Arizona Health Insurance Guide
Arizona Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As an Arizona resident you have many health insurance choices, depending on whether you’re looking for individual coverage or trying to decide on the menu of plans offered by your employer. You may also qualify for Arizona State-funded health care programs, as well as federal program such as COBRA and Medicare.
Arizona law weighs heavily in favor of the insurance companies. For starters, Arizona is not a guarantee issue state. That means that if you’re in the market for individual coverage, insurers don’t have to sell you a plan if you don’t meet their criteria. They can turn you down completely, charge you higher than standard premiums, or write you a policy that limits or excludes certain coverage because you have a pre-existing condition. You can even be confronted with a pre-existing condition limitation clause after you’ve purchased a policy if you were ever treated for a condition, even if you didn’t know you had it. There is no limitation on how far back the insurance company can look for a pre-existing condition, either. Your pre-existing condition can be subjected to an exclusionary period or excluded forever, and Arizona does not regulate the exclusionary period. On the plus side, while pregnancy counts as a pre-existing condition, once your policy is in place, any complications that result from the pregnancy do not.
Premiums for individual health insurance policies in Arizona can be based on your age, health, location, prevailing costs in your area and your lifestyle habits. There is absolutely no cap on what you can be charged. Furthermore, your premiums can go up for no reason at all at renewal time. By the way, if the insurer discontinues your type of policy, they can cancel you at renewal time. However, in a nod to consumer rights, Arizona does not allow insurers to deny you renewal because of a change in your health (but they can certainly charge you a higher premium). The good news here is that if your insurance is provided through your employer’s group plan, your coverage cannot be denied, limited or subject to higher premiums because of your health.
Arizona Mandated Health Benefits
Arizona law requires private health insurance policies to cover several state-mandated benefits. These include:
- Ambulatory surgery
- Breast reconstruction
- Clinical trials
- Contraceptives
- Diabetes supplies and self management
- Emergency services
- Home health care
- Mammography
- Maternity stays
- Mental health parity
- Off-label drug use
- PKU/formula
- Coverage for newborns
- Coverage for adopted childrend
- Coverage for handicapped
- Coverage of continuation dependents
- Coverage for people who convert to non-group plans
Types of Health Insurance Plans Available in Arizona
Indemnity or Fee for Service Health Insurance
Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health care providers and facilities. Depending on your plan, you will have to pay a deductible and/or co-payment.
Health Maintenance Organizations (HMOs)
HMO plans require you to select a primary care physician (PCP) from a prescribed network of providers. You cannot see a specialist without a referral from your PCP. Comprehensive health care services include preventive care, medical treatments and hospitalization. There is no deductible, but there are co-pays when services are rendered and for any prescriptions. HMOs offer the advantage of relatively affordable premiums and low out-of-pocket costs as long as you stay within the network. Non-emergency services out of network are usually not reimbursed.
Preferred Provider Organizations (PPOs)
Like HMOs, there is a network of preferred providers in a PPO, but you can opt to see a provider outside the network if you don’t mind paying higher co-pays. Unlike HMOs, you need not select a PPC or secure a referral to see a specialist. PPOs typically have deductibles you must satisfy, as well as higher co-pays. The trade-off is greater freedom of choice in providers and services.
Point-of-Service Plans (POS)
A POS plan is a hybrid of HMOs and PPOs; you get the lowers costs of the former and the freedom of choice of the latter. You are required to select a PPC, but he or she can refer you to specialists in and out of network. Medical care provided out of network involves a deductible and either a percentage of the costs not covered by the POS, or the difference between what the provider charges and what your POS considers reasonable and customary for the service. There is no deductible for in-network services, but there is a small co-pay.
Alternative Health Programs in Arizona
Arizona does not have a no-risk pool for its medically uninsurable citizens, but there is a program to assist children.
Arizona KidsCare – For children 18 or younger who live with low-income families but don’t qualify for Medicaid or employer-based coverage. The child must be an U.S. Citizen or a qualified eligible immigrant. The program covers doctor’s office visits, physical exams, prescriptions, lab test and x-rays, well-child visits and immunization, specialist care, hearing tests and aids, hospitalization, 24-hour emergency care, emergency and non-emergency medical transportation, behavioral health, care for pre-existing conditions, dental screening and treatment, eye exams and glasses, and family planning services (excluding abortions and abortion counseling).
Regulatory Agencies
The Arizona Department of Insurance and The Arizona State Department of Health Services is responsible for Arizonans’ health care services.
Get access to Arizona health insurance quotes from http://www.einsurance.com/health-insurance.
Arizona Department of Insurance
2910 N 44th St, Ste 210
Phoenix, AZ 85018-7269
(602) 354-2499 or (800) 325-2548
http://www.id.state.az.us
AHCCCS
(602) 417-5437 (within Maricopa County)
(877) 7645437 (statewide)
http://www.azahcccs.gov/applicants/categories/KidsCare.aspx
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/