Ariz. Admin. Code § 2-6-101

Current through Register Vol. 31, No. 2, January 10, 2025

Section R2-6-101 - Definitions

In this Chapter, unless otherwise specified:

1. "Accident and health insurance," as used in A.R.S. Title 38, Chapter 4, Article 4, means health insurance and dental insurance.

2. "Agency" means a department, board, office, authority, commission, or other governmental budget unit of the state.

3. "Agency head" means the chief executive officer of an agency.

4. "Appeal" means a request to a plan provider for review of a decision made by the plan provider.

5. "Approved leave" means an employee's or officer's absence from assigned work that is authorized by the employee's or officer's supervisor.

6. "Base pay" means the fixed compensation paid to an employee or officer. Base pay excludes pay for overtime, shift differential, bonuses, special performance adjustment, special incentive program, or other allowance.

7. "Basic life insurance" means the amount of life insurance that the Department provides at no charge to an employee or officer.

8. "Child" means an individual who falls within one or more of the following categories:

a. A natural child, adopted child, stepchild, or foster child of an employee, officer, retiree, or former elected official who is younger than 26;

b. A child who is younger than 26 for whom the employee, officer, retiree, or former elected official has court-ordered guardianship;

c. A child who is younger than 26 and placed in the home of the employee, officer, retiree, or former elected official by court order pending adoption; or

d. A natural child, adopted child, stepchild or foster child of an employee, officer, retiree, or former elected official

i. Who was disabled as defined at 42 U.S.C. 1382c before the age of 26;

ii. Who continues to be disabled as defined at 42 U.S.C. 1382c;

iii. Who is dependent for support and maintenance upon the employee, officer, retiree, or former elected official, ; and

iv. For whom the employee, officer, retiree, or former elected official had custody before the child was 26.

9. "COBRA" means Consolidated Omnibus Budget Reconciliation Act of 1986, which is a federal law that provides the opportunity to continue group health insurance cover- age that might otherwise be terminated.

10. "COBRA member" means a former member or formerly eligible dependent of a member or former member who opts to continue health insurance through COBRA after no longer meeting the eligibility standards in Article 3.

11. "Compensation" means the total taxable remuneration provided by the state to an employee or officer in exchange for the employee's or officer's services.

12. "Creditable coverage" has the same meaning as prescribed at 29 U.S.C. 1181.

13. "Day" means a calendar day.

14. "Dental insurance" means an arrangement under which a policy holder makes advance payment to an insurer and the insurer pays amounts on behalf of an insured for certain preventive, diagnostic, and remedial care of the insured's teeth and gums.

15. "Department" means the Arizona Department of Administration.

16. "Director" means the Director of the Department or the Director's designee.

17. "Disability income insurance" means a form of insurance that insures a specified portion of the compensation of an employee or officer against the risk that disability will make working impossible.

18. "Eligible dependent" means a member's spouse or child, who is lawfully present in the U.S.

19. "Employee" for the purposes of eligibility, means an individual who is hired by the state, including the state universities, and who is regularly scheduled to work at least 20 hours per week for at least 90 days, but does not include:

a. A patient or inmate employed at a state institution;

b. A non-state employee, officer, or enlisted personnel of the National Guard of Arizona;

c. A seasonal, temporary, or variable hour employee, unless the employee is determined to have been paid for an average of at least 30 hours per week using a 12-month measurement period;

d. An individual who fills a position designed primarily to provide rehabilitation to the individual;

e. An individual hired by a state university or college for whom the state university or college does not contribute to a state-sponsored retirement plan unless the individual is:

i. A non-immigrant alien employee,

ii. Participating in a medical residency or post- doctoral training program,

iii. On federal appointment with Cooperative Extension, or

iv. A retiree who has returned to work under A.R.S. § 38-766.01.

20. "Employee flexible benefit plan," is the State of Arizona Cafeteria Plan as approved by the Internal Revenue Service and means the insurance plans specified in R2-6-204, the value of which is excludable from an employee's or officer's compensation under Section 125 of the Internal Revenue Code.

21. "Flexible spending account" means a financial arrangement under which an employee or officer authorizes the Department to reduce the employee's or officer's compensation on a pre-tax basis by a specified amount that the employee or officer uses to pay for eligible out-of- pocket expenses for health care, dependent care, or both.

22. "Former elected official" means an individual who was elected by popular vote in this state to serve, but who no longer serves as a:

a. State official;

b. County official;

c. Justice of the Supreme Court;

d. Judge of the court of appeals or superior court;

e. Full-time superior court commissioner except a full- time superior court commissioner who did not make a timely election of membership under the judges' retirement plan repealed on August 7, 1985; and

f. Official of an incorporated city or town if the incorporated city or town has executed an agreement with the state for coverage of the official.

23. "Grievance" means a written expression of dissatisfaction about any benefits matter other than a decision by a plan provider.

24. "Health insurance" means an arrangement under which a policy holder makes advance payments to an insurer and the insurer pays amounts on behalf of an insured for routine, preventive, and emergency health-care procedures and pharmaceuticals.

25. "Incumbent" means the employee or officer who currently holds a position or office.

26. "Institution" means a facility that provides supervision or care for residents on a 24-hours-per-day, seven-days-per- week basis.

27. "Life insurance" means a contract between an insurer and a policy holder under which the insurer agrees to pay a sum of money upon the occurrence of an insured's death in exchange for the policy holder paying a stipulated amount at regular intervals.

28. "Long-term disability insurance" means an insurance product that replaces part of an employee's or officer's compensation after an initial waiting period for the duration of time that the employee or officer is medically determined to be totally disabled as a result of a covered injury, illness, or pregnancy.

29. "Manifest error" means an act or failure to act that clearly is or has caused a mistake.

30. "Member" means an employee, officer, retiree, or former elected official who meets the criteria at R2-6-301(B), who enrolls in one or more of the insurance plans made available by the Department.

31. "Officer" means an individual who:

a. Is elected or appointed to a state office, including a member of the state legislature; or

b. Is a member of a state board, commission, or council and serves at least 1,000 hours per year.

32. "Open enrollment" means a specified period during which a member may make additions, changes, or deletions to the member's participation in the insurance plans made available by the Department.

33. "Ophthalmic goods" means eyeglasses or contact lenses for which a prescription is required and components of the eyeglasses.

34. "Plan provider" means an entity that enters into a contract with the Department to provide an insurance plan to members and their eligible dependents.

35. "Plan year" means a specified period of 12 consecutive months during which a member is able to change the member's participation in the insurance plans made available by the Department only if the member experiences a qualified life event.

36. "QMCSO" means qualified medical child support order and has the same meaning as prescribed at 29 U.S.C. 1169.

37. "Qualified life event" means a change in a member's dependents, employment status, or residence that entitles the member to change the member's or an eligible dependent's participation in the insurance plans made available by the Department before the open enrollment period. Qualified life event includes:

a. Change in marital status caused by marriage, divorce, legal separation, annulment, or death of spouse;

b. Change in dependent status caused by birth, adoption, placement for adoption, court-ordered guardianship, death, or dependent eligibility due to age;

c. Change in employment status or work schedule that affects a member's eligibility to participate in the insurance plans made available by the Department; and

d. Change in residence that affects available insurance plan options.

38. "Retiree" means an employee or officer who is retired under a state-sponsored retirement plan or who receives long-term disability payments under a plan made available by the Department.

39. "Salary-reduction order" means a document signed by an employee or officer who elects to participate in the employee flexible benefit plan authorizing the state to reduce the employee's or officer's compensation under Section 125 of the Internal Revenue Code.

40. "Seasonal employee" means an individual who is employed by the state for not more than six months of the year and whose state employment is dependent on an easily identifiable increase in work associated with a specific and reoccurring season. Seasonal employees do not include employees of education entities who work during the active portions of the academic year.

41. "Short-term disability insurance" means an insurance product that replaces part of an employee's or officer's compensation for a predetermined period if the employee or officer is medically determined to be unable to work due to illness, pregnancy, or a non-work-related injury.

42. "Spouse" means a member's husband or wife under Arizona law.

43. "Supplemental life insurance" means life insurance that is in addition to basic life insurance.

44. "Surviving dependent," as used in A.R.S. § 38- 651.01(A) or A.R.S. § 38-1114, means:

a. An insured eligible dependent of an insured retiree who dies, or

b. An insured spouse or insured eligible dependent child of an insured employee or officer who dies when eligible for retirement under the Arizona State Retirement System, or

c. An insured or uninsured dependent of a deceased law enforcement officer killed in the line of duty.

45. "Surviving spouse," as used in A.R.S. § 38-651.01(B) or A.R.S. § 38-1114, means the insured spouse of:

a. An incumbent elected official who dies when the incumbent elected official would be qualified for eligibility under R2-6-301(B) if the incumbent elected official had not been in office at the time of death, or

b. An insured former elected official who dies when qualified for eligibility under R2-6-301(B), or

c. An insured or uninsured spouse of a deceased law enforcement officer killed in the line of duty.

46. "Temporary employee" means an appointment made for a maximum of 1,500 hours worked in any agency in each calendar year. A temporary appointment employee may work full time for a portion of the year, intermittently, on a seasonal basis, or on an as needed basis.

47. "Variable hour employee" means an individual who is employed by the state, if based on the facts and circumstances at the employee's start date, for whom the state cannot determine whether the employee is reasonably expected to be employed an average of at least 30 hours per week, including any paid leave, because the employee's hours are variable or otherwise uncertain.

48. "Vision insurance" means a form of insurance that provides coverage for the services rendered by an eye-care professional and for the purchase of ophthalmic goods.

Ariz. Admin. Code § R2-6-101

Adopted effective August 31, 1984 (Supp. 84-4). Former Section R2-6-101 renumbered to R2-6-201, new Section R2-6-101 adopted effective September 16, 1997 (Supp. 97-3). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 5017, effective September 30, 2002 (Supp. 02-4). New Section made by final rulemaking at 15 A.A.R. 258, effective March 7, 2009 (Supp. 09-1). Amended by final rulemaking at 23 A.A.R. 1719, effective 6/6/2017.