A. Insurers, hospital and medical service corporations, health care services organizations, group health plans and prepaid dental plans shall not deny enrollment of a child under a policy, certificate, evidence of coverage or contract of a child’s parent for any of the following reasons:

Terms Used In Arizona Laws 20-1692.03

  • Alternate recipient: means a child of a participant who has a right to enrollment under a group health plan pursuant to a medical child support order. See Arizona Laws 20-1692
  • Child: means an individual who is under eighteen years of age as of the date of the adoption or placement for adoption. See Arizona Laws 20-1692
  • 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.
  • Dependent: A person dependent for support upon another.
  • 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.
  • Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
  • Writing: includes printing. See Arizona Laws 1-215

1. The child was born out of wedlock.

2. The child is not claimed as a dependent on the parent’s federal or state tax return.

3. The child does not reside with the parent or in the insurer’s, hospital and medical service corporation‘s, health care services organization’s or prepaid dental plan’s service area.

B. If the child has health coverage through an insurer of the noncustodial parent, the insurer shall:

1. Provide any information to the custodial parent that may be necessary for the child to obtain benefits through the custodial parent’s insurer.

2. Permit the custodial parent or the provider with the custodial parent’s approval to submit claims for covered services without the approval of the noncustodial parent.

3. Make payments on claims that are submitted pursuant to paragraph 2 of this subsection directly to the custodial parent, the provider or the Arizona health care cost containment system.

C. If a court or administrative order requires a parent to provide health coverage for a child and the parent is eligible for family coverage, the insurer, hospital and medical service corporation, health care services organization or prepaid dental plan shall:

1. Permit the parent to enroll the child under the family coverage if the child is otherwise eligible for the coverage without regard to any enrollment season restrictions.

2. If the parent is enrolled in family coverage but fails to enroll the child, enroll the child under the family coverage on the application of the child’s other parent or pursuant to title 36, chapter 29, article 1.

3. Not refuse to enroll or terminate the coverage of a child unless the insurer receives satisfactory written evidence that one of the following applies:

(a) The court or administrative order is no longer in effect.

(b) The child will be enrolled in comparable health coverage through another insurer and the coverage will take effect not later than the effective date of the termination of coverage.

(c) The employer has eliminated family coverage for all of its employees.

(d) Nonpayment of premium.

4. Establish reasonable procedures for determining if a child is covered under a qualified medical support order. The procedures shall:

(a) Be in writing.

(b) Provide for the notification of each person who is specified in a medical child support order as eligible to receive benefits under the plan of the procedures. The insurer shall promptly send the notice to the address included in the medical child support order on receipt by the insurer of the medical child support order.

(c) Permit an alternate recipient to designate a representative for the receipt of copies of notices that are sent to the alternate recipient pursuant to a medical child support order.

D. Insurers, hospital and medical service corporations and health care services organizations may not reduce their coverage of pediatric vaccines below the level that was in effect on May 1, 1993.