reglab/statecodes huggingface dataset:
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-306 - Extraterritorial jurisdiction - Group long-term care insurance

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state determines that the definition of "group long-term care insurance" under §
23-97-304
has been met.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-307 - Disclosure and performance standards for long-term care insurance

(a)
The Insurance Commissioner may adopt rules for long-term care insurance that include, but are not limited to, standards for full and fair disclosure addressing:
(1)
The manner, content, and required disclosures for the sale of long-term care insurance policies;
(2)
Terms of renewability;
(3)
Initial and subsequent conditions of eligibility;
(4)
Nonduplication of coverage provisions;
(5)
Coverage of dependents;
(6)
Preexisting conditions;
(7)
Termination of insurance;
(8)
Continuation or conversion of coverage;
(9)
Probationary periods;
(10)
Limitations, exceptions, reductions, and elimination periods;
(11)
Requirements for replacement;
(12)
Recurrent conditions; and
(13)
Definitions of terms.
(b)
No long-term care insurance policy shall:
(1)
Be cancelled, not renewed, or otherwise terminated because of age or the deterioration of the mental or physical health of the insured individual or certificate holder;
(2)
Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form of coverage within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or
(3)
Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care within a facility than coverage for lower levels of care.
Amended by Act 2019, No. 315,§ 2790, eff. 7/24/2019.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-308 - Preexisting condition

(a)
No long-term care insurance policy or certificate other than a policy or certificate issued to a group approved by the Insurance Commissioner under §
23-97-304(6)(B)
shall:
(1)
Use a definition of "preexisting condition" that is more restrictive than the following: "Preexisting condition" means a condition for which medical advice or treatment was recommended by or received from a provider of healthcare services within six (6) months preceding the effective date of coverage of an insured person; or
(2)
Exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six (6) months following the effective date of coverage of an insured person.
(b)
The commissioner may extend the limitation periods set forth in subsection (a) of this section for specific age group categories in specific policy forms upon finding that the extension is in the best interest of the public.
(c)
(1)
The definition of "preexisting condition" does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant when underwriting in accordance with the insurer's established underwriting standards.
(2)
Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (a)(2) of this section expires.
(3)
No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (a)(2) of this section.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-309 - Prior hospitalization or institutionalization

(a)
No long-term care insurance policy shall be delivered or issued for delivery in this state if the policy:
(1)
Conditions eligibility for any benefits on a prior hospitalization requirement;
(2)
Conditions eligibility for any benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
(3)
Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.
(b)
(1)
A long-term care insurance policy containing post-confinement, post-acute care, or recuperative benefits shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits" the limitations or conditions, including any required number of days of confinement.
(2)
A long-term care insurance policy or rider that conditions eligibility for noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty (30) days.
(c)
No long-term care insurance policy or rider that provides benefits only following institutionalization shall condition such benefits upon admission to a facility for the same or related conditions within a period of less than thirty (30) days after discharge from the institution.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-310 - Loss ratio standards

(a)
The Insurance Commissioner may adopt rules establishing loss ratio standards for long-term care insurance policies.
(b)
A specific reference to long-term care insurance policies shall be contained in the rules.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-311 - Right to return - Free look

(a)
Long-term care insurance applicants shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if after examination of the policy or certificate the applicant is not satisfied for any reason.
(b)
Long-term care insurance policies and certificates shall contain a notice prominently printed on or attached to the first page stating in substance that the applicant shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if after examination of the policy or certificate the applicant is not satisfied for any reason.
(c)
If an application is denied, the issuer shall refund to the applicant any premium and any other fee paid by the applicant to apply within thirty (30) days of the denial.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-312 - Outline of coverage

(a)
(1)
An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the outline of coverage and its purpose.
(2)
The Insurance Commissioner shall prescribe a standard format for the outline, including style, arrangement, overall appearance, and content.
(3)
In the case of agent solicitations, an agent shall deliver the outline of coverage prior to the presentation of an application or enrollment form.
(4)
In the case of direct response solicitations, the outline of coverage shall be presented in conjunction with any application or enrollment form.
(5)
(A)
In the case of a policy issued to a group approved by the commissioner under §
23-97-304(6)(B)
, an outline of coverage shall not be required to be delivered if the information described in subsection (b) of this section is provided to applicants in other materials relating to enrollment.
(B)
Materials relating to enrollment shall be made available to the commissioner upon request.
(b)
The outline of coverage shall include:
(1)
A description of the principal benefits and coverage provided in the policy;
(2)
A statement of the principal exclusions, reductions, and limitations contained in the policy;
(3)
(A)
A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premium.
(B)
Continuation or conversion provisions of group coverage shall be specifically described;
(4)
A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;
(5)
A description of the terms under which the policy or certificate may be returned and premium refunded;
(6)
A brief description of the relationship between cost of care and benefits; and
(7)
A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under section 7702B(b) of the Internal Revenue Code of 1986.
Acts 2005, No. 1697, § 31; 2007, No. 496, § 21.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-313 - Certificates

A certificate issued for delivery in this state under a group long-term care insurance policy shall include:
(1)
A description of the principal benefits and coverage provided in the policy;
(2)
A statement of the principal exclusions, reductions, and limitations contained in the policy; and
(3)
A statement that the group master policy determines governing contractual provisions.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-314 - Delivery of policy and summary - Disclosures

(a)
If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval.
(b)
(1)
At the time of the delivery of the policy, a policy summary shall be delivered for an individual life insurance policy that provides long-term care benefits within the policy or by rider.
(2)
In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant's request or at the time of policy delivery, whichever first occurs.
(3)
The summary shall comply with all applicable requirements and include:
(A)
An explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits;
(B)
An illustration of the amount of benefits, the length of benefit, and the guaranteed lifetime benefits, if any, for each covered person;
(C)
Any exclusions, reductions, and limitations on long-term care benefits; and
(D)
A statement that any long-term care inflation protection option, if required by rules of the Insurance Commissioner, is not available under the policy.
(4)
If applicable to the policy type, the summary shall also include:
(A)
A disclosure of the effects of exercising other rights under the policy;
(B)
A disclosure of guarantees related to long-term care costs of insurance charges; and
(C)
Current and projected maximum lifetime benefits.
Amended by Act 2019, No. 315,§ 2791, eff. 7/24/2019.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-315 - Acceleration of death benefit

(a)
Any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, a monthly report shall be provided to the policyholder.
(b)
The report shall include:
(1)
Any long-term care benefits paid out during the month;
(2)
An explanation of any changes in the policy, including, but not limited to, death benefits or cash values, due to the payment of long-term care benefits; and
(3)
The remaining amount of long-term care benefits.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-316 - Denial of claims

If a claim under a long-term care insurance contract is denied, within sixty (60) days of the date of a written request by the policyholder or certificate holder or a representative of the policyholder or certificate holder, the issuer shall:
(1)
Provide a written explanation of the reasons for the denial; and
(2)
Make available all information directly related to the denial.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-317 - Offer of long-term care or nursing home insurance

Any policy or rider advertised, marketed, or offered as long-term care or nursing home insurance shall comply with the provisions of this subchapter.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-318 - Incontestability period

(a)
An insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if:
(1)
The long-term care insurance policy or certificate has been in force for less than six (6) months and the insurer relied upon a material misrepresentation in providing coverage; or
(2)
The long-term care insurance policy or certificate has been in force for at least six (6) months but less than two (2) years and the insurer relied upon a material misrepresentation in providing coverage that pertains to the condition for which benefits are sought.
(b)
A policy or certificate that has been in force for two (2) years or more may be contested only by showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(c)
(1)
No long-term care insurance policy or certificate may be field issued based on medical or health status.
(2)
As used in this section, "field issued" means issued by an agent or a third-party administrator under the underwriting authority granted to the agent or third-party administrator by an insurer.
(d)
If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer if the policy or certificate is rescinded.
(e)
(1)
Except as provided in subdivision (e)(2) of this section, this section shall apply to all life insurance policies that accelerate benefits for long-term care.
(2)
(A)
In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care.
(B)
The remaining death benefit shall be governed by §
23-81-105
.
Acts 2005, No. 1697, § 31; 2007, No. 827, § 189.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-319 - Nonforfeiture benefits

(a)
(1)
Except as provided in subsection (b) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate containing a nonforfeiture benefit.
(2)
The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy.
(3)
If the policyholder or certificate holder declines the nonforfeiture benefit, then the insurer shall provide a contingent benefit upon lapse that shall be available for the period of time specified by the Insurance Commissioner following a substantial increase in premium rates.
(b)
(1)
When a group long-term care insurance policy is issued, the offer required in subsection (a) of this section shall be made to the group policyholder.
(2)
However, if the policy is issued as group long-term care insurance as defined under §
23-97-304(6)(B)
, other than to a continuing care retirement community or similar entity, then the offering shall be made to each proposed certificate holder.
(c)
The commissioner shall promulgate rules specifying:
(1)
The type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates;
(2)
The standards for nonforfeiture benefits; and
(3)
The rules regarding contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse under subsection (a) of this section.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-320 - Authority to promulgate rules

The Insurance Commissioner shall issue rules for long-term care insurance to:
(1)
Promote premium adequacy;
(2)
Protect the policyholder in the event of substantial rate increases; and
(3)
Establish minimum standards for:
(A)
Marketing practices;
(B)
Agent compensation;
(C)
Agent testing;
(D)
Penalties; and
(E)
Reporting practices.
Amended by Act 2019, No. 315,§ 2792, eff. 7/24/2019.
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 97 - LONG-TERM CARE INSURANCE (§§ 23-97-201 — 23-97-321) › Subchapter 3 - LONG-TERM CARE INSURANCE ACT OF 2005 (§§ 23-97-301 — 23-97-321) › Section 23-97-321 - Penalties

In addition to any other penalties provided by the laws of this state, any insurer or agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of long-term care insurance is subject to the greater of:
(1)
A fine of up to three (3) times the amount of any commissions paid for each policy involved in the violation; or
(2)
A fine of up to ten thousand dollars ($10,000).
Acts 2005, No. 1697, § 31.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 23-98-101 - Legislative findings

The General Assembly finds that the cost of health insurance coverage is not affordable for many small businesses, their employees, self-employed persons, and other individuals, and that as a result hundreds of thousands of Arkansas citizens do not have any health insurance coverage. It is the intent of the General Assembly to reduce the cost of health insurance for these citizens by:
(1)
Authorizing the development of new classes of hospital and medical insurance coverage for qualified groups, families, and individuals; and
(2)
Authorizing the Insurance Commissioner to develop means to assist in limiting the marketing and administrative costs of certain of such new classes of insurance coverage.
Acts 1991, No. 238, § 1.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 23-98-103 - Notices and hearings before adopting rules

The Insurance Commissioner shall provide notice and conduct hearings in accordance with the Arkansas Administrative Procedure Act, §
25-15-201
et seq., before adopting any rules of general applicability to minimum basic benefit policies to be issued pursuant to this chapter.
Amended by Act 2019, No. 315,§ 2794, eff. 7/24/2019.
Acts 1991, No. 238, § 10.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 23-98-104 - Formation of trusts of qualified individuals

Solely for purposes of obtaining minimum basic benefit policies pursuant to the authority granted by this chapter, trusts may be formed composed of qualified individuals, qualified families, or qualified groups. Each trust may serve as a master policyholder. Members of qualified groups and members of such trusts may join together solely for the purpose of obtaining health insurance coverage under the provisions of this chapter. The Insurance Commissioner shall adopt rules governing the formation and operation of the trust to assure the protection of persons purchasing policies pursuant to this chapter.
Amended by Act 2019, No. 315,§ 2795, eff. 7/24/2019.
Acts 1991, No. 238, § 4.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 23-98-105 - Issuance of minimum basic benefit policies permitted - Applicability

Insurers are authorized to issue minimum basic benefit policies pursuant to and in compliance with the provisions of this chapter to qualified individuals, qualified families, qualified trusts, and qualified groups. This chapter shall apply only to those minimum basic benefit policies issued under this chapter and rules issued by the Insurance Commissioner pursuant to the authority of this chapter. Nothing in this chapter shall be deemed to add to, detract from, or in any manner apply to policies, subscription contracts, benefits, or related activities under any other statutory or regulatory authorities.
Amended by Act 2019, No. 315,§ 2796, eff. 7/24/2019.
Acts 1991, No. 238, § 3.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 23-98-108 - Notice of minimum basic benefit policies - Payroll deduction

(a)
Those employers in the State of Arkansas that do not provide a portion of the cost of health insurance for their employees shall provide notice to their employees of the existence of the minimum basic benefit policy authorized by this chapter. The notice shall be in a form prepared by the Insurance Commissioner and may be provided to employees by posting at the place of employment or in any other reasonable manner.
(b)
Any insured, or dependent of an insured, under this chapter may provide written request to his or her employer to withhold the amount of premium on a minimum basic benefit policy from his or her paycheck along with written instructions for remittance of the premium, in which case the employer shall withhold the premium and remit the premium payment to the insurer, unless to do so would require the employer to make remittances to more than three (3) different insurers.
(c)
No employer required to make a remittance of a premium under the provisions of this chapter shall be required to make such remittances more often than one (1) time per month.
(d)
Nothing in this chapter shall be construed to require or mandate in any way that an employer provide or pay any portion of the cost of a minimum basic benefit policy issued under this chapter.
(e)
Upon request by the commissioner, the Division of Workforce Services is authorized to provide a copy of the form of notice prepared by the commissioner to employers as the commissioner and the division may agree upon.
Amended by Act 2019, No. 910,§ 612, eff. 7/1/2019.
Acts 1991, No. 238, § 6.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 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 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.
(b)
Nothing in this chapter shall be construed to prohibit an insurer from including in a minimum basic benefit policy other managed care and cost control provisions which, subject to the approval of the commissioner, have the potential to control costs in a manner which does not result in inequitable treatment of an insured under this chapter.
Acts 1991, No. 238, § 7.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 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.
Amended by Act 2019, No. 315,§ 2798, eff. 7/24/2019.
Acts 1991, No. 238, § 9.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 98 - MINIMUM BASIC BENEFIT POLICIES AND SUBSCRIPTION CONTRACTS (§§ 23-98-101 — 23-98-111) › Section 23-98-111 - Record-keeping and reporting requirement for insurers

Each insurer issuing a minimum basic benefit policy in this state shall maintain separate and distinct records of enrollment, claim costs, premium income, utilization, and such other information as may be required by the Insurance Commissioner. Each insurer providing a minimum basic benefit policy shall furnish an annual report to the commissioner in a form prescribed by the commissioner which shall contain such information as the commissioner may require to analyze the effect of insurance coverage issued pursuant to this chapter. The annual report required shall be in a form consistent with the forms, if any, adopted by the National Association of Insurance Commissioners for such a purpose.
Acts 1991, No. 238, § 11.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-201 - Short title

This subchapter may be cited as the "Patient Protection Act of 1995".
Acts 1995, No. 505, § 1.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-202 - Legislative findings and intent

The General Assembly finds that patients should be given the opportunity to see the healthcare provider of their choice. In order to assure the citizens of the State of Arkansas the right to choose the provider of their choice, it is the intent of the General Assembly to provide the opportunity of providers to participate in health benefit plans.
Acts 1995, No. 505, § 2.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-203 - Definitions

(a)
(1)
"Copayment" means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of healthcare costs with their healthcare insurer paying the remainder of the charge.
(2)
The copayment is incurred at the time the service is rendered.
(3)
The copayment may be a fixed or variable amount.
(b)
"Gatekeeper system" means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment, and specialty referral for persons covered by the health benefit plan.
(c)
"Health benefit plan" means any entity or program that provides reimbursement, including capitation, for healthcare services, except and excluding any entity or program that provides reimbursement and benefits pursuant to Arkansas Constitution, Amendment 26, Acts 1993, No. 796, or the Public Employee Workers' Compensation Act, §
21-5-601
et seq., and rules and schedules adopted thereunder.
(d)
"Healthcare provider" means those individuals or entities licensed by the State of Arkansas to provide healthcare services, limited to the following:
(1)
Advanced practice nurses;
(2)
Athletic trainers;
(3)
Audiologists;
(4)
Certified behavioral health providers;
(5)
Certified orthotists;
(6)
Chiropractors;
(7)
Community mental health centers or clinics;
(8)
Dentists;
(9)
Home health care;
(10)
Hospice care;
(11)
Hospital-based services;
(12)
Hospitals;
(13)
Licensed ambulatory surgery centers;
(14)
Licensed certified social workers;
(15)
Licensed dieticians;
(16)
Licensed intellectual and developmental disabilities service providers;
(17)
Licensed professional counselors;
(18)
Licensed psychological examiners;
(19)
Long-term care facilities;
(20)
Occupational therapists;
(21)
Optometrists;
(22)
Pharmacists;
(23)
Physical therapists;
(24)
Physicians and surgeons (M.D. and D.O.);
(25)
Podiatrists;
(26)
Prosthetists;
(27)
Psychologists;
(28)
Respiratory therapists;
(29)
Rural health clinics; and
(30)
Speech pathologists.
(e)
"Healthcare services" means services and products provided by a healthcare provider within the scope of the healthcare provider's license.
(f)
"Healthcare insurer" means any entity, including, but not limited to:
(1)
Insurance companies;
(2)
Hospital and medical service corporations;
(3)
Health maintenance organizations;
(4)
Preferred provider organizations;
(5)
Physician hospital organizations;
(6)
Third-party administrators; and
(7)
Prescription benefit management companies,
authorized to administer, offer, or provide health benefit plans.
Amended by Act 2019, No. 315,§ 2799, eff. 7/24/2019.
Amended by Act 2019, No. 316,§ 1, eff. 7/24/2019.
Acts 1995, No. 505, § 3; 1995, No. 1193, § 1; 2005, No. 2238, § 1.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-204 - Terms of health benefit plan

(a)
A healthcare insurer shall not, directly or indirectly:
(1)
(A)
Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those healthcare providers who participate in the health benefit plan according to the terms offered.
(B)
"Monetary advantage or penalty" includes:
(i)
A higher copayment;
(ii)
A reduction in reimbursement for services; or
(iii)
Promotion of one healthcare provider over another by these methods;
(2)
Impose upon a beneficiary of healthcare services under a health benefit plan any copayment, fee, or condition that is not equally imposed upon all beneficiaries in the same benefit category, class, or copayment level under that health benefit plan when the beneficiary is receiving services from a participating healthcare provider pursuant to that health benefit plan; or
(3)
Prohibit or limit a healthcare provider that is qualified under §
23-99-203(d)
and is willing to accept the health benefit plan's operating terms and conditions, schedule of fees, covered expenses, and utilization rules and quality standards, from the opportunity to participate in that health benefit plan.
(b)
Nothing in this subchapter shall prevent a health benefit plan from instituting measures designed to maintain quality and to control costs, including, but not limited to, the utilization of a gatekeeper system, as long as such measures are imposed equally on all providers in the same class.
(c)
(1)
A healthcare insurer may pay a claim for healthcare services by any lawful method, including the alternative payment method by gift card, credit card, or other type of electronic payment or virtual credit card as payment if the healthcare provider is given clear instructions about how to select the alternative payment method.
(2)
However, a healthcare insurer is prohibited from requiring a healthcare provider to accept a gift card, credit card, or other type of electronic payment or virtual credit card as payment of a claim for healthcare services if the method of payment charges the healthcare provider a service fee to process.
Amended by Act 2019, No. 315,§ 2800, eff. 7/24/2019.
Amended by Act 2019, No. 300,§ 2, eff. 7/24/2019.
Acts 1995, No. 505, § 4; 1995, No. 1193, § 2.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-205 - Construction

(a)
Nothing in this subchapter shall be construed to require any healthcare insurer to cover any specific healthcare service.
(b)
Provided, however, no condition or measure shall have the effect of excluding any type or class of provider qualified under §
23-99-204(a)(3)
to provide that service.
Acts 1995, No. 505, § 5; 1995, No. 1193, § 3.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-206 - Violations

It is a violation of this subchapter for any healthcare insurer or other person or entity to provide any health benefit plan providing for healthcare services to residents of this state that does not conform to this subchapter, but nothing in this subchapter shall constitute a violation on the basis of actions taken by the health benefit plan to maintain quality, enforce utilization rules, and to control costs.
Amended by Act 2019, No. 315,§ 2801, eff. 7/24/2019.
Acts 1995, No. 505, § 8.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-207 - Civil penalties

To the extent permitted by the Employee Retirement Income Security Act of 1974, as amended,
29 U.S.C. § 1001
et seq., any provider adversely affected by a violation of this subchapter may sue in circuit court only for injunctive relief against the healthcare insurer, but not for damages. The prevailing party shall be allowed a reasonable attorney's fee and costs.
Acts 1995, No. 505, § 6; 2005, No. 960, § 1.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-208 - Void provisions

(a)
To avoid impairment of existing contracts, this subchapter shall only apply to contracts issued or renewed after July 28, 1995.
(b)
Any provision in a health benefit plan which is executed, delivered, or renewed, or otherwise contracts for provision of services in this state that is contrary to this subchapter, shall, to the extent of the conflict, be void.
Acts 1995, No. 505, § 7; 1995, No. 1193, § 4.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-209 - Applicability

The provisions of this subchapter shall not apply to self-funded or other health benefit plans that are exempt from state regulation by virtue of the Employee Retirement Income Security Act of 1974, as amended.
Acts 1995, No. 1193, § 5.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 2 - PATIENT PROTECTION ACT OF 1995 (§§ 23-99-201 — 23-99-210) › Section 23-99-210 - Healthcare provider - Adverse professional review action

A healthcare insurer shall not exclude a physician as a participating healthcare provider in a health benefit plan based solely on an adverse professional review action, including those described in the Arkansas Peer Review Fairness Act, §
20-9-1301
et seq., unless a hospital's physician peer review committee concludes that the conduct of the physician adversely affected or could have adversely affected a patient by violating the standard of care or posing a risk to the health or welfare of a patient.
Added by Act 2019, No. 996,§ 1, eff. 4/15/2019.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 3 - PRIMARY EYE CARE PROVIDER ACT (§§ 23-99-301 — 23-99-305) › Section 23-99-301 - Short title

This subchapter shall be known and may be cited as the "Primary Eye Care Provider Act".
Acts 1995, No. 515, § 1; 1995, No. 1092, § 1.
Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 3 - PRIMARY EYE CARE PROVIDER ACT (§§ 23-99-301 — 23-99-305) › Section 23-99-303 - Requirements for health benefit plans

A health benefit plan that includes, or may include, eye and/or vision care benefits shall:
(1)
Include all primary eye care providers who are selected by covered persons of the health benefit plan for the provision of all eye and/or vision care benefits provided by the health benefit plan;
(2)
Permit any licensed optometrist or ophthalmologist who agrees to abide by the terms, conditions, reimbursement rates, and standards of quality of the health benefit plan to serve as a primary eye care provider to any person covered by that health benefit plan;
(3)
Guarantee that all covered persons who are eligible for eye and/or vision care benefits under a health benefit plan shall have direct access to the primary eye care provider of their choice independent of, and without referral from, any other provider or entity;
(4)
(A)
Assure that those plans utilizing a gatekeeper system shall designate the primary eye care provider as the gatekeeper who shall provide basic patient care and coordinate diagnostic testing, indicated treatment, and specialty referral for those covered persons in the provision of eye and/or vision care benefits.
(B)
(i)
Nothing in this subchapter shall prevent a covered person from having direct access to that person's primary care provider, or gatekeeper, for the treatment of eye disease or injury and being reimbursed in accordance with the terms and fee schedule of the health benefit plan.
(ii)
However, nothing contained in this subchapter shall require payment of the monthly patient management fee by the Arkansas Medicaid Program to a primary eye care provider gatekeeper;
(5)
Not discriminate between individual providers or classes of providers in the amount of reimbursement, copayment, or other financial compensation for the same or essentially similar services provided by the health benefit plan;
(6)
Not promote or recommend any individual provider or class of providers to a covered person by any method or means;
(7)
Assure that all primary eye care providers selected by persons covered by a health benefit plan are included on the list of participating providers of the health benefit plan;
(8)
Assure that an adequate number of primary eye care providers are included to guarantee reasonable accessibility, timeliness of care, convenience, and continuity of care to covered persons; and
(9)
Make available to covered persons a listing of all primary eye care providers, their practice locations, and telephone numbers on a regular, timely basis.
Acts 1995, No. 515, § 3; 1995, No. 1092, § 3.