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ARIZONA STATE SENATE
Fifty-Sixth Legislature, Second Regular Session
AMENDED
health care; costs; reimbursement
Purpose
Allows a health insurer (insurer) to establish a health care plan saving incentive program (program).
Background
The Department of Insurance and Financial Institutions regulates policies, certificates, evidences of coverage and contracts of insurance that are issued or delivered by insurers. Insurers include disability insurers, group disability insurers, blanket disability insurers, health care services organizations, hospital service corporations, prepaid dental plan organizations, medical service corporations, dental service corporations or optometric service corporations or hospital, medical, dental and optometric service corporations. Every insurer that offers individual health insurance coverage in the individual market in Arizona must provide guaranteed availability of coverage to eligible individuals who desire to enroll in individual health insurance coverage (A.R.S. § 20-1379).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Allows each insurer to establish a program that provides enrollees a savings incentive for medically necessary covered health care services that health care providers (providers) and health care facilities provide at a price below the insurer's usual reimbursement.
2. Defines usual reimbursement as the amount the insurer would ordinarily pay an in-network provider or an in-network health care facility for the service.
3. Allows a program to enable eligible enrollees who receive covered health care services from a provider or health care facility at a price below the insurer's usual reimbursement to:
a) have the amount the enrollee pays applied toward the enrollee's deductible and out-of-pocket maximum; and
b) be reimbursed for a portion of the amount of the difference between the price the enrollee paid and the insurer's usual reimbursement.
4. Defines terms.
5. Makes technical and conforming changes.
6. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Allows, rather than requires, an insurer to establish a program for health care services provided at a price that is below the health insurer's usual reimbursement, rather than the deidentified minimum negotiated charge.
2. Removes program disclosure requirements and payment procedures.
3. Authorizes a program to enable an eligible enrollee to be reimbursed for a portion, rather than one-half, of the amount of the difference between the price the enrollee paid and the health insurer's usual reimbursement.
4. Removes the modifications to a health care provider's direct pay prices reporting requirements and receipt information.
5. Removes the authorization for an enrollee to split a portion of the saving incentive with an assisting third party.
6. Defines usual reimbursement as the amount the health insurer would ordinarily pay an in-network health care provider or an in-network health care facility for the service.
7. Makes technical and conforming changes.
Senate Action
FICO 2/12/24 DPA 7-0-0
Prepared by Senate Research
February 14, 2024
MG/AB/sdr/cs