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23-86-312. Guaranteed availability of coverage for employers in the small-group market.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-312. Guaranteed availability of coverage for employers in the small-group market.
(a) Issuance of Coverage in the Small-Group Market — In General. Subject to subsections (b)-(e) of this section, each health insurance issuer that offers health insurance coverage in the small-group market in Arkansas:
(1) Must accept every small employer in Arkansas that applies for that health insurance coverage; and
(2) Must accept for enrollment under the health insurance coverage every eligible individual as defined in § 23-86-303(8) who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction which is inconsistent with § 23-86-306 on an eligible individual's being a participant or beneficiary.
(b)Special Rules for Network Plans.
(1) In General. In the case of a health insurance issuer that offers health insurance coverage in the small-group market through a network plan, the health insurance issuer may:
(A) Limit the employers that may apply for that health insurance coverage to those with eligible individuals who live, work, or reside in the service area for the network plan; and
(B) Within the service area of the network plan, deny that health insurance coverage to the employers if the health insurance issuer has demonstrated, if required, to the Insurance Commissioner that:
(i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and
(ii) It is applying this subsection uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents or any health status-relate
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-312
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:23-86-312
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 0032e54fe9b65247a2074aecad40868055da4ae348dd21c34f7087f29ad6fb4a
Source location: content.xml paragraph 52477
Stored source content
23-86-312. Guaranteed availability of coverage for employers in the small-group market.
(a) Issuance of Coverage in the Small-Group Market — In General. Subject to subsections (b)-(e) of this section, each health insurance issuer that offers health insurance coverage in the small-group market in Arkansas:
(1) Must accept every small employer in Arkansas that applies for that health insurance coverage; and
(2) Must accept for enrollment under the health insurance coverage every eligible individual as defined in § 23-86-303(8) who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction which is inconsistent with § 23-86-306 on an eligible individual's being a participant or beneficiary.
(b)Special Rules for Network Plans.
(1) In General. In the case of a health insurance issuer that offers health insurance coverage in the small-group market through a network plan, the health insurance issuer may:
(A) Limit the employers that may apply for that health insurance coverage to those with eligible individuals who live, work, or reside in the service area for the network plan; and
(B) Within the service area of the network plan, deny that health insurance coverage to the employers if the health insurance issuer has demonstrated, if required, to the Insurance Commissioner that:
(i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and
(ii) It is applying this subsection uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents or any health status-related factor relating to such employees and dependents.
(2) One-Hundred-Eighty-Day Suspension Upon Denial of Coverage. Upon denying health insurance coverage in any service area in accordance with subdivision (b)(1)(B) of this section, a health insurance issuer may not offer health insurance coverage in the small-group market within the service area in this state for a period of one hundred eighty (180) days after the date the health insurance coverage is denied.
(c)Application of Financial Capacity Limits.
(1) In General. A health insurance issuer may deny health insurance coverage in the small-group market in Arkansas if the health insurance issuer has demonstrated to the commissioner that:
(A) It does not have the financial reserves necessary to underwrite additional health insurance coverage; and
(B) It is applying this subdivision (c)(1) uniformly to all employers in the small-group market in Arkansas consistent with applicable Arkansas law and without regard to the claims experience of those employers and their employees and their dependents or any health status-related factor relating to such employees and dependents.
(2)One-Hundred-Eighty-Day Suspension Upon Denial of Health Insurance Coverage.
(A) Upon denying health insurance coverage in connection with group health plans in accordance with subdivision (c)(1) of this section, a health insurance issuer in Arkansas may not offer health insurance coverage in connection with group health plans in the small-group market in this state for a period of one hundred eighty (180) days after the date the health insurance coverage is denied or until the health insurance issuer has demonstrated to the commissioner that the health insurance issuer has sufficient financial reserves to underwrite additional health insurance coverage, whichever is later.
(B) The commissioner may provide for the application of this subsection on a service-area-specific basis.
(d) Exception to Requirement for Failure to Meet Certain Minimum Participation or Contribution Rules — In General. Subsection (a) of this section shall not be construed to preclude a health insurance issuer from establishing employer contribution rules or group participation rules for the offering of health insurance coverage in connection with a group health plan in the small-group market, as allowed under Arkansas law.
(e) Exception for Coverage Offered Only to Bona Fide Association Members. Subsection (a) of this section shall not apply to health insurance coverage offered by a health insurance issuer if the health insurance coverage is made available in the small-group market only through one (1) or more bona fide associations as defined in § 23-86-303(2).
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-303. Definitions.
As used in this subchapter:
(1) “Affiliation period” means a period that, under the terms of the coverage offered by the health maintenance organization, must expire before the coverage becomes effective;
(2) “Bona fide association” means, with respect to health insurance coverage offered in Arkansas, an association that:
(A) Has been actively in existence for at least five (5) years;
(B) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(C) Does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee;
(D) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members or individuals eligible for coverage through a member;
(E) Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and
(F) Meets the additional requirements that may be imposed under Arkansas law;
(3) “Church plan” has the meaning given the term under section 3(33) of the Employee Retirement Income Security Act of 1974 (ERISA);
(4) “COBRA continuation provision” means any of the following:
(A) Part 6 of Subtitle B of Title 1 of the Employee Retirement Income Security Act of 1974, other than section 609 of the act;
(B) Section 4980B of the Internal Revenue Code of 1986, other than subsection (f)(1) of the section insofar as it relates to pediatric vaccines;
(C) Title XXII of the Public Health Service Act;
(5) “Commissioner” means the Insurance Commissioner;
(6) “Creditable coverage” means, with respect to an individual,
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-303
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 23-86-303. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-306. Prohibiting discrimination against individual participants and beneficiaries based on health status.
(a)Ineligibility to Enroll.
(1) In General. Subject to subdivision (a)(2) of this section, a group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan may not establish rules for eligibility including continued eligibility of any individual to enroll under the terms of the group health plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(A) Health status;
(B) Medical condition, including both physical and mental illnesses;
(C) Claims experience;
(D) Receipt of health care;
(E) Medical history;
(F) Genetic information;
(G) Evidence of insurability including conditions arising out of acts of domestic violence; or
(H) Disability.
(2) No Application to Benefits or Exclusions. To the extent consistent with § 23-86-304, subdivision (a)(1) of this section shall not be construed:
(A) To require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of such a group health plan or group health insurance coverage; or
(B) To prevent such a group health plan or group health insurance coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the group health plan or group health insurance coverage.
(3) Construction. For purposes of subdivision (a)(1) of this section, rules for eligibility to enroll under a group health plan include rules defining any applicable waiting periods for such enrollment.
(b)In Premium Con
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-306
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 23-86-306. This identifies an authority to review, not proof of applicability.