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054.00.119-7. Required Application Documentation

AR ADC 054.00.119-7Arkansas Administrative CodeEffective: December 5, 2019

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule119. Multiple-Employer Welfare Benefits Plan
Effective: December 5, 2019
Ark. Admin. Code 054.00.119-7
054.00.119-7. Required Application Documentation
(a) The Commissioner shall promptly review the documentation submitted by the applicant and shall have the power to conduct any investigation which may be necessary and to examine under oath any persons interested or connected with the multiple-employer welfare arrangement. Unless such time is extended by the Commissioner, within 60 days of the filing of the completed application, the Commissioner shall issue a certificate of authority provided that the provisions of this Rule are satisfied and the conditions in paragraphs (1)-(15) of this subsection have been met, as follows:
(1) the employers in the multiple-employer welfare arrangement have formed a valid MEWA as defined under Section 4(6) of this Rule and are composed of at least two (2) employers;
(2) the employee welfare plan of the association or group in the multiple-employer welfare arrangement is controlled and sponsored directly by participating employers, participating employees, or both;
(3) the association or group of employers in the multiple-employer welfare arrangement is a not-for-profit organization;
(4) for an association sponsored multiple-employer welfare arrangement, the association has been organized and maintained in good faith in active existence for at least two (2) years for purposes other than that of obtaining insurance or insuring members, employees, or employees of members of the association for the benefit of persons other than the association or its officers or trustees;
(5) the multiple-employer welfare arrangement has within its own organization adequate facilities and competent personnel, as determined by the Commissioner, to service the employee benefit plan or has contracted with a third party administrator that holds a current certificate of authority to engage in business in the State of Arkansas;
(6) the multiple-welfare arrangement has applications from not less than two (2) employers, and will provide similar benefits for not less than 200 separate participating employees, and the annual gross premiums or contributions to the plan will be not less than $20,000 for a plan that provides only vision benefits, $75,000 for a plan that provides only dental benefits and $200,000 for all other plans;
(7) the multiple-employer welfare arrangement possesses a written commitment, binder, or policy for stop-loss insurance issued by an insurer that has a certificate of authority to transact business in the State of Arkansas, providing not less than 30 days notice to the Commissioner of any cancellation or non-renewal of coverage; (this instrument shall provide both specific and aggregate coverage with an aggregate retention of no more than 125% of the amount of expected claims for the next plan year and any specific retention amount as determined by the Finance Division of the Arkansas Insurance Department);
(8) both the specific and aggregate coverage will require all claims to be submitted within 90 days after the claim is incurred and provide a 12-month claims incurred period and a 15-month paid claims period for each policy year;
(9) the contributions shall be set to fund at least 100% of the aggregate retention plus all other costs of the multiple-employer welfare arrangement;
(10) if the required reserves exceed the greater of 40% of the total contributions for the current plan year, or 40% of the total contributions expected for the current plan year, the contributions may be reduced to fund less than 100% of the aggregate retention plus all other costs of the multiple-employer welfare arrangement, but in no event less than the level of contributions necessary to fund the minimum reserves required;
(11) the reserves shall be established before a certificate of authority is issued;
(12) the multiple-employer welfare arrangement has established a procedure for handling claims for benefits in the event of dissolution of the multiple-employer welfare arrangement;
(13) the multiple-employer welfare arrangement has obtained the required fidelity bond;
(14) the multiple-employer welfare arrangement has submitted its plan document or any instrument describing the rights and obligations of the employers, employees and beneficiaries with respect to the multiple-employer welfare arrangement; and
(15) the multiple-employer welfare arrangement has submitted a summary plan description and has filed for review any notifications such as an identification card, policy or contract, in connection with the employee welfare benefit plan, which notifications include any of the disclosures set out in subparagraphs (A)-(D) of this paragraph, as follow [FN1]:
(A) that the multiple-employer welfare arrangement is insured from stop-loss insurance;
(B) that in the event the plan or the multiple-employer welfare arrangement does not ultimately pay medical expenses that are eligible for payment under the plan for any reason, the participating employer or its participating employee covered by the plan may be liable for those expenses;
(C) that, if applicable, the plan does not participate in the guaranty fund; such disclosure being provided in the same notice format required of insurers and health maintenance organizations in this State; and
(D) the toll-free number for the complaints section of the Arkansas Insurance Department consumer services division.
(b) Unless excepted by statute or by this Rule, a multiple-employer welfare arrangement may commence doing business in this state only after it receives its initial certificate of authority.
(c) The multiple-employer welfare arrangement shall appoint the Commissioner as its registered agent for service of process, by filing same on the prescribed form.

Credits

Adopted Dec. 5, 2019.
[FN1]
So in original.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.119-7, AR ADC 054.00.119-7
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