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,
and Act 1004 of 1997, and other applicable laws.
SECTION 3
, EFFECTIVE DATE
The Rule shall be effective on April 1, 1998.
SECTION 4.
APPLICABILITY AND
SCOPE
This Rule shall apply to all individuals, limited liability
companies, and corporate or partnership (general or limited) agencies engaged
in the business of marketing contacts, soliciting enrollments, or offering
memberships with a Health Maintenance Organization ("HMO").
SECTION 5.
DEFINITIONS
a. "Agent" means any individual person who,
limited liability company which, or corporation or partnership (general or
limited) 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 who, or firm
or partnership (general or limited) which, limited liability company or
corporation which has applied for a certificate of authority as a Health
Maintenance Organization, or 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, or have the
disabilities of minority removed by a Court of law for general
purposes.
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 disability
examination or other appropriate examination as required by the Commissioner.
Must complete required hours of pre-licensure education as is required by the
Commissioner's Rule and Regulation 31, "Educational Requirements for Insurance
Agents".
6. Must file letter of
certificate 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 or
limited liability company 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 a certificate of organization from the
Arkansas Secretary of State if an Arkansas limited liability company. Must file
registration if required by 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.
If Commissioner contracts for these services, then the amount and
method of payment and due date of fees may be determined by the Vendor, subject
to Rule 57 or §
23-61-401.
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 LIMITED LIABILITY COMPANY 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 Twenty Dollar ($20.00)
initial/annual fee amount paid to the Commissioner for the initial/renewal
appointment of a CORPORATE OR LIMITED LIABILITY COMPANY OR PARTNERSHIP AGENCY
license from a RESIDENT.
c. There shall be a Ten Dollar ($10.00) fee
paid to the Commissioner to cancel, 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, except for payments to Vendors as permitted by the
Commissioner.
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 be
renewed biennially on even numbered years contemporaneous with life and/or
disability insurance agent appointments under Ark. Code Ann. §§
23-64-219(c)
as amended by Act 1004 of 1997. HMO agent licenses will be renewed when the
Department receives the appointment forms, Forms I-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 for timely compliance with continuing
education hours as mandated by the Commissioner's Rule 50, "Agents' Continuing
Education", as amended or hereinafter amended, to be eligible for renewal
licensure.
SECTION 9.
REVOCATION AND SUSPENSION OF LICENSE
a. The Commissioner may suspend for not more
than thirty-six months pursuant to Ark. Code Ann. §
23-64-216,
as amended by Act 1004 of 1997 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,
etseq., and/or
23-64-216,
as amended by Act 1004 of 1997; 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 the
licensee's own use or benefit any moneys received through the course of
business that do not belong to the licensee.
5. Conviction of or pleading of guilty or
nolo contendre to a felony, or any felony involving dishonesty or a breach of
trust.
6. If in the conduct of the
licensee's affairs, the licensee has used fraudulent or dishonest practices, or
trade practices prohibited by the insurance code or statutes and regulations of
the State.
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, unless waived in writing by the Commissioner; 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, providence,
district, or territory; or if the licensee no longer meets the qualifications
for
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 one thousand dollars under Act 1004 of 1997, or if the
Commissioner has found willful misconduct or willful violation by the licensee,
five thousand dollars ($5,000) under Act 1004 of 1997. The Commissioner may
take judicial notice of prior sanction orders issued against the licensee 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 §
23-64-216
as amended by Act 1004 of 1997, or 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. §
23-64-217(b)
as amended by Act 1004 of 1997 as for insurance agents and brokers, subject to
other applicable laws.
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.
