Arkansas health-insurance questions blend national medical-plan design with a layer of Arkansas-specific continuation, conversion, and required-provision rules. This guide reviews the building blocks every health agent needs—plan types and cost-sharing—then makes the Arkansas overlay the spine: the state's small-group continuation ("mini-COBRA"), the conversion privilege, external review of denials, Medicaid through the Arkansas Department of Human Services, and the policy provisions the Arkansas Insurance Department enforces.

The national base: types of medical plans

Most health questions begin with how a plan balances cost, choice, and network:

• Indemnity / fee-for-service — pays a share of covered charges with broad provider choice; now uncommon.
• HMO (Health Maintenance Organization) — lowest cost, network-based care coordinated through a primary care physician (PCP) with referrals to specialists.
• PPO (Preferred Provider Organization) — a network with lower in-network cost but out-of-network access at a higher cost share, usually without referrals.
• EPO (Exclusive Provider Organization) — network-only like an HMO but typically no PCP/referral requirement.
• POS (Point of Service) — a hybrid using a PCP gatekeeper like an HMO while allowing out-of-network care like a PPO.

Universal cost-sharing terms apply across all designs: the premium (what you pay to have coverage), the deductible (paid before the plan shares), the copay (a flat per-visit charge), coinsurance (a percentage split after the deductible), and the out-of-pocket (OOP) maximum (the annual cap after which the plan pays 100% of covered, in-network care). A health savings account (HSA) must be paired with a qualified high-deductible health plan. Coverage is also sold group (employer-sponsored, lower cost, limited or no individual underwriting) versus individual (bought directly, now guaranteed issue under federal law).

The ACA floor (federal minimums)

The Affordable Care Act sets a national floor every Arkansas plan must meet:

• Guaranteed issue — insurers cannot decline an applicant for health reasons.
• No health rating — premiums vary only by age, geography, tobacco use, and family size, not health status.
• Pre-existing conditions covered — no exclusions or waiting periods for prior conditions.
• Essential health benefits — ten required categories (e.g., hospitalization, maternity, prescriptions, mental health, preventive care).
• Dependents to age 26 — adult children may stay on a parent's plan.

Arkansas builds on top of this floor; it does not subtract from it. Note that many ACA plans cover specified preventive services at no cost share to encourage early detection.

Arkansas mandated benefits

Like every state, Arkansas requires insured (non-self-funded) health plans to include certain state-mandated benefits that often exceed the federal minimum. Treat these by category rather than memorizing dollar caps, which change:

• Mental health and substance use coverage consistent with parity rules.
• Mammography and other cancer screenings; childhood immunizations.
• Maternity and newborn care, including minimum post-delivery stays.
• Diabetes self-management, supplies, and education.

Self-funded ERISA plans are generally exempt from state mandates—a common exam distinction.

Arkansas group continuation ("mini-COBRA")

Federal COBRA applies to employers with 20 or more employees and allows continuation generally up to 18 months (or 36 months for certain events such as divorce, death, or a dependent aging out). Arkansas fills the gap below the federal threshold with its own small-group continuation law, often called "mini-COBRA":

• Who: employees of small employers under 20 who therefore are not covered by federal COBRA.
• Eligibility: generally requires a period of prior continuous coverage (verify the current figure).
• How long: Arkansas continuation runs for a limited period (verify current durations, which differ for the employee versus dependent/spousal events such as death or divorce).
• Cost: the participant pays the full premium themselves.
• Notice/election: the employee must elect within the statutory window after notice of the right.

The exam loves the size split: 20+ employees → federal COBRA; under 20 → Arkansas mini-COBRA.

Conversion privilege

Separate from continuation, Arkansas group health coverage generally carries a conversion privilege. When group coverage (or continuation) ends, the insured may convert to an individual policy without new evidence of insurability, within a set time. Conversion coverage may offer narrower benefits, but it preserves access. On the exam, distinguish continuation (keeping the same group plan temporarily) from conversion (moving to an individual policy).

External review of denials

Arkansas gives an insured who disagrees with a health plan's final denial of a covered service the right to request an independent external review. An outside reviewer evaluates the plan's final adverse benefit determination—an important consumer protection that the Arkansas Insurance Department oversees. Know that external review exists and is distinct from the plan's internal appeal.

Arkansas Medicaid and the ACA marketplace

• Medicaid in Arkansas is administered by the Arkansas Department of Human Services (DHS)—the income-based public program (distinct from Medicare). DHS, not the Insurance Department, runs Medicaid.
• Arkansas expanded Medicaid through a premium-assistance approach (historically "Private Option," now commonly referred to as ARHOME), which uses Medicaid funds to buy qualified private coverage for eligible adults (verify the current program name and structure).
• For the ACA marketplace, Arkansas has used the federal platform with a state role; verify the current operational status and branding.

Required policy provisions and timelines

The Arkansas Insurance Department enforces standard health-policy provisions, including:

• Grace period — extra time to pay a late premium before the policy lapses (length varies by payment mode).
• Free look — a window (commonly at least 10 days for health policies) to return the policy for a full refund; verify the exact figure.
• Time limit on certain defenses (incontestability) — after the policy has been in force a stated period (commonly 2 years), the insurer generally cannot contest it for misstatements, with limited fraud exceptions.
• Time of payment of claims — insurers must pay covered claims promptly after acceptable proof of loss.
• Outline of coverage — delivered so the consumer can understand benefits and limitations before buying.

Key Arkansas numbers to memorize

Common exam traps

• Confusing COBRA and mini-COBRA. Federal COBRA = 20+ employees; Arkansas mini-COBRA covers employers under 20.
• Mixing up continuation and conversion. Continuation keeps the group plan temporarily; conversion moves to an individual policy with no new evidence of insurability.
• Sending Medicaid questions to the Insurance Department. Arkansas Medicaid is run by DHS.
• Forgetting external review. A final health-plan denial can go to an independent external reviewer.
• Assuming the ACA floor can be undercut. Guaranteed issue, no health rating, and pre-existing coverage are federal minimums Arkansas cannot reduce.
• Asserting exact mandate caps or durations. Treat figures as statutory and subject to change—hedge and verify.
• Forgetting self-funded ERISA plans are usually exempt from state mandates.

Quick recap

Arkansas medical-plan questions start with national design—HMO, PPO, EPO, POS, and indemnity—and the universal cost-sharing terms (premium, deductible, copay, coinsurance, OOP max, plus HSA + HDHP), along with the ACA floor: guaranteed issue, no health rating, pre-existing coverage, essential health benefits, and dependents to age 26. The Arkansas overlay is the spine: mini-COBRA continuation for employers under 20 (where federal COBRA's 20+ rule does not reach), a conversion privilege to individual coverage with no new underwriting, external review of final denials, Medicaid through DHS (expansion via ARHOME / premium assistance). Round it out with required provisions the Arkansas Insurance Department enforces—grace period, ~10-day free look, ~2-year incontestability, and prompt claim payment—verify any specific number, and the Arkansas health section becomes manageable.