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ARIZONA STATE SENATE
Fifty-Fourth Legislature, Second Regular Session
insurers; notices; methods of delivery
Purpose
Replaces the requirement that a notice or correspondence be mailed with the requirement that it be sent and defines send, sending or sent. Modifies processes for health insurance appeals.
Background
Statute allows any notice or any other required document in an insurance transaction or that is to serve as evidence of insurance coverage to be delivered, stored and presented by electronic means if statutory requirements regarding electronic transactions are met. A party must electronically consent, or electronically confirm consent in advance, to the method of electronic delivery and has the right to withdraw consent at any time. A party's withdrawal of consent is effective within seven days after an insurer receives the withdrawal. Electronic delivery of a notice or document is equivalent to any delivery method required in statute governing insurance, including delivery by the United States Postal Service (USPS) by first class mail, postage prepaid, certified mail, certificate of mailing or first class mail using intelligent barcode or another similar approved tracking method by the USPS (A.R.S. § 20-239).
Any member who is denied a covered service or whose claim for a service is denied may pursue a health insurance appeal (A.R.S. § 20-2533). A member who does not qualify for an expedited medical review has up to two years after an insurer denies a request for a covered service to request an informal reconsideration (A.R.S. § 20-2535). In the event of a denial of a claim for a service that has already been provided, a member may appeal that denial by filing a written appeal with a utilization review agent within two years after receipt of the denial notice (A.R.S. § 20‑2536).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Replaces the requirement that a notice and correspondence be mailed with the requirement that they be sent and defines send, sending or sent as delivering by:
a) U.S. mail, personal delivery or fax; or
b) electronic means consistent with statutory requirements for electronic transactions.
2. Directs an insurer sending a notice or correspondence by:
a) mail, to send the notice or correspondence to the recipient's last known mailing address on file with the insurer; or
b) electronic means, to send the notice or correspondence to the recipient's last known email address as provided by the recipient to the insurer.
3. Deems, as sufficient proof of notice, any method of proof retained by an insurer for sending a notice of cancellation by any method other than by mail for policies of insurance, other than motor vehicle insurance and workers' compensation insurance, that meet certain conditions.
4. Deems, as sufficient proof of notice, any method of proof retained by an insurer for sending a notice of cancellation, or of nonrenewal or of premium or coverage changes of commercial insurance by any method other than by mail.
5. Requires an insurer who sends a notice of cancellation of commercial insurance by mail to obtain proof of mailing by U.S. certified mail or first class mail using an intelligent mail barcode or another similar tracking method used or approved by the USPS.
6. Requires a health care insurer to provide a member or member's treating provider access to a copy of the information packet on its website.
7. Removes the requirement that a health care insurer provide a copy of its information packet to a member within five business days after the initiation date of a health care appeal.
8. Allows a member who is denied a service and who does not qualify for an expedited medical review to request an informal reconsideration within one year, rather than two years, after the denial.
9. Allows a member to appeal a denied claim for a service that has already been provided by filing a written appeal with a utilization review agent within one year, rather than two years, after receipt of the denial notice.
10. Makes technical and conforming changes.
11. Becomes effective on the general effective date.
Prepared by Senate Research
January 13, 2020
MG/AB/gs