LegalFix

§ 23-79-153. Health insurance -- Closing a block of business

AR Code § 23-79-153 (2018) (N/A)
Copy with citation
Copy as parenthetical citation

(a) As used in this section:

(1) "Block of business" means a particular policy form or contract other than a group policy form or contract providing health insurance coverage that includes distinct benefits, services, and terms individually underwritten and issued by a carrier to one (1) or more individuals residing in the State of Arkansas;

(2) "Carrier" means an entity subject to the insurance laws of the State of Arkansas or the jurisdiction of the Insurance Commissioner that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, or a hospital medical service corporation;

(3) "Closed block of business" means a block of business that a carrier ceases to actively offer or sell to new applicants; and

(4) (A) "Health insurance coverage" means benefits consisting of medical, pharmaceutical, surgical, hospitalization, or similar goods or services for the purpose of preventing, alleviating, curing, or healing human illness provided directly or indirectly through insurance, reimbursement, or otherwise, including:

(i) Items and services paid under any policy or contract individually underwritten and issued by a carrier; and

(ii) Without limitation, the following classifications of individual policies or individual contracts offered by a carrier:

(a) Comprehensive major medical;

(b) Critical illness and specified disease;

(c) Dental;

(d) HMO and managed care;

(e) Industrial health;

(f) Medical and surgical outpatient benefits;

(g) Supplemental hospital indemnity; and

(h) Vision.

(B) "Health insurance coverage" does not include policies or contracts covering only:

(i) Accident, credit, disability income, or long-term care insurance;

(ii) Automobile medical payment insurance;

(iii) A Medicare supplemental policy as defined in 42 U.S.C. § 1395ss(g)(1), as it existed on January 1, 2005; or

(iv) Claims under the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.

(b)

(1) A block of business shall not be closed by a carrier unless the carrier pools the experience of the closed block of business with all blocks of business within the same classification previously closed by the carrier for the purpose of determining the percentage premium rate increase of any policy or contract within the closed block of business.

(2) The carrier shall not impose a rate penalty or surcharge under subdivision (b)(1) of this section beyond that which reflects the experience of the combined pool.

(c) The commissioner may approve other rate increases based upon:

(1) The size of the rate action;

(2) The experience of policy forms within a pool;

(3) The remaining amount of health insurance coverage in force by policy or contract form; and

(4) Other factors the commissioner considers appropriate.

(d) (1) Unless an insurer presents evidence satisfactory to the commissioner to the contrary, a block of business shall be presumed to be closed if the block of business has been in existence for more than twenty-four (24) months and:

(A) For a period of twenty-four (24) months, the number of contracts for the block of business has decreased by twelve percent (12%) or more; or

(B) The block of business has fewer than one hundred (100) policies or contracts in the State of Arkansas.

(2)

(A) The fact that a block of business does not meet one (1) of the presumptions set forth in this subsection shall not preclude a different determination by the commissioner.

(B) At the request of an insurer adversely affected by the commissioner's determination, the commissioner shall schedule a hearing within thirty (30) days after receipt of the request for a hearing.

(3)

(A) The closed block of business for a class of policies or contracts shall be determined at the time of a rate filing of any block of business within the class.

(B) In addition, other blocks of business within the same class shall be reviewed before submitting a proposed rate increase for the block of business.

(C) A justification for excluding the block of business from the closed block of business shall be included as part of the proposed rate increase.

(e)

(1) A carrier shall notify the commissioner in writing within thirty (30) days of its decision to close a block of business.

(2) The carrier shall provide any additional information requested by the commissioner within:

(A) Fifteen (15) business days of the request; or

(B) A later time if allowed by the commissioner.

(f) A carrier shall preserve for a period of not less than five (5) years in an identified location that is readily accessible for review by the commissioner all books and records relating to any action taken by the carrier under subsection (b) of this section.

(g) A carrier with the purpose of evading this section shall not:

(1) Offer or sell any policy or contract; or

(2) Provide false or misleading information about the active or closed status of a block of business.

LegalFix

Copyright ©2024 LegalFix. All rights reserved. LegalFix is not a law firm, is not licensed to practice law, and does not provide legal advice, services, or representation. The information on this website is an overview of the legal plans you can purchase—or that may be provided by your employer as an employee benefit or by your credit union or other membership group as a membership benefit.

LegalFix provides its members with easy access to affordable legal services through a network of independent law firms. LegalFix, its corporate entity, and its officers, directors, employees, agents, and contractors do not provide legal advice, services, or representation—directly or indirectly.

The articles and information on the site are not legal advice and should not be relied upon—they are for information purposes only. You should become a LegalFix member to get legal services from one of our network law firms.

You should not disclose confidential or potentially incriminating information to LegalFix—you should only communicate such information to your network law firm.

The benefits and legal services described in the LegalFix legal plans are not always available in all states or with all plans. See the legal plan Benefit Overview and the more comprehensive legal plan contract during checkout for coverage details in your state.

Use of this website, the purchase of legal plans, and access to the LegalFix networks of law firms are subject to the LegalFix Terms of Service and Privacy Policy.

We have updated our Terms of Service, Privacy Policy, and Disclosures. By continuing to browse this site, you agree to our Terms of Service, Privacy Policy, and Disclosures.
§ 23-79-153. Health insurance -- Closing a block of business