reglab/housing_qa huggingface dataset:
36 OK Stat § 36-6833 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6833. Burden of proof.

|A. A company asserting the insurance compliance self-evaluative privilege set forth in Section 1 of this act has the burden of demonstrating the applicability of the privilege. Once a company has established the applicability of the privilege, the party seeking disclosure under this act has the burden of proving that the privilege is asserted in bad faith or for a fraudulent or any other similar improper purpose. The Insurance Commissioner, district attorney, or Attorney General seeking disclosure under this act has the burden of proving the elements set forth in subsection B or C of Section 2 of this act. |B. The parties may at any time stipulate in proceedings under Section 2 or 3 of this act to entry of an order directing that specific information contained in an insurance compliance self-evaluative audit document is or is not subject to the privilege provided under Section 1 of this act. Any such stipulation may be limited to the instant proceeding and, absent specific language to the contrary, shall not be applicable to any other proceeding.Added by Laws 2012, c. 257, § 4, eff. Nov. 1, 2012.
36 OK Stat § 36-6834 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6834. Non-privileged information.

|The privilege set forth in Section 1 of this act shall not extend to any of the following: |1. Documents, communications, data, reports, or other information expressly required to be collected, developed, maintained, or reported to a regulatory agency pursuant to this act, or other federal or state law;2. Information obtained by observation, monitoring or examination by any regulatory agency;3. Information contained from a source independent of the insurance compliance audit; or4. Documents and other material created or maintained in the ordinary course of the insurer’s business, specifically including communications between the insurer and insureds, individual claim files and any other similar documents which are currently discoverable under existing law.Added by Laws 2012, c. 257, § 5, eff. Nov. 1, 2012.
36 OK Stat § 36-6835 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6835. Definitions.

|As used in this act: |1. "Insurance compliance audit" means a voluntary internal evaluation, review, assessment, audit, or investigation for the purpose of identifying or preventing noncompliance with, or promoting compliance with, laws, regulations, orders, or industry or professional standards, which is conducted by or on behalf of a company licensed or regulated under the Oklahoma Insurance Code, or which involves an activity regulated under this Code. Once initiated, an audit shall be completed within a reasonable period of time. Nothing in this section shall be construed to authorize uninterrupted or continuous auditing; and2. "Insurance compliance self-evaluative audit document" means documents prepared as a result of or in connection with an insurance compliance audit. An insurance compliance self-evaluative audit document may include, but is not limited to, as applicable, field notes and records of observations, findings, opinions, suggestions, conclusions, drafts, memoranda, drawings, photographs, exhibits, computer-generated or electronically recorded information, phone records, maps, charts, graphs, and surveys; provided, this supporting information is collected or developed for the primary purpose and in the course of an insurance compliance audit. An insurance compliance self-evaluative audit document also includes, but is not limited to, any of the following:a.an insurance compliance audit report prepared by an auditor, who may be an employee of the company or an independent contractor, which may include the scope of the audit, the information gained in the audit, and conclusions and recommendations, with exhibits and appendices,b.memoranda and documents analyzing portions or all of the insurance compliance audit report and discussing potential implementation issues,c.an implementation plan that addresses correcting past noncompliance, improving current compliance, and preventing future noncompliance, ord.analytic data generated in the course of conducting the insurance compliance audit.Documents, communications, data, reports or other information which are created as a result of a claim involving personal injury, property damage or workers’ compensation made against an insurance policy are not insurance compliance self-evaluative audit documents and are admissible as evidence in civil, criminal or administrative proceedings as otherwise provided by applicable rules of evidence or civil procedure, subject to any applicable statutory or common-law privilege.Added by Laws 2012, c. 257, § 6, eff. Nov. 1, 2012.
36 OK Stat § 36-6836 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6836. Privilege effective date.

|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. |Added by Laws 2012, c. 257, § 7, eff. Nov. 1, 2012.
36 OK Stat § 36-6837 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6837. Effect upon statutory or common law privileges.

|Nothing in this act nor the release of any self-evaluative audit document hereunder shall limit, waive, or abrogate the scope or nature of any statutory or common law privilege including, but not limited to, the work product doctrine, the attorney-client privilege, or the subsequent remedial measures exclusion. |Added by Laws 2012, c. 257, § 8, eff. Nov. 1, 2012.
36 OK Stat § 36-6850.1 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6850.1. Notification of deletions in prescription coverage.

|Any health benefit plan that provides prescription drug coverage or contracts with a third party for prescription drug services shall notify an enrollee presently taking a prescription drug of any deletions, other than generic substitutions, in the health benefit plan's prescription drug formulary. Such notification shall be made in writing, or electronically upon request of the enrollee, at least sixty (60) days prior. |This section does not apply to coverage for a drug that is determined by a therapeutics committee of the health benefit plan to be subject to new safety warnings or a safety recall by the Federal Drug Administration.As used in this section, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes.Added by Laws 2013, c. 247, § 1, eff. Nov. 1, 2013.
36 OK Stat § 36-6901 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6901. Short title.

|This act shall be known and may be cited as the "Health Maintenance Organization Act of 2003". |Added by Laws 2003, c. 197, § 1, eff. Nov. 1, 2003.
36 OK Stat § 36-6903.1 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6903.1. Exemption of certain domestic health maintenance organizations from certain provisions of act.

|Domestic health maintenance organizations that contract with the Oklahoma Health Care Authority to provide basic health services to Medicaid recipients and that do not provide basic health care services to any other group of persons shall be exempt from the provisions of Sections 6911, 6914, 6915 and 6932 of this title. |Added by Laws 2004, c. 146, § 1, eff. Nov. 1, 2004; Amended by Laws 2017, c. 287, § 6, eff. Nov. 1, 2017.
36 OK Stat § 36-6904 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6904. Certification by Insurance Commissioner - Issuance of certificate.

|A. Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall within forty-five (45) days determine whether the applicant, with respect to health care services to be furnished, has complied with the provisions of Section 6907 of this title. |B. The Insurance Commissioner shall, within forty-five (45) days of determining compliance or deficiency, issue a certificate of authority to a person filing a completed application upon receipt of the prescribed fees and upon the Insurance Commissioner's being satisfied that:1. The persons responsible for the conduct of the affairs of the applicant are competent and trustworthy, and possess good reputations;2. Any deficiency identified has been corrected and the Insurance Commissioner has determined that the health maintenance organization's proposed plan of operation meets the requirements of Section 6907 of this title;3. The health maintenance organization will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments or deductibles, or both; and4. The health maintenance organization is in compliance with the provisions of Sections 6913 and 6915 of this title.C. A certificate of authority shall be denied only after the Insurance Commissioner complies with the requirements of Section 6920 of this act title. No other criteria may be used to deny a certificate of authority.Added by Laws 2003, c. 197, § 4, eff. Nov. 1, 2003. Amended by Laws 2021, c. 478, § 36, emerg. eff. May 12, 2021.
36 OK Stat § 36-6905 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6905. Powers of health maintenance organization - Notice of effect on financial soundness.

|A. The powers of a health maintenance organization (HMO) include, but are not limited to, the following: |1. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment and property reasonably required for its principal office or for purposes necessary to the transaction of the business of the organization;2. Transactions between affiliated entities, including loans and the transfer of responsibility under all provider or subscriber contracts between affiliates or between the health maintenance organization and its parent;3. The furnishing of health care services through providers, provider associations or agents for providers which are under contract with or employed by the health maintenance organization;4. The contracting with a person for the performance on its behalf of certain functions such as marketing, enrollment and administration;5. The contracting with an insurance company licensed in this state, or with a hospital or medical service corporation authorized to do business in this state, for the provision of insurance, indemnity or reimbursement against the cost of health care services provided by the health maintenance organization;6. The offering of other health care services in addition to basic health care services. Nonbasic health care services may be offered by a health maintenance organization on a prepaid basis without offering basic health care services to any group or individual; and7. The joint marketing of products with an insurance company licensed in this state or with a hospital or medical service corporation authorized to do business in this state as long as the company that is offering each product is clearly identified.B. 1. A health maintenance organization shall file notice, with adequate supporting information, with the Insurance Commissioner prior to the exercise of any power granted in paragraphs 1, 2 or 4 of subsection A of this section that may affect the financial soundness of the health maintenance organization. The Insurance Commissioner shall disapprove the exercise of power only if, in the Insurance Commissioner’s opinion, it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the Insurance Commissioner does not disapprove such exercise of power within sixty (60) days of the filing, it shall be deemed approved.2. The Insurance Commissioner may promulgate rules exempting those activities having a de minimis effect from the filing requirement of paragraph 1 of this subsection.Added by Laws 2003, c. 197, § 5, eff. Nov. 1, 2003.
36 OK Stat § 36-6906 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6906. Receipt, collection, disbursement or investment of funds - Fiduciary relationship - Fidelity bond or insurance.

|A. A director, officer, employee or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of the organization shall be responsible for the funds in a fiduciary relationship to the organization. |B. A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such employees, officers, directors and partners in an amount that is not less than Two Hundred Fifty Thousand Dollars ($250,000.00) for each health maintenance organization, or a maximum of Five Million Dollars ($5,000,000.00) in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or the sum prescribed by the Insurance Commissioner.Added by Laws 2003, c. 197, § 6, eff. Nov. 1, 2003. Amended by Laws 2005, c. 129, § 19, eff. Nov. 1, 2005.
36 OK Stat § 36-6909 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6909. Reports and statements.

|A. Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two principal officers with the Insurance Commissioner covering the preceding calendar year. The report shall be on forms and shall include all forms prescribed by the National Association of Insurance Commissioners (NAIC). The report shall be filed with the NAIC in electronic format, as approved by the NAIC, along with applicable fees. In addition, the health maintenance organization shall file with the Insurance Commissioner via electronic format and a paper copy by the first day of March, unless otherwise stated: |1. Audited financial statements on or before June 1;2. An actuarial opinion prepared and signed by a qualified actuary;3. A list of the providers who have executed a contract that complies with the provisions of paragraph 1 of subsection D of Section 13 of this act; and4.a.a description of the grievance procedures, andb.the total number of grievances handled through these procedures, a compilation of the causes underlying those grievances, and a summary of the final disposition of those grievances.B. Domestic health maintenance organizations shall file quarterly financial statements with the Insurance Commissioner on or before the forty-fifth day following the end of each calendar quarter other than the fourth quarter of each year. The report shall be on forms and shall include all forms prescribed by the NAIC. The report shall be filed with the NAIC in electronic format, as approved by the NAIC, along with applicable fees.C. The Insurance Commissioner may require additional reports deemed necessary and appropriate to enable the Insurance Commissioner to carry out his or her duties under this act.Added by Laws 2003, c. 197, § 9, eff. Nov. 1, 2003.
36 OK Stat § 36-6910 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6910. Information to be provided to subscribers.

|Every health maintenance organization (HMO) shall: |1. Provide to its subscribers electronically or in paper copy a list of providers upon enrollment and make such list available electronically or in paper copy upon reenrollment; provided, a subscriber has submitted written assurances that the subscriber can view and print such electronic copy;2. Provide to its subscribers notice of any material change in the operation of the organization that will affect them directly, no later than thirty (30) days after such change;3. Immediately notify an enrollee in writing of the termination of the enrollee’s primary care provider and shall provide assistance to the enrollee in transferring to another participating primary care provider; and4. Provide to subscribers, electronically or in paper copy, information on:a.how to obtain services,b.where to obtain additional information on access to services, andc.how to contact the HMO at no cost to the enrollee.Added by Laws 2003, c. 197, § 10, eff. Nov. 1, 2003.
36 OK Stat § 36-6911 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6911. Grievance procedures.

|A. Every health maintenance organization shall establish and maintain a grievance procedure that has been approved by the Insurance Commissioner to provide for the resolution of grievances initiated by enrollees. Such grievance procedure shall be approved by the Insurance Commissioner within thirty (30) days of submission. The health maintenance organization shall maintain a record of grievances received since the date of its last examination of grievances. |B. The Insurance Commissioner may examine the grievance procedures.C. Health maintenance organizations shall comply with the requirements of an insurer as set out in Sections 1250.1 through 1250.16 of this title.Added by Laws 2003, c. 197, § 11, eff. Nov. 1, 2003. Amended by Laws 2021, c. 478, § 38, emerg. eff. May 12, 2021.
36 OK Stat § 36-6912 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6912. Investment of funds.

|With the exception of investments made in accordance with the provisions of paragraph 1 of subsection A of Section 5 of this act, the funds of a health maintenance organization shall be invested only in accordance with the provisions of Article 16 of the Insurance Code. |Added by Laws 2003, c. 197, § 12, eff. Nov. 1, 2003.
36 OK Stat § 36-6916 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6916. Premium rates - Approval by Insurance Commissioner.

|A. No premium rate may be used by a health maintenance organization until such time as a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the Insurance Commissioner. Such premium rates shall be confidential and not subject to public disclosure. |B. Either a specific schedule of premium rates or a methodology for determining premium rates shall be established in accordance with actuarial principles for various categories of enrollees; provided, that the premium applicable to an enrollee shall not be individually determined based on the status of the enrollee’s health. Provided further, that the premium rates shall not be excessive, inadequate, unfair or discriminatory. A certification by a qualified actuary or other qualified person acceptable to the Insurance Commissioner as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information.C. The Insurance Commissioner shall approve the schedule of premium rates or methodology for determining premium rates if the requirements of subsection B of this section are met. If the Insurance Commissioner disapproves the filing, the Insurance Commissioner shall notify the health maintenance organization. In the notice, the Insurance Commissioner shall specify the reasons for disapproval. A hearing will be conducted within thirty (30) days after a request in writing by the person filing. If the Insurance Commissioner does not take action on the schedule or methodology within thirty (30) days of the filing of the schedule or methodology, it shall be deemed approved.D. When contracting with educational entities within the meaning of Section 1306 of Title 74 of the Oklahoma Statutes, in setting health insurance premiums for active employees and for retirees under sixty-five (65) years of age, health maintenance organizations shall set the monthly premium for active employees at a maximum of Ninety Dollars ($90.00) less than the monthly premium for retirees under sixty-five (65) years of age.Added by Laws 2003, c. 197, § 16, eff. Nov. 1, 2003.
36 OK Stat § 36-6917 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6917. Producer license - Exempted persons.

|A. Health maintenance organization producers shall comply with all applicable statutes and provisions of Title 36 of the Oklahoma Statutes and rules relating to producer licensing, including the Oklahoma Producer Licensing Act. |B. The following persons shall not be required to hold a health maintenance organization producer license:1. A regular salaried officer or employee of a health maintenance organization who devotes substantially all of his or her time to activities other than the taking or transmitting of applications or membership fees or premiums for health maintenance organization membership, or who receives no commission or other compensation directly dependent upon the business obtained, and who does not solicit or accept from the public applications for health maintenance organization membership;2. Employers or their officers or employees or the trustees of an employee benefit plan to the extent that the employers, officers, employees or trustees are engaged in the administration or operation of a program of employee benefits involving the use of health maintenance organization memberships; provided, that the employers, officers, employees or trustees are not in any manner compensated directly or indirectly by the health maintenance organization issuing health maintenance organization memberships;3. Banks or their officers and employees to the extent that the banks, officers and employees collect and remit charges by charging them against accounts of depositors on the orders of the depositors; or4. A person or the employee of a person who has contracted to provide administrative, management or health care services to a health maintenance organization and who is compensated for those services by the payment of an amount calculated as a percentage of the revenues, net income or profit of the health maintenance organization, if that method of compensation is the sole basis for subjecting that person or the employee of the person to this act.C. The Insurance Commissioner may by rule exempt certain classes of persons from the requirement of obtaining a license:1. If the functions such persons perform do not require special competence, trustworthiness or the regulatory surveillance made possible by licensing; or2. If other existing safeguards make regulation unnecessary.Added by Laws 2003, c. 197, § 17, eff. Nov. 1, 2003.
36 OK Stat § 36-6918 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6918. Organizations permitted to organize and operate health maintenance organization - Contracts for insurance against cost of care provided.

|A. An insurance company licensed in this state or a hospital or medical service corporation authorized to do business in this state may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization pursuant to the provisions of this act. Notwithstanding any other law which may be inconsistent, any two or more insurance companies, hospital or medical service corporations, or subsidiaries or affiliates thereof may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or its subsidiary. |B. Notwithstanding any provision of insurance and hospital or medical service corporation laws in Title 36 of the Oklahoma Statutes, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. An insurer or a hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to such contracts.Added by Laws 2003, c. 197, § 18, eff. Nov. 1, 2003.