reglab/statecodes huggingface dataset:
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2607 - Information to applicants

20-2607.
Information to applicants
A. An insurer that delivers or issues for delivery in this state a variable life insurance policy shall deliver the following information to the applicant for the policy:
1. A summary explanation of the principal features of the policy. The summary explanation shall be in nontechnical terms and shall include a description of the manner in which the variable benefits will reflect the investment experience of the separate account and the factors that affect the variation. The explanation shall include notice of the requirements of section 20-2604,  subsection D,  paragraph 1,  subdivision (e) and paragraph 7.
2. A statement of the investment policy of the separate account,  including a description of both:
(a) The investment objectives of the separate account and the principal types of investments that will be made.
(b) The restrictions or limitations on the manner in which the operations of the separate account will be conducted.
3. A statement of the net investment return of the separate account for each of the last ten years,  or if the separate account has been in existence for less than ten years,  a statement of the net investment return of the separate account for each of the years that the separate account has been in existence.
4. A statement of the charges that were levied against the separate account during the previous year.
5. A summary of the method the insurer will use in valuing the assets that are held by the separate account.
6. A summary of the federal income tax aspects of the policy that apply to the insured,  the policyholder and the beneficiary.
7. Illustrations of benefits that are payable under the variable life insurance contract. The insurer shall prepare the illustrations. The illustrations shall not include projections of past investment experience into the future or attempted predictions of future investment experience. This paragraph does not prohibit the use of hypothetical assumed rates of return to illustrate possible levels of benefits if the illustration makes it clear that the assumed rates are hypothetical only.
B. This section is satisfied if a disclosure that contains the information required by this section is delivered to the applicant. The disclosure shall either:
1. Be a prospectus that satisfies the requirements of the securities act of 1933 (15 United States Code sections 77a through 77aa) and that the securities and exchange commission declares effective.
2. Contain the information and reports that are required by the employee retirement income security act of 1974 (29 United States Code sections 1001 through 1461) if the policies are exempt from the registration requirements of the securities act of 1933.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2608 - Variable life insurance policy application requirements

20-2608.
Variable life insurance policy application requirements
A variable life insurance policy application shall contain all of the following:
1. A prominent statement that the death benefit may be variable or fixed under specified conditions.
2. A prominent statement that cash values may increase or decrease according to the investment experience of the separate account.
3. Questions that enable the insurer to determine the suitability of variable life insurance for the applicant.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2610 - Foreign companies; compliance with laws of domiciliary state

20-2610.
Foreign companies;  compliance with laws of domiciliary state
If the laws of a foreign company's domiciliary state provide a degree of protection to the policyholders and the public that is substantially similar to the degree of protection that is provided by this article,  the director may determine that the foreign company has complied with this article.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2631 - Definitions

20-2631.
Definitions
In this article,  unless the context otherwise requires:
1. " Company"  means an insurer licensed pursuant to this title to transact life insurance or annuities in this state.
2. " Variable annuity"  means an individual policy or contract that provides for annuity benefits that vary according to the investment experience of a separate account or accounts that the insurer maintains pursuant to section 20-651 or the corresponding insurance laws of a foreign insurer's domiciliary state.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2632 - Qualifications to issue variable annuities

20-2632.
Qualifications to issue variable annuities
A. A company shall not issue or issue for delivery in this state variable annuities unless the director is satisfied that the company's condition or method of operation in connection with the issuance of variable annuity contracts will not be hazardous to the public or the company's policyholders in this state. The director shall consider the following:
1. The history and financial condition of the company.
2. The character,  responsibility and fitness of the company's officers and directors.
3. If the company is a foreign company,  the law under which the company is authorized in its domiciliary state to issue variable annuities.
B. If the company is a subsidiary of an authorized life insurance company or is affiliated with an authorized life insurance company by common management or ownership,  the director may determine that the subsidiary has complied with subsection A,  paragraph 2,  if either:
1. The authorized life insurance company has satisfied the requirements under subsection A.
2. The authorized life insurance company or the company is authorized to and has a satisfactory record of doing business in this state for at least three years.
C. Before a company issues or issues for delivery variable annuities in this state,  the company shall submit all of the following to the director:
1. A general description of the kinds of variable annuities the company intends to issue.
2. If requested by the director,  a copy of the laws of the company's state of domicile under which the company is authorized to issue variable annuities.
3. If requested by the director,  biographical data on the company's officers and directors. The biographical data shall be submitted on the national association of insurance commissioners' biographical data forms.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2634 - Filing of contracts; approval

20-2634.
Filing of contracts;  approval
Unless exempt pursuant to chapter 5,  article 1 of this title,  each insurer shall file with the director all variable annuity contracts and all riders,  endorsements,  applications and other documents that are attached to and made part of the contract and that relate to the variable nature of the contract. The director shall approve all variable annuity contracts before they are delivered or issued for delivery in this state.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2637 - Reports

20-2637.
Reports
A. At least once in each contract year after the first contract year,  a company that issues individual variable annuities shall send to the contract holder at the contract holder's last known address a statement reporting the investments that are held in the separate account as of a date not more than four months before the sent date. The company shall submit annually to the director on a form prescribed by the national association of insurance commissioners a statement of the business of its separate account or accounts.
B. If payments under an annuity contract have not yet commenced the statement shall contain either:
1. The number of accumulation units that are credited to the contract and the dollar value of a unit.
2. The value of the contract holder's account.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2661 - Scope of article; definitions

20-2661.
Scope of article;  definitions
A. This article applies to all agents as defined in section 20-2601 seeking qualification to sell or offer for sale variable contracts or variable group contracts in this state.
B. In this article,  unless the context otherwise requires:
1. " Variable contracts"  means a variable life insurance policy or a variable annuity as defined in sections 20-2601 and 20-2631,  respectively.
2. " Variable group annuity"  means a group policy or contract of two or more individuals that provides for annuity benefits that vary according to the investment experience of a separate account or accounts that the insurer maintains pursuant to section 20-651 or the corresponding insurance laws of a foreign insurer's domiciliary state.
3. " Variable group contracts"  means a variable group annuity or a variable group life insurance policy.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2662 - Insurance producer qualifications; reports

20-2662.
Insurance producer qualifications;  reports
A. A person may not sell or offer for sale in this state any variable contracts unless the person is licensed as a life insurance producer by the department and files with the director evidence that the person is licensed by the financial industry regulatory authority as a principal or a registered representative and that the person is authorized to solicit or sell variable contracts by an insurer admitted to transact variable contract business in this state.
B. A person may not sell or offer for sale in this state any variable group contracts unless the person is licensed as a life insurance producer by the department and is authorized to solicit or sell variable group contracts by an insurer who is admitted to transact variable group contract business in this state.
C. Any examination that is administered by the department to determine if a person is eligible for licensing as an insurance producer may include any questions that the director deems appropriate and that concern the history,  purpose,  regulation and sale of variable contracts or variable group contracts.
D. Any person who is qualified to sell or offer to sell variable contracts or variable group contracts under this article shall immediately report to the director:
1. The suspension or revocation of the insurance producer's license in any other state or territory of the United States.
2. The imposition of any disciplinary sanction,  including the suspension or expulsion of the insurance producer from membership,  or suspension,  revocation or denial of the insurance producer's registration by any national securities exchange,  national securities association or federal,  state or territorial agency that has jurisdiction over securities or variable contracts.
3. The entry of a judgment or injunction against the insurance producer for conduct involving fraud,  deceit or misrepresentation or a violation of any insurance or securities law.
E. The director may reject an application or suspend,  revoke or refuse to renew an insurance producer's qualification to sell or offer to sell variable contracts on any ground that would bar the applicant or insurance producer from being licensed to sell other life insurance contracts in this state. The rules that apply to a proceeding relating to the suspension or revocation of an insurance producer's license also apply to a proceeding for the suspension or revocation of an insurance producer's qualification to sell or offer to sell variable contracts.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2801 - Definitions

20-2801.
Definitions
In this chapter,  unless the context otherwise requires:
1. " Coverage"  means the contractual obligation of a health care services plan to pay its enrollee or a contracted or noncontracted provider for medically necessary emergency services rendered by the provider to an enrollee,  as specified in the governing agreement,  contract or policy between the plan and the enrollee,  subject to applicable copayments,  coinsurance and deductibles.
2. " Emergency ambulance services"  means services provided by an ambulance service authorized to operate pursuant to title 36,  chapter 21.1 following the onset of a medical condition that manifests itself by symptoms of pain,  illness or injury that the absence of accessing an ambulance or emergency response by calling 911 or a designated telephone number to reach a public safety answering point and receiving time sensitive medical attention could reasonably be expected to result in any of the following:
(a) Placing the health of the individual or,  with respect to a pregnant woman,  the health of her unborn child,  in serious jeopardy.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
3. " Emergency services"  means health care services that are provided to an enrollee in a licensed hospital emergency facility by a provider after the recent onset of a medical condition that manifests itself by symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to the patient's health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
4. " Enrollee"  means an individual,  or a dependent of that individual,  who is currently enrolled with and covered by a health care services plan.
5. " Health care services plan"  means a plan offered by a disability insurer,  group disability insurer,  blanket disability insurer,  health care services organization,  hospital service corporation or medical service corporation that contractually agrees to pay or make reimbursement for health care expenses for one or more individuals residing in Arizona but does not apply to benefits provided under limited benefit coverage as defined in section 20-1137.
6. " Prior authorization"  means authorization by telephone or telefacsimile given in advance of the performance of an emergency service on an enrollee,  by a health care services plan after receipt of necessary medical and enrollment information on the enrollee. Prior authorization shall not be considered as a guarantee of full payment.
7. " Provider"  means any physician,  hospital or other person that is licensed or otherwise authorized to furnish emergency services in this state.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2802 - Scope of chapter

20-2802.
Scope of chapter
A. This chapter does not apply to:
1. A provider employed by or under contract with the enrollee's health care services plan.
2. A health care services plan administered under title 36.
3. A health care services plan that only covers health care expenses incurred by an enrollee who is subsequently admitted to a licensed hospital as part of the treatment.
B. This chapter does not create any private right or cause of action for or on behalf of any enrollee,  provider or other person,  whether a resident or nonresident of this state. This chapter provides solely an administrative remedy to the director for any violation of this chapter or any related rule.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2804 - Utilization review; medically necessary emergency services

20-2804.
Utilization review;  medically necessary emergency services
A. A health care services plan engaging in utilization review to determine whether any emergency services rendered by a provider were medically necessary and in accordance with this chapter shall consider the following factors:
1. Current emergency medical literature and standards of care.
2. Clinical information reasonably available to the provider at the time of the services.
B. A health care services plan shall not deny a claim for emergency services on the basis that the services were not medically necessary without review by a physician of the plan's choosing.
C. For the purpose of claims payment and utilization review of emergency services,  a health care services plan shall have the right to require as a condition of payment that each treating provider produce all of the following:
1. Copies of all medical records pertaining to the emergency services provided to the enrollee.
2. Copies of records pertaining to any prior authorization and specialty consultation requests made by the provider.
3. A detailed and itemized billing statement.
D. If a health care services plan pays any portion of a provider's claim for services rendered to an enrollee,  the plan shall not be permitted to recover all or part of that payment from the enrollee,  except for:
1. The cost of an initial medical screening examination and related charges where the examination determined that emergency services were not medically necessary.
2. Payments made as a result of misrepresentation,  fraud or clerical error.
3. Copayment,  coinsurance or deductible amounts that are the responsibility of the enrollee.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2901 - Definitions

20-2901.
Definitions
In this article,  unless the context otherwise requires:
1. " Applicant"  means a provider organization that submits an application to the contractor to provide continuing education courses.
2. " Approved continuing education course"  means any course that has been approved by at least five other states or that is approved by a contractor or automatically approved pursuant to section 20-2904.
3. " Approved provider"  means an organization or individual that offers an approved continuing education course and that is authorized by the contractor to offer the course to a licensee for credit toward the licensee's continuing education requirements.
4. " Continuously licensed"  means that a licensee's license has not terminated for any reason. For the purposes of this paragraph,  a license that expires under section 20-289,  subsection E is not considered to have terminated if the late fee is timely paid and the license is renewed or the license is placed on inactive status pursuant to section 20-289.01.
5. " Contractor"  means the person who has a contract with the department to approve continuing education providers and courses and to administer the continuing education program and who is paid through fees collected from approved providers when the approved providers apply for continuing education course approval.
6. " Credit hour"  means the value assigned to an hour of instruction in an approved continuing education course.
7. " Ethics training"  means continuing education course content regarding the ethical responsibilities insurance producers owe to insurers,  applicants,  policyholders,  regulators,  insurance professionals and the public.
8. " License period"  means the period between the date an Arizona insurance license is issued or last renewed and the expiration date of the Arizona insurance license.
9. " Licensee"  means an individual insurance producer licensed for major line insurance as defined in section 20-281. Licensee does not include any business entity.
10. " Nonresident licensee"  means a licensee who is applying to renew a nonresident license in this state.
11. " Provider organization"  means a person that provides continuing education courses but that has not yet been accepted as an approved provider pursuant to section 20-2904.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2903 - Record keeping

20-2903.
Record keeping
A. Licensees shall maintain their own continuing education records described in section 20-2902,  subsection F and shall keep the records until the second renewal date after the period for which the continuing education credits were earned.
B. In order to verify the attendance and successful course completion of all licensees enrolled in an approved course,  approved providers shall maintain records for five years in a manner acceptable to the director. The records are subject to audit by the department. Each approved provider shall maintain records that include at least the following information for each approved continuing education course provided by the approved provider:
1. The title and subject.
2. A list of attendees.
3. The name of the instructor.
4. A copy of the continuing education course outline.
5. Other information deemed necessary by the director.
C. Based on an audit prescribed in subsection B of this section,  if the director discovers that an approved provider has failed to maintain records in the manner prescribed in subsection B of this section,  the director shall immediately notify the contractor described in section 20-2904 of the approved provider's noncompliance and the contractor shall remove the approved provider from the contractor's list of approved providers. The contractor shall not accept that provider organization as an approved provider for at least one year. The approved provider's noncompliance does not affect the licensee's ability to obtain a renewal of a nonresident license if the licensee complies with section 20-2902 and subsection A of this section.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-2904 - Continuing education; contractor requirements; automatic approval

20-2904.
Continuing education;  contractor requirements;  automatic approval
A. Pursuant to title 41,  chapter 23,  the director shall enter into a contract with a person for the approval of approved providers and courses and administration of the continuing education program. The director shall include in any request for proposals the minimum performance standards established by the continuing education review committee.
B. The contractor shall:
1. After a complete review and investigation based on the minimum standards established by the continuing education review committee:
(a) Accept or reject provider organizations as approved providers.
(b) Except as provided in subsection C of this section,  review course content for approval or disapproval as an approved continuing education course.
2. Charge an applicant an application fee for acceptance as an approved provider and a fee for approval of a continuing education course.
C. A continuing education course is automatically approved if either:
1. Thirty days after the contractor receives an application,  the contractor does not disapprove the course described in the application or does not request supplemental information from the applicant.
2. The course is approved by the insurance regulatory authority in at least five other states and the approved provider provides the contractor with a certificate or letter from the regulatory authority in the five other states that confirms the approval of the course.
D. The contractor's decision pursuant to subsection B,  paragraph 1,  subdivision (b) of this section is an appealable agency action as defined in section 41-1092 and the approved provider is entitled to a hearing pursuant to title 41,  chapter 6,  article 10 and,  except as provided in section 41-1092.08,  subsection H,  is entitled to judicial review pursuant to title 12,  chapter 7,  article 6.
E. Except as provided in section 20-2903,  the acceptance of an approved provider is valid for five years. At the end of the five years,  the approved provider may submit an application for renewal to the contractor and the contractor shall charge the approved provider the fee prescribed in subsection B of this section. The approval of a continuing education course is valid for two years or until the course content or outline changes. At the end of the two years or when the course content or outline changes,  the approved provider may submit an application for renewal to the contractor and the contractor shall charge the approved provider the fee prescribed in subsection B of this section.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3101 - Definitions

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"  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. Grievance does not include a complaint:
(a) By a noncontracted provider regarding an insurer's decision to deny the noncontracted provider admission to the insurer's network.
(b) About an insurer's decision to terminate a health care provider from the insurer's network.
(c) 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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3111 - Definitions

20-3111.
Definitions
In this article,  unless the context otherwise requires:
1. " Arbitration"  means a dispute resolution process in which an impartial arbitrator determines the dollar amount a health care provider is entitled to receive for payment of a surprise out-of-network bill.
2. " Arbitrator"  means an impartial person who is appointed to conduct an arbitration.
3. " Billing company"  means any affiliated or unaffiliated company that is hired by a health care provider or health care facility to coordinate the payment of bills with health insurers and to generate or bill and collect payment from enrollees on the health care provider's or health care facility's behalf.
4. " Contracted provider"  means a health care provider that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates.
5. " Cost sharing requirements"  means an enrollee's applicable out-of-network coinsurance,  copayment and deductible requirements under a health plan based on the adjudicated claim.
6. " Emergency services"  has the same meaning prescribed in section 20-2801.
7. " Enrollee"  means an individual who is eligible to receive benefits through a health plan.
8. " Health care facility"  has the same meaning prescribed in section 36-437.
9. " Health care provider"  means a person who is licensed,  registered or certified as a health care professional under title 32 or a laboratory or durable medical equipment provider that furnishes services to a patient in a network facility and that separately bills the patient for the services.
10. " Health care services"  means treatment,  services,  medications,  tests,  equipment,  devices,  durable medical equipment,  laboratory services or supplies rendered or provided to an enrollee for the purpose of diagnosing,  preventing,  alleviating,  curing or healing human disease,  illness or injury.
11. " Health insurer"  means a disability insurer,  group disability insurer,  blanket disability insurer,  hospital service corporation or medical service corporation that provides health insurance in this state.
12. " Health plan"  means a group or individual health plan that finances or furnishes health care services and that is issued by a health insurer.
13. " Network facility"  means a health care facility that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates.
14. " Surprise out-of-network bill"  means a bill for a health care service that was provided in a network facility by a health care provider that is not a contracted provider and that meets one of the requirements listed in section 20-3113.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3112 - Applicability

20-3112.
Applicability
This article does not apply to:
1. Health care services that are not covered by the enrollee's health plan.
2. Limited benefit coverage as defined in section 20-1137.
3. Charges for health care services that are subject to a direct payment agreement under section 32-3216 or 36-437.
4. Health plans that do not include coverage for out-of-network health care services,  unless otherwise required by law.
5. State health and accident coverage for full-time officers and employees of this state and their dependents that is provided pursuant to title 38,  chapter 4,  article 4.
6. A self-funded or self-insured employee benefit plan if the regulation of that plan is preempted by the employee retirement income security act of 1974 (P.L. 93-406;  88 Stat. 829;  29 United States Code section 1144(b)).
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3113 - Surprise out-of-network bill; requirements; notice

20-3113.
Surprise out-of-network bill;  requirements;  notice
A. A bill for a health care service that was provided in a network facility by a health care provider that is not a contracted provider must meet one of the following requirements to qualify as a surprise out-of-network bill:
1. The bill was for emergency services,  including under circumstances described by section 20-2803,  subsection A and health care services directly related to the emergency services that are provided during an inpatient admission to any network facility.
2. The bill was for a health care service that was not provided in the case of an emergency and the health care provider or the provider's representative did not provide to the enrollee,  or did not provide to the enrollee within a reasonable amount of time before the enrollee received the services,  a written dated disclosure that contained the following information:
(a) Notice that contains the name of the billing health care provider and that states the health care provider is not a contracted provider.
(b) The estimated total cost to be billed by the health care provider or the provider's representative.
(c) Notice that the enrollee or the enrollee's authorized representative is not required to sign the disclosure to obtain medical care but if the enrollee or the enrollee's representative signs the disclosure,  the enrollee may have waived any rights to dispute resolution under this article.
3. The bill was for a health care service that was not provided in the case of an emergency and the enrollee received the disclosure prescribed in paragraph 2 of this subsection,  but the enrollee or the enrollee's authorized representative chose not to sign the disclosure.
B. Notwithstanding any provision of this article,  a health insurer and any health plan offered by a health insurer shall comply with chapter 17,  article 1 of this title.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3114 - Dispute resolution; settlement teleconference; arbitration; surprise out-of-network bills

20-3114.
Dispute resolution;  settlement teleconference;  arbitration;  surprise out-of-network bills
A. An enrollee who has received a surprise out-of-network bill and who disputes the amount of the bill may seek dispute resolution of the bill by filing a request for arbitration with the department not later than one year after the date of service noted in the surprise out-of-network bill,  except as otherwise provided in this section,  if all of the following apply:
1. The enrollee has resolved any health care appeal pursuant to chapter 15,  article 2 of this title that the enrollee may have had against the health insurer following the health insurer's initial adjudication of the claim. The one-year time period for requesting arbitration is tolled from the date that the enrollee files a health care appeal until the date of final resolution of the appeal.
2. The enrollee has not instituted a civil lawsuit or other legal action against the insurer or health care provider related to the same surprise out-of-network bill or the health care services provided.
3. The amount of the surprise out-of-network bill for which the enrollee is responsible for all related health care services provided by the health care provider whether contained in one or multiple bills,  after deduction of the enrollee's cost sharing requirements and the insurer's allowable reimbursement,  is at least one thousand dollars.
B. If an enrollee requests dispute resolution of a surprise out-of-network bill,  the enrollee or the enrollee's authorized representative shall participate in an informal settlement teleconference and may participate in the arbitration of the bill. If the enrollee or enrollee's authorized representative fails to attend the informal settlement teleconference,  the conference shall be terminated and the enrollee,  within fourteen days after the first scheduled informal settlement teleconference,  may request that the department reschedule the informal settlement teleconference. If the enrollee does not request that the department reschedule the informal settlement teleconference,  the enrollee forfeits the right to arbitrate the surprise out-of-network bill. The health care provider or the provider's representative and the health insurer shall participate in the informal settlement teleconference and the arbitration.
C. An enrollee may not seek dispute resolution of a bill if the enrollee or the enrollee's authorized representative signed the disclosure prescribed in section 20-3113,  subsection A,  paragraph 2 and the amount actually billed to the enrollee is less than or equal to the estimated total cost provided in the disclosure.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3117 - Dispute resolution; notice of rights

20-3117.
Dispute resolution;  notice of rights
A. The department in conjunction with the appropriate health care boards shall prescribe the notice outlining an enrollee's rights to dispute surprise out-of-network bills under this article.
B. Health insurers shall include the notice prescribed pursuant to subsection A of this section in each explanation of benefits or other similar claim adjudication notice that is issued to enrollees and that involves covered services provided by a noncontracted health care provider.
C. If an enrollee contacts a health care provider,  a provider's representative or a billing company regarding a dispute involving a surprise out-of-network bill,  the health care provider,  the provider's representative or the billing company shall provide written notice as prescribed in subsection A of this section to the enrollee of the dispute resolution process.
D. The department shall post on its website information for health care consumers regarding what constitutes a surprise out-of-network bill,  how to try to avoid a surprise out-of-network bill and how the dispute resolution process may be used to resolve a surprise out-of-network bill.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3118 - Surprise out-of-network bills; annual report

20-3118.
Surprise out-of-network bills;  annual report
A. On or before December 31,  2019 and each December 31 thereafter,  the department shall report on the resolution of disputed surprise out-of-network bills. The report shall include:
1. The total number of inquiries regarding dispute resolution of surprise out-of-network bills.
2. The total number of requests that did not qualify for dispute resolution and the reasons why the disputed bills did not qualify.
3. The number of requests that qualified for dispute resolution.
4. The most common requests for dispute resolution by health care provider specialty area.
5. The most common requests for dispute resolution by health care service.
6. The number of requests for dispute resolution by geographic area in this state.
7. The most common requests for dispute resolution based on the type of health care facility in which the health care services were provided.
8. The number of requests for dispute resolution that were settled during a settlement teleconference.
9. The number of requests for dispute resolution that were settled during arbitration.
10. The number of times a health insurer,  a health care provider or the provider's representative or an enrollee failed to attend the settlement teleconference.
11. The average percentage by which disputed surprise out-of-network bills were reduced from the initially billed amount.
12. Any additional information that the department determines is relevant in evaluating the effectiveness of the dispute resolution process.
B. The department shall submit the report to the governor,  the president of the senate and the speaker of the house of representatives and shall provide a copy of the report to the secretary of state.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3119 - Right of civil action

20-3119.
Right of civil action
An enrollee who is aggrieved by an arbitration decision regarding a disputed surprise out-of-network bill may file a civil action in superior court not later than one year after the date of the disputed decision to obtain appropriate relief with respect to the same surprise out-of-network bill.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3151 - Definitions

20-3151.
Definitions
For the purposes of this section:
1. " Enrollee"  means an individual who is enrolled in a health care plan provided by a health care insurer.
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 and medical service corporation.
3. " Health care plan"  means a policy,  contract or evidence of coverage issued to an enrollee. Health care plan does not include limited benefit coverage as defined in section 20-1137.
4. " Health care professional"  means a professional who is regulated pursuant to title 32,  chapter 7,  8,  11,  13,  14,  15,  15.1,  16,  17,  18,  19,  19.1,  25,  28,  29,  33,  34,  35,  39 or 41,  title 36,  chapter 6,  article 7 or title 36,  chapter 17.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3152 - Exemptions; waiver

20-3152.
Exemptions;  waiver
A. This chapter does not create:
1. Any liability on the part of any employer or employer group purchasing organization that purchases coverage or assumes risk on behalf of its employees or on behalf of self-funded employee benefit plans.
2. Any new or additional liability on the part of a health care insurer for harm caused that is attributable to the medical negligence of a treating health care professional or health care institution as defined in section 36-401.
B. This chapter does not abrogate or limit any other theory of liability or defense otherwise available at law.
C. Any waiver by an enrollee of any provision of this chapter is contrary to public policy and is unenforceable and void.
D. An enrollee who files an action pursuant to section 20-3153 may not pursue a common law action for breach of the duty of good faith and fair dealing against the health care insurer. An enrollee who files a common law action for breach of the duty of good faith and fair dealing against a health care insurer may not pursue an action pursuant to section 20-3153.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3153 - Health care insurer liability

20-3153.
Health care insurer liability
A. A health care insurer is liable for any damages caused to the insurer's enrollee by the insurer's delay in authorizing or failure to authorize a request for medically necessary health care services covered under the health care plan or by the insurer's denial of payment of benefits covered under the health care plan if both:
1. The health care insurer delayed authorizing or failed to authorize the requested health care services or denied payment of the covered benefits without a reasonable basis for that action.
2. The health care insurer knew that it acted without a reasonable basis or failed to perform an investigation or evaluation adequate to determine whether its action was supported by a reasonable basis.
B. A health care insurer:
1. Is liable under this section if the insurer's conduct was a cause of the enrollee's damages and if the damages would not have occurred without that conduct.
2. Is not liable under this section if the insurer's conduct under this section was inadvertent or unintentional.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3154 - Health care appeals; admissibility

20-3154.
Health care appeals;  admissibility
In an action under this chapter,  any person,  enrollee or health care insurer may introduce into evidence for any purpose any of the documents,  findings,  decisions or information concerning events that occurred in the health care appeals process pursuant to chapter 15,  article 2 of this title. The fact that the enrollee did not participate in the health care appeals process may also be introduced into evidence.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3155 - Notice of intent to file suit

20-3155.
Notice of intent to file suit
A. Before an enrollee files an action pursuant to section 20-3153,  the enrollee shall either:
1. Complete the health care appeals process prescribed in chapter 15,  article 2 of this title.
2. Provide written notice to the health care insurer at least thirty days before filing suit stating the enrollee's intention to file suit and setting forth the basis for the suit.
B. If the enrollee provides notice pursuant to subsection A,  paragraph 2 of this section,  the enrollee shall deliver the notice to the health care insurer in compliance with the terms specified for delivery of written notices prescribed in the policy,  contract or evidence of coverage. If the policy,  contract or evidence of coverage does not specify the terms for delivery of written notices,  the enrollee may provide notice to the last representative of the health care insurer who corresponded in writing with the enrollee.
C. Participation in the health care appeals process prescribed in chapter 15,  article 2 of this title does not prohibit or limit the enrollee from filing suit at the conclusion of the appeals process.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3203 - Contract requirements

20-3203.
Contract requirements
A. A person may not use any form of life settlement contract in this state unless it is filed with and,  if required,  approved by the director in a manner that conforms with the filing procedures and any time restrictions or deeming provisions for life insurance forms,  policies or contracts.
B. As a condition of responding to a request for verification of coverage or in connection with the transfer of a policy pursuant to a life settlement contract,  an insurer may not require that the owner,  insured,  provider or broker sign any form,  disclosure,  consent,  waiver or acknowledgment that has not been expressly approved by the director for use in connection with life settlement contracts in this state.
C. A person may not use a life settlement contract form or provide to an owner a disclosure statement form in this state unless the form is first filed with and approved by the director. The director may not approve a life settlement contract form or disclosure statement form if,  in the director's opinion,  the contract or provisions of the contract fail to meet the requirements of this chapter or are unreasonable,  contrary to the public interest or otherwise misleading or unfair to the owner.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3205 - Privacy

20-3205.
Privacy
Except as otherwise provided by law,  a provider,  broker,  insurance company,  insurance producer or any other person with actual knowledge of an insured's identity shall not disclose the identity of an insured or any information that there is a reasonable basis to believe could be used to identify the insured or the insured's financial or medical information to any other person unless the disclosure is one of the following:
1. Necessary to effect a life settlement contract between the owner and a provider and the owner and insured have provided prior written consent to the disclosure.
2. Necessary to effect the sale of life settlement contracts or interests in life settlement contracts as investments if the sale is conducted pursuant to applicable state and federal securities law and the owner and the insured have both provided prior written consent to the disclosure.
3. Provided in response to an investigation or examination by the director or any other state or federal agency.
4. A term or condition to the transfer of a policy by one provider to another provider,  in which case the receiving provider shall be required to comply with all applicable laws regarding the confidentiality of medical information.
5. Necessary to allow the provider or broker or the provider's or broker's authorized representatives to make contacts for the purpose of determining health status. For the purposes of this paragraph,  authorized representative does not include any person who has or may have any financial interest in the settlement contract other than a provider or licensed broker. Authorized representatives shall agree in writing to adhere to all applicable confidentiality and privacy laws.
6. Required to purchase stop loss coverage.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3206 - Rule making; examinations

20-3206.
Rule making;  examinations
A. The director may adopt rules reasonably necessary to regulate life settlements and transactions consistent with the provisions of this chapter.
B. The director,  whenever the director deems it reasonably necessary to protect the interests of the public,  may examine the business and affairs of any licensee or applicant for a license. The director may order any licensee or applicant to produce any records,  books,  files or other information to ascertain whether or not the licensee or applicant is acting or has acted in violation of this title or otherwise contrary to the interests of the public. The licensee or applicant shall pay any expenses incurred in conducting any examination.
C. In lieu of an examination of any foreign or alien licensee licensed in this state,  the director,  at the director's discretion,  may accept an examination report on the licensee prepared by the director for the licensee's state of domicile or port-of-entry state.
D. Names of and individual identification data for all owners and insureds is private and confidential information and shall not be disclosed by the director unless required by law.
E. The provider shall maintain records of all consummated transactions and life settlement contracts for three years after the death of the insured. The director may inspect these records during reasonable business hours.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3208 - Conflict of interest; examiners

20-3208.
Conflict of interest;  examiners
A. The director may not appoint an examiner if the examiner,  either directly or indirectly,  has a conflict of interest or is affiliated with the management of or owns a pecuniary interest in any person subject to examination under this chapter. This section does not automatically preclude an examiner from being an owner,  an insured in a life settlement contract or insurance policy or a beneficiary in an insurance policy that is proposed for a life settlement contract.
B. Notwithstanding subsection A,  the director may retain on an individual basis qualified actuaries,  certified public accountants or other similar individuals who are independently practicing their professions even though these persons may from time to time be similarly employed or retained by persons subject to examination under this chapter.