Utah Code 31A-21-314. Prohibited provisions
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(1) As used in this section:
Terms Used In Utah Code 31A-21-314
- 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
- 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.
- 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- 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.
- Life insurance: means :
(114)(a)(i) insurance on a human life; and(114)(a)(ii) insurance pertaining to or connected with human life. 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(1)(a) “Reserving discretionary authority” means a policy provision that:(1)(a)(i) has the effect of conferring discretion on an insurer, or other claim administrator, to:(1)(a)(i)(A) determine eligibility for benefits; or(1)(a)(i)(B) interpret the terms or provisions of the policy, contract, certificate, or agreement; and(1)(a)(ii) could lead to a deferential standard of review by a reviewing court.(1)(b) “Reserving discretionary authority” does not include a policy provision that:(1)(b)(i) informs an insured that, as part of the insurer’s routine operations, the insurer applies the terms of the contract for:(1)(b)(i)(A) making a decision, including making a determination regarding eligibility, or receipt of benefits or claims; or(1)(b)(i)(B) explaining the insurer’s policies and procedures; and(1)(b)(ii) does not give rise to a deferential standard of review by a reviewing court.(2) An insurance policy subject to this chapter may not contain a provision:(2)(a) requiring the insurance policy to be construed according to the laws of another jurisdiction except as necessary to meet the requirements of compulsory insurance laws of other jurisdictions;(2)(b) depriving Utah courts of jurisdiction over an action against the insurer, except as provided in permissible arbitration provisions;(2)(c) limiting the right of action against the insurer to less than three years from the date the cause of action accrues; or(2)(d) for life insurance or accident and health insurance, reserving discretionary authority.(3) For purposes of Subsection (2)(c), the cause of action accrues on a fidelity bond on the date the insurer first denies all or part of a claim made under the fidelity bond.