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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!


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