Title 20 — Insurance

A. A contract, entered into or renewed on or after January 1, 2011, between a health care services organization and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under an evidence of coverage based o…

A. An evidence of coverage issued, delivered or renewed by a health care services organization in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encou…

A. An evidence of coverage that is issued, delivered or renewed by a health care services organization on or after January 1, 2016 and that provides coverage both for cancer treatment medications that are injected or intravenously administered by a health care provider and for pa…

A. An evidence of coverage that is issued or renewed on or after January 1, 2017 and that provides coverage for prescription drugs: 1. May not deny coverage and shall prorate the cost sharing rate for a prescription drug covered by the evidence of coverage that is dispensed by a …

A. Beginning January 1, 2018, any evidence of coverage that is issued, delivered or renewed by a health care services organization and that provides coverage for prescription eyedrops to treat glaucoma or ocular hypertension may not deny coverage for a refill of a prescription fo…

Any evidence of coverage issued, delivered or renewed on or after July 1, 2017 by a health care services organization in this state must provide coverage for lawful health care services that are provided by a health care provider to an enrollee regardless of the familial relation…

1. Require the optometrist to provide a service to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the service for which the fee applies is a covered service under the individual's evidence of coverage. 2. Pro…

B. An evidence of coverage shall cover biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of an enrollee's disease or condition to guide treatment decisions when the test provides clinical utility as demonstrated by medical an…

A. An evidence of coverage may limit coverage to an enrollee for the human organ transplant or posttransplant care if either of the following applies: 1. The transplant operation is performed in the People's Republic of China or the Hong Kong special administrative region. 2. The…

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 health care services organization organized under the laws of this state to examine its financial …

A. Every health care services organization annually on or before March 31 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 renewal fee pr…

A. This section applies to reporting entities that directly provide health care services to enrollees. B. In addition to the assets allowed by section 20-501, the following are admitted assets to the extent the assets conform with the accounting practices and procedures manual ad…

A. Except as provided in subsection C of this section, on the tax payment dates prescribed in section 20-224, each health care services 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 trans…

A. Chapter 2, article 6 of this title relating to unfair trade practices and frauds applies to health care services organizations, except to the extent the director determines that the nature of health care services organizations renders particular provisions inappropriate. B. A …

The director may, after notice and hearing, promulgate such reasonable 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 proposed in cha…

A. An insurer, or a hospital or medical service corporation, authorized to do business in this state either directly or through a subsidiary or an affiliate may organize and operate a health care services organization under the provisions of this article. Notwithstanding any othe…

A. The director may conduct an examination of the affairs of any health care services organization as often as the director deems it necessary for the protection of the interests of the people of this state and for this purpose shall have the powers set forth in this title with r…

A. The director may suspend or revoke any certificate of authority issued to a health care services organization under this article if the director finds that any of the following conditions exists: 1. The health care services organization is operating significantly in contravent…

A. Any rehabilitation, liquidation, or conservation of a health care services organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and shall be conducted as provided in chapter 3, article 4 of this title. B. Unless preempted under fede…

A. Except as they relate to an insurer or a hospital or medical service corporation, the provisions of this title are applicable to health care services organizations only as provided in this article, chapter 1 of this title, chapter 2, article 12 of this title, chapter 3, articl…

A. With respect to enrollees who are members of a group with more than one carrier, if there is an insolvency of a health care services organization, each open enrollment carrier shall offer enrollees of the insolvent health care services organization who are members of that grou…

A. No health care services organization may merge with another foreign or domestic health care services organization or may be acquired by a person except on approval by the director and by complying with the provisions of general law governing the merger or consolidation of stoc…

A. An insurance contract offered by a health care services organization shall not exclude coverage of a condition if the insured person has previously had tests for the condition and the condition was not found to exist. There must be evidence that a condition actually existed be…

A. Every written contract between a health care services organization and a provider or hospital shall set forth that if the organization fails to pay for covered health care services as set forth in the enrollee's evidence of coverage or contract the enrollee is not liable to th…

A. Except as specifically provided in sections 20-1379 and 20-1380, with respect to the determination of whether a person is an eligible individual, a health care services organization shall not consider the availability of or a person's eligibility for medical assistance under a…

A. A health care services organization shall submit quarterly to the director a list of all provider contracts that have been terminated during the prior three months. The list shall be in writing and shall include the name and address of each provider whose contract has been ter…

A. A health care services organization shall not attempt to sell or otherwise transfer to an affiliate Arizona assets in excess of ten per cent of the organization's unimpaired capital or surplus as reported in its most recent annual statement, without prior approval by the direc…

A health care services organization that requires its enrollees to use a freestanding urgent care center as a condition of coverage or a reduction in copayment, coinsurance or deductible amounts for covered health care services shall: 1. Develop and maintain policies for the appr…

The director may adopt rules pursuant to title 41, chapter 6 to carry out this article.

A. A health care services organization may issue an evidence of coverage to an uninsured individual that is not subject to the requirements of any of the following: 1. Section 20-1057, subsections C, K, L, Y, Z, AA and BB. 2. Sections 20-1057.01, 20-1057.03, 20-1057.04 and 20-105…

This article applies only to domestic life and disability reinsurers.

In this article, unless the context otherwise requires: 1. "Affiliated" has the same meaning prescribed in section 20-481. 2. "Credit life and disability reinsurer" means a domestic life and disability reinsurer that reinsures only credit life insurance or credit disability insur…

A. All other provisions of this title that are not inconsistent with the provisions of this article apply to domestic life and disability reinsurers. B. Notwithstanding section 20-223, an unaffiliated credit life and disability reinsurer shall submit an annual statement in a form…

A. Five or more individuals aged eighteen years or more may incorporate a domestic life and disability reinsurer. Not less than two-thirds of the incorporators shall be citizens of the United States residing in this state. B. In addition to the requirements of title 10, chapter 2…

A. To qualify for initial authority to transact business a domestic life and disability reinsurer shall possess and thereafter maintain minimum required capital stock in the amount of $100,000. B. To qualify for initial authority to transact business, an unaffiliated credit life …

A. A life and disability reinsurer shall have on organization initial surplus in an amount not less than one-half of its minimum required capital stock and shall thereafter maintain one-half of such initial surplus. B. This section does not apply to unaffiliated credit life and d…

A. The director shall not issue a certificate of authority to any life and disability reinsurer unless the reinsurer has deposited in trust with the state treasurer through the director's office cash or securities eligible for the investment of capital funds of domestic insurers …

Domestic life and disability reinsurers may be formed, with capital and surplus as specified in sections 20-1085 and 20-1086 to accept any risk as a reinsurer under which the maximum possible benefits payable on the death or on the disability of any one insured shall not exceed f…

A. Any domestic limited stock insurer formed and existing pursuant to section 20-708 which does not come within the provisions of section 20-708, subsection B, and which holds a valid certificate of authority as such an insurer, shall become a domestic life and disability reinsur…

Any domestic life and disability reinsurer, with appropriate powers in its articles of incorporation and with the necessary capital and surplus, and upon application to the director, may become a domestic life and disability insurer free from the restrictions otherwise imposed by…

Any life and disability insurer may relinquish its authority to write policies direct and, upon application to the director, may become a life and disability reinsurer under the provisions of this article.

A. The director may require that a domestic life and disability stock reinsurer designate and comply with either or a combination of the following: 1. That pursuant to all written agreements with ceding insurers, assets in an amount up to the net reserves established by such rein…

The amount required to be deposited or placed in a trust or custodial account pursuant to section 20-1092 shall be reduced by any amount deposited or placed in a trust or custodial account pursuant to the laws of another state.

Notwithstanding section 20-732, an unaffiliated credit life and disability reinsurer shall file with the director all reinsurance agreements and amendments to which the reinsurer is a party. The agreement or amendment is not effective until the agreement or amendment is approved …

A. An unaffiliated credit life and disability reinsurer shall secure liabilities that are assumed under a reinsurance agreement subject to approval pursuant to this article in any of the following: 1. With funds withheld. 2. With funds that are maintained in a trust fund that com…

In this article, unless the context otherwise requires: 1. "Consumer": (a) Means a buyer other than for purposes of resale of any consumer product, any person to whom the product is transferred during the duration of an implied or written warranty or service contract applicable t…

A. A service company may not offer or issue a service contract unless the service company has qualified for and been issued a permit by the director. B. Except for the registration requirements in this article applicable to service companies, service companies and related service…

A. This article, except for section 20-1095.09, does not apply to the following: 1. Warranties issued by manufacturers, builders or sellers on the actual items, structures or improvements that they manufacture, build or sell. 2. Service contract programs if a motor vehicle manufa…

A. The director shall not issue a permit to a service company unless all of the following conditions are met: 1. The applicant is solvent and organized under the laws of this state or another state, district, territory or possession of the United States. 2. The applicant furnishe…

A. To ensure faithful performance of its obligations to contract holders, every service company electing to comply with section 20-1095.03, subsection A, paragraph 3, subdivision (a), before the issuance of a permit, shall file with or for the benefit of the director a surety bon…