Utah Code 31A-23b-301. Unfair practices — Compensation — Limit of scope of practice
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(1) As used in this section, “false or misleading information” includes, with intent to deceive a person examining it:
Terms Used In Utah Code 31A-23b-301
- 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 Section31A-23a-301 ,31A-25-207 , or31A-26-209 . See Utah Code 31A-1-301- business of insurance: includes :
(98)(a) providing health care insurance by an organization that is or is required to be licensed under this title;(98)(b) providing a benefit to an employee in the event of a contingency not within the control of the employee, in which the employee is entitled to the benefit as a right, which benefit may be provided either:(98)(b)(i) by a single employer or by multiple employer groups; or(98)(b)(ii) through one or more trusts, associations, or other entities;(98)(c) providing an annuity:(98)(c)(i) including an annuity issued in return for a gift; and(98)(c)(ii) except an annuity provided by a person specified in Subsections31A-22-1305 (2) and (3);(98)(d) providing the characteristic services of a motor club;(98)(e) providing another person with insurance;(98)(f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor, or surety, a contract or policy offering title insurance;(98)(g) transacting or proposing to transact any phase of title insurance, including:(98)(g)(i) solicitation;(98)(g)(ii) negotiation preliminary to execution;(98)(g)(iii) execution of a contract of title insurance;(98)(g)(iv) insuring; and(98)(g)(v) transacting matters subsequent to the execution of the contract and arising out of the contract, including reinsurance;(98)(h) transacting or proposing a life settlement; and(98)(i) doing, or proposing to do, any business in substance equivalent to Subsections (98)(a) through (h) in a manner designed to evade this title. See Utah Code 31A-1-301- Department: means the Insurance Department. 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- 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- 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- 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.
- 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- PPACA: means the Patient Protection and Affordable Care Act, Pub. See Utah Code 31A-1-301
- Public programs: means the state Medicaid program in Title 26B, Chapter 3, Health Care - Administration and Assistance, and Title 26B, Chapter 3, Part 9, Utah Children's Health Insurance Program. See Utah Code 31A-23b-102
- Small employer: means , in connection with a health benefit plan and with respect to a calendar year and to a plan year, an employer who:
(182)(a)(i)(182)(a)(i)(A) employed at least one but not more than 50 eligible employees on business days during the preceding calendar year; or(182)(a)(i)(B) if the employer did not exist for the entirety of the preceding calendar year, reasonably expects to employ an average of at least one but not more than 50 eligible employees on business days during the current calendar year;(182)(a)(ii) employs at least one employee on the first day of the plan year; and(182)(a)(iii) for an employer who has common ownership with one or more other employers, is treated as a single employer under 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) filing a report;(1)(b) making a false entry in a record; or(1)(c) willfully refraining from making a proper entry in a record.(2)(2)(a) Communication that contains false or misleading information relating to enrollment in an insurance plan or a public program, including information that is false or misleading because it is incomplete, may not be made by:(2)(a)(i) a person who is or should be licensed under this title;(2)(a)(ii) an employee of a person described in Subsection (2)(a)(i);(2)(a)(iii) a person whose primary interest is as a competitor of a person licensed under this title; and(2)(a)(iv) a person on behalf of a person listed in this Subsection (2)(a).(2)(b) A licensee under this chapter may not:(2)(b)(i) use a business name, slogan, emblem, or related device that is misleading or likely to cause the exchange, insurer, or other licensee to be mistaken for another governmental agency, a PPACA exchange, insurer, or other licensee already in business; or(2)(b)(ii) use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that a state or federal government agency, public program, or insurer:(2)(b)(ii)(A) is responsible for the insurance or public program enrollment assistance activities of the person;(2)(b)(ii)(B) stands behind the credit of the person; or(2)(b)(ii)(C) is a source of payment of an insurance obligation of or sold by the person.(2)(c) A person who is not an insurer may not assume or use a name that deceptively implies or suggests that person is an insurer.(3) A person may not engage in an unfair method of competition or any other unfair or deceptive act or practice in the business of insurance, as defined by the commissioner by rule, after a finding that the method of competition, the act, or the practice:(3)(a) is misleading;(3)(b) is deceptive;(3)(c) is unfairly discriminatory;(3)(d) provides an unfair inducement; or(3)(e) unreasonably restrains competition.(4) A navigator licensed under this chapter is subject to the unfair marketing practices and inducement provisions of Sections 31A-23a-402 and 31A-23a-402.5.(5) A navigator licensed under this chapter or who should be licensed under this chapter:(5)(a) may not receive direct or indirect compensation from an accident or health insurer or from an individual who receives services from a navigator in accordance with:(5)(a)(i) federal conflict of interest regulations established pursuant to PPACA; and(5)(a)(ii) administrative rule adopted by the department;(5)(b) may be compensated by the exchange for performing the duties of a navigator;(5)(c)(5)(c)(i) may perform, offer to perform, or advertise a service as a navigator only for a person selecting a qualified health plan or public program offered on an exchange; and(5)(c)(ii) may not perform, offer to perform, or advertise services as a navigator for individuals or small employer groups selecting accident and health insurance plans, qualified health plans, public programs, business, or services that are not offered on an exchange; and(5)(d) may not recommend a particular accident and health insurance plan or qualified health plan. - Agency: means :