A.R.S. § 20-1631 — Arizona Code / Title 20 / Chapter 6 / Article 11 / Section 1631
20-1631 Definition of motor vehicle; cancellation of or failure to renew coverage; limitations; limitation of liability; exceptions; insurance producers; definitions
Status: in_force

20-1631. Definition of motor vehicle; cancellation of or failure to renew coverage; limitations; limitation of liability; exceptions; insurance producers; definitions

A. In this article, unless the context otherwise requires, "motor vehicle" means a licensed land, motor-driven vehicle but does not mean:

1. A private passenger or station wagon type vehicle used as a public or livery conveyance or rented to others.

2. Any other four-wheel motor vehicle of a load capacity of fifteen hundred pounds or less that is used in the business of transporting passengers for hire, used in business primarily to transport property or equipment, used as a public or livery conveyance or rented to others.

3. Any motor vehicle with a load capacity of more than fifteen hundred pounds.

4. A vehicle that otherwise qualifies as a motor vehicle under this subsection but only while the driver of the vehicle is logged in to a transportation network company's digital network or software application to be a driver or is providing transportation network services, unless expressly covered by the private passenger policy.

B. A motor vehicle used as a public or livery conveyance or rented to others does not include a motor vehicle used in the course of volunteer work for a tax-exempt organization as described in section 501(c)(3) of the internal revenue code.

C. An insurer shall not cancel or refuse to renew a motor vehicle insurance policy solely because of the location of residence, age, race, color, religion, sex, national origin or ancestry of anyone who is an insured, except that an insurer may refuse to renew a motor vehicle insurance policy if a named insured establishes a primary residence in a state other than this state.

D. An insurer shall not issue a motor vehicle insurance policy in this state unless the cancellation and renewal conditions of the policy or the endorsement on the policy includes the limitations required by this section.  After a policy issued in this state has been in effect for sixty days, or if the policy is a renewal, effective immediately, the company shall not exercise its right to cancel the insurance afforded under the policy unless:

1. The named insured fails to discharge when due any of the obligations of the named insured in connection with the payment of premium for this policy or any installment of the premium.

2. The insurance was obtained through fraudulent misrepresentation.

3. The named insured, any person who resides in the same household as the named insured and who customarily operates a motor vehicle insured under the policy or any other person who regularly and frequently operates a motor vehicle insured under the policy:

(a) Has had the person's driver license suspended or revoked during the policy period.

(b) Develops a permanent disability, either physically or mentally, and the person does not produce a certificate from a physician or a registered nurse practitioner testifying to the person's ability to operate a motor vehicle.

(c) Is or has been convicted during the thirty-six months immediately preceding the effective date of the policy or during the policy period of:

(i) Criminal negligence resulting in death, homicide or assault and arising out of the operation of a motor vehicle.

(ii) Operating a motor vehicle while in an intoxicated condition or while under the influence of drugs.

(iii) Leaving the scene of an accident.

(iv) Making false statements in an application for a driver license.

(v) Reckless driving.

4. The insurer is placed in rehabilitation or receivership by the insurance supervisory official in its state of domicile or by a court of competent jurisdiction or the director has suspended the insurer's certificate of authority based on its financially hazardous condition.

5. The named insured, any person who resides in the same household as the named insured and who customarily operates a motor vehicle insured under the policy or any other person who regularly and frequently operates a motor vehicle insured under the policy uses a motor vehicle rated or insured under the policy as a private passenger motor vehicle regularly and frequently for commercial purposes.

6.  The named insured, any person who resides in the same household as the named insured and who customarily operates a motor vehicle insured under the policy or any other person who regularly and frequently operates a motor vehicle insured under the policy uses a motor vehicle rated or insured under the policy to provide transportation network services unless, while the driver is logged in to the transportation network company's digital network or software application to be a driver or is providing transportation network services, the named insured either:

(a) Has procured an endorsement to the private passenger policy that expressly provides such coverage.

(b) Is covered by a motor vehicle liability insurance policy issued by another insurer expressly providing such coverage.

7. The director determines that the continuation of the policy would place the insurer in violation of the laws of this state or would jeopardize the solvency of the insurer.

E. An insurer may nonrenew a motor vehicle insurance policy if the insurer complies with this article.  An insurer shall provide notice of a nonrenewal to the named insured as prescribed by section 20-1632. A named insured who disputes the nonrenewal of the named insured's policy may file an objection with the director pursuant to section 20-1633.

F. The company shall not cancel the insurance when a person other than the named insured has violated subsection D, paragraph 3 of this section, if the named insured in writing agrees to exclude as insured the person by name when operating a motor vehicle and further agrees to exclude coverage to the named insured for any negligence that may be imputed by law to the named insured arising out of the maintenance, operation or use of a motor vehicle by the excluded person.  The written agreement that excludes coverage under a policy for a named individual is effective for each renewal of the policy by the insurer and remains in effect until the insurer agrees in writing to provide coverage for the named individual who was previously excluded from coverage.

G. This article does not apply to any policy that has been in effect less than sixty days at the time notice of cancellation is mailed or delivered by the insurer unless the policy is a renewal policy, or to policies:

1. Insuring any motor vehicle other than a private passenger motor vehicle as defined in section 20-117.

2. Insuring the motor vehicle hazard of garages, motor vehicle sales agencies, repair shops, service stations or public parking places.

3. Providing insurance only on an excess basis.

H. If a consumer purchases motor vehicle insurance coverage from an insurance producer licensed in this state, the insurance producer that owns the policy expiration shall remain the insurance producer of record for that insured.  If the insurer terminates the insurance producer's contract, the insurance producer shall continue to provide customary services to the insured. The insurer shall provide the insurance producer with a minimum degree of authority necessary to provide customary services to the insured and shall provide the same level of compensation for these services that were in effect before the termination of the insurance producer contract.

I. Subsection H of this section does not apply if one or more of the following conditions exist:

1. The insurance producer of record has had its license suspended or revoked by the department.

2. The insurance producer of record is indebted to the insurer.

3. The insured has supplied the insurer with a written request that its insurance producer of record be changed to another insurance producer of the insurer.

4. The insurance producer of record has authorized transfer of this account to another licensed insurance producer of the insurer.

5. The director has determined after a public hearing that continuation of this relationship is not in the best interest of the public.

6. The insurance producer of record is under an exclusive contract or contract requiring the insurance producer to submit all eligible business to an insurer or group of insurers under a common management.

J. Subsection H of this section does not apply to any transaction in which the expiration of the policies is owned by the insurer.

K. Notwithstanding any law to the contrary, if an insurer chooses to renew a policy, the issuance at renewal of revised policy provisions to modify an existing policy by adding coverages or policy provisions, modifying coverages or policy provisions or eliminating coverages or policy provisions is not a nonrenewal or cancellation of the policy if the modification of a basic coverage does not eliminate the essential benefit of that basic coverage. If the modification of the basic coverage eliminates the essential benefit of the basic coverage, the director shall order the insurer to remove the modification from the policy.  This subsection does not allow the insurer, without the written consent of the insured, to eliminate the basic coverages of the policy or to reduce the monetary limits of any of the basic coverages of the policy that were selected and agreed on. If an insurer chooses to renew a policy, this subsection does not limit a policyholder from continuing to renew uninsured or underinsured motorist coverage pursuant to section 20-259.01. For the purposes of this subsection, "basic coverage" means any of the following:

1. Bodily injury coverage.

2. Property damage coverage.

3. Uninsured motorist coverage.

4. Underinsured motorist coverage.

5. Medical payments coverage.

6. Comprehensive coverage.

7. Collision coverage.

L. For the purposes of this section, fail to renew or nonrenewal does not include the issuance and delivery of a new policy within the same insurer or an insurer under the same ownership or management as the original insurer as provided in this subsection.  An insurer may transfer any of its policies to an affiliated insurer.  An insurer may not transfer policyholders because of their location of residence, age, race, color, religion, sex, national origin or ancestry. A transfer by an insurer pursuant to this subsection does not allow the insurer to apply a new unrestricted sixty-day period for cancellation or nonrenewal.

M. Except as provided in this subsection, an insurer shall not refuse to renew a policy, based on an insured's failure to maintain membership in a bona fide association, until both the insurer and bona fide association have complied with this subsection and shall not refuse to renew any coverage continuously in effect before September 1, 1998, subject to all the following:

1. In addition to any other reason provided in this section, an insurer may refuse to renew an insurance policy issued pursuant to this article if all of the following conditions apply:

(a) The insurer clearly discloses to the applicant and the insured in the application for insurance and insurance policy that both the payment of dues and current membership in the bona fide association are prerequisites to obtaining or renewing the insurance.

(b) Any money paid to the bona fide association as a membership fee:

(i) Is not used by the insurer directly or indirectly to defray any costs or expenses in connection with the sale or purchase of the insurance.

(ii) Is set independently of any factor used by the insurer to make any judgment or determination about the eligibility of any individual, including the member, an employee of a member or a dependent of a member, to purchase or renew the insurance.

(c) The bona fide association has filed a certification with the director verifying the eligibility of the insurer to refuse to renew an insurance policy based on membership in the bona fide association.

2. To qualify as a bona fide association pursuant to this subsection, the association shall meet all of the requirements of this paragraph. The association shall file a statement with the director at least thirty days before the commencement of the offer or sale of insurance as provided by this subsection verifying that the association meets the requirements of this paragraph. The association shall update the filing required by this paragraph at least thirty days before the effective date of any material change in the information contained in the statement and shall file a separate notice with the director if the insurance described in the statement is no longer available through the association. The statement shall include the following information:

(a) That the association has been in active existence for at least five consecutive years immediately before the filing of the statement.

(b) That the association has been formed and maintained in good faith for purposes other than obtaining or providing insurance and does not condition membership in the association on the purchase of insurance.

(c) That the association has articles of incorporation and bylaws or other similar governing documents.

(d) That the association does not condition membership in the association or set membership fees on the eligibility of any individual, including the member, an employee of the member or a dependent of the member, to purchase or renew the insurance, or on any factor that the insurer could not lawfully consider when setting rates.

(e) That the association has a relationship with a specific insurer or insurers and identifies the insurer or insurers.

3. Membership fees collected by the bona fide association are not premiums of the insurer that issued the coverage unless the bona fide association:

(a) Uses any portion of the membership fees directly or indirectly to defray any costs or expenses in connection with the sale or purchase of the insurance.

(b) Sets or adjusts membership fees for any member of the bona fide association based on any factor used by the insurer that issues the insurance to make any judgment or determination about the eligibility of any individual, including the member, an employee of the member or a dependent of the member, to purchase or renew the insurance.

4. If the membership fees constitute premiums pursuant to paragraph 3 of this subsection, an insurer shall not refuse to renew a policy as otherwise allowed by this subsection.

N. An insurer or insurance producer shall not inquire on an application for a motor vehicle insurance policy whether the applicant, any person who resides in the same household as the applicant and who customarily operates a motor vehicle to be insured under the policy or any other person who regularly and frequently operates a motor vehicle to be insured under the policy has been nonrenewed by an insurer.

O. An insurer may issue an endorsement to a private passenger policy that expressly provides coverage for the provision of transportation network services, but that endorsement may not be treated as basic coverage as defined in subsection K of this section and any termination of the endorsement may not be treated as a modification of basic coverage. An insurer may terminate the endorsement allowed by this subsection by giving advance notice of the termination. Any notice by the insurer to the policyholder to terminate the endorsement allowed by this subsection shall be sent to the named insured at least forty-five days before the effective date of the termination.  The notice shall include an explanation to the named insured that the further provision of transportation network services following the effective date of the termination might subject the insured to cancellation or nonrenewal of the insured's private passenger motor vehicle policy.

P. This section and section 28-4009 do not create an obligation of an insurer to offer, provide or issue a policy or an endorsement that includes coverage for any liability incurred while a transportation network company driver is logged in to the transportation network company's digital network or software application to be a driver or is providing transportation network services.

Q. For the purposes of this section, "transportation network company", "transportation network company driver" and "transportation network services" have the same meanings prescribed in section 28-9551.
A.R.S. § 20-1308 — Arizona Code / Title 20 / Chapter 6 / Article 3 / Section 1308
20-1308 Nonforfeiture benefits
Status: in_force

20-1308. Nonforfeiture benefits

There shall be provisions for nonforfeiture benefits and cash surrender values as required by sections 20-1231 and 20-1231.01.
A.R.S. § 20-1098.14 — Arizona Code / Title 20 / Chapter 4 / Article 14 / Section 1098.14
20-1098.14 Rules
Status: in_force

20-1098.14. Rules

The director may adopt rules pursuant to title 41, chapter 6 to carry out this article.
A.R.S. § 20-1313 — Arizona Code / Title 20 / Chapter 6 / Article 3 / Section 1313
20-1313 Direct payment of premiums
Status: in_force

20-1313. Direct payment of premiums

In the case of weekly premium policies, there may be a provision that upon proper notice to the insurer, while premiums on the policy are not in default beyond the grace period, of the intention to pay future premiums directly to the insurer at its home office or any office designated by the insurer for the purpose, the insurer will, at the end of each period of a year from the due date of the first premium so paid, for which period such premiums are so paid continuously without default beyond the grace period, refund a stated percentage of the premiums in an amount which fairly represents the savings in collection expense.
A.R.S. § 20-102 — Arizona Code / Title 20 / Chapter 1 / Article 1 / Section 102
20-102 Definition of director
Status: in_force

20-102. Definition of director

In this title, title 6, title 32, chapters 9 and 36, title 41, chapter 31 and title 44, chapter 2.1, unless the context otherwise requires:

1. "Director" or "administrator" means the director of the department of insurance and financial institutions.

2. When used with reference to a member of the governing body of an insurer, director includes trustee.
A.R.S. § 20-321.01 — Arizona Code / Title 20 / Chapter 2 / Article 3.2 / Section 321.01
20-321.01 Licensing of adjusters; qualifications; exemption
Status: in_force

20-321.01. Licensing of adjusters; qualifications; exemption

A. A person shall not act as or claim to be an adjuster unless the person is licensed under this article.

B. To obtain a license as an adjuster a person shall apply to the director for the license and use the forms prescribed and provided by the director.  The director shall issue the license to qualified persons on payment of the license fee prescribed in section 20-167.

C. To be licensed as an adjuster the applicant shall meet all of the following qualifications:

1. Be a person who is at least eighteen years of age.

2. Be a resident of this state or a resident of another state that allows residents of this state to act as adjusters in the other state.

3. Take and pass an examination that is given by or under the supervision of the director and that reasonably tests the applicant's knowledge of insurance and legal responsibilities as an adjuster and otherwise comply with section 20-321.02.  Notwithstanding subsection D of this section, the requirements under this paragraph and paragraph 2 of this subsection are waived if the applicant holds a current claims certificate issued by a national or state-based claims association with a certification program that is approved by the director and that consists of at least forty hours of preexamination course work, a proctored examination of sufficient length to adequately determine the competency of the applicant and at least twenty-four hours of continuing education required for certification renewals on a biennial basis.

D. An adjuster who is licensed or allowed to act as an adjuster in the state of the adjuster's domicile is not required to be licensed pursuant to this section or meet the qualifications prescribed in this section if the adjuster is sent to this state on behalf of an insurer for the purpose of investigating or making adjustment of a particular loss under an insurance policy or a series of losses resulting from a catastrophe common to all those losses.

E. To determine license eligibility, the director may require fingerprints of applicants and the submission of the fee and the fingerprints as required by section 20-285, subsection E, paragraph 2.

F. The director may contract with nongovernmental entities to perform any ministerial functions, including collection of fees and data related to licensing, that the director deems appropriate.

G. A resident of Canada may apply for a license that grants the applicant the authority only to adjust portable electronics insurance claims in this state if the person has obtained an adjuster license in another state that allows that person to adjust portable electronics insurance claims in that state.  A Canadian resident who qualifies for licensure as an adjuster under this subsection is not subject to section 25-320, subsection P.

H. An applicant who resides in a state that does not issue licenses to adjusters and who is otherwise allowed to adjust portable electronics insurance claims in the applicant's resident state may apply for a license that grants the applicant the authority only to adjust portable electronics insurance claims in this state.
A.R.S. § 20-431.05 — Arizona Code / Title 20 / Chapter 2 / Article 5.1 / Section 431.05
20-431.05 Supplemental illustrations; requirements
Status: in_force

20-431.05. Supplemental illustrations; requirements

A. A supplemental illustration may be provided if:

1. The supplemental illustration is appended to, accompanied by or preceded by a basic illustration that complies with this article.

2. The nonguaranteed elements shown are not more favorable to the policyowner than the corresponding elements based on the scale that is used in the basic illustration.

3. The supplemental illustration contains the same statement required of a basic illustration that nonguaranteed elements are not guaranteed.

4. For a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration.  For policies that do not require a contract premium, the premium outlay underlying the supplemental illustration must be equal to the premium outlay shown in the basic illustration.

B. The supplemental illustration shall include a notice referring to the basic illustration for guaranteed elements and other important information.
A.R.S. § 20-1406.05 — Arizona Code / Title 20 / Chapter 6 / Article 5 / Section 1406.05
20-1406.05 Telehealth; coverage of health care services; definition
Status: in_force

20-1406.05. Telehealth; coverage of health care services; definition

A. All policies issued, delivered or renewed by a group disability insurer or a blanket disability insurer 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 encounter between the insured and a health care provider and provided to an insured receiving the service in this state.  The following requirements apply to coverage of telehealth services:

1. Except as otherwise provided in this subsection, a group or blanket disability insurer may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth.

2. Except as otherwise provided in this paragraph, a group or blanket disability insurer shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. A group or blanket disability insurer shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the group or blanket disability insurer.  A group or blanket disability insurer may not require a health care provider to use a telehealth platform that is sponsored or provided by the group or blanket disability insurer as a condition of network participation.

3. Before January 1, 2022, a group or blanket disability insurer shall cover services provided through an audio-only telehealth encounter if that service is reimbursed by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter.  Beginning January 1, 2022, a group or blanket disability insurer shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.

4. A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format.  To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media.

5. At the time of the telehealth encounter, the health care provider shall access clinical information and records, if available, that are appropriate to evaluate the patient's condition. The health care provider shall inform the insured before the telehealth encounter if there is a charge for the encounter.

6. A group or blanket disability insurer may establish reasonable requirements and parameters for telehealth services, including documentation, fraud prevention, identity verification and recordkeeping, but such requirements and parameters may not be more restrictive or less favorable to health care providers or insureds than are required for health care services delivered in person.

7. Covered telehealth services may be provided regardless of where the insured is located or the type of site.

8. Except in an emergency as prescribed in section 20-2803, the policy may limit the coverage to those health care providers who are members of the insurer's provider network.

B. Subsection A of this section does not:

1. Limit the ability of group or blanket disability insurers to provide incentives to insureds that are designed to improve health outcomes, increase adherence to a course of treatment or reduce risk.

2. Prevent group or blanket disability insurers from offering network contracts to health care providers who employ value-based purchasing or bundled payment methodologies if otherwise allowed by law or prevent health care providers from voluntarily agreeing to enter into such contracts with a group or blanket disability insurer.

C. This section does not relieve a group or blanket disability insurer from an obligation to provide adequate access to in-person health care services.  Network adequacy standards required by federal or state law may not be met by a group or blanket disability insurer through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state.

D. This section does not prevent a group or blanket disability insurer from imposing deductibles or copayment or coinsurance requirements for a health care service provided through telehealth if the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person encounter for the same health care service.  If the group or blanket disability insurer waives a deductible or copayment or coinsurance requirement that impacts a health care provider's contracted reimbursement rate, the group or blanket disability insurer shall reimburse the health care provider for the cost of the deductible or copayment or coinsurance requirement to ensure that the health care provider receives the contracted reimbursement rate if the service is covered and the claim meets other requirements of the network participation agreement.

E. Services provided through telehealth or resulting from a telehealth encounter are subject to all of this state's laws and rules that govern prescribing, dispensing and administering prescription pharmaceuticals and devices and shall comply with Arizona licensure requirements and any practice guidelines of the telehealth advisory committee on telehealth best practices established by section 36-3607 or, if not addressed, the practice guidelines of a national association of medical professionals promoting access to medical care for consumers via telecommunications technology or other qualified medical professional societies to ensure quality of care.

F. This section does not apply to limited benefit coverage as defined in section 20-1137.

G. For the purposes of this section, "telehealth":

1. Means the interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the purpose of diagnosis, consultation or treatment.

2. Includes:

(a) The use of an audio-only telephone encounter between an insured who has an existing relationship with a health care provider or provider group if both of the following apply:

(i) An audio-visual telehealth encounter is not reasonably available due to the insured's functional status, the insured's lack of technology or telecommunications infrastructure limits, as determined by the health care provider.

(ii) The telehealth encounter is initiated at the request of the insured or authorized by the insured before the telehealth encounter.

(b) The use of an audio-only encounter between the insured and a health care provider, regardless of whether there is an existing relationship with the health care provider or provider group, if the telehealth encounter is for a behavioral health or substance use disorder service and both items of subdivision (a) of this paragraph apply.

3. Does not include the sole use of a fax machine, instant messages, voice mail or email.
A.R.S. § 20-2309 — Arizona Code / Title 20 / Chapter 13 / Article 1 / Section 2309
20-2309 Renewability
Status: in_force

20-2309. Renewability

A. At least sixty days before the date of expiration of a health benefits plan, an accountable health plan that provides a health benefits plan shall provide for written notice to the employer of the terms for renewal of the plan. The notice shall include an explanation of the extent to which any increase in premiums is due to actual or expected claims experience of the individuals covered under the employer's health benefits plan contract.

B. An accountable health plan may refuse to renew or may terminate a health benefits plan only if:

1. The employer fails to pay premiums or contributions in accordance with the terms of the health benefits plan of the accountable health plan or the accountable health plan does not receive premium payments in a timely manner.

2. The employer committed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the health benefits plan.

3. The employer has failed to comply with a material plan provision relating to individual or employer participation rules as prescribed in subsection C of this section.

4. The accountable health plan has ceased to offer new coverage and has terminated or ceased to renew all in-force coverage in the group market pursuant to this section.

5. In the case of an accountable health plan that offers a health benefits plan through a network plan in this state, there is no longer any enrollee in connection with the accountable health plan who lives, resides or works in the service area of the accountable health plan or in the area served by the network plan for which the accountable health plan is authorized to do business and the accountable health plan would deny enrollment pursuant to section 20-2304, subsection G.

6. In the case of an accountable health plan that offers a health benefits plan in the group market only through one or more bona fide associations, the membership of an employer in the association has ceased but only if that coverage is terminated uniformly without regard to any health status-related factor or any covered individual.

C. An accountable health plan may require that a minimum percentage of employees who are not covered under a spouse's or parent's employer's health benefits plan be enrolled in a plan if the percentage is applied uniformly to all plans that are offered to employers of comparable size.

D. An accountable health plan is not required to renew a health benefits plan with respect to an employer or individual if the accountable health plan:

1. Elects not to renew all of its health benefits plans that are issued to employers or individuals in this state.

2. Provides notice to the director at least five business days before the accountable health plan gives notice to each employer or individual covered under a health benefits plan of the intention to discontinue offering any health benefits plans in this state.

3. Provides notice of termination or nonrenewal to each employer or individual covered under a plan at least one hundred eighty days before the renewal date of the plan. If the accountable health plan terminates coverage, the accountable health plan may not issue a health benefits plan to an employer in this state during the five year period beginning on the termination date of the last plan that was not renewed.

E. If an accountable health plan decides to discontinue offering a particular health benefits plan offered in the group market, the accountable health plan may discontinue that coverage only if the accountable health plan:

1. Provides notice to the director at least five business days before the accountable health plan gives notice to each employer or individual covered under that health benefits plan of the intention to discontinue offering that health benefits plan in this state.

2. Provides notice to each employer or individual covered under that health benefits plan at least ninety days before the date of the discontinuation of that coverage.

3. Offers to each employer whose coverage is discontinued pursuant to this subsection the option to purchase all other health benefits plans currently offered by the accountable health plan for employers in the group market uniformly without regard to any health status-related factor of any employee or a spouse or a dependent of the employee enrolled or individuals who may become eligible for that coverage.
A.R.S. § 20-2204 — Arizona Code / Title 20 / Chapter 12 / Article 1 / Section 2204
20-2204 Directors; election; appointment
Status: in_force

20-2204. Directors; election; appointment

A. The association shall be governed by a board of eleven directors annually appointed by the director. Six of the directors shall be selected from the members of the association. Three of the directors shall be domestic insurers and three shall be foreign insurers. Five of the directors shall be representatives of commercial insureds.

B. Directors of the association shall receive no compensation and shall not be entitled to travel expenses as authorized by title 38, chapter 4, article 2, but shall be entitled to be reimbursed for expenses incurred by them as members of the board from the assets of the association.
A.R.S. § 20-215 — Arizona Code / Title 20 / Chapter 2 / Article 1 / Section 215
20-215 Application for certificate of authority
Status: in_force

20-215. Application for certificate of authority

To apply for an original certificate of authority an insurer shall file with the director its application for a certificate of authority showing its name, location of its home office or principal office in the United States, if an alien insurer, kinds of insurance to be transacted, date of organization or incorporation, form of organization, state or country of domicile and such additional information as the director may reasonably require, together with the following applicable documents:

1. If a foreign or alien insurer, a copy of its corporate charter with all amendments to the charter certified by the public officer with whom the originals are on file in the state or country of domicile.

2. A copy of its bylaws, as amended, certified by its secretary or other officer having custody of the bylaws.

3. A copy of its annual statement as of December 31 last preceding.

4. A copy of the report of the last examination, if any, made of the insurer, certified by the insurance supervisory official of its state of domicile or of entry into the United States.

5. Appointment of the director as its attorney to receive service of legal process if, as to a foreign or alien insurer, such an appointment is not already on file.

6. Appointment of a statutory agent to receive service of legal process, accompanied by his name and address, as to a domestic insurer.

7. If a foreign or alien insurer, a certificate of the public official having supervision of insurance in its state or country of domicile showing that it is authorized to transact the kinds of insurance proposed to be transacted in this state.

8. If an alien insurer, a copy of the appointment and authority of its United States manager, certified by its officer having custody of its records.

9. If a foreign or alien insurer, a certificate as to deposit if to be tendered pursuant to section 20-213.
A.R.S. § 20-2401 — Arizona Code / Title 20 / Chapter 14 / Article 1 / Section 2401
20-2401 Definitions
Status: in_force

20-2401. Definitions

In this chapter, unless the context otherwise requires:

1. "Completed operations liability" means liability arising out of the installation, maintenance or repair of any product at a site which is not owned or controlled by either:

(a) A person who performs that work.

(b) A person who hires an independent contractor to perform that work. Completed operations liability includes liability for activities which are completed or abandoned before the date of the occurrence giving rise to the liability.

2. "Domicile", for purposes of determining the state in which a purchasing group is domiciled, means:

(a) For a corporation, the state in which the purchasing group is incorporated.

(b) For an unincorporated entity, the state of its principal place of business.

3. "Hazardous financial condition" means that, based on its present or reasonably anticipated financial condition, a risk retention group, although not yet financially impaired or insolvent, is unlikely to be able to either:

(a) Meet obligations to policyholders with respect to known claims and reasonably anticipated claims.

(b) Pay other obligations in the normal course of business.

4. "Insurance" means primary insurance, excess insurance, reinsurance, surplus lines insurance and any other arrangement for shifting and distributing risk which is determined to be insurance under the laws of this state.

5. "Liability":

(a) Means legal liability for damages, including costs of defense, legal costs and fees and other claims expenses, because of injuries to other persons, damage to their property or other damage or loss to other persons resulting from or arising out of either:

(i) A business, whether for profit or nonprofit, trade, product, services, including professional services, premises or operations.

(ii) An activity of a state or local government, or an agency or political subdivision of the state.

(b) Does not include personal risk liability and an employer's liability with respect to its employees other than legal liability under the federal employers' liability act (45 United States Code section 51).

6. "Personal risk liability" means liability for damages because of injury to a person, damage to property or other loss or damage resulting from any personal, familial or household responsibilities or activities other than those listed in paragraph 5.

7. "Plan of operation or feasibility study" means an analysis which presents the expected activities and results of a risk retention group including at least all of the following:

(a) Information sufficient to verify that its members are engaged in businesses or activities similar or related with respect to the liability to which the members are exposed by virtue of any related, similar or common business, trade, product, services, premises or operations.

(b) For each state in which the group intends to operate, the coverages, deductibles, coverage limits, rates and rating classification systems for each line of insurance the group intends to offer.

(c) Historical and expected loss experience of the proposed members and national experience of similar exposures to the extent that this experience is reasonably available.

(d) Pro forma financial statements and projections.

(e) Appropriate opinions by a qualified, independent casualty actuary, including a determination of minimum premium or participation levels required to commence operations and to prevent a hazardous financial condition.

(f) Identification of management, underwriting and claims procedures, marketing methods, managerial oversight methods and investment policies.

(g) Other matters as prescribed by the director for liability insurance companies authorized by the insurance laws of the state in which the risk retention group is chartered.

8. "Product liability" means liability for damages because of any personal injury, death, emotional harm, consequential economic damage or property damage, including damages resulting from the loss of use of property, arising out of the manufacture, design, importation, distribution, packaging, labeling, lease or sale of a product. Product liability does not include the liability of a person for those damages if the product involved was in the possession of the person when the incident giving rise to the claim occurred.

9. "Purchasing group" means a group which meets all of the following criteria:

(a) Has as one of its purposes the purchase of liability insurance on a group basis.

(b) Purchases the insurance only for its group members and only to cover their similar or related liability exposure, as described in subdivision (c) of this paragraph.

(c) Is composed of members whose businesses or activities are similar or related with respect to the liability to which members are exposed by virtue of any related, similar or common business, trade, product, services, premises or operations.

(d) Is domiciled in any state.

10. "Risk retention group" means a corporation or other limited liability association formed under the laws of any state which meets all of the following criteria:

(a) Its primary activity consists of assuming and spreading all or any portion of the liability exposure of its group members.

(b) It is organized for the primary purpose of conducting the activity described in subdivision (a) of this paragraph.

(c) It is either:

(i) Chartered and licensed as a liability insurance company and authorized to engage in the business of insurance under the laws of any state.

(ii) It was, before January 1, 1985, chartered or licensed and authorized to engage in the business of insurance under the laws of Bermuda or the Cayman Islands and, before January 1, 1985, had certified to the insurance commissioner of at least one state that it satisfied the capitalization requirements of the state. Any such group is a risk retention group only if it has been engaged in business continuously since January 1, 1985 and only for the purpose of continuing to provide insurance to cover product liability or completed operations liability.

(d) It does not exclude any person from membership in the group solely to provide for members of a group a competitive advantage over the person.

(e) It either:

(i) Has as its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group.

(ii) Has as its sole owner an organization which has as its members only persons who comprise the membership of the risk retention group and has as its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group.

(f) Its members are engaged in businesses or activities similar or related with respect to the liability which the members are exposed to by virtue of any related, similar or common business, trade, product, services, premises or operations.

(g) Its activities do not include the provision of insurance other than:

(i) Liability insurance for assuming and spreading all or any portion of the liability of its group members.

(ii) Reinsurance with respect to the liability of any other risk retention group or any members of any other group which is engaged in businesses or activities that meet the requirement described in subdivision (f) of this paragraph from membership in the risk retention group which provides the reinsurance.

(h) The name of the group includes the phrase "risk retention group".

11. "State" means any state of the United States or the District of Columbia.
A.R.S. § 20-482 — Arizona Code / Title 20 / Chapter 2 / Article 8.1 / Section 482
20-482 Definitions
Status: in_force

20-482. Definitions

In this article, unless the context otherwise requires:

1. "Board" means the board of directors of a converting mutual insurer.

2. "Conversion" means a process by which a domestic mutual insurer is converted to a domestic stock insurer as part of a reorganization.

3. "Converted stock insurer" means a domestic stock insurer into which a domestic mutual insurer is converted as part of a reorganization.

4. "Converting mutual insurer" means a domestic mutual insurer that is converting to a domestic stock insurer as part of a reorganization.

5. "Effective date" means, with respect to a plan, the date on which the plan or a part of the plan becomes effective as set forth in an order of the director.

6. "Eligible member" means a member of the converting mutual insurer whose insurance policy is in force as of the date on which the board adopts the plan of reorganization or on some other date that the plan specifies as the record date and that the director approves.

7. "Intermediate stock holding company" means a corporation that satisfies all of the following:

(a) The corporation was incorporated under title 10.

(b) A mutual holding company holds directly or indirectly at least a majority of the corporation's voting stock.

(c) The corporation holds directly or indirectly at least a majority of the voting stock of a converted stock insurer.

8. "Member" means:

(a) With respect to a domestic mutual insurer, a member as described in section 20-715.

(b) With respect to a mutual holding company, any holder of one or more policies of insurance, other than a policy of reinsurance, issued by the converted stock insurer resulting from a reorganization involving the organization of a mutual holding company and, if permitted under the articles of incorporation or bylaws of the mutual holding company, may include any holder of one or more policies of insurance, other than a policy of reinsurance, issued by any other insurer that is a direct or indirect subsidiary or affiliate of the mutual holding company.

9. "Membership interest" means:

(a) With respect to a converting mutual insurer, interest as set forth in section 20-716.

(b) With respect to a mutual holding company on and after the effective date of the plan, any right that a member of the mutual holding company may hold by virtue of membership in the mutual holding company arising under the articles of incorporation and bylaws of the mutual holding company, including the right to vote for the board.

10. "Mutual holding company" means a corporation that is formed and existing under the laws of this state and pursuant to the reorganization of a mutual insurance company.

11. "Plan" means a plan of reorganization.

12. "Reorganization" means a process by which a domestic mutual insurer is converted to a domestic stock insurer and a mutual holding company is organized.

13. "Voting stock":

(a) Means stock of any class or any percentage ownership interest having voting power for the election of directors, trustees or management.

(b) Includes stock having voting power only by reason of the happening of a contingency.
A.R.S. § 20-414 — Arizona Code / Title 20 / Chapter 2 / Article 5 / Section 414
20-414 Records of surplus lines brokers
Status: in_force

20-414. Records of surplus lines brokers

Each surplus lines broker shall keep in the broker's principal place of business a full and true record of each surplus lines contract procured by the broker under the license issued pursuant to this article.  The  director may examine the record at any time within three years after the expiration or cancellation date of the insurance policy. The record shall include the following items as applicable:

1. Name and address of the insurer.

2. Name and address of the insured.

3. Amount of insurance.

4. Gross premium charged.

5. Return premium paid, if any.

6. Rate of premium charged on the several items of coverage.

7. Effective date and terms of the contract.

8. Brief general description of the risks insured against and the property insured.
A.R.S. § 20-1731 — Arizona Code / Title 20 / Chapter 7 / Article 3 / Section 1731
20-1731 Immunity for serving on or furnishing information to insurance review committees
Status: in_force

20-1731. Immunity for serving on or furnishing information to insurance review committees

A person who without malice and in good faith makes a decision or recommendation or takes any action within the scope of his duties as a member, agent or employee of an insurance review committee established by or at the request of an insurer for the purpose of reviewing or evaluating applications for insurance, or for performing such other underwriting or claim evaluation functions as are requested by the insurer, shall not be subject to liability for civil damages therefor or any legal action in consequence thereof, nor shall any person who without malice and in good faith furnishes any records, information or assistance to such a committee be liable for civil damages therefor or any legal action in consequence thereof.
A.R.S. § 20-2536 — Arizona Code / Title 20 / Chapter 15 / Article 2 / Section 2536
20-2536 Voluntary internal appeal
Status: in_force

20-2536. Voluntary internal appeal

A. For a group health plan, or a grandfathered individual plan, if a health care insurer elects to include as part of its internal review levels a voluntary internal appeal level after any applicable initial appeal pursuant to section 20-2535 and the utilization review agent denies the member's initial request, the member may appeal that adverse determination to the voluntary internal appeal level.  The member shall send a written appeal to the utilization review agent within sixty days after receipt of the adverse determination.

B. The member or the member's treating provider shall submit to the utilization review agent with the written voluntary internal appeal any material justification or documentation to support the member's request for the service or claim for a service.

C. If the member's appeal involves an issue of medical necessity or appropriateness, including health care setting, level of care or effectiveness of a covered benefit, or is experimental or investigational under the coverage document and not whether the service is covered, the utilization review agent shall select a provider to review the appeal and render a determination based on the utilization review plan adopted by the utilization review agent. For the purposes of this subsection:

1. "Advanced practice registered nurse" means any of the following as defined in section 32-1601:

(a) A certified nurse midwife.

(b) A certified registered nurse anesthetist.

(c) A clinical nurse specialist.

(d) A registered nurse practitioner.

2. "Provider" means either of the following:

(a) A physician or other health care professional who is licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an advanced practice registered nurse who is licensed pursuant to title 32, chapter 15, who is qualified in a similar scope of practice as a physician or other health care professional licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an advanced practice registered nurse who is licensed pursuant to title 32, chapter 15 and who is employed or under contract with the utilization review agent.

(b) An out-of-state physician or other health care professional who is licensed in another state and who is not licensed in this state, who is employed or under contract with the utilization review agent and who either is qualified in a similar scope of practice as a physician or other health care professional Licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an advanced practice registered nurse who is licensed pursuant to title 32, chapter 15 or who typically manages the medical condition under appeal.

D. Except as provided in subsection E of this section, the utilization review agent shall send to the member and the member's treating provider a notice of the utilization review agent's determination and the basis, criteria used, clinical reasons and rationale for that determination within the time frames prescribed in section 20-2533, subsection D.

E. At any time during the voluntary internal appeal process, the utilization review agent may request an external independent review process pursuant to section 20-2537. If the utilization review agent initiates the external independent review process, the utilization review agent does not have to comply with subsection d of this section.

F. If at the conclusion of the voluntary internal appeal process the utilization review agent denies the appeal and the utilization review agent does not initiate the external independent review process, the utilization review agent shall provide the member with notice of the option to proceed to an external independent review pursuant to section 20-2537.

G. If the utilization review agent concludes that the covered service should be provided or the claim for a covered service should be paid, the health care insurer is bound by the utilization review agent's determination.
A.R.S. § 20-1367 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1367
20-1367 Illegal occupation
Status: in_force

20-1367. Illegal occupation

There may be a provision as follows: "Illegal occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation."
A.R.S. § 20-2114 — Arizona Code / Title 20 / Chapter 11 / Article 1 / Section 2114
20-2114 Director; powers
Status: in_force

20-2114. Director; powers

A. The director may examine and investigate the affairs of every insurance institution or insurance producer doing business in this state to determine whether the insurance institution or insurance producer has been or is engaged in any conduct in violation of this chapter.

B. The director may examine and investigate the affairs of every insurance support organization acting on behalf of an insurance institution or insurance producer which either transacts business in this state or transacts business outside this state that has an effect on a person residing in this state in order to determine whether the insurance support organization has been or is engaged in any conduct in violation of this chapter.
A.R.S. § 20-1567 — Arizona Code / Title 20 / Chapter 6 / Article 9 / Section 1567
20-1567 Determination of insurability required
Status: in_force

20-1567. Determination of insurability required

A. No policy or contract of title insurance shall be written on any risk located in this state except by a title insurer authorized to do business in this state, nor unless and until the title insurer has caused to be conducted a reasonable examination of the title and has caused to be made a determination of insurability of title in accordance with sound underwriting practices for title insurers.

B. No title insurer shall write title insurance in, nor issue any title insurance policy with respect to risks located in, any county of this state with a population, as shown by the latest decennial census, in excess of one hundred thousand persons, unless the title insurer or its agent in that county maintains a title insurance plant covering title records of such county, or unless the insurer issues its policy based on a policy issued to it by another title insurance company, or its agent, who meets the requirements of this section provided, however, that for the purposes of this subsection a title insurer or title insurance agent shall be deemed to maintain a title insurance plant if it is a lessee thereof or joint owner or has a beneficial interest in such a plant.

C. This section shall not apply to a reinsurer or an excess coinsurer, provided the originating insurer complies with subsections A and B.
A.R.S. § 20-216 — Arizona Code / Title 20 / Chapter 2 / Article 1 / Section 216
20-216 Issuance or refusal of certificate
Status: in_force

20-216. Issuance or refusal of certificate

A. If on the completion of an application the director finds that the insurer has met the requirements for and is entitled under this title, the director shall issue to the insurer a proper certificate of authority. If the director does not so find, the director shall issue an order refusing such certificate. The director shall act on an application for a certificate of authority within ninety days after its completion.

B. The certificate, if issued, shall specify the kind or kinds of insurance the insurer is authorized to transact in this state. At the insurer's request, the director may issue a certificate of authority limited to particular types of insurance included within a kind of insurance as defined in this title.
A.R.S. § 20-1265 — Arizona Code / Title 20 / Chapter 6 / Article 2 / Section 1265
20-1265 Individual certificates
Status: in_force

20-1265. Individual certificates

In group life policies there shall be a provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which he is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in sections 20-1266, 20-1267 and 20-1268.
A.R.S. § 20-302 — Arizona Code / Title 20 / Chapter 2 / Article 3 / Section 302
20-302 Rules
Status: in_force

20-302. Rules

The director may adopt rules pursuant to title 41, chapter 6 to carry out this article.
A.R.S. § 20-488.05 — Arizona Code / Title 20 / Chapter 2 / Article 12 / Section 488.05
20-488.05 Mandatory control level event
Status: in_force

20-488.05. Mandatory control level event

A. If a mandatory control level event occurs, the director shall take any actions that are necessary to place the insurer under regulatory control pursuant to chapter 1, article 2 and chapter 3, article 4 of this title.  The mandatory control level event shall be deemed to be sufficient grounds for the director to take action under chapter 1, article 2 and chapter 3, article 4 of this title, and the director has the rights, powers and duties with respect to the insurer that are set forth in chapter 1, article 2 and chapter 3, article 4 of this title.  If the director takes any action under this subsection pursuant to an adjusted RBC report, the insurer is entitled to the same protection that is afforded to insurers under chapter 1, article 2 and chapter 3, article 4 of this title.

B. Notwithstanding subsection A, the director may forgo action for up to ninety days after the mandatory control level event if the director finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety day period.
A.R.S. § 20-764 — Arizona Code / Title 20 / Chapter 4 / Article 2 / Section 764
20-764 Compliance by existing insurers
Status: in_force

20-764. Compliance by existing insurers

Existing authorized reciprocal insurers shall after January 1, 1955 comply with the provisions of this article, and shall make such amendments to their subscribers' agreement, power of attorney, policies and other documents and accounts and perform such other acts as may be required for such compliance.
A.R.S. § 20-456 — Arizona Code / Title 20 / Chapter 2 / Article 6 / Section 456
20-456 Cease and desist order for defined or prohibited practices; civil penalty
Status: in_force

20-456. Cease and desist order for defined or prohibited practices; civil penalty

A. If after a hearing the director finds that the person charged has engaged or is engaging in any act or practice defined in or prohibited under this article as an illegal or unfair method of competition or an unfair or deceptive act or practice, the director shall order the person to cease and desist from the proscribed acts or practices.

B. If the act or practice is a violation of section 20-443, 20-443.01, 20-444, 20-445, 20-446, 20-447, 20-448, 20-448.01, 20-448.02, 20-449, 20-451, 20-452 or 20-467, chapter 27 of this title or a general business practice of committing or performing acts or omissions proscribed by sections 20-461, 20-468 and 20-469, the director may also impose a civil penalty of not more than one thousand dollars for each act or violation but not to exceed an aggregate penalty of ten thousand dollars unless the person intentionally violates any section enumerated in this subsection, in which case the director may impose a civil penalty of up to five thousand dollars for each act or violation but not to exceed an aggregate penalty of fifty thousand dollars in any six month period.

C. No order of the director pursuant to this section or order of a court to enforce it, or holding of a hearing, may in any manner relieve or absolve any person affected by the order or hearing from any other liability, penalty or forfeiture under law.
A.R.S. § 20-1621 — Arizona Code / Title 20 / Chapter 6 / Article 10.1 / Section 1621
20-1621 Scope of article
Status: in_force

20-1621. Scope of article

A. This article applies to an insurer or producer transacting credit property insurance.

B. All credit property insurance written in connection with credit transactions for personal, family or household purposes is subject to this article, except:

1. Insurance resulting from transactions involving extensions of credit primarily for business or commercial purposes.

2. Insurance on mobile homes.

3. Insurance written in connection with a credit transaction that is secured by a real estate mortgage or deed of trust.

4. Creditor-placed insurance.

5. Title insurance.

6. Nonrecording insurance.

7. Insurance purchased by a creditor after repossession or a similar event where the creditor gains possession of the property.

C. All credit property insurance issued or made effective relative to consumer lender loans under title 6, chapter 5 is subject to this article.

D. All other provisions of this title not inconsistent with this article apply to transaction of credit property insurance.
A.R.S. § 20-697.01 — Arizona Code / Title 20 / Chapter 3 / Article 9 / Section 697.01
20-697.01 Confidentiality; sharing of information
Status: in_force

20-697.01. Confidentiality; sharing of information

A. Documents, materials or other information in the possession or control of the department that are considered an actuarial report, work papers or actuarial opinion summary provided in support of the opinion and any other material provided by the company to the director in connection with the actuarial report, work papers or actuarial opinion summary are confidential, shall not be subject to public records requests, shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action.

B. This section and section 20-697 shall not be construed to limit the director's authority to release the documents to the actuarial board for counseling and discipline so long as the material is required for the purpose of professional disciplinary proceedings and that the actuarial board for counseling and discipline establishes procedures satisfactory to the director for preserving the confidentiality of the documents, nor shall this section be construed to limit the director's authority to use the documents, materials or other information in furtherance of any regulatory or legal action brought as part of the director's official duties.

C. Neither the director nor any person who receives documents, materials or other information while acting under the authority of the director shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to subsection A of this section.

D. The director may:

1. Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subsection A of this section with other state, federal and international regulatory agencies, with the national association of insurance commissioners and its affiliates and subsidiaries and with state, federal and international law enforcement authorities, provided that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information and has the legal authority to maintain confidentiality.

2. Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the national association of insurance commissioners and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information.

3. Enter into agreements governing the sharing and use of information consistent with subsections A through D of this section.

E. No waiver of any applicable privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the director under this section or as a result of sharing as authorized in subsection D of this section.
A.R.S. § 20-664 — Arizona Code / Title 20 / Chapter 3 / Article 6 / Section 664
20-664 Powers and duties of the board
Status: in_force

20-664. Powers and duties of the board

A. The board shall:

1. Investigate claims brought against the fund and adjust, compromise, settle and pay covered claims to the extent of the fund's obligation and deny all other claims.  In regard to workers' compensation claims, the board shall adjust, compromise, settle and pay compensable claims, and deny all other claims, subject to the regulatory and adjudicatory authority of the industrial commission over workers' compensation claims pursuant to title 23, chapter 6.

2. Within six months after the determination of insolvency or six months after the fund discovers or should have discovered the settlement of a covered claim, whichever is later, deny and state the basis for the denial or pay any covered claim that was settled within four months before the determination of insolvency of the insolvent insurer. This paragraph does not apply to a settlement of a workers' compensation claim or commutation of permanent disability benefits approved by the industrial commission unless the industrial commission award approving the settlement or commutation of benefits has not become final.

3. Allocate claims paid and expenses incurred among the three accounts of the fund separately.

4. Assess member insurers separately for each account of the fund and expend amounts assessed only for the purposes of the account into which the amounts assessed were placed.

5. Notify such persons as the director directs pursuant to section 20-668, subsection B, paragraph 1.

6. Handle claims through its employees or through one or more insurers or other persons designated as servicing facilities. Designation of a servicing facility shall be subject to the approval of the director. Designation may be declined by a member insurer.

7. Reimburse each servicing facility for obligations of the fund paid by the facility and for expenses incurred by the facility while handling the claims on behalf of the fund and pay the other expenses of the fund authorized pursuant to this article.

B. The board may:

1. Appear in, defend and appeal any action on a claim that is brought against the fund.

2. Employ or retain such persons as are necessary to handle claims and perform other duties of the fund.

3. Borrow funds necessary to carry out the intent of this article pursuant to the plan of operation.

4. Sue and be sued.

5. Negotiate and become a party to such contracts as are necessary to carry out the intent of this article.

6. Perform such other acts as are necessary or proper to carry out the intent of this article.
A.R.S. § 20-3215 — Arizona Code / Title 20 / Chapter 22 / Article 1 / Section 3215
20-3215 Penalties
Status: in_force

20-3215. Penalties

A. It is a violation of this chapter for any person, provider, broker or party related to the business of life settlements to commit a fraudulent life settlement act.

B. A person who commits a fraudulent life settlement act is guilty of committing insurance fraud and is subject to section 20-466.01.

C. The director may seek an injunction and an order of restitution and may levy a civil penalty pursuant to section 20-466.02 on any person who is licensed pursuant to this chapter and who is found to have committed a fraudulent life settlement act or to have violated any other provision of this chapter.

D. The director may deny, suspend for not more than twelve months, revoke or refuse to renew the license of a person who commits a fraudulent life settlement act.
A.R.S. § 20-219 — Arizona Code / Title 20 / Chapter 2 / Article 1 / Section 219
20-219 Mandatory revocation or suspension
Status: in_force

20-219. Mandatory revocation or suspension

The director shall refuse to renew or shall revoke or suspend an insurer's certificate of authority:

1. If such action is required by any provision of this title, or

2. If the insurer no longer meets the requirements for the authority originally granted, on account of deficiency in assets or otherwise.
A.R.S. § 20-543 — Arizona Code / Title 20 / Chapter 3 / Article 2 / Section 543
20-543 Acceptances and bills of exchange
Status: in_force

20-543. Acceptances and bills of exchange

An insurer may invest in bank and bankers' acceptances and other bills of exchange of the kind and maturity made eligible pursuant to law for purchase in the open market by federal reserve banks.
A.R.S. § 20-1096.04 — Arizona Code / Title 20 / Chapter 4 / Article 12 / Section 1096.04
20-1096.04 Qualifications
Status: in_force

20-1096.04. Qualifications

The director shall not issue a certificate of authority to a mechanical reimbursement reinsurer unless all of the following conditions are met:

1. The applicant is a corporation incorporated under the laws of this state.

2. The applicant furnishes such proof as necessary to the director that the directors and management of the reinsurer are competent and are capable of successfully managing its affairs in compliance with law.

3. The applicant makes the deposit as required by section 20-1096.06.

4. The applicant is in compliance and continues to be in compliance with all applicable laws.

5. The applicant pays the initial fee prescribed in section 20-167.
A.R.S. § 20-1370 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1370
20-1370 Third party ownership
Status: in_force

20-1370. Third party ownership

The word "insured," as used in this article shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein.
A.R.S. § 20-640 — Arizona Code / Title 20 / Chapter 3 / Article 4 / Section 640
20-640 Time to file claims
Status: in_force

20-640. Time to file claims

A. If, upon the granting of an order of liquidation under this article or at any time thereafter during the liquidation proceeding, the insurer is not clearly solvent, the court shall, after such notice and hearing as it deems proper, make an order declaring the insurer to be insolvent. Thereupon regardless of any prior notice which may have been given to creditors, the receiver shall notify all persons who may have claims against the insurer and who have not filed proper proofs thereof to present them to him, at a place specified in the notice, within four months from the date of entry of the order, or if the receiver certifies that it is necessary, within such longer time as the court shall prescribe. The last day for filing of proofs of claims shall be specified in the notice, and notice shall be given in a manner to be determined by the court.

B. Proofs of claim may be filed subsequent to the date specified, but no such claim shall share in the distribution of the assets until all allowed claims, proofs of which have been filed before such date, have been paid in full with interest according to the priorities established in section 20-629.
A.R.S. § 20-2534 — Arizona Code / Title 20 / Chapter 15 / Article 2 / Section 2534
20-2534 Expedited medical review; expedited appeal
Status: in_force

20-2534. Expedited medical review; expedited appeal

A. Except for a denial of a claim for service or a rescission of coverage, any member who receives an adverse determination may pursue an expedited medical review of that denial if the member's treating provider certifies in writing and provides supporting documentation to the utilization review agent that the time period for the initial appeal process prescribed in section 20-2535 and, if applicable, the voluntary internal appeal process prescribed in section 20-2536 are likely to cause a significant negative change in the member's medical condition at issue that is subject to the appeal.  The treating provider's certification is not challengeable by the health care insurer. A health care insurer whose utilization review activities consist only of claims review for services already provided is not required to provide its members an expedited medical review or expedited appeal pursuant to this section.  A health care insurer who conducts utilization review of claims in connection with services already provided is not required to provide its members an expedited medical review or expedited appeal of a claim related to a service already provided.

B. On receipt of the certification and supporting documentation, the utilization review agent has seventy-two hours to make a determination and send to the member and the member's treating provider a notice of that determination, including the basis, criteria used, clinical reasons and rationale for that determination and any references to supporting documentation.  If the member's complaint involves an issue of medical necessity or appropriateness, including health care setting, level of care or effectiveness of a covered benefit, or is experimental or investigational under the coverage document and not whether the service is covered, before making a determination, the agent shall consult with a physician or other health care professional who is licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an out-of-state provider, physician or other health care professional who is licensed in another state and who is not licensed in this state and who typically manages the medical condition under review.

C. If the utilization review agent affirms the denial of the requested service, the agent shall telephonically provide and send to the member and the member's treating provider a notice of the adverse determination and of the member's option to immediately proceed to an expedited appeal pursuant to subsection E of this section.

D. At any time during the expedited appeal process, the utilization review agent may request an expedited external independent review pursuant to section 20-2537.  If the utilization review agent initiates an expedited external independent review, the utilization review agent does not have to comply with subsection E of this section.

E. If the member chooses to proceed with an expedited appeal, the member's treating provider shall immediately submit a written appeal of the denial of the service to the utilization review agent and provide the utilization review agent with any additional material justification or documentation to support the member's request for the service.  Within three business days after receiving the request for an expedited appeal, the utilization review agent shall provide notice of the expedited appeal determination as prescribed in this subsection.  If the member's complaint involves an issue of medical necessity or appropriateness, including health care setting, level of care or effectiveness of a covered benefit, or is experimental or investigational under the coverage document and not whether the service is covered, the utilization review agent shall select a provider who shall review the appeal and render the determination based on the utilization review plan adopted by the utilization review agent. If the utilization review agent or provider denies the expedited appeal, the utilization review agent shall telephonically provide and send to the member and the member's treating provider a notice of the denial and of the member's option to immediately proceed to the external independent review prescribed in section 20-2537. For the purposes of this subsection:

1. "Advanced practice registered nurse" means any of the following as defined in section 32-1601:

(a) A certified nurse midwife.

(b) A certified registered nurse anesthetist.

(c) A clinical nurse specialist.

(d) A registered nurse practitioner.

2. "Provider" means either of the following:

(a) A physician or other health care professional who is licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an advanced practice registered nurse who is licensed pursuant to title 32, chapter 15, who is qualified in a similar scope of practice as a physician or other health care professional licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an advanced practice registered nurse who is licensed pursuant to title 32, chapter 15 and who is employed or under contract with the utilization review agent.

(b) An out-of-state physician or other health care professional who is licensed in another state and who is not licensed in this state, who is employed or under contract with the utilization review agent and who either is qualified in a similar scope of practice as a physician or other health care professional licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 16, 17, 19, 19.1 or 29 or an advanced practice registered nurse who is licensed pursuant to title 32, chapter 15 or who typically manages the medical condition under appeal.

F. If the utilization review agent, provider, physician or other health care professional concludes that the covered service should be provided, the health care insurer is bound by the utilization review agent's determination.
A.R.S. § 20-2303 — Arizona Code / Title 20 / Chapter 13 / Article 1 / Section 2303
20-2303 Approval as accountable health plan; definition
Status: in_force

20-2303. Approval as accountable health plan; definition

An entity may offer, issue or otherwise provide a health benefits plan only if the entity is authorized to transact insurance in this state and is approved as an accountable health plan by the director based on a determination that the entity meets the applicable requirements of this chapter.
A.R.S. § 20-1095.04 — Arizona Code / Title 20 / Chapter 4 / Article 11 / Section 1095.04
20-1095.04 Filing of surety bond, securities or bonds
Status: in_force

20-1095.04. Filing of surety bond, securities or bonds

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 bond that complies with subsection C of this section and that at all times has a value of at least one hundred thousand dollars.

B. The service company may file alternatives to a surety bond in the form of securities eligible for the investment of capital funds of domestic insurers under this title or bonds of the United States government.

C.  A surety bond that is filed under subsection A of this section must be issued by a surety insurer licensed to do business in this state and must be for the same purpose as required in subsection A of this section. The surety bond is subject to the approval of the director. The surety insurer shall not cancel the bond or subject the bond to cancellation unless thirty days' written notice is given to the director.

D. If securities or bonds of the United States government are filed as an alternative to a surety bond, the securities or bonds shall be irrevocably pledged to the director. The service company is entitled to any accrued interest earned from the securities or bonds.

E. The service company shall not impair or encumber the surety bond, securities or bonds of the United States government filed under this section and shall pledge the same to the director. The service company shall maintain the surety bond, securities or bonds of the United States government in force until such time as all of the service company's contractual obligations to contract holders are fulfilled.

F. Notwithstanding sections 20-116 and 35-155, a service company may not use a cash deposit to comply with this section.
A.R.S. § 20-1802 — Arizona Code / Title 20 / Chapter 8 / Article 1 / Section 1802
20-1802 Permit required; application; definition
Status: in_force

20-1802. Permit required; application; definition

A. No person may solicit or enter into a life care contract as a provider or as a provider extend the term of an existing life care contract except pursuant to this chapter.

B. To qualify for a permit to enter into life care contracts with respect to a particular facility or to provide services in a contract holder's private residence with the obligation to provide future access to services, board and lodging to the contract holder in a facility, a person shall file an application for a permit with the department on permit application forms provided by the department that shall include as an exhibit a copy of the proposed form of life care contract to be entered into with residents at each facility and the proposed form of life care contract to be entered into with contract holders to provide services at a contract holder's private residence with the right to future access to services, board and lodging at each facility. The application shall contain the following information:

1. The name and business address of the applicant.

2. The name, the address and a description of the physical property of the facility.

3. The terms and conditions of the life care contracts to be used by the applicant, including the services to be provided to residents and contract holders, pursuant to the contract and the fees or charges to be paid by residents and contract holders, including the method of payment of the fees or charges.

4. If the applicant is not an individual, such as a corporation, partnership or trust, a statement naming the fiscal year end date that is the last day of a calendar month and the type of legal entity and listing the interest and extent of such interest of each principal in the entity.

5. If the applicant is not an individual, a biographical affidavit on a form approved by the director for each of the members of the board of directors, officers, trustees or managing partners.

6. The estimated number of residents of the facility to be provided services by the applicant pursuant to the life care contracts and the estimated number of contract holders who will receive services in their private residences with the right to future access to services, board and lodging at the facility.

7. A statement of the provisions that have been made or will be made to provide reserve funding or security by the provider to enable the provider to fully perform the provider's obligations pursuant to life care contracts, including the establishment of escrow accounts, accounts in financial institutions, trusts or reserve funds.

8. A statement as to whether the applicant was or is affiliated with a religious, charitable or other nonprofit organization, the extent of any affiliation and the extent to which the affiliate organization will be responsible for the financial and contract obligations of the applicant.

9. If the applicant is a subsidiary corporation or the affiliate of another corporation, a statement identifying the parent corporation or the other affiliate corporation and the primary activities of the parent or other affiliate corporation.

10. A description of the business experience of the provider in the operation of similar facilities and, if the facility will be managed on a day-to-day basis by a corporation or organization other than the provider, a description of the business experience of the manager in the operation or management of similar facilities.

11. A statement as to whether the applicant, a promoter, a principal, a parent or subsidiary corporation or an affiliate has had any injunctive or restrictive order of a court of record, or any suspension or revocation of any state or federal license or permit, arising out of or relating to business activity or health care applied against it, including without limitation actions affecting a license to operate a foster care facility, a health care institution, a retirement home or a home for the aged.

12. A statement of any periodic rates to be initially paid by residents and contract holders, the method by which the rates are determined and the manner by which the provider may adjust the rates in the future. If the facility is already in operation, or if the provider operates one or more similar facilities within this state, the statement must include tables showing the frequency and average dollar amount of each increase in periodic rates at each facility for the previous five years or any shorter period as the facility may have been operated by the provider. If a provider is providing services to a contract holder in the person's residence, the statement must include the frequency and average dollar amount of each increase in periodic rates for contract holders for the previous five years or any shorter period as the provider has been providing services to contract holders in their private residences.

13. A statement of the terms and conditions under which a life care contract may be canceled by the provider or resident or contract holder, including any health and financial conditions required for a person to continue as a resident or contract holder and any conditions under which all or any portion of the entrance fee will be refunded by the provider.

14. If construction or purchase of the facility has not yet been completed, a statement of the anticipated source and application of the monies to be used in the purchase or construction, including all of the following:

(a) An estimate of the cost of purchasing or constructing and equipping the facility including related costs as financing expense, legal expense, land costs, occupancy development costs and all other similar costs that the provider expects to incur or become obligated for before the commencement of operations.

(b) An estimate of the total entrance fees to be received from residents on completion of occupancy.

(c) A description of any mortgage loan or other long-term financing intended to be used for the financing of the facility, including the anticipated terms and costs of the financing.

(d) An estimate of any funds that are anticipated to be necessary to fund start-up losses and to assure full performance of the obligations of the provider pursuant to life care contracts including any reserve fund escrow required by the director pursuant to section 20-1806.

15. Certified financial statements of the provider, promoter and manager as of a date not more than ninety days before the date the permit application is filed, that shall include a balance sheet and the related statements of income, retained earnings or equity and changes in financial position for the three most recent fiscal years or any shorter period of time as the provider, promoter or manager has been in existence. Each of these statements shall be prepared in accordance with generally accepted accounting principles and reported on by a certified public accountant in accordance with generally accepted auditing standards.  If the fiscal year ended more than ninety days before the date of filing, the provider shall include an income statement, that need not be certified, covering the period between the date the fiscal year ended and a date not more than ninety days before the date the application is filed.

16. A feasibility study that shall include a financial forecast of the life care facility estimating the most probable financial position, results of operations and changes in financial position for the immediately succeeding five year period. The feasibility study must set forth the actuarial assumptions for determining that the project has sufficient revenues and funds, including reserves, for the project to continue as a viable operating concern. The study must include all of the following:

(a) Beginning cash balance, and in the event that operation of the facility has not yet commenced, the beginning cash balance shall be consistent with the statement of anticipated source and application of funds described in paragraph 14.

(b) Anticipated earnings on cash reserves.

(c) Estimates of net receipts from entrance fees, other than entrance fees included in the statement of source and application of funds required under paragraph 14, less estimated entrance fee refunds and a description of the actuarial basis and method of calculation for the projection of entrance fee receipts.

(d) An estimate of gifts or bequests if any are to be relied on to meet operating expenses.

(e) A projection of estimated income from fees and charges other than entrance fees, showing individual rates presently anticipated to be charged, including a description of the assumptions used for calculating the effect on the income of the facility of subsidized health services to be provided pursuant to the life care contracts.

(f) A projection of estimated operating expenses of the facility and for providing services in contract holders' private residences, including a description of the assumptions used in calculating the expenses, and separate allowances for the replacement of equipment and furnishings and anticipated major structural repairs or additions.

(g) An estimate of annual payments of principal and interest required by any mortgage loan or other long-term financing.

17. An actuarial study prepared by a qualified actuary to be submitted with the feasibility study for the purpose of demonstrating that the project has sufficient revenues and funds, including reserves, for the project to continue as a viable operating concern. The actuarial study shall include a cash flow projection, an evaluation of the adequacy of current pricing structures and an analysis of the long-term relationship between the project's assets and liabilities.

18. If the feasibility study required by paragraph 16 indicates that the provider will have cash balances over and above two months' projected operating expenses of the facility, a description of the manner in which the reserve funds will be invested and the persons who will be making the investment decisions.

C. The application shall be signed under oath by the chief executive officer of the applicant.

D. Copies of the escrow agreements executed with an escrow agent pursuant to sections 20-1804 and 20-1806 shall be recorded as exhibits to the application.

E. The life care contract shall provide that any person entering into the contract shall have a period of seven days within which to rescind the life care contract without penalty or further obligation beginning with the first full calendar day following the last to occur of the execution of the contract, the payment of an initial sum of money as a deposit or application fee or receipt of a copy of the provider's most recent annual report if the provider has filed an annual report with the director pursuant to section 20-1807, or, if the provider has not filed an annual report, a copy of the provider's application.  In the event of a rescission, all money or property paid or transferred by the person shall be fully refunded by the provider. A person shall not be required to move into a facility or begin receiving services in the person's private residence until after the expiration of the seven-day rescission period.

F. The director may charge an applicant the fee prescribed in section 20-167 for processing the application filed pursuant to subsection B of this section.

G. Nothing in this article requires the director to determine the actual financial condition of any life care contract provider. The approval of a permit indicates only that the entity appears to be financially viable based on the information provided to the director.

H. For the purposes of this section, "principal" means any person or entity having a ten per cent or more financial interest or, if the legal entity is a trust, each beneficiary of the trust holding a ten per cent or more beneficial interest.
A.R.S. § 20-1079 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1079
20-1079 Individual health insurance policies; mandatory coverage exemption; definitions
Status: in_force

20-1079. Individual health insurance policies; mandatory coverage exemption; definitions

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 20-1057.05.

3. Section 20-1057.02, subsections B and E.

B. For the purposes of this section:

1. "Health insurance coverage":

(a) Means a health care plan or arrangement that pays for or furnishes medical or health services and that is issued by a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or medical, hospital, dental and optometric service corporation or a similar entity in another state.

(b) Includes a self-insured or self-funded employee benefit plan or multiemployer employee benefit plan created pursuant to 29 United States Code section 186(c) if the regulation of that plan is preempted by section 514(b) of the employee retirement insurance security act of 1974 (29 United States Code section 1144(b)).

(c) Does not include limited benefit coverage as defined in section 20-1137.

2. "Uninsured individual" means a person who has either:

(a) Not had health insurance coverage for the ninety days immediately before the effective date of coverage issued pursuant to this section, except that this requirement does not apply at the renewal of coverage pursuant to this section.

(b) Lost health insurance coverage in one of the following ways within ninety days immediately before the effective date of coverage issued pursuant to this section:

(i) The individual left a job that provided health insurance coverage.

(ii) The individual's employer discontinued offering health insurance coverage.

(iii) The individual exhausted continuation coverage under a COBRA continuation provision as defined in section 20-2301.

(iv) The individual's family health insurance coverage was discontinued due to the death of a spouse or a divorce.

(v) The individual attained the maximum age for dependent coverage under a health insurance policy.

(vi) The individual's participation in a public health care program was discontinued.
A.R.S. § 20-358 — Arizona Code / Title 20 / Chapter 2 / Article 4 / Section 358
20-358 Disapproval of rates
Status: in_force

20-358. Disapproval of rates

A. If at any time the director finds that a filing does not meet the standards set forth in section 20-356, he shall, after a hearing held upon not less than ten days' written notice, in which he shall specify the matters to be considered at such hearing, to every insurer and rating organization which made the filing, issue an order specifying in what respects he finds that the filing fails to meet the requirements of the rate regulatory provisions of this article, and stating when, within a reasonable period thereafter, the filing or rating system shall be deemed no longer effective. Copies of the order shall be sent to every such insurer and rating organization. The order shall not affect any contract or policy made or issued prior to the expiration of the period set forth therein.

B. Any person or organization aggrieved with respect to any filing or rating system which is in effect may make written application to the director for a hearing thereon, but the insurer or rating organization which made the filing or uses the rating system shall not be authorized to proceed under this subsection. The application shall specify the grounds to be relied upon by the applicant. If the director finds that the application is made in good faith, that the applicant would be so aggrieved if his grounds are established and that the grounds otherwise justify holding such a hearing, he shall within thirty days after receipt of the application hold a hearing upon not less than ten days' written notice to the applicant and to every insurer and rating organization which made such filing or uses such rating system. If, after the hearing, the director finds that the filing or rating system does not meet the requirements of the rate regulatory provisions of this article, he shall issue an order specifying in what respects he finds that it fails to meet such requirements and stating when, within a reasonable period thereafter, it shall be deemed no longer effective. Copies of the order shall be sent to the applicant and to every such insurer and rating organization. The order shall not affect any contract or policy made or issued prior to the expiration of the period set forth therein.

C. No manual of classifications, rules, rating plan or any modification of any of the foregoing which establishes standards for measuring variations in hazards or expense provisions, or both, and which is being used pursuant to the requirements of section 20-356, shall be disapproved if the rates thereby produced meet the requirements of the rate regulatory provisions of this article.

D. The director may utilize independent contractor examiners experienced in the review of applicable rates and reserves pursuant to sections 20-148 and 20-159 to implement the provisions of this article. All examination and examination related expenses shall be borne by the insurer and shall be paid by the insurance examiners' revolving fund pursuant to section 20-159.
A.R.S. § 20-513 — Arizona Code / Title 20 / Chapter 3 / Article 1 / Section 513
20-513 Valuation of real and personal property
Status: in_force

20-513. Valuation of real and personal property

A. Real property acquired pursuant to a mortgage loan or contract for sale, in the absence of a recent appraisal deemed by the director to be reliable, shall not be valued at an amount greater than the unpaid principal of the defaulted loan or contract at the date of such acquisition, together with any taxes and expenses paid or incurred in connection with such acquisition, and the cost of improvements thereafter made by the insurer and any amounts thereafter paid by the insurer on assessments levied for improvements in connection with the property.

B. Other real property held by an insurer shall be valued at market value as determined by recent appraisal or cost plus capitalized improvements minus normal depreciation, whichever is less. If valuation is based on an appraisal more than three years old, the director may at his discretion call for and require a new appraisal in order to determine fair value.

C. Personal property acquired pursuant to chattel mortgages made in accordance with section 20-555 shall not be valued at an amount greater than the unpaid balance of principal on the defaulted loan at the date of acquisition, together with taxes and expenses incurred in connection with the acquisition, or the fair value of the property, whichever amount is less.
A.R.S. § 20-363 — Arizona Code / Title 20 / Chapter 2 / Article 4 / Section 363
20-363 Availability of services of rating organization to members
Status: in_force

20-363. Availability of services of rating organization to members

A. Subject to rules and regulations that have been approved by the director as reasonable, each workers' compensation rating organization shall permit any insurer writing workers' compensation insurance in this state to become a member. The rating organization shall give its members notice of proposed changes in its rules and regulations.

B. Each rating organization shall furnish its rating services without discrimination to its members.

C. Any member or insurer may request that the director review the reasonableness of any rule or regulation in its application to members at a hearing held on at least ten days' written notice to the rating organization and to the member or insurer. If the director finds that the rule or regulation is unreasonable in its application, the director shall order that the rule or regulation does not apply.

D. Every insurer writing workers' compensation insurance in this state shall be a member of one workers' compensation rating organization.

E. A rating organization shall have as members at least five insurers authorized to write and who are writing workers' compensation insurance in this state and whose combined experience is determined by the director to be reasonably adequate for rate making purposes.
A.R.S. § 20-2604 — Arizona Code / Title 20 / Chapter 16 / Article 1 / Section 2604
20-2604 Variable life insurance policy and filing requirements
Status: in_force

20-2604. Variable life insurance policy and filing requirements

A. Except pursuant to chapter 5, article 1 of this title, the director shall not approve a variable life insurance form unless the insurer files with the director its variable life insurance policies, and all riders, endorsements, applications and other documents that are attached to the policy and that relate to the variable nature of the policy, and the director approves each policy before the policy is delivered or issued for delivery in this state. For the purposes of this subsection the procedures and requirements for the filing and approval of variable life insurance policies shall be the same as the filing and approval procedures that apply to other life insurance policies, to the extent those procedures are not inconsistent with this article.

B. A variable life insurance policy that is delivered or issued for delivery in this state shall comply with the following minimum requirements:

1. The insurer shall bear mortality and expense risks. The mortality and expense charges are subject to the maximums stated in the policy.

2. For scheduled premium policies, the insurer shall provide a minimum death benefit in an amount that equals or exceeds the initial face amount of the policy as long as the insured pays the premiums.

3. The policy shall reflect the investment experience of one or more separate accounts that are established and maintained by the insurer. The insurer shall demonstrate that the reflection of investment experience in the variable life insurance policy is actuarially sound.

4. Each variable life insurance policy shall be credited with the full amount of the net investment return that is applied to the benefit base.

5. At least annually the insurer shall determine any changes in the variable death benefits of each variable life insurance policy.

6. At least monthly the insurer shall determine the cash value of each variable life insurance policy. The method of computation of cash values and other nonforfeiture benefits shall be in accordance with actuarial procedures that recognize the variable nature of the policy. If the net investment return that is credited to the policy at all times from the date of issue is equal to the assumed investment rate with premiums and benefits determined accordingly under the terms of the policy, the resulting cash values shall not be less than the minimum values that are required by section 20-1231 for a general account policy with these premiums and benefits. The assumed investment rate shall not exceed the maximum interest rate permitted under section 20-1231. If the policy does not contain an assumed investment rate the method of computation shall be based on the maximum interest rate permitted under section 20-1231. The method of computation may disregard incidental minimum guarantees as to the dollar amounts payable. For the purposes of this paragraph incidental minimum guarantees include a guarantee that the amount payable at death or maturity shall equal or exceed the amount that otherwise would have been payable if the net investment return credited to the policy at all times from the date of issue had been equal to the assumed investment rate.

C. The insurer may base the computation of values that are required for each variable life insurance policy on any reasonable and necessary approximations that the director accepts.

D. Each variable life insurance policy that is filed for approval in this state shall contain at least the following:

1. The cover page or a page that corresponds to the cover page of each policy that:

(a) Prominently states in either a contrasting color or bold-faced type that the amount or duration of the death benefit may be variable or fixed under specified conditions.

(b) Prominently states in either a contrasting color or bold-faced type that cash values may increase or decrease according to the experience of the separate account, subject to any specified minimum guarantees.

(c) Describes any minimum death benefit that is required pursuant to subsection B, paragraph 2 of this section.

(d) Describes the method or refers to the policy provision that describes the method for determining the amount of insurance payable at death.

(e) Informs the policyholder that the policyholder may return the variable life insurance policy within ten days after receiving the policy and receive a refund that equals the sum of:

(i) The difference between the premiums paid and the amounts allocated to any separate accounts under the policy.

(ii) The value of the amounts that are allocated to any separate accounts under the policy on the date the returned policy is received by the insurer or the insurer's insurance producer.

(f) Identifies the owner of the contract.

(g) Includes items that are required for fixed benefit life insurance policies and that are not inconsistent with this article.

2. For scheduled premium policies, a grace period provision of not less than thirty-one days from the premium due date. The grace period shall provide that if the premium is paid within the grace period, the policy values will be the same as if the premium had been paid on or before the due date, except for the deduction of any overdue premium.

3. For flexible premium policies, a grace period provision that begins on the policy processing day on which the total charges that are authorized by the policy and that are necessary to keep the policy in force until the next policy processing day exceed the amounts available under the policy to pay the charges according to the terms of the policy. The grace period shall end on a date not less than sixty-one days after the report to policyholders is mailed pursuant to section 20-2609, paragraph 1. The death benefit that is payable during the grace period shall equal the death benefit that was in effect immediately before the grace period less any overdue charges. If the policy processing days occur monthly, the insurer may require the payment of not more than three times the charges that were due on the policy processing day on which the amounts available under the policy were insufficient to pay all of the charges that are authorized by the policy and that are necessary to keep the policy in force until the next policy processing day.

4. For scheduled premium policies, a reinstatement provision that states that the policy shall be reinstated at any time within two years from the date of default on the occurrence of all of the following:

(a) The written application of the insured and on the presentation of evidence of insurability, including good health, that is satisfactory to the insurer, unless the cash surrender value has been paid or the period of extended insurance has expired.

(b) The payment of any outstanding indebtedness that arose after the end of the grace period following the date of default together with accrued interest on the indebtedness to the date of reinstatement.

(c) Payment of an amount not exceeding the greater of:

(i) All overdue premiums with interest at a rate of not more than six per cent per annum compounded annually and any indebtedness in effect at the end of the grace period following the date of default with interest at a rate of not more than six per cent per annum compounded annually.

(ii) One hundred ten per cent of the increase in cash value resulting from reinstatement plus all overdue premiums for incidental insurance benefits with interest at a rate of not more than six per cent per annum compounded annually.

5. A full description of the benefit base, the method of calculation and the application of any factors that are used to adjust variable benefits under the policy.

6. A provision that designates the separate account to be used and that states both of the following:

(a) The assets of the separate account are available to cover the liabilities of the insurer's general account only to the extent that the assets of the separate account exceed the liabilities of the separate account arising under the variable life insurance policies supported by the separate account.

(b) The assets of the separate account will be valued monthly or more frequently if any policy benefits vary.

7. A provision that specifies what documents constitute the entire insurance contract.

8. The names of the officers who are empowered to make an agreement or representation on behalf of the insurer.

9. The conditions or requirements for the designation or change of designation of a beneficiary and for the disbursement of benefits if a beneficiary is not designated.

10. The conditions of or requirements for the assignment of the policy.

11. A description of policy value adjustments that will be made if the insured misstates the insured's age or sex.

12. A provision that after a policy has been in force for two years the insurer may not contest the policy during the lifetime of the insured. If an increase in the amount of the policy's death benefits occurs after the policy issue date, if the owner applied for or requested the increase and if the increase was subject to satisfactory proof of the insured's insurability, after the increase has been in force for two years, the insurer may not contest the increase during the lifetime of the insured.

13. A statement that the investment policy of the separate account shall not be changed without the approval of the insurance regulatory authority of the insurer's state of domicile and that the approval is on file with the director.

14. A provision that except if variable death benefits are used to pay premiums the payment of variable death benefits in excess of any minimum death benefits, cash values, policy loans or partial withdrawals or the payment of variable death benefits in excess of any partial surrenders may be deferred either:

(a) For up to six months from the date of the request, if the payments are based on policy values that do not depend on the investment performance of the separate account.

(b) For any period during which the New York stock exchange is closed for trading, except for normal holiday closing, or for any period during which the securities and exchange commission determines that a state of emergency exists.

15. If settlement options are provided, that at least one option is provided on a fixed basis only.

16. A description of the basis for computing the cash value and the surrender value under the policy.

17. A statement of the premiums or other charges for incidental insurance benefits.

18. Any other items that are currently required for fixed benefit life insurance policies and that are not inconsistent with this article.

19. A provision for nonforfeiture insurance benefits. The insurer may establish a reasonable minimum cash value below which any nonforfeiture insurance options will not be available.

20. That statements that are made by the insured or on behalf of the insured are representations and not warranties.

E. Except for term insurance policies and pure endowment policies that are delivered or issued for delivery in this state, each variable life insurance policy shall contain loan provisions for policies that have been in force for two full years that are not less favorable to the policyholder than the following:

1. At least seventy-five per cent of the policy's cash surrender value may be borrowed.

2. The amount borrowed bears interest at a rate that does not exceed the rate permitted by this title.

3. Any indebtedness shall be deducted from the proceeds payable on death.

4. Any indebtedness shall be deducted from the cash surrender value on surrender or in determining any nonforfeiture benefit.

5. For scheduled premium policies, if the indebtedness exceeds the cash surrender value, the insurer shall give notice of its intent to cancel the policy if the excess indebtedness is not repaid within thirty-one days after the date on which the notice was mailed. For flexible premium policies, if the total charges that are authorized by the policy and that are necessary to keep the policy in force until the next following policy processing day exceed the amounts available under the policy to pay the charges, the insurer must send the policyholder a report containing the information specified by section 20-2609, paragraph 3.

F. The policy may provide that, as long as the premiums are paid, if, at any time, the variable death benefit is less than it would have been if a loan or withdrawal had not been made, the policyholder may increase the variable death benefit up to the amount it would have been if a loan or withdrawal had not been made. The insured may increase the variable death benefit by paying an amount that does not exceed one hundred ten per cent of the corresponding increase in cash value and by furnishing any evidence of insurability that the insurer requests.

G. The policy may specify a reasonable minimum amount that may be borrowed at any time. The minimum does not apply to any automatic premium loan provision.

H. If the policy is under an extended insurance nonforfeiture option, a policy loan provision is not required.

I. Variable life insurance policyholders who exercise their rights under policy loan provisions shall not be disadvantaged by the exercise of those rights.

J. On the exercise of any policy loan provision, the amounts paid to the policyholder shall be withdrawn from the separate account and shall be returned to the separate account on repayment, except that a stock insurer may provide the amounts for policy loans from the general account.

K. A variable life insurance policy or related form that is delivered or issued for delivery in this state may:

1. Include an exclusion for suicide that occurs within two years of the issue date of the policy. If the owner applies for an increase in death benefits after the policy issue date, the policy may provide an exclusion for suicide that occurs within two years of any increase in death benefits to the extent of the increased death benefits only.

2. Offer incidental insurance benefits on a fixed or variable basis.

3. Offer to pay dividend amounts in cash. In addition, the policies may offer the following dividend options:

(a) The amount of the dividend may be credited against premium payments.

(b) The amount of the dividend may be applied to provide amounts of additional fixed or variable benefit life insurance.

(c) The amount of the dividend may be deposited in the general account at a specified minimum rate of interest.

(d) The amount of the dividend may be applied to provide paid-up amounts of fixed benefit one year term insurance.

(e) The amount of the dividend may be deposited as a variable deposit in a separate account.

4. Allow the policyholder to elect in writing an automatic premium loan on a basis that is not less favorable than that required of policy loans under subsection E of this section. The policy may impose a restriction that no more than two consecutive premiums can be paid under the requirements of this paragraph.

5. Allow the policyholder to make partial withdrawals.

6. Include any other policy provision that the director approves.
A.R.S. § 20-775 — Arizona Code / Title 20 / Chapter 4 / Article 2 / Section 775
20-775 Action on bond
Status: in_force

20-775. Action on bond

Action on the attorney's bond or to recover against any deposit made in lieu thereof may be brought at any time by one or more subscribers suffering loss through a violation of its conditions, or by a receiver or liquidator of the insurer. Amounts recovered on the bond shall be deposited in and become part of the insurer's funds. The total aggregate liability of the surety shall be limited to the amount of the penalty of the bond.
A.R.S. § 20-1226 — Arizona Code / Title 20 / Chapter 6 / Article 1 / Section 1226
20-1226 Limitation of liability
Status: in_force

20-1226. Limitation of liability

A. No life insurance policy shall be delivered or issued for delivery in this state if it contains a provision that excludes or restricts liability for death caused in a certain specified manner or occurring while the insured has a specified status, except that a policy may contain provisions excluding or restricting coverage as specified therein in the event of death under any one or more of the following circumstances:

1. Death as a result, directly or indirectly, of war, declared or undeclared, or of action by military forces, or of any act or hazard of such war or action, or of service in the military, naval or air forces or in civilian forces auxiliary thereto, or from any cause while a member of such military, naval or air forces of any country at war, declared or undeclared, or of any country engaged in such military action.

2. Death as a result of aviation.

3. Death as a result of a specified hazardous occupation or occupations.

4. Death while the insured is outside the continental United States and Canada.

B. A life insurance policy that is delivered or issued for delivery in this state may include an exclusion for death resulting from suicide that occurs within two years after the issue or reinstatement of the policy.  If the owner applies for an increase in death benefits after the policy issue date, the policy may provide an exclusion for suicide that occurs within one year after any increase in death benefits only to the extent of the increased death benefits.

C. A policy that contains any exclusion or restriction pursuant to this section shall also provide that in the event of death under the circumstances to which the exclusion or restriction is applicable, the insurer will pay an amount not less than a reserve determined according to the commissioners reserve valuation method upon the basis of the mortality table and interest rate specified in the policy for the calculation of nonforfeiture benefits, or if the policy provides for no such benefits, computed according to a mortality table and interest rate determined by the insurer and specified in the policy, with adjustment for indebtedness or dividend credit.

D. This section shall not apply to group life insurance, disability insurance, reinsurance or annuities, or to any provision in a life insurance policy relating to disability benefits or to additional benefits in the event of death by accident or accidental means.
A.R.S. § 20-1273 — Arizona Code / Title 20 / Chapter 6 / Article 2 / Section 1273
20-1273 Misstatements in group annuity contracts
Status: in_force

20-1273. Misstatements in group annuity contracts

In group annuity contracts there shall be a provision, with an appropriate reference thereto in the certificate, for the equitable adjustment of the benefits payable under the contract or of the stipulated payments thereunder, if it is found that the sex, age, service, salary or any other fact determining the amount of any stipulated payment or the amount or date or dates of payment of any benefit with respect to any annuitant covered thereby has been misstated.
A.R.S. § 20-687 — Arizona Code / Title 20 / Chapter 3 / Article 7 / Section 687
20-687 Plan of operation
Status: in_force

20-687. Plan of operation

A. The board shall submit to the director a plan of operation and any amendments necessary to assure the fair, reasonable and equitable administration of the fund. The plan of operation and any amendments shall become effective on approval in writing by the director. If the board fails to submit a plan of operation or if at any time the board fails to submit suitable amendments to the plan, the director shall adopt any plan or amendment that is necessary or advisable to effectuate the provisions of this article and the plan or amendment shall continue in force until modified by the director or superseded by a plan submitted by the board and approved by the director.

B. All member insurers shall comply with the plan of operation.

C. The plan of operation, in addition to all other requirements, shall:

1. Establish procedures for handling the assets of the fund and claims against the fund.

2. Establish the amount and method of reimbursing members of the board of directors pursuant to section 20-684.

3. Establish regular places and times for meetings of the board of directors.

4. Establish procedures for records to be kept of all financial transactions of the fund, its agents and the board of directors.

5. Establish the procedures for selecting the board of directors and submitting such selections to the director.

6. Establish any additional procedures for assessments required pursuant to section 20-686.

7. Contain additional provisions necessary for the execution of the powers and duties of the board.

D. The plan of operation may provide that any or all powers and duties of the board, except those in section 20-685, subsection H, paragraph 3 and section 20-686, are delegated to any corporation, association or other organization that performs or will perform functions similar to those of this fund in two or more states. Such a corporation, association or organization shall be reimbursed for any payments made on behalf of the fund and shall be paid for its performance of any function of the fund. A delegation pursuant to this subsection shall take effect only with the approval of both the board of directors and the director and may be made only to a corporation, association or organization that extends protection not substantially less favorable and effective than that provided by this article.
A.R.S. § 20-1002 — Arizona Code / Title 20 / Chapter 4 / Article 7 / Section 1002
20-1002 Establishment of prepaid dental plan organizations
Status: in_force

20-1002. Establishment of prepaid dental plan organizations

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 prepaid dental plan without obtaining and maintaining a certificate of authority pursuant to this article.

B. Within ninety days after the effective date of this article, every prepaid dental plan organization operating in this state shall submit an application for a certificate of authority to the director. Each such applicant may continue to operate as an organization until the director acts upon the application.
A.R.S. § 20-841 — Arizona Code / Title 20 / Chapter 4 / Article 3 / Section 841
20-841 Prohibiting denial of certain contract benefits
Status: in_force

20-841. Prohibiting denial of certain contract benefits

A. Notwithstanding any provision of any subscription contract of a hospital and medical service corporation, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11, if the service performed is within the lawful scope of such person's license, and if the service is surgical, such person is a member of the staff of an accredited hospital, and if such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to title 32, chapter 13.

B. If a subscription contract of a hospital and medical service corporation provides for or offers eye care services, the subscriber shall have freedom of choice to select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination, care, or treatment for which the subscriber is eligible and which falls within the scope of practice of the optometrist or physician and surgeon. Unless such subscription contract otherwise provides, there shall be no reimbursement for ophthalmic materials, lenses, spectacles, eyeglasses, or appurtenances thereto.

C. If any subscription contract of a hospital and medical service corporation is written to provide coverage for psychiatric, drug abuse or alcoholism services, reimbursement for such services shall be made in accordance with the terms of the contract without regard to whether the covered services are rendered in a psychiatric special hospital or general hospital. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
A.R.S. § 20-482.05 — Arizona Code / Title 20 / Chapter 2 / Article 8.1 / Section 482.05
20-482.05 Status of mutual holding company as corporation; status of insurer; rights and obligations of members; voting; articles of incorporation
Status: in_force

20-482.05. Status of mutual holding company as corporation; status of insurer; rights and obligations of members; voting; articles of incorporation

A. A mutual holding company is not an insurer for the purposes of this title, except that sections 20-704, 20-713, 20-713.01, 20-714, 20-716, 20-723, 20-730, 20-733 and 20-735 apply to a mutual holding company as if the mutual holding company were a domestic mutual insurer.

B. A mutual holding company may not dissolve or liquidate without approval by the director or unless required by judicial order. The director retains jurisdiction over a mutual holding company, any intermediate stock holding company and any subsidiary of an intermediate stock holding company as provided in this section and section 20-481.20.

C. The members of a mutual holding company have the rights and obligations set forth in this section and in the articles of incorporation and bylaws of the mutual holding company. A member of a mutual holding company may not transfer membership in the mutual holding company or any right arising from such membership.  Such limitation on the transfer of membership or rights arising from membership does not restrict the assignment of a policy that is otherwise permissible. A member of a mutual holding company is not personally liable for the acts, debts, liabilities or obligations of the mutual holding company merely by reason of being a member. An assessment of any kind may not be imposed on a member of a mutual holding company. Any premium due under an insurance policy or contract issued to a member of a mutual holding company is not considered an assessment.

D. A membership interest in a mutual holding company does not constitute a security as defined in section 44-1801.

E. Each member of a mutual holding company is entitled to one vote on each matter coming before a meeting of the members and for each director to be elected regardless of the number of policies or amount of insurance and benefits held by such member. The mutual holding company's bylaws shall set forth the voting rights of the members of a mutual holding company.

F. Meetings of the members of a mutual holding company shall be governed in the same manner as if the mutual holding company were a domestic mutual insurer, including provisions governing quorum requirements, the approval of matters by the members and the election of directors by the members.

G. The articles of incorporation of a mutual holding company shall contain all the following provisions:

1. The name of the mutual holding company. The name shall include the words "mutual holding company" or "mutual insurance holding company" or other words connoting the mutual character of the mutual holding company that are approved by the director.

2. A provision specifying that the mutual holding company is not authorized to issue capital stock, whether voting or nonvoting.

3. A provision setting forth any rights of the members of the mutual holding company on dissolution or liquidation.

H. A mutual holding company shall automatically be a party to any rehabilitation or liquidation proceeding involving the converted stock insurer that as a result of a reorganization is a direct or indirect subsidiary of the mutual holding company. In such a proceeding, the assets of the mutual holding company shall be counted as assets of the estate of the converted stock insurer for the purpose of satisfying the claims of the policyholders of the converted stock insurer.
A.R.S. § 20-486.02 — Arizona Code / Title 20 / Chapter 2 / Article 10 / Section 486.02
20-486.02 Required contract provisions; reinsurance intermediary brokers
Status: in_force

20-486.02. Required contract provisions; reinsurance intermediary brokers

A reinsurance intermediary broker and the insurer it represents as a reinsurance intermediary shall enter into a written contract that specifies the responsibilities of each party. The contract at a minimum shall provide that:

1. The insurer may terminate the reinsurance intermediary broker's authority at any time.

2. The reinsurance intermediary broker shall render accounts to the insurer that accurately detail all material transactions, including information necessary to support all commissions, charges and other fees received by or owed to the reinsurance intermediary broker, and shall remit all monies due to the insurer within thirty days of receipt.

3. All monies collected for the insurer's account be held in a fiduciary capacity by the reinsurance intermediary broker in a bank that is a qualified United States financial institution as defined in section 20-486.

4. The reinsurance intermediary broker comply with the provisions of section 20-486.03.

5. The reinsurance intermediary broker comply with the written standards that are established by the insurer for the cession or retrocession of all risks.

6. The reinsurance intermediary broker disclose to the insurer a relationship it has with a reinsurer to which business will be ceded or retroceded.
A.R.S. § 20-488.10 — Arizona Code / Title 20 / Chapter 2 / Article 12 / Section 488.10
20-488.10 Notice
Status: in_force

20-488.10. Notice

All notices by the director under this article to an insurer that may result in regulatory action are effective on mailing if they are transmitted by certified mail. Notice that is transmitted in any other way is effective on receipt by the insurer.
A.R.S. § 20-891 — Arizona Code / Title 20 / Chapter 4 / Article 4 / Section 891
20-891 Unfair acts and practices
Status: in_force

20-891. Unfair acts and practices

Each society authorized to transact business in this state is subject to chapter 2, article 6 of this title, except that nothing in chapter 2, article 6 of this title applies to or affects the right of a society to determine its eligibility requirements for membership or to offer its benefits exclusively to members or persons eligible for membership in the society through a subsidiary corporation or affiliated organization of the society.
A.R.S. § 20-628 — Arizona Code / Title 20 / Chapter 3 / Article 4 / Section 628
20-628 Proof of claims; notice; hearing
Status: in_force

20-628. Proof of claims; notice; hearing

A. All claims against an insurer against which delinquency proceedings have been begun shall set forth in reasonable detail the amount of the claim, or the basis upon which such amount can be ascertained, the facts upon which the claim is based and the priorities asserted, if any.  All such claims shall be verified by the affidavit of the claimant, or someone authorized to act on his behalf and having knowledge of the facts, and shall be supported by such documents as may be material thereto.

B. All claims filed in this state shall be filed with the receiver, whether domiciliary or ancillary, in this state, on or before the last date for filing as specified in this article.

C. Within ninety days after the claims bar date, or within such further period as the court may, for good cause shown, fix, the receiver shall report the claim to the court, specifying in the report his recommendation with respect to the action to be taken thereon. Upon receipt of the report, the court shall fix a time for hearing the claim and shall direct that the claimant or the receiver, as the court specifies, shall give such notice as the court determines to such persons as appear to the court to be interested therein. All such notices shall specify the time and place of the hearing and shall concisely state the amount and nature of the claim, the priorities asserted, if any, and the recommendation of the receiver with reference thereto.

D. At the hearing, all persons interested shall be entitled to appear and the court shall enter an order allowing, allowing in part or disallowing the claim. Any such order shall be deemed to be an appealable order.
A.R.S. § 20-445 — Arizona Code / Title 20 / Chapter 2 / Article 6 / Section 445
20-445 Defamation
Status: in_force

20-445. Defamation

No person shall make, publish, disseminate or circulate, directly or indirectly, or aid, abet or encourage the making, publishing, disseminating or circulating of any oral or written statement or any pamphlet, circular, article, sales material or literature which is false or maliciously critical of or derogatory to the financial condition of an insurer, and which is calculated to injure any person engaged in the business of insurance, or any domestic corporation or group being formed pursuant to this code for the purpose of becoming an insurer. This provision shall not be deemed to restrict the right, lawfully exercised, of newspapers, magazines, radio and television stations, and similar public media for news dissemination, objectively to publish and disseminate news.
A.R.S. § 20-105 — Arizona Code / Title 20 / Chapter 1 / Article 1 / Section 105
20-105 "Person" defined
Status: in_force

20-105. "Person" defined

"Person" includes an individual, company, insurer, association, organization, society, reciprocal or inter-insurance exchange, partnership, syndicate, business trust, corporation and entity.
A.R.S. § 20-841.07 — Arizona Code / Title 20 / Chapter 4 / Article 3 / Section 841.07
20-841.07 Medical supplies
Status: in_force

20-841.07. Medical supplies

Any corporation that provides coverage for medical supplies shall provide coverage for those medical supplies through one or more participating vendors who are reasonably accessible to subscribers as determined by the department in terms of hours of service and areas of coverage within the geographic service area of the health care plan.
A.R.S. § 20-1057.19 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1057.19
20-1057.19 Biomarker testing; coverage; definitions
Status: in_force

20-1057.19. Biomarker testing; coverage; definitions

A. A health care services organization that issues, amends, delivers or renews an evidence of coverage on or after January 1, 2023 shall provide coverage for biomarker testing.

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 and scientific evidence, including any of the following:

1. Labeled indications for tests that are approved or cleared by the United States food and drug administration or indicated tests for a drug that is approved by the United States food and drug administration.

2. Centers for medicare and medicaid services national coverage determinations or medicare administrative contractor local coverage determinations.

3. Nationally recognized clinical practice guidelines and consensus statements.

C. A health care services organization must ensure that coverage is provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples.

D. The enrollee and prescribing practitioner must have access to a clear, readily accessible and convenient process to request an exception to a coverage policy of a health care services organization.  The process shall be readily accessible on the health care services organization's website. This subsection does not require a separate process if the health care services organization's existing process complies with this subsection.

E. For the purposes of this section:

1. "Biomarker":

(a) Means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacologic responses to a specific therapeutic intervention.

(b) Include gene mutations or protein expression.

2. "Biomarker testing":

(a) Means the analysis of a patient's tissue, blood or other biospecimen for the presence of a biomarker.

(b) Includes single-analyte tests, multiplex panel tests and whole genome sequencing.

3. "Clinical utility" means the test result provides information that is used in the formulation of a treatment or monitoring strategy that informs a patient’s outcome and impacts the clinical decision.  The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.

4. "Consensus statements" means statements that both:

(a) Are developed by an independent, multidisciplinary panel of experts using a transparent methodology and reporting structure that includes a conflict of interest policy.

(b) Are based on the best available evidence for the purpose of optimizing clinical care outcomes.

(c) Are aimed at specific clinical circumstances.

5. "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that both:

(a) Are developed by independent organizations or medical professional societies using a transparent methodology and reporting structure and a conflict of interest policy.

(b) Establish standards of care that are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options that includes recommendations intended to optimize patient care.
A.R.S. § 20-431.04 — Arizona Code / Title 20 / Chapter 2 / Article 5.1 / Section 431.04
20-431.04 Basic illustrations; format; narrative summary; numeric summary; tabular detail; requirements
Status: in_force

20-431.04. Basic illustrations; format; narrative summary; numeric summary; tabular detail; requirements

A. The format of a basic illustration shall conform with the following requirements:

1. The basic illustration shall be labeled with the date on which the illustration was prepared.

2. Each page, including any explanatory notes or pages, shall be numbered.  The page numbers must show the relationship to the total number of pages in the illustration.

3. The assumed dates of payment receipt and benefit payout within a policy year shall be clearly identified.

4. If the age of the proposed insured is shown as a component of the tabular detail, the proposed insured's age must be shown as the issue age plus the number of years the policy is assumed to have been in force.

5. The assumed payments on which the illustrated benefits and values are based shall be identified as premium outlay or contract premium, as applicable. For policies that do not require a specific contract premium, the illustrated payments shall be identified as premium outlay.

6. Guaranteed death benefits and values available on surrender, if any, for the illustrated premium outlay or contract premium shall be shown and clearly labeled guaranteed.

7. If the illustration shows any nonguaranteed elements, those elements cannot be based on a scale more favorable to the policyowner than the insurer's illustrated scale at any duration.  These elements shall be clearly labeled nonguaranteed.

8. The guaranteed elements, if any, shall be shown before any nonguaranteed elements and shall be specifically referred to on any page of an illustration that shows or describes the nonguaranteed elements only.

9. The account or accumulation value of a policy, if shown, shall be identified by the name this value is given in the policy being illustrated and shall be shown in close proximity to the corresponding value that is available on surrender.

10. The value that is available on surrender shall be identified by the name this value is given in the policy being illustrated and shall be the amount that is available to the policyowner in a lump sum after deducting surrender charges, policy loans and policy loan interest, as applicable.

11. Illustrations may show policy benefits and values in graphic or chart form in addition to tabular form.

12. Any illustration of nonguaranteed elements shall be accompanied by a statement indicating all of the following:

(a) The benefits and values are not guaranteed.

(b) The assumptions on which the nonguaranteed elements are based are subject to change by the insurer.

(c) The actual results may be more or less favorable.

13. If the illustration shows that the premium payor may have the option to allow policy charges to be paid using nonguaranteed values, the illustration must clearly disclose that a charge continues to be required and that, depending on actual results, the premium payor may need to continue or resume premium outlays.  A similar disclosure shall be made for premium outlay of lesser amounts or shorter durations than the contract premium. If a contract premium is due, the premium outlay display may not be left blank or show a zero unless the premium outlay display is accompanied by an asterisk or similar mark to draw attention to the fact that the policy is not paid up.

14. If the applicant plans to use dividends or policy values, guaranteed or nonguaranteed, to pay all or a portion of the contract premium or policy charges or for any other purpose, the illustration may reflect those plans and the impact on future policy benefits and values.

B. A basic illustration shall contain a narrative summary that includes the following:

1. A brief description of the policy being illustrated that includes a statement that the policy is a life insurance policy.

2. A brief description of the premium outlay or contract premium, as applicable, for the policy.  For a policy that does not require payment of a specific contract premium, the illustration shall show the premium outlay that must be paid to guarantee coverage for the term of the contract, subject to maximum premiums allowable to qualify as a life insurance policy under the applicable provisions of the internal revenue code.

3. A brief description of each policy feature, rider or option, guaranteed or nonguaranteed, that is shown in the basic illustration and the impact they may have on the benefits and values of the policy.

4. An identification and brief definition of column headings and key terms that are used in the illustration.

5. A statement that contains in substance the following: "this illustration assumes that the currently illustrated nonguaranteed elements will continue unchanged for all years shown, which is likely not to occur.  The actual results may be more or less favorable than the ones shown in this illustration."

C. Following the narrative summary, a basic illustration shall include a numeric summary of the death benefits and values and the premium outlay and contract premium, as applicable.  For a policy that provides for a contract premium, the guaranteed death benefits and values shall be based on the contract premium.  This summary shall be shown for at least policy years five, ten and twenty and at age seventy, if applicable, on the three bases listed in subsection D of this section.  For multiple life policies, the numeric summary shall show policy years five, ten, twenty and thirty.

D. For the purposes of the numeric summary under subsection C of this section, all of the following apply:

1. The three bases include:

(a) Policy guarantees.

(b) Insurer's illustrated scale.

(c) Insurer's illustrated scale used but with the nonguaranteed elements reduced as follows:

(i) Dividends at fifty percent of the dividends that are contained in the illustrated scale used.

(ii) Nonguaranteed credited interest at rates that are the average of the guaranteed rates and the rates that are contained in the illustrated scale used.

(iii) All nonguaranteed charges, including term insurance charges, mortality and expense charges, at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.

2. If coverage ceases before the policy matures or when the policyowner reaches one hundred years of age, the year in which coverage ceases shall be identified for each of the three bases listed in paragraph 1 of this subsection.

E. Statements that are substantially similar to the following shall be included on the same page as the numeric summary and shall be signed by the applicant or, if an illustration is provided at the time of delivery, by the policyholder:

1. A statement to be signed and dated by the applicant or policyowner that states: "I have received a copy of this illustration and understand that any nonguaranteed elements illustrated are subject to change and could be either higher or lower.  The agent has told me they are not guaranteed."

2. A statement to be signed and dated by the insurance producer or other authorized representative of the insurer that states: "I certify that this illustration has been presented to the applicant and that I have explained that any nonguaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration."

F. All of the following tabular details apply to a basic illustration:

1. The basic illustration shall include all of the following for at least each policy year from year one to ten and for every fifth policy year thereafter until the insured reaches one hundred years of age, policy maturity or final expiration and, except for term insurance beyond the twentieth year, for any year in which the premium outlay and contract premium, if applicable, is subject to change:

(a) The premium outlay and mode the applicant plans to pay and the contract premium, as applicable.

(b) The corresponding guaranteed death benefit, as provided in the policy.

(c) The corresponding guaranteed value that is available on surrender, as provided in the policy.

2. For a policy that provides for a contract premium, the guaranteed death benefit and value that is available on surrender shall correspond to the contract premium.

3. Nonguaranteed elements may be shown if the nonguaranteed elements are described in the contract.  An illustration for a policy for which the insurer intends to credit terminal dividends, the nonguaranteed elements may be shown if the insurer's current practice is to pay terminal dividends. If any nonguaranteed elements are shown, the nonguaranteed elements must be shown at the same durations as the corresponding guaranteed elements, if any.  If a guaranteed benefit or value is not available at any duration for which a nonguaranteed benefit or value is shown, a zero shall be displayed in the guaranteed column.
A.R.S. § 20-2110 — Arizona Code / Title 20 / Chapter 11 / Article 1 / Section 2110
20-2110 Reasons for adverse underwriting decisions
Status: in_force

20-2110. Reasons for adverse underwriting decisions

A. In the event of an adverse underwriting decision the insurance institution or insurance producer responsible for the decision shall either provide the applicant, policyholder or individual proposed for coverage with the specific reason for the adverse underwriting decision in writing or advise the person, in writing, that on written request the person may receive the specific reason in writing and provide the applicant, policyholder or individual proposed for coverage with a summary of the rights established under subsection B of this section and sections 20-2108 and 20-2109.

B. On receipt of a written request within ninety business days after the date the notice or other communication of an adverse underwriting decision is sent to an applicant, policyholder or individual proposed for coverage, the insurance institution or insurance producer shall send to the person within twenty-one business days after the date of receipt of the written request:

1. The specific reason for the adverse underwriting decision, in writing, if the information was not initially furnished in writing pursuant to subsection A of this section.

2. The specific items of personal and privileged information that support those reasons except that:

(a) The insurance institution or insurance producer is not required to furnish specific items of privileged information if it has a reasonable suspicion, based on specific information available for review by the director, that the applicant, policyholder or individual proposed for coverage has engaged in criminal activity, fraud, material misrepresentation or material nondisclosure.

(b) Specific items of medical record information supplied by a medical care institution or medical professional shall be disclosed either directly to the individual about whom the information relates or to a medical professional designated by the individual and licensed to provide medical care with respect to the condition to which the information relates, at the option of the insurance institution or insurance producer.

3. The names and addresses of the institutional sources that supplied the specific items of information pursuant to paragraph 2 of this subsection, except that the identity of any medical professional or medical care institution shall be disclosed either directly to the individual or to the designated medical professional, whichever the insurance institution or insurance producer prefers.

C. The obligations imposed by this section on an insurance institution or insurance producer may be satisfied by another insurance institution or insurance producer authorized to act on its behalf.

D. If an adverse underwriting decision results solely from an oral request or inquiry, the explanation of the specific reasons and summary of rights required by subsection A of this section may be given orally.

E. In providing the specific reason for an adverse underwriting decision based on credit related information contained or not contained in an individual's consumer report, the insurance institution or agent shall provide at least the following information:

1. That the decision was based in part on a consumer report or the absence of credit history.

2. The source of the consumer report and how the individual may obtain a copy of the consumer report.

3. A description of up to four factors that were the primary cause for the adverse action that resulted from the insurance score.

F. An insurer shall not use the following types of credit history to calculate an insurance score to determine property or casualty premiums for insurance transactions that are subject to this article and shall not knowingly use an insurance score developed by a third party if the score is calculated using any of the following types of credit history:

1. The absence of credit history or the inability to determine the consumer's credit history unless the insurer's action is actuarially justified or the insurer treats the consumer as if the consumer had neutral credit information, as defined by the insurer.

2. Credit history or an insurance score based on collection accounts identified with a medical industry code.

3. A bankruptcy or a lien satisfaction that is more than seven years old.

4. The consumer's use of a particular type of credit card, charge card or debit card unless actuarially justified.

5. The consumer's total available line of credit, except that an insurer may consider the total amount of outstanding debt in relation to the total available line of credit.

6. An insurance score that is calculated using the income, gender, address, zip code, ethnic group, religion, marital status or nationality of the consumer as a factor.  This paragraph does not prohibit an insurer from using zip code, address, gender and marital status information for underwriting purposes.
A.R.S. § 20-1010 — Arizona Code / Title 20 / Chapter 4 / Article 7 / Section 1010
20-1010 Taxes
Status: in_force

20-1010. Taxes

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 percent of prepaid net charges received from members.

B. The failure by an organization to pay the tax imposed by this section results in a civil penalty determined pursuant to section 20-225.

C. A prepaid dental plan organization may claim a premium tax credit if the organization qualifies for a credit pursuant to section 20-224.03.
A.R.S. § 20-3323 — Arizona Code / Title 20 / Chapter 25 / Article 1 / Section 3323
20-3323 Audit reports
Status: in_force

20-3323. Audit reports

A. The auditing entity must deliver a preliminary audit report to the pharmacy within sixty days after the conclusion of the audit.

B. A pharmacy is allowed at least thirty days after receipt of the preliminary audit to provide documentation to address any discrepancy found in the audit.

C. Each auditing entity shall establish and make available to network pharmacies a written appeals process that shall include a process to appeal, investigate and resolve disputes regarding final audit findings.  A pharmacy shall have at least thirty days from the delivery of the final audit findings to appeal an unfavorable audit finding to the auditing entity.  This written appeals process shall be included in all contracts between a pharmacy benefits manager and a network pharmacy or a pharmacy benefits manager and a pharmacy's contracting representative.

D. Each auditing entity shall provide a telephone number at which a network pharmacy may contact the pharmacy benefits manager and speak to someone who is responsible for processing appeals.

E. The auditing entity must deliver a final audit report to the pharmacy within ninety days after receipt of the preliminary audit report or final appeal, whichever is later.

F. Chargebacks, recoupment or other penalties may not be assessed until the appeals process has been exhausted and the final audit report has been issued.

G. Unless otherwise required by state or federal law, audit information may not be shared with any entity other than the insurer on whose behalf the audit was conducted.  Auditors may have access only to previous audit reports on a particular pharmacy conducted by that same auditing entity.
A.R.S. § 20-467 — Arizona Code / Title 20 / Chapter 2 / Article 6 / Section 467
20-467 Return premiums; penalties
Status: in_force

20-467. Return premiums; penalties

All insurers and insurance producers shall comply with the requirements prescribed in sections 6-1415 and 6-1416. In addition to any penalty provided by law, any insurer or insurance producer who fails to comply with the requirements prescribed in sections 6-1415 and 6-1416 is subject to the penalties prescribed in section 20-456.
A.R.S. § 20-2610 — Arizona Code / Title 20 / Chapter 16 / Article 1 / Section 2610
20-2610 Foreign companies; compliance with laws of domiciliary state
Status: in_force

20-2610. Foreign companies; compliance with laws of domiciliary state

If the laws of a foreign company's domiciliary state provide a degree of protection to the policyholders and the public that is substantially similar to the degree of protection that is provided by this article, the director may determine that the foreign company has complied with this article.
A.R.S. § 20-407.01 — Arizona Code / Title 20 / Chapter 2 / Article 5 / Section 407.01
20-407.01 Designation as a domestic surplus lines insurer; requirements; scope of business activity permitted
Status: in_force

20-407.01. Designation as a domestic surplus lines insurer; requirements; scope of business activity permitted

A. Notwithstanding any other law, a domestic insurer possessing minimum capital and surplus of at least fifteen million dollars, pursuant to a resolution by its board of directors and on the written approval of the director, may be designated as a domestic surplus lines insurer.  A domestic surplus lines insurer shall be considered an unauthorized insurer for purposes of writing surplus lines insurance coverage pursuant to the requirements of this article.

B. A domestic surplus lines insurer shall only write surplus lines insurance in this state procured pursuant to the requirements of this article.  A domestic surplus lines insurer may write surplus lines insurance in any other jurisdiction in which the insurer is eligible to write surplus lines insurance if the domestic surplus lines insurer complies with any requirements of that jurisdiction.

C. Insurance written by a domestic surplus lines insurer is subject to the tax on premiums required by section 20-416 and is exempt from the tax on premiums required by chapter 2, article 1 of this title.

D. A domestic surplus lines insurer shall be considered a nonadmitted insurer as referenced in 15 United States Code section 8206 with respect to surplus lines insurance issued in this state.

E. Surplus lines insurance policies issued in this state by a domestic surplus lines insurer are not subject to the protection of or other provisions of the Arizona property and casualty insurance guaranty fund established by section 20-662.

F. Surplus lines insurance policies issued in this state by a domestic surplus lines insurer are not subject to and are exempt from all statutory requirements relating to insurance rating and rating plans, policy forms, policy cancellation and nonrenewal in the same manner and to the same extent as a surplus lines insurer domiciled in another state.
A.R.S. § 20-729 — Arizona Code / Title 20 / Chapter 4 / Article 1 / Section 729
20-729 Conversion of stock insurer to mutual insurer
Status: in_force

20-729. Conversion of stock insurer to mutual insurer

A. A domestic stock insurer other than a title insurer may become a domestic mutual insurer pursuant to such plan and procedure as may be approved in advance by the director.

B. The director shall not approve any such plan, procedure or mutualization unless:

1. It is equitable to both stockholders and policyholders.

2. It is subject to approval by a vote of the holders of not less than three-fourths of the insurer's capital stock having voting rights and by a vote of not less than two-thirds of the insurer's policyholders who vote on such plan in person, by proxy or by mail pursuant to such notice and procedure as may be approved by the director.

3. If a life insurer, the right to vote thereon is limited to those policyholders whose policies have face amounts of not less than $1,000 and have been in force for one year or more.

4. Mutualization will result in retirement of shares of the insurer's capital stock at a price not in excess of the fair market value thereof as determined by competent disinterested appraisers.

5. The plan provides for the purchase of the shares of any nonconsenting stockholder in accordance with title 10, chapter 13 and such nonconsenting stockholders shall have all the rights and restrictions applicable under such section to stockholders of a private corporation who do not consent to the agreed manner of converting the shares of stock of such private corporation on proposal for consolidation.

6. The plan provides for definite conditions to be fulfilled by a designated early date on which such mutualization will be deemed effective.

7. The mutualization leaves the insurer with surplus funds reasonably adequate for the security of its policyholders and to continue successfully in business in the states in which it is then authorized to transact insurance, and for the kinds of insurance included in its certificate of authority.

C. This section does not apply to mutualization under order of court pursuant to rehabilitation or reorganization of an insurer under chapter 3, article 4 of this title.
A.R.S. § 20-2540 — Arizona Code / Title 20 / Chapter 15 / Article 2 / Section 2540
20-2540 Health care appeals fund
Status: in_force

20-2540. Health care appeals fund

A. The health care appeals fund is established consisting of monies collected pursuant to subsection B of this section.  The fund is a special state fund pursuant to section 35-142, subsection A, paragraph 8.  Monies in the fund do not revert to the state general fund.  The department shall administer the fund.  Monies in the fund are continuously appropriated and are exempt from the provisions of section 35-190 relating to lapsing of appropriations.

B. The director shall charge an appealing member's health care insurer for all amounts owed to the independent review organization, pursuant to subsection C of this section, to decide the member's appeal.  The director may assess each health care insurer for administrative costs for implementing and maintaining the external independent review process as prescribed in this section and section 20-2538. The director shall deposit all collected monies in the fund.

C. The director shall use monies in the fund to:

1. Compensate procured independent review organizations for performing independent medical reviews on a per case rate unless the director determines that another method is necessary to carry out the purposes of this article.

2. Perform the responsibilities relating to the procurement of independent review organizations and to implement and maintain the external independent review process.

D. An independent review organization shall submit to the director for approval a detailed invoice consistent with the method of payment prescribed in subsection C of this section.
A.R.S. § 20-3332 — Arizona Code / Title 20 / Chapter 25 / Article 2 / Section 3332
20-3332 Prohibition against claim adjudication process fees; civil remedies
Status: in_force

20-3332. Prohibition against claim adjudication process fees; civil remedies

A. A pharmacy benefit manager may not directly or indirectly, on behalf of itself, a plan sponsor or an insurer, charge or hold a pharmacist or pharmacy responsible for a fee for any step of or component or mechanism related to the claims adjudication process, including:

1. Adjudicating a pharmacy benefit claim.

2. Processing or transmitting a pharmacy benefit claim.

3. Developing or managing a claims processing or adjudication network.

4. Participating in a claims processing or adjudication network.

B. A pharmacy may submit a complaint of a violation of this chapter to the director.  The pharmacy must include supporting documentation at the time the pharmacy files the complaint.  The director shall investigate the complaint and may examine and audit the books and records of a pharmacy benefit manager to determine if the pharmacy benefit manager has committed a violation of this chapter.  If the director finds that a pharmacy benefit manager has committed a violation of this chapter, the director may:

1. Seek an injunction in a court of competent jurisdiction and may apply for temporary and permanent orders that the director determines are necessary to restrain the pharmacy benefit manager from continuing to commit the violation.

2. Issue a cease and desist order pursuant to section 20-456 on the pharmacy benefit manager.

C. A pharmacy benefit manager that commits a violation of this chapter is subject to the penalties prescribed in section 20-456.

D. In addition to the actions and penalties prescribed in subsections B and C of this section, any person who is damaged by the acts of a pharmacy benefit manager committed in violation of this chapter may bring a civil action for damages against the pharmacy benefit manager committing the violation in a court of competent jurisdiction.
A.R.S. § 20-1057.14 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1057.14
20-1057.14 Cancer treatment medications; cost sharing; definition
Status: in_force

20-1057.14. Cancer treatment medications; cost sharing; definition

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 patient-administered cancer treatment medications, including medications that are orally administered or self-injected, may not require a higher copayment, deductible or coinsurance amount for patient-administered cancer treatment medications than is required for those cancer treatment medications that are injected or intravenously administered by a health care provider, regardless of the formulation or benefit category.

B. A health care services organization may not increase copayment, deductible or coinsurance amounts for covered cancer treatment medications that are injected or intravenously administered in order to avoid compliance with subsection A of this section, but may increase copayment, deductible or coinsurance amounts for cancer treatment medications if the increase is applied generally to other medical or pharmaceutical benefits under the evidence of coverage and is not done to circumvent subsection A of this section.

C. A health care services organization may not reclassify benefits with respect to cancer treatment medications in a manner that is inconsistent with this section.

D. For the purposes of this section, "cancer treatment medications" means prescription drugs and biologics that are used to kill, slow or prevent the growth of cancerous cells.
A.R.S. § 20-481.10 — Arizona Code / Title 20 / Chapter 2 / Article 8 / Section 481.10
20-481.10 Form and content of registration statement; disclosure of information; enterprise risk filing
Status: in_force

20-481.10. Form and content of registration statement; disclosure of information; enterprise risk filing

A. Every insurer subject to registration shall file a registration statement on a form provided by the director, which shall contain current information concerning:

1. The capital structure, general financial condition, ownership and management of the insurer and identity of any person controlling the insurer.

2. The identity of every member of the insurance holding company system that directly or indirectly controls the insurer.

3. The following agreements in force, relationships subsisting and transactions currently outstanding or that have occurred during the last calendar year between such insurer and its affiliates:

(a) Loans, other investments or purchases, sales or exchanges of securities of the affiliates by the insurer or of the insurer by its affiliates.

(b) Purchases, sales or exchanges of assets.

(c) Transactions not in the ordinary course of business.

(d) Guarantees or undertakings for the benefit of any affiliate that result in an actual contingent exposure of the insurer's assets to liability, other than insurance contracts entered into in the ordinary course of the insurer's business.

(e) All management and service contracts and all cost sharing arrangements.

(f) Reinsurance agreements.

(g) Dividends and other distributions to shareholders.

(h) Consolidated tax allocation agreements.

4. A pledge of the insurer's stock, including stock of any subsidiary or controlling affiliate, for a loan made to a member of the insurance holding company system.

5. If requested by the director, financial statements of or within an insurance holding company system, including all affiliates. Financial statements may include annual audited financial statements filed with the United States securities and exchange commission pursuant to the securities act of 1933 or the securities exchange act of 1934.  An insurer required to file financial statements pursuant to this paragraph may satisfy the request by providing the director with the most recent parent corporation financial statements filed with the United States securities and exchange commission.

6. Other matters concerning transactions between registered insurers and any affiliates as may be included from time to time in any registration forms adopted or approved by the director.

7. A statement that the insurer's board of directors oversees corporate governance and internal controls of the insurer and that the insurer's officers or senior management have approved and implemented and maintain and monitor corporate governance and internal control procedures.

8. Any other information required by the director by rule.

B. All registration statements shall contain a summary outlining all items in the current registration statement representing changes from the prior registration statement.

C. A person within an insurance holding company system that is subject to registration shall provide complete and accurate information to an insurer if this information is reasonably necessary to enable the insurer to comply with this article.

D. The following provisions apply to enterprise risk filings:

1. The ultimate controlling person of each insurer that is subject to registration shall file an annual enterprise risk report that to the best of the ultimate controlling person's knowledge and belief identifies the material risks within the insurance holding company system that could pose enterprise risk to the insurer. The ultimate controlling person shall file the report according to the procedures of the national association of insurance commissioners' financial analysis handbook.

2. Except as otherwise provided in this paragraph, the ultimate controlling person of each insurer that is subject to registration shall concurrently file an annual group capital calculation report as directed by the lead state director or commissioner.  The report shall be completed in accordance with the group capital calculation instructions, which may allow the lead state director or commissioner to allow a controlling person that is not the ultimate controlling person to file the group capital calculation report. The report shall be filed with the lead state director or commissioner in accordance with the procedures outlined in the national association of insurance commissioners' financial analysis handbook. The following provisions apply to filing the group capital calculation report:

(a) The following insurance holding companies are exempt from filing the group capital calculation report:

(i) An insurance holding company system that has only one insurer within its holding company structure, that writes only business and is licensed only in its domestic state and that assumes no business from any other insurer.

(ii) An insurance holding company system that is required to perform a group capital calculation specified by the federal reserve board. The lead state director or commissioner shall request the calculation from the federal reserve board under the terms of information sharing agreements that are in effect. If the federal reserve board cannot share the calculation with the lead state director or commissioner, the insurance holding company system is not exempt from the group capital calculation filing.

(iii) An insurance holding company system whose non-United States group-wide supervisor is located within a reciprocal jurisdiction, as described in section 20-3602, subsection H, paragraph 1, that recognizes the United States state regulatory approach to group supervision and group capital.

(iv) An insurance holding company system that provides information to the lead state that meets the requirements for accreditation under the national association of insurance commissioners financial standards and accreditation program through the group-wide supervisor who has determined that the information is satisfactory to allow the lead state to comply with the national association of insurance commissioners group supervision approach in accordance with the national association of insurance commissioners' financial analysis handbook, and whose non-United States group-wide supervisor who is not in a reciprocal jurisdiction recognizes and accepts, as specified by the director, the group capital calculation as a worldwide group capital assessment for United States insurance groups that operate in that jurisdiction.

(b) Notwithstanding subdivision (a), items (iii) and (iv) of this paragraph, a lead state director or commissioner shall require the group capital calculation for United States operations of any non-United States based insurance holding company system where, after any necessary consultation with other supervisors or officials, it is deemed appropriate by the lead state director or commissioner for prudential oversight and solvency monitoring purposes or for ensuring the competitiveness of the insurance marketplace.

(c) Notwithstanding subdivision (a) of this paragraph, the lead state director or commissioner has discretion to exempt the ultimate controlling person from filing the annual group capital calculation report or to accept a limited group capital filing or report in accordance with the criteria as specified by the director or commissioner in regulation.

(d) If the lead state director or commissioner determines that an exemption from filing the group capital calculation report no longer applies to an insurance holding company system, the insurance holding company system shall file the group capital calculation report at the next annual filing date unless reasonable grounds exist for the lead state director or commissioner to grant an extension.

3. The ultimate controlling person of each insurer that is subject to registration and selected into the national association of insurance commissioners liquidity stress test framework shall file the results of a specific year's liquidity stress test with the lead state director or commissioner according to the procedures prescribed in the national association of insurance commissioners' financial analysis handbook.  The following provisions apply to the liquidity stress test framework:

(a) The liquidity stress test framework includes scope criteria that are applicable to a specific data year.  The scope criteria must be reviewed at least annually by the national association of insurance commissioners financial stability task force or its successor.  Any change to the liquidity stress test framework or to a data year for which the scope criteria is to be measured shall be effective on January 1 of the year following the calendar year when the changes are adopted.  Insurers that meet at least one threshold of the scope criteria are considered selected into the liquidity stress test framework for the specified data year unless the lead state director or commissioner, in consultation with the national association of insurance commissioners financial stability task force or its successor, determines that the insurer should not be included into the liquidity stress test framework for that data year.  Insurers that do not meet at least one threshold of the scope criteria are excluded from the liquidity stress test framework for the specified data year unless the director, in consultation with the national association of insurance commissioners financial stability task force or its successor, determines that the insurer should be included into the liquidity stress test framework for that data year.

(b) An insurance holding company system shall perform and file a specific year's liquidity stress test in accordance with the liquidity stress test framework's instructions and reporting templates for that specific year and any lead state director or commissioner determinations.
A.R.S. § 20-767 — Arizona Code / Title 20 / Chapter 4 / Article 2 / Section 767
20-767 Attorney-in-fact of reciprocal insurers
Status: in_force

20-767. Attorney-in-fact of reciprocal insurers

A. "Attorney," as used in this article refers to the attorney-in-fact of a reciprocal insurer. The attorney may be an individual, firm or corporation.

B. The attorney of a foreign or alien reciprocal insurer, which insurer is duly authorized to transact insurance in this state, shall not, by virtue of discharge of its duties as such attorney with respect to the insurer's transactions in this state, be thereby deemed to be doing business in this state within the meaning of any laws of this state applying to foreign firms or corporations.
A.R.S. § 20-1805 — Arizona Code / Title 20 / Chapter 8 / Article 1 / Section 1805
20-1805 Recording of lien by director
Status: in_force

20-1805. Recording of lien by director

A. The director shall, as a condition to granting a permit to an applicant, record with the county recorder of any county a notice of lien against the facility's properties on behalf of all residents and contract holders who enter into life care contracts with the applicant to secure performance of the provider's obligations to residents and contract holders pursuant to life care contracts.

B. From the time of such recording there exists a lien for an amount equal to the reasonable value of services to be performed under a life care contract in favor of each resident and contract holder on the land and improvements of the facility's properties owned by the provider, not exempt from execution, which are listed in the notice of lien filed pursuant to subsection C of this section and which are located in the county in which the notice of lien is recorded.

C. The lien shall be perfected by the director by executing by affidavit the notice and claim of lien, which shall contain:

1. The legal description of the lands and improvements to be charged with a lien.

2. The name of the owner of the property affected.

3. A statement providing that the lien has been filed by the director pursuant to section 20-1805.

D. The lien may be released or partially released at the request of the applicant if, in the judgment of the director, such release or partial release inures to the benefit of the residents and contract holders and the performance of the provider's obligations to the residents and contract holders.

E. The lien may be foreclosed by civil action. Any number of persons claiming liens against the same property pursuant to this section may join in the same action. If separate actions are commenced, the court may consolidate such actions. The court shall, as part of the costs, allow reasonable attorney's fees for each claimant who is a party to the action.

F. In a civil action filed pursuant to this section, the judgment shall be given in favor of each resident and contract holder having a lien who has joined in the foreclosure action for the amount equal to the reasonable value of services to be performed under a life care contract in favor of each resident and contract holder. The court shall order the sheriff to sell any property subject to the lien at the time judgment is given, in the same manner as real and personal property is sold on execution. The lien for the reasonable value of services to be performed under a life care contract shall be on equal footing with claims of other residents and contract holders. If a sale is ordered and the property sold and the proceeds of the sale are not sufficient to discharge all liens of residents and contract holders against the property, the proceeds shall be prorated among the respective residents and contract holders.

G. The liens provided for in this section are preferred to all liens, mortgages or other encumbrances upon the property attaching subsequently to the time the lien is recorded and are preferred to all unrecorded liens, mortgages and other encumbrances. The amount secured by any lien having priority to the lien filed pursuant to this section may not be increased without prior approval of the director.

H. The director shall file a release of the lien upon proof of complete performance of all obligations to residents and contract holders pursuant to life care contracts.

I. The director may subordinate any lien filed pursuant to this section to the lien of a first mortgage or other long-term financing obtained by the provider, regardless of the time at which the subsequent lien attaches.
A.R.S. § 20-534 — Arizona Code / Title 20 / Chapter 3 / Article 2 / Section 534
20-534 Approval of investment
Status: in_force

20-534. Approval of investment

No investment or loan shall be made by an insurer unless it has been authorized or approved by the insurer's board of directors or by a committee authorized thereby and charged with the duty of supervising or making such investment or loan. The minutes of any such committee shall be recorded and regular reports of the committee shall be submitted to the board of directors. This section does not apply to loans made by a life insurer on policies or annuity contracts.
A.R.S. § 20-519 — Arizona Code / Title 20 / Chapter 3 / Article 1 / Section 519
20-519 Nonrenewals, cancellations or revisions of ceded reinsurance agreements
Status: in_force

20-519. Nonrenewals, cancellations or revisions of ceded reinsurance agreements

A. A nonrenewal, cancellation or revision of a ceded reinsurance agreement that is not material does not have to be reported pursuant to section 20-517.

B. A report of a material nonrenewal, cancellation or revision of a ceded reinsurance agreement shall be reported, regardless of which party initiated the nonrenewal, cancellation or revision of ceded reinsurance, if one or more of the following conditions exist:

1. The entire cession has not been renewed or has been cancelled or revised and ceded indemnity and loss adjustment expense reserves after nonrenewal, cancellation or revision represent less than fifty per cent of the comparable reserves that would have been ceded if the nonrenewal, cancellation or revision had not occurred.

2. An authorized or accredited reinsurer has been replaced on an existing cession by an unauthorized reinsurer.

3. The collateral requirements that were previously established for unauthorized reinsurers have been reduced. For example, the requirement to collateralize incurred but not reported claim reserves is waived with respect to one or more unauthorized reinsurers newly participating in an existing cession.

C. For the purposes of subsection B, paragraph 2 or 3 of this section, an insurer shall file a report if the result of the revision affects more than ten per cent of the cession.

D. A report of a material nonrenewal, cancellation or revision of ceded reinsurance agreement pursuant to section 20-517 shall disclose the following information:

1. The effective date of the nonrenewal, cancellation or revision.

2. A description of the transaction, including an identification of the transaction initiator.

3. The purpose of or reason for the transaction.

4. The identity of the replacement reinsurers, if applicable.

E. An insurer shall report all material nonrenewals, cancellations or revisions of ceded reinsurance agreements on a nonconsolidated basis unless the insurer is part of a consolidated group of insurers that uses a pooling arrangement or one hundred per cent reinsurance agreement that affects the solvency and integrity of the insurer's reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five per cent of the insurer's capital and surplus.

F. For the purposes of this section and section 20-517, a material nonrenewal, cancellation or revision is one that affects for property and casualty business, including accident and health business that is written as property and casualty business, more than fifty per cent of an insurer's ceded written premium, or for life, annuity and accident and health business, more than fifty per cent of an insurer's total reserve credit taken for business ceded, on an annualized basis as indicated in the insurer's most recently filed statement. A filing is not required pursuant to this subsection if the insurer's ceded written premium or the total reserve credit taken for business ceded represents, on an annualized basis, less than ten per cent of the direct plus assumed written premium or ten per cent of the statutory reserve requirement before any cession.
A.R.S. § 20-404 — Arizona Code / Title 20 / Chapter 2 / Article 5 / Section 404
20-404 Exemptions
Status: in_force

20-404. Exemptions

Sections 20-403, 20-405 and 20-406 shall not apply to such transactions as are prescribed in section 20-401.01, paragraphs 1, 2, 3, 4, 5, 7 and 8, nor to any action or proceeding against an unauthorized insurer arising out of the following types of insurance where the policy or contract contains a provision designating the director as its attorney for the acceptance of service of lawful process in any action or proceeding instituted by or on behalf of an insured or beneficiary arising out of any such policy, or where the insurer enters a general appearance in any such action:

1. Ocean marine and foreign trade insurance.

2. Insurance on subjects located, resident or to be performed, wholly outside this state, or on vehicles or aircraft owned and principally garaged outside this state.

3. Insurance on property or operations of railroads engaged in interstate commerce.
A.R.S. § 20-667 — Arizona Code / Title 20 / Chapter 3 / Article 6 / Section 667
20-667 Obligations of the fund
Status: in_force

20-667. Obligations of the fund

A. The fund is obligated solely to the extent of the covered claims existing during any of the following periods:

1. Before the determination of insolvency and arising within thirty days after the determination of insolvency.

2. Before the policy expiration date if less than thirty days after the determination of insolvency.

3. Before the insured replaces the policy or on request effects cancellation, if the insured does so within thirty days of the determination of insolvency.

B. Except for obligations arising out of a covered workers' compensation claim for benefits under title 23, chapter 6, such obligation shall include only that amount of each covered claim that is more than one hundred dollars and that is less than three hundred thousand dollars or an amount of more than twenty-five dollars but not exceeding ten thousand dollars for a covered claim for the return of unearned premiums. In no event shall the fund be obligated to a policyholder or claimant in any amount in excess of the face amount of the policy from which the claim arises.

C. The fund is deemed the insurer to the extent of its obligation on the covered claims and to such extent shall have all rights, duties and obligations of the insolvent insurer as if the insurer had not become insolvent. Notwithstanding any other law, the fund is not obligated to pay any amount that does not constitute a payment of a covered claim, including taxable costs, attorney fees or interest that could be awarded or any additional liabilities or obligations that might otherwise exist or accrue against the insolvent insurer if the insurer had not become insolvent.

D. Any settlement of a covered claim that is entered into with any insured or claimant within four months before the determination of insolvency and that has not been paid is voidable by the fund for six months after the determination of the insolvency or six months after the fund discovers or should have discovered the settlement, whichever is later.

E. Notwithstanding subsection D of this section, a settlement or commutation of a workers' compensation claim approved by an award of the industrial commission that has become final pursuant to section 23-942 or 23-943 is not voidable.

F. The fund is not bound by any settlement that is more than the fund's limits of liability established by this article.

G. Beginning on the effective date of this amendment to this section, the fund shall assume all contractual rights and obligations of the industrial commission regarding the administration of workers' compensation insolvent carrier claims if the industrial commission has contracted with a third-party processor to administer claims.
A.R.S. § 20-3343 — Arizona Code / Title 20 / Chapter 25 / Article 3 / Section 3343
20-3343 340B drug program; 340B covered entities; pharmacies; drug coverage
Status: in_force

20-3343. 340B drug program; 340B covered entities; pharmacies; drug coverage

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, clawback or adjustment on the basis that a pharmacy dispenses a 340B drug.

3. Exclude a pharmacy from a third party's pharmacy network on the basis that the pharmacy dispenses a 340B drug.

4. Restrict the methods or pharmacies within a third-party network by which a 340B covered entity may dispense or deliver 340B drugs.
A.R.S. § 20-1019 — Arizona Code / Title 20 / Chapter 4 / Article 7 / Section 1019
20-1019 Order of benefit determination for dental care
Status: in_force

20-1019. Order of benefit determination for dental care

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, if issued after the effective date of this section, shall pay benefits to its insured or certificate holder or the assignee thereof without regard to the existence of the prepaid dental plan.

B. Notwithstanding subsection A, the indemnity plan insurer is not obligated to pay any amount for a procedure covered without charge to the member of the prepaid dental plan or to pay in excess of the amount of the member's obligation under the prepaid dental plan.

C. In the event that the member's copayment obligation under the prepaid dental plan has been met, then the indemnity insurer shall remit any payments due under this section directly to its insured or certificate holder.

D. The director may adopt rules to enforce this section.
A.R.S. § 20-492.06 — Arizona Code / Title 20 / Chapter 2 / Article 16 / Section 492.06
20-492.06 Civil penalties
Status: in_force

20-492.06. Civil penalties

If an insurer fails without just cause to timely file the CGAD as required in this article, after notice and a hearing, the director may impose a civil penalty of $20 for each day's delay not to exceed $2,500. The director shall collect the civil penalty and deposit the monies in the state general fund.  The director may reduce the penalty if the insurer demonstrates to the director that the imposition of the penalty would constitute a financial hardship to the insurer.
A.R.S. § 20-1097 — Arizona Code / Title 20 / Chapter 4 / Article 13 / Section 1097
20-1097 Definitions
Status: in_force

20-1097. Definitions

In this article, unless the context otherwise requires:

1. "Administrative fee" means a fixed amount paid by a corporation on a periodic basis to a contracted attorney for the contracted attorney's overhead and administrative costs.

2. Pay or reimburse for specific legal services does not include payment of an administrative fee only.

3. "Prepaid legal insurance contract" means a contractual obligation to pay or reimburse for specific legal services rendered in the normal and ordinary course of business by an active member of the state bar of Arizona.

4. "Prepaid legal insurance corporation" or "corporation" means any corporation organized for the purpose of selling prepaid legal insurance contracts in this state or any insurer licensed pursuant to this title.