Terms Used In Utah Code > Title 31A > Chapter 22 > Part 7 - Group Accident and Health Insurance

• 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
• Administrator: includes "executor" when the subject matter justifies the use. See Utah Code 68-3-12.5
• Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
• 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
• Armed forces: means the United States Army, Navy, Air Force, Marine Corps, Space Force, and Coast Guard. See Utah Code 68-3-12.5
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• 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
• City: includes , depending on population, a metro township as defined in Section 10-3c-102. See Utah Code 68-3-12.5
• consultant: means a person who:
       (99)(a) advises another person about insurance needs and coverages;
       (99)(b) is compensated by the person advised on a basis not directly related to the insurance placed; and
       (99)(c) except as provided in Section 31A-23a-501, is not compensated directly or indirectly by an insurer or producer for advice given. See Utah Code 31A-1-301
• Contract: A legal written agreement that becomes binding when signed.
• County legislative body: means :
       (8)(a) the county commission, in the county commission or expanded county commission form of government established under Title 17, Chapter 52a, Changing Forms of County Government;
       (8)(b) the county council, in the county executive-council optional form of government authorized by Section 17-52a-203; and
       (8)(c) the county council, in the council-manager optional form of government authorized by Section 17-52a-204. See Utah Code 68-3-12.5
• Department: means the Insurance Department. See Utah Code 31A-1-301
• Dependent: A person dependent for support upon another.
• Disability: means a physiological or psychological condition that partially or totally limits an individual's ability to:
       (51)(a) perform the duties of:

            (51)(a)(i) that individual's occupation; or

            (51)(a)(ii) an occupation for which the individual is reasonably suited by education, training, or experience; or
       (51)(b) perform two or more of the following basic activities of daily living:

            (51)(b)(i) eating;

            (51)(b)(ii) toileting;

            (51)(b)(iii) transferring;

            (51)(b)(iv) bathing; or

            (51)(b)(v) dressing. 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
• Endorsement: means a written agreement attached to a policy or certificate to modify the policy or certificate coverage. See Utah Code 31A-1-301
• Exclusion: means for the purposes of accident and health insurance that an insurer does not provide insurance coverage, for whatever reason, for one of the following:
       (67)(a) a specific physical condition;
       (67)(b) a specific medical procedure;
       (67)(c) a specific disease or disorder; or
       (67)(d) a specific prescription drug or class of prescription drugs. See Utah Code 31A-1-301
• Fraud: Intentional deception resulting in injury to another.
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• Group health plan: means an employee welfare benefit plan to the extent that the plan provides medical care:
       (78)(a)

            (78)(a)(i) to an employee; or

            (78)(a)(ii) to a dependent of an employee; and
       (78)(b)

            (78)(b)(i) directly;

            (78)(b)(ii) through insurance reimbursement; or

            (78)(b)(iii) through another method. See Utah Code 31A-1-301
• Group insurance policy: means a policy covering a group of persons that is issued:
            (79)(a)(i) to a policyholder on behalf of the group; and
            (79)(a)(ii) for the benefit of a member of the group who is selected under a procedure defined in:

                 (79)(a)(ii)(A) the policy; or

                 (79)(a)(ii)(B) an agreement that is collateral to the policy. See Utah Code 31A-1-301
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Guardian: includes a person who:
       (14)(a) qualifies as a guardian of a minor or incapacitated person pursuant to testamentary or court appointment; or
       (14)(b) is appointed by a court to manage the estate of a minor or incapacitated person. See Utah Code 68-3-12.5
• Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. 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
• 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
• 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
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• 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
• Month: means a calendar month, unless otherwise expressed. See Utah Code 68-3-12.5
• 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
• Plan year: means :
       (149)(a) the year that is designated as the plan year in:

            (149)(a)(i) the plan document of a group health plan; or

            (149)(a)(ii) a summary plan description of a group health plan;
       (149)(b) if the plan document or summary plan description does not designate a plan year or there is no plan document or summary plan description:

            (149)(b)(i) the year used to determine deductibles or limits;

            (149)(b)(ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis; or

            (149)(b)(iii) the employer's taxable year if:

                 (149)(b)(iii)(A) the plan does not impose deductibles or limits on a yearly basis; and

                 (149)(b)(iii)(B)

                      (149)(b)(iii)(B)(I) the plan is not insured; or

                      (149)(b)(iii)(B)(II) the insurance policy is not renewed on an annual basis; or
       (149)(c) in a case not described in Subsection (149)(a) or (b), the calendar year. See 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
• Policyholder: means a person who controls a policy, binder, or oral contract by ownership, premium payment, or otherwise. 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
• Property: includes both real and personal property. See Utah Code 68-3-12.5
• Quorum: The number of legislators that must be present to do business.
• Rate: means :
            (163)(a)(i) the cost of a given unit of insurance; or
            (163)(a)(ii) for property or casualty insurance, that cost of insurance per exposure unit either expressed as:

                 (163)(a)(ii)(A) a single number; or

                 (163)(a)(ii)(B) a pure premium rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:

                      (163)(a)(ii)(B)(I) expenses;

                      (163)(a)(ii)(B)(II) profit; and

                      (163)(a)(ii)(B)(III) individual insurer variation in loss experience. 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
• 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
• Woman: means an adult human female. See Utah Code 68-3-12.5
• Writing: includes :
       (48)(a) printing;
       (48)(b) handwriting; and
       (48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5