A. An insurer, hospital and medical service corporation, health care services organization group health plan shall not consider the availability of or a person‘s eligibility for medical assistance pursuant to title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396a (1980)) when considering eligibility for coverage or calculating payments under a plan for eligible subscribers.

Terms Used In Arizona Laws 20-1692.02

  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • 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.
  • Group health plan: means a plan covering employees of an employer as defined in section 607(1) of the employee retirement income security act of 1974. See Arizona Laws 20-1692
  • Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
  • United States: includes the District of Columbia and the territories. See Arizona Laws 1-215

B. To the extent that payment for covered expenses has been made under the state program pursuant to title XIX of the social security act for health care items or services furnished to an individual, the state is considered to have acquired the rights of the individual to payment by any other party for those health care items or services. On presentation of proof that the state program pursuant to title XIX of the social security act has paid for covered items or services, the insurer, hospital and medical service corporation, health care services organization or group health plan shall make payments to the program pursuant to title XIX of the social security act according to the coverage provided in the policy, certificate, evidence of coverage or contract.

C. An insurer, hospital and medical service corporation, health care services organization or group health plan may not impose on a state agency that has been assigned the rights of an individual who is eligible for medical assistance and who is covered for health benefits from the insurer any requirements that are different from the requirements applicable to an agent or assignee of any other covered individual.