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23-75-111. Subscription contracts.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-75-111. Subscription contracts.
(a)(1) All rates charged by the corporation to subscribers or classes of subscribers having contracts covered by §§ 23-85-101 — 23-85-131, and the form and content of all contracts between the corporation and its subscribers, classes of subscribers, or groups of subscribers, and the certificates issued by the corporation representing their subscribers' agreements shall be subject at all times to the prior approval of the Insurance Commissioner.
(2) Application for approval shall be made to the commissioner in such form and shall set forth such information as the commissioner may require.
(3) Rates shall not be excessive, inadequate, or unfairly discriminatory in relation to the services offered.
(4)(A) Upon the commissioner's review of an application at any time, if the applicant requests a hearing, the commissioner shall hold a hearing before issuing an order of disapproval. The applicant shall be given not less than ten (10) days' written notice of the hearing. The notice shall specify the matters to be considered at the hearing.
(B) If after the hearing provided by subdivision (a)(4)(A) of this section the commissioner finds that the application or a part thereof does not meet the requirements of this code, the commissioner shall issue an order specifying in what respects he or she finds that it fails. Notice thereof shall immediately be served on the applicant, either personally or by mail. Within thirty (30) days after the date of such a notice, the applicant may apply to the Pulaski County Circuit Court to show cause why the action of the commissioner should be set aside and the application approved.
(b)(1) In any hospital service corporation contract, any medical service corporation contract, or any hospital and medi
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-75-111
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:23-75-111
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 7b25fe8b65a88eaded8d6da73b117b43c2791947065717147b2b41e0dc115363
Source location: content.xml paragraph 43323
Stored source content
23-75-111. Subscription contracts.
(a)(1) All rates charged by the corporation to subscribers or classes of subscribers having contracts covered by §§ 23-85-101 — 23-85-131, and the form and content of all contracts between the corporation and its subscribers, classes of subscribers, or groups of subscribers, and the certificates issued by the corporation representing their subscribers' agreements shall be subject at all times to the prior approval of the Insurance Commissioner.
(2) Application for approval shall be made to the commissioner in such form and shall set forth such information as the commissioner may require.
(3) Rates shall not be excessive, inadequate, or unfairly discriminatory in relation to the services offered.
(4)(A) Upon the commissioner's review of an application at any time, if the applicant requests a hearing, the commissioner shall hold a hearing before issuing an order of disapproval. The applicant shall be given not less than ten (10) days' written notice of the hearing. The notice shall specify the matters to be considered at the hearing.
(B) If after the hearing provided by subdivision (a)(4)(A) of this section the commissioner finds that the application or a part thereof does not meet the requirements of this code, the commissioner shall issue an order specifying in what respects he or she finds that it fails. Notice thereof shall immediately be served on the applicant, either personally or by mail. Within thirty (30) days after the date of such a notice, the applicant may apply to the Pulaski County Circuit Court to show cause why the action of the commissioner should be set aside and the application approved.
(b)(1) In any hospital service corporation contract, any medical service corporation contract, or any hospital and medical service corporation contract, whether group or individual, that contains a provision whereby coverage of a dependent in a family group terminates at a specified age, there shall also be a provision that coverage of an unmarried dependent who is incapable of sustaining employment by reason of intellectual and developmental disability or physical disability, who became so incapacitated prior to the attainment of nineteen (19) years of age and who is chiefly dependent upon the contract holder or certificate holder for support and maintenance, shall not terminate, but coverage shall continue so long as the contract or certificate remains in force and so long as the dependent remains in such a condition.
(2) At the request and expense of the corporation, proof of the incapacity and dependency must be furnished to the corporation by the contract or certificate holder at least thirty-one (31) days before the child's attainment of the limiting age, and, subsequently, as may be required by the corporation, but not more frequently than annually, after the two-year period following the child's attainment of the limiting age.
(c)(1) Each contract shall plainly state the services to which the subscriber is entitled and those to which the subscriber is not entitled under the plan.
(2) As to benefits provided on a service, instead of cash indemnity basis, the contract shall constitute a direct obligation of the hospitals and physicians with which or with whom the corporation has contracted for hospital or medical services.
(3) A copy of the contract shall be delivered to the subscriber.
(d)(1) The commissioner shall review filings as soon as reasonably possible after they have been made in order to determine whether they meet the requirements of this chapter.
(2) Each filing shall be on file for a waiting period of thirty (30) days before it becomes effective. The period may be extended by the commissioner for an additional period not to exceed thirty (30) days if the commissioner gives written notice within the waiting period to the insurer which made the filing that the commissioner needs such additional time for the consideration of the filing.
(3) Upon written application by the insurer, the commissioner may authorize a filing which the commissioner has reviewed to become effective before the expiration of the waiting period or any extension thereof.
(4) A filing shall be deemed to meet the requirements of this chapter unless disapproved by the commissioner within the waiting period or any extension thereof.
Cross-references
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-85-101. Franchise plan — Definition.
(a) Accident and health insurance on a franchise plan is declared to be that form of accident and health insurance issued to:
(1) Five (5) or more employees of any corporation, copartnership, or individual employer or any governmental corporation, agency, or department thereof; or
(2) Ten (10) or more members, employees, or employees of members of any trade or professional association or of a labor union or of any other association having had an active existence for at least two (2) years when:
(A) The association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance; and
(B) Such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by the persons under an arrangement whereby the premiums on the policies may be paid to the insurer periodically by:
(i) The employer, with or without payroll deductions;
(ii) The association for its members; or
(iii) Some designated person acting on behalf of the employer or association or union.
(b) As used in this section, the term “employees” may be deemed to include officers, managers, and employees and retired employees of the employer and the individual proprietor or partners if the employer is an individual proprietor or partnership.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-85-101
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. The source passage cites 23-85-101. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-85-131. Age limit — Exception.
(a) If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective and if the date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after the date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased prior to the acceptance of the premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
(b)(1) In any accident and health insurance contract that contains a provision whereby coverage of a dependent in a family group terminates at a specified age, there shall also be a provision that coverage of an unmarried dependent who is incapable of sustaining employment by reason of intellectual and developmental disability or physical disability, who became so incapacitated prior to the attainment of nineteen (19) years of age, and who is chiefly dependent upon the policyholder for support and maintenance shall not terminate, but coverage shall continue so long as the contract remains in force and so long as the dependent remains in such condition.
(2) At the request and expense of the insurer, proof of the incapacity or dependency must be furnished to the insurer by the policyholder, except in no event shall this requirement preclude eligible dependents under this section and §§ 23-85-104, 23-8
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-85-131
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. The source passage cites 23-85-131. This identifies an authority to review, not proof of applicability.