Title 23, Public Utilities and Regulated Industries

(a) If the Arkansas Life and Health Insurance Guaranty Association elects to reissue terminated coverage at a premium rate different from that charged under the terminated policy or contract, the premium shall be actuarially justified and set by the association according to the a…

This subchapter shall be known and may be cited as the “Long-Term Care Insurance Act of 2005”.

(1) The purpose of this subchapter is to:(1) Promote the public interest;(2) Promote the availability of long-term care insurance policies;(3) Protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices;(4) Establish standards for long-t…

(a) The requirements of this subchapter apply to policies delivered or issued for delivery in this state on or after August 12, 2005. (b) Except as provided in subsection (c) of this section, this subchapter is not intended to supersede the obligations to comply with other applic…

(1) As used in this subchapter:(1) “Applicant” means:(A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and(B) In the case of a group long-term care insurance policy, the proposed certificate holder;(2) “Association” m…

(a) Prior to advertising, marketing, or offering a policy within this state, an association or the insurer of the association shall file evidence with the Insurance Commissioner that the association has:(1) A minimum of one hundred (100) persons;(2) Been organized and maintained …

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in th…

(a) The Insurance Commissioner may adopt rules for long-term care insurance that include, but are not limited to, standards for full and fair disclosure addressing:(1) The manner, content, and required disclosures for the sale of long-term care insurance policies;(2) Terms of ren…

(a) No long-term care insurance policy or certificate other than a policy or certificate issued to a group approved by the Insurance Commissioner under § 23-97-304(6)(B) shall:(1) Use a definition of “preexisting condition” that is more restrictive than the following: “Preexistin…

(a) No long-term care insurance policy shall be delivered or issued for delivery in this state if the policy:(1) Conditions eligibility for any benefits on a prior hospitalization requirement;(2) Conditions eligibility for any benefits provided in an institutional care setting on…

(a) The Insurance Commissioner may adopt rules establishing loss ratio standards for long-term care insurance policies. (b) A specific reference to long-term care insurance policies shall be contained in the rules.

(a) Long-term care insurance applicants shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if after examination of the policy or certificate the applicant is not satisfied for any reason. (b) Long-term…

(a) (1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the outline of coverage and its purpose.(2) The Insurance Commissi…

(1) A certificate issued for delivery in this state under a group long-term care insurance policy shall include:(1) A description of the principal benefits and coverage provided in the policy;(2) A statement of the principal exclusions, reductions, and limitations contained in th…

(a) If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval. (b) (1) At the time of the delivery of the polic…

(a) Any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, a monthly report shall be provided to the policyholder. (b) The report shall include:(1) Any long-term care benefits paid out durin…

(1) If a claim under a long-term care insurance contract is denied, within sixty (60) days of the date of a written request by the policyholder or certificate holder or a representative of the policyholder or certificate holder, the issuer shall:(1) Provide a written explanation …

Any policy or rider advertised, marketed, or offered as long-term care or nursing home insurance shall comply with the provisions of this subchapter.

(a) An insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if:(1) The long-term care insurance policy or certificate has been in force for less than six (6) months and the insurer relied upon a material mi…

(a) (1) Except as provided in subsection (b) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate containing a n…

(1) The Insurance Commissioner shall issue rules for long-term care insurance to:(1) Promote premium adequacy;(2) Protect the policyholder in the event of substantial rate increases; and(3) Establish minimum standards for:(A) Marketing practices;(B) Agent compensation;(C) Agent t…

(1) In addition to any other penalties provided by the laws of this state, any insurer or agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of long-term care insurance is subject to the greater of:(1…

(1) The General Assembly finds that the cost of health insurance coverage is not affordable for many small businesses, their employees, self-employed persons, and other individuals, and that as a result hundreds of thousands of Arkansas citizens do not have any health insurance c…

(1) As used in this chapter:(1) “Children's preventive healthcare services” means physician-delivered or physician-supervised services for eligible dependents from birth through age six (6), with periodic physical examinations including medical history, physical examination, deve…

The Insurance Commissioner shall provide notice and conduct hearings in accordance with the Arkansas Administrative Procedure Act, § 25-15-201 et seq., before adopting any rules of general applicability to minimum basic benefit policies to be issued pursuant to this chapter.

Solely for purposes of obtaining minimum basic benefit policies pursuant to the authority granted by this chapter, trusts may be formed composed of qualified individuals, qualified families, or qualified groups. Each trust may serve as a master policyholder. Members of qualified …

Insurers are authorized to issue minimum basic benefit policies pursuant to and in compliance with the provisions of this chapter to qualified individuals, qualified families, qualified trusts, and qualified groups. This chapter shall apply only to those minimum basic benefit pol…

(a) Minimum basic benefit policies offered under the authority of this chapter shall provide basic levels of primary, preventive, and hospital care, including, but not limited to, the following:(1) Fifteen (15) days of inpatient hospitalization coverage per policy year;(2) (A) As…

(a) Before any insurer issues a minimum basic benefit policy, it shall obtain from the prospective insured a signed, written statement in a form approved by the Insurance Commissioner in which the prospective insured:(1) Certifies as to eligibility for coverage under the minimum …

(a) Those employers in the State of Arkansas that do not provide a portion of the cost of health insurance for their employees shall provide notice to their employees of the existence of the minimum basic benefit policy authorized by this chapter. The notice shall be in a form pr…

(a) The insurer may include any or all of the following managed care provisions to control the cost of a minimum basic benefit policy issued pursuant to this chapter:(1) An exclusion for services that are not medically necessary;(2) A procedure for preauthorization by telephone, …

(a) All minimum basic benefit policy forms, including applications, enrollment forms, policies, certificates, evidences of coverage, riders, amendments, endorsements, disclosure forms, and marketing communications used in connection with the sale or advertisement of a minimum bas…

Each insurer issuing a minimum basic benefit policy in this state shall maintain separate and distinct records of enrollment, claim costs, premium income, utilization, and such other information as may be required by the Insurance Commissioner. Each insurer providing a minimum ba…

This subchapter shall be known and may be cited as the “Vision Care Plan Act of 2015”.

(1) As used in this subchapter:(1) “Covered materials” means materials for which reimbursement from the insurer, vision benefit manager, vision care plan, or vision care discount plan is provided to a vision care provider by an individual's vision benefit plan or contract and tha…

(a) A participating provider agreement between an insurer, vision benefit manager, vision care plan, or vision care discount plan and a vision care provider shall not establish a fee that a vision care provider shall charge for services or materials that are not covered by a visi…

(a) A vision care provider adversely affected by any violation of this subchapter by an insurer, vision care plan, or a vision care discount plan may bring a civil action in a court of competent jurisdiction against the insurer, vision care plan, or a vision care discount plan fo…

(a) The State Insurance Department shall develop and promulgate rules for the implementation and administration of this subchapter. (b) The Insurance Commissioner shall enforce this subchapter and may seek injunctive relief for violations of this subchapter. (c) This subchapter i…

This subchapter shall be known and may be cited as the “Prior Authorization Transparency Act”.

(a) The General Assembly finds that:(1) A physician-patient relationship is paramount and should not be subject to third-party intrusion; and(2) Prior authorizations can place attempted cost savings ahead of optimal patient care. (1) A physician-patient relationship is paramount …

(1) As used in this subchapter:(1) (A) “Adverse determination” means a decision by a utilization review entity to deny, reduce, or terminate coverage for a healthcare service furnished or proposed to be furnished to a subscriber on the basis that the healthcare service is not med…

(a) (1) (A) A utilization review entity shall disclose all of its prior authorization requirements, clinical criteria, and restrictions in a publicly accessible manner on its website.(B) The disclosure under subdivision (a)(1)(A) of this section shall be explained in detail and i…

(a) If a utilization review entity requires prior authorization of a nonurgent healthcare service, the utilization review entity shall make an authorization or adverse determination and notify the subscriber and the subscriber's nonurgent healthcare provider of the decision withi…

(a) A utilization review entity shall render an expedited authorization or adverse determination concerning an urgent healthcare service and notify the subscriber and the subscriber's healthcare provider of that expedited prior authorization or adverse determination no later than…

(a) A utilization review entity shall not require prior authorization for prehospital transportation or for provision of an emergency healthcare service. (b) (1) A utilization review entity shall allow a subscriber and the subscriber's healthcare provider a minimum of twenty-four…

If a subscriber's covered prescription pain medication requires a prior authorization, then the prior authorization shall not be denied if the subscriber has a terminal illness.