Okla. Stat. tit. 36, § 36-4803 — OK Code / Title 36 / Section 36-4803
Standard policy provisions - Permissible variations
Status: in_force

A. The printed form of a policy of fire insurance as set forth

in subsection G of this section shall be known and designated as the

standard fire insurance policy to be used in the State of Oklahoma.

B. Except as provided in subsection F of this section, no

policy or contract of fire insurance shall be made, issued or

delivered by any insurer or by any agent or representative thereof,

on any property in the state, unless it shall conform as to all

Oklahoma Statutes - Title 36. Insurance Page 1005

provisions, stipulations, agreements and conditions, with such form

of policy.

There shall be printed at the head of said policy the name of

the insurer or insurers issuing the policy; the location of the home

office or United States Office thereof; a statement as to whether

said insurer or insurers are stock or mutual corporations or are

reciprocal insurers or Lloyd's underwriters; and there may be added

to the policy such device or devices as the insurer or insurers

issuing said policy shall desire. Any company organized under

special charter provisions may so indicate upon its policy, and may

add to the policy a statement of the plan under which it operates in

this state.

If the policy is issued by a mutual, cooperative or reciprocal

insurer having special regulations with respect to the payment by

the policyholder of assessments, such regulations shall be made a

part of the policy, and any such insurer may print upon the policy

such regulations as may be appropriate to or required by its home

state or its form of organization.

There may also be added a statement of the group insurers with

which the insurer is financially affiliated.

In lieu of the facsimile signatures of the president and

secretary of the insurer there may be used the name or names of such

officers or managers as are authorized to execute the contract.

C. Appropriate forms of additional contracts, riders or

endorsements, insuring against indirect or consequential loss or

damage or against any one or more perils other than those of fire

and lightning, or providing coverage which the insurer issuing the

policy is authorized by charter and by the laws of this state to

assume or issue, may be issued in connection with the standard fire

policy.

Such other perils or coverages may include those excluded in the

standard fire insurance policy, and may include any of the perils or

coverages permitted to be insured against or issued by property and

casualty insurers. Such forms of contracts, riders and endorsements

may contain provisions and stipulations inconsistent with such

standard fire insurance policy, if said provisions and stipulations

are applicable only to such additional coverage or to the additional

peril or perils insured against.

D. Provisions to be contained on the first page of the policy

may be rewritten, supplemented, or rearranged to facilitate policy

issuance and to include matter which may otherwise properly be added

by endorsement.

The pages of the standard fire insurance policy may be

renumbered and the format rearranged for convenience in the

preparation of individual contracts, and to provide space for the

listing of rates and premiums for coverages insured hereunder or

under endorsements attached or printed thereon, and such other data

Oklahoma Statutes - Title 36. Insurance Page 1006

as may be conveniently included for duplication on daily reports for

office records.

E. There may be printed upon the standard fire policy the words

"Standard Fire Insurance Policy for Oklahoma", and there may be

inserted before and after the word "Oklahoma" a designation of any

state or states in which such form of policy is standard.

There may be endorsed on any such policy the name, with the word

"agent" or "agents" and place of business, or any insurance agent or

agents either by writing, printing, stamping or otherwise.

F. Notwithstanding any other provision of this section, the

Insurance Commissioner may approve for use within the state any form

of policy with variations in terms and conditions from the standard

fire insurance policy provided for in this section.

G. The form of the standard fire insurance policy, with

permission to substitute for the word "company" a more accurate

descriptive term for the type of insurer, shall be as follows:

(FIRST PAGE OF) STANDARD FIRE INSURANCE POLICY

NO.

(Space for insertion of name of company or companies issuing the

policy and other matter permitted to be stated at the head of the

policy.)

(Space for listing amounts of insurance, rates and premiums for the

basic coverages insured under the standard form of policy and for

additional coverages or perils insured under endorsements attached.)

IN CONSIDERATION OF THE PROVISIONS AND STIPULATIONS HEREIN OR ADDED

HERETO AND OF the premium above specified, this Company, for the

term of from at Noon (Standard Time) to

at Noon (Standard Time)

at location of property involved, to an amount not exceeding the

amount(s) above specified, does insure

and legal representatives, to the extent of the actual cash value of

the property at the time of loss, but not exceeding the amount which

it would cost to repair or replace the property with material of

like kind and quality within a reasonable time after such loss,

without allowance for any increased cost of repair or reconstruction

by reason of any ordinance or law regulating construction or repair,

and without compensation for loss resulting from interruption of

business or manufacture, nor in any event for more than the interest

of the insured, against all DIRECT LOSS BY FIRE, LIGHTNING AND BY

REMOVAL FROM PREMISES ENDANGERED BY THE PERILS INSURED AGAINST IN

THIS POLICY, EXCEPT AS HEREINAFTER PROVIDED, to the property

described hereinafter while located or contained as described in

this policy, or pro rata for five days at each proper place to which

any of the property shall necessarily be removed for preservation

from the perils insured against in this policy, but not elsewhere.

Assignment of this policy shall not be valid except with the

written consent of this Company.

Oklahoma Statutes - Title 36. Insurance Page 1007

This policy is made and accepted subject to the foregoing

provisions and stipulations and those hereinafter stated, which are

hereby made a part of this policy, together with such other

provisions, stipulations and agreements as may be added hereto, as

provided in this policy.

IN WITNESS WHEREOF, this Company has executed and attested these

presents; but this policy shall not be valid unless countersigned by

the duly authorized Agent of this Company at

___________________________________________________________________

___________________________________________________________________

Signature of proper officer or officers.

Countersigned this ______________ day of ______________, 19_________

Agent.

(SECOND PAGE OF) STANDARD FIRE INSURANCE POLICY

Concealment, fraud. This entire policy shall be void if,

whether before or after a loss, the insured has willfully concealed

or misrepresented any material fact or circumstance concerning this

insurance or the subject thereof, or the interest of the insured

therein, or in case of any fraud or false swearing by the insured

relating thereto.

Uninsurable and excepted property. This policy shall not cover

accounts, bills, currency, deeds, evidences of debt, money or

securities; nor, unless specifically named hereon in writing,

bullion or manuscripts.

Perils not included. This Company shall not be liable for loss

by fire or other perils insured against in this policy caused,

directly or indirectly, by: (a) enemy attack by armed forces,

including action taken by military, naval or air forces in resisting

an actual or an immediately impending enemy attack; (b) invasion;

(c) insurrection; (d) rebellion; (e) revolution; (f) civil war; (g)

usurped power; (h) order of any civil authority except acts of

destruction at the time of and for the purpose of preventing the

spread of fire, provided that such fire did not originate from any

of the perils excluded by this policy; (i) neglect of the insured to

use all reasonable means to save and preserve the property at and

after a loss, or when the property is endangered by fire in

neighboring premises; (j) nor shall this Company be liable for loss

by theft.

Other Insurance. Other Insurance may be prohibited or the

amount of insurance may be limited by endorsement attached hereto.

Conditions suspending or restricting insurance. Unless

otherwise provided in writing added hereto this Company shall not be

liable for loss occurring

(a) while the hazard is increased by any means within the

control or knowledge of the insured; or

Oklahoma Statutes - Title 36. Insurance Page 1008

(b) while a described building, whether intended for occupancy

by owner or tenant, is vacant or unoccupied beyond a period of sixty

consecutive days; or

(c) as a result of explosion or riot, unless fire ensues, and

in that event for loss by fire only.

Other perils or subjects. Any other peril to be insured against

or subject of insurance to be covered in this policy shall be by

endorsement in writing hereon or added hereto.

Added provisions. The extent of the application of insurance

under this policy and of the contribution to be made by this Company

in case of loss, and any other provision or agreement not

inconsistent with the provisions of this policy, may be provided for

in writing added hereto, but no provision may be waived except such

as by the terms of this policy is subject to change.

Waiver provisions. No permission affecting this insurance shall

exist, or waiver of any provision be valid, unless granted herein or

expressed in writing added hereto. No provision, stipulation or

forfeiture shall be held to be waived by any requirement or

proceeding on the part of this Company relating to appraisal or to

any examination provided for herein.

Cancellation of policy. This policy shall be canceled at any

time at the request of the insured, in which case this Company

shall, upon demand and surrender of this policy refund the excess of

paid premium above the customary short rates for the expired time.

This policy may be canceled at any time by this Company by giving to

the insured a five days' written notice of cancellation with or

without tender of the excess of paid premium above the pro rata

premium for the expired time, which excess, if not tendered shall be

refunded on demand. Notice of cancellation shall state that said

excess premium (if not tendered) will be refunded on demand.

Mortgagee interests and obligations. If loss hereunder is made

payable, in whole or in part, to a designated mortgagee not named

herein as the insured, such interest in this policy may be canceled

by giving such mortgagee a ten days' written notice of cancellation.

If the insured fails to render proof of loss such mortgagee,

upon notice, shall render proof of loss in the form herein specified

within sixty (60) days after, and shall be subject to the provisions

hereof relating to appraisal and time of payment and of bringing

suit. If this Company shall claim that no liability existed as to

the mortgagor or owner, it shall, to the extent of payment of loss

to the mortgagee, be subrogated to all the mortgagee's rights of

recovery, but without impairing mortgagee's right to sue, or it may

pay off the mortgage debt and require an assignment thereof and of

the mortgage. Other provisions relating to the interests and

obligations of such mortgagee may be added hereto by agreement in

writing.

Oklahoma Statutes - Title 36. Insurance Page 1009

Pro rata liability. This Company shall not be liable for a

greater proportion of any loss than the amount hereby insured shall

bear to the whole insurance covering the property against the peril

involved, whether collectible or not.

Requirements in case loss occurs. The insured shall give

immediate written notice to this Company of any loss, protect the

property from further damage, forthwith separate the damaged and

undamaged personal property, put it in the best possible order,

furnish a complete inventory of the destroyed, damaged and undamaged

property, showing in detail quantities, costs, actual cash value and

amount of loss claimed; and within sixty days after the loss, unless

such time is extended in writing by the Company, the insured shall

render to this Company a proof of loss, signed and sworn to by the

insured, stating the knowledge and belief of the insured as to the

following: the time and origin of the loss, the interest of the

insured and of all others in the property, the actual cash value of

each item thereof and the amount of loss thereto, all encumbrances

thereon, all other contracts of insurance, whether valid or not,

covering any of said property, any changes in the title, use,

occupation, location, possession or exposures of said property since

the issuing of this policy, by whom and for what purpose any

building herein described and the several parts thereof were

occupied at the time of loss and whether or not it then stood on

leased ground, and shall furnish a copy of all the descriptions and

schedules in all policies and, if required, verified plans and

specifications of any building, fixtures or machinery destroyed or

damaged. The insured, as often as may be reasonably required, shall

exhibit to any person designated by this Company all that remains of

any property herein described, and submit to examinations under oath

by any person named by this Company, and subscribe the same, and as

often as may be reasonably required, shall produce for examination

all books of account, bills, invoices and other vouchers or

certified copies thereof if originals be lost, at such reasonable

time and place as may be designated by this Company or its

representative, and shall permit extracts and copies thereof to be

made.

Appraisal. In case the insured and this Company shall fail to

agree as to the actual cash value or the amount of loss, then, on

the written demand of either, each shall select a competent and

disinterested appraiser and notify the other of the appraiser

selected within twenty (20) days of such demand. The appraisers

shall first select a competent and disinterested umpire; and failing

for fifteen (15) days to agree upon such umpire, then, on request of

the insured or this Company, after notice of hearing to the

nonrequesting party by certified mail, such umpire shall be selected

by a judge of a district court in the county where the loss

occurred. The appraisers shall then appraise the loss, stating

Oklahoma Statutes - Title 36. Insurance Page 1010

separately actual cash value and loss to each item, and, failing to

agree, shall submit their differences, only, to the umpire. An

award in writing, so itemized, of any two when filed with this

Company shall determine the amount of actual cash value and loss.

Each appraiser shall be paid by the party selecting him and the

expenses of appraisal and umpire shall be paid by the parties

equally.

Company's option. It shall be optional with this Company to

take all, or any part, of the property at the agreed or appraised

value, and also to repair, rebuild or replace the property destroyed

or damaged with other of like kind and quality within a reasonable

time, on giving notice of its intention so to do within thirty days

after the receipt of the proof of loss herein required.

Abandonment. There can be no abandonment to this Company of any

property.

When loss payable. The amount of loss for which this Company

may be liable shall be payable sixty days after proof of loss, as

herein provided, is received by this Company and ascertainment of

the loss is made either by agreement between the insured and this

Company expressed in writing or by the filing with this Company of

an award as herein provided.

Suit. No suit or action on this policy for the recovery of any

claim shall be sustainable in any court of law or equity unless all

the requirements of this policy shall have been complied with, and

unless commenced within twelve months next after inception of the

loss.

Subrogation. This Company may require from the insured an

assignment of all right of recovery against any party for loss to

the extent that payment therefor is made by this Company.

(THIRD PAGE OF) STANDARD FIRE INSURANCE POLICY

ATTACH FORMS BELOW THIS LINE

____________________________________________________________

(BACK OF STANDARD FIRE INSURANCE POLICY)

Expires________________________

Property______________________

Total

Amount $______Premiums $______

Insured________________________

_________________________________________________

SEE INSIDE OF POLICY FOR

PERILS COVERED

No.________________________

(COMPANY)

It is important that the written portions of all policies covering

the same property read exactly alike. If they do not, they should

be made uniform at once.

Oklahoma Statutes - Title 36. Insurance Page 1011
Okla. Stat. tit. 36, § 36-6470.27 — OK Code / Title 36 / Section 36-6470.27
Standards ensuring exercise of control of risk
Status: in_force

management function of insured controlled unaffiliated business –

Regulations.

The Insurance Commissioner shall promulgate regulations

establishing standards to ensure that a parent or affiliated company

is able to exercise control of the risk management for any

controlled unaffiliated business to be insured by a pure captive

insurance company; however, until such time as these regulations are

promulgated, the Insurance Commissioner may by temporary order grant

authority to a pure captive insurance company to insure risks.
Okla. Stat. tit. 36, § 36-1435.29 — OK Code / Title 36 / Section 36-1435.29
Prelicensing and continuing education
Status: in_force

A. 1. Each insurance producer, with the exception of title

producers and aircraft title producers or any other producer exempt

by rule, shall, biennially, complete not less than twenty-one (21)

clock hours of continuing insurance education. Such education may

include a written or oral examination.

2. Licensees, with the exception of title producers and

aircraft title producers or any other producer exempt by rule, shall

complete, in addition to the foregoing, three (3) clock hours of

ethics course work in this same period.

3. Each title producer and aircraft title producer shall,

biennially, complete not less than sixteen (16) clock hours of

continuing insurance education, two (2) hours of which shall be

ethics course work, which shall cover the line for which the

producer is licensed. Such education may include a written or oral

examination.

B. 1. The Insurance Commissioner shall approve courses and

providers of continuing education. The Insurance Department may use

one or more of the following to review and provide a nonbinding

recommendation to the Insurance Commissioner on approval or

disapproval of courses and providers of continuing education:

a. employees of the Insurance Commissioner,

b. a continuing education advisory committee, or

c. an independent service whose normal business

activities include the review and approval of

continuing education courses and providers. The

Commissioner may negotiate agreements with such

independent service to review documents and other

materials submitted for approval of courses and

providers and provide the Commissioner with its

nonbinding recommendation. The Commissioner may

require such independent service to collect the fee

charged by the independent service for reviewing

materials provided for review directly from the course

providers.

The Insurance Commissioner has sole authority to approve courses

and providers of continuing education. If the Insurance

Commissioner uses one of the entities listed above to provide a

nonbinding recommendation, the Commissioner shall adopt or decline

Oklahoma Statutes - Title 36. Insurance Page 364

to adopt the recommendation within thirty (30) days of receipt of

the recommendation. In the event the Insurance Commissioner takes

no action within said thirty-day period, the recommendation made to

the Commissioner will be deemed to have been adopted by the

Commissioner.

The Insurance Commissioner may certify providers and courses

offered for license examination study. The Insurance Department

shall use employees of the Insurance Commissioner to review and

certify license examination study program providers and courses.

2. Each insurance company shall be allowed to provide

continuing education to insurance producers as required by this

section; provided that such continuing education meets the general

standards for education otherwise established by the Insurance

Commissioner.

3. An insurance producer who, during the time period prior to

renewal, participates in a professional designation program,

approved by the Insurance Commissioner, shall be deemed to have met

the biennial requirement for continuing education.

The curriculum for the program shall total a minimum of twenty-

four (24) hours within a twenty-four-month period. Each approved

professional designation program included in this section shall be

reviewed for quality and compliance every two (2) years in

accordance with standardized criteria promulgated by rule.

Continuation of approved status is contingent upon the findings of

the review. The list of professional designation programs approved

under this paragraph shall be made available to producers and

providers annually.

4. The Insurance Department may promulgate rules providing that

courses or programs offered by professional associations shall

qualify for presumptive continuing education credit approval. The

rules shall include standardized criteria for reviewing the

professional associations’ mission, membership, and other relevant

information, and shall provide a procedure for the Department to

disallow all or part of a presumptively approved course.

Professional association courses approved in accordance with this

paragraph shall be reviewed every two (2) years to determine whether

they continue to qualify for continuing education credit.

5. Subject to approval by the Commissioner, the active

membership of the licensed producer or broker in local, regional,

state, or national professional insurance organizations or

associations may be approved for up to one (1) annual hour of

instruction. The hour shall be credited upon timely filing with the

Commissioner, or designee of the Commissioner, and appropriate

written evidence acceptable to the Commissioner of such active

membership in the organization or association.

6. The active service of a licensed producer as a member of a

continuing education advisory committee, as described in paragraph 1

Oklahoma Statutes - Title 36. Insurance Page 365

of this subsection, shall be deemed to qualify for continuing

education credit on an hour-for-hour basis.

C. 1. Annual fees and course submission fees shall be set

forth as a rule by the Commissioner. The fees are payable to the

Insurance Commissioner. Provided, public-funded educational

institutions, federal agencies, nonprofit organizations, not-for-

profit organizations, and state agencies shall be exempt from this

subsection.

2. The Commissioner may assess a civil penalty, after notice

and opportunity for hearing, against a continuing education provider

who fails to comply with the requirements of the Oklahoma Producer

Licensing Act, of not more than Five Hundred Dollars ($500.00), for

each occurrence. The civil penalty may be enforced in the same

manner in which civil judgments may be enforced.

D. Limited lines producers and nonresident agents who have

successfully completed an equivalent or greater requirement shall be

exempt from the provisions of this section.

E. Members of the Legislature shall be exempt from this

section.

F. The Commissioner shall adopt and promulgate such rules as

are necessary for effective administration of this section.
Okla. Stat. tit. 36, § 36-6470.1 — OK Code / Title 36 / Section 36-6470.1
Short title
Status: in_force

Sections 6470.1 through 6470.33 of this title shall be known and

may be cited as the “Oklahoma Captive Insurance Company Act”.
Okla. Stat. tit. 36, § 36-1525 — OK Code / Title 36 / Section 36-1525
Regulatory Action Level Event
Status: in_force

A. "Regulatory Action Level Event" means, with respect to any

insurer, any of the following events:

1. The filing of an RBC Report by the insurer which indicates

that the insurer's Total Adjusted Capital is greater than or equal

to its Authorized Control Level RBC but less than its Regulatory

Action Level RBC;

2. The notification by the Insurance Commissioner to an insurer

of an Adjusted RBC Report that indicates the event described in

paragraph 1 of this subsection, provided the insurer does not

challenge the Adjusted RBC Report under Section 9 of this act;

3. If, pursuant to Section 9 of this act, the insurer

challenges an Adjusted RBC Report that indicates the event described

in paragraph 1 of this subsection, the notification by the

Commissioner to the insurer that the Commissioner has, after

opportunity for a hearing, rejected the insurer's challenge;

4. The failure of the insurer to file an RBC Report by the

filing date, unless the insurer has provided an explanation for such

failure in writing prior to the filing date which is satisfactory to

the Commissioner, and has cured the failure within such time as may

be allowed by the Commissioner;

5. The failure of the insurer to submit an RBC Plan to the

Commissioner within the time period set forth in subsection C of

Section 5 of this act;

6. Notification by the Commissioner to the insurer that:

Oklahoma Statutes - Title 36. Insurance Page 417

a. the RBC Plan or Revised RBC Plan submitted by the

insurer is, in the judgment of the Commissioner,

unsatisfactory, and

b. such notification constitutes a Regulatory Action

Level Event with respect to the insurer, provided the

insurer has not challenged the determination under

Section 9 of this act;

7. If, pursuant to Section 9 of this act, the insurer

challenges a determination by the Commissioner under paragraph 6 of

this subsection, the notification by the Commissioner to the insurer

that the Commissioner has, after opportunity for a hearing, rejected

such challenge;

8. Notification by the Commissioner to the insurer that the

insurer has failed to adhere to its RBC Plan or Revised RBC Plan,

but only if the failure has a substantial adverse effect on the

ability of the insurer to eliminate the Company Action Level Event

in accordance with the RBC Plan or Revised RBC Plan and the

Commissioner has so stated in the notification, provided the insurer

has not challenged the determination under Section 9 of this act; or

9. If, pursuant to Section 9 of this act, the insurer

challenges a determination by the Commissioner under paragraph 8 of

this subsection, the notification by the Commissioner to the insurer

that the Commissioner has, after opportunity for a hearing, rejected

the challenge.

B. In the event of a Regulatory Action Level Event:

1. The insurer shall, unless otherwise directed by the

Commissioner, prepare and submit an RBC Plan or, if applicable, a

Revised RBC Plan;

2. The Commissioner may perform such examination or analysis as

the Commissioner deems necessary of the assets, liabilities, and

operations of the insurer including a review of its RBC Plan or

Revised RBC Plan; and

3. Subsequent to the examination or analysis, the Commissioner

may issue a corrective order specifying the corrective actions which

the Commissioner determines are required.

C. In determining corrective actions, the Commissioner may take

into account the factors deemed relevant with respect to the insurer

based upon the Commissioner's examination or analysis of the assets,

liabilities, and operations of the insurer, including, but not

limited to, the results of any sensitivity tests undertaken pursuant

to the RBC Instructions. The RBC Plan or Revised RBC Plan shall be

submitted:

1. Within forty-five (45) days after the occurrence of the

Regulatory Action Level Event;

2. If the insurer challenges an Adjusted RBC Report pursuant to

Section 9 of this act, within forty-five (45) days after the

Oklahoma Statutes - Title 36. Insurance Page 418

notification to the insurer that the Commissioner has, after

opportunity for a hearing, rejected the insurer's challenge; or

3. If the insurer challenges a Revised RBC Plan pursuant to

Section 9 of this act, within forty-five (45) days after the

notification to the insurer that the Commissioner has, after

opportunity for a hearing, rejected the insurer's challenge.

D. The Commissioner may retain actuaries and investment experts

and other consultants as may be necessary in the judgment of the

Commissioner to review the insurer's RBC Plan or Revised RBC Plan,

examine or analyze the assets, liabilities, and operations of the

insurer, and formulate a corrective order with respect to the

insurer. The fees, costs, and expenses relating to consultants

shall be borne by the affected insurer or such other party as

directed by the Commissioner.
Okla. Stat. tit. 36, § 36-2691.16 — OK Code / Title 36 / Section 36-2691.16
Limited liability
Status: in_force

The private property of the subscribers, agents, officers,

directors, members and employees of any corporation holding a

certificate of authority under this article shall be wholly exempt

from any of the debts, obligations and liabilities of the

corporation.
Okla. Stat. tit. 36, § 36-3102 — OK Code / Title 36 / Section 36-3102
Deposit of security prior to doing business -
Status: in_force

Qualifications - Issuance of certificates - Expiration date.

A. No company shall sell, or offer for sale, any motor club

service without first having deposited with the Commissioner the sum

of Fifty Thousand Dollars ($50,000.00), in cash or securities

approved by the Commissioner, or, in lieu thereof, a corporate

surety bond, approved by the Commissioner, in the form described by

the Commissioner, payable to the State of Oklahoma, in the sum of

One Hundred Thousand Dollars ($100,000.00), and conditioned upon the

faithful performance in the sale or rendering of motor club service

and payment of any fines or penalties levied against it for failure

to comply with the provisions of Section 3101 et seq. of this title.

Provided, however, that the aggregate liability of the surety for

all breaches of the conditions of the bond and for the payment of

Oklahoma Statutes - Title 36. Insurance Page 756

all fines and penalties shall, in no event, exceed the amount of the

bond.

B. No Certificate of Authority shall be issued by the

Commissioner until the company has filed with him the following:

1. A formal application for the certificate in such form and

detail as the Commissioner requires, executed under oath by its

president or another principal officer of the company;

2. A certified copy of its charter or articles of incorporation

and its bylaws, if any;

3. A certificate from the Secretary of State, State of

Oklahoma, in the event that it is a domestic corporation, signifying

that the company is in compliance with the corporation laws of the

State of Oklahoma;

4. A copy of its latest financial statement, or report of

independent audit, as the Commissioner may require; or, in the event

that neither is available, its most recent audited and certified

operating statement and balance sheet. Any such certified operating

statement, audit or audited and certified operating statement and

balance sheet shall be verified by the person compiling or making

the same and by an executive officer of the applicant;

5. A certificate from its domiciliary state regulatory

authority, in the event that it is a foreign corporation, to be

executed not more than thirty (30) days before the filing of its

application, signifying that it is duly authorized to do motor club

business in that state;

6. An explanation of its plan of doing business and copies of

the following:

a. its application for membership,

b. the proposed membership certificate or identification

card and any proposed addendum thereto,

c. any individual insurance policy and any group master

policy and individual certificates thereunder to be

offered, and

d. any service contract to be issued; and

7. Such other information as the Commissioner may find

necessary in order to determine the applicant's qualifications.

C. No Certificate of Authority shall be issued by the

Commissioner until the company has:

1. Paid an initial filing fee of Two Hundred Fifty Dollars

($250.00) to the State Insurance Commissioner Revolving Fund,

pursuant to Section 307.3 of this title;

2. Paid an annual license fee of One Hundred Dollars ($100.00)

to the State Insurance Commissioner Revolving Fund, pursuant to

Section 307.3 of this title;

3. Had its name approved by the Commissioner under the

provisions of Sections 620 and 2104 of this title, the provisions of

which are hereby made applicable to motor clubs, after electronic

Oklahoma Statutes - Title 36. Insurance Page 757

submission of its name request on a form prescribed by the

Commissioner;

4. Proved by affidavits of its officers, directors, managers

and individual owners of more than ten percent (10%), on a form

prescribed by the Commissioner, that it is not disqualified under

any provisions contained in Section 3101 et seq. of this title or

contained in the Insurance Code; and

5. Proved to the Commissioner's satisfaction that it is a

separate legal entity capable of being examined by the Commissioner

as provided in Section 3101 et seq. of this title.

D. Certificates of Authority issued hereunder shall expire

annually on July 1, unless sooner revoked or suspended, as

hereinafter provided.
Okla. Stat. tit. 36, § 36-2407 — OK Code / Title 36 / Section 36-2407
Permit to do business; fee; filing of copies of
Status: in_force

certificates, application blanks and bylaws.

A. The Insurance Commissioner, upon the application of any

mutual benefit association having the right to do business in this

state, as provided in this article, shall issue to such association

a permit in writing, authorizing such association to do business in

this state until the last day of February following the date of

issuance of the license, for which permit or certificate and all

proceedings in connection therewith such association shall pay the

said Insurance Commissioner the fees and licenses therefor stated in

Section 321, Article 3 of this Code; provided, that the form of

certificates to be issued, copy of application blanks, and a

certified copy of the bylaws shall be filed with the Insurance

Commissioner, and, if the same conforms to the charter of such

association and the provisions of this article, the Insurance

Commissioner shall approve the same.

B. No such association shall act as an insurer and no such

association shall transact insurance in this state except as

authorized by a subsisting authority granted to it by the Insurance

Commissioner.
Okla. Stat. tit. 36, § 36-1915 — OK Code / Title 36 / Section 36-1915
Conduct of delinquency proceedings against foreign
Status: in_force

insurers.

A. Whenever under this article an ancillary receiver is to be

appointed in delinquency proceedings for an insurer not domiciled in

this state, the court shall appoint the Insurance Commissioner as

ancillary receiver. The Insurance Commissioner shall file a

petition requesting the appointment on the grounds set forth in

section 1809 of this article (1) if he finds that there are

sufficient assets of the insurer located in this state to justify

Oklahoma Statutes - Title 36. Insurance Page 539

the appointment of an ancillary receiver, or (2) if ten (10) or more

persons resident in this state having claims against such insurer

file a petition with the Insurance Commissioner requesting the

appointment of such ancillary receiver.

B. The domiciliary receiver for the purpose of liquidating an

insurer domiciled in a reciprocal state shall be vested by operation

of law with the title to all of the property, contracts, and rights

of action and all of the books and records of the insurer located in

this state, and he shall have the immediate right to recover

balances due from local agents and to obtain possession of any books

and records of the insurer found in this state. He shall also be

entitled to recover the other assets of the insurer located in this

state, except that upon the appointment of an ancillary receiver in

this state, the ancillary receiver shall during the ancillary

receivership proceedings have the sole right to recover such other

assets. The ancillary receiver shall, as soon as practicable,

liquidate from their respective securities those special deposit

claims and secured claims which are proved and allowed in the

ancillary proceedings in this state, and shall pay the necessary

expense of the proceedings. All remaining assets he shall promptly

transfer to the domiciliary receiver. Subject to the foregoing

provisions, the ancillary receiver and his deputies shall have the

same powers and be subject to the same duties with respect to the

administration of such assets as a receiver of an insurer domiciled

in this state.

C. The domiciliary receiver of an insurer domiciled in a

reciprocal state may sue in this state to recover any assets of such

insurer to which he may be entitled under the laws of this state.
Okla. Stat. tit. 36, § 36-1223 — OK Code / Title 36 / Section 36-1223
Renumbered as § 1250.9 of this title by Laws 1994, c
Status: in_force

342, § 20, eff. Sept. 1, 1994.
Okla. Stat. tit. 36, § 36-6937 — OK Code / Title 36 / Section 36-6937
Short title - Risk-based Capital (RBC) for Health
Status: in_force

Maintenance Organizations Act of 2003.

This act shall be known and may be cited as the "Risk-based

Capital (RBC) for Health Maintenance Organizations Act of 2003".
Okla. Stat. tit. 36, § 36-6121 — OK Code / Title 36 / Section 36-6121
Permits required – Approval and denial of permit
Status: in_force

A. Any organization which shall offer for sale, accept money or

anything of value, or contract for prearranged or prepaid funeral

services, or funeral service merchandise as defined in the Funeral

Services Licensing Act, or for any contract providing future funeral

services or funeral merchandise at a fixed price or at a cost plus a

percentage, or at retail price less a percentage discount, or for

any special consideration of any kind to be granted or made

available to the purchaser or holder of such contract, in this

state, under any sales contract, bond, certificate or other form of

written document providing for prepaid, discounted or otherwise

specially priced funeral or burial benefits or services or funeral

merchandise to be delivered at an undetermined future date dependent

upon the death of a contracting party or other person designated by

a contracting party (hereinafter called "prepaid funeral benefits")

shall first obtain a permit from the Insurance Commissioner

authorizing the transaction of this type of business. It shall be

unlawful to offer for sale, accept money or anything of value for,

or contract for prepaid funeral benefits without a valid, current

permit.

B. The Insurance Commissioner may deny the issuance of a permit

if the organization:

1. Makes a material misstatement or misrepresentation in an

application for a permit;

2. Fraudulently or deceptively obtains or attempts to obtain a

permit for another; or

3. If any of its officers, owners, partners, directors, or

other persons responsible for the conduct of its affairs and day-to-

day operations are determined by the Commissioner to not be

Oklahoma Statutes - Title 36. Insurance Page 1137

competent, trustworthy, financially responsible, and of good

personal and business reputation and character.

C. The Insurance Commissioner may approve an application of an

organization for a permit and deny the request of the organization

to act as a trustor if the organization, or any of its officers,

owners, partners, directors, or other persons responsible for the

conduct of its affairs and day-to-day operations, does not satisfy

all qualifications. This shall not hinder an organization from

entering into contracts funded by assignments of insurance.

D. All permits issued pursuant to the provisions of this

section shall be displayed in a conspicuous place at all times on

the premises of the organization. No organization may consent to,

or allow the use or display of, the permit by a person other than

the persons authorized to represent the organization in contracting

prepaid funeral benefits.

E. The organization shall not be entitled to enforce a contract

made in violation of the act, but the purchaser or the heirs of the

purchaser, or legal representative, shall be entitled to recover

triple the amounts paid to the organization with interest thereon at

the rate of six percent (6%) per annum under any contract made in

violation hereof.

F. For purposes of Sections 6121 through 6136.18 of this title,

the term "organization" shall mean a "funeral establishment", as

defined in the Funeral Services Licensing Act, in Section 396.2 of

Title 59 of the Oklahoma Statutes.

G. Each permit holder, upon receipt of any inquiry from the

Insurance Commissioner, shall, within twenty (20) days from the date

of receipt of the inquiry, furnish the Insurance Commissioner with

an adequate response to the inquiry.

H. Each permit holder shall electronically notify the Insurance

Commissioner, in the manner and form prescribed by the Insurance

Commissioner, along with any applicable fees, of any change in

address or contact information within thirty (30) days of the

change. Any submission of a change of legal business name, dba or

assumed name, address or email address received more than thirty

(30) days after the change occurred shall be accompanied by a fee of

Fifty Dollars ($50.00).
Okla. Stat. tit. 36, § 36-4055.7 — OK Code / Title 36 / Section 36-4055.7
Examination of licensees - Records retention -
Status: in_force

Confidentiality - Appointment of examiner - Liability.

A. 1. The Insurance Commissioner may conduct an examination

under the Viatical Settlements Act of 2008 of a licensee as often as

the Commissioner in his or her discretion deems appropriate after

considering the factors set forth in this paragraph. In scheduling

and determining the nature, scope, and frequency of the

examinations, the Commissioner shall consider such matters as the

consumer complaints, results of financial statement analyses and

ratios, changes in management or ownership, actuarial opinions,

report of independent certified public accountants, and other

relevant criteria as determined by the Commissioner.

2. For purposes of completing an examination of a licensee

under the Viatical Settlements Act of 2008, the Commissioner may

examine or investigate any person, or the business of any person,

insofar as the examination or investigation is, in the sole

discretion of the Commissioner, necessary or material to the

examination of the licensee.

3. In lieu of an examination under the Viatical Settlements Act

of 2008 of any foreign or alien licensee licensed in this state, the

Commissioner may, at the Commissioner's discretion, accept an

examination report on the licensee as prepared by the Commissioner

for the licensee's state of domicile or port-of-entry state.

4. As far as practical, the examination of a foreign or alien

licensee shall be made in cooperation with the insurance supervisory

officials of other states in which the licensee transacts business.

B. 1. A person required to be licensed by the Viatical

Settlements Act of 2008 shall for five (5) years for all settled

policies and for two (2) years for all policies which are not

settled retain copies of all:

a. proposed, offered or executed contracts, purchase

agreements, underwriting documents, policy forms, and

applications from the date of the proposal, offer or

execution of the contract or purchase agreement,

whichever is later,

b. all checks, drafts, electronic payment or other

evidence and documentation related to the payment,

transfer, deposit or release of funds from the date of

the transaction, and

Oklahoma Statutes - Title 36. Insurance Page 879

c. all other records and documents related to the

requirements of the Viatical Settlements Act of 2008.

2. This subsection does not relieve a person of the obligation

to produce these documents to the Commissioner after the retention

period has expired if the person has retained the documents.

3. Records required to be retained by this subsection must be

legible and complete and may be retained in paper, photograph,

microprocess, magnetic, mechanical, or electronic media, or by any

process that accurately reproduces or forms a durable medium for the

reproduction of a record.

C. 1. Upon determining that an examination should be

conducted, the Commissioner shall issue an examination warrant

appointing one or more examiners to perform the examination and

instructing them as to the scope of the examination. In conducting

the examination, the examiner shall observe those guidelines and

procedures set forth in the Examiners Handbook adopted by the

National Association of Insurance Commissioners (NAIC). The

Commissioner may also employ such other guidelines or procedures as

the Commissioner may deem appropriate.

2. Every licensee or person from whom information is sought,

its officers, directors and agents shall provide to the examiners

timely, convenient and free access at all reasonable hours at its

offices to all books, records, accounts, papers, documents, assets

and computer or other recordings relating to the property, assets,

business and affairs of the licensee being examined. The officers,

directors, employees and agents of the licensee or person shall

facilitate the examination and aid in the examination so far as it

is in their power to do so. The refusal of a licensee, by its

officers, directors, employees or agents, to submit to examination

or to comply with any reasonable written request of the Commissioner

shall be grounds for suspension or refusal of, or nonrenewal of any

license or authority held by the licensee to engage in the viatical

settlement business or other business subject to the Commissioner's

jurisdiction. Any proceedings for suspension, revocation or refusal

of any license or authority shall be conducted in accordance with

the Administrative Procedures Act.

3. The Commissioner shall have the power to issue subpoenas, to

administer oaths and to examine under oath any person as to any

matter pertinent to the examination. Upon the failure or refusal of

a person to obey a subpoena, the Commissioner may petition a court

of competent jurisdiction, and upon proper showing, the Court may

enter an order compelling the witness to appear and testify or

produce documentary evidence. Failure to obey the court order shall

be punishable as contempt of court.

4. When making an examination under the Viatical Settlements

Act of 2008, the Commissioner may retain attorneys, appraisers,

independent actuaries, independent certified public accountants or

Oklahoma Statutes - Title 36. Insurance Page 880

other professionals and specialists as examiners, the reasonable

cost of which shall be borne by the licensee that is the subject of

the examination.

5. Nothing contained in the Viatical Settlements Act of 2008

shall be construed to limit the Commissioner's authority to

terminate or suspend an examination in order to pursue other legal

or regulatory action pursuant to the insurance laws of this state.

Findings of fact and conclusions made pursuant to any examination

shall be prima facie evidence in any legal or regulatory action.

6. Nothing contained in the Viatical Settlements Act of 2008

shall be construed to limit the Commissioner's authority to use and,

if appropriate, to make public any final or preliminary examination

report, any examiner or licensee workpapers or other documents, or

any other information discovered or developed during the course of

any examination in the furtherance of any legal or regulatory action

which the Commissioner may, in his or her sole discretion, deem

appropriate.

D. 1. Examination reports shall be comprised of only facts

appearing upon the books, records or other documents of the

licensee, its agents or other persons examined, or as ascertained

from the testimony of its officers or agents or other persons

examined concerning its affairs, and such conclusions and

recommendations as the examiners find reasonably warranted from the

facts.

2. No later than sixty (60) days following completion of the

examination, the examiner in charge shall file with the Commissioner

a verified written report of examination under oath. Upon receipt

of the verified report, the Commissioner shall transmit the report

to the licensee examined, together with a notice that shall afford

the licensee examined a reasonable opportunity of not more than

thirty (30) days to make a written submission or rebuttal with

respect to any matters contained in the examination report.

3. In the event the Commissioner determines that regulatory

action is appropriate as a result of an examination, the

Commissioner may initiate any proceedings or actions provided by

law.

E. 1. Names and individual identification data for all viators

shall be considered private and confidential information and shall

not be disclosed by the Commissioner, unless required by law.

2. Except as otherwise provided in the Viatical Settlements Act

of 2008, all examination reports, working papers, recorded

information, documents and copies thereof produced by, obtained by

or disclosed to the Commissioner or any other person in the course

of an examination made under the Viatical Settlements Act of 2008,

or in the course of analysis or investigation by the Commissioner of

the financial condition or market conduct of a licensee shall be

confidential by law and privileged, shall not be subject to the

Oklahoma Statutes - Title 36. Insurance Page 881

Oklahoma Open Records Act, shall not be subject to subpoena, and

shall not be subject to discovery or admissible in evidence in any

private civil action. The Commissioner is authorized to use the

documents, materials or other information in the furtherance of any

regulatory or legal action brought as part of the Commissioner's

official duties.

3. Documents, materials or other information, including, but

not limited to, all working papers, and copies thereof, in the

possession or control of the NAIC and its affiliates and

subsidiaries shall be confidential by law and privileged, shall not

be subject to subpoena, and shall not be subject to discovery or

admissible in evidence in any private civil action if they are:

a. created, produced or obtained by or disclosed to the

NAIC and its affiliates and subsidiaries in the course

of assisting an examination made under this act, or

assisting a Commissioner in the analysis or

investigation of the financial condition or market

conduct of a licensee, or

b. disclosed to the NAIC and its affiliates and

subsidiaries under paragraph 4 of this subsection by a

Commissioner.

For the purposes of paragraph 2 of this subsection, "act" means

the law of another state or jurisdiction that is substantially

similar to the Viatical Settlements Act of 2008.

4. Neither the Commissioner nor any person that received the

documents, material or other information while acting under the

authority of the Commissioner, including the NAIC and its affiliates

and subsidiaries, shall be permitted to testify in any private civil

action concerning any confidential documents, materials or

information subject to paragraph 1 of this subsection.

5. In order to assist in the performance of the Commissioner's

duties, the Commissioner:

a. may share documents, materials or other information,

including the confidential and privileged documents,

materials or information subject to paragraph 1 of

this subsection, with other state, federal and

international regulatory agencies, with the NAIC and

its affiliates and subsidiaries, and with state,

federal and international law enforcement authorities,

provided that the recipient agrees to maintain the

confidentiality and privileged status of the document,

material, communication or other information, and

b. may receive documents, materials, communications or

information, including otherwise confidential and

privileged documents, materials or information, from

the NAIC and its affiliates and subsidiaries, and from

regulatory and law enforcement officials of other

Oklahoma Statutes - Title 36. Insurance Page 882

foreign or domestic jurisdictions, and shall maintain

as confidential or privileged any document, material

or information received with notice or the

understanding that it is confidential or privileged

under the laws of the jurisdiction that is the source

of the document, material or information.

6. No waiver of any applicable privilege or claim of

confidentiality in the documents, materials or information shall

occur as a result of disclosure to the Commissioner under this

section or as a result of sharing as authorized in paragraph 5 of

this subsection.

7. A privilege established under the law of any state or

jurisdiction that is substantially similar to the privilege

established under this subsection shall be available and enforced in

any proceeding in, and in any court of, this state.

8. Nothing contained in the Viatical Settlements Act of 2008

shall prevent or be construed as prohibiting the Commissioner from

disclosing the content of an examination report, preliminary

examination report or results, or any matter relating thereto, to

the Commissioner of any other state or country, or to law

enforcement officials of this or any other state or agency of the

federal government at any time or to the NAIC, so long as such

agency or office receiving the report or matters relating thereto

agrees in writing to hold it confidential and in a manner consistent

with the Viatical Settlements Act of 2008.

F. 1. An examiner may not be appointed by the Commissioner if

the examiner, either directly or indirectly, has a conflict of

interest or is affiliated with the management of or owns a pecuniary

interest in any person subject to examination under the Viatical

Settlements Act of 2008. This section shall not be construed to

automatically preclude an examiner from being:

a. a viator,

b. an insured in a viaticated insurance policy, or

c. a beneficiary in an insurance policy that is proposed

to be viaticated.

2. Notwithstanding the requirements of this paragraph, the

Commissioner may retain from time to time, on an individual basis,

qualified actuaries, certified public accountants, or other similar

individuals who are independently practicing their professions, even

though these persons may from time to time be similarly employed or

retained by persons subject to examination under the Viatical

Settlements Act of 2008.

G. 1. No cause of action shall arise nor shall any liability

be imposed against the Commissioner, the Commissioner's authorized

representatives or any examiner appointed by the Commissioner for

any statements made or conduct performed in good faith while

carrying out the provisions of the Viatical Settlements Act of 2008.

Oklahoma Statutes - Title 36. Insurance Page 883

2. No cause of action shall arise, nor shall any liability be

imposed against any person for the act of communicating or

delivering information or data to the Commissioner or the

Commissioner's authorized representative or examiner pursuant to an

examination made under the Viatical Settlements Act of 2008, if the

act of communication or delivery was performed in good faith and

without fraudulent intent or the intent to deceive. This paragraph

does not abrogate or modify in any way any common law or statutory

privilege or immunity heretofore enjoyed by any person identified in

paragraph 1 of this subsection.

3. A person identified in paragraph 1 or 2 of this subsection

shall be entitled to an award of attorney fees and costs if he or

she is the prevailing party in a civil cause of action for libel,

slander or any other relevant tort arising out of activities in

carrying out the provisions of this act and the party bringing the

action was not substantially justified in doing so. For purposes of

this section a proceeding is "substantially justified" if it had a

reasonable basis in law or fact at the time that it was initiated.

H. The Commissioner may investigate suspected fraudulent

viatical settlement acts and persons engaged in the business of

viatical settlements.
Okla. Stat. tit. 36, § 36-311A.11 — OK Code / Title 36 / Section 36-311A.11
Reporting unremediated material weaknesses of internal
Status: in_force

controls - Description of remedial actions.

A. In addition to the annual audited financial report, each

insurer shall furnish the Insurance Commissioner with a written

communication as to any unremediated material weaknesses in its

internal controls over financial reporting noted during the audit.

Such communication shall be prepared by the accountant within sixty

(60) days after the filing of the annual audited financial report,

and shall contain a description of any unremediated material

weakness, as the term material weakness is defined by Statement on

Auditing Standard 60, Communication of Internal Control Related

Matters Noted in an Audit, or its replacement, as of December 31

immediately preceding, so as to coincide with the audited financial

Oklahoma Statutes - Title 36. Insurance Page 89

report discussed in subsection A of Section 311A.2 of this title in

the internal control over financial reporting of the insurer noted

by the accountant during the course of their audit of the financial

statements. If no unremediated material weaknesses were noted, the

communication should so state.

B. The insurer is required to provide a description of remedial

actions taken or proposed to correct unremediated material

weaknesses if the actions are not described in the communication of

the accountant.
Okla. Stat. tit. 36, § 36-6593 — OK Code / Title 36 / Section 36-6593
Duty of health care entity to exercise ordinary care -
Status: in_force

Liability for damages - Application of act.

A. A health insurance carrier, health maintenance organization,

or other managed care entity for a health care plan has the duty to

exercise ordinary care when making health care treatment decisions

and shall be liable for damages for harm to an enrollee proximately

caused by breach of the duty to exercise ordinary care if:

1. The failure to exercise ordinary care resulted in the

denial, significant delay, or modification of the health care

service recommended for, or furnished to, an enrollee; and

2. The enrollee suffered harm.

B. The standards in subsection A of this section create no

obligation on the part of the health insurance carrier, health

maintenance organization, or other managed care entity to provide to

an enrollee treatment which is not covered by the health care plan.

C. This act does not create any liability on the part of an

employer or an employer group purchasing organization that sponsors

or participates in a health care plan or purchases coverage or

Oklahoma Statutes - Title 36. Insurance Page 1325

assumes risk on behalf of or for the benefit of its employees or the

employees of one or more subsidiaries or affiliates of the employer.

D. A health care plan, health insurance carrier, health

maintenance organization, or managed care entity may not remove a

health care provider from its plan or refuse to renew the health

care provider from its plan for advocating on behalf of an enrollee

for appropriate and medically necessary health care for the

enrollee.

E. A health insurance carrier, health maintenance organization,

or other managed care entity shall not seek indemnification from a

health care provider, whether contractual or equitable, for

liability imposed by this act. Any provision in a contract to the

contrary is void and unenforceable.

F. Nothing in any law of this state prohibiting a health

insurance carrier, health maintenance organization, or other managed

care entity from practicing medicine or being licensed to practice

medicine may be asserted as a defense by a health insurance carrier,

health maintenance organization, or other managed care entity in an

action brought against it pursuant to this section or any other law

of this state.

G. This section shall not create any new or additional

liability on the part of a health insurance carrier, health

maintenance organization, or managed care entity for harm caused

that is attributable to the medical negligence of a health care

provider.

H. An enrollee who files an action under this act shall comply

with all requirements relating to cost bonds, deposits, and expert

reports.

I. This act shall not apply to insurance agents licensed by the

Insurance Department.

J. This act shall not apply to workers’ compensation insurance.
Okla. Stat. tit. 36, § 36-675 — OK Code / Title 36 / Section 36-675
Notification of cybersecurity event — Required
Status: in_force

information.

A. Every licensee shall notify the Insurance Commissioner

without unreasonable delay, but not later than three business days,

from a determination that a cybersecurity event involving nonpublic

information that is in the possession of a licensee has occurred

when either of the following criteria has been met:

1. This state is the state of domicile of the licensee, in the

case of an insurer, or this state is the home state of the licensee,

in the case of a producer, as those terms are defined in the

Oklahoma Producer Licensing Act, Sections 1435.1 through 1435.41 of

Title 36 of the Oklahoma Statutes, and the cybersecurity event has a

reasonable likelihood of materially harming any material part of the

Oklahoma Statutes - Title 36. Insurance Page 184

normal operations of the licensee or any consumer residing in this

state; or

2. The licensee reasonably believes that the nonpublic

information involved is of two hundred fifty (250) or more consumers

residing in this state and is either of the following:

a. a cybersecurity event impacting the licensee of which

notice is required to be provided to any government

body, self-regulatory agency, or any other supervisory

body pursuant to any state or federal law, or

b. a cybersecurity event that has a reasonable likelihood

of materially harming:

(1) any consumer residing in this state, or

(2) any material part of the normal operation or

operations of the licensee.

B. The licensee making the notification required in subsection

A of this section shall provide as much of the following information

as possible, electronically in the manner and form prescribed by the

Commissioner, along with any applicable fees. The licensee shall

have a continuing obligation to update and supplement initial and

subsequent notifications to the Commissioner regarding material

changes to previously provided information relating to the

cybersecurity event. The licensee shall provide:

1. Date of the cybersecurity event;

2. Description of how the information was exposed, lost,

stolen, or breached including, but not limited to, the specific

roles and responsibilities of third-party service providers, if any;

3. How the cybersecurity event was discovered;

4. Whether any lost, stolen, or breached information has been

recovered and, if so, how this was done;

5. The identity of the source of the cybersecurity event;

6. Whether the licensee has filed a police report or has

notified any regulatory, government, or law enforcement agencies

and, if so, when such notification was provided;

7. Description of the specific types of information acquired

without authorization. The term “specific types of information”

means particular data elements including, but not limited to, types

of medical information, financial information, or information

allowing identification of the consumer;

8. The period during which the information system was

compromised by the cybersecurity event;

9. The number of total consumers in this state affected by the

cybersecurity event. The licensee shall provide the best estimate

in the initial report to the Commissioner and update this estimate

with each subsequent report to the Commissioner pursuant to this

section;

Oklahoma Statutes - Title 36. Insurance Page 185

10. The results of any internal review identifying a lapse in

either automated controls or internal procedures, or confirming that

all automated controls or internal procedures were followed;

11. Description of efforts being undertaken to remediate the

situation which permitted the cybersecurity event to occur;

12. A copy of the privacy policy of the licensee and a

statement outlining the steps the licensee will take to investigate

and notify consumers affected by the cybersecurity event; and

13. Name of a contact person who is both familiar with the

cybersecurity event and authorized to act for the licensee.

C. A licensee shall comply with the procedures of the Security

Breach Notification Act, Section 161 et seq. of Title 24 of the

Oklahoma Statutes, to notify affected consumers and provide a copy

of the notice sent to consumers under that statute to the

Commissioner, when a licensee is required to notify the Commissioner

under subsection A of this section.

D. 1. In the case of a cybersecurity event in a system

maintained by a third-party service provider, of which the licensee

has become aware, the licensee shall treat the event as it would

under subsection A of this section unless the third-party service

provider provides the notice required under subsection A of this

section to the Commissioner and the licensee.

2. The computation of deadlines of the licensee shall begin on

the day after the third-party service provider notifies the licensee

of the cybersecurity event or the licensee otherwise has actual

knowledge of the cybersecurity event, whichever is sooner.

3. Nothing in this act shall prevent or abrogate an agreement

between a licensee and another licensee, a third-party service

provider, or any other party to fulfill any of the investigation

requirements or notice requirements imposed under this act.

E. 1. In the case of a cybersecurity event involving nonpublic

information that is used by the licensee that is acting as an

assuming insurer, or in the possession, custody, or control of a

licensee, that is acting as an assuming insurer and that does not

have a direct contractual relationship with the affected consumers,

the assuming insurer shall notify its affected ceding insurers and

the Commissioner of its state of domicile within three (3) business

days of making the determination that a cybersecurity event has

occurred. The ceding insurers that have a direct contractual

relationship with affected consumers shall fulfill the consumer

notification requirements imposed under the Security Breach

Notification Act, Section 161 et seq. of Title 24 of the Oklahoma

Statutes, and any other notification requirements relating to a

cybersecurity event imposed under this section.

2. In the case of a cybersecurity event involving nonpublic

information that is in the possession, custody, or control of a

third-party service provider of a licensee that is an assuming

Oklahoma Statutes - Title 36. Insurance Page 186

insurer, the assuming insurer shall notify its affected ceding

insurers and the Commissioner of its state of domicile within three

(3) business days of receiving notice from its third-party service

provider that a cybersecurity event has occurred. The ceding

insurers that have a direct contractual relationship with affected

consumers shall fulfill the consumer notification requirements

imposed under Security Breach Notification Act, Section 161 et seq.

of Title 24 of the Oklahoma Statutes, and any other notification

requirements relating to a cybersecurity event imposed under this

section.

F. In the case of a cybersecurity event involving nonpublic

information that is in the possession, custody, or control of a

licensee that is an insurer or its third-party service provider for

which a consumer accessed the services of the insurer through an

independent insurance producer, and for which consumer notice is

required by this act or the Security Breach Notification Act,

Section 161 et seq. of Title 24 of the Oklahoma Statutes, the

insurer shall notify the producers of record of all affected

consumers of the cybersecurity event no later than the time at which

notice is provided to the affected consumers. The insurer is

excused from this obligation for any producers who are not

authorized by law or contract to sell, solicit, or negotiate on

behalf of the insurer, and in those instances in which the insurer

does not have the current producer of record information for an

individual consumer. Any licensee acting as an assuming insurer

shall have no other notice obligations relating to a cybersecurity

event or other data breach under this section or any other law of

this state.
Okla. Stat. tit. 36, § 36-900.1 — OK Code / Title 36 / Section 36-900.1
Short title
Status: in_force

Sections 11 through 36 of this act shall be known and may be

cited as the "Oklahoma Insurance Rating Act".
Okla. Stat. tit. 36, § 36-1686 — OK Code / Title 36 / Section 36-1686
Application for Approval of Insurance Business Transfer
Status: in_force

Plan.

A. Application to the Commissioner for Approval of Insurance

Business Transfer Plan.

1. An Insurance Business Transfer Plan must be filed by the

applicant with the Insurance Commissioner for his or her review and

approval. The Plan must contain the information set forth below or

an explanation as to why the information is not included. The Plan

may be supplemented or revised with additional, updated, or other

information as it becomes available or when deemed necessary by the

Commissioner:

a. the name, address and telephone number of the

transferring insurer and the assuming insurer and

their respective direct and indirect controlling

persons, if any,

b. summary of the Insurance Business Transfer Plan,

c. identification and description of the subject

business,

d. most recent audited financial statements and statutory

annual and quarterly reports of the transferring

Oklahoma Statutes - Title 36. Insurance Page 504

insurer and assuming insurer filed with their

domiciliary regulator,

e. the most recent actuarial report and opinion that

quantify the liabilities associated with the subject

business,

f. pro-forma financial statements showing the projected

statutory balance sheet, results of operations and

cash flows of the assuming insurer for the three (3)

years following the proposed transfer and novation,

g. officers' certificates of the transferring insurer and

the assuming insurer attesting that each has obtained

all required internal approvals and authorizations

regarding the Insurance Business Transfer Plan and

completed all necessary and appropriate actions

relating thereto,

h. proposal for Plan implementation and administration,

i. form of notice to be provided under the Insurance

Business Transfer Plan to any policyholder whose

policy is part of the subject business including full

description as to how such notice shall be provided,

j. description of any reinsurance arrangements that will

pass to the assuming insurer under the Insurance

Business Transfer Plan,

k. description of any guarantees or additional

reinsurance that will cover the subject business

following the transfer and novation,

l. a statement describing the assuming insurer's proposed

investment policies and any contemplated third-party

claims management and administration arrangements,

m. evidence of approval or nonobjection of the transfer

from the chief insurance regulator of the state of the

transferring insurer's domicile, and

n. an opinion report from an independent expert, which

shall provide the following:

(1) a statement of the independent expert's

professional qualifications and descriptions of

the experience that qualifies him or her as an

expert suitable for the engagement,

(2) whether the independent expert has, or has had,

direct or indirect interest in the transferring

or assuming insurer or any of their respective

affiliates,

(3) the scope of the report,

(4) a summary of the terms of the Insurance Business

Transfer Plan to the extent relevant to the

report,

Oklahoma Statutes - Title 36. Insurance Page 505

(5) a listing and summaries of documents, reports and

other material information the independent expert

has considered in preparing the report and

whether any information requested was not

provided,

(6) the extent to which the independent expert has

relied on information provided by and the

judgment of others,

(7) the people upon whom the independent expert has

relied and why, in his or her opinion, such

reliance is reasonable,

(8) the independent expert's opinion of the likely

effects of the Insurance Business Transfer Plan

on policyholders, reinsurers, and claimants,

distinguishing between:

(a) transferring policyholders, reinsurers, and

claimants,

(b) policyholders, reinsurers, and claimants of

the transferring insurer whose policies will

not be transferred, and

(c) policyholders, reinsurers, and claimants of

the assuming insurer,

(9) for each opinion that the independent expert

expresses in the report the facts and

circumstances supporting the opinion, and

(10) consideration as to whether the security position

of policyholders that are affected by the

Insurance Business Transfer are materially

adversely affected by the transfer.

2. The independent expert's opinion report as required by

subparagraph n of paragraph 1 of this subsection shall include, but

not be limited to, a review of the following:

a. analysis of the transferring insurer's actuarial

review of reserves for the subject business to

determine the reserve adequacy,

b. analysis of the financial condition of the

transferring insurer and assuming insurer and the

effect the Insurance Business Transfer will have on

the financial condition of each insurance company,

c. review of the plans or proposals the assuming insurer

has with respect to the administration of the policies

subject to the plan,

d. whether the proposed transfer has a material adverse

effect on the policyholders, reinsurers, and claimants

of the transferring and the assuming insurers,

e. analysis of the assuming insurer's corporate

governance structure to ensure proper board and

Oklahoma Statutes - Title 36. Insurance Page 506

management oversight and expertise to manage the

subject business, and

f. any other information the Commissioner requests in

order to review the Insurance Business Transfer.

3. The Commissioner shall have sixty (60) business days from

the date of receipt of a complete Insurance Business Transfer Plan

to review the Plan to determine if the applicant is authorized to

submit it to the court. The Commissioner may extend the sixty-day

review period for an additional thirty (30) business days.

4. The Commissioner shall authorize the submission of the Plan

to the court unless he or she finds that the Insurance Business

Transfer will cause a material adverse effect on the interests of

policyholders, reinsurers, or claimants that are part of the subject

business.

5. If the Commissioner determines that the Insurance Business

Transfer will cause a material adverse effect on the interests of

policyholders, reinsurers, or claimants that are part of the subject

business, the Commissioner shall notify the applicant and specify

any modifications, supplements or amendments and any additional

information or documentation with respect to the Plan that must be

provided to the Commissioner before he or she will allow the

applicant to proceed with the court filing.

6. The applicant shall have thirty (30) days from the date the

Commissioner notifies him or her, pursuant to paragraph 5 of this

subsection, to file an amended Insurance Business Transfer Plan

providing the modifications, supplements or amendments and

additional information or documentation as requested by the

Commissioner. If necessary the applicant may request in writing an

extension of time of thirty (30) days. If the applicant does not

make an amended filing within the time period provided for in this

paragraph including any extension of time granted by the

Commissioner, the Insurance Business Transfer Plan filing will

terminate and a subsequent filing by the applicant will be

considered a new filing which shall require compliance with all

provisions of this act as if the prior filing had never been made.

7. The Commissioner's review period in paragraph 3 of this

subsection shall recommence when the modification, supplement,

amendment or additional information requested in paragraph 5 of this

subsection is received.

8. If the Commissioner determines that the applicant may

proceed with filing a petition with the court seeking approval and

implementation of the Plan, the Commissioner shall confirm that fact

in writing to the applicant.

B. Petition to the court for approval and implementation of the

Insurance Business Transfer Plan.

1. Within thirty (30) days after the filing and transmission of

the Commissioner's order determining the Plan satisfies the

Oklahoma Statutes - Title 36. Insurance Page 507

requirements of this act, the assuming insurer, transferring

insurer, or reinsurer may file a petition with the court seeking an

order of approval and implementation of the Insurance Business

Transfer Plan. Upon written request by the applicant to the

Commissioner, the period for filing a petition under this subsection

with the court may be extended for an additional thirty (30) days.

2. The petition shall include:

a. relief sought,

b. information, arguments, and authorities supporting the

requested relief including information and analysis

which will support the court's finding that the plan

will not result in a material adverse effect to

policyholders, reinsurers, or claimants,

c. the Insurance Business Transfer Plan,

d. preliminary list of witnesses and exhibits which the

petitioner reasonably intends to present to the court,

and

e. request for the court to enter judgment in favor of

the petitioner, which shall include finding of fact,

conclusion of law, order of approval and

implementation of the Plan, and retention of

jurisdiction to allow the parties to request such

orders regarding incidental, consequential, and

supplementary matters necessary to assure the full and

effective implementation of the Plan.

3. The Commissioner shall be a party to the proceedings before

the court concerning the petition and shall be served with copies of

all filings pursuant to subsection D of Section 2005 of Title 12 of

the Oklahoma Statutes and the Rules for District Courts of Oklahoma.

4. The Commissioner's position in the proceeding shall not be

limited by his or her initial review of the Plan.

5. Within thirty (30) days after the filing of the petition,

the petitioner shall file a request for the court to enter a

preliminary scheduling order, which shall include a date and time

for a status conference. The status conference shall occur no less

than fourteen (14) days after the conclusion of the sixty (60) day

comment period required in paragraph 8 of this subsection.

6. Within forty-five (45) days after the court enters the

preliminary scheduling order, the petitioner shall cause the

transmission and publication of a notice of the matter before the

court in accordance with the notice provisions of Section 1685 of

this title.

7. The notice shall include:

a. the date and time of the status conference required in

paragraph 5 of this subsection,

b. the name, address and telephone number of the assuming

insurer, transferring insurer, and Commissioner for

Oklahoma Statutes - Title 36. Insurance Page 508

policyholders to contact to obtain further

information,

c. procedures and deadlines for policyholders, claimants,

and third parties to submit comments, objections, and

requests to be heard at trial regarding the Plan,

d. procedure for policyholders to request the petitioner

provide one (1) hard copy, free of charge, to

policyholders unable to access or acquire an

electronic copy of the Plan and associated

information, if any,

e. a summary of the order entered by the Commissioner

pursuant to paragraph 8 of subsection A of this

section including the effect the plan will have on the

policy holders, if any,

f. name and location of the court in which the petition

is filed,

g. case number, parties, and other identifying

information of the matter in the petition,

h. relief sought in the petition,

i. procedure to access an electronic copy of the Plan and

associated information, if any,

j. further notice of filings, schedules, orders, and

other information will only be provided pursuant to

paragraph 10 of this subsection, and

k. if the Plan is approved by the court, the court shall

enter judgment consistent with paragraph 3 of

subsection C of this section.

8. The last date of transmission and publication of the notice

shall be followed by a comment period no less than sixty (60) days.

9. Any person including by their legal representative, who

provides written notice within the sixty (60) day comment period

identified in paragraph 8 of this subsection, and states the person

considers himself, herself or itself to be materially adversely

affected by the approval and implementation of the Plan may present

evidence or comments to the court at trial. However, such comment

or evidence shall not confer standing as a party on any person. Any

person participating in any pretrial proceeding or the trial of

petitioner's request for approval and implementation of the Plan

must follow the process established by the court and shall bear his

or her own costs and attorney fees.

10. Only parties to this matter and those persons and other

third parties who file a request to provide comments, objections, or

requests to be heard pursuant to paragraph 8 of this subsection

shall receive further notice and copies of filings with the court,

pursuant to subsection D of Section 2005 of Title 12 of the Oklahoma

Statutes and the Rules for District Courts of Oklahoma; provided,

however, all persons and other third parties shall receive notice

Oklahoma Statutes - Title 36. Insurance Page 509

pursuant to subparagraph d of paragraph 3 of subsection C of this

section.

11. Within forty-five (45) days of the status conference

required pursuant to paragraph 5 of this subsection, the petitioner

shall file a motion for a scheduling order and to enter this matter

on the court's trial docket.

C. Approval by the court of the Insurance Business Transfer

Plan.

1. Pursuant to a scheduling order set forth in paragraph 11 of

subsection B of this section, and other orders by the court, the

petitioner shall present the Insurance Business Transfer Plan,

evidence, and arguments to the court for approval and implementation

of the Plan.

2. At any time before the court issues judgment, the petitioner

may withdraw the petition without prejudice to refiling.

3. If the court finds that the approval and implementation of

the Insurance Business Transfer Plan will not materially adversely

affect the interests of policyholders or claimants of policies which

are part of the subject business, the court shall enter judgment in

favor of the petitioner. The judgment and order shall include:

a. findings of fact,

b. conclusion of law,

c. approval and implementation of the Plan including:

(1) simultaneous transfer and novation from the

transferring insurer to the assuming insurer of

the subject business with respect to all

policyholders, reinsurers, claimants and their

respective policies, and reinsurance agreements

under the subject business,

(2) simultaneous transfer and novation from the

transferring insurer and the assuming insurer of

all property, rights, obligations, and

liabilities including, but not limited to, the

ceded reinsurance of transferred policies and

contracts included in the subject business,

notwithstanding any nonassignment provisions in

any such reinsurance contracts or other

agreements,

(3) assuming insurer shall have all of transferring

insurer's rights, obligations, and liabilities

regarding the subject business as if it were the

original insurer of such policies including the

same standing as the transferring insurer

pursuant to contract, statute, and

interpretation, relating back to the issuance of

such policies, and

Oklahoma Statutes - Title 36. Insurance Page 510

(4) policyholders' and claimants' rights obligations

and liabilities, if any, under their respective

policies which are part of the subject business

shall not be enlarged, extended, limited, or

reduced; provided, however, the policyholders and

claimants may not pursue or be pursued by the

transferring insurer to satisfy their respective

rights, obligations, and liabilities, but instead

the policyholders and claimants may pursue or be

pursued by the assuming insurer,

d. petitioner to provide notice of the judgment including

the resulting transfer and novation in accordance with

the notice provisions in Section 1685 of this title,

e. make such other orders and provisions with respect to

incidental, consequential and supplementary matters as

are necessary to assure the full and effective

implementation of the Insurance Business Transfer

Plan, and

f. retain jurisdiction of the matter to allow the parties

to request such additional orders regarding

incidental, consequential, and supplemental matters

necessary to assure the full and effective

implementation of the Plan.

4. If the court finds that the Insurance Business Transfer Plan

should not be approved, the court by its order may:

a. deny the petition, or

b. provide the petitioner leave to file an amended

petition including an amended Insurance Business

Transfer Plan and petition.

5. Nothing in this section in any way affects the right of

appeal of any party.

D. An unexpired and in-force policy issued to a policyholder

who resides in a state other than Oklahoma shall not be transferred

and novated unless or until the assuming insurer is licensed,

authorized, permitted, or otherwise legally allowed to administer

the subject business in the same manner as the transferring insurer

in the state of the policyholder's residence.

E. The court may approve the requested transfer and novation of

the subject business, with effectiveness of all or part of the

implementation deferred until the assuming insurer can satisfy the

requirements pursuant to subsection D of this section.

F. Rules.

The Commissioner shall have the authority to promulgate rules to

effectuate the provisions of the Insurance Business Transfer Act.

G. All testimony, documents, exhibits, analysis,

communications, or other information or evidence submitted to the

Commissioner or independent expert in contemplation of an

Oklahoma Statutes - Title 36. Insurance Page 511

application, submitted to the court in support of a petition, or

developed by the Commissioner or independent expert in connection

with such application, or petition for approval and implementation

of an Insurance Business Transfer Plan, shall be treated for

purposes of confidentiality as an examination of the financial

condition and/or market conduct of the transacting companies under

Sections 309.1 through 309.7 of this title.
Okla. Stat. tit. 36, § 36-6454.1 — OK Code / Title 36 / Section 36-6454.1
Risk retention groups – Governance standards
Status: in_force

A. For the purposes of this section:

1. "Board of Directors" or "Board" means the governing body of

the risk retention group elected by the shareholders or members to

establish policy, elect or appoint officers and committees, and make

other governing decisions;

2. "Director" means a natural person designated in the articles

of the risk retention group, or designated, elected or appointed by

any other manner, name or title to act as a director;

3. "Disclose" means making information available through

electronic or any other means the Board determines is necessary; and

4. "Service Providers" means captive managers, auditors,

accountants, actuaries, investment advisors, lawyers, managing

general underwriters or other parties responsible for underwriting,

determination of rates, collection of premiums, adjusting and

settling claims and/or the preparation of financial statements.

B. Existing risk retention groups shall comply with the

following governance standards within one year of the effective date

of this act. Risk retention groups licensed on or after the

effective date of this act shall be in compliance with the standards

at the time of licensure.

C. The Board of Directors of the risk retention group shall be

composed of a majority of independent directors. No director shall

qualify as independent unless the Board affirmatively determines

that the director has no material relationship with the risk

retention group. Each risk retention group shall disclose these

determinations to its domestic regulator at least annually.

Notwithstanding any other provision of law, a person that is a

direct or indirect owner of or subscriber in the risk retention

group, or is an officer, director or employee of such an owner and

insured, is considered to be independent unless some other position

Oklahoma Statutes - Title 36. Insurance Page 1197

of such officer, director or employee constitutes a material

relationship. Material relationship of a person with the risk

retention group shall include, but is not limited to:

1. The receipt in any one twelve (12) month period of

compensation or payment of any other item of value by such person, a

member of such person's immediate family or any business with which

the person is affiliated from the risk retention group or a

consultant or service provider to the risk retention group is

greater than or equal to five percent (5%) of the risk retention

group's gross written premium for the twelve (12) month period or

two percent (2%) of its surplus, whichever is greater, as measured

at the end of any fiscal quarter falling in the twelve (12) month

period. The person or immediate family member of such person is not

independent until one year after his or her compensation from the

risk retention group falls below the threshold provided in this

paragraph.

2. A relationship with a director or an immediate family member

of a director who is affiliated with or employed in a professional

capacity by a present or former internal or external auditor of the

risk retention group is not independent until one year after the end

of the affiliation, employment or auditing relationship.

3. A relationship with a director or immediate family member of

a director who is employed as an executive officer of another

company where any of the risk retention group's present executives

serve on the other company's Board of Directors is not independent

until one year after the end of such service or the employment

relationship.

D. The term of any material service provider contract with the

risk retention group shall not exceed five (5) years. Any such

contract, or its renewal, shall require the approval of the majority

of the risk retention group's independent directors. The risk

retention group's Board shall have the right to terminate any

service provider, audit or actuarial contract at any time for cause

after providing adequate notice as defined in the contract. The

service provider contract is deemed material if the amount to be

paid for the contract is greater than or equal to five percent (5%)

of the risk retention group's annual gross written premium or two

percent (2%) of its surplus, whichever is greater. For the purpose

of this section, lawyer shall not include defense counsel retained

by the risk retention group to defend claims, unless the amount of

fees paid to such lawyers are material. No service provider

contract violating the provisions prohibiting material

relationships, as specified in subsection B of this section, shall

be entered into unless the risk retention group has notified the

Commissioner in writing of its intention to enter into such contract

at least thirty (30) days prior and the Commissioner has not

disapproved it within such period. To the extent permissible under

Oklahoma Statutes - Title 36. Insurance Page 1198

state law, service providers of a reciprocal risk retention group

shall contract with the risk retention group.

If the risk retention group is a reciprocal risk retention

group, then the attorney-in-fact would be required to adhere to the

same standards regarding independence of operation and governance as

imposed on the Board's advisory committee created pursuant to this

section.

E. The risk retention group's Board shall adopt a written

policy in the plan of operation, as approved by the Board, that

requires the Board to:

1. Assure that all owners and insureds of the risk retention

group receive evidence of ownership interest;

2. Develop a set of governance standards applicable to the risk

retention group;

3. Oversee the evaluation of the risk retention group's

management including but not limited to the performance of the

captive manager, managing general underwriter or other party or

parties responsible for underwriting, determination of rates,

collection of premium, adjusting or settling claims or the

preparation of financial statements;

4. Review and approve the amount to be paid for all material

service providers; and

5. Review and approve, at least annually:

a. the risk retention group's goals and objectives

relevant to the compensation of officers and service

providers,

b. the officers' and service providers' performance

considering those goals and objectives, and

c. the continued engagement of the officers and material

service providers.

F. 1. The risk retention group shall have an audit committee

composed of at least three independent Board members, as specified

in subsection C of this section. A nonindependent Board member may

participate in the activities of the audit committee, if invited by

the members, but shall not be a member of the committee.

2. The audit committee shall have a written charter that

defines the purpose of the committee that includes but is not

limited to:

a. assisting Board oversight of:

i. the integrity of the financial statements,

ii. the compliance with legal and regulatory

requirements, and

iii. the qualifications, independence and performance

of the independent auditor and actuary,

b. discussing the annual audited financial statements and

quarterly financial statements with management,

Oklahoma Statutes - Title 36. Insurance Page 1199

c. discussing the annual audited financial statements

with its independent auditor and, if advisable,

discuss its quarterly financial statements with its

independent auditor,

d. discussing policies with respect to risk assessment

and risk management,

e. meeting separately and periodically, either directly

or through a designated representative of the

committee, with management and independent auditors,

f. reviewing with the independent auditor any audit

problems or difficulties and management's response,

g. setting clear hiring policies of the risk retention

group as to the hiring of employees or former

employees of the independent auditor,

h. requiring the external auditor to rotate the head

audit partner having primary responsibility for the

risk retention group's audit, as well as the audit

partner responsible for reviewing that audit so that

neither individual performs audit services for more

than five (5) consecutive fiscal years, and

i. reporting regularly to the Board.

3. The domestic regulator may waive the requirement to

establish an audit committee if the risk retention group is able to

demonstrate to the domestic regulator that it is impracticable to do

so and the risk retention group's Board is able to accomplish the

purposes of an audit committee described in this subsection.

G. The Board shall adopt and disclose governance standards and

provide the information to members and insureds upon request, which

shall include but not be limited to:

1. A process by which the directors are elected by the owner

and insureds;

2. Director qualification standards;

3. Director responsibilities;

4. Director access to management and, as necessary and

appropriate, independent advisors;

5. Director compensation;

6. Director orientation and continuing education;

7. The policies and procedures that are followed for management

succession; and

8. The policies and procedures that are followed for annual

performance evaluation of the Board.

H. The Board shall adopt and disclose a code of business

conduct and ethics for directors, officers and employees of the risk

retention group and shall promptly disclose to the Board any waivers

of the code for directors or executive officers, which shall include

the following topics:

1. Conflicts of interest;

Oklahoma Statutes - Title 36. Insurance Page 1200

2. Matters covered under the corporate opportunities doctrine

under the state of domicile;

3. Confidentiality;

4. Fair dealing;

5. Protection and proper use of risk retention group assets;

6. Compliance with all applicable laws, rules and regulations;

and

7. Requiring the reporting of any illegal or unethical behavior

which affects the operation of the risk retention group.

I. The captive manager, president or chief executive officer of

the risk retention group shall promptly notify the domestic

regulator in writing if either becomes aware of any material

noncompliance with the governance standards specified in subsections

G and H of this section.
Okla. Stat. tit. 36, § 36-3647 — OK Code / Title 36 / Section 36-3647
Authorizing lower score than Flesch reading ease score -
Status: in_force

Conditions.

The Commissioner may authorize a lower score than the required

Flesch reading ease score if, in his discretion, he finds that a

lower score meets any of the following conditions:

1. The lower score will provide a more accurate reflection of

the readability of a policy form;

2. The lower score is warranted by the nature of a particular

policy form or type or class of policy form;

3. The lower score is caused by certain policy language that is

drafted to conform to the requirement of any law, rule, or agency

interpretation.
Okla. Stat. tit. 36, § 36-3624.6 — OK Code / Title 36 / Section 36-3624.6
Conflicting provisions
Status: in_force

Any and all policies of insurance, or any plan or agreement

administered by an insurer, issued, entered into, amended or renewed

after the effective date of this act containing any provisions

contrary to or in conflict with this act are void as to those

provisions only; all remaining provisions in the contract not in

conflict with these sections that are severable shall remain in full

force and effect.
Okla. Stat. tit. 36, § 36-6103.6 — OK Code / Title 36 / Section 36-6103.6
Emergency cease and desist orders - Service - Hearing
Status: in_force

A. On issuance of an emergency cease and desist order under

Section 6103.5 of this title, the Insurance Commissioner shall serve

on the person affected by the order, by registered or certified

mail, return receipt requested, to the person's last-known address,

or by other lawful means, an order that contains a statement of the

charges and require the person immediately to cease and desist from

the acts, methods or practices stated.

B. 1. If a person affected by an emergency cease and desist

order seeks to contest that order, the person may request a hearing

Oklahoma Statutes - Title 36. Insurance Page 1134

before the Commissioner. The person affected must request the

hearing not later than the 30th day after the date on which the

person receives the order. A request to contest an order must be in

writing and directed to the Commissioner and must state the grounds

for the request to set aside or modify the order.

2. On receiving the request for a hearing, the Commissioner

shall serve notice of the time and place of the hearing at which the

person requesting the hearing shall have the opportunity to show

cause why the order should not be affirmed. The hearing is to be

held not later than the 10th day after the date the Commissioner

receives the request for a hearing unless the parties mutually agree

to a later hearing date.

3. Pending the hearing, an emergency cease and desist order

continues in full force and effect unless the order is stayed by the

Commissioner.

4. The hearing on the order shall be conducted according to the

procedures for contested cases under the Administrative Procedures

Act.

5. At the hearing, the Commissioner shall affirm, modify or set

aside in whole or in part the emergency cease and desist order.

C. A person aggrieved by a final order and decision of the

Commissioner pursuant to Sections 6103.1 through 6103.11 of this

title may seek judicial review pursuant to Section 318 of Title 75

of the Oklahoma Statutes.

D. The Commissioner may recover reasonable attorney's fees if

judicial action is necessary for enforcement of the order.

E. A cease and desist order is final thirty-one (31) days after

the date it is received if the person affected by the order does not

request a hearing as provided by subsection B of this section.
Okla. Stat. tit. 36, § 36-6041 — OK Code / Title 36 / Section 36-6041
Payments - How made
Status: in_force

Payment or each periodic payment not exceeding One Thousand

Dollars ($1,000.00) for emergency living expenses made to any

policyholder or his or her dependents or beneficiaries under an

insurance policy for:

1. Fire insurance;

2. Casualty insurance;

3. Property insurance, including what may be termed a

homeowner's policy; or

4. Any other type of policy that insures against personal loss

as a consequence of loss of or damage to real or personal property;

which provides for payment or periodic payments for emergency living

expenses; and payments made under workers' compensation or

employers' liability insurance as defined in Section 707 of this

title, shall be made through the use of United States legal tender,

or through a means acceptable to the recipient of the payment

including, but not limited to, electronic funds transfer, prepaid

cards, negotiable instruments payable on demand or negotiable

drafts.
Okla. Stat. tit. 36, § 36-6658 — OK Code / Title 36 / Section 36-6658
Transaction records - Contents - Retention period -
Status: in_force

Availability for examination.

A. All vehicle protection product warrantors shall keep

accurate accounts, books, and records concerning transactions

regulated under the Vehicle Protection Product Act.

B. A vehicle protection product warrantor’s accounts, books,

and records shall include:

1. Copies of all vehicle protection product warranties;

2. The name and address of each warranty holder; and

3. The dates, amounts, and descriptions of all receipts,

claims, and expenditures.

C. A vehicle protection product warrantor shall retain all

required accounts, books, and records pertaining to each warranty

holder for at least three (3) years after the specified period of

coverage has expired. A warrantor discontinuing business in this

state shall maintain its records until it furnishes the Insurance

Commissioner satisfactory proof that the warrantor has discharged

all obligations to warranty holders in this state.

D. Vehicle protection product warrantors shall make all

accounts, books, and records concerning transactions regulated under

the Vehicle Protection Product Act available to the Commissioner for

examination.
Okla. Stat. tit. 36, § 36-6475.9 — OK Code / Title 36 / Section 36-6475.9
Circumstances when external review request can be made
Status: in_force

A. Except as provided in subsection F of this section, a

covered person or the covered person's authorized representative may

make a request for an expedited external review with the Insurance

Commissioner at the time the covered person receives:

1. An adverse determination if:

a. the adverse determination involves a medical condition

of the covered person for which the time frame for

completion of an expedited internal review of a

grievance involving an adverse determination would

seriously jeopardize the life or health of the covered

person or would jeopardize the covered person's

ability to regain maximum function, and

Oklahoma Statutes - Title 36. Insurance Page 1251

b. the covered person or the covered person's authorized

representative has filed a request for an expedited

review of a grievance involving an adverse

determination; or

2. A final adverse determination:

a. if the covered person has a medical condition where

the time frame for completion of a standard external

review pursuant to Section 6475.8 of this title would

seriously jeopardize the life or health of the covered

person or would jeopardize the covered person's

ability to regain maximum function, or

b. if the final adverse determination concerns an

admission, availability of care, continued stay or

health care service for which the covered person

received emergency services, but has not been

discharged from a facility.

B. 1. Upon receipt of a request for an expedited external

review, the Commissioner immediately shall send a copy of the

request to the health carrier.

2. Immediately upon receipt of the request pursuant to

paragraph 1 of this subsection, the health carrier shall determine

whether the request meets the reviewability requirements set forth

in subsection B of Section 6475.8 of this title. The health carrier

shall immediately notify the Commissioner and the covered person

and, if applicable, the covered person's authorized representative

of its eligibility determination.

3. a. The Commissioner may specify the form for the health

carrier's notice of initial determination under this

subsection and any supporting information to be

included in the notice.

b. The notice of initial determination shall include a

statement informing the covered person and, if

applicable, the covered person's authorized

representative that a health carrier's initial

determination that an external review request is

ineligible for review may be appealed to the

Commissioner.

4. a. The Commissioner may determine that a request is

eligible for external review under subsection B of

Section 6475.8 of this title notwithstanding a health

carrier's initial determination that the request is

ineligible and require that it be referred for

external review.

b. In making a determination under subparagraph a of this

paragraph, the Commissioner's decision shall be made

in accordance with the terms of the covered person's

health benefit plan and shall be subject to all

Oklahoma Statutes - Title 36. Insurance Page 1252

applicable provisions of the Uniform Health Carrier

External Review Act.

5. Upon receipt of the notice that the request meets the

reviewability requirements, the Commissioner immediately shall

assign an independent review organization to conduct the expedited

external review from the list of approved independent review

organizations compiled and maintained by the Commissioner pursuant

to Section 6475.12 of this title. The Commissioner shall

immediately notify the health carrier of the name of the assigned

independent review organization.

6. In reaching a decision in accordance with subsection E of

this section, the assigned independent review organization shall not

be bound by any decisions or conclusions reached during the health

carrier's utilization review process as set forth in Sections 6551

through 6565 of this title or the health carrier's internal

grievance process.

C. Upon receipt of the notice from the Commissioner of the name

of the independent review organization assigned to conduct the

expedited external review pursuant to paragraph 5 of subsection B of

this section, the health carrier or its designee utilization review

organization shall provide or transmit all necessary documents and

information considered in making the adverse determination or final

adverse determination to the assigned independent review

organization electronically or by telephone or facsimile or any

other available expeditious method.

D. In addition to the documents and information provided or

transmitted pursuant to subsection C of this section, the assigned

independent review organization, to the extent the information or

documents are available and the independent review organization

considers them appropriate, shall consider the following in reaching

a decision:

1. The covered person's pertinent medical records;

2. The attending health care professional's recommendation;

3. Consulting reports from appropriate health care

professionals and other documents submitted by the health carrier,

covered person, the covered person's authorized representative or

the covered person's treating provider;

4. The terms of coverage under the covered person's health

benefit plan with the health carrier to ensure that the independent

review organization's decision is not contrary to the terms of

coverage under the covered person's health benefit plan with the

health carrier;

5. The most appropriate practice guidelines, which shall

include evidence-based standards, and may include any other practice

guidelines developed by the federal government, national or

professional medical societies, boards and associations;

Oklahoma Statutes - Title 36. Insurance Page 1253

6. Any applicable clinical review criteria developed and used

by the health carrier or its designee utilization review

organization in making adverse determinations; and

7. The opinion of the independent review organization's

clinical reviewer or reviewers after considering paragraphs 1

through 6 of this subsection to the extent the information and

documents are available and the clinical reviewer or reviewers

consider appropriate.

E. 1. As expeditiously as the covered person's medical

condition or circumstances require, but in no event more than

seventy-two (72) hours after the date of receipt of the request for

an expedited external review that meets the reviewability

requirements set forth in subsection B of Section 6475.8 of this

title, the assigned independent review organization shall:

a. make a decision to uphold or reverse the adverse

determination or final adverse determination, and

b. notify the covered person, if applicable, the covered

person's authorized representative, the health

carrier, and the Commissioner of the decision.

2. If the notice provided pursuant to paragraph 1 of this

subsection was not in writing, within forty-eight (48) hours after

the date of providing that notice, the assigned independent review

organization shall:

a. provide written confirmation of the decision to the

covered person, if applicable, the covered person's

authorized representative, the health carrier, and the

Commissioner, and

b. include the information set forth in paragraph 2 of

subsection I of Section 6475.8 of this title.

3. Upon receipt of the notice of a decision pursuant to

paragraph 1 of this subsection reversing the adverse determination

or final adverse determination, the health carrier immediately shall

approve the coverage that was the subject of the adverse

determination or final adverse determination.

F. An expedited external review may not be provided for

retrospective adverse or final adverse determinations.

G. The assignment by the Commissioner of an approved

independent review organization to conduct an external review in

accordance with this section shall be done on a random basis among

those approved independent review organizations qualified to conduct

the particular external review based on the nature of the health

care service that is the subject of the adverse determination or

final adverse determination and other circumstances including

conflict of interest concerns pursuant to subsection D of Section

6475.13 of this title.
Okla. Stat. tit. 36, § 36-2028 — OK Code / Title 36 / Section 36-2028
Impaired or insolvent insurers
Status: in_force

A. If a member insurer is an impaired insurer, the Oklahoma

Life and Health Insurance Guaranty Association may, in its

discretion, and subject to any conditions imposed by the Association

that do not impair the contractual obligations of the impaired

insurer and that are approved by the Insurance Commissioner:

1. Guarantee, assume, reissue or reinsure, or cause to be

guaranteed, assumed, reissued or reinsured, any or all of the

policies or contracts of the impaired insurer; or

2. Provide monies, pledges, notes, guarantees or other means as

are proper to effectuate paragraph 1 of this subsection, and assure

payment of the contractual obligations of the impaired insurer

pending action under paragraph 1 of this subsection.

B. If a member insurer is an insolvent insurer, the Association

shall, in its discretion, either:

1. a. (1) guarantee, assume, reissue or reinsure, or cause

to be guaranteed, assumed, reissued or reinsured,

the policies or contracts of the insolvent

insurer, or

(2) assure payment of the contractual obligations of

the insolvent insurer, and

b. provide monies, pledges, loans, notes, guarantees or

other means as are reasonably necessary to discharge

the duties of the Association; or

2. Provide benefits and coverages in accordance with the

following provisions:

a. with respect to policies and contracts, assure payment

of benefits that would have been payable under the

Oklahoma Statutes - Title 36. Insurance Page 603

policies or contracts of the insolvent insurer for

claims incurred:

(1) with respect to group policies and contracts, not

later than the earlier of the next renewal date

under those policies or contracts or forty-five

(45) days, but in no event less than thirty (30)

days, after the date on which the Association

becomes obligated with respect to the policies

and contracts, or

(2) with respect to non-group policies, contracts,

and annuities not later than the earlier of the

next renewal date, if any, under the policies or

contracts for one (1) year, but in no event less

than thirty (30) days, from the date on which the

Association becomes obligated with respect to the

policies or contracts,

b. make diligent efforts to provide all known insureds,

enrollees or annuitants for non-group policies and

contracts, or group policy or contract owners with

respect to group policies and contracts, thirty (30)

days' notice of the termination of the benefits

provided pursuant to subparagraph a of this paragraph,

c. with respect to non-group policies and contracts

covered by the Association, make available to each

known insured, enrollee or annuitant, or owner if

other than the insured, enrollee or annuitant, and

with respect to an individual formerly an insured,

enrollee or annuitant under a group policy or contract

who is not eligible for replacement group coverage,

make available substitute coverage on an individual

basis in accordance with the provisions of

subparagraph d of this paragraph, if the insureds,

enrollees or annuitants had a right under law or the

terminated policy, contract or annuity to convert

coverage to individual coverage or to continue an

individual policy, contract or annuity in force until

a specified age or for a specified time, during which

the insurer or health maintenance organization had no

right unilaterally to make changes in any provision of

the policy, contract or annuity or had a right only to

make changes in premium by class,

d. (1) in providing the substitute coverage required

under subparagraph c of this paragraph, the

Association may offer either to reissue the

terminated coverage or to issue an alternative

policy or contract at actuarially justified

Oklahoma Statutes - Title 36. Insurance Page 604

rates, subject to the prior approval of the

Insurance Commissioner,

(2) alternative or reissued policies or contracts

shall be offered without requiring evidence of

insurability, and shall not provide for any

waiting period or exclusion that would not have

applied under the terminated policy or contract,

and

(3) the Association may reinsure any alternative or

reissued policy or contract,

e. (1) alternative policies or contracts adopted by the

Association shall be subject to the approval of

the Insurance Commissioner. The Association may

adopt alternative policies or contracts of

various types for future issuance without regard

to any particular impairment or insolvency,

(2) alternative policies or contracts shall contain

at least the minimum statutory provisions

required in this state and provide benefits that

shall not be unreasonable in relation to the

premium charged. The Association shall set the

premium in accordance with a table of rates that

it shall adopt. The premium shall reflect the

amount of insurance to be provided and the age

and class of risk of each insured, but shall not

reflect any changes in the health of the insured

after the original policy or contract was last

underwritten,

(3) any alternative policy or contract issued by the

Association shall provide coverage of a type

similar to that of the policy or contract issued

by the impaired or insolvent insurer, as

determined by the Association,

f. if the Association elects to reissue terminated

coverage at a premium rate different from that charged

under the terminated policy or contract, the premium

shall be actuarially justified and set by the

Association in accordance with the amount of insurance

or coverage provided and the age and class of risk,

subject to prior approval of the Insurance

Commissioner,

g. the obligations of the Association with respect to

coverage under any policy or contract of the impaired

or insolvent insurer or under any reissued or

alternative policy or contract shall cease on the date

the coverage or policy or contract is replaced by

another similar policy or contract by the policy or

Oklahoma Statutes - Title 36. Insurance Page 605

contract owner, the insured, enrollee or the

Association,

h. when proceeding under paragraph 2 of subsection B of

this section with respect to a policy or contract

carrying guaranteed minimum interest rates, the

Association shall assure the payment or crediting of a

rate of interest consistent with subparagraph c of

paragraph 2 of subsection B of Section 2025 of this

title.

C. Nonpayment of premiums within thirty-one (31) days after the

date required under the terms of any guaranteed, assumed,

alternative or reissued policy or contract or substitute coverage

shall terminate the Association's obligations under the policy,

contract or coverage under the Oklahoma Life and Health Insurance

Guaranty Association Act with respect to the policy, contract or

coverage, except with respect to any claims incurred or any net cash

surrender value which may be due in accordance with the provisions

of the Oklahoma Life and Health Insurance Guaranty Association Act.

D. Premiums due for coverage after entry of an order of

liquidation of an insolvent insurer shall belong to and be payable

at the direction of the Association. If the liquidator of an

insolvent insurer requests, the Association shall provide a report

to the liquidator regarding the premium collected by the

Association. The Association shall be liable for unearned premiums

due to policy or contract owners arising after the entry of the

order.

E. The protection provided by the Oklahoma Life and Health

Insurance Guaranty Association Act shall not apply where any

guaranty protection is provided to residents of this state by the

laws of the domiciliary state or jurisdiction of the impaired or

insolvent insurer other than this state.

F. In carrying out its duties under subsection B of this

section the Association may, subject to approval by a court in this

state:

1. Impose permanent policy or contract liens in connection with

a guarantee, assumption or reinsurance agreement, if the Association

finds that the amounts which can be assessed under this act are less

than the amounts needed to assure full and prompt performance of the

duties of the Association under the Oklahoma Life and Health

Insurance Guaranty Association Act, or that the economic or

financial conditions as they affect member insurers are sufficiently

adverse to render the imposition of permanent policy or contract

liens, to be in the public interest; and

2. Impose temporary moratoriums or liens on payments of cash

values and policy loans, or any other right to withdraw funds held

in conjunction with policies or contracts, in addition to any

contractual provisions for deferral of cash or policy loan value.

Oklahoma Statutes - Title 36. Insurance Page 606

In addition, in the event of a temporary moratorium or moratorium

charge imposed by the receivership court on payment of cash values

or policy loans, or on any other right to withdraw funds held in

conjunction with policies or contracts, out of the assets of the

impaired or insolvent insurer, the Association may defer the payment

of cash values, policy loans or other rights by the Association for

the period of the moratorium or moratorium charge imposed by the

receivership court, except for claims covered by the Association to

be paid in accordance with a hardship procedure established by the

liquidator or rehabilitator and approved by the receivership court.

G. A deposit in this state, held pursuant to law or required by

the Commissioner for the benefit of creditors, including but not

limited to policy or contract owners, not turned over to the

domiciliary liquidator upon the entry of a final order of

liquidation or order approving a rehabilitation plan of a member

insurer domiciled in this state or in a reciprocal state, shall be

promptly paid by the Association. The Association shall be entitled

to retain a portion of any amount so paid to it equal to the

percentage determined by dividing the aggregate amount of policy or

contract owners claims related to that insolvency for which the

Association has provided statutory benefits by the aggregate amount

of all claims by the policy or contract owners in this state related

to that insolvency and shall remit to the domiciliary receiver the

amount so paid to the Association less the amount retained pursuant

to this subsection. Any amount so paid to the Association and

retained by it shall be treated as a distribution of estate assets

pursuant to applicable state receivership laws dealing with early

access disbursements.

H. If the Association fails to act within a reasonable period

of time with respect to an insolvent insurer, as provided in

subsection B of this section, the Commissioner shall have the powers

and duties of the Association under the Oklahoma Life and Health

Insurance Guaranty Association Act with respect to the insolvent

insurer.

I. The Association may render assistance and advice to the

Commissioner, upon the request of the Commissioner, concerning

rehabilitation, payment of claims, continuance of coverage, or the

performance of other contractual obligations of an impaired or

insolvent insurer.

J. The Association shall have standing to appear or intervene

before a court or agency in this state which has jurisdiction over

an impaired or insolvent insurer concerning which the Association is

or may become obligated under the Oklahoma Life and Health Insurance

Guaranty Association Act or with jurisdiction over any person or

property against which the Association may have rights through

subrogation or otherwise. Standing shall extend to all matters

germane to the powers and duties of the Association including, but

Oklahoma Statutes - Title 36. Insurance Page 607

not limited to, proposals for reinsuring, reissuing, modifying or

guaranteeing the policies or contracts of the impaired or insolvent

insurer and the determination of the policies or contracts and

contractual obligations. The Association shall also have the right

to appear or intervene before a court or agency in another state

with jurisdiction over an impaired or insolvent insurer for which

the Association is or may become obligated or with jurisdiction over

any person or property against whom the Association may have rights

through subrogation or otherwise.

K. 1. Any person receiving benefits under the Oklahoma Life

and Health Insurance Guaranty Association Act shall be deemed to

have assigned the rights under, and any causes of action against any

person for losses arising under, resulting from or otherwise

relating to, the covered policy or contract to the Association to

the extent of the benefits received because of this act, whether the

benefits are payments of or on account of contractual obligations,

continuation of coverage or provision of substitute or alternative

policies, contracts or coverages. The Association may require an

assignment to it of the rights and cause of action by any enrollee,

payee, policy or contract owner, beneficiary, insured or annuitant

as a condition precedent to the receipt of any rights or benefits

conferred by this act upon the person.

2. The subrogation rights of the Association under this

subsection shall have the same priority against the assets of the

impaired or insolvent insurer as that possessed by the person

entitled to receive benefits under the Oklahoma Life and Health

Insurance Guaranty Association Act.

3. In addition to paragraphs 1 and 2 of this subsection, the

Association shall have all common law rights of subrogation and any

other equitable or legal remedy that would have been available to

the impaired or insolvent insurer or owner, beneficiary, enrollee or

payee of a policy or contract with respect to the policy or

contracts, including without limitation, in the case of a structured

settlement annuity, any rights of the owner, beneficiary or payee of

the annuity, to the extent of benefits received pursuant to the

Oklahoma Life and Health Insurance Guaranty Association Act, against

a person originally or by succession responsible for the losses

arising from the personal injury relating to the annuity or payment

therefor, excepting any person responsible solely by reason of

serving as an assignee in respect of a qualified assignment under

Internal Revenue Code Section 130.

4. If paragraphs 1 through 3 of this subsection are invalid or

ineffective with respect to any person or claim for any reason, the

amount payable by the Association with respect to the related

covered obligations shall be reduced by the amount realized by any

other person with respect to the person or claim that is

Oklahoma Statutes - Title 36. Insurance Page 608

attributable to the policies or contracts, or portion thereof,

covered by the Association.

5. If the Association has provided benefits with respect to a

covered obligation and a person recovers amounts as to which the

Association has rights as described in paragraphs 1 through 4 of

this subsection, the person shall pay to the Association the portion

of the recovery attributable to the policies or contracts, or

portion thereof, covered by the Association.

L. In addition to the rights and powers specified in the

Oklahoma Life and Health Insurance Guaranty Association Act, the

Association may:

1. Enter into contracts as are necessary or proper to carry out

the provisions and purposes of the Oklahoma Life and Health

Insurance Guaranty Association Act;

2. Sue or be sued, including, but not limited to, taking any

legal actions necessary or proper to recover any unpaid assessments

under Section 2030 of this title and to settle claims or potential

claims against it;

3. Borrow money to effect the purposes of the Oklahoma Life and

Health Insurance Guaranty Association Act. Any notes or other

evidence of indebtedness of the Association not in default shall be

legal investments for domestic member insurers and may be carried as

admitted assets;

4. Employ or retain persons as are necessary or appropriate to

handle the financial transactions of the Association, and to perform

other functions as become necessary or proper under the Oklahoma

Life and Health Insurance Guaranty Association Act;

5. Take any legal action as may be necessary or appropriate to

avoid or recover payment of improper claims;

6. Exercise, for the purposes of the Oklahoma Life and Health

Insurance Guaranty Association Act and to the extent approved by the

Commissioner, the powers of a domestic life insurer, health insurer

or health maintenance organization, but in no case may the

Association issue policies or contracts other than those issued to

perform its obligations under the Oklahoma Life and Health Insurance

Guaranty Association Act;

7. Organize itself as a corporation or in other legal form

permitted by the laws of the state;

8. Request information from a person seeking coverage from the

Association in order to aid the Association in determining its

obligations under the Oklahoma Life and Health Insurance Guaranty

Association Act with respect to the person, and the person shall

promptly comply with the request;

9. Unless prohibited by law, in accordance with the terms and

conditions of the policy or contract, file for actuarially justified

rate or premium increases for any policy or contract for which it

Oklahoma Statutes - Title 36. Insurance Page 609

provides coverage under the Oklahoma Life and Health Insurance

Guaranty Association Act; and

10. Take other necessary or appropriate action to discharge its

duties and obligations under the Oklahoma Life and Health Insurance

Guaranty Association Act or to exercise its powers under the

Oklahoma Life and Health Insurance Guaranty Association Act.

M. The Association may join an organization of one or more

other state associations of similar purposes, to further the

purposes and administer the powers and duties of the Association.

N. 1. a. At any time within one hundred eighty (180) days of

the date of the order of liquidation, the Association

may elect to succeed to the rights and obligations of

the ceding member insurer that relate to policies,

contracts or annuities covered, in whole or in part,

by the Association, in each case under any one or more

reinsurance contracts entered into by the insolvent

insurer and its reinsurers and selected by the

Association. Any assumption shall be effective as of

the date of the order of liquidation. The election

shall be effected by the Association or the National

Organization of Life and Health Insurance Guaranty

Associations (NOLHGA) on its behalf sending written

notice, return receipt requested, to the affected

reinsurers.

b. To facilitate the earliest practicable decision about

whether to assume any of the contracts of reinsurance,

and in order to protect the financial position of the

estate, the receiver and each reinsurer of the ceding

member insurer shall make available upon request to

the Association or to NOLHGA on its behalf as soon as

possible after commencement of formal delinquency

proceedings, copies of in-force contracts of

reinsurance and all related files and records relevant

to the determination of whether the contracts should

be assumed, and notices of any defaults under the

reinsurance contacts or any known event or condition

which with the passage of time could become a default

under the reinsurance contracts.

c. The requirements provided in this subparagraph shall

apply to reinsurance contracts assumed by the

Association:

(1) the Association shall be responsible for all

unpaid premiums due under the reinsurance

contracts for periods both before and after the

date of the order of liquidation, and shall be

responsible for the performance of all other

obligations to be performed after the date of the

Oklahoma Statutes - Title 36. Insurance Page 610

order of liquidation, in each case which relate

to policies, contracts or annuities covered, in

whole or in part, by the Association. The

Association may charge policies, contracts or

annuities covered in part by the Association,

through reasonable allocation methods, the costs

for reinsurance in excess of the obligations of

the Association and shall provide notice and an

accounting of these charges to the liquidator,

(2) the Association shall be entitled to any amounts

payable by the reinsurer under the reinsurance

contracts with respect to losses or events that

occur in periods after the date of the order of

liquidation and that relate to policies,

contracts or annuities covered, in whole or in

part, by the Association, provided that, upon

receipt of any of these amounts, the Association

shall be obliged to pay to the beneficiary under

the policy, contract or annuity on account of

which the amounts were paid a portion of the

amount equal to the lesser of:

(a) the amount received by the Association, or

(b) the excess of the amount received by the

Association over the amount equal to the

benefits paid by the Association on account

of the policy, contract or annuity less the

retention of the insurer applicable to the

loss or event,

(3) within thirty (30) days following the election

date of the Association, the Association and each

reinsurer under contracts assumed by the

Association shall calculate the net balance due

to or from the Association under each reinsurance

contract as of the election date with respect to

policies, contracts or annuities covered, in

whole or in part, by the Association, which

calculation shall give full credit to all items

paid by either the member insurer or its receiver

or the reinsurer prior to the election date. The

reinsurer shall pay the receiver any amounts due

for losses or events prior to the date of the

order of liquidation, subject to any set-off for

premiums unpaid for periods prior to the date,

and the Association or reinsurer shall pay any

remaining balance due the other, in each case

within five (5) days of the completion of the

aforementioned calculation. Any disputes over

Oklahoma Statutes - Title 36. Insurance Page 611

the amounts due to either the Association or the

reinsurer shall be resolved by arbitration

pursuant to the terms of the affected reinsurance

contracts or, if the contract contains no

arbitration clause, as otherwise provided by law.

If the receiver has received any amounts due the

Association pursuant to division (2) of this

subparagraph, the receiver shall remit the same

to the Association as promptly as practicable,

and

(4) if the Association or receiver, on the behalf of

the Association, within sixty (60) days of the

election date, pays the unpaid premiums due for

periods both before and after the election date

that relate to policies, contracts or annuities

covered, in whole or in part, by the Association,

the reinsurer shall not be entitled to terminate

the reinsurance contracts for failure to pay the

premium insofar as the reinsurance contracts

relate to policies, contracts or annuities

covered, in whole or in part, by the Association,

and shall not be entitled to set off any unpaid

amounts due under other contracts, or unpaid

amounts due from parties other than the

Association, against amounts due the Association.

2. During the period from the date of the order of liquidation

until the election date, or if the election date does not occur,

until one hundred eighty (180) days after the date of the order of

liquidation:

a. (1) neither the Association nor the reinsurer shall

have any rights or obligations under reinsurance

contracts that the Association has the right to

assume under paragraph 1 of this subsection,

whether for periods prior to or after the date of

the order of liquidation, and

(2) the reinsurer, the receiver and the Association

shall, to the extent practicable, provide each

other data and records reasonably requested.

b. Provided that once the Association has elected to

assume a reinsurance contract, the rights and

obligations of the parties shall be governed by

paragraph 1 of this subsection.

3. If the Association does not elect to assume a reinsurance

contract by the election date pursuant to paragraph 1 of this

subsection, the Association shall have no rights or obligations, in

each case for periods both before and after the date of the order of

liquidation, with respect to the reinsurance contract.

Oklahoma Statutes - Title 36. Insurance Page 612

4. When policies, contracts or annuities, or covered

obligations with respect thereto, are transferred to an assuming

insurer, reinsurance on the policies, contracts or annuities may

also be transferred by the Association, in the case of contracts

assumed under paragraph 1 of this subsection, subject to the

following:

a. unless the reinsurer and the assuming insurer agree

otherwise, the reinsurance contract transferred shall

not cover any new policies, contracts of insurance or

annuities in addition to those transferred,

b. the obligations described in paragraph 1 of this

subsection shall no longer apply with respect to

matters arising after the effective date of the

transfer, and

c. notice shall be given in writing, return receipt

requested, by the transferring party to the affected

reinsurer not less than thirty (30) days prior to the

effective date of the transfer.

5. The provisions of this subsection shall govern any affected

reinsurance contract that provides for or requires any payment of

reinsurance proceeds, on account of losses or events that occur in

periods after the date of the order of liquidation, to the receiver

of the insolvent insurer or any other person. The receiver shall

remain entitled to any amounts payable by the reinsurer under the

reinsurance contracts with respect to losses or events that occur in

periods prior to the date of the order of liquidation, subject to

applicable setoff provisions.

6. Except as otherwise provided in this section, nothing in

this subsection shall alter or modify the terms and conditions of

any reinsurance contract. Nothing in this section shall abrogate or

limit any rights of any reinsurer to claim that it is entitled to

rescind a reinsurance contract. Nothing in this section shall give

a policyholder, contract owner, enrollee, certificate holder or

beneficiary an independent cause of action against a reinsurer that

is not otherwise set forth in the reinsurance contract. Nothing in

this section shall limit or affect the rights of the Association as

a creditor of the estate against the assets of the state. Nothing

in this section shall apply to reinsurance agreements covering

property or casualty risks.

O. The Board of Directors of the Association shall have

discretion and may exercise reasonable business judgment to

determine the means by which the Association is to provide the

benefits of the Oklahoma Life and Health Insurance Guaranty

Association Act in an economical and efficient manner.

P. Where the Association has arranged or offered to provide the

benefits of the Oklahoma Life and Health Insurance Guaranty

Association Act to a covered person under a plan or arrangement that

Oklahoma Statutes - Title 36. Insurance Page 613

fulfills the obligations of the Association under the Oklahoma Life

and Health Insurance Guaranty Association Act, the person shall not

be entitled to benefits from the Association in addition to or other

than those provided under the plan or arrangement.

Q. Venue in a suit against the Association arising under the

Oklahoma Life and Health Insurance Guaranty Association Act shall be

in Oklahoma County. The Association shall not be required to give

an appeal bond in an appeal that relates to a cause of action

arising under the Oklahoma Life and Health Insurance Guaranty

Association Act.

R. In carrying out its duties in connection with guaranteeing,

assuming or reinsuring policies or contracts under subsection A or B

of this section, the Association may, subject to approval of the

receivership court, issue substitute coverage for a policy or

contract that provides an interest rate, crediting rate or similar

factor determined by use of an index or other external reference

stated in the policy or contract employed in calculating returns or

changes in value by issuing an alternative policy or contract in

accordance with the following provisions:

1. In lieu of the index or other external reference provided

for in the original policy or contract, the alternative policy or

contract provides for:

a. a fixed interest rate,

b. payment of dividends with minimum guarantees, or

c. a different method for calculating interest or changes

in value;

2. There is no requirement for evidence of insurability,

waiting period or other exclusion that would not have applied under

the replaced policy or contract; and

3. The alternative policy or contract is substantially similar

to the replaced policy or contract in all other material terms.
Okla. Stat. tit. 36, § 36-2686 — OK Code / Title 36 / Section 36-2686
Limited liability
Status: in_force

The private property of the subscribers, agents, officers,

directors, members and employees of any corporation holding a

certificate of authority under this Article shall be wholly exempt

from any of the debts, obligations and liabilities of the

corporation.
Okla. Stat. tit. 36, § 36-3635.1 — OK Code / Title 36 / Section 36-3635.1
Time of expiration of certain policies
Status: in_force

All policies insuring against loss resulting from liability

imposed by law for bodily injury or death suffered by any person

arising out of the ownership, maintenance or use of a motor vehicle,

as defined in Section 3635 of this title, shall expire at 12:01

a.m. Standard Time on the expiration date stated in the policy. This

section shall apply to all such policies on the first policy renewal

date after December 31, 1982.
Okla. Stat. tit. 36, § 36-2609 — OK Code / Title 36 / Section 36-2609
Membership; voting; membership fees
Status: in_force

A. Corporations organized under this article shall be mutual

corporations and every person who holds a policy or contract with

the corporation shall be a member of the corporation and shall be

entitled to one or more votes based upon the number of policies or

contracts held, and such members may vote in person or by proxy.

B. Mutual corporations organized in accordance with the

provisions of this article shall be entitled to charge and collect

initial membership fees or policy fees, or both such fees, in

addition to premiums.
Okla. Stat. tit. 36, § 36-6475.10 — OK Code / Title 36 / Section 36-6475.10
Timeframe for filing request for external review
Status: in_force

A. 1. Within four (4) months after the date of receipt of a

notice of an adverse determination or final adverse determination

pursuant to Section 6475.5 of this title that involves a denial of

coverage based on a determination that the health care service or

treatment recommended or requested is experimental or

investigational, a covered person or the covered person's authorized

representative may file a request for external review with the

Insurance Commissioner.

2. a. A covered person or the covered person's authorized

representative may make an oral request for an

expedited external review of the adverse determination

or final adverse determination pursuant to paragraph 1

of this subsection if the covered person's treating

physician certifies, in writing, that the recommended

or requested health care service or treatment that is

the subject of the request would be significantly less

effective if not promptly initiated.

b. Upon receipt of a request for an expedited external

review, the Commissioner immediately shall notify the

health carrier.

c. (1) Upon notice of the request for expedited external

review, the health carrier immediately shall

determine whether the request meets the

reviewability requirements of subsection B of

this section. The health carrier shall

immediately notify the Commissioner and the

covered person and, if applicable, the covered

person's authorized representative of its

eligibility determination.

(2) The Commissioner may specify the form for the

health carrier's notice of initial determination

under division (1) of this subparagraph and any

supporting information to be included in the

notice.

(3) The notice of initial determination under

division (1) of this subparagraph shall include a

statement informing the covered person and, if

applicable, the covered person's authorized

representative that a health carrier's initial

determination that the external review request is

ineligible for review may be appealed to the

Commissioner.

d. (1) The Commissioner may determine that a request is

eligible for external review under paragraph 2 of

subsection B of this section notwithstanding a

Oklahoma Statutes - Title 36. Insurance Page 1255

health carrier's initial determination the

request is ineligible and require that it be

referred for external review.

(2) In making a determination under division (1) of

this subparagraph, the Commissioner's decision

shall be made in accordance with the terms of the

covered person's health benefit plan and shall be

subject to all applicable provisions of the

Uniform Health Carrier External Review Act.

e. Upon receipt of the notice that the expedited external

review request meets the reviewability requirements of

paragraph 2 of subsection B of this section, the

Commissioner immediately shall assign an independent

review organization to review the expedited request

from the list of approved independent review

organizations compiled and maintained by the

Commissioner pursuant to Section 6475.12 of this title

and notify the health carrier of the name of the

assigned independent review organization.

f. At the time the health carrier receives the notice of

the assigned independent review organization pursuant

to subparagraph e of this paragraph, the health

carrier or its designee utilization review

organization shall provide or transmit all necessary

documents and information considered in making the

adverse determination or final adverse determination

to the assigned independent review organization

electronically or by telephone or facsimile or any

other available expeditious method.

B. 1. Except for a request for an expedited external review

made pursuant to paragraph 2 of subsection A of this section, within

one (1) business day after the date of receipt of the request, the

Commissioner receives a request for an external review, the

Commissioner shall notify the health carrier.

2. Within five (5) business days following the date of receipt

of the notice sent pursuant to paragraph 1 of this subsection, the

health carrier shall conduct and complete a preliminary review of

the request to determine whether:

a. the individual is or was a covered person in the

health benefit plan at the time the health care

service or treatment was recommended or requested or,

in the case of a retrospective review, was a covered

person in the health benefit plan at the time the

health care service or treatment was provided,

b. the recommended or requested health care service or

treatment that is the subject of the adverse

determination or final adverse determination:

Oklahoma Statutes - Title 36. Insurance Page 1256

(1) is a covered benefit under the covered person's

health benefit plan except for the health

carrier's determination that the service or

treatment is experimental or investigational for

a particular medical condition, and

(2) is not explicitly listed as an excluded benefit

under the covered person's health benefit plan

with the health carrier,

c. the covered person's treating physician has certified

that one of the following situations is applicable:

(1) standard health care services or treatments have

not been effective in improving the condition of

the covered person,

(2) standard health care services or treatments are

not medically appropriate for the covered person,

or

(3) there is no available standard health care

service or treatment covered by the health

carrier that is more beneficial than the

recommended or requested health care service or

treatment described in subparagraph d of this

paragraph,

d. the covered person's treating physician:

(1) has recommended a health care service or

treatment that the physician certifies, in

writing, is likely to be more beneficial to the

covered person, in the physician's opinion, than

any available standard health care services or

treatments, or

(2) who is a licensed, board-certified or board-

eligible physician qualified to practice in the

area of medicine appropriate to treat the covered

person's condition, has certified in writing that

scientifically valid studies using accepted

protocols demonstrate that the health care

service or treatment requested by the covered

person that is the subject of the adverse

determination or final adverse determination is

likely to be more beneficial to the covered

person than any available standard health care

services or treatments,

e. the covered person has exhausted the health carrier's

internal grievance process unless the covered person

is not required to exhaust the health carrier's

internal grievance process pursuant to Section 6475.7

of this title, and

Oklahoma Statutes - Title 36. Insurance Page 1257

f. the covered person has provided all the information

and forms required by the Commissioner that are

necessary to process an external review including the

release form provided under subsection B of Section

6475.5 of this title.

C. 1. Within one (1) business day after completion of the

preliminary review, the health carrier shall notify the Commissioner

and the covered person and, if applicable, the covered person's

authorized representative in writing whether:

a. the request is complete, and

b. the request is eligible for external review.

2. If the request:

a. is not complete, the health carrier shall inform in

writing the Commissioner and the covered person and,

if applicable, the covered person's authorized

representative and include in the notice what

information or materials are needed to make the

request complete, or

b. is not eligible for external review, the health

carrier shall inform the covered person, the covered

person's authorized representative, if applicable, and

the Commissioner in writing and include in the notice

the reasons for its ineligibility.

3. a. The Commissioner may specify the form for the health

carrier's notice of initial determination under

paragraph 2 of this subsection and any supporting

information to be included in the notice.

b. The notice of initial determination provided under

paragraph 2 of this subsection shall include a

statement informing the covered person and, if

applicable, the covered person's authorized

representative that a health carrier's initial

determination that the external review request is

ineligible for review may be appealed to the

Commissioner.

4. a. The Commissioner may determine that a request is

eligible for external review under paragraph 2 of

subsection B of this section notwithstanding a health

carrier's initial determination that the request is

ineligible and require that it be referred for

external review.

b. In making a determination under subparagraph a of this

paragraph, the Commissioner's decision shall be made

in accordance with the terms of the covered person's

health benefit plan and shall be subject to all

applicable provisions of the Uniform Health Carrier

External Review Act.

Oklahoma Statutes - Title 36. Insurance Page 1258

5. Whenever a request for external review is determined

eligible for external review, the health carrier shall notify the

Commissioner and the covered person and, if applicable, the covered

person's authorized representative.

D. 1. Within one (1) business day after the receipt of the

notice from the health carrier that the external review request is

eligible for external review pursuant to subparagraph d of paragraph

2 of subsection A of this section or paragraph 5 of subsection C of

this section, the Commissioner shall:

a. assign an independent review organization to conduct

the external review from the list of approved

independent review organizations compiled and

maintained by the Commissioner pursuant to Section

6475.12 of this title and notify the health carrier of

the name of the assigned independent review

organization, and

b. notify in writing the covered person and, if

applicable, the covered person's authorized

representative of the request's eligibility and

acceptance for external review.

2. The Commissioner shall include in the notice provided to the

covered person and, if applicable, the covered person's authorized

representative a statement that the covered person or the covered

person's authorized representative may submit in writing to the

assigned independent review organization within five (5) business

days following the date of receipt of the notice provided pursuant

to paragraph 1 of this subsection, additional information that the

independent review organization shall consider when conducting the

external review. The independent review organization is not

required to, but may, accept and consider additional information

submitted after five (5) business days.

3. Within one (1) business day after the receipt of the notice

of assignment to conduct the external review pursuant to paragraph 1

of this subsection, the assigned independent review organization

shall:

a. select one or more clinical reviewers, as it

determines is appropriate, pursuant to paragraph 4 of

this subsection to conduct the external review, and

b. based on the opinion of the clinical reviewer, or

opinions if more than one clinical reviewer has been

selected to conduct the external review, make a

decision to uphold or reverse the adverse

determination or final adverse determination.

4. a. In selecting clinical reviewers pursuant to

subparagraph a of paragraph 3 of this subsection, the

assigned independent review organization shall select

physicians or other health care professionals who meet

Oklahoma Statutes - Title 36. Insurance Page 1259

the minimum qualifications described in Section

6475.13 of this title and, through clinical experience

in the past three (3) years, are experts in the

treatment of the covered person's condition and

knowledgeable about the recommended or requested

health care service or treatment.

b. Neither the covered person, the covered person's

authorized representative, if applicable, nor the

health carrier, shall choose or control the choice of

the physicians or other health care professionals to

be selected to conduct the external review.

5. In accordance with subsection H of this section, each

clinical reviewer shall provide a written opinion to the assigned

independent review organization on whether the recommended or

requested health care service or treatment should be covered.

6. In reaching an opinion, clinical reviewers are not bound by

any decisions or conclusions reached during the health carrier's

utilization review process as set forth in Sections 6551 through

6565 of this title or the health carrier's internal grievance

process.

E. 1. Within five (5) business days after the date of receipt

of the notice provided pursuant to paragraph 1 of subsection D of

this section, the health carrier or its designee utilization review

organization shall provide to the assigned independent review

organization the documents and any information considered in making

the adverse determination or the final adverse determination.

2. Except as provided in paragraph 3 of this subsection,

failure by the health carrier or its designee utilization review

organization to provide the documents and information within the

time specified in paragraph 1 of this subsection shall not delay the

conduct of the external review.

3. a. If the health carrier or its designee utilization

review organization has failed to provide the

documents and information within the time specified in

paragraph 1 of this subsection, the assigned

independent review organization may terminate the

external review and make a decision to reverse the

adverse determination or final adverse determination.

b. Immediately upon making the decision under

subparagraph a of this paragraph, the independent

review organization shall notify the covered person,

the covered person's authorized representative, if

applicable, the health carrier, and the Commissioner.

F. 1. Each clinical reviewer selected pursuant to subsection D

of this section shall review all of the information and documents

received pursuant to subsection E of this section and any other

information submitted in writing by the covered person or the

Oklahoma Statutes - Title 36. Insurance Page 1260

covered person's authorized representative pursuant to paragraph 2

of subsection D of this section.

2. Upon receipt of any information submitted by the covered

person or the covered person's authorized representative pursuant to

paragraph 2 of subsection D of this section, within one (1) business

day after the receipt of the information, the assigned independent

review organization shall forward the information to the health

carrier.

G. 1. Upon receipt of the information required to be forwarded

pursuant to paragraph 2 of subsection F of this section, the health

carrier may reconsider its adverse determination or final adverse

determination that is the subject of the external review.

2. Reconsideration by the health carrier of its adverse

determination or final adverse determination pursuant to paragraph 1

of this subsection shall not delay or terminate the external review.

3. The external review may be terminated only if the health

carrier decides, upon completion of its reconsideration, to reverse

its adverse determination or final adverse determination and provide

coverage or payment for the recommended or requested health care

service or treatment that is the subject of the adverse

determination or final adverse determination.

4. a. Immediately upon making the decision to reverse its

adverse determination or final adverse determination,

as provided in paragraph 3 of this subsection, the

health carrier shall notify the covered person, the

covered person's authorized representative if

applicable, the assigned independent review

organization, and the Commissioner in writing of its

decision.

b. The assigned independent review organization shall

terminate the external review upon receipt of the

notice from the health carrier sent pursuant to

subparagraph a of this paragraph.

H. 1. Except as provided in paragraph 3 of this subsection,

within twenty (20) days after being selected in accordance with

subsection D of this section to conduct the external review, each

clinical reviewer shall provide an opinion to the assigned

independent review organization pursuant to subsection I of this

section on whether the recommended or requested health care service

or treatment should be covered.

2. Except for an opinion provided pursuant to paragraph 3 of

this subsection, each clinical reviewer's opinion shall be in

writing and include the following information:

a. a description of the covered person's medical

condition,

b. a description of the indicators relevant to

determining whether there is sufficient evidence to

Oklahoma Statutes - Title 36. Insurance Page 1261

demonstrate that the recommended or requested health

care service or treatment is more likely than not to

be beneficial to the covered person than any available

standard health care services or treatments and the

adverse risks of the recommended or requested health

care service or treatment would not be substantially

increased over those of available standard health care

services or treatments,

c. a description and analysis of any medical or

scientific evidence, as that term is defined in

Section 6475.3 of this title, considered in reaching

the opinion,

d. a description and analysis of any evidence-based

standard, as that term is defined in Section 6475.3 of

this title, and

e. information on whether the reviewer's rationale for

the opinion is based on subparagraph a or b of

paragraph 5 of subsection I of this section.

3. a. For an expedited external review, each clinical

reviewer shall provide an opinion orally or in writing

to the assigned independent review organization as

expeditiously as the covered person's medical

condition or circumstances require, but in no event

more than five (5) calendar days after being selected

in accordance with subsection D of this section.

b. If the opinion provided pursuant to subparagraph a of

this paragraph was not in writing, within forty-eight

(48) hours following the date the opinion was provided

the clinical reviewer shall provide written

confirmation of the opinion to the assigned

independent review organization and include the

information required under paragraph 2 of this

subsection.

I. In addition to the documents and information provided

pursuant to paragraph 2 of subsection A of this section or

subsection E of this section, each clinical reviewer selected

pursuant to subsection D of this section, to the extent the

information or documents are available and the reviewer considers

appropriate, shall consider the following in reaching an opinion

pursuant to subsection H of this section:

1. The covered person's pertinent medical records;

2. The attending physician or health care professional's

recommendation;

3. Consulting reports from appropriate health care

professionals and other documents submitted by the health carrier,

covered person, the covered person's authorized representative, or

the covered person's treating physician or health care professional;

Oklahoma Statutes - Title 36. Insurance Page 1262

4. The terms of coverage under the covered person's health

benefit plan with the health carrier to ensure that, but for the

health carrier's determination that the recommended or requested

health care service or treatment that is the subject of the opinion

is experimental or investigational, the reviewer's opinion is not

contrary to the terms of coverage under the covered person's health

benefit plan with the health carrier; and

5. Whether:

a. the recommended or requested health care service or

treatment has been approved by the federal Food and

Drug Administration, if applicable, for the condition,

or

b. medical or scientific evidence or evidence-based

standards demonstrate that the expected benefits of

the recommended or requested health care service or

treatment is more likely than not to be beneficial to

the covered person than any available standard health

care service or treatment and the adverse risks of the

recommended or requested health care service or

treatment would not be substantially increased over

those of available standard health care services or

treatments.

J. 1. a. Except as provided in subparagraph b of this

paragraph, within twenty (20) days after the date it

receives the opinion of each clinical reviewer

pursuant to subsection I of this section, the assigned

independent review organization, in accordance with

paragraph 2 of this subsection, shall make a decision

and provide written notice of the decision to:

(1) the covered person,

(2) if applicable, the covered person's authorized

representative,

(3) the health carrier, and

(4) the Commissioner.

b. (1) For an expedited external review, within forty-

eight (48) hours after the date it receives the

opinion of each clinical reviewer pursuant to

subsection I of this section, the assigned

independent review organization, in accordance

with paragraph 2 of this subsection, shall make a

decision and provide notice of the decision

orally or in writing to the persons listed in

subparagraph a of this paragraph.

(2) If the notice provided under division (1) of this

subparagraph was not in writing, within forty-

eight (48) hours after the date of providing that

notice, the assigned independent review

Oklahoma Statutes - Title 36. Insurance Page 1263

organization shall provide written confirmation

of the decision to the persons listed in

subparagraph a of this paragraph and include the

information set forth in paragraph 3 of this

subsection.

2. a. If a majority of the clinical reviewers recommend that

the recommended or requested health care service or

treatment should be covered, the independent review

organization shall make a decision to reverse the

health carrier's adverse determination or final

adverse determination.

b. If a majority of the clinical reviewers recommend that

the recommended or requested health care service or

treatment should not be covered, the independent

review organization shall make a decision to uphold

the health carrier's adverse determination or final

adverse determination.

c. (1) If the clinical reviewers are evenly split as to

whether the recommended or requested health care

service or treatment should be covered, the

independent review organization shall obtain the

opinion of an additional clinical reviewer in

order for the independent review organization to

make a decision based on the opinions of a

majority of the clinical reviewers pursuant to

subparagraph a or b of this paragraph.

(2) The additional clinical reviewer selected under

division (1) of this subparagraph shall use the

same information to reach an opinion as the

clinical reviewers who have already submitted

their opinions pursuant to subsection I of this

section.

(3) The selection of the additional clinical reviewer

under this subparagraph shall not extend the time

within which the assigned independent review

organization is required to make a decision based

on the opinions of the clinical reviewers

selected pursuant to paragraph 1 of subsection D

of this section.

3. The independent review organization shall include in the

notice provided pursuant to paragraph 1 of this subsection:

a. a general description of the reason for the request

for external review,

b. the written opinion of each clinical reviewer

including the recommendation of each clinical reviewer

as to whether the recommended or requested health care

Oklahoma Statutes - Title 36. Insurance Page 1264

service or treatment should be covered and the

rationale for the reviewer's recommendation,

c. the date the independent review organization was

assigned by the Commissioner to conduct the external

review,

d. the date the external review was conducted,

e. the date of its decision,

f. the principal reason or reasons for its decision, and

g. the rationale for its decision.

4. Upon receipt of a notice of a decision pursuant to paragraph

1 of this subsection reversing the adverse determination or final

adverse determination, the health carrier immediately shall approve

coverage of the recommended or requested health care service or

treatment that was the subject of the adverse determination or final

adverse determination.

K. The assignment by the Commissioner of an approved

independent review organization to conduct an external review in

accordance with this section shall be done on a random basis among

those approved independent review organizations qualified to conduct

the particular external review based on the nature of the health

care service that is the subject of the adverse determination or

final adverse determination and other circumstances including

conflict of interest concerns pursuant to subsection D of Section

6475.13 of this title.
Okla. Stat. tit. 36, § 36-6675 — OK Code / Title 36 / Section 36-6675
Portable electronics insurance - Termination of policy or
Status: in_force

change in terms.

Notwithstanding any other provision of law:

1. An insurer may terminate or otherwise change the terms and

conditions of a policy of portable electronics insurance only upon

providing the policyholder and enrolled customers with at least

thirty (30) days' notice;

2. If the insurer changes the terms and conditions of the

policy, then the insurer shall provide the vendor policyholder with

a revised policy or endorsement and each enrolled customer with a

revised certificate, endorsement, updated brochure, or other

evidence indicating a change in the terms and conditions has

occurred and a summary of material changes;

3. Notwithstanding paragraph 1 of this section, an insurer may

terminate an enrolled customer's enrollment under a portable

Oklahoma Statutes - Title 36. Insurance Page 1342

electronics insurance policy upon fifteen (15) days' notice for

discovery of fraud or material misrepresentation in obtaining

coverage or in the presentation of a claim thereunder;

4. Notwithstanding paragraph 2 of this section, an insurer may

immediately terminate an enrolled customer's enrollment under a

portable electronics insurance policy:

a. for nonpayment of premium,

b. if the enrolled customer ceases to have an active

service with the vendor of portable electronics, or

c. if an enrolled customer exhausts the aggregate limit

of liability, if any, under the terms of the portable

electronics insurance policy and the insurer sends

notice of termination to the enrolled customer within

thirty (30) calendar days after exhaustion of the

limit. If notice is not timely sent, enrollment shall

continue notwithstanding the aggregate limit of

liability until the insurer sends notice of

termination to the enrolled customer;

5. When a portable electronics insurance policy is terminated

by a policyholder, the policyholder shall mail or deliver written

notice to each enrolled customer advising the enrolled customer of

the termination of the policy and the effective date of termination.

The written notice shall be mailed or delivered to the enrolled

customer at least thirty (30) days prior to the termination;

6. Whenever notice or correspondence with respect to coverage

under a policy of portable electronics insurance is required

pursuant to this section, or is otherwise required by law, it shall

be in writing and sent within the notice period, if any, specified

within the statute or regulation requiring the notice or

correspondence. Notwithstanding any other provision of law, notices

and correspondence may be sent by mail or by electronic means as set

forth in this paragraph. If the notice or correspondence is mailed,

it shall be sent to the vendor of portable electronics at the

vendor's mailing address specified for such purpose and to its

affected enrolled customers' last known mailing addresses on file

with the insurer. The insurer or vendor of portable electronics, as

the case may be, shall maintain proof of mailing in a form

authorized or accepted by the United States Postal Service or other

commercial mail delivery service. If the notice or correspondence

is sent by electronic means, it shall be sent to the vendor of

portable electronics at the vendor's electronic mail address

specified for such purpose and to its affected enrolled customers'

last known electronic mail addresses as provided by each enrolled

customer to the insurer or vendor of portable electronics, as the

case may be. For purposes of this paragraph, an enrolled customer's

provision of an electronic mail address to the insurer or vendor of

portable electronics, as the case may be, shall be deemed consent to

Oklahoma Statutes - Title 36. Insurance Page 1343

receive notices and correspondence by electronic means. The insurer

or vendor of portable electronics, as the case may be, shall

maintain proof that the notice or correspondence was sent; and

7. Notice or correspondence required by this section or

otherwise required by law may be sent on behalf of an insurer or

vendor, as the case may be, by the supervising entity appointed by

the insurer.
Okla. Stat. tit. 36, § 36-6941 — OK Code / Title 36 / Section 36-6941
Regulatory action level event - Definition - Duties of
Status: in_force

Insurance Commissioner - Challenge to adjusted RBC report or revised

RBC plan - Use of actuaries, investment experts and other

consultants.

A. “Regulatory Action Level Event” means, with respect to a

health maintenance organization, any of the following events:

1. The filing of an RBC report by the health maintenance

organization that indicates that the health maintenance

organization’s total adjusted capital is greater than or equal to

its Authorized Control Level RBC but less than its Regulatory Action

Level RBC;

2. Notification by the Commissioner to a health maintenance

organization of an adjusted RBC report that indicates a Regulatory

Action Level Event specified in paragraph 1 of this subsection,

provided the health maintenance organization does not challenge the

adjusted RBC report under Section 44 of this act;

3. If, pursuant to the provisions of Section 44 of this act,

the health maintenance organization challenges an adjusted RBC

report that indicates a Regulatory Action Level Event specified

event in paragraph 1 of this subsection, the notification by the

Commissioner to the health maintenance organization that the

Commissioner has, after a hearing, rejected the health maintenance

organization’s challenge;

4. The failure of the health maintenance organization to file

an RBC report by the filing date, unless the health maintenance

organization has provided an explanation for the failure that is

satisfactory to the Commissioner and has corrected the failure

within ten (10) days after the filing date;

5. The failure of the health maintenance organization to submit

an RBC plan to the Commissioner within the time period provided in

subsection C of Section 40 of this act;

6. Notification by the Commissioner to the health maintenance

organization that:

a. the RBC plan or revised RBC plan submitted by the

health maintenance organization is, in the judgment of

the Commissioner, unsatisfactory, and

b. notification constitutes a Regulatory Action Level

Event with respect to the health maintenance

organization, provided the health maintenance

Oklahoma Statutes - Title 36. Insurance Page 1420

organization has not challenged the determination

under Section 44 of this act;

7. If, pursuant to the provisions of Section 44 of this act,

the health maintenance organization challenges a determination by

the Commissioner under paragraph 6 of this subsection, the

notification by the Commissioner to the health maintenance

organization that the Commissioner has, after a hearing, rejected

the challenge;

8. Notification by the Commissioner to the health maintenance

organization that the health maintenance organization has failed to

adhere to its RBC plan or revised RBC plan, but only if the failure

has a substantial adverse effect on the ability of the health

maintenance organization to eliminate the Company Action Level Event

in accordance with its RBC plan or revised RBC plan and the

Commissioner has so stated in the notification, provided the health

maintenance organization has not challenged the determination under

Section 44 of this act; or

9. If, pursuant to the provisions of Section 44 of this act,

the health maintenance organization challenges a determination by

the Commissioner under paragraph 8 of this subsection, the

notification by the Commissioner to the health maintenance

organization that the Commissioner has, after a hearing, rejected

the challenge.

B. In the event of a Regulatory Action Level Event the

Commissioner shall:

1. Require the health maintenance organization to prepare and

submit an RBC plan or, if applicable, a revised RBC plan;

2. Perform such examination or analysis of the assets,

liabilities and operations of the health maintenance organization as

the Commissioner deems necessary, including a review of the HMO’s

RBC plan or revised RBC plan; and

3. Subsequent to the examination or analysis, issue ato adjusted RBC report or revised RBC plan - Use of actuaries, investment experts and otherRequire the health maintenance organization to prepare and

submit an RBC plan or, if applicable, a revised RBC plan;

2. Perform such examination or analysis of the assets,

liabilities and operations of the health maintenance organization as

the Commissioner deems necessary, including a review of the HMO’s

RBC plan or revised RBC plan; and

3. Subsequent to the examination or analysis, issue a

corrective order specifying such corrective actions as the

Commissioner shall determine are required.

C. In determining corrective actions, the Commissioner may take

into account factors the Commissioner deems relevant with respect to

the health maintenance organization based upon the Commissioner’s

examination or analysis of the assets, liabilities and operations of

the health maintenance organization including, but not limited to,

the results of any sensitivity tests undertaken pursuant to the RBC

instructions. The RBC plan or revised RBC plan shall be submitted:

1. Within forty-five (45) days after the occurrence of the

Regulatory Action Level Event;

2. If the health maintenance organization challenges an

adjusted RBC report pursuant to the provisions of Section 44 of this

act and the challenge is not frivolous, in the judgment of the

Commissioner, within forty-five (45) days after the notification to

Oklahoma Statutes - Title 36. Insurance Page 1421

the health maintenance organization that the Commissioner has, after

a hearing, rejected the health maintenance organization’s challenge;

or

3. If the health maintenance organization challenges a revised

RBC plan pursuant to the provisions of Section 44 of this act and

the challenge is not frivolous, in the judgment of the Commissioner,

within forty-five (45) days after the notification to the health

maintenance organization that the Commissioner has, after a hearing,

rejected the health maintenance organization’s challenge.

D. The Commissioner may retain such actuaries, investment

experts and other consultants as may be necessary, in the judgment

of the Commissioner, to review the health maintenance organization’s

RBC plan or revised RBC plan, examine or analyze the assets,

liabilities and operations, including contractual relationships of

the health maintenance organization, and formulate the corrective

order with respect to the health maintenance organization. The

fees, costs and expenses relating to consultants shall be borne by

the affected health maintenance organization or such other party as

directed by the Commissioner.
Okla. Stat. tit. 36, § 36-3112 — OK Code / Title 36 / Section 36-3112
Penalties
Status: in_force

Any person violating any of the provisions of this act shall be

deemed guilty of a misdemeanor and upon conviction thereof shall be

punished by a fine of not more than Five Hundred Dollars ($500.00)

or by imprisonment in the county jail for not more than six (6)

months, or by both such fine and imprisonment.
Okla. Stat. tit. 36, § 36-660.10 — OK Code / Title 36 / Section 36-660.10
Organization of mutual holding company — Requirements
Status: in_force

A mutual holding company that results from the reorganization of

a domestic mutual insurance company organized under this act must be

organized in accordance with Title 18 of the Oklahoma Statutes. The

articles of incorporation, and any amendments to those articles, of

the mutual holding company are subject to approval of the Oklahoma

Insurance Commissioner in the same manner as those of a mutual

insurance company.
Okla. Stat. tit. 36, § 36-2602 — OK Code / Title 36 / Section 36-2602
Application for certificate - Contents - Fee
Status: in_force

Such a corporation may issue contracts to its subscribers only

when the Insurance Commissioner has, by certificate of authority,

authorized it so to do. Application for such certificate of

authority shall be made on forms supplied or approved by the

Commissioner, containing such information as he shall deem

necessary. Each application for such certificate of authority shall

be accompanied by the fee prescribed by Article 3 (Insurance

Department and Insurance Commissioner) of this Code and copies of

the following documents:

1. Articles of incorporation;

2. Bylaws;

3. Proposed contracts, if any, between the applicant and

participating hospitals and physicians, showing the terms under

which service is to be furnished to subscribers;

4. Proposed contracts to be issued to subscribers;

5. A table of rates to be charged to subscribers;

6. Financial statement of the corporation, including the

amounts of contributions paid or agreed to be paid to the

corporation for working capital and the name or names of each

contributor and the terms of each contribution; and

Oklahoma Statutes - Title 36. Insurance Page 683

7. A statement of the area in which the corporation proposes to

operate.
Okla. Stat. tit. 36, § 36-1250.8 — OK Code / Title 36 / Section 36-1250.8
Motor vehicle total loss or damage claim
Status: in_force

A. If an insurance policy or insurance contract provides for

the adjustment and settlement of first party motor vehicle total

losses, on the basis of actual cash value or replacement with

another of like kind and quality, one of the following methods shall

apply:

1. An insurer may elect to offer a replacement motor vehicle

which is a specific comparable motor vehicle available to the

insured, with all applicable taxes, license fees, and other fees

incident to the transfer of evidence of ownership of the motor

vehicle paid, at no cost to the insured other than any deductible

provided in the policy. The offer and any rejection thereof shall

be documented in the claim file; or

2. An insurer may elect a cash settlement based upon the actual

cost, less any deductible provided in the policy, to purchase a

comparable motor vehicle, including all applicable taxes, license

fees and other fees incident to a transfer of evidence of ownership,

or a comparable motor vehicle. Such cost may be determined by:

a. the cost of a comparable motor vehicle in the local

market area when a comparable motor vehicle is

currently or recently available in the prior ninety

(90) days in the local market area,

b. one of two or more quotations obtained by an insurer

from two or more qualified dealers located within the

local market area when a comparable motor vehicle is

not available in the local market area, or

c. the cost of a comparable motor vehicle as quoted in

the latest edition of the National Automobile Dealers

Association Official Used Car Guide or monthly edition

of any other nationally recognized published

guidebook.

B. If a first party motor vehicle total loss is settled on a

basis which deviates from the methods described in subsection A of

this section, the deviation shall be supported by documentation

giving particulars of the condition of the motor vehicle. Any

deductions from such cost, including, but not limited to, deduction

for salvage, shall be measurable, discernible, itemized and

specified as to dollar amount and shall be appropriate in amount.

Oklahoma Statutes - Title 36. Insurance Page 314

The basis for such settlement shall be fully explained to a first

party claimant.

C. If liability for motor vehicle damages is reasonably clear,

insurers shall not recommend that third party claimants make claims

pursuant to the third party claimants' own policies solely to avoid

paying claims pursuant to such insurer's insurance policy or

insurance contract.

D. Insurers shall not require a claimant to travel unreasonably

either to inspect a replacement motor vehicle, obtain a repair

estimate or have the motor vehicle repaired at a specific repair

shop.

E. Insurers shall, upon the request of a claimant, include the

deductible of a first party claimant, if any, in subrogation

demands. Subrogation recoveries shall be shared on a proportionate

basis with a first party claimant, unless the deductible amount has

been otherwise recovered. No deduction for expenses shall be made

from a deductible recovery unless an outside attorney is retained to

collect such recovery. The deduction shall then be made for only a

pro rata share of the allocated loss adjustment expense.

F. If an insurer prepares an estimate of the cost of automobile

repairs, such estimate shall be in an amount for which it reasonably

may be expected that the damage can be repaired satisfactorily. An

insurer shall give a copy of an estimate to a claimant and may

furnish to the claimant the names of one or more conveniently

located repair shops, if requested by the claimant.

G. If an amount claimed is reduced because of betterment or

depreciation, all information for such reduction shall be contained

in the claim file. Such deductions shall be itemized and specified

as to dollar amount and shall be appropriate for the amount of

deductions.

H. An insurer or its representative shall not require a

claimant to obtain motor vehicle repairs at a specific repair

facility. An insurer or its representative shall not require a

claimant to obtain motor vehicle glass repair or replacement at a

specific motor vehicle glass repair or replacement facility. An

insurer shall fully and promptly pay for the cost of the motor

vehicle repair services or products, less any applicable deductible

amount payable according to the terms of the policy. The claimant

shall be furnished an itemized priced statement of repairs by the

repair facility at the time of acceptance of the repaired motor

vehicle. Unless a cash settlement is made, if a claimant selects a

motor vehicle repair or motor vehicle glass repair or replacement

facility, the insurer shall provide payment to the facility or

claimant based on a competitive price, as established by that

insurer through market surveys or by the insured through competitive

bids at the insured's option, to determine a fair and reasonable

Oklahoma Statutes - Title 36. Insurance Page 315

market price for similar services. Reasonable deviation from this

market price is allowed based on the facts in each case.

I. An insurer shall not use as a basis for cash settlement with

a first party claimant an amount which is less than the amount which

an insurer would pay if repairs were made, other than in total loss

situations, unless such amount is agreed to by the insured.

J. An insurer shall not force a claimant to execute a full

settlement release in order to settle a property damage claim

involving a personal injury.

K. All payment or satisfaction of a claim for a motor vehicle

which has been transferred by title to the insurer shall be paid by

check, draft or electronic payment, payable on demand.

L. In the event of payment of a total loss to a third party

claimant, the insurer shall include any registered lienholder as

copayee to the extent of the lienholder's interest.

M. As used in this section, "total loss" means that the vehicle

repair costs plus the salvage value of the vehicle meets or exceeds

the actual cash value of the motor vehicle prior to the loss, as

provided in used automobile dealer guidebooks.

N. An insurer shall not offer a cash settlement as provided in

paragraph 2 of subsection A of this section for the purchase of a

comparable motor vehicle and then subsequently sell the motor

vehicle which has been determined to be a total loss back to the

claimant if the insurer has determined that the repair of the

vehicle would not result in the vehicle being restored to operative

condition as provided in Section 1111 of Title 47 of the Oklahoma

Statutes unless the claimant specifies in writing or via an

electronic signature that the claimant understands that the motor

vehicle shall be titled as a "junked vehicle".
Okla. Stat. tit. 36, § 36-2402 — OK Code / Title 36 / Section 36-2402
Formation - Prerequisites to transaction of business -
Status: in_force

Articles of association.

Any number of persons, being citizens of the United States, not

less than seven, five of whom shall also be citizens and residents

of the state of Oklahoma, desiring to form a mutual benefit

association, may associate themselves together and effect such

organization in the manner provided in this section and as otherwise

provided in this article for reorganization of associations now

doing business in this state, and not otherwise. Articles of

association shall be prepared in triplicate in the manner

hereinafter provided, and submitted to the Insurance Commissioner

for approval. If the name selected for an association is not the

same or so near the same as that of another association or

corporation doing business in this state as to cause confusion in

the minds of the people, and the objects of the association conform

to the provisions of this article, the Insurance Commissioner shall

endorse on the back of each copy of said articles of association the

fact that the Commissioner has approved the same. Before the

Insurance Commissioner shall approve such articles of association,

it shall be shown to the Commissioner by the sworn statement of one

or more of the proposed incorporators that at least one thousand

persons have signed, in good faith, applications for benefit

membership in such proposed association, and paid to the proper one

of such proposed incorporators the amount of one death or mortuary

collection, by whatever name it may be called, and that such money

is deposited with some bank or trust company and is held for the

special purpose named. For such examination and approval of the

articles of association herein mentioned, the Insurance Commissioner

shall charge and receive a fee as stated in Section 321, Article 3

of this title. Provided, however, that before such incorporators,

or any of them, or any person or persons, shall solicit members or

collect any money whatever from any applicant in an association

formed, or to be formed, under this article, they shall first

furnish to the Insurance Commissioner a surety bond running to the

State of Oklahoma, to be approved by the Commissioner, in the sum of

Oklahoma Statutes - Title 36. Insurance Page 662

Five Thousand Dollars ($5,000.00) Dollars, conditioned that all sums

collected, or to be collected, from applicants for benefit

membership in such association will be promptly returned to

respective applicants in case the articles of incorporation are not

approved or no certificate of incorporation is granted within one

(1) year from the date of the filing of such bond, or in case the

association fails to accept said charter and in good faith conduct

the business of a mutual benefit association authorized thereby.

Upon the filing of said bond, the Insurance Commissioner shall issue

a certificate to that effect, showing that the person or persons

named therein are authorized to solicit members in such proposed

association and to collect dues and assessments in advance. When

the foregoing conditions are complied with and the articles of

association are approved by the Insurance Commissioner, as

hereinbefore provided, one copy thereof shall be filed with the

Secretary of State, whereupon the said Secretary shall issue a

certificate of incorporation and affix the Seal of the State

thereto, and one copy, approved as hereinbefore provided, shall be

delivered to the incorporators of such association, and the third

approved copy of such articles shall be filed with the Insurance

Commissioner. Such articles of association shall be substantially

in the following form:

First. The preamble shall name the incorporators and give the

residence of each and the fact of their citizenship, as herein

required, and express their desire to incorporate a mutual benefit

association in accordance with and under the provisions of this

article, making definite reference to the same.

Second. Article I shall give the name of the association.

Third. Article II shall state the location of the principal

office of the association.

Fourth. Article III shall state the objects of the association

and the plans by which these objects are to be carried out,

including the extreme limit of age of persons to whom benefit

certificates may be issued, which limit of age shall not exceed

seventy-two (72) years.

Fifth. Article IV shall state the names of the persons selected

to manage the business or prudential affairs of the association for

the first term, for which such persons are to be elected, the title

of all officers and the names of such officers, with their

residence, if they have been selected.

Sixth. Article V shall contain a description of the corporate

seal adopted by such association, together with an impress of the

same.

The articles of association shall be signed and acknowledged by

each of the incorporators.
Okla. Stat. tit. 36, § 36-6905 — OK Code / Title 36 / Section 36-6905
Powers of health maintenance organization - Notice of
Status: in_force

effect on financial soundness.

Oklahoma Statutes - Title 36. Insurance Page 1386

A. The powers of a health maintenance organization (HMO)

include, but are not limited to, the following:

1. The purchase, lease, construction, renovation, operation or

maintenance of hospitals, medical facilities, or both, and their

ancillary equipment and property reasonably required for its

principal office or for purposes necessary to the transaction of the

business of the organization;

2. Transactions between affiliated entities, including loans

and the transfer of responsibility under all provider or subscriber

contracts between affiliates or between the health maintenance

organization and its parent;

3. The furnishing of health care services through providers,

provider associations or agents for providers which are under

contract with or employed by the health maintenance organization;

4. The contracting with a person for the performance on its

behalf of certain functions such as marketing, enrollment and

administration;

5. The contracting with an insurance company licensed in this

state, or with a hospital or medical service corporation authorized

to do business in this state, for the provision of insurance,

indemnity or reimbursement against the cost of health care services

provided by the health maintenance organization;

6. The offering of other health care services in addition to

basic health care services. Nonbasic health care services may be

offered by a health maintenance organization on a prepaid basis

without offering basic health care services to any group or

individual; and

7. The joint marketing of products with an insurance company

licensed in this state or with a hospital or medical service

corporation authorized to do business in this state as long as the

company that is offering each product is clearly identified.

B. 1. A health maintenance organization shall file notice,

with adequate supporting information, with the Insurance

Commissioner prior to the exercise of any power granted in

paragraphs 1, 2 or 4 of subsection A of this section that may affect

the financial soundness of the health maintenance organization. The

Insurance Commissioner shall disapprove the exercise of power only

if, in the Insurance Commissioner’s opinion, it would substantially

and adversely affect the financial soundness of the health

maintenance organization and endanger its ability to meet its

obligations. If the Insurance Commissioner does not disapprove such

exercise of power within sixty (60) days of the filing, it shall be

deemed approved.

2. The Insurance Commissioner may promulgate rules exempting

those activities having a de minimis effect from the filing

requirement of paragraph 1 of this subsection.