Free Medical Plans Study Guide
Arkansas Life, Accident & Health exam — Medical Plans.
Plan design (indemnity versus managed care, HMOs, PPOs, POS plans, cost sharing, the ACA) is covered in the national Medical Plans guide. The Arkansas Health exam adds a handful of state rules: HMO definitions (Ark. Code 23-76), clean-claim deadlines in Rule 43, external review under Rule 76, and the newborn coverage law.
HMOs in Arkansas
Under the Arkansas HMO law (23-76-102):
- An HMO is any person that undertakes to provide or arrange for one or more health care plans.
- An enrollee is an individual enrolled in a health care plan.
- The evidence of coverage is the certificate, agreement, contract, or ID card issued to an enrollee.
Paying health claims (Rule 43, Section 12)
| Claim | Pay or deny within |
|---|---|
| Clean claim submitted electronically | 30 days |
| Clean claim submitted on paper or other non-electronic means | 45 days |
A carrier that pays late owes a penalty starting on the 61st day. A health carrier answers a Department inquiry about a claim within 15 working days.
External review (Rule 76)
A covered person who receives an adverse determination may ask the Commissioner for standard external review within four months after receiving notice of the adverse determination or final adverse determination.
Newborn coverage (Ark. Code 23-79-129)
- A health policy covering family members must cover a newborn from the moment of birth, on the same basis as other family members.
- Coverage includes illness, injury, congenital defects, and premature birth.
- Routine nursery care and pediatric charges are covered for up to five full days in the hospital nursery, or until the mother is discharged if sooner.
- The insurer may require notice of the birth within 90 days, or by the next premium due date if later.
Unfair discrimination
- Arkansas prohibits unfair discrimination in A&H premiums or benefits between individuals of the same class and essentially the same hazard (23-66-206).
- Refusing coverage solely because a person is a victim of domestic abuse is unfair discrimination.
Common exam traps
- Clean claims: 30 days if electronic, 45 days if on paper.
- External review requests are due within four months and go to the Commissioner.
- Newborn coverage includes premature birth and up to five days of nursery care.
- The newborn notice window is 90 days, or the next premium due date if later.
Practice Medical Plans questions All Life, Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
