • 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-certified general appraiser: means a person who holds a current, valid certification as a state-certified general appraiser issued under this chapter. See Utah Code 61-2g-102
  • State-certified residential appraiser: means a person who holds a current, valid certification as a state-certified residential real estate appraiser issued under this chapter. See Utah Code 61-2g-102
  • State-licensed appraiser: means a person who holds a current, valid license as a state-licensed appraiser issued under this chapter. See Utah Code 61-2g-102
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Trainee: means an individual who:
              (1)(y)(i) does not hold an appraiser license or appraiser certification issued under this chapter;
              (1)(y)(ii) works under the direct supervision of a state-certified appraiser to earn experience for licensure; and
              (1)(y)(iii) is registered as a trainee under this chapter. See Utah Code 61-2g-102
  • United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
  • Utah Code: means the 1953 recodification of the Utah Code, as amended, unless the text expressly references a portion of the 1953 recodification of the Utah Code as it existed:
         (42)(a) on the day on which the 1953 recodification of the Utah Code was enacted; or
         (42)(b)
              (42)(b)(i) after the day described in Subsection (42)(a); and
              (42)(b)(ii) before the most recent amendment to the referenced portion of the 1953 recodification of the Utah Code. See Utah Code 68-3-12.5
  • Valuation appraisal: means an unbiased analysis, opinion, or conclusion that estimates the value of an identified parcel of real estate or identified real property at a particular point in time. See Utah Code 61-2g-102
  • Vulnerable adult: means the same as that term is defined in Section 26B-6-201. See Utah Code 61-2f-102
  • Writ: A formal written command, issued from the court, requiring the performance of a specific act.
  • Writ: means an order or precept in writing, issued in the name of:
         (47)(a) the state;
         (47)(b) a court; or
         (47)(c) a judicial officer. See Utah Code 68-3-12.5
  • Writing: includes :
         (48)(a) printing;
         (48)(b) handwriting; and
         (48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5