Arkansas 2025 Regular Session

Arkansas House Bill HB1595 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		Stricken language would be deleted from and underlined language would be added to present law.
2		-	Act 349 of the Regular Session
3	2		ANS291 02/25/2025 1:11:34 PM ANS291
4	3		State of Arkansas 1
5	4		95th General Assembly A Bill 2
6	5		Regular Session, 2025 HOUSE BILL 1595 3
7	6		4
8	7		By: Representative Steimel 5
9	8		By: Senator J. Boyd 6
10	9		7
11	10		For An Act To Be Entitled 8
12	11		AN ACT TO ENACT THE STATE INSURANCE DEPARTMENT'S 9
13	12		GENERAL OMNIBUS AMENDMENT OF ARKANSAS INSURANCE CODE; 10
14	13		TO AMEND THE ARKANSAS WORKERS' COMPENSATION INSURANCE 11
15	14		PLAN; TO AMEND THE LAW CONCERNING RECIPROCAL 12
16	15		INSURERS; TO CLARIFY AN ATTORNEY'S BOND REQUIREMENT; 13
17	16		TO AMEND THE LAW CONCERNING EXAMINATIONS OF HOSPITAL 14
18	17		AND MEDICAL SERVICE CORPORATIONS; TO AMEND THE LAW 15
19	18		CONCERNING SERVICE OF PROCESS IN SUITS INVOLVING 16
20	19		INSURERS; TO REPEAL THE COMPREHENSIVE HEALTH 17
21	20		INSURANCE POOL ACT; AND FOR OTHER PURPOSES. 18
22	21		19
23	22		20
24	23		Subtitle 21
25	24		TO ENACT THE STATE INSURANCE 22
26	25		DEPARTMENT'S GENERAL OMNIBUS AMENDMENT 23
27	26		OF ARKANSAS INSURANCE CODE. 24
28	27		25
29	28		BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 26
30	29		27
31	30		SECTION 1. Arkansas Code § 23 -67-304(e), concerning the ability of the 28
32	31		Insurance Commissioner to delegate responsibility under the Arkansas Workers' 29
33	32		Compensation Insurance Plan, is amended to read as follows: 30
34	33		(e)(1)(A) At his or her discretion, the The Insurance Commissioner is 31
35	34		authorized to may delegate all or any part of the commissioner's 32
36	35		responsibility to establish and operate the plan. 33
37	36		(B) However, any such plan, or plan of operation, and any 34
38	37		amendments thereto must receive the prior approval of the commissioner. 35
39	38		(2) Any person or entity to whom the establishment, 36 HB1595
40	39
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42	41		implementation, or operation of the plan is delegated pursuant to this 1
43	42		subsection shall file with and obtain the approval of the commissioner as to 2
44	43		all policy forms, rates, or supplementary rate information necessary to 3
45	44		effectuate the plan. 4
46	45		(3)(A) In delegating all or part of the commissioner's 5
47	46		responsibility, the commissioner shall not approve any plan or filing that 6
48	47		abrogates or restricts his or her authority to select the plan administrator 7
49	48		or servicing carriers. 8
50	49		(B) The commissioner shall competitively select the 9
51	50		organization or organizations to whom the responsibility of plan 10
52	51		administrator shall be delegated. 11
53	52		(C) If the administration of the plan is delegated, the 12
54	53		plan administrator or administrators shall have an office in Arkansas be 13
55	54		adequately staffed, outfitted, and maintained to provide the plan services 14
56	55		delegated. 15
57	56		(D) The commissioner shall specify duties and functions of 16
58	57		plan administrators and may structure and delegate administrative functions 17
59	58		separately such as, but not limited to, rates, forms, and statistics for the 18
60	59		best operation of the plan. 19
61	60		(4) Under the provisions of this subsection, the commissioner 20
62	61		shall vigorously promote competition for the designation of the plan 21
63	62		administrator and servicing carrier for the most effective operation of the 22
64	63		plan. 23
65	64		(5)(A) The office in Arkansas is established plan administrator 24
66	65		and personnel are placed in their positions to improve services provided by 25
67	66		the plan, to promote and secure courteous and timely service, and to assure 26
68	67		that the minimum standards as provided under subdivision (f)(2) of this 27
69	68		section are met. 28
70	69		(B) The office plan administrator and personnel in 29
71	70		Arkansas shall also assist employers or agents with questions, problems, or 30
72	71		complaints pertaining to the servicing carriers and secure and expedite 31
73	72		prompt and fair treatment to employers for servicing carrier errors and 32
74	73		service failures. 33
75	74		(6)(A) The Arkansas office manager shall have the authority to 34
76	75		intervene with servicing carriers to secure an adequate level of service and 35
77	76		prevent servicing carriers from imposing unreasonable demands or actions. 36 HB1595
78	77
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80	79		(B) The office manager shall keep a record of all employer 1
81	80		or agent problems and complaints by a servicing carrier, including a 2
82	81		description of the problem. This record shall be provided to the commissioner 3
83	82		within sixty (60) days of each calendar year or upon the request of the 4
84	83		commissioner. 5
85	84		(C) The manager shall promptly notify the commissioner of 6
86	85		any problems upon a request by an employer. 7
87	86		8
88	87		SECTION 2. Arkansas Code § 23 -70-110(a)(1), concerning the attorney's 9
89	88		bond required of a domestic reciprocal insurer, is amended to read as 10
90	89		follows: 11
91	90		(a)(1)(A) Concurrently with the filing of the declaration provided for 12
92	91		in § 23-70-106, the attorney of a domestic or foreign reciprocal insurer 13
93	92		shall file with the Insurance Commissioner a bond in favor of this state for 14
94	93		the benefit of all persons damaged as a result of breach by the attorney of 15
95	94		the conditions of his or her bond as set forth stated in subdivision (a)(2) 16
96	95		of this section. 17
97	96		(B) The bond under subdivision (a)(1)(A) of this section 18
98	97		shall be: 19
99	98		(i) executed Executed by the attorney and by an 20
100	99		authorized corporate surety ; and 21
101	100		(ii) shall be subject Subject to the commissioner's 22
102	101		approval. 23
103	102		24
104	103		SECTION 3. Arkansas Code § 23 -75-114(b)(2), concerning an examination 25
105	104		of a hospital and medical service corporation, is amended to read as follows: 26
106	105		(2) An examination shall be conducted at least every three (3) 27
107	106		five (5) years. 28
108	107		29
109	108		SECTION 4. Arkansas Code § 23-79-205(a), concerning service of process 30
110	109		against an insurer, is amended to read as follows: 31
111	110		(a) In any suit brought in this state against an insurer, process may 32
112	111		be served upon the insurer as follows: 33
113	112		(1) As to domestic insurers, service of process may be had only 34
114	113		in the manner as provided by § 16-58-124 the Arkansas Rules of Civil 35
115	114		Procedure; 36 HB1595
116	115
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118	117		(2) As to licensed foreign or alien insurers, service on and 1
119	118		after January 1, 2003, may be made as provided in § 23 -63-301 et seq.; and 2
120	119		(3) As to suits against unauthorized insurers, service of 3
121	120		process shall be made as provided in §§ 23 -65-101 — 23-65-104, § 23-65-201 et 4
122	121		seq., and §§ 23-65-301 — 23-65-318 for unauthorized insurers and surplus 5
123	122		lines. 6
124	123		7
125	124		SECTION 5. Arkansas Code Title 23, Chapter 79, Subchapter 5, is 8
126	125		repealed. 9
127	126		Subchapter 5 — Comprehensive Health Insurance Pool Act 10
128	127		11
129	128		23-79-501. Purpose. 12
130	129		(a)(1) Acts 1995, No. 1339, established the Arkansas Comprehensive 13
131	130		Health Insurance Pool as a state program that was intended to provide an 14
132	131		alternate market for health insurance for certain uninsurable Arkansas 15
133	132		residents, and further this subchapter is intended to provide for the 16
134	133		successor entity that will provide the acceptable alternative mechanism as 17
135	134		described in the Health Insurance Portability and Accountability Act of 1996 18
136	135		for providing portable and accessible individual health insurance coverage 19
137	136		for federally eligible individuals as defined in this subchapter. 20
138	137		(2) This subchapter further is intended to provide a health 21
139	138		insurance coverage option for persons eligible for a federal income tax 22
140	139		credit under section 35 of the Internal Revenue Code, as created by the Trade 23
141	140		Adjustment Assistance Reform Act of 2002 or as subsequently amended. 24
142	141		(b) The General Assembly declares that it intends for this program to 25
143	142		provide portable and accessible individual health insurance coverage for 26
144	143		every individual who qualifies for coverage in accordance with § 23 -79-509(b) 27
145	144		as a federally eligible individual or as a qualified trade adjustment 28
146	145		assistance eligible person but does not intend for every eligible person who 29
147	146		qualifies for pool coverage in accordance with § 23 -79-509 to be guaranteed a 30
148	147		right to be issued a policy under this pool as a matter of entitlement. 31
149	148		32
150	149		23-79-502. Short title. 33
151	150		This subchapter may be cited as the “Comprehensive Health Insurance 34
152	151		Pool Act”, and is amendatory to the Arkansas Insurance Code and the 35
153	152		provisions of the Arkansas Insurance Code which are not in conflict with this 36 HB1595
154	153
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156	155		subchapter are applicable to this subchapter. 1
157	156		2
158	157		23-79-503. Definitions. 3
159	158		As used in this subchapter: 4
160	159		(1) “Agent” means any person who is licensed to sell health 5
161	160		insurance in this state; 6
162	161		(2) “Board” means the Board of Directors of the Arkansas 7
163	162		Comprehensive Health Insurance Pool; 8
164	163		(3) “Church plan” has the same meaning given that term in the 9
165	164		Health Insurance Portability and Accountability Act of 1996; 10
166	165		(4) “Commissioner” means the Insurance Commissioner; 11
167	166		(5) “Continuation coverage” means continuation of coverage under 12
168	167		a group health plan or other health insurance coverage for former employees 13
169	168		or dependents of former employees that would otherwise have terminated under 14
170	169		the terms of that coverage pursuant to any continuation provisions under 15
171	170		federal or state law, including the Consolidated Omnibus Budget 16
172	171		Reconciliation Act of 1985 (COBRA), as amended, § 23 -86-114 of the Arkansas 17
173	172		Insurance Code, or any other similar requirement in another state; 18
174	173		(6) “Covered person” means a person who is and continues to 19
175	174		remain eligible for pool coverage and is covered under one (1) of the plans 20
176	175		offered by the pool; 21
177	176		(7)(A) “Creditable coverage” means, with respect to a federally 22
178	177		eligible individual or a qualified trade adjustment assistance eligible 23
179	178		person, coverage of the individual under any of the following: 24
180	179		(i) A group health plan; 25
181	180		(ii) Health insurance coverage, including group 26
182	181		health insurance coverage; 27
183	182		(iii) Medicare; 28
184	183		(iv) Medical assistance; 29
185	184		(v) 10 U.S.C. § 1071 et seq.; 30
186	185		(vi) A medical care program of the Indian Health 31
187	186		Service or of a tribal organization; 32
188	187		(vii) A state health benefits risk pool; 33
189	188		(viii) A health plan offered under 5 U.S.C. § 8901 et 34
190	189		seq.; 35
191	190		(ix) A public health plan, as defined in regulations 36 HB1595
192	191
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194	193		consistent with section 104 of the Health Insurance Portability and 1
195	194		Accountability Act of 1996 that may be promulgated by the Secretary of the 2
196	195		United States Department of Health and Human Services; and 3
197	196		(x) A health benefit plan under section 5(e) of the 4
198	197		Peace Corps Act, 22 U.S.C. § 2504(e). 5
199	198		(B) “Creditable coverage” does not include: 6
200	199		(i) Coverage consisting solely of coverage of 7
201	200		excepted benefits as defined in section 2791(C) of Title XXVII of the Public 8
202	201		Health Service Act, 42 U.S.C. § 300gg -91; or 9
203	202		(ii)(a) Any period of coverage under 10
204	203		subdivisions (7)(A)(i) -(x) of this section that occurred before a break of 11
205	204		more than sixty-three (63) days during all of which the individual was not 12
206	205		covered under subdivisions (7)(A)(i) -(x) of this section. 13
207	206		(b) Any period that an individual is in a 14
208	207		waiting period for any coverage under a group health plan or for group health 15
209	208		insurance coverage or is in an affiliation period under the terms of health 16
210	209		insurance coverage offered by a health maintenance organization shall not be 17
211	210		taken into account in determining if there has been a break of more than 18
212	211		sixty-three (63) days in any creditable coverage; 19
213	212		(8) “Department” means the State Insurance Department; 20
214	213		(9) “Excess or stop -loss coverage” means an arrangement whereby 21
215	214		an insurer insures against the risk that any one (1) claim will exceed a 22
216	215		specific dollar amount or that the entire loss of a self -insurance plan will 23
217	216		exceed a specific amount; 24
218	217		(10) “Federally eligible individual” means an individual resident 25
219	218		of Arkansas: 26
220	219		(A) For whom: 27
221	220		(i) As of the date on which the individual seeks 28
222	221		pool coverage under § 23 -79-509, the aggregate of the periods of creditable 29
223	222		coverage is eighteen (18) or more months; and 30
224	223		(ii) The most recent prior creditable coverage was 31
225	224		under group health insurance coverage offered by an insurer, a group health 32
226	225		plan, a governmental plan, a church plan, or health insurance coverage 33
227	226		offered in connection with any such plans; 34
228	227		(B) Who is not eligible for coverage under: 35
229	228		(i) A group health plan; 36 HB1595
230	229
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232	231		(ii) Part A or Part B of Medicare; or 1
233	232		(iii) Medical assistance and does not have other 2
234	233		health insurance coverage; 3
235	234		(C) With respect to whom the most recent coverage within 4
236	235		the coverage period described in subdivision (10)(A)(i) of this section was 5
237	236		not terminated based upon a factor related to nonpayment of premiums or 6
238	237		fraud; 7
239	238		(D) If the individual has been offered the option of 8
240	239		continuation coverage under a Consolidated Omnibus Budget Reconciliation Act 9
241	240		of 1985 (COBRA) continuation provision or under a similar state program, who 10
242	241		elected such coverage; and 11
243	242		(E) Who, if the individual elected the continuation 12
244	243		coverage, has exhausted the continuation coverage under such a provision or 13
245	244		program; 14
246	245		(11) “Governmental plan” has the same meaning given that term in 15
247	246		the federal Health Insurance Portability and Accountability Act of 1996; 16
248	247		(12) “Group health plan” has the same meaning given that term in 17
249	248		the federal Health Insurance Portability and Accountability Act of 1996; 18
250	249		(13)(A) “Health insurance” means any hospital and medical 19
251	250		expense-incurred policy, certificate, or contract provided by an insurer, 20
252	251		hospital or medical service corporation, health maintenance organization, or 21
253	252		any other healthcare plan or arrangement that pays for or furnishes medical 22
254	253		or healthcare services whether by insurance or otherwise and includes any 23
255	254		excess or stop-loss coverage. 24
256	255		(B) “Health insurance” does not include long -term care, 25
257	256		disability income, short -term, accident, dental -only, vision-only, fixed 26
258	257		indemnity, limited-benefit or credit insurance, coverage issued as a 27
259	258		supplement to liability insurance, insurance arising out of workers' 28
260	259		compensation or similar law, automobile medical -payment insurance, or 29
261	260		insurance under which benefits are payable with or without regard to fault 30
262	261		and that is statutorily required to be contained in any liability insurance 31
263	262		policy or equivalent self -insurance; 32
264	263		(14) “Health maintenance organization” shall have the same 33
265	264		meaning as defined in § 23 -76-102; 34
266	265		(15) “Hospital” shall have the same meaning as defined in § 20 -9-35
267	266		201; 36 HB1595
268	267
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270	269		(16) “Individual health insurance coverage” means health 1
271	270		insurance coverage offered to individuals in the individual market but does 2
272	271		not include short-term, limited-duration insurance; 3
273	272		(17)(A) “Insurer” means any entity that provides health 4
274	273		insurance, including excess or stop -loss health insurance, in the State of 5
275	274		Arkansas. 6
276	275		(B) For the purposes of this subchapter, “insurer” 7
277	276		includes an insurance company, medical services plans, hospital plans, 8
278	277		hospital medical service corporations, health maintenance organizations, 9
279	278		fraternal benefits society, or any other entity providing a plan of health 10
280	279		insurance or health benefits subject to state insurance regulation; 11
281	280		(18) “Medical assistance” means the state medical assistance 12
282	281		program provided under Title XIX of the Social Security Act or under any 13
283	282		similar program of healthcare benefits in a state other than Arkansas; 14
284	283		(19)(A)(i) “Medically necessary” means that a service, drug, 15
285	284		supply, or article is necessary and appropriate for the diagnosis or 16
286	285		treatment of an illness or injury in accord with generally accepted standards 17
287	286		of medical practice at the time the service, drug, or supply is provided. 18
288	287		(ii) When specifically applied to a confinement, 19
289	288		“medically necessary” further means that the diagnosis or treatment of the 20
290	289		covered person's medical symptoms or condition cannot be safely provided to 21
291	290		that person as an outpatient. 22
292	291		(B) A service, drug, supply, or article shall not be 23
293	292		medically necessary if it: 24
294	293		(i) Is investigational, experimental, or for 25
295	294		research purposes; 26
296	295		(ii) Is provided solely for the convenience of the 27
297	296		patient, the patient's family, physician, hospital, or any other provider; 28
298	297		(iii) Exceeds in scope, duration, or intensity that 29
299	298		level of care that is needed to provide safe, adequate, and appropriate 30
300	299		diagnosis or treatment; 31
301	300		(iv) Could have been omitted without adversely 32
302	301		affecting the covered person's condition or the quality of medical care; or 33
303	302		(v) Involves the use of a medical device, drug, or 34
304	303		substance not formally approved by the United States Food and Drug 35
305	304		Administration; 36 HB1595
306	305
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308	307		(20) “Medicare” means coverage under Part A and Part B of Title 1
309	308		XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.; 2
310	309		(21) “Physician” means a person licensed to practice medicine as 3
311	310		duly licensed by the State of Arkansas; 4
312	311		(22) “Plan” means the comprehensive health insurance plan as 5
313	312		adopted by the board or by rule; 6
314	313		(23) “Plan administrator” means the insurer designated under § 7
315	314		23-79-508 to carry out the provisions of the plan of operation; 8
316	315		(24) “Plan of operation” means the plan of operation of the pool, 9
317	316		including articles, bylaws, and operating rules adopted by the board pursuant 10
318	317		to this subchapter; 11
319	318		(25) “Provider” means any hospital, skilled nursing facility, 12
320	319		hospice, home health agency, physician, pharmacist, or any other person or 13
321	320		entity licensed in Arkansas to furnish medical care, articles, and supplies; 14
322	321		(26) “Qualified high -risk pool” has the same meaning given that 15
323	322		term in the Health Insurance Portability and Accountability Act of 1996; 16
324	323		(27) “Qualified trade adjustment assistance eligible person” 17
325	324		means a person who is a trade adjustment assistance eligible person as 18
326	325		defined by this section and for whom, on the date an application for the 19
327	326		individual is received by the pool under § 23 -79-509, has an aggregate of at 20
328	327		least three (3) months of creditable coverage without a break in coverage of 21
329	328		sixty-three (63) days or more; 22
330	329		(28) “Resident eligible person” means a person who: 23
331	330		(A) Has been legally domiciled in the State of Arkansas 24
332	331		for a period of at least: 25
333	332		(i) Ninety (90) days and continues to be domiciled 26
334	333		in Arkansas; or 27
335	334		(ii) Thirty (30) days, continues to be domiciled in 28
336	335		Arkansas, and was covered under a qualified high-risk pool in another state 29
337	336		up until sixty-three (63) days or less prior to the date that the pool 30
338	337		receives his or her application for coverage; and 31
339	338		(B) Is not eligible for coverage under: 32
340	339		(i) A group health plan; 33
341	340		(ii) Part A or Part B of Medicare; or 34
342	341		(iii) Medical assistance as defined in this section 35
343	342		and does not have other health insurance coverage as defined in this section; 36 HB1595
344	343
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346	345		and 1
347	346		(29) “Trade adjustment assistance eligible person” means a person 2
348	347		who is legally domiciled in the State of Arkansas on the date of application 3
349	348		to the pool and is eligible for the tax credit for health insurance coverage 4
350	349		premiums under section 35 of the Internal Revenue Code of 1986. 5
351	350		6
352	351		23-79-504. Arkansas Comprehensive Health Insurance Pool. 7
353	352		(a) There is created a nonprofit legal entity to be known as the 8
354	353		“Arkansas Comprehensive Health Insurance Pool” as the successor entity to the 9
355	354		nonprofit legal entity established by Acts 1995, No. 1339. 10
356	355		(b)(1) The pool shall operate subject to the supervision and control 11
357	356		of the Board of Directors of the Arkansas Comprehensive Health Insurance 12
358	357		Pool. The pool is created as a political subdivision, instrumentality, and 13
359	358		body politic of the State of Arkansas, and, as such, is not a state agency. 14
360	359		(2) Except to the extent defined in this subchapter, the pool 15
361	360		will be exempt from: 16
362	361		(A) All state, county, and local taxes; 17
363	362		(B) The Arkansas Procurement Law, § 19 -11-201 et seq.; 18
364	363		(C) The Freedom of Information Act of 1967, § 25 -19-101 et 19
365	364		seq.; and 20
366	365		(D) The Arkansas Administrative Procedure Act, § 25 -15-201 21
367	366		et seq. 22
368	367		(3) The board shall consist of the following seven (7) members 23
369	368		to be appointed by the Insurance Commissioner: 24
370	369		(A) Two (2) current or former representatives of insurance 25
371	370		companies licensed to do business in the State of Arkansas; 26
372	371		(B) Two (2) current or former representatives of health 27
373	372		maintenance organizations licensed to do business in the State of Arkansas; 28
374	373		(C) One (1) member of a health -related profession licensed 29
375	374		in the State of Arkansas; 30
376	375		(D) One (1) member from the general public who is not 31
377	376		associated with the medical profession, a hospital, or an insurer; and 32
378	377		(E) One (1) member to represent a group considered to be 33
379	378		uninsurable. 34
380	379		(4) In making appointments to the board, the commissioner shall 35
381	380		strive to ensure that at least one (1) person serving on the board is at 36 HB1595
382	381
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384	383		least sixty (60) years of age. 1
385	384		(5) All terms shall be for three (3) years. 2
386	385		(6) The board shall elect one (1) of its members as chair. 3
387	386		(7) Any vacancy in the board occurring for any reason other than 4
388	387		the expiration of a term shall be filled for the unexpired term in the same 5
389	388		manner as the original appointment. 6
390	389		(8) Members of the board may be reimbursed from moneys of the 7
391	390		pool for actual and necessary expenses incurred by them in the performance of 8
392	391		their official duties as members of the board but shall not otherwise be 9
393	392		compensated for their services. 10
394	393		(c) All insurers, as a condition of doing business in the State of 11
395	394		Arkansas, shall participate in the pool by paying the assessments, submitting 12
396	395		the reports, and providing the information required by the board or the 13
397	396		commissioner to implement the provisions of this subchapter. 14
398	397		(d)(1) Neither the board nor its employees shall be liable for any 15
399	398		obligations of the pool. 16
400	399		(2) No board member or employee of the board shall be liable, 17
401	400		and no cause of action of any nature may arise against them, for any act or 18
402	401		omission related to the performance of their powers and duties under this 19
403	402		subchapter. 20
404	403		(3) The board may provide in its bylaws or rules for 21
405	404		indemnification of, and legal representation for, the board members and 22
406	405		employees. 23
407	406		24
408	407		23-79-505. Plan of operation. 25
409	408		(a)(1) The Board of Directors of the Arkansas Comprehensive Health 26
410	409		Insurance Pool shall adopt a plan of operation pursuant to this subchapter 27
411	410		and shall submit to the Insurance Commissioner for approval the plan of 28
412	411		operation including the Arkansas Comprehensive Health Insurance Pool's 29
413	412		articles, bylaws and operating rules, and any amendments thereto necessary or 30
414	413		suitable to assure the fair, reasonable, and equitable administration of the 31
415	414		pool. The plan of operation shall become effective upon approval in writing 32
416	415		by the commissioner. 33
417	416		(2) If the board fails to submit a suitable plan of operation 34
418	417		within one hundred eighty (180) days after the appointment of the board of 35
419	418		directors, or at any time thereafter fails to submit suitable amendments to 36 HB1595
420	419
421	420		12 02/25/2025 1:11:34 PM ANS291
422	421		the plan of operation, the commissioner shall adopt and promulgate such rules 1
423	422		as are necessary or advisable to effectuate the provisions of this section. 2
424	423		The rules shall continue in force until modified by the commissioner or 3
425	424		superseded by a plan of operation submitted by the board and approved by the 4
426	425		commissioner. 5
427	426		(b) The plan of operation shall: 6
428	427		(1) Establish procedures for operation of the pool; 7
429	428		(2) Establish procedures for selecting a plan administrator in 8
430	429		accordance with § 23 -79-508; 9
431	430		(3) Create a fund, under management of the board, to pay 10
432	431		administrative claims and other expenses of the pool; 11
433	432		(4) Establish procedures for the handling, accounting, and 12
434	433		auditing of assets, moneys, and claims of the pool and the plan 13
435	434		administrator; 14
436	435		(5) Develop and implement a program to publicize the existence 15
437	436		of the plan, the eligibility requirements, and the procedures for enrollment 16
438	437		and to maintain public awareness of the plan; 17
439	438		(6)(A) Establish procedures under which applicants and 18
440	439		participants may have grievances reviewed by a grievance committee appointed 19
441	440		by the board. The grievances shall be reported to the board after completion 20
442	441		of the review. 21
443	442		(B) The board shall retain all written complaints 22
444	443		regarding the plan for at least three (3) years; and 23
445	444		(7) Provide for other matters as may be necessary and proper for 24
446	445		the execution of the board's powers, duties, and obligations under this 25
447	446		subchapter. 26
448	447		27
449	448		23-79-506. Powers. 28
450	449		(a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the 29
451	450		general powers and authority granted under the laws of the State of Arkansas 30
452	451		to health insurers and, in addition thereto, the specific authority to: 31
453	452		(A) Enter into contracts as are necessary or proper to 32
454	453		carry out the provisions and purposes of this subchapter; 33
455	454		(B) Sue or be sued, including taking any legal actions 34
456	455		necessary or proper; 35
457	456		(C) Take such legal action as necessary, including without 36 HB1595
458	457
459	458		13 02/25/2025 1:11:34 PM ANS291
460	459		limitation: 1
461	460		(i) Avoiding the payment of improper claims against 2
462	461		the pool or the coverage provided by or through the pool; 3
463	462		(ii) Recovering any amounts erroneously or improperly 4
464	463		paid by the pool; 5
465	464		(iii) Recovering any amounts paid by the pool as a 6
466	465		result of mistake of fact or law; 7
467	466		(iv) Recovering other amounts due the pool; or 8
468	467		(v) Coordinating legal action with the Insurance 9
469	468		Commissioner to enforce the provisions of this subchapter; 10
470	469		(D)(i) Establish and modify from time to time as 11
471	470		appropriate, rates, rate schedules, rate adjustments, expense allowances, 12
472	471		agent referral fees, claim reserve formulas, deductibles, copayments, 13
473	472		coinsurance, and any other actuarial function appropriate to the operation of 14
474	473		the pool. 15
475	474		(ii) Rates and rate schedules may be adjusted for 16
476	475		appropriate factors such as age, sex, and geographical variation in claim 17
477	476		costs and shall take into consideration appropriate factors in accordance 18
478	477		with established actuarial and underwriting practices; 19
479	478		(E) Issue policies of insurance in accordance with the 20
480	479		requirements of this subchapter. All policy forms shall be subject to the 21
481	480		approval of the commissioner; 22
482	481		(F) Authorize the plan administrator to prepare and 23
483	482		distribute certificate of eligibility forms and enrollment instruction forms 24
484	483		to agents and to the general public; 25
485	484		(G) Provide and employ cost -containment measures and 26
486	485		requirements, including without limitation preadmission screening, second 27
487	486		surgical opinion, concurrent utilization review, and individual case 28
488	487		management for the purposes of making the plan more cost effective; 29
489	488		(H) Design, utilize, contract, or otherwise arrange the 30
490	489		delivery of cost-effective healthcare services, including establishing or 31
491	490		contracting directly or through the plan administrator with preferred 32
492	491		provider organizations, health maintenance organizations, physician hospital 33
493	492		organizations, or other limited network provider arrangements; 34
494	493		(I) Borrow money to effect the purposes of the pool. Any 35
495	494		notes or other evidence of indebtedness of the pool not in default shall be 36 HB1595
496	495
497	496		14 02/25/2025 1:11:34 PM ANS291
498	497		legal investments for insurers and may be carried as admitted assets; 1
499	498		(J) Pledge, assign, and grant a security interest in any 2
500	499		of the assessments authorized by this subchapter or other assets of the pool 3
501	500		in order to secure any notes or other evidences of indebtedness of the pool; 4
502	501		(K) Provide reinsurance of risks incurred by the pool; 5
503	502		(L) Provide additional types of plans to provide optional 6
504	503		coverages, including Medicare supplement health insurance and health savings 7
505	504		accounts that comply with applicable federal law as in effect January 1, 8
506	505		2005; 9
507	506		(M) Enter into reciprocal agreements with other comparable 10
508	507		state plans in order to provide coverage for persons who move between states 11
509	508		and are covered by such other states' plans; and 12
510	509		(N) Establish lifetime maximum benefits under § 23 -79-13
511	510		510(a)(2)(W) for any person covered by a plan. 14
512	511		(2) In addition to the other powers granted by the Arkansas 15
513	512		Insurance Code, the commissioner may impose, after notice and hearing in 16
514	513		accordance with the provisions of the Arkansas Insurance Code, a monetary 17
515	514		penalty upon any insurer or suspend or revoke the certificate of authority to 18
516	515		transact insurance in the State of Arkansas of any insurer that fails to pay 19
517	516		an assessment or otherwise file any report or furnish information required to 20
518	517		be filed with the Board of Directors of the Arkansas Comprehensive Health 21
519	518		Insurance Pool pursuant to the board's direction that the board believes is 22
520	519		necessary in order for the board to perform its duties under this subchapter. 23
521	520		(b) All outstanding contracts executed by the Board of Directors of 24
522	521		the State Comprehensive Health Insurance Pool created by Acts 1995, No. 1339, 25
523	522		shall be deemed continuing obligations of the board created by this 26
524	523		subchapter. 27
525	524		(c) As provided for in § 23 -79-502, any health insurance benefit not 28
526	525		provided for in this subchapter shall be deemed to be in conflict with and 29
527	526		therefore inapplicable to the provisions of this subchapter. 30
528	527		31
529	528		23-79-507. Funding of pool. 32
530	529		(a) Premiums. 33
531	530		(1)(A) The Arkansas Comprehensive Health Insurance Pool shall 34
532	531		establish premium rates for plan coverage as provided in subdivision (a)(2) 35
533	532		of this section. 36 HB1595
534	533
535	534		15 02/25/2025 1:11:34 PM ANS291
536	535		(B) Separate schedules of premium rates based on age, sex, 1
537	536		and geographical location may apply for individual risks. 2
538	537		(C) Premium rates and schedules shall be submitted to the 3
539	538		Insurance Commissioner for approval prior to use. 4
540	539		(2)(A)(i) With the assistance of the commissioner, the pool 5
541	540		shall determine a standard risk rate by considering the premium rates charged 6
542	541		by other insurers offering health insurance coverage to individuals in 7
543	542		Arkansas. 8
544	543		(ii) The standard risk rate shall be established 9
545	544		using reasonable actuarial techniques and shall reflect anticipated 10
546	545		experience and expenses for the coverage. 11
547	546		(B)(i) Rates for plan coverage shall not exceed one 12
548	547		hundred fifty percent (150%) of rates established as applicable for 13
549	548		individual standard risks in Arkansas. 14
550	549		(ii) Subject to the limits provided in this 15
551	550		subdivision (a)(2), subsequent rates shall be established to help provide for 16
552	551		the expected costs of claims, including recovery of prior losses, expenses of 17
553	552		operation, investment income of claim reserves, and any other cost factors 18
554	553		subject to the limitations described in this section. 19
555	554		(b) Sources of Additional Revenue. 20
556	555		(1) In addition to the powers enumerated in § 23 -79-506, the 21
557	556		pool shall have the authority to: 22
558	557		(A) Assess insurers in accordance with the provisions of 23
559	558		this section; and 24
560	559		(B)(i) Make advance interim assessments as may be 25
561	560		reasonable and necessary for the pool's organizational and interim operating 26
562	561		expenses. 27
563	562		(ii) Any such interim assessments may be credited as 28
564	563		offsets against any regular assessments due following the close of the fiscal 29
565	564		year. 30
566	565		(2)(A) Following the close of each fiscal year, the plan 31
567	566		administrator shall determine the net premiums, that is, premiums less 32
568	567		administrative expense allowances, the pool expenses of administration and 33
569	568		operation, and the incurred losses for the year, taking into account 34
570	569		investment income and other appropriate gains and losses. 35
571	570		(B) The deficit incurred by the pool not otherwise 36 HB1595
572	571
573	572		16 02/25/2025 1:11:34 PM ANS291
574	573		recouped under either subdivision (b)(9) of this section or subsection (e) of 1
575	574		this section [repealed], or both, shall be recouped by assessments 2
576	575		apportioned among insurers by the Board of Directors of the Arkansas 3
577	576		Comprehensive Health Insurance Pool. 4
578	577		(3) Each insurer's assessment shall be determined by multiplying 5
579	578		the total assessment of all insurers as determined in subdivision (b)(2) of 6
580	579		this section by a fraction, the numerator of which equals that insurer's 7
581	580		premium and subscriber contract charges for health insurance written in the 8
582	581		state during the preceding calendar year and the denominator of which equals 9
583	582		the total of all health insurance premiums by all insurers. 10
584	583		(4)(A) If assessments or other funds received under either 11
585	584		subdivision (b)(9) of this section or subsection (e) of this section 12
586	585		[repealed], or both, or any combination of the assessments and funds exceed 13
587	586		the pool's actual losses and administrative expenses, the excess shall be 14
588	587		held at interest and used by the board to offset future losses or to reduce 15
589	588		future assessments. 16
590	589		(B) As used in this subsection, “future losses” includes 17
591	590		reserves for incurred but not reported claims. 18
592	591		(5) Each insurer's assessment shall be determined annually by 19
593	592		the board based on annual statements and other reports deemed necessary by 20
594	593		the board and filed by the insurer with the board or the commissioner. 21
595	594		(6)(A)(i) An insurer may petition the commissioner for an 22
596	595		abatement or deferment of all or part of an assessment imposed by the board. 23
597	596		(ii) The commissioner may abate or defer, in whole or 24
598	597		in part, the assessment if, in the opinion of the commissioner, payment of 25
599	598		the assessment would endanger the ability of the insurer to fulfill its 26
600	599		contractual obligations. 27
601	600		(B)(i) In the event an assessment against an insurer is 28
602	601		abated or deferred, in whole or in part, the amount by which the assessment 29
603	602		is abated or deferred shall be assessed against the other insurers in a 30
604	603		manner consistent with the basis for assessments set forth in this 31
605	604		subsection. 32
606	605		(ii) The insurer receiving the abatement or deferment 33
607	606		shall remain liable to the plan for the deficiency for four (4) years. 34
608	607		(7) For all assessments issued by the board, beginning January 35
609	608		1, 1998, only those individuals, corporations, associations, or other 36 HB1595
610	609
611	610		17 02/25/2025 1:11:34 PM ANS291
612	611		entities defined as an insurer in § 23 -79-503 shall be subject to assessment. 1
613	612		(8) In the event the board fails to act within a reasonable 2
614	613		period of time to recoup by assessment any deficit incurred by the pool, the 3
615	614		commissioner shall have all the powers and duties of the board under this 4
616	615		chapter with respect to assessing insurers. 5
617	616		(9) The General Assembly further intends that the pool be 6
618	617		eligible for, and for the pool, its board, or other officers of state 7
619	618		government, as appropriate, to take steps necessary to obtain federal grant 8
620	619		funds to offset losses of the pool, including any funds made available under 9
621	620		the Trade Adjustment Assistance Reform Act of 2002. 10
622	621		(c) Assessment Offsets. 11
623	622		(1) Any assessment may be offset in an amount equal to the 12
624	623		amount of the assessment paid to the pool against the premium tax payable by 13
625	624		that insurer for the year in which the assessment is levied or for the four 14
626	625		(4) years subsequent to that year. 15
627	626		(2) No offset shall be allowed for any penalty assessed under 16
628	627		subdivision (d)(1) of this section. 17
629	628		(d)(1) All assessments and fees shall be due and payable upon receipt 18
630	629		and shall be delinquent if not paid within thirty (30) days of the receipt of 19
631	630		the notice by the insurer. 20
632	631		(2) Failure to timely pay the assessment will automatically 21
633	632		subject the insurer to a ten percent (10%) penalty, which will be due and 22
634	633		payable within the next thirty -day period. 23
635	634		(3) The board and the commissioner shall have the authority to 24
636	635		enforce the collection of the assessment and penalty in accordance with the 25
637	636		provisions of this subchapter and the Arkansas Insurance Code. 26
638	637		(4) The board may waive the penalty authorized by this 27
639	638		subsection if it determines that compelling circumstances exist that justify 28
640	639		such a waiver. 29
641	640		30
642	641		23-79-508. Plan administrator. 31
643	642		(a) The Board of Directors of the Arkansas Comprehensive Health 32
644	643		Insurance Pool shall select an insurer through a competitive bidding process 33
645	644		to administer the plan. However, the administering insurer designated by the 34
646	645		board created by Acts 1995, No. 1339, shall serve as the plan administrator 35
647	646		under this subchapter until the expiration of the current contract of the 36 HB1595
648	647
649	648		18 02/25/2025 1:11:34 PM ANS291
650	649		administering insurer. The board shall evaluate bids submitted under this 1
651	650		section based upon criteria established by the board which shall include, but 2
652	651		not be limited to, the following: 3
653	652		(1) The plan administrator's proven ability to handle large 4
654	653		group accident and health benefit plans; 5
655	654		(2) The efficiency and timeliness of the plan administrator's 6
656	655		claim processing procedures; 7
657	656		(3) An estimate of total charges for administering the plan; 8
658	657		(4) The plan administrator's ability to apply effective cost 9
659	658		containment programs and procedures and to administer the plan in a cost 10
660	659		efficient manner; and 11
661	660		(5) The financial condition and stability of the plan 12
662	661		administrator. 13
663	662		(b)(1) The plan administrator shall serve for a period of three (3) 14
664	663		years subject to removal for cause and subject to the terms, conditions, and 15
665	664		limitations of the contract between the board and the plan administrator. 16
666	665		(2) The board shall advertise for and accept bids to serve as 17
667	666		the plan administrator for the succeeding three -year periods. 18
668	667		(c) The plan administrator shall perform functions related to the plan 19
669	668		as may be assigned to it, including: 20
670	669		(1) Determination of eligibility; 21
671	670		(2) Payment and processing of claims; 22
672	671		(3) Establishment of a premium billing procedure for collection 23
673	672		of premiums. Billings shall be made on a periodic basis as determined by the 24
674	673		board; and 25
675	674		(4) Other necessary functions to assure timely payment of 26
676	675		benefits to covered persons under the plan, including: 27
677	676		(A) Making available information relating to the proper 28
678	677		manner of submitting a claim for benefits under the plan and distributing 29
679	678		forms upon which submissions shall be made; and 30
680	679		(B) Evaluating the eligibility of each claim for payment 31
681	680		under the plan. 32
682	681		(d)(1) The plan administrator shall submit regular reports to the 33
683	682		board regarding the operation of the plan. 34
684	683		(2) Frequency, content, and form of the report shall be 35
685	684		determined by the board. 36 HB1595
686	685
687	686		19 02/25/2025 1:11:34 PM ANS291
688	687		(e)(1) The plan administrator shall pay claim expenses from the 1
689	688		premium payments received from or on behalf of plan participants and 2
690	689		allocated by the board for claim expenses. 3
691	690		(2) If the plan administrator's payments for claims expenses 4
692	691		exceed the portion of premiums allocated by the board for payment of claims 5
693	692		expenses, the board shall provide additional funds to the plan administrator 6
694	693		for payment of claims expenses. 7
695	694		(f) The plan administrator shall be governed by the requirements of 8
696	695		this subchapter and shall be compensated as provided in the contract between 9
697	696		the board and the plan administrator. 10
698	697		11
699	698		23-79-509. Plan eligibility. 12
700	699		(a) General Eligibility Requirements. The following requirements 13
701	700		apply to a resident eligible person or a trade adjustment assistance eligible 14
702	701		person in order for the person to be eligible for plan coverage: 15
703	702		(1) Except as provided in subdivision (a)(2) of this section or 16
704	703		subsection (b) of this section, any individual person who meets the 17
705	704		definition of resident eligible person as defined by § 23 -79-503 or a trade 18
706	705		adjustment assistance eligible person as defined by § 23 -79-503 and is either 19
707	706		a citizen of the United States or an alien lawfully admitted for permanent 20
708	707		residence who continues to be a resident of this state shall be eligible for 21
709	708		plan coverage if evidence is provided of: 22
710	709		(A) A notice of rejection or refusal by an insurer to 23
711	710		issue substantially similar individual health insurance coverage by reason of 24
712	711		the existence or history of a medical condition or upon such other evidence 25
713	712		that the Board of Directors of the Arkansas Comprehensive Health Insurance 26
714	713		Pool deems sufficient in order to verify that the applicant is unable to 27
715	714		obtain the coverage from an insurer due to the existence or history of a 28
716	715		medical condition; 29
717	716		(B)(i) A refusal by an insurer to issue individual health 30
718	717		insurance coverage except at a rate that the board determines is 31
719	718		substantially in excess of the applicable plan rate. 32
720	719		(ii) A rejection or refusal by a group health plan or 33
721	720		insurer offering only stop -loss or excess-of-loss insurance or contracts, 34
722	721		agreements, or other arrangements for reinsurance coverage with respect to 35
723	722		the applicant shall not be sufficient evidence under this subsection; 36 HB1595
724	723
725	724		20 02/25/2025 1:11:34 PM ANS291
726	725		(C)(i) Until September 30, 2011, a refusal by an insurer 1
727	726		to issue individual health insurance coverage to a child under nineteen (19) 2
728	727		years of age. 3
729	728		(ii) After September 30, 2011, the eligibility of a 4
730	729		child under nineteen (19) years of age for individual health insurance 5
731	730		coverage shall be determined by the board; or 6
732	731		(D) Evidence that the applicant was covered under a 7
733	732		qualified high-risk pool of another state, provided that the coverage 8
734	733		terminated no more than sixty -three (63) days prior to the date the pool 9
735	734		receives the applicant's application for coverage and the other state's 10
736	735		qualified high-risk pool did not terminate the person's coverage for fraud; 11
737	736		(2) A person shall not be eligible for coverage under the plan 12
738	737		if: 13
739	738		(A) The person has or obtains health insurance coverage 14
740	739		substantially similar to or more comprehensive than a plan policy or would be 15
741	740		eligible to have coverage if the person elected to obtain it except that: 16
742	741		(i) A person may maintain other coverage for the 17
743	742		period of time the person is satisfying any waiting period for a preexisting 18
744	743		condition under a plan policy; and 19
745	744		(ii) A person may maintain plan coverage for the 20
746	745		period of time the person is satisfying a waiting period for a preexisting 21
747	746		condition under another health insurance policy intended to replace the plan 22
748	747		policy; 23
749	748		(B) The person is determined to be eligible for healthcare 24
750	749		benefits under Title XIX of the Social Security Act; 25
751	750		(C) The person has previously terminated plan coverage 26
752	751		unless twelve (12) months have elapsed since termination of coverage; 27
753	752		(D) The person fails to pay the required premium under the 28
754	753		covered person's terms of enrollment and participation, in which event the 29
755	754		liability of the plan shall be limited to benefits incurred under the plan 30
756	755		for the same period for which premiums had been paid and the covered person 31
757	756		remained eligible for plan coverage; 32
758	757		(E) The plan has paid on behalf of the covered person the 33
759	758		maximum lifetime benefit established by the board in accordance with § 23 -79-34
760	759		510(a)(2)(W); 35
761	760		(F) The person is a resident of a public institution; 36 HB1595
762	761
763	762		21 02/25/2025 1:11:34 PM ANS291
764	763		(G) All or part of the person's premium is paid for or 1
765	764		reimbursed: 2
766	765		(i) By one (1) of the following in connection with a 3
767	766		group health plan: 4
768	767		(a) The person’s current employer; 5
769	768		(b) If the person is retired, by the person's 6
770	769		former employer; or 7
771	770		(c) If the person is a dependent of an 8
772	771		employee or retiree, by the current or former employer of the employee or 9
773	772		retiree; or 10
774	773		(ii) Under any government -sponsored program or by any 11
775	774		government agency, foundation, healthcare facility, or healthcare provider 12
776	775		except for premiums paid on behalf of: 13
777	776		(a) A trade adjustment assistance eligible 14
778	777		person or a qualified trade adjustment assistance eligible person in 15
779	778		accordance with section 35 of the Internal Revenue Code; or 16
780	779		(b) An otherwise qualifying full -time employee 17
781	780		or dependent of a qualifying full -time employee of a government agency, 18
782	781		foundation, healthcare facility, or healthcare provider; or 19
783	782		(H) The person commits a fraudulent insurance act as 20
784	783		defined in § 23-66-501(4) against the Arkansas Comprehensive Health Insurance 21
785	784		Pool; 22
786	785		(3) The board or the plan administrator shall require 23
787	786		verification of residency and may require any additional information, 24
788	787		documentation, or statements under oath whenever necessary to determine plan 25
789	788		eligibility or residency; 26
790	789		(4) Coverage shall cease: 27
791	790		(A) On the date a person is no longer a resident of the 28
792	791		State of Arkansas; 29
793	792		(B) On the date a person requests coverage to end; 30
794	793		(C) On the death of the covered person; 31
795	794		(D) On the date state law requires cancellation of the 32
796	795		policy; or 33
797	796		(E) At the plan's option, thirty (30) days after the plan 34
798	797		makes any written inquiry concerning a person's eligibility or place of 35
799	798		residence to which the person does not reply; and 36 HB1595
800	799
801	800		22 02/25/2025 1:11:34 PM ANS291
802	801		(5) Except under the conditions set forth in subdivision (a)(4) 1
803	802		of this section, the coverage of any person who ceases to meet the 2
804	803		eligibility requirements of this section terminates at the end of the month 3
805	804		that the person ceases to meet the eligibility requirements of this section. 4
806	805		(b) Persons Eligible for Guaranteed Issuance of Coverage. The 5
807	806		following requirements apply to a federally eligible individual or a 6
808	807		qualified trade adjustment assistance eligible person in order for such an 7
809	808		individual to be eligible for plan coverage: 8
810	809		(1) Notwithstanding the requirements of subsection (a) of this 9
811	810		section, any federally eligible individual or a qualified trade adjustment 10
812	811		assistance eligible person for whom a plan application and such enclosures 11
813	812		and supporting documentation as the board may require is received by the 12
814	813		board within sixty-three (63) days after the termination of prior creditable 13
815	814		coverage for reasons other than nonpayment of premium or fraud that covered 14
816	815		the applicant shall qualify to enroll in the plan under the portability 15
817	816		provisions of this subsection; 16
818	817		(2) Any individual seeking plan coverage under this subsection 17
819	818		must submit with his or her application evidence, including acceptable 18
820	819		written certification of previous creditable coverage, that will establish to 19
821	820		the board's satisfaction that he or she meets all of the requirements to be a 20
822	821		federally eligible individual or a qualified trade adjustment assistance 21
823	822		eligible person and is currently and permanently residing in the State of 22
824	823		Arkansas as of the date his or her application was received by the board; 23
825	824		(3) A period of creditable coverage shall not be counted, with 24
826	825		respect to qualifying an applicant for plan coverage as an individual under 25
827	826		this subsection, if after such a period and before the application for plan 26
828	827		coverage was received by the board, there was at least a sixty -three-day 27
829	828		period during all of which the individual was not covered under any 28
830	829		creditable coverage; 29
831	830		(4) Any individual who the board determines qualifies for plan 30
832	831		coverage under this subsection shall be offered his or her choice of 31
833	832		enrolling in one (1) of the alternative portability plans that the board is 32
834	833		authorized under this subsection to establish for those individuals; 33
835	834		(5)(A)(i) The board shall offer a choice of healthcare coverages 34
836	835		consistent with major medical coverage under the alternative plans authorized 35
837	836		by this subsection to every individual qualifying for coverage under this 36 HB1595
838	837
839	838		23 02/25/2025 1:11:34 PM ANS291
840	839		subsection. 1
841	840		(ii) The coverages to be offered under the plans, the 2
842	841		schedule of benefits, deductibles, copayments, coinsurance, exclusions, and 3
843	842		other limitations shall be approved by the board. 4
844	843		(B) One (1) optional form of coverage shall be comparable 5
845	844		to comprehensive health insurance coverage offered in the individual market 6
846	845		in the State of Arkansas or a standard option of coverage available under the 7
847	846		individual health insurance laws of the State of Arkansas. The standard plan 8
848	847		that is authorized by § 23 -79-510 may be used for this purpose. 9
849	848		(C) The board also may offer a preferred provider option 10
850	849		and such other options as the board determines may be appropriate for 11
851	850		individuals who qualify for plan coverage pursuant to this subsection; 12
852	851		(6) Notwithstanding the requirements of § 23 -79-510(f), any plan 13
853	852		coverage that is issued to individuals who qualify for plan coverage pursuant 14
854	853		to the portability provisions of this subsection shall not be subject to any 15
855	854		preexisting conditions exclusion, waiting period, or other similar limitation 16
856	855		on coverage; 17
857	856		(7) Individuals who qualify and enroll in the plan pursuant to 18
858	857		this subsection shall be required to pay such premium rates as the board 19
859	858		shall establish and approve in accordance with the requirements of § 23 -79-20
860	859		507(a); 21
861	860		(8) The total premium, without regard to any subsidy of premium, 22
862	861		for individuals who qualify and enroll in the plan pursuant to this 23
863	862		subsection shall not be greater than a similarly situated individual 24
864	863		qualifying for pool coverage under subsection (a) of this section; and 25
865	864		(9) A federally eligible individual who qualifies and enrolls in 26
866	865		the plan pursuant to this subsection must continue to satisfy all of the 27
867	866		other eligibility requirements of this subchapter to the extent not 28
868	867		inconsistent with the Health Insurance Portability and Accountability Act of 29
869	868		1996 in order to maintain continued eligibility for coverage under the plan. 30
870	869		(c) Any person who was issued a policy pursuant to the provisions of 31
871	870		Acts 1995, No. 1339, shall be deemed continuously covered consistent with the 32
872	871		terms of this subchapter and reissued a new policy in accordance with the 33
873	872		provisions of this subchapter. 34
874	873		35
875	874		23-79-510. Outline of benefits. 36 HB1595
876	875
877	876		24 02/25/2025 1:11:34 PM ANS291
878	877		(a)(1) Subject to the contractual policy form language adopted by the 1
879	878		Board of Directors of the Arkansas Comprehensive Health Insurance Pool, 2
880	879		expenses for the following services, supplies, drugs, or articles when 3
881	880		prescribed by a physician and determined by the plan to be medically 4
882	881		necessary shall be covered, subject to provisions of subsection (b) of this 5
883	882		section: 6
884	883		(A) Hospital services; 7
885	884		(B) Professional services for the diagnosis or treatment 8
886	885		of injuries, illnesses, or conditions, other than mental or dental, that are 9
887	886		rendered by a physician or by other licensed professionals at his or her 10
888	887		direction; 11
889	888		(C) Drugs requiring a physician's prescription; 12
890	889		(D) Skilled nursing services of a licensed skilled nursing 13
891	890		facility for not more than one hundred twenty (120) days during a policy 14
892	891		year; 15
893	892		(E) Services of a home health agency up to a maximum of 16
894	893		two hundred seventy (270) services per year; 17
895	894		(F) Use of radium or other radioactive materials; 18
896	895		(G) Oxygen; 19
897	896		(H) Prostheses other than dental; 20
898	897		(I) Rental of durable medical equipment, other than 21
899	898		eyeglasses and hearing aids, for which there is no personal use in the 22
900	899		absence of the conditions for which such equipment is prescribed; 23
901	900		(J) Diagnostic X rays and laboratory tests; 24
902	901		(K) Oral surgery for excision of partially or completely 25
903	902		unerupted, impacted teeth or the gums and tissues of the mouth when not 26
904	903		performed in connection with the extraction or repair of teeth; 27
905	904		(L) Services of a physical therapist; 28
906	905		(M) Emergency and other medically necessary transportation 29
907	906		provided by a licensed ambulance service to the nearest facility qualified to 30
908	907		treat a covered condition; 31
909	908		(N) Services for diagnosis and treatment of mental and 32
910	909		nervous disorders or chemical and drug dependency, provided that a covered 33
911	910		person shall be required to make a fifty percent (50%) copayment and that the 34
912	911		plan's payment shall not exceed four thousand dollars ($4,000) annually; and 35
913	912		(O) Such additional benefits deemed appropriate by the 36 HB1595
914	913
915	914		25 02/25/2025 1:11:34 PM ANS291
916	915		board in accordance with the provisions of subsection (b) of this section. 1
917	916		(2) Exclusions. Unless the contractual policy form language 2
918	917		adopted by the board provides otherwise, the following services, supplies, 3
919	918		drugs, or articles whether or not prescribed by a physician, shall not be 4
920	919		covered: 5
921	920		(A) Any charge for treatment for cosmetic purposes other 6
922	921		than surgery for the repair or treatment of an injury or a congenital bodily 7
923	922		defect to restore normal bodily functions; 8
924	923		(B) Care that is primarily for custodial or domiciliary 9
925	924		purposes; 10
926	925		(C) Any charge for confinement in a private room to the 11
927	926		extent it is in excess of the institution's charge for its most common 12
928	927		semiprivate room unless a private room is medically necessary; 13
929	928		(D) That part of any charge for services rendered or 14
930	929		articles prescribed by a physician, dentist, or other healthcare personnel 15
931	930		that exceeds the prevailing charge in the locality or for any charge not 16
932	931		medically necessary; 17
933	932		(E) Any charge for services or articles the provision of 18
934	933		which is not within the scope of authorized practice of the institution or 19
935	934		individual providing the services or articles; 20
936	935		(F) Any expense incurred prior to the effective date of 21
937	936		coverage by the plan for the person on whose behalf the expense is incurred; 22
938	937		(G) Dental care except as provided in subdivision 23
939	938		(a)(1)(K) of this section; 24
940	939		(H) Eyeglasses and hearing aids; 25
941	940		(I) Illness or injury due to acts of war; 26
942	941		(J) Services of blood donors and any fee for failure to 27
943	942		replace the first three (3) pints of blood provided to a covered person each 28
944	943		policy year; 29
945	944		(K) Personal supplies or services provided by a hospital 30
946	945		or nursing home or any other nonmedical or nonprescribed supply or service; 31
947	946		(L) Any expense or charge for services, articles, drugs, 32
948	947		or supplies that are not provided in accord with generally accepted standards 33
949	948		of current medical practice; 34
950	949		(M) Any expense for which a charge is not made in the 35
951	950		absence of insurance or for which there is no legal obligation on the part of 36 HB1595
952	951
953	952		26 02/25/2025 1:11:34 PM ANS291
954	953		the patient to pay; 1
955	954		(N) Any expense incurred for benefits provided under the 2
956	955		laws of the United States and the State of Arkansas, including Medicare and 3
957	956		Medicaid and other medical assistance, military service -connected disability 4
958	957		payments, medical services provided for members of the armed forces and their 5
959	958		dependents or employees of the United States Armed Forces, and medical 6
960	959		services financed on behalf of all citizens by the United States; 7
961	960		(O) Any expense or charge for in vitro fertilization, 8
962	961		artificial insemination, or any other artificial means used to cause 9
963	962		pregnancy; 10
964	963		(P) Any expense or charge for oral contraceptives used for 11
965	964		birth control or any other temporary birth control measures; 12
966	965		(Q) Any expense or charge for sterilization or 13
967	966		sterilization reversals; 14
968	967		(R) Any expense or charge for weight -loss programs, 15
969	968		exercise equipment, or treatment of obesity except when certified by a 16
970	969		physician as morbid obesity, i.e., at least two (2) times normal body weight; 17
971	970		(S) Any expense or charge for acupuncture treatment unless 18
972	971		used as an anesthetic agent for a covered surgery; 19
973	972		(T) Any expense or charge for organ or bone marrow 20
974	973		transplants other than those performed at a hospital with a board -approved 21
975	974		organ transplant program that has been designated by the board as a preferred 22
976	975		provider organization for that specific organ or bone marrow transplant; 23
977	976		(U) Any expense or charge for procedures, treatments, 24
978	977		equipment, or services that are provided in special settings for research 25
979	978		purposes or in a controlled environment, are being studied for safety, 26
980	979		efficiency, and effectiveness, and are awaiting endorsement by the 27
981	980		appropriate national medical specialty college for general use within the 28
982	981		medical community; 29
983	982		(V) Such additional exclusions deemed appropriate by the 30
984	983		board in accordance with the provisions of subsection (b) of this section; 31
985	984		and 32
986	985		(W)(i) Any benefits that exceed the maximum lifetime 33
987	986		benefit for plan coverage established by the board under § 23 -79-34
988	987		506(a)(1)(N). 35
989	988		(ii) The maximum lifetime benefit shall not be less 36 HB1595
990	989
991	990		27 02/25/2025 1:11:34 PM ANS291
992	991		than one million dollars ($1,000,000) and shall not exceed three million 1
993	992		dollars ($3,000,000). 2
994	993		(b) In establishing the plan coverage, the board shall take into 3
995	994		consideration the levels of health insurance provided in the state and 4
996	995		medical economic factors as may be deemed appropriate and promulgate 5
997	996		benefits, deductibles, copayments, coinsurance factors, exclusions, and 6
998	997		limitations determined to be generally reflective of and commensurate with 7
999	998		health insurance provided through a representative number of large employers 8
1000	999		in the state. 9
1001	1000		(c) The board may adjust any deductibles, copayments, and coinsurance 10
1002	1001		factors annually according to the medical component of the Consumer Price 11
1003	1002		Index for All Urban Consumers. 12
1004	1003		(d) Nonduplication of Benefits. 13
1005	1004		(1)(A) The pool shall be payer of last resort of benefits 14
1006	1005		whenever any other benefit or source of third -party payment is available. 15
1007	1006		(B) Benefits otherwise payable under plan coverage shall 16
1008	1007		be reduced by all amounts paid or payable through any other health insurance 17
1009	1008		or any other source providing benefits because of a sickness or injury and by 18
1010	1009		all hospital and medical expense benefits paid or payable under any workers' 19
1011	1010		compensation coverage, automobile medical payment, or liability insurance 20
1012	1011		whether provided on the basis of fault or nonfault and by any hospital or 21
1013	1012		medical benefits paid or payable under or provided pursuant to any state or 22
1014	1013		federal law or program. 23
1015	1014		(2) The pool shall have a cause of action against a covered 24
1016	1015		person for the recovery of the amount of benefits paid that are not covered 25
1017	1016		by the pool. Benefits due from the pool may be reduced or refused as a set -26
1018	1017		off against any amount recoverable under this subdivision (d)(2). 27
1019	1018		(e) Right of Subrogation — Recoveries. 28
1020	1019		(1)(A) Whenever the pool has paid benefits because of sickness 29
1021	1020		or an injury to any covered person resulting from a third party's wrongful 30
1022	1021		act or negligence or for which an insurance company or self -insured entity is 31
1023	1022		liable in accordance with the provisions of any policy of insurance, and the 32
1024	1023		covered person has recovered or may recover damages from a third party that 33
1025	1024		is liable for damages, the pool shall have the right to recover the benefits 34
1026	1025		it paid from any amounts that the covered person has received or may receive 35
1027	1026		regardless of the date of the sickness or injury or the date of any 36 HB1595
1028	1027
1029	1028		28 02/25/2025 1:11:34 PM ANS291
1030	1029		settlement, judgment, or award resulting from the sickness or injury. 1
1031	1030		(B) The pool shall be subrogated to any right of recovery 2
1032	1031		the covered person may have under the terms of any private or public 3
1033	1032		healthcare coverage or liability coverage including coverage under a workers' 4
1034	1033		compensation act without the necessity of assignment of claim or other 5
1035	1034		authorization to secure the right of recovery. 6
1036	1035		(C) To enforce its subrogation right, the pool may: 7
1037	1036		(i) Intervene or join in an action or proceeding 8
1038	1037		brought by the covered person or his or her personal representative, 9
1039	1038		including his or her guardian, conservator, estate, dependents, or survivors, 10
1040	1039		against any third party or the third party's insurance carrier or self -11
1041	1040		insured entity that may be liable; or 12
1042	1041		(ii) Institute and prosecute legal proceedings 13
1043	1042		against any third party or the third party's insurance carrier or self -14
1044	1043		insured entity that may be liable for the sickness or injury in an 15
1045	1044		appropriate court either in the name of the pool or in the name of the 16
1046	1045		covered person or his or her personal representative including his or her 17
1047	1046		guardian, conservator, estate, dependents, or survivors. 18
1048	1047		(2)(A)(i) If any action or claim is brought by or on behalf of a 19
1049	1048		covered person against a third party or the third party's insurance carrier 20
1050	1049		or self-insured entity, the covered person or his or her personal 21
1051	1050		representative, including his or her guardian, conservator, estate, 22
1052	1051		dependents, or survivors, shall notify the pool by personal service or 23
1053	1052		registered mail of the action or claim and of the name of the court in which 24
1054	1053		the action or claim is brought, filing proof thereof in the action or claim. 25
1055	1054		(ii) The pool may, at any time thereafter, join in 26
1056	1055		the action or claim upon its motion so that all orders of court after hearing 27
1057	1056		and judgment shall be made for its protection. 28
1058	1057		(B) No release or settlement of a claim for damages and no 29
1059	1058		satisfaction of judgment in the action shall be valid without the written 30
1060	1059		consent of the pool to the extent of its interest in the settlement or 31
1061	1060		judgment and of the covered person or his or her personal representative. 32
1062	1061		(3)(A) In the event that the covered person or his or her 33
1063	1062		personal representative fails to institute a proceeding against any 34
1064	1063		appropriate third party before the fifth month before the action would be 35
1065	1064		barred, the pool, in its own name or in the name of the covered person or 36 HB1595
1066	1065
1067	1066		29 02/25/2025 1:11:34 PM ANS291
1068	1067		personal representative, may commence a proceeding against any appropriate 1
1069	1068		third party for the recovery of damages on account of any sickness, injury, 2
1070	1069		or death to the covered person. 3
1071	1070		(B) The covered person shall cooperate in doing what is 4
1072	1071		reasonably necessary to assist the pool in any recovery and shall not take 5
1073	1072		any action that would prejudice the pool's right to recovery. 6
1074	1073		(C) The pool shall pay to the covered person or his or her 7
1075	1074		personal representative all sums collected from any third party by judgment 8
1076	1075		or otherwise in excess of amounts paid in benefits under the pool and amounts 9
1077	1076		paid or to be paid as costs, attorney's fees, and reasonable expenses 10
1078	1077		incurred by the pool in making the collection or enforcing the judgment. 11
1079	1078		(4)(A)(i) In the event of judgment or award in either a suit or 12
1080	1079		claim against a third party, the court shall first order paid from any 13
1081	1080		judgment or award the reasonable litigation expenses incurred in preparation 14
1082	1081		and prosecution of the action or claim, together with reasonable attorney's 15
1083	1082		fees. 16
1084	1083		(ii) After payment of those expenses and attorney's 17
1085	1084		fees, the court shall apply out of the balance of the judgment or award an 18
1086	1085		amount sufficient to reimburse the pool the full amount of benefits paid on 19
1087	1086		behalf of the covered person under this subchapter, provided that the court 20
1088	1087		may reduce and apportion the pool's portion of the judgment proportionately 21
1089	1088		to the recovery of the covered person. 22
1090	1089		(B)(i) The burden of producing sufficient evidence to 23
1091	1090		support the exercise by the court of its discretion to reduce the amount of a 24
1092	1091		proven charge sought to be enforced against the recovery shall rest with the 25
1093	1092		party seeking the reduction. 26
1094	1093		(ii) The court may consider the nature and extent of 27
1095	1094		the injury, economic and noneconomic loss, settlement offers, comparative or 28
1096	1095		contributory negligence as it applies to the case at hand, hospital costs, 29
1097	1096		physician costs, and all other appropriate costs. 30
1098	1097		(C) The pool shall pay its pro rata share of the 31
1099	1098		attorney's fees based on the pool's recovery as it compares to the total 32
1100	1099		judgment. 33
1101	1100		(D) Any reimbursement rights of the pool shall take 34
1102	1101		priority over all other liens and charges existing under the laws of the 35
1103	1102		State of Arkansas. 36 HB1595
1104	1103
1105	1104		30 02/25/2025 1:11:34 PM ANS291
1106	1105		(5) The pool may compromise or settle and release any claim for 1
1107	1106		benefits provided under this subchapter or waive any claims for benefits, in 2
1108	1107		whole or in part, for the convenience of the pool or if the pool determines 3
1109	1108		that collection will result in undue hardship upon the covered person. 4
1110	1109		(f) Preexisting Conditions. 5
1111	1110		(1) Except for federally eligible individuals or qualified trade 6
1112	1111		adjustment assistance eligible persons qualifying for plan coverage under § 7
1113	1112		23-79-509(b) or resident eligible persons or trade adjustment assistance 8
1114	1113		eligible persons who qualify for and elect to purchase the waiver authorized 9
1115	1114		in subdivision (f)(2) of this section, plan coverage shall exclude charges or 10
1116	1115		expenses incurred during the first six (6) months following the effective 11
1117	1116		date of coverage as to any condition if: 12
1118	1117		(A) The condition has manifested itself within the six -13
1119	1118		month period immediately preceding the effective date of coverage in such a 14
1120	1119		manner as would cause an ordinary prudent person to seek diagnosis, care, or 15
1121	1120		treatment; or 16
1122	1121		(B) Medical advice, care, or treatment was recommended or 17
1123	1122		received within the six -month period immediately preceding the effective date 18
1124	1123		of the coverage. 19
1125	1124		(2) Waiver. The preexisting condition exclusions as set forth 20
1126	1125		in subdivision (f)(1) of this section will be waived to the extent to which 21
1127	1126		the resident eligible person or trade adjustment assistance eligible person: 22
1128	1127		(A) Has satisfied similar exclusions under any prior 23
1129	1128		individual health insurance coverage that was involuntarily terminated; and 24
1130	1129		(B)(i) Has applied for plan coverage not later than thirty 25
1131	1130		(30) days following the involuntary termination. 26
1132	1131		(ii) For each resident eligible person or trade 27
1133	1132		adjustment assistance eligible person who qualifies for and elects this 28
1134	1133		waiver, there shall be added on a prorated basis to each payment of premium a 29
1135	1134		surcharge of up to ten percent (10%) of the otherwise applicable annual 30
1136	1135		premium for as long as that individual's coverage under the plan remains in 31
1137	1136		effect or sixty (60) months, whichever is less. 32
1138	1137		(3)(A) Whenever benefits are due from the plan because of 33
1139	1138		sickness or an injury to a covered person resulting from a third party's 34
1140	1139		wrongful act or negligence and the covered person has recovered or may 35
1141	1140		recover damages from a third party or its insurance carrier or self -insured 36 HB1595
1142	1141
1143	1142		31 02/25/2025 1:11:34 PM ANS291
1144	1143		entity, the plan shall have the right to reduce benefits or to refuse to pay 1
1145	1144		benefits that otherwise may be payable in the amount of damages that the 2
1146	1145		covered person has recovered or may recover regardless of the date of the 3
1147	1146		sickness or injury or the date of any settlement, judgment, or award 4
1148	1147		resulting from that sickness or injury. 5
1149	1148		(B)(i) During the pendency of any action or claim that is 6
1150	1149		brought by or on behalf of a covered person against a third party or its 7
1151	1150		insurance carrier or self -insured entity, any benefits that would otherwise 8
1152	1151		be payable except for the provisions of this subsection shall be paid if 9
1153	1152		payment by or for the third party has not yet been made and the covered 10
1154	1153		person or, if capable, that person's legal representative agrees in writing 11
1155	1154		to pay back properly the benefits paid as a result of the sickness or injury 12
1156	1155		to the extent of any future payments made by or for the third party for the 13
1157	1156		sickness or injury. 14
1158	1157		(ii) This agreement is to apply whether or not 15
1159	1158		liability for the payments is established or admitted by the third party or 16
1160	1159		whether those payments are itemized. 17
1161	1160		(C) Any amounts due the plan to repay benefits may be 18
1162	1161		deducted from other benefits payable by the plan after payments by or for the 19
1163	1162		third party are made. 20
1164	1163		(4) Benefits due from the plan may be reduced or refused as an 21
1165	1164		offset against any amount otherwise recoverable under this section. 22
1166	1165		23
1167	1166		23-79-511. Confidentiality. 24
1168	1167		(a)(1) All steps necessary under state and federal law to protect 25
1169	1168		confidentiality of applicants and covered persons shall be undertaken by the 26
1170	1169		Board of Directors of the Arkansas Comprehensive Health Insurance Pool to 27
1171	1170		prevent the identification of individual records of covered persons under the 28
1172	1171		plan, rejected by the plan, or who may become ineligible for further 29
1173	1172		participation in the plan. 30
1174	1173		(2) Procedures shall be written by the board to assure the 31
1175	1174		confidentiality of records of persons covered under, rejected by, or who 32
1176	1175		became ineligible for further participation in the plan when gathering and 33
1177	1176		submitting data to the board or any other entity. 34
1178	1177		(b) Any information submitted to the board by hospitals or any other 35
1179	1178		provider pursuant to this subchapter from which the identity of a particular 36 HB1595
1180	1179
1181	1180		32 02/25/2025 1:11:34 PM ANS291
1182	1181		individual can be determined shall be privileged and confidential and shall 1
1183	1182		not be disclosed in any manner. The foregoing includes, but shall not be 2
1184	1183		limited to, disclosure, inspection, or copying under the Freedom of 3
1185	1184		Information Act of 1967, § 25 -19-101 et seq. 4
1186	1185		5
1187	1186		23-79-512. Collective action. 6
1188	1187		Neither the participation in the plan as insurers, the establishment of 7
1189	1188		rates, forms, or procedures nor any other joint or collective action required 8
1190	1189		by this subchapter shall be the basis of any legal action, criminal or civil 9
1191	1190		liability, or penalty against the plan or any insurer. 10
1192	1191		11
1193	1192		23-79-513. Unfair referral to plan — Prohibited practices by 12
1194	1193		employers. 13
1195	1194		(a) It shall constitute an unfair trade practice under the Trade 14
1196	1195		Practices Act, § 23-66-201 et seq., for an insurer, agent, broker, or third -15
1197	1196		party administrator to refer an individual to the Arkansas Comprehensive 16
1198	1197		Health Insurance Pool or arrange for an individual to apply to the pool for 17
1199	1198		the purpose of: 18
1200	1199		(1) Separating the individual from group health insurance 19
1201	1200		coverage provided by a group health plan; or 20
1202	1201		(2) Facilitating enrollment in the pool by any of the following 21
1203	1202		individuals associated with an employer, with the knowledge that the employer 22
1204	1203		intends to pay or is paying all or part of the premium payments owed by the 23
1205	1204		individual for pool coverage: 24
1206	1205		(A) An employee of the employer; 25
1207	1206		(B) A retired employee of the employer; or 26
1208	1207		(C) A dependent of an employee or retired employee of the 27
1209	1208		employer. 28
1210	1209		(b) Because pool coverage is not intended to cover participants who 29
1211	1210		are eligible for a group health plan, an individual described in subdivision 30
1212	1211		(a)(2) of this section is not eligible: 31
1213	1212		(1) For pool coverage if the employer associated with the 32
1214	1213		applicant intends to pay for all or part of the pool premium payments for the 33
1215	1214		individual; or 34
1216	1215		(2) To continue pool coverage if the employer associated with 35
1217	1216		the individual directly or indirectly pays all or part of the pool premium 36 HB1595
1218	1217
1219	1218		33 02/25/2025 1:11:34 PM ANS291
1220	1219		payments for the individual. 1
1221	1220		2
1222	1221		23-79-514. [Repealed.] 3
1223	1222		4
1224	1223		23-79-515. Orderly cessation of operations. 5
1225	1224		(a)(1) The Arkansas Comprehensive Health Insurance Pool shall cease 6
1226	1225		enrollment and coverage under the plan on and after January 1, 2014, as 7
1227	1226		required by federal law. 8
1228	1227		(2) After taking all reasonable steps, including those specified 9
1229	1228		in this section, to timely and efficiently assist in the transition of 10
1230	1229		individuals receiving plan coverage to the individual health insurance 11
1231	1230		market, the Board of Directors of the Arkansas Comprehensive Health Insurance 12
1232	1231		Pool shall cease operating the pool after paying health insurance claims for 13
1233	1232		plan coverage and meeting all other obligations of the board under this 14
1234	1233		section. 15
1235	1234		(b) The board may take all actions it deems necessary to: 16
1236	1235		(1) Cease enrollment for plan coverage effective December 1, 17
1237	1236		2013; 18
1238	1237		(2)(A) Terminate all existing plan coverage effective at the end 19
1239	1238		of the calendar day on December 31, 2013. 20
1240	1239		(B) The board shall provide at least ninety (90) days 21
1241	1240		notice to current policyholders of the termination; and 22
1242	1241		(3) Amend plan policies and provide adequate notice to 23
1243	1242		policyholders, agents, and providers that to be paid or reimbursed, a claim 24
1244	1243		for plan services is required to be filed by the earlier of one hundred 25
1245	1244		eighty (180) days after plan coverage ends or three hundred sixty -five (365) 26
1246	1245		days after the date of service giving rise to the claim. 27
1247	1246		(c) This section does not require the board to revise plan benefits to 28
1248	1247		comply with federal law or to maintain plan coverage for any individual after 29
1249	1248		December 31, 2013. 30
1250	1249		(d)(1) After all plan coverage terminates under this section, the 31
1251	1250		board shall take reasonable steps to wind up all significant operations of 32
1252	1251		the pool by December 31, 2014. 33
1253	1252		(2) Notwithstanding any other provision of this subchapter, to 34
1254	1253		facilitate an efficient cessation of operations: 35
1255	1254		(A) The board may continue to use existing contractors 36 HB1595
1256	1255
1257	1256		34 02/25/2025 1:11:34 PM ANS291
1258	1257		until cessation of operations without the need to issue competitive requests 1
1259	1258		for proposals; 2
1260	1259		(B) The board may continue to fund operations of this 3
1261	1260		subchapter under § 23 -79-507; 4
1262	1261		(C) The board shall remain in effect: 5
1263	1262		(i) As provided by § 23 -79-504(b); and 6
1264	1263		(ii) Until a judgment, order, or decree in any 7
1265	1264		action, suit, or proceeding commenced against or by the pool is fully 8
1266	1265		executed; and 9
1267	1266		(D)(i) The term of each current board member shall be 10
1268	1267		extended until the date the pool concludes all business as provided under 11
1269	1268		this section and the Insurance Commissioner certifies the cessations of 12
1270	1269		operations under subsection (g) of this section. 13
1271	1270		(ii) The term of a board member expires when the 14
1272	1271		commissioner certifies the cessations of operations under subsection (g) of 15
1273	1272		this section. 16
1274	1273		(e) On or before June 30, 2013, the board shall amend the plan of 17
1275	1274		operation to reflect the actions necessary to implement this section. 18
1276	1275		(f) If the board has excess funds after the cessation of operations of 19
1277	1276		the pool, the funds shall be returned to the general revenue funds of the 20
1278	1277		state. 21
1279	1278		(g)(1) On or before March 1, 2016, or a later date if necessary to 22
1280	1279		complete the cessation of operations of the pool, the board shall file a 23
1281	1280		report with the General Assembly and commissioner that reflects completion of 24
1282	1281		the requirements of this section and includes an independent auditor's report 25
1283	1282		on the financial statements of the pool. 26
1284	1283		(2) If satisfied upon review of the report that the board has 27
1285	1284		complied with this section and accomplished the pool's cessation of 28
1286	1285		operations in a reasonable manner, the commissioner shall certify that the 29
1287	1286		business of the pool has concluded in accordance with this section and 30
1288	1287		publish the certification on the State Insurance Department website. 31
1289	1288		(h) Upon certification under subsection (g) of this section, the 32
1290	1289		operations of the pool are suspended indefinitely unless reactivated by the 33
1291	1290		General Assembly. 34
1292	1291		(i) The commissioner may address any matters regarding the pool 35
1293	1292		arising after the certification under subsection (g) of this section, and the 36 HB1595
1294	1293
1295	1294		35 02/25/2025 1:11:34 PM ANS291
1296	1295		Attorney General shall defend a legal action filed after the certification, 1
1297	1296		including seeking the dismissal of the action under § 23 -79-516 or for any 2
1298	1297		other purpose. 3
1299	1298		(j) Unless inconsistent with this section, the remainder of this 4
1300	1299		subchapter continues to apply to the pool and the board. 5
1301	1300		6
1302	1301		23-79-516. Statute of limitations and repose. 7
1303	1302		Because winding up the operations of the Arkansas Comprehensive Health 8
1304	1303		Insurance Pool requires the expeditious determination of its outstanding 9
1305	1304		liabilities, a cause of action against the pool or the Board of Directors of 10
1306	1305		the Arkansas Comprehensive Health Insurance Pool shall be commenced within 11
1307	1306		the earlier of one (1) year after the cause of action accrues or December 31, 12
1308	1307		2015. 13
1309	1308		14
1310	1309		23-79-517. Individuals moving to Arkansas and previously covered by 15
1311	1310		another qualified high -risk pool. 16
1312	1311		(a) Notwithstanding § 23 -79-510(f), if a resident eligible person is 17
1313	1312		eligible for plan coverage because the person previously was covered under a 18
1314	1313		qualified high-risk pool of another state, a preexisting condition exclusion 19
1315	1314		otherwise applicable to the resident eligible person: 20
1316	1315		(1) Shall be reduced by each month of coverage in which the 21
1317	1316		resident eligible person was subject to a preexisting condition exclusion in 22
1318	1317		the other state's qualified high -risk pool; or 23
1319	1318		(2) Does not apply if the resident eligible person was not 24
1320	1319		subject to a preexisting condition exclusion in the other state's qualified 25
1321	1320		high-risk pool. 26
1322	1321		(b) This section expires on the last day an individual may be enrolled 27
1323	1322		into plan coverage under this subchapter. 28
1324	1323		29
1325	1324		30
1326		-	~~APPROVED: 3/20/25~~ 31
	1325	+	31
1327	1326		32
1328	1327		33
1329	1328		34
1330	1329		35
1331	1330		36