Required Reports
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ARKANSAS INSURANCE DEPARTMENT
LEGAL DIVISION
1200 West Third Street
Little Rock, AR 72201-1904
501-371-2820
FAX 501-371-2629
Bulletin 1-98
March 2, 1998
REQUIRED REPORTS
The purpose of this Bulletin is to call attention of Health Maintenance Organizations (HMO’s) to certain required
reports that are to be submitted to this Department.
For HMO’s offering Point-of-Service contracts, a report is required to be filed on a quarterly and annual basis
providing the information required in Exhibit A of the Commissioner’s Guidelines of 1994. This authorized by
Ark. Code Ann. §23-76-109(a)(6)(C).
All HMO’s are required to file with the Commissioner and Director of the Department of Health an annual report of
complaints handled through the complaint system and a report of malpractice claims settled during the year. This is
required by Ark. Code. Ann. §23-76-116(a)(2)(A)-(C).
Samples of suggested report forms are enclosed.
These reports for 1997 were due March 1, 1998 and should have been submitted with the Annual Statement.
However, the report may be submitted separately by mailing to the Life and Health Division, Arkansas Insurance
Department, 1200 West Third Street, Little Rock, Arkansas 72201-1904.
Please note Arkansas Insurance Department Regulation 44 which requires a Complaint Register. The two (2)
reports required above are separate from the Regulation 44 Register. The Register is not submitted to the
Commissioner but maintained by the HMO and is subject to inspection by the Commissioner.
Copies of the aforementioned laws may be obtained from the Arkansas Secretary of State’s Office. Please do not
call this office to obtain copies of these laws.
Mike Pickens
INSURANCE COMMISSIONER
om the Regulation 44 Register. The Register is not submitted to the
Commissioner but maintained by the HMO and is subject to inspection by the Commissioner.
Copies of the aforementioned laws may be obtained from the Arkansas Secretary of State’s Office. Please do not
call this office to obtain copies of these laws.
Mike Pickens
INSURANCE COMMISSIONER
ARKANSAS
POINT OF SERVICE UTILIZATION ANALYSIS FOR QUARTERS
PHYSICAL REFERRAL AND HOSPITALIZATION COST ONLY
JANUARY --
MARCH
APRIL-
-
JUNE
TOTAL
JANUARY --
JUNE
In-Network Out-
Network
Total
In-
Network
Out-
Network
Total
In-
Network
Out-
Network
Total
Little
Rock
Fort
Smith
Percentage of In-Network Utilization
Year to Date
Percentage of Out-Network Utilization
NUMBER OF ENROLLEES COVERED BY POINT OF SERVICE
NUMBER OF GROUPS COVERED BY POINT OF SERVICE
SIZE OF GROUPS COVERED BY POINT OF SERVICE—LARGEST
SIZE OF GROUPS COVERED BY POINT OF SERVICE—SMALLEST
PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—1ST QUARTER
PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—2ND QUARTER
2
ARKANSAS
POINT OF SERVICE UTILIZATION ANALYSIS FOR QUARTERS (POS GROUPS ONLY)
PHYSICAL REFERRAL AND HOSPITALIZATION COST ONLY
JANUARY
--MARCH
APRIL-
JUNE
TOTAL
JANUARY
--JUNE
In-Network
Out-
Network
Total
In-
Network
Out-
Network
Total
In-
Network
Out-
Network
Total
Little
Rock
Fort Smith
Percentage of In-Network Utilization
Year to Date
Percentage of Out-Network Utilization
NUMBER OF ENROLLEES COVERED BY POINT OF SERVICE
NUMBER OF GROUPS COVERED BY POINT OF SERVICE
SIZE OF GROUPS COVERED BY POINT OF SERVICE—LARGEST
SIZE OF GROUPS COVERED BY POINT OF SERVICE—SMALLEST
PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—1ST QUARTER
PREMIUMS RECEIVE
Percentage of In-Network Utilization
Year to Date
Percentage of Out-Network Utilization
NUMBER OF ENROLLEES COVERED BY POINT OF SERVICE
NUMBER OF GROUPS COVERED BY POINT OF SERVICE
SIZE OF GROUPS COVERED BY POINT OF SERVICE—LARGEST
SIZE OF GROUPS COVERED BY POINT OF SERVICE—SMALLEST
PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—1ST QUARTER
PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—2ND QUARTER
3
HEALTH MAINENANCE ORGANIZATIONS
ARKANSAS ANNUAL MALPRACTICE CLAIMS REPORT
YEAR ________________
Enrollee Name
Date Received
Claimed Malpractice
Resolution
Date Resolved
This report is to be filed for each calendar year with the Arkansas Department of Health and the Arkansas Insurance
Department by March 1 of each year.
Required by Arkansas A.C.A. 23-76-116(a)(2)(C).
HMO 3
4
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.