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Arizona Revised Statutes Title 20. Insurance § 20-123. Guaranteed availability;  preexisting condition exclusions prohibited;  open enrollment periods;  rules;  definitions

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A. Every health care insurer that offers an individual health plan in this state shall provide guaranteed availability of coverage to an eligible individual who desires to enroll in 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 with respect to the issuance, renewal or scope of benefits provided in such coverage.

B. A health care insurer may restrict enrollment in individual health plans to open enrollment periods and special enrollment periods to the extent the periods are not inconsistent with applicable federal law.

C. The director of the department of insurance and financial institutions shall adopt rules establishing minimum open enrollment dates and minimum criteria for special enrollment periods for all individual health plans offered in this state.

D. This section does not apply to:

1. Grandfathered health plan coverage.

2. Limited benefit coverage.

E. For the purposes of this section:

1. “Grandfathered health plan coverage” means coverage provided by either:

(a) A health care insurer under a health plan in which an individual was enrolled on March 23, 2010 and has maintained grandfathered status since that date.

(b) A health care insurer under a transitional health plan.

2. “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.

3. “Individual health plan” means a policy, contract or evidence of coverage that provides health care services and benefits to an individual and that is issued by a health care insurer.

4. “Preexisting condition exclusion” means a limit or exclusion of benefits relating to a medical condition based on the fact that the condition was present before the date of enrollment for insurance coverage, regardless of whether any medical advice, diagnosis, care or treatment was recommended or received before that date.

5. “Transitional health plan” means an individual or small group health plan established after March 23, 2010 but before March 23, 2013.

Cite this article: - Arizona Revised Statutes Title 20. Insurance § 20-123. Guaranteed availability;  preexisting condition exclusions prohibited;  open enrollment periods;  rules;  definitions - last updated March 08, 2022 |

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