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054.00.32-10. OPTIONAL COVERAGE

AR ADC 054.00.32-10Arkansas Administrative Code

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule 32. Minimum Standards for Individual Policies or Certificates Issued upon Conversion from a Group Disability Insurance Policy
Ark. Admin. Code 054.00.32-10
054.00.32-10. OPTIONAL COVERAGE
Currentness
The insurer shall not be required to issue a converted policy covering any person if such person is or could be covered by Medicare (Title XVIII of the United States Social Security Act as added by the Social Security amendments of 1965 or as later amended or superseded). Furthermore, the insurer shall not be required to issue a converted policy covering any person if
(a)(i) such person is covered for similar benefits by another hospital, surgical, medial or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program; or
(ii) such person is eligible for similar benefits (whether or not covered therefor) under any arrangement of coverage for individuals in a group, whether on uninsured or uninsured basis, or
(iii) similar benefits are provided for or available to such person, pursuant to or in accordance with the requirements of any state or federal law, and
(b) the benefits provided under the sources referred to in (i) above for such person, or benefits provided or available under the sources referred to in (ii) and (iii) above for such person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards. The insurer's standards must bear some reasonable relationship to actual health care costs in the area in which the insured lives at the time of conversion and must be filed with the Commissioner of Insurance prior to their use in denying coverage.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.32-10, AR ADC 054.00.32-10
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