20-238. Health insurance; state regulation; rating areas; definitions

298 words·~1 min read·/az/title-20/20-238

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(Conditionally Rpld.)

A. The director, through the adoption of rules or other regulatory and administrative actions within the director's authority, shall ensure that this state retains its full authority to regulate policies, certificates, evidences of coverage and contracts of insurance that are issued or delivered by health insurers taking into consideration the enactment of the act.

B. Notwithstanding any other provision of this title, a health insurer subject to the act shall not issue a contract, policy, certificate or evidence of coverage or otherwise transact insurance if the coverage and benefits provided in the contract, policy, certificate or evidence of coverage are inconsistent with the applicable provisions of the act.

C. Except for coverage under individual and small group policies, certificates, evidences of coverage and contracts that are grandfathered as prescribed by 42 United States Code section 18011, the following rating areas are established and shall be used by all health insurers issuing individual and small group policies, certificates, evidences of coverage or contracts in this state:

1. Mohave, Coconino, Apache and Navajo counties.

2. Yavapai county.

3. La Paz and Yuma counties.

4. Maricopa county.

5. Pinal and Gila counties.

6. Pima and Santa Cruz counties.

7. Graham, Greenlee and Cochise counties.

D. For the purposes of this section:

1. "Act" means the patient protection and affordable care act (P.L. 111-148) as amended by the health care and education reconciliation act (P.L. 111-152) or any rules adopted pursuant to those acts.

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

3. "Rating area" means an area within which a health insurer shall not vary rates based on geography.