Arizona Laws 20-1019. Order of benefit determination for dental care
A. If a person receiving dental care is a member of a prepaid dental plan and is an insured or certificate holder under an indemnity health insurance policy which provides benefits for the same treatment as the person’s prepaid dental plan, the indemnity health insurance policy, if issued after the effective date of this section, shall pay benefits to its insured or certificate holder or the assignee thereof without regard to the existence of the prepaid dental plan.
Terms Used In Arizona Laws 20-1019
- Member: means an individual who is enrolled in a group prepaid dental plan as a principal subscriber together with such person's dependents who are entitled to dental care services under the plan solely because of their status as dependents of the principal subscriber. See Arizona Laws 20-1001
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
- Prepaid dental plan: means any contractual arrangement whereby any prepaid dental plan organization undertakes to provide directly or to arrange for prepaid dental services and to pay or make reimbursement for any remaining portion of such prepaid dental services on a prepaid basis through insurance or otherwise. See Arizona Laws 20-1001
B. Notwithstanding subsection A, the indemnity plan insurer is not obligated to pay any amount for a procedure covered without charge to the member of the prepaid dental plan or to pay in excess of the amount of the member’s obligation under the prepaid dental plan.
C. In the event that the member’s copayment obligation under the prepaid dental plan has been met, then the indemnity insurer shall remit any payments due under this section directly to its insured or certificate holder.
D. The director may adopt rules to enforce this section.