Stricken language would be deleted from and underlined language would be added to present law.
*ANS002* 01/31/2025 10:34:07 AM ANS002
State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1361 3
4
By: Representatives Gazaway, M. Shepherd 5
By: Senators C. Tucker, J. Bryant 6
7
For An Act To Be Entitled 8
AN ACT TO MAKE TECHNICAL CORRECTIONS TO TITLE 23 OF 9
THE ARKANSAS CODE CONCERNING PUBLIC UTILITIES AND 10
REGULATED INDUSTRIES; AND FOR OTHER PURPOSES. 11
12
13
Subtitle 14
TO MAKE TECHNICAL CORRECTIONS TO TITLE 15
23 OF THE ARKANSAS CODE CONCERNING 16
PUBLIC UTILITIES AND REGULATED 17
INDUSTRIES. 18
19
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 20
21
SECTION 1. Arkansas Code § 23 -3-117(a)(2)(C)(i), concerning contracts 22
for interruptible utility services, is reenacted to ratify the decision by 23
the Arkansas Code Revision Commission to change “Specify” to “Shall specify” 24
in order to correct a grammatical error. 25
(i) Shall specify the amount of interruptible load 26
to be achieved by the customer. 27
28
SECTION 2. Arkansas Code § 23 -55-611(b), concerning refunds under the 29
Uniform Money Services Act, is reenacted to ratify the decision by the 30
Arkansas Code Revision Commission to insert the phrase “all money received 31
for transmission” and combine former subdivisions (b)(1)(A) -(D) with former 32
subdivision (b)(2) to create subdivisions (b)(1) -(5), in order to clarify a 33
reference and correct designation errors. 34
(b) Every licensee shall refund all money received for transmission to 35
the sender within 10 days of receipt of the sender's written request for a 36 HB1361
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refund of all money received for transmission unless any of the following 1
occurs: 2
(1) the money has been forwarded within 10 days of the date that 3
the money was received for transmission; 4
(2) instructions have been given committing an equivalent amount 5
of money to the person designated by the sender within 10 days of the date 6
that the money was received for transmission; 7
(3)(A) the agreement between the licensee and the sender 8
instructs the licensee to forward the money at a time that is beyond 10 days 9
of the date that the money was received for transmission. 10
(B) If funds have not yet been forwarded according to the 11
terms of the agreement between the licensee and the sender, then the licensee 12
shall issue a refund under this section; 13
(4) the refund is requested for a transaction that the licensee 14
has not completed based on a reasonable belief or a reasonable basis to 15
believe that a crime or violation of law, rule, or regulation has occurred, 16
is occurring, or may occur; or 17
(5) the refund request does not enable the licensee to: 18
(A) identify the sender's name and address or telephone 19
number; or 20
(B) identify the particular transaction to be refunded in 21
the event the sender has multiple transactions outstanding. 22
23
SECTION 3. Arkansas Code § 23 -55-702(a)(6), concerning types of 24
permissible investments under the Uniform Money Services Act, is reenacted to 25
ratify the decision by the Arkansas Code Revision Commission to redesignate 26
the subdivision from (b)(6) to (a)(6) in order to correct a designation 27
error. 28
(6) 100 percent of the surety bond provided for under § 23 -55-29
204 that exceeds the average daily money transmission liability in this 30
state. 31
32
SECTION 4. Arkansas Code § 23 -55-702(b)(2)(A), concerning types of 33
permissible investments under the Uniform Money Services Act, is reenacted to 34
ratify the decision by the Arkansas Code Revision Commission to change “If” 35
to “Upon” in order to correct a grammatical error. 36 HB1361
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(2)(A) Upon any notice of expiration or nonextension of a letter 1
of credit issued under subdivision (b)(1)(D), then the licensee shall be 2
required to demonstrate to the satisfaction of the commissioner, 15 days 3
before expiration, that the licensee maintains and will maintain permissible 4
investments under § 23 -55-701(a) upon the expiration of the letter of credit. 5
6
SECTION 5. Arkansas Code § 23 -61-503(b), concerning the jurisdiction 7
of the State Insurance Department and the application of the Arkansas 8
Insurance Code, is amended to read as follows to repeal obsolete language: 9
(b) This subchapter shall not apply to : 10
(1) A a trust established under §§ 14 -54-101 and 25-20-104 to 11
provide benefits such as accident and health benefits, death benefits, dental 12
benefits, and disability income benefits ; or 13
(2) The Comprehensive Health Insurance Pool Act, § 23-79-501 et 14
seq. 15
16
SECTION 6. Arkansas Code § 23 -63-1801(4)(B), concerning definitions 17
under the Arkansas Health Insurance Marketplace Act, is amended to read as 18
follows to repeal obsolete language: 19
(B) "Health insurance coverage" does not include policies 20
or certificates covering only accident, credit, disability income, long -term 21
care, hospital indemnity, Medicare supplemental policy as defined in 42 22
U.S.C. § 1395ss(g)(1), a specified disease, other limited benefit health 23
insurance, automobile medical payment insurance, or claims under the Workers' 24
Compensation Law, § 11 -9-101 et seq., or the Public Employee Workers' 25
Compensation Act, § 21 -5-601 et seq., or the Comprehensive Health Insurance 26
Pool Act, § 23-79-501 et seq.; and 27
28
SECTION 7. Arkansas Code Title 23, Chapter 79, Subchapter 5 is 29
repealed because the subchapter expired in 2016. 30
23-79-501. Purpose. 31
(a)(1) Acts 1995, No. 1339, established the Arkansas Comprehensive 32
Health Insurance Pool as a state program that was intended to provide an 33
alternate market for health insurance for certain uninsurable Arkansas 34
residents, and further this subchapter is intended to provide for the 35
successor entity that will provide the acceptable alternative mechanism as 36 HB1361
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described in the Health Insurance Portability and Accountability Act of 1996 1
for providing portable and accessible individual health insurance coverage 2
for federally eligible individuals as defined in this subchapter. 3
(2) This subchapter further is intended to provide a health 4
insurance coverage option for persons eligible for a federal income tax 5
credit under section 35 of the Internal Revenue Code, as created by the Trade 6
Adjustment Assistance Reform Act of 2002 or as subsequently amended. 7
(b) The General Assembly declares that it intends for this program to 8
provide portable and accessible individual health insurance coverage for 9
every individual who qualifies for coverage in accordance with § 23 -79-509(b) 10
as a federally eligible individual or as a qualified trade adjustment 11
assistance eligible person but does not intend for every eligible person who 12
qualifies for pool coverage in accordance with § 23 -79-509 to be guaranteed a 13
right to be issued a policy under this pool as a matter of entitlement. 14
15
23-79-502. Short title. 16
This subchapter may be cited as the “Comprehensive Health Insurance 17
Pool Act”, and is amendatory to the Arkansas Insurance Code and the 18
provisions of the Arkansas Insurance Code which are not in conflict with this 19
subchapter are applicable to this subchapter. 20
21
23-79-503. Definitions. 22
As used in this subchapter: 23
(1) “Agent” means any person who is licensed to sell health 24
insurance in this state; 25
(2) “Board” means the Board of Directors of the Arkansas 26
Comprehensive Health Insurance Pool; 27
(3) “Church plan” has the same meaning given that term in the 28
Health Insurance Portability and Accountability Act of 1996; 29
(4) “Commissioner” means the Insurance Commissioner; 30
(5) “Continuation coverage” means continuation of coverage under 31
a group health plan or other health insurance coverage for former employees 32
or dependents of former employees that would otherwise have terminated under 33
the terms of that coverage pursuant to any continuation provisions under 34
federal or state law, including the Consolidated Omnibus Budget 35
Reconciliation Act of 1985 (COBRA), as amended, § 23 -86-114 of the Arkansas 36 HB1361
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Insurance Code, or any other similar requirement in another state; 1
(6) “Covered person” means a person who is and continues to 2
remain eligible for pool coverage and is covered under one (1) of the plans 3
offered by the pool; 4
(7)(A) “Creditable coverage” means, with respect to a federally 5
eligible individual or a qualified trade adjustment assistance eligible 6
person, coverage of the individual under any of the following: 7
(i) A group health plan; 8
(ii) Health insurance coverage, including group 9
health insurance coverage; 10
(iii) Medicare; 11
(iv) Medical assistance; 12
(v) 10 U.S.C. § 1071 et seq.; 13
(vi) A medical care program of the Indian Health 14
Service or of a tribal organization; 15
(vii) A state health benefits risk pool; 16
(viii) A health plan offered under 5 U.S.C. § 8901 17
et seq.; 18
(ix) A public health plan, as defined in regulations 19
consistent with section 104 of the Health Insurance Portability and 20
Accountability Act of 1996 that may be promulgated by the Secretary of the 21
United States Department of Health and Human Services; and 22
(x) A health benefit plan under section 5(e) of the 23
Peace Corps Act, 22 U.S.C. § 2504(e). 24
(B) “Creditable coverage” does not include: 25
(i) Coverage consisting solely of coverage of 26
excepted benefits as defined in section 2791(C) of Title XXVII of the Public 27
Health Service Act, 42 U.S.C. § 300gg -91; or 28
(ii)(a) Any period of coverage under 29
subdivisions (7)(A)(i) -(x) of this section that occurred before a break of 30
more than sixty-three (63) days during all of which the individual was not 31
covered under subdivisions (7)(A)(i) -(x) of this section. 32
(b) Any period that an individual is in a 33
waiting period for any coverage under a group health plan or for group health 34
insurance coverage or is in an affiliation period under the terms of health 35
insurance coverage offered by a health maintenance organization shall not be 36 HB1361
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taken into account in determining if there has been a break of more than 1
sixty-three (63) days in any creditable coverage; 2
(8) “Department” means the State Insurance Department; 3
(9) “Excess or stop -loss coverage” means an arrangement whereby 4
an insurer insures against the risk that any one (1) claim will exceed a 5
specific dollar amount or that the entire loss of a self -insurance plan will 6
exceed a specific amount; 7
(10) “Federally eligible individual” means an individual 8
resident of Arkansas: 9
(A) For whom: 10
(i) As of the date on which the individual seeks 11
pool coverage under § 23 -79-509, the aggregate of the periods of creditable 12
coverage is eighteen (18) or more months; and 13
(ii) The most recent prior creditable coverage was 14
under group health insurance coverage offered by an insurer, a group health 15
plan, a governmental plan, a church plan, or health insurance coverage 16
offered in connection with any such plans; 17
(B) Who is not eligible for coverage under: 18
(i) A group health plan; 19
(ii) Part A or Part B of Medicare; or 20
(iii) Medical assistance and does not have other 21
health insurance coverage; 22
(C) With respect to whom the most recent coverage within 23
the coverage period described in subdivision (10)(A)(i) of this section was 24
not terminated based upon a factor related to nonpayment of premiums or 25
fraud; 26
(D) If the individual has been offered the option of 27
continuation coverage under a Consolidated Omnibus Budget Reconciliation Act 28
of 1985 (COBRA) continuation provision or under a similar state program, who 29
elected such coverage; and 30
(E) Who, if the individual elected the continuation 31
coverage, has exhausted the continuation coverage under such a provision or 32
program; 33
(11) “Governmental plan” has the same meaning given that term in 34
the federal Health Insurance Portability and Accountability Act of 1996; 35
(12) “Group health plan” has the same meaning given that term in 36 HB1361
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the federal Health Insurance Portability and Accountability Act of 1996; 1
(13)(A) “Health insurance” means any hospital and medical 2
expense-incurred policy, certificate, or contract provided by an insurer, 3
hospital or medical service corporation, health maintenance organization, or 4
any other healthcare plan or arrangement that pays for or furnishes medical 5
or healthcare services whether by insurance or otherwise and includes any 6
excess or stop-loss coverage. 7
(B) “Health insurance” does not include long -term care, 8
disability income, short -term, accident, dental -only, vision-only, fixed 9
indemnity, limited-benefit or credit insurance, coverage issued as a 10
supplement to liability insurance, insurance arising out of workers' 11
compensation or similar law, automobile medical -payment insurance, or 12
insurance under which benefits are payable with or without regard to fault 13
and that is statutorily required to be contained in any liability insurance 14
policy or equivalent self -insurance; 15
(14) “Health maintenance organization” shall have the same 16
meaning as defined in § 23 -76-102; 17
(15) “Hospital” shall have the same meaning as defined in § 20 -18
9-201; 19
(16) “Individual health insurance coverage” means health 20
insurance coverage offered to individuals in the individual market but does 21
not include short-term, limited-duration insurance; 22
(17)(A) “Insurer” means any entity that provides health 23
insurance, including excess or stop -loss health insurance, in the State of 24
Arkansas. 25
(B) For the purposes of this subchapter, “insurer” 26
includes an insurance company, medical services plans, hospital plans, 27
hospital medical service corporations, health maintenance organizations, 28
fraternal benefits society, or any other entity providing a plan of health 29
insurance or health benefits subject to state insurance regulation; 30
(18) “Medical assistance” means the state medical assistance 31
program provided under Title XIX of the Social Security Act or under any 32
similar program of healthcare benefits in a state other than Arkansas; 33
(19)(A)(i) “Medically necessary” means that a service, drug, 34
supply, or article is necessary and appropriate for the diagnosis or 35
treatment of an illness or injury in accord with generally accepted standards 36 HB1361
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of medical practice at the time the service, drug, or supply is provided. 1
(ii) When specifically applied to a confinement, 2
“medically necessary” further means that the diagnosis or treatment of the 3
covered person's medical symptoms or condition cannot be safely provided to 4
that person as an outpatient. 5
(B) A service, drug, supply, or article shall not be 6
medically necessary if it: 7
(i) Is investigational, experimental, or for 8
research purposes; 9
(ii) Is provided solely for the convenience of the 10
patient, the patient's family, physician, hospital, or any other provider; 11
(iii) Exceeds in scope, duration, or intensity that 12
level of care that is needed to provide safe, adequate, and appropriate 13
diagnosis or treatment; 14
(iv) Could have been omitted without adversely 15
affecting the covered person's condition or the quality of medical care; or 16
(v) Involves the use of a medical device, drug, or 17
substance not formally approved by the United States Food and Drug 18
Administration; 19
(20) “Medicare” means coverage under Part A and Part B of Title 20
XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.; 21
(21) “Physician” means a person licensed to practice medicine as 22
duly licensed by the State of Arkansas; 23
(22) “Plan” means the comprehensive health insurance plan as 24
adopted by the board or by rule; 25
(23) “Plan administrator” means the insurer designated under § 26
23-79-508 to carry out the provisions of the plan of operation; 27
(24) “Plan of operation” means the plan of operation of the 28
pool, including articles, bylaws, and operating rules adopted by the board 29
pursuant to this subchapter; 30
(25) “Provider” means any hospital, skilled nursing facility, 31
hospice, home health agency, physician, pharmacist, or any other person or 32
entity licensed in Arkansas to furnish medical care, articles, and supplies; 33
(26) “Qualified high -risk pool” has the same meaning given that 34
term in the Health Insurance Portability and Accountability Act of 1996; 35
(27) “Qualified trade adjustment assistance eligible person” 36 HB1361
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means a person who is a trade adjustment assistance eligible person as 1
defined by this section and for whom, on the date an application for the 2
individual is received by the pool under § 23 -79-509, has an aggregate of at 3
least three (3) months of creditable coverage without a break in coverage of 4
sixty-three (63) days or more; 5
(28) “Resident eligible person” means a person who: 6
(A) Has been legally domiciled in the State of Arkansas 7
for a period of at least: 8
(i) Ninety (90) days and continues to be domiciled 9
in Arkansas; or 10
(ii) Thirty (30) days, continues to be domiciled in 11
Arkansas, and was covered under a qualified high -risk pool in another state 12
up until sixty-three (63) days or less prior to the date that the pool 13
receives his or her application for coverage; and 14
(B) Is not eligible for coverage under: 15
(i) A group health plan; 16
(ii) Part A or Part B of Medicare; or 17
(iii) Medical assistance as defined in this section 18
and does not have other health insurance coverage as defined in this section; 19
and 20
(29) “Trade adjustment assistance eligible person” means a 21
person who is legally domiciled in the State of Arkansas on the date of 22
application to the pool and is eligible for the tax credit for health 23
insurance coverage premiums under section 35 of the Internal Revenue Code of 24
1986. 25
26
23-79-504. Arkansas Comprehensive Health Insurance Pool. 27
(a) There is created a nonprofit legal entity to be known as the 28
“Arkansas Comprehensive Health Insurance Pool” as the successor entity to the 29
nonprofit legal entity established by Acts 1995, No. 1339. 30
(b)(1) The pool shall operate subject to the supervision and control 31
of the Board of Directors of the Arkansas Comprehensive Health Insurance 32
Pool. The pool is created as a political subdivision, instrumentality, and 33
body politic of the State of Arkansas, and, as such, is not a state agency. 34
(2) Except to the extent defined in this subchapter, the pool 35
will be exempt from: 36 HB1361
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(A) All state, county, and local taxes; 1
(B) The Arkansas Procurement Law, § 19 -11-201 et seq.; 2
(C) The Freedom of Information Act of 1967, § 25 -19-101 et 3
seq.; and 4
(D) The Arkansas Administrative Procedure Act, § 25 -15-201 5
et seq. 6
(3) The board shall consist of the following seven (7) members 7
to be appointed by the Insurance Commissioner: 8
(A) Two (2) current or former representatives of insurance 9
companies licensed to do business in the State of Arkansas; 10
(B) Two (2) current or former representatives of health 11
maintenance organizations licensed to do business in the State of Arkansas; 12
(C) One (1) member of a health -related profession licensed 13
in the State of Arkansas; 14
(D) One (1) member from the general public who is not 15
associated with the medical profession, a hospital, or an insurer; and 16
(E) One (1) member to represent a group considered to be 17
uninsurable. 18
(4) In making appointments to the board, the commissioner shall 19
strive to ensure that at least one (1) person serving on the board is at 20
least sixty (60) years of age. 21
(5) All terms shall be for three (3) years. 22
(6) The board shall elect one (1) of its members as chair. 23
(7) Any vacancy in the board occurring for any reason other than 24
the expiration of a term shall be filled for the unexpired term in the same 25
manner as the original appointment. 26
(8) Members of the board may be reimbursed from moneys of the 27
pool for actual and necessary expenses incurred by them in the performance of 28
their official duties as members of the board but shall not otherwise be 29
compensated for their services. 30
(c) All insurers, as a condition of doing business in the State of 31
Arkansas, shall participate in the pool by paying the assessments, submitting 32
the reports, and providing the information required by the board or the 33
commissioner to implement the provisions of this subchapter. 34
(d)(1) Neither the board nor its employees shall be liable for any 35
obligations of the pool. 36 HB1361
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(2) No board member or employee of the board shall be liable, 1
and no cause of action of any nature may arise against them, for any act or 2
omission related to the performance of their powers and duties under this 3
subchapter. 4
(3) The board may provide in its bylaws or rules for 5
indemnification of, and legal representation for, the board members and 6
employees. 7
8
23-79-505. Plan of operation. 9
(a)(1) The Board of Directors of the Arkansas Comprehensive Health 10
Insurance Pool shall adopt a plan of operation pursuant to this subchapter 11
and shall submit to the Insurance Commissioner for approval the plan of 12
operation including the Arkansas Comprehensive Health Insurance Pool's 13
articles, bylaws and operating rules, and any amendments thereto necessary or 14
suitable to assure the fair, reasonable, and equitable administration of the 15
pool. The plan of operation shall become effective upon approval in writing 16
by the commissioner. 17
(2) If the board fails to submit a suitable plan of operation 18
within one hundred eighty (180) days after the appointment of the board of 19
directors, or at any time thereafter fails to submit suitable amendments to 20
the plan of operation, the commissioner shall adopt and promulgate such rules 21
as are necessary or advisable to effectuate the provisions of this section. 22
The rules shall continue in force until modified by the commissioner or 23
superseded by a plan of operation submitted by the board and approved by the 24
commissioner. 25
(b) The plan of operation shall: 26
(1) Establish procedures for operation of the pool; 27
(2) Establish procedures for selecting a plan administrator in 28
accordance with § 23 -79-508; 29
(3) Create a fund, under management of the board, to pay 30
administrative claims and other expenses of the pool; 31
(4) Establish procedures for the handling, accounting, and 32
auditing of assets, moneys, and claims of the pool and the plan 33
administrator; 34
(5) Develop and implement a program to publicize the existence 35
of the plan, the eligibility requirements, and the procedures for enrollment 36 HB1361
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and to maintain public awareness of the plan; 1
(6)(A) Establish procedures under which applicants and 2
participants may have grievances reviewed by a grievance committee appointed 3
by the board. The grievances shall be reported to the board after completion 4
of the review. 5
(B) The board shall retain all written complaints 6
regarding the plan for at least three (3) years; and 7
(7) Provide for other matters as may be necessary and proper for 8
the execution of the board's powers, duties, and obligations under this 9
subchapter. 10
11
23-79-506. Powers. 12
(a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the 13
general powers and authority granted under the laws of the State of Arkansas 14
to health insurers and, in addition thereto, the specific authority to: 15
(A) Enter into contracts as are necessary or proper to 16
carry out the provisions and purposes of this subchapter; 17
(B) Sue or be sued, including taking any legal actions 18
necessary or proper; 19
(C) Take such legal action as necessary, including without 20
limitation: 21
(i) Avoiding the payment of improper claims against 22
the pool or the coverage provided by or through the pool; 23
(ii) Recovering any amounts erroneously or 24
improperly paid by the pool; 25
(iii) Recovering any amounts paid by the pool as a 26
result of mistake of fact or law; 27
(iv) Recovering other amounts due the pool; or 28
(v) Coordinating legal action with the Insurance 29
Commissioner to enforce the provisions of this subchapter; 30
(D)(i) Establish and modify from time to time as 31
appropriate, rates, rate schedules, rate adjustments, expense allowances, 32
agent referral fees, claim reserve formulas, deductibles, copayments, 33
coinsurance, and any other actuarial function appropriate to the operation of 34
the pool. 35
(ii) Rates and rate schedules may be adjusted for 36 HB1361
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appropriate factors such as age, sex, and geographical variation in claim 1
costs and shall take into consideration appropriate factors in accordance 2
with established actuarial and underwriting practices; 3
(E) Issue policies of insurance in accordance with the 4
requirements of this subchapter. All policy forms shall be subject to the 5
approval of the commissioner; 6
(F) Authorize the plan administrator to prepare and 7
distribute certificate of eligibility forms and enrollment instruction forms 8
to agents and to the general public; 9
(G) Provide and employ cost -containment measures and 10
requirements, including without limitation preadmission screening, second 11
surgical opinion, concurrent utilization review, and individual case 12
management for the purposes of making the plan more cost effective; 13
(H) Design, utilize, contract, or otherwise arrange the 14
delivery of cost-effective healthcare services, including establishing or 15
contracting directly or through the plan administrator with preferred 16
provider organizations, health maintenance organizations, physician hospital 17
organizations, or other limited network provider arrangements; 18
(I) Borrow money to effect the purposes of the pool. Any 19
notes or other evidence of indebtedness of the pool not in default shall be 20
legal investments for insurers and may be carried as admitted assets; 21
(J) Pledge, assign, and grant a security interest in any 22
of the assessments authorized by this subchapter or other assets of the pool 23
in order to secure any notes or other evidences of indebtedness of the pool; 24
(K) Provide reinsurance of risks incurred by the pool; 25
(L) Provide additional types of plans to provide optional 26
coverages, including Medicare supplement health insurance and health savings 27
accounts that comply with applicable federal law as in effect January 1, 28
2005; 29
(M) Enter into reciprocal agreements with other comparable 30
state plans in order to provide coverage for persons who move between states 31
and are covered by such other states' plans; and 32
(N) Establish lifetime maximum benefits under § 23 -79-33
510(a)(2)(W) for any person covered by a plan. 34
(2) In addition to the other powers granted by the Arkansas 35
Insurance Code, the commissioner may impose, after notice and hearing in 36 HB1361
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accordance with the provisions of the Arkansas Insurance Code, a monetary 1
penalty upon any insurer or suspend or revoke the certificate of authority to 2
transact insurance in the State of Arkansas of any insurer that fails to pay 3
an assessment or otherwise file any report or furnish information required to 4
be filed with the Board of Directors of the Arkansas Comprehensive Health 5
Insurance Pool pursuant to the board's direction that the board believes is 6
necessary in order for the board to perform its duties under this subchapter. 7
(b) All outstanding contracts executed by the Board of Directors of 8
the State Comprehensive Health Insurance Pool created by Acts 1995, No. 1339, 9
shall be deemed continuing obligations of the board created by this 10
subchapter. 11
(c) As provided for in § 23 -79-502, any health insurance benefit not 12
provided for in this subchapter shall be deemed to be in conflict with and 13
therefore inapplicable to the provisions of this subchapter. 14
15
23-79-507. Funding of pool. 16
(a) Premiums. 17
(1)(A) The Arkansas Comprehensive Health Insurance Pool shall 18
establish premium rates for plan coverage as provided in subdivision (a)(2) 19
of this section. 20
(B) Separate schedules of premium rates based on age, sex, 21
and geographical location may apply for individual risks. 22
(C) Premium rates and schedules shall be submitted to the 23
Insurance Commissioner for approval prior to use. 24
(2)(A)(i) With the assistance of the commissioner, the pool 25
shall determine a standard risk rate by considering the premium rates charged 26
by other insurers offering health insurance coverage to individuals in 27
Arkansas. 28
(ii) The standard risk rate shall be established 29
using reasonable actuarial techniques and shall reflect anticipated 30
experience and expenses for the coverage. 31
(B)(i) Rates for plan coverage shall not exceed one 32
hundred fifty percent (150%) of rates established as applicable for 33
individual standard risks in Arkansas. 34
(ii) Subject to the limits provided in this 35
subdivision (a)(2), subsequent rates shall be established to help provide for 36 HB1361
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the expected costs of claims, including recovery of prior losses, expenses of 1
operation, investment income of claim reserves, and any other cost factors 2
subject to the limitations described in this section. 3
(b) Sources of Additional Revenue. 4
(1) In addition to the powers enumerated in § 23 -79-506, the 5
pool shall have the authority to: 6
(A) Assess insurers in accordance with the provisions of 7
this section; and 8
(B)(i) Make advance interim assessments as may be 9
reasonable and necessary for the pool's organizational and interim operating 10
expenses. 11
(ii) Any such interim assessments may be credited as 12
offsets against any regular assessments due following the close of the fiscal 13
year. 14
(2)(A) Following the close of each fiscal year, the plan 15
administrator shall determine the net premiums, that is, premiums less 16
administrative expense allowances, the pool expenses of administration and 17
operation, and the incurred losses for the year, taking into account 18
investment income and other appropriate gains and losses. 19
(B) The deficit incurred by the pool not otherwise 20
recouped under either subdivision (b)(9) of this section or subsection (e) of 21
this section [repealed], or both, shall be recouped by assessments 22
apportioned among insurers by the Board of Directors of the Arkansas 23
Comprehensive Health Insurance Pool. 24
(3) Each insurer's assessment shall be determined by multiplying 25
the total assessment of all insurers as determined in subdivision (b)(2) of 26
this section by a fraction, the numerator of which equals that insurer's 27
premium and subscriber contract charges for health insurance written in the 28
state during the preceding calendar year and the denominator of which equals 29
the total of all health insurance premiums by all insurers. 30
(4)(A) If assessments or other funds received under either 31
subdivision (b)(9) of this section or subsection (e) of this section 32
[repealed], or both, or any combination of the assessments and funds exceed 33
the pool's actual losses and administrative expenses, the excess shall be 34
held at interest and used by the board to offset future losses or to reduce 35
future assessments. 36 HB1361
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(B) As used in this subsection, “future losses” includes 1
reserves for incurred but not reported claims. 2
(5) Each insurer's assessment shall be determined annually by 3
the board based on annual statements and other reports deemed necessary by 4
the board and filed by the insurer with the board or the commissioner. 5
(6)(A)(i) An insurer may petition the commissioner for an 6
abatement or deferment of all or part of an assessment imposed by the board. 7
(ii) The commissioner may abate or defer, in whole 8
or in part, the assessment if, in the opinion of the commissioner, payment of 9
the assessment would endanger the ability of the insurer to fulfill its 10
contractual obligations. 11
(B)(i) In the event an assessment against an insurer is 12
abated or deferred, in whole or in part, the amount by which the assessment 13
is abated or deferred shall be assessed against the other insurers in a 14
manner consistent with the basis for assessments set forth in this 15
subsection. 16
(ii) The insurer receiving the abatement or 17
deferment shall remain liable to the plan for the deficiency for four (4) 18
years. 19
(7) For all assessments issued by the board, beginning January 20
1, 1998, only those individuals, corporations, associations, or other 21
entities defined as an insurer in § 23 -79-503 shall be subject to assessment. 22
(8) In the event the board fails to act within a reasonable 23
period of time to recoup by assessment any deficit incurred by the pool, the 24
commissioner shall have all the powers and duties of the board under this 25
chapter with respect to assessing insurers. 26
(9) The General Assembly further intends that the pool be 27
eligible for, and for the pool, its board, or other officers of state 28
government, as appropriate, to take steps necessary to obtain federal grant 29
funds to offset losses of the pool, including any funds made available under 30
the Trade Adjustment Assistance Reform Act of 2002. 31
(c) Assessment Offsets. 32
(1) Any assessment may be offset in an amount equal to the 33
amount of the assessment paid to the pool against the premium tax payable by 34
that insurer for the year in which the assessment is levied or for the four 35
(4) years subsequent to that year. 36 HB1361
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(2) No offset shall be allowed for any penalty assessed under 1
subdivision (d)(1) of this section. 2
(d)(1) All assessments and fees shall be due and payable upon receipt 3
and shall be delinquent if not paid within thirty (30) days of the receipt of 4
the notice by the insurer. 5
(2) Failure to timely pay the assessment will automatically 6
subject the insurer to a ten percent (10%) penalty, which will be due and 7
payable within the next thirty -day period. 8
(3) The board and the commissioner shall have the authority to 9
enforce the collection of the assessment and penalty in accordance with the 10
provisions of this subchapter and the Arkansas Insurance Code. 11
(4) The board may waive the penalty authorized by this 12
subsection if it determines that compelling circumstances exist that justify 13
such a waiver. 14
15
23-79-508. Plan administrator. 16
(a) The Board of Directors of the Arkansas Comprehensive Health 17
Insurance Pool shall select an insurer through a competitive bidding process 18
to administer the plan. However, the administering insurer designated by the 19
board created by Acts 1995, No. 1339, shall serve as the plan administrator 20
under this subchapter until the expiration of the current contract of the 21
administering insurer. The board shall evaluate bids submitted under this 22
section based upon criteria established by the board which shall include, but 23
not be limited to, the following: 24
(1) The plan administrator's proven ability to handle large 25
group accident and health benefit plans; 26
(2) The efficiency and timeliness of the plan administrator's 27
claim processing procedures; 28
(3) An estimate of total charges for administering the plan; 29
(4) The plan administrator's ability to apply effective cost 30
containment programs and procedures and to administer the plan in a cost 31
efficient manner; and 32
(5) The financial condition and stability of the plan 33
administrator. 34
(b)(1) The plan administrator shall serve for a period of three (3) 35
years subject to removal for cause and subject to the terms, conditions, and 36 HB1361
18 01/31/2025 10:34:07 AM ANS002
limitations of the contract between the board and the plan administrator. 1
(2) The board shall advertise for and accept bids to serve as 2
the plan administrator for the succeeding three -year periods. 3
(c) The plan administrator shall perform functions related to the plan 4
as may be assigned to it, including: 5
(1) Determination of eligibility; 6
(2) Payment and processing of claims; 7
(3) Establishment of a premium billing procedure for collection 8
of premiums. Billings shall be made on a periodic basis as determined by the 9
board; and 10
(4) Other necessary functions to assure timely payment of 11
benefits to covered persons under the plan, including: 12
(A) Making available information relating to the proper 13
manner of submitting a claim for benefits under the plan and distributing 14
forms upon which submissions shall be made; and 15
(B) Evaluating the eligibility of each claim for payment 16
under the plan. 17
(d)(1) The plan administrator shall submit regular reports to the 18
board regarding the operation of the plan. 19
(2) Frequency, content, and form of the report shall be 20
determined by the board. 21
(e)(1) The plan administrator shall pay claim expenses from the 22
premium payments received from or on behalf of plan participants and 23
allocated by the board for claim expenses. 24
(2) If the plan administrator's payments for claims expenses 25
exceed the portion of premiums allocated by the board for payment of claims 26
expenses, the board shall provide additional funds to the plan administrator 27
for payment of claims expenses. 28
(f) The plan administrator shall be governed by the requirements of 29
this subchapter and shall be compensated as provided in the contract between 30
the board and the plan administrator. 31
32
23-79-509. Plan eligibility. 33
(a) General Eligibility Requirements. The following requirements 34
apply to a resident eligible person or a trade adjustment assistance eligible 35
person in order for the person to be eligible for plan coverage: 36 HB1361
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(1) Except as provided in subdivision (a)(2) of this section or 1
subsection (b) of this section, any individual person who meets the 2
definition of resident eligible person as defined by § 23 -79-503 or a trade 3
adjustment assistance eligible person as defined by § 23 -79-503 and is either 4
a citizen of the United States or an alien lawfully admitted for permanent 5
residence who continues to be a resident of this state shall be eligible for 6
plan coverage if evidence is provided of: 7
(A) A notice of rejection or refusal by an insurer to 8
issue substantially similar individual health insurance coverage by reason of 9
the existence or history of a medical condition or upon such other evidence 10
that the Board of Directors of the Arkansas Comprehensive Health Insurance 11
Pool deems sufficient in order to verify that the applicant is unable to 12
obtain the coverage from an insurer due to the existence or history of a 13
medical condition; 14
(B)(i) A refusal by an insurer to issue individual health 15
insurance coverage except at a rate that the board determines is 16
substantially in excess of the applicable plan rate. 17
(ii) A rejection or refusal by a group health plan 18
or insurer offering only stop -loss or excess-of-loss insurance or contracts, 19
agreements, or other arrangements for reinsurance coverage with respect to 20
the applicant shall not be sufficient evidence under this subsection; 21
(C)(i) Until September 30, 2011, a refusal by an insurer 22
to issue individual health insurance coverage to a child under nineteen (19) 23
years of age. 24
(ii) After September 30, 2011, the eligibility of a 25
child under nineteen (19) years of age for individual health insurance 26
coverage shall be determined by the board; or 27
(D) Evidence that the applicant was covered under a 28
qualified high-risk pool of another state, provided that the coverage 29
terminated no more than sixty -three (63) days prior to the date the pool 30
receives the applicant's application for coverage and the other state's 31
qualified high-risk pool did not terminate the person's coverage for fraud; 32
(2) A person shall not be eligible for coverage under the plan 33
if: 34
(A) The person has or obtains health insurance coverage 35
substantially similar to or more comprehensive than a plan policy or would be 36 HB1361
20 01/31/2025 10:34:07 AM ANS002
eligible to have coverage if the person elected to obtain it except that: 1
(i) A person may maintain other coverage for the 2
period of time the person is satisfying any waiting period for a preexisting 3
condition under a plan policy; and 4
(ii) A person may maintain plan coverage for the 5
period of time the person is satisfying a waiting period for a preexisting 6
condition under another health insurance policy intended to replace the plan 7
policy; 8
(B) The person is determined to be eligible for healthcare 9
benefits under Title XIX of the Social Security Act; 10
(C) The person has previously terminated plan coverage 11
unless twelve (12) months have elapsed since termination of coverage; 12
(D) The person fails to pay the required premium under the 13
covered person's terms of enrollment and participation, in which event the 14
liability of the plan shall be limited to benefits incurred under the plan 15
for the same period for which premiums had been paid and the covered person 16
remained eligible for plan coverage; 17
(E) The plan has paid on behalf of the covered person the 18
maximum lifetime benefit established by the board in accordance with § 23 -79-19
510(a)(2)(W); 20
(F) The person is a resident of a public institution; 21
(G) All or part of the person's premium is paid for or 22
reimbursed: 23
(i) By one (1) of the following in connection with a 24
group health plan: 25
(a) The person’s current employer; 26
(b) If the person is retired, by the person's 27
former employer; or 28
(c) If the person is a dependent of an 29
employee or retiree, by the current or former employer of the employee or 30
retiree; or 31
(ii) Under any government -sponsored program or by 32
any government agency, foundation, healthcare facility, or healthcare 33
provider except for premiums paid on behalf of: 34
(a) A trade adjustment assistance eligible 35
person or a qualified trade adjustment assistance eligible person in 36 HB1361
21 01/31/2025 10:34:07 AM ANS002
accordance with section 35 of the Internal Revenue Code; or 1
(b) An otherwise qualifying full -time employee 2
or dependent of a qualifying full -time employee of a government agency, 3
foundation, healthcare facility, or healthcare provider; or 4
(H) The person commits a fraudulent insurance act as 5
defined in § 23-66-501(4) against the Arkansas Comprehensive Health Insurance 6
Pool; 7
(3) The board or the plan administrator shall require 8
verification of residency and may require any additional information, 9
documentation, or statements under oath whenever necessary to determine plan 10
eligibility or residency; 11
(4) Coverage shall cease: 12
(A) On the date a person is no longer a resident of the 13
State of Arkansas; 14
(B) On the date a person requests coverage to end; 15
(C) On the death of the covered person; 16
(D) On the date state law requires cancellation of the 17
policy; or 18
(E) At the plan's option, thirty (30) days after the plan 19
makes any written inquiry concerning a person's eligibility or place of 20
residence to which the person does not reply; and 21
(5) Except under the conditions set forth in subdivision (a)(4) 22
of this section, the coverage of any person who ceases to meet the 23
eligibility requirements of this section terminates at the end of the month 24
that the person ceases to meet the eligibility requirements of this section. 25
(b) Persons Eligible for Guaranteed Issuance of Coverage. The 26
following requirements apply to a federally eligible individual or a 27
qualified trade adjustment assistance eligible person in order for such an 28
individual to be eligible for plan coverage: 29
(1) Notwithstanding the requirements of subsection (a) of this 30
section, any federally eligible individual or a qualified trade adjustment 31
assistance eligible person for whom a plan application and such enclosures 32
and supporting documentation as the board may require is received by the 33
board within sixty-three (63) days after the termination of prior creditable 34
coverage for reasons other than nonpayment of premium or fraud that covered 35
the applicant shall qualify to enroll in the plan under the portability 36 HB1361
22 01/31/2025 10:34:07 AM ANS002
provisions of this subsection; 1
(2) Any individual seeking plan coverage under this subsection 2
must submit with his or her application evidence, including acceptable 3
written certification of previous creditable coverage, that will establish to 4
the board's satisfaction that he or she meets all of the requirements to be a 5
federally eligible individual or a qualified trade adjustment assistance 6
eligible person and is currently and permanently residing in the State of 7
Arkansas as of the date his or her application was received by the board; 8
(3) A period of creditable coverage shall not be counted, with 9
respect to qualifying an applicant for plan coverage as an individual under 10
this subsection, if after such a period and before the application for plan 11
coverage was received by the board, there was at least a sixty -three-day 12
period during all of which the individual was not covered under any 13
creditable coverage; 14
(4) Any individual who the board determines qualifies for plan 15
coverage under this subsection shall be offered his or her choice of 16
enrolling in one (1) of the alternative portability plans that the board is 17
authorized under this subsection to establish for those individuals; 18
(5)(A)(i) The board shall offer a choice of healthcare coverages 19
consistent with major medical coverage under the alternative plans authorized 20
by this subsection to every individual qualifying for coverage under this 21
subsection. 22
(ii) The coverages to be offered under the plans, 23
the schedule of benefits, deductibles, copayments, coinsurance, exclusions, 24
and other limitations shall be approved by the board. 25
(B) One (1) optional form of coverage shall be comparable 26
to comprehensive health insurance coverage offered in the individual market 27
in the State of Arkansas or a standard option of coverage available under the 28
individual health insurance laws of the State of Arkansas. The standard plan 29
that is authorized by § 23 -79-510 may be used for this purpose. 30
(C) The board also may offer a preferred provider option 31
and such other options as the board determines may be appropriate for 32
individuals who qualify for plan coverage pursuant to this subsection; 33
(6) Notwithstanding the requirements of § 23 -79-510(f), any plan 34
coverage that is issued to individuals who qualify for plan coverage pursuant 35
to the portability provisions of this subsection shall not be subject to any 36 HB1361
23 01/31/2025 10:34:07 AM ANS002
preexisting conditions exclusion, waiting period, or other similar limitation 1
on coverage; 2
(7) Individuals who qualify and enroll in the plan pursuant to 3
this subsection shall be required to pay such premium rates as the board 4
shall establish and approve in accordance with the requirements of § 23 -79-5
507(a); 6
(8) The total premium, without regard to any subsidy of premium, 7
for individuals who qualify and enroll in the plan pursuant to this 8
subsection shall not be greater than a similarly situated individual 9
qualifying for pool coverage under subsection (a) of this section; and 10
(9) A federally eligible individual who qualifies and enrolls in 11
the plan pursuant to this subsection must continue to satisfy all of the 12
other eligibility requirements of this subchapter to the extent not 13
inconsistent with the Health Insurance Portability and Accountability Act of 14
1996 in order to maintain continued eligibility for coverage under the plan. 15
(c) Any person who was issued a policy pursuant to the provisions of 16
Acts 1995, No. 1339, shall be deemed continuously covered consistent with the 17
terms of this subchapter and reissued a new policy in accordance with the 18
provisions of this subchapter. 19
20
23-79-510. Outline of benefits. 21
(a)(1) Subject to the contractual policy form language adopted by the 22
Board of Directors of the Arkansas Comprehensive Health Insurance Pool, 23
expenses for the following services, supplies, drugs, or articles when 24
prescribed by a physician and determined by the plan to be medically 25
necessary shall be covered, subject to provisions of subsection (b) of this 26
section: 27
(A) Hospital services; 28
(B) Professional services for the diagnosis or treatment 29
of injuries, illnesses, or conditions, other than mental or dental, that are 30
rendered by a physician or by other licensed professionals at his or her 31
direction; 32
(C) Drugs requiring a physician's prescription; 33
(D) Skilled nursing services of a licensed skilled nursing 34
facility for not more than one hundred twenty (120) days during a policy 35
year; 36 HB1361
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(E) Services of a home health agency up to a maximum of 1
two hundred seventy (270) services per year; 2
(F) Use of radium or other radioactive materials; 3
(G) Oxygen; 4
(H) Prostheses other than dental; 5
(I) Rental of durable medical equipment, other than 6
eyeglasses and hearing aids, for which there is no personal use in the 7
absence of the conditions for which such equipment is prescribed; 8
(J) Diagnostic X rays and laboratory tests; 9
(K) Oral surgery for excision of partially or completely 10
unerupted, impacted teeth or the gums and tissues of the mouth when not 11
performed in connection with the extraction or repair of teeth; 12
(L) Services of a physical therapist; 13
(M) Emergency and other medically necessary transportation 14
provided by a licensed ambulance service to the nearest facility qualified to 15
treat a covered condition; 16
(N) Services for diagnosis and treatment of mental and 17
nervous disorders or chemical and drug dependency, provided that a covered 18
person shall be required to make a fifty percent (50%) copayment and that the 19
plan's payment shall not exceed four thousand dollars ($4,000) annually; and 20
(O) Such additional benefits deemed appropriate by the 21
board in accordance with the provisions of subsection (b) of this section. 22
(2) Exclusions. Unless the contractual policy form language 23
adopted by the board provides otherwise, the following services, supplies, 24
drugs, or articles whether or not prescribed by a physician, shall not be 25
covered: 26
(A) Any charge for treatment for cosmetic purposes other 27
than surgery for the repair or treatment of an injury or a congenital bodily 28
defect to restore normal bodily functions; 29
(B) Care that is primarily for custodial or domiciliary 30
purposes; 31
(C) Any charge for confinement in a private room to the 32
extent it is in excess of the institution's charge for its most common 33
semiprivate room unless a private room is medically necessary; 34
(D) That part of any charge for services rendered or 35
articles prescribed by a physician, dentist, or other healthcare personnel 36 HB1361
25 01/31/2025 10:34:07 AM ANS002
that exceeds the prevailing charge in the locality or for any charge not 1
medically necessary; 2
(E) Any charge for services or articles the provision of 3
which is not within the scope of authorized practice of the institution or 4
individual providing the services or articles; 5
(F) Any expense incurred prior to the effective date of 6
coverage by the plan for the person on whose behalf the expense is incurred; 7
(G) Dental care except as provided in subdivision 8
(a)(1)(K) of this section; 9
(H) Eyeglasses and hearing aids; 10
(I) Illness or injury due to acts of war; 11
(J) Services of blood donors and any fee for failure to 12
replace the first three (3) pints of blood provided to a covered person each 13
policy year; 14
(K) Personal supplies or services provided by a hospital 15
or nursing home or any other nonmedical or nonprescribed supply or service; 16
(L) Any expense or charge for services, articles, drugs, 17
or supplies that are not provided in accord with generally accepted standards 18
of current medical practice; 19
(M) Any expense for which a charge is not made in the 20
absence of insurance or for which there is no legal obligation on the part of 21
the patient to pay; 22
(N) Any expense incurred for benefits provided under the 23
laws of the United States and the State of Arkansas, including Medicare and 24
Medicaid and other medical assistance, military service -connected disability 25
payments, medical services provided for members of the armed forces and their 26
dependents or employees of the United States Armed Forces, and medical 27
services financed on behalf of all citizens by the United States; 28
(O) Any expense or charge for in vitro fertilization, 29
artificial insemination, or any other artificial means used to cause 30
pregnancy; 31
(P) Any expense or charge for oral contraceptives used for 32
birth control or any other temporary birth control measures; 33
(Q) Any expense or charge for sterilization or 34
sterilization reversals; 35
(R) Any expense or charge for weight -loss programs, 36 HB1361
26 01/31/2025 10:34:07 AM ANS002
exercise equipment, or treatment of obesity except when certified by a 1
physician as morbid obesity, i.e., at least two (2) times normal body weight; 2
(S) Any expense or charge for acupuncture treatment unless 3
used as an anesthetic agent for a covered surgery; 4
(T) Any expense or charge for organ or bone marrow 5
transplants other than those performed at a hospital with a board -approved 6
organ transplant program that has been designated by the board as a preferred 7
provider organization for that specific organ or bone marrow transplant; 8
(U) Any expense or charge for procedures, treatments, 9
equipment, or services that are provided in special settings for research 10
purposes or in a controlled environment, are being studied for safety, 11
efficiency, and effectiveness, and are awaiting endorsement by the 12
appropriate national medical specialty college for general use within the 13
medical community; 14
(V) Such additional exclusions deemed appropriate by the 15
board in accordance with the provisions of subsection (b) of this section; 16
and 17
(W)(i) Any benefits that exceed the maximum lifetime 18
benefit for plan coverage established by the board under § 23 -79-19
506(a)(1)(N). 20
(ii) The maximum lifetime benefit shall not be less 21
than one million dollars ($1,000,000) and shall not exceed three million 22
dollars ($3,000,000). 23
(b) In establishing the plan coverage, the board shall take into 24
consideration the levels of health insurance provided in the state and 25
medical economic factors as may be deemed appropriate and promulgate 26
benefits, deductibles, copayments, coinsurance factors, exclusions, and 27
limitations determined to be generally reflective of and commensurate with 28
health insurance provided through a representative number of large employers 29
in the state. 30
(c) The board may adjust any deductibles, copayments, and coinsurance 31
factors annually according to the medical component of the Consumer Price 32
Index for All Urban Consumers. 33
(d) Nonduplication of Benefits. 34
(1)(A) The pool shall be payer of last resort of benefits 35
whenever any other benefit or source of third -party payment is available. 36 HB1361
27 01/31/2025 10:34:07 AM ANS002
(B) Benefits otherwise payable under plan coverage shall 1
be reduced by all amounts paid or payable through any other health insurance 2
or any other source providing benefits because of a sickness or injury and by 3
all hospital and medical expense benefits paid or payable under any workers' 4
compensation coverage, automobile medical payment, or liability insurance 5
whether provided on the basis of fault or nonfault and by any hospital or 6
medical benefits paid or payable under or provided pursuant to any state or 7
federal law or program. 8
(2) The pool shall have a cause of action against a covered 9
person for the recovery of the amount of benefits paid that are not covered 10
by the pool. Benefits due from the pool may be reduced or refused as a set -11
off against any amount recoverable under this subdivision (d)(2). 12
(e) Right of Subrogation — Recoveries. 13
(1)(A) Whenever the pool has paid benefits because of sickness 14
or an injury to any covered person resulting from a third party's wrongful 15
act or negligence or for which an insurance company or self -insured entity is 16
liable in accordance with the provisions of any policy of insurance, and the 17
covered person has recovered or may recover damages from a third party that 18
is liable for damages, the pool shall have the right to recover the benefits 19
it paid from any amounts that the covered person has received or may receive 20
regardless of the date of the sickness or injury or the date of any 21
settlement, judgment, or award resulting from the sickness or injury. 22
(B) The pool shall be subrogated to any right of recovery 23
the covered person may have under the terms of any private or public 24
healthcare coverage or liability coverage including coverage under a workers' 25
compensation act without the necessity of assignment of claim or other 26
authorization to secure the right of recovery. 27
(C) To enforce its subrogation right, the pool may: 28
(i) Intervene or join in an action or proceeding 29
brought by the covered person or his or her personal representative, 30
including his or her guardian, conservator, estate, dependents, or survivors, 31
against any third party or the third party's insurance carrier or self -32
insured entity that may be liable; or 33
(ii) Institute and prosecute legal proceedings 34
against any third party or the third party's insurance carrier or self -35
insured entity that may be liable for the sickness or injury in an 36 HB1361
28 01/31/2025 10:34:07 AM ANS002
appropriate court either in the name of the pool or in the name of the 1
covered person or his or her personal representative including his or her 2
guardian, conservator, estate, dependents, or survivors. 3
(2)(A)(i) If any action or claim is brought by or on behalf of a 4
covered person against a third party or the third party's insurance carrier 5
or self-insured entity, the covered person or his or her personal 6
representative, including his or her guardian, conservator, estate, 7
dependents, or survivors, shall notify the pool by personal service or 8
registered mail of the action or claim and of the name of the court in which 9
the action or claim is brought, filing proof thereof in the action or claim. 10
(ii) The pool may, at any time thereafter, join in 11
the action or claim upon its motion so that all orders of court after hearing 12
and judgment shall be made for its protection. 13
(B) No release or settlement of a claim for damages and no 14
satisfaction of judgment in the action shall be valid without the written 15
consent of the pool to the extent of its interest in the settlement or 16
judgment and of the covered person or his or her personal representative. 17
(3)(A) In the event that the covered person or his or her 18
personal representative fails to institute a proceeding against any 19
appropriate third party before the fifth month before the action would be 20
barred, the pool, in its own name or in the name of the covered person or 21
personal representative, may commence a proceeding against any appropriate 22
third party for the recovery of damages on account of any sickness, injury, 23
or death to the covered person. 24
(B) The covered person shall cooperate in doing what is 25
reasonably necessary to assist the pool in any recovery and shall not take 26
any action that would prejudice the pool's right to recovery. 27
(C) The pool shall pay to the covered person or his or her 28
personal representative all sums collected from any third party by judgment 29
or otherwise in excess of amounts paid in benefits under the pool and amounts 30
paid or to be paid as costs, attorney's fees, and reasonable expenses 31
incurred by the pool in making the collection or enforcing the judgment. 32
(4)(A)(i) In the event of judgment or award in either a suit or 33
claim against a third party, the court shall first order paid from any 34
judgment or award the reasonable litigation expenses incurred in preparation 35
and prosecution of the action or claim, together with reasonable attorney's 36 HB1361
29 01/31/2025 10:34:07 AM ANS002
fees. 1
(ii) After payment of those expenses and attorney's 2
fees, the court shall apply out of the balance of the judgment or award an 3
amount sufficient to reimburse the pool the full amount of benefits paid on 4
behalf of the covered person under this subchapter, provided that the court 5
may reduce and apportion the pool's portion of the judgment proportionately 6
to the recovery of the covered person. 7
(B)(i) The burden of producing sufficient evidence to 8
support the exercise by the court of its discretion to reduce the amount of a 9
proven charge sought to be enforced against the recovery shall rest with the 10
party seeking the reduction. 11
(ii) The court may consider the nature and extent of 12
the injury, economic and noneconomic loss, settlement offers, comparative or 13
contributory negligence as it applies to the case at hand, hospital costs, 14
physician costs, and all other appropriate costs. 15
(C) The pool shall pay its pro rata share of the 16
attorney's fees based on the pool's recovery as it compares to the total 17
judgment. 18
(D) Any reimbursement rights of the pool shall take 19
priority over all other liens and charges existing under the laws of the 20
State of Arkansas. 21
(5) The pool may compromise or settle and release any claim for 22
benefits provided under this subchapter or waive any claims for benefits, in 23
whole or in part, for the convenience of the pool or if the pool determines 24
that collection will result in undue hardship upon the covered person. 25
(f) Preexisting Conditions. 26
(1) Except for federally eligible individuals or qualified trade 27
adjustment assistance eligible persons qualifying for plan coverage under § 28
23-79-509(b) or resident eligible persons or trade adjustment assistance 29
eligible persons who qualify for and elect to purchase the waiver authorized 30
in subdivision (f)(2) of this section, plan coverage shall exclude charges or 31
expenses incurred during the first six (6) months following the effective 32
date of coverage as to any condition if: 33
(A) The condition has manifested itself within the six -34
month period immediately preceding the effective date of coverage in such a 35
manner as would cause an ordinary prudent person to seek diagnosis, care, or 36 HB1361
30 01/31/2025 10:34:07 AM ANS002
treatment; or 1
(B) Medical advice, care, or treatment was recommended or 2
received within the six -month period immediately preceding the effective date 3
of the coverage. 4
(2) Waiver. The preexisting condition exclusions as set forth 5
in subdivision (f)(1) of this section will be waived to the extent to which 6
the resident eligible person or trade adjustment assistance eligible person: 7
(A) Has satisfied similar exclusions under any prior 8
individual health insurance coverage that was involuntarily terminated; and 9
(B)(i) Has applied for plan coverage not later than thirty 10
(30) days following the involuntary termination. 11
(ii) For each resident eligible person or trade 12
adjustment assistance eligible person who qualifies for and elects this 13
waiver, there shall be added on a prorated basis to each payment of premium a 14
surcharge of up to ten percent (10%) of the otherwise applicable annual 15
premium for as long as that individual's coverage under the plan remains in 16
effect or sixty (60) months, whichever is less. 17
(3)(A) Whenever benefits are due from the plan because of 18
sickness or an injury to a covered person resulting from a third party's 19
wrongful act or negligence and the covered person has recovered or may 20
recover damages from a third party or its insurance carrier or self -insured 21
entity, the plan shall have the right to reduce benefits or to refuse to pay 22
benefits that otherwise may be payable in the amount of damages that the 23
covered person has recovered or may recover regardless of the date of the 24
sickness or injury or the date of any settlement, judgment, or award 25
resulting from that sickness or injury. 26
(B)(i) During the pendency of any action or claim that is 27
brought by or on behalf of a covered person against a third party or its 28
insurance carrier or self -insured entity, any benefits that would otherwise 29
be payable except for the provisions of this subsection shall be paid if 30
payment by or for the third party has not yet been made and the covered 31
person or, if capable, that person's legal representative agrees in writing 32
to pay back properly the benefits paid as a result of the sickness or injury 33
to the extent of any future payments made by or for the third party for the 34
sickness or injury. 35
(ii) This agreement is to apply whether or not 36 HB1361
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liability for the payments is established or admitted by the third party or 1
whether those payments are itemized. 2
(C) Any amounts due the plan to repay benefits may be 3
deducted from other benefits payable by the plan after payments by or for the 4
third party are made. 5
(4) Benefits due from the plan may be reduced or refused as an 6
offset against any amount otherwise recoverable under this section. 7
8
23-79-511. Confidentiality. 9
(a)(1) All steps necessary under state and federal law to protect 10
confidentiality of applicants and covered persons shall be undertaken by the 11
Board of Directors of the Arkansas Comprehensive Health Insurance Pool to 12
prevent the identification of individual records of covered persons under the 13
plan, rejected by the plan, or who may become ineligible for further 14
participation in the plan. 15
(2) Procedures shall be written by the board to assure the 16
confidentiality of records of persons covered under, rejected by, or who 17
became ineligible for further participation in the plan when gathering and 18
submitting data to the board or any other entity. 19
(b) Any information submitted to the board by hospitals or any other 20
provider pursuant to this subchapter from which the identity of a particular 21
individual can be determined shall be privileged and confidential and shall 22
not be disclosed in any manner. The foregoing includes, but shall not be 23
limited to, disclosure, inspection, or copying under the Freedom of 24
Information Act of 1967, § 25 -19-101 et seq. 25
26
23-79-512. Collective action. 27
Neither the participation in the plan as insurers, the establishment of 28
rates, forms, or procedures nor any other joint or collective action required 29
by this subchapter shall be the basis of any legal action, criminal or civil 30
liability, or penalty against the plan or any insurer. 31
32
23-79-513. Unfair referral to plan — Prohibited practices by 33
employers. 34
(a) It shall constitute an unfair trade practice under the Trade 35
Practices Act, § 23-66-201 et seq., for an insurer, agent, broker, or third -36 HB1361
32 01/31/2025 10:34:07 AM ANS002
party administrator to refer an individual to the Arkansas Comprehensive 1
Health Insurance Pool or arrange for an individual to apply to the pool for 2
the purpose of: 3
(1) Separating the individual from group health insurance 4
coverage provided by a group health plan; or 5
(2) Facilitating enrollment in the pool by any of the following 6
individuals associated with an employer, with the knowledge that the employer 7
intends to pay or is paying all or part of the premium payments owed by the 8
individual for pool coverage: 9
(A) An employee of the employer; 10
(B) A retired employee of the employer; or 11
(C) A dependent of an employee or retired employee of the 12
employer. 13
(b) Because pool coverage is not intended to cover participants who 14
are eligible for a group health plan, an individual described in subdivision 15
(a)(2) of this section is not eligible: 16
(1) For pool coverage if the employer associated with the 17
applicant intends to pay for all or part of the pool premium payments for the 18
individual; or 19
(2) To continue pool coverage if the employer associated with 20
the individual directly or indirectly pays all or part of the pool premium 21
payments for the individual. 22
23
23-79-515. Orderly cessation of operations. 24
(a)(1) The Arkansas Comprehensive Health Insurance Pool shall cease 25
enrollment and coverage under the plan on and after January 1, 2014, as 26
required by federal law. 27
(2) After taking all reasonable steps, including those specified 28
in this section, to timely and efficiently assist in the transition of 29
individuals receiving plan coverage to the individual health insurance 30
market, the Board of Directors of the Arkansas Comprehensive Health Insurance 31
Pool shall cease operating the pool after paying health insurance claims for 32
plan coverage and meeting all other obligations of the board under this 33
section. 34
(b) The board may take all actions it deems necessary to: 35
(1) Cease enrollment for plan coverage effective December 1, 36 HB1361
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2013; 1
(2)(A) Terminate all existing plan coverage effective at the end 2
of the calendar day on December 31, 2013. 3
(B) The board shall provide at least ninety (90) days 4
notice to current policyholders of the termination; and 5
(3) Amend plan policies and provide adequate notice to 6
policyholders, agents, and providers that to be paid or reimbursed, a claim 7
for plan services is required to be filed by the earlier of one hundred 8
eighty (180) days after plan coverage ends or three hundred sixty -five (365) 9
days after the date of service giving rise to the claim. 10
(c) This section does not require the board to revise plan benefits to 11
comply with federal law or to maintain plan coverage for any individual after 12
December 31, 2013. 13
(d)(1) After all plan coverage terminates under this section, the 14
board shall take reasonable steps to wind up all significant operations of 15
the pool by December 31, 2014. 16
(2) Notwithstanding any other provision of this subchapter, to 17
facilitate an efficient cessation of operations: 18
(A) The board may continue to use existing contractors 19
until cessation of operations without the need to issue competitive requests 20
for proposals; 21
(B) The board may continue to fund operations of this 22
subchapter under § 23 -79-507; 23
(C) The board shall remain in effect: 24
(i) As provided by § 23 -79-504(b); and 25
(ii) Until a judgment, order, or decree in any 26
action, suit, or proceeding commenced against or by the pool is fully 27
executed; and 28
(D)(i) The term of each current board member shall be 29
extended until the date the pool concludes all business as provided under 30
this section and the Insurance Commissioner certifies the cessations of 31
operations under subsection (g) of this section. 32
(ii) The term of a board member expires when the 33
commissioner certifies the cessations of operations under subsection (g) of 34
this section. 35
(e) On or before June 30, 2013, the board shall amend the plan of 36 HB1361
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operation to reflect the actions necessary to implement this section. 1
(f) If the board has excess funds after the cessation of operations of 2
the pool, the funds shall be returned to the general revenue funds of the 3
state. 4
(g)(1) On or before March 1, 2016, or a later date if necessary to 5
complete the cessation of operations of the pool, the board shall file a 6
report with the General Assembly and commissioner that reflects completion of 7
the requirements of this section and includes an independent auditor's report 8
on the financial statements of the pool. 9
(2) If satisfied upon review of the report that the board has 10
complied with this section and accomplished the pool's cessation of 11
operations in a reasonable manner, the commissioner shall certify that the 12
business of the pool has concluded in accordance with this section and 13
publish the certification on the State Insurance Department website. 14
(h) Upon certification under subsection (g) of this section, the 15
operations of the pool are suspended indefinitely unless reactivated by the 16
General Assembly. 17
(i) The commissioner may address any matters regarding the pool 18
arising after the certification under subsection (g) of this section, and the 19
Attorney General shall defend a legal action filed after the certification, 20
including seeking the dismissal of the action under § 23 -79-516 or for any 21
other purpose. 22
(j) Unless inconsistent with this section, the remainder of this 23
subchapter continues to apply to the pool and the board. 24
25
23-79-516. Statute of limitations and repose. 26
Because winding up the operations of the Arkansas Comprehensive Health 27
Insurance Pool requires the expeditious determination of its outstanding 28
liabilities, a cause of action against the pool or the Board of Directors of 29
the Arkansas Comprehensive Health Insurance Pool shall be commenced within 30
the earlier of one (1) year after the cause of action accrues or December 31, 31
2015. 32
33
23-79-517. Individuals moving to Arkansas and previously covered by 34
another qualified high -risk pool. 35
(a) Notwithstanding § 23 -79-510(f), if a resident eligible person is 36 HB1361
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eligible for plan coverage because the person previously was covered under a 1
qualified high-risk pool of another state, a preexisting condition exclusion 2
otherwise applicable to the resident eligible person: 3
(1) Shall be reduced by each month of coverage in which the 4
resident eligible person was subject to a preexisting condition exclusion in 5
the other state's qualified high -risk pool; or 6
(2) Does not apply if the resident eligible person was not 7
subject to a preexisting condition exclusion in the other state's qualified 8
high-risk pool. 9
(b) This section expires on the last day an individual may be enrolled 10
into plan coverage under this subchapter. 11
12
SECTION 8. DO NOT CODIFY. CONSTRUCTION AND LEGISLATIVE INTENT. 13
It is the intent of the General Assembly that: 14
(1) The enactment and adoption of this act shall not expressly 15
or impliedly repeal an act passed during the regular session of the Ninety -16
Fifth General Assembly; 17
(2) To the extent that a conflict exists between an act of the 18
regular session of the Ninety -Fifth General Assembly and this act: 19
(A) The act of the regular session of the Ninety -Fifth 20
General Assembly shall be treated as a subsequent act passed by the General 21
Assembly for the purposes of: 22
(i) Giving the act of the regular session of the 23
Ninety-Fifth General Assembly its full force and effect; and 24
(ii) Amending or repealing the appropriate parts of 25
the Arkansas Code of 1987; and 26
(B) Section 1-2-107 shall not apply; and 27
(3) This act shall make only technical, not substantive, changes 28
to the Arkansas Code of 1987. 29
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