Browse Arkansas Code titles and sections
23-61-1007. Insurance standards for individual qualified health insurance plans.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-61-1007. Insurance standards for individual qualified health insurance plans.
(a) Insurance coverage for a program participant enrolled in an individual qualified health insurance plan shall be obtained through silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and § 18071, as they existed on January 1, 2016, that restrict out-of-pocket costs to amounts that do not exceed applicable out-of-pocket cost limitations.
(b) The Department of Human Services shall pay premiums and supplemental cost sharing reductions directly to a health insurer for a program participant enrolled in an individual qualified health insurance plan.
(c) All participating health insurers offering individual qualified health insurance plans in the health insurance marketplace shall:
(1)(A) Offer individual qualified health insurance plans conforming to the requirements of this section and applicable insurance rules.
(B) The individual qualified health insurance plans shall be approved by the State Insurance Department; and
(2) Maintain a medical-loss ratio of at least eighty percent (80%) for an individual qualified health insurance plan as required under 45 C.F.R. § 158.210(c), as it existed on January 1, 2016, or rebate the difference to the Department of Human Services for program participants.
(d) The State of Arkansas shall assure that at least two (2) individual qualified health insurance plans are offered in each county in the state.
(e) A health insurer offering individual qualified health insurance plans for program participants shall participate in the Arkansas Patient-Centered Medical Home Program, including:
(1) Attributing enrollees in individual qualified health insurance plans, including program participants, to a primary care physician;
(2) Providin
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-61-1007
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Stable record: arkansas_code:legal_authorities:23-61-1007
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 430f92f2367aa11e042b26208b29b607a5e2a7ca017b93937f4fdd9b77a3c7e8
Source location: content.xml paragraph 29603
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23-61-1007. Insurance standards for individual qualified health insurance plans.
(a) Insurance coverage for a program participant enrolled in an individual qualified health insurance plan shall be obtained through silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and § 18071, as they existed on January 1, 2016, that restrict out-of-pocket costs to amounts that do not exceed applicable out-of-pocket cost limitations.
(b) The Department of Human Services shall pay premiums and supplemental cost sharing reductions directly to a health insurer for a program participant enrolled in an individual qualified health insurance plan.
(c) All participating health insurers offering individual qualified health insurance plans in the health insurance marketplace shall:
(1)(A) Offer individual qualified health insurance plans conforming to the requirements of this section and applicable insurance rules.
(B) The individual qualified health insurance plans shall be approved by the State Insurance Department; and
(2) Maintain a medical-loss ratio of at least eighty percent (80%) for an individual qualified health insurance plan as required under 45 C.F.R. § 158.210(c), as it existed on January 1, 2016, or rebate the difference to the Department of Human Services for program participants.
(d) The State of Arkansas shall assure that at least two (2) individual qualified health insurance plans are offered in each county in the state.
(e) A health insurer offering individual qualified health insurance plans for program participants shall participate in the Arkansas Patient-Centered Medical Home Program, including:
(1) Attributing enrollees in individual qualified health insurance plans, including program participants, to a primary care physician;
(2) Providing financial support to patient-centered medical homes to meet practice transformation milestones; and
(3) Supplying clinical performance data to patient-centered medical homes, including data to enable patient-centered medical homes to assess the relative cost and quality of healthcare providers to whom patient-centered medical homes refer patients.
(f) On or before January 1, 2017, the State Insurance Department and the Department of Human Services may implement through certification requirements or rule, or both, the applicable provisions of this section.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Essential health benefits package** In this title,11 See References in Text note below. the term “essential health benefits package” means, with respect to any health plan, coverage that—
(1) provides for the essential health benefits defined by the Secretary under subsection (b);
(2) limits cost-sharing for such coverage in accordance with subsection (c); and
(3) subject to subsection (e), provides either the bronze, silver, gold, or platinum level of coverage described in subsection (d).
**(b) Essential health benefits**
(1) **In general** — Subject to paragraph (2), the Secretary shall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
(2) **Limitation**
(A) *In general* — The Secretary shall ensure that the scope of the essential health benefits under paragraph (1) is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary. To inform this determination, the Secretary of Labor shall conduct a survey of employer-sponsored coverage to determine the benefits typically covered by employers, including multiemployer plans, and provide a report on such survey to the Secretary.
(B) *Certification* — In defining the essential healt
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18022
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 18022. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 9097
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 18022
1 See References in Text note below.
2 So in original. Probably should be ‘‘paragraph,’’.
3 So in original. Probably should be ‘‘18031(d)(2)(B)(ii)’’.
(Pub. L. 111–148, title I, § 1301, title X, § 10104(a),
Mar. 23, 2010, 124 Stat. 162, 896.)
Editorial Notes
REFERENCES IN TEXT
This title, where footnoted in text, is title I of Pub.
L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted
this chapter and enacted, amended, and transferred nu-
merous other sections and notes in the Code. For com-
plete classification of title I to the Code, see Tables.
AMENDMENTS
2010—Subsec. (a)(2) to (4). Pub. L. 111–148, § 10104(a),
added pars. (2) to (4) and struck out former par. (2).
Prior to amendment, text of par. (2) read as follows:
‘‘Any reference in this title to a qualified health plan
shall be deemed to include a qualified health plan of-
fered through the CO-OP program under section 18042 of
this title or a community health insurance option
under section 18043 of this title, unless specifically pro-
vided for otherwise.’’
§ 18022. Essential health benefits requirements
(a) Essential health benefits package
In this title,1 the term ‘‘essential health bene-
fits package’’ means, with respect to any health
plan, coverage that—
(1) provides for the essential health benefits
defined by the Secretary under subsection (b);
(2) limits cost-sharing for such coverage in
accordance with subsection (c); and
(3) subject to subsection (e), provides either
the bronze, silver, gold, or platinum level of
coverage described in subsection (d).
(b) Essential health benefits
(1) In general
Subject to paragraph (2), the Secretary shall
define the essential health benefits, except
that such benefits shall includ
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 18022
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 18022. This identifies an authority to review, not proof of applicability.