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23-79-506. Powers.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-506. Powers.
(a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the general powers and authority granted under the laws of the State of Arkansas to health insurers and, in addition thereto, the specific authority to:
(A) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this subchapter;
(B) Sue or be sued, including taking any legal actions necessary or proper;
(C) Take such legal action as necessary, including without limitation:
(i) Avoiding the payment of improper claims against the pool or the coverage provided by or through the pool;
(ii) Recovering any amounts erroneously or improperly paid by the pool;
(iii) Recovering any amounts paid by the pool as a result of mistake of fact or law;
(iv) Recovering other amounts due the pool; or
(v) Coordinating legal action with the Insurance Commissioner to enforce the provisions of this subchapter;
(D)(i) Establish and modify from time to time as appropriate, rates, rate schedules, rate adjustments, expense allowances, agent referral fees, claim reserve formulas, deductibles, copayments, coinsurance, and any other actuarial function appropriate to the operation of the pool.
(ii) Rates and rate schedules may be adjusted for appropriate factors such as age, sex, and geographical variation in claim costs and shall take into consideration appropriate factors in accordance with established actuarial and underwriting practices;
(E) Issue policies of insurance in accordance with the requirements of this subchapter. All policy forms shall be subject to the approval of the commissioner;
(F) Authorize the plan administrator to prepare and distribute certificate of eligibility forms and enrollment instruction forms to agents and to the general pu
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-506
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:23-79-506
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 336a835069d2a9a82d51572be7b9f9039b13ab3efb5443e9f13c4b06e14c0793
Source location: content.xml paragraph 47033
Stored source content
23-79-506. Powers.
(a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the general powers and authority granted under the laws of the State of Arkansas to health insurers and, in addition thereto, the specific authority to:
(A) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this subchapter;
(B) Sue or be sued, including taking any legal actions necessary or proper;
(C) Take such legal action as necessary, including without limitation:
(i) Avoiding the payment of improper claims against the pool or the coverage provided by or through the pool;
(ii) Recovering any amounts erroneously or improperly paid by the pool;
(iii) Recovering any amounts paid by the pool as a result of mistake of fact or law;
(iv) Recovering other amounts due the pool; or
(v) Coordinating legal action with the Insurance Commissioner to enforce the provisions of this subchapter;
(D)(i) Establish and modify from time to time as appropriate, rates, rate schedules, rate adjustments, expense allowances, agent referral fees, claim reserve formulas, deductibles, copayments, coinsurance, and any other actuarial function appropriate to the operation of the pool.
(ii) Rates and rate schedules may be adjusted for appropriate factors such as age, sex, and geographical variation in claim costs and shall take into consideration appropriate factors in accordance with established actuarial and underwriting practices;
(E) Issue policies of insurance in accordance with the requirements of this subchapter. All policy forms shall be subject to the approval of the commissioner;
(F) Authorize the plan administrator to prepare and distribute certificate of eligibility forms and enrollment instruction forms to agents and to the general public;
(G) Provide and employ cost-containment measures and requirements, including without limitation preadmission screening, second surgical opinion, concurrent utilization review, and individual case management for the purposes of making the plan more cost effective;
(H) Design, utilize, contract, or otherwise arrange the delivery of cost-effective healthcare services, including establishing or contracting directly or through the plan administrator with preferred provider organizations, health maintenance organizations, physician hospital organizations, or other limited network provider arrangements;
(I) Borrow money to effect the purposes of the pool. Any notes or other evidence of indebtedness of the pool not in default shall be legal investments for insurers and may be carried as admitted assets;
(J) Pledge, assign, and grant a security interest in any of the assessments authorized by this subchapter or other assets of the pool in order to secure any notes or other evidences of indebtedness of the pool;
(K) Provide reinsurance of risks incurred by the pool;
(L) Provide additional types of plans to provide optional coverages, including Medicare supplement health insurance and health savings accounts that comply with applicable federal law as in effect January 1, 2005;
(M) Enter into reciprocal agreements with other comparable state plans in order to provide coverage for persons who move between states and are covered by such other states' plans; and
(N) Establish lifetime maximum benefits under § 23-79-510(a)(2)(W) for any person covered by a plan.
(2) In addition to the other powers granted by the Arkansas Insurance Code, the commissioner may impose, after notice and hearing in accordance with the provisions of the Arkansas Insurance Code, a monetary penalty upon any insurer or suspend or revoke the certificate of authority to transact insurance in the State of Arkansas of any insurer that fails to pay an assessment or otherwise file any report or furnish information required to be filed with the Board of Directors of the Arkansas Comprehensive Health Insurance Pool pursuant to the board's direction that the board believes is necessary in order for the board to perform its duties under this subchapter.
(b) All outstanding contracts executed by the Board of Directors of the State Comprehensive Health Insurance Pool created by Acts 1995, No. 1339, shall be deemed continuing obligations of the board created by this subchapter.
(c) As provided for in § 23-79-502, any health insurance benefit not provided for in this subchapter shall be deemed to be in conflict with and therefore inapplicable to the provisions of this subchapter.
Cross-references
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-502. Short title.
This subchapter may be cited as the “Comprehensive Health Insurance Pool Act”, and is amendatory to the Arkansas Insurance Code and the provisions of the Arkansas Insurance Code which are not in conflict with this subchapter are applicable to this subchapter.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-502
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 23-79-502. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-510. Outline of benefits.
(a)(1) Subject to the contractual policy form language adopted by the Board of Directors of the Arkansas Comprehensive Health Insurance Pool, expenses for the following services, supplies, drugs, or articles when prescribed by a physician and determined by the plan to be medically necessary shall be covered, subject to provisions of subsection (b) of this section:
(A) Hospital services;
(B) Professional services for the diagnosis or treatment of injuries, illnesses, or conditions, other than mental or dental, that are rendered by a physician or by other licensed professionals at his or her direction;
(C) Drugs requiring a physician's prescription;
(D) Skilled nursing services of a licensed skilled nursing facility for not more than one hundred twenty (120) days during a policy year;
(E) Services of a home health agency up to a maximum of two hundred seventy (270) services per year;
(F) Use of radium or other radioactive materials;
(G) Oxygen;
(H) Prostheses other than dental;
(I) Rental of durable medical equipment, other than eyeglasses and hearing aids, for which there is no personal use in the absence of the conditions for which such equipment is prescribed;
(J) Diagnostic X rays and laboratory tests;
(K) Oral surgery for excision of partially or completely unerupted, impacted teeth or the gums and tissues of the mouth when not performed in connection with the extraction or repair of teeth;
(L) Services of a physical therapist;
(M) Emergency and other medically necessary transportation provided by a licensed ambulance service to the nearest facility qualified to treat a covered condition;
(N) Services for diagnosis and treatment of mental and nervous disorders or chemical and drug dependency, provided that
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-510
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 23-79-510. This identifies an authority to review, not proof of applicability.