Terms Used In Arizona Laws > Title 20 > Chapter 13 > Article 1 - Accountable Health Plans

• Accountable health plan: means an entity that offers, issues or otherwise provides a health benefits plan and that is approved by the director as an accountable health plan pursuant to section 20-2303. See Arizona Laws 20-2301
• Action: includes any matter or proceeding in a court, civil or criminal. See Arizona Laws 1-215
• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Affiliation period: means a period of two months, or three months for late enrollees, that under the terms of the health benefits plan offered by a health care services organization must expire before the health benefits plan becomes effective and in which the health care services organization is not required to provide health care services or benefits and cannot charge the participant or beneficiary a premium for any coverage during the period. See Arizona Laws 20-2301
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Base premium rate: means , for each rating period, the lowest premium rate that could have been charged under a rating system by the accountable health plan to small employers for health benefits plans involving the same or similar coverage, family size and composition, and geographic area. See Arizona Laws 20-2301
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Bona fide association: means , for a health benefits plan issued by an accountable health plan, an association that meets the requirements of section 20-2324. See Arizona Laws 20-2301
• COBRA continuation provision: means :

  (a) Section 4980B, except subsection (f)(1) as it relates to pediatric vaccines, of the internal revenue code of 1986. See Arizona Laws 20-2301

• 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.
• Creditable coverage: means coverage solely for an individual, other than limited benefits coverage, under any of the following:

  (a) An employee welfare benefit plan that provides medical care to employees or the employees' dependents directly or through insurance or reimbursement or otherwise pursuant to the employee retirement income security act of 1974. See Arizona Laws 20-2301

• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Demographic characteristics: means objective factors an insurer considers in determining premium rates. See Arizona Laws 20-2301
• department: means the department of insurance and financial institutions. See Arizona Laws 20-101
• Dependent: A person dependent for support upon another.
• employee: includes the employees of the employer and the individual proprietor or self-employed person if the employer is an individual proprietor or self-employed person. See Arizona Laws 20-2301
• 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.
• Fiduciary: A trustee, executor, or administrator.
• Fraud: Intentional deception resulting in injury to another.
• Genetic information: means information about genes, gene products and inherited characteristics that may derive from the individual or a family member, including information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories and direct analyses of genes or chromosomes. See Arizona Laws 20-2301
• Health benefits plan: means a hospital and medical service corporation policy or certificate, a health care services organization contract, a group disability policy, a certificate of insurance of a group disability policy that is not issued in this state, a multiple employer welfare arrangement or any other arrangement under which health services or health benefits are provided to two or more individuals. See Arizona Laws 20-2301
• Health status-related factor: means any factor in relation to the health of the individual or a dependent of the individual enrolled or to be enrolled in an accountable health plan, including:

  (a) Health status. See Arizona Laws 20-2301

• Higher level of coverage: means a health benefits plan offered by an accountable health plan for which the actuarial value of the benefits under the coverage is at least fifteen percent more than the actuarial value of the health benefits plan offered by the accountable health plan as a lower level of coverage in this state but not more than one hundred twenty percent of a policy form weighted average. See Arizona Laws 20-2301
• including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
• Index rate: means , as to a rating period, the arithmetic average of the applicable base premium rate and the highest premium rate that could have been charged under a rating system by the accountable health plan to small employers for a health benefits plan involving the same or similar coverage, family size and composition, and geographic area. See Arizona Laws 20-2301
• Late enrollee: means an employee or dependent who requests enrollment in a health benefits plan after the initial enrollment period that is provided under the terms of the health benefits plan if the initial enrollment period is at least thirty-one days. See Arizona Laws 20-2301
• Lower level of coverage: means a health benefits plan offered by an accountable health plan for which the actuarial value of the benefits under the health benefits plan is at least eighty-five percent but not more than one hundred percent of the policy form weighted average. See Arizona Laws 20-2301
• Minor: means a person under eighteen years of age. See Arizona Laws 1-215
• Month: means a calendar month unless otherwise expressed. See Arizona Laws 1-215
• Network plan: means a health benefits plan provided by an accountable health plan under which the financing and delivery of health benefits are provided, in whole or in part, through a defined set of providers under contract with the accountable health plan in accordance with the determination made by the director pursuant to section 20-1053 regarding the geographic or service area in which an accountable health plan may operate. See Arizona Laws 20-2301
• Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
• Policy form weighted average: means the average actuarial value of the benefits provided by all health benefits plans issued by either the accountable health plan or, if the data are available, by all accountable health plans in the group market in this state during the previous calendar year, weighted by the enrollment for all coverage forms. See Arizona Laws 20-2301
• Preexisting condition: means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within not more than six months before the date of the enrollment of the individual under a health benefits plan issued by an accountable health plan. See Arizona Laws 20-2301
• preexisting condition exclusion: means a limitation or exclusion of benefits for a preexisting condition under a health benefits plan offered by an accountable health plan. See Arizona Laws 20-2301
• Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• sent: means to deliver by United States mail, personal delivery or fax or by electronic means consistent with the requirements of section 20-239. See Arizona Laws 20-117
• Small employer: means an employer who employs at least two but not more than fifty eligible employees on a typical business day during any one calendar year. See Arizona Laws 20-2301
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• United States: includes the District of Columbia and the territories. See Arizona Laws 1-215
• Waiting period: means the period that must pass before a potential participant or beneficiary in a health benefits plan offered by an accountable health plan is eligible to be covered for benefits as determined by the individual's employer. See Arizona Laws 20-2301
• Writing: includes printing. See Arizona Laws 1-215