§ 23-66-215 - Penalty for late payment of claims by health carriers. - Arkansas Statutes

23-66-215. Penalty for late payment of claims by health carriers.

(a) (1) A health carrier shall pay a penalty of twelve percent (12%) per annum for late payment of claims under a health insurance contract pursuant to regulations promulgated by the Insurance Commissioner, without necessity for demand for payment by a claimant.

(2) Hiring a third-party administrator or other person to process claims shall not relieve a health carrier of its obligation to pay this penalty.

(b) For purposes of this section:

(1) "Claimant" means a person insured or covered by a health carrier, a provider holding a valid assignment from a person insured or covered by a health carrier, or a provider contracted with a health carrier, who is claiming a benefit under a health insurance contract;

(2) (A) "Health carrier" means a health maintenance organization, hospital medical service corporation, or a disability insurance company.

(B) "Health carrier" includes a self-insured governmental or church plan and third-party administrators that administer or adjust disability benefits for a disability insurer, hospital medical service corporation, health maintenance organization, self-insured governmental plan or self-insured church plan.

(C) "Health carrier" does not include:

(i) An automobile insurer paying medical or hospital benefits under 23-89-202(1) or a self-insured employer health benefits plan; or

(ii) Any person, company, or organization licensed or registered to issue or who issues any insurance policy or insurance contract in this state as described in 23-62-102 and 23-62-104 -- 23-62-107 providing medical or hospital benefits for accidental injury or disability; and

(3) (A) "Health insurance contract" means a disability insurance policy, a hospital medical service corporation contract, a health maintenance organization contract, or a plan document issued or provided by a health carrier.

(B) "Health insurance contract" does not include a disability income insurance policy, a long-term care contract, a hospital indemnity contract, an accident-only contract, or any other form of disability insurance policy that provides a benefit as a result of a sickness or accident that does not directly cover expenses related to health care treatment.