The Healthcare Group of Arizona (HCG) is a state-run program that provides insurance to individuals who work for participating small employers.

When can I get coverage from HCG?

Small employers and the self-employed can buy health insurance through HCG.  To be eligible, you must have 50 or fewer employees who work at least 20 hours per week.  In addition, you must have conducted business in Arizona for at least 60 consecutive days.

You also must meet minimum participation requirements.  If you have 5 or fewer employees, 100% of eligible employees must participate for your business to be eligible to purchase insurance through HCG.  If you have 6-50 employees, at least 80% of eligible employees must enroll in HCG.  Employees can be waived from participation if they have other group health insurance or coverage through a public program.

You cannot have offered health insurance coverage in the past 6 months.  If you lost coverage due to an insurance company discontinuing your health plan, you are not subject to this requirement. You employees are not required to be uninsured to be eligible for coverage through HCG.

HCG has implemented an enrollment freeze.  As of March 2008, HCG is not accepting new employer groups; however there is a waiting list. HCG expects to begin accepting new employer groups in August, 2008.

What will HCG cover?

HCG offers an HMO series of “Healthstyle Plans” and two PPO plans. Covered services include office visits, hospital outpatient care, emergency care, and prescription drugs.  All plans offer a choice of deductibles and have a lifetime benefit maximum of $2 million (HMO plans) or $3 million (PPO plans).  Family coverage is available.

For more information about HCG, contact the Healthcare Group Arizona at 602-417-6755, or 1-800-247-2289 or visit them on the web at www.healthcaregroupaz.com.

What about pre-existing conditions?

Insurers offering coverage though HCG can apply a pre-existing condition exclusion period. The exclusion applies only on those conditions for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan.

Insurers participating in HCG can exclude coverage for pre-existing conditions only for a limited time.  The maximum period is 12 months.  However, if you enroll late in a group health plan (after you were hired and not during a regular or special enrollment period) you may have a pre-existing condition exclusion period of up to 18 months.

You will receive credit towards your pre-existing condition exclusion period for any previous continuous creditable coverage.

What can I be charged for coverage through HCG?

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, choice of plan and by county.  This is called modified community rating.