Section R20-5-1117. Ex-medical Plan; Formula; Eligibility; Necessary Information for Plan

A.      The Division shall calculate the net taxable premium under an ex-medical plan as follows: [(payroll multiplied by the appli- cable workers’ compensation rate) multiplied by (1 minus the ex-medical factor)] minus the premium discount.

B.       A self-insurer may use the ex-medical plan if:

1.        The self-insurer’s program for medical, surgical, or hos- pital services meets the requirements of A.R.S § 23-1070; and

2.        The self-insurer’s annual net taxable premium exceeds

$100,000.

C.      A self-insured shall provide the following information in sup- port of the plan submitted under this Section:

1.        Self-insurer’s Payroll Report,

2.        Self-insurer’s Hospital Report,

3.        Self-insurer’s Medical Report, and

4.        Self-insurer’s Quarterly Tax Payment form.

Historical Note

New Section made by final rulemaking at 11 A.A.R.

1008, effective April 4, 2005 (Supp. 05-1).