{"data":{"id":"us-ar/ark.-code-ann.-23-99-1301","jurisdiction":"us-ar","citation":"Ark. Code Ann. § 23-99-1301","heading":"Definitions","body":"As used in this subchapter: (1) \"Contracting entity\" means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees; (2) \"Enrollee\" means a person who is entitled to receive healthcare services under the terms of a health benefit plan; (3) (A) \"Health benefit plan\" means a plan, policy, contract, certificate, agreement, or other evidence of coverage for healthcare services offered or issued by a healthcare insurer in this state. (B) \"Health benefit plan\" does not include: (i) A disability income plan; (ii) A credit insurance plan; (iii) Insurance coverage issued as a supplement to liability insurance; (iv) Medical payments under an automobile or homeowners insurance plan; (v) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vi) A plan that provides only indemnity for hospital confinement; (vii) An accident-only plan; (viii) A specified disease plan; (ix) A long-term care insurance plan; or (x) A vision-only plan; (4) \"Healthcare contract\" means a contract entered into, materially amended, or renewed between a contracting entity and a healthcare provider for the delivery of healthcare services to enrollees; (5) (A) \"Healthcare insurer\" means an entity that is subject to state insurance regulation and provides health insurance in this state. (B) \"Healthcare insurer\" includes: (i) An insurance company; (ii) A health maintenance organization; (iii) A hospital and medical service corporation; (iv) A risk-based provider organization; and (v) A sponsor of a nonfederal self-funded governmental plan; (6) \"Healthcare provider\" means a person or entity that is licensed, certified, or otherwise authorized by the laws of this state to provide healthcare services; (7) \"Healthcare services\" means services or goods provided for the purpose of preventing, diagnosing, treating, alleviating, relieving, curing, or healing human illness, disease, condition, disability, or injury; (8) \"Out-of-network provider\" means a healthcare provider that provides healthcare services to an enrollee but is not a participating provider; (9) \"Participating provider\" means a healthcare provider that has a healthcare contract with a contracting entity to provide healthcare services to enrollees with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity; and (10) \"Payor\" means a contracting entity or healthcare insurer responsible for payment for healthcare services provided to an enrollee under the terms of a healthcare contract or a health benefit plan. Amended by Act 2023, No. 831,§ 1, eff. 1/1/2024. Added by Act 2019, No. 736,§ 1, eff. 7/24/2019.\n\nAs used in this subchapter:\n\n(1) \"Contracting entity\" means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees;\n\n(2) \"Enrollee\" means a person who is entitled to receive healthcare services under the terms of a health benefit plan;\n, No. 736,§ 1, eff. 7/24/2019.\n\nAs used in this subchapter:\n\n(1) \"Contracting entity\" means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees;\n\n(2) \"Enrollee\" means a person who is entitled to receive healthcare services under the terms of a health benefit plan;\n\n(3) (A) \"Health benefit plan\" means a plan, policy, contract, certificate, agreement, or other evidence of coverage for healthcare services offered or issued by a healthcare insurer in this state. (B) \"Health benefit plan\" does not include: (i) A disability income plan; (ii) A credit insurance plan; (iii) Insurance coverage issued as a supplement to liability insurance; (iv) Medical payments under an automobile or homeowners insurance plan; (v) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vi) A plan that provides only indemnity for hospital confinement; (vii) An accident-only plan; (viii) A specified disease plan; (ix) A long-term care insurance plan; or (x) A vision-only plan;\n\n(A) \"Health benefit plan\" means a plan, policy, contract, certificate, agreement, or other evidence of coverage for healthcare services offered or issued by a healthcare insurer in this state.\n\n(B) \"Health benefit plan\" does not include: (i) A disability income plan; (ii) A credit insurance plan; (iii) Insurance coverage issued as a supplement to liability insurance; (iv) Medical payments under an automobile or homeowners insurance plan; (v) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vi) A plan that provides only indemnity for hospital confinement; (vii) An accident-only plan; (viii) A specified disease plan; (ix) A long-term care insurance plan; or (x) A vision-only plan;\n\n(i) A disability income plan;\n\n(ii) A credit insurance plan;\n\n(iii) Insurance coverage issued as a supplement to liability insurance;\n\n(iv) Medical payments under an automobile or homeowners insurance plan;\n\n(v) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;\n\n(vi) A plan that provides only indemnity for hospital confinement;\n\n(vii) An accident-only plan;\n\n(viii) A specified disease plan;\n\n(ix) A long-term care insurance plan; or\n\n(x) A vision-only plan;\n\n(4) \"Healthcare contract\" means a contract entered into, materially amended, or renewed between a contracting entity and a healthcare provider for the delivery of healthcare services to enrollees;\n\n(5) (A) \"Healthcare insurer\" means an entity that is subject to state insurance regulation and provides health insurance in this state. (B) \"Healthcare insurer\" includes: (i) An insurance company; (ii) A health maintenance organization; (iii) A hospital and medical service corporation; (iv) A risk-based provider organization; and (v) A sponsor of a nonfederal self-funded governmental plan;\n\n(A) \"Healthcare insurer\" means an entity that is subject to state insurance regulation and provides health insurance in this state.\n\n(B) \"Healthcare insurer\" includes: (i) An insurance company; (ii) A health maintenance organization; (iii) A hospital and medical service corporation; (iv) A risk-based provider organization; and (v) A sponsor of a nonfederal self-funded governmental plan;\n\n(i) An insurance company;\n\n(ii) A health maintenance organization;\n\n(iii) A hospital and medical service corporation;\n\n(iv) A risk-based provider organization; and\ner\" includes: (i) An insurance company; (ii) A health maintenance organization; (iii) A hospital and medical service corporation; (iv) A risk-based provider organization; and (v) A sponsor of a nonfederal self-funded governmental plan;\n\n(i) An insurance company;\n\n(ii) A health maintenance organization;\n\n(iii) A hospital and medical service corporation;\n\n(iv) A risk-based provider organization; and\n\n(v) A sponsor of a nonfederal self-funded governmental plan;\n\n(6) \"Healthcare provider\" means a person or entity that is licensed, certified, or otherwise authorized by the laws of this state to provide healthcare services;\n\n(7) \"Healthcare services\" means services or goods provided for the purpose of preventing, diagnosing, treating, alleviating, relieving, curing, or healing human illness, disease, condition, disability, or injury;\n\n(8) \"Out-of-network provider\" means a healthcare provider that provides healthcare services to an enrollee but is not a participating provider;\n\n(9) \"Participating provider\" means a healthcare provider that has a healthcare contract with a contracting entity to provide healthcare services to enrollees with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity; and\n\n(10) \"Payor\" means a contracting entity or healthcare insurer responsible for payment for healthcare services provided to an enrollee under the terms of a healthcare contract or a health benefit plan.","path":["AR Code","Title 23","Chapter 99","Subchapter 13"],"source_url":"https://oss-data-us.vaquill.ai/v2026.08/us_ar_statutes.parquet","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:41Z","sha256":"62beb2437e199bfac8ef624a47579fb4c757120dee6abe683fcd7cea563bc297","source_id":"us-ar","stale":false,"prev":"us-ar/ark.-code-ann.-23-99-1210","next":"us-ar/ark.-code-ann.-23-99-1302"},"notice":"GroundRules: Original legal text. Not legal advice."}