Arizona Laws 20-1057.12. Contracts; dentists; covered services; definition
A. A contract, entered into or renewed on or after January 1, 2011, between a health care services organization and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the services for which the fee applies is a covered service under the individual’s evidence of coverage.
Terms Used In Arizona Laws 20-1057.12
- Contract: A legal written agreement that becomes binding when signed.
- 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.
- Evidence of coverage: means any certificate, agreement or contract issued to an enrollee and setting out the coverage to which the enrollee is entitled. See Arizona Laws 20-1051
- Health care services: means services for the purpose of diagnosing, preventing, alleviating, curing or healing human illness or injury. See Arizona Laws 20-1051
- Health care services organization: means any person that undertakes to conduct one or more health care plans. See Arizona Laws 20-1051
B. This section does not restrict the ability of a health care services organization to establish dental benefits for services offered by plans that are administered but not insured by the health care services organization.
C. For the purposes of this section, "covered service" means a service for which any reimbursement is available under an evidence of coverage without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.