int(8)

A. A direct primary care provider plan may arrange for primary health care for enrollees in this state.

Terms Used In Arizona Laws 44-1799.92

  • Health insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital, medical, dental and optometric service corporation holding a certificate of authority under title 20. See Arizona Laws 44-1799.91
  • 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.
  • Provider access: means the method, manner and frequency that an enrollee may use a primary care provider under the enrollee's direct primary care provider plan. See Arizona Laws 44-1799.91
  • subscription: includes a mark, if a person cannot write, with the person's name written near it and witnessed by a person who writes the person's own name as witness. See Arizona Laws 1-215
  • Writing: includes printing. See Arizona Laws 1-215

B. Every direct primary care provider plan must be in writing and is subject to this section.  A copy of the written plan must be given to the enrollee at the time the enrollee signs the plan.

C. A direct primary care provider plan must describe the specific provider access and primary health care services that the primary care provider will provide, the enrollee’s total payment obligation and the terms of cancellation, which must include cancellation terms for relocation and military duty.  A direct primary care provider plan may not charge different fees for comparable services based on an enrollee’s health status or sex.  An enrollee may cancel a direct primary care provider plan for any reason on written notice to the plan.

D. A direct primary care provider plan must provide a written disclaimer on or accompanying all application and guideline materials distributed by or on behalf of the direct primary care provider plan that reads, in substance:

Notice: The organization facilitating the direct primary care provider plan is not an insurance company, and the direct primary care company guidelines and plan operation are not an insurance policy. Participation in the direct primary care provider plan or a subscription to any of its documents should not be considered to be a health insurance policy.  Regardless of whether you receive treatment for medical issues through the direct primary care provider plan, you are always personally responsible for the payment of any additional medical expenses you may incur.

E. A primary care provider may not submit a claim for payment to any health insurer or any health insurer’s contractor or subcontractor for primary health care services provided to an enrollee under a direct primary care provider plan.