Utah Code 31A-1-103. Scope and applicability of title
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(1) This title does not apply to:
Terms Used In Utah Code 31A-1-103
- 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
- Administrator: means the same as that term is defined in Subsection (187). See Utah Code 31A-1-301
- Affiliate: means a person who controls, is controlled by, or is under common control with, another person. 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 Section31A-23a-301 ,31A-25-207 , or31A-26-209 . See Utah Code 31A-1-301- 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- Attorney-at-law: A person who is legally qualified and licensed to practice law, and to represent and act for clients in legal proceedings.
- authorized insurer: means an insurer:
(191)(b)(i) holding a valid certificate of authority to do an insurance business in this state; and(191)(b)(ii) transacting business as authorized by a valid certificate. See Utah Code 31A-1-301- 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.
- Department: means the Insurance Department. See Utah Code 31A-1-301
- Disability: means a physiological or psychological condition that partially or totally limits an individual's ability to:
(51)(a) perform the duties of:(51)(a)(i) that individual's occupation; or(51)(a)(ii) an occupation for which the individual is reasonably suited by education, training, or experience; or(51)(b) perform two or more of the following basic activities of daily living:(51)(b)(i) eating;(51)(b)(ii) toileting;(51)(b)(iii) transferring;(51)(b)(iv) bathing; or(51)(b)(v) dressing. 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- 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- 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 care sharing ministry: means an entity that:
(86)(a) is a tax-exempt nonprofit entity under the Internal Revenue Code;(86)(b) limits participants to those who are of a similar faith;(86)(c) facilitates the sharing of a participant's qualified expenses, as defined by the entity, among other participants by:(86)(c)(i) matching a participant who has qualified expenses with one or more participants who are able to contribute to paying for the qualified expenses; and(86)(c)(ii) arranging, directly or indirectly, for each contributing participant's contribution to be used to pay for the qualified expenses;(86)(d) requires an individual to make one or more minimum payments or contributions as a condition of one or more of the following:(86)(d)(i) becoming a participant;(86)(d)(ii) remaining a participant; or(86)(d)(iii) receiving a contribution to pay qualified expenses; and(86)(e) in carrying out the functions described in this Subsection (86), makes no assumption of risk or promise to pay any qualified expenses. 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- 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- insurance company: means a person doing an insurance business as a principal including:
(104)(a)(i) a fraternal benefit society;(104)(a)(ii) an issuer of a gift annuity other than an annuity specified in Subsections31A-22-1305 (2) and (3);(104)(a)(iii) a motor club;(104)(a)(iv) an employee welfare plan;(104)(a)(v) a person purporting or intending to do an insurance business as a principal on that person's own account; and(104)(a)(vi) a health maintenance organization. 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- 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.
- Mutual: means a mutual insurance corporation. 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.
- Ocean marine insurance: means insurance against loss of or damage to:
(138)(a) ships or hulls of ships;(138)(b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money, securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia interests, or other cargoes in or awaiting transit over the oceans or inland waterways;(138)(c) earnings such as freight, passage money, commissions, or profits derived from transporting goods or people upon or across the oceans or inland waterways; or(138)(d) a vessel owner or operator as a result of liability to employees, passengers, bailors, owners of other vessels, owners of fixed objects, customs or other authorities, or other persons in connection with maritime activity. See Utah Code 31A-1-301- Order: means an order of the commissioner. 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- 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- Reinsurance: means an insurance transaction where an insurer, for consideration, transfers any portion of the risk it has assumed to another insurer. See Utah Code 31A-1-301
- 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- Self-insurance: includes :
(178)(b)(i) an arrangement under which a governmental entity undertakes to indemnify an employee for liability arising out of the employee's employment; and(178)(b)(ii) an arrangement under which a person with a managed program of self-insurance and risk management undertakes to indemnify the person's affiliate, subsidiary, director, officer, or employee for liability or risk that arises out of the person's relationship with the affiliate, subsidiary, director, officer, or employee. 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
(1)(a) a retainer contract made by an attorney-at-law:(1)(a)(i) with an individual client; and(1)(a)(ii) under which fees are based on estimates of the nature and amount of services to be provided to the specific client;(1)(b) a contract similar to a contract described in Subsection (1)(a) made with a group of clients involved in the same or closely related legal matters;(1)(c) an arrangement for providing benefits that do not exceed a limited amount of consultations, advice on simple legal matters, either alone or in combination with referral services, or the promise of fee discounts for handling other legal matters;(1)(d) limited legal assistance on an informal basis involving neither an express contractual obligation nor reasonable expectations, in the context of an employment, membership, educational, or similar relationship;(1)(e) legal assistance by employee organizations to their members in matters relating to employment;(1)(f) death, accident, health, or disability benefits provided to a person by an organization or its affiliate if:(1)(f)(i) the organization is tax exempt under Section 501(c)(3) of the Internal Revenue Code and has had its principal place of business in Utah for at least five years;(1)(f)(ii) the person is not an employee of the organization; and(1)(f)(iii)(1)(f)(iii)(A) substantially all the person’s time in the organization is spent providing voluntary services:(1)(f)(iii)(A)(I) in furtherance of the organization’s purposes;(1)(f)(iii)(A)(II) for a designated period of time; and(1)(f)(iii)(A)(III) for which no compensation, other than expenses, is paid; or(1)(f)(iii)(B) the time since the service under Subsection (1)(f)(iii)(A) was completed is no more than 18 months; or(1)(g) a prepaid contract of limited duration that provides for scheduled maintenance only.(2)(2)(a) This title restricts otherwise legitimate business activity.(2)(b) What this title does not prohibit is permitted unless contrary to other provisions of Utah law.(3) Except as otherwise expressly provided, this title does not apply to:(3)(a) those activities of an insurer where state jurisdiction is preempted by Section 514 of the federal Employee Retirement Income Security Act of 1974, as amended;(3)(b) ocean marine insurance;(3)(c) death, accident, health, or disability benefits provided by an organization that:(3)(c)(i) has as the organization’s principal purpose to achieve charitable, educational, social, or religious objectives rather than to provide death, accident, health, or disability benefits;(3)(c)(ii) does not incur a legal obligation to pay a specified amount;(3)(c)(iii) does not create reasonable expectations of receiving a specified amount on the part of an insured person; and(3)(c)(iv) is not a health care sharing ministry that provides that a participant make a contribution to pay another participant’s qualified expenses with no assumption of risk or promise to pay.(3)(d) other business specified in rules adopted by the commissioner on a finding that:(3)(d)(i) the transaction of the business in this state does not require regulation for the protection of the interests of the residents of this state; or(3)(d)(ii) it would be impracticable to require compliance with this title;(3)(e) except as provided in Subsection (4), a transaction independently procured through negotiations under Section31A-15-104 ;(3)(f) self-insurance;(3)(g) reinsurance;(3)(h) subject to Subsection (5), an employee or labor union group insurance policy covering risks in this state or an employee or labor union blanket insurance policy covering risks in this state, if:(3)(h)(i) the policyholder exists primarily for purposes other than to procure insurance;(3)(h)(ii) the policyholder:(3)(h)(ii)(A) is not a resident of this state;(3)(h)(ii)(B) is not a domestic corporation; or(3)(h)(ii)(C) does not have the policyholder’s principal office in this state;(3)(h)(iii) no more than 25% of the certificate holders or insureds are residents of this state;(3)(h)(iv) on request of the commissioner, the insurer files with the department a copy of the policy and a copy of each form or certificate; and(3)(h)(v)(3)(h)(v)(A) the insurer agrees to pay premium taxes on the Utah portion of the insurer’s business, as if the insurer were authorized to do business in this state; and(3)(h)(v)(B) the insurer provides the commissioner with the security the commissioner considers necessary for the payment of premium taxes under Title 59, Chapter 9, Taxation of Admitted Insurers;(3)(i) to the extent provided in Subsection (6):(3)(i)(i) a manufacturer’s or seller’s warranty; and(3)(i)(ii) a manufacturer’s or seller’s service contract;(3)(j) except to the extent provided in Subsection (7), a public agency insurance mutual;(3)(k) except as provided in Chapter 6b, Guaranteed Asset Protection Waiver Act, a guaranteed asset protection waiver; or(3)(l) a health care sharing ministry, if the health care sharing ministry:(3)(l)(i) provides to each participant upon enrollment and annually thereafter a written statement of nationwide data from the preceding calendar year that lists the total dollar amount of contributions provided to participants toward qualified expenses; and(3)(l)(ii) includes a written disclaimer, titled “Notice”, on or with each application and all guideline materials that states:(3)(l)(ii)(A) the health care sharing ministry is not an insurance company;(3)(l)(ii)(B) nothing the health care sharing ministry offers or provides is an insurance policy, including the health care sharing ministry’s guidelines or plan of operations;(3)(l)(ii)(C) participation in the health care sharing ministry is entirely voluntary and no participant is compelled by law to contribute to another participant’s expenses;(3)(l)(ii)(D) participation in the health care sharing ministry or subscription to any of the health care sharing ministry’s services is not insurance; and(3)(l)(ii)(E) each participant is always personally responsible for the participant’s expenses regardless of whether the participant receives payment for the expenses through the health care sharing ministry or whether this health care sharing ministry continues to operate.(4) A transaction described in Subsection (3)(e) is subject to taxation under Section31A-3-301 .(5)(5)(a) After a hearing, the commissioner may order an insurer of certain group insurance policies or blanket insurance policies to transfer the Utah portion of the business otherwise exempted under Subsection (3)(h) to an authorized insurer if the contracts have been written by an unauthorized insurer.(5)(b) If the commissioner finds that the conditions required for the exemption of a group or blanket insurer are not satisfied or that adequate protection to residents of this state is not provided, the commissioner may require:(5)(b)(i) the insurer to be authorized to do business in this state; or(5)(b)(ii) that any of the insurer’s transactions be subject to this title.(5)(c) Subsection (3)(h) does not apply to a blanket insurance policy offering accident and health insurance.(6)(6)(a) As used in Subsection (3)(i) and this Subsection (6):(6)(a)(i) “manufacturer’s or seller’s service contract” means a service contract:(6)(a)(i)(A) made available by:(6)(a)(i)(A)(I) a manufacturer of a product;(6)(a)(i)(A)(II) a seller of a product; or(6)(a)(i)(A)(III) an affiliate of a manufacturer or seller of a product;(6)(a)(i)(B) made available:(6)(a)(i)(B)(I) on one or more specific products; or(6)(a)(i)(B)(II) on products that are components of a system; and(6)(a)(i)(C) under which the person described in Subsection (6)(a)(i)(A) is liable for services to be provided under the service contract including, if the manufacturer’s or seller’s service contract designates, providing parts and labor;(6)(a)(ii) “manufacturer’s or seller’s warranty” means the guaranty of:(6)(a)(ii)(A)(6)(a)(ii)(A)(I) the manufacturer of a product;(6)(a)(ii)(A)(II) a seller of a product; or(6)(a)(ii)(A)(III) an affiliate of a manufacturer or seller of a product;(6)(a)(ii)(B)(6)(a)(ii)(B)(I) on one or more specific products; or(6)(a)(ii)(B)(II) on products that are components of a system; and(6)(a)(ii)(C) under which the person described in Subsection (6)(a)(ii)(A) is liable for services to be provided under the warranty, including, if the manufacturer’s or seller’s warranty designates, providing parts and labor; and(6)(a)(iii) “service contract” means the same as that term is defined in Section31A-6a-101 .(6)(b) A manufacturer’s or seller’s warranty may be designated as:(6)(b)(i) a warranty;(6)(b)(ii) a guaranty; or(6)(b)(iii) a term similar to a term described in Subsection (6)(b)(i) or (ii).(6)(c) This title does not apply to:(6)(c)(i) a manufacturer’s or seller’s warranty;(6)(c)(ii) a manufacturer’s or seller’s service contract paid for with consideration that is in addition to the consideration paid for the product itself; and(6)(c)(iii) a service contract that is not a manufacturer’s or seller’s warranty or manufacturer’s or seller’s service contract if:(6)(c)(iii)(A) the service contract is paid for with consideration that is in addition to the consideration paid for the product itself;(6)(c)(iii)(B) the service contract is for the repair or maintenance of goods;(6)(c)(iii)(C) the purchase price of the product is $3,700 or less;(6)(c)(iii)(D) the product is not a motor vehicle; and(6)(c)(iii)(E) the product is not the subject of a home warranty service contract.(6)(d) This title does not apply to a manufacturer’s or seller’s warranty or service contract paid for with consideration that is in addition to the consideration paid for the product itself regardless of whether the manufacturer’s or seller’s warranty or service contract is sold:(6)(d)(i) at the time of the purchase of the product; or(6)(d)(ii) at a time other than the time of the purchase of the product.(7)(7)(a) For purposes of this Subsection (7), “public agency insurance mutual” means an entity formed by two or more political subdivisions or public agencies of the state:(7)(a)(i) under Title 11, Chapter 13, Interlocal Cooperation Act; and(7)(a)(ii) for the purpose of providing for the political subdivisions or public agencies:(7)(a)(ii)(A) subject to Subsection (7)(b), insurance coverage; or(7)(a)(ii)(B) risk management.(7)(b) Notwithstanding Subsection (7)(a)(ii)(A), a public agency insurance mutual may not provide health insurance unless the public agency insurance mutual provides the health insurance using:(7)(b)(i) a third party administrator licensed under Chapter 25, Third Party Administrators;(7)(b)(ii) an admitted insurer; or(7)(b)(iii) a program authorized by Title 49, Chapter 20, Public Employees’ Benefit and Insurance Program Act.(7)(c) Except for this Subsection (7), a public agency insurance mutual is exempt from this title.(7)(d) A public agency insurance mutual is considered to be a governmental entity and political subdivision of the state with all of the rights, privileges, and immunities of a governmental entity or political subdivision of the state including all the rights and benefits of Title 63G, Chapter 7, Governmental Immunity Act of Utah.