Utah Code 31A-23b-211. Exceptions to navigator licensing
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(1) For purposes of this section:
Terms Used In Utah Code 31A-23b-211
- 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
- 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 Section
31A-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
- Contract: A legal written agreement that becomes binding when signed.
- Director: means a member of the board of directors of a corporation. 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
- Employee benefits: means one or more benefits or services provided to:(58)(a) an employee; or(58)(b) a dependent of an employee. 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
- 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
- License: includes a certificate of authority issued to an insurer. 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
- 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
- producer: means a person licensed or required to be licensed under the laws of this state to sell, solicit, or negotiate insurance. 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
- 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
- Solicit: means the same as that term is defined in Section 31A-23a-102. See Utah Code 31A-23b-102
- 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) “Negotiate” is as defined in Section 31A-23a-102.
(1)(b) “Sell” is as defined in Section 31A-23a-102.
(1)(c) “Solicit” is as defined in Section 31A-23a-102.
(2) The commissioner may not require a license as a navigator of:
(2)(a) a person who is employed by or contracts with:
(2)(a)(i) a health care facility that is licensed under Title 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection, to assist an individual with enrollment in a public program or an application for premium subsidy; or
(2)(a)(ii) the state, a political subdivision of the state, an entity of a political subdivision of the state, or a public school district to assist an individual with enrollment in a public program or an application for premium subsidy;
(2)(b) a federally qualified health center as defined by Section 1905(1)(2)(B) of the Social Security Act which assists an individual with enrollment in a public program or an application for premium subsidy;
(2)(c) a person licensed under Chapter 23a, Insurance Marketing – Licensing Producers, Consultants, and Reinsurance Intermediaries, if the person is licensed in the appropriate line of authority to sell, solicit, or negotiate accident and health insurance plans;
(2)(d) an officer, director, or employee of a navigator:
(2)(d)(i) who does not receive compensation or commission from an insurer issuing an insurance contract, an agency administering a public program, an individual who enrolled in a public program or insurance product, or an exchange; and
(2)(d)(ii) whose activities:
(2)(d)(ii)(A) are executive, administrative, managerial, clerical, or a combination thereof;
(2)(d)(ii)(B) only indirectly relate to the sale, solicitation, or negotiation of insurance, or the enrollment in a public program offered through the exchange;
(2)(d)(ii)(C) are in the capacity of a special agent or agency supervisor assisting an insurance producer or navigator;
(2)(d)(ii)(D) are limited to providing technical advice and assistance to a licensed insurance producer or navigator; or
(2)(d)(ii)(E) do not include the sale, solicitation, or negotiation of insurance, or the enrollment in a public program;
(2)(e) a person who does not sell, solicit, or negotiate insurance and is not directly or indirectly compensated by an insurer issuing an insurance contract, an agency administering a public program, an individual who enrolled in a public program or insurance product, or an exchange, including:
(2)(e)(i) an employer, association, officer, director, employee, or trustee of an employee trust plan who is engaged in the administration or operation of a program:
(2)(e)(i)(A) of employee benefits for the employer’s or association’s own employees or the employees of a subsidiary or affiliate of an employer or association; and
(2)(e)(i)(B) that involves the use of insurance issued by an insurer or enrollment in a public health plan on an exchange;
(2)(e)(ii) an employee of an insurer or organization employed by an insurer who is engaging in the inspection, rating, or classification of risk, or the supervision of training of insurance producers; or
(2)(e)(iii) an employee who counsels or advises the employee’s employer with regard to the insurance interests of the employer, or a subsidiary or business affiliate of the employer; and
(2)(f) an Indian health clinic or Urban Indian Health Center, as defined in Title V of the Indian Health Care Improvement Act, which assists a person with enrollment in a public program or an application for a premium subsidy.
(3) The exemption from licensure under Subsections (2)(a), (b), and (f) does not apply if a person described in Subsections (2)(a), (b), and (f) enrolls a person in a private insurance plan.
(4) The commissioner may by rule exempt a class of persons from the license requirement of Subsection 31A-23b-201(1) if:
(4)(a) the functions performed by the class of persons do not require:
(4)(a)(i) special competence;
(4)(a)(ii) special trustworthiness; or
(4)(a)(iii) regulatory surveillance made possible by licensing; or
(4)(b) other existing safeguards make regulation unnecessary.