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Current as of January 01, 2025 | Updated by Findlaw Staff
A. A health insurer may establish a program that provides a savings incentive for enrollees for medically necessary covered health care services that health care providers and health care facilities provide at a price that is below the health insurer's usual reimbursement.
B. The program may enable an eligible enrollee who receives covered health care services from a health care provider or health care facility at a price below the health insurer's usual reimbursement to have the amount the enrollee pays applied toward the enrollee's deductible and out-of-pocket maximum and be reimbursed for a portion of the amount of the difference between the price the enrollee paid and the health insurer's usual reimbursement.
C. For the purposes of this section:
1. “Health care facility” means a hospital, outpatient surgical center, health care laboratory, diagnostic imaging center or urgent care center.
2. “Health care provider” has the same meaning prescribed in § 32-3216.
3. “Health insurer” has the same meaning prescribed in § 32-3216.
4. “Usual reimbursement” means the amount the health insurer would ordinarily pay an in-network health care provider or an in-network health care facility for the service.
Cite this article: FindLaw.com - Arizona Revised Statutes Title 20. Insurance § 20-111. Health insurers; savings incentive programs; definitions - last updated January 01, 2025 | https://codes.findlaw.com/az/title-20-insurance/az-rev-st-sect-20-111/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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