Chapter 6. DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION

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A. A corporation applying for a license to do business as a captive insurer shall pay a nonrefundable fee of $1,000.00 to the Department for issuance of the license under A.R.S. § 20-1098.01(J). A captive insurer that is a protected cell captive insurer, as defined in A.R.S. § 20…

A. Definitions. The following definitions apply to this Section and to R20-6-201.01, R20-6-201.02, and R20-6-203: 1. “Advertisement” means materials and information used by an insurer to generate insurance business. a. Advertisement includes the following information: i. Printed …

A. An insurer shall establish, and at all times maintain, a system of control over the content, form, and method of dissemination of all advertisements. The insurer whose policies are advertised is responsible for the advertisements, regardless of who writes, creates, designs, or…

Form A. An insurer that is required to file a health insurance advertisement with the Department as specified in A.R.S. §§ 20-826(T), 20-1018, 20-1057(X), 20-1110(E), or 20-1662 shall file the advertisement with a transmittal form prescribed by the Department. B. The transmittal …

A. The definitions in R20-6-201(A) and the following definition apply in this Section: “Life insurance” means a life insurance contract, including all benefits payable under the policy. B. Applicability 1. This Section applies to: a. All persons subject to regulation under A.R.S.…

A. An insurer, rate service organization, or rating organization shall provide to the Department, at the time of filing, an English language translation of each form, advertisement, or other document or material that the insurer is required by statute or rule to file with the Dep…

Historical Note Former General Rule Number 71-24; Former Section R4-14-204 repealed, new Section R4-14-204 adopted effective January 1, 1981 (Supp. 80-6). R20-6-204 recodified from R4-14-204 (Supp. 95-1). Amended effective July 14, 1998 (Supp. 98-3). Amended by final rulemaking a…

A. Definitions. 1. “Addition to the rate of tax” means the tax rate determined under subsection (D) to be applied under A.R.S. 20-230(A) and this Section to foreign or alien insurers domiciled in a foreign country or other state that impose local or regional taxes. 2. “Alien insu…

Historical Note Former General Rule Number 72-30. Repealed effective February 22, 1993 (Supp. 93-1). R20-6-206 recodified from R4-14-206 (Supp. 95-1). New Section adopted effective December 29, 1995 (Supp. 95-4). Amended effective November 5, 1998 (Supp. 98-4). Former R20-6-206 r…

A. The following definitions apply to this Section: 1. “Applicant” means a person who is applying for a policy. 2. “Policy” means an insurance policy, plan, contract, certificate, evidence of coverage, subscription contract, or binder, including a rider or endorsement offered by …

A. Definitions. The following definitions apply in this Section: 1. “Group insurance” means an insurance benefit that meets all the following conditions: a. Coverage is provided through insurance policies or subscriber contracts to classes of employees or members defined in terms…

A. Scope. 1. This Section applies to any solicitation, negotiation, or procurement of life insurance occurring in Arizona. This Section applies to any issuer of life insurance contracts, including fraternal benefit societies. 2. Unless otherwise specifically included, the Section…

A. Definitions. The following definitions apply in this Section: 1. “Readable insurance policy” means a policy that can be read and reasonably understood by a person without special knowledge or training. 2. “Policy” means a contract or agreement for insurance, or an insurance ce…

The following definitions apply in this Article: 1. “Consumer” means an individual, or the individual’s legal representative, who seeks to obtain, obtains, or has obtained an insurance product or service from a licensee that is to be used primarily for personal, family, or househ…

A licensee shall implement a comprehensive written customer information security program that includes administrative, technical, and physical safeguards for the protection of customer information. The administrative, technical, and physical safeguards included in the information…

A licensee’s customer information security program shall be designed to: 1. Ensure the security and confidentiality of customer information; 2. Protect against any anticipated threats or hazards to the security or integrity of the information; and 3. Protect against unauthorized …

A licensee may implement the requirements of R20-6-2102 and R20-6-2103 by the actions and procedures prescribed in this Section, which are non-exclusive illustrations: 1. A licensee may assess risk by: a. Identifying reasonably foreseeable internal or external threats that could …

A. Definitions. The following definitions apply in this Section: 1. “Policy” means a contract or agreement for or effecting insurance, or a certificate of insurance, regardless of the name used, and includes all clauses, riders, endorsements, and attached papers. 2. “Person” has …

An insurer shall use the following forms of the National Association of Insurance Commissioners Model Regulations (and no future editions or amendments), which are incorporated by reference and available at the Department of Insurance and Financial Institutions, Division of Insur…

An insurer shall use the following publication of the National Association of Insurance Commissioners (and no future editions), which are incorporated by reference and available at the Department of Insurance and Financial Institutions, Division of Insurance, 100 N. 15th Ave., Su…

A. Definitions. The definitions in A.R.S. § 20-1242 and this subsection apply to this Section. “Illustration” means a personalized presentation or depiction prepared for and provided to an individual consumer that includes non-guaranteed elements of an annuity contract over a per…

A. Definitions. The following definitions apply in this Section: 1. “Company” or “insurer” means any life or disability insurance company, benefit insurer, benefit stock insurer, prepaid dental plan organizations, health care service organizations, and all similar type organizati…

A. Applicability. 1. This Section applies to all: a. Group disability insurance policies; b. Group subscriber contracts of hospital and medical service corporations and health care services organizations; c. Group disability policies of benefit insurers; and d. Group-type contrac…

Historical Note Adopted effective September 7, 1981 (Supp. 81-3). Amended subsections (D) through (H), deleted Agent’s Statement and Exhibit D effective March 30, 1983 (Supp. 83-2). R20-6-215 recodified from R4-14-215 (Supp. 95-1). Amended by exempt rulemaking at 9 A.A.R. 5595, e…

Historical Note New Section made by exempt rulemaking at 9 A.A.R. 5595, effective January 1, 2004 (Supp. 03-4). Former R20-6-215.01 renumbered to R20-6-212.01 by final rulemaking at 13 A.A.R. 2061, effective August 4, 2007 (Supp. 07-2).

Historical Note Adopted effective as set forth in subsection (H) (Supp. 80-6). R20-6-216 recodified from R4-14-216 (Supp. 95-1). Former R20-6-216 renumbered to R20-6-213 by final rulemaking at 13 A.A.R. 2061, effective August 4, 2007 (Supp. 07-2).

Historical Note Adopted effective September 14, 1982 (Supp. 82-3). Amended subsections (C) and (D), deleted (F) effective January 1, 1987, filed December 16, 1986 (Supp. 86-6). R20-6-217 recodified from R4-14-217 (Supp. 95-1). Former R20-6-217 renumbered to R20-6-214 by final rul…

A. Definitions. 1. “Active duty” means full-time duty in the active military service of the United States and includes members of the reserve component (National Guard and Reserve) while serving under published orders for active duty or full-time training. “Active duty” does not …

A. This Article applies to rates charged by health insurers for individual health insurance. This Article does not apply to rates charged by health insurers for the following: 1. Health insurance that a health insurer issues to an employer or to any group described in either A.R.…

A. Preliminary Justification. For each threshold rate increase for each affected product, a health insurer shall submit to the Department and to CMS, on a form and in the manner prescribed by the Secretary in 45 CFR 154.215, a preliminary justification that contains all of the fo…

A. If R20-6-607 applies to a threshold rate increase, the health insurer shall submit its preliminary justification to the Department and to CMS on the date on which the health insurer files the rate increase request under R20-6-607. B. If R20-6-607 does not apply to a threshold …

If the health insurer receives from CMS a notice that the Department has determined that the health insurer’s threshold rate increase is unreasonable, the health insurer shall select one of the following three options: 1. Option to not implement the rate increase determined unrea…

A. For a threshold rate increase, a health insurer shall submit to the Department documentation that is sufficient to allow the Department to assess: 1. The reasonableness of the assumptions used by the health insurer to develop the proposed rate increase and the validity of the …

The definitions in A.R.S. § 20-3111 and this Section apply to this Article. 1. “Allowed Amount” is the amount reimbursable for a covered service under the terms of the enrollee’s benefit plan. The allowed amount includes both the amount payable by the insurer and the amount of th…

A. Request for Arbitration. An enrollee may request dispute resolution of a surprise out-of-network bill by filing a timely Request for Arbitration with the Department on a Request for Arbitration form available on the Department’s website. B. Deadline for filing a Request for Ar…

A. Deadline to arrange the Informal Settlement Teleconference. Upon a determination that an enrollee has made a Request for Arbitration that qualifies for Arbitration, the Department shall arrange an Informal Settlement Teleconference between the parties within 30 days of notifyi…

A. Contracted entities. The Department shall contract with one or more persons to provide Arbitrators. The Department must have a list of at least four Arbitrators to assign to Arbitrations. The Department shall publish the list of contracted entities and a list of each entity’s …

A. Enrollee’s duties. Before the Arbitration, the enrollee shall: 1. Pay or make arrangements in writing to pay to the health care provider the amount stated by the health insurer in the Informal Settlement Teleconference which shall be the total amount of the enrollee’s cost sha…

A. Conduct of Arbitration. An Arbitration of a qualifying out-of-network surprise bill shall be conducted: 1. Telephonically unless the parties agree otherwise; 2. With or without the enrollee’s participation; 3. Within 120 days after the Department’s Notice of Arbitration unless…

The following terms apply to this Article: “Certificate of Good Standing” as used in A.R.S. § 20-3333(B)(1)(f) means the same as defined under A.R.S. § 10-128. “Department” means the Arizona Department of Insurance and Financial Institutions, Insurance Division. “Director of the …

A. A person seeking to be licensed as a Pharmacy Benefit Manager in this state shall file an application for a certificate of authority on a form prescribed by the Director of the Department which shall be transmitted for review and approval through an electronic online system as…

The Notice of Modification required to be filed with the Director of the Department under A.R.S. § 20-3333(D) applies to a Pharmacy Benefit Manager who holds a certificate of authority issued by the Department. The Notice of Modification shall be filed on a form and in the manner…

A. The Pharmacy Benefit Manager certificate of authority is a biennial certificate. If the Pharmacy Benefit Manager fails to timely file a complete renewal application and pay the fee to the Director of the Department, the certificate of authority of a Pharmacy Benefit Manager ex…

A. To renew its certificate of authority, a Pharmacy Benefit Manager shall file a renewal application on a form prescribed by the Director of the Department and pay the fee on or before the expiration of the Pharmacy Benefit Manager’s certificate of authority. The form shall be t…

A. A Pharmacy Benefit Manager may contract with a utilization review agent certified by the Department pursuant to A.R.S. § 20-2504 or exempt from certification under A.R.S. § 20-2502(B) to perform utilization review for pharmaceutical claims on behalf of the Pharmacy Benefit Man…

A. Every Pharmacy Benefit Manager shall keep its corporate and business records as originals or as copies of the originals made by reproduction methods that accurately preserve the records. B. Notwithstanding the confidential nature of a pharmacy benefit manager’s information, th…