reglab/housing_qa huggingface dataset:
36 OK Stat § 36-6516 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6516. Renewability of health benefit plans - Election not to renew - Geographic service area.

|A. A health benefit plan subject to this act shall be renewable with respect to all eligible employees and dependents, at the option of the small employer, except in any of the following cases: |1. Nonpayment of the required premiums;2. Fraud or misrepresentation of the small employer or, with respect to coverage of individual insureds, the insureds or their representatives;3. Noncompliance with the carrier's minimum group participation requirements;4. Noncompliance with the carrier's employer contribution requirements;5. Repeated misuse of provider network provisions;6. The small employer carrier elects to nonrenew all of its health benefit plans issued to small employers in this state. In such a case the carrier shall:a.provide advance notice of its decision under this paragraph to the Insurance Commissioner in each state in which it is licensed, andb.provide notice of the decision not to renew coverage to all affected small employers and to the Commissioner in each state in which an affected covered individual is known to reside at least one hundred eighty (180) days prior to the nonrenewal of any health benefit plan by the carrier. Notice to the Commissioner under this subparagraph shall be provided at least three (3) working days prior to the notice to the affected small employers; or7. The Commissioner finds that the continuation of the coverage would:a.not be in the best interests of the policyholders or certificate holders, orb.impair the carrier's ability to meet its contractual obligations. In such instance the Commissioner may assist affected small employers in finding replacement coverage.B. A small employer carrier that elects not to renew a health benefit plan under paragraph 6 of subsection A of this section shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the Commissioner.C. In the case of a small employer carrier doing business in one established geographic service area of the state, the provisions of this section shall apply only to the carrier's operations in such service area.Added by Laws 1992, c. 329, § 6, eff. Sept. 1, 1992.
36 OK Stat § 36-6517 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6517. Disclosures required of small employer carriers.

|In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following: |1. The extent to which premium rates for a specified small employer are established or adjusted based upon the actual or expected variation in claims costs or actual or expected variation in health status of the employees of the small employer and their dependents;2. The provisions of the health benefit plan concerning the small employer carrier's right to change premium rates and factors, other than claim experience, that affect changes in premium rates;3. The provisions relating to renewability of policies and contracts; and4. The provisions relating to any preexisting condition provision.Added by Laws 1992, c. 329, § 7, eff. Sept. 1, 1992.
36 OK Stat § 36-6518 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6518. Maintenance and disclosure of certain information and documents - Filing of actuarial certification.

|A. Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles. |B. Each small employer carrier shall file with the Insurance Commissioner annually on or before March 15 an actuarial certification certifying that the carrier is in compliance with this act and that the rating methods of the small employer carrier are actuarially sound. Such certification shall be in a form and manner, and shall contain such information, as specified by the Commissioner. A copy of the certification shall be retained by the small employer carrier at its principal place of business.C. A small employer carrier shall make the information and documentation described in subsection A of this section available to the Commissioner upon request. Except in cases of violations of this act, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the Commissioner to persons outside of the Department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.Added by Laws 1992, c. 329, § 8, eff. Sept. 1, 1992.
36 OK Stat § 36-6526 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6526. Rulemaking.

|The Insurance Commissioner may promulgate rules in accordance with Article I of the Administrative Procedures Act, Sections 250.2 through 323 of Title 75 of the Oklahoma Statutes, for the implementation and administration of the Small Employer Health Insurance Reform Act. |Added by Laws 1994, c. 211, § 12, eff. July 1, 1994. Amended by Laws 2010, c. 222, § 46, eff. Nov. 1, 2010.
36 OK Stat § 36-6528 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6528. Reissuance of certain terminated coverage.

|The Insurance Commissioner may promulgate rules to require small employer carriers, as a condition of transacting business with small employers in this state after the effective date of this act, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after December 31, 1993. The Commissioner may prescribe such terms for the reissue of coverage as the Commissioner finds are reasonable and necessary to provide continuity of coverage to small employers. |Added by Laws 1994, c. 211, § 14, eff. July 1, 1994.
36 OK Stat § 36-6529 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6529. Suspension of implementation if inconsistent with federal law.

|In the event that the Congress of the United States enacts laws legally inconsistent with any portion of this act, the Insurance Commissioner may suspend implementation of such inconsistent portion of this act. In such case, the Commissioner shall notify the Governor, President Pro Tempore of the Senate and the Speaker of the House of Representatives. |Added by Laws 1994, c. 211, § 15, eff. July 1, 1994.
36 OK Stat § 36-6530 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6530. Bona fide association health plans.

|A. "Bona fide association" means any association that has a current form M-1 filed with and accepted by the United States Department of Labor showing Oklahoma as the state of operation and: |1. Is formed under a pathway established in accordance with the applicable provisions of 29 CFR 2510; or2. Was previously established or is newly formed under federal regulatory guidance effective prior to August 20, 2018.B. "Bona fide association health plan" means a health benefit plan that is sponsored by a bona fide association as defined in subsection A of this section.C. The provisions of the Small Employer Health Insurance Reform Act shall not apply to a health benefit plan issued to a bona fide association health plan.D. Each bona fide association health plan that meets the requirements of this section shall be considered a large group for purposes of application of the Oklahoma Insurance Code.E. A bona fide association health plan shall be subject to the following requirements:1. The bona fide association health plan shall be delivered or issued for delivery to a bona fide association in a form that meets the requirements of Section 4502 of Title 36 of the Oklahoma Statutes;2. The bona fide association health plan shall comply with any federal nondiscrimination requirement applicable to the association health plan;3. Small employer groups that have two (2) or more eligible employees and that are members of the association may not be excluded from the association health plan;4.a.Except as provided in subparagraph b of this paragraph, the association health plan shall maintain an eighty percent (80%) retention rate.b.The eighty percent (80%) retention rate specified in subparagraph a of this paragraph shall not include employer groups or working owners that:(1)go out of business, whether through merger, acquisition or any other reason,(2)no longer meet eligibility requirements for membership in the association,(3)no longer meet participation requirements for employers that are set forth in the plan documents, or(4)fail to pay premiums.c.A bona fide association health plan that fails to maintain the eighty percent (80%) retention rate during any year may have twelve (12) months to correct the retention level before being required to become subject to the requirements of the Small Employer Health Insurance Reform Act.d.A bona fide association health plan may not require a contract under this subsection between the bona fide association health plan and the member to be effective for a period of longer than two (2) years. This provision shall not be construed to prevent a contract from being extended for additional two-year periods or preventing the member from voluntarily electing a contract period of longer than two (2) years; and5. Each bona fide association health plan shall be available to be marketed and sold by all licensed agents and brokers of the health carrier, at the health carrier's standard commission and/or fee schedule for the calendar year.Added by Laws 2019, c. 265, § 3, eff. Nov. 1, 2019.
36 OK Stat § 36-6530.1 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6530.1. Oklahoma Individual Health Insurance Market Stabilization Act – Legislative intent.

|This act shall be known and may be cited as the "Oklahoma Individual Health Insurance Market Stabilization Act". It is the intent of the Legislature to provide payments to health insurance plans with respect to claims for eligible individuals for the purpose of lowering premiums for health insurance coverage offered in the individual market. Market stabilization activities shall include establishment of a high-risk pool, reinsurance, hybrid programs or any combination thereof. It is the further intent of the Legislature to bestow upon the Oklahoma Insurance Commissioner the authority to appoint a Board of Directors which shall create, implement, oversee and monitor the high-risk pool, reinsurance or hybrid programs under provisions of this act. The Board of Directors and the Oklahoma Secretary of Health and Human Services are authorized to apply for, accept and receive federal funds to implement and sustain market stabilization programs. Preliminary planning and analysis shall continue under the direction of the Oklahoma Insurance Commissioner. The onset of market stabilization implementation shall be contingent upon Oklahoma's approval for and receipt of federal funds to implement and sustain market stabilization programs. |Added by Laws 2017, c. 383, § 1, emerg. eff. June 6, 2017.
36 OK Stat § 36-6530.3 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6530.3. Eligible persons.

|Except as otherwise provided in this section, any person who is qualified for and enrolled in coverage through the market and is a permanent resident of the State of Oklahoma shall be eligible for coverage under the Oklahoma Individual Health Insurance Market Stabilization Program except that: |1. No person who is currently receiving or is entitled to receive health care benefits under any other federal or state program providing financial assistance or preventive and rehabilitative social services is eligible for coverage under the Program; and2. No inmate incarcerated in any state penal institution or confined to any narcotic detention, treatment and rehabilitation facility shall be eligible for coverage under the Program.Added by Laws 2017, c. 383, § 3, emerg. eff. June 6, 2017.
36 OK Stat § 36-6530.6 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6530.6. Board of Directors – Powers.

|The Board may: |1. Exercise powers granted to insurers under the laws of this state;2. Sue or be sued; and3. Request the Insurance Commissioner to check the reports, records, books and papers of the Insurance Department to determine the financial condition of an insurer for purposes of Section 8 of this act.Added by Laws 2017, c. 383, § 6, emerg. eff. June 6, 2017. Amended by Laws 2018, c. 267, § 2.
36 OK Stat § 36-6530.9 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6530.9. Unfair practice – Separating individual employees from group health insurance coverage.

|It shall constitute an unfair practice for the purposes of Sections 1201 through 1220 of Title 36 of the Oklahoma Statutes for an insurer, insurance agent, insurance broker or third-party administrator to refer an individual employee to the Program or arrange for an individual employee to apply for the Program, for the purpose of separating that employee from group health insurance coverage provided in connection with the employee's employment. |Added by Laws 2017, c. 383, § 9, emerg. eff. June 6, 2017.
36 OK Stat § 36-6530.10 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6530.10. Application for waiver pursuant to Patient Protection 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. |Added by Laws 2017, c. 383, § 10, emerg. eff. June 6, 2017.
36 OK Stat § 36-6551 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6551. Short title.

|Sections 1 through 16 of this act shall constitute a part of the Insurance Code and shall be known and may be cited as the "Hospital and Medical Services Utilization Review Act". |Added by Laws 1991, c. 294, § 1, eff. Nov. 1, 1991.
36 OK Stat § 36-6552 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6552. Definitions.

|As used in the Hospital and Medical Services Utilization Review Act: |1. "Utilization review" means a system for prospectively, concurrently and retrospectively reviewing the appropriate and efficient allocation of hospital resources and medical services given or proposed to be given to a patient or group of patients. It does not include an insurer's normal claim review process to determine compliance with the specific terms and conditions of the insurance policy;2. "Private review agent" means a person or entity who performs utilization review on behalf of:a.an employer in this state, orb.a third party that provides or administers hospital and medical benefits to citizens of this state, including, but not limited to:(1)a health maintenance organization issued a license pursuant to Section 2501 et seq. of Title 63 of the Oklahoma Statutes, unless the health maintenance organization is federally regulated and licensed and has on file with the Insurance Commissioner a plan of utilization review carried out by health care professionals and providing for complaint and appellate procedures for claims, or(2)a health insurer, not-for-profit hospital service or medical plan, health insurance service organization, or preferred provider organization or other entity offering health insurance policies, contracts or benefits in this state;3. "Utilization review plan" means a description of utilization review procedures;4. "Commissioner" means the Insurance Commissioner;5. "Certificate" means a certificate of registration granted by the Insurance Commissioner to a private review agent; and6. "Health care provider" means any person, firm, corporation or other legal entity that is licensed, certified, or otherwise authorized by the laws of this state to provide health care services, procedures or supplies in the ordinary course of business or practice of a profession.Added by Laws 1991, c. 294, § 2, eff. Nov. 1, 1991. Amended by Laws 2021, c. 478, § 34, emerg. eff. May 12, 2021.
36 OK Stat § 36-6553 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6553. Private review agents - Certification required - Exemptions.

|A. A private review agent who approves or denies payment or who recommends approval or denial of payment for hospital or medical services or whose review results in approval or denial of payment for hospital or medical services on a case-by-case basis shall not conduct utilization review in this state unless the Insurance Commissioner has granted the private review agent a certificate. |B. Except as provided in Section 9 of this act, the Hospital and Medical Services Utilization Review Act shall not apply to any insurance company or not-for-profit hospital service and medical indemnity plan licensed by the Commissioner to transact insurance in this state. If the insurer contracts outside the company for any or all utilization review services, the entity with whom the insurance company contracts shall be subject to all of the provisions of the Hospital and Medical Services Utilization Review Act.C. The State and Education Employees Group Insurance Board shall be exempt from the provisions of the Hospital and Medical Services Utilization Review Act and regulated accordingly as provided for in the State and Education Employees Group Insurance Act. In addition, the Board shall comply with the provisions of Section 17 of this act. If the State and Education Employees Group Insurance Board contracts for utilization review services instead of having utilization review services be performed by employees of the Board, the entity with whom the Board contracts shall be subject to all of the provisions of the Hospital and Medical Services Utilization Review Act.Added by Laws 1991, c. 294, § 3, eff. Nov. 1, 1991.
36 OK Stat § 36-6554 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6554. Exemptions - Review of patients eligible under Social Security - In-house utilization review.

|A. The Insurance Commissioner shall waive the requirements of the Hospital and Medical Services Utilization Review Act for the activities of a private review agent in connection with a contract with the federal or state government for utilization review of patients eligible for hospital and medical services under the Social Security Act. |B. No certificate is required for those private review agents conducting general in-house utilization review for hospitals, home health agencies, preferred provider organizations, or other managed care entities, clinics, private offices or any other health facility or entity, so long as the review does not result in the approval or denial of payment for hospital or medical services for a particular case. Such general in-house utilization review shall be exempt from all provisions of the Hospital and Medical Services Utilization Review Act.Added by Laws 1991, c. 294, § 4, eff. Nov. 1, 1991.
36 OK Stat § 36-6555 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6555. Rules - Forms - Issuance of certificate - Reporting requirements - Confidentiality.

|A. The Insurance Commissioner may promulgate and adopt rules to implement the provisions of this section. |B. The Commissioner shall develop standardized forms for registration, performing and implementing certification requirements pursuant to the Hospital and Medical Services Utilization Review Act.C. The Commissioner shall issue a certificate to an applicant that has met all the requirements of the Hospital and Medical Services Utilization Review Act and applicable rules.D. The Commissioner may establish reporting requirements to:1. Evaluate, based upon the information furnished pursuant to the provisions of this act, the effectiveness of private review agents; and2. Determine if the utilization review programs are in compliance with the provisions of the Hospital and Medical Services Utilization Review Act and applicable rules.E. Any information required by the Commissioner with respect to customers, patients or utilization review procedures of a private review agent shall be held in confidence and shall not be disclosed to the public. However, a patient or a person with financial responsibility for a patient's bill shall be entitled to information and documents relating to them and their claim.F. A certificate issued pursuant to the Hospital and Medical Services Utilization Review Act is not transferable.G. No individual conducting utilization review shall be required to be certified if such utilization review is performed within the scope of such person's employment with an entity already certified pursuant to the Hospital and Medical Services Review Act.Added by Laws 1991, c. 294, § 5, eff. Nov. 1, 1991.
36 OK Stat § 36-6556 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6556. Health insurance plans - Certification or contract with certified private review agent - Exceptions.

|Every health insurance plan which proposes to administer a health benefits program that provides for the coverage of hospital and/or medical benefits and the utilization review of those benefits shall: |1. Be certified in accordance with the Hospital and Medical Services Utilization Review Act; or2. Contract with a private review agent who is certified in accordance with the Hospital and Medical Services Utilization Review Act.The provisions of this section shall not apply to insurance companies and not-for-profit hospital services and medical indemnity plans, licensed by the Commissioner to transact insurance in this state, that perform in-house utilization review.Added by Laws 1991, c. 294, § 6, eff. Nov. 1, 1991.
36 OK Stat § 36-6557 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6557. Application for certificate.

|A. An applicant for a certificate shall: |1. Submit an application to an Insurance Commissioner; and2. Pay to the Commissioner an application fee in an amount of Five Hundred Dollars ($500.00), which shall be sufficient to pay for the administrative cost of the certification program and any other cost associated with carrying out the provisions of the Hospital and Medical Services Utilization Review Act.B. The application shall:1. Be on a form approved by the Commissioner and accompanied by any supporting documentation that the Commissioner requires; and2. Be signed and verified by the applicant.Added by Laws 1991, c. 294, § 7, eff. Nov. 1, 1991.
36 OK Stat § 36-6560 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6560. Expiration of certificate - Renewal.

|A. A certificate expires on the first anniversary of its effective date unless the certificate is renewed for a one-year term as provided in this section. |B. Before the certificate expires, a certificate may be renewed for an additional one-year term, if the applicant:1. Otherwise is entitled to the certificate;2. Pays the Insurance Commissioner an annual renewal fee in the amount of Five Hundred Dollars ($500.00);3. Submits to the Commissioner:a.a renewal application on the form that the Commissioner requires, andb.satisfactory evidence of compliance with any requirement for certificate renewal;4. Establishes and maintains a complaint system which has been approved by the Commissioner and which provides reasonable procedures for the resolution of written complaints concerning utilization review; and5. Maintains records of written complaints for five (5) years from the time the complaints are filed and submits to the Commissioner a summary report at such times and in such format as the Commissioner may require.Added by Laws 1991, c. 294, § 10, eff. Nov. 1, 1991.