Arkansas Code
Subchapter 10 - Arkansas Works Act of 2016
§ 23-61-1003. Definitions

As used in this subchapter:
(1) “Cost-effective” means that the cost of covering employees who are:
(A) Program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through individual qualified health insurance plans; or
(B) Eligible individuals who are not program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through a program authorized under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as it existed on January 1, 2016;

(2) “Cost sharing” means the portion of the cost of a covered medical service that is required to be paid by or on behalf of an eligible individual;
(3) “Eligible individual” means an individual who is in the eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a;
(4) “Employer health insurance coverage” means a health insurance benefit plan offered by an employer or, as authorized by this subchapter, an employer self-funded insurance plan governed by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;
(5) “Health insurance benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, but not including excepted benefits as defined under 42 U.S.C. § 300gg-91(c), as it existed on January 1, 2016;
(6) “Health insurance marketplace” means the applicable entities that were designed to help individuals, families, and businesses in Arkansas shop for and select health insurance benefit plans in a way that permits comparison of available plans based upon price, benefits, services, and quality, and refers to either:
(A) The Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., or a successor entity; or
(B) The federal health insurance marketplace or federal health benefit exchange created under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148;

(7) “Health insurer” means an insurer authorized by the State Insurance Department to provide health insurance or a health insurance benefit plan in the State of Arkansas, including without limitation:
(A) An insurance company;
(B) A medical services plan;
(C) A hospital plan;
(D) A hospital medical service corporation;
(E) A health maintenance organization;
(F) A fraternal benefits society; or
(G) Any other entity providing health insurance or a health insurance benefit plan subject to state insurance regulation;

(8) “Individual qualified health insurance plan” means an individual health insurance benefit plan offered by a health insurer through the health insurance marketplace that covers only essential health benefits as defined by Arkansas rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they existed on January 1, 2016;
(9) “Premium” means a monthly fee that is required to be paid to maintain some or all health insurance benefits;
(10) “Program participant” means an eligible individual who:
(A) Is at least nineteen (19) years of age and no more than sixty-four (64) years of age with an income that meets the income eligibility standards established by rule of the Department of Human Services;
(B) Is authenticated to be a United States citizen or documented qualified alien according to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193;
(C) Is not eligible for Medicare or advanced premium tax credits through the health insurance marketplace; and
(D) Is not determined to be more effectively covered through the traditional Arkansas Medicaid Program, including without limitation:
(i) An individual who is medically frail; or
(ii) An individual who has exceptional medical needs for whom coverage offered through the health insurance marketplace is determined to be impractical, overly complex, or would undermine continuity or effectiveness of care; and

(11)
(A) “Small group plan” means a health insurance benefit plan for a small employer that employed an average of at least two (2) but no more than fifty (50) employees during the preceding calendar year.
(B) “Small group plan” does not include a grandfathered health insurance plan as defined in 45 C.F.R. § 147.140(a)(1)(i), as it existed on January 1, 2016.