Director Announces ACA Transitional Policy Decision

Media Contact: Erin H. Klug (602) 364-3762

For Immediate Release Life & Health Division December 6, 2013

Phoenix – The Arizona Department of Insurance today announced that, beginning January 1, 2014, insurance carriers in the state will no longer be permitted to issue plans that do not comply with the Affordable Care Act (ACA). “In Arizona, we’ve been working with our insurance carriers on the best way to mitigate the impact on consumers by giving them the option to early renew their existing policies,” Insurance Director Germaine Marks said.

On November 14, 2013, the Center for Consumer Information and Insurance Oversight (CCIIO) announced a transitional policy that will permit health insurance issuers to continue to renew plans for individuals and small businesses for plans in place as of October 1, 2013. These plans would otherwise be modified or canceled because they do not meet minimum coverage requirements and financial protections under the ACA. CCIIO left the ultimate decision regarding whether or not to implement the transitional policy to state insurance regulators and insurance carriers.

Marks said changing the rules at this point in time creates uncertainty for consumers and insurance carriers. “We continue to be focused on how the reforms may impact premiums, the solvency of insurers, and the overall health and stability of Arizona’s insurance marketplace. To that end, we are confident that this determination helps Arizona insurance consumers consistent with Arizona law.”

Since receiving CCIIO’s letter, the ADOI has worked closely with Arizona’s insurance carriers to allow as many affected policyholders as possible to have the option to renew their existing coverage on or before December 31, 2013. Arizona law does not prohibit the offer of early renewals and this option minimizes the ACA’s impact on policyholders by extending the availability of existing non-ACA compliant policies who would otherwise receive cancellation notices effective December 31, 2013. Some of Arizona’s carriers have already offered policyholders the option to extend their 2013 coverage into 2014. The ADOI encourages those carriers to continue to offer this option and also encourages the carriers who have not offered early renewals to offer the extension of coverage. Carriers will assist policyholders who choose not to exercise the early renewal option with finding alternative affordable coverage.

About the Arizona Department of Insurance

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. 

 

Period: 
2013
Priority: 
05
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 


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.