Arizona Health Insurance Guide

Arizona has a lively and competitive health insurance marketplace, with dozens of companies competing for health insurance business. Those in good health, with no serious preexisting conditions, have a lot of options. Those who do have some health challenges, however, may have a problem finding individual coverage as Arizona does not maintain a state high-risk pool.

Mandates

• Arizona law requires individual policies to cover a number of common conditions. Family plans must cover newborn or adopted children for 31 days and continuing coverage for handicapped children to adulthood. Insurers must renew coverage granted to individuals, provided the premium is paid. Policies must cover breast reconstructions following covered mastectomies.

Finding an Agent

• Insurance agents doing business in Arizona must maintain a current license with the Arizona Department of Insurance. The State of Arizona is the primary licensing and disciplining authority. They require continuing education on the part of insurance professionals and occasionally revoke the licenses of agents who have committed offenses such as failure to disclose, fraud or who have sold policies from unlicensed carriers.

High-Risk Pools

• While the State of Arizona does not maintain its own high-risk pool, Arizona residents may be able to participate in the national high-risk pool, PCIP, or the Preexisting Condition Insurance Plan. To be eligible, you must be a citizen or legal resident of the United States, you must have been uninsured for the last six months, and you must have a preexisting condition or have been denied coverage because of your health condition.

Group Insurance Policies

• The State of Arizona establishes a minimum group size of two qualified workers. Group insurers may not disqualify members of group coverage pools on the basis of preexisting conditions, provided they enroll during the open enrollment period. The employer determines group eligibility, not the insurer.