Arizona Revised Statutes Title 20. Insurance § 20-2801. Definitions

1. “Coverage” means the contractual obligation of a health care services plan to pay its enrollee or a contracted or noncontracted provider for medically necessary emergency services rendered by the provider to an enrollee, as specified in the governing agreement, contract or policy between the plan and the enrollee, subject to applicable copayments, coinsurance and deductibles.

2. “Emergency ambulance services” means services that are provided by an ambulance service authorized to operate pursuant to title 36, chapter 21.1  1 following the onset of a medical condition that manifests itself by symptoms of pain, illness or injury that the absence of accessing an ambulance or emergency response by calling 911 or a designated telephone number to reach a public safety answering point and receiving time sensitive medical attention could reasonably be expected to result in any of the following:

3. “Emergency services” means health care services that are provided to an enrollee in a licensed hospital emergency facility by a provider after the recent onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in any of the following:

4. “Enrollee” means an individual, or a dependent of that individual, who is currently enrolled with and covered by a health care services plan.

5. “Health care services plan”:

6. “Prior authorization”:

7. “Provider” means any physician, hospital or other person that is licensed or otherwise authorized to furnish emergency services in this state.