Terms Used In Arizona Laws > Title 6 > Chapter 10 > Article 1 - General Provisions

• 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
• Adverse underwriting decision: means any of the following actions involving insurance coverage which is individually underwritten:

  (a) A declination of insurance coverage. See Arizona Laws 20-2102

• 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
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• 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.
• Applicant: means any person who seeks to contract for insurance coverage other than a person seeking group insurance that is not individually underwritten. See Arizona Laws 20-2102
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
• Authorized agency: means :

  (a) The office of the state fire marshal when authorized or charged with the investigation of a fire. See Arizona Laws 20-1901

• Bank: means a corporation that holds a banking permit issued pursuant to chapter 2 of this title. See Arizona Laws 6-101
• 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}
• Benefits based on the health status of the insured: means a contract of insurance to pay a fixed benefit amount, without regard to the specific services received, to a policyholder who meets certain eligibility criteria based on health status including:

  (a) A disability income insurance policy that pays a fixed daily, weekly or monthly benefit amount to an insured who is deemed to have a disability as defined by the policy terms. See Arizona Laws 20-2501

• 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
• Claim: means a request for payment for a service already provided. See Arizona Laws 20-2501
• 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

• Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Completed operations liability: means liability arising out of the installation, maintenance or repair of any product at a site which is not owned or controlled by either:

  (a) A person who performs that work. See Arizona Laws 20-2401

• Consumer report: means any written, oral or other communication of information that bears on a natural person's creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living and that is used or expected to be used in connection with an insurance transaction. See Arizona Laws 20-2102
• Consumer reporting agency: means any person who does any of the following:

  (a) Regularly engages, in whole or in part, in the practice of assembling or preparing consumer reports for a monetary fee. See Arizona Laws 20-2102

• Contract: A legal written agreement that becomes binding when signed.
• Contract holder: means a person who enters into a life care contract with a provider or who is designated, in a life care contract, to be a person provided with services in the person's private residence with the right to future access to services, board and lodging in a facility. See Arizona Laws 20-1801
• 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.
• Covered service: means a service that is included in a policy, evidence of coverage or similar document that specifies which services, insurance or other benefits are included or covered. See Arizona Laws 20-2501
• Credit report: A detailed report of an individual's credit history prepared by a credit bureau and used by a lender in determining a loan applicant's creditworthiness. ^{Source: OCC}
• 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.
• Declination of insurance coverage: means a denial, in whole or in part, by an insurance institution or insurance producer of requested insurance coverage. See Arizona Laws 20-2102
• Demographic characteristics: means objective factors an insurer considers in determining premium rates. See Arizona Laws 20-2301
• Denial: means a direct or indirect determination regarding all or part of a request for any service or a direct determination regarding a claim that may trigger a request for review or reconsideration. See Arizona Laws 20-2501
• department: means the department of insurance and financial institutions. See Arizona Laws 20-101
• Dependent: A person dependent for support upon another.
• Deputy director: means the deputy director of the financial institutions division of the department. See Arizona Laws 6-101
• 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
• Entrance fee: means an initial or deferred transfer to a provider of a sum of money or property, made or promised to be made by a person entering into a life care contract, which assures a resident or contract holder of services pursuant to a life care contract. See Arizona Laws 20-1801
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• 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.
• Executor: A male person named in a will to carry out the decedent
• Fiduciary: A trustee, executor, or administrator.
• Finance charge: The total cost of credit a customer must pay on a consumer loan, including interest. The Truth in Lending Act requires disclosure of the finance charge. ^{Source: OCC}
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. ^{Source: OCC}
• 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
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Hazardous financial condition: means that, based on its present or reasonably anticipated financial condition, a risk retention group, although not yet financially impaired or insolvent, is unlikely to be able to either:

  (a) Meet obligations to policyholders with respect to known claims and reasonably anticipated claims. See Arizona Laws 20-2401

• 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 care insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, prepaid dental plan organization, medical service corporation, dental service corporation or optometric service corporation or a hospital, medical, dental and optometric service corporation. See Arizona Laws 20-2501
• Health care insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation. See Arizona Laws 20-2341
• 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
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• 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
• Individual: means any natural person who:

  (a) In the case of property or casualty insurance, is a past, present or proposed named insured or certificate holder. See Arizona Laws 20-2102

• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Institutional source: means any person or governmental entity that provides information about an individual to an insurance producer, insurance institution or insurance support organization, other than an insurance producer, the individual who is the subject of the information or a natural person acting in a personal capacity rather than in a business or professional capacity. See Arizona Laws 20-2102
• Insurance: means primary insurance, excess insurance, reinsurance, surplus lines insurance and any other arrangement for shifting and distributing risk which is determined to be insurance under the laws of this state. See Arizona Laws 20-2401
• Insurance institution: means any corporation, association, partnership, reciprocal insurer, inter-insurer, Lloyd's association, fraternal benefit society or other person engaged in the business of insurance, including health care service organizations and hospital, medical, dental and optometric service corporations as defined in this title. See Arizona Laws 20-2102
• Insurance producer: means an insurance producer as defined in section 20-281. See Arizona Laws 20-2102
• Insurance score: means , for the purpose of insurance underwriting or rating, a designation that is derived by using a variety of data sources, including an individual's consumer report in an algorithm, computer program, model or other process that reduces the data to a number, alpha character or rating that is used for insurance underwriting and rating decisions. See Arizona Laws 20-2102
• Insurance support organization: means :

  (a) Any person who regularly engages, in whole or in part, in the practice of assembling or collecting information about natural persons for the primary purpose of providing the information to an insurance institution or insurance producer for insurance transactions, including the furnishing of consumer reports or investigative consumer reports to an insurance institution or insurance producer for use in connection with an insurance transaction or the collection of personal information from insurance institutions, insurance producers or other insurance support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity. See Arizona Laws 20-2102

• Insurance transaction: means any transaction that involves insurance primarily for personal, family or household needs rather than business or professional needs and that entails the determination of an individual's eligibility for an insurance coverage, benefit or payment or the servicing of an insurance application, policy, contract or certificate, including transfers of business. See Arizona Laws 20-2102
• Insurer: means every person or entity engaged in the business of making contracts of insurance in this state. See Arizona Laws 20-1901
• Investigative consumer report: means a consumer report or portion of a consumer report in which information about a natural person's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with the person's neighbors, friends, associates, acquaintances or others who may have knowledge concerning those items of information. See Arizona Laws 20-2102
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• 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
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Lessee: means a person contracting with a lessor for the use of a safe deposit repository. See Arizona Laws 6-1001
• Lessor: means a corporation or association authorized under the laws of this state, any other state or the United States to do business as a bank, trust company, credit union or savings and loan association and maintaining safe deposit repositories for public use. See Arizona Laws 6-1001
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Life care contract: means a contract to provide to a person for the duration of the person's life or for a term in excess of one year nursing services, medical services or health-related services, as defined in section 36-401, in addition to board and lodging for the person in a facility or services in the person's private residence with the right to future access to services, board and lodging in a facility, conditioned on the transfer of an entrance fee to the provider of such services in addition to or in lieu of the payment of regular periodic charges for the care and services involved. See Arizona Laws 20-1801
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Living unit: means an apartment, room or other area within a facility set aside for the exclusive use of one or more identified residents. See Arizona Laws 20-1801
• 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
• Manager: means a corporation, partnership, association, joint stock company, trust, or any other unincorporated organization that is contracted with to manage the residential section or health-related section, or both, of a life care facility. See Arizona Laws 20-1801
• Medical care institution: means any facility or institution that is licensed to provide health care services to natural persons including:

  (a) Health care service organizations. See Arizona Laws 20-2102

• Medical professional: means any person licensed or certified to provide health care services to natural persons, including a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, psychiatric social worker or speech therapist. See Arizona Laws 20-2102
• Medical record information: means personal information that relates to an individual's physical or mental condition, medical history or medical treatment and that is obtained from a medical professional or medical care institution, the individual or the individual's spouse, parent or legal guardian. See Arizona Laws 20-2102
• 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
• Moral turpitude: means an offense, whether a misdemeanor or felony, that is related to extortion, burglary, larceny, bribery, embezzlement, robbery, racketeering, money laundering, forgery, fraud, murder, voluntary manslaughter or a sexual offense that requires the individual to register pursuant to section 13-3821. See Arizona Laws 1-215
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Mortgage loan: A loan made by a lender to a borrower for the financing of real property. ^{Source: OCC}
• 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
• 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.
• Oversight: Committee review of the activities of a Federal agency or program.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Permit: means a permit to enter into life care contracts issued by the department. See Arizona Laws 20-1801
• Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
• Personal information: means any individually identifiable information gathered in connection with an insurance transaction and from which judgments can be made about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health or any other personal characteristics. See Arizona Laws 20-2102
• Personal risk liability: means liability for damages because of injury to a person, damage to property or other loss or damage resulting from any personal, familial or household responsibilities or activities other than those listed in paragraph 5. See Arizona Laws 20-2401
• 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
• Policyholder: means any person who:

  (a) In the case of individual property or casualty insurance, is a present named insured. See Arizona Laws 20-2102

• 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
• Pretext interview: means an interview in which a person, in an attempt to obtain information about a natural person, performs one or more of the following acts:

  (a) Pretends to be someone he or she is not. See Arizona Laws 20-2102

• Privileged information: means any individually identifiable information that relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual and that is collected in connection with or in reasonable anticipation of a claim for insurance benefits or a civil or criminal proceeding involving an individual, except that information otherwise meeting the requirements of this paragraph is considered personal information under this chapter if it is disclosed in violation of section 20-2113. See Arizona Laws 20-2102
• Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
• Product liability: means liability for damages because of any personal injury, death, emotional harm, consequential economic damage or property damage, including damages resulting from the loss of use of property, arising out of the manufacture, design, importation, distribution, packaging, labeling, lease or sale of a product. See Arizona Laws 20-2401
• Promoter: means the primary person who is employed to consult or to promote the establishment of a life care facility. See Arizona Laws 20-1801
• Property: includes both real and personal property. See Arizona Laws 1-215
• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• Provider: means a person who provides services pursuant to a life care contract. See Arizona Laws 20-1801
• Provider: means the physician or other licensed practitioner identified to the utilization review agent as having primary responsibility for providing care, treatment and services rendered to a patient. See Arizona Laws 20-2501
• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Purchasing group: means a group which meets all of the following criteria:

  (a) Has as one of its purposes the purchase of liability insurance on a group basis. See Arizona Laws 20-2401

• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Registered mail: includes certified mail. See Arizona Laws 1-215
• Relevant: means having any tendency to make the existence of any fact that is of consequence to the investigation or determination of the issue more probable or less probable than it would be without the evidence. See Arizona Laws 20-1901
• 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.
• repository: means a safe deposit box or any other safe deposit receptacle and includes the lessor's vault space made available for use by the lessee in common with others for the storage of property or documents. See Arizona Laws 6-1001
• Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
• Resident: means a person who enters into a life care contract with a provider or who is designated, in a life care contract, to be a person provided with services, board and lodging in a living unit or at a facility. See Arizona Laws 20-1801
• Residual market mechanism: means an agreement for the equitable apportionment among insurers of insurance afforded applicants who are in good faith entitled to but who are unable to procure insurance through ordinary methods. See Arizona Laws 20-2102
• Risk retention group: means a corporation or other limited liability association formed under the laws of any state which meets all of the following criteria:

  (a) Its primary activity consists of assuming and spreading all or any portion of the liability exposure of its group members. See Arizona Laws 20-2401

• 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
• Service: means a diagnostic or therapeutic medical or health care service, benefit or treatment. See Arizona Laws 20-2501
• Service of process: The service of writs or summonses to the appropriate party.
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• 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
• State: means any state of the United States or the District of Columbia. See Arizona Laws 20-2401
• Statute: A law passed by a legislature.
• Subpoena: A command to a witness to appear and give testimony.
• 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
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. ^{Source: OCC}
• Trustee: A person or institution holding and administering property in trust.
• Unauthorized insurer: means an insurance institution that has not been granted a certificate of authority by the director to transact insurance in this state. See Arizona Laws 20-2102
• under common control with: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. See Arizona Laws 20-2102
• Uninsured small business: means a small employer that did not provide a health benefits plan for at least ninety days immediately before the effective date of coverage provided pursuant to this section, except that this requirement does not apply at the renewal of coverage pursuant to this section. See Arizona Laws 20-2341
• United States: includes the District of Columbia and the territories. See Arizona Laws 1-215
• Utilization review: means a system for reviewing the appropriate and efficient allocation of inpatient hospital resources, inpatient medical services and outpatient surgery services that are being given or are proposed to be given to a patient, and of any medical, surgical and health care services or claims for services that may be covered by a health care insurer depending on determinable contingencies, including without limitation outpatient services, in-office consultations with medical specialists, specialized diagnostic testing, mental health services, emergency care and inpatient and outpatient hospital services. See Arizona Laws 20-2501
• Utilization review agent: means a person or entity that performs utilization review. See Arizona Laws 20-2501
• Utilization review plan: means a summary description of the utilization review guidelines, protocols, procedures and written standards and criteria of a utilization review agent. See Arizona Laws 20-2501
• 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