SB1553 - 562R

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 20-111, to read:

START_STATUTE20-111. Health care sharing plan or arrangement; reporting; deficiency notice; public posting; cease and desist order; exceptions

A. On or before December 1, 2024 and each June 1 thereafter, a person that is not AUTHORIZED to transact insurance in this state but that offers or intends to offer a health care sharing plan or arrangement to facilitate payment or reimbursement of health care costs or services for residents of this state, regardless of whether the person is domiciled in this state or another state, shall submit to the department:

1. All of the following information:

(a) The TOTAL number of individuals and households that participated in the plan or arrangement in this state in the immediately preceding calendar year.

(b) the total number of employer groups that participated In the plan or arrangement in this state in the immediately Preceding calendar year and shall include the total number of individuals who participated in the plan or arrangement for each participating employer group.

(c) if the person offers a plan or arrangement in other States, the total number of participants in the plan or Arrangement nationally.

(d) any contracts the person has entered into with Providers in this state that provide health care services to plan Or arrangement participants.

(e) the total amount of fees, dues or other payments Collected by the person in the immediately preceding calendar Year from individuals, employer groups or others who Participated in the plan or arrangement in this state and shall specify The percentage of fees, dues or other payments retained by the Person for administrative expenses.

(f) the total dollar amount of requests for Reimbursement of health care costs or services submitted in this State in the immediately preceding calendar year by either participants In the plan or arrangement or providers that provided Health care services to plan or arrangement participants.

(g) the total dollar amount of requests for Reimbursement of health care costs or services that were Submitted in this state and that qualified for Reimbursement under the plan or arrangement in the immediately preceding calendar year.

(h) the total amount of payments made to providers in This state in the immediately preceding calendar year for Health care services provided to or received by a plan or Arrangement participant.

(i) The total amount of health care services provided to or received by plan or arrangement participants in this state in the immediately preceding calendar year.

(j) the total number of requests for reimbursement of Health care costs or services submitted in this state in the Immediately preceding calendar year that were either:

(i) Denied, expressed by a percentage of the total REIMBURSEMENT request amount.

(ii) Appealed.

(k) the total amount of health care expenses submitted in This state by plan or arrangement participants or providers in the Immediately preceding calendar year that qualify for Reimbursement pursuant to the plan or arrangement criteria but that have not been reimbursed at the end of the calendar year, excluding any costs that PARTICIPANTs must pay before receiving reimbursement.

(l) the estimated number of plan or arrangement Participants in this state in the next Calendar year and shall specify the estimated number of individuals, Households, employer groups and employees.

(m) the specific counties in this state in which the person:

(i) offered a plan or arrangement in the immediately Preceding calendar year.

(ii) intends to offer a plan or arrangement in the next Calendar year.

(n) A list of the other states in which the person offers a plan or Arrangement.

(o) a list of any third parties, other than a producer, that Are associated with or that assisted the person in offering or enrolling Participants in the plan or arrangement in this state in the immediately preceding calendar year and shall provide copies of Training materials provided to a third party, if any, and a detailed Accounting of any commissions or other fees or remuneration paid To a third party for either:

(i) marketing, promoting or enrolling participants in a Plan or arrangement offered by the person in this state.

(ii) operating, managing or administering a plan or Arrangement offered by the person in this state.

(p) the total number of producers that are associated With or that assisted the person in offering or enrolling participants in the plan or arrangement in This state and the total number of Participants enrolled in the plan or arrangement through a Producer in the immediately preceding calendar year for marketing, promoting or enrolling participants in a plan or arrangement offered by the person in this State.

(q) copies of any consumer-facing and marketing Materials that are used in this state in promoting the person's plan or Arrangement and that include:

(i) the plan or arrangement.

(ii) the benefit descriptions.

(iii) Any other materials that explain the plan or arrangement.

(r) the name, mailing address, email address and Telephone number of an individual who serves as a contact person for The person in this state.

(s) a list of any parent companies, subsidiaries and other Names that the person has operated under at any time within the Immediately preceding five calendar years.

(t) an organizational chart for the person and a list of The officers and directors of that person.

2. a certification that, to the Best of the person's good-faith knowledge and belief, the Information submitted is accurate and satisfies the requirements prescribed in paragraph 1 of this subsection.

B. if a person who is subject to the requirements prescribed in subsection A of this section fails to submit the REQUIRED information or Certification, the submission is deemed incomplete. the director shall determine whether the submission is complete within forty-five days after receiving the submission. If the director finds that the submission does not contain the required information, the director shall issue a notice of deficiencies within forty-five days and, If the director does not notify the person of any deficiencies within forty-five days, the submission is considered complete.

C. if the director determines that a person failed to Comply with the requirements prescribed in subsection A of this section, the director:

1. Shall notify the person that the submission is incomplete and Enumerate each deficiency found in the person's submission.

2. Shall allow the person thirty days to correct any submission deficiency after receipt of the notice of deficiencies.

3. if the person does not remedy the deficiency or deficiencies within the Thirty-day period, may impose a civil penalty in an amount of not more than $5,000 per day.

4. if the person does not remedy the deficiency or Deficiencies within thirty days after imposition of the initial civil penalty, may issue a cease and desist order in accordance subsection F of this section.

D. on or before april 1, 2025 and each october 1 thereafter, the director shall do all of the following:

1. prepare a written report that summarizes the information Submitted by persons pursuant to subsection A of this section.

2. post on the department's website both of the following:

(a) The report that contains accurate And evidence-based information about the persons who submitted Information pursuant to subsection A of this SECTION.

(b) Information on how consumers may file a complaint.

E. the department may adopt rules to Implement this section.

F. the director may issue an ex parte emergency cease and desist order if the director believes that:

1. an unauthorized person is engaging in the business of insurance In violation of this section or any rule adopted by the department.

2. a person is failing to remedy or has not remedied any Deficiency in the submission.

G. a PERSON THAT IS NOT AUTHORIZED TO TRANSACT INSURANCE IN THIS STATE BUT THAT OFFERS OR INTENDS TO OFFER A HEALTH CARE SHARING PLAN OR ARRANGEMENT AND A HEALTH CARE INSURER THAT OFFERS BOTH A HEALTH CARE SHARING PLAN OR ARRANGEMENT AND HEALTH INSURANCE COVERAGE ARE REQUIRED TO EXPLAIN, VERBALLY AND IN WRITING, THE FOLLOWING INFORMATION TO PROSPECTIVE CUSTOMERs:

1. The differences between a health care sharing plan or ARRANGEMENT and health insurance coverage.

2. that A health care sharing plan or arrangement does not guarantee payment of medical claims.

3. tHE ELIGIBILITY REQUIREMENTS FOR AFFORDABLE HEALTH CARE TAX CREDITS.

h. this section does not apply to:

1. direct primary care agreements as defined in section 44-1799.91.

2. other consumer payment arrangements that are identified by the director by rule, including consumer payment plans offered Directly by a provider to a patient or the party responsible for Payment on behalf of the patient. END_STATUTE