(a) The General Assembly determines that health maintenance organizations, when properly regulated, encourage methods of treatment and controls over the quality of care which effectively contain costs and provide for continuous health care by undertaking responsibility for the provision, availability, and accessibility of services. (b) For this reason, and because the primary responsibility of a […]
As used in this chapter: (1) “Commissioner” means the Insurance Commissioner; (2) “Domestic corporation” means any corporation organized pursuant to the Arkansas Business Corporation Act, § 4-26-101 et seq., and the Arkansas Nonprofit Corporation Act, § 4-28-201 et seq.; (3) “Enrollee” means an individual who has been enrolled in a healthcare plan; (4) “Evidence of […]
(a) (1) Except as otherwise provided in this chapter, provisions of the insurance law and provisions of hospital and medical service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter. (2) Subdivision (a)(1) of this section shall not apply to an insurer or hospital and […]
(a) Except to the extent that the Insurance Commissioner determines that the nature of health maintenance organizations, healthcare plans, and evidences of coverage render such sections clearly inappropriate, the following sections are applicable to health maintenance organizations: (1) Sections 23-60-101 — 23-60-108 and 23-60-110, referring to scope of the Arkansas Insurance Code; (2) Section 23-61-101 […]
(a) In lieu of suspension or revocation of a certificate of authority under § 23-76-123, the Insurance Commissioner may levy an administration penalty in an amount not less than two hundred fifty dollars ($250), nor more than two thousand five hundred dollars ($2,500), if reasonable notice in writing is given of the intent to levy […]
No person shall perform any of the services or procedures or sell or dispense any goods or devices in the field of the healing arts for which a license is required under the laws of the State of Arkansas unless the person holds a valid license authorizing him or her to perform the procedures, render […]
(a) (1) Any person that meets the requirements of § 23-76-102(9) may apply to the Insurance Commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization. (2) No person shall establish or operate a health maintenance organization in this state, nor sell or offer to sell, nor solicit offers […]
(a) Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall determine whether the applicant furnishes or proposes to furnish adequate and accessible healthcare services for its healthcare plans subject to the requirements or rules of the State Insurance Department. (b) The commissioner shall issue a certificate of authority […]
(a) The powers of a health maintenance organization include, but are not limited to, the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and the property as may reasonably be required for its principal office or for other purposes as may be necessary […]
(a) The advisory board of any health maintenance organization shall include at least one (1) physician, one (1) dentist, one (1) pharmacist, one (1) nurse, one (1) consumer, and one (1) enrollee. (b) The advisory board shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through […]
(a) Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization shall be responsible for the funds in a fiduciary relationship to the enrollees. (b) A health maintenance organization shall maintain in force a fidelity bond or fidelity […]
(a) (1) (A) Every enrollee residing in this state is entitled to evidence of coverage under a healthcare plan. (B) If the enrollee obtains coverage under a healthcare plan through an insurance policy or a contract issued by a hospital and medical service corporation, whether by option or otherwise, the insurer or the hospital and […]
(a) A health maintenance organization shall annually on or before March 1 file a report verified by at least two (2) principal officers with the Insurance Commissioner covering the preceding calendar year. (b) (1) The report shall be on forms prescribed by the commissioner. (2) For the report to be filed March 1, 2002, and […]
(a) A health maintenance organization shall make available to its subscribers a list of providers upon enrollment and re-enrollment. (b) Every health maintenance organization shall provide within thirty (30) days to its subscribers a notice of any material change in the operation of the health maintenance organization, including any major change in its provider network, […]
(a) (1) After a health maintenance organization has been in operation twenty-four (24) months, it shall have an annual open enrollment period of at least one (1) month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for […]
(a) (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services. (2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by […]
With the exception of investments made in accordance with § 23-76-109(a)(1) and (2) and § 23-76-109(b), the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or other […]
(a) Deposit Requirements. (1) (A) All health maintenance organizations authorized to transact business in this state shall deposit through the Insurance Commissioner securities eligible for deposit under § 23-63-903 that at all times shall have a par or market value of not less than three hundred thousand dollars ($300,000), with the exception of limited benefit […]
(a) No health maintenance organization, or representative thereof, may knowingly cause or knowingly permit the use of advertising that is untrue or misleading, solicitation that is untrue or misleading, or any form of evidence of coverage that is deceptive. For purposes of this chapter: (1) A statement or item of information shall be deemed to […]
(a) After notice and hearing, the Insurance Commissioner may promulgate such reasonable rules as are necessary to provide for the licensing of agents. (b) “Agent” means a person directly or indirectly associated with a healthcare plan who engages in solicitation or enrollment.
