AR Code § 23-61-1003 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 61 - State Insurance Department|Subchapter 10 - Arkansas Works Act of 2016|§ 23-61-1003. Definitions

 As used in this subchapter:   (1) “Cost-effective” means that the cost of covering employees who are:  (A) Program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through individual qualified health insurance plans; or  (B) Eligible individuals who are not program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through a program authorized under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as it existed on January 1, 2016;    (2) “Cost sharing” means the portion of the cost of a covered medical service that is required to be paid by or on behalf of an eligible individual;  (3) “Eligible individual” means an individual who is in the eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a;  (4) “Employer health insurance coverage” means a health insurance benefit plan offered by an employer or, as authorized by this subchapter, an employer self-funded insurance plan governed by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;  (5) “Health insurance benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, but not including excepted benefits as defined under 42 U.S.C. § 300gg-91(c), as it existed on January 1, 2016;  (6) “Health insurance marketplace” means the applicable entities that were designed to help individuals, families, and businesses in Arkansas shop for and select health insurance benefit plans in a way that permits comparison of available plans based upon price, benefits, services, and quality, and refers to either:  (A) The Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., or a successor entity; or  (B) The federal health insurance marketplace or federal health benefit exchange created under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148;    (7) “Health insurer” means an insurer authorized by the State Insurance Department to provide health insurance or a health insurance benefit plan in the State of Arkansas, including without limitation:  (A) An insurance company;  (B) A medical services plan;  (C) A hospital plan;  (D) A hospital medical service corporation;  (E) A health maintenance organization;  (F) A fraternal benefits society; or  (G) Any other entity providing health insurance or a health insurance benefit plan subject to state insurance regulation;    (8) “Individual qualified health insurance plan” means an individual health insurance benefit plan offered by a health insurer through the health insurance marketplace that covers only essential health benefits as defined by Arkansas rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they existed on January 1, 2016;  (9) “Premium” means a monthly fee that is required to be paid to maintain some or all health insurance benefits;  (10) “Program participant” means an eligible individual who:  (A) Is at least nineteen (19) years of age and no more than sixty-four (64) years of age with an income that meets the income eligibility standards established by rule of the Department of Human Services;  (B) Is authenticated to be a United States citizen or documented qualified alien according to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193;  (C) Is not eligible for Medicare or advanced premium tax credits through the health insurance marketplace; and  (D) Is not determined to be more effectively covered through the traditional Arkansas Medicaid Program, including without limitation:  (i) An individual who is medically frail; or  (ii) An individual who has exceptional medical needs for whom coverage offered through the health insurance marketplace is determined to be impractical, overly complex, or would undermine continuity or effectiveness of care; and      (11)  (A) “Small group plan” means a health insurance benefit plan for a small employer that employed an average of at least two (2) but no more than fifty (50) employees during the preceding calendar year.  (B) “Small group plan” does not include a grandfathered health insurance plan as defined in 45 C.F.R. § 147.140(a)(1)(i), as it existed on January 1, 2016.