§ 23-86-502 - Definitions. - Arkansas Statutes

23-86-502. Definitions.

As used in this subchapter:

(1) "Commissioner" means the Insurance Commissioner;

(2) "Eligible employee" means an employee or individual who is a full-time employee of an eligible employer and is qualified to enroll in a health benefit plan offered through a health insurance purchasing group;

(3) "Eligible employer" means an employer employing no more than one hundred ninety-nine (199) eligible employees;

(4) (A) "Employer", "employee", and "dependent", unless otherwise defined in this section, shall have the meanings applied to the terms with respect to the coverage under the laws of the state relating to the coverage and the issuer.

(B) "Employer" includes a self-employed individual;

(5) "Full time" means employees working at least thirty (30) hours per week for an eligible employer;

(6) "Health benefits plan" means a group plan, group policy, or group contract for health care services, issued or delivered by a health insurance purchasing group health carrier, excluding plans, policies, or contracts providing health care benefits or health care services pursuant to Arkansas Constitution, Article 5, 32, the Workers' Compensation Law, 11-9-101 et seq., the Public Employee Workers' Compensation Act, 21-5-601 et seq., and the no-fault medical and hospital benefit requirements under 23-89-202;

(7) "Health insurer" means an insurer licensed to transact group accident and health insurance in this state;

(8) "Health maintenance organization" means a health maintenance organization as defined in 23-76-102 that is licensed to transact business in this state as a health maintenance organization under 23-76-107;

(9) "Health insurance purchasing group" means a health insurance purchasing group meeting the requirements of this subchapter;

(10) "Health insurance purchasing group health carrier" means a health insurer, health maintenance organization, or hospital and medical service organization;

(11) "Hospital and medical service corporation" means a hospital and medical service corporation as defined in 23-75-101 that is licensed to transact business in this state as a hospital and medical service corporation under 23-75-107;

(12) "Large group" means a combination of two (2) or more eligible employers belonging to a health insurance purchasing group;

(13) "Member" means an individual enrolled for health benefits coverage in a health insurance purchasing group;

(14) "Purchaser" means an eligible employer that has contracted with a health insurance purchasing group for the purchase of health benefits coverage;

(15) (A) (i) "State-mandated health benefits" means coverages for health care services or benefits required by state law or state regulations requiring the reimbursement or utilization related to a specific health illness, injury, or condition of the covered person or the inclusion of a specific category of licensed health care practitioner to be provided to the covered person in a health benefits plan for a health-related condition of a covered person.

(ii) However, for the purposes of the options provided by this subchapter, state-mandated health benefits that may be excluded, in whole or in part, shall not include any health care services or benefits that were mandated by Acts 1971, No. 34.

(B) "State-mandated health benefits" does not mean standard provisions or rights required to be present in a health benefit plan pursuant to state law or state regulations unrelated to a specific health illness, injury, or condition of the insured, including, but not limited to, those related to continuation of benefits in 23-86-114, or entitlement to a conversion policy under 23-86-115; and

(16) "Total eligible employees" means five hundred (500) or more eligible employees.