§ 23-98-106 - Minimum basic benefits.
23-98-106. Minimum basic benefits.
(a) Minimum basic benefit policies offered under the authority of this chapter shall provide basic levels of primary, preventive, and hospital care, including, but not limited to, the following:
(1) Fifteen (15) days of inpatient hospitalization coverage per policy year;
(2) (A) As an option, prenatal care, including:
(i) One (1) prenatal office visit per month during the first two (2) trimesters of pregnancy;
(ii) Two (2) office visits per month during the seventh and eighth months of pregnancy; and
(iii) One (1) office visit per week during the ninth month until term.
(B) Coverage for each office visit shall include:
(i) Necessary and appropriate screening, including history, physical examination, and such laboratory and diagnostic procedures as may be deemed appropriate by the physician based upon recognized medical criteria for the risk group of which the patient is a member; and
(ii) Such prenatal counseling as the physician deems appropriate;
(3) As an option, obstetrical care, including physicians' services, delivery room, and other medically necessary hospital services;
(4) (A) As an option, coverage for children's preventive health care services on a periodic basis from birth through age six (6), including thirteen (13) visits at approximately the following age intervals:
(i) Birth;
(ii) Two (2) months;
(iii) Four (4) months;
(iv) Six (6) months;
(v) Nine (9) months;
(vi) Twelve (12) months;
(vii) Fifteen (15) months;
(viii) Eighteen (18) months;
(ix) Two (2) years;
(x) Three (3) years;
(xi) Four (4) years;
(xii) Five (5) years; and
(xiii) Six (6) years.
(B) The option may provide that children's preventive health care services which are rendered during a periodic review shall:
(i) Only be covered to the extent that these services are provided by or under the supervision of a single physician during the course of one (1) visit; and
(ii) Be reimbursed at levels established by the Insurance Commissioner which shall not exceed those established for the same services under the Medicaid program in the State of Arkansas.
(C) Copayment and deductible amounts shall not be greater than copayments and deductibles imposed for other physician's office visits;
(5) A basic level of primary and preventive care, including two (2) office visits per calendar year for covered services rendered by a provider licensed to provide the services rendered;
(6) Annual, lifetime, or other benefit limits in amounts not less than may be established by the commissioner but which initially shall be not less than one hundred thousand dollars ($100,000) as an annual benefit and two hundred fifty thousand dollars ($250,000) as a lifetime benefit;
(7) Such waiting period, if any, as the commissioner may establish for transferring from any minimum basic benefit policy issued under this chapter by one (1) insurer to a minimum basic benefit policy issued under this chapter by another insurer;
(8) (A) Every policy issued pursuant to this chapter which covers the insured and members of the insured's family shall include coverage for newborn infant children of the insured from the moment of birth, and for adopted minors from the date of the interlocutory decree of adoption.
(B) The insurer may require that the insured give notice to his or her insurer of any newborn children within ninety (90) days following the birth of the newborn infant and of any adopted child within sixty (60) days of the date the insured has filed a petition to adopt. The coverage of newborn children or adopted children shall not be less than the same as is provided for other members of the insured's family; and
(9) Such provisions, if any, as the commissioner may require, for:
(A) An annual or other deductible or equivalent;
(B) Patient copayments, including a differential, if any, for nonpreferred providers;
(C) Annual stop loss amounts;
(D) Continuation of coverage;
(E) Conversion;
(F) Replacement of prior carrier's coverage;
(G) Exclusionary periods for preexisting conditions; and
(H) Continuation of benefits.
(b) Notwithstanding the provisions of subsection (a) of this section, the commissioner shall consider the cost impact and essential nature of each of such requirements as well as the competitive impact of such requirements, and may vary any of such requirements, add, fix, or remove requirements or establish alternative benefit methods to encourage participation of insurers in a manner consistent with meeting the goal of providing minimum basic health services at an affordable price to those eligible for coverage under this chapter.
(c) The commissioner may authorize a waiver of any of the policy provisions required pursuant to this section or the commissioner's authority under this section in order to authorize a minimum basic benefit policy to be issued as a medicaid supplement without requiring redundant coverage.
(d) (1) Any minimum basic benefit policy issued pursuant to the provisions of this chapter may be issued without the provision of the benefitsor requirements mandated by the following statutes to be included in or offered to be included in accident and health insurance or health maintenance organization policies or subscription contracts or regulations issued pursuant to such statutes: 23-79-129, 23-79-130, 23-79-137, 23-79-139 -- 23-79-141, 23-85-131(b), 23-85-137, 23-86-108(4) and (7), 23-86-113 -- 23-86-116, and 23-86-118.
(2) However, nothing in this chapter shall:
(A) Reduce any professional scope of practice as defined in the licensure law for any health care provider;
(B) Authorize any discrimination not permitted under Arkansas law in payment or reimbursement for services; or
(C) Be construed to repeal or eliminate the application of the Arkansas freedom of choice legislation, 23-79-114, or coordination of benefit statutes or regulations to policies issued pursuant to this chapter.