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Summary of differences between federal and state regulations
The differences are called out below, and represent where the state goes beyond the federal requirements under ERISA.
State
Contact
Arizona Department of Insurance
Regulations
Unfair discrimination in regard to hemophiliacs is prohibited for premiums, policy fees, or rates charged for any policy or contract of disability insurance or in the benefits payable or in any of the terms or conditions of the contract, or in any other manner whatever.
Genetic condition, developmental delay, or developmental disability
Insurers must not refuse to consider an application for life or disability insurance on the basis of a genetic condition, developmental delay, or developmental disability.
Domestic violence
Insurers that offer life, disability, property, or liability insurance contracts are prohibited from denying a claim incurred or denying, refusing, refusing to renew, restrict, cancel, exclude or limit coverage or charge a different rate for the same coverage solely on the basis that the insured or proposed insured is or has been a victim of domestic violence.
Arizona Revised Statutes, §20-448
Penalties
Violation of the above laws may bring a civil penalty of up to $1,000 for each act or violation. An aggregate penalty shall not exceed $10,000 except in cases of intentional violations, in which case there may be a civil penalty of up to $5,000 for each act or violation, and an aggregate penalty of up to $50,000 in any six month period.
Arizona Revised Statutes §20-456
Disability
For disability coverage, newborn children are covered at birth for employees who elect family coverage, as well as adopted children, no matter what age they are at the time of adoption. The coverage for newly born or adopted children or children placed for adoption shall include coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Arizona Revised Statutes §20-1402
Disability coverage shall not terminate at limiting age (18) for children while both incapable of self-sustaining employment by reason of mental retardation or physical handicap and chiefly dependent upon the employee or member for support and maintenance. The employee shall furnish proof of such incapacity and dependency to the insurer within thirty-one days of the child’s attainment of the limiting age or if required by the insurer, but not more frequently than annually after the two-year period after the child’s reaches the limiting age. Arizona Revised Statutes §20-1407
Those covered under the policy may not be required to purchase prescription drugs exclusively from a mail order pharmacy as a condition of obtaining benefits for the drugs. Arizona Revised Statutes §20-1410
Benefits shall not be denied if:
- The service performed is within the lawful scope of such person’s license,
- The service is surgical, such person is a member of the staff of an accredited hospital, and
- Such contract would have provided benefits if such service had been performed by a holder of a license.
Eye care: If the disability insurance contract provides for or offers eye care services, the participant may select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination, care, or treatment for which the participant is eligible and which falls within the scope of practice of the optometrist or physician and surgeon.
Psychiatric, substances: If the disability insurance policy provides coverage for psychiatric, drug abuse, or alcoholism services, reimbursement for such services must be made whether the services are rendered in a psychiatric special hospital or general hospital.
Arizona Revised Statutes §20-1406
Chiropractor If the disability policy provides for services within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a participant may select either a physician or chiropractor to provide the examination, care, or treatment. The participant must be eligible for the service, and the service must falls within the scope of practice of the chiropractor or physician.
Arizona Revised Statutes §20-1406.01
Psychological If a group disability plan provides for services within the lawful scope of the practice of a psychologist, participants may select either a physician or psychologist to provide the examination, care, or treatment. The participant must be eligible for the service, and the service must fall within the scope of practice of the psychologist or physician.
Arizona Revised Statutes §20-1406.02
Nurses If a group disability plan provides for services within the scope of the practice of a registered nurse practitioner or a certified registered nurse, benefits shall not be denied to the plan participant who receives the services of the certified registered nurse or registered nurse practitioner.
Arizona Revised Statutes §20-1406.03
Occupational/Physical therapists If a group disability plan provides for occupational or physical therapy services, and provides both an in-network and out-of-network benefit, an insurer shall not deny a claim for covered occupational or physical therapy services obtained out-of-network solely on the basis that a physician did not refer the insured to the occupational or physical therapist or prescribe specific occupational or physical therapy services.
Arizona Revised Statutes §20-1406.04
Life insurance (§20-1251 et seq.)
Following are some Arizona laws that govern employee life insurance coverage:
"Employee life insurance" is a plan of life insurance under which individual policies are issued to the employees of any employer and where such policies are issued on the lives of between two (2) and 49 employees at date of issue. Arizona Revised Statutes §20-1276
Employer contribution is required, and the participation rate is 75 percent if employees pay part of the premium, or 100 percent if employer pays the total premium. Arizona Revised Statutes §20-1252
The policyholder is entitled to a grace period of 31 days for premium payments. Arizona Revised Statutes §20-1259
If seventy-five per cent of the eligible persons are insured under the policy elect, the coverage may be extended to insure the dependents. A "dependent" includes the spouse of an insured person, the minor children of an insured person, and any other children of an insured person as provided in the group life insurance policy. Arizona Revised Statutes §20-1257
The policy must cover at least two employees at date of issue, and “employees” may include retired employees. Arizona Revised Statutes §20.1252
A policy of group life insurance issued to a labor union must cover at least two union members on the date of issue. Arizona Revised Statutes §20.1254
Long-term care
Arizona has statutes that cover long-term care insurance policies, and they are found at Title 20, Chapter 6, Article 15, §20-1691 through §20-1691.11
Stocks
Arizona has statutes that cover stocks, which are found at Title 20, Chapter 4, Article 1.
Legal insurance
Arizona’s statutes that cover legal insurance can be found at Title 20, Chapter 4, Article 13.
Federal
Contact
Employee Benefits Security Administration (EBSA)
Regulations
29 CFR chapter XXV (Parts 2509 – 2590)