Health plans - Arkansas

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).

Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply. Arkansas law includes the following provisions:

• If the plan covers family members, it must, unless it is limited to expenses from accidents or specified diseases, cover newborn infant children by the insured from the moment of birth. Coverage must include illness, injury, congenital defects, and premature birth, as well as tests for hypothyroidism, phenylketonuria, galactosemia, sickle-cell anemia, and all other disorders of metabolism for which screening is performed by or for the State of Arkansas, as well as any testing of newborn infants. §23-79-129
• Group plans must offer coverage for the necessary care and treatment of loss or impairment of speech or hearing, subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as other covered services in the policies or contracts. §23-79-130
• If the plan covers the insured and members of the insured's family, it must cover any minor under the charge, care, and control of the insured whom the insured has filed a petition to adopt. §23-79-137
• If the plan provides hospital and medical coverage on an expense incurred, service, or prepaid basis, it must offer benefits for the necessary care and treatment of alcohol and other drug dependency that are not less favorable than for physical illness generally. §23-79-139
• If the plan provides hospital and medical coverage on an expense-incurred, service, or prepaid basis, and covers family members of the insured person, it must provide to the contract holder coverage for periodic preventive care visits for covered persons from the moment of birth through eighteen (18) years of age. §23-79-141
• If the plan provides for mental health coverage, it must offer coverage for the payment of services rendered by psychological examiners. §23-79-142
• The plan may not directly or indirectly, restrict or deny health care coverage due to the fact that the minor child does not reside with the noncustodial parent or that the parent-child relationship was established through a paternity action or that the minor child is covered through the state-administered medicaid program, that the minor child is not claimed as a dependent on the noncustodial parent's federal or state income tax return, or because the child lives outside of its service area. §23-79-144
• If the plan covers prescription drugs, it must not limit or exclude coverage for any drug approved by the United States Food and Drug Administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States Food and Drug Administration for the treatment of the specific type of cancer for which the drug has been prescribed. §23-79-147
• Every health insurance policy shall include medical coverage for medically necessary equipment, supplies, and services for the treatment of Type I, Type II, and gestational diabetes, when prescribed by a physician licensed. §23-79-603
• If the plan includes eye and/or vision care benefits, it must include all primary eye care providers who are selected by covered persons of the plan for the provision of all eye and/or vision care benefits provided by the plan. §23-99-303
• Plans (except those of small employers) must cover the diagnosis and mental health treatment of mental illnesses and the mental health treatment of those with developmental disorders. §23-99-506
• With the passage of HB 2781 (Colorectal Cancer Act of 2005 – Act 2236), after August 1, 2005, covered plans must cover colorectal cancer examinations and laboratory tests. Coverage includes exams and tests for persons 50 or older, those less than 50 and at high risk, or persons experiencing symptoms. §23-79-1102
• As of January, 2005, HB 1064 (Act 94) provides for health savings account, allowing a deduction from income for amounts deposited to an HSA, and making HSAs exempt from tax. Employer contributions to an employee’s HSA are not to be included in the employee’s gross income. This applies to tax years beginning on or after January 1, 2004.
• Per HB 1030 (Act 75), plans that are offered, issued, or renewed on or after January, 2010 and cover men 40 years old or older must cover at least one screening per year for the early detection of prostate cancer for such men. §23-79-1303
• Plans are to cover mammograms and breast ultrasounds, which are to be available every year to women 40 years old and older, or upon recommendation of a doctor. §23-79-140(b)

Rules and regulations:

• Group health plans must cover one per lifetime training program per insured for diabetes self-management training, when medically necessary. Training which is compensable under the policy may include one or more visit from the physician or health care provider. The plan must also cover equipment, supplies, and services. §6 of Rule and regulation 71.
• Plans must not attempt to determine the enrollee or participant’s sexual orientation, nor discriminate against those with AIDS. §5 of Rule and regulation 42.
• Provisions of “the Arkansas Mental Parity Act” shall not apply to health benefit plans, if the Act’s application to such plans will result in an increase in the cost under the health benefit plan of at least one and one-half percent (1.5 percent). §4 of Rule and regulation 71.
• Every health insurance purchasing group, which offers a health benefits plan, which either in whole or in part, will not have state mandated health benefits, must provide each eligible employee with a written notice that the health benefits plan does not contain all state mandated benefits. §5 of Rule and regulation 78.

State

Contact

Arkansas Insurance Department

Regulations

Health insurance laws are found in the Arkansas Code at Title 23 (Public Utilities and Regulated Industries), Subtitle 3 (Insurance), Chapters 76 - Health maintenance organizations, 79 – Insurance policies generally, 86 – Group and blanket health and life insurance, and 99 Health care providers.

Insurance rules and regulations:

Minimum standards for accident and health insurance, Rule and regulation 18

Unfair discrimination, Rule and regulation 42

Mental health parity, Rule and regulation 71

Small employer purchasing groups, Rule and regulation 78

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

29 CFR chapter XXV (Parts 2509 – 2590)