reglab/housing_qa huggingface dataset:
36 OK Stat § 36-6919 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6919. Examination of affairs, programs, books, and records - Payment of expenses.

|A. The Insurance Commissioner may make an examination of the affairs of any health maintenance organization, producers and providers with whom the organization has contracts, agreements or other arrangements pursuant to the provisions of Sections 309.1 through 309.7 of this title. |B. The Insurance Commissioner may require a health maintenance organization to contract for an examination concerning the quality assurance program of the health maintenance organization and of any providers with whom the organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state, but not less frequently than once every three (3) years.C. Every health maintenance organization and provider shall submit its books and records for examination and in every way facilitate the completion of an examination. For the purpose of an examination, the Insurance Commissioner may administer oaths to, and examine the officers and agents of the health maintenance organization and the principals of the providers concerning their business.D. Any health maintenance organization examined shall pay the proper charges incurred in such examination, including the actual expense of the Insurance Commissioner or the expenses and compensation of any authorized representative and the expense and compensation of assistants and examiners employed therein. All expenses incurred in such examination shall be verified by affidavit and a copy shall be filed in the office of the Insurance Commissioner.E. In lieu of an examination, the Insurance Commissioner may accept the report of an examination made by the health maintenance organization regulatory entity of another state.Added by Laws 2003, c. 197, § 19, eff. Nov. 1, 2003. Amended by Laws 2021, c. 478, § 39, emerg. eff. May 12, 2021.
36 OK Stat § 36-6922 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6922. Order to rectify financial condition or violation - Required actions - Remedies and measures available to Insurance Commissioner.

|A. Whenever the Insurance Commissioner determines that the financial condition of a health maintenance organization (HMO) is such that its continued operation might be hazardous to its enrollees, creditors or the general public, or that the HMO has violated any provision of the Health Maintenance Organization Act of 2003, the Insurance Commissioner may, after notice and opportunity for hearing, order the health maintenance organization to take action reasonably necessary to rectify the condition or violation including, but not limited, to one or more of the following: |1. Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the Insurance Commissioner;2. Reduce the volume of new business being accepted;3. Reduce expenses by specified methods;4. Suspend or limit the writing of new business for a period of time;5. Increase the health maintenance organization’s capital and surplus by contribution; or6. Take other steps the Insurance Commissioner may deem appropriate under the circumstances.B. For purposes of this section, the violation by a health maintenance organization of any law of this state to which the health maintenance organization is subject shall be deemed a violation of this act.C. Rules of the Insurance Commissioner establishing criteria that the Insurance Commissioner may consider in making a determination that the condition of any insurer is such that continuation of such insurer's business may be hazardous to the public or to holders of its policies or certificates of insurance may be used by the Insurance Commissioner for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization.D. The remedies and measures available to the Insurance Commissioner under this section shall be in addition to, and not in lieu of, the remedies and measures available to the Insurance Commissioner under the provisions of Section 1904 of Title 36 of the Oklahoma Statutes.Added by Laws 2003, c. 197, § 22, eff. Nov. 1, 2003.
36 OK Stat § 36-6923 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6923. Rules.

|The Insurance Commissioner may promulgate rules necessary or proper to carry out the provisions of the Health Maintenance Organization Act of 2003. |Added by Laws 2003, c. 197, § 23, eff. Nov. 1, 2003.
36 OK Stat § 36-6924 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6924. Payment of fees.

|Every health maintenance organization subject to the provisions of the Health Maintenance Organization Act of 2003 shall pay to the Insurance Commissioner the fees provided in Section 321 of Title 36 of the Oklahoma Statutes. |Added by Laws 2003, c. 197, § 24, eff. Nov. 1, 2003.
36 OK Stat § 36-6926 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6926. Provisions of laws not applicable to health maintenance organizations.

|A. Except as otherwise provided in the Health Maintenance Organization Act of 2003 or unless expressly made applicable to health maintenance organizations, provisions of the insurance law and provisions of hospital or medical service corporation laws shall not be applicable to a health maintenance organization granted a certificate of authority under the provisions of this act. This provision shall not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance law or the hospital or medical service corporation laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this act. |B. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.C. Any health maintenance organization authorized under this act shall not be deemed to be practicing medicine and shall be exempt from the provisions of Title 59 of the Oklahoma Statutes related to the practice of medicine.Added by Laws 2003, c. 197, § 26, eff. Nov. 1, 2003. Amended by Laws 2005, c. 129, § 20, eff. Nov. 1, 2005.
36 OK Stat § 36-6927 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6927. Public records - Trade secrets - Privileged or confidential information.

|All applications, filings, provider contracts excluding any financial terms and/or reimbursement criteria contained in such contracts, and reports required under the Health Maintenance Organization Act of 2003 shall be treated as public records, except those that are trade secrets or privileged or confidential quality assurance, commercial, financial or other information considered privileged or confidential under state or federal law, including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA). Annual financial statements that may be required under the provisions of Section 9 of this act shall be treated as public records. |Added by Laws 2003, c. 197, § 27, eff. Nov. 1, 2003.
36 OK Stat § 36-6928 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6928. Disclosure of diagnostic, treatment or health status information.

|A. 1. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from that person or from a provider by a health maintenance organization shall be held in confidence and shall not be disclosed to any person except: |a.to the extent that it may be necessary to carry out the purposes of the Health Maintenance Organization Act of 2003,b.upon the express consent of the enrollee or applicant,c.pursuant to statute or court order for the production of evidence or the discovery thereof, ord.in the event of claim or litigation between the person and the health maintenance organization wherein the data or information is pertinent.2. A health maintenance organization shall be entitled to claim any statutory privileges against disclosure that the provider who furnished the information to the health maintenance organization is entitled to claim.B. A person who, in good faith and without malice, takes an action or makes a decision or recommendation as a member, agent or employee of a health care review committee or who furnishes any records, information or assistance to such a committee shall not be subject to liability for civil damages or any legal action in consequence of the action, nor shall the health maintenance organization that established the committee or the officers, directors, employees or agents of the health maintenance organization be liable for the activities of the person. This section shall not be construed to relieve any person of liability arising from treatment of a patient.C. 1. The information considered by a health care review committee and the records of the committee’s actions and proceedings shall be confidential and not subject to subpoena or order to produce except in proceedings before the appropriate state licensing or certifying agency, or in an appeal, if permitted, from the committee’s findings or recommendations. No member of a health care review committee, or officer, director or other member of a health maintenance organization or its staff engaged in assisting a committee, or a person assisting or furnishing information to a committee may be subpoenaed to testify in any judicial or quasi-judicial proceeding if the subpoena is based solely on such activities.2. Information considered by a health care review committee and the records of its actions and proceedings that are used pursuant to the provisions of paragraph 1 of this subsection by a state licensing or certifying agency or in an appeal shall be kept confidential and shall be subject to the same provisions concerning discovery and use in legal actions as the original information and records in the possession and control of a health care review committee.D. To fulfill its obligations under Section 7 of this act, a health maintenance organization shall have access to treatment records and other information pertaining to the diagnosis, treatment or health status of an enrollee.Added by Laws 2003, c. 197, § 28, eff. Nov. 1, 2003.
36 OK Stat § 36-6929 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6929. Contracts by Health Commissioner with qualified persons.

|The Insurance Commissioner, in carrying out his or her obligations under the Health Maintenance Organization Act of 2003, may contract with qualified persons to make recommendations concerning the determinations required to be made by the Insurance Commissioner. The recommendations may be accepted in full or in part by the Insurance Commissioner. The Insurance Commissioner shall adopt procedures to ensure that such persons are not subject to a conflict of interest that would impair their ability to make recommendations in an impartial manner. |Added by Laws 2003, c. 197, § 29, eff. Nov. 1, 2003. Amended by Laws 2021, c. 478, § 41, emerg. eff. May 12, 2021.
36 OK Stat § 36-6930 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6930. Acquisition of control of health maintenance organization.

|No person other than the issuer may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person would, directly or indirectly, or by conversion or by exercise of any right to acquire be in control of the health maintenance organization. No person may enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person complied with the provisions of Article 16A of the Insurance Code. |Added by Laws 2003, c. 197, § 30, eff. Nov. 1, 2003.
36 OK Stat § 36-6931 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6931. Coordination of benefits provisions.

|A. A health maintenance organization is permitted, but not required, to adopt coordination of benefits provisions to avoid over insurance and to provide for the orderly payment of claims when an enrollee is covered by two or more group health insurance or health care plans. |B. If a health maintenance organization adopts coordination of benefits, the provisions thereof shall be consistent with the coordination of benefits provisions that are in general use in the state for coordinating coverage between two or more group health insurance or health care plans.C. To the extent necessary for a health maintenance organization to meet its obligations as a secondary carrier under the rules for coordination, a health maintenance organization may make payments for services that are:1. Received from nonparticipating providers;2. Provided outside its service areas; or3. Not covered under the terms of its group contract or evidence of coverage.Added by Laws 2003, c. 197, § 31, eff. Nov. 1, 2003.
36 OK Stat § 36-6934 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6934. Services permitted to be provided.

|Health maintenance organizations may provide any services included in state or federal health care programs, such as state employee benefits, the state basic health benefits program, "Medicare", "Medicaid", "CHAMPUS" and Veterans Administrations and other health programs provided in whole or in part by state or federal funds, in accordance with the laws governing such programs. |Added by Laws 2003, c. 197, § 34, eff. Nov. 1, 2003.
36 OK Stat § 36-6935 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6935. Services provided to out-of-state enrollees.

|Basic health care services as herein provided may be furnished to enrollees of health maintenance organizations outside this state only in accordance with the laws of the state or of the United States that govern the provision of such services in the state or place concerned; provided, that an enrollee may be reimbursed directly for emergency health care expenses incurred by the enrollee while temporarily outside the state, when such expenses would have been provided under the enrollee's program had the enrollee been within the state. Such reimbursement made by a health maintenance organization shall not be construed as an indemnity and no health maintenance organization shall be an insurer or make any contract of insurance of any kind whatsoever. |Added by Laws 2003, c. 197, § 35, eff. Nov. 1, 2003.
36 OK Stat § 36-6936 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6936. Severability.

|If any section, term or provision of this act shall be adjudged invalid for any reason, that judgment shall not affect, impair or invalidate any other section, term or provision of this act; but the remaining sections, terms and provisions shall be and remain in full force and effect. |Added by Laws 2003, c. 197, § 36, eff. Nov. 1, 2003.
36 OK Stat § 36-6937 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6937. Short title - Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003.

|This act shall be known and may be cited as the "Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003". |Added by Laws 2003, c. 197, § 37, eff. Nov. 1, 2003. Amended by Laws 2004, c. 146, § 2, eff. Nov. 1, 2004; Laws 2017, c. 287, § 7, eff. Nov. 1, 2017.
36 OK Stat § 36-6938 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6938. Definitions.

|As used in the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003: |1. “Adjusted Risk-based Capital (RBC) report” means an RBC report which has been adjusted by the Insurance Commissioner in accordance with the provisions of subsection C of Section 39 of this act;2. “Corrective order” means an order issued by the Commissioner specifying corrective actions which the Insurance Commissioner has determined are required;3. “Domestic health maintenance organization” means a health maintenance organization domiciled in this state;4. “Foreign health maintenance organization” means a health maintenance organization that is licensed to do business in this state under the Health Maintenance Organization Act of 2003, but is not domiciled in this state;5. “NAIC” means the National Association of Insurance Commissioners;6. “Health maintenance organization” means a health maintenance organization licensed under the Health Maintenance Organization Act of 2003. This definition does not include an organization that is licensed as either a life and health insurer or a property and casualty insurer under Title 36 of the Oklahoma Statutes and that is otherwise subject to either life or property and casualty RBC requirements;7. “RBC instructions” means the RBC report including risk-based capital instructions adopted by the NAIC, as these RBC instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC;8. “RBC level” means a health maintenance organization’s Company Action Level RBC, Regulatory Action Level RBC, Authorized Control Level RBC, or Mandatory Control Level RBC where:a.“Company Action Level RBC” means, with respect to any health maintenance organization, the product of 2.0 and its Authorized Control Level RBC,b.“Regulatory Action Level RBC” means the product of 1.5 and its Authorized Control Level RBC,c.“Authorized Control Level RBC” means the number determined under the risk-based capital formula in accordance with the RBC instructions, ord.“Mandatory Control Level RBC” means the product of .70 and the Authorized Control Level RBC;9. “RBC plan” means a comprehensive financial plan containing the elements specified in subsection B of Section 40 of this act. If the Insurance Commissioner rejects the RBC plan, and it is revised by the health maintenance organization, with or without the Insurance Commissioner’s recommendation, the plan shall be called the “revised RBC plan”;10. “RBC report” means the report required in Section 39 of this act; and11. “Total adjusted capital” means the sum of:a.a health maintenance organization’s statutory capital and surplus, or its net worth, as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed under Section 9 of this act, andb.such other items, if any, as the RBC instructions may provide.Added by Laws 2003, c. 197, § 38, eff. Nov. 1, 2003.
36 OK Stat § 36-6939 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6939. Report of Risk-based Capital (RBC) levels - Formula - Adjustment by Commissioner.

|A. A domestic health maintenance organization shall, on or prior to each March 1 filing date, prepare and submit to the Insurance Commissioner a report of its Risk-based Capital (RBC) levels as of the end of the calendar year just ended, in a form and containing such information as is required by the RBC instructions. In addition, a domestic health maintenance organization shall file its RBC report: |1. With the National Association of Insurance Commissioners (NAIC) in accordance with the RBC instructions; and2. With the Insurance Commissioner in any state in which the health maintenance organization is authorized to do business, if the Insurance Commissioner has notified the health maintenance organization of its request in writing, in which case the health maintenance organization shall file its RBC report not later than the later of:a.fifteen (15) days from the receipt of notice to file its RBC report with that state, orb.the filing date.B. A health maintenance organization’s RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take the following into account and may adjust for the covariance between, determined in each case by applying the factors in the manner set forth in the RBC instructions:1. Asset risk;2. Credit risk;3. Underwriting risk; and4. All other business risks and such other relevant risks as are set forth in the RBC instructions.C. If a domestic health maintenance organization files an RBC report that, in the judgment of the Commissioner, is inaccurate, the Commissioner shall adjust the RBC report to correct the inaccuracy and shall notify the health maintenance organization of the adjustment. The notice shall contain a statement of the reason for the adjustment. An RBC report as so adjusted is referred to as an “adjusted RBC report”.Added by Laws 2003, c. 197, § 39, eff. Nov. 1, 2003.
36 OK Stat § 36-6942 (2021)
2021 Oklahoma Statutes|Title 36. Insurance|§36-6942. Authorized control level event - Definition - Duties of Insurance Commissioner.

|A. “Authorized Control Level Event” means any of the following events: |1. The filing of an RBC report by the health maintenance organization that indicates that the health maintenance organization’s total adjusted capital is greater than or equal to its Mandatory Control Level RBC, but less than its Authorized Control Level RBC;2. The notification by the Commissioner to the health maintenance organization of an adjusted RBC report that indicates an Authorized Control Level Event as 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;3. 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;4. The failure of the health maintenance organization to respond, in a manner satisfactory to the Commissioner, to a corrective order, provided the health maintenance organization has not challenged the corrective order under Section 44 of this act; or5. If the health maintenance organization has challenged a corrective order under Section 44 of this act and the Commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the health maintenance organization to respond, in a manner satisfactory to the Commissioner, to the corrective order subsequent to rejection or modification by the Commissioner.B. In the event of an Authorized Control Level Event with respect to a health maintenance organization, the Commissioner shall:1. Take such actions as are required under Section 41 of this act regarding a health maintenance organization with respect to which a Regulatory Action Level Event has occurred; or2. If the Commissioner deems it to be in the best interests of the policyholders and creditors of the health maintenance organization and of the public, take such actions as are necessary to cause the health maintenance organization to be placed under regulatory control pursuant to the provisions of Articles 18 and 19 of the Insurance Code. In the event the Commissioner takes such actions, the Authorized 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.Added by Laws 2003, c. 197, § 42, eff. Nov. 1, 2003.