How Am I Protected?

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In Arizona, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

  • Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.
  • All group health plans in Arizona must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new group health plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.
  • Your health insurance cannot be canceled because you get sick. All health insurance is guaranteed renewable.
  • If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.
  • If you lose your fully insured group health plan or individual health insurance and meet other requirements, in most cases you can buy a group or individual conversion policy if you convert within 31 days. You will not face a new pre-existing condition exclusion period. There are no limits on what you can be charged for a conversion policy and the benefits may not be as generous as your prior coverage.
  • If you lose your group health insurance and meet other qualifications, you will be HIPAA eligible. If so you have the right to buy an individual health insurance from any insurance company that sells individual health insurance in Arizona. Insurance companies must offer you a choice of at least two plans. However, they may charge you significantly higher premiums due to your health status, age, or other factors.
  • If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. This is called guaranteed issue.
  • If you are a small employer with 50 or fewer employees, including the self-employed, you may be eligible to obtain coverage through the Healthcare Group of Arizona (HCG) if you meet certain requirements.
  • If you are a small employer buying a group health plan, there are limits on what you can be charged because of health status, age, and other characteristics of those in your group.
  • If you are an employer buying a HCG health plan, you cannot be charged more due to the health status or claims experience of those in your group. Premiums for HCG plans do vary by age, gender, income, choice of plan and by county. This is called modified community rating.
  • If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Arizona Medicaid program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes. In addition, some women who are diagnosed with Breast or Cervical Cancer may be eligible for medical care through Medicaid.
  • If your children are 18 years old or younger, do not have health insurance, and meet other qualifications, you may be able to buy insurance for them through KidsCare.
  • If you believe that you may be at risk for breast or cervical cancer, you may be eligible for free screening and treatment.  The Well Woman HealthCheck Program provides qualified woman with free breast and cervical cancer screening.  In addition, women diagnosed with cancer through this program may be eligible for medical care through the Arizona Medicaid program.
  • If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 65% of the cost of qualified health coverage, including COBRA and HCG coverage.
  • If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC.


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