Arizona State Regulations & NAIC Insurance Law

Licensing

Any individual applying for an Arizona resident producer’s license must:

• Be at least 18 years old
• Be a resident of Arizona before submitting an application

Pre-licensing course and exam

Arizona does not have specific pre-licensing requirements, but a resident applicant must pass the examinations for the lines of authority applied for (Ariz. Rev. Stat. § 20-285(B)).

No more than four attempts may be made within a twelve-month period. If an individual fails an examination for a specific line of authority four times, the individual may not take an examination for that line of authority for one year (Ariz. Rev. Stat. § 20-284(H)).

Fingerprints/background check

The Director reviews an applicant’s background before issuing a license, and many states require applicants to submit fingerprints for a state and FBI criminal history check as part of the application.

Controlled business

Controlled business is insurance written on the producer’s own life, property or interests, or on those of the producer’s family, employer or a business the producer controls. A producer may insure themselves and their family, but a license exists to sell insurance to the public, so states generally restrict obtaining or using a license principally to write controlled business.

Non-resident license

A producer licensed in another state can obtain an Arizona nonresident license without taking Arizona’s examination. Under the NAIC’s Producer Licensing Model Act, which most states have adopted in some form, a nonresident receives the license if the person:

• Is currently licensed as a resident, and in good standing, in the home state
• Has applied (the home-state application or the Uniform Application) and paid the fees
• Lives in a home state that grants nonresident licenses to residents of this state on the same basis (reciprocity)

Under the same model, a producer who moves to another state files a change of address, with certification from the new home state, within 30 days. A licensed producer who moves into a state applies for a resident license there within 90 days and does not repeat prelicensing education or the examination for lines already held.

Temporary license

Most states allow the insurance regulator to issue a temporary license, without an examination, when one is needed to keep an insurance business serviced. Typical cases are:

• The surviving spouse or personal representative of a producer who dies or becomes disabled, to allow time to sell the business or train new people
• A member or employee of a business entity producer, on the death or disability of its designated producer
• The designee of a producer entering active military service

The regulator may limit what a temporary licensee may do and may require a licensed sponsor who takes responsibility for the temporary licensee’s acts.

The NAIC’s model act limits a temporary license to 180 days.

Military service

Under the NAIC’s model act, a producer who cannot meet license renewal requirements because of military service, or because of another extenuating circumstance such as a long-term medical disability, may request a waiver of those requirements and of any examination, fine or sanction for missing them.

Renewal and reinstatement

A producer license stays in effect only while the producer renews it on schedule: paying the renewal fee and completing continuing education by the due date.

Each state sets its own renewal cycle.

A producer who misses the deadline and lets the license lapse may be able to reinstate it without retaking the examination.

Under the NAIC’s model act, a lapsed license may be reinstated within 12 months of the renewal due date, for a penalty of double the unpaid renewal fee. Each state sets its own window and fee, and after the window closes the person must qualify for a new license.

Continuing education

All states, including Arizona, have continuing education (CE) requirements that must be met to renew any major lines (life, health, property, liability) insurance license.

Arizona resident producers with a major line of authority must complete 48 hours of approved continuing education every 4 years.

At least 6 of the 48 hours must be in ethics.

Nonresident producers generally satisfy CE requirements through their home state.

Notice of change of name or address

Under the NAIC’s model act, the licensee reports a change of address to the regulator within 30 days of the change.

The model also requires a producer to report to the regulator within 30 days any administrative action taken against the producer in another state or by another government agency, counted from the final disposition, and any criminal prosecution in any jurisdiction, counted from the initial pretrial hearing date. A producer who does business under any name other than their legal name must notify the regulator before using it.

Company Regulations

An insurance company must be authorized by the Department of Insurance and Financial Institutions to conduct business in Arizona.

To receive a certificate of authority, the company applies to the Director and files its charter or articles of incorporation, financial statements showing that it meets the state’s capital and surplus requirements, and the other documents and fees the state requires.

Capital and Surplus Requirement

A company that has been authorized to conduct insurance business in Arizona must maintain minimum standards as a corporation.

• The certificate of authority allows the insurer to conduct business in the state only if it maintains the minimum capital or permanent surplus required. In Arizona, the Director must refuse to renew, revoke or suspend the certificate of authority of an insurer that no longer meets the requirements for its authority, on account of deficiency in assets or otherwise (A.R.S. § 20-219).

Duties of the Director of the Department of Insurance and Financial Institutions

The Arizona Director of the Department of Insurance and Financial Institutions is a state executive position in the Arizona state government.

• The director is responsible for establishing and enforcing regulations in the Arizona insurance market in a manner that protects consumers and encourages economic development.

There are no term limits for the director.

If a vacancy occurs:

• The governor nominates a new appointee to the state Senate.
• If the departing incumbent is able to continue to hold office until the new appointee qualifies, he or she does so.
• Otherwise, the nominee assumes office pending confirmation.
• If the senate subsequently rejects the nominee, the governor makes a new appointment.

The Arizona DOI is responsible for enforcing and administering all laws pertaining to insurance in the state, including:

• Investigate all claims and complaints of legal violations relating to insurance.

• If the Director finds that laws have been violated, the findings and supporting documents may be referred for criminal prosecution.

• Monitor transactions of all companies including domestic, foreign, and alien insurance companies.

• Examine the financial condition of insurers; the NAIC’s model examination law calls for every insurer to be examined at least once every five years.

• Audit the books and records of any resident producer as frequently as necessary.

• Collect all fees associated with producers and insurers.

• Determine and administer fines associated with violations for insurers and producers.

• Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.

• Approve documentation used by insurance companies such as forms and rates.

Sidenote

Know this...

The Director does not have the authority to arrest, issue injunctions or sentence jail time.

In Arizona, fraud unit investigators have the law enforcement powers of a peace officer while acting for the Department (A.R.S. § 20-466(D)).

Suspend, Revoke or Non-renew

The Director may deny, revoke or refuse to renew a license, or suspend it for not more than 12 months, for any of the following (A.R.S. § 20-295(A)):

• Providing false information on the application for an insurance license.

• Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.

• Violating any provision of the insurance code or any rule, subpoena or order of the Director.

• Committing fraud while attempting to obtain an insurance license.

• Improperly withholding, misappropriating or converting any money or property received in the course of doing insurance business.

• Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance.

• Having been convicted of a felony.

• Having admitted or been found to have committed any insurance unfair trade practice or fraud.

• Having engaged in activities of a fraudulent nature which allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.

• Having an insurance producer license, or its equivalent, denied, suspended or revoked in any state, province, district or territory.

• Forging another’s name to any document related to an insurance transaction.

Cease and Desist

If the DOI finds that a producer has violated the state’s insurance laws, the DOI may order the producer to cease and desist.

• Receiving a cease and desist order does not mean the recipient’s registration has been suspended or revoked.
• The recipient must stop or limit the activity addressed in the order.

Hearing and penalties

A person facing action by the Director is entitled to notice and an opportunity for a hearing, within time limits set by Arizona law, and may ask a court to review the final order. Under Arizona’s unfair practices law the hearing comes first: the Director orders a person to cease and desist if, after a hearing, a violation is found (A.R.S. § 20-456(A)). For unlicensed activity and certain other licensing violations, the Director may order a person who is violating or about to violate them to cease and desist (A.R.S. § 20-292).

A violation of the insurance laws can bring a civil penalty in addition to action against a license. State law sets the maximum, usually per violation and often with a cap on the total, and a higher tier commonly applies to a violation that was knowing or flagrant. Some violations are also crimes.

Unfair Claims Settlement Practices

Under the NAIC’s model act, these practices are violations when committed flagrantly and in conscious disregard of the law, or often enough to indicate a general business practice.

• The intentional obstruction and delay of claims payment or the delay of a claims investigation is a violation of regulation.

• Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.

• Failure to provide claims without launching a thorough investigation is a violation of regulation.

• Making settlement claims based on information contained on an application that has been altered without the insured’s consent is a violation of regulation.

• Denying a claim without conducting a thorough investigation.

• Attempting to settle a claim for less than fair market value.

Policy forms

Insurers file their policy forms with the Director.

Depending on the line of insurance and the form, a state may require approval before a form is used, often with a period after which a filing that has not been acted on is deemed approved, or may allow the form to be used as soon as it is filed (“file and use”).

If a policy provision conflicts with Arizona law, the policy is read as amended to conform to the law.

Record maintenance

A producer keeps records of each transaction (the policies placed, the insureds, the premiums received and any changes) and makes them available for the Director’s inspection.

Fraudulent Producer Representation

An insurance producer who represents to the public that he/she is licensed to conduct insurance business in Arizona, but has not passed the appropriate licensing examination, is in violation of regulation.

Any means of public communication are included, such as:

• Advertisements
• Letterheads
• Circulars
• Business cards
• Other methods of representation

A producer found guilty of conducting business in Arizona in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.

Misrepresentation

• Misrepresentation involving the creation or distribution of policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy is prohibited.

• Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.

• Providing inaccurate or incomplete information for the purpose of inducing, or tending to induce, the lapse, exchange, conversion, forfeiture, or surrender of a policy is a violation as well (twisting).

False advertising

Making, publishing or circulating an advertisement, announcement or statement about the business of insurance that is untrue, deceptive or misleading is an unfair trade practice under state law, based on the NAIC’s model act. The medium does not matter: the rule reaches newspapers, magazines, radio and television, and also notices, circulars, pamphlets, letters, posters and any other way of placing the statement before the public. The model act’s test is whether the statement is untrue, deceptive or misleading, not whether the person meant to deceive.

Defamation

Defamation of an insurer is an unfair trade practice under state law, based on the NAIC’s model act: making, publishing or circulating an oral or written statement that is false, or maliciously critical of or derogatory to the financial condition of an insurer, and that is calculated to injure that insurer or any other person engaged in the business of insurance. Spreading an untrue rumor that a competing insurer is about to fail is the classic example.

Boycott, Coercion and Intimidation

Entering into an agreement to commit, or by concerted action committing, any act of boycott, coercion or intimidation that results or tends to result in unreasonable restraint of, or monopoly in, the business of insurance is prohibited.

False Financial Statements

Making or circulating a false statement of an insurer’s financial condition with intent to deceive is prohibited in Arizona (A.R.S. § 20-447(A)), and knowingly presenting a statement with an untrue statement of material fact in an application for insurance is a fraudulent practice (A.R.S. § 20-463(A)(1)(a)).

Illegal inducements

Offering anything of value not specified in the policy (money, a service, a favor or a gift) as an inducement to buy insurance is prohibited unless state law expressly allows it, and any agreement made as part of the sale must be written into the policy.

States differ on promotional gifts. The NAIC’s model act lets producers and insurers give customers non-cash gifts, meals or charitable donations up to an amount the state considers reasonable, as long as the gift is not conditioned on buying or renewing a policy and is offered without unfair discrimination. Each state sets its own limit.

Unfair discrimination

Unfair discrimination is treating people or risks that present the same hazard differently. The NAIC’s model act, on which state unfair trade practices laws are based, prohibits:

• Unfair discrimination between individuals of the same class and equal expectation of life in life insurance and annuity rates, dividends, benefits or terms
• Unfair discrimination between individuals of the same class and essentially the same hazard in health insurance premiums, benefits or terms
• Refusing, limiting or canceling coverage because of a person’s sex, marital status, race, religion or national origin
• In property and casualty insurance, refusing or limiting coverage solely because of a risk’s geographic location, unless sound underwriting and actuarial principles justify it, or solely because the applicant or insured is physically or mentally impaired

Many states also expressly forbid refusing or limiting coverage solely because a person is blind or partially blind. Arizona’s own provision is a same-class test: it bars unfair discrimination between individuals of the same class and equal expectation of life in life insurance and annuities, and between individuals of the same class and essentially the same hazard in disability insurance (A.R.S. § 20-448(A)-(B)).

Errors & Omissions

Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties.

• E&O only covers honest mistakes resulting in (financial) damage to customers/prospects.
• There is no coverage for violation of insurance regulation.

AHCCCS

States use different names for their medical welfare programs.

• In Arizona, Medicaid is called AHCCCS (pronounced ak-ses), which stands for Arizona Health Care Cost Containment System.
• For exam purposes, AHCCCS and MEDICAID are interchangeable terms.
• It is a state-administered health care program for those in financial need.
• It is funded by federal and state money.

Rebating

Arizona licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance.

Sidenote

Know this...

To “solicit” or “negotiate” insurance implies that the person is licensed.

Sharing Commission

The splitting or sharing of commissions with a licensed producer is allowed.

• Both parties must be licensed in the line of business in which the proposed commission is to be split. Under the NAIC’s model act, a commission may also be paid to an insurance agency, or to a person who does not sell, solicit or negotiate insurance.

Twisting

Providing false information or expressing derogatory ideas about the financial conditions of a competitor company with the intent to lapse or surrender an existing policy is a violation of the law.

Under the NAIC’s model act, twisting is a misrepresentation made to induce a policyholder to lapse, forfeit, surrender, exchange or convert a policy. A false or maliciously critical statement about a competing insurer’s finances, made to injure it, is defamation.

• Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information is prohibited.

Unfair Marketing Practices

The DOI is responsible for establishing minimum standards for the full and fair disclosure of policy content.

• The DOI also requires the standardization and simplification of the terms used to describe insurance coverage.

Advertising may not involve the following:

• Any statement or implication that policies are approved, or that the financial condition of a company is endorsed, by any government agency or by any independent group, individual, organization or society, unless that is the fact.

• Any statements regarding advertising that are false or untrue in reference to the time frame in which claims are paid.

Gramm-Leach Bliley Act (GLBA)

This law repealed the Glass-Steagall Act of 1933, allowing consolidation of commercial banks, investment institutions and insurance companies.

• GLBA established a framework of responsibilities of federal and state regulators for these financial industries.
• It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.

McCarran-Ferguson Act

Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level.

• Grants insurers a limited exemption from federal antitrust legislation. Since 2021 the exemption does not cover the business of health insurance, apart from narrow activities such as sharing historical loss data (15 U.S.C. § 1013©).

National Association of Insurance Commissioners (NAIC)

The U.S. standard-setting and regulatory support organization is created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories.

• Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight.
• NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally.
• NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Fair Credit Reporting Act

The Fair Credit Reporting Act (FCRA, 15 U.S.C. 1681) regulates consumer reporting agencies and the use of consumer reports, such as credit reports, MIB records and investigative reports, including in insurance underwriting.

• When an insurer requests an investigative consumer report, it must disclose that to the consumer within 3 days of the request
• When an insurer takes adverse action based on a consumer report, it must notify the consumer and identify the reporting agency. The consumer then has 60 days to request a free copy of the report and may dispute inaccurate information

Privacy Act of 1974

The federal Privacy Act of 1974 governs how federal agencies handle personal information. It does not apply to private insurers. An insurer’s use of an applicant’s personal information is governed by the FCRA, the Gramm-Leach-Bliley Act and state insurance privacy law.

In states that adopted the NAIC’s Insurance Information and Privacy Protection Model Act, an authorization to collect personal information signed with an application is valid for no more than 30 months for life, health or disability insurance and one year for property or casualty insurance.

Telemarketing

The National Do Not Call Registry is a list of telephone numbers whose owners do not want to receive telemarketing calls. Telemarketers may not call registered numbers without the person’s permission or an established business relationship, and unsolicited sales calls:

• May be made only between 8 a.m. and 9 p.m. in the recipient’s local time
• Must disclose the caller’s identity, the company the caller represents and that the purpose is a sale

CAN-SPAM

A commercial email must:

• Be identified clearly as an advertisement
• Carry accurate header information and a subject line that is not deceptive
• Include the sender’s valid physical postal address
• Offer a way to opt out, and the sender must honor an opt-out within 10 business days

Insurance guaranty association

Every state has a property and casualty insurance guaranty association that pays covered claims when a member insurer becomes insolvent. Insurers licensed to write the covered lines in the state must belong to it, and it is funded by assessments on its members.

Each state sets the most its association pays per claim. The NAIC’s model act sets $500,000 per claimant for most covered claims and $10,000 for the return of unearned premium.