reglab/statecodes huggingface dataset:
2023 Utah Code › Title 31A - Insurance Code › Chapter 6b - Guaranteed Asset Protection Waiver Act › Part 3 - Requirements for a Guaranteed Asset Protection Waiver › Section 303 - Cancellation or termination of a guaranteed asset protection waiver.

31A-6b-303.
Cancellation or termination of a guaranteed asset protection waiver.
(1)
(a) A borrower may cancel a guaranteed asset protection waiver in accordance with this section.
(b) A borrower may not waive by contract the borrower's right to cancel a guaranteed asset protection waiver in accordance with this section.
(c) A guaranteed asset protection waiver terminates on the day on which the related finance agreement terminates.
(2)
(a) A guaranteed asset protection waiver shall provide for a preliminary period of at least 30 days.
(b) If a borrower cancels a guaranteed asset protection waiver or if a guaranteed asset protection waiver terminates within the preliminary period, the borrower is entitled to a refund of the charge for the guaranteed asset protection waiver as follows:
(i) if benefits have not been provided, a full refund; or
(ii) if benefits have been provided, a refund to the extent provided for in the guaranteed asset protection waiver.
(3)
(a) If a guaranteed asset protection waiver is cancelled by the borrower or terminates after the preliminary period, to obtain a refund of any portion of the charge for the guaranteed asset protection waiver, the borrower shall request the refund:
(i) in a writing provided to:
(A) the creditor;
(B) an administrator; or
(C) another person designated in the guaranteed asset protection waiver;
(ii) within 90 days of the day on which an event occurs that terminates the finance agreement if the refund is sought on the basis of termination of a finance agreement; and
(iii) in accordance with any additional terms in the guaranteed asset protection waiver.
(b) If a guaranteed asset protection waiver is cancelled by the borrower or terminates after the preliminary period, but before the term of the finance agreement ends, a borrower is entitled to a refund:
(i) of the portion of the charge for the guaranteed asset protection waiver that under the terms of the guaranteed asset protection waiver is considered unearned; and
(ii) subject to any other terms of the guaranteed asset protection waiver.
(4)
(a) If the cancellation of a guaranteed asset protection waiver occurs as a result of any of the following, a refund may be paid directly to the creditor or administrator and applied as provided in Subsection (4)(b):
(i) a default under the finance agreement;
(ii) the repossession of the vehicle associated with the finance agreement; or
(iii) any other type of termination of the finance agreement or guaranteed asset protection waiver.
(b) A creditor may apply a refund described in this Subsection (4) to reduce the amount owed under a finance agreement, unless the borrower can show that the finance agreement is paid in full.
Enacted by Chapter 274, 2010 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 6b - Guaranteed Asset Protection Waiver Act › Part 4 - Enforcement › Section 401 - Cease and desist order -- Fines.

31A-6b-401.
Cease and desist order -- Fines.
(1) In accordance with Title 63G, Chapter 4, Administrative Procedures Act, the commissioner may:
(a) order a person who violates this chapter to cease and desist from an act that violates this chapter;
(b) impose a penalty:
(i) up to $500 per violation; and
(ii) not to exceed the aggregate of $40,000 in a calendar year for the violations under this chapter of a similar nature; or
(c) take a combination of actions under this Subsection (1).
(2) For purposes of this section, a violation is of a similar nature if the violation consists of the same or similar action, course of conduct, or practice, irrespective of the number of times the action, conduct, or practice occurs that is determined to violate this chapter.
Enacted by Chapter 274, 2010 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 1 - General Provisions › Section 101 - Definition.

31A-7-101.
Definition.
As used in this chapter, unless stated otherwise:
"Subscriber" means the person entitled by contract to health care benefits from a corporation licensed under this chapter. "Subscriber" is used interchangeably with "policyholder" in individual contracts or "certificate holder" in group contracts.
Amended by Chapter 91, 1987 General Session
Amended by Chapter 95, 1987 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 1 - General Provisions › Section 102 - Scope.

31A-7-102.
Scope.
(1) Domestic insurers authorized under former Title 31, Chapter 37, are, on July 1, 1986, automatically converted to domestic insurers authorized under this chapter. The commissioner may adopt any rules necessary to efficiently and safely effect the conversion.
(2) Any nonprofit corporation incorporated under this chapter, or subject to this chapter under Subsection (1), and organized for the purpose of establishing, maintaining, and operating a nonprofit plan, whereby hospital care, medical-surgical care, dental care, and other health services are made available to persons who become subscribers to such a plan or plans under a contract with the nonprofit corporation, are subject to the provisions of this chapter.
(3) This chapter does not apply to persons licensed under:
(a)Chapter 5, Domestic Stock and Mutual Insurance Corporations;
(b)Chapter 8, Health Maintenance Organizations and Limited Health Plans;
(c)Chapter 9, Insurance Fraternals;
(d)Chapter 10, Annuities;
(e)Chapter 11, Motor Clubs; or
(f)Chapter 14, Foreign Insurers.
Amended by Chapter 20, 1995 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 1 - General Provisions › Section 103 - Applicability of other provisions.

31A-7-103.
Applicability of other provisions.
(1) Except for exemptions specifically granted under this title, nonprofit health service insurance corporations organized or operating under this chapter are subject to all of the provisions of this title.
(2) Nonprofit health service corporations are exempt from the provisions of Chapter 5, Domestic Stock and Mutual Insurance Corporations, except where sections or parts are specifically referenced and made applicable in this chapter, in which case the referenced provisions under Chapter 5, Domestic Stock and Mutual Insurance Corporations, that apply to mutual corporations apply to nonprofit health service insurance corporations.
(3)Title 16, Chapter 6a, Utah Revised Nonprofit Corporation Act, and Title 16, Chapter 10a, Utah Revised Business Corporation Act, do not apply to nonprofit health service insurance corporations except as specifically made applicable by:
(a) this chapter;
(b) a provision adopted by reference under this chapter; or
(c) a rule adopted by the commissioner to deal with corporate law issues of nonprofit health service insurance corporations which are not settled under this chapter.
(4) Any insurer authorized under this chapter that is not in compliance with the applicable capital and surplus requirements, yet has assets in excess of its liabilities, has until July 1, 1988, to comply with the applicable capital and surplus requirements. One-half of any shortage in capital and surplus on July 1, 1986, shall be remedied by July 1, 1987.
Amended by Chapter 300, 2000 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 1 - General Provisions › Section 104 - General corporate powers and procedures.

31A-7-104.
General corporate powers and procedures.
(1) Corporations organized or operating under this chapter have the powers specified under Section 31A-5-104.
(2) Subject to the limitations upon subsidiary investment valuation otherwise stated under this title, corporations organized or operating under this chapter may invest in corporations organized for profit.
(3) Corporations subject to the provisions of this chapter may enter into contracts for the rendering of hospital services, medical-surgical services, and other health services on behalf of any of their subscribers with hospitals maintained by the state, or by any of its political subdivisions, or maintained by a nonprofit corporation organized for hospital purposes, or with other corporations, associations, partnerships, or individuals furnishing hospital services, medical-surgical services, or other health services. This chapter does not require any corporation to contract or remain under contract with any individual, hospital, physician, or other provider of health services.
Amended by Chapter 91, 1987 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 1 - General Provisions › Section 106 - Unauthorized assumption of corporate power.

31A-7-106.
Unauthorized assumption of corporate power.
Section 31A-5-106 applies to the unauthorized assumption of corporate power in corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 2 - Organization › Section 201 - Organization, incorporation, and licensing.

31A-7-201.
Organization, incorporation, and licensing.
Chapter 5, Part 2, Organization of Corporations, governs the organization, incorporation, and licensing of nonprofit health service corporations with the following exceptions:
(1) Section 16-6a-201 applies in place of Section 31A-5-202.
(2) Sections 16-6a-401 and 31A-1-109 apply in place of Subsection 31A-5-203(2)(a).
(3) The last sentence of Subsection 31A-5-203(2)(e) does not apply.
Amended by Chapter 90, 2004 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 2 - Organization › Section 202 - Members.

31A-7-202.
Members.
Sections 16-6a-601 and 16-6a-602 apply to members of corporations organized or operating under this chapter. Sections 16-6a-701, 16-6a-702, 16-6a-704, 16-6a-711, and 16-6a-712 apply to corporations organized or operating under this chapter which have members.
Amended by Chapter 300, 2000 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 301 - Principal office and registered agent.

31A-7-301.
Principal office and registered agent.
Section 31A-5-401 governs the location of the principal office and existence of a registered agent for corporations organized and operating under this chapter.
Amended by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 302 - Annual report to policyholders.

31A-7-302.
Annual report to policyholders.
Every insurer organized or operating under this chapter shall send to each policyholder or electronically post on the insurer's public website an abbreviated annual report which contains basic financial and operating data, and information about important business and corporate developments.
Amended by Chapter 253, 2012 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 303 - Board of directors.

31A-7-303.
Board of directors.
(1) Subject to other provisions under this section, Sections 16-6a-801 through 16-6a-805, and Sections 16-6a-810, 16-6a-812, 16-6a-814, 16-6a-815, and 16-6a-816 apply to the board of directors of insurers organized or operating under this chapter.
(2) The property and lawful business of every corporation subject to this chapter shall be held and managed by a governing board of trustees or directors with the powers and authority as is necessary or incidental to the complete execution of the purposes of each corporation as limited by its articles of incorporation and bylaws. A board may not consist of less than five members. A majority of the directors shall be residents of Utah.
(3) Any person employed by or receiving more than 10% of his income from a corporation licensed under this chapter, and any person related to that person within the second degree by blood or marriage, is an "insider." Insiders may not constitute a majority of the board of a corporation organized and operating under this chapter.
(4) The board shall manage the business and affairs of the corporation and may not delegate its power or responsibility to do so, except to the extent authorized by Section 31A-7-307.
(5) Section 16-6a-814 applies to the place and notice of directors' meetings.
(6) Any director may be removed from office for cause by an affirmative vote of a majority of the full board at a meeting of the board called for that purpose.
Amended by Chapter 300, 2000 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 304 - Waiver and consent.

31A-7-304.
Waiver and consent.
Sections 16-6a-813 and 16-6a-815 apply to waiver and consent in corporations organized or operating under this chapter.
Amended by Chapter 300, 2000 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 305 - Supervision of management changes.

31A-7-305.
Supervision of management changes.
Subsections 31A-5-410(1)(a) and 31A-5-410(3) apply to supervision and management changes in corporations organized and operating under this chapter. If a trustee is removed from the board of trustees in the manner specified under Subsection 31A-7-303(6), the action shall be reported to the commissioner within 10 days of the removal.
Amended by Chapter 91, 1987 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 306 - Continuity of management in emergencies.

31A-7-306.
Continuity of management in emergencies.
Section 31A-5-411 applies to continuity of management in emergencies in corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 307 - Committees of directors.

31A-7-307.
Committees of directors.
(1) If provided by the articles or bylaws of a corporation, the board of directors may, by a resolution adopted by a majority of the full board, designate one or more committees, each consisting of three or more directors, to serve at the pleasure of the board. The board may designate one or more directors as alternate members of any committee to substitute for any absent member at any meeting of the committee. The designation of a committee and delegation of authority to it does not relieve the board or any director of responsibility imposed upon it or him by law.
(2)
(a) Corporations organized and operating under this chapter shall have an audit committee and a nominating committee.
(b) A majority of the members of the audit and nominating committees may not be insiders as defined under Subsection 31A-7-303(3).
(3) When the board is not in session, a committee may exercise the powers of the board in the management of the business and affairs of the corporation to the extent authorized in the resolution or in the articles or bylaws, except final action regarding:
(a) compensation or indemnification of any person who is a director, principal officer, or one of the three most highly paid employees, and any benefits or payments requiring shareholder or policyholder approval;
(b) approval of any contract required to be approved by the board under Section 31A-7-309 or of any other transaction in which a director has a material interest adverse to the corporation;
(c) amendment of the articles or bylaws;
(d) corporate reorganization under Part 4, Reorganization;
(e) any other decision requiring shareholder or policyholder approval;
(f) amendment or repeal of any action previously taken by the full board which by its terms is not subject to amendment or repeal by a committee;
(g) dividends or other distributions to shareholders or policyholders, other than in the routine implementation of policy determinations of the full board;
(h) selection of principal officers; and
(i) filling vacancies on the board or any committee created under Subsection (1) except that the articles or bylaws may provide for temporary appointments to fill vacancies on the board or any committee, the appointments to last no longer than the end of the next board meeting.
(4) Subsection 31A-5-412(4) applies to the subsequent review provided in corporations organized and operating under this chapter.
Amended by Chapter 90, 2004 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 308 - Interlocking directorates and other relationships.

31A-7-308.
Interlocking directorates and other relationships.
Section 31A-5-413 applies to interlocking directorates and other relationships in corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 309 - Transactions in which directors and others are interested.

31A-7-309.
Transactions in which directors and others are interested.
Section 31A-5-414 applies to corporations organized and operating under this chapter, except that, for purposes of this chapter, Section 31A-5-414 does not preclude standard contracts for the provision of health care services with directors who are also providers of health care services.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 310 - Officers', directors', and employees' liability and indemnification.

31A-7-310.
Officers', directors', and employees' liability and indemnification.
Section 31A-5-415 applies to officers', directors', and employees' liability and indemnification in corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 311 - Executive compensation.

31A-7-311.
Executive compensation.
Subsections 31A-5-416(4), (5), (6), and (7) apply to executive compensation in corporations organized and operating under this chapter.
Amended by Chapter 316, 1994 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 3 - Management › Section 312 - Exclusive management and exclusive agency contracts.

31A-7-312.
Exclusive management and exclusive agency contracts.
Section 31A-5-417 applies to exclusive management and exclusive agency contracts in corporations organized and operating under this chapter, except that in this chapter, Subsection 31A-5-417(2) does not preclude exclusive agency contracts with controlled subsidiaries of the insurer organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 4 - Reorganization › Section 401 - Mergers and consolidations.

31A-7-401.
Mergers and consolidations.
Sections 31A-5-501 and 31A-5-503 apply to mergers and consolidations of corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 4 - Reorganization › Section 403 - Conversion to a Title 31A, Chapter 5, mutual insurer.

31A-7-403.
Conversion to a Title 31A, Chapter 5, mutual insurer.
(1) An insurer organized and operating under this chapter may be converted into a mutual insurer under Chapter 5, Domestic Stock and Mutual Insurance Corporations, as provided in this section.
(2)
(a) The board shall pass a resolution that the conversion is not contrary to the interests of the policyholders specifying the reasons for and the purposes of the proposed conversion, and the manner in which the conversion is expected to affect policyholders, particularly the policyholders that are members.
(b) The board's resolution shall also set forth a plan of conversion which shall include:
(i) the articles of incorporation of the new Chapter 5, Domestic Stock and Mutual Insurance Corporations, mutual insurer, including a description of the classes of policyholders who, by virtue of being policyholders, will have an interest in the converted insurer;
(ii) the bylaws of the new Chapter 5, Domestic Stock and Mutual Insurance Corporations, mutual insurer;
(iii) a description of any changes in the insurer's mode of operations after conversion to a Chapter 5, Domestic Stock and Mutual Insurance Corporations, mutual insurer; and
(iv) any other items specified by rule.
(3) The provisions of Chapter 16, Insurance Holding Companies, apply to the conversion of a Chapter 7, Nonprofit Health Service Insurance Corporations, insurer to a Chapter 5, Domestic Stock and Mutual Insurance Corporations, mutual insurance corporation.
(4) The plan of conversion shall be submitted to the commissioner for approval, together with a projection of the planned or anticipated financial condition of the insurer for two years after the conversion.
(5) The commissioner shall hold an adjudicative proceeding concerning the conversion application.
(6) The commissioner shall approve the plan of conversion, unless he finds that the plan violates the law, is contrary to the interests of policyholders or the public, or would result in an unfair distribution of interest among the insurer's policyholders.
(7)
(a) Upon the commissioner approving the conversion under Subsection (6), the commissioner shall issue a new certificate of authority.
(b) The issuance of the certificate is the conversion, and upon issuance of the certificate the Chapter 7, Nonprofit Health Service Insurance Corporations, insurer at once becomes a mutual insurance corporation organized under and fully subject to Chapter 5, Domestic Stock and Mutual Insurance Corporations.
(c) The mutual insurer is considered to have been organized at the time the converted Chapter 7, Nonprofit Health Service Insurance Corporations, insurer was organized.
(d) Unless otherwise provided in the plan of conversion, the directors, officers, agents, and employees of the Chapter 7, Nonprofit Health Service Insurance Corporations, insurer shall continue in like capacity with the mutual insurance corporation.
Amended by Chapter 161, 1987 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 4 - Reorganization › Section 404 - Transfer of business or assets.

31A-7-404.
Transfer of business or assets.
Section 31A-5-508 applies to the transfer of business or assets of corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 5 - Miscellaneous Provisions › Section 501 - Duties of officers, directors, agents, and employees.

31A-7-501.
Duties of officers, directors, agents, and employees.
Section 31A-5-601 applies to the duties of officers, directors, agents, and employees of corporations organized and operating under this chapter.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 7 - Nonprofit Health Service Insurance Corporations › Part 5 - Miscellaneous Provisions › Section 502 - Doing business in other states.

31A-7-502.
Doing business in other states.
Section 31A-5-602 applies to corporations organized and operating under this chapter doing business in other states.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 1 - General Provisions › Section 101 - Definitions.

Effective 5/9/2017
31A-8-101.
Definitions.
For purposes of this chapter:
(1) "Basic health care services" means:
(a) emergency care;
(b) inpatient hospital and physician care;
(c) outpatient medical services; and
(d) out-of-area coverage.
(2) "Health maintenance organization" means any person:
(a) other than:
(i) an insurer licensed under Chapter 7, Nonprofit Health Service Insurance Corporations; or
(ii) an individual who contracts to render professional or personal services that the individual directly performs; and
(b) that:
(i) furnishes at a minimum, either directly or through arrangements with others, basic health care services to an enrollee in return for prepaid periodic payments agreed to in amount prior to the time during which the health care may be furnished; and
(ii) is obligated to the enrollee to arrange for or to directly provide available and accessible health care.
(3)
(a) "Limited health plan" means, except as limited under Subsection (3)(b), a person who furnishes dental or vision services, either directly or through arrangements with others:
(i) to an enrollee;
(ii) in return for prepaid periodic payments agreed to in amount prior to the time during which the services may be furnished; and
(iii) for which the person is obligated to the enrollee to arrange for or directly provide the available and accessible services described in this Subsection (3)(a).
(b) "Limited health plan" does not include:
(i) a health maintenance organization;
(ii) an insurer licensed under Chapter 7, Nonprofit Health Service Insurance Corporations; or
(iii) an individual who contracts to render professional or personal services that the individual performs.
(4)
(a) "Nonprofit organization" or "nonprofit corporation" means an organization no part of the income of which is distributable to its members, trustees, or officers, or a nonprofit cooperative association, except in a manner allowed under Section 31A-8-406.
(b) "Nonprofit health maintenance organization" and "nonprofit limited health plan" are used when referring specifically to one of the types of organizations with "nonprofit" status.
(5) "Organization" means a health maintenance organization and limited health plan, unless used in the context of:
(a) "organization expenses," which is described in Section 31A-8-208.
(b) "organization permit," which is described in Sections 31A-8-204 and 31A-8-206; or
(6) "Uncovered expenditures" means the costs of health care services that are covered by an organization for which an enrollee is liable in the event of the organization's insolvency.
(7) "Unusual or infrequently used health services" means those health services that are projected to involve fewer than 10% of the organization's enrollees' encounters with providers, measured on an annual basis over the organization's entire enrollment.
Amended by Chapter 292, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 1 - General Provisions › Section 102 - Scope and purposes.

31A-8-102.
Scope and purposes.
(1) No person may operate an organization in this state without complying with and obtaining a certificate of authority under this chapter.
(2) The purposes of this chapter include to:
(a) provide for the establishment of health maintenance organizations which provide readily available, accessible, and quality comprehensive health care to their enrollees;
(b) provide for the establishment of limited health plans which provide readily available, accessible, and quality care to their enrollees;
(c) encourage the development of organizations as an alternative method of health care delivery; and
(d) assure that organizations offering health plans within this state are financially and administratively sound and that these organizations are in fact able to deliver the benefits as promised.
Enacted by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 1 - General Provisions › Section 104 - Determination of ability to provide services.

Effective 5/3/2023
31A-8-104.
Determination of ability to provide services.
(1) The commissioner may not issue a certificate of authority to an applicant for a certificate of authority under this chapter unless the applicant demonstrates to the commissioner that the applicant has:
(a) the willingness and potential ability to furnish the proposed health care services in a manner to assure both availability and accessibility of adequate personnel and facilities and continuity of service; and
(b) arrangements for an ongoing quality of health care assurance program concerning health care processes and outcomes.
(2)
(a) In accordance with Sections 31A-2-203 and 31A-2-204, the commissioner may order an independent audit or examination by one or more technical experts to determine an applicant's ability to provide the proposed health care services as described in Subsection (1).
(b) In accordance with Section 31A-2-205, an applicant shall reimburse the commissioner for the reasonable cost of an independent audit or examination.
(3) Licensing under this chapter does not exempt an organization from any licensing requirement applicable under Title 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection.
Amended by Chapter 327, 2023 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 1 - General Provisions › Section 105 - General powers of organizations.

31A-8-105.
General powers of organizations.
Organizations may:
(1) buy, sell, lease, encumber, construct, renovate, operate, or maintain hospitals, health care clinics, other health care facilities, and other real and personal property incidental to and reasonably necessary for the transaction of the business and for the accomplishment of the purposes of the organization;
(2) furnish health care through providers which are under contract with the organization;
(3) contract with insurance companies licensed in this state or with health service corporations authorized to do business in this state for insurance, indemnity, or reimbursement for the cost of health care furnished by the organization;
(4) offer to its enrollees, in addition to health care, insured indemnity benefits, but only for emergency care, out-of-area coverage, unusual or infrequently used health services as defined in Section 31A-8-101, and adoption benefits as provided in Section 31A-22-610.1;
(5) receive from governmental or private agencies payments covering all or part of the cost of the health care furnished by the organization;
(6) lend money to a medical group under contract with it or with a corporation under its control to acquire or construct health care facilities or for other uses to further its program of providing health care services to its enrollees;
(7) be owned jointly by health care professionals and persons not professionally licensed without violating Utah law; and
(8) do all other things necessary for the accomplishment of the purposes of the organization.
Amended by Chapter 329, 1998 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 1 - General Provisions › Section 105.5 - Primary care physicians.

31A-8-105.5.
Primary care physicians.
With regard to participating providers who are physicians who are members of the American College of Obstetrics and Gynecology, organizations operating under this chapter shall:
(1) permit a female enrollee to receive at least one outpatient examination per year from the enrollee's choice of one of those participating providers. An organization may not require the enrollee to receive a preapproval, preauthorization, or referral from the enrollee's primary care physician before receiving this examination; and
(2) clearly state in the organization's health benefit plan literature that enrollees may seek the care described in Subsection (1) without preapproval, preauthorization, or referral from the patient's primary care physician.
Amended by Chapter 10, 1997 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 1 - General Provisions › Section 106 - Other business.

31A-8-106.
Other business.
No organization may engage, directly or indirectly, in any business other than that of an organization and business reasonably incidental to that business.
Enacted by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 202 - Corporate name -- Office -- Registered agent.

31A-8-202.
Corporate name -- Office -- Registered agent.
(1) Sections 16-10a-402, 16-10a-403, and 42-2-5 apply to the reservation and registration of the corporate name in domestic health maintenance organizations. Reservation and registration fees under Section 31A-3-103 apply.
(2) The location of an organization's principal office and the existence of a registered agent are governed by Title 16, Chapter 17, Model Registered Agents Act.
Amended by Chapter 364, 2008 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 204 - Articles and bylaws.

31A-8-204.
Articles and bylaws.
(1) The articles of a nonprofit organization shall conform to Subsections 16-6a-202(1)(a) through (e). The articles of other organizations shall conform to Section 16-10a-202. In addition:
(a) the powers of the corporation shall be limited to those permitted under Section 31A-8-105;
(b) the articles shall state whether the organization is a health maintenance organization or a limited health plan;
(c) the articles shall state the services to be provided or for which indemnity is to be paid, which services provided and indemnity guaranteed shall be consistent with the organization's designation under Subsection (1)(b);
(d) the articles shall state that as to health care services for which individual providers are required to be licensed, the services provided by the organization shall be provided by persons properly licensed to perform the services;
(e) the articles shall state whether providers of services are subject to assessment or withholding to pay operating costs or financial deficits;
(f) the articles shall state, for organizations having members, how persons become members and that only members vote; and
(g) the articles of an organization not having members shall state how the directors of the organization shall be selected and removed.
(2) The articles or bylaws shall designate three or more officers as the principal officers of the corporation. The principal offices shall be held by at least three separate natural persons.
(3) Section 31A-5-219 applies to amendments to articles of organizations.
(4) Organizations shall adopt and maintain bylaws. Section 16-6a-206 applies to organizations, except for the statement that bylaws need not be adopted.
Amended by Chapter 364, 2008 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 205 - Organization permit and certificate of incorporation.

31A-8-205.
Organization permit and certificate of incorporation.
(1) Section 31A-5-204 applies to the formation of organizations, except that "Section 31A-5-211" in Subsection 31A-5-204(5) shall be read "Section 31A-8-209."
(2) In addition to the requirements of Section 31A-5-204, the application for a permit shall include a description of the initial locations of facilities where health care will be available to enrollees, the hours during which various services will be provided, the types of health care personnel to be used at each location and the approximate number of each personnel type to be available at each location, the methods to be used to monitor the quality of health care furnished, the method of resolving adverse benefit determinations initiated by enrollees or providers, the method used to give enrollees an opportunity to participate in matters of policy, the medical records system, and the method for documentation of utilization of health care by persons insured.
Amended by Chapter 308, 2002 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 206 - Powers under organization permit -- Deposit of proceeds of subscriptions.

31A-8-206.
Powers under organization permit -- Deposit of proceeds of subscriptions.
Sections 31A-5-207 and 31A-5-208 apply to the powers of an organization under an organization permit and the deposit of proceeds of subscriptions, except that there are no qualifying insurance policies as referred to in Subsection 31A-5-207(2)(a).
Enacted by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 207 - Termination of organization permit -- Payment of organization expenses.

31A-8-207.
Termination of organization permit -- Payment of organization expenses.
Section 31A-5-209, other than Subsection 31A-5-209(3)(c), applies to the termination of the organization permit and the payment of organization expenses of organizations, except that "Section 31A-5-212" shall be read "Section 31A-8-213."
Amended by Chapter 185, 2002 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 208 - Incorporators' liability and organization expenses.

31A-8-208.
Incorporators' liability and organization expenses.
Section 31A-5-210 applies to incorporators' liability and organization expenses in organizations.
Enacted by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 209 - Minimum capital or minimum permanent surplus.

31A-8-209.
Minimum capital or minimum permanent surplus.
(1)
(a) A health maintenance organization being organized or operating under this chapter shall have and maintain a minimum capital or minimum permanent surplus of $100,000.
(b) Each health maintenance organization authorized to do business in this state shall have and maintain qualified assets as defined in Subsection 31A-17-201(2) in an amount not less than the total of:
(i) the health maintenance organization's liabilities;
(ii) the health maintenance organization's minimum capital or minimum permanent surplus required by Subsection (1)(a); and
(iii) the greater of:
(A) the company action level RBC as defined in Subsection 31A-17-601(8)(b); or
(B) $1,300,000.
(2)
(a) The minimum required capital or minimum permanent surplus for a limited health plan may not:
(i) be less than $10,000; or
(ii) exceed $100,000.
(b) The initial minimum required capital or minimum permanent surplus for a limited health plan required by Subsection (2)(a) shall be set by the commissioner, after:
(i) a hearing; and
(ii) consideration of:
(A) the services to be provided by the limited health plan;
(B) the size and geographical distribution of the population the limited health plan anticipates serving;
(C) the nature of the limited health plan's arrangements with providers; and
(D) the arrangements, agreements, and relationships of the limited health plan in place or reasonably anticipated with respect to:
(I) insolvency insurance;
(II) reinsurance;
(III) lenders subordinating to the interests of enrollees and trade creditors;
(IV) personal and corporate financial guarantees;
(V) provider withholds and assessments;
(VI) surety bonds;
(VII) hold harmless agreements in provider contracts; and
(VIII) other arrangements, agreements, and relationships impacting the security of enrollees.
(c) Upon a material change in the scope or nature of a limited health plan's operations, the commissioner may, after a hearing, alter the limited health plan's minimum required capital or minimum permanent surplus.
(3) The commissioner may allow the minimum capital or permanent surplus account of an organization to be designated by some other name.
(4) A pattern of persistent deviation from the accounting and investment standards under this section may be grounds for the commissioner to find that the one or more persons with authority to make the organization's accounting or investment decisions are incompetent for purposes of Subsection 31A-5-410(3).
Amended by Chapter 308, 2002 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 211 - Deposit.

Effective 5/12/2020
31A-8-211.
Deposit.
(1) Except as provided in Subsection (2), each health maintenance organization authorized in this state shall maintain a deposit with the commissioner under Section 31A-2-206 in an amount equal to the sum of:
(a) $100,000; and
(b) 50% of the greater of:
(i) $900,000;
(ii) 2% of the annual premium revenues as reported on the most recent annual financial statement filed with the commissioner; or
(iii) an amount equal to the sum of three months uncovered health care expenditures as reported on the most recent financial statement filed with the commissioner.
(2)
(a) The commissioner may exempt a health maintenance organization from the deposit requirement of Subsection (1) if:
(i) the commissioner determines that the enrollees' interests are adequately protected;
(ii) the health maintenance organization has been continuously authorized to do business in this state for at least five years; and
(iii) the health maintenance organization has $5,000,000 surplus in excess of the health maintenance organization's company action level RBC as defined in Subsection 31A-17-601(8)(b).
(b) The commissioner may rescind an exemption given under Subsection (2)(a).
(3)
(a) Each limited health plan authorized in this state shall maintain a deposit with the commissioner under Section 31A-2-206 in an amount equal to the minimum capital or permanent surplus plus 50% of the greater of:
(i) .5 times minimum required capital or minimum permanent surplus; or
(ii)
(A) during the first year of operation, 10% of the limited health plan's projected uncovered expenditures for the first year of operation;
(B) during the second year of operation, 12% of the limited health plan's projected uncovered expenditures for the second year of operation;
(C) during the third year of operation, 14% of the limited health plan's projected uncovered expenditures for the third year of operation;
(D) during the fourth year of operation, 18% of the limited health plan's projected uncovered expenditures during the fourth year of operation; or
(E) during the fifth year of operation, and during all subsequent years, 20% of the limited health plan's projected uncovered expenditures for the previous 12 months.
(b) Projections of future uncovered expenditures shall be established in a manner that is approved by the commissioner.
(4) A deposit required by this section may be counted toward the minimum capital or minimum permanent surplus required under Section 31A-8-209.
Amended by Chapter 32, 2020 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 213 - Certificate of authority.

31A-8-213.
Certificate of authority.
(1) An organization may apply for a certificate of authority at any time prior to the expiration of its organization permit. The application shall include:
(a) a detailed statement by a principal officer about any material changes that have taken place or are likely to take place in the facts on which the issuance of the organization permit was based; and
(b) if any material changes are proposed in the business plan, the information about the changes that would be required if an organization permit were then being applied for.
(2) The commissioner shall issue a certificate of authority, if the commissioner finds that:
(a) the organization's capital and surplus complies with the requirements of Section 31A-8-209 as to the operations proposed under the new certificate of authority;
(b) there is no basis for revoking the organization permit under Section 31A-8-207;
(c) the deposit required by Section 31A-8-211 has been made;
(d) the organization satisfies the requirements of Section 31A-8-104; and
(e) all other applicable requirements of the law have been met.
(3) The certificate of authority shall specify any limits imposed by the commissioner upon the organization's business or methods of operation, including the general types of health care services the organization is authorized to provide.
(4) Upon the issuance of the certificate of authority:
(a) the board shall authorize and direct the issuance of certificates for shares, bonds, or notes subscribed to under the organization permit, and of insurance policies upon qualifying applications obtained under the organization permit; and
(b) the commissioner shall authorize the release to the organization of all funds held in escrow under Section 31A-5-208, as adopted by Section 31A-8-206.
(5)
(a) An organization may at any time apply to the commissioner for a new or amended certificate of authority altering the limits on its business or methods of operation. The application shall contain or be accompanied by that information reasonably required by the commissioner under Subsections 31A-5-204(2) and 31A-8-205(2). The commissioner shall issue the new certificate as requested if the commissioner finds that the organization continues to satisfy the requirements specified under Subsection (2).
(b) If the commissioner issues an order under Chapter 27, Part 5, Administrative Actions, against an organization, the commissioner may also revoke the organization's certificate and issue a new one with any limitation the commissioner considers necessary.
Amended by Chapter 309, 2007 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 214 - Securities.

31A-8-214.
Securities.
Chapter 5, Part 3, Securities of Domestic Insurance Corporations, applies to securities of organizations, except that the amount "$150,000" in Subsection 31A-5-304(1) shall be read "one-half of the minimum capital required of the organization."
Amended by Chapter 90, 2004 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 215 - Management.

31A-8-215.
Management.
Chapter 5, Part 4, Management of Insurance Corporations, applies to organizations, except that for purposes of this chapter, Subsections 31A-5-412(3)(a)(vi) through (ix) shall be read: "corporate reorganizations under Section 31A-8-216."
Amended by Chapter 349, 2009 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 8 - Health Maintenance Organizations and Limited Health Plans › Part 2 - Domestic Organizations › Section 216 - Corporate reorganizations.

31A-8-216.
Corporate reorganizations.
Sections 31A-5-501 through 31A-5-506 and Section 31A-5-508 apply to corporate reorganizations of organizations.
Enacted by Chapter 204, 1986 General Session