Current through Register Vol. 49, No. 9, September, 2024
SECTION 1. PURPOSE
The purpose of this Rule is to set the standards and guidelines
under which agents for Health Maintenance Organizations can be licensed by the
State of Arkansas.
SECTION
2. AUTHORITY
The authority for this Rule is the power given to the Insurance
Commissioner for the State of Arkansas by Ark. Code Ann. §§
23-61-108,
23-61-701, et
seq.,
25-15-201, et
seq., and
23-76-120.
SECTION 3. EFFECTIVE DATE
The Rule shall be effective on September 1, 1995.
SECTION 4. APPLICABILITY AND SCOPE
This Rule shall apply to all individuals, corporate or
partnership agencies engaged in the business of marketing contracts, soliciting
enrollments, or offering memberships with a Health Maintenance Organization
("HMO").
SECTION 5.
DEFINITIONS
a) "Agent" means any individual
person who or corporation or partnership which engages in solicitation and
enrollment for any Health Maintenance Organization, but shall exclude any
salaried officer or employee who has duties that are primarily administrative
and who receives no commission for applications taken or enrollments
made.
b) "Applicant" means any
person, firm or corporation who has applied for a certificate of authority as a
Health Maintenance Organization, or who has applied for a license as an HMO
agent.
SECTION 6.
LICENSE QUALIFICATIONS
a) Every individual
person applying for an agent license shall be qualified as follows:
(1) Must be of legal age.
(2) Must be a resident of this state or a
licensed non-resident.
(3) Must be
appointed by a licensed Health Maintenance Organization or an applicant for
said Certificate of Authority.
(4)
Must be deemed by the Commissioner to be competent, trustworthy, financially
responsible and of good personal and business reputation.
(5) Must pass such written examination as
required by the Commissioner. Must complete required hours of pre-lieensure
education as is required by the Commissioner's Rule and Regulation 31,
"Educational Requirements for Insurance Agents".
(6) Must file letter of certification issued
within ninety (90) days, evidencing the resident HMO agent license is current
or in good standing from supervisory insurance official from state of domicile,
if a nonresident.
b)
Every corporate or partnership agency applying for an agent license shall be
qualified as follows:
(1) Must be domiciled
in this state or a licensed non-resident.
(2) Must file partnership articles or
agreement, if a general or limited partnership, resident or nonresident. Must
file registration from the Arkansas Secretary of State, if a limited Arkansas
partnership.
(3) Must file articles
of incorporation duly certified by the proper domiciliary state official, if a
resident or nonresident corporation. Must file registration from the Arkansas
Secretary of State, if a foreign corporation.
(4) Must be appointed by a licensed Health
Maintenance Organization or an applicant for said Certificate of Authority.
(5) Must file letters of
certification, issued within ninety (90) days evidencing the resident HMO
agency licensure and each individual agent from that state is current or in
good standing from supervisory insurance official from state of domicile, if a
nonresident.
SECTION
7. FEES
a) Licensure Fees
Payable by APPLICANT ONLY for Resident Agent/Agency License:
(1) There shall be a Thirty Dollar ($30.00)
examination fee paid to the Commissioner prior to examination of resident
individuals, and a $30.00 retake fee.
(2) There shall be a Thirty-Five Dollar
($35.00) regulatory fee (ALF fee per Rule 57) for each issuance/annual renewal
of each resident and non-resident agent and agency license.
b) Licensure Fees Payable by the
HEALTH MAINTENANCE ORGANIZATION on behalf of an Applicant for Agent/Agency
License:
(1) There shall be a Sixty Dollar
($60.00) initial/annual fee amount paid to the Commissioner for the
initial/annual renewal appointment of an INDIVIDUAL NONRESIDENT agent's
license.
(2) There shall be a Sixty
Dollar ($60.00) initial/annual fee amount paid to the Commissioner for the
initial/renewal appointment of a CORPORATE OR PARTNERSHIP AGENCY license from a
NONRESIDENT.
(3) There shall be a
Twenty Dollar ($20.00) initial/annual fee amount paid to the Commissioner for
the initial/renewal appointment of an INDIVIDUAL RESIDENT agent's
license.
(4) There shall be a Forty
Dollar ($40.00) initial/annual fee amount paid to the Commissioner for the
initial/renewal appointment of a CORPORATE OR PARTNERSHIP AGENCY license from a
RESIDENT.
(c) There
shall be a Ten Dollar ($10.00) fee paid to the Commissioner to cancel, nonrenew
or otherwise terminate an appointment on any RESIDENT or NONRESIDENT AGENT or
AGENCY license by either the agent, agency or HMO, per appointment.
(d) All fees shall be remitted to the Agent
License Division of the Department, and shall be payable to The State Insurance
Department Trust Fund with a check or money order from the Agent or Agency or
HMO as required by and appropriate with the Commissioner's Rule 57.
SECTION 8. TERM OF
LICENSE
Every license and HMO appointment issued under the Rule shall be
valid for the calendar, year when issued and each HMO appointment must he
renewed biennially on even numbered years contemporaneous with life and/or
disability insurance agent appointments under Ark. Code Ann. §§
23-64-221(c).
HMO agent licenses will be renewed when the Department receives the appointment
forms, Forms 1-45, the HMO appointment fees, and any ALF fees due or overdue
from the HMO agent or agency. The amount of fees filed for licenses issued in
odd-numbered years will vary. In addition, each resident HMO agent who is not
otherwise exempt must file certifications and the accompanying Rule 57 fee of
$10 for timely compliance with continuing education hours as mandated by the
Commissioner's Rule 50, "Agents' Continuing Education", to be eligible for
renewal licensure.
SECTION
9. REVOCATION AND SUSPENSION OF LICENSE
a) The Commissioner may suspend for not more
than twelve (12) months, or may revoke or refuse to continue any license issued
under this Rule, after written notice to the licensee and after a hearing is
held under the provisions of Ark Code Ann. §§
23-61-303, et
seq.; and the Commissioner finds that any one or more of the following causes
exist:
(1) Any cause for which issuance of the
license could have been refused had it then existed and been known to the
Commissioner,
(2) Violation of or
noncompliance with any provision of the Insurance Code, or for willful
violation of any rule, regulation or order of the Commissioner.
(3) Obtaining or attempting to obtain any
such license through fraud or misrepresentation.
(4) Misappropriation of or conversion to his
own use any moneys received through the course of business that do not belong
to him.
(5) Conviction of a
felony.
(6) If in the conduct of
his affairs, the licensee has used fraudulent, or dishonest practices, or trade
practices prohibited by the insurance code.
(7) Failure to provide a written response
after receipt of an written inquiry from the Commissioner or his representative
as to transactions under the license within thirty (30) days after receipt
thereof; or failure to notify the Commissioner promptly of any change of
address in" writing.
(8) Having an
insurance agent or broker license or HMO agent license or other insurance
license or registration suspended or revoked in this State or any other state,
province, district, or territory; or if the licensee no longer meets the
qualifications for licensure as described in this Rule and applicable laws.
(b) If the Commissioner
finds that any one (1) or more grounds exist for the suspension or revocation
of any license, the Commissioner may in his discretion, in lieu of or in
addition to such suspension or revocation, impose an administrative penalty in
the amount of three hundred dollars ($300), or if the Commissioner has found
willful misconduct or willful violation by the licensee, one thousand dollars
($1,000). The Commissioner may take judicial notice of prior sanction orders
issued against the licerisee in this or other licensed jurisdictions and
enhance or increase the penalties ordered in any current misconduct proceeding
as to the licensee, without an abuse of discretion. The Commissioner may in his
discretion order the licensee to pay restitution of actual losses to affected
persons as specified in an order/consent order against the licensee, in
addition to other sanctions imposed under this Rule.
c) The Commissioner may not again issue any
license under this Rule to any person whose license has been revoked until
after expiration of three (3) years, and upon the same conditions expressed in
Ark. Code Ann. §
23-64-219(c)
as for insurance agents and brokers.
SECTION 10. SEVERABILITY
Any section or provision of this Rule held by a court to be
invalid or unconstitutional will not affect the validity of any other section
or provision of this rule.
