Any evidence of coverage issued, delivered or renewed on or after July 1, 2017 by a health care services organization in this state must provide coverage for lawful health care services that are provided by a health care provider to an enrollee regardless of the familial relationship of the health care provider to the enrollee if the health care service would be covered were it provided to an enrollee who was not related to the health care provider. The evidence of coverage may limit the coverage to those health care providers who are members of the health care services organization‘s provider network.

Terms Used In Arizona Laws 20-1057.17

  • Enrollee: means an individual who has been enrolled in a health care plan. See Arizona Laws 20-1051
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Evidence of coverage: means any certificate, agreement or contract issued to an enrollee and setting out the coverage to which the enrollee is entitled. See Arizona Laws 20-1051
  • Health care services: means services for the purpose of diagnosing, preventing, alleviating, curing or healing human illness or injury. See Arizona Laws 20-1051
  • Health care services organization: means any person that undertakes to conduct one or more health care plans. See Arizona Laws 20-1051
  • Provider: means any physician, hospital or other person that is licensed or otherwise authorized to furnish health care services in this state. See Arizona Laws 20-1051

 

  Previous section
Next section  
 Article 9 Contents