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. 

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.

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).

See the current captive Reference Guide on our website for more information, including Appendix B. AZ captive law is also instructive, specifically A.R.S. 20-1098.07(B)

Note the qualified auditor is expected to issue what is commonly called an Awareness Letter in conjunction with its first annual audit of an AZ captive. See the Reference Guide, Appendix B, section 6.

Qualifications may vary by the line(s) of insurance business, etc. and are guided in no small part by standards set by the actuarial profession. However, generally, it means someone who is a member in good standing of the Casualty Actuarial Society or a similar professional organization who has knowledge and experience in the insurance business, including issuing actuarial opinions and related reports for captives or other insurers. See the current captive Reference Guide on our website for more information, including Appendix A. AZ insurance law is instructive, specifically A.R.S. 20-696.01 thru 20-697.01. Generally, as long as the actuary to be used is qualified and complies with applicable professional standards, he/she may be an employee of the captive’s organization.

A person or organization that meets the definition of a “manager” in captive law, specifically, A.R.S. 20-1098(17).

Finally, we reserve the authority to require an AZ captive insurer to change providers if warranted, e.g. if a provider is not providing adequate service to its client in complying with AZ requirements. Note that we are not otherwise in a position to identify, recommend or discourage the use of any particular service provider, though we may be able to give our perspective in general terms.

There is no exact answer to this question or standard form; it will depend on facts and circumstances, including the nature and magnitude of the change. In general, all business plan change requests will include a request letter with a description of the proposed change, the proposed date of the change, the purpose, rationale and/or drivers of the change, and other basic information that may include a before and after comparison of the relevant aspects of the change.

When changing the insurance program, e.g. structure, coverages, limits, reinsurance ceded or assumed, etc., we would expect additional information to support the premium and losses expected if it is implemented, including formal or informal analysis of pricing, copies of draft policy language and/or reinsurance agreements, and the financial effects of the change, e.g. an updated pro forma balance sheet or income statement. Including commentary or rationale regarding whether or not the new risk profile would warrant a change in the amount of capital in the captive or not may also be useful.

The Jurat page of the captive annual report lists the board members and officers at a point in time. A completed bio should be submitted to DIFI for any new board member or officer in a timely fashion after the change takes place. The new bio, usually sent to us by email attachment but may also be mailed, should be accompanied by a cover letter explaining the change and purpose of the new bio.

While DIFI reviews new bios sent to us and may have questions or concerns, we do not generally approve new members as part of this update. If a bio was recently submitted and in our files for a member, a new bio may not be necessary, though if older than 2 to 3 years, we are likely to expect an updated version.

At this time, there are a number of options to pay applicable fees though there is variation depending on which fee is being paid. See the table for the available methods for each payment purpose:

Checks should be mailed to DIFIs mailing address. The DIFI website is a good resource to verify the correct address. The captive license application form(s) should also have the current mailing address and basic payment instructions.

Checks should be accompanied by a completed transmittal form (on our website) or a cover letter to indicate the purpose of the payment and identify the entity to which it applies. Failure to do so may cause delays in processing or the check to be returned.

The DIFI portal can be found on the website, currently at the Click here to make a payment link on this page: https://azinsurance.online/upload/captiveannual. This is also the main webpage for making state-specific captive report filing submissions annually (or quarterly if applicable). Payments can be made using ACH/e-check or most major credit cards (not AMEX). There is no fee or need to create an account to make a payment using the DIFI portal.

OPTins is a payment system maintained by the National Association of Insurance Commissioners (NAIC). Currently, this system can be used for most DIFI fees other than the flat annual license renewal of $5,500. DIFI does not administer or control this system, but has access to payment information made in this manner. Users wishing to make AZ captive payments using OPTins will need to establish an account with the NAIC. See more information at: optins.org. There is no account fee, but NAIC charges a flat fee (not a DIFI fee) per transaction to make payments using the system.

NO. We are not in a position to waive, modify, or extend established requirements including those related to captive filing due dates, fee payments, etc. However, based on a request made prior to the due date, for good cause and an estimated submission date, we may be able to forgo the assessment of late fees at our discretion. Note that late fees generally are applied per day late.

See the Captive Insurer Reference Guides and the DIFI and/or NAIC website for more information about RRG and non-RRG requirements and due dates.

See the relevant section (section 5 or 6) in the Reference Guides on our website.