20-3501. Definitions

283 words·~1 min read·/az/title-20/20-3501

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

In this chapter, unless the context otherwise requires:

1. "Classification of benefits" means the following classifications of benefits provided by a health plan:

(a)Inpatient, in-network.

(b)Inpatient, out-of-network.

(c)Outpatient, in-network.

(d)Outpatient, out-of-network.

(e)Emergency care.

(f)Prescription benefits.

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

3. "Health plan" means an individual health plan or accountable health plan that provides mental health services or mental health benefits, that finances or provides covered health care services, that is issued by a health care insurer in this state and that is subject to the mental health parity and addiction equity act.

4. "Mental health parity and addiction equity act" means the mental health parity and addiction equity act of 2008 (42 United States Code section 300gg-26) and implementing regulations.

5. "Product network type" means the network model associated with the type of health plan under which covered health care is delivered, such as a health care services organization, preferred provider network organization, point of service plan or indemnity plan.

6. "Treatment limits":

(a)Means limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period or other similar limits on the scope or duration of treatment.

(b)Includes both quantitative treatment limits that are expressed numerically and nonquantitative treatment limits that otherwise limit the scope or duration of benefits for treatment under a health plan.

(c)Does not include a permanent exclusion of all benefits for a particular condition or disorder.