The department must issue certificates of eligibility to qualifying applicants on a first-come, first-served basis, and insurers must reduce premiums by the certificate amount when enrolling certified applicants.
43-210 - Premium tax credit; health insurance; certification of qualified persons; violation; classification; definitions 43-210. Premium tax credit; health insurance; certification of qualified persons; violation; classification; definitions A. The department shall issue a certificate of eligibility to a person who files an application with the department in the form and manner prescribed by the department on a first come, first served basis, subject to subsection E. An application submitted to the department under this section shall contain or be verified by a written declaration that it is made under penalty of perjury. A person is entitled to receive a certificate if the department determines monies are available for this program pursuant to subsection E, the person has never before received a certificate and the person is either: 1. A small business. 2. An individual who satisfies all of the following: (a) Earns less than two hundred fifty per cent of the federal poverty level. (b) Is a legal resident of this state and a citizen of the United States or a legal resident alien. (c) Has not been covered under a health insurance policy for at least six consecutive months before the application. (d) Is not enrolled in the Arizona health care cost containment system, medicare or any other state or federal government health insurance program. B. A health care insurer that enrolls an individual or small business certified pursuant to this section shall deduct the amount of the certificate from the premium. C. For an individual, the amount of the certificate is the lesser of: 1. One thousand dollars for coverage on a single person, five hundred dollars for coverage on a child or three thousand dollars for family coverage. 2. Fifty per cent of the health insurance premium. D. For a small business, the amount of the certificate is the lesser of: 1. One thousand dollars for coverage on each single employee or three thousand dollars for each employee who elects family coverage. 2. Fifty per cent of the health insurance premium. E. A health care insurer that enrolls an individual or small business certified pursuant to this section shall notify the department of the enrollment and the amount of premium tax credit it intends to claim for the current calendar year no later than the fifteenth day of the month following commencement of coverage. The department shall not issue any certificates under this section that exceed in the aggregate a combined total of five million dollars in any calendar year. F. The initial certificate is valid for a period of ninety days after the date the department issues the certificate. If the individual or small business obtains health care insurance within this period of time the certificate is valid for one year from commencement of coverage. G. Sixty days before the expiration of the certificate the department shall review the status of the individual or small business. If the individual or small business continues to meet the qualifications pursuant to subsection A, paragraph 1 or paragraph 2, subdivisions (a), (b) and (d), the department shall reissue the certificate of eligibility. H. Individuals and small businesses are eligible for a maximum of two reissued certificates of eligibility. I. This section does not guarantee health insurance coverage to an individual or small business pursuant to this section. J. The department shall issue the certificate of eligibility in the name of a specific individual and the certificate is nontransferable. A person who sells, conveys, transfers or assigns the certificate to another person or attempts to sell, convey, transfer or assign the certificate to another person is guilty of a class 2 misdemeanor. K. For the purposes of this section: 1. "Family" means any of the following: (a) An adult and the adult's spouse. (b) An adult, the adult's spouse and all unmarried dependent children under nineteen years of age or under twenty-five years of age if a full-time student. (c) An adult and the adult's unmarried dependent children under nineteen years of age or under twenty-five years of age if a full-time student. 2. "Federal poverty level" means the federal poverty level guidelines published annually by the United States department of health and human services. 3. "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 that provides health insurance in this state. 4. "Health insurance" means a licensed health care plan or arrangement that pays for or furnishes medical or health care services and that is issued by a health care insurer. 5. "Small business" means a business that has been in existence for at least one calendar year in this state, that had not provided health insurance to its employees for at least six consecutive months before the application and that had at least two and no more than twenty-five employees during the most recent calendar year.