23-86-404. Optional health benefit plans.

Arkansas Code — all titles (historical 2020) · legal_authorities

23-86-404. Optional health benefit plans.

23-86-404. Optional health benefit plans. (a) A health maintenance organization may offer and issue health benefit plans that reimburse or arrange for covered healthcare services to covered persons through a limited network plan if: (1) The health maintenance organization provides itself, or arranges through an insurance company, for an annual option for covered persons to choose a health benefit plan or a point-of-service plan that reimburses or arranges for the covered healthcare services from any healthcare provider qualified to render the covered healthcare services; (2) The difference in the benefit level of the optional health benefit plan or point-of-service plan shall not exceed twenty-five percent (25%) of the benefit level under the limited benefit plan; (3) The employer or other group contract holder contracting with the health maintenance organization for a health benefit plan shall provide an equal contribution per covered person regardless of which option the covered person chooses pursuant to the provisions of this subchapter; and (4) Under the optional health benefit plan or point-of-service plan, the rate of reimbursement for healthcare providers out of the network shall be no higher than the normal and usual and customary rate charged by those out-of-network providers on a regular basis, provided that copayment, coinsurance, and other cost-sharing features may be different for out-of-network providers and in-network providers. (b)(1) The pricing of the optional health benefit plan or point-of-service plan must provide an expected incurred loss ratio of not less than eighty percent (80%). (2) The Insurance Commissioner shall promulgate rules as may be necessary to implement the provisions of this subchapter and to ensure that the price of

Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-404

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.