Parity means that financial cost-sharing requirements for mental health/substance use disorder benefits (such as deductibles, copayments, coinsurance, and out-of-pocket limitations) must be comparable but not identical to those for medical surgical. Parity also applies to rules regarding care management (authorization for treatment) and treatment limitations.

 Although benefits may differ across plans, parity requires that the processes related to plan benefit determinations be comparable. The ACA contributed to parity by eliminating annual and lifetime dollar limits for mental health/substance use disorder benefits.

MHPAEA requires that insurers meet mental health parity standards in two areas: quantitative limits and non-quantitative limits.

• Plans must apply comparable financial requirements (such as copay, coinsurance, & deductible) for mental health/substance use disorder and medical surgical care.
• The number of outpatient visits or inpatient days covered must be comparable for mental health/substance use disorder and medical surgical care.  
• Prior authorization requirements for mental health/substance use disorder services must be comparable to or less restrictive than those for medical surgical services.

These standards are applied according to classifications of benefits:

• Inpatient / in-network
• Inpatient / out-of-network
• Outpatient / in-network
• Outpatient / out-of-network
• Emergency care
• Prescription drugs

Parity means parity within your own plan and not parity between plans.

Individual health insurance policies issued prior to 2014, and some group health insurance, do not have to cover mental health/substance use services. In addition, short term and limited benefit policies do not have to include mental health benefits.

Some group health insurance policies are not required to provide mental health services at parity with medical services.

Unless it’s an emergency or the patient could be harmed, insurers may require patients to try less involved or intensive treatment first.

Yes. A complex formula is used to determine the maximum cost-share that an insurer may charge for mental health or substance used disorder services The copay or coinsurance for some medical services may still be lower than the maximum mental health services cost-share. 

Particular benefits must be covered under the terms of your insurance policy in order for your insurer to pay for them. Insurers can also require that the service meet criteria to be considered medically necessary before they issue prior authorization for the service.

If your insurance limits non-emergency care to in-network doctors and facilities, then your insurer can require you to go to an in-network facility in order to receive services. There may be some exceptions if you are experiencing an emergency or you have a need that can’t be met by an in-network doctor or facility.

If your insurance includes prescription drug coverage, it will include benefits for all drugs that your insurer has included on its formulary. If the drug your doctor prescribed is not covered on your insurance formulary, you may be required to appeal to your insurer to use the uncovered drug, or try an alternative drug first.

MHPAEA protections extend to most health plans, including self-insured and fully insured:

• Individual health plans issued on and off the Health Insurance Marketplace
• Large group health plans, including private and public-sector employers with more than 50 employees (certain self-insured governmental plans may opt-out).

The Patient Protection and Affordable Care Act (ACA) requires small group plans to provide mental health/substance use disorder benefits. Any plan that offers mental health/substance use disorder coverage must comply with MHPAEA.

QTLs can be measured numerically. Health insurers generally cannot impose a financial requirement (such as copays, coinsurance, deductible) or a QTL (such as the number of outpatient visits or inpatient days covered) on mental health/substance use disorder benefits that are more restrictive than the financial requirement or QTL that apply to most – but not all – medical surgical benefits in the same classification.

NQTLs are processes, strategies, evidentiary standards, or other criteria that limit the scope or duration of benefits for services provided under the plan. Certain utilization reviews, prior authorization and plan provisions may only be applied to mental health/substance use disorder benefits if they are comparable to or less restrictive than those for medical surgical services.

NQTLs include, but are not limited to:

• Medical management standards limiting or excluding benefits based on medical necessity, medical appropriateness, or based on whether the treatment is experimental or investigative (including standards for concurrent review).
• Formulary design for prescription drugs.
• Network tier design.
• Fail-first policies or step therapy protocols. For example: Refusal to pay for higher-cost therapies until it can be shown that a lower-cost therapy is not effective.
• Exclusions based on failure to complete a course of treatment.
• Restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits for services provided under the plan or coverage.

For helpful hints visit our page on "Whats is the Health Care Appeals Process?" 

For more information parity - https://www.parityregistry.org/faqs/

For Property and Casualty lines of insurance other than Workers’ Compensation and Title insurance
an "Advisory organization" means any person other than a single insurer who assists insurers or rate
service organizations in the making of rates by compiling and furnishing loss or expense statistics or
other statistical information and data, or by the submission of recommendations as to rates, forms or
supplementary rate information. Advisory organization does notinclude a joint underwriting
association, any actuarial or legal consultant, any employee of an insurer or insurers under common
control or management or their employees or manager. ARS 20-381
For Workers’ Compensation and Title insurance an Advisory Organization is any group, association
or other organization of insurers, whether located within or outside this state, which assists insurers
which make their own filings or rating organizations in rate making, by the collection and furnishing
of loss or expense statistics, or by the submission of recommendations, but which does not make
filings under this article, shall be known as an advisory organization. ARS 20-368

"Rate service organization" means any person other than a single insurer who assists insurers by
compiling and furnishing loss or expense statistics and recommending, making or filing rates, forms
or supplementary rate information. Rate service organization does notinclude a joint underwriting
association, any actuarial or legal consultant, any employee of an insurer or insurers under common
control or management, or their employees or manager. ARS 20-381

For Workers’ Compensation a Rating Organization receives and analyzes and interprets data (statistical
data, past and present loss experience, catastrophe hazards, insurer expenses and other outlays) and determines a rating system (manual of risk classifications, rules and rates, and rating plan) applicable to a type of insurance. Insurers that are members of a rating organization must use the rating organization's rating system as their own except that an insurer may file a "deviation," which is either a uniform percentage increase or decrease to the rating system, or changes from the rate rule established for a classification of risk to reflect the risk profile for a more specific subcategory of risk. ARS 20-361

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. This does not include Insurance producers, Government institutions, Insurance institutions Medical care institutions, Medical professionals. ARS 20-2102.

Who Must Be Licensed

An Insurance Support Organization is not required to be licensed; however, the director may examine and investigate the affairs of every insurance support organization acting on behalf of an insurance institution or insurance producer which either transacts business in this state or transacts business outside this state that has an effect on a person residing in this state in order to determine whether the insurance support organization has been or is engaged in any conduct in violation of this chapter. ARS 20-2114

For the purpose of this chapter, an insurance support organization transacting business outside this state which has an effect on a person residing in this state is deemed to have appointed the director to accept service of process on its behalf, if the director causes a copy of the service to be mailed immediately by registered mail to the insurance support organization at its last known principal place of business. The return postcard receipt for the mailing is sufficient proof that the copy of the service was properly mailed by the director. ARS 20-2115.

We believe it is.  Auto theft is not just a property crime but rather a crime associated with many other crimes like drug running, human smuggling, burglaries, gang activity, and even terrorism.  Auto theft is a serious crime with serious consequence with effects that reach far beyond that of just a stolen vehicle. 

While we are not a law enforcement agency, we are a crime prevention agency!   We bring law enforcement, county prosecutors, insurance companies, and our communities together to collaborate on how we can best serve the public in deter auto theft! 

No, however, we are a law enforcement supporter!  Ninety-five percent (95%) of the AATA's budget is distributed to Law Enforcement and Prosecuting agencies around Arizona in the form of grants. The Arizona Department of Public Safety's Vehicle Theft Task Force, a task force comprised of local, county, state and federal law enforcement detectives throughout Arizona, is one of our largest grantees. 

No.  Our sole funding source is the $1.00 per policy assessment collected from each Arizona registered insured vehicle.  

Yes - Law Enforcement and Emergency Vehicles under 26,000 lbs are required to pay the assessment. 

The following vehicles are not part of the Automobile Theft Assessment

Per ARS § 28-101 subsection 86 (a) and (b), “vehicle” is defined as: 

(a) Means a device in, on or by which a person or property is or may be transported or drawn on a public highway.

(b) Does not include:

(i) Electric bicycles, electric miniature scooters, electric standup scooters and devices moved by human power.

(ii) Devices used exclusively on stationary rails or tracks.

(iii) Personal delivery devices.

(iv) Scrap vehicles.

(v) Personal mobile cargo carrying devices.

The Automobile Theft Authority receives its funding for each insured vehicle registered in Arizona. The fee is $.50 per policy every 6 months in accordance with ARS §41-3451 (J).

All insurance companies are required to comply with this assessment but how and when they assess this fee is at their discretion. 

If you have an existing claim at the time of insolvency, please contact APCIGF and reference your existing claim number.

To report a new claim, please contact the Receiver for the insolvent company to establish a new claim.  The Receiver will then refer your claim to the appropriate guaranty association. Claims are generally referred to the guaranty fund in the state where the policyholder resides.  

Each claim is subject to review for potential coverage.  However, in many cases, APCIGF will continue to provide protection by defending the lawsuit.  APCIGF may also negotiate a settlement on your behalf, subject to the limitations in the fund statutes and policy coverage. 

Each claim is subject to review for potential coverage.  However, in many cases APCIGF will continue to provide protection by defending the lawsuit.  APCIGF may also negotiate a settlement on your behalf, subject to the limitations in the fund statutes and policy coverage. 

APCIGF is funded by assessments of member insurers following an insolvency and, if any, the recovered and liquidated assets of the insolvent companies 

Arizona law dictates that all other forms of insurance available must be exhausted before any claims may be considered by the APCIGF.  (See A.R.S. 20-673)

Arizona law dictates that coverage applies to the amount of a covered claim that is more than $100. For example, if your covered claim value is $500, APCIGF may be able to pay $400 of your $500 claim. 

The Arizona Life and Disability Insurance Guaranty Fund (Arizona GF) was established to provide some protection in the event that your life, annuity or disability insurance company becomes financially unable to meet its obligations.

The Arizona GF is authorized to provide protection in a variety of ways depending on the line of business. Some examples include paying claims, continuing coverage as long as premiums are paid, or transferring policies to another insurance company.

In general, the Arizona GF provides coverage to residents of Arizona. However, there are some circumstances in which a non-resident may be entitled to coverage, and some circumstances in which a resident of Arizona will not be entitled to coverage. Residency will be determined on the date the insurer is determined to be impaired or insolvent.

The basic protections provided by the Arizona GF for any one (1) life are lesser of the policy limit or value of the annuity, or:

• Life Insurance
  • $300,000 in death benefits
  • $100,000 in cash surrender or withdrawal values
• Disability Insurance
  •  $500,000 in health benefit plan benefits*
  •  $300,000 in disability insurance benefits
  •  $300,000 in long-term care insurance benefits
  •  $100,000 in other types of disability insurance benefits
• Annuities
  • $250,000 in the present value of annuity benefits, including net cash withdrawal and net cash surrender values.

*The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $300,000, but special rules apply with regard to certain health benefit plan benefits for which the maximum amount of protection is $500,000.

The basic protections provided by the Arizona GF for any one (1) life are lesser of the policy limit or value of the annuity, or:

• Life Insurance
  • $300,000 in death benefits
  • $100,000 in cash surrender or withdrawal values
• Disability Insurance
  •  $500,000 in health benefit plan benefits*
  •  $300,000 in disability insurance benefits
  •  $300,000 in long-term care insurance benefits
  •  $100,000 in other types of disability insurance benefits
• Annuities
  • $250,000 in the present value of annuity benefits, including net cash withdrawal and net cash surrender values.

*The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $300,000, but special rules apply with regard to certain health benefit plan benefits for which the maximum amount of protection is $500,000.

Yes, long-term care insurance is typically considered disability insurance and covered by the Arizona GF.

Yes. For example, the Arizona GF's liability is never greater than the benefits promised by the insolvent insurer.

You will receive a notification from the Receiver and/or the state insurance department overseeing the company if your insurance company is found to be insolvent and ordered liquidated.

Yes. If you were paying premiums to the insurance company, you must continue to do so.  Those premiums go to the Guaranty Fund providing continuing coverage. If you stop paying premiums, your insurance coverage may be terminated.

The Arizona GF is funded by insurance companies licensed to sell life, disability, or annuity policies in Arizona. These insurance companies are automatically members of the Arizona Guaranty Fund by law. The Arizona GF also may receive funds from the Liquidator of an insolvent insurance company via a claim in the liquidation estate.

Policies with insurers not licensed to do business in Arizona; Health Maintenance Organization (HMO) contacts; Mandatory state pooling plans; Mutual assessment companies; Fraternal benefit society insurance certificates; Policies issued by a nonprofit hospital or medical service organization; Policy benefits the insurer does not guarantee or for which the policyholder bears the risk (such as the non-guaranteed portion of a variable life insurance or annuity contract); Unallocated annuity contracts; Self-insured employer plans; policies or contracts that provide benefits under Medicare Part C or Part D; Interest rate yields that exceed an average rate based on Moody's corporate bond yield average, are some of the items not covered by the Arizona GF.  

Other Exclusions

Refer to the Act (A.R.S. 20-681, 20-682, 20-683, 20-684, 20-685, 20-686, 20-687, 20-688, 20-689, 20-690, 20-691, 20-692, 20-693, 20-694, 20-695) for other policies and contracts, or portions thereof, which are excluded from coverage.

The Arizona Insurance Guaranty Funds were established in 1977 by state law to provide protections to Arizona residents for covered claims.  If you are an Arizona resident insured by a licensed insurance company that becomes insolvent, part or all of your covered claims may be paid by an insurance guaranty fund. Guaranty associations exist in every state.

Arizona has two guaranty funds: 

YES. While we do not explicitly approve service providers in the usual sense, we generally consider changes in providers to be material changes to the plan of operations subject to our prior approval pursuant to A.R.S. 20-1098.22. See the Reference Guides on our website for more information about what is required when changing captive managers (section 3), opining actuaries (appendix A), and independent audit firms (appendix B).