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23-98-110. Approval of forms and rates.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-98-110. Approval of forms and rates.
(a) All minimum basic benefit policy forms, including applications, enrollment forms, policies, certificates, evidences of coverage, riders, amendments, endorsements, disclosure forms, and marketing communications used in connection with the sale or advertisement of a minimum basic benefit policy shall be submitted to the Insurance Commissioner for approval in the same manner as required by § 23-79-109(a) or § 23-76-112(a).
(b) Minimum basic benefit policies are subject to the filing and approval statutes and rules of the state. No rate shall be considered reasonable nor shall it be approved unless:
(1) It is based upon a pool, community rating, or other rating formula acceptable to the commissioner; and
(2)(A) As to individual policies and policies issued to qualified trusts, it is likely to produce a loss ratio, as certified by a qualified actuary, which is acceptable to the commissioner, but in no event shall such a loss ratio be less than sixty-five percent (65%).
(B) However, the commissioner may set a minimum loss ratio for group policies issued pursuant to this chapter if the commissioner determines that inequitable or unfair treatment of policyholders would otherwise result.
(c) To the extent that an insurer has a surplus in a given year which has been generated on minimum basic benefit policies issued pursuant to this chapter to a qualified group by a loss ratio of less than seventy-five percent (75%) or issued pursuant to this chapter to qualified individuals, qualified families, or qualified trusts by a loss ratio of less than sixty-five percent (65%), that surplus shall be taken into consideration in setting rates in following years in such manner as to benefit the holders of such minimum basic benefit poli
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-98-110
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:23-98-110
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 0fb478ce036d242de81c6dd99c83779bd3af0bd2d77229c81e8ddf7065e7b9a6
Source location: content.xml paragraph 58289
Stored source content
23-98-110. Approval of forms and rates.
(a) All minimum basic benefit policy forms, including applications, enrollment forms, policies, certificates, evidences of coverage, riders, amendments, endorsements, disclosure forms, and marketing communications used in connection with the sale or advertisement of a minimum basic benefit policy shall be submitted to the Insurance Commissioner for approval in the same manner as required by § 23-79-109(a) or § 23-76-112(a).
(b) Minimum basic benefit policies are subject to the filing and approval statutes and rules of the state. No rate shall be considered reasonable nor shall it be approved unless:
(1) It is based upon a pool, community rating, or other rating formula acceptable to the commissioner; and
(2)(A) As to individual policies and policies issued to qualified trusts, it is likely to produce a loss ratio, as certified by a qualified actuary, which is acceptable to the commissioner, but in no event shall such a loss ratio be less than sixty-five percent (65%).
(B) However, the commissioner may set a minimum loss ratio for group policies issued pursuant to this chapter if the commissioner determines that inequitable or unfair treatment of policyholders would otherwise result.
(c) To the extent that an insurer has a surplus in a given year which has been generated on minimum basic benefit policies issued pursuant to this chapter to a qualified group by a loss ratio of less than seventy-five percent (75%) or issued pursuant to this chapter to qualified individuals, qualified families, or qualified trusts by a loss ratio of less than sixty-five percent (65%), that surplus shall be taken into consideration in setting rates in following years in such manner as to benefit the holders of such minimum basic benefit policies.
(d)(1) The commissioner may require that as to each minimum basic benefit policy approved, the insurer provide a statement of the portion of the rate or premium applicable to the minimum basic benefit policy coverage required by this chapter, or the commissioner pursuant to this chapter, or such other information as the commissioner may require so that prospective purchasers of policies pursuant to this chapter may have an ability to make a direct comparison of the cost of the minimum basic benefits within policies of the same class issued by different insurers.
(2) The commissioner may include rate comparison or other cost information in the form of notice which may be provided by the commissioner to employers pursuant to this chapter.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-112. Evidence of coverage and charges for healthcare services.
(a)(1)(A) Every enrollee residing in this state is entitled to evidence of coverage under a healthcare plan.
(B) If the enrollee obtains coverage under a healthcare plan through an insurance policy or a contract issued by a hospital and medical service corporation, whether by option or otherwise, the insurer or the hospital and medical service corporation shall issue the evidence of coverage. Otherwise, the health maintenance organization shall issue the evidence of coverage.
(2) No evidence of coverage, or amendment thereto, shall be issued or delivered to any person in this state until a copy of the form of the evidence of coverage, or amendment thereto, has been filed with and approved by the Insurance Commissioner.
(3) An evidence of coverage shall contain:
(A) No provisions or statements that:
(i) Are unjust, unfair, inequitable, misleading, or deceptive;
(ii) Encourage misrepresentation; or
(iii) Are untrue, misleading, or deceptive as defined in § 23-76-119; and
(B) A clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:
(i) The healthcare services and the insurance or other benefits, if any, to which the enrollee is entitled under the healthcare plan;
(ii) Any limitations on the services, kind of services, benefits, or kind of benefits, to be provided, including any deductible or copayment feature;
(iii) Where and in what manner information is available as to how services may be obtained;
(iv) The total amount of payment for healthcare services and the indemnity or service benefits, if any, that the enrollee is obligated to pay with respect to individual contracts, or an indication whether the plan is contributory or noncont
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-112
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 23-76-112. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-109. Filing and approval of forms — Definitions.
(a)(1)(A)(i) No basic insurance policy, or annuity contract form, or application form when written application is required and is to be made a part of the policy or contract, or printed rider or endorsement form or form of renewal certificate, shall be issued, delivered, or used as to a subject of insurance resident, located, or to be performed in this state unless the form has been filed with and approved by the Insurance Commissioner and, in the case of individual accident and health contracts, the rates have been filed with and approved by the commissioner.
(ii)(a) The commissioner may consider a nonprofit insurer's surplus levels in determining whether a proposed rate is excessive.
(b) Subdivision (a)(1)(A)(ii)(a) of this section does not apply to a nonprofit insurer that offers only limited scope dental benefits.
(B) This subsection shall not apply to:
(i) Policy or coverage forms for large commercial risks, as defined in subsection (g) of this section;
(ii) Commercial umbrella policy or coverage forms;
(iii) Excess umbrella policy or coverage forms;
(iv) Excess of loss policy or coverage forms;
(v) Public officials' liability policy or coverage forms;
(vi) Fiduciary liability policy or coverage forms;
(vii) Directors' and officers' liability policy or coverage forms;
(viii) Kidnap and ransom policy or coverage forms;
(ix) Political risk policy or coverage forms;
(x) Expropriation coverage policy or coverage forms;
(xi) Mortgage pool insurance policy or coverage forms;
(xii) Railroad protective liability policy or coverage forms;
(xiii) Equity loan programs, second mortgage coverage, policy or coverage forms;
(xiv) Highly protected risk forms;
(xv) Surety bonds;
(xvi) Po
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-109
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 23-79-109. This identifies an authority to review, not proof of applicability.