Arizona Laws 20-1691.04. Requirements for certain group coverage
A. Before advertising, marketing or offering a policy within this state issued to a group defined in section 20-1691, paragraph 4, subdivision (c), the association or the insurer of the association shall file evidence with the director that the association meets all of the following requirements:
Terms Used In Arizona Laws 20-1691.04
- 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.
- Group: means any of the following:
(a) One or more employers or labor organizations, or a trust or the trustees of a fund established by one or more employers or labor organizations for employees or former employees or members or former members of the labor organization. See Arizona Laws 20-1691
- Group long-term care insurance: means a long-term care insurance policy that is delivered or issued for delivery in this state to a group. See Arizona Laws 20-1691
- Long-term care insurance: means an individual or group insurance policy or rider issued by insurers, fraternal benefit societies, nonprofit health, hospital and medical service corporations, prepaid health plans, health care services organizations or any similar organization and advertised, marketed, offered or designed to provide coverage for each covered person on an expense-incurred, indemnity, prepaid or other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, personal or custodial care services provided in a setting other than an acute care unit of a hospital. See Arizona Laws 20-1691
- Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
- Policy: means an individual or group policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital or medical service corporation, prepaid health plan or health care services organization or any similar organization. See Arizona Laws 20-1691
- Writing: includes printing. See Arizona Laws 1-215
1. Consists of at least one hundred persons.
2. Has been organized and maintained in good faith for purposes other than obtaining insurance.
3. Has been in active existence for at least one year.
4. Has a constitution and bylaws that prescribe all of the following:
(a) That the association holds regular meetings at least annually to further the purposes of the members.
(b) Except for credit unions, that the association collects dues or solicits contributions from members.
(c) That the members have voting privileges and representation on the governing board and committees.
B. Thirty days after filing the evidence required by subsection A of this section, an association is deemed to satisfy the organizational requirements of subsection A of this section unless the director notifies the association or its insurer in writing that the association does not satisfy those organizational requirements.
C. An insurer may offer a group long-term care insurance policy to a group defined in section 20-1691, paragraph 4, subdivision (d) if the director finds all of the following:
1. Issuance of the group policy is not contrary to the best interest of the public.
2. Issuance of the group policy would result in economies of acquisition or administration.
3. The benefits of the policy are reasonable in relation to the premium charged.
D. A person shall not offer long-term care insurance coverage for a resident of this state under a group policy issued in another state to a group defined in section 20-1691, paragraph 4, subdivision (d) unless the state of issuance has statutory and regulatory long-term care insurance requirements substantially similar to the requirements in this state and either this state or the state of issuance has made a determination that the requirements have been met.
E. The director may prohibit further offering to a resident of this state a policy that was issued to a group as defined in section 20-1691, paragraph 4, subdivision (c) or (d) and that was initially authorized for issuance, if the director finds that the insurer does not currently meet the requirements of this article.