Utah Code 31A-4-107.5. Penalty for failure of a regulated health insurance entity to fulfill duties related to state claims for Medicaid payment or recovery
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(1) For purposes of this section, “regulated health insurance entity” means a health insurance entity, as defined in Section 26B-3-1001, that is subject to regulation by the department.
Terms Used In Utah Code 31A-4-107.5
- 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
- Department: means the Insurance Department. 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- 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
(2) If a regulated health insurance entity fails to comply with the provisions of Section 26B-3-1004:(2)(a) the commissioner may revoke or suspend, in whole or in part, a license, certificate of authority, registration, or other authority that is granted by the commissioner to the regulated health insurance entity; and(2)(b) the regulated health insurance entity is subject to the penalties and procedures provided for in Section 31A-2-308.