Page 1,
between lines 1 and 2, insert:
"Section 1. Title 20, chapter 1, article 1, Arizona
Revised Statutes, is amended by adding section 20-127, to read:
START_STATUTE20-127. Flood
insurance; high-risk fire area
The
DEPARTMENT shall post the following INFORMATION on a publicly accessible
website using understandable, nontechnical and consumer-friendly language
that:
1. States
how a homeowner can purchase flood insurance.
2. Includes
a statement that homeowners' insurance coverage does not include flood damage,
including floods that are caused by a wildfire or other perils such as
landslide, mudslide, mudflow or debris flow and that occur after a wildfire.
3. States
how a homeowner can determine whether a homeowner's residence or property is
located in an area that is designated a high-risk fire area by the
Arizona Department of Forestry and fire management." END_STATUTE
Renumber to
conform
Page 8,
after line 30, insert:
"Sec. 4. Title
20, chapter 2, article 2, Arizona Revised Statutes, is amended by adding
section 20-252.01, to read:
START_STATUTE20-252.01. Flood
insurance; notification
An
insurer that is authorized to transact casualty insurance and that insures
residential property located in this state shall provide information to its
policyholders through a website or other reasonable means of communication in
understandable and nontechnical language about how to obtain flood insurance
and the national flood insurance program."
Renumber to
conform
Page 10,
line 22, after "insurance;" insert "early enrollment discounts;"
Line 28,
after the period strike remainder of line
Strike lines
29 and 30, insert:
"B. For the purposes of this section, an insurer may file
for medicare supplement rates that include an early enrollment discount that
will not be considered an attained age rating structure. An early
enrollment discount shall diminish over a period of TIME and is only available
to enrollees who purchase the plan within the early ENROLLMENT period
designated by the insurer. Insurers shall disclose to all applicants
how the early enrollment discount will diminish over time."
Reletter to
conform
Page 11,
between lines 26 and 27, insert:
"Sec. 7. Section
20-1379, Arizona Revised Statutes, is amended to read:
START_STATUTE20-1379. Guaranteed
availability of individual health insurance coverage; prior group coverage;
definitions
A. Every
health care insurer that offers individual health insurance coverage in the
individual market in this state shall provide guaranteed availability of
coverage to an eligible individual who desires to enroll in individual health
insurance coverage and shall not:
1. Decline
to offer that coverage to, or deny enrollment of, that individual.
2. Impose
any preexisting condition exclusion for that coverage.
B. Every
health care insurer that offers individual health insurance coverage in the
individual market in this state shall offer all policy forms of health
insurance coverage that are designed for, that are made generally available and
actively marketed to and that enroll both eligible or other individuals. A
health care insurer that offers only one policy form in the individual market
complies with this section by offering that form to eligible
individuals. A health care insurer also may comply with the
requirements of this section by electing to offer at least two different policy
forms to eligible individuals as provided by subsection C of this section.
C. A
health care insurer shall meet the requirements prescribed in subsection B of
this section if:
1. The
health care insurer offers at least two different policy forms, both of which
are designed for, are made generally available and actively marketed to and
enroll both eligible and other individuals.
2. The
offer includes at least either:
(a) The
policy forms with the largest and next to the largest earned premium volume of
all policy forms offered by the health care insurer in this state in the
individual market during a period not to exceed the preceding two calendar
years.
(b) A
choice of two policy forms with representative coverage, consisting of a lower
level of coverage policy form and a higher level of coverage policy form, each
of which includes benefits that are substantially similar to other individual
health insurance coverage offered by the health care insurer in this state and
each of which is covered by a method that provides for risk adjustment, risk
spreading or a risk spreading mechanism among the health care insurer's
policies.
D. The
health care insurer's election pursuant to subsection C of this section is
effective for policies offered during a period of at least two years.
E. If
a health care insurer offers individual health insurance coverage in the
individual market through a network plan, the health care insurer may do both
of the following:
1. Limit
the individuals who may be enrolled under health insurance coverage to those
who live, reside or work within the service area for a network plan.
2. Within
the service area of a network plan, deny health insurance coverage to
individuals if the health care insurer has demonstrated, if required, to the
director that both:
(a) The
health care insurer will not have the capacity to deliver services adequately
to additional individual enrollees because of the health care insurer's
obligations to existing group contract holders and enrollees and individual
enrollees.
(b) The
health care insurer is applying this paragraph uniformly to individuals without
regard to any health status-related factor of the individuals and without
regard to whether the individuals are eligible individuals.
F. A
health care insurer may deny individual health insurance coverage in the
individual market to an eligible individual if the health care insurer
demonstrates to the director that the health care insurer:
1. Does
not have the financial reserves necessary to underwrite additional coverage.
2. Is
denying coverage uniformly to all individuals in the individual market in this
state pursuant to state law and without regard to any health status-related
factor of the individuals and without regard to whether the individuals are
eligible individuals.
G. If
a health care insurer denies health insurance coverage in this state pursuant
to subsection F of this section, the health care insurer shall not offer that
coverage in the individual market in this state for one hundred eighty days
after the date the coverage is denied or until the health care insurer
demonstrates to the director that the health care insurer has sufficient
financial reserves to underwrite additional coverage, whichever is later.
H. An
accountable health plan as defined in section 20-2301 that offers
conversion policies on an individual or group basis in connection with a health
benefits plan pursuant to this title is not a health care insurer that offers
individual health insurance coverage solely because of the offer of a
conversion policy.
I. Nothing in This section does not:
1. Creates Create additional restrictions on
the amount of the premium rates that a health care insurer may charge an
individual for health insurance coverage provided in the individual market.
2. Prevents Prevent a health care insurer
that offers health insurance coverage in the individual market from
establishing premium rates or modifying otherwise applicable copayments or
deductibles in return for adherence to programs of health promotion and disease
prevention.
3. Requires Require a health care insurer
that offers only short-term limited duration insurance or limited benefit
coverage to individuals and no other coverage to individuals in the individual
market to offer individual health insurance coverage in the individual market.
4. Requires Require a health care insurer
offering health care coverage only on a group basis or through one or more bona
fide associations, or both, to offer health insurance coverage in the
individual market.
J. A
health care insurer shall provide, without charge, a written certificate of
creditable coverage as described in this section for creditable coverage
occurring after June 30, 1996 if the individual:
1. Ceases
to be covered under a policy offered by a health care insurer. An
individual who is covered by a policy that is issued on a group basis by a
health care insurer, that is terminated or not renewed at the choice of the
sponsor of the group and where the replacement of the coverage is without a
break in coverage is not entitled to receive the certification prescribed in
this paragraph but is instead entitled to receive the certification prescribed
in paragraph 2 of this subsection.
2. Requests
certification from the health care insurer within twenty-four months
after the coverage under a health insurance coverage policy offered by a health
care insurer ceases.
K. The
certificate of creditable coverage provided by a health care insurer is a
written certification of the period of creditable coverage of the individual
under the health insurance coverage offered by the health care
insurer. The department may enforce and monitor the issuance and
delivery of the notices and certificates by health care insurers as required by
this section, section 20-1380, the health insurance portability and
accountability act of 1996 (P.L. 104-191; 110 Stat. 1936) and any federal
regulations adopted to implement the health insurance portability and
accountability act of 1996. notwithstanding any other
law, an insurer is not required to provide a certificate of creditable coverage
if the federal laws that require providing a certificate of creditable coverage
are superseded by the prohibition on preexisting condition EXCLUSIONS.
L. Any
health care insurer, accountable health plan or other entity that issues health
care coverage in this state, as applicable, shall issue and accept a
certificate of creditable coverage of the individual that contains at least the
following information:
1. The
date that the certificate is issued.
2. The
name of the individual or dependent for whom the certificate applies and any
other information that is necessary to allow the issuer providing the coverage
specified in the certificate to identify the individual, including the
individual's identification number under the policy and the name of the
policyholder if the certificate is for or includes a dependent.
3. The
name, address and telephone number of the issuer providing the certificate.
4. The
telephone number to call for further information regarding the certificate.
5. One
of the following:
(a) A
statement that the individual has at least eighteen months of creditable
coverage. For the purposes of this subdivision, "eighteen
months" means five hundred forty-six days.
(b) Both
the date that the individual first sought coverage, as evidenced by a
substantially complete application, and the date that creditable coverage
began.
6. The
date creditable coverage ended, unless the certificate indicates that creditable
coverage is continuing from the date of the certificate.
7. The
consumer assistance telephone number for the department.
8. The
following statement in at least fourteen-point type:
Important Notice!
Keep
this certificate with your important personal records to protect your rights
under the health insurance portability and accountability act of 1996
("HIPAA"). This certificate is proof of your prior health
insurance coverage. You may need to show this certificate to have a
guaranteed right to buy new health insurance ("Guaranteed
issue"). This certificate may also help you avoid waiting
periods or exclusions for preexisting conditions. Under HIPAA, these
rights are guaranteed only for a very short time period. After your
group coverage ends, you must apply for new coverage within 63 days to be
protected by HIPAA. If you have questions, call the Arizona
department of insurance and financial institutions.
M. A
health care insurer has satisfied the certification requirement under this
section if the insurer offering the health benefits plan provides the
certificate of creditable coverage in accordance with this section within
thirty days after the event that triggered the issuance of the certificate.
N. Periods
of creditable coverage for an individual are established by the presentation of
the certificate described in this section and section 20-2310. In
addition to the written certificate of creditable coverage as described in this
section, individuals may establish creditable coverage through the presentation
of documents or other means. In order to make a determination that is based on
the relevant facts and circumstances of the amount of creditable coverage that
an individual has, a health care insurer shall take into account all information
that the insurer obtains or that is presented to the insurer on behalf of the
individual.
O. A
health care insurer shall calculate creditable coverage according to the
following rules:
1. The
health care insurer shall allow an individual credit for each day the
individual was covered by creditable coverage.
2. The
health care insurer shall not count a period of creditable coverage for an
individual enrolled under any form of health insurance coverage if after the
period of coverage and before the enrollment date there were sixty-three
consecutive days during which the individual was not covered by any creditable
coverage.
3. The
health care insurer shall not include any period that an individual is in a
waiting period or an affiliation period for any health coverage or is awaiting
action by a health care insurer on an application for the issuance of health
insurance coverage when the health care insurer determines the continuous
period pursuant to paragraph 1 of this subsection.
4. The
health care insurer shall not include any period that an individual is waiting
for approval of an application for health care coverage, provided the
individual submitted an application to the health care insurer for health care
coverage within sixty-three consecutive days after the individual's most
recent creditable coverage.
5. The
health care insurer shall not count a period of creditable coverage with
respect to enrollment of an individual if, after the most recent period of
creditable coverage and before the enrollment date, sixty-three
consecutive days lapse during all of which the individual was not covered under
any creditable coverage. The health care insurer shall not include
in the determination of the period of continuous coverage described in this
section any period that an individual is in a waiting period for health
insurance coverage offered by a health care insurer, is in a waiting period for
benefits under a health benefits plan offered by an accountable health plan or
is in an affiliation period.
6. In
determining the extent to which an individual has satisfied any portion of any
applicable preexisting condition period the health care insurer shall count a
period of creditable coverage without regard to the specific benefits covered
during that period.
P. An
individual is an eligible individual if, on the date the individual seeks
coverage pursuant to this section, the individual has an aggregate period of
creditable coverage as defined and calculated pursuant to this section of at
least eighteen months and all of the following apply:
1. The
most recent creditable coverage for the individual was under a plan offered by:
(a) An
employee welfare benefit plan that provides medical care to employees or the
employees' dependents directly or through insurance, reimbursement or otherwise
pursuant to the employee retirement income security act of 1974 (P.L. 93-406;
88 Stat. 829; 29 United States Code sections 1001 through 1461).
(b) A
church plan as defined in the employee retirement income security act of 1974.
(c) A
governmental plan as defined in the employee retirement income security act of
1974, including a plan established or maintained for its employees by the
government of the United States or by any agency or instrumentality of the
United States.
(d) An
accountable health plan as defined in section 20-2301.
2. The
individual is not eligible for coverage under:
(a) An
employee welfare benefit plan that provides medical care to employees or the
employees' dependents directly or through insurance, reimbursement or otherwise
pursuant to the employee retirement income security act of 1974.
(b) A
health benefits plan issued by an accountable health plan as defined in section
20-2301.
(c) Part
A or part B of title XVIII of the social security act.
(d) Title
36, chapter 29 or any other plan established under title XIX of the social
security act, and the individual does not have other health insurance coverage.
3. The
most recent coverage within the coverage period was not terminated based on any
factor described in section 20-2309, subsection B, paragraph 1 or 2
relating to nonpayment of premiums or fraud.
4. The
individual was offered and elected the option of continuation coverage under a
COBRA continuation provision pursuant to the consolidated omnibus budget
reconciliation act of 1985 (P.L. 99-272; 100 Stat. 82) or a similar state
program.
5. The
individual exhausted the continuation coverage pursuant to the consolidated
omnibus budget reconciliation act of 1985.
Q. Notwithstanding
subsection P of this section, an individual is an eligible individual if:
1. The
individual is an individual enrollee in a health care services organization
that is domiciled in this state on the date that the health care services organization
is declared insolvent, including any health care services organization that is
not an accountable health plan as defined in section 20-2301.
2. The
individual's coverage terminates during the delinquency proceeding, after the
health care services organization is declared insolvent.
3. The
individual satisfies the requirements of an eligible individual as prescribed
in this section other than the required period of creditable coverage.
R. Notwithstanding
subsection P of this section, a newborn child, adopted child or child placed
for adoption is an eligible individual if the child was timely enrolled and
otherwise would have met the definition of an eligible individual as prescribed
in this section other than the required period of creditable coverage and the
child is not subject to any preexisting condition exclusion or limitation if
the child has been continuously covered under health insurance coverage or a
health benefits plan offered by an accountable health plan since birth,
adoption or placement for adoption.
S. If
a health care insurer imposes a waiting period for coverage of preexisting
conditions, within a reasonable period of time after receiving an individual's
proof of creditable coverage and not later than the date by which the individual
must select an insurance plan, the health care insurer shall give the
individual written disclosure of the insurer's determination regarding any
preexisting condition exclusion period that applies to that
individual. The disclosure shall include all of the following
information:
1. The
period of creditable coverage allowed toward the waiting period for coverage of
preexisting conditions.
2. The
basis for the insurer's determination and the source and substance of any
information on which the insurer has relied.
3. A
statement of any right the individual may have to present additional evidence
of creditable coverage and to appeal the insurer's determination, including an
explanation of any procedures for submission and appeal.
T. This
section and section 20-1380 apply to all health insurance coverage that
is offered, sold, issued, renewed, in effect or operated in the individual
market after June 30, 1997, regardless of when a period of creditable coverage
occurs.
U. For
the purposes of this section and section 20-1380 as applicable:
1. "Affiliation
period" has the same meaning prescribed in section 20-2301.
2. "Bona
fide association" means, for health care coverage issued by a health care
insurer, an association that meets the requirements of section 20-2324.
3. "Creditable
coverage" means coverage solely for an individual, other than limited
benefits coverage, under any of the following:
(a) An
employee welfare benefit plan that provides medical care to employees or the
employees' dependents directly or through insurance, reimbursement or otherwise
pursuant to the employee retirement income security act of 1974.
(b) A
church plan as defined in the employee retirement income security act of 1974.
(c) A
health benefits plan issued by an accountable health plan as defined in section
20-2301.
(d) Part
A or part B of title XVIII of the social security act.
(e) Title
XIX of the social security act, other than coverage consisting solely of
benefits under section 1928.
(f) Title
10, chapter 55 of the United States Code.
(g) A
medical care program of the Indian health service or of a tribal organization.
(h) A
health benefits risk pool operated by any state of the United States.
(i) A
health plan offered pursuant to title 5, chapter 89 of the United States Code.
(j) A
public health plan as defined by federal law.
(k) A
health benefit plan pursuant to section 5(e) of the peace corps act (P.L. 87-293;
75 Stat. 612; 22 United States Code sections 2501 through 2523).
(l) A
policy or contract, including short-term limited duration insurance,
issued on an individual basis by an insurer, a health care services
organization, a hospital service corporation, a medical service corporation or
a hospital, medical, dental and optometric service corporation.
(m) A
policy or contract issued by a health care insurer or an accountable health
plan to a member of a bona fide association.
4. "Delinquency
proceeding" has the same meaning prescribed in section 20-611.
5. "Different
policy forms" means variations between policy forms offered by a health
care insurer, including policy forms that have different cost sharing
arrangements or different riders.
6. "Genetic
information" means information about genes, gene products and inherited
characteristics that may derive from the individual or a family member,
including information regarding carrier status and information derived from
laboratory tests that identify mutations in specific genes or chromosomes,
physical medical examinations, family histories and direct analyses of genes or
chromosomes.
7. "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.
8. "Health
status-related factor" means any factor in relation to the health of
the individual or a dependent of the individual enrolled or to be enrolled in a
health care services organization including:
(a) Health
status.
(b) Medical
condition, including physical and mental illness.
(c) Claims
experience.
(d) Receipt
of health care.
(e) Medical
history.
(f) Genetic
information.
(g) Evidence
of insurability, including conditions arising out of acts of domestic violence
as defined in section 20-448.
(h) The
existence of a physical or mental disability.
9. "Higher
level of coverage" means a policy form for which the actuarial value of
the benefits under the health insurance coverage offered by a health care
insurer is at least fifteen percent more than the actuarial value of the health
insurance coverage offered by the health care insurer as a lower level of
coverage in this state but not more than one hundred twenty percent of a policy
form weighted average.
10. "Individual
health insurance coverage" means health insurance coverage offered by a
health care insurer to individuals in the individual market but does not
include limited benefit coverage or short-term limited duration
insurance. A health care insurer that offers limited benefit
coverage or short-term limited duration insurance to individuals and no
other coverage to individuals in the individual market is not a health care
insurer that offers health insurance coverage in the individual market.
11. "Limited
benefit coverage" has the same meaning prescribed in section 20-1137.
12. "Lower
level of coverage" means a policy form offered by a health care insurer
for which the actuarial value of the benefits under the health insurance
coverage is at least eighty-five percent but not more than one hundred
percent of the policy form weighted average.
13. "Network
plan" means a health care plan provided by a health care insurer under
which the financing and delivery of health care services are provided, in whole
or in part, through a defined set of providers either under contract with a
health care insurer licensed pursuant to chapter 4, article 3 of this title or
under contract with a health care insurer in accordance with the determination
made by the director pursuant to section 20-1053 regarding the geographic
or service area in which a health care insurer may operate.
14. "Policy
form weighted average" means the average actuarial value of the benefits
provided by a health care insurer that issues health coverage in this state
that is provided by either the health care insurer or, if the data are
available, by all health care insurers that issue health coverage in this state
in the individual health coverage market during the previous calendar year, except
coverage pursuant to this section, weighted by the enrollment for all coverage
forms.
15. "Preexisting
condition" means a condition, regardless of the cause of the condition,
for which medical advice, diagnosis, care or treatment was recommended or received
within not more than six months before the date of the enrollment of the
individual under the health insurance policy or other contract that provides
health coverage benefits. A genetic condition is not a preexisting condition
in the absence of a diagnosis of the condition related to the genetic
information and shall not result in a preexisting condition limitation or
preexisting condition exclusion.
16. "Preexisting
condition limitation" or "preexisting condition exclusion" means
a limitation or exclusion of benefits for a preexisting condition under a
health insurance policy or other contract that provides health coverage
benefits.
17. "Short-term
limited duration insurance" has the same meaning prescribed in section 20-1384
and is not intended or marketed as health insurance coverage subject to
guaranteed issuance or guaranteed renewal provisions of the laws of this state
but is creditable coverage within the meaning of this section and section 20-2301.
END_STATUTE
Sec. 8. Section
20-1382, Arizona Revised Statutes, is amended to read:
START_STATUTE20-1382. Health
care insurers; reporting requirements
A. On
or before March 1 of each year, each health care insurer shall submit to the
director a written report that contains the following information:
1. The
number of eligible individuals covered by policies that were written by that
health care insurer in the individual market during the previous calendar year.
2. The
number of individuals covered by policies that were issued other than to
eligible individuals during the previous calendar year.
3. The
earned premium for each category of individual policy for the previous calendar
year.
4. The
total number of eligible individuals covered by policies that were issued by
the health care insurer as of the end of the previous calendar year.
B. Each
health care insurer shall submit the following information to the department,
if applicable, to demonstrate compliance with sections 20-1379, 20-1380
and 20-1381:
1. The
health care insurer's name and address.
2. The
identification, form number and summary of all products that the health care
insurer offers in the individual market.
3. If
the health care insurer elects the option prescribed in section 20-1379,
subsection C, paragraph 2, subdivision (a) the data on premium volumes of all
policy forms that the health care insurer offers in the individual market and
the number of individuals who are covered under each form during the preceding
calendar year.
4. If
the health care insurer elects the option prescribed in section 20-1379,
subsection C, paragraph 2, subdivision (b) the data, assumptions and methods
used to calculate the actuarial values of the two representative policy forms.
5. An
explanation of how the health care insurer is complying with sections 20-1379,
20-1380 and 20-1381.
6. A
list of all products, including all marketing material, that the health care
insurer is making or will make available to eligible individuals and an
explanation of how the health care insurer will inform individuals of these
policy forms.
7. A
description of the risk spreading and financial subsidization mechanism.
C. The
health care insurer shall submit the information described in subsection B of
this section to the department by March 1 of each year.
D. If
all or part of the information required by subsection B, paragraph 5, 6 or 7 of
this section has not changed since the health care insurer's last previous
submission, instead of refiling the information the health care insurer may
indicate the information that has not changed.
e. notwithstanding
any other law, an insurer is not required to comply with the reporting
requirements of this section if the federal laws that require providing a
certificate of creditable coverage are superseded by the prohibition on
preexisting condition EXCLUSIONS.
END_STATUTE
Sec. 9. Title
20, chapter 6, article 7, Arizona Revised Statutes, is amended by adding
section 20-1510, to read:
START_STATUTE20-1510. Flood
insurance; notification
An
insurer that is authorized to transact property insurance and that insures
residential property located in this state shall provide information to its
policyholders through a website or other reasonable means of communication in
understandable and nontechnical language about how to obtain flood insurance
and the national flood insurance program."END_STATUTE
Renumber to
conform
Page 12,
strike lines 14 through 31
Strike pages
13 through 15
Page 16,
strike lines 1 through 5, insert:
"Sec. 11. Section
20-2310, Arizona Revised Statutes, is amended to read:
START_STATUTE20-2310. Discrimination
prohibited; preexisting conditions; wellness programs
A. Except
as provided in subsection B of this section, a health benefits plan may not
deny, limit or condition the coverage or benefits based on a person's health
status-related factors or a lack of evidence of insurability.
B. A
health benefits plan shall not exclude coverage for preexisting conditions,
except that:
1. A
health benefits plan may exclude coverage for preexisting conditions for a period
of not more than twelve months or, in the case of a late enrollee, eighteen
months. The exclusion of coverage does not apply to services that
are furnished to newborns who were otherwise covered from the time of their
birth or to persons who satisfy the portability requirements under section 20-2308.
2. The
accountable health plan shall reduce the period of any applicable preexisting
condition exclusion by the aggregate of the periods of creditable coverage that
apply to the individual.
C. A
health benefits plan shall not include an affiliation period in a policy unless
the affiliation period satisfies the requirements prescribed in 45 Code of
Federal Regulations section 146.119(b).
D. On
request of a health benefits plan, a person who provides coverage during a
period of continuous coverage with respect to a covered individual shall
promptly disclose the coverage provided to the covered individual, the period
of the coverage and the benefits provided under the coverage.
E. The
accountable health plan shall calculate creditable coverage according to the
following rules:
1. The
accountable health plan shall give an individual credit for each day the
individual was covered by creditable coverage.
2. The
accountable health plan shall not count a period of creditable coverage for an
individual enrolled in a health benefits plan if after the period of coverage
and before the enrollment date there were sixty-three consecutive days
during which the individual was not covered under any creditable coverage.
3. The
accountable health plan shall give credit in the calculation of creditable
coverage for any period that an individual is in a waiting period or an
affiliation period for any health coverage.
4. The
accountable health plan shall not count a period of creditable coverage with
respect to enrollment of an individual if, after the most recent period of
creditable coverage and before the enrollment date, sixty-three
consecutive days lapse during all of which the individual was not covered under
any creditable coverage. The accountable health plan shall not include in the
determination of the period of continuous coverage described in this section
any period that an individual is in a waiting period for health insurance
coverage offered by a health care insurer, is in a waiting period for benefits
under a health benefits plan offered by an accountable health plan or is in an
affiliation period.
5. In
determining the extent to which an individual has satisfied any portion of any
applicable preexisting condition period the accountable health plan shall count
a period of creditable coverage without regard to the specific benefits covered
during that period.
6. An
accountable health plan shall not impose any preexisting condition exclusion in
the case of an individual who is covered under creditable coverage thirty-one
days after the individual's date of birth.
7. An
accountable health plan shall not impose any preexisting condition exclusion in
the case of a child who is adopted or placed for adoption before age eighteen
and who is covered under creditable coverage thirty-one days after the
adoption or placement for adoption.
F. An
accountable health plan shall provide the certificate of creditable coverage
described in subsection G of this section without charge for creditable
coverage occurring after June 30, 1996 if the individual:
1. Ceases
to be covered under a health benefits plan offered by an accountable health
plan or otherwise becomes covered under a COBRA continuation provision. An
individual who is covered by a health benefits plan that is offered by an
accountable health plan, that is terminated or not renewed at the choice of the
employer and where the replacement of the health benefits plan is without a
break in coverage is not entitled to receive the certification prescribed in
this paragraph but is instead entitled to receive the certifications prescribed
in paragraphs 2 and 3 of this subsection.
2. Who
was covered under a COBRA continuation provision ceases to be covered under the
COBRA continuation provision.
3. Requests
certification from the accountable health plan within twenty-four months
after the coverage under a health benefits plan offered by an accountable
health plan ceases.
G. The
certificate of creditable coverage provided by an accountable health plan is a
written certification of:
1. The
period of creditable coverage of the individual under the accountable health
plan and any applicable coverage under a COBRA continuation provision.
2. Any
applicable waiting period or affiliation period imposed on an individual for
any coverage under the accountable health plan.
H. Any
accountable health plan that issues health benefits plans in this state, as
applicable, shall issue and accept a written certificate of creditable coverage
of the individual that contains at least the following information:
1. The
date that the certificate is issued.
2. The
name of the individual or dependent for whom the certificate applies and any
other information that is necessary to allow the issuer providing the coverage
specified in the certificate to identify the individual, including the
individual's identification number under the policy and the name of the
policyholder if the certificate is for or includes a dependent.
3. The
name, address and telephone number of the issuer providing the certificate.
4. The
telephone number to call for further information regarding the certificate.
5. One
of the following:
(a) A
statement that the individual has at least eighteen months of creditable coverage. For
the purposes of this subdivision, "eighteen months" means five
hundred forty-six days.
(b) Both
the date that the individual first sought coverage, as evidenced by a
substantially complete application, and the date that creditable coverage
began.
6. The
date creditable coverage ended, unless the certificate indicates that
creditable coverage is continuing from the date of the certificate.
7. The
consumer assistance telephone number for the department.
8. The
following statement in at least fourteen-point type:
Important
notice!
Keep this
certificate with your important personal records to protect your rights under
the health insurance portability and accountability act of 1996
("HIPAA"). This certificate is proof of your prior health
insurance coverage. You may need to show this certificate to have a guaranteed
right to buy new health insurance ("Guaranteed issue"). This
certificate may also help you avoid waiting periods or exclusions for
preexisting conditions. Under HIPAA, these rights are guaranteed
only for a very short time period. After your group coverage ends, you must
apply for new coverage within 63 days to be protected by HIPAA. If
you have questions, call the Arizona department of insurance and financial
institutions.
I. An
accountable health plan may provide any certification pursuant to subsection F,
paragraph 1 of this section at the same time the accountable health plan sends
the notice required by the applicable COBRA continuation provision.
J. An
accountable health plan has satisfied the certification requirement under this
section if the accountable health plan offering the health benefits plan
provides the prescribed certificate in accordance with this section within
thirty days after the event that triggered the issuance of the certification.
K. If
an accountable health plan imposes a waiting period for coverage of preexisting
conditions, within a reasonable period of time after receiving an individual's
proof of creditable coverage and not later than the date by which the
individual must select an insurance plan, the accountable health plan shall
give the individual written disclosure of the accountable health plan's
determination regarding any preexisting condition exclusion period that applies
to that individual. The disclosure shall include all of the
following information:
1. The
period of creditable coverage allowed toward the waiting period for coverage of
preexisting conditions.
2. The
basis for the accountable health plan's determination and the source and
substance of any information on which the accountable health plan has relied.
3. A
statement of any right the individual may have to present additional evidence
of creditable coverage and to appeal the accountable health plan's
determination, including an explanation of any procedures for submission and
appeal.
L. Periods
of creditable coverage for an individual are established by presentation of the
written certifications described in this section and section 20-1379. In
addition to written certification of the period of creditable coverage as
described in this section, individuals may establish creditable coverage
through the presentation of documents or other means. In order to make a
determination that is based on the relevant facts and circumstances of the
amount of creditable coverage that an individual has, an accountable health
plan shall take into account all information that the plan obtains or that is
presented to the plan on behalf of the individual.
M. The
department may enforce and monitor the issuance and delivery of the notices and
certificates by accountable health plans and insurers as required by this
section, the health insurance portability and accountability act of 1996 (P.L.
104-191; 110 Stat. 1936) and any federal regulations adopted to implement
the health insurance portability and accountability act of 1996.
N. This
section does not prohibit any health benefits plan from providing or offering
to provide rewards or incentives under a wellness program that satisfies the
requirements for an exception from the general prohibition against
discrimination based on a health factor under the health insurance portability
and accountability act of 1996 (P.L. 104-191; 110 stat. 1936), including any
federal regulations that are adopted pursuant to that act.
O. notwithstanding
any other law, an insurer is not required to provide a certificate of
creditable coverage if the federal laws that require providing a certificate of
creditable coverage are superseded by the prohibition on preexisting condition
EXCLUSIONS. END_STATUTE
Sec. 12. Section
37-1302, Arizona Revised Statutes, as amended by Laws 2022, chapter 129,
section 1, is amended to read:
START_STATUTE37-1302. Powers
and duties of state forester; rules; legislative presentation; acceptance of
federal law
A. The
state forester is designated as the agent of this state and shall administer
this chapter. The state forester shall:
1. Exercise
and perform all powers and duties vested in or imposed on the Arizona
department of forestry and fire management.
2. Adopt
rules necessary to discharge the powers and duties of the Arizona department of
forestry and fire management, including rules that create efficiencies, protect
the public health and safety and prescribe budgetary obligations.
3. Subject
to title 41, chapter 4, article 4, appoint an assistant director to the office
of the state fire marshal, a state fire training officer and a state fire
resource coordinator, all of whom serve at the pleasure of the state forester.
4. Subject
to title 41, chapter 4, article 4, employ, determine the terms and conditions
of employment of and prescribe the duties and powers of administrative,
professional, technical, secretarial, clerical and other persons as may be
necessary in the performance of the Arizona department of forestry and fire
management's duties. The compensation of department employees shall
be as determined pursuant to section 38-611.
5. Contract
for the services of outside advisors, consultants and aides as may be
reasonably necessary.
6. Perform
all management and administrative functions assigned or delegated to this state
by the United States relating to forestry and financial assistance and grants
relating to forestry and wildfire prevention, mitigation and suppression
activities. The state forester shall obtain and maintain a copy of
the initial and any revised delegation of authority agreement entered into with
the United States.
7. Identify
sources of information relating to forest management, including wildfire
prevention, mitigation, suppression and recovery and administrative and
judicial appeals and litigation with respect to timber sales and forest
thinning projects in this state, and develop procedures for compiling and
distributing that information.
8. Take
necessary action to maximize state fire assistance grants, including
establishing timelines for using grant monies and reallocating lapsed grant
monies to other projects.
9. Conduct
education and outreach in forest communities by explaining the wildfire threat
to private property caused by the lack of timber harvesting, forest thinning,
land management and watershed protection and enhancement.
10. Monitor
and conduct forestry projects and wildfire prevention, mitigation and
suppression activities.
11. Assist
in the development of the forestry products industry in this state.
12. Intervene
on behalf of this state and its citizens in administrative and judicial appeals
and litigation that challenge governmental efforts supported by the state
forester if the state forester determines that intervention is in the best
interests of this state.
13. Annually
develop and implement a comprehensive statewide wildfire response plan for the
deployment of state, county, municipal, fire district, volunteer fire
association and private fire service provider contract resources to wildfire
suppression activities. The statewide wildfire response plan shall
take into account anticipated fire conditions and fire severity and may include
prepositioning resources as necessary. The state forester shall consult with
federal land management firefighting agencies, state and county emergency
agencies, municipal fire departments, fire districts, statewide fire district
and statewide fire chiefs associations, volunteer fire departments and private
fire contractors in the development of the comprehensive statewide wildfire
response plan, the implementation of standards for training and certification
for all classes of wildland fire and hazard personnel and the implementation of
standards for wildland fire apparatus and equipment that are deployed under
cooperative agreements with the state forester.
14. Make
available to the department of insurance and financial institutions the list of
areas that have been designated as high risk for wildfire.
14. 15. Provide necessary
oversight to ensure standardized training and certification for all
classifications of firefighters to be deployed to any incident.
15. 16. Develop recommendations for
minimum standards for safeguarding life and property from wildland fires and
fire hazards, preventing wildland fires and alleviating fire hazards.
16. 17. Develop
recommendations for minimum standards for the storage, sale, distribution and
use of dangerous chemicals, combustibles, flammable liquids, explosives and
radioactive materials in wildland-urban interface areas.
17. 18. Consult with the
department of public safety, the department of emergency and military affairs
and local governments regarding the establishment of fire evacuation routes and
community alert systems.
18. 19. Make recommendations
for minimum standards for the creation of defensible spaces in and around
wildland-urban interface areas as authorized by existing county and municipal
laws and ordinances.
B. During
the first regular session of each legislature, the state forester shall present
information to the legislative committees with jurisdiction over forestry
issues. The state forester shall collaborate with, and invite the
participation of, relevant state, federal and local governmental officers and
agencies. A written report is not required, but the presentation
shall include information concerning:
1. Forestry
management, including the current conditions of the forests in this state on
federal, state and private property as affected by federal, state and local
public policies, climatic conditions, wildfire hazards, pest infestations,
overgrowth and overgrowth control policies and methods and the effects of
current federal policy on forest management and impacts on forest land
management.
2. The
wildland-urban interface, including the effects of county and municipal
zoning policies and wildfire hazards on public and private property.
3. Wildfire
emergency management and all hazard response issues, including:
(a) Intergovernmental
and interagency primacy, cooperation, coordination, roles and training of
federal, state and local forestry, firefighting and law enforcement agencies.
(b) Channels
and methods of communicating emergency information to the public.
(c) The
roles of governmental and nongovernmental disaster relief agencies and
organizations.
(d) The
level of federal, state and local emergency funding.
C. The
state forester may:
1. Furnish
technical advice to the people of this state on forestry and land management
matters.
2. Do
all other acts necessary to take advantage of and carry out the provisions of
the act of Congress described in subsection D of this section.
D. This
state accepts the provisions of the cooperative forestry assistance act of 1978
(P.L. 95-313; 92 Stat. 365; 16 United States Code chapter 41) providing
for federal forestry assistance programs to states." END_STATUTE
Amend title to conform
