Okla. Stat. tit. 36, § 36-309.4 — OK Code / Title 36 / Section 36-309.4
Report of examination - Review by Commissioner -
Status: in_force

Investigatory hearing - Disclosure.

A. All examination reports shall be comprised of only facts

appearing upon the books, records, or other documents of the

company, 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 such

facts.

B. No later than thirty (30) days following completion of the

examination, the examiner in charge shall file with the Insurance

Department a verified written report of examination under oath.

Upon receipt of the verified report, the Department shall transmit

the report to the company examined, together with a notice which

shall afford such company examined a reasonable opportunity of not

more than twenty (20) days to make a written submission or written

rebuttal with respect to any matters contained in the examination

report.

Oklahoma Statutes - Title 36. Insurance Page 65

C. Within twenty (20) days of the end of the period allowed for

the receipt of written submissions or written rebuttals, the

Insurance Commissioner shall fully consider and review the report,

together with any written submissions or written rebuttals and any

relevant portions of the examiners' work papers and enter an order:

1. Adopting the examination report as filed or with

modification or corrections. If the examination report reveals that

the company is operating in violation of any law, regulation or

prior order of the Commissioner, the Commissioner may order the

company to take any action the Commissioner considers necessary and

appropriate to cure such violation;

2. Rejecting the examination report with directions to the

examiners to reopen the examination for purposes of obtaining

additional data, documentation or information, and refiling pursuant

to subsection A of this section; or

3. Calling for an investigatory hearing with notice pursuant to

the Administrative Procedures Act to the company for purposes of

obtaining additional documentation, data, information and testimony.

D. 1. All orders entered pursuant to paragraph 1 of subsection

C of this section shall be accompanied by findings and conclusions

resulting from the Commissioner's consideration and review of the

examination report, relevant examiner work papers and any written

submissions or rebuttals. Any such order shall be considered a

final administrative decision and may be appealed pursuant to the

Administrative Procedures Act, and shall be served upon the company

by certified mail, together with a copy of the adopted examination

report. Within thirty (30) days of the issuance of the adopted

report, the company shall file affidavits executed by each of its

directors stating under oath that they have received a copy of the

adopted report and related orders.

2. Any hearing conducted pursuant to paragraph 3 of subsection

C of this section by the Commissioner or authorized representative

shall be conducted as a nonadversarial confidential investigatory

proceeding as necessary for the resolution of any inconsistencies,

discrepancies or disputed issues apparent upon the face of the filed

examination report or raised by or as a result of the Commissioner's

review of relevant work papers or by the written submission or

rebuttal of the company. Within thirty (30) days of the conclusion

of any such hearing, the Commissioner shall enter an order pursuant

to paragraph 1 of subsection C of this section.

3. The Commissioner shall not appoint an examiner as an

authorized representative to conduct the hearing. The Commissioner

or a representative of the Commissioner may issue subpoenas for the

attendance of any witnesses or the production of any documents

deemed relevant to the investigation whether under the control of

the Department, the company or other persons. The documents

produced shall be included in the record, and testimony taken by the

Oklahoma Statutes - Title 36. Insurance Page 66

Commissioner or representative of the Commissioner shall be under

oath and preserved for the record.

4. Nothing contained in this section shall require the

Department to disclose any information or records which would

indicate or show the existence or content of any investigation or

activity of a criminal justice agency.

5. The hearing shall proceed with the Commissioner or a

representative of the Commissioner posing questions to the persons

subpoenaed. Thereafter the company and the Department may present

testimony relevant to the investigation. The company and the

Department shall be permitted to make closing statements and may be

represented by counsel of their choice.

E. 1. Upon the adoption of the examination report under

paragraph 1 of subsection C of this section, the Commissioner shall

continue to hold the content of the examination report as private

and confidential information for a period of two (2) days except to

the extent provided in subsection B of this section and subsection F

of Section 309.3 of this title. Thereafter, the Commissioner may

open the report for public inspection so long as no court of

competent jurisdiction has stayed its publication.

2. Nothing contained in Sections 309.1 through 309.7 of this

title 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 insurance department of this or 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, 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 Sections

309.1 through 309.7 of this title.

3. In the event the Commissioner determines that regulatory

action is appropriate as a result of any examination, the

Commissioner may initiate any proceedings or actions as provided by

law.

4. No waiver of any applicable privilege or claim of

confidentiality in the documents, materials or information provided

to the Commissioner shall occur as a result of disclosure to the

Commissioner under this section or as a result of sharing as

authorized in subparagraph 2 of this paragraph.

F. All working papers, recorded information, documents, data

calls, Market Conduct Annual Statements and copies thereof produced

by, obtained by or disclosed to the Commissioner or any other person

in the course of an examination made under Sections 309.1 through

309.7 of this title, or in the course of analysis by the

Commissioner or any other person of the financial condition or

market conduct of a company, shall be given confidential treatment

and are not subject to subpoena and may not be made public by the

Oklahoma Statutes - Title 36. Insurance Page 67

Commissioner or any other person, except to the extent provided in

subsection E of this section and subsection F of Section 309.3 of

this title. Access may also be granted to the National Association

of Insurance Commissioners. Such parties shall agree in writing

prior to receiving the information to provide to it the same

confidential treatment as required by this section, unless the prior

written consent of the company to which it pertains has been

obtained.
Okla. Stat. tit. 36, § 36-6001 — OK Code / Title 36 / Section 36-6001
Discrimination through fictitious grouping prohibited
Status: in_force

No insurer, admitted or nonadmitted, shall make available

through any rating plan or form, property, marine, vehicle, casualty

or surety insurance to any firm, corporation, or association of

individuals, any preferred rate or premium based upon any fictitious

grouping of such firm, corporation or association of individuals.
Okla. Stat. tit. 36, § 36-3623.3 — OK Code / Title 36 / Section 36-3623.3
Charging insurance producer for documentation costs
Status: in_force

No insurer, at any time, shall charge the insurance producer for

any costs associated with the necessary documentation or records

needed to underwrite a policy. The provisions of this section shall

apply only to personal insurance as defined in Section 952 of Title

36 of the Oklahoma Statutes.
Okla. Stat. tit. 36, § 36-6570.2 — OK Code / Title 36 / Section 36-6570.2
Utilization review entities — Duties
Status: in_force

A utilization review entity shall make any current prior

authorization requirements and restrictions, including written

clinical criteria, readily accessible on its website to enrollees

and health care providers. Prior authorization requirements shall

be described in detail but also in easily understandable language.

If a utilization review entity intends either to implement a new

prior authorization requirement or restriction, or amend an existing

requirement or restriction, the utilization review entity shall

ensure that the new or amended requirement or restriction is not

implemented unless the utilization review entity's website has been

updated to reflect the new or amended requirement or restriction.

If a utilization review entity intends either to implement a new

prior authorization requirement or restriction, or amend an existing

requirement or restriction, the utilization review entity shall

Oklahoma Statutes - Title 36. Insurance Page 1310

provide contracted health care providers credentialed to perform the

service, or enrollees who have a chronic condition and are already

receiving the service for which the prior authorization changes will

impact, notice of the new or amended requirement or restriction no

less than sixty (60) days before the requirement or restriction is

implemented.
Okla. Stat. tit. 36, § 36-2682 — OK Code / Title 36 / Section 36-2682
Relationship of dentist and patient
Status: in_force

Nothing in this Article shall be deemed to alter the statutory

relationship of dentist and patient which has heretofore been

established. No dental service corporation shall in any way attempt

to influence the subscriber in the free choice of a dentist other

than to limit its benefit to properly licensed dentists of this

state who are in good standing with the Board of Dentistry. Nothing

in this Article shall be deemed to abridge the right of any dentist

to decline patients in accordance with the standards of practices of

such dentist; and no such corporation shall be deemed to be engaged

in the corporate practice of dentistry.
Okla. Stat. tit. 36, § 36-6060.43 — OK Code / Title 36 / Section 36-6060.43
Promulgation of rules
Status: in_force

The Insurance Department shall promulgate necessary rules for

the implementation of the Oklahoma Right to Shop Act.
Okla. Stat. tit. 36, § 36-1507 — OK Code / Title 36 / Section 36-1507
Unearned premium reserve for marine insurance
Status: in_force

With reference to marine insurance, premiums on trip risks not

terminated shall be deemed unearned, and the Insurance Commissioner

may require the insurer to carry a reserve thereon equal to one

hundred percent (100%) on trip risks written during the month ended

as of the date of statement.
Okla. Stat. tit. 36, § 36-6205 — OK Code / Title 36 / Section 36-6205
Application for license - Nonresidents
Status: in_force

A. Application for a license as an adjuster shall be made to

the Insurance Commissioner upon forms prescribed and furnished by

the Commissioner. As a part of and in connection with the

application, the applicant shall furnish such information concerning

the applicant's identity, personal history, business experience,

business record and such other pertinent information which the

Commissioner shall reasonably require.

B. Unless denied licensure pursuant to Section 6220 of this

title, a nonresident applicant shall receive a nonresident adjuster

license if:

1. The applicant has passed an examination in the applicant’s

home state or in another state in which the applicant is currently

licensed and in good standing;

2. The applicant is currently licensed and in good standing in

the home state of the applicant;

3. The applicant has submitted the proper request for licensure

and has paid the fees required by Section 6212 of this title; and

4. The applicant’s home state awards nonresident adjuster

licenses to residents of this state on the same basis.

C. If a nonresident applicant’s home state does not license or

require an examination for an adjuster license, the adjuster may

declare another state which has an examination requirement and in

which the adjuster is licensed to be the home state. Should the

applicant not hold an active adjuster license in his or her home

state or declared home state, the applicant shall pass the adjuster

examination of this state prior to receiving a nonresident adjuster

license.

D. An individual who is a resident of Canada shall not be

licensed pursuant to the Insurance Adjusters Licensing Act nor

designate this state as the individual's home state, unless the

individual has successfully passed the adjuster examination and has

complied with all applicable requirements of the Insurance Adjusters

Licensing Act; except that any such applicant shall not be required

Oklahoma Statutes - Title 36. Insurance Page 1165

to comply with paragraph 2 of subsection A of Section 6206 of this

title or Section 6215 of this title.
Okla. Stat. tit. 36, § 36-6936 — OK Code / Title 36 / Section 36-6936
Severability
Status: in_force

If any section, term or provision of this act shall be adjudged

invalid for any reason, that judgment shall not affect, impair or

invalidate any other section, term or provision of this act; but the

remaining sections, terms and provisions shall be and remain in full

force and effect.
Okla. Stat. tit. 36, § 36-3639.2 — OK Code / Title 36 / Section 36-3639.2
Policies issued under Market Assistance program -
Status: in_force

Exemption from §3639.1.

Homeowner insurance policies issued under the voluntary Market

Assistance program shall be exempt from this act.
Okla. Stat. tit. 36, § 36-6475.7 — OK Code / Title 36 / Section 36-6475.7
External review procedure
Status: in_force

A. 1. Except as provided in subsection B of this section, a

request for an external review pursuant to Section 6475.8, 6475.9,

or 6475.10 of this title shall not be made until the covered person

has exhausted the health carrier's internal grievance process.

2. A covered person shall be considered to have exhausted the

health carrier's internal grievance process for purposes of this

Oklahoma Statutes - Title 36. Insurance Page 1244

section, if the covered person or the covered person's authorized

representative:

a. has filed a grievance involving an adverse

determination, and

b. except to the extent the covered person or the covered

person's authorized representative requested or agreed

to a delay, has not received a written decision on the

grievance from the health carrier within thirty (30)

days following the date the covered person or the

covered person's authorized representative filed the

grievance with the health carrier.

3. Notwithstanding paragraph 2 of this subsection, a covered

person or the covered person's authorized representative may not

make a request for an external review of an adverse determination

involving a retrospective review determination made pursuant to

Sections 6551 through 6565 of this title until the covered person

has exhausted the health carrier's internal grievance process.

B. 1. a. At the same time a covered person or the covered

person's authorized representative files a request for

an expedited review of a grievance involving an

adverse determination, the covered person or the

covered person's authorized representative may file a

request for an expedited external review of the

adverse determination:

(1) under Section 6475.9 of this title if the covered

person has a medical condition where the time

frame for completion of an expedited review of

the 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, or

(2) under Section 6475.10 of this title if the

adverse determination involves a denial of

coverage based on a determination that the

recommended or requested health care service or

treatment is experimental or investigational and

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 adverse determination would be

significantly less effective if not promptly

initiated.

b. Upon receipt of a request for an expedited external

review under subparagraph a of this paragraph, the

independent review organization conducting the

external review in accordance with the provisions of

Oklahoma Statutes - Title 36. Insurance Page 1245

Section 6475.9 or 6475.10 of this title shall

determine whether the covered person shall be required

to complete the expedited review process before it

conducts the expedited external review.

c. Upon a determination made pursuant to subparagraph b

of this paragraph that the covered person must first

complete the expedited grievance review process, the

independent review organization immediately shall

notify the covered person and, if applicable, the

covered person's authorized representative of this

determination and that it will not proceed with the

expedited external review set forth in Section 6475.9

of this title until completion of the expedited

grievance review process and the covered person's

grievance at the completion of the expedited grievance

review process remains unresolved.

2. A request for an external review of an adverse determination

may be made before the covered person has exhausted the health

carrier's internal grievance procedures whenever the health carrier

agrees to waive the exhaustion requirement.

C. If the requirement to exhaust the health carrier's internal

grievance procedures is waived under paragraph 2 of subsection B of

this section, the covered person or the covered person's authorized

representative may file a request in writing for a standard external

review as set forth in Section 6475.8 or 6475.10 of this title.
Okla. Stat. tit. 36, § 36-6060.51 — OK Code / Title 36 / Section 36-6060.51
Definitions
Status: in_force

As used in this section:

Oklahoma Statutes - Title 36. Insurance Page 1121

1. “Health benefit plan” means group hospital coverage,

individual and group medical insurance coverage, a not-for-profit

hospital or medical service or indemnity plan, a prepaid health

plan, a health maintenance organization plan, a preferred provider

organization plan, the Oklahoma Employees Insurance Plan, and

coverage provided by a multiple employer welfare arrangement. The

term shall not include:

a. a plan that provides coverage:

(1) only for a specified disease or diseases or under

an individual limited benefit policy,

(2) only for accidental death or dismemberment,

(3) only for dental or vision care,

(4) for a hospital confinement indemnity policy,

(5) for disability income insurance or a combination

of accident-only and disability income insurance,

or

(6) as a supplement to liability insurance,

b. any health plan offered by a contracted entity, as

defined in Section 4002.2 of Title 56 of the Oklahoma

Statutes, that provides coverage to members of the

state Medicaid program,

c. a Medicare supplemental policy as defined by Section

1882(g)(1) of the Social Security Act (42 U.S.C.,

Section 1395ss),

d. workers’ compensation insurance coverage,

e. medical payment insurance issued as part of a motor

vehicle insurance policy,

f. a long-term care policy, including a nursing home

fixed indemnity policy, unless a determination is made

that the policy provides benefit coverage so

comprehensive that the policy meets the definition of

a health benefit plan, or

g. short-term health insurance issued on a nonrenewable

basis with a duration of six (6) months or less;

2. “Health care provider” means the same as defined in Section

1219.6 of Title 36 of the Oklahoma Statutes; and

3. “Health care service” means any service provided by a health

care provider, or by an individual working for or under the

supervision of a health care provider, that relates to the

diagnosis, assessment, prevention, treatment, or care of any human

illness, disease, injury, or condition.

The term shall also include mental health and substance use

disorder services, as defined by Section 6060.10 of Title 36 of the

Oklahoma Statutes, and durable medical equipment as defined by

Section 375.2 of Title 59 of the Oklahoma Statutes. The term shall

not include the administration or prescription of pharmaceutical

products or services.

Oklahoma Statutes - Title 36. Insurance Page 1122
Okla. Stat. tit. 36, § 36-305.1 — OK Code / Title 36 / Section 36-305.1
Delinquency proceedings; appointment of personnel;
Status: in_force

exemptions.

In any proceeding commenced against an insurer pursuant to

Article 18 or 19 of Title 36 of the Oklahoma Statutes for the

purpose of liquidating, rehabilitating, reorganizing or conserving

such insurer:

1. No former employee of the Insurance Department shall be

employed or appointed to serve in any capacity by the court to

assist the Insurance Department for a period of one (1) year

following such employee's former employment;

2. No former member of the State Legislature shall be employed

to assist the Insurance Department for a period of two (2) years

following the expiration of such member's service in office; and

3. If any former officer or employee of any other company has

been employed to assist the Insurance Department with the said

proceeding against the insurer, such other company may not purchase

the assets of or acquire any other interest in said insurer for a

period of one (1) year following the expiration or termination of

such officer's or employee's term of office or employment.
Okla. Stat. tit. 36, § 36-3108 — OK Code / Title 36 / Section 36-3108
Misrepresentation
Status: in_force

A motor service club or an officer or producer thereof shall not

in any manner misrepresent the terms, benefits or privileges of any

service contract issued or to be issued by it or by another motor

service club.
Okla. Stat. tit. 36, § 36-1441 — OK Code / Title 36 / Section 36-1441
Short title
Status: in_force

Sections 1 through 13 of this act shall be known and may be

cited as the "Third-party Administrator Act".
Okla. Stat. tit. 36, § 36-1250.7 — OK Code / Title 36 / Section 36-1250.7
Property and casualty insurer - Denial or acceptance of
Status: in_force

claim.

A. Within sixty (60) days after receipt by a property and

casualty insurer of properly executed proofs of loss, the first

party claimant shall be advised of the acceptance or denial of the

claim by the insurer, or if further investigation is necessary. No

property and casualty insurer shall deny a claim because of a

specific policy provision, condition, or exclusion unless reference

to such provision, condition, or exclusion is included in the

denial. A denial shall be given to any claimant in writing, and the

claim file of the property and casualty insurer shall contain a copy

of the denial. If there is a reasonable basis supported by specific

information available for review by the Commissioner that the first

party claimant has fraudulently caused or contributed to the loss, a

property and casualty insurer shall be relieved from the

requirements of this subsection. In the event of a weather-related

catastrophe or a major natural disaster, as declared by the

Oklahoma Statutes - Title 36. Insurance Page 312

Governor, the Insurance Commissioner may extend the deadline imposed

under this subsection an additional twenty (20) days.

B. If a claim is denied for reasons other than those described

in subsection A of this section, and is made by any other means than

writing, an appropriate notation shall be made in the claim file of

the property and casualty insurer until such time as a written

confirmation can be made.

C. Every property and casualty insurer shall complete

investigation of a claim within sixty (60) days after notification

of proof of loss unless such investigation cannot reasonably be

completed within such time. If such investigation cannot be

completed, or if a property and casualty insurer needs more time to

determine whether a claim should be accepted or denied, it shall so

notify the claimant within sixty (60) days after receipt of the

proofs of loss, giving reasons why more time is needed. If the

investigation remains incomplete, a property and casualty insurer

shall, within sixty (60) days from the date of the initial

notification, send to such claimant a letter setting forth the

reasons additional time is needed for investigation. Except for an

investigation of possible fraud or arson which is supported by

specific information giving a reasonable basis for the

investigation, the time for investigation shall not exceed one

hundred twenty (120) days after receipt of proof of loss. Provided,

in the event of a weather-related catastrophe or a major natural

disaster, as declared by the Governor, the Insurance Commissioner

may extend this deadline for investigation an additional twenty (20)

days.

D. Insurers shall not fail to settle first party claims on the

basis that responsibility for payment should be assumed by others

except as may otherwise be provided by policy provisions.

E. Insurers shall not continue or delay negotiations for

settlement of a claim directly with a claimant who is neither an

attorney nor represented by an attorney, for a length of time which

causes the claimant's rights to be affected by a statute of

limitations, or a policy or contract time limit, without giving the

claimant written notice that the time limit is expiring and may

affect the claimant's rights. Such notice shall be given to first

party claimants and third party claimants one year after the date of

the loss.

F. No insurer shall make statements which indicate that the

rights of a third party claimant may be impaired if a form or

release is not completed within a given period of time unless the

statement is given for the purpose of notifying a third party

claimant of the provision of a statute of limitations.

G. If a lawsuit on the claim is initiated, the time limits

provided for in this section shall not apply.

Oklahoma Statutes - Title 36. Insurance Page 313
Okla. Stat. tit. 36, § 36-1478 — OK Code / Title 36 / Section 36-1478
Rules and regulations
Status: in_force

The Insurance Commissioner may adopt reasonable rules and

regulations for the implementation and administration of the

provisions of this act.
Okla. Stat. tit. 36, § 36-1165 — OK Code / Title 36 / Section 36-1165
Participation in employer sponsored health plan - Retired
Status: in_force

military employees.

No employer shall require any employee who is retired from a

branch of the United States military and has been provided with

health coverage through a federal plan to participate in employer-

sponsored health insurance coverage if the health insurance coverage

requires a contribution from the employee. The employee shall

provide to the employer before the beginning of each plan year proof

of that coverage.
Okla. Stat. tit. 36, § 36-6103.1 — OK Code / Title 36 / Section 36-6103.1
Purpose of act
Status: in_force

A. The purpose of Sections 11 through 21 of this act is to

subject certain persons and insurers to the jurisdiction of:

1. The Insurance Commissioner, including proceedings before the

Commissioner; and

Oklahoma Statutes - Title 36. Insurance Page 1128

2. The courts of this state in suits by or on behalf of this

state and insureds or beneficiaries under insurance contracts.

B. The Legislature declares that it is a subject of concern

that many residents of this state hold policies of insurance issued

by persons and insurers not authorized to do insurance business in

this state, thus presenting to such residents the often insuperable

obstacle of asserting their legal rights under such policies in

forums foreign to them under laws and rules of practice with which

they are not familiar. The Legislature declares that it is also

concerned with the protection of residents of this state against

acts by persons and insurers not authorized to do an insurance

business in this state by:

1. The maintenance of fair and honest insurance markets;

2. Protecting the premium tax revenues of this state;

3. Protecting authorized persons and insurers which are subject

to strict regulation from unfair competition by unauthorized persons

and insurers; and

4. Protecting against the evasion of the insurance regulatory

laws of this state.
Okla. Stat. tit. 36, § 36-1250.9 — OK Code / Title 36 / Section 36-1250.9
Periodic reports
Status: in_force

A. If the Insurance Commissioner determines, based on an

investigation of complaints of unfair claim settlement practices,

that an insurer has engaged in unfair claim settlement practices

with such frequency as to indicate a general business practice and

that such insurer should be subjected to closer supervision with

respect to such practices, the Commissioner may require the insurer

to file a report at such periodic intervals as the Commissioner

deems necessary. The Commissioner shall also devise a statistical

Oklahoma Statutes - Title 36. Insurance Page 316

plan for such periodic reports, which shall contain but not be

limited to the following information:

1. The total number of written claims filed, including the

original amount filed for by the insured and the classification by

line of insurance of each individual written claim, for the past

twelve-month period or from the date of the insurer's last periodic

report, whichever time is shorter;

2. The total number of written claims denied, for the past

twelve-month period or from the date of the insurer's last periodic

report, whichever time is shorter;

3. The total number of written claims settled, including the

original amount filed for by the insured, the settled amount, and

the classification of line of insurance of each individual settled

claim, for the past twelve-month period or from the date of the

insurer's last periodic report, whichever time is shorter;

4. The total number of written claims for which lawsuits were

instituted against the insurer, including the original amount of the

claim filed for by the insured, the amount of final adjudication,

the reason for the lawsuit and the classification by line of

insurance of each individual written claim, for the past twelve-

month period or from the date of the insurer's last periodic report,

whichever time is shorter; and

5. All information required by paragraph 14 of Section 1250.5

of this title.

B. For the purposes of this section, "written claims" means

those claims reduced to writing and filed by a resident of this

state with an insurer.
Okla. Stat. tit. 36, § 36-1802 — OK Code / Title 36 / Section 36-1802
Definitions
Status: in_force

Oklahoma Statutes - Title 36. Insurance Page 524

As used in Article 18 of the Insurance Code, the following words

and terms set forth below shall have the meanings ascribed to them

unless the context otherwise indicates:

1. "Commissioner" means the Insurance Commissioner of this

state;

2. "Insurer" is a person, organization, association or company,

authorized or unauthorized, admitted or nonadmitted, acting as an

insurer, or as principal or agent of an insurer, including any

domestic, foreign or alien insurer, as defined in Article 6 of the

Insurance Code, and including stock companies, reciprocals or

insurance exchanges, Lloyds Associations, fraternal benefit

societies, stipulated premium companies, and mutual companies of all

kinds, including statewide mutual assessment corporations, local

mutual aids, burial associations, county mutual insurance companies

and farm mutual insurance companies, and health maintenance

organizations;

3. "Insolvent" or "insolvency" means any actual or threatened

insurer delinquency including, but not limited to, any one or more

of the following circumstances:

a. an insurer's required surplus or capital is impaired

to an extent prohibited by law,

b. an insurer continues to write new business when it is

not possessed of the surplus or capital required of it

by law,

c. the business of any such insurer is being conducted

fraudulently,

d. any such insurer attempts to dissolve or liquidate

without first having made provisions, satisfactory to

the Commissioner, for liabilities arising from

policies of insurance issued by such insurer; or

e. the insurer has made investments in violation of the

Insurance Code or has knowingly over-valued insurer's

assets;

4. "Exceeded its powers" includes, but is not limited to, the

following circumstances:

a. an insurer's refusal to permit examination of its

books, papers, accounts, records or affairs by the

Commissioner, his or her deputy or duly-commissioned

examiners; or if such insurer being organized in the

State of Oklahoma removes from the state such books,

papers, accounts or records necessary for an

examination of such insurer,

b. an insurer's failure to promptly answer inquiries

authorized by Section 1905(6) of this title,

c. an insurer's neglect or refusal to observe an order of

the Commissioner to make good, within the time

Oklahoma Statutes - Title 36. Insurance Page 525

prescribed by law, any prohibited deficiency in its

capital or surplus,

d. an insurer, without first obtaining written approval

of the Commissioner, by contract or otherwise:

(1) totally reinsuring its entire outstanding

business, or

(2) merging or consolidating substantially its entire

property or business with another approved

insurer, or

e. an insurer continuing to write business after its

license has been revoked or suspended; and

5. "Consent" means any agreement by the insurer to either

supervision or conservatorship.
Okla. Stat. tit. 36, § 36-2012 — OK Code / Title 36 / Section 36-2012
Exhaustion of rights under other policies, governmental
Status: in_force

program or associations.

A. 1. Any person having a claim against an insurer shall be

required to first exhaust all coverage provided by another policy if

it arises from the same facts, injury or loss that gave rise to the

covered claim against the Oklahoma Property and Casualty Insurance

Guaranty Association. The requirement to exhaust all coverage shall

apply without regard to whether the other insurance policy is a

policy written by a member insurer. However, no person shall be

required to exhaust any right under the policy of an insolvent

insurer or any right under a life insurance policy.

2. Any amount payable on a covered claim under the Oklahoma

Property and Casualty Insurance Guaranty Association Act shall be

reduced by the full applicable limits stated in the insurance policy

or by the amount of the recovery under the insurance policy as

provided herein. The Association shall receive a full credit for

the stated limits, unless the claimant demonstrates that the

claimant used reasonable efforts to exhaust all coverage and limits

applicable under the other insurance policy. If the claimant

demonstrates that the claimant used reasonable efforts to exhaust

all coverage and limits applicable under the insurance policy, or if

there are no applicable stated limits under the policy, the

Association shall receive a full credit for the total recovery.

B. Any person having a claim which may be recovered under more

than one insurance guaranty association or its equivalent in another

state shall seek recovery first from the association of the place of

residence of the insured. If it is a first party claim for damage

to property with a permanent location, the person shall seek

recovery first from the association of the state where the property

is located, and if it is a workers' compensation claim, the person

shall seek recovery first from the association of the residence of

the claimant. Any recovery under this act shall be reduced by the

amount of recovery from any other insurance guaranty association or

its equivalent.
Okla. Stat. tit. 36, § 36-6530.10 — OK Code / Title 36 / Section 36-6530.10
Application for waiver pursuant to Patient Protection
Status: in_force

and Affordable Care Act.

The Oklahoma Secretary of Health and Human Services may apply to

the United States Secretary of Health and Human Services for a

waiver pursuant to Section 1332 of the Patient Protection and

Affordable Care Act (42 U.S.C., Section 18052), "1332 State

Innovation Waiver", with respect to health insurance coverage in the

state for a plan year beginning on or after January 1, 2018. The

Secretary may implement a state plan meeting the waiver requirements

in a manner consistent with state and federal law and as approved by

the United States Secretary of Health and Human Services.
Okla. Stat. tit. 36, § 36-5110 — OK Code / Title 36 / Section 36-5110
Examination
Status: in_force

A. A reinsurance intermediary shall be subject to examination

by the Commissioner. The Commissioner shall have access to all

books, bank accounts and records of the reinsurance intermediary in

a form usable to the Commissioner.

B. An RM may be examined as if the RM were the reinsurer.
Okla. Stat. tit. 36, § 36-311A.16 — OK Code / Title 36 / Section 36-311A.16
Report of the insurer's internal control over
Status: in_force

financial reporting.

A. Every insurer required to file an audited financial report

pursuant to the Oklahoma Annual Financial Report Act that has annual

direct written and assumed premiums, excluding premiums reinsured

with the Federal Crop Insurance Corporation and Federal Flood

Program, of Five Hundred Million Dollars ($500,000,000.00) or more

shall prepare a report of the insurer's or group of insurers'

internal control over financial reporting. The report shall be

filed with the Insurance Commissioner along with the Communication

of Internal Control Related Matters Noted in an Audit described

under Section 311A.11 of this title. Management's Report of

Internal Control over Financial Reporting shall be as of December 31

immediately preceding.

B. Notwithstanding the premium threshold in subsection A of

this section, the Commissioner may require an insurer to file

Management's Report of Internal Control over Financial Reporting if

the insurer is in any RBC level event, or meets any one or more of

the standards of an insurer deemed to be in hazardous financial

condition.

C. An insurer or a group of insurers that is:

1. Directly subject to Section 404;

2. Part of a holding company system whose parent is directly

subject to Section 404;

3. Not directly subject to Section 404 but is a SOX Compliant

Entity; or

4. A member of a holding company system whose parent is not

directly subject to Section 404 but is a SOX Compliant Entity,

may file its or its parent's Section 404 Report and an addendum in

satisfaction of the requirements of this section provided that those

internal controls of the insurer or group of insurers' audited

statutory financial statements included in paragraphs 2 through 7 of

subsection B of Section 311A.5 of this title were included in the

scope of the Section 404 Report. The addendum shall be a positive

statement by management that there are no material processes with

respect to the preparation of the insurer's or group of insurers'

audited statutory financial statements included in paragraphs 2

through 7 of subsection B of Section 311A.5 of this title excluded

from the Section 404 Report. If there are internal controls of the

insurer or group of insurers that have a material impact on the

preparation of the insurer's or group of insurers' audited statutory

financial statements and those internal controls were not included

in the scope of the Section 404 Report, the insurer or group of

insurers may either file a report pursuant to this section or the

Section 404 Report and a report pursuant to this section for those

Oklahoma Statutes - Title 36. Insurance Page 96

internal controls that have a material impact on the preparation of

the insurer's or group of insurers' audited statutory financial

statements not covered by the Section 404 Report.

D. Management's Report of Internal Control over Financial

Reporting shall include:

1. A statement that management is responsible for establishing

and maintaining adequate internal control over financial reporting;

2. A statement that management has established internal control

over financial reporting and an assertion, to the best of the

knowledge and belief of management, after diligent inquiry, as to

whether its internal control over financial reporting is effective

to provide reasonable assurance regarding the reliability of

financial statements in accordance with statutory accounting

principles;

3. A statement that briefly describes the approach or processes

by which management evaluated the effectiveness of its internal

control over financial reporting;

4. A statement that briefly describes the scope of work that is

included and whether any internal controls were excluded;

5. Disclosure of any unremediated material weaknesses in the

internal control over financial reporting identified by management

as of December 31 immediately preceding. Management is not

permitted to conclude that the internal control over financial

reporting is effective to provide reasonable assurance regarding the

reliability of financial statements in accordance with statutory

accounting principles if there is one or more unremediated material

weaknesses in its internal control over financial reporting;

6. A statement regarding the inherent limitations of internal

control systems; and

7. Signatures of the chief executive officer and the chief

financial officer or equivalent positions or titles.

E. Management shall document and make available upon financial

condition examination the basis upon which its assertions, required

in subsection D of this section, are made. Management may base its

assertions, in part, upon its review, monitoring, and testing of

internal controls undertaken in the normal course of its activities.

1. Management shall have discretion as to the nature of the

internal control framework used, and the nature and extent of

documentation, in order to make its assertion in a cost-effective

manner and, as such, may include assembly of or reference to

existing documentation.

2. Management's Report of Internal Control over Financial

Reporting, required by subsection A of this section and any

documentation provided in support thereof during the course of a

financial condition examination, shall be kept confidential by the

Insurance Department.

Oklahoma Statutes - Title 36. Insurance Page 97
Okla. Stat. tit. 36, § 36-1126 — OK Code / Title 36 / Section 36-1126
Public access to documents and reports - Confidentiality
Status: in_force

A. The Statement of Actuarial Opinion shall be provided with

the annual statement in accordance with the appropriate National

Associations of Insurance Commissioners Property and Casualty Annual

Statement Instructions and shall be treated as a public document.

B. 1. Documents, materials or other information in the

possession or control of the Insurance Department that are

considered an actuarial report, work papers or actuarial opinion

summary provided in support of the opinion, and any other material

provided by the company to the Insurance Commissioner in connection

with the actuarial report, work papers or actuarial opinion summary,

Oklahoma Statutes - Title 36. Insurance Page 261

and any work papers used by the Commissioner or any other person in

the analysis of the actuarial report, work papers, other material or

actuarial opinion summary provided in support of the opinion, shall

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

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 confidentiality and protection from

discovery by subpoena provided in this paragraph shall not be

construed to be extended to identical, similar or other related

documents or information or to the work papers that are not deemed

to be in the possession, custody or control of the Commissioner.

2. This provision shall not be construed to limit the

Commissioner’s authority to release the documents to the Actuarial

Board for Counseling and Discipline (ABCD) so long as the material

is required for the purpose of professional disciplinary proceedings

and the ABCD establishes procedures satisfactory to the Commissioner

for preserving the confidentiality of the documents, nor shall this

section be construed to limit the Commissioner’s authority to use

the documents, materials or other information in furtherance of any

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

official duties.

C. Neither the Commissioner nor any person who received

documents, materials or other information while acting under the

authority of the Commissioner shall be permitted or required to

testify in any private civil action concerning any confidential

documents, materials or information subject to subsection B of this

section.

D. In order to assist in the performance of the Commissioner’s

duties, the Commissioner:

1. May share documents, materials or other information,

including the confidential and privileged documents, materials or

information subject to subsection B of this section with other

state, federal and international regulatory agencies, with the

National Association of Insurance Commissioners 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 or other information and has the legal authority to

maintain confidentiality;

2. May receive documents, materials or information, including

otherwise confidential and privileged documents, materials or

information, from the National Association of Insurance

Commissioners and its affiliates and subsidiaries, and from

regulatory and law enforcement officials of other 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

Oklahoma Statutes - Title 36. Insurance Page 262

under the laws of the jurisdiction that is the source of the

document, material or information; and

3. May enter into agreements governing sharing and use of

information consistent with subsections B through D of this section.

E. 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 subsection D of

this section.
Okla. Stat. tit. 36, § 36-4427 — OK Code / Title 36 / Section 36-4427
Rulemaking authority - Civil penalty
Status: in_force

A. The Insurance Commissioner may adopt rules to implement the

provisions of the Long-Term Care Insurance Act. The Commissioner

may adopt rules that apply to all providers of long-term care

insurance coverage, whether or not a provider is otherwise subject

to the provisions of the Insurance Code, and that include, but are

Oklahoma Statutes - Title 36. Insurance Page 975

not limited to, standards for full and fair disclosure setting forth

the manner, content, and required disclosure for the sale of long-

term care insurance policies, terms of renewability, initial and

subsequent conditions of eligibility, nonduplication of coverage

provisions, coverage of dependents, preexisting conditions,

termination of insurance, continuation or conversion, probationary

periods, limitations, exceptions, reductions, elimination periods,

requirements for replacement, recurrent conditions, and definition

of terms. The Commissioner may issue reasonable rules to establish

minimum standards for marketing practices, agent compensation, agent

testing, penalties and reporting practices for long-term care

insurance.

B. In addition to any other penalties provided by the laws of

this state, any insurer and any agent found to have violated any

requirement of this state relating to the regulation of long-term

care insurance or the marketing of such insurance shall be subject

to a civil penalty of up to three (3) times the amount of any

commissions paid for each policy involved in the violation or up to

Ten Thousand Dollars ($10,000.00) whichever is greater.
Okla. Stat. tit. 36, § 36-1435.8 — OK Code / Title 36 / Section 36-1435.8
Lines of authority - Continuation in effect of license
Status: in_force

- Reinstatement - Contracting by Insurance Commissioner with

nongovernmental entities.

A. Unless denied licensure pursuant to Section 1435.13 of this

title, persons who have met the requirements of Sections 1435.6 and

1435.7 of this title shall be issued an insurance producer license.

An insurance producer may receive qualification for a license in one

or more of the following lines of authority:

1. Life - insurance coverage on human lives including benefits

of endowment and annuities, and may include benefits in the event of

death or dismemberment by accident and benefits for disability

income;

Oklahoma Statutes - Title 36. Insurance Page 339

2. Accident and health or sickness - insurance coverage for

sickness, bodily injury or accidental death and may include benefits

for disability income;

3. Property - insurance coverage for the direct or

consequential loss or damage to property of every kind;

4. Casualty - insurance coverage against legal liability,

including that for death, injury or disability or damage to real or

personal property;

5. Variable life and variable annuity products - insurance

coverage provided under variable life insurance contracts and

variable annuities;

6. Personal lines - property and casualty insurance coverage

sold to individuals and families for primarily noncommercial

purposes;

7. Commercial lines – property and casualty insurance coverage

sold to businesses for primarily commercial purposes;

8. Credit - limited line credit insurance;

9. Title insurance – insurance coverage that insures or

guarantees the title to real or personal property or any interest

therein or encumbrance thereon;

10. Aircraft title insurance – insurance coverage that protects

an aircraft owner or lender against loss of the aircraft or priority

security position in the event of a successful adverse claim on the

title to an aircraft; and

11. Any other line of insurance permitted under state laws or

regulations.

B. An insurance producer license shall remain in effect unless

revoked or suspended as long as the fee set forth in Section 1435.23

of this title is paid and education requirements for resident

individual producers are met by the due date.

C. An individual insurance producer who allows the license to

lapse may, within twelve (12) months from the due date of the

renewal fee, reinstate the same license without the necessity of

passing a written examination unless the license was revoked,

suspended, or continuation thereof was refused by the Commissioner.

However, a penalty in the amount of double the unpaid renewal fee

shall be required for any renewal fee received after the due date.

Continuing education requirements must be kept current.

D. A licensed insurance producer who is unable to comply with

license renewal procedures due to military service or some other

extenuating circumstance, such as a long-term medical disability,

may request a waiver of those procedures. The producer may also

request a waiver of any examination requirement or any other fine or

sanction imposed for failure to comply with renewal procedures.

E. The license shall contain the licensee's name, physical

residential address, physical business address, preferred mailing

address, personal identification number, and the date of issuance,

Oklahoma Statutes - Title 36. Insurance Page 340

the lines of authority, the expiration date and any other

information the Insurance Commissioner deems necessary.

F. Licensees shall inform by any means acceptable to the

Insurance Commissioner of a change of legal name, address, or e-mail

address within thirty (30) days of the change to permit the

Insurance Commissioner to give proper notice to licensees. A change

in legal name or address submitted more than thirty (30) days after

the change must include an administrative fee of Fifty Dollars

($50.00). Failure to provide acceptable notification of a change of

legal name or address to the Insurance Commissioner within forty-

five (45) days of the date the administrative fee is assessed shall

result in penalties pursuant to Section 1435.13 of this title.

G. In order to assist in the performance of the Insurance

Commissioner's duties, the Insurance Commissioner may contract with

nongovernmental entities, including the National Association of

Insurance Commissioners (NAIC) or any affiliates or subsidiaries

that the NAIC oversees, to perform any ministerial functions,

including the collection of fees, related to producer licensing that

the Insurance Commissioner and the nongovernmental entity may deem

appropriate.

H. The Commissioner may participate, in whole or in part, with

the National Association of Insurance Commissioners, or any

affiliates or subsidiaries the National Association of Insurance

Commissioners oversees, in a centralized producer license registry

where insurance producer licenses and appointments may be centrally

or simultaneously effected for all states that require an insurance

producer license and participate in such centralized producer

license registry. If the Commissioner finds that participation in

such a centralized producer license registry is in the public

interest, the Commissioner may adopt by rule any uniform standards

or procedures as are necessary to participate in the registry. This

includes the central collection of all fees for licenses or

appointments that are processed through the registry.
Okla. Stat. tit. 36, § 36-6961 — OK Code / Title 36 / Section 36-6961
Retail pharmacy network access standards
Status: in_force

A. Pharmacy benefits managers (PBMs) shall comply with the

following retail pharmacy network access standards:

1. At least ninety percent (90%) of covered individuals

residing in an urban service area live within two (2) miles of a

retail pharmacy participating in the PBM's retail pharmacy network;

2. At least ninety percent (90%) of covered individuals

residing in an urban service area live within five (5) miles of a

retail pharmacy designated as a preferred participating pharmacy in

the PBM's retail pharmacy network;

3. At least ninety percent (90%) of covered individuals

residing in a suburban service area live within five (5) miles of a

retail pharmacy participating in the PBM's retail pharmacy network;

4. At least ninety percent (90%) of covered individuals

residing in a suburban service area live within seven (7) miles of a

retail pharmacy designated as a preferred participating pharmacy in

the PBM's retail pharmacy network;

Oklahoma Statutes - Title 36. Insurance Page 1433

5. At least seventy percent (70%) of covered individuals

residing in a rural service area live within fifteen (15) miles of a

retail pharmacy participating in the PBM's retail pharmacy network;

and

6. At least seventy percent (70%) of covered individuals

residing in a rural service area live within eighteen (18) miles of

a retail pharmacy designated as a preferred participating pharmacy

in the PBM's retail pharmacy network.

B. Mail-order pharmacies shall not be used to meet access

standards for retail pharmacy networks.

C. Pharmacy benefits managers shall not require patients to use

pharmacies that are directly or indirectly owned by the pharmacy

benefits manager, including all regular prescriptions, refills or

specialty drugs regardless of day supply.

D. Pharmacy benefits managers shall not in any manner on any

material, including but not limited to mail and ID cards, include

the name of any pharmacy, hospital or other providers unless it

specifically lists all pharmacies, hospitals and providers

participating in the preferred and nonpreferred pharmacy and health

networks.
Okla. Stat. tit. 36, § 36-4524 — OK Code / Title 36 / Section 36-4524
Rates – Choice of plans – Benefits not required to
Status: in_force

contain state-mandated benefits – Plan requirements – Premium

discounts and modification of copayments or deductibles.

Oklahoma Statutes - Title 36. Insurance Page 997

A. Each Health Insurance Purchasing Group (HIPG), in

conjunction with a HIPG health carrier, shall make available a

health benefits plan in the manner described in this section to all

eligible employers and eligible employees at rates, including

employers’ and employees’ shares, on a policy- or product-specific

basis which may vary only as permitted under law.

B. Subject to subsection C of this section, a HIPG shall not

offer a health benefit plan which unfairly discriminates against

eligible employees.

C. Nothing in this act shall be construed as requiring a HIPG

health carrier to provide coverage outside the service area of the

insurer or organization.

D. Each HIPG shall provide a health benefits plan only through

contracts with HIPG health carriers and shall not assume insurance

risk with respect to the coverage.

E. Except as provided in this act, the HIPG may develop or

offer a health benefits plan for its members, in whole or in part,

not subject to state-mandated health benefits.

F. The HIPG shall offer at least two types of plans to its

members, including one plan providing a choice of deductibles with

state-mandated health benefits.

G. The HIPG may also offer a health benefits plan not subject

to state-mandated health benefits which does not contain standard

provisions or rights required to be present in a health benefits

plan pursuant to law or regulations unrelated to a specific illness,

injury or condition of the insured, for the provisions as may be

determined by rules and regulations of the Commissioner.

H. Every health benefits plan offered through a HIPG shall:

1. Be underwritten by a HIPG health carrier that:

a. is licensed or otherwise regulated under state

law,

b. meets all applicable state standards relating to

consumer protection, including, but not limited

to, state solvency and market conduct, and

c. offers the coverage under an approved contract

with the HIPG;

2. Be approved or otherwise permitted to be offered under law;

3. Provide full portability of creditable coverage for

individuals who remain members of the same HIPG notwithstanding that

they change the eligible employer through which they are members;

and

4. Comply with the provisions of the Oklahoma Insurance Code in

their sales and solicitation of insurance including, but not limited

to, the Trade Practices Act, and to the degree that an agent is

involved in the solicitation, sale or purchase of a health benefits

plan offered to a HIPG, that agent must be duly licensed by the

Oklahoma Statutes - Title 36. Insurance Page 998

State Insurance Department and hold a valid license to transact the

business of insurance.

I. A HIPG shall be subject to the requirements of the Small

Employer Health Insurance Reform Act.

J. Nothing in this act shall be construed as precluding a HIPG

health carrier from offering a health benefits plan through a HIPG

by establishing premium discounts for members, or from modifying

otherwise applicable copayments or deductibles in return for

adherence to programs of health promotion and disease prevention, so

long as the programs are agreed to in advance by the HIPG and comply

with all other provisions of this act and do not discriminate among

similarly situated members.
Okla. Stat. tit. 36, § 36-999.4 — OK Code / Title 36 / Section 36-999.4
Subsidence coverage for residences, living units and
Status: in_force

commercial buildings - Exemption.

Oklahoma Statutes - Title 36. Insurance Page 244

A. Beginning January 1, 2006, every insurer, as defined by

Section 3 of this act, may offer mine subsidence coverage, upon the

request by the policyholder, on policies, as defined by Section 3 of

this act, issued or renewed, insuring residences, living units and

commercial buildings.

B. The Insurance Commissioner may exempt policies insuring

residences, living units or commercial buildings located in any

specified county of this state from the provisions of this section

if the Commissioner determines that such coverage is not necessary

for a specified county.
Okla. Stat. tit. 36, § 36-4424 — OK Code / Title 36 / Section 36-4424
Definitions
Status: in_force

Unless the context requires otherwise, the definitions in this

section apply throughout the Long-Term Care Insurance Act.

1. a. "Long-term care insurance" means any insurance policy,

certificate or rider, including qualified long-term

care insurance contracts and long-term care

partnership program contracts, which are advertised,

marketed, offered or designed primarily to provide

coverage for not less than twelve (12) consecutive

months for each covered person on an expense incurred,

indemnity, prepaid, or other basis, for one or more

necessary or medically necessary diagnostic,

preventive, therapeutic, rehabilitative, maintenance,

or personal care services, provided in a setting other

than an acute care unit of a hospital.

b. This term includes group and individual health

policies or riders or group and individual life

policies or annuities or riders which provide,

directly or as a supplement, coverage for long-term

care, whether issued by insurers, fraternal benefit

societies, nonprofit health, hospital, and medical

service corporations, prepaid health plans, health

maintenance organizations, life care communities, or

any similar organization.

c. This term also includes a policy or rider which

provides for payment of long-term care benefits based

upon cognitive impairment or the loss of functional

capacity.

d. Long-term care insurance shall not include any

insurance policy which is offered primarily to provide

basic Medicare supplement coverage, basic hospital

expense coverage, basic medical-surgical expense

Oklahoma Statutes - Title 36. Insurance Page 965

coverage, hospital confinement indemnity coverage,

major medical expense coverage, disability income

protection coverage or related asset-protection

coverage, catastrophic coverage, comprehensive

coverage, accident only coverage, specified disease or

specified accident coverage, or limited benefit health

coverage.

e. With regard to life insurance, this term does not

include life insurance policies which accelerate the

death benefit specifically for one or more of the

qualifying events of terminal illness, medical

conditions requiring extraordinary medical

intervention, or permanent institutional confinement,

and which provide the option of a lump-sum payment for

those benefits and in which neither the benefits nor

the eligibility for the benefits is conditioned upon

the receipt of long-term care.

f. Notwithstanding any other provision contained herein,

any product advertised, marketed or offered as long-

term care insurance shall be subject to the provisions

of the Long-Term Care Act.

2. "Applicant" means:

a. in the case of an individual long-term care insurance

policy, the person who seeks to contract for such

benefits, and

b. in the case of a group long-term care insurance

policy, the proposed certificate holder.

3. "Certificate" means any certificate issued under a group

long-term care insurance policy, which certificate has been

delivered, or issued for delivery, in this state.

4. "Group long-term care insurance" means a long-term care

insurance policy which is delivered, or issued for delivery, in this

state and issued to:

a. one or more employers or labor organizations, or to a

trust or to the trustees of a fund established by one

or more employers or labor organizations, or a

combination thereof, for employees or former

employees, or a combination thereof or for members or

former members, or a combination thereof, of the labor

organizations, or

b. any professional, trade or occupational association

for its members or former or retired members, or

combination thereof, if such association:

(1) is composed of individuals, all of whom are or

were actively engaged in the same profession,

trade or occupation, and

Oklahoma Statutes - Title 36. Insurance Page 966

(2) has been maintained in good faith for purposes

other than insurance, or

c. an association, a trust, or the trustee or trustees of

a fund established, created, or maintained for the

benefit of members of one or more associations. Prior

to advertising, marketing or offering such policy

within this state, the association or associations, or

the insurer of the association or associations, shall

file evidence with the Insurance Commissioner that the

association or associations shall have at the outset

of transacting long-term care insurance in this state

a minimum of one hundred (100) persons in the

association or associations and shall have been

organized and maintained in good faith for purposes

other than that of obtaining insurance; shall have

been in active existence for at least one (1) year;

and shall have a constitution and bylaws which provide

that (i) the association or associations hold regular

meetings not less than annually to further purposes of

the members, (ii) except for credit unions, the

association or associations collect dues or solicit

contributions from members, and (iii) the members have

voting privileges and representation on the governing

board and committees. Thirty (30) days after such

filing the association or associations shall be deemed

to satisfy such organizational requirements, unless

the Commissioner makes a finding that the association

or associations do not satisfy those organizational

requirements, or

d. a group other than as described in subparagraphs a, b

and c of this paragraph, subject to a finding by the

Commissioner that:

(1) the issuance of the group policy is not contrary

to the best interest of the public,

(2) the issuance of the group policy would result in

economies of acquisition or administration, and

(3) the benefits are reasonable in relation to the

premiums charged.

5. "Not-for-Profit Life care community" within the meaning of

Section 1-853.1 of Title 63 of the Oklahoma Statutes means any not-

for-profit organization that enters into an arrangement pursuant to

which a person contracts for a place of residence and personal care

services, including but not limited to services which progress from

independent living to semi-dependent nursing care to acute nursing

care, in consideration of an endowed prepayment, license or entry

fee which has been actuarially established to meet the cost of the

promised services and accommodations. For communities commencing

Oklahoma Statutes - Title 36. Insurance Page 967

operations after January 1, 2016, the amount of the endowed

prepayment must be independently, actuarially determined, in

compliance with the Actuarial Standards of Practice promulgated by

the Actuarial Standards Board of the American Academy of Actuaries,

prior to opening the community and annually thereafter to ensure

that sufficient payments are collected to meet the future services

of the residents. The actuarial study shall take into consideration

projected or actual project costs, resident fees and charges,

resident contract provisions and any other factors affecting the

operation of the facility. It shall contain mortality and morbidity

data and an actuary's signed opinion that the proposed is feasible

and that the study has been prepared in accordance with standards

adopted by the American Academy of Actuaries. A not-for-profit life

care community shall not include the following:

a. traditional landlord and tenant agreements utilizing

periodic rental and security deposit payments,

b. residential care homes licensed pursuant to the

Oklahoma Residential Care Act,

c. assisted living centers and continuum of care

facilities licensed pursuant to the Oklahoma Continuum

of Care and Assisted Living Act,

d. facilities licensed pursuant to the Oklahoma Nursing

Home Care Act, or

e. any facility where the endowed prepayment, license or

entry fee is less than Fifty Thousand Dollars

($50,000.00).

6. "Policy" means any policy, contract, certificate, subscriber

agreement, rider or endorsement delivered, or issued for delivery,

in this state by an insurer, fraternal benefit society, nonprofit

health, hospital, or medical service corporation, prepaid health

plan, health maintenance organization, life care community, or any

similar organization.

7. "Qualified long-term care insurance contract" means any:

a. individual or group insurance contract if the contract

meets the requirements of Section 7702(B) of the

Internal Revenue Code, as amended, and if:

(1) the only insurance protection provided under the

contract is coverage of qualified long-term care

services,

(2) the contract does not pay or reimburse expenses

incurred for services or items to the extent that

such expenses are reimbursable under Title XVIII

of the Social Security Act as amended, or would

be so reimbursable but for the application of a

deductible or coinsurance amount. The

requirements of this subparagraph do not apply to

contracts where Medicare is a secondary payor, or

Oklahoma Statutes - Title 36. Insurance Page 968

where the contract makes per diem or other

periodic payments without regard to expenses,

(3) the contract is guaranteed renewable,

(4) the contract does not provide for a cash

surrender value or other money that can be paid,

assigned, pledged as collateral for a loan, or

borrowed. All refunds of premiums and all

policyholder dividends or similar amounts, under

such contract are to be applied as a reduction in

future premiums or to increase future benefits,

except that a refund of the aggregate premium

paid under the contract may be allowed in the

event of death of the insured or a complete

surrender or cancellation of the contract, and

(5) the contract contains the consumer protection

provisions set forth in Section 7702(B)(g) of the

Internal Revenue Code, or

b. life insurance contract which provides long-term care

coverage by rider or as part of the contract if the

contract complies with the applicable provisions of

Section 7702(B) of the Internal Revenue Code, as

amended.

8. "Qualified long-term care services" means necessary

diagnostic, preventive, therapeutic, curing, treating, mitigating,

and rehabilitative services, and maintenance for personal care

services for which an insured is eligible under a qualified long-

term care insurance contract, and which are provided pursuant to a

plan of care prescribed by a licensed health care practitioner.
Okla. Stat. tit. 36, § 36-6514 — OK Code / Title 36 / Section 36-6514
Classes of business - Criteria to establish - Number -
Status: in_force

Rules - Additional classes.

A. A small employer carrier may establish a class of business

only to reflect substantial differences in expected claims

experience or administrative costs related to the following reasons:

1. The small employer carrier uses more than one type of system

for the marketing and sale of health benefit plans to small

employers;

2. The small employer carrier has acquired a class of business

from another small employer carrier; or

3. The small employer carrier provides coverage to one or more

association groups that meet the requirements of an association as

set forth in Section 4501 of this title.

B. A small employer carrier may establish up to nine separate

classes of business under subsection A of this section.

C. The Insurance Commissioner may establish rules to provide

for a period of transition in order for a small employer carrier to

Oklahoma Statutes - Title 36. Insurance Page 1278

come into compliance with subsection B of this section in the

instance of acquisition of an additional class of business from

another small employer carrier.

D. The Commissioner may approve the establishment of additional

classes of business upon application to the Commissioner and a

finding by the Commissioner that such action would enhance the

efficiency and fairness of the small employer marketplace.

E. A small employer carrier shall offer each product currently

marketed to all classes of business established pursuant to this

section.
Okla. Stat. tit. 36, § 36-117 — OK Code / Title 36 / Section 36-117
General penalty
Status: in_force

Oklahoma Statutes - Title 36. Insurance Page 46

In addition to any other penalty which may be applicable

thereto, either under this Code or otherwise, violation of any

provision of this Code shall constitute a misdemeanor and shall be

punishable as such where no greater penalty is provided therefor.
Okla. Stat. tit. 36, § 36-6570.51 — OK Code / Title 36 / Section 36-6570.51
Online accessibility for prescription drug prior
Status: in_force

authorization requirements, restrictions, and formularies.

A utilization review entity shall make any current prescription

drug prior authorization requirements and restrictions, including

written clinical criteria, readily accessible on its website to

enrollees and health care providers. Prior authorization

requirements shall be described in detail but also in easily

understandable language.

Any health plan shall make any current prescription drug plan

formulary readily accessible on its website to enrollees and health

care providers.

All health benefit plans shall submit a secured webpage link for

the plan's formulary, to the Insurance Commissioner, on or before

October 1 of each year. The Commissioner shall issue guidance and

standardized reporting requirements to ensure compliance with the

provisions of this section. Any confidential or trade secret

information shall be redacted prior to submission to the

Commissioner. No later than December 31, 2025, and by December 31

of each year thereafter, the Commissioner shall make available to

Oklahoma Statutes - Title 36. Insurance Page 1318

the public the reports submitted by insurers, as required by this

section.

If a utilization review entity intends either to implement a new

prior authorization requirement or restriction, or amend an existing

requirement or restriction, the utilization review entity shall

ensure that the new or amended requirement or restriction is not

implemented unless the utilization review entity's website has been

updated to reflect the new or amended requirement or restriction.

If a utilization review entity intends either to implement a new

prior authorization requirement or restriction, or amend an existing

requirement or restriction, the utilization review entity shall

provide contracted health care providers credentialed to prescribe

the drug, or enrollees who have a chronic condition and are already

receiving the prescription drug which the prior authorization

changes will impact, notice of the new or amended requirement or

restriction no less than sixty (60) days before the requirement or

restriction is implemented.

Provided the provisions of this section do not violate any

applicable law, regulation, or the Oklahoma Medicaid State Plan.
Okla. Stat. tit. 36, § 36-705 — OK Code / Title 36 / Section 36-705
"Marine insurance" defined
Status: in_force

"Marine insurance" includes:

1. Insurance against any and all kinds of loss or damage to

vessels, craft, aircraft, cars, automobiles and vehicles of every

kind, as well as all goods, freight, cargoes, merchandise, effects,

disbursements, profits, moneys, bullion, precious stones,

securities, choses in action, evidence of debt, valuable papers,

bottomry and respondentia interests and all other kinds of property

and interests therein, in respect to, appertaining to or in

connection with any and all risks or perils of navigation, transit,

or transportation, including war risks, on or under any seas or

other waters, on land or in the air, or while being assembled,

packed, crated, baled, compressed or similarly prepared for shipment

or while awaiting the same or during any delays, storage,

transshipment, or reshipment incident thereto, including marine

builders' risks and all personal property floater risks;

Oklahoma Statutes - Title 36. Insurance Page 191

2. Insurance against any and all kinds of loss or damage to

person or to property in connection with or appertaining to a

marine, inland marine, transit or transportation insurance,

including liability for loss of or damage to either, arising out of

or in connection with the construction, repair, operation,

maintenance or use of the subject matter of such insurance (but not

including life insurance or surety bonds nor insurance against loss

by reason of bodily injury to the person arising out of the

ownership, maintenance or use of automobiles);

3. Insurance against any and all kinds of loss or damage to

precious stones, jewelry, gold, silver and other precious metals,

whether used in business or trade or otherwise and whether the same

be in course of transportation or otherwise;

4. Insurance against any and all kinds of loss or damage to

bridges, tunnels and other instrumentalities of transportation and

communication (excluding buildings, their furniture and furnishings,

fixed contents and supplies held in storage) unless fire, tornado,

sprinkler leakage, hail, explosion, earthquake, riot or civil

commotion or any or all of them are the only hazards to be covered;

5. Insurance against any and all kinds of loss or damage to

piers, wharves, docks and slips, excluding the risks of fire,

tornado, sprinkler leakage, hail, explosion, earthquake, riot and

civil commotion and each of them;

6. Insurance against any and all kinds of loss or damage to

other aids to navigation and transportation, including dry docks and

marine railways, dams and appurtenant facilities for the control of

waterways; and

7. Marine protection and indemnity insurance, which is

insurance against, or against legal liability of the insured for,

loss, damage or expense arising out of, or incident to, the

ownership, operation, chartering, maintenance, use, repair or

construction of any vessel, craft or instrumentality in use in ocean

or inland waterways, including liability of the insured for personal

injury, illness or death or for loss of or damage to the property of

another person.
Okla. Stat. tit. 36, § 36-6981 — OK Code / Title 36 / Section 36-6981
Policy of coverage — Issuance to enrollees — Filing and
Status: in_force

approval — Requirements.

A. Every enrollee of a prepaid vision plan shall be issued a

coverage policy by the prepaid vision plan organization. No policy

for coverage or amendment to the policy shall be issued or delivered

to any person in this state until a copy of the policy for coverage

or amendment to the policy has been filed with and approved by the

Insurance Commissioner.

B. A policy for coverage shall contain a statement of:

1. The prepaid vision services or other benefits to which the

enrollee is entitled under the prepaid vision plan;

Oklahoma Statutes - Title 36. Insurance Page 1456

2. Any limitations of the services or benefits to which the

enrollee is entitled under the prepaid vision plan;

3. Information as to how services may be obtained; and

4. The obligation of the enrollee for charges for the prepaid

vision plan.

C. The Commissioner shall approve any policy of coverage if the

requirements of this section are complied with and the prepaid

vision plan, in the judgment of the Commissioner, is able to meet

its financial obligations for the membership coverage. It shall be

unlawful for a prepaid vision plan organization to issue a policy

until it is approved by the Commissioner.

D. 1. If the Commissioner does not disapprove any policy

within thirty (30) days after filing, the policy shall be deemed

approved.

2. If the Commissioner disapproves a policy of membership

coverage, the Commissioner shall notify the prepaid vision plan

organization, specifying the reasons for disapproval. The

Commissioner shall grant a hearing on any disapproval within thirty

(30) days after a request in writing for a hearing is received by

the Commissioner from the prepaid vision plan organization.
Okla. Stat. tit. 36, § 36-3007 — OK Code / Title 36 / Section 36-3007
Liability of underwriters; limitation
Status: in_force

An underwriter at a Lloyd's may limit his total liability on all

risks to the amount of his subscription as expressed in his power of

attorney and agreement with the attorney-in-fact; provided at least

half of the subscription of each underwriter must be paid or

contributed to the guaranty fund in cash or admissible securities.

Each underwriter shall be responsible solely for his own liability

as fixed in the contract of insurance and shall not be liable as a

partner and in no event shall the liability of an underwriter exceed

the amount of his total underwriters agreement executed in favor of

his respective successor attorney or attorneys-in-fact.
Okla. Stat. tit. 36, § 36-1683 — OK Code / Title 36 / Section 36-1683
Definitions
Status: in_force

1. "Affiliate" has the meaning ascribed to such term in Section

1631 of this title.

2. "Applicant" means an assuming insurer, a transferring

insurer, or a reinsurer applying to the Commissioner for approval of

an Insurance Business Transfer Plan pursuant to this act.

3. "Assuming insurer" means an insurer domiciled in this state

that assumes or seeks to assume policies from a transferring insurer

Oklahoma Statutes - Title 36. Insurance Page 500

pursuant to this act. An assuming insurer may be a company

established pursuant to the Oklahoma Captive Insurance Company Act.

4. "Court" means the district court of a county in Oklahoma

with a population of more than two hundred fifty thousand (250,000).

5. "Department" means the Insurance Department.

6. "Commissioner" means the Insurance Commissioner.

7. "Implementation order" means an order issued by the court

under Section 1686 of this title.

8. "Independent expert" means a person who shall assist the

Commissioner and the court in connection with their review of a

proposed transaction. The Commissioner shall select an independent

expert from a list of at least two nominees submitted jointly by the

transferring insurer and the assuming insurer; provided, however, if

the Commissioner, in his or her sole discretion, rejects the

nominees submitted jointly by the transferring insurer and the

assuming insurer, the Commissioner may appoint another person to

serve as an independent expert. An independent expert selected

under this subsection shall meet all of the following criteria:

a. hold no financial interest in either the assuming

insurer or the transferring insurer,

b. not be employed by, or act as an officer, director,

consultant, or independent contractor for either the

assuming insurer or the transferring insurer within

the previous twelve (12) months,

c. not be simultaneously appointed by the Commissioner to

assist in any capacity in any proceeding initiated

pursuant to Article 18 or Article 19 of this title,

d. receives or is promised no compensation in connection

with the Insurance Business Transfer for which he or

she is selected to serve as an independent expert;

provided, however, a fee may be approved by the

Commissioner that is not contingent upon the approval

or consummation of an Insurance Business Transfer

Plan, and

e. provides proof of insurance covering the services

provided as an independent expert, to be approved by

the Commissioner.

9. "Insurance Business Transfer" means a transfer and novation

in accordance with this act. Insurance Business Transfers will

transfer insurance obligations, risks, rights, or any combination

thereof, of existing or in-force contracts of insurance or

reinsurance from a transferring insurer to an assuming insurer.

Once approved pursuant to this act, the Insurance Business Transfer

will effect a transfer and novation of the transferred contracts of

insurance or reinsurance with the result that the assuming insurer

becomes directly liable to the policyholders of the transferring

Oklahoma Statutes - Title 36. Insurance Page 501

insurer and the transferring insurer's insurance obligations or

risks, or both, under the contracts are extinguished.

10. "Insurance Business Transfer Plan" or "Plan" means the plan

submitted to the Department to accomplish the transfer and novation

pursuant to an Insurance Business Transfer including any associated

transfer of assets and rights from or on behalf of the transferring

insurer to the assuming insurer.

11. "Insurer" means an insurance or surety company including a

reinsurance company, and shall be deemed to include a corporation,

company, partnership, association, society, order, individual or

aggregation of individuals engaging in or proposing or attempting to

engage in any kind of insurance or surety business including the

exchanging of reciprocal or inter-insurance contracts between

individuals, partnerships and corporations.

12. "Petitioner" means an assuming insurer, transferring

insurer, or reinsurer petitioning a court for an order of approval

and implementation of a Plan pursuant to this act.

13. "Policy" means a policy, annuity contract or certificate of

insurance or a contract of reinsurance pursuant to which the insurer

agrees to assume an obligation or risk, or both, of the policyholder

or to make payments on behalf of, or to, the policyholder or its

beneficiaries, and shall include property, casualty, life, health

and any other line of insurance the Commissioner finds, pursuant to

this act, is suitable for an insurance business transfer.

14. "Policyholder" means an insured or a reinsured under a

policy which is part of the subject business.

15. "Subject business" means the policy or policies designated

for transfer and novation pursuant to a corresponding Insurance

Business Transfer Plan.

16. "Transfer and novation" means the transfer of insurance

obligations, risks, rights, or any combination thereof, of existing

or in-force policies from a transferring insurer to an assuming

insurer, and is intended to effect a transfer and novation of the

transferred policies with the result that the assuming insurer

becomes directly liable to the policyholders of the transferring

insurer on the transferred policies and the transferring insurer's

insurance obligations, risks, rights, or any combination thereof,

under the transferred policies are extinguished.

17. "Transferring insurer" means an insurer or reinsurer which

seeks to or has accomplished a transfer and novation of obligations,

risks, rights, or any combination thereof, under one or more

policies to an assuming insurer pursuant to an Insurance Business

Transfer Plan and the provisions of this act.
Okla. Stat. tit. 36, § 36-6470.29 — OK Code / Title 36 / Section 36-6470.29
Sponsored captive insurance company – Supplemental
Status: in_force

materials – Protected cells.

A. In addition to the provisions of Sections 6470.1 through

6470.28 of this title and the provisions of Sections 6470.29 through

6470.31 of this title shall apply to sponsored captive insurance

companies, and the provisions of Section 6470.24.1 of this title

shall apply to each protected cell of a sponsored captive insurance

company.

B. Supplemental license application materials.

In addition to the information required by subsection C of

Section 6470.3 of this title, each applicant sponsored captive

insurance company shall file with the Commissioner the following:

1. Materials demonstrating to the satisfaction of the

Commissioner how the applicant will report to the Commissioner on,

and account for, the loss and expense experience of each protected

cell;

2. A statement acknowledging that all financial records of the

sponsored captive insurance company, including records pertaining to

any protected cells, shall be made available for inspection or

examination by the Commissioner or the Commissioner's designated

agent;

3. All contracts or sample contracts between the sponsored

captive insurance company and any participants; and

4. Evidence that expenses shall be allocated to each protected

cell in a fair and equitable manner.

C. One or more sponsors may form a sponsored captive insurance

company under the Oklahoma Captive Insurance Company Act.

D. A sponsored captive insurance company formed or licensed

under the Oklahoma Captive Insurance Company Act may establish and

maintain one or more protected cells to insure risks of one or more

participants, subject to the following conditions:

1. The persons holding the voting interests of a sponsored

captive insurance company must be limited to its participants and

sponsors; provided, that a sponsored captive insurance company may

issue nonvoting securities or interests to other persons on terms

approved by the Commissioner;

2. Each protected cell must be accounted for separately on the

books and records of the sponsored captive insurance company to

reflect the financial condition and results of operations of the

protected cell, net income or loss, dividends or other distributions

Oklahoma Statutes - Title 36. Insurance Page 1231

to participants, and other factors may be provided in the

participant contract or required by the Insurance Commissioner;

3. The assets of a protected cell must not be chargeable with

liabilities of any other protected cell or, unless otherwise agreed

in the applicable participant contract, of the sponsored captive

insurance company;

4. No sale, exchange, or other transfer of assets, or dividend

or other distribution, may be made with respect to a protected cell

by the sponsored captive insurance company without the consent of

the participants of each affected protected cell;

5. No sale, exchange, transfer of assets, dividend, or

distribution, other than a payment to a sponsor in accordance with

the applicable participant contract, may be made from a protected

cell to a sponsor or participant without the approval of the

Insurance Commissioner and in no event may the approval be given if

the sale, exchange, transfer, dividend, or distribution would result

in insolvency or impairment with respect to a protected cell;

6. A sponsored captive insurance company annually shall file

with the Insurance Commissioner financial reports the Insurance

Commissioner requires, which shall include, but are not limited to,

accounting statements detailing the financial experience of each

protected cell;

7. A sponsored captive insurance company shall notify the

Insurance Commissioner in writing within ten (10) business days of a

protected cell that is insolvent or otherwise unable to meet its

claim or expense obligations; and

8. No participant contract shall take effect without the prior

written approval of the Insurance Commissioner, and the addition of

each new protected cell and withdrawal of any participant or

termination of any existing protected cell constitutes a change in

the business plan of the sponsored captive insurance company

requiring the prior written approval of the Insurance Commissioner.
Okla. Stat. tit. 36, § 36-6570.9 — OK Code / Title 36 / Section 36-6570.9
Treatment of chronic conditions — Validity period for
Status: in_force

prior authorization of inpatient and non-inpatient care.

A. If a prior authorization is required for a health care

service, other than for inpatient care, for the treatment of a

chronic condition of an enrollee, then the prior authorization shall

remain valid for at least six (6) months from the date the health

care provider receives the prior authorization approval, unless

clinical criteria changes and notice of the change in clinical

criteria is provided as stipulated in this act.

B. If a prior authorization is required for inpatient acute

care for the treatment of a chronic condition of an enrollee, then

the prior authorization shall remain valid for at least fourteen

(14) calendar days from the date the health care provider receives

the prior authorization approval.

1. If an enrollee requires inpatient care beyond the length of

stay that was previously approved by the utilization review entity,

then the utilization review entity shall evaluate any prior

authorization requests for the continuation of inpatient care

according to the provisions of this act. A utilization review

entity shall not use any stricter criteria to determine medical

necessity and appropriateness of the continuation of inpatient care

as the utilization review entity used to evaluate the initial

request for authorization of inpatient care. A utilization review

entity shall review any relevant and pertinent literature or data

provided by the health care provider to determine the medical

necessity and appropriateness of the requested length of stay and/or

continuation of inpatient care. A prior authorization for the

Oklahoma Statutes - Title 36. Insurance Page 1314

continuation of inpatient care shall remain valid for a maximum of

fourteen (14) calendar days from the date the health care provider

receives the prior authorization approval.

2. If a utilization review entity fails to respond to a health

care provider's timely prior authorization request for the

continuation of inpatient acute care before the termination of the

previously approved length of stay, then the health benefit plan

shall continue to compensate the health care provider at the

contracted rate for inpatient care provided until the utilization

review entity issues its determination on the prior authorization

request.

For the purposes of this section, a timely request for

continuation of inpatient care means a request that is submitted at

least twenty-four (24) hours prior to the termination of the

previously approved prior authorization and includes all necessary

information for the utilization review entity to make a

determination.

3. If a utilization review entity issues an adverse

determination to a health care provider's prior authorization

request for continuation of inpatient acute care and the health care

provider appeals the adverse determination according to the

provisions of this act, then the health benefit plan shall continue

to compensate the health care provider at the contracted rate for

inpatient care provided until the appeal has been finalized.

C. This section does not require a health benefit plan to cover

care, treatment, or services for a health condition that the terms

of coverage otherwise completely exclude from the policy's covered

benefits without regard for whether the care, treatment, or services

are medically necessary.
Okla. Stat. tit. 36, § 36-5108 — OK Code / Title 36 / Section 36-5108
Duties of RM
Status: in_force

The RM shall not:

1. Bind retrocessions on behalf of the reinsurer, except that

the RM may bind facultative retrocessions pursuant to obligatory

facultative agreements if the contract with the reinsurer contains

reinsurance underwriting guidelines for such retrocessions. Such

guidelines shall include a list of reinsurers with which such

automatic agreements are in effect, and for each such reinsurer, the

coverages and amounts or percentages that may be reinsured, and

commission schedules;

2. Commit the reinsurer to participate in reinsurance

syndicates;

3. Appoint any producer without assuring that the producer is

lawfully licensed to transact the type of reinsurance for which he

is appointed;

4. Without prior approval of the reinsurer, pay or commit the

reinsurer to pay a claim or net of retrocessions, that exceeds the

lesser of an amount specified by the reinsurer or one percent (1%)

of the reinsurer's policyholder's surplus as of December 31 of the

last complete calendar year;

5. Collect any payment from a retrocessionaire or commit the

reinsurer to any claim settlement with a retrocessionaire, without

prior approval of the reinsurer. If prior approval is given, a

report shall be forwarded promptly to the reinsurer;

Oklahoma Statutes - Title 36. Insurance Page 1033

6. Jointly employ an individual who is employed by the

reinsurer; or

7. Appoint a sub-RM.
Okla. Stat. tit. 36, § 36-1142 — OK Code / Title 36 / Section 36-1142
Permitted activities and services
Status: in_force

Oklahoma Statutes - Title 36. Insurance Page 264

Any licensed advisory organization, in addition to other

activities not prohibited, is authorized on behalf of its members

and subscribers to:

1. Develop statistical plans including territorial and class

definitions;

2. Collect statistical data from members, subscribers or any

other source;

3. Prepare, file and distribute prospective loss costs which

may include provisions for special assessments and taxes;

4. Prepare, file and distribute factors, calculations or

formulas pertaining to classification, territory, increased limits

and other variables;

5. Prepare, file and distribute manuals of rating rules, rating

schedules and other supplementary rating information that does not

include final rates, expense provisions, profit provisions or

minimum premiums;

6. Distribute information that is required or directed to be

filed with the Commissioner;

7. Conduct research and on-site inspections in order to prepare

classifications of public fire defenses;

8. Consult with public officials regarding public fire

protection as it would affect members, subscribers and others;

9. Conduct research and collect statistics in order to

discover, identify and classify information relating to causes or

prevention of losses;

10. Conduct research and collect information to determine the

impact of statutory and other law changes upon prospective loss

costs and special assessments;

11. Prepare, file and distribute policy forms and endorsements

and consult with members, subscribers and others relative to their

use and application;

12. Conduct research and on-site inspections for the purpose of

providing risk information relating to individual structures;

13. Conduct on-site inspections to determine rating

classifications for individual insureds;

14. Collect, compile and publish past and current prices of

individual insurers; provided, such information is also made

available to the general public for a reasonable price;

15. Collect and compile exposure and loss experience for the

purpose of individual risk experience ratings;

16. File final rates for residual market mechanisms; and

17. Furnish any other services, as approved or directed by the

Insurance Commissioner, related to those enumerated in this section.
Okla. Stat. tit. 36, § 36-105 — OK Code / Title 36 / Section 36-105
"Transacting" insurance
Status: in_force

"Transact" with respect to insurance includes any of the

following:

1. Solicitation and inducement.

2. Preliminary negotiations.

3. Effectuation of a contract of insurance.

4. Transaction of matters subsequent to effectuation of the

contract and arising out of it.
Okla. Stat. tit. 36, § 36-2111 — OK Code / Title 36 / Section 36-2111
Initial qualification, domestic mutuals
Status: in_force

When newly organized, a domestic mutual insurer may be

authorized to transact any one or more kinds of insurance other than

title insurance. When applying for an original certificate of

authority as an insurer, a domestic mutual insurer must be otherwise

qualified therefor under this code, must possess and maintain the

minimum requirements for surplus in regard to policyholders as set

forth in Sections 610 and 611 of this code, and must have received

and accepted bona fide applications with respect to substantial

insurable subjects for insurance coverage of a substantial character

of the kind of insurance proposed to be transacted, must have

collected in full and in cash the proper premium therefor at a rate

substantially equal to that usually charged by stock insurers for

comparable coverages, must have surplus funds on hand as at

completion of issuance of all such policies so applied for, or, in

lieu of such applications, premiums, and surplus, may deposit

surplus, all in accordance with the requirements set forth in

Sections 610 and 611 of this code.
Okla. Stat. tit. 36, § 36-4509.2 — OK Code / Title 36 / Section 36-4509.2
Acceptance by succeeding carriers - Preexisting
Status: in_force

conditions limitations or waiting requirements.

A. When an insured individual or a dependent who was covered by

group insurance pursuant to the provisions of the Health Insurance

Portability and Accountability Act of 1996, 29 U.S.C.A., Section

1181 et seq., gains employment with an employer who provides for

health insurance through a group plan, the succeeding group carrier

shall accept the insured individual and dependents of the insured

individual who were covered under the prior coverage and shall not

apply limitations or exclusions based on preexisting conditions or

apply waiting-period requirements for the insured individual or the

dependents of the insured individual beyond the time when any

surviving exclusion or waiting period with the prior carrier would

have been fulfilled. The insured individual and any dependents of

such individual must apply for the new coverage within sixty-three

(63) days following the date of termination of prior creditable

coverage.

B. When an insured individual or dependent who was covered by

individual insurance pursuant to the provisions of the Health

Insurance Portability and Accountability Act of 1996, 29 U.S.C.A.,

Section 1181 et seq., gains employment with an employer who provides

for health insurance through a group plan, the succeeding group

carrier shall accept the insured individual and dependents of the

insured individual who were covered under the prior coverage and

shall not apply limitations or exclusions based on preexisting

conditions or apply waiting-period requirements for the insured

individual or the dependents of the insured individual beyond the

time when any surviving exclusion or waiting period with the prior

carrier would have been fulfilled. The insured individual and any

dependents of such individual must apply for the new coverage within

sixty-three (63) days following the date of termination of prior

creditable coverage.

C. Insurance carriers receiving an application for individual

insurance may underwrite the risk or decline coverage based on the

underwriting guidelines of the insurance carrier.

D. When there is a lapse in the coverage of the insured

individual or a dependent of the insured individual provided for by

subsections A, B, and C of this section for any reason other than a

probationary period or similar waiting period imposed pursuant to

personnel policies of an employer, the provisions of subsections A,

B, and C of this section shall not apply to the person whose

coverage lapsed.

E. When an individual employee who was covered under a group

health insurance plan terminates employment with an employer and

gains employment with another employer who provides for health

insurance through a group plan, the carrier of the succeeding

Oklahoma Statutes - Title 36. Insurance Page 990

employer shall not apply preexisting conditions limitations or

exclusions of preexisting conditions or apply waiting-period

requirements for the individual employee or his dependents covered

under the group plan of the previous employer beyond the time when

any surviving exclusion or waiting period with the prior carrier

would have been fulfilled, provided the individual employee applies

for the new coverage within thirty-one (31) days following the date

of eligibility for participation in the plan in accordance with the

employment or personnel policies of the employer of such

participation.

F. When there is a lapse in the coverage of the individual

employee provided for by subsection E of this section for any reason

other than a probationary period or similar waiting period imposed

by the employment or personnel policies of the employer, the

provisions of subsection E of this section shall not apply.
Okla. Stat. tit. 36, § 36-403 — OK Code / Title 36 / Section 36-403
Powers of Insurance Commissioner - Injunctive relief
Status: in_force

Oklahoma Statutes - Title 36. Insurance Page 118

A. Whenever the Insurance Commissioner has reason to believe or

it appears that any person has violated subsection A of Section 2 of

this act, the Insurance Commissioner may:

1. Revoke any license or registration issued or approved by the

Insurance Commissioner;

2. Issue an ex parte cease and desist order under the

procedures provided by Section 5 of this act;

3. Institute in the district court of Oklahoma County a civil

suit for injunctive relief to restrain the person from continuing

the violation;

4. Institute in the district court of Oklahoma County a civil

suit to recover a civil penalty as provided for in Section 2 of this

act; or

5. Exercise any combination of the acts provided for in this

subsection.

B. On application for injunctive relief and a finding that a

person is violating or threatening to violate any provision of the

Crimes By or Affecting Persons Engaged in the Business of Insurance

Act or order of the Insurance Commissioner issued pursuant to the

Crimes By or Affecting Persons Engaged in the Business of Insurance

Act, the district court shall grant the injunctive relief and the

injunction shall be issued without bond.
Okla. Stat. tit. 36, § 36-6928 — OK Code / Title 36 / Section 36-6928
Disclosure of diagnostic, treatment or health status
Status: in_force

information.

A. 1. Any data or information pertaining to the diagnosis,

treatment or health of any enrollee or applicant obtained from that

person or from a provider by a health maintenance organization shall

be held in confidence and shall not be disclosed to any person

except:

a. to the extent that it may be necessary to carry out

the purposes of the Health Maintenance Organization

Act of 2003,

b. upon the express consent of the enrollee or applicant,

c. pursuant to statute or court order for the production

of evidence or the discovery thereof, or

d. in the event of claim or litigation between the person

and the health maintenance organization wherein the

data or information is pertinent.

2. A health maintenance organization shall be entitled to claim

any statutory privileges against disclosure that the provider who

furnished the information to the health maintenance organization is

entitled to claim.

B. A person who, in good faith and without malice, takes an

action or makes a decision or recommendation as a member, agent or

employee of a health care review committee or who furnishes any

records, information or assistance to such a committee shall not be

subject to liability for civil damages or any legal action in

consequence of the action, nor shall the health maintenance

organization that established the committee or the officers,

directors, employees or agents of the health maintenance

organization be liable for the activities of the person. This

section shall not be construed to relieve any person of liability

arising from treatment of a patient.

C. 1. The information considered by a health care review

committee and the records of the committee’s actions and proceedings

shall be confidential and not subject to subpoena or order to

produce except in proceedings before the appropriate state licensing

or certifying agency, or in an appeal, if permitted, from the

committee’s findings or recommendations. No member of a health care

review committee, or officer, director or other member of a health

maintenance organization or its staff engaged in assisting a

committee, or a person assisting or furnishing information to a

committee may be subpoenaed to testify in any judicial or quasi-

judicial proceeding if the subpoena is based solely on such

activities.

2. Information considered by a health care review committee and

the records of its actions and proceedings that are used pursuant to

the provisions of paragraph 1 of this subsection by a state

licensing or certifying agency or in an appeal shall be kept

Oklahoma Statutes - Title 36. Insurance Page 1411

confidential and shall be subject to the same provisions concerning

discovery and use in legal actions as the original information and

records in the possession and control of a health care review

committee.

D. To fulfill its obligations under Section 7 of this act, a

health maintenance organization shall have access to treatment

records and other information pertaining to the diagnosis, treatment

or health status of an enrollee.
Okla. Stat. tit. 36, § 36-6530.5 — OK Code / Title 36 / Section 36-6530.5
Board of Directors – Duties – Sunset of Program
Status: in_force

A. The Board of Directors of the Oklahoma Individual Health

Insurance Market Stabilization Program shall:

1. Develop, implement and administer the Program.

Implementation of the Program shall be contingent upon Oklahoma's

approval for and receipt of federal funds to implement and sustain

the Program;

2. Apply for and utilize federal funding for the reinsurance

program, as provided in subsection C of this section;

3. Make payments to provide for the market stabilization

activities authorized by this act and for administrative expenses

incurred or estimated to be incurred during the period for which

assessment is made;

4. Establish administrative and accounting processes and

procedures for the operation of the Program and create operating

rules to effectuate the provisions of this act including but not

limited to:

a. determine eligibility of individuals to receive

coverage under the Program,

b. establish standards for qualification based upon

health status, health conditions, prior or current

insurance coverage status, health costs as a result of

utilization of consuming health care,

c. establish the dollar amount of claims for eligible

individuals after which the Program will provide

payments to health insurance plans and the proportion

of such claims above such dollar amount that the

Program will pay,

d. establish the rate at which the Program will reimburse

a health insurance plan for claims incurred for an

enrolled individual's claims, above the attachment

point and below the reinsurance cap,

e. determine the threshold amount for claims costs

incurred by a health insurance plan for an enrolled

individual's claims, after which the claims costs for

Oklahoma Statutes - Title 36. Insurance Page 1296

benefits are no longer eligible for reinsurance

payments, and

f. determine the diagnosed health condition of an

eligible individual for which the Program will provide

payments to health insurance plans for claims incurred

after such diagnosis is made; and

5. Apply for, accept and receive federal funding for the

operation of the Program, including the following:

a. approval of a waiver provided by Section 1332 of the

Patient Protection and Affordable Care Act, "1332

State Innovation Waiver", authorizing federal funding

to support market stabilization program payments,

b. Oklahoma's participation in any federal grant program

or programs, or

c. any combination of the above approaches.

B. In the event Oklahoma is unable to secure federal approval

of a 1332 State Innovation Waiver or secure funding from federal

grant programs within two (2) years from the effective date of this

act, the Oklahoma Individual Health Insurance Market Stabilization

Program shall sunset, and any remaining monies shall be returned to

insurers on a pro rata basis based on the amount each insurer has

paid in assessments since the creation of the Program.

C. To the extent that federal funds become available under

federal law, regulation or executive action, the Board may:

1. Apply for the funds; and

2. Use the funds to establish and administer a reinsurance

program for the purposes of the Oklahoma Individual Health Insurance

Market Stabilization Act.

D. The Board shall not have the authority to assess insurers,

employers, policies or plans or any other entity to fund the

program. The Board may accept funding from other sources for the

purpose of the Oklahoma Individual Health Insurance Market

Stabilization Act.
Okla. Stat. tit. 36, § 36-7135 — OK Code / Title 36 / Section 36-7135
State Insurance Commissioner Revolving Fund
Status: in_force

Upon the effective date of this act, all monies received by the

State Banking Commissioner pursuant to the Cemetery Merchandise

Trust Act and all monies deposited in the Cemetery Merchandise Trust

Act Revolving Fund and any other monies as required by law shall be

transferred to the State Treasury and deposited into the State

Insurance Commissioner Revolving Fund provided for in Section 307.3

of Title 36 of the Oklahoma Statutes. Monies received after the

effective date of this act pursuant to the Cemetery Merchandise

Trust Act shall be deposited into the State Insurance Commissioner

Revolving Fund. Monies in the fund may be expended for expenses

incurred in administering and enforcing the Cemetery Merchandise

Trust Act and the Perpetual Care Fund Act.
Okla. Stat. tit. 36, § 36-5004 — OK Code / Title 36 / Section 36-5004
"Title insurance policy" and "aircraft title insurance
Status: in_force

policy" - Definitions.

A. A "title insurance policy" is any written instrument

purporting to show the title to real or personal property or any

interest therein or encumbrance thereon, or to furnish such

information relative to real property, which written instrument in

express terms purports to insure or guarantee such title or the

correctness of such information.

B. An “aircraft title insurance policy” is any written

instrument purporting to show title to aircraft or any interest

therein or encumbrance thereon, which written instrument in express

terms protects an aircraft owner or lender against loss of the

aircraft or priority security position in the event of a successful

adverse claim on the title to an aircraft.
Okla. Stat. tit. 36, § 36-712 — OK Code / Title 36 / Section 36-712
Posting of standard policies and endorsements
Status: in_force

Any insurance company offering property and casualty insurance

policies may, in lieu of mailing or delivering, post on their

website standard policies and endorsements that do not contain

personally identifiable information. If an insurer elects to

provide standard policy and endorsement forms on the insurer’s

Oklahoma Statutes - Title 36. Insurance Page 196

website, the insurer shall ensure that the policies and endorsements

are posted in a manner that complies with the following conditions:

1. The policy and endorsements shall be easily accessible;

2. The insurer shall archive all policies and endorsements for

a period of five (5) years after the expiration of the policy;

3. All policies and endorsements shall be posted in a manner

that allows an insured to print and save electronic copies of the

documents;

4. The insurer shall provide notice at the time of issuance of

the initial policy forms and upon renewal of a method by which the

insured may obtain, without charge, a paper or electronic copy of

the insured’s policy and endorsements;

5. Each declaration page issued to an insured shall clearly

identify the policy and endorsement forms purchased by the insured;

and

6. The insurer shall provide notice of any changes to the forms

or endorsements and of the insured’s right to obtain, without

charge, paper or electronic copies of the forms in the manner the

insurer customarily communicates with the insured.
Okla. Stat. tit. 36, § 36-6659 — OK Code / Title 36 / Section 36-6659
Examination and enforcement by Commissioner - Notice and
Status: in_force

hearing - Civil penalty.

A. The Insurance Commissioner may conduct examinations of

warrantors, administrators, or other persons to enforce the Vehicle

Protection Product Act and protect warranty holders in this state.

Upon request of the Commissioner, a warrantor shall make available

for the Commissioner all accounts, books, and records concerning

vehicle protection products sold by the warrantor that are necessary

to enable the Commissioner to reasonably determine compliance or

noncompliance with the Vehicle Protection Product Act. The

Oklahoma Statutes - Title 36. Insurance Page 1336

examination shall be conducted pursuant to Sections 309.1 through

309.7 of Title 36 of the Oklahoma Statutes.

B. The Commissioner may take action that is necessary or

appropriate to enforce the provisions of the Vehicle Protection

Product Act and the Commissioner’s rules and orders and to protect

warranty holders in this state. If a warrantor engages in a pattern

or practice of conduct that violates the Vehicle Protection Product

Act and that the Commissioner reasonably believes threatens to

render the warrantor insolvent or cause irreparable loss or injury

to the property or business of any person or company located in this

state, the Commissioner may:

1. Issue an order directed to that warrantor to cease and

desist from engaging in further acts, practices, or transactions

that are causing the conduct;

2. Issue an order prohibiting that warrantor from selling or

offering for sale vehicle protection products in violation of the

Vehicle Protection Product Act;

3. Issue an order imposing a civil penalty on that warrantor;

or

4. Issue any combination of the foregoing, as applicable.

C. Prior to the effective date of any order issued pursuant to

this section, the Commissioner must provide written notice of the

order to the warrantor and the opportunity for a hearing to be set

within ten (10) business days after receipt of the notice, except

prior notice and hearing shall not be required if the Commissioner

reasonably believes that the warrantor has become, or is about to

become, insolvent.

D. A person aggrieved by an order issued under this section may

request a hearing before the Commissioner. The hearing request

shall be filed with the Commissioner within twenty (20) days after

the date the Commissioner’s order is effective, and the Commissioner

must set such a hearing within fifteen (15) days after the receipt

of the hearing request.

E. At the hearing, the burden shall be on the Commissioner to

show why the order issued pursuant to this section is justified.

The provisions of the Administrative Procedures Act shall apply to a

hearing request under this section.

F. The Commissioner may bring an action in any court of

competent jurisdiction for an injunction or other appropriate relief

to enjoin threatened or existing violations of the Vehicle

Protection Product Act or of the Commissioner’s orders or rules. An

action filed under this section also may seek restitution on behalf

of persons aggrieved by a violation of the Vehicle Protection

Product Act or orders or rules of the Commissioner.

G. A person who is found to have violated provisions of the

Vehicle Protection Product Act or orders or rules of the

Commissioner may be ordered to pay to the Commissioner a civil

Oklahoma Statutes - Title 36. Insurance Page 1337

penalty in an amount, determined by the Commissioner, of not more

than Five Hundred Dollars ($500.00) per violation and not more than

Ten Thousand Dollars ($10,000.00) in the aggregate for all

violations of a similar nature. For purposes of this section,

violations shall be of a similar nature if the violation consists of

the same or similar course of conduct, action, or practice,

irrespective of the number of times the conduct, action, or practice

that is determined to be a violation of the Vehicle Protection

Product Act occurred.
Okla. Stat. tit. 36, § 36-3645 — OK Code / Title 36 / Section 36-3645
Requirement to be included in life, accident and health
Status: in_force

insurance policies.

A. No policy forms, unless exempt from the provisions of the

Life, Accident and Health Insurance Policy Language Simplification

Act, shall be delivered or issued for delivery in this state on or

after January 1, 1992, unless:

1. The text achieves a minimum score of forty on the Flesch

reading ease test, or an equivalent score on any other comparable

test which is recognized as a standard test for determining

readability and which is approved by the Commissioner pursuant to

subsection C of this section;

2. It is printed, except for specification pages, schedules,

and tables, in not less than ten-point type, one-point leaded;

3. The style, arrangement, and overall appearance of the policy

give no undue prominence to any portion of the text of the policy,

or to any endorsements or riders of the policy;

4. It contains a table of contents or an index of the principal

sections of the policy, if the policy has more than three thousand

words printed on three or fewer pages of text, or if the policy has

more than three pages regardless of the number of words.

Oklahoma Statutes - Title 36. Insurance Page 821

B. For the purposes of this section, a Flesch reading ease test

score shall be measured by the following method:

1. For policy forms containing ten thousand words or less of

text, the entire form shall be analyzed. For policy forms

containing more than ten thousand words, the readability of two-

hundred-word samples per page may be analyzed instead of the entire

form. The samples shall be separated by at least twenty printed

lines.

2. The number of words and sentences in the text shall be

counted and the total number of words divided by the total number of

sentences. The figure obtained shall be multiplied by a factor of

one and fifteen-thousandths.

3. The total number of syllables shall be counted and divided

by the total number of words. The figure obtained shall be

multiplied by a factor of eighty-four and six-tenths.

4. The sum of the figures computed pursuant to paragraphs 2 and

3 of this subsection subtracted from two hundred six and eight

hundred thirty-five-thousandths equals the Flesch reading ease score

for the policy form.

5. For purposes of paragraphs 2, 3 and 4 of this subsection,

the following procedures shall be used:

a. A contraction, hyphenated word, or numbers and

letters, when separated by spaces, shall be counted as one word.

b. A unit of words ending with a period, semicolon,

or colon, but excluding headings and captions, shall be counted as a

sentence.

c. A syllable means a unit of spoken language

consisting of one or more letters of a word as divided by an

accepted dictionary. Where the dictionary shows two or more equally

acceptable pronunciations of a word, the pronunciation containing

fewer syllables may be used.

6. As used in this section, "text" includes all printed

matter, except the following:

a. The name and address of the insurer, the name,

number, or title to the policy, the table of contents or index,

captions and subcaptions, specification pages, schedules, or tables;

b. Any policy language that is drafted to conform

to the requirements of any federal law, regulation, or agency

interpretation; any policy language required by a collectively

bargained agreement; any medical terminology; any words that are

defined in the policy; and any policy language required by state law

or regulation, if the insurer identifies the language or terminology

excepted by this paragraph and certifies, in writing, that the

language or terminology is drafted to conform with said

requirements.

Oklahoma Statutes - Title 36. Insurance Page 822

C. Any other reading test may be approved by the Commissioner

for use as an alternative to the Flesch reading ease test if it is

comparable in result to the Flesch reading ease test.

D. Every filing subject to this section shall be accompanied

by a certificate signed by an officer of the insurer stating that

the filing meets the minimum reading ease score on the test used, or

stating that the score is lower than the minimum required but should

be approved in accordance with Section 7 of this act. To confirm

the accuracy of any certification, the Commissioner may require the

submission of further information to verify the certification in

question.

E. At the option of the insurer, riders, endorsements,

applications, and other forms made a part of the policy may be

scored as separate forms or as part of the policy with which they

may be used.
Okla. Stat. tit. 36, § 36-1535 — OK Code / Title 36 / Section 36-1535
Definitions
Status: in_force

As used in this act:

1. "Commissioner" means the Insurance Commissioner of this

state;

2. "Corporate Governance Annual Disclosure (CGAD)" means a

confidential report filed by the insurer or insurance group made in

accordance with the requirements of this act;

3. "Insurance group" means those insurers and affiliates

included within an insurance holding company system as defined in

Section 1631 of Title 36 of the Oklahoma Statutes;

4. "Insurer" means the same as set forth in Section 103 of

Title 36 of the Oklahoma Statutes, except that it shall not include

agencies, authorities or instrumentalities of the United States, its

possessions and territories, the Commonwealth of Puerto Rico, the

District of Columbia, or a state or political subdivision of a

state; and

Oklahoma Statutes - Title 36. Insurance Page 424

5. "ORSA Summary Report" means the report filed in accordance

with Section 3305 of Title 36 of the Oklahoma Statutes.
Okla. Stat. tit. 36, § 36-1435.7 — OK Code / Title 36 / Section 36-1435.7
Applications for resident and business entity insurance
Status: in_force

producer licenses - Requirements for approval.

A. A person applying for a resident insurance producer license

shall make application to the Insurance Commissioner on the Uniform

Application or an application approved by the Commissioner and

declare under penalty of refusal, suspension or revocation of the

license that the statements made in the application are true,

correct and complete to the best of the individual's knowledge and

belief. Before approving the application, the Insurance

Commissioner shall find that the individual:

1. Is at least eighteen (18) years of age;

2. Has not committed any act that is a ground for denial,

suspension or revocation set forth in Section 1435.13 of this title;

3. Has paid the fees set forth in Section 1435.23 of this

title; and

4. Has successfully passed the examinations for the lines of

authority for which the person has applied.

B. A business entity acting as an insurance producer is

required to obtain an insurance producer license. Application shall

be made using the Uniform Business Entity Application or an

Oklahoma Statutes - Title 36. Insurance Page 338

application approved by the Commissioner. Before approving the

application, the Insurance Commissioner shall find that:

1. The business entity has paid the fees set forth in Section

1435.23 of this title;

2. The business entity has designated a licensed producer

responsible for the business entity's compliance with the insurance

laws, rules and regulations of this state;

3. A domestic business entity is organized pursuant to the

provisions of the laws of this state and maintains its principal

place of business in this state; and

4. No person whose license as an insurance producer has been

revoked by order of the Commissioner, nor any business entity in

which such person has a majority ownership interest, whether direct

or indirect, owns any interest in the business entity licensed as an

insurance producer.

C. An applicant for any license required by the provisions of

the Oklahoma Producer Licensing Act shall demonstrate to the

Insurance Commissioner that the applicant is competent, trustworthy,

financially responsible, and of good personal and business

reputation.

D. The Insurance Commissioner may require any documents

reasonably necessary to verify the information contained in an

application.
Okla. Stat. tit. 36, § 36-4513 — OK Code / Title 36 / Section 36-4513
Disclosure of patient insurance coverage and benefit
Status: in_force

information to medical service providers, health plans or health

plan sponsors.

A. All entities providing health insurance or health care

coverage to individuals residing within the state shall provide such

information on coverage and benefits as may be required by any

health care provider, health plan, health plan sponsor or their

agent regarding the coverage provided by the entity to any patient

or beneficiary of the medical service provider, health plan, or

health plan sponsor.

B. Any health care provider, health plan, health plan sponsor

or their agent is authorized to transmit the simple human

identifiers in ANSI X.12 270 inquiries including the name, gender,

Oklahoma Statutes - Title 36. Insurance Page 993

date of birth, and member number or policyholder identification

number if required by the health plan of a patient to any and all

entities licensed or registered to provide health insurance or

health care coverage to individuals residing within the state to

establish the coverage in force for a patient presenting or about to

present a claim.

C. Any party named in subsection A of this section shall have a

cause of action for injunctive relief and costs including, but not

limited to, attorney fees for the enforcement of this section

against any noncompliant health plan.
Okla. Stat. tit. 36, § 36-4506 — OK Code / Title 36 / Section 36-4506
Misrepresentation prohibited
Status: in_force

No insurance company, authorized to issue accident and health

contracts in this state, and no officer, director, agent, employee,

solicitor, or other representative thereof, or any other person,

shall make, issue, circulate or cause or permit to be made, issued

or circulated, any estimate, illustration, circular or statement of

any sort misrepresenting the terms, conditions or character of any

policy issued by it or the benefits or advantages promised thereby,

or shall use any name or title on any policy or class of policies

misrepresenting the true nature thereof.
Okla. Stat. tit. 36, § 36-6570.55 — OK Code / Title 36 / Section 36-6570.55
Prior authorization not required for emergency
Status: in_force

services.

A utilization review entity shall not require prior

authorization for prescription drugs administered as a part of the

provision of emergency health care services.
Okla. Stat. tit. 36, § 36-7402 — OK Code / Title 36 / Section 36-7402
Evaluation of effect of limits on opioid prescriptions
Status: in_force

and claims and out-of-pocket costs - Report.

The Insurance Department shall evaluate the effect of the limits

on prescriptions for opioid drugs established by this act on the

claims paid by health insurance carriers and the out-of-pocket costs

including copayments, coinsurance and deductibles paid by individual

and group health insurance policyholders. On or before January 1,

2021, the Insurance Department shall submit a report on the

evaluation, along with any recommended policy and regulatory options

that will ensure costs for patients are not increased as a result of

new prescribing limitations on the amounts of opioid drugs, to the

standing committees of the Legislature having jurisdiction over

health and human services matters and over insurance and financial

services matters. The Insurance Commissioner may adopt reasonable

rules and regulations for the implementation and administration of

the provisions of this subsection.
Okla. Stat. tit. 36, § 36-4001 — OK Code / Title 36 / Section 36-4001
Scope of article
Status: in_force

This article applies to contracts of life insurance and

annuities, other than reinsurance, group life insurance, group

annuities, and industrial life insurance; except that Section 2 of

this act (Return of policy within ten days), Section 3 of this act

(Interest on proceeds), and Sections 4015 (Excluded or restricted

coverage), 4024 (Limitation of liability), 4025 (Incontestability

after reinstatement), 4028 (Dual or multiple pay policies

prohibited) and 4029 (Nonforfeiture provisions) of this article

shall apply to industrial life insurance also.

Oklahoma Statutes - Title 36. Insurance Page 824
Okla. Stat. tit. 36, § 36-6570.8 — OK Code / Title 36 / Section 36-6570.8
Time frame in which prior authorization may not be
Status: in_force

altered — Contracted payment rate requirement and exceptions.

A. A health benefit plan may not revoke, limit, condition, or

restrict a prior authorization if care is provided within forty-five

(45) business days from the date the health care provider received

Oklahoma Statutes - Title 36. Insurance Page 1313

the prior authorization unless the enrollee was no longer eligible

for care on the day care was provided.

B. A health benefit plan must pay a contracted health care

provider at the contracted payment rate for a health care service

provided by the health care provider per a prior authorization,

unless:

1. The health care provider knowingly and materially

misrepresented the health care service in the prior authorization

request with the specific intent to deceive and obtain an unlawful

payment from a utilization review entity;

2. The health care service was no longer a covered benefit on

the day it was provided;

3. The health care provider was no longer contracted with the

patient's health benefit plan on the date the care was provided;

4. The health care provider failed to meet the utilization

review entity's timely filing requirements; or

5. The patient was no longer eligible for health care coverage

on the day the care was provided.
Okla. Stat. tit. 36, § 36-4214 — OK Code / Title 36 / Section 36-4214
Direct payment of premiums
Status: in_force

In the case of weekly premium policies, there may be a provision

that upon proper notice to the insurer, while premiums on the policy

are not in default beyond the grace period, of the intention to pay

future premiums directly to the insurer at its home office or any

office designated by the insurer for the purpose, the insurer will,

at the end of each period of a year from the due date of the first

premium so paid, for which period such premiums are so paid

continuously without default beyond the grace period, refund a

stated percentage of the premiums in an amount which fairly

represents the savings in collection expense.
Okla. Stat. tit. 36, § 36-1208 — OK Code / Title 36 / Section 36-1208
Judicial review of cease and desist orders
Status: in_force

A. Any person required by an order of the Insurance

Commissioner under Section 1207 of this title to cease and desist

from engaging in any unfair method of competition or any unfair or

deceptive act or practice defined in Section 1204 of this title may

Oklahoma Statutes - Title 36. Insurance Page 278

obtain a review of such order by filing in the district court of

Oklahoma County, or the county in which the order was served, within

thirty (30) days from the date of service of such order, a written

petition praying that the order of the Commissioner be set aside. A

copy of the petition shall be served upon the Commissioner, and

thereupon the Commissioner shall certify and file in such court a

transcript of the entire record in the proceeding, including all the

evidence taken and the report and order of the Commissioner. Upon

filing the petition and transcript, the court shall have

jurisdiction of the proceeding and of the question determined

therein, shall determine whether the filing of the petition shall

operate as a stay of the order of the Commissioner, and shall have

power to make and enter upon the pleadings, evidence, and

proceedings set forth in the transcript a decree modifying,

affirming or reversing the order of the Commissioner, in whole or in

part. The findings of the Commissioner as to the facts, if

supported by the evidence, shall be conclusive.

B. To the extent that the order of the Commissioner is

affirmed, the court shall thereupon issue its own order commanding

obedience to the terms of the order of the Commissioner. If either

party shall apply to the court for leave to adduce additional

evidence, and shall show to the satisfaction of the court that

additional evidence is material and that there were reasonable

grounds for the failure to adduce such evidence in the proceeding

before the Commissioner, the court may order additional evidence be

taken before the Commissioner, and to be adduced upon the hearing in

such manner and upon such terms and conditions as to the court may

seem proper. The Commissioner may modify findings of fact, or make

new findings by reason of the additional evidence so taken, and

shall file such modified or new findings which, if supported by the

evidence, shall be conclusive, and his recommendation, if any, for

the modification or setting aside of his original order, with the

return of such additional evidence. Appeal may be taken from the

district court as provided in other civil cases.

C. A cease and desist order issued by the Commissioner under

Section 1207 of this title shall become final:

1. Upon the expiration of the time allowed for filing a

petition for review if no such petition has been duly filed within

such time; except that the Commissioner may thereafter modify or set

aside an order to the extent provided in subsection B of Section

1207 of this title; or

2. Upon the final decision of the court if the court directs

that the order of the Commissioner be affirmed or the petition for

review dismissed.

D. No order of the Commissioner under this article or order of

a court to enforce the same shall in any way relieve or absolve any

Oklahoma Statutes - Title 36. Insurance Page 279

person affected by such order from any liability under any other

laws of this state.
Okla. Stat. tit. 36, § 36-992 — OK Code / Title 36 / Section 36-992
Insurers - Prohibited activity
Status: in_force

Insurers; Prohibited Activity.

A. No insurer shall:

1. Attempt to monopolize, or combine or conspire with any

person or persons to monopolize an insurance market;

2. Engage in a boycott, on a concerted basis, of an insurance

market; and

3. Except as set forth in subsection B of this section, agree

to mandate adherence to or to mandate use of any rate, prospective

loss cost, rating plan, rating schedule, rating rule, policy or bond

form, rate classification, rate territory, underwriting rule,

survey, inspection or similar material. Insurers and advisory

organizations may agree to develop and adhere to statistical plans

permitted by this title.

B. The fact that two or more insurers, whether or not members

or subscribers of an advisory organization, use consistently or

intermittently the same rates, prospective loss costs, rating plans,

rating schedules, rating rules, policy or bond forms, rate

classifications, rate territories, underwriting rules, surveys or

inspections or similar materials is not sufficient in itself to

support a finding that an agreement exists.

C. Two or more insurers having a common ownership or operating

in this state under common management or control may act in concert

between or among themselves with respect to any matters pertaining

to those activities authorized in the Property and Casualty

Competitive Loss Cost Rating Act as if they constituted a single

insurer.
Okla. Stat. tit. 36, § 36-1259 — OK Code / Title 36 / Section 36-1259
Renumbered as § 1250.12 of this title by Laws 1994, c
Status: in_force

342, § 20, eff. Sept. 1, 1994.
Okla. Stat. tit. 36, § 36-2622 — OK Code / Title 36 / Section 36-2622
Subsidiaries
Status: in_force

A corporation organized pursuant to Article 26 of the Insurance

Code, either by itself or in cooperation with one or more persons,

may organize or acquire one or more subsidiaries. Such subsidiaries

may conduct any type of business or businesses and their authority

to do so will not be limited by the fact that they are subsidiaries

of such corporation. Further, such subsidiaries may conduct

additional kinds of insurance as authorized by Section 2112 of

Article 21 of the Insurance Code.
Okla. Stat. tit. 36, § 36-6060.14 — OK Code / Title 36 / Section 36-6060.14
Short title
Status: in_force

This act shall be known and may be cited as the "Health Savings

Account Act".
Okla. Stat. tit. 36, § 36-6966.1 — OK Code / Title 36 / Section 36-6966.1
Violations – Penalties - Hearings
Status: in_force

A. The Insurance Commissioner may censure, suspend, revoke, or

refuse to issue or renew a license of or levy a civil penalty

against any person licensed under the insurance laws of this state

Oklahoma Statutes - Title 36. Insurance Page 1440

for any violation of the Patient’s Right to Pharmacy Choice Act,

Section 6958 et seq. of this title.

B. 1. If the Attorney General finds, after notice and

opportunity for hearing, that a pharmacy benefits manager (PBM)

violated one or more provisions of the Patient’s Right to Pharmacy

Choice Act, the Pharmacy Audit Integrity Act or the provisions of

Sections 357 through 360 of Title 59 of the Oklahoma Statutes, the

Attorney General may instruct the Insurance Commissioner that the

PBM be censured or his or her license be suspended or revoked. If

the Attorney General makes such instruction, the Commissioner shall

enforce such action within thirty (30) days.

2. In addition to or in lieu of any censure or suspension or

revocation of a license by the Commissioner, the Attorney General

may levy a civil or administrative fine not less than One Hundred

Dollars ($100.00) and not greater than Ten Thousand Dollars

($10,000.00) for each violation of the provisions of the Patient’s

Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act or

the provisions of Sections 357 through 360 of Title 59 of the

Oklahoma Statutes.

3. The Attorney General may order restitution for economic loss

suffered by pharmacies or patients for violations of the Patient’s

Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, or

the provisions of Sections 357 through 360 of Title 59 of the

Oklahoma Statutes.

C. Notwithstanding whether the license of a PBM has been

issued, suspended, revoked, surrendered or lapsed by operation of

law, the Attorney General is hereby authorized to enforce the

provisions of the Patient’s Right to Pharmacy Choice Act and impose

any penalty or remedy authorized under the act against a PBM under

investigation for or charged with a violation of the Patient’s Right

to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, the

provisions of Sections 357 through 360 of Title 59 of the Oklahoma

Statutes or any provision of the insurance laws of this state.

D. Each day that a PBM conducts business in this state without

a license from the Insurance Department shall be deemed a violation

of the Patient’s Right to Pharmacy Choice Act.

E. 1. All hearings conducted by the Office of the Attorney

General pursuant to this section shall be public and held in

accordance with the Administrative Procedures Act.

2. Hearings shall be held at the Office of the Attorney General

or any other place the Attorney General may deem convenient.

3. The Attorney General, upon written request from a PBM

affected by the hearing, shall cause a full stenographic record of

the proceedings to be made by a competent court reporter. This

record shall be at the expense of the PBM.

4. The ordinary fees and costs of the hearing examiner

appointed pursuant to Section 319 of this title may be assessed by

Oklahoma Statutes - Title 36. Insurance Page 1441

the hearing examiner against the respondent unless the respondent is

the prevailing party.

F. Any PBM whose license has been censured, suspended, revoked

or denied renewal or who has had a fine levied against him or her

shall have the right of appeal from the final order of the Attorney

General, pursuant to Section 318 et seq. of Title 75 of the Oklahoma

Statutes.

G. If the Attorney General determines, based upon an

investigation of complaints, that a PBM has engaged in violations of

the provisions of the Patient’s Right to Pharmacy Choice Act, the

Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title

59 of the Oklahoma Statutes with such frequency as to indicate a

general business practice, and that the PBM should be subjected to

closer supervision with respect to those practices, the Attorney

General may require the PBM to file a report at any periodic

interval the Attorney General deems necessary.

H. 1. The Attorney General shall have the authority to collect

all fines, penalties, restitution, and interest thereon pursuant to

the provisions of the Patient’s Right to Pharmacy Choice Act, the

Pharmacy Audit Integrity Act, and the provisions of Sections 357

through 360 of Title 59 of the Oklahoma Statutes, or any other

charge, cause of action, prelitigation settlement, or other

settlement that requires the recovery of money as a result of

violations of the Patient’s Right to Pharmacy Choice Act. Funds

collected by the Attorney General pursuant to the Patient’s Right to

Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections

357 through 360 of Title 59 of the Oklahoma Statutes shall be

deposited into the Attorney General’s Pharmacy Benefits Manager

Enforcement Revolving Fund created in Section 5 of this act.

2. Costs of investigation, litigation, attorney fees, and other

expenses incurred shall be retained by the Office of the Attorney

General. Remaining funds shall be distributed to pharmacists,

patients, or other injured parties as determined by the Attorney

General.

3. The Attorney General shall promulgate rules for the

distribution of funds pursuant to this subsection.

I. All claims processed by a PBM on behalf of a provider that

participates in 340B drug pricing or on behalf of a 340B entity

shall be deemed final at the point of adjudication.
Okla. Stat. tit. 36, § 36-6570.1 — OK Code / Title 36 / Section 36-6570.1
Definitions
Status: in_force

As used in this act:

1. "Adverse determination" means a determination by a health

carrier or its designee utilization review entity that an admission,

availability of care, continued stay, or other health care service

that is a covered benefit has been reviewed and, based upon the

information provided, does not meet the health carrier's

requirements for medical necessity, appropriateness, health care

setting, level of care, or effectiveness, and the requested service

or payment for the service is therefore denied, reduced, or

terminated as defined by Section 6475.3 of Title 36 of the Oklahoma

Statutes;

2. "Chronic condition" means a condition that lasts one (1)

year or more and requires ongoing medical attention or limits

activities of daily living or both;

Oklahoma Statutes - Title 36. Insurance Page 1307

3. "Clinical criteria" means the written policies, written

screening procedures, determination rules, determination abstracts,

clinical protocols, practice guidelines, medical protocols, and any

other criteria or rationale used by the utilization review entity to

determine the necessity and appropriateness of health care services;

4. "Emergency health care services", with respect to an

emergency medical condition as defined in 42 U.S.C.A., Section

300gg-111, means:

a. a medical screening examination, as required under

Section 1867 of the Social Security Act, 42 U.S.C.,

Section 1395dd, or as would be required under such

section if such section applied to an independent,

freestanding emergency department, that is within the

capability of the emergency department of a hospital

or of an independent, freestanding emergency

department, as applicable, including ancillary

services routinely available to the emergency

department to evaluate such emergency medical

condition, and

b. within the capabilities of the staff and facilities

available at the hospital or the independent,

freestanding emergency department, as applicable, such

further medical examination and treatment as are

required under Section 1395dd of the Social Security

Act, or as would be required under such section if

such section applied to an independent, freestanding

emergency department, to stabilize the patient,

regardless of the department of the hospital in which

such further examination or treatment is furnished, as

defined by 42 U.S.C.A., Section 300gg-111;

5. "Emergency Medical Treatment and Active Labor Act" or

"EMTALA" means Section 1867 of the Social Security Act and

associated regulations;

6. "Enrollee" means an individual who is enrolled in a health

care plan, including covered dependents, as defined by Section

6592.1 of Title 36 of the Oklahoma Statutes;

7. "Health care provider" means any person or other entity who

is licensed pursuant to the provisions of Title 59 or Title 63 of

the Oklahoma Statutes, or pursuant to the definition in Section 1-

1708.1C of Title 63 of the Oklahoma Statutes;

8. "Health care services" means any services provided by a

health care provider, or by an individual working for or under the

supervision of a health care provider, that relate to the diagnosis,

assessment, prevention, treatment, or care of any human illness,

disease, injury, or condition, as defined by paragraph 2 of Section

1-1708.1C of Title 63 of the Oklahoma Statutes.

Oklahoma Statutes - Title 36. Insurance Page 1308

The term also includes the provision of mental health and substance

use disorder services, as defined by Section 6060.10 of Title 36 of

the Oklahoma Statutes, and the provision of durable medical

equipment. The term does not include the provision, administration,

or prescription of pharmaceutical products or services;

9. "Licensed mental health professional" means:

a. a psychiatrist who is a diplomate of the American

Board of Psychiatry and Neurology,

b. a psychiatrist who is a diplomate of the American

Osteopathic Board of Neurology and Psychiatry,

c. a physician licensed pursuant to the Oklahoma

Allopathic Medical and Surgical Licensure and

Supervision Act or the Oklahoma Osteopathic Medicine

Act,

d. a clinical psychologist who is duly licensed to

practice by the State Board of Examiners of

Psychologists,

e. a professional counselor licensed pursuant to the

Licensed Professional Counselors Act,

f. a person licensed as a clinical social worker pursuant

to the provisions of the Social Worker's Licensing

Act,

g. a licensed marital and family therapist as defined in

the Marital and Family Therapist Licensure Act,

h. a licensed behavioral practitioner as defined in the

Licensed Behavioral Practitioner Act,

i. an advanced practice nurse as defined in the Oklahoma

Nursing Practice Act,

j. a physician assistant who is licensed in good standing

in this state, or

k. a licensed alcohol and drug counselor/mental health

(LADC/MH) as defined in the Licensed Alcohol and Drug

Counselors Act;

10. "Medically necessary" means services or supplies provided

by a health care provider that are:

a. appropriate for the symptoms and diagnosis or

treatment of the enrollee's condition, illness,

disease, or injury,

b. in accordance with standards of good medical practice,

c. not primarily for the convenience of the enrollee or

the enrollee's health care provider, and

d. the most appropriate supply or level of service that

can safely be provided to the enrollee as defined by

Section 6592 of Title 36 of the Oklahoma Statutes;

11. "Notice" means communication delivered either

electronically or through the United States Postal Service or common

carrier;

Oklahoma Statutes - Title 36. Insurance Page 1309

12. "Physician" means an allopathic or osteopathic physician

licensed by the State of Oklahoma or another state to practice

medicine;

13. "Prior authorization" means the process by which

utilization review entities determine the medical necessity and

medical appropriateness of otherwise covered health care services

prior to the rendering of such health care services. The term shall

include "authorization", "pre-certification", and any other term

that would be a reliable determination by a health benefit plan.

The term shall not be construed to include or refer to such

processes as they may pertain to pharmaceutical services;

14. "Urgent health care service" means a health care service

with respect to which the application of the time periods for making

an urgent care determination, which, in the opinion of a physician

with knowledge of the enrollee's medical condition:

a. could seriously jeopardize the life or health of the

enrollee or the ability of the enrollee to regain

maximum function, or

b. in the opinion of a physician with knowledge of the

claimant's medical condition, would subject the

enrollee to severe pain that cannot be adequately

managed without the care or treatment that is the

subject of the utilization review; and

15. "Utilization review entity" means an individual or entity

that performs prior authorization for a health benefit plan as

defined by Section 6060.4 of Title 36 of the Oklahoma Statutes, but

shall not include any health plan offered by a contracted entity

defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that

provides coverage to members of the state Medicaid program or other

insurance subject to the Long-Term Care Insurance Act.
Okla. Stat. tit. 36, § 36-1922 — OK Code / Title 36 / Section 36-1922
Power and authority of the receiver
Status: in_force

A. The receiver shall have the power:

1. To hold hearings, to subpoena witnesses for the purpose of

compelling their attendance, to administer oaths, to examine any

Oklahoma Statutes - Title 36. Insurance Page 543

person under oath, and to compel any persons to subscribe to their

testimony after it has been correctly reduced to writing; and in

connection therewith to require the production of any books, papers,

records, data or other documents, electronic or paper, that the

receiver deems relevant to the inquiry;

2. To audit the books and records of all agents of the insurer,

including, but not limited to, third-party administrators, and

affiliated and nonaffiliated management companies insofar as those

records relate to the business activities of the insurer;

3. To conduct litigation, including:

a. to continue to prosecute or defend, and to institute

in the name of the insurer or in the receiver's own

name, suits or other legal proceedings, in this state

or elsewhere,

b. to abandon the prosecution of claims the receiver

deems unprofitable to pursue further,

c. to collect all debts and monies due and claims

belonging to the insurer, wherever located, and in

furtherance of this purpose to institute action in

this or other jurisdictions in order to forestall

garnishment and attachment proceedings against those

debts, including the power to sell, compound,

compromise or assign debts for purposes of collection

upon such terms and conditions as the receiver deems

consistent with the purpose of the Uniform Insurers

Liquidation Act, and pursue any creditor's remedies

available to enforce the insurer's claims,

d. to assert all defenses available to the insurer as

against third persons, including statutes of

limitation, statutes of frauds and the defense of

usury. A waiver of any defense by the insurer after a

petition for supervision, conservation, receivership,

rehabilitation or liquidation has been filed shall not

bind the receiver. Whenever a guaranty association

has an obligation to defend any suit, the receiver

shall defer to that obligation and may defend only in

cooperation with the guaranty association or in the

absence of the guaranty association's defense,

e. to exercise and enforce all the rights, remedies and

powers of any creditor, shareholder, policyholder or

member, including any power to avoid any transfer,

transaction or lien that may be avoidable under the

Uniform Insurers Liquidation Act or otherwise, and

f. to intervene in any proceeding wherever instituted

that might lead to the appointment of a receiver or

trustee for the insurer or any of its property, and to

Oklahoma Statutes - Title 36. Insurance Page 544

act as the receiver or trustee whenever the

appointment is offered.

The receiver shall have exclusive standing in any action that

may exist to assert claims or defenses on behalf of the creditors,

members, policyholders or shareholders of the insurer or the public

against any person, except to the extent that a claim is personal to

a specific creditor, member, policyholder or shareholder and

recovery on the claim would not inure to the benefit of the estate.

If the receiver sells or dissolves the corporate entity or charter

of the insurer, the receiver shall have the power to apply to any

court in this state or elsewhere for leave to substitute the

receiver for the insurer as a party. This paragraph does not

infringe or impair any of the rights provided to a guaranty

association pursuant to its enabling statute or otherwise;

4. a. To conduct public or private sales of the insurer's

property, and thereby to acquire, hypothecate,

encumber, lease, sell, improve, transfer, abandon or

otherwise dispose of or deal with any property of the

insurer at its market value or upon such terms and

conditions as are fair and reasonable, and to settle

or resolve any claim or lawsuit brought by the

receiver on behalf of the insurer or pending when a

petition for supervision, conservation, receivership,

rehabilitation or liquidation is filed, or commute or

settle any claim of reinsurance under any contract of

reinsurance,

b. to transfer either proceeds of or rights to payment

under ceding reinsurance agreements covering policies

to a third-party transferee. A transfer of rights to

payment shall only be made with the consent of the

reinsurer and in conjunction with the transfer to such

person of all rights and obligations relating to the

transferred ceding reinsurance agreement and of all

property, including any guarantees or other credit

enhancement, securing any claims of each party under

each reinsurance agreement. The consent of a

reinsurer under this subparagraph shall not be

unreasonably withheld. If the receiver believes that

the consent of a reinsurer was unreasonably withheld,

the receiver may petition the receivership court to

order binding arbitration. The arbitration shall be

conducted in accordance with the arbitration

procedures in the reinsurance contract, or if no such

provisions exist, in accordance with the procedures of

the American Arbitration Association. A transferee

under this subparagraph shall have the rights to

collect and enforce collection of the reinsurance for

Oklahoma Statutes - Title 36. Insurance Page 545

the amount payable to the ceding insurer or to its

receiver, without diminution because of the insolvency

or because the receiver has failed to pay all or a

portion of the claim. The transfer of these rights

shall not give rise to any defense regarding the

reinsurer's obligations under the reinsurance

agreement regardless of whether the agreement or other

applicable law prohibits the transfer of rights under

the reinsurance agreement. Except as provided in this

subparagraph, any transfer of rights pursuant to this

provision shall not impair any rights or defenses of

the reinsurer that existed prior to the transfer or

would have existed in the absence of the transfer.

Except as otherwise provided in this subparagraph, any

transfer of rights pursuant to this provision shall

not relieve the transferee or the receiver from

obligations owed to the reinsurer pursuant to the

reinsurance or other agreement, and

c. to execute, acknowledge and deliver any deeds,

assignments, releases and other instruments necessary

or proper to effectuate any sale of property or other

transaction in connection with the liquidation or

rehabilitation and to file any necessary documents for

record in the office of any recorder of deeds or

record office in this state or elsewhere where

property of the insurer is located;

5. a. To use property of the estate to transfer policy

obligations to a solvent assuming insurer, if the

transfer can be arranged without prejudice to

applicable priorities under Section 1927.1 of this

title,

b. to use property of the estate to transfer the

insurer's obligations under surety bonds and surety

undertakings, and collateral held by the insurer with

respect to the reimbursement obligations of the

principals under those surety bonds and surety

undertakings, to a solvent assuming insurer, if the

transfer can be arranged without prejudice to

applicable priorities under Section 1927.1 of this

title; and if the receivership court so orders, the

estate shall have no further liability under the

transferred policies, surety bonds, or surety

undertakings after the transfer is made, and

c. upon the issuance of an order of liquidation and a

finding of insolvency, policies or portions of

policies of life, disability income, long-term care or

health insurance or annuities covered by one or more

Oklahoma Statutes - Title 36. Insurance Page 546

guaranty associations, under applicable law, shall

continue in force, subject to the terms of the policy,

including any terms restructured pursuant to a court-

approved rehabilitation plan, to the extent necessary

to permit the guaranty associations to discharge their

statutory obligations. Policies or portions of

policies of life, disability income, long-term care or

health insurance or annuities, not covered by one or

more guaranty associations, and other types of

policies, shall terminate by operation of law, except

to the extent the receiver proposes and the

receivership court approves the use of property of the

estate, consistent with subparagraphs a and b of this

paragraph, for the purpose of continuing the contracts

or coverage by transferring them to an assuming

reinsurer;

6. To borrow money on the security of the property of the

estate or without security and to execute and deliver all documents

necessary to that transaction for the purpose of facilitating the

liquidation or rehabilitation. Any such funds borrowed may be

repaid as an administrative expense and have priority over any other

claims in Class 1 under the priority of distribution in Section

1927.1 of this title;

7. To enter into contracts, and to assume or reject any

executory contract or unexpired lease to which the insurer is a

party; provided, however, if the receiver is bound by any provision

of any contract of or by the insurer which requires arbitration,

such arbitration shall be conducted in the State of Oklahoma;

notwithstanding the foregoing, or any other provision of this

chapter, no receiver shall have the power to reject, disavow or

repudiate any Federal Home Loan Bank security agreement, or any

pledge, security, collateral or guarantee agreement or any other

similar arrangement or credit enhancement relating to such Federal

Home Loan Bank security agreement;

8. To take possession of the records and property of the

insurer. Guaranty associations shall have reasonable access to the

records of the insurer necessary for them to carry out their

statutory obligations;

9. To deposit in one or more banks in this state sums required

for meeting current administration expenses and dividend

distributions;

10. To invest the assets of the estate;

11. To enter into agreements with any receivers or

commissioners of any other states; and

12. To exercise all powers now held or hereafter conferred upon

receivers by the applicable statutory and common law of this state

Oklahoma Statutes - Title 36. Insurance Page 547

not inconsistent with the provisions of the Uniform Insurers

Liquidation Act.

B. The receiver is vested with all the rights of the entity or

entities in receivership.

C. The enumeration, in this section, of the powers and

authority of the receiver shall not be construed as a limitation

upon the receiver, nor shall it exclude in any manner the right to

do other acts not specifically enumerated or otherwise provided for,

to the extent necessary or appropriate for the accomplishment of or

in aid of the purpose of liquidation or rehabilitation.

D. The receiver shall not be obligated to defend any action

against the insurer or insured. An insured not defended by a

guaranty association may provide his or her own defense, and include

the cost of the defense as part of any claim of the insured against

the estate, if the defense was an obligation of the insurer. The

right of the receiver to contest coverage on a particular claim

shall be deemed preserved without the necessity of an express

reservation of rights.
Okla. Stat. tit. 36, § 36-6475.2 — OK Code / Title 36 / Section 36-6475.2
Purpose
Status: in_force

The purpose of the Uniform Health Carrier External Review Act is

to provide uniform standards for the establishment and maintenance

of external review procedures to assure that covered persons have

the opportunity for an independent review of an adverse

determination or final adverse determination, as defined in this

act.
Okla. Stat. tit. 36, § 36-4004 — OK Code / Title 36 / Section 36-4004
Incontestability
Status: in_force

There shall be a provision that the policy (exclusive of

provisions relating to disability benefits or to additional benefits

in the event of death by accident or accidental means) shall be

incontestable, except for nonpayment of premiums, after it has been

in force during the lifetime of the insured for a period of two (2)

years from its date of issue.
Okla. Stat. tit. 36, § 36-6836 — OK Code / Title 36 / Section 36-6836
Privilege effective date
Status: in_force

The insurance compliance self-evaluative privilege created by

this act shall apply to all audits performed or commissioned after

the effective date of this act, whether or not the litigation or

administrative proceedings were pending on the effective date of

this act.
Okla. Stat. tit. 36, § 36-1613 — OK Code / Title 36 / Section 36-1613
Acceptances and bill of exchange
Status: in_force

An insurer may invest in bank and bankers' acceptances and other

bills of exchange of the kind and maturity made eligible pursuant to

law for purchase in the open market by federal reserve banks.
Okla. Stat. tit. 36, § 36-2418 — OK Code / Title 36 / Section 36-2418
Legal reserve life insurance company, conversion into;
Status: in_force

adoption of plan.

Any mutual benefit association may convert itself into a stock

legal reserve life insurance company under an amended charter. The

plan of conversion shall be adopted at any regular annual

policyholders' meeting of such association. Amended articles of

incorporation providing for such conversion shall be adopted at the

same meeting and shall be in the form as set out in either Section

2105, Article 21 of this Code and shall provide for a minimum

capital stock of One Hundred Thousand Dollars ($100,000.00) or in

the form of Section 2502, Article 25, of this Code, and shall

provide for a minimum capital stock of Fifty Thousand Dollars

($50,000.00); provided, however, such conversion may be accomplished

by paying up twenty per cent (20%) of the capital required by either

of such sections at the time of such reorganization and not less

than twenty per cent (20%) additional of the required amount each

year thereafter until the full amount has been paid in. In the

event the capital stock is not increased as herein provided the same

shall be deemed to be impaired and the Insurance Commissioner shall

proceed against the company as provided by law in such cases.
Okla. Stat. tit. 36, § 36-3639.1 — OK Code / Title 36 / Section 36-3639.1
Personal residential insurance - Cancellation,
Status: in_force

nonrenewal or increase in premium for filing first claim - Notice.

A. No insurer shall cancel, refuse to renew or increase the

premium of a homeowner's insurance policy or any other personal

residential insurance coverage, which has been in effect more than

forty-five (45) days, solely because the insured filed a first claim

against the policy. The provisions of this section shall not be

construed to prevent the cancellation, nonrenewal or increase in

premium of a homeowner's insurance policy for the following reasons:

1. Nonpayment of premium;

2. Discovery of fraud or material misrepresentation in the

procurement of the insurance or with respect to any claims submitted

thereunder;

3. Discovery of willful or reckless acts or omissions on the

part of the named insured which increase any hazard insured against;

4. A change in the risk which substantially increases any

hazard insured against after insurance coverage has been issued or

renewed;

5. Violation of any local fire, health, safety, building, or

construction regulation or ordinance with respect to any insured

property or the occupancy thereof which substantially increases any

hazard insured against;

6. A determination by the Insurance Commissioner that the

continuation of the policy would place the insurer in violation of

the insurance laws of this state; or

7. Conviction of the named insured of a crime having as one of

its necessary elements an act increasing any hazard insured against.

B. An insurer shall give to the named insured at the mailing

address shown on a homeowner's policy, a written renewal notice that

shall include new premium, new deductible, new limits or coverage at

least thirty (30) days prior to the expiration date of the policy.

If the insurer fails to provide such notice, the premium,

deductible, limits and coverage provided to the named insurer prior

to the change shall remain in effect until notice is given or until

the effective date of replacement coverage obtained by the named

insured, whichever occurs first. If notice is given by mail, the

notice shall be deemed to have been given on the day the notice is

mailed. If the insured elects not to renew, any earned premium for

the period of extension of the terminated policy shall be calculated

pro rata at the lower of the current or previous year's rate. If

Oklahoma Statutes - Title 36. Insurance Page 815

the insured accepts the renewal, the premium increase, if any, and

other changes shall be effective the day following the prior

policy's expiration or anniversary date.

C. In the event an insured cancels a homeowner's insurance

policy or any other personal residential insurance coverage, written

notice shall be provided by the insured to the insurer that provided

the coverage being canceled. The notice of cancellation shall

provide the date of the cancellation of the policy and the insurer

shall reimburse the insured for any premiums paid for coverage

beyond the date of cancellation of the policy.

D. An insurer canceling a policy under subsection C of this

section shall not be liable for claims arising after the date of

cancellation.
Okla. Stat. tit. 36, § 36-2020.2 — OK Code / Title 36 / Section 36-2020.2
High net worth insured claims - Obligation to pay -
Status: in_force

Procedures.

A. For purposes of this section, "high net worth insured" means

any insured whose net worth exceeds Fifty Million Dollars

($50,000,000.00) on December 31 of the year prior to the year in

which the insurer becomes an insolvent insurer; provided that the

net worth of an insured on that date shall be deemed to include the

aggregate net worth of the insured and all of its subsidiaries and

affiliates as calculated on a consolidated basis.

B. 1. The Oklahoma Property and Casualty Insurance Guaranty

Association shall not be obligated to pay any first-party claims by

a high net worth insured;

2. The Association shall have the right to recover from a high

net worth insured all amounts paid by the Association to or on

behalf of the insured, whether for indemnity, defense or otherwise;

and

3. The Association may also, at its sole discretion and without

assumption of any ongoing duty to do so, pay any cybersecurity

insurance obligations covered by a policy or endorsement of an

insolvent company on behalf of a high net worth insured as defined

in this section. In that case, the Association shall recover from

the high net worth insured under this section all amounts paid on

its behalf, all allocated claim adjusted expenses related to such

claims, the Association's attorney fees, and all court costs in any

action necessary to collect the full amount to the Association's

reimbursement under this section.

C. The Association shall not be obligated to pay any claim that

would otherwise be a covered claim that is an obligation to or on

behalf of a person who has a net worth greater than that allowed by

the insurance guaranty association law of the state of residence of

the claimant at the time specified by the applicable law of that

state, and which association has denied coverage to that claimant on

that basis.

D. The Association shall establish reasonable procedures for

requesting financial information from insureds on a confidential

basis for purposes of applying this section, provided that the

Oklahoma Statutes - Title 36. Insurance Page 589

financial information may be shared with any other association

similar to the association and the liquidator for the insolvent

insurer on the same confidential basis. Any request to an insured

seeking financial information shall advise the insured of the

consequences of failing to provide the financial information. If an

insured refuses to provide the requested financial information where

it is requested and available, the Association may, until the time

as the information is provided, provisionally deem the insured to be

a high net worth insured for the purpose of denying a claim under

subsection B of this section.

E. In any lawsuit contesting the applicability of this section

where the insured has refused to provide financial information under

the procedure established pursuant to subsection D of this section,

the insured shall bear the burden of proof concerning its net worth

at the relevant time. If the insured fails to prove that its net

worth at the relevant time was less than the applicable amount, the

court shall award the association its full costs, expenses and

reasonable attorney fees in contesting the claim.
Okla. Stat. tit. 36, § 36-633 — OK Code / Title 36 / Section 36-633
MEWA defined - Information relating to administrative
Status: in_force

services contracts.

A. As used in this act, the term "Multiple Employer Welfare

Arrangement" or "MEWA" means that term as defined in Section 3 of

the Employee Retirement Income Security Act of 1974, 29 U.S.C.,

Section 1002(40)(A), as amended, that meets either or both of the

following criteria:

1. One or more of the employer members of the MEWA is either

domiciled in this state or has its principal place of business or

principal administrative office in this state; or

2. The MEWA solicits an employer that is domiciled in this

state or that has its principal place of business or principal

administrative office in this state.

B. Each insurer licensed to do business in this state,

including any corporation organized under the provisions of Article

26 of Title 36 of the Oklahoma Statutes, that administers a MEWA

shall provide the Insurance Commissioner with such information

regarding the insurer's administrative services contract or

contracts with such MEWA or MEWAs that the Commissioner may

reasonably require.

C. A MEWA shall be administered only by a licensed insurer or a

licensed third party administrator.
Okla. Stat. tit. 36, § 36-4030.11 — OK Code / Title 36 / Section 36-4030.11
Calculation of certain benefits under contracts with
Status: in_force

fixed scheduled considerations.

Any paid-up annuity, cash surrender or death benefits available

at any time, other than on the contract anniversary under any

contract with fixed scheduled considerations, shall be calculated

with allowance for the lapse of time and the payment of any

scheduled considerations beyond the beginning of the contract year

in which cessation of payment of considerations under the contract

occurs.
Okla. Stat. tit. 36, § 36-2132 — OK Code / Title 36 / Section 36-2132
Reinsurance, stock insurers
Status: in_force

A. A domestic stock insurer may accept reinsurance for the same

kind of insurance and within the same limits as it is authorized to

transact direct, unless such reinsurance is prohibited by its

articles of incorporation.

Oklahoma Statutes - Title 36. Insurance Page 654

B. A domestic stock insurer may reinsure all or substantially

all its business in force, or substantially all of a major class

thereof, with another insurer by an agreement of bulk reinsurance;

but no such agreement shall become effective unless filed with and

approved in writing by the Commissioner.

C. The Commissioner shall approve such agreement within a

reasonable time after such filing unless the Commissioner finds that

the agreement would substantially reduce the protection or service

to the policyholders of the insurer. If the Commissioner does not

approve the agreement, he shall so notify the insurer in writing

specifying his reasons therefor.
Okla. Stat. tit. 36, § 36-6060.21 — OK Code / Title 36 / Section 36-6060.21
Screening, diagnosis and treatment of autism spectrum
Status: in_force

disorder.

A. For all plans issued or renewed on or after November 1,

2016, a health benefit plan and the Oklahoma Employees Health

Insurance Plan shall provide coverage for the screening, diagnosis

and treatment of autism spectrum disorder in individuals. No

insurer shall terminate coverage, or refuse to deliver, execute,

issue, amend, adjust or renew coverage to an individual solely

because the individual is diagnosed with or has received treatment

for an autism spectrum disorder.

B. Coverage under this section shall be subject to the

provisions set forth in Section 6060.11 of this title; provided,

however, that coverage shall not be subject to any limits on the

number of visits an individual may make for treatment of autism

spectrum disorder.

C. Coverage under this section shall not be subject to dollar

limits, deductibles or coinsurance provisions that are less

favorable to an insured than the dollar limits, deductibles or

Oklahoma Statutes - Title 36. Insurance Page 1116

coinsurance provisions that apply to substantially all medical and

surgical benefits under the health benefit plan.

D. This section shall not be construed as limiting benefits

that are otherwise available to an individual under a health benefit

plan.

E. Coverage for applied behavior analysis shall include the

services provided or supervised by a board-certified behavior

analyst, a board-certified assistant behavior analyst or a licensed

doctoral-level psychologist.

F. Except for inpatient services, if an insured is receiving

treatment for an autism spectrum disorder, an insurer shall have the

right to review the treatment plan annually, unless the insurer and

the insured's treating physician or psychologist agree that a more

frequent review is necessary. Any such agreement regarding the

right to review a treatment plan more frequently shall apply only to

a particular insured being treated for an autism spectrum disorder

and shall not apply to all individuals being treated for autism

spectrum disorder by a physician or psychologist. The cost of

obtaining any review or treatment plan shall be borne by the

insurer.

G. This section shall not be construed as affecting any

obligation to provide services to an individual under an

individualized family service plan, an individualized education

program or an individualized service plan.

H. As used in this section:

1. "Applied behavior analysis" means the design, implementation

and evaluation of environmental modifications, using behavioral

stimuli and consequences, to produce socially significant

improvement in human behavior including the use of direct

observation, measurement and functional analysis of the relationship

between environment and behavior;

2. "Autism spectrum disorder" means any of the pervasive

developmental disorders or autism spectrum disorders as defined by

the most recent edition of the Diagnostic and Statistical Manual of

Mental Disorders (DSM) or the edition that was in effect at the time

of diagnosis;

3. "Behavioral health treatment" means counseling and treatment

programs including applied behavior analysis, that are:

a. necessary to develop, maintain or restore, to the

maximum extent practicable, the functioning of an

individual, and

b. provided or supervised by a board-certified behavior

analyst, a board-certified assistant behavior analyst

or by a licensed doctoral-level psychologist so long

as the services performed are commensurate with the

psychologist's university training and experience;

Oklahoma Statutes - Title 36. Insurance Page 1117

4. "Diagnosis of autism spectrum disorder" means medically

necessary assessment, evaluations or tests to diagnose whether an

individual has an autism spectrum disorder;

5. "Health benefit plan" means any plan or arrangement as

defined in subsection C of Section 6060.4 of Title 36 of the

Oklahoma Statutes;

6. "Oklahoma Employees Health Insurance Plan" means "Health

Insurance Plan" as defined in Section 1303 of Title 74 of the

Oklahoma Statutes;

7. "Pharmacy care" means medications prescribed by a licensed

physician and any health-related services deemed medically necessary

to determine the need or effectiveness of the medications;

8. "Psychiatric care" means direct or consultative services

provided by a psychiatrist licensed in the state in which the

psychiatrist practices;

9. "Psychological care" means direct or consultative services

provided by a psychologist licensed in the state in which the

psychologist practices;

10. "Therapeutic care" means services provided by licensed or

certified speech therapists, occupational therapists or physical

therapists; and

11. "Treatment for autism spectrum disorder" means evidence-

based care and related equipment prescribed or ordered for an

individual diagnosed with an autism spectrum disorder by a licensed

physician or a licensed doctoral-level psychologist who determines

the care to be medically necessary including, but not limited to:

a. behavioral health treatment,

b. pharmacy care,

c. psychiatric care,

d. psychological care, and

e. therapeutic care.
Okla. Stat. tit. 36, § 36-6570.7 — OK Code / Title 36 / Section 36-6570.7
Services not requiring prior authorization — Time frame
Status: in_force

to notify utilization review entity of such services.

A. A utilization review entity shall not require prior

authorization for pre-hospital transportation, for the provision of

emergency health care services, or for transfers between facilities

as required by the Emergency Medical Treatment and Active Labor Act.

B. A utilization review entity shall allow an enrollee and the

enrollee's health care provider a minimum of twenty-four (24) hours

following an emergency admission or provision of emergency health

care services for the enrollee or health care provider to notify the

utilization review entity of the admission or provision of health

care services. If the admission or health care service occurs on a

holiday or weekend, a utilization review entity cannot require

notification until the next business day after the admission or

provision of the health care services.

C. A utilization review entity shall cover emergency health

care services in accordance with the requirements of Section 6907 of

Title 36 of the Oklahoma Statutes.
Okla. Stat. tit. 36, § 36-999.7 — OK Code / Title 36 / Section 36-999.7
Right of subrogation
Status: in_force

All insurers issuing mine subsidence policies shall retain the

right of subrogation.
Okla. Stat. tit. 36, § 36-304 — OK Code / Title 36 / Section 36-304
Funds to be deposited weekly - Collection by
Status: in_force

nongovernmental entities.

A. The Insurance Commissioner shall deposit weekly with the

State Treasurer all funds in the Commissioner’s hands collected for

the use of the state.

B. The Insurance Commissioner may contract with nongovernmental

entities to collect fees and taxes on behalf of the Insurance

Department.
Okla. Stat. tit. 36, § 36-1250.2 — OK Code / Title 36 / Section 36-1250.2
Definitions
Status: in_force

As used in the Unfair Claims Settlement Practices Act:

1. "Agent" means any individual, corporation, association,

partnership, or other legal entity authorized to represent an

insurer with respect to a claim;

2. "Claimant" means either a first party claimant, a third

party claimant, or both, and includes such claimant's designated

legal representatives and includes a member of the claimant's

immediate family designated by the claimant;

3. "Commissioner" means the Insurance Commissioner;

4. "First-party claimant" means an individual, corporation,

association, partnership, or other legal entity, including a

subscriber under any plan providing health services, asserting a

right to payment pursuant to an insurance policy or insurance

contract for an occurrence of contingency or loss covered by such

policy or contract;

5. "Health benefit plan" means group hospital or medical

insurance coverage, a not-for-profit hospital or medical service or

indemnity plan, a prepaid health plan, a health maintenance

organization plan, a preferred provider organization plan, the State

and Education Employees Group Health Insurance Plan, and coverage

provided by a Multiple Employer Welfare Arrangement (MEWA) or

employee self-insured plan except as exempt under federal ERISA

provisions. The term shall not include short-term accident, fixed

indemnity, or specified disease policies, disability income

contracts, limited benefit or credit disability insurance, workers'

compensation insurance coverage, automobile medical payment

insurance, or insurance under which benefits are payable with or

without regard to fault and which is required by law to be contained

in any liability insurance policy or equivalent self-insurance;

6. "Insurance policy or insurance contract" means any contract

of insurance, certificate, indemnity, medical or hospital service,

suretyship, annuity, subscriber certificate or any evidence of

coverage of a health maintenance organization issued, proposed for

issuance, or intended for issuance by any entity subject to this

Code;

7. "Insurer" means a person licensed by the Commissioner to

issue or who issues any insurance policy or insurance contract in

this state and also includes health maintenance organizations.

Provided that, for the purposes of paragraphs 15 and 16 of Section

1250.5 of this title, "insurer" shall include the State and

Education Employees Group Insurance Board;

Oklahoma Statutes - Title 36. Insurance Page 306

8. "Investigation" means all activities of an insurer directly

or indirectly related to the determination of liabilities under

coverages afforded by an insurance policy or insurance contract;

9. "Notification of claim" means any notification, whether in

writing or other means acceptable under the terms of an insurance

policy or insurance contract, to an insurer or its agent, by a

claimant, which reasonably apprises the insurer of the facts

pertinent to a claim;

10. "Preauthorization/precertification" means a determination

by a health benefit plan, based on the information presented at the

time by the health care provider, that health care services proposed

by the health care provider are medically necessary. The term shall

include "authorization", "certification" and any other term that

would be a reliable determination by a health benefit plan. A

preauthorization/precertification from a previous health plan shall

not bind a succeeding health benefit plan;

11. "Third-party claimant" means any individual, corporation,

association, partnership, or other legal entity asserting a claim

against any individual, corporation, association, partnership, or

other legal entity insured under an insurance policy or insurance

contract; and

12. "Verification of eligibility" means a representation by a

health benefit plan to a health care provider that a claimant is

entitled to covered benefits under the policy. Such verification of

eligibility shall be valid for four (4) business days from the date

given by the health benefit plan.
Okla. Stat. tit. 36, § 36-2730.1 — OK Code / Title 36 / Section 36-2730.1
Injunction, liquidation or receivership of domestic
Status: in_force

society.

A. When the Insurance Commissioner upon investigation finds

that a domestic society:

1. Has exceeded its powers;

2. Has failed to comply with any provision of this article;

3. Is not fulfilling its contracts in good faith;

4. Has a membership of less than four hundred after an

existence of one (1) year or more; or

5. Is conducting business fraudulently or in a manner hazardous

to its members, creditors, the public or the business;

the Commissioner shall notify the society of such deficiency or

deficiencies and state in writing the reasons for his or her

Oklahoma Statutes - Title 36. Insurance Page 731

dissatisfaction. The Commissioner shall at once issue a written

notice to the society requiring that the deficiency or deficiencies

be corrected. After such notice, the society shall have a thirty-

day period in which to comply with the Commissioner's request for

correction. If the society fails to comply with such request, the

Commissioner shall notify the society of such findings of

noncompliance and require the society to show cause on a date named

why it should not be enjoined from carrying on any business until

the violation complained of shall have been corrected, or why an

action in the nature of quo warranto should not be commenced against

the society.

B. If on such date the society does not present good and

sufficient reasons why it should not be so enjoined or why such

action should not be commenced, the Commissioner may present the

facts relating thereto to the Attorney General who shall, if he or

she deems the circumstances warrant, commence an action to enjoin

the society from transacting business or an action in the nature of

quo warranto.

C. The court shall thereupon notify the officers of the society

of a hearing. If, after a full hearing, it appears that the society

should be so enjoined or liquidated or a receiver appointed, the

court shall enter the necessary order. No society so enjoined shall

have the authority to do business until:

1. The Commissioner finds that the violation complained of has

been corrected;

2. The costs of such action shall have been paid by the society

if the court finds that the society was in default as charged;

3. The court has dissolved its injunction; and

4. The Commissioner has reinstated the certificate of

authority.

D. If the court orders the society liquidated, it shall be

enjoined from carrying on any further business, whereupon the

receiver of the society shall proceed at once to take possession of

the books, papers, money and other assets of the society and, under

the direction of the court, proceed forthwith to close the affairs

of the society and to distribute its funds to those entitled.

E. No action under this section shall be recognized in any

court of this state unless brought by the Attorney General upon

request of the Commissioner. Whenever a receiver is to be appointed

for a domestic society, the court shall appoint the Commissioner as

the receiver.

F. The provisions of this section relating to hearing by the

Commissioner, action by the Attorney General at the request of the

Commissioner, hearing by the court, injunction and receivership

shall be applicable to a society which shall voluntarily determine

to discontinue business.
Okla. Stat. tit. 36, § 36-6123 — OK Code / Title 36 / Section 36-6123
Administration of act - Contracts
Status: in_force

Sections 6121 through 6136.18 of this title shall be

administered by the Insurance Commissioner. The Insurance

Commissioner is authorized to prescribe reasonable rules and

regulations concerning keeping and inspection of records, the filing

of contracts and reports, and all other matters incidental to the

orderly administration of this law; and the Insurance Commissioner

shall first approve all forms for sale contracts for prepaid funeral

benefits. All contracts for prepaid funeral benefits shall be in

writing and no contract form shall be used without first being

approved by the Insurance Commissioner. On any prepaid funeral when

the person dies and the funeral is performed, and the money is drawn

down, any organization receiving the monies so drawn down shall

retain the itemized statement of charges in the files of the

organization for at least six (6) years.
Okla. Stat. tit. 36, § 36-4022 — OK Code / Title 36 / Section 36-4022
Reinstatement of annuities
Status: in_force

In an annuity or pure endowment contract, other than a

reversionary, survivorship, or group annuity, there shall be a

provision that the contract may be reinstated at any time within one

(1) year from the default in making stipulated payments to the

insurer, unless the cash surrender value has been paid, but all

overdue stipulated payments and any indebtedness to the insurer on

the contract shall be paid or reinstated with interest thereon at a

rate to be specified in the contract but not exceeding six percent

(6%) per annum payable annually, and in cases where applicable the

insurer may also include a requirement of evidence of insurability

satisfactory to the insurer.
Okla. Stat. tit. 36, § 36-406 — OK Code / Title 36 / Section 36-406
Rules
Status: in_force

The Insurance Commissioner may promulgate rules necessary to

carry out the provisions of the Crimes By or Affecting Persons

Engaged in the Business of Insurance Act.
Okla. Stat. tit. 36, § 36-1925 — OK Code / Title 36 / Section 36-1925
Rights and liabilities fixed as of date liquidation order
Status: in_force

filed.

The rights and liabilities of the insurer and of its creditors,

policyholders, stockholders, members, subscribers, and all other

persons interested in its estate shall, unless otherwise directed by

the court, be fixed as of the date on which the order directing the

liquidation of the insurer is filed in the office of the clerk of

the court which made the order, subject to the provisions of this

article with respect to the rights of claimants holding contingent

claims.
Okla. Stat. tit. 36, § 36-1688 — OK Code / Title 36 / Section 36-1688
Fees – Reimbursement - Costs
Status: in_force

A. At the time of filing its application with the Insurance

Commissioner for review and approval of an Insurance Business

Transfer Plan, the applicant shall pay a nonrefundable fee to the

Insurance Department in the amount of Ten Thousand Dollars

($10,000.00).

B. In the Commissioner's discretion, in connection with the

Department's participation in the proceedings undertaken pursuant to

the Insurance Business Transfer Act, the applicant shall reimburse

the Department for any compensation and benefits paid to the

personnel of the Department for time spent engaged in the

proceedings, including but not limited to examiners, actuaries,

attorneys, managers and paraprofessionals.

C. The Commissioner may retain independent attorneys,

appraisers, actuaries, certified public accountants, or other

professionals and specialists to assist Department personnel in

connection with the review required by the Insurance Business

Transfer Act, the cost of which shall be borne by the applicant.

D. The applicant shall pay the expenses of the Department and

its authorized consultants incurred in fulfilling their obligations

under this act, including the actual expenses of the Department or

the expenses and compensation of any consultants retained by the

Department.

E. The transferring insurer and the assuming insurer shall

jointly be obligated to pay any compensation, costs and expenses of

the independent expert and any consultants retained by the

independent expert and approved by the Department incurred in

fulfilling the obligations of the independent expert under this act.

Oklahoma Statutes - Title 36. Insurance Page 512

Nothing in this act shall be construed to create any duty for the

independent expert to any party other than the Department or the

Court.

F. Failure to pay any of the requisite fees or reimbursements

within thirty (30) days of demand shall be grounds for the

Commissioner to request that the court dismiss the petition for

approval of the Insurance Business Transfer Plan prior to the filing

of an implementation order by the court or, if after the filing of

an implementation order, the Commissioner may suspend or revoke the

assuming insurer's certificate of authority to transact insurance

business in this state.