Arkansas (AR)
Individual Health Insurance Regulations

Learn more about Arkansas Individual Health Insurance

Health insurance is the perfect solution for your family’s physical well-being. In the event of unforeseen circumstances, a suitable health coverage can save you from unexpected medical bills. Getting a health insurance policy can be challenging, but not impossible. You should evaluate your family’s medical needs and finances, before selecting a policy. If you are an Arkansas citizen, you can choose from wide range of health insurance alternatives. The Arkansas Insurance Department controls the regulations under which the Alaska health insurers can sell private health insurance to individuals and families.

Your eligibility to obtain individual health insurance in Arkansas is strongly influenced by your current and previous health status. Health insurance companies are permitted to accept or decline coverage to an individual, mainly because the health care costs for an individual would pose a risk on their claims ratios. For existing members, the insurance companies are permitted to look back 60 months at medical records to determine if any claim classifies as a pre-existing medical condition, in which case they may be able to deny payment of claim. Insurance companies may accept you for coverage, but place an elimination rider on the policy that exempts them from paying claims on the disclosed pre-existing medical condition. The Arkansas state has not provided the limits for exclusionary period for pre-existing medical conditions. Health insurance companies are also permitted to exclude any pre-existing medical condition for any period they choose, regardless of the insured’s prior health insurance. The costs for individual health coverage varies from one insurer to another.

If you are denied coverage for a pre-existing medical condition, you may be eligible for the Arkansas Comprehensive Health Insurance Pool.

Arkansas (AR)
Small Group Health Insurance Regulations

Arkansas law defines a small group as any employer with 2-50 employees including the owner. Insurance companies offering a small group product are required to accept any qualified group for coverage, regardless of the health status of any employee participating in that group. Insurance applications for group plans include health-related questions and the answers may influence the premium rates charged by the insurance company. The maximum rate adjustment factor is ±25% of the insurance company’s index rate, as approved by the Arkansas Insurance Department. For new members without prior health insurance coverage, as defined by federal HIPAA regulations, the insurance company can exclude paying benefits on pre-existing medical conditions for up to 12 months. The insurance company has the right to review into your 6-month health history for any pre-existing conditions.To qualify for small group coverage, your company must have at least 2 employees that are working for at least 6 months out of the year and, at least 20 hours per week for that business.

Arkansas COBRA and Continuation Coverage

Groups with 20 or more employees must fallow federal COBRA regulations which state that a departing employee is entitled to remain on the group health plan for a period of 18 months, provided that group health plan remains in existence. An employee who has left work on his own or was terminated from the job is eligible to be covered by COBRA. The one exception to this is if the former employer was fired for “gross misconduct”. COBRA provides health coverage to individuals and their beneficiaries, spouses and dependents. The COBRA recipient will be responsible for the payment of the entire the insurance premium that the employer was paying for his coverage as well as 2% administrative costs.

Arkansas Mini-COBRA

Arkansas also has a mini-COBRA (Act 997 of 1997) that applies to qualified employers with less than 20 employees. Under this law, continuation of coverage under the group health plan must be made available to individuals for 120 days (4 months), if that individual was insured under the group plan for at least 3 months. Once the mini-COBRA coverage expires, the individual may receive an option to convert his unemployed health coverage into an individual health insurance policy. Arkansas also offers a state sponsored program (see below) for individuals that have lost their COBRA coverage and are not eligible for individual coverage due to the pre-existing conditions.