As used in this part:

1. (1)

   1. (A) “Cost effectiveness” means insurance premium payments are cost effective if the premiums, coinsurance, deductibles, and other cost-sharing obligations under a health plan, plus an amount for administrative costs, are likely to be less than the amount paid for equivalent Medicaid services.

   2. (B) HIPP is not cost effective when:

      1. (i) Private insurance premiums are used to meet a spend down obligation under the medically needy program;
      2. (ii) The client’s eligibility category is “aged”;

2. (2) “Covered benefits” means:

   1. (A) Medical assistance as defined in Section 1905 of the Social Security Act that is covered under the state Medicaid plan; and
   2. (B) Any additional services covered under a waiver approved by the Secretary of the United States Department of Health and Human Services;
3. (3) “Equivalent services” means healthcare treatment and services that correspond with covered benefits;

4. (4)

   1. (A) “Family members” means family members whom the Division of Medical Services may choose to enroll into the health plan who are not Medicaid eligible, if cost effective.

   2. (B)

      1. (i) For Medicaid-ineligible family members, the Division of Medical Services covers payment only for the premiums.
      2. (ii) Other cost-sharing expenses are not covered.
      3. (iii) The family member may reside in a different household;

5. (5)

   1. (A) “Group health plan” means any plan of an employer, or contributed to by an employer, including a self-insured plan, to provide health care, directly or otherwise, to the:

      1. (i) Employer’s employees;
      2. (ii) Former employees; or
      3. (iii) Families of employees or former employees.

   2. (B) A group health plan must meet Section 5000(b)(1) of the Internal Revenue Code of 1986, and includes continuation coverage pursuant to:

      1. (i) Title XXII of the Public Health Services Act;
      2. (ii) Section 4980B of the Internal Revenue Code of 1986; or
      3. (iii) Title IV of the Employee Retirement Income Security Act of 1974;

6. (6)

   1. (A) “Health plan” means any health insurance plan that, in exchange for premiums paid, pays benefits for medical services.
   2. (B) Medicare Part B premiums are excluded;
7. (7) “HIPP” means the Health Insurance Premium Payment program;
8. (8) “MMIS” means the Medicaid Management Information System; and

9. (9)

   1. (A) “Premium cost” means the premium cost which is determined by applying a premium factor for the percentage of clients who would receive services compared to those eligible for Medicaid.
   2. (B) This accounts for Arkansas’s costs being based on per client data instead of per eligible data.