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23-86-314. Exclusion of certain plans.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-314. Exclusion of certain plans.
(a) Exception for Certain Small Group Health Plans. The requirements of § 23-86-304, limitation on preexisting conditions, § 23-86-306, prohibiting discrimination based on health status, § 23-86-311, guaranteed renewability, § 23-86-312, guaranteed availability, and § 23-86-313, disclosure of information, of this subchapter shall not apply to any group health plan and health insurance coverage offered in connection with a group health plan for any group health plan year if, on the first day of the group health plan year, the group health plan has fewer than two (2) participants who are current employees.
(b)Limitation on Application of Provisions Relating to Group Health Plans.
(1) In General. The requirements of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 shall apply with respect to group health plans only:
(A) Subject to subdivision (b)(2) of this section, in the case of a group health plan that is a nonfederal governmental plan; and
(B) With respect to health insurance coverage offered in connection with a group health plan including such a plan that is a church plan or a governmental plan.
(2)Treatment of Nonfederal Governmental Plans.
(A) Election to be Excluded. If the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 otherwise apply makes an election under this subdivision (b)(2)(A), then the requirements of those sections insofar as they apply directly to group health plans, and not merely to group health insurance coverage, shall not apply to the governmental plans for such a period except as provided in this subsection.
(B) Period of Election. An election under subdivision (b)(2)(A) of this sec
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-314
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:23-86-314
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 1ebeede1af92edd182f183caabf1f5c967ae281f303b65a1badb46f129411f15
Source location: content.xml paragraph 52515
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23-86-314. Exclusion of certain plans.
(a) Exception for Certain Small Group Health Plans. The requirements of § 23-86-304, limitation on preexisting conditions, § 23-86-306, prohibiting discrimination based on health status, § 23-86-311, guaranteed renewability, § 23-86-312, guaranteed availability, and § 23-86-313, disclosure of information, of this subchapter shall not apply to any group health plan and health insurance coverage offered in connection with a group health plan for any group health plan year if, on the first day of the group health plan year, the group health plan has fewer than two (2) participants who are current employees.
(b)Limitation on Application of Provisions Relating to Group Health Plans.
(1) In General. The requirements of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 shall apply with respect to group health plans only:
(A) Subject to subdivision (b)(2) of this section, in the case of a group health plan that is a nonfederal governmental plan; and
(B) With respect to health insurance coverage offered in connection with a group health plan including such a plan that is a church plan or a governmental plan.
(2)Treatment of Nonfederal Governmental Plans.
(A) Election to be Excluded. If the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 otherwise apply makes an election under this subdivision (b)(2)(A), then the requirements of those sections insofar as they apply directly to group health plans, and not merely to group health insurance coverage, shall not apply to the governmental plans for such a period except as provided in this subsection.
(B) Period of Election. An election under subdivision (b)(2)(A) of this section shall apply:
(i) For a single specified plan year; or
(ii) In the case of a plan provided pursuant to a collective bargaining agreement, for the term of the agreement. An election under subdivision (b)(2)(B)(i) of this section may be extended through subsequent elections under this subdivision (b)(2)(B).
(C) Notice to Enrollees. Under such an election, the plan shall provide for:
(i) Notice to enrollees on an annual basis and at the time of enrollment under the plan of the fact and consequences of such an election; and
(ii) Certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with § 23-86-304(e).
(c) Exception for Certain Benefits. The requirements of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 shall not apply to any group health plan or group health insurance coverage in relation to its provision of excepted benefits described in § 23-86-310(a)(1).
(d)Exception for Certain Benefits if Certain Conditions Met.
(1) Limited, Excepted Benefits. The requirements of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 shall not apply to any group health plan or group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in § 23-86-310(b) if the benefits:
(A) Are provided under a separate policy, certificate, or contract of insurance; or
(B) Are otherwise not an integral part of the group health plan.
(2) Noncoordinated, Excepted Benefits. The requirements of §§ 23-86-304, 23-86-306, and 23-86-311 — 23-86-313 shall not apply to any group health plan or group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in § 23-86-310(c) if all of the following conditions are met:
(A) The benefits are provided under a separate policy, certificate, or contract of insurance;
(B) There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor; and
(C) 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.
(3) Supplemental Excepted Benefits. The requirements of this subsection shall not apply to any group health plan or group health insurance coverage in relation to its provision of excepted benefits described in § 23-86-310(d) if the benefits are provided under a separate policy, certificate, or contract of insurance.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-304. Increased portability through limitation on preexisting conditions exclusions.
(a) Limitation on Preexisting Condition Exclusion Period — Crediting for Periods of Previous Coverage. Subject to subsection (d) of this section, a group health plan and a health insurance issuer offering group health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if:
(1) The preexisting condition exclusion relates to a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date;
(2) The preexisting condition exclusion extends for a period of not more than twelve (12) months, or eighteen (18) months in the case of a late enrollee, after the enrollment date; and
(3) The period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage, if any, as defined in subdivision (c)(1) of this section, applicable to the participant or beneficiary as of the enrollment date.
(b) Treatment of Genetic Information. Genetic information shall not be treated as a condition described in subdivision (a)(1) of this section in the absence of a diagnosis of the condition related to that information.
(c)Creditable Coverage — Rules Relating to Crediting Previous Coverage.
(1)Not Counting Periods Before Significant Breaks in Coverage.
(A) In General. A period of creditable coverage shall not be counted, with respect to enrollment of an individual under a group health plan, if, after such a period and before the enrollment date, there was a sixty-three-day period during all of which the individual was not covered u
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-304
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 23-86-304. 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.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-311. Guaranteed renewability of coverage for employers in the group market.
(a) In General. Except as provided in this section, if a health insurance issuer offers health insurance coverage in the small-group market or the large-group market in connection with a group health plan, the issuer must renew or continue in force that coverage at the option of the plan sponsor.
(b) General Exceptions. A health insurance issuer may nonrenew or discontinue health insurance coverage offered in connection with a group health plan in the small-group market or the large-group market based only on one (1) or more of the following:
(1) Nonpayment of Premiums. The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the health insurance issuer has not received timely premium payments;
(2) Fraud. The plan sponsor has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;
(3) Violation of Participation or Contribution Rules. The plan sponsor has failed to comply with a material plan provision relating to employer contribution or group participation rules in the case of the small-group market or pursuant to applicable Arkansas law in the case of the large-group market;
(4) Termination of Coverage. The issuer is ceasing to offer coverage in such a market in accordance with subsection (c) of this section and applicable state law;
(5) Movement Outside Service Area. In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, there is no longer any enrollee in connection with the network plan who lives, resides, or works in the service area of the heal
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-311
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 23-86-311. This identifies an authority to review, not proof of applicability.
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. The source passage cites 23-86-312. This identifies an authority to review, not proof of applicability.