Title 20, Insurance

A. This article applies to third parties that provide or manage drug coverage under a health care plan in this state. B. This article does not apply to any of the following: 1. The Arizona health care cost containment system administration and its contractors as defined in sectio…

All contracts that are issued, delivered or renewed on or after January 1, 2024 for a third party that reimburses for 340B drugs shall not do any of the following: 1. Discriminate in reimbursement on the basis that the pharmacy dispenses a 340B drug. 2. Assess any fee, chargeback…

In this article, unless the context otherwise requires: 1. "Adverse determination": (a) Means a decision by a health care services plan or its utilization review agent that the health care services furnished or proposed to be furnished to an enrollee are not medically necessary a…

A. A health care services plan or its utilization review agent may impose a prior authorization requirement for health care services provided to an enrollee, except for emergency ambulance services and emergency services as specified in section 20-2803, health care services arisi…

A. If a health care services plan contains a prior authorization requirement, all of the following apply: 1. The health care services plan or its utilization review agent shall make available to all providers on its website or provider portal a listing of all prior authorization …

A. If a plan offered by a health care services plan contains a prior authorization requirement, all of the following apply: 1. For prior authorization requests concerning urgent health care services, the health care services plan or its utilization review agent shall notify the p…

A. For a prior authorization request related to a chronic pain condition, the health care services plan or its utilization review agent shall honor a prior authorization that is granted for an approved prescription drug for the earliest of the following: 1. Six months after the d…

A. Notwithstanding any other law, on or before January 1, 2022, the department shall approve a uniform prior authorization request form for prescription drugs, devices or durable medical equipment and a uniform prior authorization request form for all other health care procedures…

Before a health care insurer may issue a direct denial of a prior authorization of a service that was requested by a provider and that involves medical necessity, the medical director shall individually review the denial. During each individual review, the medical director shall …

In this chapter, unless the context otherwise requires: 1. "Applicant" means a provider that submits a credentialing application to a health insurer to become a participating provider in the health insurer's network. 2. "Application" means an applicant's initial application to be…

A. A health insurer shall establish a process for the electronic submission of a credentialing application. On or before December 31, 2019, the health insurers shall adopt and implement a standard application. B. On or before December 31, 2019, to the greatest extent possible, a …

A. Except as provided in subsection C of this section, the health insurer shall conclude the process of credentialing within sixty calendar days and loading the applicant's information into the health insurer's billing system within thirty calendar days after the date the health …

A. When submitting a credentialing application, a health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer's receipt of the application. The applicant shall include in the application a contact name, te…

A health insurer shall take reasonable steps to correct discrepancies in the provider or network plan directory within thirty calendar days after receiving a written or electronic report of the discrepancy from a participating provider. A participating provider shall notify a hea…

A. A provider may receive payment from a health insurer pursuant to this section for services that were provided from the date that was included on the notice of complete credentialing application to the date the provider's network participation contract is executed. A health ins…

A. A health insurer shall make the following nonproprietary information available to all applicants for credentialing and shall post the information on its website: 1. The applicable credentialing policies and procedures. 2. A list of all the information required to be included i…

A. A health insurer or its designee may recredential participating providers at least once every thirty-six months and more frequently if required by federal or state law or the health insurer's accreditation standards, or if permitted by the health insurer's contract with the pa…

A. A health insurer that complies in good faith with the requirements of this chapter is immune from civil liability for the purposes of reviewing and approving a credentialing application. B. A health insurer that does not credential a provider is not subject to civil liability …

In this chapter, unless the context otherwise requires: 1. "Classification of benefits" means the following classifications of benefits provided by a health plan: (a) Inpatient, in-network. (b) Inpatient, out-of-network. (c) Outpatient, in-network. (d) Outpatient, out-of-network.…

A. Each health care insurer that issues a health plan in this state shall comply with the mental health parity and addiction equity act. B. After January 1, 2022, on a date specified by the director, each health care insurer that issues a health plan in this state shall submit a …

A. The department shall enforce this chapter. B. On or before January 1, 2021, the department shall develop a web page that provides the following information in nontechnical and readily understandable language: 1. Consumer-friendly information concerning the scope and applicabil…

A. Notwithstanding any other provision of this title, any health care insurer that issues a health plan in this state that includes mental health or substance use disorder benefits may not deny any claim for mental health or substance use disorder benefits for a minor solely on g…

A. The mental health parity advisory committee is established to advise the directors of the department of insurance and financial institutions and department of health services relating to matters pertinent to mental health parity, including recommendations related to case manag…

In this chapter, unless the context otherwise requires: 1. "Aggregator site" means a website that provides access to information regarding insurance products from more than one insurer, including product and insurer information, for use in comparison shopping. 2. "Blanket travel …

A. The purpose of this chapter is to promote the public welfare by creating a comprehensive legal framework within which travel insurance may be sold in this state. B. The requirements of this chapter apply to travel insurance that covers any resident of this state and that is so…

A. Notwithstanding any other provision of this title, a travel retailer may offer and issue travel insurance under a limited lines travel insurance producer business entity license under the following conditions: 1. The limited lines travel insurance producer or travel retailer p…

A. A travel insurer shall pay premium tax as provided in section 20-224 on travel insurance premiums paid by any of the following: 1. An individual primary policyholder who is a resident of this state. 2. A primary certificate holder who is a resident of this state and who elects…

Travel protection plans may be offered for one price for the combined features that the travel protection plan offers in this state if both: 1. The travel protection plan clearly discloses to the consumer, at or before the time of purchase, that it includes travel insurance, trav…

A. All persons offering travel insurance to residents of this state are subject to chapter 2, article 6 of this title relating to unfair trade practices and frauds, except as otherwise provided in this section. If a conflict exists between this chapter and another provision of th…

A. Notwithstanding any other provision of this title, a person may not act or represent itself as travel administrator for travel insurance in this state unless that person either: 1. Is a licensed property and casualty insurance producer in this state for activities allowed unde…

A. Notwithstanding any other provision of this title, travel insurance is classified and filed for purposes of rates and forms under an inland marine line of insurance, except that travel insurance that provides coverage for sickness, accident, disability or death occurring durin…

A. For the purposes of section 20-3603, subsection B, paragraph 3, "qualified United States financial institution" means an institution that both: 1. Is: (a) Organized or, in the case of a United States office of a foreign banking organization, is licensed under the laws of the U…

A. A domestic ceding insurer shall be allowed a credit for reinsurance as either an asset or a reduction from liability on account of reinsurance ceded only when the reinsurer meets the requirements of subsection C, D, E, F, G, H or M of this section. The director may adopt rules…

A. An asset or a reduction from liability for the reinsurance ceded by a domestic insurer to an assuming insurer that does not meet the requirements of section 20-3602 shall be allowed in an amount not exceeding the liabilities carried by the ceding insurer. The director may adop…

A. The director may adopt rules pursuant to title 41, chapter 6 to carry out this article. B. The rules may include regulation of reinsurance arrangements relating to any of the following: 1. Life insurance policies with guaranteed nonlevel gross premiums or guaranteed nonlevel b…

This article applies to all cessions after September 29, 2021 under reinsurance agreements that have an inception, anniversary or renewal date not less than six months after September 29, 2021.

In this article, unless the context otherwise requires: 1. "Clinical practice guidelines" means a systematically developed statement to assist health care providers and patients in making decisions about appropriate health care for specific clinical circumstances and conditions. …

This article applies to: 1. Any health care plan that is subject to state law regulating insurance, that provides prescription drug benefits and that includes coverage for a step therapy protocol regardless of how that coverage is described. 2. A contractor, agent or similar enti…

A. Clinical review criteria that are used by a health care insurer, pharmacy benefit manager or utilization review agent to establish a step therapy protocol shall be based on clinical practice guidelines that: 1. Recommend that the prescription drugs be taken in the specific seq…

A. Notwithstanding any other law, if coverage of a prescription drug for the treatment of any medical condition is restricted for use by a health care insurer, pharmacy benefit manager or utilization review agent through the use of a step therapy protocol, the patient and prescri…