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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-127 - Order of certain provisions

The provisions which are the subject of §§
23-85-106
-
23-85-126
, or any corresponding provisions which are used in lieu thereof in accordance with the sections, shall be printed in the consecutive order of the provisions in such sections. At the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided that the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered, or issued.
Acts 1959, No. 148, § 413; A.S.A. 1947, § 66-3628.
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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-128 - Refusal to renew policy

(a)
Accident and health insurance policies in which the insurer reserves the right to refuse renewal on an individual basis shall provide in substance in a provision thereof, in an endorsement thereon, or rider attached thereto that, subject to the right to terminate the policy for nonpayment of premium when due, the right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on or after the next policy anniversary, or in the case of lapse and reinstatement, at the renewal date occurring on or after the next anniversary of the last reinstatement. The provision, endorsement, or rider shall also state that any refusal of renewal shall be without prejudice to any claim originating while the policy is in force.
(b)
The reference to lapse and reinstatement in subsection (a) of this section may be omitted at the insurer's option.
Acts 1959, No. 148, § 412; 1975, No. 729, § 6; A.S.A. 1947, § 66-3627; Acts 2001, No. 909, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-129 - Requirements of other jurisdictions

(a)
Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this chapter and which is prescribed or required by the law of the state or country under which the insurer is organized.
(b)
When issued for delivery in any other state or country, any policy of a domestic insurer may contain any provision permitted or required by the laws of the other state or country.
Acts 1959, No. 148, § 415; A.S.A. 1947, § 66-3630.
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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-130 - Conforming to statute

(a)
No policy provision which is not subject to this section and §§
23-85-101
-
23-85-129
and
23-85-131
shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this section and §§
23-85-101
-
23-85-129
and
23-85-131
.
(b)
(1)
A policy delivered or issued for delivery to any person in this state in violation of this section and §§
23-85-101
-
23-85-129
and
23-85-131
shall be held valid but shall be construed as provided in this section and §§
23-85-101
-
23-85-129
and
23-85-131
.
(2)
When any provision in a policy subject to this section and §§
23-85-101
-
23-85-129
and
23-85-131
is in conflict with any provision of this section and §§
23-85-101
-
23-85-129
and
23-85-131
, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of this section and §§
23-85-101
-
23-85-129
and
23-85-131
.
Acts 1959, No. 148, § 416; A.S.A. 1947, § 66-3631.
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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-131 - Age limit - Exception

(a)
If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective and if the date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after the date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased prior to the acceptance of the premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
(b)
(1)
In any accident and health insurance contract that contains a provision whereby coverage of a dependent in a family group terminates at a specified age, there shall also be a provision that coverage of an unmarried dependent who is incapable of sustaining employment by reason of intellectual and developmental disability or physical disability, who became so incapacitated prior to the attainment of nineteen (19) years of age, and who is chiefly dependent upon the policyholder for support and maintenance shall not terminate, but coverage shall continue so long as the contract remains in force and so long as the dependent remains in such condition.
(2)
At the request and expense of the insurer, proof of the incapacity or dependency must be furnished to the insurer by the policyholder, except in no event shall this requirement preclude eligible dependents under this section and §§
23-85-104
,
23-86-102
, and
23-86-108
, regardless of age.
(3)
If the incapacity or dependency is thereafter removed or terminated, the policyholder shall so notify the insurer.
Amended by Act 2019, No. 1035,§ 51, eff. 7/24/2019.
Acts 1959, No. 148, § 417; 1967, No. 418, § 2; 1969, No. 263, § 2; 1975, No. 404, § 1; 1975, No. 649, §§ 1, 8; 1983, No. 522, § 47; A.S.A. 1947, §§ 66-3632, 66-3632.1; Acts 1997, No. 208, § 26; 2001, No. 909, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-132 - Reduction of benefits due to other insurance contracts prohibited

(a)
No contract of individual accident and health insurance or health coverage sold, delivered, or issued for delivery or offered for sale in this state by an insurer, hospital and medical service corporation, or health maintenance organization, directly or indirectly providing indemnity services, healthcare services, or cash to an individual as a result of hospitalization, medical or surgical treatment, or dental care shall contain a provision reducing the benefit that would otherwise be payable to the individual in the absence of other insurance or health coverage if the reduction of benefits is due solely to the existence of one (1) or more additional contracts providing benefits to that individual unless the reduction complies with coordination of benefit rules adopted by the Insurance Commissioner.
(b)
No contract of individual accident and health insurance sold, delivered, or issued for delivery or offered for sale in this state providing disability income coverage shall contain any provision for the denial or reduction of benefits because of the existence of other insurance, except as provided in §
23-85-122
or any coverages approved by the commissioner pursuant thereto and except that the benefits may be reduced to offset disability income benefits payable under the Social Security Act.
(c)
The commissioner may issue rules to implement this section, including, but not limited to, rules as to the amount of reductions and the nature and timing of proofs of eligibility for Social Security benefits.
Amended by Act 2019, No. 315,§ 2743, eff. 7/24/2019.
Acts 1971, No. 346, §§ 1, 2; 1981, No. 809, §§ 15, 16; A.S.A. 1947, §§ 66-3634, 66-3635; Acts 1999, No. 624, § 1; 2001, No. 909, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-133 - Coverage of outpatient services required - Exception - Definitions

(a)
(1)
No policy or contract of accident and health insurance, including contracts issued by hospital and medical service corporations, that provides coverage for any of the following services when delivered on an inpatient basis shall be sold, delivered, or issued for delivery or offered for sale in this state unless the identical coverage for the following services is provided when delivered on an outpatient basis:
(A)
Laboratory and pathological tests;
(B)
X rays;
(C)
Chemotherapy;
(D)
Radiation treatment; and
(E)
Renal dialysis.
(2)
However, the coverage required by subsection (a) of this section shall not be required when any policyholder or contract holder rejects coverage in writing.
(b)
As used in this section:
(1)
"Chemotherapy" means the administration, other than orally, of antineoplastic agents that are an integral part of cancer therapy;
(2)
"Laboratory and pathological tests" means those services, including machine tests, ordered by the attending physician when necessary to and rendered in conjunction with the medical or surgical diagnosis or treatment of an illness or injury;
(3)
"Radiation treatment" means treatment, when ordered by the attending physician, of cancer by X ray, radium, or radioisotopes;
(4)
"Renal dialysis" means treatment, when ordered by the attending physician, of chronic renal disease by a process by which waste products are removed from the body by diffusion from one (1) fluid compartment to another across a semipermeable membrane and shall include hemodialysis and peritoneal dialysis; and
(5)
"X rays" means diagnostic X-ray examinations, including fluoroscopic examinations, ordered by the attending physician when such X-ray examinations are necessary to and rendered in conjunction with the medical or surgical diagnosis or treatment of an illness or injury.
Acts 1981, No. 445, §§ 1, 2; 1983, No. 522, § 30; A.S.A. 1947, §§ 66-3636, 66-3637; Acts 2001, No. 909, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-134 - Refund of unearned premiums upon death of insured

(a)
Upon the death of an insured, the proceeds payable to the insured or his or her estate under the policy of individual accident and health insurance, delivered or issued for delivery in this state after June 17, 1981, shall include premiums paid for accident and health insurance coverage for the insured for any period beyond the end of the policy month in which the death occurred.
(b)
Unearned premiums shall be paid in lump sum on a date no later than thirty (30) days after the proof of the insured's death has been furnished to the insurer.
(c)
This section shall be applicable to all individual contracts of accident and health insurance, including individual contracts issued by hospital and medical service corporations.
Acts 1981, No. 811, §§ 1-3; A.S.A. 1947, §§ 66-3638 -- 66-3640; Acts 2001, No. 909, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-136 - Standard claim form required

(a)
All accident and health insurers transacting business in this state shall use Form HCFA 1500 and Form UB-92/HCFA 1450, or the claim format required by the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, as the standard claim forms until and unless the Insurance Commissioner prescribes otherwise.
(b)
Pursuant to the applicable provisions of the Arkansas Insurance Code, the commissioner may suspend or revoke the certificate of authority of any insurance company that refuses to use and accept the standard claim form required by this section, or the commissioner may utilize any remedy provided in §
23-66-210
.
Acts 1987, No. 736, § 1; 1995, No. 701, § 1; 2001, No. 909, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-137 - In vitro fertilization coverage required

(a)
All accident and health insurance companies doing business in this state shall include, as a covered expense, in vitro fertilization.
(b)
Pursuant to the applicable provisions of the Arkansas Insurance Code, the Insurance Commissioner may suspend or revoke the certificate of authority of any insurance company failing to comply with the provisions of this section.
(c)
After conducting appropriate studies and public hearings, the commissioner shall establish minimum and maximum levels of coverage to be provided by the accident and health insurance companies.
(d)
Coverage required under this section shall include services and procedures performed at a medical facility licensed or certified by the Department of Health or another state health department that conform to the guidelines and minimum standards of the:
(1)
American College of Obstetricians and Gynecologists for in vitro fertilization clinics; or
(2)
American Society for Reproductive Medicine for programs of in vitro fertilization.
(e)
Continued certification shall require that the facility is achieving a reasonable success rate with both fertilization and births.
(f)
Appropriate laboratory facilities must be provided by the entity requesting certification.
Acts 1987, No. 779, § 1; 1991, No. 920, § 1; 2001, No. 909, § 12; 2011, No. 1119, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-139 - Written notice for premium payments made

(a)
No insurer issuing or renewing policies pursuant to this chapter or conversion policies issued pursuant to §
23-86-115
shall unilaterally change the premium payment mode for the policyholder or payor unless the insurer provides written notice of the effective date of the premium payment mode change to the policyholder or payor at least sixty (60) days prior to the change.
(b)
This section shall not apply when an insurer unilaterally changes the premium payment mode solely due to a policyholder's or payor's nonpayment of premium.
Acts 2001, No. 1177, § 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 85 - ACCIDENT AND HEALTH INSURANCE (§§ 23-85-101 — 23-85-140) › Section 23-85-140 - Nonparticipation in maintenance of licensure or maintenance of certification - Insurer prohibited from denying reimbursement or discriminating in reimbursement levels - Definitions

(a)
As used in this section:
(1)
"Maintenance of certification" means any process requiring periodic recertification examinations or other activities to maintain specialty medical certification; and
(2)
"Specialty medical board certification" means a certification by a board that:
(A)
Specializes in one (1) particular area of medicine; and
(B)
Typically requires examinations that are in addition to the requirements of the Arkansas State Medical Board to practice medicine.
(b)
An insurer shall not:
(1)
Deny reimbursement to or prevent a physician from participating in any provider network based solely on a decision of the physician not to participate in any form of maintenance of certification; or
(2)
Discriminate with respect to reimbursement levels based solely on a decision of the physician not to participate in any form of maintenance of certification.
Added by Act 2019, No. 804,§ 3, eff. 7/24/2019.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-101 - Blanket accident and health insurance - Definition

Blanket accident and health insurance is declared to be that form of accident and health insurance covering groups of persons as enumerated in one (1) of the following subdivisions:
(1)
Under a policy or contract issued to any common carrier or to any operator, owner, or lessee of a means of transportation, who or which shall be deemed the policyholder, covering a group defined as all persons or all persons of a class who may become passengers on the common carrier or such means of transportation;
(2)
Under a policy or contract issued to an employer, who shall be deemed the policyholder, covering all employees, dependents, or guests, defined by reference to specified hazards incident to the activities or operations of the employer or any class of employees, dependents, or guests similarly defined;
(3)
Under a policy or contract issued to a school or other institution of learning, camp, or sponsor thereof or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or campers. Supervisors and employees may be included;
(4)
Under a policy or contract issued in the name of any religious, charitable, recreational, educational, or civic organization, which shall be deemed the policyholder, covering participants in activities sponsored by the organization;
(5)
Under a policy or contract issued to a sports team or sponsors thereof, which shall be deemed the policyholder, covering members, officials, and supervisors;
(6)
Under a policy or contract issued in the name of any volunteer fire department, first aid, or other such volunteer group or agency having jurisdiction thereof, which shall be deemed the policyholder, covering all of the members of the fire department or group; or
(7)
Under a policy or contract issued to cover any other risk or class of risks that, in the discretion of the Insurance Commissioner, may be properly eligible for blanket accident and health insurance. The discretion of the commissioner may be exercised on an individual risk basis or class of risks, or both.
Acts 1959, No. 148, § 422; A.S.A. 1947, § 66-3704; Acts 2001, No. 1063, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-103 - Blanket accident and health insurance - Application and certificates not required

An individual application shall not be required from a person covered under a blanket accident and health insurance policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate.
Acts 1959, No. 148, § 424; A.S.A. 1947, § 66-3706; Acts 2001, No. 1063, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-104 - Blanket accident and health insurance - Payment of benefits

(a)
(1)
All benefits under any blanket accident and health insurance policy shall be payable to the person insured, to the designated beneficiaries, or to his or her estate.
(2)
However, if the person insured is a minor or mental incompetent, the benefits may be made payable to the parent, guardian, or other person actually supporting the minor or mental incompetent. If the entire cost of the insurance has been borne by the employer, the benefits may be made payable to the employer.
(b)
(1)
However, the policy may provide that all or any portion of any indemnities provided by the policy on account of hospital, nursing, medical, or surgical services, at the insurer's option, may be paid directly to the hospital or person rendering the services, but the policy may not require that the service be rendered by a particular hospital or person.
(2)
Payment so made shall discharge the insurer's obligation with respect to the amount of insurance paid.
Acts 1959, No. 148, § 425; A.S.A. 1947, § 66-3707; Acts 2001, No. 1063, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-107 - Group accident and health insurance - Authorized insurer required

(a)
All group accident and health insurance placed by an employer on employees who are residents of this state shall be placed by the employer with an insurer authorized to transact insurance in this state.
(b)
This section shall not apply to group insurance lawfully placed in an insurer transacting insurance as a surplus lines insurer under §
23-65-101
et seq., the Unauthorized Insurers Process Act, §
23-65-201
et seq., and the Surplus Lines Insurance Law, §
23-65-301
et seq.
Acts 1959, No. 148, § 426; 1985, No. 804, § 16; A.S.A. 1947, § 66-3708; Acts 2001, No. 1063, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-109 - Group accident and health insurance - Optional continuation of benefit provisions

Any group accident and health insurance policy that contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, or surgical services for members of the family or dependents of a person in the insured group may provide for the continuation of the benefit provisions, or any parts thereof, after the death of the person in the insured group.
Acts 1959, No. 148, § 419; A.S.A. 1947, § 66-3701; Acts 2001, No. 1063, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-110 - Group accident and health insurance - Administration of benefits

(a)
(1)
All group accident and health insurance carriers including hospital and medical service corporations shall be subject to the "primary" and "secondary" carrier rules promulgated by the Insurance Commissioner.
(2)
The secondary carrier shall administer benefits on a timely basis.
(b)
This section applies to group contracts of accident and health insurance sold, delivered, or issued for delivery, renewed, or offered for sale in this state.
Amended by Act 2019, No. 315,§ 2744, eff. 7/24/2019.
Acts 1975, No. 900, §§ 2, 3; 1981, No. 702, § 2; A.S.A. 1947, §§ 66-3710, 66-3711; Acts 2001, No. 1063, § 10; 2011, No. 760, § 15.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-112 - Group accident and health insurance - Direct payment of hospital or medical services

(a)
On request by the group policyholder, any group accident and health insurance policy may provide that all or any portion of any indemnities provided by any policy on account of hospital, nursing, medical, or surgical services may be paid, at the insurer's option, directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person.
(b)
Payment so made shall discharge the insurer's obligation with respect to the amount of insurance paid.
Acts 1959, No. 148, § 421; A.S.A. 1947, § 66-3703; Acts 2001, No. 1063, § 12.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 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.
Acts 1987, No. 253, § 1; 1989, No. 772, § 18; 2001, No. 1063, § 16.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-117 - Standard claim form required

(a)
All accident and health insurers transacting business in this state shall use Form HCFA 1500 and Form UB-92/HCFA 1450 or in the claim format required by the Health Insurance Portability and Accountability Act of 1996 as the standard claim forms until and unless the Insurance Commissioner prescribes otherwise.
(b)
Pursuant to the applicable provisions of the Arkansas Insurance Code, the commissioner may suspend or revoke the certificate of authority of any insurance company that refuses to use and accept the standard claim form required by this section, or the commissioner may utilize any remedy provided in §
23-66-210
.
Acts 1987, No. 736, § 1; 1995, No. 701, § 1; 2001, No. 1063, § 17.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-118 - In vitro fertilization coverage required

(a)
All accident and health insurance companies doing business in this state shall include, as a covered expense, in vitro fertilization.
(b)
Pursuant to the applicable provisions of the Arkansas Insurance Code, the Insurance Commissioner may suspend or revoke the certificate of authority of any insurance company failing to comply with the provisions of this section.
(c)
After conducting appropriate studies and public hearings, the commissioner shall establish minimum and maximum levels of coverage to be provided by the accident and health insurance companies.
(d)
Coverage required under this section shall include services performed at a medical facility licensed or certified by the Department of Health, those performed at a facility certified by the department that conforms to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization clinics, or those performed at a facility certified by the department that meets the American Society for Reproductive Medicine minimal standards for programs of in vitro fertilization.
Acts 1987, No. 779, § 1; 1991, No. 920, § 2; 2001, No. 1063, § 18.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-119 - Disclosure to policyholders

(a)
Upon request from a policyholder with more than twenty-five (25) insured employees under a comprehensive health insurance policy, any insurer issuing or delivering group accident and health insurance policies in this state shall provide to the policyholder the following information for the most recent twelve-month period or for the entire period of coverage, whichever is shorter:
(1)
Claims incurred by month;
(2)
Premiums paid by month;
(3)
Number of insureds to include dependents by month; and
(4)
Claims exceeding ten thousand dollars ($10,000) on any individual with diagnosis during the same period.
(b)
This section does not require the insurer to disclose any information that is required by law to be confidential.
Acts 1999, No. 1002, § 1; 2001, No. 1063, § 19; 2007, No. 496, § 18.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-120 - Hospice care coverage for terminally ill patients

(a)
(1)
Every accident and health insurance company, hospital service corporation, health maintenance organization, or other health insurance provider in the State of Arkansas shall offer to each master group contract holder, coverage for hospice facilities and hospice programs as defined under §
20-7-117
.
(2)
(A)
The offer of these benefits shall be subject to the right of the policy or contract holder to reject the coverage.
(B)
The rejection by the policy or contract holder shall be in writing.
(b)
The insurance coverage required in subsection (a) of this section shall provide terminally ill patients with coverage for prognosis and treatment of at least the rates of reimbursement as are provided for hospice care under Medicare and the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as in effect January 1, 1999.
(c)
This section does not apply to contracts or policies providing disability income insurance, specified disease insurance, hospital indemnity insurance, long-term care insurance, short-term limited duration insurance, accident only insurance, Medicare supplement insurance, or all other supplemental insurance.
Acts 1999, No. 922, § 1; 2001, No. 1063, § 20.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-122 - Prior approval process for experimental and investigational surgical products and medical devices - Definition

(a)
As used in this section:
(1)
"Health carrier" means a:
(A)
Health maintenance organization;
(B)
Hospital medical service corporation; and
(C)
Disability insurance company;
(2)
"Health carrier" includes a:
(A)
Self-insured governmental or church plan; and
(B)
Third-party administrator that administers or adjusts disability benefits for a disability insurer, hospital medical service corporation, health maintenance organization, self-insured governmental plan, or self-insured church plan; and
(3)
"Health carrier" does not include:
(A)
An automobile insurer paying medical or hospital benefits under §
23-89-202(1)
or a self-insured employer health benefits plan; or
(B)
A person, company, or organization licensed or registered to issue or that issues an insurance policy or insurance contract in this state as described in §§
23-62-102
and
23-62-104
-
23-62-107
providing medical or hospital benefits for accidental injury or disability.
(b)
A health carrier that excludes or denies coverage for a specific surgical product or medical device approved for marketing by the United States Food and Drug Administration as experimental or investigational, or both, shall develop a process by which a surgeon, before utilizing the surgical product or medical device, may present medical evidence to obtain a review for the individual patient for coverage of the surgical product or medical device.
Amended by Act 2015, No. 1164,§ 6, eff. 7/22/2015.
Added by Act 2013, No. 464,§ 1, eff. 8/16/2013.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 1 - GENERAL PROVISIONS (§§ 23-86-101 — 23-86-123) › Section 23-86-123 - Prior authorization by physician - Definitions

(a)
As used in this section:
(1)
"Prior authorization" means the process by which a health carrier determines the medical necessity or eligibility for coverage of a healthcare service before a covered person receives the healthcare service in order to provide coverage and reimbursement for the healthcare service; and
(2)
"Telemedicine" means the same as defined in §
23-79-1601
.
(b)
When conducting prior authorization, whether for healthcare services provided through telemedicine or provided in person, a physician who possesses a current and unrestricted license to practice medicine in the State of Arkansas shall make all adverse determinations for healthcare services, medications, or equipment prescribed by a physician.
Amended by Act 2017, No. 203,§ 5, eff. 8/1/2017.
Added by Act 2015, No. 887,§ 5, eff. 4/1/2015.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 2 - SMALL-EMPLOYER HEALTH INSURANCE (§§ 23-86-201 — 23-86-209) › Section 23-86-201 - Purpose

The intent of this subchapter is to:
(1)
Promote the availability of health insurance coverage to small employers;
(2)
Prevent abusive rating practices; and
(3)
Improve the efficiency and fairness of the small group health insurance marketplace.
Acts 1991, No. 1143, § 2; 1997, No. 1000, § 18.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 2 - SMALL-EMPLOYER HEALTH INSURANCE (§§ 23-86-201 — 23-86-209) › Section 23-86-203 - Health insurance plans subject to this subchapter

(a)
Except as provided in subsection (b) of this section, the provisions of this subchapter apply to any health benefit plan that provided coverage to two (2) or more employees of a small employer.
(b)
The provisions of this subchapter shall not apply to individual health insurance policies that are subject to policy form and premium rate approval as provided in §
23-79-109
and §
23-85-101
et seq.
Acts 1991, No. 1143, § 2; 2001, No. 1063, § 22.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 2 - SMALL-EMPLOYER HEALTH INSURANCE (§§ 23-86-201 — 23-86-209) › Section 23-86-207 - Maintenance of records

(a)
Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation which demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
(b)
Each small employer carrier shall file each March 1 with the Insurance Commissioner an actuarial certification that the carrier is in compliance with this section and that the rating methods of the carrier are actuarially sound. A copy of the certification shall be retained by the carrier at its principal place of business.
(c)
A small employer carrier shall make the information and documentation described in subsection (a) of this section available to the commissioner upon request. The information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the commissioner to persons outside of the State Insurance Department except as agreed to by the carrier or as ordered by a court of competent jurisdiction.
Acts 1991, No. 1143, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 2 - SMALL-EMPLOYER HEALTH INSURANCE (§§ 23-86-201 — 23-86-209) › Section 23-86-208 - Discretion of commissioner

The Insurance Commissioner may suspend all or any part of §
23-86-204
as to the premium rates applicable to one (1) or more small employers for one (1) or more rating periods upon a filing by the small employer carrier and a finding by the commissioner that either the suspension is reasonable in light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health insurance.
Acts 1991, No. 1143, § 2; 1997, No. 1000, § 22.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 2 - SMALL-EMPLOYER HEALTH INSURANCE (§§ 23-86-201 — 23-86-209) › Section 23-86-209 - Effective date

(a)
The provisions of this subchapter shall apply to each health benefit plan for a small employer that is delivered, issued for delivery, renewed, or continued in this state after July 1, 1997.
(b)
For purposes of this section, the date a plan is continued is the first rating period which commences after July 1, 1997.
Acts 1991, No. 1143, § 2; 1997, No. 1000, § 23.
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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 3 - ARKANSAS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1997 (§§ 23-86-301 — 23-86-314) › Section 23-86-301 - Title

This subchapter may be cited as the "Arkansas Health Insurance Portability and Accountability Act of 1997".
Acts 1997, No. 997, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 3 - ARKANSAS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1997 (§§ 23-86-301 — 23-86-314) › Section 23-86-305 - Group health plan - Application of certain rules in determination of employer size

(a)
Application of Aggregation Rule for Employers.
All persons treated as a single employer under subsection (b), subsection (c), subsection (m), or subsection (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as one (1) employer.
(b)
Employers Not in Existence in Preceding Year.
In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether the employer is a small employer or a large employer shall be based on the average number of employees that it is reasonably expected the employer will employ on business days in the current calendar year.
(c)
Predecessors.
Any reference in this section to an employer shall include a reference to any predecessor of the employer.
Acts 1997, No. 997, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 3 - ARKANSAS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1997 (§§ 23-86-301 — 23-86-314) › Section 23-86-307 - Guaranteed renewability in multiemployer plans and multiple employer welfare arrangements

A group health plan which is a multiemployer plan or which is a multiple employer welfare arrangement may not deny an employer whose employees are covered under such a plan continued access to the same or different coverage under the terms of such a plan, other than:
(1)
For nonpayment of contributions;
(2)
For fraud or other intentional misrepresentation of material fact by the employer;
(3)
For noncompliance with material plan provisions;
(4)
Because the plan is ceasing to offer any coverage in a geographic area;
(5)
In the case of a plan that offers benefits through a network plan, there is no longer any individual enrolled through the employer who lives, resides, or works in the service area of the network plan and the plan applies this subdivision (5) uniformly without regard to the claims experience of employers or any health status-related factor in relation to the individuals or their dependents; and
(6)
For failure to meet the terms of an applicable collective bargaining agreement, to renew a collective bargaining or other agreement requiring or authorizing contributions to the plan, or to employ employees covered by such an agreement.
Acts 1997, No. 997, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 3 - ARKANSAS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1997 (§§ 23-86-301 — 23-86-314) › Section 23-86-308 - Rules of construction

Nothing in this subchapter shall be construed as requiring a group health plan or health insurance coverage to provide specific benefits under the terms of such a group health plan or health insurance coverage.
Acts 1997, No. 997, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 3 - ARKANSAS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1997 (§§ 23-86-301 — 23-86-314) › Section 23-86-310 - Excepted benefits - Definition

For purposes of this section, the term "excepted benefits" means benefits under one (1) or more, or any combination thereof, of the following:
(1)
Benefits not subject to requirements:
(A)
Coverage only for accident or disability income insurance, or any combination thereof;
(B)
Coverage issued as a supplement to liability insurance;
(C)
Liability insurance, including general liability insurance and automobile liability insurance;
(D)
Workers' compensation or similar insurance;
(E)
Automobile medical payment insurance;
(F)
Credit-only insurance;
(G)
Coverage for on-site medical clinics;
(H)
Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;
(2)
Benefits not subject to requirements if offered separately:
(A)
Limited scope dental or vision benefits;
(B)
Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof;
(C)
Such other similar, limited benefits as specified in rules;
(3)
Benefits not subject to requirements if offered as independent, noncoordinated benefits:
(A)
Coverage only for a specified disease or illness; and
(B)
Hospital indemnity or other fixed indemnity insurance; and
(4)
Benefits not subject to requirements if offered as a separate insurance policy. Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act, coverage supplemental to the coverage provided under United States Code Title 10, Chapter 55, and similar supplemental coverage provided to coverage under a group health plan.
Amended by Act 2019, No. 315,§ 2748, eff. 7/24/2019.
Acts 1997, No. 997, § 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 86 - GROUP AND BLANKET ACCIDENT AND HEALTH INSURANCE (§§ 23-86-101 — 23-86-512) › Subchapter 3 - ARKANSAS HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1997 (§§ 23-86-301 — 23-86-314) › Section 23-86-313 - Disclosure of information

(a)
Disclosure of Information by Health Insurance Issuers.
In connection with the offering of any health insurance coverage to a small employer, a health insurance issuer:
(1)
Shall make a reasonable disclosure to the small employer as part of its solicitation and sales materials of the availability of information described in subsection (b) of this section; and
(2)
Upon request of such a small employer, provide that information.
(b)
Information Described.
(1)
In General.
Subject to subdivision (b)(3) of this section, with respect to a health insurance issuer offering health insurance coverage to a small employer, information described in this section is information concerning:
(A)
The provisions of the health insurance coverage concerning the health insurance issuer's right to change premium rates and the factors that may affect changes in premium rates;
(B)
The provisions of the health insurance coverage relating to renewability of health insurance coverage;
(C)
The provisions of the health insurance coverage relating to any preexisting condition exclusion; and
(D)
The benefits and premiums available under all health insurance coverage for which the small employer is qualified.
(2)
Form of Information.
Information under this section shall be provided to small employers in a manner determined by the Insurance Commissioner to be understandable by the average small employer, and shall be sufficient to reasonably inform small employers of their rights and obligations under the health insurance coverage.
(3)
Exception.
A health insurance issuer is not required under this section to disclose any information that is proprietary or trade secret information under applicable law.
Acts 1997, No. 997, § 1.