reglab/statecodes huggingface dataset:
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1016 - Rehabilitation, liquidation or conservation of prepaid dental plan organization

20-1016.
Rehabilitation,  liquidation or conservation of prepaid dental plan organization
Any rehabilitation,  liquidation or conservation of a prepaid dental plan organization shall be deemed to be the rehabilitation,  liquidation or conservation of an insurer and shall be conducted pursuant to chapter 3,  article 4 of this title.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1018 - Advertising matter or sales materials

20-1018.
Advertising matter or sales materials
A prepaid dental plan organization shall not issue or deliver any advertising matter or sales material to any person in this state until the prepaid dental plan organization files the advertising matter or sales material with the director. This section does not require a prepaid dental plan to have the prior approval of the director to issue or deliver the advertising matter or sale material. If the director finds that the advertising matter or sales material,  in whole or in part,  is false,  deceptive or misleading,  the director may issue an order disapproving the advertising matter or sales material,  directing the prepaid dental plan organization to cease and desist from issuing,  circulating,  displaying or using the advertising matter or sales material within a period of time specified by the director but not less than ten days and imposing any penalties prescribed in this title. At least five days before issuing an order pursuant to this section,  the director shall provide the prepaid dental plan organization with a written notice of the basis of the order to provide the prepaid dental plan organization with an opportunity to cure the alleged deficiency in the advertising matter or sales material within a single five day period for the particular advertising matter or sales material at issue. The prepaid dental plan organization may appeal the director's order pursuant to title 41,  chapter 6,  article 10. Except as otherwise provided in this section,  a prepaid dental plan organization may obtain a stay of the effectiveness of the order as prescribed in section 20-162. If the director certifies in the order and provides a detailed explanation of the reasons in support of the certification that continued use of the advertising matter or sales material poses a threat to the health,  safety or welfare of the public,  the order may be entered immediately without opportunity for cure and the effectiveness of the order is not stayed pending the hearing on the notice of appeal but the hearing shall be promptly instituted and determined.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1019 - Order of benefit determination for dental care

20-1019.
Order of benefit determination for dental care
A. If a person receiving dental care is a member of a prepaid dental plan and is an insured or certificate holder under an indemnity health insurance policy which provides benefits for the same treatment as the person's prepaid dental plan,  the indemnity health insurance policy,  if issued after the effective date of this section,  shall pay benefits to its insured or certificate holder or the assignee thereof without regard to the existence of the prepaid dental plan.
B. Notwithstanding subsection A,  the indemnity plan insurer is not obligated to pay any amount for a procedure covered without charge to the member of the prepaid dental plan or to pay in excess of the amount of the member's obligation under the prepaid dental plan.
C. In the event that the member's copayment obligation under the prepaid dental plan has been met,  then the indemnity insurer shall remit any payments due under this section directly to its insured or certificate holder.
D. The director may adopt rules to enforce this section.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1021 - Lloyd's association defined

20-1021.
Lloyd's association defined
As used in this article,  unless the context otherwise requires,  " Lloyd's association"  means any aggregation of individuals,  called " underwriters, "  who under a common name engage in the business of insurance for profit through an attorney-in-fact having authority to obligate the underwriters severally,  within such limits as may be lawfully specified in the power of attorney,  on contracts of insurance made or issued by such attorney-in-fact,  in the name of such aggregation of individuals,  to and with any person or persons insured.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1022 - Forms of insurance authorized

20-1022.
Forms of insurance authorized
Lloyd's associations are authorized to make any insurance as provided in this article,  except life insurance or title insurance,  on the Lloyd's plan,  by complying with the requirements set forth in this article. Every policy form issued in this state by a Lloyd's association shall comply with all applicable provisions of chapters 5 and 6 of this title,  and in addition shall contain,  prominently displayed,  in type not substantially smaller than the type used for the name of the company,  the legend " not domesticated in Great Britain"  or other equivalent language indicating that the insurer is not an alien Lloyd's association or insurer.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1023 - "Attorney" defined; office

20-1023.
" Attorney"  defined;  office
Policies of insurance may be executed by an attorney or by an attorney-in-fact,  or other representative,  hereby designated " attorney" ,  authorized by and acting for the underwriters who constitute the Lloyd's association. The principal office of such attorney shall be maintained at such place as may be designated by the underwriters in their articles of agreement.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1024 - Application for license; contents

20-1024.
Application for license;  contents
The attorney shall file with the director a verified application for a certificate of authority setting forth and accompanied by:
1. The name of the attorney or attorneys and the title under which the business is to be conducted,  which title shall contain the name Lloyd's and the name of the country or state under which it is organized,  and shall not be so similar to any name or title in use in this state as to be likely to confuse or deceive.
2. The location of the principal office.
3. The kind or combination of kinds of insurance to be written,  as defined in article 2 of chapter 2 of this title.
4. A copy of the form of power of attorney by virtue of which the attorney is to act for and bind the several underwriters,  and a copy of the articles of agreement entered into between the underwriters themselves and the attorney.
5. The names and addresses of all underwriters,  whose number shall not be smaller than three.
6. A financial statement showing in detail the assets contributed or accumulated in the hands of the attorneys-in-fact,  committee of underwriters,  trustees,  or other officers of such Lloyd's association,  together with the liabilities incurred and outstanding and the income received and disbursements made by the attorney for the underwriters.
7. An instrument executed by each and all of the underwriters specially empowering the attorney to accept service of process for each underwriter in any action on any policy or contract of insurance,  and an instrument from the attorney to the director delegating the attorney's powers in this respect to the director.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1027 - Liability of underwriters; limitation

20-1027.
Liability of underwriters;  limitation
An underwriter in a Lloyd's association may limit his total liability on all risks to the amount of his subscription as expressed in his power of attorney and agreement with the attorney-in-fact,  provided that at least half of the subscription of each underwriter shall be paid or contributed to the guaranty fund in cash or securities constituting admitted assets. Each underwriter shall be responsible solely for his own liability as fixed in the contract of insurance and shall not be liable as a partner,  and in no event shall the liability of an underwriter exceed the amount of his total underwriters agreement executed in favor of his attorney or attorneys-in-fact.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1028 - Liability of additional or substituted underwriters; authority of deputy, substitute or successor attorney

20-1028.
Liability of additional or substituted underwriters;  authority of deputy,  substitute or successor attorney
Additional or substituted underwriters shall be bound in the same manner and to the same extent as original subscribers to the articles of agreement and power of attorney on file with the director. The acts of the duly appointed deputy,  substitute or successor attorney or any attorney or attorneys licensed under this chapter,  in accepting powers of attorney from underwriters,  in making and issuing policies and contracts of insurance,  and in doing any additional acts incident thereto,  shall be deemed authorized by the certificate of authority issued to the original attorney or attorneys.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1030 - Actions on policies or insurance contracts; process; judgments; costs

20-1030.
Actions on policies or insurance contracts;  process;  judgments;  costs
Action on any policy or contract of insurance issued by an attorney for the underwriters may be brought against the attorney. In such action,  summons and process shall be served on either the director or on the attorney-in-fact,  and when so served shall have the same effect as if served on the attorney and on each underwriter personally. A judgment in any such action against the attorney shall be binding upon and be judgment against each and all of the underwriters as their several liabilities may appear in the contract of insurance on which the action is brought. Any such summons or other process shall be served in accordance with the provisions of section 20-222,  and the provisions of that section shall be in all respects applicable thereto.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1031 - Deposit required of Lloyd's association

20-1031.
Deposit required of Lloyd's association
The deposit requirements of section 20-213 and section 20-583 shall in all respects apply to any Lloyd's association,  foreign or domestic,  provided that the director shall not issue a certificate of authority to any Lloyd's association unless it has deposited in trust with the state treasurer of Arizona or in public custody in any other state or states cash or securities eligible for the investment of capital funds of domestic insurers in an amount not less than four hundred thousand dollars.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1032 - Revocation of license

20-1032.
Revocation of license
If any attorney-in-fact or underwriter of a Lloyd's association shall violate any of the provisions of this title,  or any of the other laws of the state of Arizona which are applicable to them,  the certificate of authority issued to such attorney shall be revoked and the right to do business in Arizona shall be cancelled.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1052 - Establishment of health care services organizations

20-1052.
Establishment of health care services organizations
A. A person shall not establish or operate a health care services organization in this state,  or sell or offer to sell,  or solicit offers to purchase,  or receive advance or periodic consideration in conjunction with a health care plan without obtaining and maintaining a certificate of authority pursuant to this article.
B. A health care services organization shall be incorporated under the laws of this or any other state.
C. A health care services organization shall possess and maintain unimpaired capital or surplus,  or both,  in the amount of one million five hundred thousand dollars at the time of obtaining a certificate of authority. Thereafter,  a health care services organization that is subject to the unimpaired capital or surplus requirements of this section shall maintain unimpaired capital or surplus,  or both,  in the amount of one million dollars or in the amount prescribed in chapter 2,  article 12 of this title,  whichever is greater.
D. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1052.01 - Establishment of provider sponsored health care services organizations; rules; limitations

20-1052.01.
Establishment of provider sponsored health care services organizations;  rules;  limitations
A. No person shall establish or operate a provider sponsored health care services organization in this state,  or sell or offer to sell,  or solicit offers to purchase,  or receive advance or periodic consideration in conjunction with a health care plan without obtaining and maintaining a certificate of authority pursuant to this article.
B. To operate as a provider sponsored health care services organization in this state,  the firm or corporation shall:
1. Be a provider sponsored organization as defined in this article.
2. To the extent that the requirements are not preempted by federal law,  meet the requirements prescribed in this article that apply to health care services organizations.
C. In addition to the general rule making authority vested in the director pursuant to chapter 1,  article 2 of this title,  the director may also adopt rules that:
1. Are necessary to implement the provider sponsored health care services organization provisions of this article.
2. Impose solvency requirements of a provider sponsored health care services organization that are the same as the requirements pursuant to the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII,  part C of the social security act,  sections 1851 through 1859) and any rules adopted under the medicare-plus-choice program.
D. A certificate of authority issued to a provider sponsored health care services organization pursuant to this article is a limited certificate of authority that authorizes the provider sponsored health care services organization to provide coverage for health care services only to medicare beneficiaries pursuant to the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII,  part C of the social security act,  sections 1851 through 1859).
E. The solvency standards adopted by rule pursuant to this section apply only to a provider sponsored health care services organization that provides coverage for health care services only to medicare beneficiaries pursuant to the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII,  part C of the social security act,  sections 1851 through 1859).
F. Nothing in this section applies to an insurer,  health care services organization,  hospital service corporation,  medical service corporation,  dental service corporation,  optometric service corporation or hospital,  medical,  dental and optometric service corporation or any other person licensed under this title other than a provider sponsored organization that is licensed as a provider sponsored health care services organization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1054 - Issuance of certificate of authority

20-1054.
Issuance of certificate of authority
A. Issuance of a certificate of authority shall be granted within the time prescribed in section 20-216 by the director if the director is satisfied that the following conditions are met:
1. The persons responsible for conducting the affairs of the health care services organization are competent and are professionally capable of providing or arranging for the provision of health and medical services being offered.
2. The health care services organization constitutes an appropriate mechanism to achieve an effective health care plan pursuant to this title and any rule that is adopted by the director.
3. The health care services organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. In making this determination,  the director may consider:
(a) The financial soundness of the health care plan's arrangements for health care services and the schedule of charges used in connection therewith.
(b) Any agreement with an insurer,  a hospital or a medical service corporation,  a government or any other organization for insuring the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the plan.
(c) Any agreement with providers for the provision of health care services.
4. Each officer responsible for conducting the affairs of the health care services organization has filed with the director,  subject to the director's approval,  a fidelity bond in the amount of $50, 000.
B. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1055 - Deposit requirement

20-1055.
Deposit requirement
A. A health care services organization at all times shall maintain on deposit with the state treasurer through the director's office cash,  or securities eligible for the investment of capital funds of domestic insurers under this title,  or other financial security approved by the director in an amount of not less than five hundred thousand dollars.
B. The deposit prescribed by subsection A shall be held by the state treasurer in trust for the benefit and protection of persons covered by a health care plan and for the satisfaction of all debts and liabilities of the health care services organization.
C. Any securities within the description of subsection A,  with the approval of the director,  may be exchanged for similar securities or cash of equal amount. Interest on securities so deposited shall be payable to the health care services organization depositing them.
D. An unsettled final judgment arising upon an evidence of coverage shall be a lien on the deposit prescribed by subsection A,  subject to execution after thirty days from the entry of final judgment. If the deposit is reduced,  it shall be replenished within ninety days by the health care services organization.
E. Upon liquidation,  dissolution or withdrawal of a health care services organization and the satisfaction of all of its debts and liabilities,  any balance remaining of the cash or securities deposit prescribed in subsection A together with any other assets of the health care services organization shall be returned by the director to the health care services organization.
F. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.01 - Standing referrals to network health care professionals; definition

20-1057.01.
Standing referrals to network health care professionals;  definition
A. A health care services organization shall establish a procedure by which an enrollee may apply for a standing referral to a network health care professional. The health care services organization shall provide an enrollee with a standing referral if all of the following conditions are met:
1. The enrollee is a covered member of that health care services organization.
2. The enrollee has a disease or condition that is life threatening,  degenerative,  chronic or disabling.
3. The enrollee's primary care physician or registered nurse practitioner in conjunction with a network health care professional determines that the enrollee's health care requires a network health care professional's expertise.
4. The enrollee's primary care physician or registered nurse practitioner determines that the enrollee's disease or condition will require ongoing medical care for an extended period of time.
5. The standing referral is made by the enrollee's primary care physician or registered nurse practitioner to a network health care professional who is responsible for providing and coordinating the enrollee's specialty care.
6. The network health care professional is authorized by the health care services organization to provide the services under the standing referral.
B. The health care services organization may limit the number of visits and time period for which an enrollee may receive a standing referral.
C. If the enrollee receives a standing referral or any other referral from the enrollee's primary care physician,  that referral remains in effect even if the primary care physician leaves the health care services organization's network.
D. If the treating health care professional leaves the network or the enrollee ceases to be a covered member,  the standing referral expires.
E. 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 health care services organization to provide services in a specialty discipline that is recognized by an American medical specialty board.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.03 - Chiropractic care; definitions

20-1057.03.
Chiropractic care;  definitions
A. Every health care services organization shall provide coverage for chiropractic services provided by network chiropractic providers pursuant to this section.
B. A health care services organization is not required to provide coverage for chiropractic services obtained from a provider who is not a member of the health care services organization's provider network.
C. An enrollee may obtain medically necessary chiropractic services from a network chiropractic provider through self-referral for a minimum of twelve visits in an annual contract period,  unless the enrollee's evidence of coverage with the health care services organization allows for additional visits or benefits.
D. This section does not:
1. Require a health care services organization to provide services that are not covered by the enrollee's evidence of coverage and does not diminish or impair any preexisting condition limitation in the evidence of coverage.
2. Prohibit an enrollee from seeking chiropractic services in addition to the limits prescribed in this section from any chiropractic provider if the enrollee accepts financial responsibility for those services.
E. Nothing in this section prohibits the use of deductibles,  coinsurance,  copayments or other cost sharing in relation to the chiropractic benefits offered.
F. For the purposes of this section:
1. " Chiropractic services"  means only nonsurgical and noninvasive treatment of neck and back pain through physiotherapy,  musculoskeletal manipulation and other physical corrections of musculoskeletal conditions within the scope of the chiropractic practice.
2. " Musculoskeletal"  means any function of the musculoskeletal system that is integrated with neurological function and is expressed by biological regulatory mechanisms.
3. " Network chiropractic provider"  means a chiropractic physician who is licensed pursuant to title 32,  chapter 8 and who is under written contract with the health care services organization to provide services pursuant to this section.
4. " Self-referral"  means obtaining treatment by a provider without referral from a primary care physician.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.09 - Health care services organizations; varying copayments and deductibles allowed

20-1057.09.
Health care services organizations;  varying copayments and deductibles allowed
A. Except as provided in sections 20-1379 and 20-2304,  a health care services organization may offer one or more health care plans 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 health care services organization that offers such a health care plan 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 › § 20-1057.10 - Eosinophilic gastrointestinal disorder; formula

20-1057.10.
Eosinophilic gastrointestinal disorder;  formula
A. Any contract or evidence of coverage that is offered by a health care services organization 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 enrollee has been diagnosed with an eosinophilic gastrointestinal disorder.
2. The enrollee 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 health care services organization shall cover at least seventy-five per cent of the cost of the formula. The health care services organization 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 › § 20-1057.11 - Health care services organizations; autism spectrum disorder; coverage; exceptions; definitions

20-1057.11.
Health care services organizations;  autism spectrum disorder;  coverage;  exceptions;  definitions
A. A health care services organization 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 an evidence of coverage 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 evidence of coverage. Nothing in this section prevents an organization 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 › § 20-1057.12 - Contracts; dentists; covered services; definition

20-1057.12.
Contracts;  dentists;  covered services;  definition
A. A contract,  entered into or renewed on or after January 1,  2011,  between a health care services organization and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the services for which the fee applies is a covered service under the individual's evidence of coverage.
B. This section does not restrict the ability of a health care services organization to establish dental benefits for services offered by plans that are administered but not insured by the health care services organization.
C. For the purposes of this section,  " covered service"  means a service for which any reimbursement is available under an evidence of coverage 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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.14 - Cancer treatment medications; cost sharing; definition

20-1057.14.
Cancer treatment medications;  cost sharing;  definition
A. An evidence of coverage that is issued,  delivered or renewed by a health care services organization on or after January 1,  2016 and that provides coverage both for cancer treatment medications that are injected or intravenously administered by a health care provider and for patient-administered cancer treatment medications,  including medications that are orally administered or self-injected,  may not require a higher copayment,  deductible or coinsurance amount for patient-administered cancer treatment medications than is required for those cancer treatment medications that are injected or intravenously administered by a health care provider,  regardless of the formulation or benefit category.
B. A health care services organization may not increase copayment,  deductible or coinsurance amounts for covered cancer treatment medications that are injected or intravenously administered in order to avoid compliance with subsection A of this section,  but may increase copayment,  deductible or coinsurance amounts for cancer treatment medications if the increase is applied generally to other medical or pharmaceutical benefits under the evidence of coverage and is not done to circumvent subsection A of this section.
C. A health care services organization may not reclassify benefits with respect to cancer treatment medications in a manner that is inconsistent with this section.
D. For the purposes of this section,  " cancer treatment medications"  means prescription drugs and biologics that are used to kill,  slow or prevent the growth of cancerous cells.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.15 - Prescriptions; cost sharing; refills; dispensing fees; definition

20-1057.15.
Prescriptions;  cost sharing;  refills;  dispensing fees;  definition
A. An evidence of coverage that is issued or renewed on or after January 1,  2017 and that provides coverage for prescription drugs:
1. May not deny coverage and shall prorate the cost sharing rate for a prescription drug covered by the evidence of coverage that is dispensed by a network pharmacy for less than the standard refill amount if the enrollee requests enrollment into a medication synchronization program and less than the standard refill amount for the purpose of synchronizing the enrollee's medications.
2. Shall accept early refill and short fill requests for prescription drugs using the submission clarification and message codes as adopted by the national council for prescription drug plans or alternative codes provided by the plan upon July 3,  2015.
B. For the purposes of this section,  " medication synchronization"  means the coordination of medication refills for a patient taking two or more medications for a chronic condition that are being dispensed by a single contracted pharmacy to facilitate the synchronization of the patient's medications for the purpose of improving medication adherence.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.16 - Prescription eyedrops; refills

20-1057.16.
Prescription eyedrops;  refills
A. Beginning January 1,  2018,  any evidence of coverage that is issued,  delivered or renewed by a health care services organization 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 enrollee 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 enrollee.
(ii) The date of the most recent refill that was distributed to the enrollee.
(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 enrollee.
(ii) The date of the most recent refill that was distributed to the enrollee.
(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 enrollee.
(ii) The date of the most recent refill that was distributed to the enrollee.
2. The prescription eyedrops to treat glaucoma or ocular hypertension prescribed by the health care provider are a covered benefit under the enrollee's evidence of coverage.
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 enrollee 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 evidence of coverage that are applicable to this coverage.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.17 - Coverage of health care services

20-1057.17.
Coverage of health care services
Any evidence of coverage issued,  delivered or renewed on or after July 1,  2017 by a health care services organization in this state must provide coverage for lawful health care services that are provided by a health care provider to an enrollee regardless of the familial relationship of the health care provider to the enrollee if the health care service would be covered were it provided to an enrollee who was not related to the health care provider. The evidence of coverage may limit the coverage to those health care providers who are members of the health care services organization's provider network.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1057.18 - Contracts; optometrists; covered services; definition

20-1057.18.
Contracts;  optometrists;  covered services;  definition
A. Except as provided in subsection C of this section,  a contract,  entered into or renewed on or after January 1,  2022,  between a health care services organization and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the service for which the fee applies is a covered service under the individual's evidence of coverage.
2. Prohibit an optometrist from offering or providing a vision service that is not a covered service to a covered individual at a fee determined by the optometrist or by the optometrist and the covered individual.
3. Require an optometrist to use one or more specific vendors to replenish the optometrist's inventory of spectacle lenses after the optometrist dispenses the optometrist's inventory to eligible members of the vision plan as a covered vision service.
B. This section applies to an administrator providing third-party administration services or a provider network for a vision plan.
C. This section does not restrict the ability of a health care services organization to enter into a contract for an optometrist to participate in a discount program sponsored by the health care services organization for services that are not covered if:
1. Participation in the health care services organization network is not contingent on participation in the sponsored discount program.
2. The health care services organization offers equal treatment to an optometrist who does not participate in a sponsored discount program,  regarding:
(a) Promotional treatment.
(b) Marketing benefits.
(c) Materials.
(d) Contract terms for providing a covered service.
D. Notwithstanding subsection C,  paragraph 2,  subdivision (d) of this section,  a health care services organization,  when providing a typically formatted list of optometrists in the health care services organization network,  may identify whether an optometrist participates in a discount program for services not covered by the health care services organization if all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1,  2022,  but not later than December 31,  2022.
F. For the purposes of this section,  " covered service"  means a service for which any reimbursement is available under an evidence of coverage 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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1058 - Examination of health care services organizations

20-1058.
Examination of health care services organizations
A. The director may once in each six months for the first three years after organization and once each year thereafter,  or more often if deemed necessary by the director,  visit each health care services organization organized under the laws of this state to examine its financial condition,  its ability to meet its liabilities and its compliance with the laws of this state affecting the conduct of its business. The director may annually similarly visit and examine,  either alone or jointly with representatives of the insurance supervising departments of other states,  each health care services organization not organized under the laws of this state but authorized to transact business in this state.
B. The director may in like manner examine each health care services organization applying for an initial certificate of authority to do business in this state.
C. In lieu of making an examination,  the director may accept a full report of the last recent examination of a foreign or alien health care services organization,  certified to by the insurance supervisory official of another state,  territory,  commonwealth or district of the United States.
D. The director of the department of health services may participate in the examinations and visits described in this section and section 20-1064 to review the delivery of health and medical services by the health care services organization.
E. All examinations and examination related expenses shall be borne by the health care services organization and shall be paid by the insurance examiners' revolving fund in accordance with sections 20-156 and 20-159.
F. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1059 - Annual report to director

20-1059.
Annual report to director
A. Every health care services organization annually on or before March 31 shall file with the director a report 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. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
C. A health care services organization that fails to timely file the annual report required under subsection A of this section is subject to the penalties prescribed in section 20-223.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1059.01 - Admitted assets; health care delivery assets

20-1059.01.
Admitted assets;  health care delivery assets
A. This section applies to reporting entities that directly provide health care services to enrollees.
B. In addition to the assets allowed by section 20-501,  the following are admitted assets to the extent the assets conform with the accounting practices and procedures manual adopted by the national association of insurance commissioners:
1. Furniture,  medical equipment and fixtures and leasehold improvements that are used for the direct delivery of health care services.
2. Pharmaceuticals,  surgical supplies and durable medical equipment that are used for the direct delivery of health care services.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1060 - Taxes; exemption

20-1060.
Taxes;  exemption
A. Except as provided in subsection C of this section,  on the tax payment dates prescribed in section 20-224,  each health care services organization shall pay to the director for deposit,  pursuant to sections 35-146 and 35-147,  in a form prescribed by the director a tax for transacting a health care plan in the amount of 2.0 percent of net charges received from enrollees.
B. The failure by an organization to pay the tax imposed by this section results in a civil penalty determined pursuant to section 20-225.
C. Payments received by health care services organizations from the United States secretary of health and human services pursuant to a contract issued pursuant to 42 United States Code section 1395mm(g) are not taxable under this section.
D. A health care services organization may claim a premium tax credit if the organization qualifies for a credit pursuant to section 20-224.03.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1061 - Prohibited practices; definition

20-1061.
Prohibited practices;  definition
A. Chapter 2,  article 6 of this title relating to unfair trade practices and frauds applies to health care services organizations,  except to the extent the director determines that the nature of health care services organizations renders particular provisions inappropriate.
B. A contract between the health care services organization 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 evidence of coverage with an enrollee or group of enrollees 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 an enrollee or a group of enrollees for a specific disease or condition. Each health care services organization shall file with its annual report a written statement with the director that certifies that the health care services organization is in compliance with this subsection.
C. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
D. 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 › § 20-1062 - Regulation of agents

20-1062.
Regulation of agents
The director may,  after notice and hearing,  promulgate such reasonable rules and regulations as are necessary to provide for the licensing of agents which shall include provisions for examination,  licensing,  annual fees and disciplinary procedures similar to those proposed in chapter 2,  article 3 of this title.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1063 - Powers of insurers and hospital and medical service corporations

20-1063.
Powers of insurers and hospital and medical service corporations
A. An insurer,  or a hospital or medical service corporation,  authorized to do business in this state either directly or through a subsidiary or an affiliate may organize and operate a health care services organization under the provisions of this article. Notwithstanding any other law to the contrary,  any two or more such insurers,  hospital or medical service corporations,  or subsidiaries or affiliates thereof,  may jointly organize and operate a health care services organization.
B. Any such insurer or hospital or medical service corporation may contract with a health care services organization to provide coverage in the event of the failure of the health care services organization to meet its obligations.
C. Any such insurer or hospital or medical service corporation which is in compliance with title 20 generally and which in the judgment of the director shall have complied with provisions of this title that are comparable to or more restrictive than the provisions of this article shall be deemed to have satisfied all provisions of this article and shall not be required to comply also in any specific manner with this article except sections 20-1051 through 20-1054 as the director shall deem appropriate,  and except as per rules or regulations the director may promulgate to safeguard public health or safety.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1064 - Examination

20-1064.
Examination
A. The director may conduct an examination of the affairs of any health care services organization as often as the director deems it necessary for the protection of the interests of the people of this state and for this purpose shall have the powers set forth in this title with respect to examinations of insurers.
B. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-1066 - Rehabilitation, liquidation or conservation of health maintenance organization

20-1066.
Rehabilitation,  liquidation or conservation of health maintenance organization
A. Any rehabilitation,  liquidation,  or conservation of a health care services organization shall be deemed to be the rehabilitation,  liquidation,  or conservation of an insurer and shall be conducted as provided in chapter 3,  article 4 of this title.
B. Unless preempted under federal law or unless federal law imposes greater requirements than this section,  this section applies to a provider sponsored health care services organization.