reglab/statecodes huggingface dataset:
2023 Oklahoma Statutes › Title 36. Insurance › §36-6031. Report of holdings and change in ownership - Unfair use of information - Recovery of profits.

A. Every person who is directly or indirectly the beneficial owner of more than ten per cent (10%) of any class of equity security of an insurer or who is a director or officer of such insurer shall file in the office of the Insurance Commissioner within (10) ten days after becoming such beneficial owner, director or officer a statement, in such form and detail and subject to such rules as the Insurance Commissioner may prescribe, of the amount of all equity securities of such insurer of which he or she is the beneficial owner, director or officer within ten (10) days after the close of each calendar month thereafter, if there has been a change in such ownership during such month, shall file in the office of the Insurance Commissioner a statement, in such form and detail and subject to such rules as the Insurance Commissioner may prescribe, indicating his or her ownership at the close of the calendar month and such changes in his or her ownership as have occurred during such calendar month.
B. For the purpose of preventing the unfair use of information which may have been obtained by such beneficial owner, director or officer by reason of his or her relationship to such insurer, any profit realized by him or her from any purchase and sale or any sale and purchase, of any equity security of such insurer within any period of less than two (2) years subsequent to the incorporation of the insurer, shall inure to and be recoverable by the insurer, unless such equity security was acquired in good faith in connection with a debt previously contracted, irrespective of any intention on the part of such beneficial owner, director or officer in entering into such transaction.
C. Suit to recover such profit may be instituted at law or in equity in any court of competent jurisdiction by the insurer or by the owner of any equity security of the insurer in the name and in behalf of the insurer if the insurer shall fail or refuse to bring such suit within sixty (60) days after request or shall fail diligently to prosecute the same thereafter. If no suit to recover such profit is so filed within six (6) months following the date such profit was realized or accrued or if at any time such suit is not diligently prosecuted, the Insurance Commissioner may file or prosecute such suit for and on behalf of the insurer at the expense of the insurer.
Added by Laws 1965, c. 341, § 1, emerg. eff. June 28, 1965. Amended by Laws 1997, c. 418, § 101, eff. Nov. 1, 1997.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6032. Limitation on sales of equity securities of certain domestic life insurance companies.

A. Not more than forty-nine percent (49%) of the equity securities of any insurer shall be sold to any person, firm, corporation or trustee or nominee thereof where said insurer has been organized within two (2) years preceding the acquisition of such equity securities, unless the stock so sold or acquired shall have been at a price not less than the highest market value of such stock during two (2) years subsequent to incorporation or the highest price at which such stock is offered to the public during two (2) years subsequent to incorporation, whichever sum is the greater. Should more than forty-nine percent (49%) of the equity securities of any insurer be sold to any person, firm, corporation or trustee or nominee thereof at a price less than the highest market price or the highest price such stock is offered to the public during the first two (2) years subsequent to incorporation, such excess between the purchase price and such highest market or highest offering price shall inure to and be recoverable by the insurer, unless such equity security was acquired in good faith in connection with a debt previously contracted, irrespective of any intention on the part of such purchaser in entering into such transaction.
B. Suit to recover such profit may be instituted at law or in equity in any court of competent jurisdiction by the insurer or by the owner of any equity security of the insurer in the name of and in behalf of the insurer if the insurer shall fail or refuse to bring suit within sixty (60) days after request or shall fail to diligently prosecute the same thereafter. If no suit to recover the difference between the purchase price and such highest market or highest offered price is filed within six (6) months after the realization of such profit or after the expiration of two (2) years subsequent to the incorporation of the insurer, or if at any time such suit is not diligently prosecuted, the Insurance Commissioner may file or prosecute such suit for and on behalf of the insurer at the expense of the insurer.
C. If the Insurance Commissioner shall find from substantial evidence submitted that for the best interest of the policyholders or creditors of an insurer the Commissioner should approve some plan of merger, consolidation, rehabilitation or sale of such insurer but is prevented or hindered from doing so because of the provisions of this section, the Commissioner may order that said transaction be exempt from the provisions of this section.
Added by Laws 1965, c. 341, § 2, emerg. eff. June 28, 1965. Amended by Laws 1997, c. 418, § 102, eff. Nov. 1, 1997.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6033. Limitation on compensation, fees or commissions.

It shall be unlawful for any person, firm, or corporation to pay or to receive more than fifteen per cent (15%) of the price received or paid for the equity security of any insurer as compensation for services, fees or commissions related directly or indirectly to the organization and promotion of the insurer and for the issuance or sale of the equity security of the insurer. In addition to any other penalty which may be applicable thereto, either under the Insurance Code or otherwise, violation of this section shall constitute a misdemeanor and shall be punishable as such where no greater penalty is provided therefor. In addition thereto, any person, firm or corporation that pays or receives in excess of the said fifteen per cent (15%) for such purposes shall be liable to the insurer for an amount double such excess. Suit to recover such excess may be instituted at law or in equity in any court of competent jurisdiction by the insurer or by the owner of any equity security of the insurer in the name and in behalf of the insurer if the insurer shall fail or refuse to bring such suit within sixty days after request or shall fail diligently to prosecute the same thereafter. If no suit to recover such profit is so filed within six months following the date such profit was realized or accrued or if at any time such suit is not diligently prosecuted, the Insurance Commissioner may file or prosecute such suit for and on behalf of the insurer at the expense of the insurer.
Laws 1965, c. 341, § 3, emerg. eff. June 28, 1965.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6034. Sale or transfer of securities issued under incentive, bonus or stock option plans.

After the effective date of this act, no equity securities issued by any domestic life insurance company, under any incentive, bonus, "stock option" or similar plan, and no rights to acquire any such equity securities shall, within a period of two (2) years after the date of original allotment by the issuer thereof be sold, or be transferred for value, or be exchanged, for a consideration exceeding one hundred fifteen percent (115%) of the net proceeds received by the issuer thereof for such securities or rights at the time of allotment, provided, however, that the limitations in this section set forth shall not be applicable to any such securities or rights originally issued or allotted at a price or value equal to the market price of such securities or rights on the date of issue or allotment, or to any such securities or rights allotted or issued by the issuer thereof for eighty-five percent (85%) or more of the price or value at which such securities or rights were offered by such issuer to the public on the date of allotment or issue thereof, whichever is the greater, or to any such securities or rights which were deposited and held in escrow for at least two (2) years from date of issue or allotment in compliance with a rule promulgated or an order issued by the Administrator, Oklahoma Securities Commission, under the Oklahoma Uniform Securities Act of 2004. It shall be unlawful for any person to sell, transfer or exchange any such equity securities in contravention of this section.
Added by Laws 1965, c. 341, § 4, emerg. eff. June 28, 1965. Amended by Laws 2022, c. 77, § 3, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6035. Enforcement of act - Definitions.

This act shall be administered and enforced by the Insurance Commissioner. The term "insurer" when used in this act means any domestic life insurance company during the first two (2) years of its existence and the provisions hereof are applicable to any such insurer and to any person, firm or corporation that holds, sells or deals in equity securities or options therefor of any domestic life insurance company during the first two years of existence or prior thereto. Provided, however, the provisions of this act shall not apply after a period of two (2) years subsequent to the latest registration for public offering under the Oklahoma Uniform Securities Act of 2004. The term "equity securities" when used herein includes options therefor. This act applies to domestic life insurance companies during the first two (2) years of existence and to every person, firm or corporation that holds, sells, or deals in equity securities, or options therefor, of any domestic life insurance company during the first two (2) years of the existence of a domestic life insurance company or prior thereto or which engages in the formation, organization or promotion of a domestic life insurance company.
Added by Laws 1965, c. 341, § 5, emerg. eff. June 28, 1965. Amended by Laws 2022, c. 77, § 4, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6041. Payments - How made.

Payment or each periodic payment not exceeding One Thousand Dollars ($1,000.00) for emergency living expenses made to any policyholder or his or her dependents or beneficiaries under an insurance policy for:
1. Fire insurance;
2. Casualty insurance;
3. Property insurance, including what may be termed a homeowner's policy; or
4. Any other type of policy that insures against personal loss as a consequence of loss of or damage to real or personal property; which provides for payment or periodic payments for emergency living expenses; and payments made under workers' compensation or employers' liability insurance as defined in Section 707 of this title, shall be made through the use of United States legal tender, or through a means acceptable to the recipient of the payment including, but not limited to, electronic funds transfer, prepaid cards, negotiable instruments payable on demand or negotiable drafts.
Added by Laws 1981, c. 230, § 1, emerg. eff. June 22, 1981. Amended by Laws 2015, c. 298, § 12, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6045. Reimbursement for mental or behavioral health or alcohol or drug treatment services.

Notwithstanding any provision of any individual or group policy, contract, plan or agreement of accident and/or health insurance or any provisions of a policy, contract, plan or agreement for hospital or medical service or indemnity, whenever such policy, contract, plan or agreement provides for reimbursement for any mental or behavioral health or alcohol and drug treatment service which is within the lawful scope of practice of a duly licensed physician, physician assistant, licensed clinical social worker, licensed professional counselor, licensed marriage and family therapist, licensed alcohol and drug counselor, licensed behavioral practitioner, licensed psychologist, or advance practice registered nurse, the person entitled to benefits, or the person performing services, under such policy, contract, plan or agreement shall be entitled to reimbursement on an equitable basis for such service at a rate commensurate with the requirements for their licensure.
Added by Laws 2008, c. 165, § 1, eff. Nov. 1, 2008.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6050. Prepaid or discounted ambulance service membership subscriptions.

All persons, companies, governmental entities or trust authorities operating an ambulance service within this state may sell prepaid or discounted ambulance service membership subscriptions to individuals who reside within its authorized service area in exchange for payment of an annual membership fee. The agreement between the ambulance service and an individual shall not be deemed to be insurance and shall expressly provide for the assignment of insurance benefits directly to the ambulance service. Under such assignment, the insurer shall be obligated directly to the ambulance service for the lesser of the full and customary charge by the ambulance service or the designated or allowable amount set forth by the insurance policy for any services actually rendered to the individual by the ambulance service during the membership year less any applicable deductible or copayment.
Added by Laws 2002, c. 307, § 34, eff. Nov. 1, 2002.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6051. Free choice of practitioner and profession - Equal reimbursement.

Notwithstanding any provision of any individual or group policy, contract, plan or agreement of accident and/or health insurance or any provisions of a policy, contract, plan or agreement for hospital or medical service or indemnity, whenever such policy, contract, plan or agreement provides for reimbursement for any visual or optometric service which is within the lawful scope of practice of a duly licensed optometrist, the person entitled to benefits, or person performing services, under such policy, contract, plan or agreement shall be entitled to reimbursement on an equal basis for such service, whether the said service is performed by a physician licensed under 59 O.S.1961, Sections 481 through 518, inclusive, or by an optometrist licensed under 59 O.S.1961, Sections 581 through 606, inclusive. Optometric services shall include eye and/or visual examination or a correction of any vision or muscular anomaly and the supplying of ophthalmic materials, including contact lenses and subnormal vision aids. Unless such policy, contract, plan or agreement shall otherwise provide, there shall be no reimbursement for ophthalmic materials, lenses, contact lenses, spectacles, eyeglasses, and/or appurtenances thereto.
Laws 1967, c. 17, § 1, emerg. eff. Feb. 21, 1967.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6052. Copayment requirements - Disclosure of calculations - Penalty - Rules.

A. Any policy, contract or agreement issued or renewed by an insurer, as defined in Section 6054 of Title 36 of the Oklahoma Statutes, or any contract or agreement issued or renewed for any preferred provider or other provider arrangement or managed care plan, which requires the insured or enrollee to make a copayment when benefits are provided, shall disclose to the insured or enrollee the calculation for the copayment. In no case shall the copayment be based on a higher figure than either the amount billed or the amount paid, whichever is less. This subsection shall apply to any health insurance plan offered through the State and Education Employees Group Insurance Act.
B. Any insurer, hospital or licensed health care provider determined to be in violation of subsection A of this section by the Insurance Commissioner, the State Board of Health or the appropriate health care professional licensing entity, after notice, shall be subject to an administrative fine of not less than One Thousand Dollars ($1,000.00) or more than Five Thousand Dollars ($5,000.00) for each violation. Notice under this section shall include a statement of violations on which the fine is based and notice of the opportunity for a hearing.
C. The Insurance Commissioner, the State Board of Health or the appropriate health care professional licensing entity shall promulgate rules providing for enforcement of the provisions of this act. In addition, each entity may promulgate rules providing for suspension or revocation of a license for substantial failure to comply with the provisions of this act. Such rules shall provide for notice and a hearing prior to the suspension or revocation of a license.
Added by Laws 1996, c. 335, § 1, eff. Nov. 1, 1996.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6053. Short title and application.

A. Sections 6053 through 6057 of this title and Sections 6 through 9 of this act shall be known and may be cited as the “Health Care Freedom of Choice Act”.
B. The provisions of the Health Care Freedom of Choice Act shall not apply to contracts executed with a preferred provider organization to provide health care services for employer-sponsored self-funded plans covered by the federal Employee Retirement Income Security Act (ERISA).
Added by Laws 1994, c. 342, § 18, eff. Sept. 1, 1994. Amended by Laws 1999, c. 331, § 1, eff. Nov. 1, 1999.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6054. Definitions.

As used in the Health Care Freedom of Choice Act:
1. “Accident and health insurance policy” or “policy” means any policy, certificate, contract, agreement or other instrument that provides accident and health insurance, as defined in Section 703 of this title, to any person in this state;
2. “Ambulatory surgical center” means any ambulatory surgery facility licensed by the State Department of Health as defined in Section 2657 of Title 63 of the Oklahoma Statutes;
3. “Home care agency” means any sole proprietorship, partnership, association, corporation, or other organization which administers, offers, or provides home care services, for a fee or pursuant to a contract for such services, to clients in their place of residence. The term “home care agency” shall not include an individual who contracts with the Department of Human Services to provide personal care services; provided, such individual shall not be exempt from certification as a home health aide;
4. “Hospital” means any facility as defined in Section 1-701 of Title 63 of the Oklahoma Statutes;
5. “Insured” means any person entitled to reimbursement for expenses of health care services and procedures under an accident and health insurance policy issued by an insurer;
6. “Insurer” means any entity that provides an accident and health insurance policy in this state, including but not limited to a licensed insurance company, a not-for-profit hospital service and medical indemnity corporation, a fraternal benefit society, a multiple employer welfare arrangement, or any other entity subject to regulation by the Insurance Commissioner;
7. “Practitioner” means any person holding a valid license to practice medicine and surgery, osteopathic medicine, chiropractic, podiatric medicine, optometry or dentistry, pursuant to the state licensing provisions of Title 59 of the Oklahoma Statutes; and
8. “Preferred provider organization (PPO)” means a network of practitioners, hospitals, home care agencies or ambulatory surgical centers, which have entered into a contract with an insurer to provide health care services under the terms and conditions established in the contract.
Added by Laws 1989, c. 37, § 1, eff. Nov. 1, 1989. Amended by Laws 1994, c. 342, § 19, eff. Sept. 1, 1994; Laws 1996, c. 76, § 1, eff. Nov. 1, 1996; Laws 1999, c. 331, § 2, eff. Nov. 1, 1999.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6056. Place where services may be performed.

Services and procedures covered under an accident and health insurance policy may be performed at any hospital, home care agency or ambulatory surgical center where a practitioner is authorized to practice, doctor's office or clinic, at the choice of the insured, or the insured's parent or guardian if the insured is a minor, and the practitioner who is providing the services and procedures.
Added by Laws 1971, c. 183, § 6. Amended by Laws 1989, c. 37, § 3, eff. Nov. 1, 1989; Laws 1996, c. 76, § 3, eff. Nov. 1, 1996; Laws 1999, c. 331, § 4, eff. Nov. 1, 1999.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6057. Denial under policy coverage as void – Compliance with act.

A. Any provision, exclusion or limitation in an accident and health insurance policy which:
1. Denies an insured, or the insured's parent or guardian if the insured is a minor, the free choice of any practitioner or the use of any hospital, home care agency or ambulatory surgical center where the practitioner is authorized to practice, doctor's office or clinic; or
2. Otherwise conflicts with any provision of the Health Care Freedom of Choice Act,
shall, to the extent of the denial or conflict, be void, but such voidance shall not affect the validity of the other provisions of the policy.
B. Any policy form presently approved for use containing any provision, exclusion or limitation determined by the Insurance Commissioner to be in conflict with any provision of the Health Care Freedom of Choice Act shall be brought into compliance with the act by the filing of a rider, an endorsement, or a new or revised policy form approved by the Commissioner.
Added by Laws 1971, c. 183, § 7. Amended by Laws 1989, c. 37, § 4, eff. Nov. 1, 1989; Laws 1996, c. 76, § 4, eff. Nov. 1, 1996; Laws 1999, c. 331, § 5, eff. Nov. 1, 1999.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6057.1. Examination and enforcement by Commissioner – Attorneys’ fees.

A. In order to enforce the provisions of the Health Care Freedom of Choice Act, the Insurance Commissioner may conduct an examination of insurers’ and preferred provider organizations’ claims files pursuant to the procedure set forth in Section 1250.4 of this title.
B. The Commissioner, upon finding an insurer in violation of any provision of the Health Care Freedom of Choice Act, may issue a cease and desist order to the insurer directing the insurer to stop such unlawful practices. If the insurer refuses or fails to comply with the order, the Commissioner shall have the authority to revoke or suspend the insurer’s certificate of authority. The Commissioner shall use the authority specified in this subsection to the extent deemed necessary to obtain the insurer’s compliance with the order. The Attorney General shall offer assistance if requested by the Commissioner to enforce the Commissioner’s orders.
C. Reasonable attorney fees shall be awarded to the Commissioner if judicial action is necessary for the enforcement of the orders. Such fees shall be based upon those prevailing in the community. Fees collected by the Commissioner without the assistance of the Attorney General shall be credited to the Insurance Commissioner’s Revolving Fund. Fees collected by the Attorney General shall be credited to the Attorney General’s Revolving Fund.
Added by Laws 1999, c. 331, § 6, eff. Nov. 1, 1999. Amended by Laws 2000, c. 353, § 43, eff. Nov. 1, 2000.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6057.2. Penalties.

For any violation of the Health Care Freedom of Choice Act, the Insurance Commissioner may, after notice and opportunity hearing, subject an insurer or practitioner to an administrative penalty of not less than One Hundred Dollars ($100.00) nor more than Five Thousand Dollars ($5,000.00) for each occurrence. Such administrative penalty may be enforced in the same manner in which civil judgments may be enforced. The penalties collected shall be placed in the Insurance Commissioner’s Revolving Fund.
Added by Laws 1999, c. 331, § 7, eff. Nov. 1, 1999.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6058. Newly-born children - Health insurance benefits.

A. All individual and group health insurance policies providing coverage on an expense incurred, fixed, or capitated basis, and all individual and group insurance policies, certificates, service or indemnity type contracts issued by insurance companies, health maintenance organizations, nonprofit corporations, or charitable and benevolent corporations established for the purpose of operating a nonprofit hospital service, indemnity, fixed or capitated plan, or a nonprofit medical or indemnity plan, and all self-insurers which provide coverage for a family member of the insured or subscriber shall, as to such family member's coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured or subscriber from the moment of birth.
B. The coverage for newly born children shall consist of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Such coverage shall also include transportation necessary for the provision of medical care for such newly born children when (1) the newly born is transported to the nearest hospital capable of providing the medically necessary treatment on a timely basis, and (2) the mode of transportation is the most economical consistent with the well-being of the newly born. Transportation coverage shall not exceed the reasonable costs of providing such service and an itemized statement of costs shall accompany each claim.
The provisions of this subsection shall not apply to policies involving Medicare and supplements to Medicare.
C. If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth and payment of the required premium or fees must be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one (31) days after the date of birth in order to have the coverage continue beyond such thirty-one-day period.
Added by Laws 1975, c. 87, § 1, operative Sept. 1, 1975. Amended by Laws 1984, c. 129, § 1, eff. July 1, 1985; Laws 2006, c. 264, § 63, eff. July 1, 2006.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.1. Bone density testing.

A. All individual and group health insurance policies providing coverage on an expense incurred basis, and all individual and group service or indemnity type contracts issued by a nonprofit corporation which provide coverage for a female forty-five (45) years of age or older in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall include the coverage specified by this section for a bone density test to qualified individuals covered by the policy when such test is requested by a primary care or referral physician. The test shall be subject to the policy deductible, copayments and coinsurance limits of the plan; provided, however, no policy or contract shall be required to reimburse more than One Hundred Fifty Dollars ($150.00) for any such test.
B. For purposes of this section:
1. "Qualified individual" means an individual:
a.
with an estrogen hormone deficiency,
b.
with:
(1)
vertebral abnormalities,
(2)
primary hyperparathyroidism, or
(3)
a history of fragility bone fractures,
c.
who is receiving long-term glucocorticoid, or
d.
who is currently under treatment for osteoporosis; and
2. "Bone density test" means a medically accepted measurement of bone mass used to detect low bone mass and to determine a qualified individual's risk for osteoporosis.
Added by Laws 1996, c. 102, § 1, eff. Nov. 1, 1996.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.3a. Annual obstetrical/gynecological examinations.

A. Any health benefit plan, including the State and Education Employees Group Health Insurance plan, that is offered, issued or renewed in this state on or after January 1, 2005, that provides medical and surgical benefits shall provide coverage for routine annual obstetrical/gynecological examinations.
B. The benefit required to be provided by this section shall in no way diminish or limit diagnostic benefits otherwise allowable under a health benefit plan.
C. Nothing in this section shall be construed as requiring such routine annual examination to be performed by an obstetrician, gynecologist, or obstetrician/gynecologist.
D. As used in this section, “health benefit plan” means any plan or arrangement as defined in subsection C of Section 6060.4 of this title, except that the term “health benefit plan” does not include policies or certificates issued to individuals or groups with fewer than fifty employees.
E. The provisions of this section shall not apply to policies or certificates issued to individuals or groups with fewer than fifty employees.
Added by Laws 2004, c. 397, § 1, eff. Nov. 1, 2004. Amended by Laws 2010, c. 222, § 32, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.4. Child immunization coverage.

A. A health benefit plan delivered, issued for delivery or renewed in this state on or after January 1, 1998, that provides benefits for the dependents of an insured individual shall provide coverage for each child of the insured, from birth through the date the child is eighteen (18) years of age for:
1. Immunization against:
a.
diphtheria,
b.
hepatitis B,
c.
measles,
d.
mumps,
e.
pertussis,
f.
polio,
g.
rubella,
h.
tetanus,
i.
varicella,
j.
haemophilus influenzae type B, and
k.
hepatitis A; and
2. Any other immunization subsequently required for children by the State Board of Health.
B. Benefits required pursuant to subsection A of this section shall not be subject to a deductible, co-payment, or coinsurance requirement.
C. 1. For purposes of this section, "health benefit plan" means group hospital or medical insurance coverage, a not-for-profit hospital or medical service or indemnity plan, a prepaid health plan, a health maintenance organization plan, a preferred provider organization plan, the State and Education Employees Group Health Insurance Plan, and coverage provided by a Multiple Employer Welfare Arrangement or employee self-insured plan as permitted under Employee Retirement Income Security Act of 1974.
2. The term "health benefit plan" shall not include:
a.
a plan that provides coverage:
(1)
only for a specified disease or diseases or under an individual limited benefit policy,
(2)
only for accidental death or dismemberment,
(3)
only for dental or vision care,
(4)
a hospital confinement indemnity policy,
(5)
disability income insurance or a combination of accident-only and disability income insurance, or
(6)
as a supplement to liability insurance,
b.
a Medicare supplemental policy as defined by Section 1882(g)(1) of the Social Security Act (42 U.S.C., Section 1395ss),
c.
workers' compensation insurance coverage,
d.
medical payment insurance issued as part of a motor vehicle insurance policy,
e.
a long-term care policy, including a nursing home fixed indemnity policy, unless a determination is made that the policy provides benefit coverage so comprehensive that the policy meets the definition of a health benefit plan, or
f.
short-term health insurance issued on a nonrenewable basis with a duration of six (6) months or less.
Added by Laws 1997, c. 75, § 1, eff. Nov. 1, 1997. Amended by Laws 2000, c. 61, § 1, eff. Nov. 1, 2000; Laws 2003, c. 464, § 6, eff. July 1, 2003; Laws 2006, c. 264, § 65, eff. July 1, 2006; Laws 2010, c. 222, § 33, eff. Nov. 1, 2010; Laws 2016, c. 73, § 7, eff. Nov. 1, 2016; Laws 2022, c. 199, § 2, eff. Nov. 1, 2022.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.4a. Claims in conjunction with arrest or pretrial detention.

A. No health benefit plan, including, but not limited to, the State and Education Employees Group Health Insurance Plan, that is offered, issued or renewed in the state on or after January 1, 2009, shall exclude otherwise allowable claims which occur in conjunction with the arrest or pretrial detention of the policyholder prior to adjudication of guilt and sentencing to incarceration of the policyholder. The reimbursement rate for out-of-network claims for these services shall be set at the current Medicare rate.
B. As used in this section, “health benefit plan” means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
Added by Laws 2008, c. 351, § 1, eff. Nov. 1, 2008. Amended by Laws 2010, c. 222, § 34, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.4b. Standard serological tests for syphilis.

A. As used in this section:
1. “Health benefit plan” has the same meaning as provided by Section 6060.4 of Title 36 of the Oklahoma Statutes; and
2. “Medically necessary” means services or supplies provided by a health care provider that are:
a.
provided for the diagnosis of syphilis,
b.
necessary for and appropriate to the diagnosis of syphilis,
c.
within the generally accepted standards of medical care in the community, and
d.
not solely for the convenience of the insured, the insured’s family, or the provider.
B. A health benefit plan shall cover the cost of medically necessary standard serological tests for syphilis required under Section 1-515 of Title 63 of the Oklahoma Statutes.
Added by Laws 2023, c. 116, § 1, eff. Nov. 1, 2023.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.5. Oklahoma Breast Cancer Patient Protection Act.

A. This section shall be known and may be cited as the "Oklahoma Breast Cancer Patient Protection Act".
B. Any health benefit plan that is offered, issued or renewed in this state on or after January 1, 1998, that provides medical and surgical benefits with respect to the treatment of breast cancer and other breast conditions shall ensure that coverage is provided for not less than forty-eight (48) hours of inpatient care following a mastectomy and not less than twenty-four (24) hours of inpatient care following a lymph node dissection for the treatment of breast cancer.
C. Nothing in this section shall be construed as requiring the provision of inpatient coverage where the attending physician in consultation with the patient determines that a shorter period of hospital stay is appropriate.
D. Any plan subject to subsection B of this section shall also provide coverage for reconstructive breast surgery performed as a result of a partial or total mastectomy. Because breasts are a paired organ, any such reconstructive breast surgery shall include coverage for all stages of reconstructive breast surgery performed on a nondiseased breast to establish symmetry with a diseased breast when reconstructive surgery on the diseased breast is performed, provided that the reconstructive surgery and any adjustments made to the nondiseased breast must occur within twenty-four (24) months of reconstruction of the diseased breast.
E. In implementing the requirements of this section, a health benefit plan may not modify the terms and conditions of coverage based on the determination by an enrollee to request less than the minimum coverage required pursuant to subsections B and D of this section.
F. A health benefit plan shall provide notice to each insured or enrollee under the plan regarding the coverage required by this section in the evidence of coverage of the plan, and shall provide additional written notice of the coverage to the insured or enrollee as follows:
1. In the next mailing made by the plan to the employee;
2. As part of any yearly informational packet sent to the enrollee; or
3. Not later than December 1, 1997;
whichever is earlier.
G. As used in this act, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
H. The Insurance Commissioner shall promulgate any rules necessary to implement the provisions of this section.
Added by Laws 1997, c. 135, § 1, eff. Nov. 1, 1997. Amended by Laws 2003, c. 464, § 7, eff. July 1, 2003; Laws 2010, c. 222, § 35, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.6. Dental procedures for certain minor and severely disabled persons.

A. Any health benefit plan that is offered, issued or renewed in this state on or after January 1, 1999, that provides hospitalization benefits shall provide coverage for anesthesia expenses including anesthesia practitioner expenses for the administration of the anesthesia, and hospital and ambulatory surgical center expenses associated with any medically necessary dental procedure when provided to a covered person who is:
1. Severely disabled; or
2.
a.
A minor eight (8) years of age or under, and who has a medical or emotional condition which requires hospitalization or general anesthesia for dental care, or
b.
A minor four (4) years of age or under, who in the judgment of the practitioner treating the child, is not of sufficient emotional development to undergo a medically necessary dental procedure without the use of anesthesia.
B. A health benefit plan may require prior authorization for either inpatient or outpatient hospitalization for dental care in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
C. Coverage provided for in subsection A of this section shall be subject to the same annual deductibles, copayments or coinsurance limits as established for all other covered benefits under the health benefit plan.
D. As used in this section, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
Added by Laws 1998, c. 66, § 1, eff. Nov. 1, 1998. Amended by Laws 1999, c. 98, § 1, eff. July 1, 1999; Laws 2010, c. 222, § 36, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.7. Audiological services and hearing aids for children.

A. 1. Any health benefit plan that is offered, issued, or renewed on or after the effective date of this act shall provide coverage for audiological services and hearing aids for children up to eighteen (18) years of age.
2. Such coverage:
a.
shall only apply to hearing aids that are prescribed, filled and dispensed by a licensed audiologist, and
b.
may limit the hearing aid benefit payable for each hearing-impaired ear to every forty-eight (48) months; provided, however, coverage may provide for up to four additional ear molds per year for children up to two (2) years of age.
B. Nothing in this section shall be construed to extend the practice or privileges of any health care provider beyond that provided in the laws governing the practice and privileges of the provider.
C. As used in this section, “health benefit plan” means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
Added by Laws 1999, c. 136, § 1, eff. Nov. 1, 1999. Amended by Laws 2002, c. 30, § 1, eff. Nov. 1, 2002; Laws 2010, c. 222, § 37, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.8. Prostate cancer screening coverage.

A. Any health benefit plan that is offered, issued or renewed in this state on or after January 1, 2000, that provides coverage to men forty (40) years of age or older in this state shall offer coverage for annual screening for the early detection of prostate cancer in men over the age of fifty (50) years and in men over the age of forty (40) years who are in high-risk categories. The coverage shall not be subject to policy deductibles. The coverage shall not exceed the actual cost of the prostate cancer screening up to a maximum of Sixty-five Dollars ($65.00) per screening.
B. The benefit required to be provided by subsection A of this section shall in no way diminish or limit diagnostic benefits otherwise allowable under a health benefit plan.
C. The prostate cancer screening coverage shall be offered as follows:
1. The screening shall be performed by a qualified medical professional including, but not limited to, a urologist, internist, general practitioner, doctor of osteopathy, nurse practitioner, or physician assistant;
2. The screening shall consist, at a minimum, of the following tests:
a.
a prostate-specific antigen blood test, and
b.
a digital rectal examination;
3. At least one screening per year shall be covered for any man fifty (50) years of age or older; and
4. At least one screening per year shall be covered for any man from forty (40) to fifty (50) years of age who is at increased risk of developing prostate cancer as determined by a physician.
D. As used in this section, “health benefit plan” means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
Added by Laws 1999, c. 137, § 1, eff. Nov. 1, 1999. Amended by Laws 2003, c. 464, § 8, eff. July 1, 2003; Laws 2010, c. 222, § 38, eff. Nov. 1, 2010.
NOTE: Editorially renumbered from Title 36, § 6060.7 to avoid a duplication in numbering.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.8a. Colorectal cancer coverage.

A. Any health benefit plan, including the State and Education Employees Group Health Insurance Plan, that is offered, issued or renewed in this state on or after January 1, 2002, which provides medical and surgical benefits, shall offer coverage for colorectal cancer examinations and laboratory tests for cancer for any nonsymptomatic covered individual, in accordance with standard, accepted published medical practice guidelines for colorectal cancer screening, who is:
1. At least fifty (50) years of age; or
2. Less than fifty (50) years of age and at high risk for colorectal cancer according to the standard, accepted published medical practice guidelines.
B. The coverage provided for by this section shall be subject to the same annual deductibles, co-payments or coinsurance limits as established for other covered benefits under the health plan.
C. To minimize costs for nonsymptomatic screening, third-party reimbursement may be at the existing Medicaid rate which shall be payment in full.
D. As used in this section, “health benefit plan” means any plan or arrangement as defined in subsection C of Section 6060.4 of this title; provided, however, the provisions of this section shall not apply to policies or certificates issued to individuals or to groups with fifty (50) or fewer employees, or to plans offered under the state Medicaid program.
Added by Laws 2001, c. 409, § 1, eff. Nov. 1, 2001. Amended by Laws 2010, c. 222, § 39, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.9. Coverage for wigs or other scalp prostheses.

A. Any health benefit plan, including the State and Education Employees Group Health Insurance Plan, that is offered, issued, or renewed in this state on or after January 1, 2001, that provides medical and surgical benefits with respect to the treatment of cancer and other conditions treated by chemotherapy or radiation therapy shall provide coverage for wigs or other scalp prostheses necessary for the comfort and dignity of the covered person.
B. The coverage provided for by this section shall be subject to the same annual deductibles, copayments, or coinsurance limits as established for all other covered benefits under the health benefit plan not to exceed One Hundred Fifty Dollars ($150.00) annually.
C. A health benefit plan shall provide notice to each insured or enrollee under the plan regarding the coverage required by this section in the evidence of coverage of the plan and shall provide additional written notice of the coverage to the insured or enrollee as follows:
1. In the next mailing made by the plan to the insured or enrolled employee;
2. As part of any yearly informational packet sent to the enrollee; or
3. Not later than December 1, 2000;
whichever is earlier.
D. As used in this act, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of this title. However, this section shall not apply to policies or certificates issued to individuals or groups with fifty (50) or fewer employees or plans offered under the State Medicaid Program.
E. The Insurance Commissioner shall promulgate any rules necessary to implement the provisions of this section.
Added by Laws 2000, c. 171, § 4, eff. July 1, 2000. Amended by Laws 2010, c. 222, § 40, eff. Nov. 1, 2010.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.9a. Anti-cancer medication coverage.

A. 1. Any health benefit plan that provides coverage and benefits for cancer treatment shall provide coverage of prescribed orally administered anticancer medications on a basis no less favorable than intravenously administered or injected cancer medications.
2. Coverage of orally administered anticancer medication shall not be subject to any prior authorization, dollar limit, copayment, deductible, or other out-of-pocket expense that does not apply to intravenously administered or injected cancer medication, regardless of formulation or benefit category determination by the company administering the health benefit plan.
3. A health benefit plan shall not reclassify or increase any type of cost-sharing to the covered person for anticancer medications in order to achieve compliance with this section. Any change in health insurance coverage that otherwise increases an out-of-pocket expense to anticancer medications shall also be applied to the majority of comparable medical or pharmaceutical benefits covered by the health benefit plan.
4. A health benefit plan that limits the total amount paid by a covered person through all cost-sharing requirements to no more than One Hundred Dollars ($100.00) per filled prescription for any orally administered anticancer medication shall be considered in compliance with this section. For purposes of this paragraph, "cost-sharing requirements" shall include copayments, coinsurance, deductibles, and any other amounts paid by the covered person for that prescription.
B. As used in this section:
1. "Anticancer medications" means medications used to kill or slow the growth of cancer cells;
2. "Covered person" means a policyholder, subscriber, enrollee, or other individual enrolled in or insured by a health benefit plan for health insurance coverage; and
3. "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. 115, § 1, eff. Nov. 1, 2013.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.9b. Cancer therapy coverage – Standard for proton radiation therapy.

A. A health benefit plan, as defined in subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes, that provides coverage for cancer therapy shall be prohibited from holding proton radiation therapy to a higher standard of clinical evidence for medical policy benefit coverage decisions than the health plan requires for coverage of any other radiation therapy treatment.
B. Nothing in this section shall be construed to mandate the coverage of proton radiation therapy by a health benefit plan.
Added by Laws 2015, c. 74, § 1, eff. Nov. 1, 2015.
2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.9c. Anti-abuse-formulated opioids - Study of effectiveness

The College of Pharmacy at Southwestern Oklahoma State University shall analyze the effectiveness of the anti-abuse properties of anti-abuse-formulated opioids. In addition, the College of Pharmacy shall analyze the discrepancies between insurance coverage for the anti-abuse-formulated prescription opioids and coverage for prescription opioids without abuse-deterrent properties. Such information shall be submitted in a report to the President Pro Tempore of the Senate and the Speaker of the House of Representatives on or before December 31, 2016.
Added by Laws 2016, c. 381, § 1, eff. Nov. 1, 2016.