20-111. Health insurers; savings incentive programs; definitions
189 words·~1 min read·
/az/title-20/20-111A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. A health insurer may establish a program that provides a savings incentive for enrollees for medically necessary covered health care services that health care providers and health care facilities provide at a price that is below the health insurer's usual reimbursement.
B. The program may enable an eligible enrollee who receives covered health care services from a health care provider or health care facility at a price below the health insurer's usual reimbursement to have the amount the enrollee pays applied toward the enrollee's deductible and out-of-pocket maximum and be reimbursed for a portion of the amount of the difference between the price the enrollee paid and the health insurer's usual reimbursement.
C. For the purposes of this section:
1. "Health care facility" means a hospital, outpatient surgical center, health care laboratory, diagnostic imaging center or urgent care center.
2. "Health care provider" has the same meaning prescribed in section 32-3216.
3. "Health insurer" has the same meaning prescribed in section 32-3216.
4. "Usual reimbursement" means the amount the health insurer would ordinarily pay an in-network health care provider or an in-network health care facility for the service.