reglab/statecodes huggingface dataset:
2023 Oklahoma Statutes › Title 36. Insurance › §36-4213. Beneficiary; change of beneficiary; payment of proceeds.

A. Each such policy shall have a space on the front or back page of the policy for the name of the beneficiary designated; and shall contain a reservation of the right to designate or change the beneficiary after the issuance of the policy.
B. The policy may also provide that no designation or change of beneficiary shall be binding on the insurer unless endorsed on the policy by the insurer, and that the insurer may refuse to endorse the name of any proposed beneficiary who does not appear to the insurer to have an insurable interest in the life of the insured. Such a policy may also provide that if the beneficiary designated in the policy does not surrender the policy with due proof of death within the period stated in the policy, which shall be not less than thirty (30) days after the death of the insured, or if the beneficiary is the estate of the insured or is a minor, or dies before the insured, or is not legally competent to give a valid release, then the insurer may make payment thereunder to the executor or administrator of the insured, or to any of the insured's relatives by blood or legal adoption or connection by marriage, or to any person appearing to the insurer to be equitably entitled thereto by reason of having been named beneficiary, or by reason of having incurred expense for the maintenance, medical attention or burial of the insured. Such policy may also include a similar provision applicable to any other payment due under the policy.
Laws 1957, p. 387, § 4213.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4214. Direct payment of premiums.

In the case of weekly premium policies, there may be a provision that upon proper notice to the insurer, while premiums on the policy are not in default beyond the grace period, of the intention to pay future premiums directly to the insurer at its home office or any office designated by the insurer for the purpose, the insurer will, at the end of each period of a year from the due date of the first premium so paid, for which period such premiums are so paid continuously without default beyond the grace period, refund a stated percentage of the premiums in an amount which fairly represents the savings in collection expense.
Laws 1957, p. 387, § 4214.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4215. Conversion.

There may be a provision in the case of industrial policies granting to the insured, upon proper written request and upon presentation of evidence of insurability satisfactory to the insurer, the privilege of converting any industrial insurance policy to any form of life insurance with less frequent premium payments regularly issued by the insurer, in accordance with terms and conditions agreed upon with the insurer. The privilege of making such conversion need be granted only if the insurer's industrial policies on the life insured, in force as premium paying insurance and on which conversion is requested, grant benefits in event of death, exclusive of additional accidental death benefits and exclusive of any dividend additions, in an amount not less than the minimum amount of such insurance with less frequent premium payments issued by the insurer at the age of the insured on the plan of industrial or ordinary insurance desired.
Laws 1957, p. 387, § 4215.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4217. Provisions inapplicable to single premium or term policies.

Any of the provisions required by Sections 4214 to 4216, inclusive, of this article or any portion thereof which are not applicable to single premium or term policies or to policies issued or granted pursuant to nonforfeiture provisions shall to that extent not be incorporated therein.
Laws 1957, p. 388, § 4217.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4218. Prohibited provisions.

No policy of industrial insurance shall contain any of the following provisions:
1. A provision by which the insurer may deny liability under the policy for the reason that the insured has previously obtained other insurance from the same insurer.
2. A provision giving the insurer the right to declare the policy void because the insured has had any disease or ailment, whether specified or not, or because the insured has received institutional, hospital, medical or surgical treatment or attention, except a provision which gives the insurer the right to declare the policy void if the insured has, within two (2) years prior to the issuance of the policy, received institutional, hospital, medical or surgical treatment or attention and if the insured or claimant under the policy fails to show that the condition occasioning such treatment or attention was not of a serious nature or was not material to the risk.
3. A provision giving the insurer the right to declare the policy void because the insured has been rejected for insurance, unless such right be conditioned upon a showing by the insurer that knowledge of such rejection would have led to a refusal by the insurer to make such contract.
Laws 1957, p. 388, § 4218.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4250. Rate filing – Definitions.

A. On or after the effective date of this act, pursuant to the provisions of this section and any other applicable section of Title 36 of the Oklahoma Statutes, every health benefit plan shall file all group and individual initial rates and group and individual rate adjustments with the Insurance Commissioner. If the Commissioner determines that the initial rate or rate adjustment is unreasonable, excessive, unjustified or unfairly discriminatory, the Commissioner shall make a written decision stating the reason or reasons for the determination, and shall deliver a copy of the determination to the company within thirty (30) calendar days unless the Commissioner extends the determination period for an additional thirty (30) calendar days.
B. 1. For purposes of this section, "health benefit plan" means a plan that:
a.
provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, and
b.
is offered by any insurance company, group hospital service corporation, or health maintenance organization that delivers or issues for delivery an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an evidence of coverage, or, to the extent permitted by the Employee Retirement Income Security Act of 1974, 29 U.S.C., Section 1001 et seq., by a multiple employer welfare arrangement as defined in Section 3 of the Employee Retirement Income Security Act of 1974, or any other analogous benefit arrangement, whether the payment is fixed or by indemnity.
2. The term "health benefit plan" shall not include:
a.
a plan that provides coverage:
(1)
only for a specified disease or diseases or under an individual limited benefit policy,
(2)
only for accidental death or dismemberment,
(3)
for dental or vision care,
(4)
a hospital confinement indemnity policy or other fixed indemnity insurance,
(5)
disability income insurance or a combination of accident-only and disability income insurance, or
(6)
as a supplement to liability insurance,
b.
a Medicare supplemental policy as defined by Section 1882(g)(1) of the Social Security Act (42 U.S.C., Section 1395ss),
c.
workers’ compensation insurance coverage,
d.
medical payment insurance issued as part of a motor vehicle insurance policy,
e.
a long-term care policy, including a nursing home fixed indemnity policy, unless a determination is made that the policy provides benefit coverage so comprehensive that the policy meets the definition of a health benefit plan,
f.
short-term health insurance issued on a nonrenewable basis with duration of six (6) months or less,
g.
policy issued under Title XVIII, or
h.
a plan issued to any person, firm, corporation, partnership, limited liability company or association that is actively engaged in business and that, on at least fifty percent (50%) of its working days during the preceding calendar quarter, employed more than fifty (50) eligible employees.
Added by Laws 2011, c. 278, § 29. Amended by Laws 2011, c. 360, § 24.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4400. Criteria for inflation protection coverage.

A. In accordance with Section 6021 of the Deficit Reduction Act of 2005 (P.L. 109-171) and any applicable provision relating to the Oklahoma Long-Term Care Insurance Partnership Program, any policy intended to meet the requirements under such Program must meet the following criteria for inflation protection coverage:
1. For a person who is less than sixty-one (61) years of age as of the date of purchase of the Partnership policy, such policy provides annual inflation protection of at least three percent (3%) per year compounded annually or a rate, compounded annually, that is based upon changes in the consumer price index;
2. For a person who is at least sixty-one (61) years of age but less than seventy-six (76) years of age as of the date of purchase of the Partnership policy, such policy provides annual inflation protection of at least three percent (3%) simple or a rate that is based on the annual consumer price index;
3. For a person who is at least seventy-six (76) years of age as of the date of purchase of the Partnership policy, such policy may provide inflation protection.
B. Persons who purchase a Partnership policy that meets the inflation protection criteria in subsection A of this section may adjust their inflation protection as they age. Their policies will maintain Partnership status as long as the inflation protection continues to meet the minimum requirements for their attained age.
C. For the purposes of this section, "consumer price index" means the consumer price index for all urban consumers as determined by the Bureau of Labor Statistics within the United States Department of Labor. The Insurance Commissioner may approve an alternative index to be used in place of the consumer price index or alternative inflation protection programs developed by the insurer if the Commissioner deems that such programs would meet the intent of this section.
Added by Laws 2014, c. 99, § 1, eff. Nov. 1, 2014.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4401. Scope of article.

This article shall apply to all insurance companies, foreign and domestic, including mutual benefit associations licensed pursuant to Article 24, limited stock life, accident and health insurers licensed pursuant to Article 25, reciprocal inter-insurance exchanges licensed pursuant to Article 29, and Lloyd's insurers licensed pursuant to Article 30, hereinafter referred to in this article as "the insurer" or "insurer," issuing policies of insurance against loss or expense from sickness, or from bodily injury or death by accident.
Laws 1957, p. 388, § 4401.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4402. Accident and health policies; filing.

On and after the effective date of this Code no policy of insurance against loss or expense from the sickness, or from the bodily injury or death of the insured by accident shall be issued or delivered to any person in this state, nor shall any application, rider or endorsement be used in connection therewith until a copy of the form thereof, and of the classification of risks, and the premium rates pertaining thereto, have been filed with the Insurance Commissioner. If the Insurance Commissioner disapproves the policy, application, rider or endorsement form, said Commissioner shall make a written decision stating the reason or reasons therefor, and shall deliver a copy thereof to the company, and it shall be unlawful for any such insurer to use any such form in the state. Any such insurer shall have twenty (20) days from the date of receipt of the notice of disapproval in which to request a hearing on such disapproval.
Laws 1957, p. 388, § 4402.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4403. Definition of accident and health insurance policy.

The term "policy of accident and health insurance" as used herein includes any policy or contract insuring against loss resulting from sickness, or from bodily injury or death by accident or both. Provided, however, the term does not include coverage provided under a limited benefit insurance policy or contract as defined in Section 4403.1 of this title.
Added by Laws 1957, p. 388, § 4403. Amended by Laws 1996, c. 246, § 10, eff. July 1, 1996.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4403.1. Definition of limited benefit insurance policy.

A. 1. "Limited benefit insurance" means a policy or contract designed to be purchased individually or to supplement major medical accident and health insurance and which only provides coverage that is less than the minimum standard for benefits required under basic hospital expense coverage or basic medical-surgical expense coverage.
2. A limited benefit insurance policy or contract may specify a waiting period for coverage, maximum benefits, maximum length of coverage, and an exact definition of the disease covered.
B. Nothing in this section shall increase, limit, or remove jurisdiction of the Insurance Commissioner over limited benefit insurance.
Added by Laws 1996, c. 246, § 11, eff. July 1, 1996.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4406. Conforming to statute.

A. Other Policy Provisions. No policy provision which is not subject to section 4405 of this article shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this article.
B. Policy Conflicting with this Article. A policy delivered or issued for delivery to any person in this state in violation of this article shall be held valid but shall be construed as provided in this article. When any provision in a policy subject to this article is in conflict with any provision of this article, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this article.
Laws 1957, p. 396, § 4406.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4407. Application.

A. The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof. If any such policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of such policy shall make written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall, within fifteen (15) days after the receipt of such request at its home office or any branch office of the insurer, deliver or mail to the person making such request a copy of such application. If such copy shall not be so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal. B. No alteration of any written application for any such policy shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.
C. The falsity of any statement in the application for any policy covered by this article may not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.
Laws 1957, p. 396, § 4407.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4408. Notice; waiver.

The acknowledgment by any insurer of the receipt of notice given under any policy covered by this article, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
Laws 1957, p. 397, § 4408.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4409. Age limit.

If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
Added by Laws 1957, p. 397, § 4409, operative July 1, 1957.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4410. Franchise accident and health insurance law.

Accident and health insurance on a franchise plan is hereby declared to be that form of accident and health insurance issued to: 1. Five or more employees of any corporation, copartnership or individual employer or any governmental corporation, agency or department thereof; or
2. Ten or more members, employees or employees of members of any trade or professional association or of a labor union or of any other association having had an active existence for at least two (2) years where such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance;
where such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons under an arrangement whereby the premiums on such policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association for its members, or by some designated person acting on behalf of such employer or association. The term "employees" as used herein may be deemed to include the officers, managers and employees of the employer and the individual proprietor or partners if the employer is an individual proprietor or partnership.
Laws 1957, p. 397, § 4410.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4411. Nonapplication to certain policies.

Nothing in this article shall apply to or affect:
1. any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein; or
2. any policy or contract of reinsurance; or
3. any blanket or group policy of insurance except as provided in paragraph F, Section 4405 of this article; or
4. life insurance, endowment or annuity contracts, or contracts supplemental thereto, which contain only such provisions relating to accident and health insurance as (a) provide additional benefits in case of death or dismemberment or loss of sight by accident, as (b) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract, or as (c) provide additional benefits providing acceleration of life or endowment or annuity benefits in advance of the time they would otherwise be payable, as an indemnity for long-term care which is certified or ordered by a physician, including but not limited to, professional nursing care, medical care expenses, custodial nursing care, nonnursing custodial care provided in a nursing home or at a residence of the insured or providing such acceleration upon the occurrence of a catastrophic disease or diseases as designated and defined by the policy, provided, no life insurance policy, except industrial life insurance policy and group life insurance policy, shall be issued or delivered in this state which contains or provides accident and health coverage, except as provided by the foregoing (a), (b) and (c). A rider providing additional benefits as described in the foregoing (c) shall conform to the requirements of the Long-Term Care Insurance Act and accompanying regulations. The Insurance Commissioner shall have authority to require appropriate reserves for the rider as is provided for additional reserves in subparagraph (d) of paragraph 3 of Section 1505 of this title. The Insurance Commissioner shall have power to make reasonable rules and regulations concerning such provisions, and contracts or supplemental contracts containing such provisions, and the same shall not be issued or delivered to any person in the state unless and until a copy of the form thereof has been filed with the Insurance Commissioner as required by law.
Laws 1957, p. 397, § 4411.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4419. Short-term, limited-duration insurance policies – Limitations on benefits provided.

A. For the purposes of this section "short-term, limited-duration insurance" or "STLDI" means individual health insurance coverage provided pursuant to a contract with an insurer that has an expiration date specified in the contract that is less than twelve (12) months after the original effective date of the contract and, taking into account renewals or extensions, has a duration of no longer than thirty-six (36) months in total.
B. An STLDI policy shall not be subject to the continuation provisions of the Health Insurance Portability and Accountability Act of 1996, and shall be exempt from medical loss ratio calculations associated with individual accident and health insurance issued within this state.
C. No STLDI policy shall be deemed to be included under the definition of group accident and health insurance issued or renewed inside or outside of this state and covering persons residing in this state.
D. The benefits provided by an STLDI policy may be limited as follows:
1. An STLDI policy shall not be required to contain one or more of the mandated accident and health insurance benefits otherwise required by Title 36 of the Oklahoma Statutes; and
2. An STLDI policy shall include the definitions of individual accident and health insurance with respect to major medical benefits and standard provisions or rights of coverage.
E. An applicant for an STLDI policy shall be provided, at the time of application and in addition to any notice required by applicable federal law or regulation, a written notice that one or more of the benefits mandated by Oklahoma law is not included in the STLDI policy.
1. The notice shall specify the essential health benefits that are included in the STLDI policy. For purposes of this subsection, "essential health benefits" means those benefits set forth in 42 U.S.C., Section 18022(b).
2. The notice shall specifically list the accident and health insurance benefits otherwise required to be covered by Title 36 of the Oklahoma Statutes that will not be covered.
3. The insurer shall retain a signed copy of this notice on file as a part of the original application as evidence that the insured has acknowledged such notice.
4. Such signed copy may be in original form, electronic file form or in any other reproducible file form as may be consistent with the insurer's method of retaining application copies.
F. An STLDI policy may offer various optional combinations of coverage at additional premiums for each optional benefit offered.
G. STLDI policies issued in Oklahoma shall be subject to the filing requirements of Section 4402 of Title 36 of the Oklahoma Statutes.
H. Any individual insured under an STLDI policy shall be issued an identification card which clearly indicates that the STLDI policy is a limited duration policy not subject to Affordable Care Act requirements.
Added by Laws 2019, c. 418, § 1, eff. Nov. 1, 2019.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4421. Short title.

Section 4421 et seq. of this title shall be a part of the Insurance Code and shall be known and may be cited as the "Long-Term Care Insurance Act".
Added by Laws 1987, c. 175, § 25, eff. Nov. 1, 1987. Amended by Laws 1989, c. 107, § 1, eff. Nov. 1, 1989; Laws 1995, c. 244, § 1, eff. Nov. 1, 1995.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4422. Purpose of act.

The purpose of the Long-Term Care Insurance Act is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage.
Added by Laws 1987, c. 175, § 26, eff. Nov. 1, 1987.
2023 Oklahoma Statutes › Title 36. Insurance › §36-4423. Application of act.

A. The requirements of the Long-Term Care Insurance Act shall apply to policies, other than life care community policies delivered or issued for delivery in this state on or after November 1, 1987. The requirements of the Long-Term Care Insurance Act shall apply to life care community policies delivered or issued for delivery in this state on or after November 1, 1989.
B. Notwithstanding any other provision, the Long-Term Care Insurance Act shall not apply to the following:
1. Residential care homes licensed pursuant to the Oklahoma Residential Care Act;
2. Assisted living centers and continuum of care facilities licensed pursuant to the Oklahoma Continuum of Care and Assisted Living Act; or
3. Facilities licensed pursuant to the Oklahoma Nursing Home Care Act.
C. The Long-Term Care Insurance Act is not intended to supersede the obligations of entities subject to said act to comply with the substance of other applicable insurance laws insofar as they do not conflict with the Long-Term Care Insurance Act, except that laws and regulations designed and intended to apply to Medicare supplement insurance policies shall not apply to long-term care insurance. A policy which is not advertised, marketed or offered as long-term care insurance need not meet the requirements of the Long-Term Care Insurance Act. The Long-Term Care Insurance Act is not intended to require life care communities to be licensed insurers. Life care communities which are not licensed insurers shall not be subject to the provisions of the Insurance Code or the jurisdiction of the Insurance Commissioner, except as provided in the Long-Term Care Insurance Act.
Added by Laws 1987, c. 175, § 27, eff. Nov. 1, 1987. Amended by Laws 1989, c. 107, § 2, eff. Nov. 1, 1989; Laws 2000, c. 171, § 1, emerg. eff. May 2, 2000.
2023 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.
2023 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.
2023 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; and
3. 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, and
c.
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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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; and
2. "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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.