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Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.10-002 - Rule 99 - Advertisement of Life Insurance and Annuities

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Purpose
The purpose of this regulation is to set forth minimum standards
			 and guidelines to assure a full and truthful disclosure to the public of all
			 material and relevant information in the advertising of life insurance policies
			 and annuity contracts.
Section
		  2.
Authority
This Rule is issued under the authority of Ark. Code Ann.
			 §§
								23-61-108,
			 23-66-207,
			 23-66-307,
			 25-15-210
			 et seq. and other applicable laws.
Section 3.
Definitions
For the purpose of this regulation:
A.
(1)
		  "Advertisement" means material designed to create public interest in life
		  insurance or annuities or in an insurer, or in an insurance producer; or to
		  induce the public to purchase, increase, modify, reinstate, borrow on,
		  surrender, replace or retain a policy including:
(a) Printed and published material,
		  audiovisual material and descriptive literature of an insurer or insurance
		  producer used in direct mail, newspapers, magazines, radio and television
		  scripts, telemarketing scripts, billboards and similar displays, and the
		  Internet or any other mass communication media.
(b) Descriptive literature and sales aids of
		  all kinds, authored by the insurer, its insurance producers, or third parties,
		  issued, distributed or used by the insurer or insurance producer; including but
		  not limited to circulars, leaflets, booklets, web pages, depictions,
		  illustrations and form letters;
(c)
		  Material used for the recruitment, training and education of an insurer's
		  insurance producers which is designed to be used or is used to induce the
		  public to purchase, increase, modify, reinstate, borrow on, surrender, replace
		  or retain a policy;
(d) Prepared
		  sales talks, presentations and materials for use by insurance
		  producers.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.11-003 - Rule 30: Funeral Expense Insurance

Current through Register Vol. 49, No. 6, June, 2024
SECTION
		  1.
PURPOSE
The purpose of this Rule is to define funeral expense insurance
			 as required by
Ark. Code Ann.
§
								23-64-202(c)(7)(B),
			 and to set out the general requirements that must be met in selling this form
			 of life insurance.
SECTION
		  2.
AUTHORITY
This Rule is promulgated pursuant to the Commissioner's authority
			 under
Ark. Code Ann.
§
								23-61-108, and
			 §
								23-63-106,
			 §
								23-64-202(c)(7)(B)
			 and §§
								25-15-201, et
			 seq.
SECTION 3.
DEFINITIONS
A. Funeral Expense
		  Insurance
Funeral expense insurance is that form of life insurance as
			 defined in
Ark. Code Ann.
§
									23-62-102 which
			 provides benefits for expenses incurred in connection with the death of the
			 insured and which does not exceed $15,000.00; and which term includes deferred
			 annuities which do not exceed total premiums of $15,000.00 for the same
			 purposes, excluding variable annuities.
B. Insurer
Insurer as used in this Rule is any authorized life insurer,
			 fraternal benefit society, stipulated premium insurer or mutual assessment life
			 insurer.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.12-003 - Rule 101 - Prohibition on the Use of Discretionary Clauses in Disability Income Policies

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This Rule is promulgated pursuant to Ark. Code Ann. §
								23-61-108, Ark.
			 Code Ann. §
								23-66-207,
			 Ark. Code Ann. §
								25-15-204
			 and other applicable laws or rules.
Section 2.
Purpose
The purpose of this Rule is to prohibit conflicts of interest
			 which may arise when an insurer responsible for providing disability income
			 benefits has discretionary authority to decide what benefits are due. Nothing
			 in this Rule shall be construed as imposing any requirement or duty on any
			 person other than an insurer that offers disability income protection
			 coverage.
Section 3.
Definitions
A. "Commissioner"
		  means the Arkansas Insurance Commissioner.
B. "Disability income protection coverage" is
		  a policy, contract, certificate or agreement issued by an insurer subject to
		  the insurance laws and regulations of this State, or subject to the
		  jurisdiction of the Commissioner, that provides for periodic payments, weekly
		  or monthly, for a specified period during the continuance of disability
		  resulting from either sickness or injury or a combination of them.
C. "Person" means an individual, a
		  corporation, a partnership, an association, a joint venture, a joint stock
		  company, a trust, an unincorporated organization, any similar entity or
		  combination of the foregoing.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.13-001 - Rule 104 - Health Insurance Marketplace Assister Fees

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This Rule is promulgated pursuant to Section One (1) of Act 1439
			 of 2013 of the Arkansas General Assembly to be codified in Ark. Code Ann.
			 §
								23-64-607,
			 Ark. Code Ann. §
								23-61-108, Ark.
			 Code Ann. §
								25-15-204,
			 and other applicable laws or rules.
Section 2.
Purpose
The purpose of this Rule is to establish Health Insurance
			 Marketplace Assister fees for licensures.
Section 3.
Definitions
A. "Commissioner" means the Arkansas
		  Insurance Commissioner.
B.
		  "License" means a license obtained from the Arkansas Insurance Department for
		  an IPA Guide, Navigator, Certified Application Counselor, or Health Insurance
		  Marketplace licensed producer.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.14-001 - Rule #108 - Patient-Centered Medical Home Standard

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This Rule is issued pursuant to Section One of Act 1498 of 2013
			 of the Arkansas Eighty-Ninth General Assembly, also known as the "Health Care
			 Independence Act of 2013" (hereafter, the "Health Care Independence Program,"
			 or "HCIP"), now codified in Ark. Code Ann. §§
								20-77-2401
			 et seq. Pursuant to Ark. Code Ann. §
								20-77-2405(g)(l)
			 and Ark. Code Ann. §
								20-77-2406(e),
			 the Arkansas Insurance Department ("AID") and Arkansas Department of Human
			 Services ("ADHS") are authorized to issue Rules to implement provisions under
			 HCIP. In addition, this Rule is issued pursuant to Ark. Code Ann. §
								23-61-108(b)(l)
			 which states that the Arkansas Insurance Commissioner ("Commissioner") has
			 authority to promulgate rules and regulations necessary for the effective
			 regulation of the business of insurance.
Section 2.
Purpose
The purpose of this Rule is to provide standards for
			 patient-centered medical home ("PCMH") programs for Health Carriers in the
			 Health Insurance Marketplace which issue Qualified Health Plans ("QHPs") on or
			 after January 1,2015.
Section
		  3.
Applicability & Scope
This Rule applies to all Health Carriers issuing QHPs in the
			 Health Insurance Marketplace on or after January 1,2015. Under Ark. Code Ann.
			 §
								20-77-2406(d),
			 Health Carriers participating in the Health Insurance Marketplace are required
			 to participate in the Arkansas Payment Improvement Initiative ("APII")
			 including:
(1) Assignment of primary
		  care clinician;
(2) Support for
		  patient-centered medical home; and
(3) Access of clinical performance data for
		  providers. The HOP requires Health Carriers to participate in the APII as
		  multi-payer participants. This Rule requires Health Carriers to participate in
		  PCMH standards as one active or available option in QHP networks on or after
		  January 1,2015. Additionally, these standards set a floor for participation and
		  do not preclude Health Carriers from developing and implementing standards that
		  exceed the requirements set forth in this Rule.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.15-001 - Proposed Rule 109: Orthotic and Prosthetic Reimbursement

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This Rule is issued pursuant to the authority granted the
			 Arkansas Insurance Commissioner ("Commissioner") under Ark. Code Ann. §
								23-99-417(a)(l)
			 and by Ark. Code Ann. §
								23-99-417(e)
			 to promulgate a rule governing payment standards by health benefit plans for
			 orthotic devices, orthotic services, prosthetic devices, and prosthetic
			 services.
Section 2.
Purpose
The purpose of this Rule is to require health benefit plans that
			 are subject to Ark. Code Ann. §
								23-99-417
			 to update coverage for eligible charges for prosthetic and orthotic devices and
			 services to no less than eighty percent (80%) of the Medicare allowable rates
			 for such devices and services as of January 1 of each year in which the health
			 benefit plan is issued or renewed. The current statutory requirement in Ark.
			 Code Ann. §
								23-99-417(a)(l)
			 ties the coverage requirements for such devices and services to January 1, 2009
			 CMS Medicare coverage amounts under its Healthcare Common Procedure Coding
			 System ("CPT"). The Commissioner intends in this Rule to establish the
			 requirement that such coverage at least equal eighty-percent (80%) of CMS CPT
			 allowable amounts as established by CMS as of January 1 of each year in which
			 the health benefit plan is issued or renewed, rather than promulgating an
			 amendment to this Rule each year to require the adjustment.
Section 3.
Applicability and
		  Scope
This Rule applies to all health benefit plans as defined in Ark.
			 Code Ann. §
								23-99-403(4).
Section 4.
Reimbursement
		  Requirements
Health benefit plans shall provide coverage for eligible charges
			 for prosthetic and orthotic devices and services of no less than eighty-percent
			 (80%) of CMS CPT allowable amounts for such devices and services, as
			 established by CMS, as of January 1 of each year in which the health benefit
			 plan is issued or renewed.
Section
		  5.
Penalties
The Commissioner is permitted to impose penalties for violations
			 of Ark. Code Ann. §
								23-99-417,
			 et seq, under Ark. Code Ann. §
								23-99-415
			 for provisions governed under Subchapter Four (4) of the Arkansas Health Care
			 Consumer Act of 1997, as amended.
Section 6.
Effective Date
The effective date of this Rule is October 19,
			 2015.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.15-003 - Rule 110: Prepaid Funeral Benefits Contracts Fee

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This Rule is promulgated pursuant to Section Two (2) of Act 880
			 of 2015 of the Arkansas General Assembly, codified in Ark. Code Ann. §
								23-40-122(b);
			 authority is also found in Ark. Code Ann. §
								23-61-108, Ark.
			 Code Ann. §
								25-15-204,
			 and other applicable laws or rules.
Section 2.
Purpose
The puipose of this Rule is to establish a fee for a transfer or
			 cancellation of prepaid funeral benefits contracts, when the transfer or
			 cancellation is initiated by the policyholder.
Section 3.
Definitions
A. "Seller" means the organization who sold
		  the prepaid funeral benefits contract to the consumer.
B. "Policyholder" means the contract
		  purchaser.
C. "Funding life
		  insurance company" means the life insurance company that is responsible for
		  funding the prepaid funeral benefits contract.
D. "Substitute provider" means the funeral
		  home which is assuming the prepaid funeral benefits contract in the case of a
		  transfer.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.15-004 - Rule 111: Craniofacial Anomaly Reconstructive Surgery Coverage

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1.
		  AUTHORITY
This Rule is issued pursuant to Ark. Code Ann. §
								23-79-1503 which
			 requires the Arkansas Insurance Department ("AID") to issue rules for the
			 implementation and administration of coverage for craniofacial anomaly
			 reconstructive surgery under Ark. Code Ann. §
								23-79-1501
			 etseq.
SECTION 2.
		  DEFINITIONS
Unless otherwise separately defined in this rule and consistent
			 with state law, the terms or phrases as used in this rule shall follow the
			 definitions of such terms or phrases as defined in Ark. Code Ann. §
								23-79-1501.
SECTION 3. COVERAGE REQUIREMENT
		  REVIEW
(a) Pursuant to Ark. Code Ann. §
								23-79-1502(a)(l),
		  a health benefit plan that is offered, issued, provided, or renewed in this
		  state shall include coverage and benefits for reconstructive surgery and
		  related medical care for a person of any age who is diagnosed as having a
		  craniofacial anomaly if the reconstructive surgery and treatment are medically
		  necessary to improve a functional impairment that results from the craniofacial
		  anomaly as determined by a nationally approved cleft-craniofacial team,
		  approved by the American Cleft Palate-Craniofacial Association ("ACPA approved
		  team") in Chapel Hill, North Carolina.
(1)
		  The services included in the coverage and benefits for reconstructive surgery
		  and related medical care may be performed in this state by providers in an ACPA
		  approved team that has diagnosed a craniofacial anomaly, or may be performed by
		  licensed and qualified specialist in this state not in an ACPA approved team as
		  long as such specialist has received:
(i) a
		  diagnosis or evaluation that the patient has a craniofacial anomaly by an ACPA
		  approved team;
(ii) a written
		  authorization or approval of the proposed services and treatment plan by an
		  ACPA approved team, including approval of any additional services or care,
		  subsequent to the treatment plan;
(iii) the licensed and qualified specialist
		  agrees it must maintain clinical records and provide appropriate documentation
		  whenever requested by an ACPA approved team;
(iv) the licensed and qualified specialist
		  must be willing to allow the member(s) of the ACPA approved team to closely
		  oversee all treatment(s); and
(v)
		  the licensed and qualified medical specialist must also agree to the ACPA team
		  providing ongoing review for all authorized services including accepting any
		  limitations or withdrawal of such approvals depending on the outcome and
		  medical needs and care of the patient.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.15-011 - Rule 31: Pre-License Education for Producers

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1. PURPOSE
The purpose of this Rule ("Rule") is to implement Act 534 of
			 1983, as amended, and Ark. Code Ann. §
								23-64-202(b)(2),
			 as amended by Act 1948 of 2005, by establishing curricula for courses of
			 instruction required to be completed by applicants seeking insurance producer
			 licenses in Arkansas, to establish criteria for approval of course providers of
			 the courses of instruction, and to establish a mechanism of examination and
			 review of the performance and quality of the instruction.
SECTION 2. AUTHORITY
This Rule is used pursuant to the authority vested in the
			 Commissioner under Ark. Code Ann. Sections
			 23-61-108,
			 §
								23-74-609(a),
			 §
								23-75-102(5),
			 §
								23-76-120(a),
			 §§
								25-15-202,
			 et seq., and Act 534 of 1983, as amended, and codified as Sections
			 23-64-201,
			 et seq., and §§
								23-64-501,
			 et seq.; and §§
								23-64-202,
			 as amended by Act 1948 of 2005.
SECTION
		  3. APPLICABILITY AND SCOPE
I.
		  Applicability.
A. This Rule shall apply to
		  insurance producers, including original license applicants or
		  currently-licensed applicants seeking an additional line of authority, which
		  for purposes of this Rule shall be deemed to include all who are referred to
		  collectively as insurance producers ("producers") under the Producer License
		  Model Act ("PLMA"), Ark. Code Ann. §§
									23-64-501,
		  et seq.
B. This Rule shall also
		  apply to:
1. all applicants seeking a license
		  as an insurance producer;
2. all
		  applicants seeking a hcense as a health maintenance organization ("HMO")
		  producer, or as a producer for a limited benefit health maintenance
		  organization, except those specifically exempted pursuant to the provisions of
		  Arkansas law. This Rule is intended to complement the provisions of Rule 35,
		  "Agent License for Health Maintenance Organizations", but is not intended to
		  supersede it;
3. all applicants
		  seeking a license as a fraternal benefit society producer, except those
		  specifically exempted pursuant to the provisions of Arkansas law;
4. all applicants seeking a license as a
		  producer for a hospital or medical service corporation; and
5. all applicants who are producers from
		  another state, and who are not licensed as a producer under the Producer
		  License Model Act, shall be required to comply with this Rule in order to
		  secure any new resident or non-resident producer license.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.16-001 - Rule 114: Prior Authorizations for Pain Medications for Terminal Illnesses

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1.
AUTHORITY
This Rule is issued pursuant to Ark. Code Ann. § 23-99-414
			 which authorizes the Arkansas Insurance Commissioner ("Commissioner") to
			 promulgate rules necessary to carry out the "Arkansas Health Care Consumer Act"
			 subchapter, Act 992 of 2015, "An Act to Regulate the Prior Authorization
			 Procedure for Treatment of a Terminal Illness," adds various provisions to the
			 prior authorization section in the "Arkansas Health Care Consumer Act"
			 pertaining to prescription pain medication for persons with terminal illnesses.
			 This Rule is also issued pursuant to Ark. Code Ann. §
								23-61-108(a)(1) and
			 (b)(1). The requirements in Act 992 of 2015
			 were not later codified in the Prior Authorization subchapter in Act 1106 of
			 2015, the "Prior Authorization Transparency Act." The Arkansas Insurance
			 Department ("Department") however interprets the provisions in Act 992 of 2015
			 to be enforceable and valid as enacted. The Department is also promulgating the
			 requirements in Act 992 of 2015 to clarify their application to health benefit
			 plans as defined in this Rule, subject to requirements of this Rule.
SECTION 2.
DEFINITIONS
(1) "Covered person"
		  means a "covered person" as defined in Ark. Code Ann. §
								23-99-403(3);
(2) "Health benefit plan" means a "health
		  benefit plan" as defined in Ark. Code Ann. §
								23-99-1103(7);
(3) "Healthcare insurer" means a "healthcare
		  insurer" as defined in Ark. Code Ann. §
								23-99-1103(8);
(4) "Prescription pain medication" means any
		  medication prescribed as treatment for pain;
(5) "Prior Authorization" means "prior
		  authorization" as defined in Ark. Code Ann. §
								23-99-1103(16).
(6) "Terminal illness" means an illness, a
		  progressive disease, or an advanced disease state from which:
(A) there is no expectation of recovery; and
(B) death as a result of the
		  illness or disease is reasonably expected within six (6) months; and
(7) "Utilization review entity"
		  means a "utilization review entity" as defined in Ark. Code Ann. §
								23-99-1103(21);
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.16-003 - Rule 113: Vision Care Plan Coverage

Current through Register Vol. 49, No. 6, June, 2024
SECTION
		  1.
AUTHORITY
This Rule is issued pursuant to Ark. Code Ann. §
								23-99-1005
			 which requires the Arkansas Insurance Commissioner ("Commissioner") to develop
			 and promulgate a rule to implement Act 959 of 2015, "An Act to Regulate an
			 Insurer that Offers Vision Care Plans" ("Vision Care Plan Act of 2015").
SECTION 2.
DEFINITIONS
Unless otherwise separately defined in this rule and consistent
			 with state law, the terms or phrases as used in this rule shall follow the
			 definitions of such terms or phrases as defined under Section One (1) of the
			 Vision Care Plan Act of 2015, now codified in Ark. Code Ann. §
								23-99-1001 et
			 seq., or as later amended.
SECTION
		  3.
PROHIBITED PRACTICES
A. Pursuant to Ark. Code Ann. §
								23-99-1003(a),
		  a participating provider agreement between an insurer, vision care plan, or
		  vision care discount plan and a vision care provider shall not establish a fee
		  that a vision care provider shall charge for services or materials that are not
		  covered by a vision benefit plan or contract. A vision care insurer, vision
		  care plan or vision care discount plan shall not circumvent or avoid this
		  restriction by providing minimal or de minimus coverage for a service or
		  material, or by designating a service or material as "covered" as defined in
		  Ark. Code Ann. §
								23-99-1002(1) and
		  (2).
B. Pursuant to Ark. Code Ann. §
								23-99-1003(b),
		  a vision care provider shall not charge a fee for services or materials that is
		  more than the vision care provider's normal rate for the services or materials
		  if the services or materials are noncovered services or noncovered materials.
		  This restriction or limitation of a vision care provider's charges for fees to
		  not exceed normal rates for service or materials under Ark. Code Ann. §
								23-99-1003(b)
		  is a reference to the vision care provider's charges or pricing to the insured
		  and not to a vision care provider's normal reimbursement fees or allowed
		  charges for such services or materials in a vision care plan or vision care
		  discount plan participation agreement.
C. Under Ark. Code Ann. §
								23-99-1003(e),
		  a participating provider agreement between an insurer, vision care plan, or
		  vision care discount plan and a vision care provider shall not restrict or
		  limit, directly or indirectly, the vision care provider's choice of optical
		  labs or choice of sources and suppliers of services or materials provided by
		  the vision care provider to an individual who is insured by the
		  insurer.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.17-002 - Rule 117: Provider-Led Organization Licensure Standards

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This rule is issued pursuant to Ark. Code Ann. §
								23-61-117(b)
			 which authorizes the Arkansas Insurance Conunissioner ("Commissioner") to issue
			 rules to regulate the licensure and financial solvency of risk-based provider
			 organizations under Act 775 of 2017 of the 91st
			 Arkansas General Assembly also known as the "Medicaid Provider-Led Organized
			 Care Act" (hereafter, the "Organized Care Act"). In addition, Section Seven (7)
			 of the Organized Care Act requires the Commissioner to adopt rules on or before
			 June 1, 2017 to implement various provisions of the Act.
Section 2.
Purpose
The purpose of this Rule is to establish licensure and solvency
			 requirements of risk-based provider organizations ("RBPOs") participating in
			 the Organized Care Act. This Rule provides application requirements of the RBPO
			 participating in the program, addresses standards for imposition of additional
			 amounts of funds above reserve requirements to adjust to risk in Ark. Code Ann.
			 §
								20-77-2706(f)(4)(B),
			 establishes financial reporting requirements of the RBPO, imposes a reasonable
			 fee for the regulation and licensing of the RBPO by rule under §
								23-61-117(b)(2),
			 and, finally, prescribes the reporting, forms, and requirements related to the
			 payment of the quarterly tax under Ark. Code Aim.
			 23-61-117(b)(3).
Section 3.
Applicability and Scope
A.
Certificate of Authority
		  Limited To Participation in the Organized Care Act Program
.
This Rule applies to the licensure and solvency standards of
			 RBPOs, as defined in Ark. Code Ann. §
									20-77-2703(13)
			 under the Organized Care Act. Nothing in this Rule is intended to sanction,
			 permit or establish a process for a provider sponsored organization to obtain a
			 certificate of authority to engage in risk assumption or risk sharing
			 activities in this State, outside of its participation in the Organized Care
			 Act program.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.17-003 - Proposed Rule 27: Minimum Standards for Medicare Supplement Policies

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1.
PURPOSE.
The purpose of this rule is to provide for the reasonable
			 standardization of coverage and simplification of terms and benefits of
			 Medicare supplement policies; to facilitate public understanding and comparison
			 of such policies; to eliminate provisions contained in such policies which may
			 be misleading or confusing in connection with the purchase of such policies or
			 with the settlement of claims; and to provide for full disclosures in the sale
			 of accident and health insurance coverages to persons eligible for
			 Medicare.
SECTION 2.
AUTHORITY.
This rule is issued pursuant to the authority vested in the
			 Commissioner under Act 72 of 1991 (First Extraordinary Session), Act 684 of
			 2017, Ark. Code Ann. §
								23-79-404,
			 §
								23-61-108,
			 §
								23-66-201 through §
								23-66-214,
			 §§
								23-66-301,
			 et seq, §
								23-79-109,
			 §
								23-79-110,
			 §
								23-85-105,
			 § 23-74-122, §
								23-75-111,
			 §
								23-76-125 and
			 §§
								25-15-202,
			 et seq., known as the Arkansas Administrative Procedure Act, and
			 Public
			 Law 101-508.
SECTION 3.
APPLICABILITY AND
		  SCOPE.
A. Except as otherwise
		  specifically provided in Sections 7, 13, 14, 17 and 22, this rule shall apply
		  to:
(1) All Medicare supplement policies
		  delivered or issued for delivery in Arkansas on or after the effective date of
		  this rule; and
(2) All certificates
		  issued under group Medicare supplement policies which certificates have been
		  delivered or issued for delivery in Arkansas.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.18-001 - Rule 118: Pharmacy Benefits Managers Regulation

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This rule is issued pursuant to Act One (1) and Act Three (3) of
			 the Second Extraordinary Session of 2018 by the Ninety-First
			 (91st) Arkansas General Assembly, "An Act To Create
			 The Arkansas Pharmacy Benefits Manager Licensure Act," (hereafter, the "PBM
			 Licensure Act") which authorizes the Arkansas Insurance Commissioner
			 ("Commissioner") to issue rules to regulate the licensure and activities of
			 pharmacy benefits managers ("PBMs").
Pursuant to Ark. Code Arm. §
								23-61-108(a)(1)
			 and §
								23-92-504(b)(1)
			 in the PBM Licensure Act, the Commissioner is authorized to issue rules
			 establishing the licensing, fees, application, financial standards, and
			 reporting requirements of pharmacy benefits managers subject to the PBM
			 Licensure Act. In addition, under Ark. Code Ann. §
								23-92-509, the
			 Commissioner is authorized to issue rules governing the financial solvency,
			 network adequacy, maximum allowable cost practices, compensation, rebates and
			 other matters as delineated in Ark. Code Ann. §
								23-92-509 of
			 pharmacy benefits managers subject to the PBM Licensure Act.
Section 2.
Purpose
The purpose of this rule is to implement the PBM Licensure Act
			 and to provide licensing, reporting and activity standards for pharmacy benefit
			 managers which provide claims processing services or other prescription drug or
			 device services, or both, for health benefit plans.
Section 3.
Applicability &
		  Scope
Sections Four (4) through Seven (7) of this rule apply to PBMs
			 that provide claims processing services or other prescription drug or device
			 services for health benefit plans as defined under Ark. Code Ann. §
								23-92-503(2)(A)
			 in the PBM Licensure Act. Section Seven (7) of this Rule, which relates to
			 pharmacy network adequacy, applies to PBMs and Healthcare insurers, where
			 applicable. Section Eight (8) of this Rule, which relates to examinations,
			 applies to PBMs and Healthcare insurers, where applicable. Section Nine (9) of
			 this Rule, which pertains to reporting requirements, applies to PBMs and
			 Healthcare insurers, where applicable. Section (10) applies to PBMs. The
			 penalty provisions in Section Eleven (11) apply to PBMs and Healthcare
			 insurers, where applicable.
Section
		  4.
Definitions
As used in this rule:
(1) "Claims processing services" means the
		  administrative services performed in connection with the processing and
		  adjudicating of claims relating to pharmacist services that include:
(A) Receiving payments for pharmacist
		  services;
(B) Making payments to
		  pharmacists or pharmacies for pharmacist services; or
(C) Both subdivisions (1)(A) and (B) of this
		  section;
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.19-004 - Multiple-Employer Welfare Benefits Plan

Current through Register Vol. 49, No. 6, June, 2024
SECTION
		  1.
AUTHORITY
This Rule is promulgated under Ark. Code Ann. §
								23-92-101(c)(3),
			 as amended by Act 919 of 2019, and Ark. Code Ann. §
								23-61-108(a)(1).
			 Under Ark. Code Ann. §
								23-92-101(c)(3),
			 the Arkansas Insurance Commissioner ("Commissioner") is authorized to issue
			 rules regulating multiple employer trusts and multiple employer welfare
			 arrangements ("MEWAs") which are not fully-insured concerning:
(a) the criteria and application for
		  obtaining a certificate of authority from the State Insurance Department to
		  conduct business in Arkansas;
(b)
		  the benefits to be offered;
(c)
		  financial requirements;
(d)
		  fees;
(e) insolvency
		  procedures;
(f)
		  examinations;
(g) filing of forms
		  and rates;
(h) written disclosures
		  and other consumer protections;
(i)
		  reporting requirements;
(j) excess
		  or stop loss insurance; and
(k)
		  other factors the Commissioner deems necessary for the effective regulation of
		  multiple employer welfare trusts and multiple employer welfare arrangements
		  that are not fully-insured.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.22-001 - Final Rule 118: "Pharmacy Benefits Managers Regulations"

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This rule is issued pursuant to Ark. Code Ann. §
								23-61-108(a)(1)
			 and §
								23-92-504(b)(1),
			 the Arkansas Pharmacy Benefits Manager Licensure Act, (hereafter, the "PBM
			 Licensure Act") authorizes the Arkansas Insurance Commissioner ("Commissioner")
			 to issue rules to regulate the licensure and activities of pharmacy benefits
			 managers ("PBMs").The Commissioner is authorized to issue rules establishing
			 the licensing, fees, application, financial standards, and reporting
			 requirements of pharmacy benefits managers subject to the PBM Licensure Act. In
			 addition, under Ark. Code Ann. §
								23-92-509, the
			 Commissioner is authorized to issue rules governing the financial solvency,
			 network adequacy, maximum allowable cost practices, compensation, rebates and
			 other matters as delineated in Ark. Code Ann. §
								23-92-509 of
			 pharmacy benefits managers subject to the PBM Licensure Act.
Pursuant to Act 665 of 2021, the Commissioner is authorized to
			 issue a rule on the Pharmacy Audit Bill of Rights. Finally, the Commissioner is
			 authorized to issue Rules setting penalties or fines including monetary fines
			 against pharmacy benefit managers under Ark. Code Ann. §
								23-92-509(b)(1).
This Rule is also issued pursuant to the authority vested in the
			 Commissioner to issue Emergency Rules under Ark. Code Ann. §
								25-15-204(c).
			 Immediate adoption of this Rule is necessary to implement Act 665 of 2021 and
			 to comply with court rulings on the applicability of the PBM Licensure Act to
			 self-funded health plans, as well as immediately necessary to adopt PBM
			 standards related to maximum allowable cost and National Average Drug
			 Acquisition Cost ("NADAC") reimbursement bulletins recently issued by the
			 Department, and to provide updated licensing standards for PBMs conducting
			 business in this State. It is hereby declared that the adoption of this Rule is
			 necessary to prevent imminent peril to the health, safety or welfare of the
			 citizens of this State.
Section
		  2.
Purpose
The purpose of this rule is to implement the PBM Licensure Act
			 and to provide licensing, reporting and activity standards for pharmacy benefit
			 managers which provide claims processing services or other prescription drug or
			 device services, or both, for health benefit plans.
Section 3.
Applicability &
		  Scope
The provisions of this rule shall apply to all PBMs administering
			 or transacting Pharmacy benefits plan or programs for health benefit plans in
			 this State.
Section 4.
Definitions
As used in this rule:
(1) "Adverse impact" means:
(A) the participation of pharmacies is
		  reduced by 10 % or more within the distance compliance requirements as
		  specified in Rule 118 (7)(B); and
(B) the reduction in participation is solely
		  due to a reduction in the compensation or reimbursement to a
		  pharmacy.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.90-001 - Rule and Regulation 48: Agent Licensing for Automobile Clubs or Associations

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1.
		  PURPOSE
The purpose of this Rule is to set the standards and guidelines
			 under which agents and representatives for Automobile Clubs or Associations can
			 obtain and maintain licenses issued by the State of Arkansas.
SECTION 2. AUTHORITY
This Rule is issued pursuant to the authority vested in the
			 Insurance Commissioner for the State of Arkansas under Ark. Code Ann.
			 §§
								23-77-103(3),
			 23-77-105(a)(1),
			 and
			 25-15-201, et
			 seq.
SECTION 3. EFFECTIVE
		  DATE
The provisions of this Rule shall become effective May 1,
			 1990.
SECTION 4.
		  APPLICABILITY AND SCOPE
This Rule shall apply to all agents and representatives engaged
			 in the solicitation and sale of Arkansas membership for automobile clubs and
			 associations.
SECTION 5.
		  DEFINITIONS
a) "Agent" or Representative"
		  means any person who engages in solicitation and enrollment of Arkansas members
		  for any authorized automobile club or association, but shall exclude any
		  salaried officer or employee who has duties that are primarily administrative
		  or clerical and who receives no commission or fee for applications taken, or
		  for membership enrollments made, or for insurance policies sold to
		  members.
b) "Automobile Club" or
		  "Automobile Association" shall be defined pursuant to Ark. Code Ann. §
								23-77-101(1)
		  (1987).
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.90-003 - Rule and Regulation 36: Regulation of Bail Bond Business

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1. PURPOSE
The purpose of this Rule and Regulation is to set specific
			 requirements that should be followed hy companies engaged in the bail bond
			 business in this State, pursuant to Act 417 of 1989.
SECTION 2. AUTHORITY
This Rule is issued pursuant to the authority vested in the
			 Commissioner under Ark. Code Ann. §§
								25-15-201, et
			 seq.. and all other applicable provisions of Arkansas law.
SECTION 3. EFFECTIVE DATE AND APPLICABILITY
This Rule and Regulation shall be effective September 1, 1990 and
			 shall be applicable to all qualified professional bail bond companies and their
			 licensees and all applicants for a professional bail bond company or individual
			 bail bondsman license.
SECTION
		  4. DEFINITIONS
The following definitions are issued in this Rule and Regulation
			 and shall have the following meaning:
A. "Department" shall mean the Arkansas
		  Insurance Department;
B.
		  "Commissioner" shall mean the Commissioner of Insurance;
C. "Company" shall mean a professional bail
		  bond company as defined by Ark. Code Ann. §
								17-17-101(7);
D. "Bail bondsman" shall mean a professional
		  bail bondsman as defined by Ark. Code Ann. §
								17-17-101(6);
E. "Premium" shall mean the money paid to a
		  bail bondsman or professional bail bond company for release of an
		  arrestee;
F. "Arrestee" shall mean
		  any person actually detained or subject to detention in custody whose release
		  may lawfully be effected by bail;
G. "Licensee" shall mean a professional bail
		  bond company or a professional bail bondsman;
H. "Bail bond" shall mean a bond for a
		  specified monetary amount executed by the defendant or principal and a
		  qualified licensee which is issued to a court, magistrate, or authorized
		  officer as security for the subsequent court appearance of the defendant upon
		  his release from actual custody pending the appearance;
I. "Jail" shall mean any police station,
		  sheriff s office or other place where persons in the custody of the law are
		  detained;
J. "Principal" shall mean
		  the person(s) paying the bail bond premium and/or giving the
		  collateral.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.90-004 - Rule and Regulation 50: Agents Continuing Education

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1. PURPOSE
The purpose of this Rule and Regulation is to implement Act 445
			 of 1989, Ark. Code Ann. §§
								23-64-301,
			 et seq., establishing requirements and standards for continuing education for
			 natural persons licensed as insurance agents, solicitors, brokers, or
			 consultants.
SECTION 2.
		  AUTHORITY
This Rule is issued pursuant to the authority vested in the
			 Commissioner of Insurance ("Commissioner") by Ark. Code Ann. §
								23-64-304(a).
SECTION 3. EFFECTIVE DATE AND APPLICABILITY
This Rule and Regulation shall be effective July 1, 1990 and
			 shall be applicable to those persons licensed to act as an insurance agent,
			 solicitor, consultant or broker and engaged in the sale of the following types
			 of insurance:
A. Life and disability
		  insurance
B. Property and casualty
		  insurance
C. All lines of insurance
		  for which an examination is required for licensing.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.90-005 - Rule and Regulation 27: Minimum Standards of Medicare Supplement Policies

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Purpose
The purpose of this regulation is to provide reasonable
			 standardization and simplification of terms and coverages of Medicare
			 Supplement Policies in order to facilitate public understanding and comparison
			 of such policies and to eliminate provisions contained in such policies are
			 contracts which may be misleading or confusing in connection either with the
			 purchase of such coverages or with the settlement of claims and to provide for
			 full disclosures in the sale of such coverages to persons eligible for Medicare
			 by reason of age.
Section 2.
Authority
This rule is issued pursuant to the authority vested in the
			 Commissioner under Ark. Code Ann. §
								23-61-108,
			 §
								23-66-201 through §
								23-66-214,
			 §§
								23-66-301
			 et seq., §
								23-79-109,
			 §
								23-79-110,
			 §
								23-85-105,
			 §
								23-86-105,
			 § 23-74-122, §
								23-75-111,
			 §
								23-76-125 and
			 §§
								25-15-202,
			 et seq., and
			 Public
			 Law 101-234.
Section 3.
Applicability and
		  Scope
Except as otherwise specifically provided in Sections 10 and 11,
			 this regulation shall apply to:
A. All
		  Medicare Supplement policies and subscriber contracts delivered or issued for
		  delivery in this State on or after the effective date hereof; and
B. All certificates issued under group
		  Medicare Supplement policies or subscriber contracts, which certificates have
		  been delivered or issued for delivery in this state.
C. This regulation shall not apply to a
		  policy or contract of one or more employers or labor organizations, or of the
		  trustees of a fund established by one or more employers or labor organizations,
		  or a combination thereof, for employees or former employees, or a combination
		  thereof, or for members or former members, or a combination thereof, of the
		  labor organizations.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.91-004 - Rule and Regulation 25: Annual Audited Financial Reports

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1.
		  AUTHORITY
This Rule and Regulation is promulgated by the Commissioner
			 pursuant to the authority vested in the Commissioner under Arkansas Code
			 Annotated §§
								23-61-108,
			 23-63-216,
			 23-71-103,
			 23-72-103,
			 23-74-602 and
			 25-15-201, et
			 seq.
SECTION 2. PURPOSE AND
		  SCOPE
The purpose of this Rule and Regulation is to improve the
			 Arkansas Insurance Department's surveillance of the financial condition of
			 insurers by requiring an annual examination by independent certified public
			 accountants of the financial statements reporting the financial position and
			 the results of operations of insurers.
Every insurer as defined in Section 3. shall be subject to this
			 Rule and Regulation. Insurers having direct premiums written in this state of
			 less than $1,000,000 in any calendar year, and less than 1,000 policyholders or
			 certificateholders of direct written policies nationwide at the end of such
			 calendar year shall be exempt from this Rule and Regulation for such year,
			 unless the Commissioner makes a specific finding that compliance is necessary
			 far the Commissioner to carry out statutory responsibilities; except that
			 insurers having assumed premiums pursuant to contracts and/or treaties of
			 reinsurance of $1,000,000 or more will not be so exempt.
Foreign or alien insurers filing Audited Financial Reports in
			 another state, pursuant to such other state's requirement of Audited Financial
			 Reports which has been found by the Commissioner to be substantially similar to
			 the requirements herein, are exempt from this Rule and Regulation if:
A. A copy of the Audited Financial Report,
		  Report on Significant Deficiencies in Internal Controls, and the Accountant*s
		  Letter of Qualifications which are filed with such other state are filed with
		  the Commissioner in accordance with the filing dates specified in Sections 4,
		  11 and 12, respectively. Canadian insurers may submit accountants' reports as
		  filed with the Canadian Dominion Department of Insurance; and
B. A copy of any Notification of Adverse
		  Financial Condition Report filed with such other state is filed with the
		  Commissioner within the time specified in Section 10.
This Rule and Regulation shall not prohibit, preclude or in any
			 way limit the Commissioner from ordering and/or conducting and/or performing
			 examinations of insurers under Arkansas Code Annotated §§
									23-61-201
			 et seq.
Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.91-008 - Educational Requirements for Insurance Agents

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1. PURPOSE
The purpose of this rule is to implement Act 534 of 1983, as
			 amended by establishing curricula for courses of instruction required to be
			 completed by applicants seeking insurance licenses in Arkansas, to establish
			 criteria for approval of providers of the courses of instruction, to establish
			 a mechanism of examination and review of the performance and quality of the
			 instruction and to establish duties of The Insurance Advisory Examining
			 Board.
SECTION 2. AUTHORITY
The rule is used pursuant to the authority vested in the
			 Commissioner under Ark. Code Ann. §
								23-61-108
			 (1987),
			 23-76-125 (1987),
			 25-15-202
			 (1987), et sea-, and Act 534 of 1983, as amended.
SECTION 3. APPLICABILITY AND SCOPE
This rule shall apply to all applicants seeking a license as an
			 insurance 'agent, broker, solicitor, and consultant, and seeking a license as a
			 health maintenance organization ("HMO") agent, except those specifically
			 exempted pursuant to the provisions of Arkansas law. This rule is intended to
			 complement the provisions of Rule and Regulation 35, "Agent License for Health
			 Maintenance Organizations", and is not intended to supersede Regulation
			 35.
SECTION 4. EFFECTIVE
		  DATE
Under the emergency provisions of Ark. Code Ann. §
								25-15-204(b)
			 (Supp. 1991), it is hereby declared that the immediate adoption of this Rule is
			 necessary to prevent any imminent peril to the public health, safety or welfare
			 of the citizens of this State. Therefore, the effective date of this Rule is
			 September 1, 1991.
SECTION
		  5. COURSE REQUIREMENTS
A. All
		  candidates for an Arkansas life and/or disability agent's license, and for a
		  health maintenance organization agents license are hereby required to complete
		  a course of instruction with a minimum of 36 hours of classroom instruction
		  which includes, but is not limited to, all of the following,
as
applicable:
1. Life Policy
		  Provisions
2. Life Policy
		  Options
3. Whole Life, Term, and
		  Endowment Life Insurance
4. Annuity
		  Contract Provisions
5. Universal
		  Life Insurance 5. Credit Life
7.
		  Rate Making and Reverses
8.
		  Interest Adjusted Cost Index
9.
		  Disability Income
10. Accident and
		  Health
11. Medicare Supplement
		  Insurance 12 Five hours of state regulation