Terms Used In Utah Code > Title 31A > Chapter 46 > Part 3 - Operating Requirements

• Abusive conduct: means verbal, nonverbal, or physical conduct of an employee to another employee of the same employer that, based on the severity, nature, or frequency of the conduct, a reasonable person would determine:
            (1)(a)(i) is intended to cause intimidation, humiliation, or unwarranted distress;
            (1)(a)(ii) results in substantial physical harm or substantial psychological harm as a result of intimidation, humiliation, or unwarranted distress; or
            (1)(a)(iii) exploits an employee's known physical or psychological disability. See Utah Code 67-26-102
• Abusive conduct complaint process: means the process described in Section 67-26-202. See Utah Code 67-26-102
• Administrative review process: means a process that allows an employee, in relation to the findings of an abusive conduct investigation, to seek an administrative review that:
       (3)(a) an employer conducts in accordance with Section 67-26-202; or
       (3)(b) in relation to a state executive branch agency, the Career Service Review Office conducts in accordance with Section 67-19a-501. See Utah Code 67-26-102
• Affiliate: means a person who controls, is controlled by, or is under common control with, another person. See Utah Code 31A-1-301
• Allowable claim amount: means the amount paid by an insurer under the customer's health benefit plan. See Utah Code 31A-46-102
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
• Career service employee: means the same as that term is defined in Section 63A-17-102. See Utah Code 67-27-102
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Contracting insurer: means an insurer with whom a pharmacy benefit manager contracts to provide a pharmacy benefit management service. See Utah Code 31A-46-102
• Cost share: means the amount paid by an insured customer under the customer's health benefit plan. See Utah Code 31A-46-102
• Department: means the Insurance Department. See Utah Code 31A-1-301
• Device: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Direct or indirect remuneration: means any adjustment in the total compensation:
       (9)(a) received by a pharmacy from a pharmacy benefit manager for the sale of a drug, device, or other product or service; and
       (9)(b) that is determined after the sale of the product or service. See Utah Code 31A-46-102
• Dispense: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Division: means the Division of Human Resource Management. See Utah Code 67-26-102
• Drug: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Employee: includes an elected or appointed official of an employer. See Utah Code 67-26-102
• Employer: means :
       (6)(a) a state executive branch agency; or
       (6)(b) an independent entity, as defined in Section 63E-1-102. See Utah Code 67-26-102
• Enrollee: includes an insured. See Utah Code 31A-1-301
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Executive branch elected official: means :
       (2)(a) the governor;
       (2)(b) the lieutenant governor;
       (2)(c) the attorney general;
       (2)(d) the state treasurer; or
       (2)(e) the state auditor. See Utah Code 67-27-102
• Form: means one of the following prepared for general use:
            (74)(a)(i) a policy;
            (74)(a)(ii) a certificate;
            (74)(a)(iii) an application;
            (74)(a)(iv) an outline of coverage; or
            (74)(a)(v) an endorsement. See Utah Code 31A-1-301
• Fraud: Intentional deception resulting in injury to another.
• 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
• Insurer: means the same as that term is defined in Section 31A-22-636. See Utah Code 31A-46-102
• Lobbying: is a s defined in Section 36-11-102. See Utah Code 67-24-102
• Lobbyist: is a s defined in Section 36-11-102. See Utah Code 67-24-102
• Maximum allowable cost: means :
       (13)(a) a maximum reimbursement amount for a group of pharmaceutically and therapeutically equivalent drugs; or
       (13)(b) any similar reimbursement amount that is used by a pharmacy benefit manager to reimburse pharmacies for multiple source drugs. See Utah Code 31A-46-102
• Medicaid program: means the same as that term is defined in Section 26B-3-101. See Utah Code 31A-46-102
• Obsolete: means a product that may be listed in national drug pricing compendia but is no longer available to be dispensed based on the expiration date of the last lot manufactured. See Utah Code 31A-46-102
• Office: means the Career Service Review Office created under Section 67-19a-201. See Utah Code 67-26-102
• Person: means :
       (24)(a) an individual;
       (24)(b) an association;
       (24)(c) an institution;
       (24)(d) a corporation;
       (24)(e) a company;
       (24)(f) a trust;
       (24)(g) a limited liability company;
       (24)(h) a partnership;
       (24)(i) a political subdivision;
       (24)(j) a government office, department, division, bureau, or other body of government; and
       (24)(k) any other organization or entity. See Utah Code 68-3-12.5
• Pharmaceutical manufacturer: means a pharmaceutical facility that manufactures prescription drugs. See Utah Code 31A-46-102
• Pharmacist: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Pharmacy: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Pharmacy benefit manager: means a person licensed under this chapter to provide a pharmacy benefits management service. See Utah Code 31A-46-102
• Pharmacy service: means a product, good, or service provided to an individual by a pharmacy or pharmacist. See Utah Code 31A-46-102
• Pharmacy service entity: means :
       (25)(a) a pharmacy services administration organization; or
       (25)(b) a pharmacy benefit manager. See Utah Code 31A-46-102
• Physical harm: means the impairment of an individual's physical health or bodily integrity, as established by competent evidence. See Utah Code 67-26-102
• Prescription device: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Prescription drug: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
• Psychological harm: means the impairment of an individual's mental health, as established by competent evidence. See Utah Code 67-26-102
• Rebate: means a refund, discount, or other price concession that is paid by a pharmaceutical manufacturer to a pharmacy benefit manager based on a prescription drug's utilization or effectiveness. See Utah Code 31A-46-102
• Reimbursement report: means a report on the adjustment in total compensation for a claim. See Utah Code 31A-46-102
• Retail pharmacy: means the same as that term is defined in Section 58-17b-102. See Utah Code 31A-46-102
• Sale: means a prescription drug or prescription device claim covered by a health benefit plan. See Utah Code 31A-46-102
• 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
• State agency: means a department, division, board, council, committee, institution, office, bureau, or other similar administrative unit of the executive branch of state government. See Utah Code 67-27-102
• State executive branch agency: includes an agency under the authority of the governor, lieutenant governor, state treasurer, state auditor, or attorney general. See Utah Code 67-26-102
• State official: means :
       (3)(a) a member of the Legislature;
       (3)(b) the governor;
       (3)(c) the lieutenant governor;
       (3)(d) the state auditor;
       (3)(e) the state treasurer; and
       (3)(f) the attorney general. See Utah Code 67-24-102
• Statute: A law passed by a legislature.
• United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5