Find Laws Find Lawyers Free Legal Forms USA State Laws

ARKANSAS STATUTES AND CODES

§ 23-86-404 - Optional health benefit plans.

23-86-404. Optional health benefit plans.

(a) A health maintenance organization may offer and issue health benefit plans that reimburse or arrange for covered health care services to covered persons through a limited network plan if:

(1) The health maintenance organization provides itself, or arranges through an insurance company, for an annual option for covered persons to choose a health benefit plan or a point-of-service plan that reimburses or arranges for the covered health care services from any health care provider qualified to render the covered health care services;

(2) The difference in the benefit level of the optional health benefit plan or point-of-service plan shall not exceed twenty-five percent (25%) of the benefit level under the limited benefit plan;

(3) The employer or other group contract holder contracting with the health maintenance organization for a health benefit plan shall provide an equal contribution per covered person regardless of which option the covered person chooses pursuant to the provisions of this subchapter; and

(4) Under the optional health benefit plan or point-of-service plan, the rate of reimbursement for health providers out of the network shall be no higher than the normal and usual and customary rate charged by those out-of-network providers on a regular basis, provided that copayment, coinsurance, and other cost-sharing features may be different for out-of-network providers and in-network providers.

(b) (1) The pricing of the optional health benefit plan or point-of-service plan must provide an expected incurred loss ratio of not less than eighty percent (80%).

(2) The Insurance Commissioner shall promulgate rules and regulations as may be necessary to implement the provisions of this subchapter and to ensure that the price of the option provided in this section bears a reasonable relationship to the costs and benefits of the limited network plan.

(c) This subchapter shall apply to any health benefit plan issued or renewed on or after January 1, 2000.

Arkansas Forms by Issue

Arkansas Appeals Forms
Arkansas Auto Accident Forms
Arkansas Child Support Agency Forms
Arkansas Court Forms
> Substance Abuse
Arkansas Divorce Forms
Arkansas Family Forms
Arkansas Tax Forms

Arkansas Law

Arkansas State Laws
    > Arkansas Child Support
    > Arkansas Gun Laws
    > Arkansas Statute
Arkansas State
    > Arkansas State Parks
Arkansas Tax
    > Arkansas State Tax
Arkansas Agencies
    > Arkansas Department of Corrections
    > Arkansas Department of Education
    > Arkansas Federal Credit Union
    > Arkansas Secretary of State
    > Arkansas State Police

Arkansas Court Map

Tips