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23-76-123. Suspension or revocation of certificate of authority.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-123. Suspension or revocation of certificate of authority.
(a) The Insurance Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if the commissioner finds that any of the following conditions exist:
(1) The health maintenance organization is operating in contravention of its basic organizational document, its healthcare plan, or in a manner contrary to that described in and reasonably inferred from any other information submitted under § 23-76-107, unless amendments to the submissions have been filed with and approved by the commissioner;
(2) The health maintenance organization issues evidence of coverage or uses a schedule of charges for healthcare services which do not comply with the requirements of § 23-76-112;
(3) The healthcare plan does not provide or arrange for basic healthcare services;
(4) The health maintenance organization:
(A) Does not meet the requirements of § 23-76-108; or
(B) Is unable to fulfill its obligations to furnish healthcare services as required under its healthcare plan;
(5) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(6) The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under § 23-76-110;
(7) The health maintenance organization has failed to implement the complaint system required by § 23-76-116 in a manner to reasonably resolve valid complaints;
(8) The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, mislead
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-123
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:23-76-123
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 548af273b7ee2072ec142e1dfcbd30aa8e05e3bc7f0f53d8885e72a974556853
Source location: content.xml paragraph 43915
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23-76-123. Suspension or revocation of certificate of authority.
(a) The Insurance Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if the commissioner finds that any of the following conditions exist:
(1) The health maintenance organization is operating in contravention of its basic organizational document, its healthcare plan, or in a manner contrary to that described in and reasonably inferred from any other information submitted under § 23-76-107, unless amendments to the submissions have been filed with and approved by the commissioner;
(2) The health maintenance organization issues evidence of coverage or uses a schedule of charges for healthcare services which do not comply with the requirements of § 23-76-112;
(3) The healthcare plan does not provide or arrange for basic healthcare services;
(4) The health maintenance organization:
(A) Does not meet the requirements of § 23-76-108; or
(B) Is unable to fulfill its obligations to furnish healthcare services as required under its healthcare plan;
(5) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(6) The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under § 23-76-110;
(7) The health maintenance organization has failed to implement the complaint system required by § 23-76-116 in a manner to reasonably resolve valid complaints;
(8) The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;
(9) The continued operation of the health maintenance organization would be hazardous to its enrollees; or
(10) The health maintenance organization has otherwise failed to substantially comply with this chapter.
(b) A certificate of authority shall be suspended or revoked only after compliance with the requirements of § 23-76-126.
(c) When the certificate of authority of a health maintenance organization is suspended, during the period of the suspension the health maintenance organization shall not:
(1) Enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees; and
(2) Engage in any advertising or solicitation whatsoever.
(d)(1) When the certificate of authority of a health maintenance organization is revoked, the health maintenance organization shall:
(A) Proceed to wind up its affairs immediately following the effective date of the order of revocation;
(B) Conduct no further business except as may be essential to the orderly conclusion of the affairs of the health maintenance organization; and
(C) Engage in no further advertising or solicitation whatsoever.
(2) By written order, the commissioner may permit the further operation of the health maintenance organization as the commissioner may find to be in the best interest of enrollees, to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing healthcare coverage.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-107. Establishment.
(a)(1) Any person that meets the requirements of § 23-76-102(9) may apply to the Insurance Commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization.
(2) No person shall establish or operate a health maintenance organization in this state, nor sell or offer to sell, nor solicit offers to purchase or receive advance or periodic consideration in conjunction with a health maintenance organization without obtaining a certificate of authority under this chapter.
(3) The corporation must have the express authority to operate a health maintenance organization contained in its articles of incorporation. Incorporation shall not be required of any entity that has been issued a certificate of authority prior to March 30, 1987.
(b)(1) Every health maintenance organization, as of July 9, 1975, shall submit an application for a certificate of authority under subsection (c) of this section within sixty (60) days of July 9, 1975.
(2) Each applicant may continue to operate until the commissioner acts upon the application.
(3) In the event that an application is denied under § 23-76-108, the applicant shall henceforth be treated as a health maintenance organization whose certificate of authority has been revoked.
(c) Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the commissioner, and shall set forth or be accompanied by the following:
(1) A copy of the basic organizational document, if any, of the applicant, such as the articles of incorporation, articles of association, partnership agreement, trust agreement, or other applicable documents, and all amendments thereto;
(2) A cop
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-107
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 23-76-107. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-108. Issuance of certificate of authority.
(a) Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall determine whether the applicant furnishes or proposes to furnish adequate and accessible healthcare services for its healthcare plans subject to the requirements or rules of the State Insurance Department.
(b) The commissioner shall issue a certificate of authority to any person filing an application pursuant to § 23-76-107 within sixty (60) days of receipt of the application if the commissioner is satisfied that:
(1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;
(2) The health maintenance organization's proposed plan of operation meets the requirements of subsection (a) of this section;
(3) The healthcare plan will allow the health maintenance organization effectively to provide or arrange for the provision of basic healthcare services through insurance or otherwise on a prepaid basis, subject to reasonable requirements for copayments;
(4) The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees;
(5) The healthcare plan's arrangements for healthcare services and the schedule of charges for use therewith are financially sound and reasonable;
(6) Any agreements with insurers, hospitals, medical service corporations, governmental entities, or any other organizations for insuring the payment of the cost of healthcare services or the provision for automatic applicability of alternative coverage in the event of discontinuance of the healthcare plan are reasonable and adequate;
(7) Agreements with providers for the prov
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-108
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 23-76-108. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-110. Advisory board.
(a) The advisory board of any health maintenance organization shall include at least one (1) physician, one (1) dentist, one (1) pharmacist, one (1) nurse, one (1) consumer, and one (1) enrollee.
(b) The advisory board shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.
(c) The advisory board shall not be deemed to be the governing body of the health maintenance organization licensed under this chapter.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-110
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 23-76-110. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-112. Evidence of coverage and charges for healthcare services.
(a)(1)(A) Every enrollee residing in this state is entitled to evidence of coverage under a healthcare plan.
(B) If the enrollee obtains coverage under a healthcare plan through an insurance policy or a contract issued by a hospital and medical service corporation, whether by option or otherwise, the insurer or the hospital and medical service corporation shall issue the evidence of coverage. Otherwise, the health maintenance organization shall issue the evidence of coverage.
(2) No evidence of coverage, or amendment thereto, shall be issued or delivered to any person in this state until a copy of the form of the evidence of coverage, or amendment thereto, has been filed with and approved by the Insurance Commissioner.
(3) An evidence of coverage shall contain:
(A) No provisions or statements that:
(i) Are unjust, unfair, inequitable, misleading, or deceptive;
(ii) Encourage misrepresentation; or
(iii) Are untrue, misleading, or deceptive as defined in § 23-76-119; and
(B) A clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:
(i) The healthcare services and the insurance or other benefits, if any, to which the enrollee is entitled under the healthcare plan;
(ii) Any limitations on the services, kind of services, benefits, or kind of benefits, to be provided, including any deductible or copayment feature;
(iii) Where and in what manner information is available as to how services may be obtained;
(iv) The total amount of payment for healthcare services and the indemnity or service benefits, if any, that the enrollee is obligated to pay with respect to individual contracts, or an indication whether the plan is contributory or noncont
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-112
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 23-76-112. This identifies an authority to review, not proof of applicability.