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Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-79-2302. Definitions

Current as of March 28, 2024 | Updated by Findlaw Staff

As used in this subchapter:

(1) “Cost-sharing requirement” means a copayment, coinsurance, deductible, or annual limitation on cost sharing, including without limitation a limitation subject to the Patient Protection and Affordable Care Act, Pub. L. No. 111-148,  1 that is required by or on behalf of an enrollee in order to receive a specific healthcare service, including a prescription drug, covered by a health benefit plan;

(2) “Enrollee” means an individual entitled to healthcare services from a healthcare insurer;

(3)(A) “Health benefit plan” means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare insurer in this state.

(B) “Health benefit plan” does not include:

(i) Accident-only plans;

(ii) Specified disease plans;

(iii) Disability income plans;

(iv) Plans that provide only for indemnity for hospital confinement;

(v) Long-term-care-only plans that do not include pharmacy benefits;

(vi) Other limited-benefit health insurance policies or plans;

(vii) Health benefit plans provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., and the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;

(viii) A plan that provides only dental benefits or eye and vision care benefits; or

(ix) A program or plan authorized and funded under 42 U.S.C. § 1396a et seq.;

(4)(A) “Healthcare insurer” means an insurance company that is subject to state law regulating insurance and offers health insurance coverage under 42 U.S.C. § 300gg-91, as it existed on January 1, 2021, a health maintenance organization, or a hospital and medical service corporation.

(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;

(5) “Healthcare service” means an item or service provided to an individual for the purpose of preventing, alleviating, curing, or healing illness, injury, or physical disability; and

(6) “Person” means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government, or governmental subdivision or agency.

1 42 U.S.C.A. §300gg et seq.; 42 U.S.C.A. §18001 et seq.
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Cite this article: FindLaw.com - Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-79-2302. Definitions - last updated March 28, 2024 | https://codes.findlaw.com/ar/title-23-public-utilities-and-regulated-industries/ar-code-sect-23-79-2302/

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