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23-98-102. Definitions.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-98-102. Definitions.
As used in this chapter:
(1) “Children's preventive healthcare services” means physician-delivered or physician-supervised services for eligible dependents from birth through age six (6), with periodic physical examinations including medical history, physical examination, developmental assessment, anticipatory guidance and appropriate immunizations, and laboratory tests, in keeping with prevailing medical standards for the purposes of this section;
(2) “COBRA” means the “Consolidated Omnibus Budget Reconciliation Act of 1985”;
(3) “Commissioner” means the Insurance Commissioner;
(4) “Insured” means any individual or group insured under a minimum basic benefit policy issued pursuant to the provisions of this chapter;
(5) “Insurer” means an insurer, health maintenance organization, hospital, or medical service corporation offering a minimum basic benefit policy pursuant to this chapter;
(6) “Loss ratio” means the percentage derived by dividing incurred claims, both reported and not reported, by total premiums earned;
(7) “Minimum basic benefit policy” means a policy or subscription contract which an insurer may choose to offer to a qualified individual, qualified family, or qualified group pursuant to the provisions of this chapter;
(8) “Periodic physical examinations” means the routine tests and procedures for the purpose of detection of abnormalities or malfunctions of bodily systems and parts according to accepted medical practice;
(9) “Permitted coverages” means health or hospitalization coverage under a minimum basic benefit policy issued pursuant to this chapter, under Medicaid, Medicare, limited benefit policies as defined by rules of the commissioner, the Consolidated Omnibus Budget Reconciliation Act of 1985, or the prov
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-98-102
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:23-98-102
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 17251d559d74059489b0951ad5b2b2435165e1d33308f2cee0972b968db14c8a
Source location: content.xml paragraph 58135
Stored source content
23-98-102. Definitions.
As used in this chapter:
(1) “Children's preventive healthcare services” means physician-delivered or physician-supervised services for eligible dependents from birth through age six (6), with periodic physical examinations including medical history, physical examination, developmental assessment, anticipatory guidance and appropriate immunizations, and laboratory tests, in keeping with prevailing medical standards for the purposes of this section;
(2) “COBRA” means the “Consolidated Omnibus Budget Reconciliation Act of 1985”;
(3) “Commissioner” means the Insurance Commissioner;
(4) “Insured” means any individual or group insured under a minimum basic benefit policy issued pursuant to the provisions of this chapter;
(5) “Insurer” means an insurer, health maintenance organization, hospital, or medical service corporation offering a minimum basic benefit policy pursuant to this chapter;
(6) “Loss ratio” means the percentage derived by dividing incurred claims, both reported and not reported, by total premiums earned;
(7) “Minimum basic benefit policy” means a policy or subscription contract which an insurer may choose to offer to a qualified individual, qualified family, or qualified group pursuant to the provisions of this chapter;
(8) “Periodic physical examinations” means the routine tests and procedures for the purpose of detection of abnormalities or malfunctions of bodily systems and parts according to accepted medical practice;
(9) “Permitted coverages” means health or hospitalization coverage under a minimum basic benefit policy issued pursuant to this chapter, under Medicaid, Medicare, limited benefit policies as defined by rules of the commissioner, the Consolidated Omnibus Budget Reconciliation Act of 1985, or the provisions of § 23-86-114, § 23-86-115, or § 23-86-116;
(10) “Qualified family” means individuals all of whom are qualified individuals and all of whom are related by blood, marriage, or adoption;
(11) “Qualified group” means a group, organized other than pursuant to § 23-98-109, in which each covered individual, or covered dependent of such a covered individual, within the group is a qualified individual. A qualified group may include less than all employees of an employer;
(12)(A) “Qualified individual” means an individual who is employed in or is a resident of Arkansas and who has been without health insurance coverage, other than permitted coverage, for the twelve-month period immediately preceding the effective date of a minimum basic benefit policy issued pursuant to this chapter and who meets reasonable underwriting standards.
(B) However, children newborn to or adopted by an insured after the effective date of a policy issued to the insured pursuant to this chapter which covers the insured and members of the insured's family, shall be considered qualified individuals; and
(13) “Qualified trust” means a group organized pursuant to § 23-98-104 in which each covered individual, or covered dependent of such a covered individual, within the group is a qualified individual.
Cross-references
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-114. Group accident and health insurance — Continuation of coverage beyond termination of employment, change in marital status, etc.
(a) Every group accident and health insurance policy, contract, or certificate providing hospital, surgical, or major medical coverage, other than accident only or specified disease policies, shall contain a provision that any certificate holder, member, or spouse whose coverage under the policy would otherwise terminate due to termination of employment or membership or a change in marital status may continue coverage under the policy for themselves and their eligible dependents as provided in this section.
(b) The continued coverage need not include benefits for dental care, vision services, or prescription drug expenses.
(c)(1) Continuation of coverage shall be available only to individuals who have been insured continuously under the group policy during the three-month period prior to the termination of employment membership or change in marital status.
(2) Continuation of coverage shall not be available to an individual who is eligible for:
(A) Federal Medicare coverage; or
(B)(i) Full coverage under any other group accident and health policy or contract.
(ii) This coverage must provide benefits for all preexisting conditions to be considered full coverage.
(iii) Accordingly, under this subdivision (c)(2), an individual may continue his or her previous group coverage until all preexisting conditions are covered or would be covered under another group policy or contract or until termination pursuant to subsection (f) of this section or pursuant to the applicable provisions of federal law.
(d) An individual who wishes to continue coverage must request continuation in writing not later than ten (10) days after the
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-114
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 23-86-114. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-115. Group accident and health insurance — Entitlement to conversion policy upon termination of group policy.
(a)(1) Every group policy, contract, or certificate of accident and health insurance delivered or issued for delivery in this state that provides hospital, surgical, or major medical coverage on an expense-incurred basis, other than coverage limited to expenses from accidents or specified diseases, shall provide that an employee, member, or covered dependent whose insurance under the group policy has been terminated for any reason, including the discontinuance of the group policy in its entirety, shall be entitled to have issued to him or her by the insurer a policy of accident and health insurance referred to in this section as a “conversion policy”.
(2) An employee, member, or dependent shall not be entitled to a conversion policy, if the termination of the group policy, contract, or certificate was a result of his or her failure to pay any required contribution or if the terminated policy is replaced by similar coverage within thirty-one (31) days.
(3) An individual wishing to exercise his or her conversion privilege must apply for the conversion policy in writing not later than thirty (30) days after the termination of the group coverage.
(b)(1)(A) The conversion policy shall provide coverage equal to or greater than the minimum standards established by the Insurance Commissioner.
(B) All conversion policies shall contain a wording in bold print that “the benefits in this policy do not necessarily equal or match those benefits provided in your previous group policy”.
(2) The conversion policy shall not exclude coverage for pregnancy or other illness or injury on the grounds of a preexisting condition, provided that the combination of time s
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-115
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 23-86-115. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-116. Continuation of benefits upon termination of policy.
(a) Every group accident and health insurance policy, contract, or certificate that provides coverage for hospital or medical services or expenses shall provide that the insurer shall continue its obligation for benefits under the policy or contract for any person insured under the policy or contract who is hospitalized on the date of termination, if the policy or contract is terminated and replaced by a group health insurance policy or contract issued by another insurer or by a self-funded healthcare plan.
(b) Any payment required under this section is subject to all terms, limitations, and conditions of the policy or contract except those relating to termination of benefits. Any obligation by an insurer under this section continues until the hospital confinement ends or hospital benefits under the policy or contract are exhausted, whichever is earlier.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-116
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 23-86-116. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-98-109. Managed care and cost control provisions.
(a) The insurer may include any or all of the following managed care provisions to control the cost of a minimum basic benefit policy issued pursuant to this chapter:
(1) An exclusion for services that are not medically necessary;
(2) A procedure for preauthorization by telephone, to be confirmed in writing, by the insurer or its designee of any medical service, the cost of which is anticipated to exceed a minimum threshold, except for services necessary to treat a medical emergency;
(3)(A) A preferred panel of providers who have entered into written agreements with the insurer to provide services at specified levels of reimbursement.
(B) With the exception of health maintenance organizations, participation in such a preferred panel shall be open to all providers licensed to provide the services to be covered.
(C)(i) Any such written agreement between a provider and an insurer shall contain a provision under which the parties agree that the insured individual or covered member will have no obligation to make payment for any medical service rendered by the provider that is determined not to be medically necessary.
(ii) However, charges for medically necessary services received by the insured which are not covered by the minimum basic benefit policy shall be considered the responsibility of the insured; and
(4)(A) A provision under which any insured who obtains medical services from a nonpreferred provider shall receive reimbursement only in the amount that would have been received had services been rendered by a preferred provider, less a differential, if any, in an amount to be approved by the Insurance Commissioner but which may not exceed twenty-five percent (25%).
(B) However, charges for medicall
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-98-109
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 23-98-109. This identifies an authority to review, not proof of applicability.