Act 736 OF 1987

ARKANSAS INSURANCE DEPARTMENT LEGAL DIVISION 1200 West Third Street Little Rock, AR 72201-1904 501-371-2820 FAX 501-371-2629 Bulletin 14-87 Act 736 OF 1987 June 5, 1987 Act 736 of 1987 directs the Insurance Commissioner for the State of Arkansas to prescribe a standard disability insurance claim form to be used by all disability insurers doing business in this State. The effective date of this legislation is July 20, 1987. Pursuant to this Act, the Commissioner is hereby directing all disability insurers transacting business in this State to use Form HCFA 1500 and Form UB-82/HCFA 1450 as the standard claim forms. Insurers must use and accept these forms after January 1, 1988. This Act does not prohibit insurers from accepting other claim forms submitted by insureds or providers. Copies of these forms may be obtained from the U.S. government Printing Office, North Capital and H Streets, Washington, D.C. 20401. Robert M. Eubanks, III INSURANCE COMMISSIONER