Determination for 2016 Transition to Affordable Care Act-Compliant Policies

The Department has considered all relevant factors in making its determination that insurers that renewed existing plans, on or before December 31, 2014, that otherwise would have been modified or canceled under the Affordable Care Act (ACA), may renew those transitional policies in the individual and small group markets through October 1, 2016.  The transitional policies may not extend to policy years beginning after October 1, 2016, but by renewing the policies on or before October 1, 2016, carriers are extending coverage through September 30, 2017.  This constitutes a one-year extension of the Department’s May 8, 2014 determination regarding transition policies and is consistent with the Center for Consumer Information and Insurance Oversight’s (CCIIO’s) March 5, 2014 bulletin.

Further, this determination applies to policies sold to large businesses of 51-100 employees currently in the large group market but that, for policy years beginning on or after January 1, 2016, will be redefined as small businesses purchasing insurance in the small group market.

The Department will not compel any carrier to renew transition policies if it chooses not to do so

Priority: 
Germaine L. Marks
Small Business Bill of Rights
Health Insurance Telemarketers Annoy; Pose Fraud Risks

Phoenix, AZ—The Arizona Department of Insurance (ADOI) wants to make citizens aware of scams involving aggressive telemarketers attempting to sell health insurance plans and, in some cases, attempting to gain personal and financial information possibly for criminal purposes.

The ADOI has received complaints from people who received multiple phone calls, robocalls, and text messages claiming to be from the National Health Enrollment Center, the Healthcare Enrollment Center and from Healthcare.gov. Some people report that they were contacted multiple times a day, sometimes from different phone numbers, despite requests to be placed on the companies' do-not-call lists. Additionally, some people report having been asked to provide health insurance enrollment information, including such information as address, date of birth, social security number, and personal health information that, in the wrong hands, could be used in identity theft or other fraud schemes.

Arizona citizens who have received persistent phone calls or text messages from these or other callers attempting to sell them health insurance are encouraged to file a complaint with:

Federal Trade Commission (FTC)

Arizona Department of Insurance Consumer Protection Division

  • Visit https://insurance.az.gov/consumers
  • Or call the ADOI’s Consumer Protection Hotline at 602-364-2499, or 1-800-325-2548 if calling within Arizona but outside Maricopa County.

We can all take steps to avoid becoming victims of fraud.

  • Never provide someone who calls you with your bank account number, your social security number, your credit card number, or your personal health information. If you are asked to provide this information, hang up.
  • Research the insurance agent and insurance company you are considering using by finding their license information through the ADOI’s License Search webpage (https://insurance.az.gov/license-search), and use contact information in the license record to contact them. Be skeptical and do research.
  • For information about insurance available from Health Insurance Marketplace, visit the Healthcare.gov website or call Healthcare.gov directly at 1-800-318-2596. The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

Arbitration for Surprise Healthcare Bills Will Be Available SOON

Phoenix, AZ - A new state law is going into effect that will, under certain circumstances, allow a health plan enrollee who receives health care treatment on or after January 1, 2019, to request arbitration of a so-called “surprise out-of-network, or SOON, bill.”  

A SOON billing happens when a health care provider who is not on contract with the health insurance company (also referred to as an “out-of-network provider”) bills a patient for expenses that are not covered by the patient's insurance. The new law applies when patients go to an in-network hospital or facility, perhaps believing the medical services would be covered by their health insurance plans, but later get bills from medical professionals or medical equipment suppliers who do not have contracts under their health insurance plans.  If the bill is $1,000 or more after the enrollee pays cost-sharing amounts (copayment, coinsurance and deductible), and if certain other conditions are met, the enrollee can ask the Arizona Department of Insurance (“AZDOI”) to schedule an arbitration for the bill so that the enrollee only has to pay cost-sharing amounts. 

The new law requires out-of-network health care providers to give information to enrollees in a disclosure notice a reasonable amount of time before treatment.  This way, in non-emergency circumstances, an enrollee can decide to delay treatment for a time when a health care provider contracted with the enrollee’s health insurer is available.   The law also says an enrollee is not required to sign the disclosure notice to obtain medical care, but if an enrollee signs the disclosure notice, the enrollee waives rights to the SOON billing arbitration process. 

To see if you are eligible for the SOON billing dispute resolution process, visit the AZDOI’s SOON Billing Dispute Resolution webpage at https://insurance.az.gov/soonbdr

The Arizona Department of Insurance, an agency of the State of Arizona, is responsible for the education and protection of insurance consumers and for oversight of the insurance industry in the state.

Regulatory Bulletin 2019-01

Use of Credits and Premium Rebates in the Health Insurance Market 


New Rate & Form Division at ADOI

The Arizona Department of Insurance begins 2015 with a reorganization that will streamline management and optimize resources by merging similar operations of two divisions into a new Rate & Form Division.

The Rate & Form Division now combines the rate and form review and analysis for both the Life & Health Division and what had been the Property & Casualty Division. 

There will no longer be an independent Property & Casualty Division, which had been administered by Dean Ehler. Ehler retired Dec. 31, 2014 after nearly twenty years of service to the Department.

“Dean ran the Property & Casualty Division efficiently and effectively, and he had a wealth of institutional knowledge. He will be missed by everyone here,” said Germaine Marks, Director of the Arizona Department of Insurance. “His retirement, however, forced us to consider how we could more effectively maximize Department resources.”

Erin H. Klug, who most recently served as the Assistant Director of the Life & Health Division, will lead the new Rate & Form Division. The new Rate and Form Division now includes three sections:  the Property & Casualty Section, Life & Health Section and the Health Insurance Oversight Section (to include Affordable Care Act and network/managed care activities).

The licensing functions performed by the Life & Health and Property & Casualty divisions will now be overseen in the Financial Affairs Division by Cary W. Cook, the Chief Financial Compliance Officer

Phone and fax numbers, as well as e-mail addresses, of ADOI employees within the two divisions are not expected to change with the creation of the new Rate and Form Division.

Arizona Sample Notice of Continuation Coverage (Mini-COBRA)

Pursuant to ARS § 20-2330, a health benefits plan issued or renewed after December 31, 2018, must allow an enrollee and any qualified dependent to continue coverage after a qualifying event.  The law requires a small employer (with an average of at least 1 but fewer than 20 employees) to notify an enrollee in writing of the right of the enrollee and any qualified dependents to continue coverage under the employer's health benefits plan upon an enrolee's qualifying event.  Pursuant to Subsection C of the law, the Department has prepared a sample notice of coverage continuation form and is making the sample available on its website.  A small employer that uses, properly completes, and timely issues the Department's form is presumed to satisfy notification requirements.  On January 23, 2019, the Department uploaded a new version of the form.