Arizona Health Insurance (AZ)

Arizona (AZ)
Individual Health Insurance Regulations

Learn more about Arizona Individual Health Insurance

Health insurance is an essential part of an individual’s life. As a head of the family, your main priority should include protecting your family against unpredicted events through a suitable health coverage. Before choosing a particular health insurance policy, a detailed assessment of your family’s healthcare needs and your finances is requisite. If you reside in Arizona, you can choose from various health insurance alternatives. The Arizona Division of Insurance supervises the legislature under which the Arizona health insurers can sell private health insurance to individuals and families.

As in most health insurance policies, Arizona health insurers provide individual and family health insurance based on your age, health status and lifestyle habits. Insurance companies offering individual health insurance in Arizona are permitted to deny coverage to any person that has a pre-existing medical condition. However, exceptions include those individuals that are HIPAA eligible under federal law and can receive guaranteed coverage on a select number of individual health plans. HIPAA-eligible individuals are people who have left job-based group health coverage and have elected and fully exhausted any COBRA or state-operated continuation coverage. The premiums charged under these plans may be substantially higher than standard issue plans for healthy individuals. There are many different levels of health plans available that range in premium, deductibles, co-payments and covered services. Insurance companies are allowed to impose exclusionary periods on pre-existing medical conditions and may deny future claims if they determine your medical treatment was related to a medical condition that existed prior to your application for insurance. The Arizona state has not provided the limits for exclusionary and look-back period for pre-existing medical conditions. There are no state regulations that require an insurance company to provide credit from prior health insurance coverage to the pre-existing condition exclusionary period.

Arizona (AZ)
Small Group Health Insurance Regulations

Arizona law defines a small group as any employer with 2-50 employees. The employees must work for at least 6 months out of the year, and work 20 hours per week to be eligible for the group health coverage. Coverage is guaranteed issue to small groups, meaning that the insurance company must accept the group for coverage, regardless of overall health status. Insurance companies offering small group health insurance can place a 6-month look-back period and12-month exclusionary period on pre-existing conditions. Prior creditable health insurance must be applied to the exclusionary period. Insurance companies are allowed to adjust their published rates for smaller groups or groups with a higher percentage of employees with existing medical conditions or risk factors. Usually, the benefits vary depending on the type of the chosen group plan. The Arizona state regulations cap small group rates at ±60% of the insurance company’s index rate.

Arizona COBRA and Continuation Coverage

Arizona is required by federal COBRA law to require employers to give employees who lost their health insurance benefits the right to choose to continue group health benefits provided by the plan under certain circumstances. In contrast to other states, Arizona does not have a state mini-COBRA regulation for companies with less than 20 employees. Federal COBRA laws apply to companies with more than 20 employees. Your coverage under the COBRA option is the same coverage you had while you were covered under your group plan. Most COBRA plans last for 18 months, but certain qualified beneficiaries may remain on COBRA for 36 months, such as a widow of a primary insured. The premium amount, plus a 2% administration fee will be charged directly to the insured. COBRA coverage will end if the group health plan of the company is terminated because the company goes out of business or stops offering health care benefits to their employees. If you lose your group coverage, you may also be able to purchase a conversion policy that is offered by the insurance company that managed your group plan. These are permanent individual health plans, but the premiums may be considerably higher than COBRA coverage or other individual health plans.

Additional Arizona Resources

• Arizona KidsCare
  Provides health care coverage to children in Arizona that are 18 years old or younger and do not have access to other medical insurance and whose families fall within the low-income bracket.
• Arizona Health Care Cost Containment System
  Provides medical insurance and other services to low-income families that are residents of Arizona.
• Arizona Medicare Assistance
  The Health Services Advisory Group is a Medicare Quality Improvement Organization that provides assistance to the elderly and disabled in understanding their Medicare rights and those that have complaints about their insurance company.

AZ Medical Insurance Statistics

Total Population: 6,308,138
With Health Insurance: 5,070,816 / 80.4%
Without Health Insurance: 1,237,322 / 19.6%
*According to the Census Bureau’s March 2007 and 2008 Current Population Survey (CPS: Annual Social and Economic Supplements).

Note: There perecentage of Arizonans without health insurance increased by 3.1% from 2004

Arizona Department of Insurance
Phone: 800-325-2548, (602) 364-2499
Regulates the insurance laws in the state of Arizona. The department provides consumer assistance; hears and investigates complaints; reviews and approves license application for insurance agents and insurance companies wanting to conduct business in the state.

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