Penalty for late payment of claims by health carriers

1. Law
2. Arkansas Code
3. Public Utilities and Regulated Industries
4. Insurance
5. Trade Practices
6. Trade Practices Act
7. Penalty for late payment of claims by health carriers

1. (a)

   1. (1) A health carrier shall pay a penalty of twelve percent (12%) per annum for late payment of claims under a health insurance contract pursuant to rules promulgated by the Insurance Commissioner, without necessity for demand for payment by a claimant.

   2. (2) Hiring a third-party administrator or other person to process claims shall not relieve a health carrier of its obligation to pay this penalty.

2. (b) For purposes of this section:

   1. (1) “Claimant” means a person insured or covered by a health carrier, a provider holding a valid assignment from a person insured or covered by a health carrier, or a provider contracted with a health carrier, who is claiming a benefit under a health insurance contract;

   2. (2)

      1. (A) “Health carrier” means a health maintenance organization, hospital medical service corporation, or a disability insurance company.

      2. (B) “Health carrier” includes a self-insured governmental or church plan and third-party administrators that administer or adjust disability benefits for a disability insurer, hospital medical service corporation, health maintenance organization, self-insured governmental plan, or self-insured church plan.

      3. (C) “Health carrier” does not include:

         1. (i) An automobile insurer paying medical or hospital benefits under § 23-89-202(1) or a self-insured employer health benefits plan; or

         2. (ii) Any person, company, or organization licensed or registered to issue or who issues any insurance policy or insurance contract in this state as described in §§ 23-62-102 and 23-62-104 — 23-62-107 providing medical or hospital benefits for accidental injury or disability; and

   3. (3)

      1. (A) “Health insurance contract” means a disability insurance policy, a hospital medical service corporation contract, a health maintenance organization contract, or a plan document issued or provided by a health carrier.

      2. (B) “Health insurance contract” does not include a disability income insurance policy, a long-term care contract, a hospital indemnity contract, an accident-only contract, or any other form of disability insurance policy that provides a benefit as a result of a sickness or accident that does not directly cover expenses related to health care treatment.

Download our app to see the most-to-date content.