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:
            (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
• Agency: means :
       (6)(a) a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and
       (6)(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
• Department: means the Insurance Department. See Utah Code 31A-1-301
• Employee: means a person who performs a service for wages or other remuneration under a contract of hire, written or oral, express or implied. See Utah Code 67-21-2
• Employer: includes an agent of an employer. See Utah Code 67-21-2
• Enrollee: includes an insured. See Utah Code 31A-1-301
• Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
• 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
• 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
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Managed care organization: means :
       (2)(a) a managed care organization as that term is defined in Section 31A-1-301; and
       (2)(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
• 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
• PPACA: means the Patient Protection and Affordable Care Act, Pub. 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
• Public body: means any of the following:
       (11)(a) a state officer, employee, agency, department, division, bureau, board, commission, council, authority, educational institution, or any other body in the executive branch of state government;
       (11)(b) an agency, board, commission, council, institution member, or employee of the legislative branch of state government;
       (11)(c) a county, city, town, regional governing body, council, school district, special district, special service district, or municipal corporation, board, department, commission, council, agency, or any member or employee of them;
       (11)(d) any other body that is created by state or local authority, or that is primarily funded by or through state or local authority, or any member or employee of that body;
       (11)(e) a law enforcement agency or any member or employee of a law enforcement agency; and
       (11)(f) the judiciary and any member or employee of the judiciary. See Utah Code 67-21-2
• Retaliatory action: means the same as that term is defined in Section 67-19a-101. See Utah Code 67-21-2
• 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