Stricken language would be deleted from and underlined language would be added to present law.
Act 349 of the Regular Session
*ANS291* 02/25/2025 1:11:34 PM ANS291
State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1595 3
4
By: Representative Steimel 5
By: Senator J. Boyd 6
7
For An Act To Be Entitled 8
AN ACT TO ENACT THE STATE INSURANCE DEPARTMENT'S 9
GENERAL OMNIBUS AMENDMENT OF ARKANSAS INSURANCE CODE; 10
TO AMEND THE ARKANSAS WORKERS' COMPENSATION INSURANCE 11
PLAN; TO AMEND THE LAW CONCERNING RECIPROCAL 12
INSURERS; TO CLARIFY AN ATTORNEY'S BOND REQUIREMENT; 13
TO AMEND THE LAW CONCERNING EXAMINATIONS OF HOSPITAL 14
AND MEDICAL SERVICE CORPORATIONS; TO AMEND THE LAW 15
CONCERNING SERVICE OF PROCESS IN SUITS INVOLVING 16
INSURERS; TO REPEAL THE COMPREHENSIVE HEALTH 17
INSURANCE POOL ACT; AND FOR OTHER PURPOSES. 18
19
20
Subtitle 21
TO ENACT THE STATE INSURANCE 22
DEPARTMENT'S GENERAL OMNIBUS AMENDMENT 23
OF ARKANSAS INSURANCE CODE. 24
25
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 26
27
SECTION 1. Arkansas Code § 23 -67-304(e), concerning the ability of the 28
Insurance Commissioner to delegate responsibility under the Arkansas Workers' 29
Compensation Insurance Plan, is amended to read as follows: 30
(e)(1)(A) At his or her discretion, the The Insurance Commissioner is 31
authorized to may delegate all or any part of the commissioner's 32
responsibility to establish and operate the plan. 33
(B) However, any such plan, or plan of operation, and any 34
amendments thereto must receive the prior approval of the commissioner. 35
(2) Any person or entity to whom the establishment, 36 HB1595
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implementation, or operation of the plan is delegated pursuant to this 1
subsection shall file with and obtain the approval of the commissioner as to 2
all policy forms, rates, or supplementary rate information necessary to 3
effectuate the plan. 4
(3)(A) In delegating all or part of the commissioner's 5
responsibility, the commissioner shall not approve any plan or filing that 6
abrogates or restricts his or her authority to select the plan administrator 7
or servicing carriers. 8
(B) The commissioner shall competitively select the 9
organization or organizations to whom the responsibility of plan 10
administrator shall be delegated. 11
(C) If the administration of the plan is delegated, the 12
plan administrator or administrators shall have an office in Arkansas be 13
adequately staffed, outfitted, and maintained to provide the plan services 14
delegated. 15
(D) The commissioner shall specify duties and functions of 16
plan administrators and may structure and delegate administrative functions 17
separately such as, but not limited to, rates, forms, and statistics for the 18
best operation of the plan. 19
(4) Under the provisions of this subsection, the commissioner 20
shall vigorously promote competition for the designation of the plan 21
administrator and servicing carrier for the most effective operation of the 22
plan. 23
(5)(A) The office in Arkansas is established plan administrator 24
and personnel are placed in their positions to improve services provided by 25
the plan, to promote and secure courteous and timely service, and to assure 26
that the minimum standards as provided under subdivision (f)(2) of this 27
section are met. 28
(B) The office plan administrator and personnel in 29
Arkansas shall also assist employers or agents with questions, problems, or 30
complaints pertaining to the servicing carriers and secure and expedite 31
prompt and fair treatment to employers for servicing carrier errors and 32
service failures. 33
(6)(A) The Arkansas office manager shall have the authority to 34
intervene with servicing carriers to secure an adequate level of service and 35
prevent servicing carriers from imposing unreasonable demands or actions. 36 HB1595
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(B) The office manager shall keep a record of all employer 1
or agent problems and complaints by a servicing carrier, including a 2
description of the problem. This record shall be provided to the commissioner 3
within sixty (60) days of each calendar year or upon the request of the 4
commissioner. 5
(C) The manager shall promptly notify the commissioner of 6
any problems upon a request by an employer. 7
8
SECTION 2. Arkansas Code § 23 -70-110(a)(1), concerning the attorney's 9
bond required of a domestic reciprocal insurer, is amended to read as 10
follows: 11
(a)(1)(A) Concurrently with the filing of the declaration provided for 12
in § 23-70-106, the attorney of a domestic or foreign reciprocal insurer 13
shall file with the Insurance Commissioner a bond in favor of this state for 14
the benefit of all persons damaged as a result of breach by the attorney of 15
the conditions of his or her bond as set forth stated in subdivision (a)(2) 16
of this section. 17
(B) The bond under subdivision (a)(1)(A) of this section 18
shall be: 19
(i) executed Executed by the attorney and by an 20
authorized corporate surety ; and 21
(ii) shall be subject Subject to the commissioner's 22
approval. 23
24
SECTION 3. Arkansas Code § 23 -75-114(b)(2), concerning an examination 25
of a hospital and medical service corporation, is amended to read as follows: 26
(2) An examination shall be conducted at least every three (3) 27
five (5) years. 28
29
SECTION 4. Arkansas Code § 23-79-205(a), concerning service of process 30
against an insurer, is amended to read as follows: 31
(a) In any suit brought in this state against an insurer, process may 32
be served upon the insurer as follows: 33
(1) As to domestic insurers, service of process may be had only 34
in the manner as provided by § 16-58-124 the Arkansas Rules of Civil 35
Procedure; 36 HB1595
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(2) As to licensed foreign or alien insurers, service on and 1
after January 1, 2003, may be made as provided in § 23 -63-301 et seq.; and 2
(3) As to suits against unauthorized insurers, service of 3
process shall be made as provided in §§ 23 -65-101 — 23-65-104, § 23-65-201 et 4
seq., and §§ 23-65-301 — 23-65-318 for unauthorized insurers and surplus 5
lines. 6
7
SECTION 5. Arkansas Code Title 23, Chapter 79, Subchapter 5, is 8
repealed. 9
Subchapter 5 — Comprehensive Health Insurance Pool Act 10
11
23-79-501. Purpose. 12
(a)(1) Acts 1995, No. 1339, established the Arkansas Comprehensive 13
Health Insurance Pool as a state program that was intended to provide an 14
alternate market for health insurance for certain uninsurable Arkansas 15
residents, and further this subchapter is intended to provide for the 16
successor entity that will provide the acceptable alternative mechanism as 17
described in the Health Insurance Portability and Accountability Act of 1996 18
for providing portable and accessible individual health insurance coverage 19
for federally eligible individuals as defined in this subchapter. 20
(2) This subchapter further is intended to provide a health 21
insurance coverage option for persons eligible for a federal income tax 22
credit under section 35 of the Internal Revenue Code, as created by the Trade 23
Adjustment Assistance Reform Act of 2002 or as subsequently amended. 24
(b) The General Assembly declares that it intends for this program to 25
provide portable and accessible individual health insurance coverage for 26
every individual who qualifies for coverage in accordance with § 23 -79-509(b) 27
as a federally eligible individual or as a qualified trade adjustment 28
assistance eligible person but does not intend for every eligible person who 29
qualifies for pool coverage in accordance with § 23 -79-509 to be guaranteed a 30
right to be issued a policy under this pool as a matter of entitlement. 31
32
23-79-502. Short title. 33
This subchapter may be cited as the “Comprehensive Health Insurance 34
Pool Act”, and is amendatory to the Arkansas Insurance Code and the 35
provisions of the Arkansas Insurance Code which are not in conflict with this 36 HB1595
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subchapter are applicable to this subchapter. 1
2
23-79-503. Definitions. 3
As used in this subchapter: 4
(1) “Agent” means any person who is licensed to sell health 5
insurance in this state; 6
(2) “Board” means the Board of Directors of the Arkansas 7
Comprehensive Health Insurance Pool; 8
(3) “Church plan” has the same meaning given that term in the 9
Health Insurance Portability and Accountability Act of 1996; 10
(4) “Commissioner” means the Insurance Commissioner; 11
(5) “Continuation coverage” means continuation of coverage under 12
a group health plan or other health insurance coverage for former employees 13
or dependents of former employees that would otherwise have terminated under 14
the terms of that coverage pursuant to any continuation provisions under 15
federal or state law, including the Consolidated Omnibus Budget 16
Reconciliation Act of 1985 (COBRA), as amended, § 23 -86-114 of the Arkansas 17
Insurance Code, or any other similar requirement in another state; 18
(6) “Covered person” means a person who is and continues to 19
remain eligible for pool coverage and is covered under one (1) of the plans 20
offered by the pool; 21
(7)(A) “Creditable coverage” means, with respect to a federally 22
eligible individual or a qualified trade adjustment assistance eligible 23
person, coverage of the individual under any of the following: 24
(i) A group health plan; 25
(ii) Health insurance coverage, including group 26
health insurance coverage; 27
(iii) Medicare; 28
(iv) Medical assistance; 29
(v) 10 U.S.C. § 1071 et seq.; 30
(vi) A medical care program of the Indian Health 31
Service or of a tribal organization; 32
(vii) A state health benefits risk pool; 33
(viii) A health plan offered under 5 U.S.C. § 8901 et 34
seq.; 35
(ix) A public health plan, as defined in regulations 36 HB1595
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consistent with section 104 of the Health Insurance Portability and 1
Accountability Act of 1996 that may be promulgated by the Secretary of the 2
United States Department of Health and Human Services; and 3
(x) A health benefit plan under section 5(e) of the 4
Peace Corps Act, 22 U.S.C. § 2504(e). 5
(B) “Creditable coverage” does not include: 6
(i) Coverage consisting solely of coverage of 7
excepted benefits as defined in section 2791(C) of Title XXVII of the Public 8
Health Service Act, 42 U.S.C. § 300gg -91; or 9
(ii)(a) Any period of coverage under 10
subdivisions (7)(A)(i) -(x) of this section that occurred before a break of 11
more than sixty-three (63) days during all of which the individual was not 12
covered under subdivisions (7)(A)(i) -(x) of this section. 13
(b) Any period that an individual is in a 14
waiting period for any coverage under a group health plan or for group health 15
insurance coverage or is in an affiliation period under the terms of health 16
insurance coverage offered by a health maintenance organization shall not be 17
taken into account in determining if there has been a break of more than 18
sixty-three (63) days in any creditable coverage; 19
(8) “Department” means the State Insurance Department; 20
(9) “Excess or stop -loss coverage” means an arrangement whereby 21
an insurer insures against the risk that any one (1) claim will exceed a 22
specific dollar amount or that the entire loss of a self -insurance plan will 23
exceed a specific amount; 24
(10) “Federally eligible individual” means an individual resident 25
of Arkansas: 26
(A) For whom: 27
(i) As of the date on which the individual seeks 28
pool coverage under § 23 -79-509, the aggregate of the periods of creditable 29
coverage is eighteen (18) or more months; and 30
(ii) The most recent prior creditable coverage was 31
under group health insurance coverage offered by an insurer, a group health 32
plan, a governmental plan, a church plan, or health insurance coverage 33
offered in connection with any such plans; 34
(B) Who is not eligible for coverage under: 35
(i) A group health plan; 36 HB1595
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(ii) Part A or Part B of Medicare; or 1
(iii) Medical assistance and does not have other 2
health insurance coverage; 3
(C) With respect to whom the most recent coverage within 4
the coverage period described in subdivision (10)(A)(i) of this section was 5
not terminated based upon a factor related to nonpayment of premiums or 6
fraud; 7
(D) If the individual has been offered the option of 8
continuation coverage under a Consolidated Omnibus Budget Reconciliation Act 9
of 1985 (COBRA) continuation provision or under a similar state program, who 10
elected such coverage; and 11
(E) Who, if the individual elected the continuation 12
coverage, has exhausted the continuation coverage under such a provision or 13
program; 14
(11) “Governmental plan” has the same meaning given that term in 15
the federal Health Insurance Portability and Accountability Act of 1996; 16
(12) “Group health plan” has the same meaning given that term in 17
the federal Health Insurance Portability and Accountability Act of 1996; 18
(13)(A) “Health insurance” means any hospital and medical 19
expense-incurred policy, certificate, or contract provided by an insurer, 20
hospital or medical service corporation, health maintenance organization, or 21
any other healthcare plan or arrangement that pays for or furnishes medical 22
or healthcare services whether by insurance or otherwise and includes any 23
excess or stop-loss coverage. 24
(B) “Health insurance” does not include long -term care, 25
disability income, short -term, accident, dental -only, vision-only, fixed 26
indemnity, limited-benefit or credit insurance, coverage issued as a 27
supplement to liability insurance, insurance arising out of workers' 28
compensation or similar law, automobile medical -payment insurance, or 29
insurance under which benefits are payable with or without regard to fault 30
and that is statutorily required to be contained in any liability insurance 31
policy or equivalent self -insurance; 32
(14) “Health maintenance organization” shall have the same 33
meaning as defined in § 23 -76-102; 34
(15) “Hospital” shall have the same meaning as defined in § 20 -9-35
201; 36 HB1595
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(16) “Individual health insurance coverage” means health 1
insurance coverage offered to individuals in the individual market but does 2
not include short-term, limited-duration insurance; 3
(17)(A) “Insurer” means any entity that provides health 4
insurance, including excess or stop -loss health insurance, in the State of 5
Arkansas. 6
(B) For the purposes of this subchapter, “insurer” 7
includes an insurance company, medical services plans, hospital plans, 8
hospital medical service corporations, health maintenance organizations, 9
fraternal benefits society, or any other entity providing a plan of health 10
insurance or health benefits subject to state insurance regulation; 11
(18) “Medical assistance” means the state medical assistance 12
program provided under Title XIX of the Social Security Act or under any 13
similar program of healthcare benefits in a state other than Arkansas; 14
(19)(A)(i) “Medically necessary” means that a service, drug, 15
supply, or article is necessary and appropriate for the diagnosis or 16
treatment of an illness or injury in accord with generally accepted standards 17
of medical practice at the time the service, drug, or supply is provided. 18
(ii) When specifically applied to a confinement, 19
“medically necessary” further means that the diagnosis or treatment of the 20
covered person's medical symptoms or condition cannot be safely provided to 21
that person as an outpatient. 22
(B) A service, drug, supply, or article shall not be 23
medically necessary if it: 24
(i) Is investigational, experimental, or for 25
research purposes; 26
(ii) Is provided solely for the convenience of the 27
patient, the patient's family, physician, hospital, or any other provider; 28
(iii) Exceeds in scope, duration, or intensity that 29
level of care that is needed to provide safe, adequate, and appropriate 30
diagnosis or treatment; 31
(iv) Could have been omitted without adversely 32
affecting the covered person's condition or the quality of medical care; or 33
(v) Involves the use of a medical device, drug, or 34
substance not formally approved by the United States Food and Drug 35
Administration; 36 HB1595
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(20) “Medicare” means coverage under Part A and Part B of Title 1
XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.; 2
(21) “Physician” means a person licensed to practice medicine as 3
duly licensed by the State of Arkansas; 4
(22) “Plan” means the comprehensive health insurance plan as 5
adopted by the board or by rule; 6
(23) “Plan administrator” means the insurer designated under § 7
23-79-508 to carry out the provisions of the plan of operation; 8
(24) “Plan of operation” means the plan of operation of the pool, 9
including articles, bylaws, and operating rules adopted by the board pursuant 10
to this subchapter; 11
(25) “Provider” means any hospital, skilled nursing facility, 12
hospice, home health agency, physician, pharmacist, or any other person or 13
entity licensed in Arkansas to furnish medical care, articles, and supplies; 14
(26) “Qualified high -risk pool” has the same meaning given that 15
term in the Health Insurance Portability and Accountability Act of 1996; 16
(27) “Qualified trade adjustment assistance eligible person” 17
means a person who is a trade adjustment assistance eligible person as 18
defined by this section and for whom, on the date an application for the 19
individual is received by the pool under § 23 -79-509, has an aggregate of at 20
least three (3) months of creditable coverage without a break in coverage of 21
sixty-three (63) days or more; 22
(28) “Resident eligible person” means a person who: 23
(A) Has been legally domiciled in the State of Arkansas 24
for a period of at least: 25
(i) Ninety (90) days and continues to be domiciled 26
in Arkansas; or 27
(ii) Thirty (30) days, continues to be domiciled in 28
Arkansas, and was covered under a qualified high-risk pool in another state 29
up until sixty-three (63) days or less prior to the date that the pool 30
receives his or her application for coverage; and 31
(B) Is not eligible for coverage under: 32
(i) A group health plan; 33
(ii) Part A or Part B of Medicare; or 34
(iii) Medical assistance as defined in this section 35
and does not have other health insurance coverage as defined in this section; 36 HB1595
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and 1
(29) “Trade adjustment assistance eligible person” means a person 2
who is legally domiciled in the State of Arkansas on the date of application 3
to the pool and is eligible for the tax credit for health insurance coverage 4
premiums under section 35 of the Internal Revenue Code of 1986. 5
6
23-79-504. Arkansas Comprehensive Health Insurance Pool. 7
(a) There is created a nonprofit legal entity to be known as the 8
“Arkansas Comprehensive Health Insurance Pool” as the successor entity to the 9
nonprofit legal entity established by Acts 1995, No. 1339. 10
(b)(1) The pool shall operate subject to the supervision and control 11
of the Board of Directors of the Arkansas Comprehensive Health Insurance 12
Pool. The pool is created as a political subdivision, instrumentality, and 13
body politic of the State of Arkansas, and, as such, is not a state agency. 14
(2) Except to the extent defined in this subchapter, the pool 15
will be exempt from: 16
(A) All state, county, and local taxes; 17
(B) The Arkansas Procurement Law, § 19 -11-201 et seq.; 18
(C) The Freedom of Information Act of 1967, § 25 -19-101 et 19
seq.; and 20
(D) The Arkansas Administrative Procedure Act, § 25 -15-201 21
et seq. 22
(3) The board shall consist of the following seven (7) members 23
to be appointed by the Insurance Commissioner: 24
(A) Two (2) current or former representatives of insurance 25
companies licensed to do business in the State of Arkansas; 26
(B) Two (2) current or former representatives of health 27
maintenance organizations licensed to do business in the State of Arkansas; 28
(C) One (1) member of a health -related profession licensed 29
in the State of Arkansas; 30
(D) One (1) member from the general public who is not 31
associated with the medical profession, a hospital, or an insurer; and 32
(E) One (1) member to represent a group considered to be 33
uninsurable. 34
(4) In making appointments to the board, the commissioner shall 35
strive to ensure that at least one (1) person serving on the board is at 36 HB1595
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least sixty (60) years of age. 1
(5) All terms shall be for three (3) years. 2
(6) The board shall elect one (1) of its members as chair. 3
(7) Any vacancy in the board occurring for any reason other than 4
the expiration of a term shall be filled for the unexpired term in the same 5
manner as the original appointment. 6
(8) Members of the board may be reimbursed from moneys of the 7
pool for actual and necessary expenses incurred by them in the performance of 8
their official duties as members of the board but shall not otherwise be 9
compensated for their services. 10
(c) All insurers, as a condition of doing business in the State of 11
Arkansas, shall participate in the pool by paying the assessments, submitting 12
the reports, and providing the information required by the board or the 13
commissioner to implement the provisions of this subchapter. 14
(d)(1) Neither the board nor its employees shall be liable for any 15
obligations of the pool. 16
(2) No board member or employee of the board shall be liable, 17
and no cause of action of any nature may arise against them, for any act or 18
omission related to the performance of their powers and duties under this 19
subchapter. 20
(3) The board may provide in its bylaws or rules for 21
indemnification of, and legal representation for, the board members and 22
employees. 23
24
23-79-505. Plan of operation. 25
(a)(1) The Board of Directors of the Arkansas Comprehensive Health 26
Insurance Pool shall adopt a plan of operation pursuant to this subchapter 27
and shall submit to the Insurance Commissioner for approval the plan of 28
operation including the Arkansas Comprehensive Health Insurance Pool's 29
articles, bylaws and operating rules, and any amendments thereto necessary or 30
suitable to assure the fair, reasonable, and equitable administration of the 31
pool. The plan of operation shall become effective upon approval in writing 32
by the commissioner. 33
(2) If the board fails to submit a suitable plan of operation 34
within one hundred eighty (180) days after the appointment of the board of 35
directors, or at any time thereafter fails to submit suitable amendments to 36 HB1595
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the plan of operation, the commissioner shall adopt and promulgate such rules 1
as are necessary or advisable to effectuate the provisions of this section. 2
The rules shall continue in force until modified by the commissioner or 3
superseded by a plan of operation submitted by the board and approved by the 4
commissioner. 5
(b) The plan of operation shall: 6
(1) Establish procedures for operation of the pool; 7
(2) Establish procedures for selecting a plan administrator in 8
accordance with § 23 -79-508; 9
(3) Create a fund, under management of the board, to pay 10
administrative claims and other expenses of the pool; 11
(4) Establish procedures for the handling, accounting, and 12
auditing of assets, moneys, and claims of the pool and the plan 13
administrator; 14
(5) Develop and implement a program to publicize the existence 15
of the plan, the eligibility requirements, and the procedures for enrollment 16
and to maintain public awareness of the plan; 17
(6)(A) Establish procedures under which applicants and 18
participants may have grievances reviewed by a grievance committee appointed 19
by the board. The grievances shall be reported to the board after completion 20
of the review. 21
(B) The board shall retain all written complaints 22
regarding the plan for at least three (3) years; and 23
(7) Provide for other matters as may be necessary and proper for 24
the execution of the board's powers, duties, and obligations under this 25
subchapter. 26
27
23-79-506. Powers. 28
(a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the 29
general powers and authority granted under the laws of the State of Arkansas 30
to health insurers and, in addition thereto, the specific authority to: 31
(A) Enter into contracts as are necessary or proper to 32
carry out the provisions and purposes of this subchapter; 33
(B) Sue or be sued, including taking any legal actions 34
necessary or proper; 35
(C) Take such legal action as necessary, including without 36 HB1595
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limitation: 1
(i) Avoiding the payment of improper claims against 2
the pool or the coverage provided by or through the pool; 3
(ii) Recovering any amounts erroneously or improperly 4
paid by the pool; 5
(iii) Recovering any amounts paid by the pool as a 6
result of mistake of fact or law; 7
(iv) Recovering other amounts due the pool; or 8
(v) Coordinating legal action with the Insurance 9
Commissioner to enforce the provisions of this subchapter; 10
(D)(i) Establish and modify from time to time as 11
appropriate, rates, rate schedules, rate adjustments, expense allowances, 12
agent referral fees, claim reserve formulas, deductibles, copayments, 13
coinsurance, and any other actuarial function appropriate to the operation of 14
the pool. 15
(ii) Rates and rate schedules may be adjusted for 16
appropriate factors such as age, sex, and geographical variation in claim 17
costs and shall take into consideration appropriate factors in accordance 18
with established actuarial and underwriting practices; 19
(E) Issue policies of insurance in accordance with the 20
requirements of this subchapter. All policy forms shall be subject to the 21
approval of the commissioner; 22
(F) Authorize the plan administrator to prepare and 23
distribute certificate of eligibility forms and enrollment instruction forms 24
to agents and to the general public; 25
(G) Provide and employ cost -containment measures and 26
requirements, including without limitation preadmission screening, second 27
surgical opinion, concurrent utilization review, and individual case 28
management for the purposes of making the plan more cost effective; 29
(H) Design, utilize, contract, or otherwise arrange the 30
delivery of cost-effective healthcare services, including establishing or 31
contracting directly or through the plan administrator with preferred 32
provider organizations, health maintenance organizations, physician hospital 33
organizations, or other limited network provider arrangements; 34
(I) Borrow money to effect the purposes of the pool. Any 35
notes or other evidence of indebtedness of the pool not in default shall be 36 HB1595
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legal investments for insurers and may be carried as admitted assets; 1
(J) Pledge, assign, and grant a security interest in any 2
of the assessments authorized by this subchapter or other assets of the pool 3
in order to secure any notes or other evidences of indebtedness of the pool; 4
(K) Provide reinsurance of risks incurred by the pool; 5
(L) Provide additional types of plans to provide optional 6
coverages, including Medicare supplement health insurance and health savings 7
accounts that comply with applicable federal law as in effect January 1, 8
2005; 9
(M) Enter into reciprocal agreements with other comparable 10
state plans in order to provide coverage for persons who move between states 11
and are covered by such other states' plans; and 12
(N) Establish lifetime maximum benefits under § 23 -79-13
510(a)(2)(W) for any person covered by a plan. 14
(2) In addition to the other powers granted by the Arkansas 15
Insurance Code, the commissioner may impose, after notice and hearing in 16
accordance with the provisions of the Arkansas Insurance Code, a monetary 17
penalty upon any insurer or suspend or revoke the certificate of authority to 18
transact insurance in the State of Arkansas of any insurer that fails to pay 19
an assessment or otherwise file any report or furnish information required to 20
be filed with the Board of Directors of the Arkansas Comprehensive Health 21
Insurance Pool pursuant to the board's direction that the board believes is 22
necessary in order for the board to perform its duties under this subchapter. 23
(b) All outstanding contracts executed by the Board of Directors of 24
the State Comprehensive Health Insurance Pool created by Acts 1995, No. 1339, 25
shall be deemed continuing obligations of the board created by this 26
subchapter. 27
(c) As provided for in § 23 -79-502, any health insurance benefit not 28
provided for in this subchapter shall be deemed to be in conflict with and 29
therefore inapplicable to the provisions of this subchapter. 30
31
23-79-507. Funding of pool. 32
(a) Premiums. 33
(1)(A) The Arkansas Comprehensive Health Insurance Pool shall 34
establish premium rates for plan coverage as provided in subdivision (a)(2) 35
of this section. 36 HB1595
15 02/25/2025 1:11:34 PM ANS291
(B) Separate schedules of premium rates based on age, sex, 1
and geographical location may apply for individual risks. 2
(C) Premium rates and schedules shall be submitted to the 3
Insurance Commissioner for approval prior to use. 4
(2)(A)(i) With the assistance of the commissioner, the pool 5
shall determine a standard risk rate by considering the premium rates charged 6
by other insurers offering health insurance coverage to individuals in 7
Arkansas. 8
(ii) The standard risk rate shall be established 9
using reasonable actuarial techniques and shall reflect anticipated 10
experience and expenses for the coverage. 11
(B)(i) Rates for plan coverage shall not exceed one 12
hundred fifty percent (150%) of rates established as applicable for 13
individual standard risks in Arkansas. 14
(ii) Subject to the limits provided in this 15
subdivision (a)(2), subsequent rates shall be established to help provide for 16
the expected costs of claims, including recovery of prior losses, expenses of 17
operation, investment income of claim reserves, and any other cost factors 18
subject to the limitations described in this section. 19
(b) Sources of Additional Revenue. 20
(1) In addition to the powers enumerated in § 23 -79-506, the 21
pool shall have the authority to: 22
(A) Assess insurers in accordance with the provisions of 23
this section; and 24
(B)(i) Make advance interim assessments as may be 25
reasonable and necessary for the pool's organizational and interim operating 26
expenses. 27
(ii) Any such interim assessments may be credited as 28
offsets against any regular assessments due following the close of the fiscal 29
year. 30
(2)(A) Following the close of each fiscal year, the plan 31
administrator shall determine the net premiums, that is, premiums less 32
administrative expense allowances, the pool expenses of administration and 33
operation, and the incurred losses for the year, taking into account 34
investment income and other appropriate gains and losses. 35
(B) The deficit incurred by the pool not otherwise 36 HB1595
16 02/25/2025 1:11:34 PM ANS291
recouped under either subdivision (b)(9) of this section or subsection (e) of 1
this section [repealed], or both, shall be recouped by assessments 2
apportioned among insurers by the Board of Directors of the Arkansas 3
Comprehensive Health Insurance Pool. 4
(3) Each insurer's assessment shall be determined by multiplying 5
the total assessment of all insurers as determined in subdivision (b)(2) of 6
this section by a fraction, the numerator of which equals that insurer's 7
premium and subscriber contract charges for health insurance written in the 8
state during the preceding calendar year and the denominator of which equals 9
the total of all health insurance premiums by all insurers. 10
(4)(A) If assessments or other funds received under either 11
subdivision (b)(9) of this section or subsection (e) of this section 12
[repealed], or both, or any combination of the assessments and funds exceed 13
the pool's actual losses and administrative expenses, the excess shall be 14
held at interest and used by the board to offset future losses or to reduce 15
future assessments. 16
(B) As used in this subsection, “future losses” includes 17
reserves for incurred but not reported claims. 18
(5) Each insurer's assessment shall be determined annually by 19
the board based on annual statements and other reports deemed necessary by 20
the board and filed by the insurer with the board or the commissioner. 21
(6)(A)(i) An insurer may petition the commissioner for an 22
abatement or deferment of all or part of an assessment imposed by the board. 23
(ii) The commissioner may abate or defer, in whole or 24
in part, the assessment if, in the opinion of the commissioner, payment of 25
the assessment would endanger the ability of the insurer to fulfill its 26
contractual obligations. 27
(B)(i) In the event an assessment against an insurer is 28
abated or deferred, in whole or in part, the amount by which the assessment 29
is abated or deferred shall be assessed against the other insurers in a 30
manner consistent with the basis for assessments set forth in this 31
subsection. 32
(ii) The insurer receiving the abatement or deferment 33
shall remain liable to the plan for the deficiency for four (4) years. 34
(7) For all assessments issued by the board, beginning January 35
1, 1998, only those individuals, corporations, associations, or other 36 HB1595
17 02/25/2025 1:11:34 PM ANS291
entities defined as an insurer in § 23 -79-503 shall be subject to assessment. 1
(8) In the event the board fails to act within a reasonable 2
period of time to recoup by assessment any deficit incurred by the pool, the 3
commissioner shall have all the powers and duties of the board under this 4
chapter with respect to assessing insurers. 5
(9) The General Assembly further intends that the pool be 6
eligible for, and for the pool, its board, or other officers of state 7
government, as appropriate, to take steps necessary to obtain federal grant 8
funds to offset losses of the pool, including any funds made available under 9
the Trade Adjustment Assistance Reform Act of 2002. 10
(c) Assessment Offsets. 11
(1) Any assessment may be offset in an amount equal to the 12
amount of the assessment paid to the pool against the premium tax payable by 13
that insurer for the year in which the assessment is levied or for the four 14
(4) years subsequent to that year. 15
(2) No offset shall be allowed for any penalty assessed under 16
subdivision (d)(1) of this section. 17
(d)(1) All assessments and fees shall be due and payable upon receipt 18
and shall be delinquent if not paid within thirty (30) days of the receipt of 19
the notice by the insurer. 20
(2) Failure to timely pay the assessment will automatically 21
subject the insurer to a ten percent (10%) penalty, which will be due and 22
payable within the next thirty -day period. 23
(3) The board and the commissioner shall have the authority to 24
enforce the collection of the assessment and penalty in accordance with the 25
provisions of this subchapter and the Arkansas Insurance Code. 26
(4) The board may waive the penalty authorized by this 27
subsection if it determines that compelling circumstances exist that justify 28
such a waiver. 29
30
23-79-508. Plan administrator. 31
(a) The Board of Directors of the Arkansas Comprehensive Health 32
Insurance Pool shall select an insurer through a competitive bidding process 33
to administer the plan. However, the administering insurer designated by the 34
board created by Acts 1995, No. 1339, shall serve as the plan administrator 35
under this subchapter until the expiration of the current contract of the 36 HB1595
18 02/25/2025 1:11:34 PM ANS291
administering insurer. The board shall evaluate bids submitted under this 1
section based upon criteria established by the board which shall include, but 2
not be limited to, the following: 3
(1) The plan administrator's proven ability to handle large 4
group accident and health benefit plans; 5
(2) The efficiency and timeliness of the plan administrator's 6
claim processing procedures; 7
(3) An estimate of total charges for administering the plan; 8
(4) The plan administrator's ability to apply effective cost 9
containment programs and procedures and to administer the plan in a cost 10
efficient manner; and 11
(5) The financial condition and stability of the plan 12
administrator. 13
(b)(1) The plan administrator shall serve for a period of three (3) 14
years subject to removal for cause and subject to the terms, conditions, and 15
limitations of the contract between the board and the plan administrator. 16
(2) The board shall advertise for and accept bids to serve as 17
the plan administrator for the succeeding three -year periods. 18
(c) The plan administrator shall perform functions related to the plan 19
as may be assigned to it, including: 20
(1) Determination of eligibility; 21
(2) Payment and processing of claims; 22
(3) Establishment of a premium billing procedure for collection 23
of premiums. Billings shall be made on a periodic basis as determined by the 24
board; and 25
(4) Other necessary functions to assure timely payment of 26
benefits to covered persons under the plan, including: 27
(A) Making available information relating to the proper 28
manner of submitting a claim for benefits under the plan and distributing 29
forms upon which submissions shall be made; and 30
(B) Evaluating the eligibility of each claim for payment 31
under the plan. 32
(d)(1) The plan administrator shall submit regular reports to the 33
board regarding the operation of the plan. 34
(2) Frequency, content, and form of the report shall be 35
determined by the board. 36 HB1595
19 02/25/2025 1:11:34 PM ANS291
(e)(1) The plan administrator shall pay claim expenses from the 1
premium payments received from or on behalf of plan participants and 2
allocated by the board for claim expenses. 3
(2) If the plan administrator's payments for claims expenses 4
exceed the portion of premiums allocated by the board for payment of claims 5
expenses, the board shall provide additional funds to the plan administrator 6
for payment of claims expenses. 7
(f) The plan administrator shall be governed by the requirements of 8
this subchapter and shall be compensated as provided in the contract between 9
the board and the plan administrator. 10
11
23-79-509. Plan eligibility. 12
(a) General Eligibility Requirements. The following requirements 13
apply to a resident eligible person or a trade adjustment assistance eligible 14
person in order for the person to be eligible for plan coverage: 15
(1) Except as provided in subdivision (a)(2) of this section or 16
subsection (b) of this section, any individual person who meets the 17
definition of resident eligible person as defined by § 23 -79-503 or a trade 18
adjustment assistance eligible person as defined by § 23 -79-503 and is either 19
a citizen of the United States or an alien lawfully admitted for permanent 20
residence who continues to be a resident of this state shall be eligible for 21
plan coverage if evidence is provided of: 22
(A) A notice of rejection or refusal by an insurer to 23
issue substantially similar individual health insurance coverage by reason of 24
the existence or history of a medical condition or upon such other evidence 25
that the Board of Directors of the Arkansas Comprehensive Health Insurance 26
Pool deems sufficient in order to verify that the applicant is unable to 27
obtain the coverage from an insurer due to the existence or history of a 28
medical condition; 29
(B)(i) A refusal by an insurer to issue individual health 30
insurance coverage except at a rate that the board determines is 31
substantially in excess of the applicable plan rate. 32
(ii) A rejection or refusal by a group health plan or 33
insurer offering only stop -loss or excess-of-loss insurance or contracts, 34
agreements, or other arrangements for reinsurance coverage with respect to 35
the applicant shall not be sufficient evidence under this subsection; 36 HB1595
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(C)(i) Until September 30, 2011, a refusal by an insurer 1
to issue individual health insurance coverage to a child under nineteen (19) 2
years of age. 3
(ii) After September 30, 2011, the eligibility of a 4
child under nineteen (19) years of age for individual health insurance 5
coverage shall be determined by the board; or 6
(D) Evidence that the applicant was covered under a 7
qualified high-risk pool of another state, provided that the coverage 8
terminated no more than sixty -three (63) days prior to the date the pool 9
receives the applicant's application for coverage and the other state's 10
qualified high-risk pool did not terminate the person's coverage for fraud; 11
(2) A person shall not be eligible for coverage under the plan 12
if: 13
(A) The person has or obtains health insurance coverage 14
substantially similar to or more comprehensive than a plan policy or would be 15
eligible to have coverage if the person elected to obtain it except that: 16
(i) A person may maintain other coverage for the 17
period of time the person is satisfying any waiting period for a preexisting 18
condition under a plan policy; and 19
(ii) A person may maintain plan coverage for the 20
period of time the person is satisfying a waiting period for a preexisting 21
condition under another health insurance policy intended to replace the plan 22
policy; 23
(B) The person is determined to be eligible for healthcare 24
benefits under Title XIX of the Social Security Act; 25
(C) The person has previously terminated plan coverage 26
unless twelve (12) months have elapsed since termination of coverage; 27
(D) The person fails to pay the required premium under the 28
covered person's terms of enrollment and participation, in which event the 29
liability of the plan shall be limited to benefits incurred under the plan 30
for the same period for which premiums had been paid and the covered person 31
remained eligible for plan coverage; 32
(E) The plan has paid on behalf of the covered person the 33
maximum lifetime benefit established by the board in accordance with § 23 -79-34
510(a)(2)(W); 35
(F) The person is a resident of a public institution; 36 HB1595
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(G) All or part of the person's premium is paid for or 1
reimbursed: 2
(i) By one (1) of the following in connection with a 3
group health plan: 4
(a) The person’s current employer; 5
(b) If the person is retired, by the person's 6
former employer; or 7
(c) If the person is a dependent of an 8
employee or retiree, by the current or former employer of the employee or 9
retiree; or 10
(ii) Under any government -sponsored program or by any 11
government agency, foundation, healthcare facility, or healthcare provider 12
except for premiums paid on behalf of: 13
(a) A trade adjustment assistance eligible 14
person or a qualified trade adjustment assistance eligible person in 15
accordance with section 35 of the Internal Revenue Code; or 16
(b) An otherwise qualifying full -time employee 17
or dependent of a qualifying full -time employee of a government agency, 18
foundation, healthcare facility, or healthcare provider; or 19
(H) The person commits a fraudulent insurance act as 20
defined in § 23-66-501(4) against the Arkansas Comprehensive Health Insurance 21
Pool; 22
(3) The board or the plan administrator shall require 23
verification of residency and may require any additional information, 24
documentation, or statements under oath whenever necessary to determine plan 25
eligibility or residency; 26
(4) Coverage shall cease: 27
(A) On the date a person is no longer a resident of the 28
State of Arkansas; 29
(B) On the date a person requests coverage to end; 30
(C) On the death of the covered person; 31
(D) On the date state law requires cancellation of the 32
policy; or 33
(E) At the plan's option, thirty (30) days after the plan 34
makes any written inquiry concerning a person's eligibility or place of 35
residence to which the person does not reply; and 36 HB1595
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(5) Except under the conditions set forth in subdivision (a)(4) 1
of this section, the coverage of any person who ceases to meet the 2
eligibility requirements of this section terminates at the end of the month 3
that the person ceases to meet the eligibility requirements of this section. 4
(b) Persons Eligible for Guaranteed Issuance of Coverage. The 5
following requirements apply to a federally eligible individual or a 6
qualified trade adjustment assistance eligible person in order for such an 7
individual to be eligible for plan coverage: 8
(1) Notwithstanding the requirements of subsection (a) of this 9
section, any federally eligible individual or a qualified trade adjustment 10
assistance eligible person for whom a plan application and such enclosures 11
and supporting documentation as the board may require is received by the 12
board within sixty-three (63) days after the termination of prior creditable 13
coverage for reasons other than nonpayment of premium or fraud that covered 14
the applicant shall qualify to enroll in the plan under the portability 15
provisions of this subsection; 16
(2) Any individual seeking plan coverage under this subsection 17
must submit with his or her application evidence, including acceptable 18
written certification of previous creditable coverage, that will establish to 19
the board's satisfaction that he or she meets all of the requirements to be a 20
federally eligible individual or a qualified trade adjustment assistance 21
eligible person and is currently and permanently residing in the State of 22
Arkansas as of the date his or her application was received by the board; 23
(3) A period of creditable coverage shall not be counted, with 24
respect to qualifying an applicant for plan coverage as an individual under 25
this subsection, if after such a period and before the application for plan 26
coverage was received by the board, there was at least a sixty -three-day 27
period during all of which the individual was not covered under any 28
creditable coverage; 29
(4) Any individual who the board determines qualifies for plan 30
coverage under this subsection shall be offered his or her choice of 31
enrolling in one (1) of the alternative portability plans that the board is 32
authorized under this subsection to establish for those individuals; 33
(5)(A)(i) The board shall offer a choice of healthcare coverages 34
consistent with major medical coverage under the alternative plans authorized 35
by this subsection to every individual qualifying for coverage under this 36 HB1595
23 02/25/2025 1:11:34 PM ANS291
subsection. 1
(ii) The coverages to be offered under the plans, the 2
schedule of benefits, deductibles, copayments, coinsurance, exclusions, and 3
other limitations shall be approved by the board. 4
(B) One (1) optional form of coverage shall be comparable 5
to comprehensive health insurance coverage offered in the individual market 6
in the State of Arkansas or a standard option of coverage available under the 7
individual health insurance laws of the State of Arkansas. The standard plan 8
that is authorized by § 23 -79-510 may be used for this purpose. 9
(C) The board also may offer a preferred provider option 10
and such other options as the board determines may be appropriate for 11
individuals who qualify for plan coverage pursuant to this subsection; 12
(6) Notwithstanding the requirements of § 23 -79-510(f), any plan 13
coverage that is issued to individuals who qualify for plan coverage pursuant 14
to the portability provisions of this subsection shall not be subject to any 15
preexisting conditions exclusion, waiting period, or other similar limitation 16
on coverage; 17
(7) Individuals who qualify and enroll in the plan pursuant to 18
this subsection shall be required to pay such premium rates as the board 19
shall establish and approve in accordance with the requirements of § 23 -79-20
507(a); 21
(8) The total premium, without regard to any subsidy of premium, 22
for individuals who qualify and enroll in the plan pursuant to this 23
subsection shall not be greater than a similarly situated individual 24
qualifying for pool coverage under subsection (a) of this section; and 25
(9) A federally eligible individual who qualifies and enrolls in 26
the plan pursuant to this subsection must continue to satisfy all of the 27
other eligibility requirements of this subchapter to the extent not 28
inconsistent with the Health Insurance Portability and Accountability Act of 29
1996 in order to maintain continued eligibility for coverage under the plan. 30
(c) Any person who was issued a policy pursuant to the provisions of 31
Acts 1995, No. 1339, shall be deemed continuously covered consistent with the 32
terms of this subchapter and reissued a new policy in accordance with the 33
provisions of this subchapter. 34
35
23-79-510. Outline of benefits. 36 HB1595
24 02/25/2025 1:11:34 PM ANS291
(a)(1) Subject to the contractual policy form language adopted by the 1
Board of Directors of the Arkansas Comprehensive Health Insurance Pool, 2
expenses for the following services, supplies, drugs, or articles when 3
prescribed by a physician and determined by the plan to be medically 4
necessary shall be covered, subject to provisions of subsection (b) of this 5
section: 6
(A) Hospital services; 7
(B) Professional services for the diagnosis or treatment 8
of injuries, illnesses, or conditions, other than mental or dental, that are 9
rendered by a physician or by other licensed professionals at his or her 10
direction; 11
(C) Drugs requiring a physician's prescription; 12
(D) Skilled nursing services of a licensed skilled nursing 13
facility for not more than one hundred twenty (120) days during a policy 14
year; 15
(E) Services of a home health agency up to a maximum of 16
two hundred seventy (270) services per year; 17
(F) Use of radium or other radioactive materials; 18
(G) Oxygen; 19
(H) Prostheses other than dental; 20
(I) Rental of durable medical equipment, other than 21
eyeglasses and hearing aids, for which there is no personal use in the 22
absence of the conditions for which such equipment is prescribed; 23
(J) Diagnostic X rays and laboratory tests; 24
(K) Oral surgery for excision of partially or completely 25
unerupted, impacted teeth or the gums and tissues of the mouth when not 26
performed in connection with the extraction or repair of teeth; 27
(L) Services of a physical therapist; 28
(M) Emergency and other medically necessary transportation 29
provided by a licensed ambulance service to the nearest facility qualified to 30
treat a covered condition; 31
(N) Services for diagnosis and treatment of mental and 32
nervous disorders or chemical and drug dependency, provided that a covered 33
person shall be required to make a fifty percent (50%) copayment and that the 34
plan's payment shall not exceed four thousand dollars ($4,000) annually; and 35
(O) Such additional benefits deemed appropriate by the 36 HB1595
25 02/25/2025 1:11:34 PM ANS291
board in accordance with the provisions of subsection (b) of this section. 1
(2) Exclusions. Unless the contractual policy form language 2
adopted by the board provides otherwise, the following services, supplies, 3
drugs, or articles whether or not prescribed by a physician, shall not be 4
covered: 5
(A) Any charge for treatment for cosmetic purposes other 6
than surgery for the repair or treatment of an injury or a congenital bodily 7
defect to restore normal bodily functions; 8
(B) Care that is primarily for custodial or domiciliary 9
purposes; 10
(C) Any charge for confinement in a private room to the 11
extent it is in excess of the institution's charge for its most common 12
semiprivate room unless a private room is medically necessary; 13
(D) That part of any charge for services rendered or 14
articles prescribed by a physician, dentist, or other healthcare personnel 15
that exceeds the prevailing charge in the locality or for any charge not 16
medically necessary; 17
(E) Any charge for services or articles the provision of 18
which is not within the scope of authorized practice of the institution or 19
individual providing the services or articles; 20
(F) Any expense incurred prior to the effective date of 21
coverage by the plan for the person on whose behalf the expense is incurred; 22
(G) Dental care except as provided in subdivision 23
(a)(1)(K) of this section; 24
(H) Eyeglasses and hearing aids; 25
(I) Illness or injury due to acts of war; 26
(J) Services of blood donors and any fee for failure to 27
replace the first three (3) pints of blood provided to a covered person each 28
policy year; 29
(K) Personal supplies or services provided by a hospital 30
or nursing home or any other nonmedical or nonprescribed supply or service; 31
(L) Any expense or charge for services, articles, drugs, 32
or supplies that are not provided in accord with generally accepted standards 33
of current medical practice; 34
(M) Any expense for which a charge is not made in the 35
absence of insurance or for which there is no legal obligation on the part of 36 HB1595
26 02/25/2025 1:11:34 PM ANS291
the patient to pay; 1
(N) Any expense incurred for benefits provided under the 2
laws of the United States and the State of Arkansas, including Medicare and 3
Medicaid and other medical assistance, military service -connected disability 4
payments, medical services provided for members of the armed forces and their 5
dependents or employees of the United States Armed Forces, and medical 6
services financed on behalf of all citizens by the United States; 7
(O) Any expense or charge for in vitro fertilization, 8
artificial insemination, or any other artificial means used to cause 9
pregnancy; 10
(P) Any expense or charge for oral contraceptives used for 11
birth control or any other temporary birth control measures; 12
(Q) Any expense or charge for sterilization or 13
sterilization reversals; 14
(R) Any expense or charge for weight -loss programs, 15
exercise equipment, or treatment of obesity except when certified by a 16
physician as morbid obesity, i.e., at least two (2) times normal body weight; 17
(S) Any expense or charge for acupuncture treatment unless 18
used as an anesthetic agent for a covered surgery; 19
(T) Any expense or charge for organ or bone marrow 20
transplants other than those performed at a hospital with a board -approved 21
organ transplant program that has been designated by the board as a preferred 22
provider organization for that specific organ or bone marrow transplant; 23
(U) Any expense or charge for procedures, treatments, 24
equipment, or services that are provided in special settings for research 25
purposes or in a controlled environment, are being studied for safety, 26
efficiency, and effectiveness, and are awaiting endorsement by the 27
appropriate national medical specialty college for general use within the 28
medical community; 29
(V) Such additional exclusions deemed appropriate by the 30
board in accordance with the provisions of subsection (b) of this section; 31
and 32
(W)(i) Any benefits that exceed the maximum lifetime 33
benefit for plan coverage established by the board under § 23 -79-34
506(a)(1)(N). 35
(ii) The maximum lifetime benefit shall not be less 36 HB1595
27 02/25/2025 1:11:34 PM ANS291
than one million dollars ($1,000,000) and shall not exceed three million 1
dollars ($3,000,000). 2
(b) In establishing the plan coverage, the board shall take into 3
consideration the levels of health insurance provided in the state and 4
medical economic factors as may be deemed appropriate and promulgate 5
benefits, deductibles, copayments, coinsurance factors, exclusions, and 6
limitations determined to be generally reflective of and commensurate with 7
health insurance provided through a representative number of large employers 8
in the state. 9
(c) The board may adjust any deductibles, copayments, and coinsurance 10
factors annually according to the medical component of the Consumer Price 11
Index for All Urban Consumers. 12
(d) Nonduplication of Benefits. 13
(1)(A) The pool shall be payer of last resort of benefits 14
whenever any other benefit or source of third -party payment is available. 15
(B) Benefits otherwise payable under plan coverage shall 16
be reduced by all amounts paid or payable through any other health insurance 17
or any other source providing benefits because of a sickness or injury and by 18
all hospital and medical expense benefits paid or payable under any workers' 19
compensation coverage, automobile medical payment, or liability insurance 20
whether provided on the basis of fault or nonfault and by any hospital or 21
medical benefits paid or payable under or provided pursuant to any state or 22
federal law or program. 23
(2) The pool shall have a cause of action against a covered 24
person for the recovery of the amount of benefits paid that are not covered 25
by the pool. Benefits due from the pool may be reduced or refused as a set -26
off against any amount recoverable under this subdivision (d)(2). 27
(e) Right of Subrogation — Recoveries. 28
(1)(A) Whenever the pool has paid benefits because of sickness 29
or an injury to any covered person resulting from a third party's wrongful 30
act or negligence or for which an insurance company or self -insured entity is 31
liable in accordance with the provisions of any policy of insurance, and the 32
covered person has recovered or may recover damages from a third party that 33
is liable for damages, the pool shall have the right to recover the benefits 34
it paid from any amounts that the covered person has received or may receive 35
regardless of the date of the sickness or injury or the date of any 36 HB1595
28 02/25/2025 1:11:34 PM ANS291
settlement, judgment, or award resulting from the sickness or injury. 1
(B) The pool shall be subrogated to any right of recovery 2
the covered person may have under the terms of any private or public 3
healthcare coverage or liability coverage including coverage under a workers' 4
compensation act without the necessity of assignment of claim or other 5
authorization to secure the right of recovery. 6
(C) To enforce its subrogation right, the pool may: 7
(i) Intervene or join in an action or proceeding 8
brought by the covered person or his or her personal representative, 9
including his or her guardian, conservator, estate, dependents, or survivors, 10
against any third party or the third party's insurance carrier or self -11
insured entity that may be liable; or 12
(ii) Institute and prosecute legal proceedings 13
against any third party or the third party's insurance carrier or self -14
insured entity that may be liable for the sickness or injury in an 15
appropriate court either in the name of the pool or in the name of the 16
covered person or his or her personal representative including his or her 17
guardian, conservator, estate, dependents, or survivors. 18
(2)(A)(i) If any action or claim is brought by or on behalf of a 19
covered person against a third party or the third party's insurance carrier 20
or self-insured entity, the covered person or his or her personal 21
representative, including his or her guardian, conservator, estate, 22
dependents, or survivors, shall notify the pool by personal service or 23
registered mail of the action or claim and of the name of the court in which 24
the action or claim is brought, filing proof thereof in the action or claim. 25
(ii) The pool may, at any time thereafter, join in 26
the action or claim upon its motion so that all orders of court after hearing 27
and judgment shall be made for its protection. 28
(B) No release or settlement of a claim for damages and no 29
satisfaction of judgment in the action shall be valid without the written 30
consent of the pool to the extent of its interest in the settlement or 31
judgment and of the covered person or his or her personal representative. 32
(3)(A) In the event that the covered person or his or her 33
personal representative fails to institute a proceeding against any 34
appropriate third party before the fifth month before the action would be 35
barred, the pool, in its own name or in the name of the covered person or 36 HB1595
29 02/25/2025 1:11:34 PM ANS291
personal representative, may commence a proceeding against any appropriate 1
third party for the recovery of damages on account of any sickness, injury, 2
or death to the covered person. 3
(B) The covered person shall cooperate in doing what is 4
reasonably necessary to assist the pool in any recovery and shall not take 5
any action that would prejudice the pool's right to recovery. 6
(C) The pool shall pay to the covered person or his or her 7
personal representative all sums collected from any third party by judgment 8
or otherwise in excess of amounts paid in benefits under the pool and amounts 9
paid or to be paid as costs, attorney's fees, and reasonable expenses 10
incurred by the pool in making the collection or enforcing the judgment. 11
(4)(A)(i) In the event of judgment or award in either a suit or 12
claim against a third party, the court shall first order paid from any 13
judgment or award the reasonable litigation expenses incurred in preparation 14
and prosecution of the action or claim, together with reasonable attorney's 15
fees. 16
(ii) After payment of those expenses and attorney's 17
fees, the court shall apply out of the balance of the judgment or award an 18
amount sufficient to reimburse the pool the full amount of benefits paid on 19
behalf of the covered person under this subchapter, provided that the court 20
may reduce and apportion the pool's portion of the judgment proportionately 21
to the recovery of the covered person. 22
(B)(i) The burden of producing sufficient evidence to 23
support the exercise by the court of its discretion to reduce the amount of a 24
proven charge sought to be enforced against the recovery shall rest with the 25
party seeking the reduction. 26
(ii) The court may consider the nature and extent of 27
the injury, economic and noneconomic loss, settlement offers, comparative or 28
contributory negligence as it applies to the case at hand, hospital costs, 29
physician costs, and all other appropriate costs. 30
(C) The pool shall pay its pro rata share of the 31
attorney's fees based on the pool's recovery as it compares to the total 32
judgment. 33
(D) Any reimbursement rights of the pool shall take 34
priority over all other liens and charges existing under the laws of the 35
State of Arkansas. 36 HB1595
30 02/25/2025 1:11:34 PM ANS291
(5) The pool may compromise or settle and release any claim for 1
benefits provided under this subchapter or waive any claims for benefits, in 2
whole or in part, for the convenience of the pool or if the pool determines 3
that collection will result in undue hardship upon the covered person. 4
(f) Preexisting Conditions. 5
(1) Except for federally eligible individuals or qualified trade 6
adjustment assistance eligible persons qualifying for plan coverage under § 7
23-79-509(b) or resident eligible persons or trade adjustment assistance 8
eligible persons who qualify for and elect to purchase the waiver authorized 9
in subdivision (f)(2) of this section, plan coverage shall exclude charges or 10
expenses incurred during the first six (6) months following the effective 11
date of coverage as to any condition if: 12
(A) The condition has manifested itself within the six -13
month period immediately preceding the effective date of coverage in such a 14
manner as would cause an ordinary prudent person to seek diagnosis, care, or 15
treatment; or 16
(B) Medical advice, care, or treatment was recommended or 17
received within the six -month period immediately preceding the effective date 18
of the coverage. 19
(2) Waiver. The preexisting condition exclusions as set forth 20
in subdivision (f)(1) of this section will be waived to the extent to which 21
the resident eligible person or trade adjustment assistance eligible person: 22
(A) Has satisfied similar exclusions under any prior 23
individual health insurance coverage that was involuntarily terminated; and 24
(B)(i) Has applied for plan coverage not later than thirty 25
(30) days following the involuntary termination. 26
(ii) For each resident eligible person or trade 27
adjustment assistance eligible person who qualifies for and elects this 28
waiver, there shall be added on a prorated basis to each payment of premium a 29
surcharge of up to ten percent (10%) of the otherwise applicable annual 30
premium for as long as that individual's coverage under the plan remains in 31
effect or sixty (60) months, whichever is less. 32
(3)(A) Whenever benefits are due from the plan because of 33
sickness or an injury to a covered person resulting from a third party's 34
wrongful act or negligence and the covered person has recovered or may 35
recover damages from a third party or its insurance carrier or self -insured 36 HB1595
31 02/25/2025 1:11:34 PM ANS291
entity, the plan shall have the right to reduce benefits or to refuse to pay 1
benefits that otherwise may be payable in the amount of damages that the 2
covered person has recovered or may recover regardless of the date of the 3
sickness or injury or the date of any settlement, judgment, or award 4
resulting from that sickness or injury. 5
(B)(i) During the pendency of any action or claim that is 6
brought by or on behalf of a covered person against a third party or its 7
insurance carrier or self -insured entity, any benefits that would otherwise 8
be payable except for the provisions of this subsection shall be paid if 9
payment by or for the third party has not yet been made and the covered 10
person or, if capable, that person's legal representative agrees in writing 11
to pay back properly the benefits paid as a result of the sickness or injury 12
to the extent of any future payments made by or for the third party for the 13
sickness or injury. 14
(ii) This agreement is to apply whether or not 15
liability for the payments is established or admitted by the third party or 16
whether those payments are itemized. 17
(C) Any amounts due the plan to repay benefits may be 18
deducted from other benefits payable by the plan after payments by or for the 19
third party are made. 20
(4) Benefits due from the plan may be reduced or refused as an 21
offset against any amount otherwise recoverable under this section. 22
23
23-79-511. Confidentiality. 24
(a)(1) All steps necessary under state and federal law to protect 25
confidentiality of applicants and covered persons shall be undertaken by the 26
Board of Directors of the Arkansas Comprehensive Health Insurance Pool to 27
prevent the identification of individual records of covered persons under the 28
plan, rejected by the plan, or who may become ineligible for further 29
participation in the plan. 30
(2) Procedures shall be written by the board to assure the 31
confidentiality of records of persons covered under, rejected by, or who 32
became ineligible for further participation in the plan when gathering and 33
submitting data to the board or any other entity. 34
(b) Any information submitted to the board by hospitals or any other 35
provider pursuant to this subchapter from which the identity of a particular 36 HB1595
32 02/25/2025 1:11:34 PM ANS291
individual can be determined shall be privileged and confidential and shall 1
not be disclosed in any manner. The foregoing includes, but shall not be 2
limited to, disclosure, inspection, or copying under the Freedom of 3
Information Act of 1967, § 25 -19-101 et seq. 4
5
23-79-512. Collective action. 6
Neither the participation in the plan as insurers, the establishment of 7
rates, forms, or procedures nor any other joint or collective action required 8
by this subchapter shall be the basis of any legal action, criminal or civil 9
liability, or penalty against the plan or any insurer. 10
11
23-79-513. Unfair referral to plan — Prohibited practices by 12
employers. 13
(a) It shall constitute an unfair trade practice under the Trade 14
Practices Act, § 23-66-201 et seq., for an insurer, agent, broker, or third -15
party administrator to refer an individual to the Arkansas Comprehensive 16
Health Insurance Pool or arrange for an individual to apply to the pool for 17
the purpose of: 18
(1) Separating the individual from group health insurance 19
coverage provided by a group health plan; or 20
(2) Facilitating enrollment in the pool by any of the following 21
individuals associated with an employer, with the knowledge that the employer 22
intends to pay or is paying all or part of the premium payments owed by the 23
individual for pool coverage: 24
(A) An employee of the employer; 25
(B) A retired employee of the employer; or 26
(C) A dependent of an employee or retired employee of the 27
employer. 28
(b) Because pool coverage is not intended to cover participants who 29
are eligible for a group health plan, an individual described in subdivision 30
(a)(2) of this section is not eligible: 31
(1) For pool coverage if the employer associated with the 32
applicant intends to pay for all or part of the pool premium payments for the 33
individual; or 34
(2) To continue pool coverage if the employer associated with 35
the individual directly or indirectly pays all or part of the pool premium 36 HB1595
33 02/25/2025 1:11:34 PM ANS291
payments for the individual. 1
2
23-79-514. [Repealed.] 3
4
23-79-515. Orderly cessation of operations. 5
(a)(1) The Arkansas Comprehensive Health Insurance Pool shall cease 6
enrollment and coverage under the plan on and after January 1, 2014, as 7
required by federal law. 8
(2) After taking all reasonable steps, including those specified 9
in this section, to timely and efficiently assist in the transition of 10
individuals receiving plan coverage to the individual health insurance 11
market, the Board of Directors of the Arkansas Comprehensive Health Insurance 12
Pool shall cease operating the pool after paying health insurance claims for 13
plan coverage and meeting all other obligations of the board under this 14
section. 15
(b) The board may take all actions it deems necessary to: 16
(1) Cease enrollment for plan coverage effective December 1, 17
2013; 18
(2)(A) Terminate all existing plan coverage effective at the end 19
of the calendar day on December 31, 2013. 20
(B) The board shall provide at least ninety (90) days 21
notice to current policyholders of the termination; and 22
(3) Amend plan policies and provide adequate notice to 23
policyholders, agents, and providers that to be paid or reimbursed, a claim 24
for plan services is required to be filed by the earlier of one hundred 25
eighty (180) days after plan coverage ends or three hundred sixty -five (365) 26
days after the date of service giving rise to the claim. 27
(c) This section does not require the board to revise plan benefits to 28
comply with federal law or to maintain plan coverage for any individual after 29
December 31, 2013. 30
(d)(1) After all plan coverage terminates under this section, the 31
board shall take reasonable steps to wind up all significant operations of 32
the pool by December 31, 2014. 33
(2) Notwithstanding any other provision of this subchapter, to 34
facilitate an efficient cessation of operations: 35
(A) The board may continue to use existing contractors 36 HB1595
34 02/25/2025 1:11:34 PM ANS291
until cessation of operations without the need to issue competitive requests 1
for proposals; 2
(B) The board may continue to fund operations of this 3
subchapter under § 23 -79-507; 4
(C) The board shall remain in effect: 5
(i) As provided by § 23 -79-504(b); and 6
(ii) Until a judgment, order, or decree in any 7
action, suit, or proceeding commenced against or by the pool is fully 8
executed; and 9
(D)(i) The term of each current board member shall be 10
extended until the date the pool concludes all business as provided under 11
this section and the Insurance Commissioner certifies the cessations of 12
operations under subsection (g) of this section. 13
(ii) The term of a board member expires when the 14
commissioner certifies the cessations of operations under subsection (g) of 15
this section. 16
(e) On or before June 30, 2013, the board shall amend the plan of 17
operation to reflect the actions necessary to implement this section. 18
(f) If the board has excess funds after the cessation of operations of 19
the pool, the funds shall be returned to the general revenue funds of the 20
state. 21
(g)(1) On or before March 1, 2016, or a later date if necessary to 22
complete the cessation of operations of the pool, the board shall file a 23
report with the General Assembly and commissioner that reflects completion of 24
the requirements of this section and includes an independent auditor's report 25
on the financial statements of the pool. 26
(2) If satisfied upon review of the report that the board has 27
complied with this section and accomplished the pool's cessation of 28
operations in a reasonable manner, the commissioner shall certify that the 29
business of the pool has concluded in accordance with this section and 30
publish the certification on the State Insurance Department website. 31
(h) Upon certification under subsection (g) of this section, the 32
operations of the pool are suspended indefinitely unless reactivated by the 33
General Assembly. 34
(i) The commissioner may address any matters regarding the pool 35
arising after the certification under subsection (g) of this section, and the 36 HB1595
35 02/25/2025 1:11:34 PM ANS291
Attorney General shall defend a legal action filed after the certification, 1
including seeking the dismissal of the action under § 23 -79-516 or for any 2
other purpose. 3
(j) Unless inconsistent with this section, the remainder of this 4
subchapter continues to apply to the pool and the board. 5
6
23-79-516. Statute of limitations and repose. 7
Because winding up the operations of the Arkansas Comprehensive Health 8
Insurance Pool requires the expeditious determination of its outstanding 9
liabilities, a cause of action against the pool or the Board of Directors of 10
the Arkansas Comprehensive Health Insurance Pool shall be commenced within 11
the earlier of one (1) year after the cause of action accrues or December 31, 12
2015. 13
14
23-79-517. Individuals moving to Arkansas and previously covered by 15
another qualified high -risk pool. 16
(a) Notwithstanding § 23 -79-510(f), if a resident eligible person is 17
eligible for plan coverage because the person previously was covered under a 18
qualified high-risk pool of another state, a preexisting condition exclusion 19
otherwise applicable to the resident eligible person: 20
(1) Shall be reduced by each month of coverage in which the 21
resident eligible person was subject to a preexisting condition exclusion in 22
the other state's qualified high -risk pool; or 23
(2) Does not apply if the resident eligible person was not 24
subject to a preexisting condition exclusion in the other state's qualified 25
high-risk pool. 26
(b) This section expires on the last day an individual may be enrolled 27
into plan coverage under this subchapter. 28
29
30
APPROVED: 3/20/25 31
32
33
34
35
36