Arkansas Administrative Code

23 CAR § 85-106. Failure to comply. Failure of an insurer to provide or deliver a buyer’s guide, a policy summary, or policy data shall constitute an omission that misrepresents the benefits, advantages, conditions, or terms of an insurance policy.

23 CAR § 86-101. Purpose. The purpose of this part is to implement Arkansas Code §§ 23-85-105, 23-76-125, and § 23-74-401 et seq., so as to provide reasonable standardization and simplification of terms and coverages of individual accident and health insurance policies, individua…

23 CAR § 86-102. Applicability and scope. This part shall apply to all policies delivered or issued for delivery in this state on or after the effective date hereof, except it shall not apply to: (1) Individual policies or contracts issued pursuant to a conversion privilege under…

23 CAR § 86-103. Severability. Any section or provision of this part held by a court to be invalid or unconstitutional will not affect the validity of any other section or provision.

23 CAR § 86-104. Definitions. Except as provided hereafter, no policy or policies delivered or issued for delivery to any person in this state shall contain definitions respecting the matters set forth below unless such definitions comply with the requirements of this section: (1…

23 CAR § 86-201. Prohibited policy provisions. (a)(1) Except as provided in 23 CAR § 86-104(12), no policy shall contain provisions establishing a probationary or waiting period during which no coverage is provided under the policy subject to the further exception that a policy m…

23 CAR § 86-301. Minimum standards — Generally. (a)(1) The following minimum standards for benefits are prescribed for the categories of coverage noted in the following subsections. (2) No individual policy shall be delivered or issued for delivery in this state that does not mee…

23 CAR § 86-302. Basic hospital expense coverage. (a) "Basic hospital expense coverage" is a policy of accident and health insurance that provides coverage for a period of not less than thirty-one (31) days during any continuous hospital confinement for each person insured under …

23 CAR § 86-303. Basic medical-surgical expense coverage. "Basic medical-surgical expense coverage" is a policy of accident and health insurance that provides coverage for each person insured under the policy for the expenses incurred for the necessary services rendered by a phys…

23 CAR § 86-304. Hospital confinement indemnity coverage. (a) "Hospital confinement indemnity coverage" is a policy of accident and health insurance that provides daily benefits for hospital confinement on an indemnity basis in an amount not less than eighty dollars ($80.00) per …

23 CAR § 86-305. Major medical expense coverage or comprehensive health expense coverage. “Major medical expense coverage" or "comprehensive health expense coverage" is a policy of accident and health insurance that provides hospital, medical, and surgical expense coverage to an …

23 CAR § 86-306. Disability income protection coverage. (a) "Disability income protection coverage" is a policy that provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from either sickness or injury or a combin…

23 CAR § 86-307. Accident-only coverage and specified accident coverage. (a)(1) "Accident-only coverage" is a policy of accident and health insurance that provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by acc…

23 CAR § 86-308. Specified disease coverage. (a)(1) "Specified disease coverage" pays benefits for the diagnosis and treatment of a specifically named disease or diseases. (2)(A) Any such policy must meet the following general rules and one (1) of the following sets of minimum st…

23 CAR § 86-309. Nursing home confinement indemnity coverage. (a) "Nursing home confinement indemnity coverage" is a policy of accident and health insurance that provides benefits for confinement in facilities as defined in 23 CAR § 86-104(2) on a daily indemnity basis. (b) Benef…

23 CAR § 86-310. Intensive care unit indemnity coverage. (a)(1) "Intensive care unit indemnity coverage" is a policy of accident and health insurance that provides daily benefits for hospital confinement in an intensive care unit on an indemnity basis in an amount not less than o…

23 CAR § 86-311. Limited benefit health insurance coverage. (a) "Limited benefit health insurance coverage" is any policy or contract that provides benefits that are less than the minimum standards for benefits required under 23 CAR §§ 86-302 – 86-311. (b)(1) Such policies or con…

23 CAR § 86-401. General rules. (a)(1) Each policy shall include a renewal, continuation, or nonrenewal provision. (2) The language or specification of such provision must be consistent with the type of contract to be issued. (3) Such provision shall be appropriately captioned an…

23 CAR § 86-402. Outline of coverage requirements for individual coverages. (a) No policies subject to this part shall be delivered or issued for delivery in this state unless: (1) An appropriate outline of coverage, as prescribed in 23 CAR §§ 86-403 – 86-410, is completed as to …

23 CAR § 86-403. Basic hospital expense coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-302. (b) The items included in the outline of coverage must appear in…

23 CAR § 86-404. Basic medical-surgical expense coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-303. (b) The items included in the outline of coverage must a…

23 CAR § 86-405. Basic hospital and medical-surgical expense coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR §§ 86-302 and 86-303. (b) The items included in the o…

23 CAR § 86-406. Hospital confinement indemnity coverage, nursing home confinement indemnity coverage, or intensive care unit indemnity coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting th…

23 CAR § 86-407. Major medical expense coverage or comprehensive health expense coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-305. (b) The items included i…

23 CAR § 86-408. Disability income protection coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-306. (b) The items included in the outline of coverage must app…

23 CAR § 86-409. Accident-only coverage, specified accident coverage, or specified disease coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-307. (b) The items…

23 CAR § 86-410. Limited-benefit health insurance coverage — Outline of coverage. (a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies that do not meet the minimum standards of 23 CAR §§ 86-302 – 86-305 and 86-307 – 86-310. (b) The…

23 CAR § 86-501. Notice and form. (a)(1) Application forms shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any other disability insurance presently in force. (2) A supplementary application or other form to b…

23 CAR § 87-101. Purpose. The purpose of this part is to: (1) Establish a uniform order of benefit determination under which plans pay claims; (2) Reduce duplication of benefits by permitting a reduction of the benefits to be paid by plans that, pursuant to rules established by t…

23 CAR § 87-102. Definitions. As used in this part, these words and terms have the following meanings, unless the context clearly indicates otherwise: (1)(A) “Allowable expense”, except as set forth below or where a statute requires a different definition, means any healthcare ex…

23 CAR § 87-103. Applicability and scope. This part applies to all plans that are issued on or after the effective date of this part, which is July 1, 2010.

23 CAR § 87-104. Use of model COB contract provision. (a)(1) Appendix A contains a model COB provision for use in contracts. (2) The use of this model COB provision is subject to the provisions of: (A) Subsections (b), (c), and (d) of this section; and (B) 23 CAR § 87-105. (b)(1)…

23 CAR § 87-105. Rules for coordination of benefits. (a) When a person is covered by two (2) or more plans, the rules for determining the order of benefit payments are as follows. (b)(1) The primary plan shall pay or provide its benefits as if the secondary plan or plans did not …

23 CAR § 87-106. Procedure to be followed by secondary plan to calculate benefits and pay a claim. (a) In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have…

23 CAR § 87-107. Notice to covered persons. A plan shall, in its explanation of benefits provided to covered persons, include the following language: “If you are covered by more than one health benefit plan, you should file all your claims with each plan.”

23 CAR § 87-108. Miscellaneous provisions. (a)(1) A secondary plan that provides benefits in the form of services may recover the reasonable cash value of the services from the primary plan to the extent that benefits for the services: (A) Are covered by the primary plan; and (B)…

23 CAR § 87-109. Effective date for existing contracts. (a) A contract that provides healthcare benefits and that was issued before the effective date of this part shall be brought into compliance with this part by: (1) The later of: (A) The next anniversary date or renewal date …

23 CAR § 88-101. Applicability and scope. (a) These standards apply to all individual and group disability insurance coverages except credit insurance. (b) When an insurer determines that adequacy of its disability insurance reserves requires reserves in excess of the minimum sta…

23 CAR § 88-102. Claim reserves. (a) General. (1) Claim reserves are required for all incurred but unpaid claims on all disability insurance policies. (2) Appropriate claim expenses reserves are required with respect to the estimated expense of settlement of all incurred but unpa…

23 CAR § 88-105. Premium reserves. (a) General. (1) Unearned premium reserves are required for all contracts with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation. (2)(A) If premiums due and unp…

23 CAR § 88-106. Contract reserves. (a) General. (1)(A) Contract reserves are required, unless otherwise specified in subdivision (a)(2) of this section for: (i) All individual and group contracts with which level premiums are used; or (ii) All individual and group contracts with…

23 CAR § 88-107. Reinsurance. Increases to or credits against reserves carried, arising because of reinsurance assumed or reinsurance ceded, must be determined in a manner consistent with: (1) These minimum reserve standards; and (2) All applicable provisions of the reinsurance c…

23 CAR § 89-101. Purpose. The purpose of this part is to: (1) Provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; (2) Facilitate public understanding and comparison of such policies; (3) Eliminate provis…

23 CAR § 89-102. Applicability and scope. (a) Except as otherwise specifically provided in 23 CAR §§ 89-106, 89-115, 89-116, 89-119, and 89-124, this part shall apply to: (1) All Medicare supplement policies delivered or issued for delivery in Arkansas on or after the effective d…

23 CAR § 89-103. Definitions. For purposes of this part: (1) “1990 standardized Medicare supplement benefit plan”, “1990 standardized benefit plan”, or “1990 plan” means a group or individual policy of Medicare supplement insurance issued with an effective date of coverage on or …

23 CAR § 89-104. Policy definitions and terms. No policy or certificate may be advertised, solicited, or issued for delivery in Arkansas as a Medicare supplement policy or certificate unless such policy or certificate contains definitions or terms that conform to the requirements…

23 CAR § 89-105. Policy provisions. (a) Except for permitted preexisting condition clauses as described in 23 CAR § 89-106(b)(1), 23 CAR § 89-107(b)(1), and 23 CAR § 89-108(b)(1), no policy or certificate may be advertised, solicited, or issued for delivery in the State of Arkans…