|
REFERENCE TITLE: health care insurance; requirements |
|
State of Arizona Senate Fifty-fourth Legislature Second Regular Session 2020
|
|
SB 1599 |
|
|
|
Introduced by Senators Navarrete: Alston, Bradley, Contreras, Dalessandro, Gonzales, Mendez, Otondo, Peshlakai, Quezada, Rios, Steele
|
AN ACT
amending title 20, chapter 1, article 1, Arizona Revised Statutes, by adding section 20‑123; relating to health care insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding section 20-123, to read:
20-123. Health care insurance; preexisting condition exclusions; eligibility; annual and lifetime limits; premium rates; young adult coverage; definitions
A. Notwithstanding any other law, a health care insurer that offers an individual, group or small employer health benefits plan in this state:
1. May not impose any preexisting condition exclusion with respect to coverage under the plan.
2. Must accept every employer and individual in this state that apply for coverage under a health benefits plan and that are eligible to apply.
3. May not impose an annual or lifetime dollar limit on any essential benefit.
4. Shall develop and vary its premium rates with respect to a particular health benefits plan or coverage based only on the following characteristics:
(a) Whether the health benefits plan or coverage covers an individual or family.
(b) A geographic rating area that is established in accordance with federal law.
(c) An individual's age, except that the rate may not vary by more than three to one for adults.
(d) Tobacco use, except that the rate may not vary by more than 1.07 to one.
5. With respect to family coverage under an individual or small employer health benefits plan, shall apply the rating variations allowed under paragraph 4 of this subsection based on the portion of the premium that is attributable to each family member who is covered under the plan in accordance with any applicable rules adopted by the director.
6. May not adjust the premium charged with respect to any individual or small employer health benefits plan more frequently than annually, except that the health care insurer may adjust the premium rate more often to reflect the following:
(a) With respect to a small employer health benefits plan, changes to the enrollment of the small employer.
(b) Changes to the insured's family composition.
(c) With respect to an individual health benefits plan, changes in the insured's geographic rating area or tobacco use.
(d) Changes to the health benefits plan requested by the insured or small employer.
(e) Other Changes required by federal law or expressly allowed by state law.
7. Shall continue to cover an insured's child who is covered under the health benefits plan until the child reaches twenty‑six years of age even if the child Is any of the following:
(a) Married.
(b) Not living with the child's parents.
(c) Attending school.
(d) Not financially dependent on the child's parents.
(e) Eligible to enroll in the health benefits plan provided by the child's employer.
8. Shall allow an eligible individual who reaches twenty‑six years of age and who was previously covered under a family health benefits plan to enroll in another health benefits plan without having to wait for an open enrollment period if the individual qualifies for the plan.
B. For the purposes of the section:
1. "Essential benefit" means any of the following:
(a) Ambulatory services.
(b) Emergency services.
(c) Hospitalization provided in an inpatient care setting.
(d) Pregnancy, maternity and newborn care services.
(e) Mental health and substance use disorder services, including behavioral health treatment services.
(f) Prescription drug benefits.
(g) Rehabilitative and habilitative services and devices that assist an individual with an injury, disability or chronic condition to gain or recover mental or physical skills.
(h) Laboratory services.
(i) Preventive, wellness and chronic disease management services.
(j) Pediatric services, including pediatric oral and vision care services.
2. "Health benefits plan" means a policy, contract or evidence of coverage that provides health care services and benefits and that is issued by a health care insurer.
3. "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.
4. "Preexisting condition exclusion" means a limitation or exclusion of benefits, including a denial of coverage, that is based on the fact that the condition was present before the effective date of coverage or, if coverage is denied, the date of denial, whether or not any medical advice, diagnosis, care or treatment was recommended or received before that date.
5. "Small employer" means an employer who employs at least two but not more than fifty eligible employees on a typical business day during any one calendar year.