Act 511 Request Form

Act 511 (HB 1301) of the 2025 Legislative Session:

(f)(1) Upon request, a healthcare insurer or a pharmacy benefits manager shall send an eligibility file notification to a healthcare provider.

(2) An eligibility file notification under subdivision (f)(1) of this section shall indicate whether a subscriber is enrolled in a:

(A) Health benefit plan that is:

• Self-insured under the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406;
• A fully insured health benefit plan; or
• A self-funded health benefit plan;

(B) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state; or

(C) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased as a health benefit plan under Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual over four hundred percent (400%) of the federal poverty level.

In compliance with Act 511 of the 2025 Legislative Session, we are providing a way for providers to request limited eligibility data for patients that are our members. Please complete the fields noted below and submit. Information will be provided within 5 business days and will be sent using the contact information we have on file for the requesting provider. Please validate that your contact information on file with us is correct before submitting the request.