As used in this chapter:

(1) “Covered benefit” or “benefit” means the health care services to which a covered person is entitled under the terms of a health care insurance plan offered by a managed care organization.

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Terms Used In Utah Code 31A-45-102

  • Administrator: means the same as that term is defined in Subsection (187). 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
  • 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
  • Managed care organization: means :
         (2)(a) a managed care organization as that term is defined in Section 31A-1-301; and
         (2)(b) a third party administrator as that term is defined in Section 31A-1-301. See Utah Code 31A-45-102
  • 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
(2) “Managed care organization” means:

     (2)(a) a managed care organization as that term is defined in Section 31A-1-301; and
     (2)(b) a third party administrator as that term is defined in Section 31A-1-301.