A. “Commissioner” shall mean the Arkansas Insurance Commissioner;

B. “Insured” shall mean any individual or group insured under a minimum basic benefit policy issued pursuant to the provisions of Act 238 of 1991 and this Rule and Regulation;

C. “Insurer” means an insurer, health maintenance organization, hospital or medical services corporation offering a minimum basic benefit policy pursuant to Act 238 of 1991;

D. “Loss Ratio” means the percentage derived by dividing incurred claims (both reported and not reported) by the total premiums earned;

E. “Permitted Coverages” shall mean health or hospitalization coverage under a minimum basic benefit policy issued pursuant to Act 238 of 1991, under medicaid, medicare, limited benefit policies as defined by Rule and Regulation 18, COBRA or the provisions of Ark. Code Ann. §§ 23-86-114, 23-86-115 or 23-86-116;

F. “Minimum Basic Benefit Policy” shall mean a policy offered by an insurer to a qualified individual, qualified family, or qualified group pursuant to the provisions of Act 238 of 1991 and this rule;

G. “Qualified Family” means individuals all of whom are qualified individuals and all of whom are related by blood, marriage, or adoption;

H. “Qualified Group” means a group of twenty-five people or less, organized other than pursuant to Section 4 of Act 238 of 1991, in which each covered individual, or covered dependent of such covered individual, within the group is a qualified individual: provided a “qualified group” may include less than all employees of an employer;

I. “Qualified Individual” means an individual who is employed in or is a resident of Arkansas and who has been without health insurance coverage, other than Permitted Coverage, for the twelve (12) month period immediately preceding the effective date of a minimum basic benefit policy issued pursuant to Act 238 of 1991 and who meets reasonable underwriting standards; provided, children newborn to or adopted by an insured after the effective date of a policy issued to the insured pursuant to Act 238 which covers the insured and members of the insured's family, shall be considered qualified individuals.

J “Qualified Trust” means a group organized pursuant to Section 4 of Act 238 of 1991 in which each covered individual, or covered dependent of such covered individual, within the group is a qualified individual;

K. “Children's Preventive Health Care Services” means physiciande livered or physiciansupervised services for eligible dependents from birth through age six (6), with periodic physical examinations including medical history, physical examination, developmental assessment, anticipatory guidance and appropriate immunizations and laboratory tests, in keeping with prevailing medical standards;

L. “Periodic Physical Examinations” means the routine tests and procedures for the purpose of detection of abnormalities or malfunctions of bodily systems and parts according to accepted medical practice; and

M. “Primary and Preventive Care” means that medical care provided to a covered individual which constitutes the first level of entry into the health care system and includes routine diagnostic office visits, routine health screening not related to reproductive or sex organ systems, preventative immunizations and routine periodic physical examinations.

N. “Medically Necessary” means the treatment, services, medicines, or supplies necessary and appropriate for the diagnosis or treatment of a sickness or injury which is provided in accordance with generally accepted professional standards.