reglab/statecodes huggingface dataset:
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.16. Reinsurance on risks ceded by another insurer – Credit for reserves.

A captive insurance company may cede or assume reinsurance and take credit for reserves, as authorized for domestic insurers by the Oklahoma Insurance Code.
Added by Laws 2004, c. 334, § 23, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 14, eff. Nov. 1, 2013; Laws 2015, c. 298, § 20, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.18. Membership in, contribution to, or benefit from plan, pool, association, or guaranty or insolvency fund.

A captive insurance company may not join or contribute financially to a plan, pool, association, or guaranty or insolvency fund in this state, and a captive insurance company, or its insured or its parent or any affiliated company or any member organization of its association, or in the case of a captive insurance company organized as a reciprocal insurer, a subscriber of the company, or in the case of a sponsored captive insurance company, a protected cell or participant in a protected cell may not receive a benefit from a plan, pool, association, or guaranty or insolvency fund for claims arising out of the operations of such captive insurance company.
Added by Laws 2004, c. 334, § 25, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 15, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.20. Sanctions.

A captive insurance company failing to make returns or to pay all taxes required by this section is subject to sanctions provided in the Oklahoma Insurance Code.
Added by Laws 2004, c. 334, § 27, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 17, eff. Nov. 1, 2013; Laws 2015, c. 298, § 22, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.21. Rules.

The Insurance Commissioner may promulgate and, from time to time, amend rules and issue orders relating to captive insurance companies as are necessary to enable the Insurance Commissioner to carry out the provisions of the Oklahoma Captive Insurance Company Act.
Added by Laws 2004, c. 334, § 28, emerg. eff. May 25, 2004.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.22. Exemptions for special purpose captive insurance companies.

The Insurance Commissioner may, by rule, regulation, or order, exempt special purpose captive insurance companies, on a case-by-case basis, from provisions of the Oklahoma Insurance Code, Oklahoma Captive Insurance Company Act and any rule or regulation established under either that he or she determines to be inappropriate to apply to such companies given the nature of the risks to be insured.
Added by Laws 2004, c. 334, § 29, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 18, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.24.1. Notice requirements.

No captive insurance company shall voluntarily take any of the following actions without providing the Insurance Commissioner at least thirty (30) days prior written notice and receiving the Commissioner's approval of any such action:
1. The dissolution of the captive insurance company;
2. A sale, exchange, lease, mortgage, assignment, pledge or other transfer of or granting of a security interest in, all or substantially all of the assets of the captive insurance company;
3. Incurring a material indebtedness by the captive insurance company;
4. Any making of a material loan or other material extension of credit by the captive insurance company;
5. Any material payment out of capital and surplus;
6. Any merger or consolidation to which the captive insurance company is a constituent party;
7. Any conversion of the captive insurance company to another business form;
8. Any transfer to or domestication in any jurisdiction by the captive insurance company; or
9. Any amendment of the organizational documents of the captive insurance company.
For purposes of this section, "material", in relation to financial matters, means any transaction or series of related transactions involving more than the lesser of five percent (5%) of the captive insurance company's assets or twenty-five percent (25%) of its capital and surplus. "Assets" and "capital and surplus" shall be measured as of the most recent filed report required by Section 6470.11 of Title 36 of the Oklahoma Statutes.
Added by Laws 2013, c. 41, § 1, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.24.2. Inspection and preservation of records.

A. Unless otherwise approved by the Commissioner, a captive insurance company formed under the provisions of this act shall maintain its books, records, documents, accounts, vouchers and agreements in this state.
A captive insurance company shall make its books, records, documents, accounts, vouchers and agreements available for inspection by the Commissioner at any time. A captive insurance company shall keep its books, records, documents, accounts, vouchers and agreements in such manner that its financial condition, affairs and operations can be readily ascertained and in such manner that the Commissioner may readily verify its financial statements and determine its compliance with this act.
B. Unless otherwise approved by the Commissioner, all original books, records, documents, accounts, vouchers and agreements of a captive insurance company formed under the provisions of this act must be preserved and kept available in this state for the purpose of examination and inspection until the Commissioner approves the destruction or other disposition of the books, records, documents, accounts, vouchers and agreements. If the Commissioner approves the preservation and keeping of the foregoing outside this state, the captive insurance company shall maintain a complete and true copy of each such original in the state. Books, records, documents, accounts, vouchers and agreements may be photographed, reproduced on film or stored and reproduced electronically.
Added by Laws 2013, c. 41, § 2, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.25. Protected cell - Use of assets.

In the case of a sponsored captive insurance company:
1. The assets of the protected cell may not be used to pay expenses or claims other than those attributable to the protected cell; and
2. Its capital and surplus at all times must be available to pay expenses of or claims against the sponsored captive insurance company and may not be used to pay expenses or claims attributable to a protected cell.
Added by Laws 2004, c. 334, § 32, emerg. eff. May 25, 2004. Amended by Laws 2006, c. 264, § 69, eff. July 1, 2006; Laws 2015, c. 298, § 23, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.27. Standards ensuring exercise of control of risk management function of insured controlled unaffiliated business – Regulations.

The Insurance Commissioner shall promulgate regulations establishing standards to ensure that a parent or affiliated company is able to exercise control of the risk management for any controlled unaffiliated business to be insured by a pure captive insurance company; however, until such time as these regulations are promulgated, the Insurance Commissioner may by temporary order grant authority to a pure captive insurance company to insure risks.
Added by Laws 2004, c. 334, § 34, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 19, eff. Nov. 1, 2013; Laws 2015, c. 298, § 24, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.28. Acquisition of control.

The provisions of Article 16A of the Insurance Code applicable to acquisition of control or merger with a domestic insurer shall apply to acquisition of control of an association captive insurance company, sponsored captive insurance company, special purpose captive insurance company, or industrial insured captive insurance company formed or licensed under the Oklahoma Captive Insurance Company Act.
Added by Laws 2004, c. 334, § 35, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 20, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.30. Sponsor of sponsored captive insurance company.

A sponsor of a sponsored captive insurance company must be an insurer licensed pursuant to the laws of a state, an insurance holding company that controls an insurer licensed pursuant to the laws of any state and subject to registration pursuant to the insurance holding company system laws of the state of domicile of the insurer, a reinsurer authorized or approved pursuant to the laws of a state, or a captive insurance company formed or licensed pursuant to the Oklahoma Captive Insurance Company Act, a holding company, a trust, an individual or other organization as permitted by the Insurance Commissioner. A risk retention group may be a participant of a sponsored captive insurance company only to the extent that it is the sole participant of one or more protected cells.
Added by Laws 2004, c. 334, § 37, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 22, eff. Nov. 1, 2013; Laws 2015, c. 298, § 26, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.30.1. Requirements for writing business.

The business written by a sponsored captive insurance company with respect to each protected cell must be:
1. Fronted by an insurance company licensed pursuant to the laws of any state or any jurisdiction if the insurance company is a wholly owned subsidiary of an insurance company licensed pursuant to the laws of any state;
2. Reinsured by a reinsurer authorized or approved by this state; or
3. Secured by a trust fund in the United States for the benefit of policyholders and claimants or funded by an irrevocable letter of credit or other asset acceptable to the Insurance Commissioner. The amount of security provided may not be less than the reserves associated with those liabilities, not fronted or reinsured, including reserves for losses, allocated loss adjustment expenses, incurred but unreported losses, and unearned premiums for business written through the protected cell of the participant. The Insurance Commissioner may require the sponsored captive to increase the funding of any security arrangement established pursuant to this subsection. If the form of security is a letter of credit, the letter of credit must be established, issued, or confirmed by a financial institution chartered in this state, a member of the federal reserve system, or a bank chartered by another state if that state-chartered bank is acceptable to the Insurance Commissioner. A trust and trust instrument maintained pursuant to this item must be in a form and upon terms approved by the Insurance Commissioner.
Added by Laws 2013, c. 41, § 3, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.31. Participants in sponsored captive insurance company.

A. An association, a corporation, a limited liability company, a partnership, a trust, or other business entity may be a participant in a sponsored captive insurance company formed or licensed pursuant to the Oklahoma Captive Insurance Company Act.
B. A sponsor may be a participant in a sponsored captive insurance company.
C. A participant need not be an owner of the sponsored captive insurance company or an affiliate of the company.
D. Unless otherwise approved by the Insurance Commissioner, a participant may insure through a sponsored captive insurance company only its own risks or the risks of its affiliates who are participants.
Added by Laws 2004, c. 334, § 38, emerg. eff. May 25, 2004. Amended by Laws 2013, c. 41, § 23, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.31.1. Combination of assets.

Notwithstanding the provisions of paragraph 2 of subsection B of Section 6470.29 of Title 36 of the Oklahoma Statutes, a sponsored captive insurance company may combine the assets of two or more protected cells for purposes of investing those assets. Such a combination of assets may not be construed as defeating the segregation of assets required by this act, or for accounting or other purposes.
Added by Laws 2013, c. 41, § 4, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.34. Entity-protected cell.

A. A protected cell of a sponsored captive insurance company may be formed as an entity-protected cell. "Entity-protected cell" means a protected cell that is established as any type of legal entity separate from the sponsored captive insurance company of which it is a part.
B. Subject to the prior written approval of the sponsored captive insurance company and of the Insurance Commissioner, an entity-protected cell shall be entitled to enter into contracts and undertake obligations in its own name and for its own account. In the case of a contract or obligation to which the sponsored captive insurance company is not a party, either in its own name and for its own account or on behalf of a protected cell, the counterparty to the contract or obligation shall have no right or recourse against the sponsored captive insurance company and its assets other than against assets properly attributable to the entity-protected cell that is a party to the contract or obligation.
C. The articles of incorporation or articles of organization of an entity-protected cell shall refer to the sponsored captive insurance company for which it is a protected cell and shall state that the protected cell is incorporated or organized for the limited purposes authorized by the sponsored captive insurance company's license. A copy of the prior written approval of the Commissioner to add the entity-protected cell, required by Section 6470.29 of Title 36 of the Oklahoma Statutes, shall be attached to and filed with the articles of incorporation or the articles of organization.
D. Sponsored captive insurance companies, including those licensed as special purpose captive insurance companies, shall have the option to establish one or more protected cells as a separate corporation, mutual corporation, nonprofit corporation, limited liability company, or reciprocal insurer. This section shall not be construed to limit any rights or protections applicable to protected cells not established as corporations, mutual corporations, nonprofit corporations, limited liability companies, or reciprocal insurers.
Added by Laws 2015, c. 298, § 27, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6470.35. Dormant captive insurance company – Certificate of dormancy.

A. As used in this section, "dormant captive insurance company" means a captive insurance company that has:
1. Ceased transacting the business of insurance including the issuance of insurance policies; and
2. No remaining liabilities associated with insurance business transactions or insurance policies issued prior to the filing of its application for a certificate of dormancy under this section.
B. A dormant captive insurance company domiciled in this state that meets the criteria of subsection A of this section may apply to the Insurance Commissioner for a certificate of dormancy. The certificate of dormancy shall be subject to renewal every five (5) years and shall be forfeited if not renewed within such time.
C. A dormant captive insurance company that has been issued a certificate of dormancy shall:
1. Possess and thereafter maintain unimpaired, paid-in capital and surplus of not less than Twenty-five Thousand Dollars ($25,000.00);
2. Submit on or before March 1 of each year to the Insurance Commissioner a report of its financial condition, verified by an oath of two of its executive officers, in a form prescribed by the Insurance Commissioner; and
3. Pay a nonrefundable annual fee of Five Hundred Dollars ($500.00).
D. A dormant captive insurance company shall not be subject to or liable for the payment of any tax under Section 6470 of this title for the initial five-year dormancy.
E. A dormant captive insurance company shall apply to the Insurance Commissioner for approval to surrender its certificate of dormancy and resume conducting the business of insurance prior to issuing any insurance policies.
F. A certificate of dormancy shall be revoked if a dormant captive insurance company no longer meets the criteria of subsection A of this section.
G. A dormant captive insurance company may be subject to examination under Section 6470.13 of this title for any year when it did not qualify as a dormant captive insurance company. The Insurance Commissioner may examine a dormant captive insurance company pursuant to Section 6470.13 of this title.
H. The Insurance Commissioner may promulgate and adopt rules and regulations implementing the provisions of this section.
Added by Laws 2021, c. 478, § 33, emerg. eff. May 12, 2021. Amended by Laws 2022, c. 154, § 10, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.1. Uniform Health Carrier External Review Act.

Sections 6475.1 through 6475.17 of this title shall be known and may be cited as the "Uniform Health Carrier External Review Act".
Added by Laws 2011, c. 278, § 35. Amended by Laws 2011, c. 360, § 25; Laws 2022, c. 154, § 11, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.2. Purpose.

The purpose of the Uniform Health Carrier External Review Act is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determination, as defined in this act.
Added by Laws 2011, c. 278, § 36 and Laws 2011, c. 360, § 26.
NOTE: Laws 2011, c. 278, § 36 and Laws 2011, c. 360, § 26 added identical sections under the same number.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.4. Applicability of act.

A. Except as provided in subsection B of this section, the Uniform Health Carrier External Review Act shall apply to all health carriers.
B. The provisions of the Uniform Health Carrier External Review Act shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, dental, disability income, hospital indemnity, long-term care insurance, as defined in Section 4424 of Title 36 of the Oklahoma Statutes, vision care or any other limited supplemental benefit or to a Medicare supplement policy of insurance, as defined in Section 3611.1 of Title 36 of the Oklahoma Statutes, coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, any coverage issued under Chapter 55 of Title 10, U.S. Code and any coverage issued as supplement to that coverage, any coverage issued as supplemental to liability insurance, workers’ compensation or similar insurance, automobile medical-payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.
Added by Laws 2011, c. 278, § 38 and Laws 2011, c. 360, § 28.
NOTE: Laws 2011, c. 278, § 38 and Laws 2011, c. 360, § 28 added identical sections under the same number.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.6. Form of external review requests.

A. 1. Except for a request for an expedited external review as set forth in Section 6475.9 of this title, all requests for external review shall be made in writing to the Insurance Commissioner.
2. The Commissioner may prescribe by rule the form and content of external review requests required to be submitted under this section.
B. A covered person or the covered person's authorized representative may make a request for an external review of an adverse determination or final adverse determination.
Added by Laws 2011, c. 278, § 40. Amended by Laws 2011, c. 360, § 30; Laws 2022, c. 154, § 13, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.11. Binding power of external review decision.

A. An external review decision is binding on the health carrier except to the extent the health carrier has other remedies available under applicable state law.
B. An external review decision is binding on the covered person except to the extent the covered person has other remedies available under applicable federal or state law.
C. A covered person or the covered person’s authorized representative shall not file a subsequent request for external review involving the same adverse determination or final adverse determination for which the covered person has already received an external review decision pursuant to the Uniform Health Carrier External Review Act.
Added by Laws 2011, c. 278, § 45 and Laws 2011, c. 360, § 35.
NOTE: Laws 2011, c. 278, § 45 and Laws 2011, c. 360, § 35 added identical sections under the same number.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.14. Employee liability.

No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable in damages to any person for any opinions rendered or acts or omissions performed within the scope of the organization’s or person’s duties under the law during or upon completion of an external review conducted pursuant to the Uniform Health Carrier External Review Act, unless the opinion was rendered or act or omission performed in bad faith or involved gross negligence.
Added by Laws 2011, c. 278, § 48. Amended by Laws 2011, c. 360, § 38.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.15. Written records.

A. 1. An independent review organization assigned pursuant to Section 6475.8, 6475.9, or 6475.10 of this title to conduct an external review shall maintain written records in the aggregate by state and by health carrier on all requests for external review for which it conducted an external review during a calendar year and, upon request, submit a report to the Insurance Commissioner, as required under paragraph 2 of this subsection.
2. Each independent review organization required to maintain written records on all requests for external review pursuant to paragraph 1 of this subsection for which it was assigned to conduct an external review shall submit to the Commissioner, upon request, a report in the format specified by the Commissioner.
3. The report shall include in the aggregate by state, and for each health carrier:
a.
the total number of requests for external review,
b.
the number of requests for external review resolved and, of those resolved, the number resolved upholding the adverse determination or final adverse determination and the number resolved reversing the adverse determination or final adverse determination,
c.
the average length of time for resolution,
d.
a summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the Commissioner,
e.
the number of external reviews pursuant to subsection G of Section 6475.8 of this title that were terminated as the result of a reconsideration by the health carrier of its adverse determination or final adverse determination after the receipt of additional information from the covered person or the covered person's authorized representative, and
f.
any other information the Commissioner may request or require.
4. The independent review organization shall retain the written records required pursuant to this subsection for at least three (3) years.
B. 1. Each health carrier shall maintain written records in the aggregate, by state and for each type of health benefit plan offered by the health carrier on all requests for external review that the health carrier receives notice of from the Commissioner pursuant to this act.
2. Each health carrier required to maintain written records on all requests for external review pursuant to paragraph 1 of this subsection shall submit to the Commissioner, upon request, a report in the format specified by the Commissioner.
3. The report shall include in the aggregate, by state, and by type of health benefit plan:
a.
the total number of requests for external review,
b.
from the total number of requests for external review reported under subparagraph a of this paragraph, the number of requests determined eligible for a full external review, and
c.
any other information the Commissioner may request or require.
4. The health carrier shall retain the written records required pursuant to this subsection for at least three (3) years.
Added by Laws 2011, c. 278, § 49. Amended by Laws 2011, c. 360, § 39; Laws 2022, c. 154, § 19, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.16. Cost of independent review organization.

The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review.
Added by Laws 2011, c. 278, § 50 and Laws 2011, c. 360, § 40.
NOTE: Laws 2011, c. 278, § 50 and Laws 2011, c. 360, § 40 added identical sections under the same number.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6475.17. Description of external review procedures.

A. 1. Each health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons.
2. The disclosure required by paragraph 1 of this subsection shall be in a format prescribed by the Insurance Commissioner.
B. The description required under subsection A of this section shall include a statement that informs the covered person of the right of the covered person to file a request for an external review of an adverse determination or final adverse determination with the Commissioner. The statement shall explain that external review is available when the adverse determination or final adverse determination involves an issue of medical necessity, appropriateness, health care setting, level of care or effectiveness. The statement shall include the telephone number and address of the Commissioner.
C. In addition to subsection B of this section, the statement shall inform the covered person that, when filing a request for an external review, the covered person will be required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the external review.
Added by Laws 2011, c. 278, § 51 and Laws 2011, c. 360, § 41.
NOTE: Laws 2011, c. 278, § 51 and Laws 2011, c. 360, § 41 added identical sections under the same number.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6511. Short title.

Sections 6511 through 6518 and Sections 5 through 15 of this act shall be known and may be cited as the "Small Employer Health Insurance Reform Act".
Added by Laws 1992, c. 329, § 1, eff. Sept. 1, 1992. Amended by Laws 1994, c. 211, § 1, eff. July 1, 1994.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6513. Application of act to certain group health benefit plans.

A. Except as otherwise provided in this section and in Section 3 of this act, the Small Employer Health Insurance Reform Act shall apply to any group health benefit plan that provides coverage to two (2) or more eligible employees of a small employer in this state and to individual health benefits plans providing coverage for the eligible employees of a small employer which may include the employer when three (3) or more of such individual plans are sold to a small employer if any of the following conditions are met:
1. Any portion of the premium or benefits is paid by or on behalf of the small employer;
2. An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium; or
3. The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of Section 162 or Section 106 of the United States Internal Revenue Code.
B. 1. Except as provided in paragraph 2 of this subsection, for the purposes of the Small Employer Health Insurance Reform Act, carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by the Small Employer Health Insurance Reform Act shall apply as if all health benefit plans issued to small employers in this state by such affiliated carriers were issued by one carrier, unless on or before July 1, 1992, the respective affiliate carriers operated with separate books of business as insurers of health benefit plans in which event each such affiliate carrier shall be treated as a separate carrier.
2. An affiliated carrier that is a health maintenance organization granted a certificate of authority by the Insurance Commissioner pursuant to the provisions of Sections 6901 through 6951 of Title 36 of the Oklahoma Statutes may be considered to be a separate carrier for the purposes of the Small Employer Health Insurance Reform Act.
Added by Laws 1992, c. 329, § 3, eff. Sept. 1, 1992. Amended by Laws 1994, c. 211, § 3, eff. July 1, 1994; Laws 1999, c. 360, § 1, eff. July 1, 1999; Laws 2000, c. 171, § 3, eff. July 1, 2000; Laws 2012, c. 151, § 2, eff. Nov. 1, 2012; Laws 2019, c. 265, § 2, eff. Nov. 1, 2019.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6514. Classes of business - Criteria to establish - Number - Rules - Additional classes.

A. A small employer carrier may establish a class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:
1. The small employer carrier uses more than one type of system for the marketing and sale of health benefit plans to small employers;
2. The small employer carrier has acquired a class of business from another small employer carrier; or
3. The small employer carrier provides coverage to one or more association groups that meet the requirements of an association as set forth in Section 4501 of this title.
B. A small employer carrier may establish up to nine separate classes of business under subsection A of this section.
C. The Insurance Commissioner may establish rules to provide for a period of transition in order for a small employer carrier to come into compliance with subsection B of this section in the instance of acquisition of an additional class of business from another small employer carrier.
D. The Commissioner may approve the establishment of additional classes of business upon application to the Commissioner and a finding by the Commissioner that such action would enhance the efficiency and fairness of the small employer marketplace.
E. A small employer carrier shall offer each product currently marketed to all classes of business established pursuant to this section.
Added by Laws 1992, c. 329, § 4, eff. Sept. 1, 1992. Amended by Laws 2001, c. 363, § 26, eff. July 1, 2001.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6516. Renewability of health benefit plans - Election not to renew - Geographic service area.

A. A health benefit plan subject to this act shall be renewable with respect to all eligible employees and dependents, at the option of the small employer, except in any of the following cases:
1. Nonpayment of the required premiums;
2. Fraud or misrepresentation of the small employer or, with respect to coverage of individual insureds, the insureds or their representatives;
3. Noncompliance with the carrier's minimum group participation requirements;
4. Noncompliance with the carrier's employer contribution requirements;
5. Repeated misuse of provider network provisions;
6. The small employer carrier elects to nonrenew all of its health benefit plans issued to small employers in this state. In such a case the carrier shall:
a.
provide advance notice of its decision under this paragraph to the Insurance Commissioner in each state in which it is licensed, and
b.
provide notice of the decision not to renew coverage to all affected small employers and to the Commissioner in each state in which an affected covered individual is known to reside at least one hundred eighty (180) days prior to the nonrenewal of any health benefit plan by the carrier. Notice to the Commissioner under this subparagraph shall be provided at least three (3) working days prior to the notice to the affected small employers; or
7. The Commissioner finds that the continuation of the coverage would:
a.
not be in the best interests of the policyholders or certificate holders, or
b.
impair the carrier's ability to meet its contractual obligations. In such instance the Commissioner may assist affected small employers in finding replacement coverage.
B. A small employer carrier that elects not to renew a health benefit plan under paragraph 6 of subsection A of this section shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the Commissioner.
C. In the case of a small employer carrier doing business in one established geographic service area of the state, the provisions of this section shall apply only to the carrier's operations in such service area.
Added by Laws 1992, c. 329, § 6, eff. Sept. 1, 1992.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6517. Disclosures required of small employer carriers.

In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:
1. The extent to which premium rates for a specified small employer are established or adjusted based upon the actual or expected variation in claims costs or actual or expected variation in health status of the employees of the small employer and their dependents;
2. The provisions of the health benefit plan concerning the small employer carrier's right to change premium rates and factors, other than claim experience, that affect changes in premium rates;
3. The provisions relating to renewability of policies and contracts; and
4. The provisions relating to any preexisting condition provision.
Added by Laws 1992, c. 329, § 7, eff. Sept. 1, 1992.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6518. Maintenance and disclosure of certain information and documents - Filing of actuarial certification.

A. Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
B. Each small employer carrier shall file with the Insurance Commissioner annually on or before March 15 an actuarial certification certifying that the carrier is in compliance with this act and that the rating methods of the small employer carrier are actuarially sound. Such certification shall be in a form and manner, and shall contain such information, as specified by the Commissioner. A copy of the certification shall be retained by the small employer carrier at its principal place of business.
C. A small employer carrier shall make the information and documentation described in subsection A of this section available to the Commissioner upon request. Except in cases of violations of this act, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the Commissioner to persons outside of the Department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.
Added by Laws 1992, c. 329, § 8, eff. Sept. 1, 1992.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6526. Rulemaking.

The Insurance Commissioner may promulgate rules in accordance with Article I of the Administrative Procedures Act, Sections 250.2 through 323 of Title 75 of the Oklahoma Statutes, for the implementation and administration of the Small Employer Health Insurance Reform Act.
Added by Laws 1994, c. 211, § 12, eff. July 1, 1994. Amended by Laws 2010, c. 222, § 46, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6528. Reissuance of certain terminated coverage.

The Insurance Commissioner may promulgate rules to require small employer carriers, as a condition of transacting business with small employers in this state after the effective date of this act, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after December 31, 1993. The Commissioner may prescribe such terms for the reissue of coverage as the Commissioner finds are reasonable and necessary to provide continuity of coverage to small employers.
Added by Laws 1994, c. 211, § 14, eff. July 1, 1994.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6529. Suspension of implementation if inconsistent with federal law.

In the event that the Congress of the United States enacts laws legally inconsistent with any portion of this act, the Insurance Commissioner may suspend implementation of such inconsistent portion of this act. In such case, the Commissioner shall notify the Governor, President Pro Tempore of the Senate and the Speaker of the House of Representatives.
Added by Laws 1994, c. 211, § 15, eff. July 1, 1994.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6530. Bona fide association health plans.

A. "Bona fide association" means any association that has a current form M-1 filed with and accepted by the United States Department of Labor showing Oklahoma as the state of operation and:
1. Is formed under a pathway established in accordance with the applicable provisions of 29 CFR 2510; or
2. Was previously established or is newly formed under federal regulatory guidance effective prior to August 20, 2018.
B. "Bona fide association health plan" means a health benefit plan that is sponsored by a bona fide association as defined in subsection A of this section.
C. The provisions of the Small Employer Health Insurance Reform Act shall not apply to a health benefit plan issued to a bona fide association health plan.
D. Each bona fide association health plan that meets the requirements of this section shall be considered a large group for purposes of application of the Oklahoma Insurance Code.
E. A bona fide association health plan shall be subject to the following requirements:
1. The bona fide association health plan shall be delivered or issued for delivery to a bona fide association in a form that meets the requirements of Section 4502 of Title 36 of the Oklahoma Statutes;
2. The bona fide association health plan shall comply with any federal nondiscrimination requirement applicable to the association health plan;
3. Small employer groups that have two (2) or more eligible employees and that are members of the association may not be excluded from the association health plan;
4.
a.
Except as provided in subparagraph b of this paragraph, the association health plan shall maintain an eighty percent (80%) retention rate.
b.
The eighty percent (80%) retention rate specified in subparagraph a of this paragraph shall not include employer groups or working owners that:
(1)
go out of business, whether through merger, acquisition or any other reason,
(2)
no longer meet eligibility requirements for membership in the association,
(3)
no longer meet participation requirements for employers that are set forth in the plan documents, or
(4)
fail to pay premiums.
c.
A bona fide association health plan that fails to maintain the eighty percent (80%) retention rate during any year may have twelve (12) months to correct the retention level before being required to become subject to the requirements of the Small Employer Health Insurance Reform Act.
d.
A bona fide association health plan may not require a contract under this subsection between the bona fide association health plan and the member to be effective for a period of longer than two (2) years. This provision shall not be construed to prevent a contract from being extended for additional two-year periods or preventing the member from voluntarily electing a contract period of longer than two (2) years; and
5. Each bona fide association health plan shall be available to be marketed and sold by all licensed agents and brokers of the health carrier, at the health carrier's standard commission and/or fee schedule for the calendar year.
Added by Laws 2019, c. 265, § 3, eff. Nov. 1, 2019.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6530.1. Oklahoma Individual Health Insurance Market Stabilization Act – Legislative intent.

This act shall be known and may be cited as the "Oklahoma Individual Health Insurance Market Stabilization Act". It is the intent of the Legislature to provide payments to health insurance plans with respect to claims for eligible individuals for the purpose of lowering premiums for health insurance coverage offered in the individual market. Market stabilization activities shall include establishment of a high-risk pool, reinsurance, hybrid programs or any combination thereof. It is the further intent of the Legislature to bestow upon the Oklahoma Insurance Commissioner the authority to appoint a Board of Directors which shall create, implement, oversee and monitor the high-risk pool, reinsurance or hybrid programs under provisions of this act. The Board of Directors and the Oklahoma Secretary of Health and Human Services are authorized to apply for, accept and receive federal funds to implement and sustain market stabilization programs. Preliminary planning and analysis shall continue under the direction of the Oklahoma Insurance Commissioner. The onset of market stabilization implementation shall be contingent upon Oklahoma's approval for and receipt of federal funds to implement and sustain market stabilization programs.
Added by Laws 2017, c. 383, § 1, emerg. eff. June 6, 2017.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6530.3. Eligible persons.

Except as otherwise provided in this section, any person who is qualified for and enrolled in coverage through the market and is a permanent resident of the State of Oklahoma shall be eligible for coverage under the Oklahoma Individual Health Insurance Market Stabilization Program except that:
1. No person who is currently receiving or is entitled to receive health care benefits under any other federal or state program providing financial assistance or preventive and rehabilitative social services is eligible for coverage under the Program; and
2. No inmate incarcerated in any state penal institution or confined to any narcotic detention, treatment and rehabilitation facility shall be eligible for coverage under the Program.
Added by Laws 2017, c. 383, § 3, emerg. eff. June 6, 2017.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6530.6. Board of Directors – Powers.

The Board may:
1. Exercise powers granted to insurers under the laws of this state;
2. Sue or be sued; and
3. Request the Insurance Commissioner to check the reports, records, books and papers of the Insurance Department to determine the financial condition of an insurer for purposes of Section 8 of this act.
Added by Laws 2017, c. 383, § 6, emerg. eff. June 6, 2017. Amended by Laws 2018, c. 267, § 2.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6530.9. Unfair practice – Separating individual employees from group health insurance coverage.

It shall constitute an unfair practice for the purposes of Sections 1201 through 1220 of Title 36 of the Oklahoma Statutes for an insurer, insurance agent, insurance broker or third-party administrator to refer an individual employee to the Program or arrange for an individual employee to apply for the Program, for the purpose of separating that employee from group health insurance coverage provided in connection with the employee's employment.
Added by Laws 2017, c. 383, § 9, emerg. eff. June 6, 2017.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6530.10. Application for waiver pursuant to Patient Protection and Affordable Care Act.

The Oklahoma Secretary of Health and Human Services may apply to the United States Secretary of Health and Human Services for a waiver pursuant to Section 1332 of the Patient Protection and Affordable Care Act (42 U.S.C., Section 18052), "1332 State Innovation Waiver", with respect to health insurance coverage in the state for a plan year beginning on or after January 1, 2018. The Secretary may implement a state plan meeting the waiver requirements in a manner consistent with state and federal law and as approved by the United States Secretary of Health and Human Services.
Added by Laws 2017, c. 383, § 10, emerg. eff. June 6, 2017.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6552. Definitions.

As used in the Hospital and Medical Services Utilization Review Act:
1. "Utilization review" means a system for prospectively, concurrently and retrospectively reviewing the appropriate and efficient allocation of hospital resources and medical services given or proposed to be given to a patient or group of patients. It does not include an insurer's normal claim review process to determine compliance with the specific terms and conditions of the insurance policy;
2. "Private review agent" means a person or entity who performs utilization review on behalf of:
a.
an employer in this state, or
b.
a third party that provides or administers hospital and medical benefits to citizens of this state, including, but not limited to:
(1)
a health maintenance organization issued a license pursuant to Section 2501 et seq. of Title 63 of the Oklahoma Statutes, unless the health maintenance organization is federally regulated and licensed and has on file with the Insurance Commissioner a plan of utilization review carried out by health care professionals and providing for complaint and appellate procedures for claims, or
(2)
a health insurer, not-for-profit hospital service or medical plan, health insurance service organization, or preferred provider organization or other entity offering health insurance policies, contracts or benefits in this state;
3. "Utilization review plan" means a description of utilization review procedures;
4. "Commissioner" means the Insurance Commissioner;
5. "Certificate" means a certificate of registration granted by the Insurance Commissioner to a private review agent; and
6. "Health care provider" means any person, firm, corporation or other legal entity that is licensed, certified, or otherwise authorized by the laws of this state to provide health care services, procedures or supplies in the ordinary course of business or practice of a profession.
Added by Laws 1991, c. 294, § 2, eff. Nov. 1, 1991. Amended by Laws 2021, c. 478, § 34, emerg. eff. May 12, 2021.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6553. Private review agents - Certification required - Exemptions.

A. A private review agent who approves or denies payment or who recommends approval or denial of payment for hospital or medical services or whose review results in approval or denial of payment for hospital or medical services on a case-by-case basis shall not conduct utilization review in this state unless the Insurance Commissioner has granted the private review agent a certificate.
B. Except as provided in Section 9 of this act, the Hospital and Medical Services Utilization Review Act shall not apply to any insurance company or not-for-profit hospital service and medical indemnity plan licensed by the Commissioner to transact insurance in this state. If the insurer contracts outside the company for any or all utilization review services, the entity with whom the insurance company contracts shall be subject to all of the provisions of the Hospital and Medical Services Utilization Review Act.
C. The State and Education Employees Group Insurance Board shall be exempt from the provisions of the Hospital and Medical Services Utilization Review Act and regulated accordingly as provided for in the State and Education Employees Group Insurance Act. In addition, the Board shall comply with the provisions of Section 17 of this act. If the State and Education Employees Group Insurance Board contracts for utilization review services instead of having utilization review services be performed by employees of the Board, the entity with whom the Board contracts shall be subject to all of the provisions of the Hospital and Medical Services Utilization Review Act.
Added by Laws 1991, c. 294, § 3, eff. Nov. 1, 1991.