23-61-802. Definitions.

23-61-802. Definitions. As used in this subchapter: (1) “Federal act” means the federal healthcare laws established by Pub. L. No. 111-148, as amended by Pub. L. No. 111-152, and any amendments to or regulations or guidance issued under those statutes existing on April 23, 2013; (2)(A) “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services. (B) “Health benefit plan” does not include: (i) Coverage only for accident or disability income insurance, or both; (ii) Coverage issued as a supplement to liability insurance; (iii) Liability insurance, including without limitation general liability insurance and automobile liability insurance; (iv) Workers' compensation or similar insurance; (v) Automobile medical payment insurance; (vi) Credit-only insurance; (vii) Coverage for on-site medical clinics; or (viii) Other similar insurance coverage, specified in federal regulations issued under the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, and existing on April 23, 2013, under which benefits for healthcare services are secondary or incidental to other insurance benefits. (C) “Health benefit plan” does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan: (i) Limited scope dental or vision benefits; (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or a combination of these; or (iii) Other similar limited benefits specified in federal regulations issued under the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, and existing on April 23, 2013. (D) “Health benefit plan” does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor: (i) Coverage only for a specified disease or illness; or (ii) Hospital indemnity or other fixed indemnity insurance. (E) “Health benefit plan” does not include the following if offered as a separate policy, certificate, or contract of insurance: (i) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act, Pub. L. No. 74-271, as existing on April 23, 2013; (ii) Coverage supplemental to the coverage provided to military personnel and their dependents under Chapter 55 of Title 10 of the United States Code and the Civilian Health and Medical Program of the Uniformed Services, 32 C.F.R. Part 199; or (iii) Similar supplemental coverage provided to coverage under a group health plan; (3) “Health insurance” means insurance that is primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease or amounts paid for the purpose of affecting any structure of the body, including transportation that is essential to obtaining health insurance, but excluding: (A) Coverage only for accident or disability income insurance, or any combination thereof; (B) Coverage issued as a supplement to liability insurance; (C) Liability insurance, including general liability insurance and automobile liability insurance; (D) Workers' compensation or similar insurance; (E) Automobile medical payment insurance; (F) Credit-only insurance; (G) Coverage for on-site medical clinics; (H) Coverage only for limited scope vision benefits; (I) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; (J) Coverage for specified disease or critical illness; (K) Hospital indemnity or other fixed indemnity insurance; (L) Medicare supplement policies; (M) Medicare, Medicaid, or the Federal Employee Health Benefit Program; (N) Coverage only for medical and surgical outpatient benefits; (O) Excess or stop-loss insurance; and (P) Other similar insurance coverage: (i) Under which benefits for health insurance are secondary or incidental to other insurance benefits; or (ii) Specified in federal regulations issued under the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, and existing on April 23, 2013, under which benefits for healthcare services are secondary or incidental to other insurance benefits; (4) “Health insurer” means an entity that provides health insurance or a health benefit plan in the State of Arkansas, including without limitation an insurance company, medical services plan, hospital plan, hospital medical service corporation, health maintenance organization, fraternal benefits society, or any other entity providing a plan of health insurance or health benefits subject to state insurance regulation; (5) “Qualified employer” means a small employer that elects to make its full-time employees eligible for one (1) or more qualified health plans offered through the small business health options program, and at the option of the employer, some or all of its part-time employees, provided that the employer: (A) Has its principal place of business in this state and elects to provide coverage through the small business health options program to all of its eligible employees, wherever employed; or (B) Elects to provide coverage through the small business health options program to all of its eligible employees who are principally employed in this state; (6) “Qualified health plan” means a health benefit plan that has in effect a certification that the plan meets the criteria for certification described in section 1311(c) of the federal act; and (7)(A) “Small employer” means an employer that employed an average of not more than fifty (50) employees during the preceding calendar year. (B) For purposes of this subdivision (7): (i) 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 as existing on April 23, 2013, shall be treated as a single employer; (ii) An employer and any predecessor employer shall be treated as a single employer; (iii) All employees shall be counted, including part-time employees and employees who are not eligible for coverage through the employer; (iv) If an employer was not in existence throughout the preceding calendar year, the determination of whether that employer is a small employer shall be based on the average number of employees that is reasonably expected that the employer will employ on business days in the current calendar year; and (v) An employer that makes enrollment in qualified health plans available to its employees through the small business health options program and would cease to be a small employer because of an increase in the number of its employees shall continue to be treated as a small employer for purposes of this subchapter as long as it continuously makes enrollment through the small business health options program available to its employees.