Key Takeaways
- Arkansas requires a 10-day free look period for individual health insurance policies
- Arkansas Insurance Department (AID) regulates health insurance including HMOs
- Arkansas uses the federal Healthcare.gov marketplace for ACA enrollment
- Pre-existing condition exclusions are prohibited in ACA-compliant plans
- Arkansas expanded Medicaid through the Arkansas Works program
Arkansas Health Insurance Policy Requirements
Arkansas regulates health insurance through state law and in coordination with federal ACA requirements. The Arkansas Insurance Department (AID) oversees all health insurance activities.
Regulatory Structure
Arkansas health coverage is regulated by AID:
| Agency | Regulates |
|---|---|
| AID | All health insurance, HMOs, PPOs |
| Dept. of Human Services | Medicaid, Arkansas Works |
| Health Dept. | Public health programs |
Free Look Period
Arkansas provides a 10-day free look period for individual health insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- Applies to individual health policies
- Same as life insurance free look period
Standard Policy Provisions
Arkansas health insurance policies must contain required provisions:
Mandatory Provisions
| Provision | Requirement |
|---|---|
| Grace Period | Minimum 31 days for premium payment |
| Reinstatement | Right to reinstate within time limit |
| Time Limit on Defenses | 2 years after issue |
| Claim Procedures | Written proof of loss within 90 days |
| Legal Actions | Time limits for filing suit |
Arkansas Health Insurance Marketplace
Arkansas uses the federal Healthcare.gov marketplace:
- Only place to get premium subsidies
- Open enrollment: November 1 - January 15
- Special enrollment periods for qualifying life events
- Premium tax credits available based on income
- Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
ACA Compliance in Arkansas
Arkansas's health insurance market operates under federal Affordable Care Act (ACA) requirements:
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Arkansas Works (Medicaid Expansion)
Arkansas expanded Medicaid through the Arkansas Works program:
- Premium assistance model using private insurance
- Available to adults with income up to 138% FPL
- Participants select marketplace plans
- Premiums subsidized by Medicaid
Pre-Existing Condition Protections
For ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual (ACA) | Prohibited |
| Small Group (ACA) | Prohibited |
| Large Group | Federal rules apply |
| Short-Term Plans | May apply |
Mental Health Parity
Arkansas follows federal mental health parity requirements:
- Mental health benefits must be equal to medical benefits
- Same copays, deductibles, and limits
- Covers mental illness and substance use disorders
- Applies to group and individual plans
Short-Term Health Insurance
Arkansas allows short-term health insurance with certain rules:
- Not ACA-compliant
- May exclude pre-existing conditions
- Limited duration allowed
- Different consumer protections than ACA plans
Which marketplace does Arkansas use for ACA health insurance enrollment?
What is the free look period for individual health insurance policies in Arkansas?
What is the Arkansas Works program?