Free Senior and Special Needs Study Guide
Arizona Accident & Health exam — Senior and Special Needs.
The federal programs (Medicare Parts A through D, standardized Medigap plans, Medicaid) are covered in the national Senior and Special Needs guide. Arizona adds the Arizona Long Term Care System (its Medicaid long-term care program), Medigap rules based on the NAIC model (A.A.C. R20-6-1101), and detailed long-term care insurance law (A.R.S. 20-1691 and following and R20-6-1005, -1006).
Medicaid in Arizona
Arizona's Medicaid long-term care for eligible low-income residents is the Arizona Long Term Care System (ALTCS), run by the AHCCCS administration (A.R.S. 36-2932). A person eligible for both Medicare and Medicaid is a dual eligible.
Medicare supplement
- Arizona adopts the NAIC Medicare Supplement Minimum Standards Model Regulation (R20-6-1101).
- Under federal law, a Medigap policy may be returned for a full refund within 30 days.
- People newly eligible for Medicare on or after January 1, 2020 may not buy a Medigap policy that covers the Part B deductible.
- When one Medigap policy replaces another, the new insurer must credit waiting, elimination, probationary, and preexisting-condition periods already satisfied (42 U.S.C. 1395ss(s)).
- A producer may not charge any fee in connection with Medicare supplement insurance (20-465(D)).
Long-term care insurance
| Rule | Arizona requirement |
|---|---|
| Minimum coverage | At least 24 consecutive months per covered person (20-1691.03(C)) |
| Renewability | Can't be cancelled or nonrenewed solely for age or declining health (20-1691.03(A)) |
| Preexisting condition | Excluded only for a loss beginning within six months after coverage starts (20-1691.03(I)) |
| Prior stay | Can't require prior hospitalization. A required prior institutional stay for noninstitutional benefits can't exceed 30 days (20-1691.05(D)) |
| Outline of coverage | Delivered before the application is presented (20-1691.06(A)) |
| Policy delivery | Within 30 days after approval (20-1691.06(G)) |
| Claim decisions | Within 15 working days once documentation is complete; never more than 60 days (20-1691.06(H)) |
| Free look | 30 days, with the refund due within 30 days of the return (20-1691.07) |
| Contestability | 6 months to 2 years: misrepresentation must be material and related to the condition claimed. After 2 years: only knowing and intentional misrepresentation (20-1691.10) |
| Nonforfeiture | The insurer must offer a nonforfeiture benefit. If declined, a contingent benefit upon lapse applies after a substantial rate increase (20-1691.11) |
| Inflation protection | Must offer at least 5% compounded annually. A rejection must be signed (R20-6-1006) |
| Lapse notice | To the insured and any designee at least 30 days before termination, and not until premium is 30 days overdue (R20-6-1005(F)) |
| Cognitive impairment reinstatement | Request within five months after termination (R20-6-1005(G)) |
| Producer training | An A&H license, 8 hours of initial LTC training, then 4 hours every two years (20-1691.12) |
Common exam traps
- Arizona's minimum LTC benefit period is 24 months.
- An LTC claim decision can never take more than 60 days.
- LTC sellers need the accident and health line plus LTC training.
- No fees may be charged on Medicare supplement sales.
- ALTCS is Arizona's Medicaid long-term care program. It is not private insurance.
Practice Senior and Special Needs questions All Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
