HB 560 — Ambulance Amendments

-(A) 6for -the 02-16life 12:02of 1stthe Sub.insured;

(Buff) H.B.

560 (A) for the life of the insured;

(29)(a)(29) (a) "Control," "controlling," "controlled," or "under common control" means the direct or indirect possession of the power to direct or cause the direction of the management and policies of a person.

or - 7 - HB0560 compared with HB0560S01 (iv) by a means other than those described in Subsections (29)(a)(i) through (iii).

(34)(a)(34) (a) "Corporation" means an insurance corporation, except when referring to:

-(IV) 7a -consultant; 1st Sub.

(Buff) H.B.

560 02-16 12:02 (IV) a consultant;

or - 8 - HB0560 compared with HB0560S01 (III) Chapter 26, Insurance Adjusters;

(35)(a)(35) (a) "Creditable coverage" has the same meaning as provided in federal regulations adopted [pursuant to] in accordance with the Health Insurance Portability and Accountability Act.

(37)(a)(37) (a) "Credit insurance" means insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation.

-(iv) 8credit -unemployment 02-16insurance; 12:02 1st Sub.

(Buff) H.B.

560 (iv) credit unemployment insurance;

- 9 - HB0560 compared with HB0560S01 (39) "Creditor" means a person, including an insured, having a claim, whether:

(42)(a)(42) (a) "Crop insurance" means insurance providing protection against damage to crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation, disease, or other yield-reducing conditions or perils that is:

(43)(a)(43) (a) "Customer service representative" means a person that provides an insurance service and insurance product information:

-(i) 9for -the 1stcustomer Sub.service representative's:

(Buff) H.B.

560 02-16 12:02 (i) for the customer service representative's:

or - 10 - HB0560 compared with HB0560S01 (C) consultant employer;

(48)(a)(48) (a) "Direct response solicitation" means an offer for life or accident and health insurance coverage that allows the individual to apply for or enroll in the insurance coverage on the basis of the offer.

(49) "Direct response insurance policy" means an insurance policy solicited and sold -without 10the -policyholder 02-16having 12:02direct 1stcontact Sub.with a natural person intermediary.

(Buff) H.B.

560 without the policyholder having direct contact with a natural person intermediary.

- 11 - HB0560 compared with HB0560S01 (51) "Disability" means a physiological or psychological condition that partially or totally limits an individual's ability to:

(55)(a)(55) (a) "Eligible employee" means:

- 1112 - 1stHB0560 Sub.compared with HB0560S01 (i) an individual who works on a temporary or substitute basis for a small employer;

(Buff) H.B.

560 02-16 12:02 (i) an individual who works on a temporary or substitute basis for a small employer;

(59)(a)(59) (a) "Employee welfare fund" means a fund:

(61)(a)(61) - 13 - HB0560 compared with HB0560S01 (a) "Enrollee" means:

-(i) 12a -policyholder; 02-16 12:02 1st Sub.

(Buff) H.B.

560 (i) a policyholder;

(64)(a)(64) (a) "Escrow" means:

- 14 - HB0560 compared with HB0560S01 (b) "Escrow" does not include:

-(B) 13a -copy 1stcertification; Sub.

(Buff) H.B.

560 02-16 12:02 (B) a copy certification;

(66)(a)(66) (a) "Excludes" is not exhaustive and does not mean that another thing is not also excluded.

(69)(a)(69) (a) "Filed" means that a filing is:

or - 15 - HB0560 compared with HB0560S01 (B) rule.

-(c) 14a -form; 02-16 12:02 1st Sub.

(Buff) H.B.

560 (c) a form;

(72)(a)(72) (a) "Fixed indemnity insurance" means accident and health insurance written to provide a fixed amount for a specified event relating to or resulting from an illness or injury.

(74)(a)(74) (a) "Form" means one of the following prepared for general use:

- 16 - HB0560 compared with HB0560S01 (iii) an application;

-(b) 15title -insurance 1stunder Sub.one of the following sublines of authority:

(Buff) H.B.

560 02-16 12:02 (b) title insurance under one of the following sublines of authority:

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

and (b)(i)(b) (i) directly;

- 17 - HB0560 compared with HB0560S01 (ii) through insurance reimbursement;

(79)(a)(79) (a) "Group insurance policy" means a policy covering a group of persons that is issued:

-(81) 16"Guaranteed -automobile 02-16protection 12:02insurance" 1stmeans Sub.insurance offered in connection with an extension of credit that pays the difference in amount between the insurance settlement and the balance of the loan if the insured automobile is a total loss.

(Buff)(82) H.B.(a) "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.

560 (81) "Guaranteed automobile protection insurance" means insurance offered in connection with an extension of credit that pays the difference in amount between the insurance settlement and the balance of the loan if the insured automobile is a total loss.

(82)(a) "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.

(viii) other similar insurance coverage, specified in federal regulations issued [[pursuant pursuant to] in accordance with Pub.

- 18 - HB0560 compared with HB0560S01 (A) limited scope dental or vision benefits;

-(A) 17Medicare -supplement 1stinsurance; Sub.

(Buff) H.B.

560 02-16 12:02 (A) Medicare supplement insurance;

(84)(a)(84) (a) "Health care insurance" or "health insurance" means insurance providing:

or - 19 - HB0560 compared with HB0560S01 (ii) payment of an incurred health care expense.

-(86) 18"Health -care 02-16sharing 12:02ministry" 1stmeans Sub.an entity that:

(Buff) H.B.

560 (86) "Health care sharing ministry" means an entity that:

- 20 - HB0560 compared with HB0560S01 (87) "Health insurance exchange" means an exchange as defined in 45 C.F.R.

and -(e) 19personal -and 1stcommercial Sub.property floaters.

(Buff) H.B.

560 02-16 12:02 (e) personal and commercial property floaters.

(96)(a)(96) (a) "Insurance" means:

- 21 - HB0560 compared with HB0560S01 (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;

-(d) 20providing -the 02-16characteristic 12:02services 1stof Sub.a motor club;

(Buff) H.B.

560 (d) providing the characteristic services of a motor club;

and - 22 - HB0560 compared with HB0560S01 (i) doing, or proposing to do, any business in substance equivalent to Subsections (98)(a) through (h) in a manner designed to evade this title.

(102)(a)(102) (a) "Insurance producer" or "producer" means a person licensed or required to be licensed under the laws of this state to sell, solicit, or negotiate insurance.

(b)(i)(b) (i) "Producer for the insurer" means a producer who is compensated directly or indirectly by an insurer for selling, soliciting, or negotiating an insurance product of that insurer.

(ii) "Producer for the insurer" may be referred to as an "agent." (c)(i)(c) (i) "Producer for the insured" means a producer who:

and (B) receives no compensation directly or indirectly from an insurer for selling, soliciting, or negotiating an insurance product of that insurer to an insurance -customer 21or -insured. 1st Sub.

(Buff)(ii) H.B."Producer for the insured" may be referred to as a "broker." (103) (a) "Insured" means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:

560 02-16 12:02 customer or insured.

(ii) "Producer for the insured" may be referred to as a "broker." (103)(a) "Insured" means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:

- 23 - HB0560 compared with HB0560S01 (i) applies only to this title;

(104)(a)(104) (a) "Insurer," "carrier," "insurance carrier," or "insurance company" means a person doing an insurance business as a principal including:

-(107) 22"Involuntary -unemployment 02-16insurance" 12:02means 1stinsurance: Sub.

(Buff) H.B.

560 (107) "Involuntary unemployment insurance" means insurance:

- 24 - HB0560 compared with HB0560S01 (108) "Large employer," in connection with a health benefit plan, means an employer who, with respect to a calendar year and to a plan year:

(111)(a)(111) (a) Except for a retainer contract or legal assistance described in Section 31A-1-103, "legal expense insurance" means insurance written to indemnify or pay for a specified legal expense.

(112)(a)(112) (a) "Liability insurance" means insurance against liability:

(ii) for a medical, hospital, surgical, and funeral benefit to a person other than the insured who is injured, irrespective of legal liability of the insured, when issued with or supplemental to insurance against legal liability for the death, injury, or -disability 23of -a 1sthuman Sub.being, exclusive of the coverages under:

(Buff) H.B.

560 02-16 12:02 disability of a human being, exclusive of the coverages under:

- 25 - HB0560 compared with HB0560S01 (B) professional liability insurance;

(113)(a)(113) (a) "License" means authorization issued by the commissioner to engage in an activity that is part of or related to the insurance business.

(114)(a)(114) (a) "Life insurance" means:

- 26 - HB0560 compared with HB0560S01 (a) is issued for a specific product of insurance;

-(116) 24"Limited -line 02-16credit 12:02insurance" 1stincludes Sub.the following forms of insurance:

(Buff) H.B.

560 (116) "Limited line credit insurance" includes the following forms of insurance:

- 27 - HB0560 compared with HB0560S01 (119) "Limited lines authority" includes the lines of insurance listed in Subsection (118).

(121)(a)(121) (a) "Long-term care insurance" means an insurance policy or rider advertised, -marketed, 25offered, -or 1stdesignated Sub.to provide coverage:

(Buff) H.B.

560 02-16 12:02 marketed, offered, or designated to provide coverage:

(C)(I)(C) (I) a nonprofit health hospital;

or - 28 - HB0560 compared with HB0560S01 (B) a life insurance policy or rider;

-(ii) 26basic -hospital 02-16expense 12:02coverage; 1st Sub.

(Buff) H.B.

560 (ii) basic hospital expense coverage;

or (b)(i)(b) - 29 - HB0560 compared with HB0560S01 (i) licensed under:

-(125) 27(a) -"Medicare 1stsupplement Sub.insurance" means health insurance coverage that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of individuals eligible for Medicare.

(Buff) H.B.

560 02-16 12:02 (125)(a) "Medicare supplement insurance" means health insurance coverage that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of individuals eligible for Medicare.

- 30 - HB0560 compared with HB0560S01 (131) "Motor club" means a person:

or (iii)(A)(iii) (A) trip reimbursement;

-(C) 28emergency -road 02-16services; 12:02 1st Sub.

(Buff) H.B.

560 (C) emergency road services;

- 31 - HB0560 compared with HB0560S01 (137) "Nonparticipating" means a plan of insurance under which the insured is not entitled to receive a dividend representing a share of the surplus of the insurer.

or (d) a vessel owner or operator as a result of liability to employees, passengers, bailors, owners of other vessels, owners of fixed objects, customs or other authorities, or -other 29persons -in 1stconnection Sub.with maritime activity.

(Buff) H.B.

560 02-16 12:02 other persons in connection with maritime activity.

(a)(i)(a) (i) of each material and relevant risk associated with the insurer or insurance group;

(145) "Participation," as used in a health benefit plan, means a requirement relating to the minimum percentage of eligible employees that must be enrolled in relation to the total number of eligible - 32 - HB0560 compared with HB0560S01 employees of an employer reduced by each eligible employee who voluntarily declines coverage under the plan because the employee:

-(e) 30a -joint 02-16stock 12:02company; 1st Sub.

(Buff) H.B.

560 (e) a joint stock company;

or - 33 - HB0560 compared with HB0560S01 (iii) the employer's taxable year if:

and (B)(I)(B) (I) the plan is not insured;

(150)(a)(150) (a) "Policy" means a document, including an attached endorsement or application that:

or -(B) 31Chapter -8, 1stHealth Sub.Maintenance Organizations and Limited Health Plans.

(Buff) H.B.

560 02-16 12:02 (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.

and - 34 - HB0560 compared with HB0560S01 (b) does not include a condition indicated by genetic information unless an actual diagnosis of the condition by a physician has been made.

(156)(a)(156) (a) "Premium" means the monetary consideration for an insurance policy.

(c)(i)(c) (i) "Premium" does not include consideration paid to a third party administrator for the third party administrator's services.

(160)(a)(160) (a) "Property insurance" means insurance against loss or damage to real or personal -property 32of -every 02-16kind 12:02and 1stany Sub.interest in that property:

(Buff) H.B.

560 property of every kind and any interest in that property:

- 35 - HB0560 compared with HB0560S01 (a) an individual or group insurance contract that meets the requirements of Section 7702B(b), Internal Revenue Code;

(i)(A)(i) (A) by rider;

(163)(a)(163) (a) "Rate" means:

or -(B) 33a -pure 1stpremium Sub.rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:

(Buff) H.B.

560 02-16 12:02 (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:

(164)(a)(164) - 36 - HB0560 compared with HB0560S01 (a) "Rate service organization" means a person who assists an insurer in rate making or filing by:

(166)(a)(166) (a) "Rebate" means a licensee paying, allowing, giving, or offering to pay, allow, or give, directly or indirectly:

or -(iii) 34savings -or 02-16wellness 12:02benefits 1stas Sub.provided in the contract by the licensee.

(Buff) H.B.

560 (iii) savings or wellness benefits as provided in the contract by the licensee.

- 37 - HB0560 compared with HB0560S01 (d) the received date recorded on an item delivered, if delivered by:

(172)(a)(172) (a) "Retrocession" means reinsurance with another insurer of a liability assumed under a reinsurance contract.

-(173) 35"Rider" -means 1stan Sub.endorsement to:

(Buff) H.B.

560 02-16 12:02 (173) "Rider" means an endorsement to:

- 38 - HB0560 compared with HB0560S01 (174) "Scope criteria" means the designated exposure bases and minimum magnitudes for a specified data year that are used to establish a preliminary list of insurers considered scoped into the NAIC liquidity stress test framework for that data year.

(176)(a)(176) (a) "Security" means a:

or - 39 - HB0560 compared with HB0560S01 (C) an annuity contract;

or -(ii) 36a -burial 02-16certificate 12:02or 1stburial Sub.contract.

(Buff) H.B.

560 (ii) a burial certificate or burial contract.

(178)(a)(178) (a) "Self-insurance" means an arrangement under which a person provides for spreading the person's own risks by a systematic plan.

- 40 - HB0560 compared with HB0560S01 (181) "Significant break in coverage" means a period of 63 consecutive days during each of which an individual does not have creditable coverage.

(182)(a)(182) (a) "Small employer" means, in connection with a health benefit plan and with respect to a calendar year and to a plan year, an employer who:

(i)(A)(i) (A) employed at least one but not more than 50 eligible employees on business -days 37during -the 1stpreceding Sub.calendar year;

(Buff) H.B.

560 02-16 12:02 days during the preceding calendar year;

(184)(a)(184) (a) "Subsidiary" of a person means an affiliate controlled by that person either directly or indirectly through one or more affiliates or intermediaries.

(186)(a)(186) - 41 - HB0560 compared with HB0560S01 (a) "Surplus" means the excess of assets over the sum of paid-in capital and liabilities.

(b)(i)(b) (i) "Permanent surplus" means the surplus of an insurer or organization that is designated by the insurer or organization as permanent.

-(i) 38for -a 02-16life 12:02insurer, 1staccident Sub.and health insurer, health organization, or property and casualty insurer as defined in Section 31A-17-601, the lesser of:

(Buff) H.B.

560 (i) for a life insurer, accident and health insurer, health organization, or property and casualty insurer as defined in Section 31A-17-601, the lesser of:

- 42 - HB0560 compared with HB0560S01 (c) an employer on behalf of the employer's employees or the employees of one or more of the subsidiary or affiliated corporations of the employer;

-(iii) 39Chapter -8, 1stHealth Sub.Maintenance Organizations and Limited Health Plans;

(Buff) H.B.

560 02-16 12:02 (iii) Chapter 8, Health Maintenance Organizations and Limited Health Plans;

- 43 - HB0560 compared with HB0560S01 (a) the statutory accounting applicable to the annual financial statements required to be filed under Section 31A-4-113;

(190)(a)(190) (a) "Trustee" means "director" when referring to the board of directors of a corporation.

(b) "Trustee," when used in reference to an employee welfare fund, means an individual, firm, association, organization, joint stock company, or corporation, whether acting individually or jointly and whether designated by that name or any other, that is -charged 40with -or 02-16has 12:02the 1stoverall Sub.management of an employee welfare fund.

(Buff)(191) H.B.(a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted insurer" means an insurer:

560 charged with or has the overall management of an employee welfare fund.

(191)(a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted insurer" means an insurer:

- 44 - HB0560 compared with HB0560S01 (b) employer's liability insurance incidental to workers' compensation insurance and written in connection with workers' compensation insurance;

Section 31A-6c-1012 is enacted to read:

CHAPTER31A-6c-101. 6c.

Ambulance Membership Organizations Part 1.

General Provisions 31A-6c-101 .

As6c. used in this chapter:

-Ambulance 41Membership -Organizations 1st1. Sub.

(Buff)General H.B.Provisions As used in this chapter:

560 02-16 12:02 (1) "Ambulance membership contract" means a contract in which one party agrees to reimburse the following expenses for another party in the event of an emergency:

(2)(a)(2) (a) "Ambulance membership organization" means a person that offers an ambulance membership contract.

Section 31A-6c-1023 is enacted to read:

31A-6c-10231A-6c-102. .

- 45 - HB0560 compared with HB0560S01 (1) An ambulance membership organization may not issue, sell, or offer for sale an ambulance membership contract, unless the ambulance membership organization complies with this chapter.

-(h) 42Chapter -14, 02-16Foreign 12:02Insurers; 1st Sub.

(Buff) H.B.

560 (h) Chapter 14, Foreign Insurers;

Section 31A-6c-1034 is enacted to read:

31A-6c-10331A-6c-103. .

Section 31A-6c-2015 is enacted to read:

Part- 2.46 - HB0560 compared with HB0560S01 31A-6c-201.

Licensing 31A-6c-201 .

(1)2. A person may not perform, offer to perform, or advertise as an ambulance membership organization in this state unless the person is licensed under this chapter.

Licensing (1) A person may not perform, offer to perform, or advertise as an ambulance membership organization in this state unless the person is licensed under this chapter.

-(B) 43whether -the 1stapplicant Sub.is currently under investigation by law enforcement, a federal entity, or a state entity or is the subject of a pending legal action;

(Buff) H.B.

560 02-16 12:02 (B) whether the applicant is currently under investigation by law enforcement, a federal entity, or a state entity or is the subject of a pending legal action;

Section 31A-6c-2026 is enacted to read:

31A-6c-20231A-6c-202. .

- 47 - HB0560 compared with HB0560S01 (a) an updated list of the name and address of each ambulance provider of the ambulance membership organization, including:

and (d) any other information related to the ambulance membership organization that the -commissioner 44requires -to 02-16ensure 12:02compliance 1stwith Sub.this chapter.

(Buff)(3) H.B.(a) The commissioner {shall suspend } may not renew an ambulance membership organization's license if the ambulance membership organization fails to file a complete annual report in accordance with Subsection (1).

560(b) If the commissioner requires{suspends to} ensuredoes compliancenot renew an ambulance membership organization's license in accordance with Subsection (3)(a), the ambulance membership organization may not enroll new members or do business in this chapter.state until:

(3)(a) The commissioner may not renew an ambulance membership organization's license if the ambulance membership organization fails to file a complete annual report in accordance with Subsection (1).

(b) If the commissioner does not renew an ambulance membership organization's license in accordance with Subsection (3)(a), the ambulance membership organization may not enroll new members or do business in this state until:

- 48 - HB0560 compared with HB0560S01 Section 7.

Section 31A-6c-3017 is enacted to read:

Part31A-6c-301. 3.

Operational Requirements 31A-6c-301 .

(1)3. An ambulance membership organization licensed under this chapter shall:

Operational Requirements (1) An ambulance membership organization licensed under this chapter shall:

and -(d) 45pay -the 1stcosts Sub.of collection upon a judgment in favor of a member and attorney fees in a successful action brought by member against the ambulance membership organization.

(Buff) H.B.

560 02-16 12:02 (d) pay the costs of collection upon a judgment in favor of a member and attorney fees in a successful action brought by member against the ambulance membership organization.

Section 31A-6c-3028 is enacted to read:

31A-6c-30231A-6c-302. .

- 49 - HB0560 compared with HB0560S01 (4) An ambulance membership organization shall provide the terms and conditions of an ambulance membership contract to each prospective member before the day on which the prospective member enters into the ambulance membership contract.

and -(ii) 46that -the 02-16ambulance 12:02membership 1stcontract Sub.is not an insurance contract;

(Buff) H.B.

560 (ii) that the ambulance membership contract is not an insurance contract;

Section 31A-6c-3039 is enacted to read:

31A-6c-303- .50 - HB0560 compared with HB0560S01 31A-6c-303.

(2)(a)(2) (a) If an individual who enters into an ambulance membership contract subsequently enrolls in the Medicaid program during the term of the ambulance membership contract, the individual shall notify the ambulance membership organization of the enrollment within 30 days of the day on which the individual enrolls in the Medicaid program.

(b) If the individual notifies the ambulance membership organization in accordance with Subsection (2)(a),(2) (a), the ambulance membership organization shall provide the individual a prorated refund of any consideration the individual pays for the period from the effective date of the Medicaid program enrollment through the day on which the ambulance membership contract expires.

-(c) 47If -the 1stindividual Sub.does not notify the ambulance membership organization in accordance with Subsection (2)(a):

(Buff) H.B.

560 02-16 12:02 (c) If the individual does not notify the ambulance membership organization in accordance with Subsection (2)(a):

Section 31A-6c-30410 is enacted to read:

31A-6c-30431A-6c-304. .

- 51 - HB0560 compared with HB0560S01 (ii) use language in the ambulance membership organization's advertisement, marketing material, brochure, or presentation in relation to the following that could reasonably mislead an individual into believing that the ambulance membership contract is insurance or has been endorsed by the state or a governmental entity:

(3) An ambulance membership organization shall make the following general disclosures in writing, in bold, and in at least 12-point font on the first content page of an advertisement, marketing material, or brochure the ambulance membership organization -makes 48available -to 02-16prospective 12:02members 1stor Sub.the public:

(Buff) H.B.

560 makes available to prospective members or the public:

- 52 - HB0560 compared with HB0560S01 (c) a detailed list of each one-time and periodic fee the ambulance membership organization charges or will charge to the prospective member to join the ambulance membership organization and continue membership in the ambulance membership organization;

Section 31A-6c-40111 is enacted to read:

-31A-6c-401. 49 - 1st Sub.

(Buff) H.B.

560 02-16 12:02 Part 4.

Enforcement 31A-6c-401 .

(1)4. The commissioner may suspend or revoke a license issued under this chapter if the commissioner determines that the ambulance membership organization:

Enforcement (1) The commissioner may suspend or revoke a license issued under this chapter if the commissioner determines that the ambulance membership organization:

and - 53 - HB0560 compared with HB0560S01 (b) may suspend the authority of the ambulance membership organization to enroll new members for a period of time that may not exceed 90 days for each occurrence, if the commissioner sends the ambulance membership organization a written notice of suspension that describes the conditions the ambulance membership organization shall meet before the commissioner will reinstate the ambulance membership organization's authority to enroll new members.

(4)(a)(4) (a) The commissioner may not reinstate a suspended ambulance membership organization's license unless the ambulance membership organization requests the reinstatement.

-Section 5012. - 02-16 12:02 1st Sub.

(Buff)Section H.B.12 is enacted to read:

56031A-6c-402. Section 12.

Section 31A-6c-402 is enacted to read:

31A-6c-402 .

Effective date.

This bill takes effect on {May 6, 2026} January 1, 2027.

2-16-26 12:02 PM - 5154 -