PROPOSED
HOUSE OF REPRESENTATIVES AMENDMENTS TO S.B. 1404
(Reference to Senate engrossed bill)
Page 1, line 5, strike "notice;"
Line 6, after "plan" insert "issued pursuant to title 44, chapter 11, article 25"
Line 8, strike ", providing" insert "if"
Strike lines 11 through 25
Reletter to conform
Line 27, after the second "provider" insert ", group, entity"
After line 40, insert:
"Sec. 2. Title 44, chapter 11, Arizona Revised Statutes, is amended by adding article 25, to read:
ARTICLE 25. DIRECT PRIMARY CARE PROVIDER PLANS
44-1799.91. Definitions
In this article, unless the context otherwise requires:
1. "Direct primary care provider plan" has the same meaning prescribed in section 20‑123.
2. "Enrollee" has the same meaning prescribed in section 20‑123.
3. "Health 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 holding a certificate of authority under title 20.
4. "Primary care provider" has the same meaning prescribed in section 20‑123.
5. "Primary health care" has the same meaning prescribed in section 20‑123.
6. "Provider access" means the method, manner and frequency that an enrollee may use a primary care provider under the enrollee's direct primary care provider plan.
44-1799.92. Direct primary care provider plans; requirements; notice; prohibition
A. A direct primary care provider plan may arrange for primary health care for enrollees in this state.
B. Every direct primary care provider plan must be in writing and is subject to this section. A copy of the written plan must be given to the enrollee at the time the enrollee signs the plan.
C. A direct primary care provider plan must describe the specific provider access and primary health care services that the primary care provider will provide, the enrollee's total payment obligation and the terms of cancellation, which must include cancellation terms for relocation and military duty.
D. A direct primary care provider plan must provide a written disclaimer on or accompanying all application and guideline materials distributed by or on behalf of the direct primary care provider plan that reads, in substance:
Notice: The organization facilitating the direct primary care provider plan is not an insurance company, and the direct primary care company guidelines and plan operation are not an insurance policy. Participation in the direct primary care provider plan or a subscription to any of its documents should not be considered to be a health insurance policy. Regardless of whether you receive treatment for medical issues through the direct primary care provider plan, you are always personally responsible for the payment of any additional medical expenses you may incur.
E. A primary care provider may not submit a claim for payment to any health insurer or any health insurer's contractor or subcontractor for primary health care services provided to an enrollee under a direct primary care provider plan."
Amend title to conform
HEATHER CARTER |