As used in this part:

1. (1) "Children's preventive healthcare services" means physician-delivered or physician-supervised services for eligible dependents from birth through age six (6), with periodic physical examinations including medical history, physical examination, developmental assessment, anticipatory guidance, and appropriate immunizations and laboratory tests, in keeping with prevailing medical standards;
2. (2) "Commissioner" shall mean the Insurance Commissioner;
3. (3) "Insured" shall mean any individual or group insured under a minimum basic benefit policy issued pursuant to the provisions of Acts 1991, No. 238, and this part;
4. (4) "Insurer" means an insurer, health maintenance organization, hospital, or medical services corporation offering a minimum basic benefit policy pursuant to Acts 1991, No. 238;
5. (5) "Loss ratio" means the percentage derived by dividing incurred claims (both reported and not reported) by the total premiums earned;
6. (6) "Medically necessary" means the treatment, services, medicines, or supplies necessary and appropriate for the diagnosis or treatment of a sickness or injury that is provided in accordance with generally accepted professional standards;
7. (7) "Minimum basic benefit policy" shall mean a policy offered by an insurer to a qualified individual, qualified family, or qualified group pursuant to the provisions of Acts 1991, No. 238, and this part;
8. (8) "Periodic physical examinations" means the routine tests and procedures for the purpose of detection of abnormalities or malfunctions of bodily systems and parts according to accepted medical practice;

9. (9) "Permitted coverages" shall mean health or hospitalization coverage under a minimum basic benefit policy issued pursuant to Acts 1991, No. 238, under:

   1. (A) Medicaid;
   2. (B) Medicare;
   3. (C) Limited benefit policies as defined by Minimum Standards for Accident and Health Insurance, 23 CAR pt. 86;
   4. (D) COBRA; or
   5. (E) The provisions of Arkansas Code § 23-86-114, § 23-86-115, or § 23-86-116;

10. (10) "Primary and preventive care" means that medical care provided to a covered individual which constitutes the first level of entry into the healthcare system and includes:

    1. (A) Routine diagnostic office visits;
    2. (B) Routine health screening not related to reproductive or sex organ systems;
    3. (C) Preventive immunizations; and
    4. (D) Routine periodic physical examinations;

11. (11) "Qualified family" means individuals all of whom are:

    1. (A) Qualified individuals; and

    2. (B) Related by:

       1. (i) Blood;
       2. (ii) Marriage; or
       3. (iii) Adoption;
12. (12) "Qualified group" means a group of twenty-five (25) people or less, organized other than pursuant to Section 4 of Acts 1991, No. 238, in which each covered individual, or covered dependent of such covered individual, within the group is a qualified individual, provided a "qualified group" may include less than all employees of an employer;
13. (13) "Qualified individual" means an individual who is employed in or is a resident of Arkansas and who has been without health insurance coverage, other than permitted coverage, for the twelve-month period immediately preceding the effective date of a minimum basic benefit policy issued pursuant to Acts 1991, No. 238, and who meets reasonable underwriting standards, provided, children newborn to or adopted by an insured after the effective date of a policy issued to the insured pursuant to Acts 1991, No. 238, that covers the insured and members of the insured's family, shall be considered qualified individuals; and
14. (14) "Qualified trust" means a group organized pursuant to Section 4 of Acts 1991, No. 238, in which each covered individual, or covered dependent of such covered individual, within the group is a qualified individual.

Codification Notes: The Consolidated Omnibus Budget Reconciliation Act (COBRA), which was enacted as Pub. L. No. 99-272.