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1 State of Arkansas A Bill
2 95th General Assembly
3 Regular Session, 2025 HOUSE BILL 1361
4
5 By: Representatives Gazaway, M. Shepherd
6 By: Senators C. Tucker, J. Bryant
7
8 For An Act To Be Entitled
9 AN ACT TO MAKE TECHNICAL CORRECTIONS TO TITLE 23 OF
10 THE ARKANSAS CODE CONCERNING PUBLIC UTILITIES AND
11 REGULATED INDUSTRIES; AND FOR OTHER PURPOSES.
12
13
14 Subtitle
15 TO MAKE TECHNICAL CORRECTIONS TO TITLE
16 23 OF THE ARKANSAS CODE CONCERNING
17 PUBLIC UTILITIES AND REGULATED
18 INDUSTRIES.
19
20 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
21
22 SECTION 1. Arkansas Code � 23-3-117(a)(2)(C)(i), concerning contracts
23 for interruptible utility services, is reenacted to ratify the decision by
24 the Arkansas Code Revision Commission to change "Specify" to "Shall specify"
25 in order to correct a grammatical error.
26 (i) Shall specify the amount of interruptible load
27 to be achieved by the customer.
28
29 SECTION 2. Arkansas Code � 23-55-611(b), concerning refunds under the
30 Uniform Money Services Act, is reenacted to ratify the decision by the
31 Arkansas Code Revision Commission to insert the phrase "all money received
32 for transmission" and combine former subdivisions (b)(1)(A)-(D) with former
33 subdivision (b)(2) to create subdivisions (b)(1)-(5), in order to clarify a
34 reference and correct designation errors.
35 (b) Every licensee shall refund all money received for transmission to
36 the sender within 10 days of receipt of the sender's written request for a
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1 refund of all money received for transmission unless any of the following
2 occurs:
3 (1) the money has been forwarded within 10 days of the date that
4 the money was received for transmission;
5 (2) instructions have been given committing an equivalent amount
6 of money to the person designated by the sender within 10 days of the date
7 that the money was received for transmission;
8 (3)(A) the agreement between the licensee and the sender
9 instructs the licensee to forward the money at a time that is beyond 10 days
10 of the date that the money was received for transmission.
11 (B) If funds have not yet been forwarded according to the
12 terms of the agreement between the licensee and the sender, then the licensee
13 shall issue a refund under this section;
14 (4) the refund is requested for a transaction that the licensee
15 has not completed based on a reasonable belief or a reasonable basis to
16 believe that a crime or violation of law, rule, or regulation has occurred,
17 is occurring, or may occur; or
18 (5) the refund request does not enable the licensee to:
19 (A) identify the sender's name and address or telephone
20 number; or
21 (B) identify the particular transaction to be refunded in
22 the event the sender has multiple transactions outstanding.
23
24 SECTION 3. Arkansas Code � 23-55-702(a)(6), concerning types of
25 permissible investments under the Uniform Money Services Act, is reenacted to
26 ratify the decision by the Arkansas Code Revision Commission to redesignate
27 the subdivision from (b)(6) to (a)(6) in order to correct a designation
28 error.
29 (6) 100 percent of the surety bond provided for under � 23-55-
30 204 that exceeds the average daily money transmission liability in this
31 state.
32
33 SECTION 4. Arkansas Code � 23-55-702(b)(2)(A), concerning types of
34 permissible investments under the Uniform Money Services Act, is reenacted to
35 ratify the decision by the Arkansas Code Revision Commission to change "If"
36 to "Upon" in order to correct a grammatical error.
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1 (2)(A) Upon any notice of expiration or nonextension of a letter
2 of credit issued under subdivision (b)(1)(D), then the licensee shall be
3 required to demonstrate to the satisfaction of the commissioner, 15 days
4 before expiration, that the licensee maintains and will maintain permissible
5 investments under � 23-55-701(a) upon the expiration of the letter of credit.
6
7 SECTION 5. Arkansas Code � 23-61-503(b), concerning the jurisdiction
8 of the State Insurance Department and the application of the Arkansas
9 Insurance Code, is amended to read as follows to repeal obsolete language:
10 (b) This subchapter shall not apply to:
11 (1) A a trust established under �� 14-54-101 and 25-20-104 to
12 provide benefits such as accident and health benefits, death benefits, dental
13 benefits, and disability income benefits; or
14 (2) The Comprehensive Health Insurance Pool Act, � 23-79-501 et
15 seq.
16
17 SECTION 6. Arkansas Code � 23-63-1801(4)(B), concerning definitions
18 under the Arkansas Health Insurance Marketplace Act, is amended to read as
19 follows to repeal obsolete language:
20 (B) "Health insurance coverage" does not include policies
21 or certificates covering only accident, credit, disability income, long-term
22 care, hospital indemnity, Medicare supplemental policy as defined in 42
23 U.S.C. � 1395ss(g)(1), a specified disease, other limited benefit health
24 insurance, automobile medical payment insurance, or claims under the Workers'
25 Compensation Law, � 11-9-101 et seq., or the Public Employee Workers'
26 Compensation Act, � 21-5-601 et seq., or the Comprehensive Health Insurance
27 Pool Act, � 23-79-501 et seq.; and
28
29 SECTION 7. Arkansas Code Title 23, Chapter 79, Subchapter 5 is
30 repealed because the subchapter expired in 2016.
31 23-79-501. Purpose.
32 (a)(1) Acts 1995, No. 1339, established the Arkansas Comprehensive
33 Health Insurance Pool as a state program that was intended to provide an
34 alternate market for health insurance for certain uninsurable Arkansas
35 residents, and further this subchapter is intended to provide for the
36 successor entity that will provide the acceptable alternative mechanism as
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1 described in the Health Insurance Portability and Accountability Act of 1996
2 for providing portable and accessible individual health insurance coverage
3 for federally eligible individuals as defined in this subchapter.
4 (2) This subchapter further is intended to provide a health
5 insurance coverage option for persons eligible for a federal income tax
6 credit under section 35 of the Internal Revenue Code, as created by the Trade
7 Adjustment Assistance Reform Act of 2002 or as subsequently amended.
8 (b) The General Assembly declares that it intends for this program to
9 provide portable and accessible individual health insurance coverage for
10 every individual who qualifies for coverage in accordance with � 23-79-509(b)
11 as a federally eligible individual or as a qualified trade adjustment
12 assistance eligible person but does not intend for every eligible person who
13 qualifies for pool coverage in accordance with � 23-79-509 to be guaranteed a
14 right to be issued a policy under this pool as a matter of entitlement.
15
16 23-79-502. Short title.
17 This subchapter may be cited as the "Comprehensive Health Insurance
18 Pool Act", and is amendatory to the Arkansas Insurance Code and the
19 provisions of the Arkansas Insurance Code which are not in conflict with this
20 subchapter are applicable to this subchapter.
21
22 23-79-503. Definitions.
23 As used in this subchapter:
24 (1) "Agent" means any person who is licensed to sell health
25 insurance in this state;
26 (2) "Board" means the Board of Directors of the Arkansas
27 Comprehensive Health Insurance Pool;
28 (3) "Church plan" has the same meaning given that term in the
29 Health Insurance Portability and Accountability Act of 1996;
30 (4) "Commissioner" means the Insurance Commissioner;
31 (5) "Continuation coverage" means continuation of coverage under
32 a group health plan or other health insurance coverage for former employees
33 or dependents of former employees that would otherwise have terminated under
34 the terms of that coverage pursuant to any continuation provisions under
35 federal or state law, including the Consolidated Omnibus Budget
36 Reconciliation Act of 1985 (COBRA), as amended, � 23-86-114 of the Arkansas
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1 Insurance Code, or any other similar requirement in another state;
2 (6) "Covered person" means a person who is and continues to
3 remain eligible for pool coverage and is covered under one (1) of the plans
4 offered by the pool;
5 (7)(A) "Creditable coverage" means, with respect to a federally
6 eligible individual or a qualified trade adjustment assistance eligible
7 person, coverage of the individual under any of the following:
8 (i) A group health plan;
9 (ii) Health insurance coverage, including group
10 health insurance coverage;
11 (iii) Medicare;
12 (iv) Medical assistance;
13 (v) 10 U.S.C. � 1071 et seq.;
14 (vi) A medical care program of the Indian Health
15 Service or of a tribal organization;
16 (vii) A state health benefits risk pool;
17 (viii) A health plan offered under 5 U.S.C. � 8901
18 et seq.;
19 (ix) A public health plan, as defined in regulations
20 consistent with section 104 of the Health Insurance Portability and
21 Accountability Act of 1996 that may be promulgated by the Secretary of the
22 United States Department of Health and Human Services; and
23 (x) A health benefit plan under section 5(e) of the
24 Peace Corps Act, 22 U.S.C. � 2504(e).
25 (B) "Creditable coverage" does not include:
26 (i) Coverage consisting solely of coverage of
27 excepted benefits as defined in section 2791(C) of Title XXVII of the Public
28 Health Service Act, 42 U.S.C. � 300gg-91; or
29 (ii)(a) Any period of coverage under
30 subdivisions (7)(A)(i)-(x) of this section that occurred before a break of
31 more than sixty-three (63) days during all of which the individual was not
32 covered under subdivisions (7)(A)(i)-(x) of this section.
33 (b) Any period that an individual is in a
34 waiting period for any coverage under a group health plan or for group health
35 insurance coverage or is in an affiliation period under the terms of health
36 insurance coverage offered by a health maintenance organization shall not be
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1 taken into account in determining if there has been a break of more than
2 sixty-three (63) days in any creditable coverage;
3 (8) "Department" means the State Insurance Department;
4 (9) "Excess or stop-loss coverage" means an arrangement whereby
5 an insurer insures against the risk that any one (1) claim will exceed a
6 specific dollar amount or that the entire loss of a self-insurance plan will
7 exceed a specific amount;
8 (10) "Federally eligible individual" means an individual
9 resident of Arkansas:
10 (A) For whom:
11 (i) As of the date on which the individual seeks
12 pool coverage under � 23-79-509, the aggregate of the periods of creditable
13 coverage is eighteen (18) or more months; and
14 (ii) The most recent prior creditable coverage was
15 under group health insurance coverage offered by an insurer, a group health
16 plan, a governmental plan, a church plan, or health insurance coverage
17 offered in connection with any such plans;
18 (B) Who is not eligible for coverage under:
19 (i) A group health plan;
20 (ii) Part A or Part B of Medicare; or
21 (iii) Medical assistance and does not have other
22 health insurance coverage;
23 (C) With respect to whom the most recent coverage within
24 the coverage period described in subdivision (10)(A)(i) of this section was
25 not terminated based upon a factor related to nonpayment of premiums or
26 fraud;
27 (D) If the individual has been offered the option of
28 continuation coverage under a Consolidated Omnibus Budget Reconciliation Act
29 of 1985 (COBRA) continuation provision or under a similar state program, who
30 elected such coverage; and
31 (E) Who, if the individual elected the continuation
32 coverage, has exhausted the continuation coverage under such a provision or
33 program;
34 (11) "Governmental plan" has the same meaning given that term in
35 the federal Health Insurance Portability and Accountability Act of 1996;
36 (12) "Group health plan" has the same meaning given that term in
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1 the federal Health Insurance Portability and Accountability Act of 1996;
2 (13)(A) "Health insurance" means any hospital and medical
3 expense-incurred policy, certificate, or contract provided by an insurer,
4 hospital or medical service corporation, health maintenance organization, or
5 any other healthcare plan or arrangement that pays for or furnishes medical
6 or healthcare services whether by insurance or otherwise and includes any
7 excess or stop-loss coverage.
8 (B) "Health insurance" does not include long-term care,
9 disability income, short-term, accident, dental-only, vision-only, fixed
10 indemnity, limited-benefit or credit insurance, coverage issued as a
11 supplement to liability insurance, insurance arising out of workers'
12 compensation or similar law, automobile medical-payment insurance, or
13 insurance under which benefits are payable with or without regard to fault
14 and that is statutorily required to be contained in any liability insurance
15 policy or equivalent self-insurance;
16 (14) "Health maintenance organization" shall have the same
17 meaning as defined in � 23-76-102;
18 (15) "Hospital" shall have the same meaning as defined in � 20-
19 9-201;
20 (16) "Individual health insurance coverage" means health
21 insurance coverage offered to individuals in the individual market but does
22 not include short-term, limited-duration insurance;
23 (17)(A) "Insurer" means any entity that provides health
24 insurance, including excess or stop-loss health insurance, in the State of
25 Arkansas.
26 (B) For the purposes of this subchapter, "insurer"
27 includes an insurance company, medical services plans, hospital plans,
28 hospital medical service corporations, health maintenance organizations,
29 fraternal benefits society, or any other entity providing a plan of health
30 insurance or health benefits subject to state insurance regulation;
31 (18) "Medical assistance" means the state medical assistance
32 program provided under Title XIX of the Social Security Act or under any
33 similar program of healthcare benefits in a state other than Arkansas;
34 (19)(A)(i) "Medically necessary" means that a service, drug,
35 supply, or article is necessary and appropriate for the diagnosis or
36 treatment of an illness or injury in accord with generally accepted standards
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1 of medical practice at the time the service, drug, or supply is provided.
2 (ii) When specifically applied to a confinement,
3 "medically necessary" further means that the diagnosis or treatment of the
4 covered person's medical symptoms or condition cannot be safely provided to
5 that person as an outpatient.
6 (B) A service, drug, supply, or article shall not be
7 medically necessary if it:
8 (i) Is investigational, experimental, or for
9 research purposes;
10 (ii) Is provided solely for the convenience of the
11 patient, the patient's family, physician, hospital, or any other provider;
12 (iii) Exceeds in scope, duration, or intensity that
13 level of care that is needed to provide safe, adequate, and appropriate
14 diagnosis or treatment;
15 (iv) Could have been omitted without adversely
16 affecting the covered person's condition or the quality of medical care; or
17 (v) Involves the use of a medical device, drug, or
18 substance not formally approved by the United States Food and Drug
19 Administration;
20 (20) "Medicare" means coverage under Part A and Part B of Title
21 XVIII of the Social Security Act, 42 U.S.C. � 1395 et seq.;
22 (21) "Physician" means a person licensed to practice medicine as
23 duly licensed by the State of Arkansas;
24 (22) "Plan" means the comprehensive health insurance plan as
25 adopted by the board or by rule;
26 (23) "Plan administrator" means the insurer designated under �
27 23-79-508 to carry out the provisions of the plan of operation;
28 (24) "Plan of operation" means the plan of operation of the
29 pool, including articles, bylaws, and operating rules adopted by the board
30 pursuant to this subchapter;
31 (25) "Provider" means any hospital, skilled nursing facility,
32 hospice, home health agency, physician, pharmacist, or any other person or
33 entity licensed in Arkansas to furnish medical care, articles, and supplies;
34 (26) "Qualified high-risk pool" has the same meaning given that
35 term in the Health Insurance Portability and Accountability Act of 1996;
36 (27) "Qualified trade adjustment assistance eligible person"
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1 means a person who is a trade adjustment assistance eligible person as
2 defined by this section and for whom, on the date an application for the
3 individual is received by the pool under � 23-79-509, has an aggregate of at
4 least three (3) months of creditable coverage without a break in coverage of
5 sixty-three (63) days or more;
6 (28) "Resident eligible person" means a person who:
7 (A) Has been legally domiciled in the State of Arkansas
8 for a period of at least:
9 (i) Ninety (90) days and continues to be domiciled
10 in Arkansas; or
11 (ii) Thirty (30) days, continues to be domiciled in
12 Arkansas, and was covered under a qualified high-risk pool in another state
13 up until sixty-three (63) days or less prior to the date that the pool
14 receives his or her application for coverage; and
15 (B) Is not eligible for coverage under:
16 (i) A group health plan;
17 (ii) Part A or Part B of Medicare; or
18 (iii) Medical assistance as defined in this section
19 and does not have other health insurance coverage as defined in this section;
20 and
21 (29) "Trade adjustment assistance eligible person" means a
22 person who is legally domiciled in the State of Arkansas on the date of
23 application to the pool and is eligible for the tax credit for health
24 insurance coverage premiums under section 35 of the Internal Revenue Code of
25 1986.
26
27 23-79-504. Arkansas Comprehensive Health Insurance Pool.
28 (a) There is created a nonprofit legal entity to be known as the
29 "Arkansas Comprehensive Health Insurance Pool" as the successor entity to the
30 nonprofit legal entity established by Acts 1995, No. 1339.
31 (b)(1) The pool shall operate subject to the supervision and control
32 of the Board of Directors of the Arkansas Comprehensive Health Insurance
33 Pool. The pool is created as a political subdivision, instrumentality, and
34 body politic of the State of Arkansas, and, as such, is not a state agency.
35 (2) Except to the extent defined in this subchapter, the pool
36 will be exempt from:
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1 (A) All state, county, and local taxes;
2 (B) The Arkansas Procurement Law, � 19-11-201 et seq.;
3 (C) The Freedom of Information Act of 1967, � 25-19-101 et
4 seq.; and
5 (D) The Arkansas Administrative Procedure Act, � 25-15-201
6 et seq.
7 (3) The board shall consist of the following seven (7) members
8 to be appointed by the Insurance Commissioner:
9 (A) Two (2) current or former representatives of insurance
10 companies licensed to do business in the State of Arkansas;
11 (B) Two (2) current or former representatives of health
12 maintenance organizations licensed to do business in the State of Arkansas;
13 (C) One (1) member of a health-related profession licensed
14 in the State of Arkansas;
15 (D) One (1) member from the general public who is not
16 associated with the medical profession, a hospital, or an insurer; and
17 (E) One (1) member to represent a group considered to be
18 uninsurable.
19 (4) In making appointments to the board, the commissioner shall
20 strive to ensure that at least one (1) person serving on the board is at
21 least sixty (60) years of age.
22 (5) All terms shall be for three (3) years.
23 (6) The board shall elect one (1) of its members as chair.
24 (7) Any vacancy in the board occurring for any reason other than
25 the expiration of a term shall be filled for the unexpired term in the same
26 manner as the original appointment.
27 (8) Members of the board may be reimbursed from moneys of the
28 pool for actual and necessary expenses incurred by them in the performance of
29 their official duties as members of the board but shall not otherwise be
30 compensated for their services.
31 (c) All insurers, as a condition of doing business in the State of
32 Arkansas, shall participate in the pool by paying the assessments, submitting
33 the reports, and providing the information required by the board or the
34 commissioner to implement the provisions of this subchapter.
35 (d)(1) Neither the board nor its employees shall be liable for any
36 obligations of the pool.
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1 (2) No board member or employee of the board shall be liable,
2 and no cause of action of any nature may arise against them, for any act or
3 omission related to the performance of their powers and duties under this
4 subchapter.
5 (3) The board may provide in its bylaws or rules for
6 indemnification of, and legal representation for, the board members and
7 employees.
8
9 23-79-505. Plan of operation.
10 (a)(1) The Board of Directors of the Arkansas Comprehensive Health
11 Insurance Pool shall adopt a plan of operation pursuant to this subchapter
12 and shall submit to the Insurance Commissioner for approval the plan of
13 operation including the Arkansas Comprehensive Health Insurance Pool's
14 articles, bylaws and operating rules, and any amendments thereto necessary or
15 suitable to assure the fair, reasonable, and equitable administration of the
16 pool. The plan of operation shall become effective upon approval in writing
17 by the commissioner.
18 (2) If the board fails to submit a suitable plan of operation
19 within one hundred eighty (180) days after the appointment of the board of
20 directors, or at any time thereafter fails to submit suitable amendments to
21 the plan of operation, the commissioner shall adopt and promulgate such rules
22 as are necessary or advisable to effectuate the provisions of this section.
23 The rules shall continue in force until modified by the commissioner or
24 superseded by a plan of operation submitted by the board and approved by the
25 commissioner.
26 (b) The plan of operation shall:
27 (1) Establish procedures for operation of the pool;
28 (2) Establish procedures for selecting a plan administrator in
29 accordance with � 23-79-508;
30 (3) Create a fund, under management of the board, to pay
31 administrative claims and other expenses of the pool;
32 (4) Establish procedures for the handling, accounting, and
33 auditing of assets, moneys, and claims of the pool and the plan
34 administrator;
35 (5) Develop and implement a program to publicize the existence
36 of the plan, the eligibility requirements, and the procedures for enrollment
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1 and to maintain public awareness of the plan;
2 (6)(A) Establish procedures under which applicants and
3 participants may have grievances reviewed by a grievance committee appointed
4 by the board. The grievances shall be reported to the board after completion
5 of the review.
6 (B) The board shall retain all written complaints
7 regarding the plan for at least three (3) years; and
8 (7) Provide for other matters as may be necessary and proper for
9 the execution of the board's powers, duties, and obligations under this
10 subchapter.
11
12 23-79-506. Powers.
13 (a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the
14 general powers and authority granted under the laws of the State of Arkansas
15 to health insurers and, in addition thereto, the specific authority to:
16 (A) Enter into contracts as are necessary or proper to
17 carry out the provisions and purposes of this subchapter;
18 (B) Sue or be sued, including taking any legal actions
19 necessary or proper;
20 (C) Take such legal action as necessary, including without
21 limitation:
22 (i) Avoiding the payment of improper claims against
23 the pool or the coverage provided by or through the pool;
24 (ii) Recovering any amounts erroneously or
25 improperly paid by the pool;
26 (iii) Recovering any amounts paid by the pool as a
27 result of mistake of fact or law;
28 (iv) Recovering other amounts due the pool; or
29 (v) Coordinating legal action with the Insurance
30 Commissioner to enforce the provisions of this subchapter;
31 (D)(i) Establish and modify from time to time as
32 appropriate, rates, rate schedules, rate adjustments, expense allowances,
33 agent referral fees, claim reserve formulas, deductibles, copayments,
34 coinsurance, and any other actuarial function appropriate to the operation of
35 the pool.
36 (ii) Rates and rate schedules may be adjusted for
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1 appropriate factors such as age, sex, and geographical variation in claim
2 costs and shall take into consideration appropriate factors in accordance
3 with established actuarial and underwriting practices;
4 (E) Issue policies of insurance in accordance with the
5 requirements of this subchapter. All policy forms shall be subject to the
6 approval of the commissioner;
7 (F) Authorize the plan administrator to prepare and
8 distribute certificate of eligibility forms and enrollment instruction forms
9 to agents and to the general public;
10 (G) Provide and employ cost-containment measures and
11 requirements, including without limitation preadmission screening, second
12 surgical opinion, concurrent utilization review, and individual case
13 management for the purposes of making the plan more cost effective;
14 (H) Design, utilize, contract, or otherwise arrange the
15 delivery of cost-effective healthcare services, including establishing or
16 contracting directly or through the plan administrator with preferred
17 provider organizations, health maintenance organizations, physician hospital
18 organizations, or other limited network provider arrangements;
19 (I) Borrow money to effect the purposes of the pool. Any
20 notes or other evidence of indebtedness of the pool not in default shall be
21 legal investments for insurers and may be carried as admitted assets;
22 (J) Pledge, assign, and grant a security interest in any
23 of the assessments authorized by this subchapter or other assets of the pool
24 in order to secure any notes or other evidences of indebtedness of the pool;
25 (K) Provide reinsurance of risks incurred by the pool;
26 (L) Provide additional types of plans to provide optional
27 coverages, including Medicare supplement health insurance and health savings
28 accounts that comply with applicable federal law as in effect January 1,
29 2005;
30 (M) Enter into reciprocal agreements with other comparable
31 state plans in order to provide coverage for persons who move between states
32 and are covered by such other states' plans; and
33 (N) Establish lifetime maximum benefits under � 23-79-
34 510(a)(2)(W) for any person covered by a plan.
35 (2) In addition to the other powers granted by the Arkansas
36 Insurance Code, the commissioner may impose, after notice and hearing in
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1 accordance with the provisions of the Arkansas Insurance Code, a monetary
2 penalty upon any insurer or suspend or revoke the certificate of authority to
3 transact insurance in the State of Arkansas of any insurer that fails to pay
4 an assessment or otherwise file any report or furnish information required to
5 be filed with the Board of Directors of the Arkansas Comprehensive Health
6 Insurance Pool pursuant to the board's direction that the board believes is
7 necessary in order for the board to perform its duties under this subchapter.
8 (b) All outstanding contracts executed by the Board of Directors of
9 the State Comprehensive Health Insurance Pool created by Acts 1995, No. 1339,
10 shall be deemed continuing obligations of the board created by this
11 subchapter.
12 (c) As provided for in � 23-79-502, any health insurance benefit not
13 provided for in this subchapter shall be deemed to be in conflict with and
14 therefore inapplicable to the provisions of this subchapter.
15
16 23-79-507. Funding of pool.
17 (a) Premiums.
18 (1)(A) The Arkansas Comprehensive Health Insurance Pool shall
19 establish premium rates for plan coverage as provided in subdivision (a)(2)
20 of this section.
21 (B) Separate schedules of premium rates based on age, sex,
22 and geographical location may apply for individual risks.
23 (C) Premium rates and schedules shall be submitted to the
24 Insurance Commissioner for approval prior to use.
25 (2)(A)(i) With the assistance of the commissioner, the pool
26 shall determine a standard risk rate by considering the premium rates charged
27 by other insurers offering health insurance coverage to individuals in
28 Arkansas.
29 (ii) The standard risk rate shall be established
30 using reasonable actuarial techniques and shall reflect anticipated
31 experience and expenses for the coverage.
32 (B)(i) Rates for plan coverage shall not exceed one
33 hundred fifty percent (150%) of rates established as applicable for
34 individual standard risks in Arkansas.
35 (ii) Subject to the limits provided in this
36 subdivision (a)(2), subsequent rates shall be established to help provide for
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1 the expected costs of claims, including recovery of prior losses, expenses of
2 operation, investment income of claim reserves, and any other cost factors
3 subject to the limitations described in this section.
4 (b) Sources of Additional Revenue.
5 (1) In addition to the powers enumerated in � 23-79-506, the
6 pool shall have the authority to:
7 (A) Assess insurers in accordance with the provisions of
8 this section; and
9 (B)(i) Make advance interim assessments as may be
10 reasonable and necessary for the pool's organizational and interim operating
11 expenses.
12 (ii) Any such interim assessments may be credited as
13 offsets against any regular assessments due following the close of the fiscal
14 year.
15 (2)(A) Following the close of each fiscal year, the plan
16 administrator shall determine the net premiums, that is, premiums less
17 administrative expense allowances, the pool expenses of administration and
18 operation, and the incurred losses for the year, taking into account
19 investment income and other appropriate gains and losses.
20 (B) The deficit incurred by the pool not otherwise
21 recouped under either subdivision (b)(9) of this section or subsection (e) of
22 this section [repealed], or both, shall be recouped by assessments
23 apportioned among insurers by the Board of Directors of the Arkansas
24 Comprehensive Health Insurance Pool.
25 (3) Each insurer's assessment shall be determined by multiplying
26 the total assessment of all insurers as determined in subdivision (b)(2) of
27 this section by a fraction, the numerator of which equals that insurer's
28 premium and subscriber contract charges for health insurance written in the
29 state during the preceding calendar year and the denominator of which equals
30 the total of all health insurance premiums by all insurers.
31 (4)(A) If assessments or other funds received under either
32 subdivision (b)(9) of this section or subsection (e) of this section
33 [repealed], or both, or any combination of the assessments and funds exceed
34 the pool's actual losses and administrative expenses, the excess shall be
35 held at interest and used by the board to offset future losses or to reduce
36 future assessments.
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1 (B) As used in this subsection, "future losses" includes
2 reserves for incurred but not reported claims.
3 (5) Each insurer's assessment shall be determined annually by
4 the board based on annual statements and other reports deemed necessary by
5 the board and filed by the insurer with the board or the commissioner.
6 (6)(A)(i) An insurer may petition the commissioner for an
7 abatement or deferment of all or part of an assessment imposed by the board.
8 (ii) The commissioner may abate or defer, in whole
9 or in part, the assessment if, in the opinion of the commissioner, payment of
10 the assessment would endanger the ability of the insurer to fulfill its
11 contractual obligations.
12 (B)(i) In the event an assessment against an insurer is
13 abated or deferred, in whole or in part, the amount by which the assessment
14 is abated or deferred shall be assessed against the other insurers in a
15 manner consistent with the basis for assessments set forth in this
16 subsection.
17 (ii) The insurer receiving the abatement or
18 deferment shall remain liable to the plan for the deficiency for four (4)
19 years.
20 (7) For all assessments issued by the board, beginning January
21 1, 1998, only those individuals, corporations, associations, or other
22 entities defined as an insurer in � 23-79-503 shall be subject to assessment.
23 (8) In the event the board fails to act within a reasonable
24 period of time to recoup by assessment any deficit incurred by the pool, the
25 commissioner shall have all the powers and duties of the board under this
26 chapter with respect to assessing insurers.
27 (9) The General Assembly further intends that the pool be
28 eligible for, and for the pool, its board, or other officers of state
29 government, as appropriate, to take steps necessary to obtain federal grant
30 funds to offset losses of the pool, including any funds made available under
31 the Trade Adjustment Assistance Reform Act of 2002.
32 (c) Assessment Offsets.
33 (1) Any assessment may be offset in an amount equal to the
34 amount of the assessment paid to the pool against the premium tax payable by
35 that insurer for the year in which the assessment is levied or for the four
36 (4) years subsequent to that year.
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1 (2) No offset shall be allowed for any penalty assessed under
2 subdivision (d)(1) of this section.
3 (d)(1) All assessments and fees shall be due and payable upon receipt
4 and shall be delinquent if not paid within thirty (30) days of the receipt of
5 the notice by the insurer.
6 (2) Failure to timely pay the assessment will automatically
7 subject the insurer to a ten percent (10%) penalty, which will be due and
8 payable within the next thirty-day period.
9 (3) The board and the commissioner shall have the authority to
10 enforce the collection of the assessment and penalty in accordance with the
11 provisions of this subchapter and the Arkansas Insurance Code.
12 (4) The board may waive the penalty authorized by this
13 subsection if it determines that compelling circumstances exist that justify
14 such a waiver.
15
16 23-79-508. Plan administrator.
17 (a) The Board of Directors of the Arkansas Comprehensive Health
18 Insurance Pool shall select an insurer through a competitive bidding process
19 to administer the plan. However, the administering insurer designated by the
20 board created by Acts 1995, No. 1339, shall serve as the plan administrator
21 under this subchapter until the expiration of the current contract of the
22 administering insurer. The board shall evaluate bids submitted under this
23 section based upon criteria established by the board which shall include, but
24 not be limited to, the following:
25 (1) The plan administrator's proven ability to handle large
26 group accident and health benefit plans;
27 (2) The efficiency and timeliness of the plan administrator's
28 claim processing procedures;
29 (3) An estimate of total charges for administering the plan;
30 (4) The plan administrator's ability to apply effective cost
31 containment programs and procedures and to administer the plan in a cost
32 efficient manner; and
33 (5) The financial condition and stability of the plan
34 administrator.
35 (b)(1) The plan administrator shall serve for a period of three (3)
36 years subject to removal for cause and subject to the terms, conditions, and
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1 limitations of the contract between the board and the plan administrator.
2 (2) The board shall advertise for and accept bids to serve as
3 the plan administrator for the succeeding three-year periods.
4 (c) The plan administrator shall perform functions related to the plan
5 as may be assigned to it, including:
6 (1) Determination of eligibility;
7 (2) Payment and processing of claims;
8 (3) Establishment of a premium billing procedure for collection
9 of premiums. Billings shall be made on a periodic basis as determined by the
10 board; and
11 (4) Other necessary functions to assure timely payment of
12 benefits to covered persons under the plan, including:
13 (A) Making available information relating to the proper
14 manner of submitting a claim for benefits under the plan and distributing
15 forms upon which submissions shall be made; and
16 (B) Evaluating the eligibility of each claim for payment
17 under the plan.
18 (d)(1) The plan administrator shall submit regular reports to the
19 board regarding the operation of the plan.
20 (2) Frequency, content, and form of the report shall be
21 determined by the board.
22 (e)(1) The plan administrator shall pay claim expenses from the
23 premium payments received from or on behalf of plan participants and
24 allocated by the board for claim expenses.
25 (2) If the plan administrator's payments for claims expenses
26 exceed the portion of premiums allocated by the board for payment of claims
27 expenses, the board shall provide additional funds to the plan administrator
28 for payment of claims expenses.
29 (f) The plan administrator shall be governed by the requirements of
30 this subchapter and shall be compensated as provided in the contract between
31 the board and the plan administrator.
32
33 23-79-509. Plan eligibility.
34 (a) General Eligibility Requirements. The following requirements
35 apply to a resident eligible person or a trade adjustment assistance eligible
36 person in order for the person to be eligible for plan coverage:
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1 (1) Except as provided in subdivision (a)(2) of this section or
2 subsection (b) of this section, any individual person who meets the
3 definition of resident eligible person as defined by � 23-79-503 or a trade
4 adjustment assistance eligible person as defined by � 23-79-503 and is either
5 a citizen of the United States or an alien lawfully admitted for permanent
6 residence who continues to be a resident of this state shall be eligible for
7 plan coverage if evidence is provided of:
8 (A) A notice of rejection or refusal by an insurer to
9 issue substantially similar individual health insurance coverage by reason of
10 the existence or history of a medical condition or upon such other evidence
11 that the Board of Directors of the Arkansas Comprehensive Health Insurance
12 Pool deems sufficient in order to verify that the applicant is unable to
13 obtain the coverage from an insurer due to the existence or history of a
14 medical condition;
15 (B)(i) A refusal by an insurer to issue individual health
16 insurance coverage except at a rate that the board determines is
17 substantially in excess of the applicable plan rate.
18 (ii) A rejection or refusal by a group health plan
19 or insurer offering only stop-loss or excess-of-loss insurance or contracts,
20 agreements, or other arrangements for reinsurance coverage with respect to
21 the applicant shall not be sufficient evidence under this subsection;
22 (C)(i) Until September 30, 2011, a refusal by an insurer
23 to issue individual health insurance coverage to a child under nineteen (19)
24 years of age.
25 (ii) After September 30, 2011, the eligibility of a
26 child under nineteen (19) years of age for individual health insurance
27 coverage shall be determined by the board; or
28 (D) Evidence that the applicant was covered under a
29 qualified high-risk pool of another state, provided that the coverage
30 terminated no more than sixty-three (63) days prior to the date the pool
31 receives the applicant's application for coverage and the other state's
32 qualified high-risk pool did not terminate the person's coverage for fraud;
33 (2) A person shall not be eligible for coverage under the plan
34 if:
35 (A) The person has or obtains health insurance coverage
36 substantially similar to or more comprehensive than a plan policy or would be
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1 eligible to have coverage if the person elected to obtain it except that:
2 (i) A person may maintain other coverage for the
3 period of time the person is satisfying any waiting period for a preexisting
4 condition under a plan policy; and
5 (ii) A person may maintain plan coverage for the
6 period of time the person is satisfying a waiting period for a preexisting
7 condition under another health insurance policy intended to replace the plan
8 policy;
9 (B) The person is determined to be eligible for healthcare
10 benefits under Title XIX of the Social Security Act;
11 (C) The person has previously terminated plan coverage
12 unless twelve (12) months have elapsed since termination of coverage;
13 (D) The person fails to pay the required premium under the
14 covered person's terms of enrollment and participation, in which event the
15 liability of the plan shall be limited to benefits incurred under the plan
16 for the same period for which premiums had been paid and the covered person
17 remained eligible for plan coverage;
18 (E) The plan has paid on behalf of the covered person the
19 maximum lifetime benefit established by the board in accordance with � 23-79-
20 510(a)(2)(W);
21 (F) The person is a resident of a public institution;
22 (G) All or part of the person's premium is paid for or
23 reimbursed:
24 (i) By one (1) of the following in connection with a
25 group health plan:
26 (a) The person's current employer;
27 (b) If the person is retired, by the person's
28 former employer; or
29 (c) If the person is a dependent of an
30 employee or retiree, by the current or former employer of the employee or
31 retiree; or
32 (ii) Under any government-sponsored program or by
33 any government agency, foundation, healthcare facility, or healthcare
34 provider except for premiums paid on behalf of:
35 (a) A trade adjustment assistance eligible
36 person or a qualified trade adjustment assistance eligible person in
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1 accordance with section 35 of the Internal Revenue Code; or
2 (b) An otherwise qualifying full-time employee
3 or dependent of a qualifying full-time employee of a government agency,
4 foundation, healthcare facility, or healthcare provider; or
5 (H) The person commits a fraudulent insurance act as
6 defined in � 23-66-501(4) against the Arkansas Comprehensive Health Insurance
7 Pool;
8 (3) The board or the plan administrator shall require
9 verification of residency and may require any additional information,
10 documentation, or statements under oath whenever necessary to determine plan
11 eligibility or residency;
12 (4) Coverage shall cease:
13 (A) On the date a person is no longer a resident of the
14 State of Arkansas;
15 (B) On the date a person requests coverage to end;
16 (C) On the death of the covered person;
17 (D) On the date state law requires cancellation of the
18 policy; or
19 (E) At the plan's option, thirty (30) days after the plan
20 makes any written inquiry concerning a person's eligibility or place of
21 residence to which the person does not reply; and
22 (5) Except under the conditions set forth in subdivision (a)(4)
23 of this section, the coverage of any person who ceases to meet the
24 eligibility requirements of this section terminates at the end of the month
25 that the person ceases to meet the eligibility requirements of this section.
26 (b) Persons Eligible for Guaranteed Issuance of Coverage. The
27 following requirements apply to a federally eligible individual or a
28 qualified trade adjustment assistance eligible person in order for such an
29 individual to be eligible for plan coverage:
30 (1) Notwithstanding the requirements of subsection (a) of this
31 section, any federally eligible individual or a qualified trade adjustment
32 assistance eligible person for whom a plan application and such enclosures
33 and supporting documentation as the board may require is received by the
34 board within sixty-three (63) days after the termination of prior creditable
35 coverage for reasons other than nonpayment of premium or fraud that covered
36 the applicant shall qualify to enroll in the plan under the portability
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1 provisions of this subsection;
2 (2) Any individual seeking plan coverage under this subsection
3 must submit with his or her application evidence, including acceptable
4 written certification of previous creditable coverage, that will establish to
5 the board's satisfaction that he or she meets all of the requirements to be a
6 federally eligible individual or a qualified trade adjustment assistance
7 eligible person and is currently and permanently residing in the State of
8 Arkansas as of the date his or her application was received by the board;
9 (3) A period of creditable coverage shall not be counted, with
10 respect to qualifying an applicant for plan coverage as an individual under
11 this subsection, if after such a period and before the application for plan
12 coverage was received by the board, there was at least a sixty-three-day
13 period during all of which the individual was not covered under any
14 creditable coverage;
15 (4) Any individual who the board determines qualifies for plan
16 coverage under this subsection shall be offered his or her choice of
17 enrolling in one (1) of the alternative portability plans that the board is
18 authorized under this subsection to establish for those individuals;
19 (5)(A)(i) The board shall offer a choice of healthcare coverages
20 consistent with major medical coverage under the alternative plans authorized
21 by this subsection to every individual qualifying for coverage under this
22 subsection.
23 (ii) The coverages to be offered under the plans,
24 the schedule of benefits, deductibles, copayments, coinsurance, exclusions,
25 and other limitations shall be approved by the board.
26 (B) One (1) optional form of coverage shall be comparable
27 to comprehensive health insurance coverage offered in the individual market
28 in the State of Arkansas or a standard option of coverage available under the
29 individual health insurance laws of the State of Arkansas. The standard plan
30 that is authorized by � 23-79-510 may be used for this purpose.
31 (C) The board also may offer a preferred provider option
32 and such other options as the board determines may be appropriate for
33 individuals who qualify for plan coverage pursuant to this subsection;
34 (6) Notwithstanding the requirements of � 23-79-510(f), any plan
35 coverage that is issued to individuals who qualify for plan coverage pursuant
36 to the portability provisions of this subsection shall not be subject to any
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1 preexisting conditions exclusion, waiting period, or other similar limitation
2 on coverage;
3 (7) Individuals who qualify and enroll in the plan pursuant to
4 this subsection shall be required to pay such premium rates as the board
5 shall establish and approve in accordance with the requirements of � 23-79-
6 507(a);
7 (8) The total premium, without regard to any subsidy of premium,
8 for individuals who qualify and enroll in the plan pursuant to this
9 subsection shall not be greater than a similarly situated individual
10 qualifying for pool coverage under subsection (a) of this section; and
11 (9) A federally eligible individual who qualifies and enrolls in
12 the plan pursuant to this subsection must continue to satisfy all of the
13 other eligibility requirements of this subchapter to the extent not
14 inconsistent with the Health Insurance Portability and Accountability Act of
15 1996 in order to maintain continued eligibility for coverage under the plan.
16 (c) Any person who was issued a policy pursuant to the provisions of
17 Acts 1995, No. 1339, shall be deemed continuously covered consistent with the
18 terms of this subchapter and reissued a new policy in accordance with the
19 provisions of this subchapter.
20
21 23-79-510. Outline of benefits.
22 (a)(1) Subject to the contractual policy form language adopted by the
23 Board of Directors of the Arkansas Comprehensive Health Insurance Pool,
24 expenses for the following services, supplies, drugs, or articles when
25 prescribed by a physician and determined by the plan to be medically
26 necessary shall be covered, subject to provisions of subsection (b) of this
27 section:
28 (A) Hospital services;
29 (B) Professional services for the diagnosis or treatment
30 of injuries, illnesses, or conditions, other than mental or dental, that are
31 rendered by a physician or by other licensed professionals at his or her
32 direction;
33 (C) Drugs requiring a physician's prescription;
34 (D) Skilled nursing services of a licensed skilled nursing
35 facility for not more than one hundred twenty (120) days during a policy
36 year;
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1 (E) Services of a home health agency up to a maximum of
2 two hundred seventy (270) services per year;
3 (F) Use of radium or other radioactive materials;
4 (G) Oxygen;
5 (H) Prostheses other than dental;
6 (I) Rental of durable medical equipment, other than
7 eyeglasses and hearing aids, for which there is no personal use in the
8 absence of the conditions for which such equipment is prescribed;
9 (J) Diagnostic X rays and laboratory tests;
10 (K) Oral surgery for excision of partially or completely
11 unerupted, impacted teeth or the gums and tissues of the mouth when not
12 performed in connection with the extraction or repair of teeth;
13 (L) Services of a physical therapist;
14 (M) Emergency and other medically necessary transportation
15 provided by a licensed ambulance service to the nearest facility qualified to
16 treat a covered condition;
17 (N) Services for diagnosis and treatment of mental and
18 nervous disorders or chemical and drug dependency, provided that a covered
19 person shall be required to make a fifty percent (50%) copayment and that the
20 plan's payment shall not exceed four thousand dollars ($4,000) annually; and
21 (O) Such additional benefits deemed appropriate by the
22 board in accordance with the provisions of subsection (b) of this section.
23 (2) Exclusions. Unless the contractual policy form language
24 adopted by the board provides otherwise, the following services, supplies,
25 drugs, or articles whether or not prescribed by a physician, shall not be
26 covered:
27 (A) Any charge for treatment for cosmetic purposes other
28 than surgery for the repair or treatment of an injury or a congenital bodily
29 defect to restore normal bodily functions;
30 (B) Care that is primarily for custodial or domiciliary
31 purposes;
32 (C) Any charge for confinement in a private room to the
33 extent it is in excess of the institution's charge for its most common
34 semiprivate room unless a private room is medically necessary;
35 (D) That part of any charge for services rendered or
36 articles prescribed by a physician, dentist, or other healthcare personnel
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1 that exceeds the prevailing charge in the locality or for any charge not
2 medically necessary;
3 (E) Any charge for services or articles the provision of
4 which is not within the scope of authorized practice of the institution or
5 individual providing the services or articles;
6 (F) Any expense incurred prior to the effective date of
7 coverage by the plan for the person on whose behalf the expense is incurred;
8 (G) Dental care except as provided in subdivision
9 (a)(1)(K) of this section;
10 (H) Eyeglasses and hearing aids;
11 (I) Illness or injury due to acts of war;
12 (J) Services of blood donors and any fee for failure to
13 replace the first three (3) pints of blood provided to a covered person each
14 policy year;
15 (K) Personal supplies or services provided by a hospital
16 or nursing home or any other nonmedical or nonprescribed supply or service;
17 (L) Any expense or charge for services, articles, drugs,
18 or supplies that are not provided in accord with generally accepted standards
19 of current medical practice;
20 (M) Any expense for which a charge is not made in the
21 absence of insurance or for which there is no legal obligation on the part of
22 the patient to pay;
23 (N) Any expense incurred for benefits provided under the
24 laws of the United States and the State of Arkansas, including Medicare and
25 Medicaid and other medical assistance, military service-connected disability
26 payments, medical services provided for members of the armed forces and their
27 dependents or employees of the United States Armed Forces, and medical
28 services financed on behalf of all citizens by the United States;
29 (O) Any expense or charge for in vitro fertilization,
30 artificial insemination, or any other artificial means used to cause
31 pregnancy;
32 (P) Any expense or charge for oral contraceptives used for
33 birth control or any other temporary birth control measures;
34 (Q) Any expense or charge for sterilization or
35 sterilization reversals;
36 (R) Any expense or charge for weight-loss programs,
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1 exercise equipment, or treatment of obesity except when certified by a
2 physician as morbid obesity, i.e., at least two (2) times normal body weight;
3 (S) Any expense or charge for acupuncture treatment unless
4 used as an anesthetic agent for a covered surgery;
5 (T) Any expense or charge for organ or bone marrow
6 transplants other than those performed at a hospital with a board-approved
7 organ transplant program that has been designated by the board as a preferred
8 provider organization for that specific organ or bone marrow transplant;
9 (U) Any expense or charge for procedures, treatments,
10 equipment, or services that are provided in special settings for research
11 purposes or in a controlled environment, are being studied for safety,
12 efficiency, and effectiveness, and are awaiting endorsement by the
13 appropriate national medical specialty college for general use within the
14 medical community;
15 (V) Such additional exclusions deemed appropriate by the
16 board in accordance with the provisions of subsection (b) of this section;
17 and
18 (W)(i) Any benefits that exceed the maximum lifetime
19 benefit for plan coverage established by the board under � 23-79-
20 506(a)(1)(N).
21 (ii) The maximum lifetime benefit shall not be less
22 than one million dollars ($1,000,000) and shall not exceed three million
23 dollars ($3,000,000).
24 (b) In establishing the plan coverage, the board shall take into
25 consideration the levels of health insurance provided in the state and
26 medical economic factors as may be deemed appropriate and promulgate
27 benefits, deductibles, copayments, coinsurance factors, exclusions, and
28 limitations determined to be generally reflective of and commensurate with
29 health insurance provided through a representative number of large employers
30 in the state.
31 (c) The board may adjust any deductibles, copayments, and coinsurance
32 factors annually according to the medical component of the Consumer Price
33 Index for All Urban Consumers.
34 (d) Nonduplication of Benefits.
35 (1)(A) The pool shall be payer of last resort of benefits
36 whenever any other benefit or source of third-party payment is available.
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1 (B) Benefits otherwise payable under plan coverage shall
2 be reduced by all amounts paid or payable through any other health insurance
3 or any other source providing benefits because of a sickness or injury and by
4 all hospital and medical expense benefits paid or payable under any workers'
5 compensation coverage, automobile medical payment, or liability insurance
6 whether provided on the basis of fault or nonfault and by any hospital or
7 medical benefits paid or payable under or provided pursuant to any state or
8 federal law or program.
9 (2) The pool shall have a cause of action against a covered
10 person for the recovery of the amount of benefits paid that are not covered
11 by the pool. Benefits due from the pool may be reduced or refused as a set-
12 off against any amount recoverable under this subdivision (d)(2).
13 (e) Right of Subrogation -- Recoveries.
14 (1)(A) Whenever the pool has paid benefits because of sickness
15 or an injury to any covered person resulting from a third party's wrongful
16 act or negligence or for which an insurance company or self-insured entity is
17 liable in accordance with the provisions of any policy of insurance, and the
18 covered person has recovered or may recover damages from a third party that
19 is liable for damages, the pool shall have the right to recover the benefits
20 it paid from any amounts that the covered person has received or may receive
21 regardless of the date of the sickness or injury or the date of any
22 settlement, judgment, or award resulting from the sickness or injury.
23 (B) The pool shall be subrogated to any right of recovery
24 the covered person may have under the terms of any private or public
25 healthcare coverage or liability coverage including coverage under a workers'
26 compensation act without the necessity of assignment of claim or other
27 authorization to secure the right of recovery.
28 (C) To enforce its subrogation right, the pool may:
29 (i) Intervene or join in an action or proceeding
30 brought by the covered person or his or her personal representative,
31 including his or her guardian, conservator, estate, dependents, or survivors,
32 against any third party or the third party's insurance carrier or self-
33 insured entity that may be liable; or
34 (ii) Institute and prosecute legal proceedings
35 against any third party or the third party's insurance carrier or self-
36 insured entity that may be liable for the sickness or injury in an
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1 appropriate court either in the name of the pool or in the name of the
2 covered person or his or her personal representative including his or her
3 guardian, conservator, estate, dependents, or survivors.
4 (2)(A)(i) If any action or claim is brought by or on behalf of a
5 covered person against a third party or the third party's insurance carrier
6 or self-insured entity, the covered person or his or her personal
7 representative, including his or her guardian, conservator, estate,
8 dependents, or survivors, shall notify the pool by personal service or
9 registered mail of the action or claim and of the name of the court in which
10 the action or claim is brought, filing proof thereof in the action or claim.
11 (ii) The pool may, at any time thereafter, join in
12 the action or claim upon its motion so that all orders of court after hearing
13 and judgment shall be made for its protection.
14 (B) No release or settlement of a claim for damages and no
15 satisfaction of judgment in the action shall be valid without the written
16 consent of the pool to the extent of its interest in the settlement or
17 judgment and of the covered person or his or her personal representative.
18 (3)(A) In the event that the covered person or his or her
19 personal representative fails to institute a proceeding against any
20 appropriate third party before the fifth month before the action would be
21 barred, the pool, in its own name or in the name of the covered person or
22 personal representative, may commence a proceeding against any appropriate
23 third party for the recovery of damages on account of any sickness, injury,
24 or death to the covered person.
25 (B) The covered person shall cooperate in doing what is
26 reasonably necessary to assist the pool in any recovery and shall not take
27 any action that would prejudice the pool's right to recovery.
28 (C) The pool shall pay to the covered person or his or her
29 personal representative all sums collected from any third party by judgment
30 or otherwise in excess of amounts paid in benefits under the pool and amounts
31 paid or to be paid as costs, attorney's fees, and reasonable expenses
32 incurred by the pool in making the collection or enforcing the judgment.
33 (4)(A)(i) In the event of judgment or award in either a suit or
34 claim against a third party, the court shall first order paid from any
35 judgment or award the reasonable litigation expenses incurred in preparation
36 and prosecution of the action or claim, together with reasonable attorney's
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1 fees.
2 (ii) After payment of those expenses and attorney's
3 fees, the court shall apply out of the balance of the judgment or award an
4 amount sufficient to reimburse the pool the full amount of benefits paid on
5 behalf of the covered person under this subchapter, provided that the court
6 may reduce and apportion the pool's portion of the judgment proportionately
7 to the recovery of the covered person.
8 (B)(i) The burden of producing sufficient evidence to
9 support the exercise by the court of its discretion to reduce the amount of a
10 proven charge sought to be enforced against the recovery shall rest with the
11 party seeking the reduction.
12 (ii) The court may consider the nature and extent of
13 the injury, economic and noneconomic loss, settlement offers, comparative or
14 contributory negligence as it applies to the case at hand, hospital costs,
15 physician costs, and all other appropriate costs.
16 (C) The pool shall pay its pro rata share of the
17 attorney's fees based on the pool's recovery as it compares to the total
18 judgment.
19 (D) Any reimbursement rights of the pool shall take
20 priority over all other liens and charges existing under the laws of the
21 State of Arkansas.
22 (5) The pool may compromise or settle and release any claim for
23 benefits provided under this subchapter or waive any claims for benefits, in
24 whole or in part, for the convenience of the pool or if the pool determines
25 that collection will result in undue hardship upon the covered person.
26 (f) Preexisting Conditions.
27 (1) Except for federally eligible individuals or qualified trade
28 adjustment assistance eligible persons qualifying for plan coverage under �
29 23-79-509(b) or resident eligible persons or trade adjustment assistance
30 eligible persons who qualify for and elect to purchase the waiver authorized
31 in subdivision (f)(2) of this section, plan coverage shall exclude charges or
32 expenses incurred during the first six (6) months following the effective
33 date of coverage as to any condition if:
34 (A) The condition has manifested itself within the six-
35 month period immediately preceding the effective date of coverage in such a
36 manner as would cause an ordinary prudent person to seek diagnosis, care, or
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1 treatment; or
2 (B) Medical advice, care, or treatment was recommended or
3 received within the six-month period immediately preceding the effective date
4 of the coverage.
5 (2) Waiver. The preexisting condition exclusions as set forth
6 in subdivision (f)(1) of this section will be waived to the extent to which
7 the resident eligible person or trade adjustment assistance eligible person:
8 (A) Has satisfied similar exclusions under any prior
9 individual health insurance coverage that was involuntarily terminated; and
10 (B)(i) Has applied for plan coverage not later than thirty
11 (30) days following the involuntary termination.
12 (ii) For each resident eligible person or trade
13 adjustment assistance eligible person who qualifies for and elects this
14 waiver, there shall be added on a prorated basis to each payment of premium a
15 surcharge of up to ten percent (10%) of the otherwise applicable annual
16 premium for as long as that individual's coverage under the plan remains in
17 effect or sixty (60) months, whichever is less.
18 (3)(A) Whenever benefits are due from the plan because of
19 sickness or an injury to a covered person resulting from a third party's
20 wrongful act or negligence and the covered person has recovered or may
21 recover damages from a third party or its insurance carrier or self-insured
22 entity, the plan shall have the right to reduce benefits or to refuse to pay
23 benefits that otherwise may be payable in the amount of damages that the
24 covered person has recovered or may recover regardless of the date of the
25 sickness or injury or the date of any settlement, judgment, or award
26 resulting from that sickness or injury.
27 (B)(i) During the pendency of any action or claim that is
28 brought by or on behalf of a covered person against a third party or its
29 insurance carrier or self-insured entity, any benefits that would otherwise
30 be payable except for the provisions of this subsection shall be paid if
31 payment by or for the third party has not yet been made and the covered
32 person or, if capable, that person's legal representative agrees in writing
33 to pay back properly the benefits paid as a result of the sickness or injury
34 to the extent of any future payments made by or for the third party for the
35 sickness or injury.
36 (ii) This agreement is to apply whether or not
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1 liability for the payments is established or admitted by the third party or
2 whether those payments are itemized.
3 (C) Any amounts due the plan to repay benefits may be
4 deducted from other benefits payable by the plan after payments by or for the
5 third party are made.
6 (4) Benefits due from the plan may be reduced or refused as an
7 offset against any amount otherwise recoverable under this section.
8
9 23-79-511. Confidentiality.
10 (a)(1) All steps necessary under state and federal law to protect
11 confidentiality of applicants and covered persons shall be undertaken by the
12 Board of Directors of the Arkansas Comprehensive Health Insurance Pool to
13 prevent the identification of individual records of covered persons under the
14 plan, rejected by the plan, or who may become ineligible for further
15 participation in the plan.
16 (2) Procedures shall be written by the board to assure the
17 confidentiality of records of persons covered under, rejected by, or who
18 became ineligible for further participation in the plan when gathering and
19 submitting data to the board or any other entity.
20 (b) Any information submitted to the board by hospitals or any other
21 provider pursuant to this subchapter from which the identity of a particular
22 individual can be determined shall be privileged and confidential and shall
23 not be disclosed in any manner. The foregoing includes, but shall not be
24 limited to, disclosure, inspection, or copying under the Freedom of
25 Information Act of 1967, � 25-19-101 et seq.
26
27 23-79-512. Collective action.
28 Neither the participation in the plan as insurers, the establishment of
29 rates, forms, or procedures nor any other joint or collective action required
30 by this subchapter shall be the basis of any legal action, criminal or civil
31 liability, or penalty against the plan or any insurer.
32
33 23-79-513. Unfair referral to plan -- Prohibited practices by
34 employers.
35 (a) It shall constitute an unfair trade practice under the Trade
36 Practices Act, � 23-66-201 et seq., for an insurer, agent, broker, or third-
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1 party administrator to refer an individual to the Arkansas Comprehensive
2 Health Insurance Pool or arrange for an individual to apply to the pool for
3 the purpose of:
4 (1) Separating the individual from group health insurance
5 coverage provided by a group health plan; or
6 (2) Facilitating enrollment in the pool by any of the following
7 individuals associated with an employer, with the knowledge that the employer
8 intends to pay or is paying all or part of the premium payments owed by the
9 individual for pool coverage:
10 (A) An employee of the employer;
11 (B) A retired employee of the employer; or
12 (C) A dependent of an employee or retired employee of the
13 employer.
14 (b) Because pool coverage is not intended to cover participants who
15 are eligible for a group health plan, an individual described in subdivision
16 (a)(2) of this section is not eligible:
17 (1) For pool coverage if the employer associated with the
18 applicant intends to pay for all or part of the pool premium payments for the
19 individual; or
20 (2) To continue pool coverage if the employer associated with
21 the individual directly or indirectly pays all or part of the pool premium
22 payments for the individual.
23
24 23-79-515. Orderly cessation of operations.
25 (a)(1) The Arkansas Comprehensive Health Insurance Pool shall cease
26 enrollment and coverage under the plan on and after January 1, 2014, as
27 required by federal law.
28 (2) After taking all reasonable steps, including those specified
29 in this section, to timely and efficiently assist in the transition of
30 individuals receiving plan coverage to the individual health insurance
31 market, the Board of Directors of the Arkansas Comprehensive Health Insurance
32 Pool shall cease operating the pool after paying health insurance claims for
33 plan coverage and meeting all other obligations of the board under this
34 section.
35 (b) The board may take all actions it deems necessary to:
36 (1) Cease enrollment for plan coverage effective December 1,
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1 2013;
2 (2)(A) Terminate all existing plan coverage effective at the end
3 of the calendar day on December 31, 2013.
4 (B) The board shall provide at least ninety (90) days
5 notice to current policyholders of the termination; and
6 (3) Amend plan policies and provide adequate notice to
7 policyholders, agents, and providers that to be paid or reimbursed, a claim
8 for plan services is required to be filed by the earlier of one hundred
9 eighty (180) days after plan coverage ends or three hundred sixty-five (365)
10 days after the date of service giving rise to the claim.
11 (c) This section does not require the board to revise plan benefits to
12 comply with federal law or to maintain plan coverage for any individual after
13 December 31, 2013.
14 (d)(1) After all plan coverage terminates under this section, the
15 board shall take reasonable steps to wind up all significant operations of
16 the pool by December 31, 2014.
17 (2) Notwithstanding any other provision of this subchapter, to
18 facilitate an efficient cessation of operations:
19 (A) The board may continue to use existing contractors
20 until cessation of operations without the need to issue competitive requests
21 for proposals;
22 (B) The board may continue to fund operations of this
23 subchapter under � 23-79-507;
24 (C) The board shall remain in effect:
25 (i) As provided by � 23-79-504(b); and
26 (ii) Until a judgment, order, or decree in any
27 action, suit, or proceeding commenced against or by the pool is fully
28 executed; and
29 (D)(i) The term of each current board member shall be
30 extended until the date the pool concludes all business as provided under
31 this section and the Insurance Commissioner certifies the cessations of
32 operations under subsection (g) of this section.
33 (ii) The term of a board member expires when the
34 commissioner certifies the cessations of operations under subsection (g) of
35 this section.
36 (e) On or before June 30, 2013, the board shall amend the plan of
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1 operation to reflect the actions necessary to implement this section.
2 (f) If the board has excess funds after the cessation of operations of
3 the pool, the funds shall be returned to the general revenue funds of the
4 state.
5 (g)(1) On or before March 1, 2016, or a later date if necessary to
6 complete the cessation of operations of the pool, the board shall file a
7 report with the General Assembly and commissioner that reflects completion of
8 the requirements of this section and includes an independent auditor's report
9 on the financial statements of the pool.
10 (2) If satisfied upon review of the report that the board has
11 complied with this section and accomplished the pool's cessation of
12 operations in a reasonable manner, the commissioner shall certify that the
13 business of the pool has concluded in accordance with this section and
14 publish the certification on the State Insurance Department website.
15 (h) Upon certification under subsection (g) of this section, the
16 operations of the pool are suspended indefinitely unless reactivated by the
17 General Assembly.
18 (i) The commissioner may address any matters regarding the pool
19 arising after the certification under subsection (g) of this section, and the
20 Attorney General shall defend a legal action filed after the certification,
21 including seeking the dismissal of the action under � 23-79-516 or for any
22 other purpose.
23 (j) Unless inconsistent with this section, the remainder of this
24 subchapter continues to apply to the pool and the board.
25
26 23-79-516. Statute of limitations and repose.
27 Because winding up the operations of the Arkansas Comprehensive Health
28 Insurance Pool requires the expeditious determination of its outstanding
29 liabilities, a cause of action against the pool or the Board of Directors of
30 the Arkansas Comprehensive Health Insurance Pool shall be commenced within
31 the earlier of one (1) year after the cause of action accrues or December 31,
32 2015.
33
34 23-79-517. Individuals moving to Arkansas and previously covered by
35 another qualified high-risk pool.
36 (a) Notwithstanding � 23-79-510(f), if a resident eligible person is
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1 eligible for plan coverage because the person previously was covered under a
2 qualified high-risk pool of another state, a preexisting condition exclusion
3 otherwise applicable to the resident eligible person:
4 (1) Shall be reduced by each month of coverage in which the
5 resident eligible person was subject to a preexisting condition exclusion in
6 the other state's qualified high-risk pool; or
7 (2) Does not apply if the resident eligible person was not
8 subject to a preexisting condition exclusion in the other state's qualified
9 high-risk pool.
10 (b) This section expires on the last day an individual may be enrolled
11 into plan coverage under this subchapter.
12
13 SECTION 8. DO NOT CODIFY. CONSTRUCTION AND LEGISLATIVE INTENT.
14 It is the intent of the General Assembly that:
15 (1) The enactment and adoption of this act shall not expressly
16 or impliedly repeal an act passed during the regular session of the Ninety-
17 Fifth General Assembly;
18 (2) To the extent that a conflict exists between an act of the
19 regular session of the Ninety-Fifth General Assembly and this act:
20 (A) The act of the regular session of the Ninety-Fifth
21 General Assembly shall be treated as a subsequent act passed by the General
22 Assembly for the purposes of:
23 (i) Giving the act of the regular session of the
24 Ninety-Fifth General Assembly its full force and effect; and
25 (ii) Amending or repealing the appropriate parts of
26 the Arkansas Code of 1987; and
27 (B) Section 1-2-107 shall not apply; and
28 (3) This act shall make only technical, not substantive, changes
29 to the Arkansas Code of 1987.
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35 01/31/2025 10:34:07 AM ANS002Every fact on this page links to its source, starting with the official bill record.