reglab/housing_qa huggingface dataset:
36 OK Stat § 36-4426.1 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4426.1. Rescission or denial of claim upon grounds of misrepresentation.

|A. For a policy or certificate that has been in force for less than six (6) months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage. |B. For a policy or certificate that has been in force for at least six (6) months but less than two (2) years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the conditions for which benefits are sought.C. After a policy or certificate has been in force for two (2) years, it is not contestable upon the grounds of misrepresentation alone; such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.D. 1. No long-term care insurance policy or certificate may be field-issued based on medical or health status.2. For purposes of this section, "field-issued" means a policy or certificate issued by an agent or a third-party administrator pursuant to the underwriting authority granted to the agent or third-party administrator by an insurer.E. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.F. Provided further, if under the provisions of this section said policy or certificate is rescinded by the insurer, then in that event the insured shall be refunded within thirty (30) days of rescission all premiums paid to the insurer by the insured for the policy or certificate.Added by Laws 1993, c. 136, § 3, eff. Sept. 1, 1993.
36 OK Stat § 36-4427 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4427. Rulemaking authority - Civil penalty.

|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 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.Added by Laws 1987, c. 175, § 31, eff. Nov. 1, 1987. Amended by Laws 1989, c. 107, § 5, eff. Nov. 1, 1989; Laws 1993, c. 136, § 4, eff. Sept. 1, 1993; Laws 1997, c. 418, § 97, eff. Nov. 1, 1997.
36 OK Stat § 36-4428 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4428. Investment of life care community policy funds.

|Any funds received pursuant to a life care community policy shall be invested only in assets enumerated in Section 1607 of Title 36 of the Oklahoma Statutes. |Added by Laws 1989, c. 107, § 6, eff. Nov. 1, 1989.
36 OK Stat § 36-4429 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4429. Suitability standards.

|A. 1. This section shall not apply to life insurance policies or riders containing accelerated long-term care benefits. |2. For certificates issued on or after the effective date of this act, under a group long-term care insurance policy as defined in Section 4424 of Title 36 of the Oklahoma Statutes, which policy was in force at the time this act became effective, the provisions of this section shall not apply.B. Every provider of long-term care insurance shall:1. Develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the applicant;2. Train its agents in the use of its suitability standards; and3. Maintain a copy of its suitability standards and make them available for inspection upon request by the Insurance Commissioner.C. 1. To determine whether the applicant meets the standards developed by the provider, the agent and provider shall develop procedures that take the following into consideration:a.the ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage,b.the applicant's goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs, andc.the values, benefits and costs of the applicant's existing insurance, if any, when compared to the values, benefits and costs of the recommended purchase or replacement.2. The provider and, where an agent is involved, the agent shall make reasonable efforts to obtain the information set out in paragraph 1 of this subsection. The efforts shall include, at or prior to application, providing the applicant with a personal worksheet and a disclosure form which have been prescribed by the Commissioner and are consistent with the National Association of Insurance Commissioners (NAIC) Long-Term Care Insurance Model Regulation.3. A completed personal worksheet shall be returned to the provider prior to the provider's consideration of the applicant for coverage, except that the personal worksheet need not be returned for sales of employer group long-term care insurance to employees and their spouses.4. The sale or dissemination outside the company or agency by the provider or agent of information obtained through the personal worksheet is prohibited.D. The provider shall use the suitability standards it has developed pursuant to this section and information furnished by the applicant in determining whether issuing long-term care insurance coverage to an applicant is appropriate.Added by Laws 1995, c. 244, § 3, eff. Nov. 1, 1995.
36 OK Stat § 36-4430 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4430. Renewal premium rates.

|A. Upon approval of the Insurance Commissioner, an insurer may charge an increased renewal premium upon showing that the increase is necessary because of utilization of policy benefits in excess of the expected rate. |B. 1. This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.2. For certificates issued or delivered on or after November 1, 1995, under a group long-term care insurance policy as defined in Section 4424 of this title, which policy was in force on November 1, 1995, the provisions of this section shall not apply.3. This section does not apply to policies or certificates approved for issue or delivery on or after November 1, 2001.Added by Laws 1995, c. 244, § 4, eff. Nov. 1, 1995. Amended by Laws 2001, c. 363, § 21, eff. July 1, 2001; Laws 2002, c. 307, § 31, eff. Nov. 1, 2002; Laws 2009, c. 176, § 32, eff. Nov. 1, 2009.
36 OK Stat § 36-4502.1 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4502.1. Conversion privilege.

|A. A health insurance policy delivered or issued for delivery in this state that provides for conversion to an individual policy by an insured on termination of membership in or employment with the group shall provide a conversion privilege to an individual policy to the spouse of the insured on death of the insured or on divorce from the insured or on termination of the insured's membership in or employment with the group for any reason including retirement. If the conversion privilege available to the insured provides for coverage of the insured's spouse, the group insurer shall not be required to issue a separate conversion policy to the spouse. |B. Subsection A of this section applies only to a spouse of an insured if the spouse is covered under the health insurance policy at the time of the insured's death or divorce from the insured or termination of the insured's coverage.C. This act applies to all health insurance policies that are delivered or issued for delivery in this state on or after October 1, 1981. Any presently approved policy forms containing any provision in conflict with the requirements of this act may be brought into compliance with this act by the use of riders and endorsements which have been approved by the Commissioner of Insurance.D. As used in this section:1. "Health insurance policy" means a group policy or contract providing insurance for hospital, surgical, or medical expenses incurred as a result of an accident or sickness.2. "Insured" means an employee or member of a group that is covered by a health insurance policy.E. The person who accepts the conversion policy shall become the insured and pay the premiums direct to the insurer.Laws 1981, c. 160, § 2.
36 OK Stat § 36-4503 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4503. Direct payment of hospital, medical services.

|Any group accident and health policy may provide that subject to any written direction of the insured in the application or otherwise, all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option, and unless the insured requests otherwise not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but the policy may not require that the service be rendered by a particular hospital or person. Payments so made shall discharge the insurer's obligation with respect to the amount of insurance so paid. |Laws 1957, p. 399, § 4503.
36 OK Stat § 36-4504 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4504. Blanket accident and health insurance.

|A. Blanket accident and health insurance is hereby declared to be that form of accident and health insurance covering special groups of persons as enumerated in one of the following paragraphs (1) to (7) inclusive: |1. Under a policy or contract issued to any common carrier, which shall be deemed the policyholder, covering a group defined as all persons who may become passengers on such common carrier.2. Under a policy or contract issued to an employer, who shall be deemed the policyholder, covering all employees or any group of employees defined by reference to exceptional hazards incident to such employment. Dependents of the employees and guests of the employer may also be included where exposed to the same hazards.3. Under a policy or contract issued to a college, school, or other institution of learning or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or teachers.4. Under a policy or contract issued in the name of any volunteer fire department, first aid, or other such volunteer group, or agency having jurisdiction thereof, which shall be deemed the policyholder, covering all of the members of such fire department or group.5. Under a policy or contract issued to a creditor, who shall be deemed the policyholder, to insure debtors of the creditor.6. Under a policy or contract issued to a sports team or to a camp or sponsor thereof, which shall be deemed the policyholder, covering members or campers.7. Under a policy or contract issued to any other substantially similar group which, in the discretion of the Insurance Commissioner, may be subject to the issuance of a blanket accident and health policy or contract.B. An individual application need not be required from a person covered under a blanket accident and health policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate.C. All benefits under any blanket accident and health policy shall be payable to the person insured, or to his designated beneficiary or beneficiaries, or to his estate, except that if the person insured be a minor, such benefits may be made payable to his parent, guardian, or other person actually supporting him; except, that the policy may provide that subject to any written direction of the insured in the application or otherwise, all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option and unless the insured requests otherwise not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payments so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.D. Nothing contained in this section shall be deemed to affect the legal liability of policyholders for the death of or injury to any such member of such group.Laws 1957, p. 399, § 4504.
36 OK Stat § 36-4505 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4505. Group and blanket accident and health policy provisions.

|The provisions of Article 44 (Individual Accident and Health Insurance) shall not apply to group accident and health or blanket accident and health insurance policies, but no such policy of group or blanket accident and health insurance shall contain any provision relative to notice or proof of loss, or to the time for paying benefits, or to the time within which suit may be brought on the policy, which is less favorable to the individuals insured than would be permitted by the standard provisions required for individual accident and health insurance policies. |Laws 1957, p. 400, § 4505.
36 OK Stat § 36-4506 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4506. Misrepresentation prohibited.

|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. |Laws 1957, p. 400, § 4506.
36 OK Stat § 36-4507 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4507. Rules and regulations.

|The Insurance Commissioner may make and promulgate written rules and regulations reasonable, necessary and incidental to the enforcement and administration of the provisions of this article. |Laws 1957, p. 400, § 4507.
36 OK Stat § 36-4508 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4508. Selection of licensed psychologist or licensed and certified clinical social worker - Definitions.

|A. If the terms of any group or blanket accident and health insurance policy cover services within the lawful scope of practice of a licensed psychologist or licensed and certified clinical social worker then: |1. Such services may be performed by any person licensed to do so in this state as provided in subsection B of this section.2. Selection of such a psychologist or social worker may be made by the insured at his option and, provided other conditions of the policy are met, reimbursement shall not be denied when service is rendered by a person so licensed.3. The provisions of this section shall apply to the policies and contracts of insurance issued thereunder which are delivered, amended, ratified, or issued for delivery in Oklahoma, after October 1, 1982.4. Any provision, exclusion, or limitation of a policy that denies an insured the privilege of selecting such a psychologist or social worker shall, to the extent of the denial, be void, but such void provision shall not affect the validity of the other provisions of the policy.B. For purposes of this section:1. "Licensed psychologist" means a person licensed and complying with the Psychologists Licensing Act, Sections 1351 through 1375 of Title 59 of the Oklahoma Statutes; and2. "Licensed and certified social worker" means a person licensed and complying with the Social Workers' Licensing Act, Sections 1250.1 (3) and 1261.1 (B) of Title 59 of the Oklahoma Statutes.Amended by Laws 1982, c. 61, § 3, operative Oct. 1, 1982.
36 OK Stat § 36-4509.3 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4509.3. Rules.

|The Insurance Commissioner shall adopt and promulgate rules for the provisions of Sections 4501 and 4509.1 of Title 36 of the Oklahoma Statutes and Section 3 of this act. |Added by Laws 1992, c. 304, § 4, eff. Jan. 1, 1993.
36 OK Stat § 36-4511 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4511. Employer health care programs - Pharmacy services - Violation.

|A. No employer providing pharmacy services including prescription drugs to any employee or retiree of said employer, as part of a health care program, shall knowingly require the employee or retiree of said employer to obtain drugs from a mail order pharmacy as a condition of obtaining the employer's payment for such prescription drugs. |B. Any person violating the provisions of this section, upon conviction, shall be guilty of a misdemeanor. Each such violation shall constitute a separate offense.Added by Laws 1987, c. 139, § 2, emerg. eff. June 19, 1987. Renumbered from § 353.28 of Title 59 by Laws 1990, c. 127, § 1, eff. Sept. 1, 1990. Amended by Laws 2002, c. 307, § 32, eff. Nov. 1, 2002.
36 OK Stat § 36-4513 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4513. Disclosure of patient insurance coverage and benefit 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, 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.Added by Laws 2006, c. 315, § 13, emerg. eff. June 9, 2006.
36 OK Stat § 36-4521 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4521. Short title.

|Sections 1 through 9 of this act shall be known and may be cited as the "Employer Health Insurance Purchasing Group Act". |Added by Laws 2002, c. 276, § 1, eff. Nov. 1, 2002.
36 OK Stat § 36-4525 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4525. Filing of forms and plan – Notice required on face page of policy and certificate.

|A. Each Health Insurance Purchasing Group (HIPG) shall file forms as may be described by rules and regulations of the Commissioner. |B. Each HIPG health carrier shall file the health benefits plan to be issued to a HIPG pursuant to Article 36 of the Oklahoma Insurance Code.C. Each HIPG health carrier, which develops or offers a health benefits plan for a HIPG that is a limited benefit plan not subject to state-mandated health benefits, shall specify on the face page of the policy and certificate, printed in ten-point or larger type, a statement that clearly indicates in substance the following:“IMPORTANT NOTICE: This policy is a limited benefit contract which has been established by a Health Insurance Purchasing Group (HIPG). It may not contain mandated benefits found under Oklahoma Insurance Laws. READ YOUR POLICY CAREFULLY.”Added by Laws 2002, c. 276, § 5, eff. Nov. 1, 2002.
36 OK Stat § 36-4526 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4526. Services for members – Contracts with third-party administrators – Information to be disseminated to members – Administrative charges.

|A. Each Health Insurance Purchasing Group (HIPG) may provide administrative services for its members. The services may include, but are not limited to, accounting, billing, enrollment information, and employee coverage status reports. |B. The HIPG may delegate or contract its billing and other administrative duties to a third-party administrator as defined under Article 14B of the Oklahoma Insurance Code.C. 1. Nothing in this section shall be construed as preventing a HIPG from serving as an administrative service organization to any entity.2. Each HIPG shall collect and disseminate or arrange for the collection and dissemination of consumer-oriented information on the scope, cost, and enrollee satisfaction of all coverage options offered through the HIPG to its members.3. The information shall be defined by the HIPG and shall be in a manner appropriate to the type of coverage offered.4. To the extent practicable, the information shall include information on provider performance, locations, and hours of operation of providers, outcomes, and similar matters.5. Nothing in this section shall be construed as preventing the dissemination of the information or other information by the HIPG or by the health care insurer through electronic or other means.D. The contract between a HIPG and a HIPG health carrier shall provide that the HIPG may collect premiums on behalf of the issuer for coverage, less a predetermined administrative charge negotiated by the HIPG and the issuer.Added by Laws 2002, c. 276, § 6, eff. Nov. 1, 2002.
36 OK Stat § 36-4527 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-4527. Members of boards of directors – Conflict of interest – Definition of “affiliated”.

|A. A member of a board of directors of a Health Insurance Purchasing Group (HIPG) shall not serve as an employee or paid consultant to the HIPG, but may receive reasonable reimbursement for travel expenses for purposes of attending meetings of the board or committees thereof. |B. An individual is not eligible to serve in a paid or unpaid capacity on the board of directors of a HIPG or as an employee of the HIPG, if the individual is employed by, represents in any capacity, owns, or controls any ownership interest in an organization from whom the HIPG receives contributions, rents, or other funds not connected with a contract for coverage through the HIPG.C. An individual who is serving on a board of directors of a HIPG as a representative described in subsection B of this section shall not be employed by or affiliated with a HIPG health carrier. For purposes of this subsection, the term "affiliated" does not include membership in a health benefits plan or the obtaining of health benefits coverage offered by a HIPG health carrier.Added by Laws 2002, c. 276, § 7, eff. Nov. 1, 2002.