health insurance; requirements; essential benefits

SB1771 - 572R - I Ver

REFERENCE TITLE:
health insurance; requirements; essential benefits

State of Arizona

Senate

Fifty-seventh Legislature

Second Regular Session

2026

SB 1771

Introduced by

Senator
Gonzales

AN
ACT

amending title 20, chapter 1, article 1,
Arizona Revised Statutes, by adding section 20-128; amending section 20-1384,
Arizona Revised Statutes; relating to health care insurance.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 1, article 1,
Arizona Revised Statutes, is amended by adding section 20-128, to read:

START_STATUTE
20-128.

Health care insurers; requirements; prohibitions; definitions

A. Notwithstanding any other law,
every health care insurer that offers an individual health care plan,
short-term limited duration insurance or a small employer group health care
plan in this state:

1. Shall:

(
a
) Ensure that
all products sold cover essential health care benefits.

(
b
) Limit cost
sharing for the coverage of essential health care benefits, including
deductibles, coinsurance and copayments.

(
c
) Provide
coverage without cost sharing for preventive health care benefits recommended
by the United States preventive services task force, the advisory committee on
immunization practices of the United States centers for disease control and prevention
and the health resources and services administration of the United States
department of health and human services.

(
d
) If the
health care insurer offers dependent coverage, continue to offer dependent
coverage to adult children until the end of the calendar year in which the
adult child attains twenty-six years of age.

2. May not:

(
a
) Decline to
offer coverage to, or deny enrollment in, a health care plan for an individual
or employee of a small employer based solely on the individual's or employee's
health status.

(
b
) Impose any
preexisting condition exclusion or limitation in any health care plan.

(
c
) Cancel or
refuse to renew a health care plan based solely on an individual's or
employee's preexisting condition or health status.

(
d
) Use an
individual's or small employer group's health status to establish premiums.

(
e
) Refuse to
cover services that are necessary to treat a preexisting condition.

(
f
) Impose
annual or lifetime dollar limits on essential health care benefits.

(
g
) Apply any
additional deductible, copayment or coinsurance based solely on an individual's
or employee's preexisting condition.

(
h
) Unfairly
discriminate against an individual or employee in establishing or adjusting
premium rates based on the individual's or employee's age or sex.

B. For the purposes of this section:

1. "Essential health care
benefits" means the items and services covered within the following ten
general categories:

(
a
) Ambulatory services.

(
b
) Emergency services.

(
c
) Hospitalization.

(
d
) Maternity
and newborn care.

(
e
) Mental
health and substance abuse disorder services.

(
f
) Prescription
drugs.

(
g
) Rehabilitative
and habilitative services and devices.

(
h
) Laboratory
services.

(
i
) Preventive
and wellness services.

(
j
) Pediatric
services, including oral and vision care.

2. "Health care insurer"
means a disability insurer, group disability insurer, blanket disability
insurer, health care services organization, hospital service corporation,
medical service corporation or hospital and medical service corporation.

3. "Health care plan" means
a policy, evidence of coverage or contract THAT IS issued by a health care
insurer.

4. "Preexisting condition
exclusion or limitation" means an exclusion or limitation of benefits,
including a denial of coverage, based on the fact that the condition was
present before the date of enrollment, regardless of whether any medical
advice, diagnosis, care or treatment was recommended or received before that
date.

5. "Short-term limited duration
insurance" has the same meaning prescribed in section 20-1384.

6. "Small employer group"
means an employer who employs at least two but not more than fifty eligible
employees on a typical business day during any one calendar year.

END_STATUTE

Sec. 2. Section 20-1384, Arizona Revised
Statutes, is amended to read:

START_STATUTE
20-1384.

Short-term limited duration insurance; notice; definitions

A. All policies or certificates issued, delivered or
renewed in this state for short-term limited duration insurance shall
display on the policy's fact page and in any application materials provided in
connection with enrollment in such coverage the following federal disclosure in
at least fourteen-point type:

Notice

This coverage is not required to comply with certain federal
market requirements for health insurance, principally those contained in the
affordable care act.� Be sure to check your policy carefully to make sure you
are aware of any exclusions or limitations regarding coverage of preexisting
conditions or health benefits (such as hospitalization, emergency services,
maternity care, preventive care, prescription drugs and mental health and
substance use disorder services). Your policy might also have lifetime
or annual dollar limits on health benefits, or both. If this
coverage expires or you lose eligibility for this coverage, you might have to
wait until an open enrollment period to get other health insurance coverage.

B. A health care insurer shall provide notice to the
insured before expiration that the policy needs to be renewed or is expiring.

C. For the purposes of this section:

1. "Health care insurer" has the same
meaning prescribed in section 20-1379.

2. "Short-term limited duration
insurance" means health insurance coverage that is offered by a health
care insurer,
that is not subject to state health coverage
mandates in this title,
that has an expiration date specified in the
contract that is less than twelve months after the original effective date of
the contract and, taking into account renewals or extensions, that has a
duration of not longer than thirty-six months.
END_STATUTE