20-2310

20-2310. Discrimination prohibited;
preexisting conditions; wellness programs

A. Except as provided in subsection B of this section, a health benefits plan may
not deny, limit or condition the coverage or benefits based on a person's health
status-related factors or a lack of evidence of insurability.

B. A health benefits plan shall not exclude coverage for preexisting conditions,
except that:

1. A health benefits plan may exclude coverage for preexisting conditions for a
period of not more than twelve months or, in the case of a late enrollee, eighteen
months. The exclusion of coverage does not apply to services that are furnished to
newborns who were otherwise covered from the time of their birth or to persons who
satisfy the portability requirements under section 20-2308.

2. The accountable health plan shall reduce the period of any applicable
preexisting condition exclusion by the aggregate of the periods of creditable coverage
that apply to the individual.

C. A health benefits plan shall not include an affiliation period in a policy
unless the affiliation period satisfies the requirements prescribed in 45 Code of Federal
Regulations section 146.119(b).

D. On request of a health benefits plan, a person who provides coverage during a
period of continuous coverage with respect to a covered individual shall promptly
disclose the coverage provided to the covered individual, the period of the coverage and
the benefits provided under the coverage.

E. The accountable health plan shall calculate creditable coverage according to the
following rules:

1. The accountable health plan shall give an individual credit for each day the
individual was covered by creditable coverage.

2. The accountable health plan shall not count a period of creditable coverage for
an individual enrolled in a health benefits plan if after the period of coverage and
before the enrollment date there were sixty-three consecutive days during which the
individual was not covered under any creditable coverage.

3. The accountable health plan shall give credit in the calculation of creditable
coverage for any period that an individual is in a waiting period or an affiliation
period for any health coverage.

4. The accountable health plan shall not count a period of creditable coverage with
respect to enrollment of an individual if, after the most recent period of creditable
coverage and before the enrollment date, sixty-three consecutive days lapse during all of
which the individual was not covered under any creditable coverage. The accountable
health plan shall not include in the determination of the period of continuous coverage
described in this section any period that an individual is in a waiting period for health
insurance coverage offered by a health care insurer, is in a waiting period for benefits
under a health benefits plan offered by an accountable health plan or is in an
affiliation period.

5. In determining the extent to which an individual has satisfied any portion of
any applicable preexisting condition period the accountable health plan shall count a
period of creditable coverage without regard to the specific benefits covered during that
period.

6. An accountable health plan shall not impose any preexisting condition exclusion
in the case of an individual who is covered under creditable coverage thirty-one days
after the individual's date of birth.

7. An accountable health plan shall not impose any preexisting condition exclusion
in the case of a child who is adopted or placed for adoption before age eighteen and who
is covered under creditable coverage thirty-one days after the adoption or placement for
adoption.

F. An accountable health plan shall provide the certificate of creditable coverage
described in subsection G of this section without charge for creditable coverage
occurring after June 30, 1996 if the individual:

1. Ceases to be covered under a health benefits plan offered by an accountable
health plan or otherwise becomes covered under a COBRA continuation provision. An
individual who is covered by a health benefits plan that is offered by an accountable
health plan, that is terminated or not renewed at the choice of the employer and where
the replacement of the health benefits plan is without a break in coverage is not
entitled to receive the certification prescribed in this paragraph but is instead
entitled to receive the certifications prescribed in paragraphs 2 and 3 of this
subsection.

2. Who was covered under a COBRA continuation provision ceases to be covered under
the COBRA continuation provision.

3. Requests certification from the accountable health plan within twenty-four
months after the coverage under a health benefits plan offered by an accountable health
plan ceases.

G. The certificate of creditable coverage provided by an accountable health plan is
a written certification of:

1. The period of creditable coverage of the individual under the accountable health
plan and any applicable coverage under a COBRA continuation provision.

2. Any applicable waiting period or affiliation period imposed on an individual for
any coverage under the accountable health plan.

H. Any accountable health plan that issues health benefits plans in this state, as
applicable, shall issue and accept a written certificate of creditable coverage of the
individual that contains at least the following information:

1. The date that the certificate is issued.

2. The name of the individual or dependent for whom the certificate applies and any
other information that is necessary to allow the issuer providing the coverage specified
in the certificate to identify the individual, including the individual's identification
number under the policy and the name of the policyholder if the certificate is for or
includes a dependent.

3. The name, address and telephone number of the issuer providing the certificate.

4. The telephone number to call for further information regarding the certificate.

5. One of the following:

(a) A statement that the individual has at least eighteen months of creditable
coverage. For the purposes of this subdivision, "eighteen months" means five hundred
forty-six days.

(b) Both the date that the individual first sought coverage, as evidenced by a
substantially complete application, and the date that creditable coverage began.

6. The date creditable coverage ended, unless the certificate indicates that
creditable coverage is continuing from the date of the certificate.

7. The consumer assistance telephone number for the department.

8. The following statement in at least fourteen point type:

Important notice!

Keep this certificate with your important personal records to protect your
rights under the health insurance portability and accountability act of 1996
("HIPAA"). This certificate is proof of your prior health insurance coverage.
You may need to show this certificate to have a guaranteed right to buy new
health insurance ("Guaranteed issue"). This certificate may also help you
avoid waiting periods or exclusions for preexisting conditions. Under HIPAA,
these rights are guaranteed only for a very short time period. After your
group coverage ends, you must apply for new coverage within 63 days to be
protected by HIPAA. If you have questions, call the Arizona department of
insurance.

I. An accountable health plan may provide any certification pursuant to subsection
F, paragraph 1 of this section at the same time the accountable health plan sends the
notice required by the applicable COBRA continuation provision.

J. An accountable health plan has satisfied the certification requirement under
this section if the accountable health plan offering the health benefits plan provides
the prescribed certificate in accordance with this section within thirty days after the
event that triggered the issuance of the certification.

K. If an accountable health plan imposes a waiting period for coverage of
preexisting conditions, within a reasonable period of time after receiving an
individual's proof of creditable coverage and not later than the date by which the
individual must select an insurance plan, the accountable health plan shall give the
individual written disclosure of the accountable health plan's determination regarding
any preexisting condition exclusion period that applies to that individual. The
disclosure shall include all of the following information:

1. The period of creditable coverage allowed toward the waiting period for coverage
of preexisting conditions.

2. The basis for the accountable health plan's determination and the source and
substance of any information on which the accountable health plan has relied.

3. A statement of any right the individual may have to present additional evidence
of creditable coverage and to appeal the accountable health plan's determination,
including an explanation of any procedures for submission and appeal.

L. Periods of creditable coverage for an individual are established by presentation
of the written certifications described in this section and section 20-1379. In addition
to written certification of the period of creditable coverage as described in this
section, individuals may establish creditable coverage through the presentation of
documents or other means. In order to make a determination that is based on the relevant
facts and circumstances of the amount of creditable coverage that an individual has, an
accountable health plan shall take into account all information that the plan obtains or
that is presented to the plan on behalf of the individual.

M. The department may enforce and monitor the issuance and delivery of the notices
and certificates by accountable health plans and insurers as required by this section,
the health insurance portability and accountability act of 1996 (P.L. 104-191; 110 Stat.
1936) and any federal regulations adopted to implement the health insurance portability
and accountability act of 1996.

N. This section does not prohibit any health benefits plan from providing or
offering to provide rewards or incentives under a wellness program that satisfies the
requirements for an exception from the general prohibition against discrimination based
on a health factor under the health insurance portability and accountability act of 1996
(P.L. 104-191; 110 stat. 1936), including any federal regulations that are adopted
pursuant to that act.