reglab/housing_qa huggingface dataset:
36 OK Stat § 36-6943 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6943. Mandatory control level event - Definition - Duties of Insurance Commissioner.

|A. “Mandatory Control Level Event” means any of the following events: |1. The filing of an RBC report which indicates that the health maintenance organization’s total adjusted capital is less than its Mandatory Control Level RBC;2. Notification by the Commissioner to the health maintenance organization of an adjusted RBC report that indicates a Mandatory Control Level Event specified in paragraph 1 of this subsection, provided the health maintenance organization does not challenge the adjusted RBC report under Section 44 of this act; or3. If, pursuant to the provisions of Section 44 of this act, the health maintenance organization challenges an adjusted RBC report that indicates the event in paragraph 1 of this subsection, notification by the Commissioner to the health maintenance organization that the Commissioner has, after a hearing, rejected the health maintenance organization’s challenge.B. In the event of a Mandatory Control Level Event, the Commissioner shall take such actions as are necessary to place the health maintenance organization under regulatory control pursuant to the provisions of Articles 18 and 19 of the Insurance Code. In that event, the Mandatory Control Level Event shall be deemed sufficient grounds for the Commissioner to take action pursuant to the provisions of Articles 18 and 19 of the Insurance Code, and the Commissioner shall have the rights, powers and duties with respect to the health maintenance organization as provided in Articles 18 and 19 of the Insurance Code. Notwithstanding any of the preceding provisions, the Commissioner may forego action for up to ninety (90) days after the Mandatory Control Level Event if the Commissioner finds there is a reasonable expectation that the Mandatory Control Level Event may be eliminated within the ninety-day period.Added by Laws 2003, c. 197, § 43, eff. Nov. 1, 2003.
36 OK Stat § 36-6944 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6944. Challenge of determination or action by Insurance Commissioner - Required events - Hearing.

|Upon the occurrence of any of the events specified in this section, the health maintenance organization shall have the right to a confidential departmental hearing, on the record, at which time the health maintenance organization may challenge any determination or action by the Insurance Commissioner. The health maintenance organization shall notify the Commissioner of its request for a hearing within five (5) days after the notification by the Commissioner pursuant to the provisions of paragraph 1, 2, 3 or 4 of this section. Upon receipt of the health maintenance organization’s request for a hearing, the Commissioner shall set a date for the hearing, which shall be not less than ten (10), nor more than thirty (30) days after the date of the health maintenance organization’s request. The events include: |1. Notification to a health maintenance organization by the Commissioner of an adjusted Risk-Based Capital (RBC) report;2. Notification to a health maintenance organization by the Commissioner that:a.the health maintenance organization’s RBC plan or revised RBC plan is unsatisfactory, andb.notification constitutes a Regulatory Action Level Event with respect to the health maintenance organization;3. Notification to a health maintenance organization by the Commissioner that the health maintenance organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health maintenance organization to eliminate the Company Action Level Event with respect to the health maintenance organization in accordance with its RBC plan or revised RBC plan; or4. Notification to a health maintenance organization by the Commissioner of a corrective order with respect to the health maintenance organization.Added by Laws 2003, c. 197, § 44, eff. Nov. 1, 2003.
36 OK Stat § 36-6946 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6946. Application of act - Rules for implementation of act.

|A. The provisions of the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003 are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the Insurance Commissioner under such laws including, but not limited to, Articles 18 and 19 of the Insurance Code and promulgated rules related to health maintenance organizations in hazardous financial condition. |B. The Commissioner may adopt reasonable rules necessary for the implementation of this act.C. The Commissioner may exempt from the application of this act a domestic health maintenance organization that:1. Writes direct business only in this state; and2. Assumes no reinsurance in excess of five percent (5%) of direct premium written.Added by Laws 2003, c. 197, § 46, eff. Nov. 1, 2003. Amended by Laws 2004, c. 146, § 3, eff. Nov. 1, 2004.
36 OK Stat § 36-6947 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6947. Foreign health maintenance organizations.

|A. 1. A foreign health maintenance organization shall, upon the written request of the Insurance Commissioner, submit to the Commissioner a Risk-Based Capital (RBC) report as of the end of the calendar year just ended the later of: |a.the date an RBC report would be required to be filed by a domestic health maintenance organization under this act, orb.fifteen (15) days after the request is received by the foreign health maintenance organization.2. A foreign health maintenance organization shall, at the written request of the Commissioner, promptly submit to the Commissioner a copy of any RBC plan that is filed with the Insurance Commissioner of any other state.B. In the event of a Company Action Level Event, Regulatory Action Level Event or Authorized Control Level Event with respect to a foreign health maintenance organization, as determined under the RBC statute applicable in the state of domicile of the health maintenance organization or, if no RBC statute is in force in that state, under the provisions of this act, if the Insurance Commissioner of the state of domicile of the foreign health maintenance organization fails to require the foreign health maintenance organization to file an RBC plan in the manner specified under that state’s RBC statute or, if no RBC statute is in force in that state, under the provisions of Section 40 of this act, the Commissioner may require the foreign health maintenance organization to file an RBC plan with the Commissioner. In such event, the failure of the foreign health maintenance organization to file an RBC plan with the Commissioner shall be grounds to order the health maintenance organization to cease and desist from writing new insurance business in this state.C. In the event of a Mandatory Control Level Event with respect to a foreign health maintenance organization, if no domiciliary receiver has been appointed for the foreign health maintenance organization under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign health maintenance organization, the Commissioner may make application to the District Court of Oklahoma County as permitted under Article 19 of the Insurance Code with respect to the liquidation of property of foreign health maintenance organizations found in this state, and the occurrence of the Mandatory Control Level Event shall be considered adequate grounds for the application.Added by Laws 2003, c. 197, § 47, eff. Nov. 1, 2003.
36 OK Stat § 36-6948 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6948. Immunity from liability on part of Insurance Commissioner or Insurance Department or its employees or agents.

|There shall be no liability on the part of, and no cause of action shall arise against, the Insurance Commissioner or the Insurance Department or its employees or agents for any action taken by them in the performance of their powers and duties under the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003. |Added by Laws 2003, c. 197, § 48, eff. Nov. 1, 2003.
36 OK Stat § 36-6949 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6949. Severability.

|If any provision of the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003 or its application to any person or circumstance is held invalid, such determination shall not affect the provisions or applications of this act that can be given effect without the invalid provision or application, and to that end the provisions of this act are severable. |Added by Laws 2003, c. 197, § 49, eff. Nov. 1, 2003.
36 OK Stat § 36-6950 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6950. Effective date of notices by Insurance Commissioner.

|All notices by the Insurance Commissioner to a health maintenance organization that may result in regulatory action under this act shall be effective upon the date the notice is postmarked by the United States Postal Service if transmitted by registered or certified mail or, in the case of any other transmission, shall be effective upon the health maintenance organization’s receipt of notice. |Added by Laws 2003, c. 197, § 50, eff. Nov. 1, 2003.
36 OK Stat § 36-6951 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6951. Requirements for RBC reports filed in 2003.

|For Risk-based Capital (RBC) reports required to be filed by health maintenance organizations in 2003, the following requirements shall apply in lieu of the provisions of Sections 40, 41, 42 and 43 of this act: |1. In the event of a Company Action Level Event in a domestic health maintenance organization, the Insurance Commissioner shall take no regulatory action under this act;2. In the event of a Regulatory Action Level Event under the provisions of paragraphs 1, 2 or 3 of subsection A of Section 41 of this act the Commissioner shall take the actions required under Section 40 of this act;3. In the event of a Regulatory Action Level Event under paragraphs 4, 5, 6, 7, 8 or 9 of subsection A of Section 41 of this act or an Authorized Control Level Event, the Commissioner shall take the actions required under Section 41 of this act; or4. In the event of a Mandatory Control Level Event in a health maintenance organization, the Commissioner shall take the actions required under Section 42 of this act.Added by Laws 2003, c. 197, § 51, eff. Nov. 1, 2003.
36 OK Stat § 36-6952 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6952. Nonprofit health maintenance organizations.

|A. Nonprofit charitable and benevolent health maintenance organization corporations may hereafter be organized under the laws of the State of Oklahoma for the purpose of establishing, maintaining and operating a nonprofit health maintenance organization by complying with the provisions of this act. |B. Existing Oklahoma-licensed domestic health maintenance organizations may amend their corporate organizational documents to become nonprofit health maintenance organization corporations pursuant to the provisions of this act, which shall entitle them to all rights, obligations and provisions of this act. Existing Oklahoma-licensed domestic health maintenance organizations that amend their corporate organizational documents to become nonprofit health maintenance organization corporations shall continue to exist without interruption in business, licenses, certifications or other continuity.C. The Oklahoma Insurance Commissioner may first approve the amended Certificate of Incorporation and the amended Business Plan of an existing Oklahoma-licensed domestic health maintenance organization subject to Section 3 of this act.Added by Laws 2014, c. 272, § 1, eff. July 1, 2014.
36 OK Stat § 36-6953 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6953. Certificate of authority to issue contracts.

|A nonprofit health maintenance organization corporation may issue contracts to its subscribers only when the Insurance Commissioner has, by certificate of authority, authorized it to do so. Application for such certificate of authority shall be made on forms supplied or approved by the Commissioner, containing such information as the Commissioner shall deem necessary. Each application for a certificate of authority shall be accompanied by copies of the documents required by Section 6903 of Title 36 of the Oklahoma Statutes. |Added by Laws 2014, c. 272, § 2, eff. July 1, 2014.
36 OK Stat § 36-6954 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6954. Application for certificate of authority - Requirements.

|The Insurance Commissioner may certify nonprofit health maintenance organization corporations by issuing a certificate of authority, authorizing the applicant to issue contracts to its subscribers, when it is shown to the satisfaction of the Commissioner that: |1. The applicant is established as a bona fide nonprofit health maintenance organization corporation;2. The contracts between the applicant and the participating physicians or other providers of health services obligate each provider executing the same to render service to which each subscriber may be entitled under the terms of the contract to be issued to the subscribers;3. The amount of required working capital of the corporation is paid into the corporation and, if subject to repayment, can be repaid only out of operating income, without endangering the solvency or financial strength of the nonprofit health maintenance organization corporation; and4. The nonprofit corporation has met, or will be able to meet, the requirements set forth in the Health Maintenance Organization Act of 2003 and the risk-based capital for the Health Maintenance Organization Act of 2003.Added by Laws 2014, c. 272, § 3, eff. July 1, 2014.
36 OK Stat § 36-6955 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6955. Transfers for existing health maintenance organizations to nonprofit status.

|Any existing Oklahoma licensed domestic health maintenance organization that amends its Certificate of Incorporation and is approved as a nonprofit health maintenance organization corporation by the Insurance Commissioner may utilize its existing contracts, forms and rates already on file with the Commissioner. |Added by Laws 2014, c. 272, § 4, eff. July 1, 2014.
36 OK Stat § 36-6956 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6956. Private or publicly owned nonprofits – Application of Health Maintenance Organization Act of 2003 and rules to nonprofits.

|A nonprofit health maintenance organization corporation may be privately or publicly owned. All of the requirements of the Health Maintenance Organization Act of 2003, the risk-based capital for the Health Maintenance Organization Act of 2003 and any rules promulgated thereunder shall be applicable to nonprofit health maintenance organization corporations, except that such corporations shall use their income and profit to further facilitate the providing of health care services to the public after paying expenses of operation and ownership. |Added by Laws 2014, c. 272, § 5, eff. July 1, 2014.
36 OK Stat § 36-6957 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6957. Scope of act.

|The provisions of this act shall govern and apply only to nonprofit health maintenance organization corporations. Such corporations shall comply with all other laws applicable to health maintenance organizations under Title 36 of the Oklahoma Statutes and any rules promulgated thereunder. |Added by Laws 2014, c. 272, § 6, eff. July 1, 2014.
36 OK Stat § 36-6958 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6958. Short title - Patient's Right to Pharmacy Choice Act.

|This act shall be known and may be cited as the "Patient's Right to Pharmacy Choice Act". |Added by Laws 2019, c. 426, § 1, eff. Nov. 1, 2019.
36 OK Stat § 36-6959 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6959. Purpose of act.

|The purpose of the Patient's Right to Pharmacy Choice Act is to establish minimum and uniform access to a provider and standards and prohibitions on restrictions of a patient's right to choose a pharmacy provider. |Added by Laws 2019, c. 426, § 2, eff. Nov. 1, 2019.
36 OK Stat § 36-6960 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6960. Definitions.

|For purposes of the Patient's Right to Pharmacy Choice Act: |1. "Health insurer" means any corporation, association, benefit society, exchange, partnership or individual licensed by the Oklahoma Insurance Code;2. "Mail-order pharmacy" means a pharmacy licensed by this state that primarily dispenses and delivers covered drugs via common carrier;3. "Pharmacy benefits manager" or "PBM" means a person that performs pharmacy benefits management and any other person acting for such person under a contractual or employment relationship in the performance of pharmacy benefits management for a managed-care company, nonprofit hospital, medical service organization, insurance company, third-party payor or a health program administered by a department of this state;4. "Pharmacy and therapeutics committee" or "P&T committee" means a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary;5. "Retail pharmacy network" means retail pharmacy providers contracted with a PBM in which the pharmacy primarily fills and sells prescriptions via a retail, storefront location;6. "Rural service area" means a five-digit ZIP code in which the population density is less than one thousand (1,000) individuals per square mile;7. "Suburban service area" means a five-digit ZIP code in which the population density is between one thousand (1,000) and three thousand (3,000) individuals per square mile; and8. "Urban service area" means a five-digit ZIP code in which the population density is greater than three thousand (3,000) individuals per square mile.Added by Laws 2019, c. 426, § 3, eff. Nov. 1, 2019.
36 OK Stat § 36-6961 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6961. Retail pharmacy network access standards.

|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;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; and6. 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.Added by Laws 2019, c. 426, § 4, eff. Nov. 1, 2019.
36 OK Stat § 36-6963 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6963. Health insurer to monitor activities and ensure compliance.

|A. A health insurer shall be responsible for monitoring all activities carried out by, or on behalf of, the health insurer under the Patient's Right to Pharmacy Choice Act, and for ensuring that all requirements of this act are met. |B. Whenever a health insurer contracts with another person to perform activities required under this act, the health insurer shall be responsible for monitoring the activities of that person with whom the health insurer contracts and for ensuring that the requirements of this act are met.C. An individual may be notified at the point of sale when the cash price for the purchase of a prescription drug is less than the individual's copayment or coinsurance price for the purchase of the same prescription drug.D. A health insurer or pharmacy benefits manager (PBM) shall not restrict an individual's choice of in-network provider for prescription drugs.E. An individual's choice of in-network provider may include a retail pharmacy or a mail-order pharmacy. A health insurer or PBM shall not restrict such choice. Such health insurer or PBM shall not require or incentivize using any discounts in cost-sharing or a reduction in copay or the number of copays to individuals to receive prescription drugs from an individual's choice of in-network pharmacy.F. A health insurer, pharmacy or PBM shall adhere to all Oklahoma laws, statutes and rules when mailing, shipping and/or causing to be mailed or shipped prescription drugs into the State of Oklahoma.Added by Laws 2019, c. 426, § 6, eff. Nov. 1, 2019.
36 OK Stat § 36-6964 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6964. Formulary to identify drugs that offer greatest value.

|A. A health insurer's pharmacy and therapeutics committee (P&T committee) shall establish a formulary, which shall be a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. |B. A health insurer shall prohibit conflicts of interest for members of the P&T committee.1. A person may not serve on a P&T committee if the person is currently employed or was employed within the preceding year by a pharmaceutical manufacturer, developer, labeler, wholesaler or distributor.2. A health insurer shall require any member of the P&T committee to disclose any compensation or funding from a pharmaceutical manufacturer, developer, labeler, wholesaler or distributor. Such P&T committee member shall be recused from voting on any product manufactured or sold by such pharmaceutical manufacturer, developer, labeler, wholesaler or distributor.Added by Laws 2019, c. 426, § 7, eff. Nov. 1, 2019.