Your Rights Regarding
Health Insurance
Arizona Department of Insurance
(link
here)
Appeals:
You have the right to appeal an
insurer's denial of services or
claim payments for 2 years
after the denial. For more
information read our Consumer Guide to
Health Care Appeals.
Provider Timely Pay:
Healthcare providers have the right
to timely claim payments and to
contest denied claim payments. For
more information, obtain our Timely Pay Grievances
pamphlet.
Employee Eligibility:
Employers determine employee
eligibility for health insurance...not
the insurer.
A.R.S. § 20-2307.
Small Group Policies:
All group health
insurers MUST write policies for
small groups (2-50 employees) and
cannot refuse to insure individual
employees due to health condition.
A.R.S. §§ 20-2304 and 20-2307.
Portability:
If you lose your group health
insurance coverage (after having at
least 18 months of continuous
coverage) you are GUARANTEED the
offer of an individual health
insurance policy with ANY insurer
(that sells "individual" policies)
regardless of your health condition.
A.R.S. § 20-1379.
Pre-Existing
Conditions:
Health insurers may not impose a
pre-existing condition waiting
period of more than 12 months on any
group member and must reduce or
eliminate the waiting period in
accordance with the employee's prior
"creditable coverage".
A.R.S. § 20-2310.
Balance Billing:
Healthcare providers cannot "balance
bill" patients for covered,
in-network services to
HMO enrollees.
A.R.S. § 20-1072.
Emergency Care
Access: You have the right to
receive EMERGENCY screening and
stabilizing treatment services
without prior authorization from
your health insurer.
A.R.S. § 20-2801.
Newborns: When family health or
dental coverage is in place, newborns
and newly adopted children are
automatically covered for 31 days;
insurers MUST add the child to the
policy if requested and paid for
within 31 days.
A.R.S. §§ 20-1402(A)(2), 20-1342(A)(3),
20-1057(B), 20-826(E), 20-1007(B).
Conversion: Under most health
policies, dependents have the right to
convert to their own policy following
death or divorce of the named insured.
A.R.S. §§ 20-1057(M), 201377, 20-1408.
Breast Reconstruction:
Insurers must pay for breast
reconstructive surgery and at least 2
external postoperative prostheses
following a covered mastectomy.
A.R.S. §§ 20-1402(A)(5), 20-1342(A)(9),
20-1057(I), 20826(H).
Non-Formulary Drugs:
HMO's covering prescriptions must have a
process for both medically necessary
non-formulary drugs, and for drug
availability during non-business hours.
A.R.S. §§ 20-1057.02(B) 20-841.05(B).
Read your health
benefit documents thoroughly to
learn about your coverage!
