Article 1 General Provisions 20-2801 – 20-2804

Terms Used In Arizona Laws > Title 20 > Chapter 17

  • Coverage: means the contractual obligation of a health care services plan to pay its enrollee or a contracted or noncontracted provider for medically necessary emergency services rendered by the provider to an enrollee, as specified in the governing agreement, contract or policy between the plan and the enrollee, subject to applicable copayments, coinsurance and deductibles. See Arizona Laws 20-2801
  • Dependent: A person dependent for support upon another.
  • Emergency ambulance services: means services provided by an ambulance service authorized to operate pursuant to title 36, chapter 21. See Arizona Laws 20-2801
  • Emergency services: means health care services that are provided to an enrollee in a licensed hospital emergency facility by a provider after the recent onset of a medical condition that manifests itself by symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in any of the following:

    (a) Serious jeopardy to the patient's health. See Arizona Laws 20-2801

  • Enrollee: means an individual, or a dependent of that individual, who is currently enrolled with and covered by a health care services plan. See Arizona Laws 20-2801
  • Health care services plan: means a plan offered by a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation or medical service corporation that contractually agrees to pay or make reimbursement for health care expenses for one or more individuals residing in Arizona but does not apply to benefits provided under limited benefit coverage as defined in section 20-1137. See Arizona Laws 20-2801
  • Insured: means any person covered under an insurance contract or other evidence of insurance coverage subject to regulation under title 20. See Arizona Laws 6-1401
  • 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.
  • Premium finance agreement: means a written agreement by which an insured or prospective insured agrees to pay to a premium finance company the amount advanced or to be advanced under the written agreement to an insurance producer in payment of premiums of an insurance contract together with interest or discount and a service charge as authorized and limited by this article. See Arizona Laws 6-1401
  • Prior authorization: means authorization by telephone or telefacsimile given in advance of the performance of an emergency service on an enrollee, by a health care services plan after receipt of necessary medical and enrollment information on the enrollee. See Arizona Laws 20-2801
  • Provider: means any physician, hospital or other person that is licensed or otherwise authorized to furnish emergency services in this state. See Arizona Laws 20-2801