Title 20 — Insurance

In this article, unless the context otherwise requires: 1. "Member" means an individual who is enrolled in a group prepaid dental plan as a principal subscriber together with such person's dependents who are entitled to dental care services under the plan solely because of their …

A. No person, unless authorized pursuant to article 3 or article 9 of this chapter, may establish or operate a prepaid dental plan organization in this state, or sell or offer to sell, or solicit offers to purchase, or receive advance or periodic consideration in conjunction with…

A. An application for a certificate of authority to operate as a prepaid dental plan organization shall be filed with the director in a form prescribed by the director, shall be verified by an officer or authorized representative of the applicant and shall set forth, or be accomp…

Issuance of a certificate of authority shall be granted by the director if the director is satisfied that the following conditions are met: 1. The persons responsible for conducting the affairs of the prepaid dental plan organization are competent and are professionally capable o…

A. A prepaid dental plan organization shall maintain on deposit with the state treasurer through the director's office a surety bond, guaranteeing services under the plan, or cash or securities eligible for investment of capital funds, in the following amounts depending on the nu…

A. A prepaid dental plan organization at all times shall maintain for protection of members a financial reserve consisting of two per cent of prepaid charges collected from members for the plan, until such reserve totals five hundred thousand dollars. Such reserve shall be in add…

A. A prepaid dental plan organization shall comply with chapter 2, article 12 of this title. B. A prepaid dental plan organization that is exempt from the risk-based capital requirements prescribed in section 20-488.08 shall maintain unimpaired capital or surplus, or both, in an …

A. Every member in a prepaid dental plan shall be issued a membership coverage form by the prepaid dental plan organization. B. Any contract applied for that provides family coverage shall, as to such coverage of individuals in the family, also provide that the benefits applicabl…

A. The director may once in each six months for the first three years after organization and once each year thereafter, or more often if deemed necessary by the director, visit each prepaid dental plan organization organized under the laws of this state and examine its financial …

A. Every prepaid dental plan organization annually on or before the first day of March shall file with the director a report of its financial condition, transactions and affairs as of the preceding December 31 as prescribed in sections 20-223 and 20-234 and shall pay the annual r…

A. On the tax payment dates prescribed in section 20-224, each prepaid dental plan organization shall pay to the director for deposit, pursuant to sections 35-146 and 35-147, in a form prescribed by the director a tax for transacting a prepaid dental plan in the amount of 2.0 per…

No more than thirty per cent of prepaid charges in the first year of operation, twenty-five per cent of prepaid charges in the second year of operation and twenty per cent of prepaid charges in any subsequent year shall be used for the marketing and administrative expenses of a p…

Chapter 2, article 6 of this title, relating to unfair trade practices and frauds, shall apply to prepaid dental plan organizations, except to the extent the director determines that the nature of prepaid dental plan organizations render particular provisions inappropriate.

The director shall, after notice and hearing, promulgate such rules and regulations as are necessary to provide for the licensing of agents which shall include provisions for examination, licensing, annual fees and disciplinary procedures similar to those provided in chapter 2, a…

The director may conduct an examination of the affairs of any prepaid dental plan organization as often as the director deems it necessary for the protection of the interests of the people of this state.

A. The director may suspend or revoke any certificate of authority issued to a prepaid dental plan organization pursuant to this article if the director finds that any of the following conditions exists: 1. The prepaid dental plan organization is operating significantly in contra…

Any rehabilitation, liquidation or conservation of a prepaid dental plan organization shall be deemed to be the rehabilitation, liquidation or conservation of an insurer and shall be conducted pursuant to chapter 3, article 4 of this title.

[Repealed or reserved.]

A. If a person receiving dental care is a member of a prepaid dental plan and is an insured or certificate holder under an indemnity health insurance policy which provides benefits for the same treatment as the person's prepaid dental plan, the indemnity health insurance policy, …

As used in this article, unless the context otherwise requires, "Lloyd's association" means any aggregation of individuals, called "underwriters," who under a common name engage in the business of insurance for profit through an attorney-in-fact having authority to obligate the u…

Lloyd's associations are authorized to make any insurance as provided in this article, except life insurance or title insurance, on the Lloyd's plan, by complying with the requirements set forth in this article. Every policy form issued in this state by a Lloyd's association shal…

Policies of insurance may be executed by an attorney or by an attorney-in-fact, or other representative, hereby designated "attorney", authorized by and acting for the underwriters who constitute the Lloyd's association. The principal office of such attorney shall be maintained a…

The attorney shall file with the director a verified application for a certificate of authority setting forth and accompanied by: 1. The name of the attorney or attorneys and the title under which the business is to be conducted, which title shall contain the name Lloyd's and the…

No attorney shall be licensed for the underwriters doing business as a Lloyd's association under this article unless the surplus of such association, required to be maintained under section 20-210, shall be at least four hundred thousand dollars in cash, or other admitted assets.

Underwriters doing business as a Lloyd's association shall compute reserve liabilities for all outstanding business and for all incurred losses upon the same basis required for stock insurance companies doing the same class and character of business in Arizona.

An underwriter in a Lloyd's association may limit his total liability on all risks to the amount of his subscription as expressed in his power of attorney and agreement with the attorney-in-fact, provided that at least half of the subscription of each underwriter shall be paid or…

Additional or substituted underwriters shall be bound in the same manner and to the same extent as original subscribers to the articles of agreement and power of attorney on file with the director. The acts of the duly appointed deputy, substitute or successor attorney or any att…

No profits shall accrue to an underwriter, except upon the basis of his actual investment in cash or securities, disregarding any obligation or subscription to pay in additional cash or securities at a later date.

Action on any policy or contract of insurance issued by an attorney for the underwriters may be brought against the attorney. In such action, summons and process shall be served on either the director or on the attorney-in-fact, and when so served shall have the same effect as if…

The deposit requirements of section 20-213 and section 20-583 shall in all respects apply to any Lloyd's association, foreign or domestic, provided that the director shall not issue a certificate of authority to any Lloyd's association unless it has deposited in trust with the st…

If any attorney-in-fact or underwriter of a Lloyd's association shall violate any of the provisions of this title, or any of the other laws of the state of Arizona which are applicable to them, the certificate of authority issued to such attorney shall be revoked and the right to…

A. The provisions of this article are applicable to domestic and foreign Lloyd's associations. B. To the extent not modified by the provisions of this article, Lloyd's associations shall be subject to and governed by the other applicable provisions of this title.

In this article, unless the context otherwise requires: 1. "Enrollee" means an individual who has been enrolled in a health care plan. 2. "Evidence of coverage" means any certificate, agreement or contract issued to an enrollee and setting out the coverage to which the enrollee i…

A. A person shall not establish or operate a health care services organization in this state, or sell or offer to sell, or solicit offers to purchase, or receive advance or periodic consideration in conjunction with a health care plan without obtaining and maintaining a certifica…

A. No person shall establish or operate a provider sponsored health care services organization in this state, or sell or offer to sell, or solicit offers to purchase, or receive advance or periodic consideration in conjunction with a health care plan without obtaining and maintai…

A. An application for a certificate of authority to operate as a health care services organization shall be filed with the director in a form prescribed by the director, shall be verified by an officer or authorized representative of the applicant and shall set forth, or be accom…

A. Issuance of a certificate of authority shall be granted within the time prescribed in section 20-216 by the director if the director is satisfied that the following conditions are met: 1. The persons responsible for conducting the affairs of the health care services organizati…

A. A health care services organization at all times shall maintain on deposit with the state treasurer through the director's office cash, or securities eligible for the investment of capital funds of domestic insurers under this title, or other financial security approved by the…

A. Every enrollee in a health care plan shall be issued an evidence of coverage by the responsible health care services organization. B. Any contract, except accidental death and dismemberment, applied for that provides family coverage shall also provide, as to such coverage of f…

A. A health care services organization shall establish a procedure by which an enrollee may apply for a standing referral to a network health care professional. The health care services organization shall provide an enrollee with a standing referral if all of the following condit…

A. A health care services organization with a prescription drug benefit that uses a drug formulary as a component of the evidence of coverage shall provide to its enrollees notice in the evidence of coverage regarding the applicable drug formulary. The health care services organi…

A. Every health care services organization shall provide coverage for chiropractic services provided by network chiropractic providers pursuant to this section. B. A health care services organization is not required to provide coverage for chiropractic services obtained from a pr…

A. A health care services organization shall allow any new enrollee whose health care provider is not a member of the provider network, on written request of the enrollee to the health care services organization, to continue an active course of treatment with that health care pro…

Any health care services organization that provides coverage for medical supplies shall provide coverage for those medical supplies through one or more participating vendors who are reasonably accessible to enrollees as determined by the department in terms of hours of service an…

A health care services organization shall not request information from a health care professional that does not apply to the medical condition at issue for the purposes of determining whether to approve or deny a prior authorization request.

A. A health care services organization is not obligated to pay any costs, other than covered patient costs, that are directly associated with a cancer clinical trial that is offered in this state and in which the enrollee participates voluntarily. A cancer clinical trial is a cou…

A. If a health care services organization issues evidence of coverage that provides coverage for: 1. Prescription drugs, the evidence of coverage shall provide coverage for any prescribed drug or device that is approved by the United States food and drug administration for use as…

B. This section does not prohibit a health benefits plan that is intended to qualify as a high deductible health plan as defined by 26 United States Code section 223(c)(2) from requiring the application of deductibles, copayments or coinsurance to benefits provided under the heal…

A. Any contract or evidence of coverage that is offered by a health care services organization and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if: 1. The enrollee has been diagnos…

A. A health care services organization shall not: 1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagno…