As used in this part:

(1) “Association” means the Utah Life and Health Insurance Guaranty Association continued under Section 31A-28-106.
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Terms Used In Utah Code 31A-28-105

  • 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
  • Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
  • Annuity: means an agreement to make periodical payments for a period certain or over the lifetime of one or more individuals if the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life. See Utah Code 31A-1-301
  • Association: means the Utah Life and Health Insurance Guaranty Association continued under Section 31A-28-106. See Utah Code 31A-28-105
  • authorized: when used in the context of assessments, means that the board of directors passed a resolution by which an assessment will be called immediately or in the future from member insurers for an amount specified in the resolution. See Utah Code 31A-28-105
  • Benefit plan: means a specific benefit plan of:
         (3)(a) employees;
         (3)(b) a union; or
         (3)(c) an association of natural persons. See Utah Code 31A-28-105
  • Board of directors: means the board of directors established under Section 31A-28-107. See Utah Code 31A-28-105
  • called: when used in the context of assessments, means that the association issued a notice to member insurers requiring that an authorized assessment be paid within the time frame set forth in the notice. See Utah Code 31A-28-105
  • Cash surrender value: means the cash surrender value without reduction for an outstanding policy loan or surrender charge. See Utah Code 31A-28-105
  • 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.
  • contract owner: means a person who:
              (16)(a)(i) is identified as the legal owner under the terms of the policy or contract; or
              (16)(a)(ii) is otherwise vested with legal title to the policy or contract through a valid assignment:
                   (16)(a)(ii)(A) completed in accordance with the terms of the policy or contract; and
                   (16)(a)(ii)(B) properly recorded as the owner on the books of the insurer. See Utah Code 31A-28-105
  • Contractual obligation: means an obligation under any of the following for which coverage is provided under Section 31A-28-103:
         (7)(a) a policy or contract;
         (7)(b) a certificate under a group policy or contract; or
         (7)(c) a portion of a policy or contract. See Utah Code 31A-28-105
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Corporation: means an insurance corporation, except when referring to:
              (34)(a)(i) a corporation doing business:
                   (34)(a)(i)(A) as:
                        (34)(a)(i)(A)(I) an insurance producer;
                        (34)(a)(i)(A)(II) a surplus lines producer;
                        (34)(a)(i)(A)(III) a limited line producer;
                        (34)(a)(i)(A)(IV) a consultant;
                        (34)(a)(i)(A)(V) a managing general agent;
                        (34)(a)(i)(A)(VI) a reinsurance intermediary;
                        (34)(a)(i)(A)(VII) a third party administrator; or
                        (34)(a)(i)(A)(VIII) an adjuster; and
                   (34)(a)(i)(B) under:
                        (34)(a)(i)(B)(I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and Reinsurance Intermediaries;
                        (34)(a)(i)(B)(II) Chapter 25, Third Party Administrators; or
                        (34)(a)(i)(B)(III) Chapter 26, Insurance Adjusters; or
              (34)(a)(ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance Holding Companies. See Utah Code 31A-1-301
  • Coverage date: means the date on which the association becomes responsible for the obligations of a member insurer. See Utah Code 31A-28-105
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • 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
  • Impaired insurer: means a member insurer that is not an insolvent insurer and:
         (12)(a) is considered by the commissioner to be hazardous pursuant to this title; or
         (12)(b) is placed under an order of rehabilitation or conservation by a court of competent jurisdiction. See Utah Code 31A-28-105
  • Individual: means a natural person. See Utah Code 31A-1-301
  • insolvent: means that:
         (95)(a) an insurer is unable to pay the insurer's obligations as the obligations are due;
         (95)(b) an insurer's total adjusted capital is less than the insurer's mandatory control level RBC under Subsection 31A-17-601(8)(c); or
         (95)(c) an insurer's admitted assets are less than the insurer's liabilities. See Utah Code 31A-1-301
  • Insolvent insurer: means a member insurer that is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency. See Utah Code 31A-28-105
  • 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.
  • License: includes a certificate of authority issued to an insurer. See Utah Code 31A-1-301
  • 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
  • Member: means a person having membership rights in an insurance corporation. See Utah Code 31A-1-301
  • Member insurer: includes an insurer whose license or certificate of authority in this state may have been:
              (14)(b)(i) suspended;
              (14)(b)(ii) revoked;
              (14)(b)(iii) not renewed; or
              (14)(b)(iv) voluntarily withdrawn. See Utah Code 31A-28-105
  • 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.
  • 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
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Plan sponsor: means the same as that term is defined in 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
  • 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
  • premiums: means an amount or consideration received on covered policies or contracts, less:
              (17)(a)(i) returned:
                   (17)(a)(i)(A) premiums;
                   (17)(a)(i)(B) considerations; and
                   (17)(a)(i)(C) deposits; and
              (17)(a)(ii) dividends and experience credits. See Utah Code 31A-28-105
  • Receiver: means , as the context requires:
         (19)(a) a rehabilitator;
         (19)(b) a liquidator;
         (19)(c) an ancillary receiver; or
         (19)(d) a conservator. See Utah Code 31A-28-105
  • Resident: means a person:
              (21)(a)(i) to whom a contractual obligation is owed; and
              (21)(a)(ii) who resides in this state on the earlier of the date a member insurer is an:
                   (21)(a)(ii)(A) impaired insurer; or
                   (21)(a)(ii)(B) insolvent insurer. See Utah Code 31A-28-105
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • 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
  • United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
(2)

     (2)(a) “Authorized assessment” or “authorized,” when used in the context of assessments, means that the board of directors passed a resolution by which an assessment will be called immediately or in the future from member insurers for an amount specified in the resolution.
     (2)(b) An assessment is authorized when the resolution is passed.
(3) “Benefit plan” means a specific benefit plan of:

     (3)(a) employees;
     (3)(b) a union; or
     (3)(c) an association of natural persons.
(4) “Board of directors” means the board of directors established under Section 31A-28-107.
(5)

     (5)(a) “Called assessment” or “called,” when used in the context of assessments, means that the association issued a notice to member insurers requiring that an authorized assessment be paid within the time frame set forth in the notice.
     (5)(b) All or part of an authorized assessment becomes a called assessment when notice is mailed by the association to member insurers.
(6) “Cash surrender value” means the cash surrender value without reduction for an outstanding policy loan or surrender charge.
(7) “Contractual obligation” means an obligation under any of the following for which coverage is provided under Section 31A-28-103:

     (7)(a) a policy or contract;
     (7)(b) a certificate under a group policy or contract; or
     (7)(c) a portion of a policy or contract.
(8) “Coverage date” means the date on which the association becomes responsible for the obligations of a member insurer.
(9) “Covered policy” or “covered contract” means any of the following for which coverage is provided in Section 31A-28-103:

     (9)(a) a policy or contract; or
     (9)(b) a portion of a policy or contract.
(10)

     (10)(a) “Covered portion” means:

          (10)(a)(i) for a covered policy that has a cash surrender value, a fraction calculated with:

               (10)(a)(i)(A) the numerator being the lesser of:

                    (10)(a)(i)(A)(I)

                         (10)(a)(i)(A)(I)(Aa) $200,000 for a life insurance policy; or
                         (10)(a)(i)(A)(I)(Bb) $250,000 for a covered policy that is not a life insurance policy; or
                    (10)(a)(i)(A)(II) the cash surrender value of the policy; and
               (10)(a)(i)(B) the denominator being the cash surrender value of the policy; and
          (10)(a)(ii) for a covered policy that does not have a cash surrender value, a fraction calculated with:

               (10)(a)(ii)(A) the numerator being the lesser of:

                    (10)(a)(ii)(A)(I)

                         (10)(a)(ii)(A)(I)(Aa) $200,000 for a life insurance policy; and
                         (10)(a)(ii)(A)(I)(Bb) $250,000 for a covered policy that is not a life insurance policy; or
                    (10)(a)(ii)(A)(II) the policy’s minimum statutory reserve; and
               (10)(a)(ii)(B) the denominator being the policy’s minimum statutory reserve.
     (10)(b) For purposes of this Subsection (10)(b), the cash surrender value and the minimum statutory reserve are determined as of the coverage date in accordance with the exclusions in Subsection 31A-28-103(7)(c).
(11) “Extra-contractual claim” includes a claim relating to:

     (11)(a) bad faith in the payment of a claim;
     (11)(b) punitive or exemplary damages; or
     (11)(c) attorney fees and costs.
(12) “Impaired insurer” means a member insurer that is not an insolvent insurer and:

     (12)(a) is considered by the commissioner to be hazardous pursuant to this title; or
     (12)(b) is placed under an order of rehabilitation or conservation by a court of competent jurisdiction.
(13) “Insolvent insurer” means a member insurer that is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency.
(14)

     (14)(a) “Member insurer” means an insurer that holds a certificate of authority to transact in this state any kind of insurance for which coverage is provided under Section 31A-28-103.
     (14)(b) “Member insurer” includes an insurer whose license or certificate of authority in this state may have been:

          (14)(b)(i) suspended;
          (14)(b)(ii) revoked;
          (14)(b)(iii) not renewed; or
          (14)(b)(iv) voluntarily withdrawn.
     (14)(c) “Member insurer” does not include:

          (14)(c)(i) a for-profit or nonprofit:

               (14)(c)(i)(A) hospital;
               (14)(c)(i)(B) hospital service organization; or
               (14)(c)(i)(C) medical service organization;
          (14)(c)(ii) a fraternal benefit society;
          (14)(c)(iii) a mandatory state pooling plan;
          (14)(c)(iv) a mutual assessment company or other person that operates on an assessment basis;
          (14)(c)(v) an insurance exchange;
          (14)(c)(vi) an organization described in Subsection 31A-22-1305(2); or
          (14)(c)(vii) an entity similar to an entity described in Subsections (14)(c)(i) through (vi).
(15) “Moody’s Corporate Bond Yield Average” means the Monthly Average Corporates as published by Moody’s Investors Service, Inc., or any successor to Moody’s Investors Service, Inc.
(16)

     (16)(a) “Owner” of a policy or contract, “policyholder,” “policy owner,” or “contract owner” means a person who:

          (16)(a)(i) is identified as the legal owner under the terms of the policy or contract; or
          (16)(a)(ii) is otherwise vested with legal title to the policy or contract through a valid assignment:

               (16)(a)(ii)(A) completed in accordance with the terms of the policy or contract; and
               (16)(a)(ii)(B) properly recorded as the owner on the books of the insurer.
     (16)(b) “Owner,” “policyholder,” “policy owner,” or “contract owner” does not include a person with only a beneficial interest in a policy or contract.
(17)

     (17)(a) Notwithstanding Section 31A-1-301, “premiums” means an amount or consideration received on covered policies or contracts, less:

          (17)(a)(i) returned:

               (17)(a)(i)(A) premiums;
               (17)(a)(i)(B) considerations; and
               (17)(a)(i)(C) deposits; and
          (17)(a)(ii) dividends and experience credits.
     (17)(b)

          (17)(b)(i) “Premiums” does not include an amount or consideration received for:

               (17)(b)(i)(A) a policy or contract for which coverage is not provided under Subsections 31A-28-103(6) and (7); or
               (17)(b)(i)(B) the portion of a policy or contract for which coverage is not provided under Subsections 31A-28-103(6) and (7).
          (17)(b)(ii) Notwithstanding Subsection (17)(b)(i), an assessable premium may not be reduced on account of:

               (17)(b)(ii)(A) Subsection 31A-28-103(7)(c) relating to interest limitations; or
               (17)(b)(ii)(B) Subsection 31A-28-103(8) relating to limitations for:

                    (17)(b)(ii)(B)(I) one individual;
                    (17)(b)(ii)(B)(II) any one participant; or
                    (17)(b)(ii)(B)(III) any one policy or contract owner.
     (17)(c) “Premiums” does not include premiums in excess of $5,000,000:

          (17)(c)(i) on an unallocated annuity contract not issued under a governmental retirement plan established under Section 401, 403(b), or 457, Internal Revenue Code; or
          (17)(c)(ii) for multiple nongroup policies of life insurance owned by one owner:

               (17)(c)(ii)(A) whether the policy or contract owner is an individual, firm, corporation, or other person;
               (17)(c)(ii)(B) whether the persons insured are officers, managers, employees, or other persons; and
               (17)(c)(ii)(C) regardless of the number of policies or contracts held by the owner.
(18)

     (18)(a) “Principal place of business” of a plan sponsor or a person other than a natural person means the single state:

          (18)(a)(i) in which the natural persons who establish policy for the direction, control, and coordination of the operations of the entity as a whole primarily exercise the function; and
          (18)(a)(ii) determined by the association in its reasonable judgment by considering the following factors:

               (18)(a)(ii)(A) the state in which the primary executive and administrative headquarters of the entity are located;
               (18)(a)(ii)(B) the state in which the principal office of the chief executive officer of the entity is located;
               (18)(a)(ii)(C) the state in which the board of directors, or similar governing person or persons, of the entity conducts the majority of its meetings;
               (18)(a)(ii)(D) the state in which the executive or management committee of the board of directors, or similar governing person, of the entity conducts the majority of its meetings;
               (18)(a)(ii)(E) the state from which the management of the overall operations of the entity is directed; and
               (18)(a)(ii)(F) in the case of a benefit plan sponsored by affiliated companies comprising a consolidated corporation, the state in which the holding company or controlling affiliate has its principal place of business as determined using the factors described in Subsections (18)(a)(ii)(A) through (E).
     (18)(b) Notwithstanding Subsection (18)(a), in the case of a plan sponsor, if more than 50% of the participants in the benefit plan are employed in a single state, the state where more than 50% of the participants are employed is considered to be the principal place of business of the plan sponsor.
     (18)(c)

          (18)(c)(i) The principal place of business of a plan sponsor of a benefit plan is considered to be the principal place of business of the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan.
          (18)(c)(ii) If there is not a specific or clear designation of a principal place of business under Subsection (18)(c)(i) for a benefit plan, the principal place of business is considered to be the principal place of business of the employer or employee organization that has the largest investment in the benefit plan.
(19) “Receiver” means, as the context requires:

     (19)(a) a rehabilitator;
     (19)(b) a liquidator;
     (19)(c) an ancillary receiver; or
     (19)(d) a conservator.
(20) “Receivership court” means the court in the insolvent or impaired insurer‘s state having jurisdiction over the conservation, rehabilitation, or liquidation of the member insurer.
(21)

     (21)(a) “Resident” means a person:

          (21)(a)(i) to whom a contractual obligation is owed; and
          (21)(a)(ii) who resides in this state on the earlier of the date a member insurer is an:

               (21)(a)(ii)(A) impaired insurer; or
               (21)(a)(ii)(B) insolvent insurer.
     (21)(b) A person may be a resident of only one state, which in the case of a person other than a natural person is where its principal place of business is located.
     (21)(c) A citizen of the United States that is either a resident of a foreign country or a resident of a United States possession, territory, or protectorate that does not have an association similar to the association created by this part, is considered a resident of the state of domicile of the member insurer that issued the policy or contract.
(22) “Structured settlement annuity” means an annuity purchased to fund periodic payments for a plaintiff or other claimant in payment for personal injury suffered by the plaintiff or other claimant.
(23) “Structured settlement factoring transaction” means the same as that term is defined in 26 U.S.C. § 5891(c)(3)(A).
(24) “Supplemental contract” means a written agreement entered into for the distribution of proceeds under a policy or contract for:

     (24)(a) life insurance;
     (24)(b) accident and health insurance; or
     (24)(c) annuity.
(25) “Unallocated annuity contract” means an annuity contract or group annuity certificate that is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate.

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