§ 23-86-311 — Guaranteed renewability of coverage for employers in the group market

Arkansas § 23-86-311

• Jurisdiction: Arkansas
• Title: 23

Text

(a) In General. Except as provided in this section, if a health insurance issuer offers health insurance coverage in the small-group market or the large-group market in connection with a group health plan, the issuer must renew or continue in force that coverage at the option of the plan sponsor. (b) General Exceptions. A health insurance issuer may nonrenew or discontinue health insurance coverage offered in connection with a group health plan in the small-group market or the large-group market based only on one (1) or more of the following: (1) Nonpayment of Premiums. The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the health insurance issuer has not received timely premium payments; (2) Fraud. The plan sponsor has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage; (3) Violation of Participation or Contribution Rules. The plan sponsor has failed to comply with a material plan provision relating to employer contribution or group participation rules in the case of the small-group market or pursuant to applicable Arkansas law in the case of the large-group market; (4) Termination of Coverage. The issuer is ceasing to offer coverage in such a market in accordance with subsection (c) of this section and applicable state law; (5) Movement Outside Service Area. In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, there is no longer any enrollee in connection with the network plan who lives, resides, or works in the service area of the health insurance issuer, or in the area for which the health insurance issuer is authorized to do business, and, in the case of the small-group market, the health insurance issuer would deny enrollment with respect to the network plan under § 23-86-312(c)(1)(A) ; (6) Association Membership Ceases. In the case of health insurance coverage that is made available in the small-group market or the large-group market, as the case may be, only through one (1) or more bona fide associations, the membership of an employer in the bona fide association on the basis of which the coverage is provided ceases but only if the coverage is terminated under this subdivision (b)(6) uniformly without regard to any health status-related factor relating to any covered individual; (7) (A) If a health insurance issuer nonrenews or discontinues group health insurance coverage under subdivision (b)(1) of this section, the health insurance issuer shall provide written notice to the individual employees insured under the group health plan so that the employees will have no fewer than fourteen (14) days to acquire alternative health coverage without loss of creditable coverage due to a break in coverage, as provided under § 23-86-304(d)(4) . (B) The Insurance Commissioner shall determine by rule the form, content, and timing of the notice under subdivision (b)(7)(A) of this section. (c) Requirements for Uniform Termination of Coverage. (1) Particular Type of Coverage Not Offered. In any case in which a health insurance issuer decides to discontinue offering a particular type of group health insurance coverage offered in the small-group market or the large-group market, coverage of this type may be discontinued by the health insurance issuer in accordance with Arkansas law in such a market only if: (A) The health insurance issuer provides notice to each plan sponsor provided coverage of this type in such a market and participants and beneficiaries covered under that coverage of the discontinuation at least ninety (90) days prior to the date of the discontinuation of the coverage; (B) The health insurance issuer offers to each plan sponsor provided coverage of this type in such a market the option to purchase all or, in the case of the large-group market, any other health insurance coverage currently being offered by the health insurance issuer to a group health plan in such a market; and (C) In exercising the option to discontinue coverage of this type and in offering the option of coverage under subdivision (c)(1)(B) of this section, the health insurance issuer acts uniformly without regard to the claims experience of those sponsors or any health status-related factor relating to any participants or beneficiaries covered or new participants or beneficiaries who may become eligible for that coverage. (2) Discontinuance of All Coverage. (A) In General. In any case in which a health insurance issuer elects to discontinue offering all health insurance coverage in the small-group market or the large-group market, or both markets in this state, health insurance coverage may be discontinued by the health insurance issuer only in accordance with Arkansas law and if: (i) The health insurance issuer provides notice to the Insurance Commissioner and to each plan sponsor and participants and beneficiaries covered under the coverage of the discontinuation at least one hundred eighty (180) days prior to the date of the discontinuation of the coverage; and (ii) All health insurance issued or delivered for issuance in this state in the market or markets is discontinued and coverage under the health insurance coverage in the market or markets is not renewed. (B) Prohibition on Market Reentry. In the case of a discontinuation under subdivision (c)(2)(A) of this section in a market, the health insurance issuer may not provide for the issuance of any health insurance coverage in the market in this state during the five-year period beginning on the date of the discontinuation of the last health insurance coverage not so renewed. (d) Exception for Uniform Modification of Coverage. At the time of coverage renewal, a health insurance issuer may modify the health insurance coverage for a product offered to a group health plan: (1) In the large-group market; or (2) In the small-group market if, for coverage that is available in such a market other than only through one (1) or more bona fide associations, such a modification is consistent with Arkansas law and effective on a uniform basis among group health plans with that product. (e) Application to Coverage Offered Only Through Associations. In applying this subsection in the case of health insurance coverage that is made available by a health insurance issuer in the small-group market or the large-group market to employers only through one (1) or more associations, a reference to "plan sponsor" is deemed, with respect to coverage provided to an employer member of the association, to include a reference to such an employer.

Legislative History

Amended by Act 2019, No. 315,§ 2749, eff. 7/24/2019. Acts 1997, No. 997, § 1; 2003, No. 859, § 1.