reglab/statecodes huggingface dataset:
2023 Oklahoma Statutes › Title 36. Insurance › §36-6676. License application requirements.

A. A sworn application for the license provided for in Section 6671 of this title shall be made to and filed with the Insurance Commissioner on forms prescribed and furnished by the Insurance Commissioner.
B. The application shall:
1. Provide the name, residence address, and other information required by the Insurance Commissioner for an employee or officer of the vendor that is designated by the applicant as the person responsible for the vendor's compliance with the requirements of Sections 6670 through 6676 of this title and update such information within thirty (30) days of a change in the same. If the vendor derives more than fifty percent (50%) of its revenue from the sale of portable electronics insurance, the information required in this subparagraph shall be provided for all officers, directors, and shareholders of record having beneficial ownership of ten percent (10%) or more of any class of securities registered under the federal securities law;
2. Appoint the Insurance Commissioner as the applicant's attorney to receive service of all legal process issued against it in any civil action or proceeding in this state and agreeing that process so served shall be valid and binding against the applicant. The appointment shall be irrevocable, shall bind the company and any successor in interest as the assets or liabilities of the applicant, and shall remain in effect as long as the applicant's license remains in force in this state; and
3. Specify the location of the applicant's home office.
C. Applications for licensure pursuant to Section 6671 of this title shall be made within ninety (90) days of the application being made available by the Insurance Commissioner.
D. Initial licenses issued pursuant to Section 6671 of this title shall be valid for a period of twenty-four (24) months.
E. Each vendor of portable electronics licensed pursuant to Sections 6670 through 6676 of this title shall pay to the Insurance Commissioner a fee as prescribed by the Insurance Commissioner but in no event shall the fee exceed One Thousand Dollars ($1,000.00) for an initial portable electronics limited lines license and Five Hundred Dollars ($500.00) for each renewal thereof. For a vendor that is engaged in portable electronics transactions at ten or fewer locations in the state the fee shall not exceed One Hundred Dollars ($100.00) for an initial license and for each renewal thereof.
Added by Laws 2011, c. 93, § 7, eff. Nov. 1, 2011. Amended by Laws 2012, c. 147, § 5, eff. Nov. 1, 2012.
NOTE: Editorially renumbered from Title 36, Section 6636 to provide consistency in numbering.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6701. Workers' compensation providers – Notice to policyholder.

A. Each insurance company that provides workers' compensation insurance or an equivalent insurance product in this state shall maintain or provide workplace safety services for its policyholders as a condition for approval by the Insurance Commissioner to write such insurance. Such services shall be adequate to implement workplace safety plans as required by the nature of its policyholders' operations and shall include but not be limited to surveys, recommendations, training programs, consultations, analyses of accident causes, industrial hygiene, and industrial health services.
B. Notice that workplace safety services are available to the policyholder from the insurance company must appear in no less than ten-point bold type on the front of each workers' compensation insurance or equivalent insurance policy delivered or issued for delivery in this state.
Added by Laws 1994, 2nd Ex. Sess., c. 1, § 11, emerg. eff. Nov. 4, 1994. Amended by Laws 2013, c. 254, § 27, eff. Jan. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6711. Purpose and application of act.

A. The purpose of this act is to promote the public welfare by creating a comprehensive legal framework within which travel insurance may be sold in this state.
B. The requirements of the act shall apply to travel insurance covering any resident of this state that is sold, solicited, negotiated or offered in this state and policies and certificates that are delivered or issued for delivery in this state. It shall not apply to cancellation fee waivers and travel assistance services, except as expressly provided herein.
C. All other applicable provisions of this state’s insurance laws shall continue to apply to travel insurance except that the specific provisions of the Travel Insurance Act shall supersede any general provisions of law that would otherwise be applicable to travel insurance.
Added by Laws 2018, c. 159, § 3, eff. Nov. 1, 2018. Amended by Laws 2021, c. 84, § 1, eff. Nov. 1, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6714. Premium tax.

A. A travel insurer shall pay premium tax, as provided in Section 624 of this title, on travel insurance premiums paid by any of the following:
1. An individual primary policyholder who is a resident of this state;
2. A primary certificate-holder who is a resident of this state who elects coverage under a group travel insurance policy; or
3. A blanket travel insurance policyholder that is a resident of this state, or has its principal place of business or the principal place of business of an affiliate or subsidiary that has purchased blanket travel insurance in this state for eligible blanket group members, subject to any apportionment rules which apply to the insurer across multiple taxing jurisdictions or that permit the insurer to allocate premium on an apportioned basis in a reasonable and equitable manner in those jurisdictions.
B. A travel insurer shall:
1. Document the state of residence or principal place of business of the policyholder or certificate-holder, as required in subsection A of this section; and
2. Report as premium only the amount allocable to travel insurance and not any amounts received for travel assistance services or cancellation fee waivers.
C. For purposes of this section:
1. “Primary certificate holder” means an individual person who elects and purchases travel insurance under a group policy; and
2. “Primary policyholder” means an individual person who elects and purchases individual travel insurance.
Added by Laws 2018, c. 159, § 6, eff. Nov. 1, 2018. Amended by Laws 2021, c. 84, § 4, eff. Nov. 1, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6715. Travel protection plans.

Travel protection plans may be offered for one price for the combined features that the travel protection plan offers in this state if:
1. The travel protection plan clearly discloses to the consumer at, or prior to, the time of purchase that it includes travel insurance, travel assistance services and cancellation fee waivers as applicable, and provides information and an opportunity at, or prior to, the time of purchase for the consumer to obtain additional information regarding the features and pricing of each; and
2. The fulfillment materials:
a.
describe and delineate the travel insurance, travel assistance services and cancellation fee waivers in the travel protection plan, and
b.
include the applicable travel insurance disclosures and the contact information for persons providing travel assistance services and cancellation fee waiver.
Added by Laws 2018, c. 159, § 7, eff. Nov. 1, 2018.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6717. Qualifications for travel administrators.

A. Notwithstanding any other provisions of law, no person shall act or represent itself as a travel administrator for travel insurance in this state unless that person:
1. Is a licensed property and casualty insurance producer in this state for activities permitted under that producer license;
2. Holds a valid managing general agent license in this state; or
3. Holds a valid third-party administrator license in this state.
B. A travel administrator and its employees are exempt from the licensing requirements of the Insurance Adjuster Licensing Act, Sections 6201 et seq. of this title, for travel insurance it administers.
C. An insurer is responsible for the acts of a travel administrator managing travel insurance underwritten by the insurer, and is responsible for ensuring that the travel administrator maintains all books and records relevant to the insurer, to be made available by the travel administrator to the Insurance Commissioner upon request.
Added by Laws 2018, c. 159, § 9, eff. Nov. 1, 2018. Amended by Laws 2021, c. 84, § 6, eff. Nov. 1, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6718. Classification and filing terms - Individual and group policies allowed.

A. Notwithstanding any other provision of the Travel Insurance Act, travel insurance shall be classified and filed for purposes of rates and forms under an inland marine line of insurance; provided, however, that travel insurance covering sickness, accident, disability or death occurring during travel, either exclusively or in conjunction with related coverages of emergency evacuation or repatriation of remains, may be filed under either an inland marine line of insurance or an accident and health line of insurance.
B. Travel insurance may be provided under an individual policy or under a group or master policy.
C. Eligibility and underwriting standards for travel insurance may be developed and provided based on travel protection plans designed for the individual or identified marketing or distribution channels, provided those standards also meet the underwriting standards for inland marine lines of insurance in this state.
Added by Laws 2018, c. 159, § 10, eff. Nov. 1, 2018. Amended by Laws 2021, c. 84, § 7, eff. Nov. 1, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6751. Purpose - Exemptions.

A. The purpose of the Oklahoma Home Service Contract Act is to create an independent legal framework within which home service contracts and home warranties are defined, may be sold and are regulated in this state. The Oklahoma Home Service Contract Act declares that home service contracts and home warranties, as defined in Section 6752 of this title, are not insurance and not otherwise subject to the Insurance Code. The Oklahoma Home Service Contract Act requires simple registration, financial assurance options and enforcement by the Insurance Commissioner. Proper registration under the Oklahoma Home Service Contract Act exempts applicability under the Service Warranty Act, which may regulate extended warranty, retail, automobile and agreements not defined in the Oklahoma Home Service Contract Act. Nothing in the Service Warranty Act is changed or amended by the Oklahoma Home Service Contract Act.
B. The following items are exempt from the provisions of the Oklahoma Home Service Contract Act:
1. Warranties as defined in Section 6752 of this title;
2. Maintenance agreements as defined in Section 6752 of this title; and
3. Service contracts sold or offered for sale to persons other than consumers, consumer product (extended warranty) service contracts on new retail goods if made at the time of sale and motor vehicle service contracts, all of which may be separately regulated elsewhere in the Oklahoma Statutes.
C. The types of agreements covered by the Oklahoma Home Service Contract Act are not insurance and do not have to comply with any other provision of the Insurance Code outside of the Oklahoma Home Service Contract Act.
Added by Laws 2011, c. 224, § 2, eff. Nov. 1, 2011. Amended by Laws 2012, c. 150, § 37, eff. Nov. 1, 2012; Laws 2021, c. 137, § 1, eff. Nov. 1, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6802v1. Telemedicine defined.

As used in the Oklahoma Telemedicine Act, "telemedicine" means technology-enabled health and care management and delivery systems that extend capacity and access, which includes:
a.
synchronous mechanisms, which may include live audiovisual interaction between a patient and a health care professional or real-time provider to provider consultation through live interactive audiovisual means,
b.
asynchronous mechanisms, which include store and forward transfers, online exchange of health information between a patient and a health care professional and online exchange of health information between health care professionals, but shall not include the use of automated text messages or automated mobile applications that serve as the sole interaction between a patient and a health care professional,
c.
remote patient monitoring, and
d.
other electronic means that support clinical health care, professional consultation, patient and professional health-related education, public health and health administration.
Added by Laws 1997, c. 209, § 2, eff. July 1, 1997. Amended by Laws 2009, c. 148, § 6, eff. Nov. 1, 2009; Laws 2021, c. 293, § 1, eff. Nov. 1, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6813. Compilation of data - Report.

The Department shall compile the data included in individual closed claim reports filed pursuant to this act into a composite form and shall prepare annually a written report of the composite data. The Department shall make the composite data report available to the public.
Added by Laws 2003, c.390, § 14, eff. July 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6814. Electronic database.

The Commissioner shall:
1. Establish an electronic database composed of composite data reports required pursuant to Section 14 of this act;
2. Provide the public with access to that data;
3. Establish a system to provide access to that data by electronic data transmittal processes; and
4. Set and charge a fee for electronic access to the database in an amount reasonable and necessary to cover the costs of access.
Added by Laws 2003, c. 390, § 15, eff. July 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6815. Submission of composite data reports Governor and Legislature.

A. The Department shall submit copies of the composite data report required pursuant to Section 14 of this act to the Governor, the President Pro Tempore of the Senate and the Speaker of the House of Representatives.
B. The Department, on request of the Governor, the President Pro Tempore of the Senate, or the Speaker of the House of Representatives, shall provide to the Governor and the Legislature additional composite data reports. Composite data reports prepared under this subsection shall be available to the public.
Added by Laws 2003, c. 390, § 16, eff. July 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6816. Confidentiality.

A. Information included in an individual closed claim report submitted by an insurer under Sections 12 and 13 of this act is confidential and shall not be made available by the Department to the public and shall not be subject to the Oklahoma Open Records Act.
B. Information included in an individual closed claim report may be examined only by the Commissioner and Department employees.
Added by Laws 2003, c. 390, § 17, eff. July 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6817. Designated statistical agent - Definition.

STATISTICAL DATA COLLECTION
As used in Sections 19 and 20 of this act, “designated statistical agent” means an organization designated or contracted with by the Commissioner pursuant to Section 19 of this act.
Added by Laws 2003, c. 390, § 18, eff. July 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6818. Designation of or contract with organization to serve as statistical agent.

The Insurance Commissioner may designate or contract with a qualified organization to serve as the statistical agent for the Commissioner to analyze the information provided pursuant to Sections 12 and 13 of this act.
Added by Laws 2003, c. 390, § 19, eff. July 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6830. Insurance compliance audits - Confidentiality.

A. Except as provided in Sections 2 and 3 of this act, an insurance compliance self-evaluative audit is privileged information and is not discoverable, or admissible as evidence in any legal action in any civil, criminal, or administrative proceeding. The privilege created herein is a matter of substantive law of this state and is not merely a procedural matter governing civil or criminal procedures in the courts of this state.
B. If any company, person, or entity performs or directs the performance of an insurance compliance audit, an officer, employee or agent involved with the insurance audit, or any consultant who is hired for the purpose of performing the insurance compliance audit, may not be examined in any civil, criminal, or administrative proceeding as to the insurance compliance audit or any insurance compliance self-evaluative audit document, as defined in this section. This section does not apply if the privilege set forth in subsection A of this section is determined under Section 2 or 3 of this act not to apply.
C. A company may voluntarily submit, in connection with examinations conducted under this act, an insurance compliance self-evaluative audit document to the Insurance Commissioner, or designee, as a confidential document without waiving the privilege set forth in this section to which the company would otherwise be entitled; provided, however, that the provisions of the Oklahoma Insurance Code permitting the Commissioner to make confidential documents public and grant access to documents to the National Association of Insurance Commissioners shall not apply to the insurance compliance self-evaluative audit document. Any such report furnished to the Insurance Commissioner shall not be provided to any other persons or entities and shall be accorded the same confidentiality and other protections as provided above for voluntarily submitted documents.
D. A company's insurance compliance self-evaluative audit document submitted to the Commissioner shall remain subject to all applicable statutory or common law privileges including, but not limited to, the work product doctrine, attorney-client privilege, or the subsequent remedial measures exclusion.
E. Any compliance self-evaluative audit document so submitted and in the possession of the Commissioner shall remain the property of the company and shall not be subject to any disclosure or production under the Oklahoma Open Records Act.
F. Disclosure of an insurance compliance self-evaluative audit document to a governmental agency, whether voluntary or pursuant to compulsion of law, shall not constitute a waiver of the privilege set forth in subsection A of this section with respect to any other persons or any other governmental agencies.
Added by Laws 2012, c. 257, § 1, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6831. Applicability of confidentiality privilege - Disclosure.

A. The privilege set forth in Section 1 of this act does not apply:
1. To the extent that it is expressly waived by the company that prepared or caused to be prepared the insurance compliance self-evaluative audit document;
2. If the company that prepared or caused to be prepared the insurance compliance self-evaluative audit document provides the audit or any audit documents to any witness for the purpose of testimonial use in the matter in which the privilege is being asserted; or
3. If the insurance compliance self-evaluative audit document shows evidence of noncompliance with applicable state or federal laws, rules, regulations or orders and appropriate efforts to achieve compliance with such laws, rules, regulations or orders were not initiated within a reasonable time and pursued with reasonable diligence upon discovery of noncompliance.
B. In a civil or administrative proceeding, a court of record may, after an in camera review, require disclosure of material for which the privilege set forth in Section 1 of this act is asserted, if the court determines one of the following:
1. The privilege is intentionally asserted in bad faith or for a fraudulent or any other similar improper purpose; or
2. The material is not subject to the privilege.
If the court requires disclosure because of paragraph 1 of this subsection, the court may impose sanctions as for any other violation of the rules of discovery.
C. In a criminal proceeding, a court of record may, after an in camera review, require disclosure of material for which the privilege described in Section 1 of this act is asserted, if the court determines one of the following:
1. The privilege is asserted in bad faith or for a fraudulent or any other similar improper purpose;
2. The material is not subject to the privilege; or
3. The material contains evidence relevant to commission of a criminal offense, and all three of the following factors are present:
a.
the Insurance Commissioner, district attorney, or Attorney General has a compelling need for the information,
b.
the information is not otherwise available, and
c.
the Insurance Commissioner, district attorney, or Attorney General is unable to obtain the substantial equivalent of the information by any other means without incurring unreasonable cost and delay.
Added by Laws 2012, c. 257, § 2, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6832. Petition for in camera hearing - Contents.

A. Within thirty (30) days after the Insurance Commissioner, district attorney, Attorney General, or opposing party in a civil, criminal or administrative proceeding, serves on an insurer a written request by certified mail for disclosure of an insurance compliance self-evaluative audit document under this act, the company that prepared or caused the document to be prepared may file with the appropriate court a petition requesting an in camera hearing on whether the insurance compliance self-evaluative audit document or portions of the document are privileged or subject to disclosure. Failure by the company to file a petition waives the privilege for this request only.
B. A company asserting the insurance compliance self-evaluative privilege in response to a request for disclosure under this act shall include in its request for an in camera hearing all of the information set forth in subsection E of this section.
C. Upon the filing of a petition under this section, the court shall issue an order scheduling, within forty-five (45) days after the filing of the petition, an in camera hearing to determine whether the insurance compliance self-evaluative audit document or portions of the document are privileged under this section or subject to disclosure.
D. The court, after an in camera review, may require disclosure of material for which the privilege in Section 1 of this act is asserted if the court determines, based upon its in camera review, that any one of the conditions set forth in subsection B of Section 2 of this act is applicable as to a civil or administrative proceeding or that any one of the conditions set forth in subsection C of Section 2 of this act is applicable as to a criminal proceeding. Upon making such a determination, the court may only compel the disclosure of those portions of an insurance compliance self-evaluative audit document relevant to issues in dispute in the underlying proceeding. Any compelled disclosure will not be considered to be a public document or be deemed to be a waiver of the privilege for any other civil, criminal, or administrative proceeding. A party unsuccessfully opposing disclosure may apply to the court for an appropriate order protecting the document from further disclosure.
E. A company asserting the insurance compliance self-evaluative privilege in response to a request for disclosure under this act shall provide to the Insurance Commissioner, district attorney, Attorney General, or opposing party in a civil, criminal or administrative proceeding, as the case may be, at the time of filing any objection to the disclosure, all of the following information:
1. The date of the insurance compliance self-evaluative audit document;
2. The identity of the entity conducting the audit;
3. The general nature of the activities covered by the insurance compliance self-evaluative audit; and
4. An identification of the portions of the insurance compliance self-evaluative audit document for which the privilege is being asserted.
Added by Laws 2012, c. 257, § 3, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6833. Burden of proof.

A. A company asserting the insurance compliance self-evaluative privilege set forth in Section 1 of this act has the burden of demonstrating the applicability of the privilege. Once a company has established the applicability of the privilege, the party seeking disclosure under this act has the burden of proving that the privilege is asserted in bad faith or for a fraudulent or any other similar improper purpose. The Insurance Commissioner, district attorney, or Attorney General seeking disclosure under this act has the burden of proving the elements set forth in subsection B or C of Section 2 of this act.
B. The parties may at any time stipulate in proceedings under Section 2 or 3 of this act to entry of an order directing that specific information contained in an insurance compliance self-evaluative audit document is or is not subject to the privilege provided under Section 1 of this act. Any such stipulation may be limited to the instant proceeding and, absent specific language to the contrary, shall not be applicable to any other proceeding.
Added by Laws 2012, c. 257, § 4, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6834. Non-privileged information.

The privilege set forth in Section 1 of this act shall not extend to any of the following:
1. Documents, communications, data, reports, or other information expressly required to be collected, developed, maintained, or reported to a regulatory agency pursuant to this act, or other federal or state law;
2. Information obtained by observation, monitoring or examination by any regulatory agency;
3. Information contained from a source independent of the insurance compliance audit; or
4. Documents and other material created or maintained in the ordinary course of the insurer’s business, specifically including communications between the insurer and insureds, individual claim files and any other similar documents which are currently discoverable under existing law.
Added by Laws 2012, c. 257, § 5, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6835. Definitions.

As used in this act:
1. "Insurance compliance audit" means a voluntary internal evaluation, review, assessment, audit, or investigation for the purpose of identifying or preventing noncompliance with, or promoting compliance with, laws, regulations, orders, or industry or professional standards, which is conducted by or on behalf of a company licensed or regulated under the Oklahoma Insurance Code, or which involves an activity regulated under this Code. Once initiated, an audit shall be completed within a reasonable period of time. Nothing in this section shall be construed to authorize uninterrupted or continuous auditing; and
2. "Insurance compliance self-evaluative audit document" means documents prepared as a result of or in connection with an insurance compliance audit. An insurance compliance self-evaluative audit document may include, but is not limited to, as applicable, field notes and records of observations, findings, opinions, suggestions, conclusions, drafts, memoranda, drawings, photographs, exhibits, computer-generated or electronically recorded information, phone records, maps, charts, graphs, and surveys; provided, this supporting information is collected or developed for the primary purpose and in the course of an insurance compliance audit. An insurance compliance self-evaluative audit document also includes, but is not limited to, any of the following:
a.
an insurance compliance audit report prepared by an auditor, who may be an employee of the company or an independent contractor, which may include the scope of the audit, the information gained in the audit, and conclusions and recommendations, with exhibits and appendices,
b.
memoranda and documents analyzing portions or all of the insurance compliance audit report and discussing potential implementation issues,
c.
an implementation plan that addresses correcting past noncompliance, improving current compliance, and preventing future noncompliance, or
d.
analytic data generated in the course of conducting the insurance compliance audit.
Documents, communications, data, reports or other information which are created as a result of a claim involving personal injury, property damage or workers’ compensation made against an insurance policy are not insurance compliance self-evaluative audit documents and are admissible as evidence in civil, criminal or administrative proceedings as otherwise provided by applicable rules of evidence or civil procedure, subject to any applicable statutory or common-law privilege.
Added by Laws 2012, c. 257, § 6, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6836. Privilege effective date.

The insurance compliance self-evaluative privilege created by this act shall apply to all audits performed or commissioned after the effective date of this act, whether or not the litigation or administrative proceedings were pending on the effective date of this act.
Added by Laws 2012, c. 257, § 7, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6837. Effect upon statutory or common law privileges.

Nothing in this act nor the release of any self-evaluative audit document hereunder shall limit, waive, or abrogate the scope or nature of any statutory or common law privilege including, but not limited to, the work product doctrine, the attorney-client privilege, or the subsequent remedial measures exclusion.
Added by Laws 2012, c. 257, § 8, eff. Nov. 1, 2012.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6850.1. Notification of deletions in prescription coverage.

Any health benefit plan that provides prescription drug coverage or contracts with a third party for prescription drug services shall notify an enrollee presently taking a prescription drug of any deletions, other than generic substitutions, in the health benefit plan's prescription drug formulary. Such notification shall be made in writing, or electronically upon request of the enrollee, at least sixty (60) days prior.
This section does not apply to coverage for a drug that is determined by a therapeutics committee of the health benefit plan to be subject to new safety warnings or a safety recall by the Federal Drug Administration.
As used in this section, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes.
Added by Laws 2013, c. 247, § 1, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6903.1. Exemption of certain domestic health maintenance organizations from certain provisions of act.

Domestic health maintenance organizations that contract with the Oklahoma Health Care Authority to provide basic health services to Medicaid recipients and that do not provide basic health care services to any other group of persons shall be exempt from the provisions of Sections 6911, 6914, 6915 and 6932 of this title.
Added by Laws 2004, c. 146, § 1, eff. Nov. 1, 2004; Amended by Laws 2017, c. 287, § 6, eff. Nov. 1, 2017.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6904. Certification by Insurance Commissioner - Issuance of certificate.

A. Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall within forty-five (45) days determine whether the applicant, with respect to health care services to be furnished, has complied with the provisions of Section 6907 of this title.
B. The Insurance Commissioner shall, within forty-five (45) days of determining compliance or deficiency, issue a certificate of authority to a person filing a completed application upon receipt of the prescribed fees and upon the Insurance Commissioner's being satisfied that:
1. The persons responsible for the conduct of the affairs of the applicant are competent and trustworthy, and possess good reputations;
2. Any deficiency identified has been corrected and the Insurance Commissioner has determined that the health maintenance organization's proposed plan of operation meets the requirements of Section 6907 of this title;
3. The health maintenance organization will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments or deductibles, or both; and
4. The health maintenance organization is in compliance with the provisions of Sections 6913 and 6915 of this title.
C. A certificate of authority shall be denied only after the Insurance Commissioner complies with the requirements of Section 6920 of this act title. No other criteria may be used to deny a certificate of authority.
Added by Laws 2003, c. 197, § 4, eff. Nov. 1, 2003. Amended by Laws 2021, c. 478, § 36, emerg. eff. May 12, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6905. Powers of health maintenance organization - Notice of effect on financial soundness.

A. The powers of a health maintenance organization (HMO) include, but are not limited to, the following:
1. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment and property reasonably required for its principal office or for purposes necessary to the transaction of the business of the organization;
2. Transactions between affiliated entities, including loans and the transfer of responsibility under all provider or subscriber contracts between affiliates or between the health maintenance organization and its parent;
3. The furnishing of health care services through providers, provider associations or agents for providers which are under contract with or employed by the health maintenance organization;
4. The contracting with a person for the performance on its behalf of certain functions such as marketing, enrollment and administration;
5. The contracting with an insurance company licensed in this state, or with a hospital or medical service corporation authorized to do business in this state, for the provision of insurance, indemnity or reimbursement against the cost of health care services provided by the health maintenance organization;
6. The offering of other health care services in addition to basic health care services. Nonbasic health care services may be offered by a health maintenance organization on a prepaid basis without offering basic health care services to any group or individual; and
7. The joint marketing of products with an insurance company licensed in this state or with a hospital or medical service corporation authorized to do business in this state as long as the company that is offering each product is clearly identified.
B. 1. A health maintenance organization shall file notice, with adequate supporting information, with the Insurance Commissioner prior to the exercise of any power granted in paragraphs 1, 2 or 4 of subsection A of this section that may affect the financial soundness of the health maintenance organization. The Insurance Commissioner shall disapprove the exercise of power only if, in the Insurance Commissioner’s opinion, it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the Insurance Commissioner does not disapprove such exercise of power within sixty (60) days of the filing, it shall be deemed approved.
2. The Insurance Commissioner may promulgate rules exempting those activities having a de minimis effect from the filing requirement of paragraph 1 of this subsection.
Added by Laws 2003, c. 197, § 5, eff. Nov. 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6906. Receipt, collection, disbursement or investment of funds - Fiduciary relationship - Fidelity bond or insurance.

A. A director, officer, employee or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of the organization shall be responsible for the funds in a fiduciary relationship to the organization.
B. A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such employees, officers, directors and partners in an amount that is not less than Two Hundred Fifty Thousand Dollars ($250,000.00) for each health maintenance organization, or a maximum of Five Million Dollars ($5,000,000.00) in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or the sum prescribed by the Insurance Commissioner.
Added by Laws 2003, c. 197, § 6, eff. Nov. 1, 2003. Amended by Laws 2005, c. 129, § 19, eff. Nov. 1, 2005.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6909. Reports and statements.

A. Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two principal officers with the Insurance Commissioner covering the preceding calendar year. The report shall be on forms and shall include all forms prescribed by the National Association of Insurance Commissioners (NAIC). The report shall be filed with the NAIC in electronic format, as approved by the NAIC, along with applicable fees. In addition, the health maintenance organization shall file with the Insurance Commissioner via electronic format and a paper copy by the first day of March, unless otherwise stated:
1. Audited financial statements on or before June 1;
2. An actuarial opinion prepared and signed by a qualified actuary;
3. A list of the providers who have executed a contract that complies with the provisions of paragraph 1 of subsection D of Section 13 of this act; and
4.
a.
a description of the grievance procedures, and
b.
the total number of grievances handled through these procedures, a compilation of the causes underlying those grievances, and a summary of the final disposition of those grievances.
B. Domestic health maintenance organizations shall file quarterly financial statements with the Insurance Commissioner on or before the forty-fifth day following the end of each calendar quarter other than the fourth quarter of each year. The report shall be on forms and shall include all forms prescribed by the NAIC. The report shall be filed with the NAIC in electronic format, as approved by the NAIC, along with applicable fees.
C. The Insurance Commissioner may require additional reports deemed necessary and appropriate to enable the Insurance Commissioner to carry out his or her duties under this act.
Added by Laws 2003, c. 197, § 9, eff. Nov. 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6910. Information to be provided to subscribers.

Every health maintenance organization (HMO) shall:
1. Provide to its subscribers electronically or in paper copy a list of providers upon enrollment and make such list available electronically or in paper copy upon reenrollment; provided, a subscriber has submitted written assurances that the subscriber can view and print such electronic copy;
2. Provide to its subscribers notice of any material change in the operation of the organization that will affect them directly, no later than thirty (30) days after such change;
3. Immediately notify an enrollee in writing of the termination of the enrollee’s primary care provider and shall provide assistance to the enrollee in transferring to another participating primary care provider; and
4. Provide to subscribers, electronically or in paper copy, information on:
a.
how to obtain services,
b.
where to obtain additional information on access to services, and
c.
how to contact the HMO at no cost to the enrollee.
Added by Laws 2003, c. 197, § 10, eff. Nov. 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6911. Grievance procedures.

A. Every health maintenance organization shall establish and maintain a grievance procedure that has been approved by the Insurance Commissioner to provide for the resolution of grievances initiated by enrollees. Such grievance procedure shall be approved by the Insurance Commissioner within thirty (30) days of submission. The health maintenance organization shall maintain a record of grievances received since the date of its last examination of grievances.
B. The Insurance Commissioner may examine the grievance procedures.
C. Health maintenance organizations shall comply with the requirements of an insurer as set out in Sections 1250.1 through 1250.16 of this title.
Added by Laws 2003, c. 197, § 11, eff. Nov. 1, 2003. Amended by Laws 2021, c. 478, § 38, emerg. eff. May 12, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6912. Investment of funds.

With the exception of investments made in accordance with the provisions of paragraph 1 of subsection A of Section 5 of this act, the funds of a health maintenance organization shall be invested only in accordance with the provisions of Article 16 of the Insurance Code.
Added by Laws 2003, c. 197, § 12, eff. Nov. 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6916. Premium rates - Approval by Insurance Commissioner.

A. No premium rate may be used by a health maintenance organization until such time as a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the Insurance Commissioner. Such premium rates shall be confidential and not subject to public disclosure.
B. Either a specific schedule of premium rates or a methodology for determining premium rates shall be established in accordance with actuarial principles for various categories of enrollees; provided, that the premium applicable to an enrollee shall not be individually determined based on the status of the enrollee’s health. Provided further, that the premium rates shall not be excessive, inadequate, unfair or discriminatory. A certification by a qualified actuary or other qualified person acceptable to the Insurance Commissioner as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information.
C. The Insurance Commissioner shall approve the schedule of premium rates or methodology for determining premium rates if the requirements of subsection B of this section are met. If the Insurance Commissioner disapproves the filing, the Insurance Commissioner shall notify the health maintenance organization. In the notice, the Insurance Commissioner shall specify the reasons for disapproval. A hearing will be conducted within thirty (30) days after a request in writing by the person filing. If the Insurance Commissioner does not take action on the schedule or methodology within thirty (30) days of the filing of the schedule or methodology, it shall be deemed approved.
D. When contracting with educational entities within the meaning of Section 1306 of Title 74 of the Oklahoma Statutes, in setting health insurance premiums for active employees and for retirees under sixty-five (65) years of age, health maintenance organizations shall set the monthly premium for active employees at a maximum of Ninety Dollars ($90.00) less than the monthly premium for retirees under sixty-five (65) years of age.
Added by Laws 2003, c. 197, § 16, eff. Nov. 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6917. Producer license - Exempted persons.

A. Health maintenance organization producers shall comply with all applicable statutes and provisions of Title 36 of the Oklahoma Statutes and rules relating to producer licensing, including the Oklahoma Producer Licensing Act.
B. The following persons shall not be required to hold a health maintenance organization producer license:
1. A regular salaried officer or employee of a health maintenance organization who devotes substantially all of his or her time to activities other than the taking or transmitting of applications or membership fees or premiums for health maintenance organization membership, or who receives no commission or other compensation directly dependent upon the business obtained, and who does not solicit or accept from the public applications for health maintenance organization membership;
2. Employers or their officers or employees or the trustees of an employee benefit plan to the extent that the employers, officers, employees or trustees are engaged in the administration or operation of a program of employee benefits involving the use of health maintenance organization memberships; provided, that the employers, officers, employees or trustees are not in any manner compensated directly or indirectly by the health maintenance organization issuing health maintenance organization memberships;
3. Banks or their officers and employees to the extent that the banks, officers and employees collect and remit charges by charging them against accounts of depositors on the orders of the depositors; or
4. A person or the employee of a person who has contracted to provide administrative, management or health care services to a health maintenance organization and who is compensated for those services by the payment of an amount calculated as a percentage of the revenues, net income or profit of the health maintenance organization, if that method of compensation is the sole basis for subjecting that person or the employee of the person to this act.
C. The Insurance Commissioner may by rule exempt certain classes of persons from the requirement of obtaining a license:
1. If the functions such persons perform do not require special competence, trustworthiness or the regulatory surveillance made possible by licensing; or
2. If other existing safeguards make regulation unnecessary.
Added by Laws 2003, c. 197, § 17, eff. Nov. 1, 2003.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6918. Organizations permitted to organize and operate health maintenance organization - Contracts for insurance against cost of care provided.

A. An insurance company licensed in this state or a hospital or medical service corporation authorized to do business in this state may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization pursuant to the provisions of this act. Notwithstanding any other law which may be inconsistent, any two or more insurance companies, hospital or medical service corporations, or subsidiaries or affiliates thereof may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or its subsidiary.
B. Notwithstanding any provision of insurance and hospital or medical service corporation laws in Title 36 of the Oklahoma Statutes, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. An insurer or a hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to such contracts.
Added by Laws 2003, c. 197, § 18, eff. Nov. 1, 2003.