A.R.S. § 20-1379 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1379
20-1379 Guaranteed availability of individual health insurance coverage; prior group coverage; definitions
Status: in_force

20-1379. Guaranteed availability of individual health insurance coverage; prior group coverage; definitions

A. Every health care insurer that offers individual health insurance coverage in the individual market in this state shall provide guaranteed availability of coverage to an eligible individual who desires to enroll in individual health insurance coverage and shall not:

1. Decline to offer that coverage to, or deny enrollment of, that individual.

2. Impose any preexisting condition exclusion for that coverage.

B. Every health care insurer that offers individual health insurance coverage in the individual market in this state shall offer all policy forms of health insurance coverage that are designed for, that are made generally available and actively marketed to and that enroll both eligible or other individuals.  A health care insurer that offers only one policy form in the individual market complies with this section by offering that form to eligible individuals. A health care insurer also may comply with the requirements of this section by electing to offer at least two different policy forms to eligible individuals as provided by subsection C of this section.

C. A health care insurer shall meet the requirements prescribed in subsection B of this section if:

1. The health care insurer offers at least two different policy forms, both of which are designed for, are made generally available and actively marketed to and enroll both eligible and other individuals.

2. The offer includes at least either:

(a) The policy forms with the largest and next to the largest earned premium volume of all policy forms offered by the health care insurer in this state in the individual market during a period not to exceed the preceding two calendar years.

(b) A choice of two policy forms with representative coverage, consisting of a lower level of coverage policy form and a higher level of coverage policy form, each of which includes benefits that are substantially similar to other individual health insurance coverage offered by the health care insurer in this state and each of which is covered by a method that provides for risk adjustment, risk spreading or a risk spreading mechanism among the health care insurer's policies.

D. The health care insurer's election pursuant to subsection C of this section is effective for policies offered during a period of at least two years.

E. If a health care insurer offers individual health insurance coverage in the individual market through a network plan, the health care insurer may do both of the following:

1. Limit the individuals who may be enrolled under health insurance coverage to those who live, reside or work within the service area for a network plan.

2. Within the service area of a network plan, deny health insurance coverage to individuals if the health care insurer has demonstrated, if required, to the director that both:

(a) The health care insurer will not have the capacity to deliver services adequately to additional individual enrollees because of the health care insurer's obligations to existing group contract holders and enrollees and individual enrollees.

(b) The health care insurer is applying this paragraph uniformly to individuals without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.

F. A health care insurer may deny individual health insurance coverage in the individual market to an eligible individual if the health care insurer demonstrates to the director that the health care insurer:

1. Does not have the financial reserves necessary to underwrite additional coverage.

2. Is denying coverage uniformly to all individuals in the individual market in this state pursuant to state law and without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.

G. If a health care insurer denies health insurance coverage in this state pursuant to subsection F of this section, the health care insurer shall not offer that coverage in the individual market in this state for one hundred eighty days after the date the coverage is denied or until the health care insurer demonstrates to the director that the health care insurer has sufficient financial reserves to underwrite additional coverage, whichever is later.

H. An accountable health plan as defined in section 20-2301 that offers conversion policies on an individual or group basis in connection with a health benefits plan pursuant to this title is not a health care insurer that offers individual health insurance coverage solely because of the offer of a conversion policy.

I. This section does not:

1. Create additional restrictions on the amount of the premium rates that a health care insurer may charge an individual for health insurance coverage provided in the individual market.

2. Prevent a health care insurer that offers health insurance coverage in the individual market from establishing premium rates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

3. Require a health care insurer that offers only short-term limited duration insurance or limited benefit coverage to individuals and no other coverage to individuals in the individual market to offer individual health insurance coverage in the individual market.

4. Require a health care insurer offering health care coverage only on a group basis or through one or more bona fide associations, or both, to offer health insurance coverage in the individual market.

J. A health care insurer shall provide, without charge, a written certificate of creditable coverage as described in this section for creditable coverage occurring after June 30, 1996 if the individual:

1. Ceases to be covered under a policy offered by a health care insurer.  An individual who is covered by a policy that is issued on a group basis by a health care insurer, that is terminated or not renewed at the choice of the sponsor of the group and where the replacement of the coverage is without a break in coverage is not entitled to receive the certification prescribed in this paragraph but is instead entitled to receive the certification prescribed in paragraph 2 of this subsection.

2. Requests certification from the health care insurer within twenty-four months after the coverage under a health insurance coverage policy offered by a health care insurer ceases.

K. The certificate of creditable coverage provided by a health care insurer is a written certification of the period of creditable coverage of the individual under the health insurance coverage offered by the health care insurer. The department may enforce and monitor the issuance and delivery of the notices and certificates by health care insurers as required by this section, section 20-1380, the health insurance portability and accountability act of 1996 (P.L. 104-191; 110 Stat. 1936) and any federal regulations adopted to implement the health insurance portability and accountability act of 1996. Notwithstanding any other law, an insurer is not required to provide a certificate of creditable coverage if the federal laws that require providing a certificate of creditable coverage are superseded by the prohibition on preexisting condition exclusions.

L. Any health care insurer, accountable health plan or other entity that issues health care coverage in this state, as applicable, shall issue and accept a certificate of creditable coverage of the individual that contains at least the following information:

1. The date that the certificate is issued.

2. The name of the individual or dependent for whom the certificate applies and any other information that is necessary to allow the issuer providing the coverage specified in the certificate to identify the individual, including the individual's identification number under the policy and the name of the policyholder if the certificate is for or includes a dependent.

3. The name, address and telephone number of the issuer providing the certificate.

4. The telephone number to call for further information regarding the certificate.

5. One of the following:

(a) A statement that the individual has at least eighteen months of creditable coverage. For the purposes of this subdivision, "eighteen months" means five hundred forty-six days.

(b) Both the date that the individual first sought coverage, as evidenced by a substantially complete application, and the date that creditable coverage began.

6. The date creditable coverage ended, unless the certificate indicates that creditable coverage is continuing from the date of the certificate.

7. The consumer assistance telephone number for the department.

8. The following statement in at least fourteen-point type:

Important Notice!

Keep this certificate with your important personal records to protect your rights under the health insurance portability and accountability act of 1996 ("HIPAA"). This certificate is proof of your prior health insurance coverage. You may need to show this certificate to have a guaranteed right to buy new health insurance ("Guaranteed issue"). This certificate may also help you avoid waiting periods or exclusions for preexisting conditions. Under HIPAA, these rights are guaranteed only for a very short time period. After your group coverage ends, you must apply for new coverage within 63 days to be protected by HIPAA. If you have questions, call the Arizona department of insurance and financial institutions.

M. A health care insurer has satisfied the certification requirement under this section if the insurer offering the health benefits plan provides the certificate of creditable coverage in accordance with this section within thirty days after the event that triggered the issuance of the certificate.

N. Periods of creditable coverage for an individual are established by the presentation of the certificate described in this section and section 20-2310. In addition to the written certificate of creditable coverage as described in this section, individuals may establish creditable coverage through the presentation of documents or other means.  In order to make a determination that is based on the relevant facts and circumstances of the amount of creditable coverage that an individual has, a health care insurer shall take into account all information that the insurer obtains or that is presented to the insurer on behalf of the individual.

O. A health care insurer shall calculate creditable coverage according to the following rules:

1. The health care insurer shall allow an individual credit for each day the individual was covered by creditable coverage.

2. The health care insurer shall not count a period of creditable coverage for an individual enrolled under any form of health insurance coverage if after the period of coverage and before the enrollment date there were sixty-three consecutive days during which the individual was not covered by any creditable coverage.

3. The health care insurer shall not include any period that an individual is in a waiting period or an affiliation period for any health coverage or is awaiting action by a health care insurer on an application for the issuance of health insurance coverage when the health care insurer determines the continuous period pursuant to paragraph 1 of this subsection.

4. The health care insurer shall not include any period that an individual is waiting for approval of an application for health care coverage, provided the individual submitted an application to the health care insurer for health care coverage within sixty-three consecutive days after the individual's most recent creditable coverage.

5. The health care insurer shall not count a period of creditable coverage with respect to enrollment of an individual if, after the most recent period of creditable coverage and before the enrollment date, sixty-three consecutive days lapse during all of which the individual was not covered under any creditable coverage. The health care insurer shall not include in the determination of the period of continuous coverage described in this section any period that an individual is in a waiting period for health insurance coverage offered by a health care insurer, is in a waiting period for benefits under a health benefits plan offered by an accountable health plan or is in an affiliation period.

6. In determining the extent to which an individual has satisfied any portion of any applicable preexisting condition period the health care insurer shall count a period of creditable coverage without regard to the specific benefits covered during that period.

P. An individual is an eligible individual if, on the date the individual seeks coverage pursuant to this section, the individual has an aggregate period of creditable coverage as defined and calculated pursuant to this section of at least eighteen months and all of the following apply:

1. The most recent creditable coverage for the individual was under a plan offered by:

(a) An employee welfare benefit plan that provides medical care to employees or the employees' dependents directly or through insurance, reimbursement or otherwise pursuant to the employee retirement income security act of 1974 (P.L. 93-406; 88 Stat. 829; 29 United States Code sections 1001 through 1461).

(b) A church plan as defined in the employee retirement income security act of 1974.

(c) A governmental plan as defined in the employee retirement income security act of 1974, including a plan established or maintained for its employees by the government of the United States or by any agency or instrumentality of the United States.

(d) An accountable health plan as defined in section 20-2301.

2. The individual is not eligible for coverage under:

(a) An employee welfare benefit plan that provides medical care to employees or the employees' dependents directly or through insurance, reimbursement or otherwise pursuant to the employee retirement income security act of 1974.

(b) A health benefits plan issued by an accountable health plan as defined in section 20-2301.

(c) Part A or part B of title XVIII of the social security act.

(d) Title 36, chapter 29 or any other plan established under title XIX of the social security act, and the individual does not have other health insurance coverage.

3. The most recent coverage within the coverage period was not terminated based on any factor described in section 20-2309, subsection B, paragraph 1 or 2 relating to nonpayment of premiums or fraud.

4. The individual was offered and elected the option of continuation coverage under a COBRA continuation provision pursuant to the consolidated omnibus budget reconciliation act of 1985 (P.L. 99-272; 100 Stat. 82) or a similar state program.

5. The individual exhausted the continuation coverage pursuant to the consolidated omnibus budget reconciliation act of 1985.

Q. Notwithstanding subsection P of this section, an individual is an eligible individual if:

1. The individual is an individual enrollee in a health care services organization that is domiciled in this state on the date that the health care services organization is declared insolvent, including any health care services organization that is not an accountable health plan as defined in section 20-2301.

2. The individual's coverage terminates during the delinquency proceeding, after the health care services organization is declared insolvent.

3. The individual satisfies the requirements of an eligible individual as prescribed in this section other than the required period of creditable coverage.

R. Notwithstanding subsection P of this section, a newborn child, adopted child or child placed for adoption is an eligible individual if the child was timely enrolled and otherwise would have met the definition of an eligible individual as prescribed in this section other than the required period of creditable coverage and the child is not subject to any preexisting condition exclusion or limitation if the child has been continuously covered under health insurance coverage or a health benefits plan offered by an accountable health plan since birth, adoption or placement for adoption.

S. If a health care insurer imposes a waiting period for coverage of preexisting conditions, within a reasonable period of time after receiving an individual's proof of creditable coverage and not later than the date by which the individual must select an insurance plan, the health care insurer shall give the individual written disclosure of the insurer's determination regarding any preexisting condition exclusion period that applies to that individual. The disclosure shall include all of the following information:

1. The period of creditable coverage allowed toward the waiting period for coverage of preexisting conditions.

2. The basis for the insurer's determination and the source and substance of any information on which the insurer has relied.

3. A statement of any right the individual may have to present additional evidence of creditable coverage and to appeal the insurer's determination, including an explanation of any procedures for submission and appeal.

T. This section and section 20-1380 apply to all health insurance coverage that is offered, sold, issued, renewed, in effect or operated in the individual market after June 30, 1997, regardless of when a period of creditable coverage occurs.

U. For the purposes of this section and section 20-1380 as applicable:

1. "Affiliation period" has the same meaning prescribed in section 20-2301.

2. "Bona fide association" means, for health care coverage issued by a health care insurer, an association that meets the requirements of section 20-2324.

3. "Creditable coverage" means coverage solely for an individual, other than limited benefits coverage, under any of the following:

(a) An employee welfare benefit plan that provides medical care to employees or the employees' dependents directly or through insurance, reimbursement or otherwise pursuant to the employee retirement income security act of 1974.

(b) A church plan as defined in the employee retirement income security act of 1974.

(c) A health benefits plan issued by an accountable health plan as defined in section 20-2301.

(d) Part A or part B of title XVIII of the social security act.

(e) Title XIX of the social security act, other than coverage consisting solely of benefits under section 1928.

(f) Title 10, chapter 55 of the United States Code.

(g) A medical care program of the Indian health service or of a tribal organization.

(h) A health benefits risk pool operated by any state of the United States.

(i) A health plan offered pursuant to title 5, chapter 89 of the United States Code.

(j) A public health plan as defined by federal law.

(k) A health benefit plan pursuant to section 5(e) of the peace corps act (P.L. 87-293; 75 Stat. 612; 22 United States Code sections 2501 through 2523).

(l) A policy or contract, including short-term limited duration insurance, issued on an individual basis by an insurer, a health care services organization, a hospital service corporation, a medical service corporation or a hospital, medical, dental and optometric service corporation.

(m) A policy or contract issued by a health care insurer or an accountable health plan to a member of a bona fide association.

4. "Delinquency proceeding" has the same meaning prescribed in section 20-611.

5. "Different policy forms" means variations between policy forms offered by a health care insurer, including policy forms that have different cost sharing arrangements or different riders.

6. "Genetic information" means information about genes, gene products and inherited characteristics that may derive from the individual or a family member, including information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories and direct analyses of genes or chromosomes.

7. "Health care insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital, medical, dental and optometric service corporation.

8. "Health status-related factor" means any factor in relation to the health of the individual or a dependent of the individual enrolled or to be enrolled in a health care services organization including:

(a) Health status.

(b) Medical condition, including physical and mental illness.

(c) Claims experience.

(d) Receipt of health care.

(e) Medical history.

(f) Genetic information.

(g) Evidence of insurability, including conditions arising out of acts of domestic violence as defined in section 20-448.

(h) The existence of a physical or mental disability.

9. "Higher level of coverage" means a policy form for which the actuarial value of the benefits under the health insurance coverage offered by a health care insurer is at least fifteen percent more than the actuarial value of the health insurance coverage offered by the health care insurer as a lower level of coverage in this state but not more than one hundred twenty percent of a policy form weighted average.

10. "Individual health insurance coverage" means health insurance coverage offered by a health care insurer to individuals in the individual market but does not include limited benefit coverage or short-term limited duration insurance. A health care insurer that offers limited benefit coverage or short-term limited duration insurance to individuals and no other coverage to individuals in the individual market is not a health care insurer that offers health insurance coverage in the individual market.

11. "Limited benefit coverage" has the same meaning prescribed in section 20-1137.

12. "Lower level of coverage" means a policy form offered by a health care insurer for which the actuarial value of the benefits under the health insurance coverage is at least eighty-five percent but not more than one hundred percent of the policy form weighted average.

13. "Network plan" means a health care plan provided by a health care insurer under which the financing and delivery of health care services are provided, in whole or in part, through a defined set of providers either under contract with a health care insurer licensed pursuant to chapter 4, article 3 of this title or under contract with a health care insurer in accordance with the determination made by the director pursuant to section 20-1053 regarding the geographic or service area in which a health care insurer may operate.

14. "Policy form weighted average" means the average actuarial value of the benefits provided by a health care insurer that issues health coverage in this state that is provided by either the health care insurer or, if the data are available, by all health care insurers that issue health coverage in this state in the individual health coverage market during the previous calendar year, except coverage pursuant to this section, weighted by the enrollment for all coverage forms.

15. "Preexisting condition" means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within not more than six months before the date of the enrollment of the individual under the health insurance policy or other contract that provides health coverage benefits.  A genetic condition is not a preexisting condition in the absence of a diagnosis of the condition related to the genetic information and shall not result in a preexisting condition limitation or preexisting condition exclusion.

16. "Preexisting condition limitation" or "preexisting condition exclusion" means a limitation or exclusion of benefits for a preexisting condition under a health insurance policy or other contract that provides health coverage benefits.

17. "Short-term limited duration insurance" has the same meaning prescribed in section 20-1384 and is not intended or marketed as health insurance coverage subject to guaranteed issuance or guaranteed renewal provisions of the laws of this state but is creditable coverage within the meaning of this section and section 20-2301.
A.R.S. § 20-1377 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1377
20-1377 Continuation of coverage under individual policies; requirements; exceptions; renewability
Status: in_force

20-1377. Continuation of coverage under individual policies; requirements; exceptions; renewability

A. A policy of disability insurance delivered or issued for delivery in this state shall provide for the right of covered family members to continue coverage on the death of the named insured, the entry of a decree of dissolution of marriage of the named insured and any other conditions, other than failure of the insured to pay the required premium, specifically stated in the policy under which coverage would otherwise terminate as to the covered spouse or covered dependent children of the named insured.

B. At the option of the insurer, coverage shall either continue under the existing policy or by the issuance of a converted policy with the person exercising the right to convert designated as the named insured. Coverage provided by a conversion policy must provide benefits most similar to the coverage contained in the policy that was terminated. A person entitled to continuation or conversion rights under this section may elect a lesser form of coverage.

C. Continuation or conversion of coverage may, at the option of the spouse exercising the right, include covered dependent children for whom the spouse has responsibility for care or support.

D. The person exercising the continuation or conversion rights shall notify the insurer and make payment of the appropriate premium within thirty-one days following the termination of the existing policy. A monthly premium rate shall be offered to the person exercising continuation or conversion rights, and payment of one monthly premium shall be deemed sufficient consideration to enact the continuation or conversion policy.

E. Coverage provided through continuation or conversion shall be without additional evidence of insurability and shall not impose any preexisting condition limitations, exclusions or other contractual time limitations other than those remaining unexpired under the policy or contract from which continuation or conversion is exercised.

F. Conversion is not available to a person who is eligible for medicare or eligible for or covered by other similar disability benefits which together with the conversion coverage would constitute overinsurance.

G. This section does not apply to disability income policies, to accidental death or dismemberment policies or to single term nonrenewable policies.

H. Each policy of disability insurance shall include notice of the continuation and conversion privilege.

I. Except as provided in subsection J of this section, any policy, including a conversion or continuation policy, that is issued under this section shall not be cancelled or nonrenewed except for the following reasons:

1. The individual has failed to pay premiums or contributions in accordance with the terms of the coverage or the insurer has not received premium payments in a timely manner.

2. The individual has performed an act or practice that constitutes fraud or the individual made an intentional misrepresentation of material fact under the terms of the coverage.

3. The insurer has ceased to offer coverage to individuals that is consistent with the requirements of sections 20-1379 and 20-1380.

4. If the insurer offers health care coverage in this state through a network plan, the individual no longer resides, lives or works in the service area served by the network plan or in an area for which the insurer is authorized to transact business but only if the coverage is terminated uniformly without regard to any health status-related factor of any covered individual.

5. If the insurer offers health care coverage in this state in the individual market only through one or more bona fide associations, the membership of the individual in the association has ceased but only if that coverage is terminated uniformly without regard to any health status-related factor of any covered individual.

J. An insurer who offers only one form of an individual medical expense policy may modify the conversion policy if the modification complies with the notice and disclosure requirements set forth in the policy and applies uniformly to the policy offered to the general public and to the conversion policy.

K. At the time of filing a petition for dissolution of marriage, the clerk of the court shall provide to the petitioner for a dissolution of marriage two copies of the notice of the right of a dependent spouse to convert health insurance coverage under this section. The petitioner shall cause one copy of the notice to be served on the respondent together with a copy of the petition, summons and preliminary injunction. The director shall prepare the notice which must include a summary of this section. The clerk of the court or the director is not liable for damages arising from information contained in or omitted from the notices prepared or provided under this section.

L. Any person who is a United States armed forces reservist, who is ordered to active military duty on or after August 22, 1990 and who had coverage under an individual disability insurance policy at such time shall have the right to reinstate such coverage upon release from active military duty subject to the following conditions:

1. The reservist shall make written application to the insurer within ninety days of discharge from active military duty or within one year of hospitalization continuing after discharge. Coverage shall be effective upon receipt of application by the insurer.

2. The insurer may exclude from such coverage any health or physical condition arising during and occurring as a direct result of active military duty.

M. Each dependent of a person eligible for reinstatement under this section shall be afforded the same rights and be subject to the same conditions as the insured, if the dependent was insured under the individual disability insurance policy at the time the eligible person entered active duty. Any dependent of such person born during the period of active military duty shall have the same rights as other dependents noted in this section.

N. The director shall adopt emergency rules applicable to persons who are leaving active service in the armed forces of the United States and returning to civilian status consistent with the provisions of subsection L of this section, including:

1. Conditions of eligibility.

2. Coverage of dependents.

3. Preexisting conditions.

4. Termination of insurance.

5. Probationary periods.

6. Limitations.

7. Exceptions.

8. Reductions.

9. Elimination periods.

10. Requirements for replacement.

11. Any other conditions of coverage.
A.R.S. § 20-1057.20 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1057.20
20-1057.20 Organ harvesting; insurance coverage limitations
Status: in_force

20-1057.20. Organ harvesting; insurance coverage limitations

A. An evidence of coverage may limit coverage to an enrollee for the human organ transplant or posttransplant care if either of the following applies:

1. The transplant operation is performed in the People's Republic of China or the Hong Kong special administrative region.

2. The human organ to be transplanted was procured by a sale or donation originating in the People's Republic of China or the Hong Kong special administrative region.

B. This section does not:

1. Require coverage for human organ transplants.

2. Limit a health care services organization from denying coverage for any valid reason.
A.R.S. § 20-255 — Arizona Code / Title 20 / Chapter 2 / Article 2 / Section 255
20-255 "Marine and transportation insurance" defined
Status: in_force

20-255. "Marine and transportation insurance" defined

"Marine and transportation insurance" includes:

1. Insurance against any and all kinds of loss or damage to vessels, craft, aircraft, cars, automobiles and vehicles of every kind, as well as all goods, freight, cargoes, merchandise, effects, disbursements, profits, monies, bullion, precious stones, securities, choses in action, evidences of debt, valuable papers, bottomry and respondentia interests and all other kinds of property and interests therein, in respect to, appertaining to or in connection with any and all risks or perils of navigation, transit or transportation, including war risks, on or under any seas or other waters, on land or in the air, or while being assembled, packed, crated, baled, compressed or similarly prepared for shipment or while awaiting shipment or during any delays, storage, transshipment or reshipment incident thereto, including marine builders' risks and all personal property floater risks.

2. Insurance against any and all kinds of loss or damage to person or to property in connection with or appertaining to a marine, inland marine, transit or transportation insurance, including liability for loss of or damage to either, arising out of or in connection with the construction, repair, operation, maintenance or use of the subject matter of such insurance, but not including life insurance or surety bonds nor insurance against loss by reason of bodily injury to the person arising out of the ownership, maintenance or use of automobiles.

3. Insurance against any and all kinds of loss or damage to precious stones, jewels, jewelry, gold, silver and other precious metals, whether used in business or trade or otherwise and whether it be in course of transportation or otherwise.

4. Insurance against any and all kinds of loss or damage to bridges, tunnels and other instrumentalities of transportation and communication (excluding buildings, their furniture and furnishings, fixed contents and supplies held in storage) unless fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot or civil commotion or any or all of them are the only hazards to be covered.

5. Insurance against any and all kinds of loss or damage to piers, wharves, docks and slips, excluding the risks of fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and civil commotion and each of them.

6. Insurance against any and all kinds of loss or damage to other aids to navigation and transportation, including dry docks and marine railways, dams and appurtenant facilities for the control of waterways.

7. Marine protection and indemnity insurance, which is insurance against, or against legal liability of the insured for, loss, damage or expense arising out of, or incident to, the ownership, operation, chartering, maintenance, use, repair or construction of any vessel, craft or instrumentality in use in ocean or inland waterways, including liability of the insured for personal injury, illness or death or for loss of or damage to the property of another person.
A.R.S. § 20-2321 — Arizona Code / Title 20 / Chapter 13 / Article 1 / Section 2321
20-2321 Maternity benefits; adoption; coverage
Status: in_force

20-2321. Maternity benefits; adoption; coverage

A. A contract that is issued to an enrollee pursuant to this article and that provides coverage for maternity benefits shall also provide that the maternity benefits apply to the costs of the birth of a child who is legally adopted by the enrollee if all of the following are true:

1. The child is adopted within one year of birth.

2. The enrollee is legally obligated to pay the costs of birth.

3. All preexisting conditions and other limitations have been met and all deductibles and copayments have been paid by the enrollee.

4. The enrollee has notified the insurer of the enrollee's acceptability to adopt children pursuant to section 8-105 within sixty days after this approval or within sixty days after a change in insurance policies, plans or companies.

B. The coverage prescribed by subsection A of this section is excess to any other coverage the natural mother may have for maternity benefits except coverage made available to persons pursuant to title 36, chapter 29 but not including coverage made available to persons defined as eligible under section 36-2901, paragraph 6, subdivisions (b), (c), (d) and (e).

C. If other coverage exists the agency, attorney or individual arranging the adoption shall make arrangements for the insurance to pay those costs that may be covered under that policy and shall advise the adopting parent in writing of the existence and extent of the coverage without disclosing any confidential information such as the identity of the natural parent.

D. The enrollee adopting parents shall notify their accountable health plan of the existence and extent of the other coverage.

E. An accountable health plan is not required to pay any costs in excess of the amounts it would have been obligated to pay to its hospitals and providers if the natural mother and child had received the maternity and newborn care directly from or through that accountable health plan.

F. Beginning January 1, 1998, any contract that provides maternity benefits shall not restrict benefits for any hospital length of stay in connection with childbirth for the mother or the newborn child to less than forty-eight hours following a normal vaginal delivery or ninety-six hours following a cesarean section. The contract shall not require the provider to obtain authorization from the accountable health plan for prescribing the minimum length of stay required by this subsection. The contract may provide that an attending provider in consultation with the mother may discharge the mother or the newborn child before the expiration of the minimum length of stay required by this subsection. The accountable health plan shall not:

1. Deny the mother or the newborn child eligibility or continued eligibility to enroll or to renew coverage under the terms of the contract solely for the purpose of avoiding the requirements of this subsection.

2. Provide monetary payments or rebates to mothers to encourage those mothers to accept less than the minimum protections available pursuant to this subsection.

3. Penalize or otherwise reduce or limit the reimbursement of an attending provider because that provider provided care to any insured under the contract in accordance with this subsection.

4. Provide monetary or other incentives to an attending provider to induce that provider to provide care to an insured under the contract in a manner that is inconsistent with this subsection.

5. Except as described in subsection G of this section, restrict benefits for any portion of a period within the minimum length of stay in a manner that is less favorable than the benefits provided for any preceding portion of that stay.

G. Nothing in subsection F of this section:

1. Requires a mother to give birth in a hospital or to stay in the hospital for a fixed period of time following the birth of the child.

2. Prevents an accountable health plan from imposing deductibles, coinsurance or other cost sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or a newborn child under the contract, except that any coinsurance or other cost sharing for any portion of a period within a hospital length of stay required pursuant to subsection F of this section shall not be greater than the coinsurance or cost sharing for any preceding portion of that stay.

3. Prevents an accountable health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with subsection F of this section.

H. An accountable health plan shall not impose any preexisting condition exclusions or limitations relating to pregnancy as a preexisting condition.
A.R.S. § 20-726.01 — Arizona Code / Title 20 / Chapter 4 / Article 1 / Section 726.01
20-726.01 Insider trading by officers, directors and principal stockholders
Status: in_force

20-726.01. Insider trading by officers, directors and principal stockholders

A. Every person who is directly or indirectly the beneficial owner of more than ten per cent of any class of equity security of a domestic stock insurance company, or who is a corporate director or an officer of such company, shall file in the office of the director before the first day of July, 1966, or thereafter within ten days after he becomes such beneficial owner, corporate director or officer, a statement, in such form as the director may prescribe, of the amount of all classes of equity securities of such company of which he is the beneficial owner, and within ten days after the close of each calendar month thereafter, if there has been a change in such ownership during such month, shall file in the office of the director a statement, in such form as the director may prescribe, indicating his ownership at the close of the calendar month and such changes in his ownership as have occurred during such calendar month.

B. For the purpose of preventing the unfair use of information which may have been obtained by such beneficial owner, corporate director or officer by reason of his relationship to such company, any profit realized by him from any purchase and sale, or any sale and purchase, of any equity security of such company within any period of less than six months unless such equity security was acquired in good faith in connection with a debt previously contracted, shall inure to and be recoverable by the company, irrespective of any intention on the part of such beneficial owner, director or officer in entering into such transaction of holding the equity security purchased or of not repurchasing the equity security sold for a period exceeding six months. Suit to recover such profit may be instituted at law or in equity in any court of competent jurisdiction by the company or by the owner of any security of the company in the name and in behalf of the company if the company shall fail or refuse to bring such suit within sixty days after the request or shall fail diligently to prosecute the same thereafter, but no such suit shall be brought more than two years after the date such profit was realized. This subsection shall not be construed to cover any transaction where such beneficial owner was not such both at the time of the purchase and sale, or the sale and purchase, of the equity security involved, or any transaction or transactions which the director may by rules or regulations exempt as not comprehended within the purpose of this subsection.

C. It shall be unlawful for any such beneficial owner, corporate director or officer, directly or indirectly, to sell any equity security of such company if the person selling the equity security or his principal:

1. Does not own the equity security sold; or

2. If owning the equity security, does not deliver it against such sale within twenty days thereafter, or does not within five days after such sale deposit it in the mails or other usual channels of transportation, but no person shall be deemed to have violated this provision if he proves that notwithstanding the exercise of good faith he was unable to make such delivery or deposit within such time, or that to do so would cause undue inconvenience or expense.

D. The provisions of subsection B of this section shall not apply to any purchase and sale, or sale and purchase, and the provisions of subsection C of this section shall not apply to any sale, of an equity security not then or theretofore held by him in an investment account, by a dealer in the ordinary course of his business and incident to the establishment or maintenance by him of a primary or secondary market, otherwise than on an exchange as presently defined in the securities exchange act of 1934, for such security.

E. The provisions of this section shall not apply to foreign or domestic arbitrage transactions unless made in contravention of such rules and regulations as the director may adopt in order to carry out the purposes of this section.

F. The term "equity security" means:

1. Any stock or similar security.

2. Any security convertible, with or without consideration, into such a security, or carrying any warrant or right to subscribe to or purchase such a security.

3. Any such warrant or right.

4. Any other security which the director shall deem to be of similar nature and consider necessary or appropriate, by such rules and regulations as he may prescribe in the public interest or for the protection of investors, to treat as an equity security.

G. The provisions of subsections A, B and C of this section shall not apply to equity securities of a domestic stock insurance company having a class of equity securities which are registered or are required to be registered pursuant to section 12 of the securities exchange act of 1934, as amended, or as may be amended, or of a domestic stock insurance company not having a class of equity securities held of record by one hundred or more persons.

H. The director shall have the power to make such rules and regulations as may be necessary for the execution of the functions vested in him by subsections A through G of this section, and may for such purpose classify domestic stock insurance companies, securities, and other persons or matters within his jurisdiction under this section. No provision of subsections A, B and C of this section imposing any liability shall apply to any act done or omitted in good faith in conformity with any rule or regulation of the director, in the event that such rule or regulation may, after such act or omission, be amended or rescinded or determined by judicial or other authority to be invalid for any reason.
A.R.S. § 20-1365 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1365
20-1365 Cancellation
Status: in_force

20-1365. Cancellation

There may be a provision as follows: "Cancellation: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his last address as shown by the records of the insurer, stating when, not less than thirty days thereafter, such cancellation shall be effective; and after the policy has been continued beyond its original term the insured may cancel this policy at any time by written notice delivered or mailed to the insurer, effective upon receipt or on such later date as may be specified in such notice. In the event of cancellation, the insurer will return promptly the unearned portion of any premium paid. If the insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the state official having supervision of insurance in the state where the insured resided when the policy was issued. If the insurer cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation."
A.R.S. § 20-1407 — Arizona Code / Title 20 / Chapter 6 / Article 5 / Section 1407
20-1407 Children with disabilities
Status: in_force

20-1407. Children with disabilities

A group hospital or medical expense insurance policy delivered or issued for delivery in this state more than one hundred twenty days after August 27, 1977 that provides that coverage of a dependent child of an employee or other member of the covered group shall terminate on attainment of the limiting age for dependent children specified in the policy, shall also provide in substance that attainment of such limiting age shall not operate to terminate the coverage of that child while the child is and continues to be both incapable of self-sustaining employment by reason of intellectual disability or physical disability and chiefly dependent on the employee or member for support and maintenance.  Proof of such incapacity and dependency shall be furnished to the insurer by the employee or member within thirty-one days of the child's attainment of the limiting age and subsequently as may be required by the insurer, but not more frequently than annually after the two-year period following the child's attainment of the limiting age.
A.R.S. § 20-641 — Arizona Code / Title 20 / Chapter 3 / Article 4 / Section 641
20-641 Report for assessment
Status: in_force

20-641. Report for assessment

Within three years from the date an order of rehabilitation or liquidation of a domestic mutual insurer or a domestic reciprocal insurer was filed in the office of the clerk of the court by which the order was made, the receiver may make a report to the court setting forth:

1. The reasonable value of the assets of the insurer.

2. The insurer's probable liabilities.

3. The probable necessary assessment, if any, to pay all claims and expenses in full, including expenses of administration.
A.R.S. § 20-825 — Arizona Code / Title 20 / Chapter 4 / Article 3 / Section 825
20-825 Certificate of authority; requirements
Status: in_force

20-825. Certificate of authority; requirements

The director shall issue a certificate of authority authorizing the applicant to issue contracts to its subscribers when it is shown to the satisfaction of the director that:

1. The applicant is established as a bona fide, nonprofit hospital service corporation, medical service corporation, dental service corporation or optometric service corporation or combination thereof.

2. The contracts between the applicant and the participating hospitals, physicians, dentists or optometrists obligate each hospital, physician, dentist or optometrist executing them to render service to which each subscriber may be entitled under the terms of the contract to be issued to the subscribers.

3. The amounts provided as working capital of the corporation are repayable, without interest, out of operating expenses.

4. The amount of money actually available for working capital is sufficient to carry on the plan for a period of six months from the date of issuance of the certificate of authority.

5. The applicant has secured contracts of participation from sufficient hospitals, physicians, dentists or optometrists or any combination thereof to provide ample protection for its subscribers within the area proposed to be served by the applicant.
A.R.S. § 20-1241.02 — Arizona Code / Title 20 / Chapter 6 / Article 1.1 / Section 1241.02
20-1241.02 Policy summary requirements
Status: in_force

20-1241.02. Policy summary requirements

A. Any policy summary required under this article shall be in writing and shall satisfy the requirements of this section.

B. A summary of a policy or contract other than a universal life policy shall contain, to the extent applicable, at least the following information:

1. Current death benefit.

2. Annual contract premium.

3. Current cash surrender value.

4. Current dividend.

5. Application of current dividend.

6. Amount of outstanding loan.

C. A summary of a universal life policy shall contain at least the following information:

1. The beginning and end date of the current report period.

2. The policy value at the end of the previous report period and at the end of the current report period.

3. The total amounts that have been credited or debited to the policy value during the current report period, identifying each by type.

4. The current death benefit at the end of the current report period on each life covered by the policy.

5. The net cash surrender value of the policy as of the end of the current report period.

6. The amount of outstanding loans, if any, as of the end of the current report period.
A.R.S. § 20-1691.10 — Arizona Code / Title 20 / Chapter 6 / Article 15 / Section 1691.10
20-1691.10 Contestable periods
Status: in_force

20-1691.10. Contestable periods

A. If a policy or certificate has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim only on a showing of misrepresentation that is material to the acceptance for coverage.

B. If a policy or certificate has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim only on a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.

C. After a policy or certificate has been in force for two years it is not contestable solely for misrepresentation, but the insurer may contest the policy or certificate on a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.

D. An insurance producer or third party administrator shall not issue a long-term insurance policy or certificate pursuant to the underwriting authority granted to the insurance producer or third party administrator by an insurer that is based on medical or health status.

E. If an insurer paid benefits under the long-term care insurance policy or certificate, the insurer shall not recover the benefit payments if the insurer rescinds the policy or certificate.

F. If an insured dies, this section does not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. Section 20-1204 applies to the remaining death benefits.
A.R.S. § 20-1007 — Arizona Code / Title 20 / Chapter 4 / Article 7 / Section 1007
20-1007 Membership coverage by prepaid dental plan organizations
Status: in_force

20-1007. Membership coverage by prepaid dental plan organizations

A. Every member in a prepaid dental plan shall be issued a membership coverage form by the prepaid dental plan organization.

B. Any contract applied for that provides family coverage shall, as to such coverage of individuals in the family, also provide that the benefits applicable for children shall be payable with respect to a newly born child of the insured from the instant of such child's birth, to a child adopted by the insured, regardless of the age at which the child was adopted, and to a child who has been placed for adoption with the insured and for whom the application and approval procedures for adoption pursuant to section 8-105 or 8-108 have been completed to the same extent that such coverage applies to other members in the family. If payment of a specific premium is required to provide coverage for a child, the contract may require that notification of birth, adoption or adoption placement of the child and payment of the required premium shall be furnished to the insurer within thirty-one days after the date of birth, adoption or adoption placement in order to have the coverage continue beyond the thirty-one day period.

C. No membership coverage or amendment shall be issued or delivered to any person in this state until a copy of the form of the membership coverage or amendment has been filed with and approved by the director.

D. A membership coverage shall contain a clear and complete statement of a contract, or a reasonably complete summary if it is a certificate of contract, of:

1. The prepaid dental services or other benefits to which the member is entitled under the prepaid dental plan.

2. Any limitations of the services, kind of services or benefits to be provided, including any deductible or co-payment feature.

3. Where and in what manner information is available as to how services may be obtained.

4. The member's obligation respecting charges for the prepaid dental plan.

E. A membership coverage and advertising and sales material shall contain no provisions or statements that are unjust, unfair, inequitable, misleading or deceptive or that encourage misrepresentation or that are untrue.

F. The director shall approve any form of membership coverage if the requirements of subsections D and E are met and the prepaid dental plan is able in the judgment of the director to meet its financial obligations under the membership coverage. It is unlawful to issue such form until approved. If the director does not disapprove any such form within thirty days after the filing, it shall be deemed approved. If the director disapproves a form of membership coverage, the director shall notify the prepaid dental plan organization, specifying the reasons for disapproval. The director shall grant a hearing on such disapproval within fifteen days after a request in writing is received from the prepaid dental plan organization.

G. As used in subsection B of this section, the term "child", for purposes of initial coverage of an adopted child or a child placed for adoption but not for purposes of termination of coverage of such child, means a person under the age of eighteen years.
A.R.S. § 20-289.01 — Arizona Code / Title 20 / Chapter 2 / Article 3 / Section 289.01
20-289.01 Inactive license or application status during military service
Status: in_force

20-289.01. Inactive license or application status during military service

A. A licensee or applicant who is ordered into active military service may request that the license or application be placed on inactive status by sending the department a written statement that includes all of the following:

1. The licensee's name.

2. The licensee's license number or social security number.

3. The date that the active military service begins.

4. A request for inactive status.

B. The license or application is deemed to be on inactive status while the licensee or applicant is in active military service.

C. A licensee whose license is on inactive status:

1. Shall not sell, solicit or negotiate insurance.

2. May receive renewal or other deferred commissions for selling, soliciting or negotiating insurance in this state if the licensee was required to be licensed under this article at the time of the sale, solicitation or negotiation and held an active license at that time.

D. The time periods for submission of the license renewal fee and for completion of the applicable renewal requirements prescribed in this article and the continuing education requirements that are prescribed in chapter 18, article 1 of this title and that apply to a licensee with an active license are extended for a licensee whose license is on inactive status by the number of days that the licensee is in active military service. A licensee applying for renewal under this section shall include, with the renewal application, a copy of the documentation from the armed forces showing the period of time that the licensee was in active military service.

E. For the purposes of this section, active military service does not include periodic and routine service as a military reservist.
A.R.S. § 20-3501 — Arizona Code / Title 20 / Chapter 28 / Article 1 / Section 3501
20-3501 Definitions
Status: in_force

20-3501. Definitions

In this chapter, unless the context otherwise requires:

1. "Classification of benefits" means the following classifications of benefits provided by a health plan:

(a) Inpatient, in-network.

(b) Inpatient, out-of-network.

(c) Outpatient, in-network.

(d) Outpatient, out-of-network.

(e) Emergency care.

(f) Prescription benefits.

2. "Health care insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital, medical, dental and optometric service corporation that issues a health plan in this state.

3. "Health plan" means an individual health plan or accountable health plan that provides mental health services or mental health benefits, that finances or provides covered health care services, that is issued by a health care insurer in this state and that is subject to the mental health parity and addiction equity act.

4. "Mental health parity and addiction equity act" means the mental health parity and addiction equity act of 2008 (42 United States Code section 300gg-26) and implementing regulations.

5. "Product network type" means the network model associated with the type of health plan under which covered health care is delivered, such as a health care services organization, preferred provider network organization, point of service plan or indemnity plan.

6. "Treatment limits":

(a) Means limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period or other similar limits on the scope or duration of treatment.

(b) Includes both quantitative treatment limits that are expressed numerically and nonquantitative treatment limits that otherwise limit the scope or duration of benefits for treatment under a health plan.

(c) Does not include a permanent exclusion of all benefits for a particular condition or disorder.
A.R.S. § 20-1405 — Arizona Code / Title 20 / Chapter 6 / Article 5 / Section 1405
20-1405 Provisions of group and blanket disability policy
Status: in_force

20-1405. Provisions of group and blanket disability policy

The provisions of article 4 of chapter 6 of this title shall not apply to group disability or blanket disability insurance policies, but no such policy of group or blanket disability insurance shall contain any provision relative to notice or proof of loss, or to the time for paying benefits, or to the time within which suit may be brought on the policy, which is less favorable to the individuals insured than would be permitted by the standard provisions required for individual disability insurance policies.
A.R.S. § 20-401 — Arizona Code / Title 20 / Chapter 2 / Article 5 / Section 401
20-401 Definitions
Status: in_force

20-401. Definitions

In this article, unless the context otherwise requires:

1. "Affiliated" means, with respect to an insured, any entity that controls, is controlled by or is under common control with the insured.  For the purposes of this paragraph, "control" means either:

(a) Directly or indirectly acting through one or more other persons who own, control or have the power to vote twenty-five percent or more of any class of voting securities of the other entity.

(b) Control in any manner over the election of a majority of the directors or trustees of the other entity.

2. "Affiliated group" means any group of entities that are affiliated.

3. "Clearinghouse" means the mechanism or entity established pursuant to a multistate agreement or compact for the receipt and distribution of premium taxes and transaction data related to the sale of unauthorized insurance.

4. "Diligent effort" means having sought insurance for the same risk from at least three insurers authorized in this state to write the particular insurance coverage or type, class or kind of insurance.

5. "Domestic surplus lines insurer" means an insurer that is domiciled in and authorized to transact insurance in this state and that has received approval from the department pursuant to section 20-407.01 to write surplus lines insurance coverage in this state.

6. "Foreign decree" means any decree or order in equity of a court located in a reciprocal state, including a court of the United States located therein, obtained by a qualified party against any insurer incorporated or authorized to do business in this state.

7. "Home state" means one of the following:

(a) The state in which an insured maintains its principal place of business or, in the case of an individual, the individual's principal place of residence.

(b) If one hundred percent of the insured risk is located out of the state that would be the insured's home state pursuant to subdivision (a) of this paragraph, the state to which the greatest percentage of the insured's taxable premium is allocated for the insurance contract in question.

(c) If more than one insured from an affiliated group are named insureds on a single nonadmitted insurance contract, the state as determined pursuant to subdivision (a) of this paragraph of the member of the affiliated group that has the largest percentage of premium attributed to it under the insurance contract.

8. "Multistate risk" means a risk covered by an unauthorized insurer with insured exposures in more than one state.

9. "Qualified party" means a state regulatory agency acting in its capacity to enforce the insurance laws of that state.

10. "Reciprocal state" means any state or territory of the United States the laws of which give to insurers organized under the laws of this state the same right to defend actions as that granted to foreign insurers under the laws of this state and the laws of which contain procedures substantially similar to those specified in this article for the enforcement of decrees or orders in equity issued by courts located in other states or territory of the United States against any insurer incorporated or authorized to do business in that state or territory.

11. "Single-state risk" means a risk with insured exposures in only one state.

12. "Unauthorized insurance", "surplus lines insurance" or "nonadmitted insurance" means any insurance permitted to be placed directly or through a surplus lines broker with an insurer who is not licensed to transact insurance in this state or with a domestic surplus lines insurer.
A.R.S. § 20-1098 — Arizona Code / Title 20 / Chapter 4 / Article 14 / Section 1098
20-1098 Definitions
Status: in_force

20-1098. Definitions

In this article, unless the context otherwise requires:

1. "Affiliate" has the same meaning prescribed in section 20-481.

2. "Agency captive insurer" means a captive insurer that is owned by one or more business entities that are licensed in any state as insurance producers or managing general agents and that only insure risks on policies placed through their owners.

3. "Alien captive insurer" means any insurer that is formed to write insurance business for its affiliates and that is licensed pursuant to the laws of an alien jurisdiction that imposes statutory or regulatory standards that are acceptable to the director on companies transacting the business of insurance in such a jurisdiction.

4. "Association" means any lawfully formed association of individuals or business entities that has been in existence for at least one year and that is organized for a primary purpose other than procuring or providing insurance for its members.

5. "Association captive insurer" means a captive insurer that is completely under the direct or indirect voting control of an association.

6. "Branch business" means any insurance business that is transacted by a branch captive insurer in this state.

7. "Branch captive insurer" means an alien captive insurer or a foreign captive insurer that establishes a business unit with a principal place of business in this state and that is licensed pursuant to this chapter to transact the business of insurance through the business unit.

8. "Branch operations" means any business operations of a branch captive insurer in this state.

9. "Business entity" means any legal entity other than an individual or sole proprietorship.

10. "Captive insurer" means any pure captive insurer, agency captive insurer, group captive insurer or protected cell captive insurer that is domiciled in this state and that is formed and licensed under this article.

11. "Controlled unaffiliated business" means an individual or business entity that satisfies all of the following:

(a) Is not an affiliate of the captive insurer providing coverage or reinsurance.

(b) Has a contractual relationship with an affiliate of the captive insurer providing coverage or reinsurance.

(c) Whose risk management function that is related to the covered risk of loss is controlled by an affiliate of the captive insurer providing coverage or reinsurance.

12. "Deductible reimbursement" means insurance coverage that reimburses the insured for the deductible it paid under a separate commercial insurance policy issued to the same insured, without other conditions related to the underlying loss.

13. "Direct or directly", when used in this article to describe the transaction of insurance business by a captive insurer, means a transaction in which the captive insurer issues an insurance policy that provides primary coverage to the insured under the policy and that does not provide reinsurance coverage to another insurer.

14. "Dormant captive insurer":

(a) Means a captive insurer that has both:

(i) Ceased transacting the business of insurance, including issuing insurance policies.

(ii) No outstanding liabilities associated with the business of insurance or has not issued any insurance policy before filing an application for a certificate of dormancy.

(b) Does not include a captive risk retention group.

15. "Foreign captive insurer" means any captive insurer that is domiciled in and licensed under the laws of another state that imposes statutory or regulatory standards on captive insurance companies in that state that are acceptable to the director.

16. "Group captive insurer" means any of the following:

(a) A risk retention group.

(b) An industry group captive insurer.

(c) An association captive insurer.

17. "Industry group" means two or more business entities or persons that are engaged in businesses or activities similar or related with respect to the liability that they are exposed to by virtue of any related, similar or common business, trade, product, services, premises or operations.

18. "Industry group captive insurer" means a captive insurer that is completely under the direct or indirect voting control of an industry group.

19. "Manager" means a person who is experienced in the field of captive insurance and who maintains all documents relating to a captive insurer's operations, transactions and affairs in this state and assists the captive insurer in its management and compliance with this article.

20. "Member" means any individual or business entity that belongs to a group captive insurer.

21. "Participant" means an entity and any affiliates of the entity that are insured by a protected cell captive insurer pursuant to a participant contract.

22. "Participant contract" means a contract by which a protected cell captive insurer insures risks of one or more participants and limits losses under the contract to the assets of a protected cell.

23. "Protected cell" means a separate account that is established and maintained by a protected cell captive insurer pursuant to a participant contract.

24. "Protected cell captive insurer" means a captive insurer:

(a) In which the minimum capital and surplus required by applicable law is provided by one or more sponsors.

(b) That is formed and licensed under this article.

(c) That insures the risks of participants through participant contracts.

(d) That segregates liability under a participant contract through one or more protected cells.

25. "Pure captive insurer" means a captive insurer that insures only the risks of its affiliates and controlled unaffiliated business.

26. "Risk retention group" means a captive insurer that is organized pursuant to the liability risk retention act of 1986 (15 United States Code sections 3901 and 3902) and chapter 14 of this title.

27. "Sponsor" means an entity that meets the requirements of section 20-1098.06 and that the director has approved to provide all or part of the capital and surplus required by applicable law to operate a protected cell captive insurer.
A.R.S. § 20-1693.02 — Arizona Code / Title 20 / Chapter 6 / Article 17 / Section 1693.02
20-1693.02 Portable electronics insurance; requirements; disclosures
Status: in_force

20-1693.02. Portable electronics insurance; requirements; disclosures

A. At every location where portable electronics insurance is offered to customers, brochures or other written materials must be made available to a prospective customer that:

1. Disclose that portable electronics insurance may provide a duplication of coverage already provided by a customer's homeowner's insurance policy, renter's insurance policy or other source of coverage.

2. State that the enrollment by the customer in a portable electronics insurance policy is not required in order to purchase or lease portable electronics or services.

3. Summarize the material terms of the insurance coverage, including:

(a) The identity of the insurer.

(b) The identity of the supervising entity.

(c) The amount of any applicable deductible and how it is to be paid.

(d) Benefits of the coverage.

(e) Key terms and conditions of the coverage, including whether portable electronics may be repaired or replaced with similar make and model reconditioned or nonoriginal manufacturer parts or equipment.

4. Summarize the process for filing a claim, including a description of how to return portable electronics and the maximum fee applicable in the event the customer fails to comply with any equipment return requirements.

5. State that an enrolled customer may cancel enrollment for coverage under a portable electronics insurance policy at any time and the person paying the premium shall receive a refund or credit of any applicable unearned premium.

B. Portable electronics insurance may be offered on a month to month or other periodic basis as a group or master commercial inland marine policy issued to a vendor of portable electronics for its enrolled customers.

C. Eligibility and underwriting standards for customers electing to enroll in coverage shall be established for each portable electronics insurance program.
A.R.S. § 20-841.04 — Arizona Code / Title 20 / Chapter 4 / Article 3 / Section 841.04
20-841.04 Standing referrals to network health care professionals; definition
Status: in_force

20-841.04. Standing referrals to network health care professionals; definition

A. Any corporation that offers a health benefits plan shall establish a procedure by which a subscriber may apply for a standing referral to a network health care professional.  The corporation shall provide a subscriber with a standing referral if all of the following conditions are met:

1. The subscriber is a covered member of that corporation.

2. The subscriber has a disease or condition that is life threatening, degenerative, chronic or disabling.

3. The subscriber's primary care physician or registered nurse practitioner in conjunction with a network health care professional determines that the subscriber's health care requires a network health care professional's expertise.

4. The subscriber's primary care physician or registered nurse practitioner determines that the subscriber's disease or condition will require ongoing medical care for an extended period of time.

5. The standing referral is made by the subscriber's primary care physician or registered nurse practitioner to a network health care professional who is responsible for providing and coordinating the subscriber's specialty care.

6. The network health care professional is authorized by the corporation to provide the services under the standing referral.

B. The corporation may limit the number of visits and time period for which a subscriber may receive a standing referral.

C. If the subscriber receives a standing referral or any other referral from the subscriber's primary care physician, that referral remains in effect even if the primary care physician leaves the corporation's network.

D. If the treating health care professional leaves the network or the subscriber ceases to be a covered member, the standing referral expires.

E. This section does not apply to any corporation that holds a certificate of authority to operate either as a dental service corporation or an optometric service corporation.

F. For the purposes of this section, "network health care professional" means a practitioner of a health profession as defined in section 32-3101 who is under written contract with the corporation to provide services in a specialty discipline that is recognized by an American medical specialty board.
A.R.S. § 20-517 — Arizona Code / Title 20 / Chapter 3 / Article 1 / Section 517
20-517 Report of acquisitions and dispositions
Status: in_force

20-517. Report of acquisitions and dispositions

A. Each insurer that is domiciled in this state shall file with the director a report that discloses material acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements unless the insurer has submitted the acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements to the director for review, approval or information purposes pursuant to any other law or rule.

B. The insurer shall file the report within fifteen days after the end of the calendar month in which any of the transactions listed in subsection A occur.

C. The insurer shall file a copy of the report, including any exhibits or other attachments that are filed with the report, with the national association of insurance commissioners.

D. All reports that are obtained by or disclosed to the director pursuant to this section are confidential and are not subject to subpoena. The director, the national association of insurance commissioners and any other person may disclose a report to the insurance department of another state but may not make a report public without the prior written consent of the insurer unless the director, after giving the insurer notice and an opportunity to be heard, determines that the interests of the policyholders, shareholders or public will be served by the publication of the report. If the director determines that publication is in the interests of the policyholders, shareholders or public, the director may publish part or all of the report in a manner that the director deems appropriate.
A.R.S. § 20-1136 — Arizona Code / Title 20 / Chapter 5 / Article 1 / Section 1136
20-1136 Accelerated payments of certain benefits in life insurance policies
Status: in_force

20-1136. Accelerated payments of certain benefits in life insurance policies

A. Notwithstanding any other provision of this title, any policy of life insurance may provide, in accordance with the provisions of subsection B, for the acceleration of death benefits in advance of the time such benefits would otherwise be payable upon the occurrence of a terminal illness, a catastrophic illness, or eligibility for long-term care.

B. The director may adopt rules regarding advertising, disclosure, benefit levels, benefit eligibility, nonforfeiture, and reserves for the accelerated payment of death benefits set forth under subsection A.
A.R.S. § 20-871 — Arizona Code / Title 20 / Chapter 4 / Article 4 / Section 871
20-871 Authority to maintain institutions
Status: in_force

20-871. Authority to maintain institutions

A. A society may create, maintain and operate or establish an organization to operate not for profit institutions to further the purposes of the society as prescribed by section 20-864. An institution established pursuant to this section may provide services for free or for a reasonable charge.

B. The society shall report in each annual statement any real or personal property that the society owns, holds or leases for the purposes of any institutions established pursuant to this section, except that the property shall not be allowed as an admitted asset of the society.
A.R.S. § 20-449 — Arizona Code / Title 20 / Chapter 2 / Article 6 / Section 449
20-449 Rebates on life or disability insurance
Status: in_force

20-449. Rebates on life or disability insurance

A. Except as otherwise expressly provided by law, no person shall knowingly permit or offer to make or make any contract of life insurance, life annuity or disability insurance, or agreement as to such contract other than as plainly expressed in the contract issued thereon, or pay or allow, or give or offer to pay, allow or give, directly or indirectly, as an inducement to such insurance or annuity, any rebate of premiums payable on the contract, or any special favor or advantage in the dividends or other benefits thereon, or any valuable consideration or inducement whatever not specified in the contract.

B. This section does not prohibit an insurer from retaining an independent third party to conduct a customer feedback effort intended to help the insurer improve the quality of its products or services and to offer an insured business or individual a reasonable incentive to participate in the feedback effort.  An incentive is presumed reasonable if it does not exceed two hundred dollars.  An insurer may not offer, reference or promote an incentive or feedback effort under this section in connection with an application for or renewal of insurance coverage.  For the purposes of this subsection, "feedback effort" means activities that are designed to elicit customer perceptions on a predetermined set of topics that are related to the insurer's products or services, including in-person, telephonic or online surveys, polls, focus groups, interviews, questionnaires and other recognized opinion-gathering mechanisms.
A.R.S. § 20-1502 — Arizona Code / Title 20 / Chapter 6 / Article 7 / Section 1502
20-1502 "Fire insurance" defined
Status: in_force

20-1502. "Fire insurance" defined

"Fire insurance" is insurance against the perils of fire or lightning as written under the Arizona standard fire policy.
A.R.S. § 20-1693.05 — Arizona Code / Title 20 / Chapter 6 / Article 17 / Section 1693.05
20-1693.05 Termination of portable electronics insurance; notice; cancellation
Status: in_force

20-1693.05. Termination of portable electronics insurance; notice; cancellation

A. Notwithstanding any other law:

1. An insurer may terminate or otherwise change the terms and conditions of a portable electronics insurance policy only on providing the policyholder and enrolled customers with at least thirty days' notice.

2. If the insurer changes the terms and conditions of a policy, the insurer shall provide the vendor policyholder with a revised policy or endorsement and each enrolled customer with a revised certificate, endorsement, updated brochure or other evidence indicating that a change in the terms and conditions has occurred and that includes a summary of the material changes.

B. Notwithstanding subsection A, paragraph 1 of this section:

1. An insurer may terminate a customer's enrollment under a portable electronics insurance policy with fifteen days' notice for discovery of fraud or material misrepresentation in obtaining coverage or in the presentation of a claim.

2. An insurer may immediately terminate a customer's enrollment under a portable electronics insurance policy for any of the following reasons:

(a) Nonpayment of premium.

(b) If the enrolled customer ceases to have an active service with the vendor.

(c) If an enrolled customer exhausts the aggregate limit of liability, if any, under the terms of the portable electronics insurance policy and the insurer sends notice of termination to the enrolled customer within thirty calendar days after exhaustion of the limit. If notice is not timely sent, enrollment shall continue notwithstanding the aggregate limit of liability until the insurer sends notice of termination to the enrolled customer.

C. If a vendor terminates a portable electronics insurance policy, the vendor shall mail or deliver written notice to each enrolled customer advising the enrolled customer of the termination of the policy and the effective date of termination. The written notice shall be mailed or delivered to the enrolled customer at least thirty days before the termination.

D. If notice or correspondence with respect to a policy of portable electronics insurance is required pursuant to this section or is otherwise required by law, it shall be in writing and sent within the notice period, if any, specified in the statute or rule requiring the notice or correspondence. Notwithstanding any other law, notices and correspondence may be sent either by mail or by electronic means.  If the notice or correspondence is mailed, it shall be sent to the vendor at the vendor's mailing address specified for such purpose and to its affected enrolled customers' last known mailing addresses on file with the insurer.  The insurer or vendor shall maintain proof of mailing in a form authorized or accepted by the United States postal service or other commercial mail delivery service. If the notice or correspondence is sent by electronic means, it shall be sent to the vendor at the vendor's electronic mail address specified for such purpose and to its affected enrolled customers' last known electronic mail addresses as provided by each enrolled customer to the insurer or vendor, as applicable. For the purposes of this section, an enrolled customer's provision of an electronic mail address to the insurer or vendor is deemed to constitute consent to receive notices and correspondence by electronic means. The insurer or vendor, as applicable, shall maintain proof that the notice or correspondence was sent.

E. The supervising entity appointed by the insurer may send notice or correspondence that is required by this section, or that is otherwise required by law, on behalf of an insurer or vendor.

F. An enrolled customer may cancel enrollment for coverage under a portable electronics insurance policy at any time and the person paying the premium shall receive a pro rata refund or credit of any applicable unearned premium within sixty days after the insurer or vendor receives the notice of cancellation from the enrolled customer.
A.R.S. § 20-1348 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1348
20-1348 Reinstatement
Status: in_force

20-1348. Reinstatement

A. There shall be a provision as follows:  "Reinstatement: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy, provided, however, that if the insurer or such agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application.  The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty days prior to the date of reinstatement."

B. The last sentence of the provision set forth in subsection A of this section may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age fifty or, in the case of a policy issued after age forty-four for at least five years from its date of issue.
A.R.S. § 20-1606.01 — Arizona Code / Title 20 / Chapter 6 / Article 10 / Section 1606.01
20-1606.01 Credit unemployment insurance; provisions
Status: in_force

20-1606.01. Credit unemployment insurance; provisions

A. A credit unemployment insurance policy shall contain benefits that are at least as favorable to insureds as the following provisions:

1. The policy shall provide coverage for unemployment for any reason, except that coverage may be excluded for unemployment due to:

(a) Voluntary forfeiture of salary, wage or other employment income.

(b) Resignation.

(c) Retirement.

(d) General strike.

(e) Illegal walk out.

(f) War.

(g) Separation from the military.

(h) Willful misconduct, criminal misconduct or unlawful behavior.

(i) Disability caused by injury, sickness or pregnancy.

2. For credit unemployment insurance that provides a monthly benefit, benefits shall start after a waiting period of no more than thirty days, but need not be retroactive to the first day of unemployment and shall have a maximum benefit period of at least six months.

B. A credit unemployment insurance policy shall not contain eligibility requirements more restrictive than the following:

1. The policy may exclude from qualification for coverage:

(a) A self-employed individual.

(b) A worker in a seasonal or temporary job.  For the purposes of this subdivision, "seasonal or temporary job" means a job designed to last no more than six consecutive months.

(c) A debtor who has been notified in writing of any layoff or employment termination that is to occur within sixty days of the date coverage begins.

2. The policy shall not have an employment requirement more restrictive than requiring a debtor to be employed full-time on the effective date of coverage for at least six consecutive months before the effective date of coverage.  For the purposes of this paragraph, "full-time" means a regular work week of not less than thirty hours.
A.R.S. § 20-1060 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1060
20-1060 Taxes; exemption
Status: in_force

20-1060. Taxes; exemption

A. Except as provided in subsection C of this section, on the tax payment dates prescribed in section 20-224, each health care services organization shall pay to the director for deposit, pursuant to sections 35-146 and 35-147, in a form prescribed by the director a tax for transacting a health care plan in the amount of 2.0 percent of net charges received from enrollees.

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. Payments received by health care services organizations from the United States secretary of health and human services pursuant to a contract issued pursuant to 42 United States Code section 1395mm(g) are not taxable under this section.

D. A health care services organization may claim a premium tax credit if the organization qualifies for a credit pursuant to section 20-224.03.
A.R.S. § 20-3101 — Arizona Code / Title 20 / Chapter 20 / Article 1 / Section 3101
20-3101 Definitions
Status: in_force

20-3101. Definitions

In this article, unless the context otherwise requires:

1. "Adjudicate" means an insurer's decision to deny or pay a claim, in whole or in part, including the decision as to how much to pay.

2. "Clean claim" means a written or electronic claim for health care services or benefits that may be processed without obtaining additional information, including coordination of benefits information, from the health care provider, the enrollee or a third party, except in cases of fraud.

3. "Enrollee" means an individual who is enrolled under a health care insurer's policy, contract or evidence of coverage.

4. "Grievance":

(a) Means any written complaint that is subject to resolution through the insurer's system that is prescribed in section 20-3102, subsection F and submitted by a health care provider and received by a health care insurer.

(b) Includes any delay in the timeliness of claim adjudication that results in a delay of payment of a clean claim as prescribed in section 20-3102.

(c) Does not include a complaint:

(i) By a noncontracted provider regarding an insurer's decision to deny the noncontracted provider admission to the insurer's network.

(ii) About an insurer's decision to terminate a health care provider from the insurer's network.

(iii) That is the subject of a health care appeal pursuant to chapter 15, article 2 of this title.

5. "Health care insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, prepaid dental plan organization, hospital service corporation, medical service corporation, dental service corporation, optometric service corporation, or hospital, medical, dental and optometric service corporation.
A.R.S. § 20-1674 — Arizona Code / Title 20 / Chapter 6 / Article 14 / Section 1674
20-1674 Notice of cancellation; refund of unearned premium
Status: in_force

20-1674. Notice of cancellation; refund of unearned premium

A. A cancellation under section 20-1673 is not effective unless the insurer sends a copy of the notice of cancellation to the insured's agent and to the named insured at least forty-five days before the effective date of the cancellation, except that, if cancellation is for nonpayment of premium, at least ten days' notice of cancellation must be given. The notice must state the specific facts that constitute the grounds set forth in section 20-1673 that are relied on.  If the insurer sends the notice by mail, the insurer shall obtain proof of mailing by United States certified mail or first class mail using intelligent mail barcode or another similar tracking method used or approved by the United States postal service.

B. The notice of cancellation and any refund of unearned premium may be sent separately, but both must be sent within the time frames established in subsection A of this section.  If a premium has been financed, a refund of unearned premium shall be returned as provided in section 6-1416.
A.R.S. § 20-454 — Arizona Code / Title 20 / Chapter 2 / Article 6 / Section 454
20-454 Programs for purchase by policyholders of securities of companies not engaged in insurance
Status: in_force

20-454. Programs for purchase by policyholders of securities of companies not engaged in insurance

Notwithstanding the provisions of section 20-452 and notwithstanding any other provision of law, domestic life insurers, whether of the stock, mutual, fraternal or limited capital stock type that on January 1, 1955 are engaged pursuant to the requirements of title 44, chapter 12 in a program whereby the holders of their life insurance policies are offered the right from time to time to buy for cash or to exchange dividends on such policies or other policy values resulting therefrom for securities in domestic corporations neither engaged in nor organized to engage in the insurance business shall be permitted, subject to the requirements of title 44, chapter 12, to continue to engage in such program notwithstanding the adoption of this title, but no such insurer shall so engage unless the right to buy or the dividends or other policy values subject to exchange result from ownership of or are payable on account of a policy that from its inception is or that, within a period of not to exceed six years from its issue date, becomes a life insurance policy on a permanent plan other than term. From and after being placed on such permanent plan, every such policy shall be in full compliance with sections 20-1231 and 20-1231.01 (standard nonforfeiture law), computed as from the date of being placed on such permanent plan.  No such program shall be engaged in by the insurer subsequent to January 1, 1960, except that any such insurer may, subject to title 44, chapter 12, cause to be delivered stock in such corporation for an indefinite period subsequent to such limiting date if the right to acquire the stock arises as a result of a policy actually issued and delivered prior to such date.
A.R.S. § 20-2532 — Arizona Code / Title 20 / Chapter 15 / Article 2 / Section 2532
20-2532 Utilization review standards and criteria; requirements
Status: in_force

20-2532. Utilization review standards and criteria; requirements

A. Each utilization review agent shall:

1. Adopt a written utilization review plan with standards and criteria that apply to all utilization review determinations and that are objective, clinically valid and compatible with established principles of health care.

2. Establish the utilization review plan with input from physician advisors who represent major medical specialties and who are certified or board eligible under the standards of the appropriate American medical specialty board.

3. Include in the adopted utilization review plan a process for prompt initial reconsideration of an adverse determination and a process for appeals that meet the requirements of this article. This paragraph does not apply to utilization review activities limited to retrospective claims review.

B. Deviations from the written standards and criteria in the utilization review plan are allowed if the utilization review agent determines that the member and other members with similar symptoms and diagnoses would materially benefit from new treatments available because of medical or technological advances made since the adoption of the utilization review plan and made in accordance with accepted medical standards. This subsection does not apply to utilization review activities limited to retrospective claims review. Nothing in this subsection creates a private right or cause of action against a health care insurer or utilization review agent for failure to deviate from the utilization review plan.

C. A health care insurer who uses the services of an outside utilization review agent shall adopt a utilization review plan pursuant to subsections A and B of this section. The utilization review plan adopted and filed by the health care insurer who uses the services of an outside utilization review agent is deemed adopted by that utilization review agent.

D. A health care insurer who uses the services of an outside utilization review agent is responsible for the utilization review agent's acts that are within the scope of the written and filed utilization review plan, including the administration of all patient claims processed by the utilization review agent on behalf of the health care insurer.

E. Each utilization review agent shall file a notice with the director that provides a specific description and the published date of the source of the written standards and criteria of the utilization review plan and that certifies that the utilization review plan in use complies with the requirements of this section, is available for review and inspection at a designated location in this state or at an office accessible to authorized representatives of the director in another state and is the complete utilization review plan with all standards and criteria on which utilization review decisions are based. A copy of any portion of the utilization review plan on which any adverse determinations have been based shall be made before the effective date of any modification and the utilization review agent shall retain a copy at the designated location for review and inspection for a period of five years after the date of the modification. If at any time a complete change in the written standards and criteria occurs, the utilization review agent shall file a new certification notice with the director.

F. On or before March 1 of each year after the year in which the utilization review agent filed the notice prescribed in subsection E of this section, the utilization review agent or the agent's successor shall submit a signed and notarized annual report to the director that includes the designated location for review and inspection by the director or the director's authorized representative and that certifies that:

1. The utilization review plan and all modifications remain in compliance with the requirements of this section.

2. The utilization review agent will conduct all utilization reviews in accordance with the plan.

3. All adverse determinations made in the prior year were based on the plan in effect on the date of those adverse determinations.

G. On written request, the utilization review agent shall provide copies to any member or the member's treating provider of:

1. Those portions of the utilization review agent's utilization review plan that are relevant to the request for a covered service or claim for a covered service.

2. The protocols or guidelines that were used if the standards and criteria adopted are based on protocols or guidelines developed by an American medical specialty board.

H. Any person who requests records pursuant to subsection G of this section shall direct the request to the utilization review agent and not to the department.

I. If the utilization review plan is copyrighted by a person other than the utilization review agent, the health care insurer shall make a good faith effort to obtain permission from that person to make copies of the relevant material. If the health care insurer is unable to secure copyright permission, the utilization review agent shall provide a detailed summary of the relevant portions of the utilization review plan.

J. Health care insurers having utilization review activities limited to retrospective claims review shall be required to adopt only those procedures and sources of review that are traditionally associated with and necessary for retrospective claims review.
A.R.S. § 20-825.01 — Arizona Code / Title 20 / Chapter 4 / Article 3 / Section 825.01
20-825.01 Minimum capital or surplus required; application
Status: in_force

20-825.01. Minimum capital or surplus required; application

A corporation that is exempt from the risk-based capital requirement prescribed in section 20-488.08 shall maintain unimpaired capital or surplus, or both, in the amount of at least twenty-five thousand dollars.
A.R.S. § 20-1111 — Arizona Code / Title 20 / Chapter 5 / Article 1 / Section 1111
20-1111 Grounds for disapproval of forms
Status: in_force

20-1111. Grounds for disapproval of forms

A. The director shall disapprove any form of policy, application, rider or endorsement or withdraw any previous approval thereof only:

1. If it is in any respect in violation of or does not comply with this title.

2. If it contains or incorporates by reference any inconsistent, ambiguous or misleading clauses, or exceptions and conditions which deceptively affect the risk purported to be assumed in the general coverage of the contract.

3. If it has any title, heading or other indication of its provisions which is misleading.

4. If the purchase of such policy is being solicited by false, deceptive or misleading advertising matter, sales material or representations.

B. The director may disapprove any proof of death or loss form only if it imposes unreasonable requirements, or is in violation of this title, or contains deceptive or ambiguous matter.

C. The director may disapprove any advertising matter or sales material which is in violation of this title.
A.R.S. § 20-365 — Arizona Code / Title 20 / Chapter 2 / Article 4 / Section 365
20-365 Cooperation in rate making
Status: in_force

20-365. Cooperation in rate making

Cooperation among rating organizations and among rating organizations and insurers in rate making and in other matters within the scope of this article is authorized, if the filings resulting from such cooperation are subject to the provisions of this article. The director may review such cooperative activities and practices and if, after a hearing, he finds that any such activity or practice is unfair or unreasonable or otherwise inconsistent with the provisions of this article, he may issue a written order specifying in what respects such activity or practice is unfair or unreasonable or otherwise inconsistent, and requiring the discontinuance of such activity or practice.
A.R.S. § 20-1692.02 — Arizona Code / Title 20 / Chapter 6 / Article 16 / Section 1692.02
20-1692.02 Eligibility under title XIX of the social security act
Status: in_force

20-1692.02. Eligibility under title XIX of the social security act

A. An insurer, hospital and medical service corporation, health care services organization group health plan shall not consider the availability of or a person's eligibility for medical assistance pursuant to title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396a (1980)) when considering eligibility for coverage or calculating payments under a plan for eligible subscribers.

B. To the extent that payment for covered expenses has been made under the state program pursuant to title XIX of the social security act for health care items or services furnished to an individual, the state is considered to have acquired the rights of the individual to payment by any other party for those health care items or services. On presentation of proof that the state program pursuant to title XIX of the social security act has paid for covered items or services, the insurer, hospital and medical service corporation, health care services organization or group health plan shall make payments to the program pursuant to title XIX of the social security act according to the coverage provided in the policy, certificate, evidence of coverage or contract.

C. An insurer, hospital and medical service corporation, health care services organization or group health plan may not impose on a state agency that has been assigned the rights of an individual who is eligible for medical assistance and who is covered for health benefits from the insurer any requirements that are different from the requirements applicable to an agent or assignee of any other covered individual.
A.R.S. § 20-485.08 — Arizona Code / Title 20 / Chapter 2 / Article 9 / Section 485.08
20-485.08 Delivery of written communications
Status: in_force

20-485.08. Delivery of written communications

Any policies, certificates, booklets, termination notices or other written communications delivered by the insurer to the administrator for delivery to its policyholders shall be delivered by the administrator promptly after receipt of instructions from the insurer to do so.
A.R.S. § 20-1097.05 — Arizona Code / Title 20 / Chapter 4 / Article 13 / Section 1097.05
20-1097.05 Prepaid legal insurance contracts; rates
Status: in_force

20-1097.05. Prepaid legal insurance contracts; rates

Rates shall not be considered unfairly discriminatory when they are averaged broadly among persons covered under group, blanket or franchise contracts. Rates for legal insurance shall be established consistent with the requirements of title 20, chapter 2, article 4.1.
A.R.S. § 20-481.21 — Arizona Code / Title 20 / Chapter 2 / Article 8 / Section 481.21
20-481.21 Confidential records; consent to release; release without consent; information sharing
Status: in_force

20-481.21. Confidential records; consent to release; release without consent; information sharing

A. All documents, materials or other information that is in the possession or control of the department and that is obtained by or disclosed to the director or any other person in the course of a filing, an examination or an investigation made pursuant to sections 20-481.03, 20-481.10, 20-481.12, 20-481.19 and 20-481.20 is recognized by this state as being proprietary and containing trade secrets, is confidential and privileged, is not subject to title 39, chapter 1, article 2, is not subject to subpoena and is not subject to discovery or admissible as evidence in a private civil action. The director may use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the director's official duties. The director shall not make the documents, materials or other information public without the prior written consent of the insurer to which it pertains unless the director determines, after giving the insurer and its affiliates who would be affected by the publication notice and an opportunity to be heard, that the interests of policyholders, shareholders or the public will be served by the publication. The director may then publish all or any part of the documents, materials or other information as the director deems appropriate.

B. For the purposes of the information that is reported and provided to the department pursuant to section 20-481.10, subsection D, paragraph 2, the director shall maintain the confidentiality of the following:

1. The group capital calculation and the group capital ratio produced within the calculation.

2. Any group capital calculation information that is received from an insurance holding company system supervised by the federal reserve board or any United States group-wide supervisor.

C. For the purposes of the information that is reported and provided to the department pursuant to section 20-481.10, subsection D, paragraph 3, the director shall maintain the confidentiality of the liquidity stress test results and supporting disclosures and any liquidity stress test framework information that is received from an insurance holding company system supervised by the federal reserve board or any non-United States group-wide supervisor.

D. The director may:

1. Share nonpublic documents, materials or other information, including proprietary and trade secret documents and materials, with other state, federal and international regulatory agencies, with the national association of insurance commissioners and with any third-party consultants designated by the director, with state, federal and international law enforcement authorities, including members of any supervisory college described in section 20-481.31, if the recipient agrees and warrants that it has the authority to maintain the confidentiality and privileged status of the documents, materials or other information and has verified in writing the legal authority to maintain confidentiality.

2. Receive documents, materials and other information, including proprietary and trade secret documents and materials, from the national association of insurance commissioners or a third-party consultant designated by the director and from regulatory and law enforcement officials of other jurisdictions and shall maintain as confidential or privileged any document, material or other 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 other information.

E. The director shall enter into written agreements with the national association of insurance commissioners and any third-party consultant designated by the director that govern the sharing and use of information provided pursuant to this article and that are consistent with this section and that do all of the following:

1. Specify procedures and protocols regarding the confidentiality and security of information shared with the national association of insurance commissioners or a third-party consultant designated by the director pursuant to this article, including procedures and protocols for sharing information by the national association of insurance commissioners with other state, federal or international regulators. The agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the documents, materials or other information and has verified in writing the legal authority to maintain such confidentiality.

2. Specify that the director has ownership of all information shared with the national association of insurance commissioners or a third-party consultant designated by the director pursuant to this article and the national association of insurance commissioners' or the third-party consultant's use of the information is subject to the direction of the director.

3. Except as provided in section 20-481.10, subsection D, paragraph 3, prohibit the national association of insurance commissioners or a third-party consultant designated by the director from storing the information shared in this article in a permanent database after the underlying analysis is completed.

4. Require prompt notice to be given to an insurer whose confidential information in the possession of the national association of insurance commissioners or a third-party consultant designated by the director pursuant to this article is subject to a request or subpoena to the national association of insurance commissioners or a third-party consultant designated by the director for disclosure or production.

5. Require the national association of insurance commissioners or a third-party consultant designated by the director to consent to intervention by an insurer in any judicial or administrative action in which the national association of insurance commissioners or a third-party consultant designated by the director may be required to disclose confidential information about the insurer shared with the national association of insurance commissioners and its affiliates and subsidiaries pursuant to this article.

6. For reporting pursuant to section 20-481.10, subsection D, paragraph 3, if the agreement involves a third-party consultant, provide notification of the identity of any third-party consultant to all applicable insurers.

F. Notwithstanding subsection D, paragraph 1 of this section, the director may share confidential and privileged documents, material or information reported pursuant to section 20-481.10, subsection D only with the directors or commissioners of insurance of other states having statutes or regulations substantially similar to subsection A of this section and who have agreed in writing not to disclose such information. The sharing of information by the director pursuant to this article does not constitute a delegation of regulatory authority by the director and the director is solely responsible for the administration, execution and enforcement of this article.

G. A disclosure to or by the director pursuant to this section or as a result of sharing information pursuant to subsection D of this section is not a waiver of any applicable privilege or claim of confidentiality in the documents, materials or other information disclosed or shared.

H. Documents, materials or other information in the possession or control of the national association of insurance commissioners or a third-party consultant designated by the director pursuant to this article is confidential by law and privileged, is not subject to title 39, chapter 1, article 2, is not subject to subpoena and is not subject to discovery or admissible in evidence in any private civil action.

I. The group capital calculation and resulting group capital ratio required by section 20-481.10, subsection D, paragraph 2 and the liquidity stress test along with its results and supporting disclosures required by section 20-481.10, subsection D, paragraph 3 are regulatory tools for assessing group risks and capital adequacy and group liquidity risks, respectively, and are not intended as a means to rank insurers or insurance holding company systems generally.  Except as otherwise provided in this article, the making, publishing, disseminating, circulating or placing before the public, or causing directly or indirectly to be made, published, disseminated, circulated or placed before the public in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station or any electronic means of communication available to the public, or in any other way as an advertisement, announcement or statement containing a representation or statement with regard to the group capital calculation, group capital ratio, the liquidity stress test results, or supporting disclosures for the liquidity stress test of any insurer or any insurer group, or of any component derived in the calculation by any insurer, broker or other person engaged in any manner in the insurance business would be misleading and is prohibited.  If any materially false statement with respect to the group capital calculation, resulting group capital ratio, an inappropriate comparison of any amount to an insurer's or insurance group's group capital calculation or resulting group capital ratio, liquidity stress test result, supporting disclosures for the liquidity stress test or an inappropriate comparison of any amount to an insurer's or insurance group's liquidity stress test result or supporting disclosures is published in any written publication and the insurer is able to demonstrate to the commissioner with substantial proof the falsity of the statement or the inappropriate comparison, the insurer may publish announcements in a written publication if the sole purpose of the announcement is to rebut the materially false statement.
A.R.S. § 20-2301 — Arizona Code / Title 20 / Chapter 13 / Article 1 / Section 2301
20-2301 Definitions; late enrollee coverage
Status: in_force

20-2301. Definitions; late enrollee coverage

A. In this chapter, unless the context otherwise requires:

1. "Accountable health plan" means an entity that offers, issues or otherwise provides a health benefits plan and that is approved by the director as an accountable health plan pursuant to section 20-2303.

2. "Affiliation period" means a period of two months, or three months for late enrollees, that under the terms of the health benefits plan offered by a health care services organization must expire before the health benefits plan becomes effective and in which the health care services organization is not required to provide health care services or benefits and cannot charge the participant or beneficiary a premium for any coverage during the period.

3. "Base premium rate" means, for each rating period, the lowest premium rate that could have been charged under a rating system by the accountable health plan to small employers for health benefits plans involving the same or similar coverage, family size and composition, and geographic area.

4. "Bona fide association" means, for a health benefits plan issued by an accountable health plan, an association that meets the requirements of section 20-2324.

5. "COBRA continuation provision" means:

(a) Section 4980B, except subsection (f)(1) as it relates to pediatric vaccines, of the internal revenue code of 1986.

(b) Title I, subtitle B, part 6, except section 609, of the employee retirement income security act of 1974 (P.L. 93-406; 88 Stat. 829; 29 United States Code sections 1001 through 1461).

(c) Title XXII of the public health service act.

(d) Section 20-2330 or a similar provision of the law of this state or any other state.

6. "Creditable coverage" means coverage solely for an individual, other than limited benefits coverage, under any of the following:

(a) An employee welfare benefit plan that provides medical care to employees or the employees' dependents directly or through insurance or reimbursement or otherwise pursuant to the employee retirement income security act of 1974.

(b) A church plan as defined in the employee retirement income security act of 1974.

(c) A health benefits plan issued by an accountable health plan as defined in this section.

(d) Part A or part B of title XVIII of the social security act.

(e) Title XIX of the social security act, other than coverage consisting solely of benefits under section 1928.

(f) Title 10, chapter 55 of the United States Code.

(g) A medical care program of the Indian health service or of a tribal organization.

(h) A health benefits risk pool operated by any state of the United States.

(i) A health plan offered pursuant to title 5, chapter 89 of the United States Code.

(j) A public health plan as defined by federal law.

(k) A health benefit plan pursuant to section 5(e) of the peace corps act (P.L. 87-293; 75 Stat. 612; 22 United States Code sections 2501 through 2523).

(l) A policy or contract, including short-term limited duration insurance, issued on an individual basis by an insurer, a health care services organization, a hospital service corporation, a medical service corporation or a hospital, medical, dental and optometric service corporation.

(m) A policy or contract issued by a health care insurer or an accountable health plan to a member of a bona fide association.

7. "Demographic characteristics" means objective factors an insurer considers in determining premium rates. Demographic characteristics do not include health status-related factors, industry or duration of coverage since issue.

8. "Different policy forms" means variations between policy forms offered by a health care insurer, including policy forms that have different cost sharing arrangements or different riders.

9. "Genetic information" means information about genes, gene products and inherited characteristics that may derive from the individual or a family member, including information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories and direct analyses of genes or chromosomes.

10. "Health benefits plan" means a hospital and medical service corporation policy or certificate, a health care services organization contract, a group disability policy, a certificate of insurance of a group disability policy that is not issued in this state, a multiple employer welfare arrangement or any other arrangement under which health services or health benefits are provided to two or more individuals. Health benefits plan does not include the following:

(a) Accident only, dental only, vision only, disability income only or long-term care only insurance, fixed or hospital indemnity coverage, limited benefit coverage, specified disease coverage, credit coverage or Taft-Hartley trusts.

(b) Coverage that is issued as a supplement to liability insurance.

(c) Medicare supplemental insurance.

(d) Workers' compensation insurance.

(e) Automobile medical payment insurance.

11. "Health status-related factor" means any factor in relation to the health of the individual or a dependent of the individual enrolled or to be enrolled in an accountable health plan, including:

(a) Health status.

(b) Medical condition, including physical and mental illness.

(c) Claims experience.

(d) Receipt of health care.

(e) Medical history.

(f) Genetic information.

(g) Evidence of insurability, including conditions arising out of acts of domestic violence as defined in section 20-448.

(h) The existence of a physical or mental disability.

12. "Higher level of coverage" means a health benefits plan offered by an accountable health plan for which the actuarial value of the benefits under the coverage is at least fifteen percent more than the actuarial value of the health benefits plan offered by the accountable health plan as a lower level of coverage in this state but not more than one hundred twenty percent of a policy form weighted average.

13. "Index rate" means, as to a rating period, the arithmetic average of the applicable base premium rate and the highest premium rate that could have been charged under a rating system by the accountable health plan to small employers for a health benefits plan involving the same or similar coverage, family size and composition, and geographic area.

14. "Late enrollee" means an employee or dependent who requests enrollment in a health benefits plan after the initial enrollment period that is provided under the terms of the health benefits plan if the initial enrollment period is at least thirty-one days.  An employee or dependent shall not be considered a late enrollee if:

(a) The person:

(i) At the time of the initial enrollment period was covered under a public or private health insurance policy or any other health benefits plan.

(ii) Lost coverage under a public or private health insurance policy or any other health benefits plan due to the employee's termination of employment or eligibility, the reduction in the number of hours of employment, the termination of the other plan's coverage, the death of the spouse, legal separation or divorce or the termination of employer contributions toward the coverage.

(iii) Requests enrollment within thirty-one days after the termination of creditable coverage that is provided under a public or private health insurance or other health benefits plan.

(iv) Requests enrollment within thirty-one days after the date of marriage.

(b) The person is employed by an employer that offers multiple health benefits plans and the person elects a different plan during an open enrollment period.

(c) A court orders that coverage be provided for a spouse or minor child under a covered employee's health benefits plan and the person requests enrollment within thirty-one days after the court order is issued.

(d) The person becomes a dependent of a covered person through marriage, birth, adoption or placement for adoption and requests enrollment no later than thirty-one days after becoming a dependent.

15. "Lower level of coverage" means a health benefits plan offered by an accountable health plan for which the actuarial value of the benefits under the health benefits plan is at least eighty-five percent but not more than one hundred percent of the policy form weighted average.

16. "Network plan" means a health benefits plan provided by an accountable health plan under which the financing and delivery of health benefits are provided, in whole or in part, through a defined set of providers under contract with the accountable health plan in accordance with the determination made by the director pursuant to section 20-1053 regarding the geographic or service area in which an accountable health plan may operate.

17. "Policy form weighted average" means the average actuarial value of the benefits provided by all health benefits plans issued by either the accountable health plan or, if the data are available, by all accountable health plans in the group market in this state during the previous calendar year, weighted by the enrollment for all coverage forms.

18. "Preexisting condition" means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within not more than six months before the date of the enrollment of the individual under a health benefits plan issued by an accountable health plan. A genetic condition is not a preexisting condition in the absence of a diagnosis of the condition related to the genetic information and shall not result in a preexisting condition limitation or preexisting condition exclusion.

19. "Preexisting condition limitation" or "preexisting condition exclusion" means a limitation or exclusion of benefits for a preexisting condition under a health benefits plan offered by an accountable health plan.

20. "Small employer" means an employer who employs at least two but not more than fifty eligible employees on a typical business day during any one calendar year. For the purposes of this paragraph, "employee" includes the employees of the employer and the individual proprietor or self-employed person if the employer is an individual proprietor or self-employed person.

21. "Taft-Hartley trust" means a jointly-managed trust, as allowed by 29 United States Code sections 141 through 187, that contains a plan of benefits for employees and that is negotiated in a collective bargaining agreement governing the wages, hours and working conditions of the employees, as allowed by 29 United States Code section 157.

22. "Waiting period" means the period that must pass before a potential participant or beneficiary in a health benefits plan offered by an accountable health plan is eligible to be covered for benefits as determined by the individual's employer.

B. Coverage for a late enrollee begins on the date the person becomes a dependent if a request for enrollment is received within thirty-one days after the person becomes a dependent.
A.R.S. § 20-1691.03 — Arizona Code / Title 20 / Chapter 6 / Article 15 / Section 1691.03
20-1691.03 Limitations of long-term care insurance policies
Status: in_force

20-1691.03. Limitations of long-term care insurance policies

A. No insurer may cancel, fail to renew or otherwise terminate a long-term care insurance policy solely on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder.

B. No long-term care insurance policy may contain a provision establishing any new waiting period if existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder.

C. A long-term care insurance policy shall provide coverage for at least twenty-four consecutive months for each covered person.

D. No preexisting condition limitation period in a long-term care insurance policy or certificate may exceed the following:

1. If not approved under paragraph 2, six months after the effective date of coverage of an insured for whom medical advice or treatment was recommended by, or received from, a health care services provider.

2. A period of time set by the director after the effective date of coverage of an insured who is a member of a designated group for which the director has found that a different limitation period is justified because the group is specially limited by age, group categories or other specific policy provisions and that the different limitation period will be a benefit to the certificate holders.

E. No long-term care insurance policy or certificate may use a definition of preexisting condition which is more restrictive than the definition prescribed in this article.

F. A long-term care insurance policy shall not exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the periods allowed under subsection D.

G. The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards.

H. No long-term care insurance policy or certificate issued on or after July 1, 1990 may provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care, or coverage that conditions eligibility for benefits for levels of care on the receipt of higher levels of care. In evaluating the requirements of this subsection, the director shall consider the amount of coverage provided based on aggregate days of care covered for lower levels of care when compared to days of care covered for skilled care.

I. A long-term care insurance policy or certificate, other than a policy or certificate that is issued to a group, may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person.
A.R.S. § 20-3335 — Arizona Code / Title 20 / Chapter 25 / Article 2 / Section 3335
20-3335 Pharmacy benefit managers; prescribing; formulary change; notice; exemption; enforcement; applicability; definitions
Status: in_force

20-3335. Pharmacy benefit managers; prescribing; formulary change; notice; exemption; enforcement; applicability; definitions

A. A pharmacy benefit manager that enters into an agreement with a health care insurer to provide pharmacy benefit management services to covered individuals on behalf of the pharmacy benefit manager or a health care insurer may not limit or exclude coverage of a prescription drug for any covered individual who is on a specific prescription drug if both of the following apply:

1. The prescription drug was previously approved by the pharmacy benefit manager or health care insurer for coverage for the covered individual.

2. The covered individual continues to be an insured, enrollee or subscriber of the health care insurer that the pharmacy benefit manager has contracted with to provide pharmacy benefit management services.

B. If subsection A of this section applies, the drug coverage shall continue for a covered individual's specific prescription drug through the last day of the covered individual's health care plan year.

C. A pharmacy benefit manager or health care insurer may not change a covered individual from the previously covered prescription drug if the covered individual's prescribing health care provider provides electronic or written notice to the pharmacy benefit manager or health care insurer notifying the pharmacy benefit manager or health care insurer that the covered individual will continue on the current prescription drug.

D. If a pharmacy benefit manager or health care insurer makes any formulary change that limits or excludes coverage of a prescription drug, the pharmacy benefit manager or health care insurer shall provide electronic or written notice of the removal of or change for any prescription drug on the drug formulary to each impacted covered individual and the impacted covered individual's prescribing health care provider at least sixty days before the formulary change.  The notice shall do both of the following:

1. Set forth the process by which the covered individual's health care provider may notify the pharmacy benefit manager or health care insurer for the continued use of the nonformulary prescription drugs.

2. Include notification to the prescribing health care provider that if the health care provider notifies the pharmacy benefit manager or health care insurer that the insured, enrollee or subscriber will continue on the nonformulary prescription drug for the remainder of the health care plan year, the health care provider will need to apply for a formulary exception pursuant to section 20-3336 for the continued use of the nonformulary prescription drug on renewal of the health care plan.

E. This section does not:

1. Prevent a health care provider from prescribing another prescription drug that is covered by the health care insurer of the pharmacy benefit manager if the health care provider deems the prescription drug medically necessary for the covered individual.

2. Prevent a health care insurer or pharmacy benefit manager that is contracted to provide pharmacy benefit management services from:

(a) Adding a prescription drug to its formulary.

(b) Removing a prescription drug from its formulary if the drug manufacturer has removed the prescription drug for sale in the United States.

(c) Making any formulary changes for patients who are not on a previously approved prescription drug.

F. If a health care insurer, pharmacy benefit manager or utilization review agent violates this section, the director may enforce this section pursuant to section 20-3333 or chapter 15, article 1 of this title, as applicable.

G. This section applies only to pharmacy benefit managers that are subject to section 20-3333.

H. For the purposes of this section:

1. "Health care insurer" has the same meaning prescribed in section 20-2501.

2. "Health care plan" means a policy, contract or evidence of coverage that a health care insurer issues to an insured, enrollee or subscriber.

3. "Limit or exclude coverage" means to:

(a) Limit or reduce the maximum coverage of prescription drug benefits.

(b) Increase cost sharing for a covered prescription drug.

(c) Require an additional prior authorization for a patient who is currently approved for a prescription drug based solely on the movement of the prescription drug to a more restrictive formulary tier.

(d) Remove a prescription drug from a formulary unless either of the following applies:

(i) The United States food and drug administration revokes approval for or removes a prescription drug from the prescription drug market.

(ii) The prescription drug manufacturer notifies the United States food and drug administration of a manufacturing discontinuation or a potential discontinuation as required by section 506c of the federal food, drug, and cosmetic act (21 United States Code section 356c).

4. "Utilization review agent" means a utilization review agent as defined in section 20-2530 that is contracted to provide pharmacy benefit management services for a health care insurer.
A.R.S. § 20-463.02 — Arizona Code / Title 20 / Chapter 2 / Article 6 / Section 463.02
20-463.02 Advanced driver assistance system; auto glass repair; notice; violations; civil penalties; definitions
Status: in_force

20-463.02. Advanced driver assistance system; auto glass repair; notice; violations; civil penalties; definitions

A. If a vehicle is equipped with an advanced driver assistance system, an auto glass repair or replacement facility that conducts glass repair, replacement or recalibration shall inform the customer both:

1. If a recalibration of that system is required.

2. If a recalibration of that system is performed that it must meet or exceed the vehicle manufacturer's specifications.

B. An auto glass repair or replacement facility shall provide the customer with an itemized description of the work to be done on the vehicle.

C. An auto glass repair or replacement facility may not represent to a customer that the cost of a repair, replacement or recalibration will be paid for entirely by the customer's insurer and at no cost to the customer unless the cost of the repair, replacement or recalibration is fully covered as provided by the customer's insurance policy.

D. If a recalibration was not performed or not completed successfully, the auto glass repair or replacement facility shall inform the customer and the customer's insurer electronically or in writing that the recalibration was not successful or was not performed and that the vehicle should be taken to a vehicle manufacturer's certified dealership or a qualified auto glass repair or replacement facility capable of performing the recalibration of an advanced driver assistance system that meets or exceeds the vehicle manufacturer's specifications.

E. An auto glass repair or replacement facility that conducts a recalibration for vehicle glass repair or replacement services on a vehicle equipped with an advanced driver assistance system:

1. Is not limited to vehicle glass, tooling, equipment or repair procedures dictated or recommended by the vehicle manufacturer.

2. Shall recalibrate the advanced driver assistance system to meet or exceed the vehicle manufacturer's specifications.

F. An auto glass repair or replacement facility may not bill or charge the customer or the customer's insurer for vehicle glass repair, replacement or recalibration services that are not performed in accordance with the vehicle manufacturer's specifications.

G. A person who violates this section is subject to a civil penalty of $2,500.  A violation of this section is subject to enforcement pursuant to this article.

H. For the purposes of this section:

1. "Advanced driver assistance system" means electronic systems that use automated technology, such as sensors and cameras, to detect nearby obstacles or driver errors and that respond to assist drivers to safely operate a vehicle.

2. "Recalibrate" or "recalibration" means to instruct a vehicle's advanced driver assistance system, including internal computers, to readjust targeted cameras, sensors and other technology to function properly in accordance with the vehicle manufacturer's specifications.
A.R.S. § 20-1253 — Arizona Code / Title 20 / Chapter 6 / Article 2 / Section 1253
20-1253 Debtor groups
Status: in_force

20-1253. Debtor groups

The lives of a group of individuals may be insured under a policy issued to a creditor, who shall be deemed the policyholder, to insure debtors of the creditor, subject to the following requirements:

1. The debtors eligible for insurance under the policy shall be all of the debtors of the creditor whose indebtedness is repayable in installments, or all of any class or classes thereof determined by conditions pertaining to the indebtedness or to the purchase giving rise to the indebtedness. The policy may provide that the term "debtors" shall include the debtors of one or more subsidiary corporations, and the debtors of one or more affiliated corporations, proprietors or partnerships if the business of the policyholder and of such affiliated corporations, proprietors or partnerships is under common control through stock ownership, contract or otherwise.

2. The premium for the policy shall be paid by the policyholder, either from the creditor's funds, or from charges collected from the insured debtors, or from both. A policy on which part or all of the premium is to be derived from the collection from the insured debtors of identifiable charges not required of uninsured debtors shall not include, in the class or classes of debtors eligible for insurance, debtors under obligations outstanding at its date of issue without evidence of individual insurability unless at least seventy-five per cent of the then eligible debtors elect to pay the required charges. A policy on which no part of the premium is to be derived from the collection of such identifiable charges shall insure all eligible debtors, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer.

3. The policy may be issued only if the group of eligible debtors is then receiving new entrants at the rate of at least one hundred persons yearly, or may reasonably be expected to receive at least one hundred new entrants during the first policy year, and only if the policy reserves to the insurer the right to require evidence of individual insurability if less than seventy-five per cent of the new entrants become insured.

4. The amount of insurance on the life of any debtor shall at no time exceed the amount of the unpaid indebtedness.

5. The insurance shall be payable to the policyholder. Such payment shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of such payment.
A.R.S. § 20-1342.04 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1342.04
20-1342.04 Disability insurance policies; varying copayments and deductibles allowed
Status: in_force

20-1342.04. Disability insurance policies; varying copayments and deductibles allowed

A. Except as provided in sections 20-1379 and 20-2304, a disability insurer may offer one or more disability insurance policies that contain a choice of deductibles, coinsurance, copayments, out-of-pocket and any other cost sharing levels.  Plans offered under this section shall clearly disclose in marketing materials, certificates of coverage and contracts the insured’s financial responsibilities.  A disability insurer that offers such a disability insurance policy shall continue to provide any mandated health coverage that is required by this state or by federal law.

B. This section does not prohibit a health benefits plan that is intended to qualify as a high deductible health plan as defined by 26 United States Code section 223(c)(2) from requiring the application of deductibles, copayments or coinsurance to benefits provided under the health benefits plan.
A.R.S. § 20-401.07 — Arizona Code / Title 20 / Chapter 2 / Article 5 / Section 401.07
20-401.07 Premium receipts tax on industrial insureds contracting with unauthorized insurer; definitions
Status: in_force

20-401.07. Premium receipts tax on industrial insureds contracting with unauthorized insurer; definitions

A. Every industrial insured under a contract procured from an unauthorized insurer shall pay to the director for coverage on Arizona single-state risks or to the clearinghouse for coverage on multistate risks on or before the dates prescribed by in section 20-415 a premium receipts tax of three per cent of the gross premiums, less premiums returned on account of cancellation or reduction of premium. Such insurance procured by an insured whose home state is Arizona, whether procured through negotiation or an application, in whole or in part occurring or made within or outside of this state, or for which premiums in whole or in part are remitted directly or indirectly from within or outside of this state, shall be deemed to be insurance effectuated or continued in this state.

B. Beginning January 1, 2015 and every five years thereafter, the amounts listed in subsection C, paragraph 1, subdivisions (a) and (e) shall be adjusted to reflect the percentage change for the five-year period in the consumer price index for all urban consumers published by the bureau of labor statistics of the United States department of labor.

C. For the purposes of this section:

1. "Industrial insured" means an insured whose home state is Arizona, that applies for or procures any insurance that is subject to article 4.1 of this chapter through the use of a qualified risk manager, that has aggregate annual gross premiums for insurance on all property and casualty risks that are subject to article 4.1 of this chapter totaling at least one hundred thousand dollars as of the insured's preceding fiscal year end and that meets one of the following criteria:

(a) Possesses a net worth of over twenty million dollars as of the preceding fiscal year end of the industrial insured as verified by a certified public accountant.

(b) Has net revenues or sales exceeding fifty million dollars as of the preceding fiscal year end of the industrial insured as verified by a certified public accountant.

(c) Has more than five hundred full-time employees or equivalent per individual company or is a member of an affiliated group employing more than one thousand employees in the aggregate.

(d) Is a municipality with a population of more than fifty thousand persons.

(e) Is a nonprofit organization or public entity generating annual budgeted expenditures of at least thirty million dollars.

2. "Qualified risk manager" has the same meaning prescribed in the nonadmitted and reinsurance reform act of 2010 (15 United States Code section 8206).
A.R.S. § 20-790 — Arizona Code / Title 20 / Chapter 4 / Article 2 / Section 790
20-790 Merger or conversion
Status: in_force

20-790. Merger or conversion

A. A domestic reciprocal insurer upon affirmative vote of not less than two thirds of its subscribers who vote on such merger pursuant to due notice and the approval of the director of the terms therefor, may merge with another reciprocal insurer or be converted to a stock or mutual insurer.

B. Such a stock or mutual insurer shall be subject to the same capital requirements and shall have the same rights as a like domestic insurer transacting like kinds of insurance.

C. The director shall not approve any plan for merger or conversion which is inequitable to subscribers, or which, if for conversion to a stock insurer, does not give each subscriber preferential right to acquire stock of the proposed insurer proportionate to his interest in the reciprocal insurer as determined in accordance with section 20-789 and a reasonable length of time within which to exercise such right.
A.R.S. § 20-1563 — Arizona Code / Title 20 / Chapter 6 / Article 9 / Section 1563
20-1563 Qualifications
Status: in_force

20-1563. Qualifications

A. Any foreign or domestic stock insurer authorized by its corporate charter to engage in business as a title insurer shall be entitled to the issuance of a certificate of authority as a title insurer in this state upon meeting the applicable requirements of article 1 of chapter 2 of this title, together with the following additional requirements:

1. The insurer shall not transact any other kind of insurance.

2. The insurer shall have on deposit in public trust pursuant to section 20-213, the sum of two hundred fifty thousand dollars, plus fifty thousand dollars for each state or territorial subdivision of the United States, other than the state of its domicile, in which it shall be or become qualified to engage in the business of title insurance. When the aggregate of amounts so deposited in this or such other states or territorial subdivision has reached the sum of seven hundred fifty thousand dollars no further deposit shall be required of any domestic or foreign insurer.

3. The capital, surplus and accumulations of every foreign insurer shall be invested in obligations, assets and property of a kind and quality equal in value and safety to those permitted to domestic insurers by this title, and such investments, except with the consent of the director, shall not exceed the limitations provided hereby with respect to domestic insurers. Subsection A of section 20-559 shall not apply to title insurers.

B. If the provisions of this title require a greater amount of capital, surplus or deposit than the capital, surplus or deposit of a title insurer which was the holder of a validly issued, unexpired and unrevoked certificate of authority immediately prior to the effective date hereof, such title insurer shall have the period ending July 1 five years after the effective date hereof within which to comply with any such increased requirement.
A.R.S. § 20-1091 — Arizona Code / Title 20 / Chapter 4 / Article 10 / Section 1091
20-1091 Transfers to this article
Status: in_force

20-1091. Transfers to this article

Any life and disability insurer may relinquish its authority to write policies direct and, upon application to the director, may become a life and disability reinsurer under the provisions of this article.
A.R.S. § 20-1241.04 — Arizona Code / Title 20 / Chapter 6 / Article 1.1 / Section 1241.04
20-1241.04 Duties of insurers that use insurance producers
Status: in_force

20-1241.04. Duties of insurers that use insurance producers

A. An insurer that uses an insurance producer shall comply with the requirements of this section.

B. The insurer shall maintain a system for supervision and control of insurance producers that ensures compliance with the requirements of this article including at least the following:

1. A method to inform insurance producers of the requirements of this article and to incorporate those requirements into the insurer's relevant insurance producer training manuals.

2. A system to provide each insurance producer with a written statement of the insurer's position on the acceptability of replacements to guide the insurance producer as to the appropriateness of a replacement transaction.

3. A system to review the appropriateness of each replacement transaction for compliance with the insurer's replacement policy described in paragraph 2 of this subsection.

4. A procedure to confirm that the requirements of this article have been met.

5. A procedure to detect replacement transactions that have not been reported as such by the applicant or insurance producer.  An insurer may comply with this requirement by systematic customer surveys, interviews, confirmation letters or programs of internal monitoring.

C. The insurer shall have the capacity to monitor each producer's policy and contract replacements for that insurer and shall be able to produce, on request, and make available to the department the following records for each insurance producer:

1. Life replacements, including financed purchases, as a percentage of the producer's total annual sales for life policies covered under section 20-1241.01.

2. Number of lapses of policies by the insurance producer as a percentage of the insurance producer's total annual sales for life policies covered under section 20-1241.01.

3. Annuity contract and replacements as a percentage of the producer's total annual annuity contract sales.

4. Number of transactions that are unreported replacements of existing policies or contracts detected by the insurer's monitoring system as required by subsection B, paragraph 5 of this section.

5. Replacements, indexed by the replacing insurance producer and the existing insurer.

D. With or as a part of each application for a policy or contract, the insurer shall require the signed statement prescribed by section 20-1241.03, subsection A.

E. With each application for a replacement policy or contract, the insurer shall require the notice prescribed by section 20-1241.03, subsections C and D.

F. If an applicant has an existing policy or contract, the insurer shall require and shall be able to produce for at least five years after the termination or expiration of the proposed policy or contract:

1. Copies of any sales materials.

2. The basic illustration and any supplemental illustrations related to the specific policy or contract that is purchased.

3. The insurance producer's and applicant's signed statements with respect to financing and replacement.

G. The insurer shall ascertain that the sales material and illustrations used in the replacement, as provided in section 20-1241.03, subsection G, meet the requirements of this article and are complete and accurate for the proposed policy or contract.

H. If an application does not meet the requirements of this article, the insurer shall notify the insurance producer and applicant and fulfill any outstanding requirements.

I. An insurer may maintain the records required by this section in paper, photograph, microprocess, magnetic, mechanical or electronic media, or other process that accurately reproduces that actual document.
A.R.S. § 20-626 — Arizona Code / Title 20 / Chapter 3 / Article 4 / Section 626
20-626 Claims of nonresidents against domestic insurers
Status: in_force

20-626. Claims of nonresidents against domestic insurers

A. In a delinquency proceeding begun in this state against a domestic insurer, claimants residing in reciprocal states may file claims either with the ancillary receivers, if any, in their respective states, or with the domiciliary receiver. All such claims shall be filed on or before the last date fixed for the filing of claims in the domiciliary delinquency proceedings.

B. Controverted claims belonging to claimants residing in reciprocal states may either be proved in this state, or if ancillary proceedings have been commenced in such reciprocal states, may be proved in those proceedings. In the event a claimant elects to prove his claim in ancillary proceedings, if notice of the claim and opportunity to appear and be heard is afforded the domiciliary receiver of this state as provided in section 20-627 with respect to ancillary proceedings in this state, the final allowance of such claim by the courts in the ancillary state shall be accepted in this state as conclusive as to its amount and shall also be accepted as conclusive as to its priority, if any, against special deposits or other security located within the ancillary state, but shall not be conclusive as to its priority against general assets under section 20-629.
A.R.S. § 20-265 — Arizona Code / Title 20 / Chapter 2 / Article 2 / Section 265
20-265 Motor vehicle insurance; premium and fee comparisons and complaint ratios
Status: in_force

20-265. Motor vehicle insurance; premium and fee comparisons and complaint ratios

The department of insurance and financial institutions shall compile comparisons of premiums and fees charged at policy inception and complaint ratios for motor vehicle insurance policies that insure six or fewer motor vehicles. The comparisons shall reflect premiums and fees associated with the inception of a policy for not fewer than five hypothetical insureds for urban areas and five hypothetical insureds for rural areas. The department of insurance and financial institutions shall forward copies of the comparisons of premiums and fees charged at policy inception and complaint ratios to the department of transportation. The director of the department of transportation in consultation with the director of the department of insurance and financial institutions shall make the copies available to the public.  The department of insurance and financial institutions may include in the comparison information consumer information that describes the nature of bodily injury coverage, property damage coverage, collision coverage, comprehensive coverage, medical payment coverage, uninsured motorist coverage and underinsured motorist coverage.
A.R.S. § 20-611 — Arizona Code / Title 20 / Chapter 3 / Article 4 / Section 611
20-611 Definitions
Status: in_force

20-611. Definitions

In this article, unless the context otherwise requires:

1. "Ancillary state" means any state other than a domiciliary state.

2. "Commodity exchange act" means the federal commodity exchange act (7 United States Code chapter 1).

3. "Court" means, unless the context otherwise requires, the judge of the superior court assigned to the delinquency proceeding.

4. "Delinquency proceeding" means any proceeding commenced against an insurer pursuant to this article for the purpose of liquidating, rehabilitating, reorganizing or conserving such insurer.

5. "Domiciliary state" means the state in which an insurer is incorporated or organized, or in the case of an insurer incorporated or organized in a foreign country, the state in which such insurer, having become authorized to do business in such state, has, at the commencement of delinquency proceedings, the largest amount of its assets held in trust and assets held on deposit for the benefit of its policyholders or policyholders and creditors in the United States, and any such insurer is deemed to be domiciled in such state.

6. "Federal home loan bank" means an institution that is established under the federal home loan bank act (12 United States Code sections 1421 through 1449) or its successor statute.

7. "Foreign country" means territory not in any state.

8. "General assets" means all property, real, personal or otherwise, not specifically mortgaged, pledged, deposited or otherwise encumbered for the security or benefit of specified persons or a limited class or classes of persons, and as to such specifically encumbered property the term includes all such property or its proceeds in excess of the amount necessary to discharge the amount or amounts secured thereby.  Assets held in trust and assets held on deposit for the security or benefit of all policyholders or all policyholders and creditors in the United States shall be deemed general assets.

9. "Impairment" or "insolvency" means that the capital of a stock insurer or limited capital stock insurer, or the surplus of a mutual or reciprocal insurer, is deemed impaired and the insurer is deemed insolvent, when the insurer is not possessed of assets at least equal to all liabilities and required reserves together with its total issued and outstanding capital stock if a stock insurer, or the minimum surplus if a mutual or reciprocal insurer, required by this title to be maintained for the kind or kinds of insurance it is then authorized to transact.

10. "Insurer" means any person, firm, corporation, association or aggregation of persons doing an insurance business and subject to the insurance supervisory authority of, or to liquidation, rehabilitation, reorganization or conservation by the director or the equivalent insurance supervisory official of another state.

11. "Insurer member" means an insurer that is a member of a federal home loan bank.

12. "Netting agreement" means:

(a) A contract or an agreement including a master agreement that documents one or more transactions between the parties to the agreement for or involving one or more qualified financial contracts and that provides for the netting, liquidation, setoff, termination, acceleration or close out under or in connection with one or more qualified financial contracts or present or future payment or delivery obligations or payment or delivery entitlements thereunder, including liquidation or close-out values relating to the obligations or entitlements, among the parties to the netting agreement. A master agreement, together with all schedules, confirmations, definitions and addenda thereto and transactions under any thereof, shall be treated as one netting agreement.

(b) Any master agreement or bridge agreement for one or more master agreements described in subdivision (a) of this paragraph.

(c) Any security agreement or arrangement or other credit enhancement or guarantee or reimbursement obligation related to any contract or agreement described in subdivision (a) or (b) of this paragraph.  Any contract or agreement described in subdivision (a) or (b) of this paragraph relating to agreements or transactions that are not qualified financial contracts are deemed to be a netting agreement only with respect to those agreements or transactions that are qualified financial contracts.

13. "Preferred claim" means any claim with respect to which the law of the state or of the United States accords priority of payments from the general assets of the insurer.

14. "Qualified financial contract" means any commodity contract, forward contract, repurchase agreement, securities contract and swap agreement and any similar agreement that the director determines by rule or order to be a qualified financial contract for the purposes of this article.  For the purposes of this paragraph:

(a) "Commodity contract" means:

(i) A contract for the purchase or sale of a commodity for future delivery on, or subject to the rules of, a board of trade or contract market under the commodity exchange act or a board of trade outside the United States.

(ii) An agreement that is subject to regulation under section 19 of the commodity exchange act and that is commonly known to the commodities trade as a margin account, margin contract, leverage account or leverage contract.

(iii) An agreement or transaction that is subject to regulation under section 6c(b) of the commodity exchange act and that is commonly known to the commodities trade as a commodity option.

(iv) Any combination of the agreements or transactions referred to in this paragraph.

(v) Any option to enter into an agreement or transaction referred to in this paragraph.

(b) "Forward contract", "repurchase agreement", "securities contract" and "swap agreement" have the same meanings prescribed in the federal deposit insurance act, 12 United States Code section 1821(e)(8)(D), as amended.

15. "Receiver" means the director as receiver, liquidator, rehabilitator or conservator as the context may require.

16. "Reciprocal state" means any state other than this state in which in substance and effect the provisions of the uniform insurers liquidation act, as defined in section 20-631, are in force, including the provisions requiring that the director of insurance or equivalent insurance supervisory official be the receiver of a delinquent insurer.

17. "Secured claim" means any claim secured by mortgage, trust deed, pledge, deposit as security, escrow or otherwise, including federal, state or local tax liens that are perfected before the commencement of a delinquency proceeding but not including a special deposit claim or claims against general assets.  The term also includes claims that more than four months before the commencement of delinquency proceedings in the state of the insurer's domicile have become liens on specific assets by reason of judicial process.

18. "Special deposit claim" means any claim secured by a deposit made pursuant to statute for the security or benefit of a limited class or classes of persons, but not including any general assets.

19. "State" means any state of the United States, the District of Columbia and the territories and possessions of the United States.
A.R.S. § 20-3455 — Arizona Code / Title 20 / Chapter 27 / Article 1 / Section 3455
20-3455 Reported discrepancies; corrective action
Status: in_force

20-3455. Reported discrepancies; corrective action

A health insurer shall take reasonable steps to correct discrepancies in the provider or network plan directory within thirty calendar days after receiving a written or electronic report of the discrepancy from a participating provider. A participating provider shall notify a health insurer of any change in the provider's name, address, telephone number, business structure or tax identification number within ten business days after making the change.
A.R.S. § 20-485.02 — Arizona Code / Title 20 / Chapter 2 / Article 9 / Section 485.02
20-485.02 Administrator as intermediary between insurer and insured; right of action preserved
Status: in_force

20-485.02. Administrator as intermediary between insurer and insured; right of action preserved

If an insurer utilizes the services of an administrator under the terms of a written agreement as required in section 20-485.01, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured shall be deemed to have been received by the insurer, and the payment of return premiums or claims by the insurer to the administrator shall not be deemed payment to the insured or claimant until such payments are received by the insured or claimant. Nothing in this article shall limit any right of the insurer against the administrator resulting from such administrator's failure to make payments to the insurer, insureds or claimants.
A.R.S. § 20-624 — Arizona Code / Title 20 / Chapter 3 / Article 4 / Section 624
20-624 Conduct of delinquency proceedings against domestic and alien insurers
Status: in_force

20-624. Conduct of delinquency proceedings against domestic and alien insurers

A. If under this article a receiver is to be appointed in delinquency proceedings for a domestic or alien insurer, the court shall appoint the director as receiver. The court shall order the receiver to take immediate possession of the assets of the insurer and to administer them under the orders of the court.

B. As domiciliary receiver, the director is vested by operation of law with the title to all of the property, contracts and rights of action and all of the books and records of the insurer, wherever located, as of the date of entry of the order directing the director to rehabilitate or liquidate a domestic insurer or to liquidate the United States branch of an alien insurer domiciled in this state, and the director shall have the right to recover the assets and reduce them to possession, except that ancillary receivers in reciprocal states, as to assets located in their respective states, shall have the rights and powers that are prescribed in this article for ancillary receivers appointed in this state as to assets located in this state.

C. The recording of a certified copy of the order directing possession to be taken in the office of the county recorder of the county where the proceedings are pending shall impart the same notice as would be imparted by a deed, a bill of sale or any other evidence of title duly recorded or filed.

D. The director as domiciliary receiver shall be responsible for the proper administration of all assets coming into the director's possession or control. The court may at any time require a bond from the director or the director's deputies if deemed desirable for the protection of the assets.

E. On taking possession of the assets of an insurer, the domiciliary receiver, subject to the direction of the court, shall immediately proceed to conduct the business of the insurer or to take such steps as are authorized by this article for the purpose of rehabilitating, liquidating or conserving the affairs or assets of the insurer.
A.R.S. § 20-413 — Arizona Code / Title 20 / Chapter 2 / Article 5 / Section 413
20-413 Placing of surplus lines coverage; endorsement by broker; list of unauthorized insurers; removal from list; definition
Status: in_force

20-413. Placing of surplus lines coverage; endorsement by broker; list of unauthorized insurers; removal from list; definition

A. A surplus lines broker shall not knowingly place any surplus lines coverage on behalf of an insured whose home state is Arizona with an unauthorized insurer, Lloyd's association, insurance exchange or syndicate of an insurance exchange that does not meet the minimum financial requirements of this section or that is declared by the director to be in a hazardous financial condition, improperly managed or unreliable in insurance transactions.  A surplus lines broker may place surplus lines coverage with a syndicate of an unauthorized insurance exchange even if another syndicate of the insurance exchange is declared by the director to be in a hazardous financial condition, improperly managed or unreliable in insurance transactions, as long as that syndicate does not participate in insuring the risk and unless the declaration of the director specifies that the insurance exchange shall not accept surplus lines placements.

B. An unauthorized foreign insurer authorized to transact insurance on an admitted or surplus lines basis in at least one other state shall possess a minimum capital and surplus that equals the greater of either the minimum capital and surplus requirements imposed by article 1 of this chapter or fifteen million dollars.

C. An unauthorized alien insurer other than a title insurer shall possess minimum capital and surplus of at least fifteen million dollars and shall maintain within the United States in public depositories or trust institutions approved by the director assets in the amount of two million five hundred thousand dollars. The director may require the unauthorized alien insurer to maintain a larger deposit if the director determines that the public interest reasonably requires a larger deposit. A broker shall not knowingly place any insurance with the unauthorized alien insurer until the insurer complies with the director's requirement to maintain a larger deposit. Notwithstanding the requirements of this subsection, a surplus lines broker may place insurance with an alien insurer that is listed on the quarterly listing of alien insurers maintained by the national association of insurance commissioners international insurers department.

D. Any unauthorized Lloyd's association or any similar association of individual or incorporated insurers under a common administration shall maintain a trust fund in the United States of at least one hundred million dollars as joint and several security for all United States policyholders of any member of the association. The director may require the association to maintain a larger fund if the director determines that the public interest reasonably requires a larger fund. A broker shall not knowingly place any insurance with the association until the association complies with the director's requirement to maintain a larger fund.

E. An unauthorized insurance exchange authorized to transact insurance on an admitted or surplus lines basis in at least one other state shall possess minimum aggregate capital and surplus of at least fifty million dollars. Each syndicate of the insurance exchange with which a risk is to be placed shall possess minimum aggregate capital and surplus of at least four million dollars until December 31, 1996. Beginning January 1, 1997 each syndicate with which a risk is to be placed shall possess minimum capital and surplus of at least five million dollars. The insurance exchange shall maintain a deposit of at least two million five hundred thousand dollars in public custody in trust, in part, for the purpose of protecting all of the policyholders of the insurance exchange. Each syndicate of an insurance exchange qualified to transact surplus lines insurance in this state shall file with the director on or before June 1 an annual statement for the preceding year in a form prescribed by the national association of insurance commissioners. The annual statement is in addition to any other document required of the insurance exchange by the director.

F. If the surplus lines broker delivers a certificate in a form prescribed by the director, it is prima facie evidence of the insurer's compliance with the financial requirements of this section. The certificate shall state the names of the public officials or other persons who have supervision over the insurer in any other state and shall certify the amount of capital and surplus that the insurer possesses and the amount of the trust deposit that the insurer maintains, as determined from the records and knowledge of the public officials or other persons, together with any supporting documentation that the director requires. The certifying surplus lines broker of an alien insurer may deliver other evidence acceptable to the director to establish that the alien insurer meets the financial requirements of this section. The certifying surplus lines broker may withdraw the certificate by providing written notice of intent to withdraw to the director and the affected insurer. The withdrawal is not effective until forty-five days after delivery of the notice to all parties. The withdrawal is not grounds for removal from the list pursuant to subsection H if, before the withdrawal becomes effective, another licensed surplus lines broker delivers to the director a replacement certificate based on the qualifying documentation already on file with the department.

G. The director may periodically publish a list of unauthorized insurers that may write surplus lines insurance in this state established on the basis of documentation provided to the director pursuant to this section. The director may mail a copy of the list to each licensed surplus lines broker at the last address on the records of the department. This subsection is not deemed to require the director to determine the actual financial condition or claims practices of any unauthorized insurer, and the appearance of an unauthorized insurer on the list indicates only that the insurer appears to be financially sound and to have satisfactory claims practices. A broker shall restrict all surplus lines business placed by the broker with an unauthorized insurer to those insurers qualified with the director as provided in this section.

H. The director may refuse to add an insurer to the list established pursuant to subsection G or may remove an insurer from that list if the director believes that the insurer:

1. Is in a hazardous financial condition.

2. No longer meets the requirements of this article.

3. Does not have the endorsement of a surplus lines broker pursuant to subsection F.

4. Does not comply with all applicable provisions of this title.

5. Is improperly managed.

6. Is unreliable in insurance transactions.

I. In addition to any other penalty provided by law, if a surplus lines broker's license is revoked for a violation of this section, the director shall not license the broker again within a period of two years thereafter.

J. For the purposes of subsections F, G and H, "insurer" means an unauthorized insurer, Lloyd's association, insurance exchange or syndicate of an insurance exchange.
A.R.S. § 20-1116 — Arizona Code / Title 20 / Chapter 5 / Article 1 / Section 1116
20-1116 Execution of policies
Status: in_force

20-1116. Execution of policies

A. Every insurance policy shall be executed in the name of and on behalf of the insurer by its officer, attorney-in-fact, employee or representative duly authorized by the insurer.

B. A facsimile signature of any such executing individual may be used in lieu of an original signature.

C. No insurance contract issued and which is otherwise valid shall be rendered invalid by reason of the apparent execution thereof on behalf of the insurer by the imprinted facsimile signature of an individual not authorized so to execute as of the date of the policy, if the policy is countersigned with the original signature or initial of an individual then so authorized.
A.R.S. § 20-377 — Arizona Code / Title 20 / Chapter 2 / Article 4 / Section 377
20-377 Justification for title insurance rates
Status: in_force

20-377. Justification for title insurance rates

A. A title insurance filing shall be accompanied by a statement of the title insurer, title insurance agent, or title insurance rating organization making the filing, setting forth the basis upon which the rate was fixed, and the manner in which fees are to be computed. Any filing may be justified by:

1. The experience or judgment of the title insurer, title insurance agent, or title insurance rating organization making the filing.

2. Its interpretation of any statistical data relied upon.

3. The experience of other title insurers, title insurance agents, or title insurance rating organizations.

4. Any other factors which the title insurer, title insurance agent, or title insurance rating organization deems relevant.

B. The statement and justification shall be open to public inspection after the rate to which they apply becomes effective.
A.R.S. § 20-1053 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1053
20-1053 Application for certificate of authority
Status: in_force

20-1053. Application for certificate of authority

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

1. A copy of the articles of incorporation and all amendments to the articles.

2. A copy of the bylaws, rules and regulations, or similar document, if any, regulating the conduct of the internal affairs of the applicant.

3. A list of the names, addresses and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers in the case of a corporation, and the partners or members in the case of a partnership or association.

4. A copy of any contract made or to be made between any providers or persons listed in paragraph 3 and the applicant.

5. A statement generally describing the health care services organization and its health care plan or plans, facilities and personnel, as approved by the director.

6. A copy of the form of evidence of coverage to be issued to the enrollees.

7. A copy of the form of the group contract, if any, that is to be issued to employers, unions, trustees or other organizations.

8. Financial statements showing the applicant's assets, liabilities and sources of financial support. If the applicant's financial affairs are audited by independent certified public accountants, a copy of the applicant's most recent regular certified financial statement shall be deemed to satisfy this requirement unless the director determines that additional or more recent financial information is required for the proper administration of this article.

9. A description of the proposed method of marketing the plan, a financial plan that includes a three-year projection of the initial operating results anticipated and a statement as to the sources of working capital as well as any other sources of funding.

10. A power of attorney duly executed by the applicant, if not domiciled in this state, appointing the director and the director's successors in office, and duly authorized deputies, as the true and lawful attorney of the applicant in and for this state, on whom all lawful process in any legal action or proceeding against the health care services organization on a cause of action arising in this state may be served.

11. A statement reasonably describing the geographic area or areas to be served, as approved by the director.

12. The fee prescribed by section 20-167.

13. Such other information as the director may require.

B. Within ten days following any significant modification of information previously furnished pursuant to subsection A of this section, a health care services organization shall file a notice of the modification with the director.

C. Unless preempted under federal law or unless federal law imposes greater requirements than this section, this section applies to a provider sponsored health care services organization.
A.R.S. § 20-2306 — Arizona Code / Title 20 / Chapter 13 / Article 1 / Section 2306
20-2306 Use of uniform employee health status questionnaire
Status: in_force

20-2306. Use of uniform employee health status questionnaire

A. An accountable health plan shall use the uniform employee health status questionnaire prescribed by the department for all small groups for which the accountable health plan requires employees and their covered dependents to complete health status questionnaires.

B. An accountable health plan may add to the questionnaire additional questions that pertain to eligibility for coverage and for underwriting purposes and may ask the producer or the employees and dependents follow-up questions about their responses to the uniform employee health status questionnaire.
A.R.S. § 20-1204 — Arizona Code / Title 20 / Chapter 6 / Article 1 / Section 1204
20-1204 Incontestability
Status: in_force

20-1204. Incontestability

There shall be a provision that the policy, exclusive of provisions relating to disability benefits or to additional benefits in the event of death by accident or accidental means, shall be incontestable, except for nonpayment of premiums, after it has been in force during the lifetime of the insured for a period of two years from its date of issue.
A.R.S. § 20-1120 — Arizona Code / Title 20 / Chapter 5 / Article 1 / Section 1120
20-1120 Binders
Status: in_force

20-1120. Binders

A. Binders or other contracts for temporary insurance may be made orally or in writing, and shall be deemed to include all the usual terms of the policy as to which the binder was given together with such applicable endorsements as are designated in the binder, except as superseded by the clear and express terms of the binder.

B. No binder shall be valid beyond the issuance of the policy with respect to which it was given, or beyond ninety days from its effective date, whichever period is the shorter.

C. If the policy has not been issued a binder may be extended or renewed beyond such ninety days with the written approval of the director, or in accordance with such rules and regulations relative thereto as the director may promulgate.

D. This section shall not apply to life or disability insurances.
A.R.S. § 20-1087 — Arizona Code / Title 20 / Chapter 4 / Article 10 / Section 1087
20-1087 Deposits
Status: in_force

20-1087. Deposits

A. The director shall not issue a certificate of authority to any life and disability reinsurer unless the reinsurer has deposited in trust with the state treasurer through the director's office cash or securities eligible for the investment of capital funds of domestic insurers under this title in an amount not less than the minimum paid-in capital stock required pursuant to this article to be maintained for authority to transact the kinds of insurance to be transacted.

B. This section does not apply to unaffiliated credit life and disability reinsurers that deliver to the director a letter of credit pursuant to section 20-1085, subsection B.
A.R.S. § 20-212 — Arizona Code / Title 20 / Chapter 2 / Article 1 / Section 212
20-212 Funds required to transact additional kinds of insurance
Status: in_force

20-212. Funds required to transact additional kinds of insurance

An insurer otherwise qualified may be authorized to transact combinations of kinds of insurance, other than the life and disability combination shown in section 20-210, while possessing and maintaining thereafter additional minimum required capital stock, if a stock insurer, or additional minimum required basic surplus, if a mutual or reciprocal insurer, not less in amount than that determined as follows: For any lawful combination add two hundred thousand dollars for each additional kind of insurance included in the combination to the amount required under section 20-210 for that one kind of insurance in the combination for which the largest amount is required under said section 20- 210, except:

1. Vehicle and disability insurances may be combined with casualty, and in any combination including casualty, without funds in addition to those required because of casualty.

2. With such additional minimum required capital stock or such additional minimum required basic surplus in an amount of not less than five hundred thousand dollars, an insurer, if otherwise qualified, may be authorized to transact all kinds of insurance except life and title insurance. Any domestic stock insurer which on January 1, 1954, was lawfully authorized to transact vehicle insurance, for physical damage only, or casualty insurance, and while possessing paid-in capital of not less than two hundred fifty thousand dollars, may be so authorized to transact all kinds of insurance other than life and title insurances.

3. The amount of such capital or surplus shall not in any event be less than would be required if the insurer proposed to transact in this state all those kinds of insurance which it is transacting elsewhere.
A.R.S. § 20-550 — Arizona Code / Title 20 / Chapter 3 / Article 2 / Section 550
20-550 Policy loans
Status: in_force

20-550. Policy loans

A life insurer may lend to its policyholder upon pledge of the policy as collateral security a sum not exceeding the applicable cash surrender value specified in the policy.
A.R.S. § 20-1057.05 — Arizona Code / Title 20 / Chapter 4 / Article 9 / Section 1057.05
20-1057.05 Medical supplies
Status: in_force

20-1057.05. Medical supplies

Any health care services organization that provides coverage for medical supplies shall provide coverage for those medical supplies through one or more participating vendors who are reasonably accessible to enrollees as determined by the department in terms of hours of service and areas of coverage within the geographic service area of the health care plan.
A.R.S. § 20-344 — Arizona Code / Title 20 / Chapter 2 / Article 4 / Section 344
20-344 Uniform plans
Status: in_force

20-344. Uniform plans

A. Except as provided in subsections B and C of this section, every rating organization and every insurer that transacts workers' compensation insurance in this state shall adhere to plans approved by the director as the uniform statistical plan, uniform classification plan and uniform experience rating plan for the state.

B. A rating organization may use its own statistical plan to the extent that the statistical plan does not materially conflict with the uniform statistical plan for the purposes of making all reports to the statistical agent designated by the director pursuant to section 20-371, subsection D.  The rating organization shall file its statistical plan with the director and receive the director's approval before using its own statistical plan.

C. An insurer may directly or through the rating organization of which it is a member develop subclassifications of the uniform classification plan. The insurer, or a rating organization on the insurer's behalf, shall file each subclassification and the rate for the subclassification with the director, and they shall be on file for a waiting period of at least fifteen days before they become effective.  The director shall disapprove the subclassification if the insurer fails to demonstrate that the data produced by the subclassification can be reported consistently with the uniform classification plan and uniform statistical plan or the rate of the subclassification does not meet the standards of section 20-356, paragraph 1.
A.R.S. § 20-670 — Arizona Code / Title 20 / Chapter 3 / Article 6 / Section 670
20-670 Meetings; information; subpoena power; confidentiality
Status: in_force

20-670. Meetings; information; subpoena power; confidentiality

A. Upon receipt of notification from the board that a member insurer may be unable to fulfill its contractual obligations, the director shall meet with the board.

B. At such meeting, the director may divulge to the board any information in his possession and any records of his office, including examination reports or preliminary reports from examiners relating to such insurer.

C. The director may subpoena officers, directors and employees of an insolvent or impaired insurer or of an insurer the director considers to be in danger of insolvency or impairment, to appear before the board for a conference or for taking of testimony.

D. The board shall not reveal information received in such meetings to anyone unless authorized by the director or when required as a witness in court.
A.R.S. § 20-539 — Arizona Code / Title 20 / Chapter 3 / Article 2 / Section 539
20-539 Federally guaranteed loans
Status: in_force

20-539. Federally guaranteed loans

An insurer may invest any of its funds in loans guaranteed as to principal and interest by the United States or by any agency or instrumentality thereof, to the extent of such guaranty.
A.R.S. § 20-1561 — Arizona Code / Title 20 / Chapter 6 / Article 9 / Section 1561
20-1561 Law governing title insurers
Status: in_force

20-1561. Law governing title insurers

A. This article applies to all title insurers, title insurance rating organizations, title insurance agents, applicants for title insurance and policyholders and to all persons and business entities engaged in the business of title insurance.

B. To the extent not modified by this article, title insurers are subject to and governed by the other applicable sections of this title.

C. Any new insurance law enacted after January 1, 1968 does not apply to title insurers, title insurance rating organizations, title insurance agents, applicants for title insurance, title insurance policyholders or title insurance, except by express reference therein.

D. Section 20-223 applies to title insurers.

E. Title insurance agents shall be licensed pursuant to this article. Chapter 2, article 3 of this title does not apply to licensure of title agents except by specific reference in that article, except that to the extent not inconsistent with this article, section 20-285, section 20-286, subsections C and D and sections 20-287, 20-289, 20-289.01, 20-290, 20-291, 20-292, 20-295, 20-296, 20-297, 20-298, 20-299, 20-300 and 20-301 apply to title insurance agents.
A.R.S. § 20-385 — Arizona Code / Title 20 / Chapter 2 / Article 4.1 / Section 385
20-385 Filing of rates
Status: in_force

20-385. Filing of rates

A. Except as to marine, inland marine and transportation risks, which by general custom of the business are not written according to manual rates and rating plans, and except as provided in subsection F of this section or section 20-400.10, every authorized insurer and every rate service organization which has been designated by any insurer for the filing of rates pursuant to section 20-387, subsection B shall file with the director all rates and supplementary rate information and all changes and amendments to those rates made by it for use in this state within thirty days after they become effective. If a rate service organization files prospective loss costs on behalf of its member insurers with the director, each member insurer that adopts the rate service organization's prospective loss costs shall file, on a form approved by the director, the loss cost adjustment and loss cost modification factors applicable to the prospective loss costs filed by the rate service organization.  Each member insurer that does not adopt or that delays adoption of the loss costs filed by the rate service organization shall notify the director of that decision, in a form acceptable to the director, within thirty days after the effective date of the prospective loss costs.

B. For any filing made pursuant to subsection A of this section, the director may require the filing of supporting data including:

1. The experience and judgment of the filer.

2. The experience and judgment of other insurers or rate service organizations.

3. The filer's interpretation of any statistical data relied upon.

4. A description of the methods used in making the rates.

5. A description of the methods used and statistics relied on by the insurer in developing its loss cost modification factor and providing its loss cost adjustment.

6. A description of the methods used and statistics relied on by the rate service organization in developing its prospective loss costs filing.

C. An insurer is not required to file with the director the insurer’s final rate pages that combine the prospective loss costs separately filed by the rate service organization with the loss cost modification factor filed by the insurer.

D. For the purposes of this section, an insurer does not need to file with the director the insurer's final rate pages that combine the prospective loss costs with the loss cost adjustments.

E. On written consent of the insured stating the insured's reasons, the insurer may use a rate in excess of that provided by an otherwise applicable filing on a specific risk, if that rate is filed with the director pursuant to subsection A of this section.

F. For as long as the director deems proper, the director by order may exempt from the requirements of this section any insurance rate, rating class, rating rule or rating program or type the filing of which in the director's opinion is not desirable or necessary for the protection of the public.

G. If, after a hearing, the director finds that a particular market is noncompetitive, the director shall order that all rates or rate changes and all supplementary rate information in the noncompetitive market be filed with the director at least thirty days before the effective date. The order remains in effect until the director determines that a competitive market has been restored.
A.R.S. § 20-1906 — Arizona Code / Title 20 / Chapter 9 / Article 1 / Section 1906
20-1906 Violation; classification
Status: in_force

20-1906. Violation; classification

A person, insurer or authorized agency that knowingly fails to provide information pursuant to section 20-1902, subsection A or who knowingly fails to hold information in confidence pursuant to section 20-1904 is guilty of a class 2 misdemeanor.
A.R.S. § 20-1368 — Arizona Code / Title 20 / Chapter 6 / Article 4 / Section 1368
20-1368 Intoxicants and narcotics
Status: in_force

20-1368. Intoxicants and narcotics

There may be a provision as follows: "Intoxicants and narcotics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician."
A.R.S. § 20-1022 — Arizona Code / Title 20 / Chapter 4 / Article 8 / Section 1022
20-1022 Forms of insurance authorized
Status: in_force

20-1022. Forms of insurance authorized

Lloyd's associations are authorized to make any insurance as provided in this article, except life insurance or title insurance, on the Lloyd's plan, by complying with the requirements set forth in this article. Every policy form issued in this state by a Lloyd's association shall comply with all applicable provisions of chapters 5 and 6 of this title, and in addition shall contain, prominently displayed, in type not substantially smaller than the type used for the name of the company, the legend "not domesticated in Great Britain" or other equivalent language indicating that the insurer is not an alien Lloyd's association or insurer.
A.R.S. § 20-224.06 — Arizona Code / Title 20 / Chapter 2 / Article 1 / Section 224.06
20-224.06 Premium tax credit for contributions to school tuition organization; low-income scholarships
Status: in_force

20-224.06. Premium tax credit for contributions to school tuition organization; low-income scholarships

A. A credit is allowed against the premium tax liability incurred by an insurer pursuant to section 20-224, 20-837, 20-1010, 20-1060 or 20-1097.07 for the amount of voluntary cash contributions made by the insurer during the tax year to a school tuition organization.

B. The amount of the credit is the total amount of the insurer's contributions for the tax year under subsection A of this section that is preapproved by the department of revenue pursuant to section 43-1183, subsection D.

C. The procedures, conditions, limitations, definitions and other requirements prescribed by section 43-1183 and title 43, chapter 15 apply to the following:

1. Insurers that claim a credit under this section.

2. Claims for credit under this section.

3. School tuition organizations that receive contributions from insurers for the purposes of this section.

4. Schools that qualify to receive scholarship monies contributed by insurers for the purposes of this section.

5. Students who receive scholarships from monies contributed by insurers for the purposes of this section.

D. If the allowable amount of a credit under this section exceeds the insurer's state premium tax liability, the amount of the claim not used to offset the premium tax liability may be carried forward as a credit against the insurer's subsequent years' premium tax liability for a period not to exceed five taxable years.

E. A credit is not allowed if the insurer designates the contribution for the direct benefit of any specific student.

F. An insurer that claims a tax credit against state premium tax liability is not required to pay any additional retaliatory tax imposed pursuant to section 20-230 as a result of claiming that tax credit.

G. The department of insurance and financial institutions, with the cooperation of the department of revenue, shall adopt rules and publish and prescribe forms and procedures necessary for the administration of this section.
A.R.S. § 20-841.08 — Arizona Code / Title 20 / Chapter 4 / Article 3 / Section 841.08
20-841.08 Prohibiting denial of occupational or physical therapist contract benefits
Status: in_force

20-841.08. Prohibiting denial of occupational or physical therapist contract benefits

If a hospital service corporation or medical service corporation subscription contract provides coverage for occupational or physical therapy services, and provides both an in-network and out-of-network benefit, a service corporation shall not deny a claim for covered occupational or physical therapy services obtained out-of-network solely on the basis that a physician did not refer the insured to the occupational or physical therapist or prescribe specific occupational or physical therapy services. A service corporation may impose coinsurance, copayments, deductibles, dollar caps, limitations on the number of visits, provider network restrictions or other cost containment measures as a condition of coverage of occupational and physical therapy services for both in-network and out-of-network benefits.