SECTION 1.
AUTHORITY
This Rule is issued pursuant to Ark. Code Ann. §
23-99-1005
which requires the Arkansas Insurance Commissioner ("Commissioner") to develop
and promulgate a rule to implement Act 959 of 2015, "An Act to Regulate an
Insurer that Offers Vision Care Plans" ("Vision Care Plan Act of 2015").
SECTION 2.
DEFINITIONS
Unless otherwise separately defined in this rule and consistent
with state law, the terms or phrases as used in this rule shall follow the
definitions of such terms or phrases as defined under Section One (1) of the
Vision Care Plan Act of 2015, now codified in Ark. Code Ann. §
23-99-1001 et
seq., or as later amended.
SECTION
3.
PROHIBITED PRACTICES
A. Pursuant to Ark. Code Ann. §
23-99-1003(a),
a participating provider agreement between an insurer, vision care plan, or
vision care discount plan and a vision care provider shall not establish a fee
that a vision care provider shall charge for services or materials that are not
covered by a vision benefit plan or contract. A vision care insurer, vision
care plan or vision care discount plan shall not circumvent or avoid this
restriction by providing minimal or de minimus coverage for a service or
material, or by designating a service or material as "covered" as defined in
Ark. Code Ann. §
23-99-1002(1) and
(2).
B. Pursuant to Ark. Code Ann. §
23-99-1003(b),
a vision care provider shall not charge a fee for services or materials that is
more than the vision care provider's normal rate for the services or materials
if the services or materials are noncovered services or noncovered materials.
This restriction or limitation of a vision care provider's charges for fees to
not exceed normal rates for service or materials under Ark. Code Ann. §
23-99-1003(b)
is a reference to the vision care provider's charges or pricing to the insured
and not to a vision care provider's normal reimbursement fees or allowed
charges for such services or materials in a vision care plan or vision care
discount plan participation agreement.
C. Under Ark. Code Ann. §
23-99-1003(e),
a participating provider agreement between an insurer, vision care plan, or
vision care discount plan and a vision care provider shall not restrict or
limit, directly or indirectly, the vision care provider's choice of optical
labs or choice of sources and suppliers of services or materials provided by
the vision care provider to an individual who is insured by the
insurer.
SECTION 4.
APPLICATION OF VISION CARE PLAN ACT OF 2015
Pursuant to Ark. Code Ann. §
23-99-1005(c),
the Vision Care Plan Act of 2015 is applicable to all vision benefit plan or
contracts issued, renewed, or recredentialed in this state on and after July
22, 2015. The Arkansas Insurance Department ("Department") interprets the
Vision Care Plan Act of 2015 to apply to all contracts newly issued after July
22, 2015, or renewed after July 22, 2015, but also to apply to all vision care
provider contracts when they are recredentialed after the effective date of the
Act, even though a renewal process on the contract has not occurred.
SECTION 5.
EFFECTIVE
DATE
The effective date of this Rule shall be January 1,2017.
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