Ariz. Admin. Code § 2-6-401

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

Section R2-6-401 - Appeal of a Plan-provider Decision

A. The Department has delegated to each plan provider the authority to:

1. Interpret and apply the terms of the plan provider's particular insurance plan;

2. Determine whether a particular benefit is included in the plan and, if included, the amount of payment to be made under the plan; and

3. Perform a full and fair review of any decision by the plan provider regarding benefits included in or payments to be made under the plan if the decision is appealed in accordance with the plan provider's specified procedures.

B. An individual who is enrolled in an insurance plan made available by the Department and who wishes to appeal a decision by the plan provider shall follow the appeal procedures specified in the applicable plan description.

Ariz. Admin. Code § R2-6-401

Adopted effective July 27, 1983 (Supp. 83-4). Section repealed, new Section adopted effective September 16, 1997 (Supp. 97-3).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).