Title 23, Public Utilities and Regulated Industries

(1) Group accident and health insurance is declared to be that form of accident and health insurance covering groups of persons as defined in this section, with or without one (1) or more members of their families or one (1) or more of their dependents, or covering one (1) or mor…

(a) All group accident and health insurance placed by an employer on employees who are residents of this state shall be placed by the employer with an insurer authorized to transact insurance in this state. (b) This section shall not apply to group insurance lawfully placed in an…

(1) Each group accident and health insurance policy shall contain in substance the following provisions:(1) A provision that, in the absence of fraud, all statements made by applicants or the policyholder or by an insured person shall be deemed representations and not warranties …

Any group accident and health insurance policy that contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, or surgical services for members of the family or dependents of a person in the insured group may pro…

(a) (1) All group accident and health insurance carriers including hospital and medical service corporations shall be subject to the “primary” and “secondary” carrier rules promulgated by the Insurance Commissioner.(2) The secondary carrier shall administer benefits on a timely b…

(a) (1) No contract of group accident and health insurance coverage sold, delivered or issued for delivery, renewed, or offered for sale in this state by an insurer, hospital and medical service corporation, or health maintenance organization, directly or indirectly providing ind…

(a) Except as provided under subsection (c) of this section, on request by the group policyholder, any group accident and health insurance policy or health benefit plan may provide that all or any portion of any indemnities provided by any policy or health benefit plan on account…

(a) Unless refused in writing, every group accident and health insurance policy or group contract of hospital and medical service corporations issued or renewed after July 1, 1983, providing hospitalization or medical benefits to Arkansas residents for conditions arising from men…

(a) Every group accident and health insurance policy, contract, or certificate providing hospital, surgical, or major medical coverage, other than accident only or specified disease policies, shall contain a provision that any certificate holder, member, or spouse whose coverage …

(a) (1) Every group policy, contract, or certificate of accident and health insurance delivered or issued for delivery in this state that provides hospital, surgical, or major medical coverage on an expense-incurred basis, other than coverage limited to expenses from accidents or…

(a) Every group accident and health insurance policy, contract, or certificate that provides coverage for hospital or medical services or expenses shall provide that the insurer shall continue its obligation for benefits under the policy or contract for any person insured under t…

(a) All accident and health insurers transacting business in this state shall use Form HCFA 1500 and Form UB-92/HCFA 1450 or in the claim format required by the Health Insurance Portability and Accountability Act of 1996 as the standard claim forms until and unless the Insurance …

(a) As used in this section:(1) (A) “Fertility awareness-based methods” means modern, evidence-based methods of tracking the menstrual cycle of a woman through observable biological signs, including without limitation:(i) Body temperature;(ii) Cervical fluid; or(iii) Hormone prod…

(a) (1) Upon request from a policyholder with more than twenty-five (25) insured employees under a comprehensive group health insurance policy, an insurer issuing or delivering a group accident and health insurance policy in this state shall provide to the policyholder the follow…

(a) (1) Every accident and health insurance company, hospital service corporation, health maintenance organization, or other health insurance provider in the State of Arkansas shall offer to each master group contract holder, coverage for hospice facilities and hospice programs a…

(a) As used in this section, “health benefit plan” means any policy, contract, or agreement offered by an insurance company, health maintenance organization, or hospital and medical service corporation to provide, reimburse, or pay for healthcare services, but does not include th…

(a) As used in this section:(1) “Health carrier” means a:(A) Health maintenance organization;(B) Hospital medical service corporation; and(C) Disability insurance company;(2) “Health carrier” includes a:(A) Self-insured governmental or church plan; and(B) Third-party administrato…

(a) As used in this section:(1) “Prior authorization” means the process by which a health carrier determines the medical necessity or eligibility for coverage of a healthcare service before a covered person receives the healthcare service in order to provide coverage and reimburs…

(1) The intent of this subchapter is to:(1) Promote the availability of health insurance coverage to small employers;(2) Prevent abusive rating practices; and(3) Improve the efficiency and fairness of the small group health insurance marketplace. (1) Promote the availability of h…

(1) “Actuarial certification” means a written statement by a member of the American Academy of Actuaries or other individuals acceptable to the Insurance Commissioner that a small employer carrier is in compliance with the provisions of § 23-86-204 based upon the person's examina…

(a) Except as provided in subsection (b) of this section, the provisions of this subchapter apply to any health benefit plan that provided coverage to two (2) or more employees of a small employer. (b) The provisions of this subchapter shall not apply to individual health insuran…

(a) Premium rates for health benefit plans subject to this subchapter shall be subject to the following provisions:(1) The index rate for a rating period for any class of business shall not exceed the index rate for any other class of business by more than twenty percent (20%). T…

(a) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation which demonstrate that its rating methods and practices are ba…

The Insurance Commissioner may suspend all or any part of § 23-86-204 as to the premium rates applicable to one (1) or more small employers for one (1) or more rating periods upon a filing by the small employer carrier and a finding by the commissioner that either the suspension …

(a) The provisions of this subchapter shall apply to each health benefit plan for a small employer that is delivered, issued for delivery, renewed, or continued in this state after July 1, 1997. (b) For purposes of this section, the date a plan is continued is the first rating pe…

This subchapter may be cited as the “Arkansas Health Insurance Portability and Accountability Act of 1997”.

(a) In General. Except as provided in this section, this subchapter and the amendments made by this section shall apply with respect to group health plans for plan years beginning after June 30, 1997. (b) Determination of Creditable Coverage. (1) Period of Coverage — In General. …

(1) As used in this subchapter:(1) “Affiliation period” means a period that, under the terms of the coverage offered by the health maintenance organization, must expire before the coverage becomes effective;(2) “Bona fide association” means, with respect to health insurance cover…

(a) Limitation on Preexisting Condition Exclusion Period — Crediting for Periods of Previous Coverage. Subject to subsection (d) of this section, a group health plan and a health insurance issuer offering group health insurance coverage may, with respect to a participant or benef…

(a) Application of Aggregation Rule for Employers. All persons treated as a single employer under subsection (b), subsection (c), subsection (m), or subsection (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as one (1) employer. (b) Employers Not in Exist…

(a) Ineligibility to Enroll. (1) In General. Subject to subdivision (a)(2) of this section, a group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan may not establish rules for eligibility including continue…

(1) A group health plan which is a multiemployer plan or which is a multiple employer welfare arrangement may not deny an employer whose employees are covered under such a plan continued access to the same or different coverage under the terms of such a plan, other than:(1) For n…

Nothing in this subchapter shall be construed as requiring a group health plan or health insurance coverage to provide specific benefits under the terms of such a group health plan or health insurance coverage.

(a) General Exception for Certain Small Group Health Plans. The requirements of this subchapter shall not apply to any group health plan or group health insurance coverage offered in connection with a group health plan for any plan year if, on the first day of the group health pl…

(1) For purposes of this section, the term “excepted benefits” means benefits under one (1) or more, or any combination thereof, of the following:(1) Benefits not subject to requirements:(A) Coverage only for accident or disability income insurance, or any combination thereof;(B)…

(a) In General. Except as provided in this section, if a health insurance issuer offers health insurance coverage in the small-group market or the large-group market in connection with a group health plan, the issuer must renew or continue in force that coverage at the option of …

(a) Issuance of Coverage in the Small-Group Market — In General. Subject to subsections (b)-(e) of this section, each health insurance issuer that offers health insurance coverage in the small-group market in Arkansas:(1) Must accept every small employer in Arkansas that applies …

(a) Disclosure of Information by Health Insurance Issuers. In connection with the offering of any health insurance coverage to a small employer, a health insurance issuer:(1) Shall make a reasonable disclosure to the small employer as part of its solicitation and sales materials …

(a) Exception for Certain Small Group Health Plans. The requirements of § 23-86-304, limitation on preexisting conditions, § 23-86-306, prohibiting discrimination based on health status, § 23-86-311, guaranteed renewability, § 23-86-312, guaranteed availability, and § 23-86-313, …

This subchapter may be cited as the “Freedom of Choice Among Health Benefit Plans Act of 1999”.

(1) The General Assembly finds that:(1) Citizens covered by health benefit plans should have the opportunity to obtain healthcare services at an affordable price;(2) The cost of health benefit plans can vary depending upon the kind of arrangement the health benefit plan has with …

(1) As used in this subchapter:(1) “Benefit level” means an obligation of the health maintenance organization or insurance company under its health benefit plan. The benefit level is actuarially determined considering the copayments, deductibles, and dollar limits of the health b…

(a) A health maintenance organization may offer and issue health benefit plans that reimburse or arrange for covered healthcare services to covered persons through a limited network plan if:(1) The health maintenance organization provides itself, or arranges through an insurance …

Nothing in this subchapter shall be construed to prohibit a health maintenance organization from pricing any health benefit plan according to sound actuarial principles.

Nothing in this subchapter shall be construed to require a health maintenance organization to cover any specific healthcare service.

This subchapter shall be known and cited as the “Small Employer Health Insurance Purchasing Group Act of 2001”.