reglab/statecodes huggingface dataset:
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-788 - Distribution of savings

20-788.
Distribution of savings
A reciprocal insurer may from time to time return to its subscribers any unused premiums,  savings or credits accruing to their accounts. Any such distribution shall not unfairly discriminate between classes of risks,  or policies,  or between subscribers,  but this shall not prevent retrospective rating,  nor distribution on a retrospective plan.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-789 - Subscriber's share in assets

20-789.
Subscriber's share in assets
Upon the liquidation of a domestic reciprocal insurer,  its assets remaining after discharge of its indebtedness and policy obligations,  the return of any contributions of the attorney or other persons to its surplus made as provided in section 20-778,  and the return of any unused premium,  savings or credits then standing on subscribers' accounts,  shall be distributed to its subscribers who were such within the twelve months prior to the last termination of its certificate of authority,  according to such reasonable formula as the director may approve.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-790 - Merger or conversion

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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-791 - Impaired reciprocal insurers

20-791.
Impaired reciprocal insurers
A. If the assets of a reciprocal insurer are at any time insufficient to discharge its liabilities,  other than any liability on account of funds contributed by the attorney or others,  and to maintain the required surplus,  its attorney shall forthwith make up the deficiency or levy an assessment upon the subscribers for the amount needed to make up the deficiency,  but subject to the limitation set forth in the power of attorney or policy.
B. If the attorney fails to make up the deficiency or to make the assessment within thirty days after the director orders him to do so,  or if the deficiency is not fully made up within sixty days after the date the assessment was made,  the insurer shall be deemed insolvent and shall be proceeded against as authorized by this title.
C. If liquidation of such an insurer is ordered,  an assessment shall be levied upon the subscribers for such an amount,  subject to limits as provided by this article,  as the director determines to be necessary to discharge all liabilities of the insurer,  exclusive of any funds contributed by the attorney or other persons,  but including the reasonable cost of the liquidation.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-792 - Ownership of real property

20-792.
Ownership of real property
Legal title of real property acquired as an eligible investment in accordance with section 20-556 must be held in the name of the reciprocal insurer. Notwithstanding any other provision in this section,  all deeds,  notes,  mortgages or other documents relating to the purchase,  sale,  lease,  encumbrance or other interest in such real property may be executed in the name of the reciprocal insurer by its attorney-in-fact.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-821 - Scope of article; rules; authority of director

20-821.
Scope of article;  rules;  authority of director
A. Hospital service corporations,  medical service corporations,  dental service corporations,  optometric service corporations and hospital,  medical,  dental and optometric service corporations incorporated in this state are governed by this article and are exempt from all other provisions of this title,  except as expressly provided by this article and any rule adopted by the director pursuant to section 20-143 relating to contracts of such service corporations. No insurance law enacted after January 1,  1955 applies to such corporations unless the law specifically refers to corporations.
B. Chapter 2,  articles 8 and 12 of this title,  sections 20-223,  20-234,  20-261,  20-1133,  20-1377,  20-1408,  20-1692,  20-1692.01,  20-1692.02 and 20-1692.03 and chapters 15,  17,  20 and 30 of this title and any rules adopted to implement these provisions apply to all corporations governed by this article.
C. Chapter 21 of this title applies to a hospital service corporation,  a medical service corporation or a hospital and medical service corporation.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-822 - Definitions

20-822.
Definitions
In this article,  unless the context otherwise requires,  " hospital service corporations" ,  " medical service corporations" ,  " dental service corporations" ,  " optometric service corporations"  and " hospital,  medical,  dental and optometric service corporations"  mean corporations organized under the laws of this state for the purpose of establishing,  maintaining and operating nonprofit hospital service or medical or dental or optometric service plans,  or a combination of such plans,  whereby hospital,  medical or dental or optometric service may be provided by hospitals,  which within the meaning of this article may include extended care facilities and home health agencies,  or by physicians,  which within the meaning of this article may include professional and technical personnel under the direction of a physician,  or by podiatrists,  or by dentists which may include those engaged in the general practice of dentistry as well as the specialized or restricted practice of dentistry,  or by optometrists which may include those engaged in the general practice of optometry as well as the specialized or restricted practice of optometry,  with which the corporations have contracted for such purpose,  to such of the public as become subscribers to the corporations under contracts that entitle each subscriber to certain hospital,  medical,  dental or optometric service,  or in the case of hospital service corporations or medical service corporations,  all such services,  or whereby as operating expense or refunds,  payments may be made to subscribers with respect to any such service that is rendered by a hospital,  physician,  podiatrist,  dentist or optometrist with which the corporations have not so contracted.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-823 - Incorporation of hospital, medical, dental and optometric service corporations

20-823.
Incorporation of hospital,  medical,  dental and optometric service corporations
The corporation as defined in section 20-822 shall be organized under the laws of this state relating to private corporations not for pecuniary profit,  insofar as such laws are not inconsistent with any of the provisions of this article.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-824 - Application for certificate; fee

20-824.
Application for certificate;  fee
Such a corporation may issue contracts to its subscribers only when the director has,  by certificate of authority,  authorized it so to do. Application for a certificate of authority shall be made on forms supplied or approved by the director containing such information as the director deems necessary. Each application for a certificate of authority shall be accompanied by the fee prescribed by chapter 1,  article 2 of this title for medical,  hospital,  dental and optometric service corporations and copies of the following documents:
1. Articles of incorporation.
2. Bylaws.
3. Proposed contracts between the applicant and participating hospitals,  physicians,  dentists or optometrists showing the terms under which service is to be furnished to subscribers.
4. Proposed contracts to be issued to subscribers.
5. A table of rates to be charged to subscribers.
6. Financial statement of the corporation,  including the amounts of contributions paid or agreed to be paid to the corporation for working capital,  and the name or names of each contributor and the terms of each contribution.
7. A statement of the area in which the corporation proposes to operate.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-825 - Certificate of authority; requirements

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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-826.02 - Subscription contracts; varying copayments and deductibles allowed

20-826.02.
Subscription contracts;  varying copayments and deductibles allowed
A. Except as provided in sections 20-1379 and 20-2304,  a corporation may offer one or more subscription contracts 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 corporation that offers such a subscription contract 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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-826.03 - Eosinophilic gastrointestinal disorder; formula

20-826.03.
Eosinophilic gastrointestinal disorder;  formula
A. Any contract that is offered by a hospital service corporation or medical service corporation and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if:
1. The subscriber has been diagnosed with an eosinophilic gastrointestinal disorder.
2. The subscriber is under the continuous supervision of a physician who is licensed pursuant to title 32,  chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32,  chapter 15.
3. There is risk of a mental or physical impairment without the use of the formula.
B. A hospital service corporation or medical service corporation shall cover at least seventy-five per cent of the cost of the formula. The hospital service corporation or medical service corporation may limit the maximum annual benefit for formula under this section to twenty thousand dollars.
C. This section does not apply to limited benefit coverage as defined in section 20-1137.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-826.04 - Subscription contracts; autism spectrum disorder; coverage; exceptions; definitions

20-826.04.
Subscription contracts;  autism spectrum disorder;  coverage;  exceptions;  definitions
A. A hospital service corporation or medical service corporation shall not:
1. Exclude or deny coverage for a treatment or impose dollar limits,  deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph,  " treatment"  includes diagnosis,  assessment and services.
2. Exclude or deny coverage for medically necessary behavioral therapy services. To be eligible for coverage,  behavioral therapy services shall be provided or supervised by a licensed or certified provider.
B. This section does not:
1. Apply to a subscription contract that is issued to an individual or a small employer.
2. Apply to limited benefit coverage as defined in section 20-1137.
3. Require coverage for services provided outside of this state.
C. The coverage required by this section is subject to all the terms and conditions of the subscription contract. Nothing in this section prevents a corporation from imposing deductibles,  coinsurance or other cost sharing in relation to the coverage required by this section.
D. Coverage for behavioral therapy is subject to:
1. A fifty thousand dollar maximum benefit per year for an eligible person up to the age of nine.
2. A twenty-five thousand dollar maximum benefit per year for an eligible person who is between the ages of nine and sixteen.
E. For the purposes of this section:
1. " Autism spectrum disorder"  means one of the three following disorders as defined in the most recent edition of the diagnostic and statistical manual of mental disorders of the American psychiatric association:
(a) Autistic disorder.
(b) Asperger's syndrome.
(c) Pervasive developmental disorder not otherwise specified.
2. " Behavioral therapy"  means interactive therapies derived from evidence based research,  including applied behavior analysis,  which includes discrete trial training,  pivotal response training,  intensive intervention programs and early intensive behavioral intervention.
3. " Small employer"  has the same meaning prescribed in section 20-2301.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-828 - Deposit for protection of members

20-828.
Deposit for protection of members
A. Corporations governed by this article shall at all times have on deposit with the state treasurer the following amounts:
1. If newly formed under this article,  two hundred thousand dollars.
2. If formed under prior law,  such amount as was so required under prior law.
B. Every such corporation each year shall deposit with the state treasurer,  not later than February 1,  an amount equal to two per cent of the gross subscriptions collected during the preceding calendar year,  until the deposit of the corporation reaches a total of five hundred thousand dollars. All such deposits shall be held by the state treasurer in trust for the benefit and protection of the subscribers of the corporation making the deposit.
C. The deposit prescribed by this section shall be subject to withdrawal in whole or in part on the order of and as directed by the director,  but may,  with the approval of the director,  be invested pursuant to section 35-313. Interest earned on the deposits shall be payable to the corporation making the deposit.
D. An unsettled final judgment,  arising upon a certificate of participation against such a corporation,  shall be a lien on the deposit prescribed by this section,  subject to execution after thirty days from the entry of final judgment. If the deposit is reduced thereby,  it shall be replenished within ninety days.
E. Upon the liquidation or dissolution of the corporation and the satisfaction of all its liabilities,  any balance remaining in the deposit in the hands of the state treasurer and any other assets of the insurer shall be distributed to the holders of certificates of participation in good standing at the time proceedings for the liquidation or dissolution of the corporation were commenced,  prorated according to the gross amount of subscriptions which have been paid on the certificates up to the time such proceedings were commenced.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-829 - Directors

20-829.
Directors
The directors of a corporation governed by this article shall at all times include representatives of:
1. Dentists licensed to practice in this state who have contracted with the corporation to render dental service to subscribers,  if the corporation is a dental service corporation.
2. Optometrists licensed to practice in this state who have contracted with the corporation to render optometric service to subscribers,  if the corporation is an optometric service corporation.
3. The general public,  exclusive of dentists and optometrists.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-830 - Expenses and investments

20-830.
Expenses and investments
A. The operating and administrative expenses of any such corporation,  including all costs in connection with solicitation of subscribers to the corporation and capital expenditures,  shall not exceed thirty per cent of paid subscriptions during the first year of operation,  twenty-five per cent of paid subscriptions during the second year of operation,  and twenty per cent of paid subscriptions in any year thereafter.
B. All funds not set aside for operating expenses shall be placed in a reserve that may be expended only for payment to participating hospitals,  physicians,  dentists,  optometrists,  certified registered nurses,  registered nurse practitioners,  psychologists and chiropractors for services to subscribers,  for payment to subscribers for coverage on prescription drugs when provision is so made in subscription contracts,  or as a refund to the subscribers. The funds of the corporation shall be invested as prescribed by article 2,  chapter 3 of this title for domestic insurers.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-831 - Annual statement; examination

20-831.
Annual statement;  examination
A. Not later than March 31 of each year every corporation shall file with the director a statement of its financial condition,  transactions and affairs as of the preceding December 31 as prescribed in sections 20-223 and 20-234 and shall pay the annual renewal fee prescribed in section 20-167.
B. At the time of filing its annual statement as required by section 20-223,  a corporation shall also disclose to the director,  in the form or manner prescribed by the director,  information similar to that required of other corporations transacting business in this state pursuant to title 10,  chapter 39,  article 2 that is not already filed with or available to the director.
C. The director may appoint an examiner,  deputy examiner or other person to examine into the affairs of the corporation who has the power of visitation and examination,  is entitled to free access to all the books,  papers and documents relating to the business of the corporation and may summon the officers,  agents or employees or any other persons and require them to testify under oath concerning the affairs,  transactions and condition of the corporation. An examination shall be conducted at least every five years.
D. The corporation shall pay the cost of the examination and audit,  but the corporation is not required to pay for more than one audit or examination in any one year. The corporation shall pay the costs as provided for insurers pursuant to section 20-159.
E. A corporation that fails to timely file the annual statement required under subsection A of this section or fails to provide information required under subsection B of this section is subject to the penalties prescribed in section 20-223.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-832 - Limitation on salaries

20-832.
Limitation on salaries
A corporation shall not:
1. Pay to any officer of the corporation any salary,  compensation or emolument amounting in any year to more than $5, 000,  unless the board of directors of the corporation first authorizes the salary,  compensation or emolument.
2. Make any agreement with any officer whereby the corporation agrees that for any services rendered or to be rendered the officer will receive a salary,  compensation or emolument for a period of more than three years from the date of the agreement.
3. Pay any bonus,  commission or dividend to any director of the corporation.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-833 - Relationship of health care professional and patient; financial incentives; definition

20-833.
Relationship of health care professional and patient;  financial incentives;  definition
A. Nothing in this article alters the relationship of physician and patient,  registered nurse practitioner and patient,  dentist and patient or optometrist and patient.
B. The corporation shall not in any way influence the subscriber in the subscriber's free choice of hospital,  physician,  registered nurse practitioner,  dentist or optometrist other than to limit its benefits to participating hospitals,  physicians,  dentists and optometrists.
C. Nothing in this article abridges the right of any physician,  hospital,  dentist or optometrist to decline patients in accordance with the standards and practices of such physician,  hospital,  dentist or optometrist,  and the corporation shall not be deemed to be engaged in the corporate practice of medicine,  dentistry or optometry.
D. A contract between the corporation and a health care professional shall not contain a financial incentive plan that includes a specific payment made to or withheld from the health care professional as an inducement to deny,  reduce,  limit or delay medically necessary care that is covered by the contract with a subscriber or group of subscribers for a specific disease or condition. This section does not prohibit per diem or per case payments,  diagnostic related grouping payments,  or financial incentive plans,  including capitation payments or shared risk arrangements,  that are not connected to specific medical decisions relating to a subscriber or a group of subscribers for a specific disease or condition. Each corporation shall file with its annual report a written statement with the director that certifies that the corporation is in compliance with this subsection.
E. For the purposes of this section,  " health care professional"  has the same meaning prescribed in section 20-3151.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-836 - Limitation on liability

20-836.
Limitation on liability
No liability shall attach to any corporation holding a certificate of authority under this article by reason of the failure on the part of any of its participating hospitals,  physicians,  dentists or optometrists to render service,  except as provided by this article,  to any of its subscribers,  nor for the negligence,  malpractice or other acts of its participating hospitals,  physicians,  dentists or optometrists.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-837 - Tax exemption; exceptions

20-837.
Tax exemption;  exceptions
A. Every corporation doing business pursuant to this article is declared to be a nonprofit and benevolent institution and to be exempt from state,  county,  district,  municipal and school taxes,  including the taxes prescribed by this title,  and excepting only the fees prescribed by section 20-167 and taxes on real and tangible personal property located within this state. Each corporation is subject to a state tax of 2.0 percent on net premiums that are received to effect or maintain the corporation's subscription contracts,  except that the tax shall not apply with respect to any coverage concerning which the corporation's relationship is as administrative or fiscal agent for national,  state or municipal government or any political subdivision or body thereof,  and such tax shall not apply with respect to any premiums received from funds of national,  state or municipal government or any political subdivision or body thereof. The tax shall be determined,  filed and reported in the manner prescribed in section 20-224. The failure by a corporation to pay the tax on or before the prescribed payment dates results in a civil penalty determined pursuant to section 20-225.
B. A corporation may claim a premium tax credit if the corporation qualifies for a credit pursuant to section 20-224.03.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-838 - Subscribers and employees exempt from corporate indebtedness

20-838.
Subscribers and employees exempt from corporate indebtedness
The private property of the subscribers,  agents,  officers,  directors,  members and employees of any corporation holding a certificate of authority under this article shall be wholly exempt from any of the debts,  obligations and liabilities of the corporation.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-839 - Exemption of certain hospital plans

20-839.
Exemption of certain hospital plans
A. This article shall not apply to any corporation operating or maintaining a hospital service plan,  medical service plan,  dental service plan or optometric service plan,  participation in which is limited to its employees and the employees of other persons or corporations with which such corporation may have contracted to provide such services.
B. As used in this section,  the term " employees"  shall include members of the families of employees.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-840 - Continuation of existing certificates, licenses and rights

20-840.
Continuation of existing certificates,  licenses and rights
This article shall not be construed in any manner to abrogate,  amend or annul any certificate,  license or right acquired prior to January 1,  1955 by any corporation,  insurer,  hospital,  physician,  dentist,  optometrist,  individual or subscriber under or pursuant to Laws 1945,  1st special session,  chapter 13,  and all of such certificates,  licenses and rights shall be and they are continued in full force and effect.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841 - Prohibiting denial of certain contract benefits

20-841.
Prohibiting denial of certain contract benefits
A. Notwithstanding any provision of any subscription contract of a hospital and medical service corporation,  benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32,  chapter 7 or 11,  if the service performed is within the lawful scope of such person's license,  and if the service is surgical,  such person is a member of the staff of an accredited hospital,  and if such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to title 32,  chapter 13.
B. If a subscription contract of a hospital and medical service corporation provides for or offers eye care services,  the subscriber shall have freedom of choice to select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination,  care,  or treatment for which the subscriber is eligible and which falls within the scope of practice of the optometrist or physician and surgeon. Unless such subscription contract otherwise provides,  there shall be no reimbursement for ophthalmic materials,  lenses,  spectacles,  eyeglasses,  or appurtenances thereto.
C. If any subscription contract of a hospital and medical service corporation is written to provide coverage for psychiatric,  drug abuse or alcoholism services,  reimbursement for such services shall be made in accordance with the terms of the contract without regard to whether the covered services are rendered in a psychiatric special hospital or general hospital. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32,  chapter 13 or 19.1 or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.01 - Prohibiting denial of chiropractic contract benefits; direct reimbursement

20-841.01.
Prohibiting denial of chiropractic contract benefits;  direct reimbursement
If a subscription contract of a hospital and medical service corporation provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered,  a subscriber covered under such contract may select either a physician or duly certified or licensed chiropractor to provide the examination,  care or treatment for which the subscriber is eligible and which falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32,  chapter 8 or 13 who has a participation contract with the hospital and medical service corporation or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.02 - Prohibiting denial of psychologist contract benefits

20-841.02.
Prohibiting denial of psychologist contract benefits
If a subscription contract of a hospital and medical service corporation provides for or offers reimbursement for any service which is within the lawful scope of the practice of a psychologist holding a certificate or license issued by the state in which the services are rendered,  a subscriber covered under such contract may select either a physician or duly certified or licensed psychologist to provide the examination,  care or treatment for which the subscriber is eligible and which falls within the scope of practice of the psychologist or physician.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.03 - Prohibiting denial of contract benefits; nurses; reimbursement

20-841.03.
Prohibiting denial of contract benefits;  nurses;  reimbursement
If a subscription contract of a hospital and medical service corporation provides or offers reimbursement for any service which is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nursing regarding extended nursing practice and licensed pursuant to title 32,  chapter 15,  the hospital and medical service corporation shall not deny benefits to a subscriber who receives the services of the certified registered nurse or registered nurse practitioner. The cost of the service may be reimbursed directly to the certified registered nurse or registered nurse practitioner if the certified registered nurse or registered nurse practitioner has a participation contract with the hospital and medical service corporation or to the subscriber if another provider or health care institution was not reimbursed for the cost of the service.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.04 - Standing referrals to network health care professionals; definition

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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.08 - Prohibiting denial of occupational or physical therapist contract benefits

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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.10 - Cancer treatment medications; cost sharing; definition

20-841.10.
Cancer treatment medications;  cost sharing;  definition
A. A contract that is issued,  delivered or renewed by a corporation on or after January 1,  2016 and that provides coverage both for cancer treatment medications that are injected or intravenously administered by a health care provider and for patient-administered cancer treatment medications,  including medications that are orally administered or self-injected,  may not require a higher copayment,  deductible or coinsurance amount for patient-administered cancer treatment medications than is required for those cancer treatment medications that are injected or intravenously administered by a health care provider,  regardless of the formulation or benefit category.
B. A corporation may not increase copayment,  deductible or coinsurance amounts for covered cancer treatment medications that are injected or intravenously administered in order to avoid compliance with subsection A of this section,  but may increase copayment,  deductible or coinsurance amounts for cancer treatment medications if the increase is applied generally to other medical or pharmaceutical benefits under the contract and is not done to circumvent subsection A of this section.
C. A corporation may not reclassify benefits with respect to cancer treatment medications in a manner that is inconsistent with this section.
D. For the purposes of this section,  " cancer treatment medications"  means prescription drugs and biologics that are used to kill,  slow or prevent the growth of cancerous cells.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.11 - Prescription eyedrops; refills

20-841.11.
Prescription eyedrops;  refills
A. Beginning January 1,  2018,  any contract that is issued,  delivered or renewed by a corporation and that provides coverage for prescription eyedrops to treat glaucoma or ocular hypertension may not deny coverage for a refill of a prescription for eyedrops to treat glaucoma or ocular hypertension if all of the following apply:
1. The subscriber requests the refill:
(a) For a thirty-day supply,  at least twenty-three days and less than thirty days from the later of:
(i) The original date that the prescription was distributed to the subscriber.
(ii) The date of the most recent refill that was distributed to the subscriber.
(b) For a sixty-day supply,  at least forty-five days and less than sixty days from the later of:
(i) The original date that the prescription was distributed to the subscriber.
(ii) The date of the most recent refill that was distributed to the subscriber.
(c) For a ninety-day supply,  at least sixty-eight days and less than ninety days from the later of:
(i) The original date that the prescription was distributed to the subscriber.
(ii) The date of the most recent refill that was distributed to the subscriber.
2. The prescription eyedrops to treat glaucoma or ocular hypertension prescribed by the health care provider are a covered benefit under the subscriber's contract.
3. The prescribing health care provider indicates on the original prescription that additional quantities of the prescription eyedrops to treat glaucoma or ocular hypertension are needed.
4. The refill requested by the subscriber does not exceed the number of additional quantities prescribed.
B. To the extent practicable,  the requirements of this section are limited in quantity to the remaining dosage initially approved for coverage,  except that any limited refilling may not limit or restrict coverage to any previously or subsequently approved prescription eyedrops to treat glaucoma or ocular hypertension and is subject to the terms and conditions of the contract that are applicable to this coverage.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-841.12 - Coverage of health care services

20-841.12.
Coverage of health care services
All contracts issued,  delivered or renewed on or after July 1,  2017 by a corporation in this state must provide coverage for lawful health care services that are provided by a health care provider to a subscriber regardless of the familial relationship of the health care provider to the subscriber if the health care service would be covered were it provided to a subscriber who was not related to the health care provider. The contract may limit the coverage to those health care providers who are members of the corporation's provider network.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-842 - Prohibition against excluding coverage because of previous tests for a condition

20-842.
Prohibition against excluding coverage because of previous tests for a condition
An insurance contract offered by a hospital,  medical,  dental or optometric service corporation shall not exclude coverage of a condition if the insured person has previously had tests for the condition and the condition was not found to exist. There must be evidence that a condition actually existed before the insurance contract was entered into in order to exclude coverage of the condition.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-843 - Eligibility; prohibiting cancellation because of eligibility for certain benefits

20-843.
Eligibility;  prohibiting cancellation because of eligibility for certain benefits
A. Except as specifically provided in sections 20-1379 and 20-1380,  with respect to the determination of whether a person is an eligible individual,  a hospital and medical service corporation 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 that are 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 hospital and medical service corporation shall pay the state program pursuant to title XIX of the social security act according to the coverage provided in the contract.
C. A hospital and medical service corporation 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.
D. A hospital or medical service corporation shall not cancel or fail to renew the contract of any person based on that person's eligibility for or enrollment in a program funded under title XIX of the social security act or title 36,  chapter 29 or 34. Nothing in this section prohibits cancellation or failure to renew for nonpayment of monies due under the contract.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-844 - Right to open enrollment period; subscribers; definition

20-844.
Right to open enrollment period;  subscribers;  definition
A. With respect to subscribers who are members of a group with more than one carrier,  if there is an insolvency of a hospital service corporation,  medical service corporation,  dental service corporation,  optometric service corporation or hospital,  medical,  dental and optometric service corporation,  all other carriers that participated in an open enrollment period shall offer subscribers of the insolvent corporation who are members of that group a thirty day open enrollment period beginning on the date the insolvency is declared. Each carrier shall offer these subscribers the same coverages and rates that it currently offers to other subscribers in the group without any waiting periods or preexisting conditions,  exclusions,  limitations or restrictions. On declaration of insolvency,  the corporation shall notify each group contract holder of the insolvency. Each group contract holder shall notify its remaining carrier or carriers of the insolvency and notify its members of their rights to open enrollment as provided in this section.
B. Sections 20-1069.01 and 20-1409 apply to all corporations within the scope of section 20-821.
C. For purposes of this section,  " carrier"  means an insurer,  a health care services organization,  a hospital service corporation,  a medical service corporation,  a dental service corporation,  an optometric service corporation or a hospital,  medical,  dental and optometric service corporation or any combination.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-846 - Individual health insurance policies; mandatory coverage exemption; definitions

20-846.
Individual health insurance policies;  mandatory coverage exemption;  definitions
A. A hospital service corporation,  medical service corporation or hospital and medical service corporation may issue a subscription contract to an uninsured individual that is not subject to the requirements of any of the following:
1. Section 20-461,  subsection A,  paragraph 17 and subsection B.
2. Section 20-826,  subsections F,  J,  K,  U,  V,  W and X.
3. Section 20-841,  subsections A and C.
4. Sections 20-841.01,  20-841.02,  20-841.03,  20-841.04,  20-841.06,  20-841.07 and 20-841.08.
5. Section 20-841.05,  subsections B and E.
B. For the purposes of this section:
1. " Health insurance coverage" :
(a) Means a health care plan or arrangement that pays for or furnishes medical or health services and that is issued by a disability insurer,  group disability insurer,  blanket disability insurer,  health care services organization,  hospital service corporation,  medical service corporation or medical,  hospital,  dental and optometric service corporation or a similar entity in another state.
(b) Includes a self-insured or self-funded employee benefit plan or multiemployer employee benefit plan created pursuant to 29 United States Code section 186(c) if the regulation of that plan is preempted by section 514(b) of the employee retirement insurance security act of 1974 (29 United States Code section 1144(b)).
(c) Does not include limited benefit coverage as defined in section 20-1137.
2. " Uninsured individual"  means a person who has either:
(a) Not had health insurance coverage for the ninety days immediately before the effective date of coverage issued pursuant to this section,  except that this requirement does not apply at the renewal of coverage pursuant to this section.
(b) Lost health insurance coverage in one of the following ways within ninety days immediately before the effective date of coverage issued pursuant to this section:
(i) The individual left a job that provided health insurance coverage.
(ii) The individual's employer discontinued offering health insurance coverage.
(iii) The individual exhausted continuation coverage under a COBRA continuation provision as defined in section 20-2301.
(iv) The individual's family health insurance coverage was discontinued due to the death of a spouse or a divorce.
(v) The individual attained the maximum age for dependent coverage under a health insurance policy.
(vi) The individual's participation in a public health care program was discontinued.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-847 - Contracts; dentists; covered services; definition

20-847.
Contracts;  dentists;  covered services;  definition
A. A contract,  entered into or renewed on or after January 1,  2011,  between a dental service corporation and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under a subscription contract based on a fee set by the dental service corporation unless the service for which the fee applies is a covered service under the individual's subscription contract.
B. This section does not restrict the ability of a dental service corporation to establish dental benefits for services offered by plans that are administered but not insured by the dental service corporation.
C. For the purposes of this section,  " covered service"  means a service for which any reimbursement is available under a subscription contract without regard to contractual limitations by a deductible,  copayment,  coinsurance,  waiting period,  annual or lifetime maximum,  frequency limitation,  alternative benefit payment,  exclusion or other limitation.