§ 23-86-111 — Group accident and health insurance - Payment of benefits when other like insurance exists

(a) (1) No contract of group accident and health insurance coverage sold, delivered or issued for delivery, renewed, or offered for sale in this state by an insurer, hospital and medical service corporation, or health maintenance organization, directly or indirectly providing indemnity, services, healthcare services, or cash to an individual as a result of hospitalization, medical or surgical treatment, or dental care, shall contain any provision for the denial or reduction of benefits because of the existence of other like insurance except to the extent that the aggregate benefits with respect to the covered medical expenses incurred under the contract and all other like insurance with other insurers, hospital and medical service corporations, or health maintenance organizations exceed all covered medical expenses incurred. (2) The term "other like insurance" may include group accident and health insurance or blanket accident and health insurance or group coverage provided by health maintenance organizations, hospital and medical service corporations, government insurance plans, except Medicaid, union welfare plans, employer or employee benefit organizations, or workers' compensation insurance or no-fault automobile coverage provided for or required by any statute. (b) (1) No group accident and health insurance policy providing disability income coverage sold, delivered or issued for delivery, renewed, or offered for sale in this state shall provide for reduction in the amount of the disability benefits payable to the insured to the extent of and because of the existence of other such coverage unless the policy provides a minimum amount payable, regardless of the reduction, of fifty dollars ($50.00) per month. (2) "Other such coverage" for which a reduction may be effected includes: (A) Governmental programs such as Social Security, the Arkansas Public Employees' Retirement System, the state workers' compensation system, and all other government-sponsored, mandatory plans or programs that provide for disability benefit coverage; (B) Disability or pension income coverages as established by the Insurance Commissioner through implementing rules; and (C) Such other programs, coverages, or permissible reductions as the commissioner may establish through rules. (3) The amount of any such reduction shall not be increased with any increase in the level of Social Security benefits payable that becomes effective after a claim commences. (4) The commissioner may also issue rules to implement this section and § 23-86-110 , including, but not limited to, the nature and timing of proofs of eligibility for Social Security benefits. (c) This section shall be applicable to all group contracts of accident and health insurance sold, delivered or issued for delivery, renewed, or offered for sale in this state, except group contracts for employees whose employer pays one hundred percent (100%) of the premiums.

Legislative History

Amended by Act 2019, No. 315,§ 2745, eff. 7/24/2019. Acts 1975, No. 900, §§ 1, 2; 1979, No. 806, § 1; 1981, No. 702, §§ 1, 2; A.S.A. 1947, §§ 66-3709, 66-3710; Acts 1999, No. 624, § 2; 2001, No. 1063, § 11.