reglab/housing_qa huggingface dataset:
36 OK Stat § 36-6561 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6561. Refusal to issue or renew or suspension or revocation of certificate - Hearing - Appeal.

|A. The Insurance Commissioner may refuse to issue or renew or may suspend or revoke a certificate if the holder does not comply with performance assurances under this section, violates any provision of the Hospital and Medical Services Utilization Review Act, or violates any rule adopted pursuant thereto. |B. The Commissioner shall deny or refuse to renew a certificate to any applicant if, upon review of the application, the Commissioner finds that the applicant proposing to conduct utilization review does not:1. Have available the services of a sufficient number of qualified medical professionals supervised by appropriate health care providers to carry out the applicant's utilization review activities. Said sufficiency shall be based on standards and criteria pursuant to the provisions of subparagraph b of paragraph 1 of Section 8 of this act;2. Meet any applicable rules the Commissioner adopted pursuant to the Hospital and Medical Services Utilization Review Act relating to the qualifications of private review agents or the performance of utilization review; and3. Provide assurances satisfactory to the Commissioner that:a.the procedure and policies of the private review agent shall protect the confidentiality of medical records, andb.the review agent shall be reasonably accessible in this state to patients, hospitals and health care providers as required by this act.C. Before denying, not renewing, or revoking a certificate, the Commissioner shall provide the applicant or certificate holder with reasonable time to supply additional information demonstrating compliance with the requirements of the Hospital and Medical Services Utilization Review Act and the opportunity to request a hearing. If an applicant or certificate holder requests a hearing, the Commissioner shall send a hearing notice and conduct a hearing in accordance with the Administrative Procedures Act.D. Any person aggrieved by a final decision of the Commissioner in a contested case may appeal the decision as provided for in the Administrative Procedures Act.Added by Laws 1991, c. 294, § 11, eff. Nov. 1, 1991.
36 OK Stat § 36-6562 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6562. Disclosure or publication of confidential medical information.

|A private review agent shall not disclose or publish individual medical records or any other confidential medical information obtained in the performance of utilization review activities without the appropriate procedures for protecting the patient's confidentiality. Provided, however, that nothing in the Hospital and Medical Services Utilization Review Act shall prohibit a private review agent from providing patient information to a third party with whom the private review agent is affiliated, under contract, or for whom the agent is acting. |Added by Laws 1991, c. 294, § 12, eff. Nov. 1, 1991.
36 OK Stat § 36-6563 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6563. Liability - Construction of act.

|Nothing in the Hospital and Medical Services Utilization Review Act shall be deemed to reduce or expand the liability of any person or entity for any actions or activities with respect to utilization review. |Added by Laws 1991, c. 294, § 13, eff. Nov. 1, 1991.
36 OK Stat § 36-6564 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6564. Examination of affairs of private review agent.

|Whenever the Insurance Commissioner deems it to be prudent for the benefit of the insureds, health care providers, or insurers, the Commissioner or any person designated by the Commissioner may visit and examine the affairs of any private review agent to determine if the agent is in compliance with the provisions of the Hospital and Medical Services Utilization Review Act or any rules adopted or orders issued pursuant thereto. |Any person or entity examined pursuant to the provisions of the Hospital and Medical Services Utilization Review Act shall pay the proper charges incurred for such examination, including the actual expenses of the Insurance Commissioner or the expenses and compensation of his authorized representative and the expenses and compensation of assistants and examiners employed therein.Added by Laws 1991, c. 294, § 14, eff. Nov. 1, 1991.
36 OK Stat § 36-6565 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6565. Civil fines.

|For any violation of the provisions of the Hospital and Medical Services Utilization Review Act or any rule adopted pursuant thereto, the Insurance Commissioner may, upon notice and hearing, subject a person or entity to a civil fine of not less than One Hundred Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00) for each occurrence. |Added by Laws 1991, c. 294, § 15, eff. Nov. 1, 1991.
36 OK Stat § 36-6571 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6571. Determination of average area or customary and reasonable charges - Disclosure to health care provider of information used.

|A. As used in this section: |1. "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; and2. "Insurer" means any insurance company, not-for-profit hospital service and medical indemnity plan, health insurance service organization, preferred provider organization or other entity offering health insurance policies, contracts or benefits in this state.B. Any insurer which:1. Makes a determination or contracts with a third party who makes the determination of average area charges or customary and reasonable charges for health care services, procedures or supplies; and2. Based on such determination, authorizes payment in an amount which is less than the amount charged by the health care provider for such services, procedures or supplies;shall, upon the request of a health care provider, furnish the name, mailing address and telephone number of the party making the determination to the health care provider.C. Upon the request of the health care provider, the party shall furnish, for a reasonable charge, information used to determine the average area charges or customary and reasonable charges for the services, procedures or supplies provided by the health care provider and authorized for payment pursuant to paragraph 2 of subsection B of this section. The information shall include the rationale and documentation of sources used in the determination of the average area charges or customary and reasonable charges for the services, procedures or supplies in question, including names, mailing addresses and telephone numbers of sources if available. Such information shall be furnished to the health care provider no later than ten (10) working days after the request for information by the health care provider.D. 1. No insurer shall use the services of a party for the determination of average area charges or customary and reasonable charges which is not in compliance with the provisions of this section.2. Noncompliance shall be reported to the Insurance Commissioner who, upon investigation of the complaint and determination that the party is in noncompliance and that no resolution of the complaint will be made within a reasonable time, shall compile and maintain a list of parties which are not in compliance with the provisions of this section.Added by Laws 1992, c. 297, § 1, eff. Sept. 1, 1992.
36 OK Stat § 36-6581 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6581. Uniform health claim forms - Uniform billing forms - Rules.

|A. On or before January 1, 1994, the Insurance Commissioner shall develop and adopt: |1. Uniform health care claim forms for use by all health care providers and carriers in the state; and2. Uniform standards and procedures for processing such claim forms in electronic and hard-copy form.The Commissioner shall direct all insurers licensed in the state to begin using the uniform claim forms by July 1, 1994.B. The Commissioner shall adopt the health care financing administration (HCFA) 1500 form for outpatient billing and claim submission, or its successor, and the uniform billing (UB) 92 form for hospital billing and claim submission, or its successor as the uniform health care claim and billing form for appropriate hospital and medical expenses, and shall develop uniform forms for other health care provider services, including but not limited to pharmacy and dental services.C. The Commissioner shall promulgate such rules as are necessary for developing, adopting and administering the uniform claim forms and processing system.Added by Laws 1993, c. 304, § 1, emerg. eff. June 7, 1993. Amended by Laws 1995, c. 246, § 2, eff. Nov. 1, 1995.
36 OK Stat § 36-6591 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6591. Short title - Declaration of necessity.

|A. Sections 1 through 6 of this act shall be known and may be cited as the "Managed Health Care Reform and Accountability Act". |B. The Legislature hereby declares that the public good and the general welfare of the citizens of this state require the enactment of this measure under the police power of the state as part of and in furtherance of the regulation of the business of insurance.Added by Laws 2000, c. 163, § 1, eff. July 1, 2000.
36 OK Stat § 36-6592 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6592. Definitions.

|For purposes of this act: |1. "Enrollee" means an individual who is enrolled in a health care plan, including covered dependents;2. "Health care plan" means any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the costs of any health care services for an enrollee;3. "Health care provider" means a physician, hospital, pharmaceutical company, pharmacy, pharmacist, laboratory, or other state-licensed or state-recognized provider of health care services;4. "Health insurance carrier" means an insurance company that issues policies of accident and health insurance and is or should be licensed to sell insurance in this state;5. "Health maintenance organization" means an organization which is or should be licensed by the State Department of Health pursuant to Section 2501 et seq. of Title 63 of the Oklahoma Statutes;6. "Managed care entity" means any entity which is a health care plan, health insurance carrier or health maintenance organization as defined in this section, but does not include an employer that sponsors or participates in a health care plan or purchases coverage or assumes risk on behalf of or for the benefit of its employees or the employees of one or more subsidiaries or affiliates of the employer; and7. "Medically necessary” means services or supplies provided by a health care provider that are:a.appropriate for the symptoms and diagnosis or treatment of the enrollee’s condition, illness, disease, or injury,b.in accordance with standards of good medical practice,c.not primarily for the convenience of the enrollee or the enrollee’s health care provider, andd.the most appropriate supply or level of service that can safely be provided to the enrollee.Added by Laws 2000, c. 163, § 2, eff. July 1, 2000.
36 OK Stat § 36-6593 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6593. Duty of health care entity to exercise ordinary care - Liability for damages - Application of act.

|A. A health insurance carrier, health maintenance organization, or other managed care entity for a health care plan has the duty to exercise ordinary care when making health care treatment decisions and shall be liable for damages for harm to an enrollee proximately caused by breach of the duty to exercise ordinary care if: |1. The failure to exercise ordinary care resulted in the denial, significant delay, or modification of the health care service recommended for, or furnished to, an enrollee; and2. The enrollee suffered harm.B. The standards in subsection A of this section create no obligation on the part of the health insurance carrier, health maintenance organization, or other managed care entity to provide to an enrollee treatment which is not covered by the health care plan.C. This act does not create any liability on the part of an employer or an employer group purchasing organization that sponsors or participates in a health care plan or purchases coverage or assumes risk on behalf of or for the benefit of its employees or the employees of one or more subsidiaries or affiliates of the employer.D. A health care plan, health insurance carrier, health maintenance organization, or managed care entity may not remove a health care provider from its plan or refuse to renew the health care provider from its plan for advocating on behalf of an enrollee for appropriate and medically necessary health care for the enrollee.E. A health insurance carrier, health maintenance organization, or other managed care entity shall not seek indemnification from a health care provider, whether contractual or equitable, for liability imposed by this act. Any provision in a contract to the contrary is void and unenforceable.F. Nothing in any law of this state prohibiting a health insurance carrier, health maintenance organization, or other managed care entity from practicing medicine or being licensed to practice medicine may be asserted as a defense by a health insurance carrier, health maintenance organization, or other managed care entity in an action brought against it pursuant to this section or any other law of this state.G. This section shall not create any new or additional liability on the part of a health insurance carrier, health maintenance organization, or managed care entity for harm caused that is attributable to the medical negligence of a health care provider.H. An enrollee who files an action under this act shall comply with all requirements relating to cost bonds, deposits, and expert reports.I. This act shall not apply to insurance agents licensed by the Insurance Department.J. This act shall not apply to workers’ compensation insurance.Added by Laws 2000, c. 163, § 3, eff. July 1, 2000.
36 OK Stat § 36-6594 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6594. Prerequisites to maintaining cause of action - Exhaustion of appeal and review process and all applicable remedies - Notice.

|A. A person may not maintain a cause of action under this act against a health insurance carrier, health maintenance organization, or other managed care entity unless the affected enrollee or the representative of the enrollee, has exhausted any appeal and review process applicable under the utilization review requirements of the plan, has exhausted all applicable remedies specified in the Oklahoma Managed Care External Review Act and gives written notice of the claim as provided in subsection B of this section. |B. The notice required by subsection A of this section shall be delivered or mailed to the health insurance carrier, health maintenance organization, or managed care entity against whom the action will be brought at least thirty (30) days before the action is filed.C. If the enrollee or the representative of the enrollee has not exhausted the appeal and review processes and gives notice as required by subsection A of this section before the statute of limitations applicable to a claim against a managed care entity has expired, the limitations period is tolled until thirty (30) days after the date the enrollee or the representative of the enrollee has exhausted the processes for appeal and review pursuant to subsection A of this section.Added by Laws 2000, c. 163, § 4, eff. July 1, 2000.
36 OK Stat § 36-6595 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6595. Class action.

|No cause of action brought pursuant to this act shall be certified as a class action. |Added by Laws 2000, c. 163, § 5, eff. July 1, 2000.
36 OK Stat § 36-6596 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6596. Application of Section 9.1 of Title 23 to cause of action brought under act.

|Subparagraph c of paragraph 2 of subsection C of Section 9.1 of Title 23 of the Oklahoma Statutes shall not apply to any cause of action brought under the Managed Health Care Reform and Accountability Act. |Added by Laws 2000, c. 163, § 6, eff. July 1, 2000.
36 OK Stat § 36-6650 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6650. Short title.

|Sections 2 through 13 of this act shall be known and may be cited as the “Vehicle Protection Product Act”. |Added by Laws 2008, c. 353, § 2, eff. Jan. 1, 2009.
36 OK Stat § 36-6651 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6651. Definitions.

|As used in the Vehicle Protection Product Act: |1. "Administrator" means a third party other than the warrantor who is designated by the warrantor to be responsible for the administration of vehicle protection product warranties;2. "Commissioner" means the Insurance Commissioner;3. "Department" means the Insurance Department;4. "Incidental costs" means expenses specified in the warranty incurred by the warranty holder related to the failure of the vehicle protection product to perform as provided in the warranty. Incidental costs may include insurance policy deductibles, rental vehicle charges, the difference between the actual value of the stolen vehicle at the time of theft and the cost of a replacement vehicle, vehicle excise taxes, vehicle registration fees, certificate of title fees, transaction fees and mechanical inspection fees;5. "Service contract" means a contract or agreement as defined under the Service Warranty Act in Title 15 of the Oklahoma Statutes;6. "Vehicle protection product" means a vehicle protection device, system, or service that:a.is installed on or applied to a vehicle,b.is designed to prevent loss or damage to a vehicle from a specific cause, andc.includes a written warranty.For purposes of this section, the term vehicle protection product shall include alarm systems, body part marking products, steering locks, window etch products, pedal and ignition locks, fuel and ignition kill switches, and electronic, radio and satellite tracking devices;7. "Vehicle protection product warranty" or "warranty" means a written agreement by a warrantor that provides if the vehicle protection product fails to prevent loss or damage to a vehicle from a specific cause, that the warrantor will pay to or on behalf of the warranty holder specified incidental costs as a result of the failure of the vehicle protection product to perform pursuant to the terms of the warranty;8. "Vehicle protection product warrantor" or "warrantor" means a person who is contractually obligated to the warranty holder under the terms of the vehicle protection product warranty agreement. Warrantor does not include an authorized insurer providing a warranty reimbursement insurance policy;9. "Warranty holder" means a person who purchases a vehicle protection product or who is a permitted transferee; and10. "Warranty reimbursement insurance policy" means a policy of insurance that is issued to the vehicle protection product warrantor to provide reimbursement to the warrantor or to pay on behalf of the warrantor all covered contractual obligations incurred by the warrantor under the terms and conditions of the insured vehicle protection product warranties issued by the warrantor.Added by Laws 2008, c. 353, § 3, eff. Jan. 1, 2009. Amended by Laws 2012, c. 150, § 34, eff. Nov. 1, 2012; Laws 2014, c. 418, § 5, eff. Nov. 1, 2014.
36 OK Stat § 36-6652 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6652. Compliance with act.

|A. No vehicle protection product may be sold or offered for sale in this state unless the seller, warrantor and administrator, if any, comply with the provisions of the Vehicle Protection Product Act. |B. Vehicle protection product warrantors and related vehicle protection product sellers and warranty administrators complying with the Vehicle Protection Product Act are not required to comply with and are not subject to any other provisions of the Insurance Code.C. Service contract providers who sell vehicle protection products and are licensed under the Service Warranty Act in Title 15 of the Oklahoma Statutes are not subject to the requirements of the Vehicle Protection Product Act and sales of the vehicle protection products under the Vehicle Protection Product Act are exempt from the requirements of the Service Warranty Act.D. Warranties, indemnity agreements and guarantees that are not provided as a part of a vehicle protection product are not subject to the provisions of the Vehicle Protection Product Act.Added by Laws 2008, c. 353, § 4, eff. Jan. 1, 2009. Amended by Laws 2012, c. 150, § 35, eff. Nov. 1, 2012; Laws 2014, c. 418, § 6, eff. Nov. 1, 2014.
36 OK Stat § 36-6653 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6653. Warrantor registration.

|A. A person may not operate as a warrantor or represent to the public that the person is a warrantor unless the person is registered with the Insurance Department on a form prescribed by the Insurance Commissioner. |B. Warrantor registration records shall be filed annually and shall be updated within thirty (30) days of any change. The registration records shall contain the following information:1. The warrantor’s name, any fictitious names under which the warrantor does business in the state, principal office address, and telephone number;2. The name and address of the warrantor’s agent for service of process in the state if other than the warrantor;3. The names of the warrantor’s executive officer or officers directly responsible for the warrantor’s vehicle protection product business;4. The name, address, and telephone number of any administrators designated by the warrantor to be responsible for the administration of vehicle protection product warranties in this state;5. A copy of the warranty reimbursement insurance policy or policies or other financial information required by Section 6 of this act;6. A copy of each warranty the warrantor proposes to use in this state; and7. A statement indicating under which provision of Section 6 of this act the warrantor qualified to do business in this state as a warrantor.C. The Commissioner may charge each registrant a reasonable fee to offer the cost of processing the registration and maintaining the records in an amount to be set by rule. The information in paragraphs 1 and 2 of subsection B of this section shall be made available to the public.D. If a registrant fails to register by the renewal deadline, the Commissioner shall give the registrant written notice of the failure and the registrant will have thirty (30) days to complete the renewal of registration before the registrant is suspended from being registered in this state.E. An administrator or person who sells or solicits a sale of a vehicle protection product but who is not a warrantor shall not be required to register as a warrantor or be licensed under the insurance laws of this state to sell vehicle protection products.Added by Laws 2008, c. 353, § 5, eff. Jan. 1, 2009.