reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 35 - Privacy › Subchapter 3 - Standards for Safeguarding Customer Information Regulation › Section 365:35-3-8 - Oversee service provider arrangements

Current through Vol. 41,
				No. 20, July 1, 2024
The licensee:
(1)
				Exercises appropriate due diligence in selecting its service providers;
				and
(2) Requires its service
				providers to implement appropriate measures designed to meet the objectives of
				this regulation, and, where indicated by the licensee's risk assessment, takes
				appropriate steps to confirm that its service providers have satisfied these
				obligations.
Added at 22 Ok Reg 2059,
				  eff 7-14-05
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 35 - Privacy › Subchapter 3 - Standards for Safeguarding Customer Information Regulation › Section 365:35-3-9 - Adjust the program

Current through Vol. 41, No. 20, July 1,
				2024
The licensee monitors, evaluates and adjusts, as appropriate,
				  the information security program in light of any relevant changes in
				  technology, the sensitivity of its customer information, internal or external
				  threats to information, and the licensee's own changing business arrangements,
				  such as mergers and acquisitions, alliances and joint ventures, outsourcing
				  arrangements and changes to customer information systems.
Added at 22 Ok Reg 2059,
				  eff 7-14-05
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 35 - Privacy › Subchapter 3 - Standards for Safeguarding Customer Information Regulation › Section 365:35-3-10 - Violation

Current through Vol. 41, No. 20, July 1, 2024
Violation of this regulation is a violation of Article 12 of
				  Title 36 of this state's statutes.
Added at 22 Ok Reg 2059,
				  eff 7-14-05
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 35 - Privacy › Subchapter 3 - Standards for Safeguarding Customer Information Regulation › Section 365:35-3-11 - Effective Date

Current through Vol. 41, No. 20, July 1,
				2024
Each licensee shall establish and implement an information
				  security program, including appropriate policies and systems pursuant to this
				  regulation by December 31, 2005.
Added at 22 Ok Reg 2059,
				  eff 7-14-05
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 35 - Privacy › Appendix A - Sample Clauses

Current through Vol. 41, No. 20, July 1,
			 2024
Figure
				1
Added at 18 Ok Reg 3646,
				eff 7-20-01 (emergency) ; Added at 19 Ok Reg 1326, eff
				7-14-02
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 1 - General Provisions › Section 365:40-1-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
This regulation provides rules administering the Health
				  Maintenance Organizations Act of 2003, 36 O.S. §
									6901, et
				  seq., and related provisions of the Oklahoma Insurance Code.
Added at 21 Ok Reg 77,
				  eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
				  7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 1 - General Provisions › Section 365:40-1-2 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
As used in this Chapter, unless the context requires
				  otherwise:
"Alien HMO"
means an HMO formed under the laws
				  of a country other than the United States, except that for purposes of the
				  Holding Company Act, alien HMO shall have the same meaning as foreign
				  HMO.
"Department"
means the Oklahoma Insurance
				  Department pursuant to Title 36 of the Oklahoma Statutes.
"Domestic HMO"
means an HMO formed under the
				  laws of Oklahoma.
"Executive officer"
means chief executive
				  officer, chief operating officer, chief financial officer, treasurer,
				  secretary, controller, and any other individual performing functions
				  corresponding to those performed by the foregoing officers under whatever
				  title.
"Foreign HMO"
means an HMO formed under the laws
				  of another state, commonwealth, territory, or district of the United
				  States.
"HMO Act"
means the Health Maintenance
				  Organization Act of 2003 as amended, 36 O.S. §
									6901, et
				  seq.
"Health Maintenance Organization"
(HMO) has the
				  meaning as defined at 36 O.S. §
									6902, and,
				  for purposes of this regulation, any reference to the terms insurer, insurance
				  company or company in this regulation, in statutes referenced by this
				  regulation or in statutes referenced in the HMO Act also includes health
				  maintenance organizations.
"Holding Company Act"
means the Insurance
				  Holding Company System Regulatory Act, 36 O.S. §
									1651, et
				  seq.
"NAIC"
means the National Association of
				  Insurance Commissioners.
"Ultimate controlling person"
means that person
				  which is not controlled by any other person.
Added at 21 Ok Reg 77,
				  eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
				  7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 1 - General Provisions › Section 365:40-1-3 - Medicaid HMOs

Current through Vol. 41, No. 20, July 1,
				2024
Domestic health maintenance organizations that contract with
				  the Oklahoma Health Care Authority to provide basic health care services to
				  Medicaid recipients and do not provide basic health care services to any other
				  group of persons shall be exempt from compliance with
				  365:40-5-44 of this
				  Chapter.
Added at 21 Ok Reg 77,
				  eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
				  7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 1 - General Provisions › Section 365:40-1-4 - Severability provision

Current through Vol. 41, No. 20, July 1,
				2024
If any provision of this regulation, or the application
				  thereof to any person or circumstances, is held invalid, such invalidity shall
				  not affect other provisions or applications of this regulation, which can be
				  given effect without the invalid provision, or application, and to that end the
				  provisions of this regulation are severable.
Added at 21 Ok Reg 77,
				  eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
				  7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 1 - HMO FORMS AND INSTRUCTIONS › Section 365:40-3-2 - Deposit of securities forms

Current through Vol. 41, No. 20, July
				  1, 2024
(a)
Deposit form.
The deposit form is used by all companies depositing
				  securities with the Insurance Department . A description of the securities and
				  value must be itemized on this form and said form must accompany securities
				  being deposited when presented to the Insurance Commissioner for approval.
				  After completion of transaction, a copy of this form is sent to said company
				  for use to obtain release of deposited securities. Prior to the withdrawal of
				  said securities, the deposit form must be executed by a company official
				  authorized to make such withdrawals and presented to the Insurance Commissioner
				  for approval.
(b)
Deposits in
				  the name of Insurance Commissioner and HMO.
Deposits with the Insurance
				  Commissioner made pursuant to 36 O.S. §
										6913(B)
				  shall be in the name of the Insurance Commissioner and the HMO making the
				  deposit, and shall not be released by any company holding such security without
				  the signatures of the Insurance Commissioner and the authorized personnel of
				  the HMO. The deposit shall be held by the Insurance Commissioner unless the
				  Insurance Commissioner approves, pursuant to 36 O.S. §
										6913(B),
				  the holding of said deposit by an organization or trustee acceptable to the
				  Insurance Commissioner through which a custodial or controlled account is
				  utilized.
(c)
Resolution
				  form.
Each company having securities on deposit with the Insurance
				  Department must adopt a resolution and file it with the Insurance
				  Commissioner's Office authorizing and empowering certain persons designated by
				  said company to deal with the securities on deposit. Requests for exchange or
				  withdrawal of deposited securities will not be honored unless made by
				  designated persons.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-10 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
Unless the context otherwise requires, terms found in this
					 subsection shall have the same meaning as defined in Section
					 1651 of
					 Title 36.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-11 - Compliance with Article 16A of Title 36

Current through Vol. 41,
				  No. 20, July 1, 2024
Definitions of terms found in Section
					 1651 of
					 Title 36 shall apply when an HMO is seeking to comply with Article 16A of the
					 Oklahoma Insurance Code pursuant to Section
					 6930
					 of Title 36. For purposes of this section, the definition of the term insurer
					 as set out in Section
					 1651 of
					 Title 36 shall include HMOs.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-12 - Annual registration statements

Current through Vol. 41, No.
				  20, July 1, 2024
(a)
Registration.
Every HMO which is authorized to do business in this
				  state and every individual who controls an HMO shall annually register with the
				  Insurance Commissioner, except a foreign HMO subject to disclosure requirements
				  and standards adopted by statute or regulation in the jurisdiction of its
				  domicile which are substantially similar to those contained in this section.
				  Any HMO, which is subject to registration under this section, shall register
				  thirty (30) days after it becomes subject to registration, unless the Insurance
				  Commissioner for good cause shown extends the time for registration, and then
				  within such extended time.
(b)
Information and form required.
Every HMO subject to registration
				  shall file a registration statement on a form prescribed by the National
				  Association of Insurance Commissioners, which shall contain current information
				  about:
(1) the capital structure, general
				  financial condition, ownership and management of the HMO and any person
				  controlling the HMO;
(2) the
				  identity and relationship of every member of the insurance holding company
				  system;
(3) the following
				  agreements in force, relationships subsisting, and transactions currently
				  outstanding or which have occurred during the previous calendar year between
				  such HMO and its affiliates:
(A) loans, other
				  investments or purchases, sales or exchanges of securities of the affiliates by
				  the HMO or of the HMO by its affiliates;
(B) purchases, sales or exchanges of
				  assets;
(C) transactions not in the
				  ordinary course of business;
(D)
				  guarantees or undertakings for the benefit of an affiliate which result in an
				  actual contingent exposure of the HMO's assets to liability, other than
				  contracts for health care services entered into in the ordinary course of the
				  HMO's business;
(E) all management
				  and service contracts and all cost-sharing arrangements;
(F) reinsurance agreements;
(G) dividends and other distributions to
				  shareholders; and
(H) consolidated
				  tax allocation agreements.
(4) other matters concerning transactions
				  between registered HMOs and any affiliates as may be included from time to time
				  in any registration forms adopted or approved by the Commissioner;
				  and
(5) any pledge of the HMO's
				  stock, including stock of any subsidiary or controlling affiliate, for a loan
				  made to any member of the insurance holding company system.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-13 - Transactions with Affiliates

Current through Vol. 41, No. 20, July
				  1, 2024
(a)
Material transactions.
The board of directors will be charged with
				  exercising that degree of care that a prudent person would have exercised under
				  similar circumstances. Material transactions shall be subject to the following
				  standards:
(1) the terms shall be fair and
				  reasonable;
(2) the books, accounts
				  and records of each party shall be so maintained as to clearly and accurately
				  disclose the precise nature and details of the transaction; and
(3) the HMO's capital and surplus following
				  any dividends or distributions to shareholder affiliates shall be reasonable in
				  relation to the HMO's outstanding liabilities and adequate to its financial
				  needs.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-14 - Prior approval pursuant to 36 O.S.Section 6903(C)

Current
				  through Vol. 41, No. 20, July 1, 2024
(a) Pursuant to 36 O.S. §
										6903(D),
				  the prior written approval of the Insurance Commissioner shall be required for
				  amendments or modifications to items required by 36 O.S. §
										6903(C)(4),
				  (5), (6), and ( 11 ) .
(b) Requests for prior written approval
				  required by 36 O.S. §
										6903(C)(4)
				  and (11) shall be made on HMO Form D as set
				  forth in Appendix D of this Chapter. Pursuant to O.A.C.
				  365:40-3-12,
				  an Amended Registration Statement (HMO Form B) shall be filed for all items
				  approved by the Insurance Commissioner.
(c) Requests for prior written approval of
				  items required by 36 O.S. §
										6903(C)(5)
				  and (6) shall be submitted to the Rate and
				  Form Compliance Division of the Oklahoma Insurance Department. Pursuant to
				  Section
				  365:40-3-12,
				  an Amended Registration Statement (HMO Form B) shall be filed for all items
				  approved by the Insurance Commissioner.
(d) Nothing in this section shall supersede
				  approvals granted under other sections of this title or transactions occurring
				  prior to July 14, 2010.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff 7-14-04; Amended at 27 Ok
					 Reg 1565, eff 7-14-10
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-15 - Notice of amendments or modifications pursuant to 36 O.S.Section 6903(C)

Current through Vol. 41, No. 20, July 1, 2024
Pursuant to 36 O.S. §
										6903(D),
					 amendments or modifications to the items required by 36 O.S. §
										6903(C)(1),
					 (2), (3), (7), (8), (9), (10), (12), (13) and
					 (14) shall be included in the Amendments to
					 Registration Statements and shall be made on HMO Form B as set forth in
					 Appendix B of this Chapter.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-16 - Redomestication

Current through Vol. 41, No. 20, July 1, 2024
(a) Any HMO which is organized under the laws
				  of any other state and is admitted to do business in this state for the purpose
				  of transacting business of a health maintenance organization may become a
				  domestic HMO by complying with all of the requirements of law relative to the
				  organization and licensing of a domestic HMO and by designating its principal
				  place of business at a location in this state. Said domestic HMO will be
				  entitled to like certificates and licenses to transact business in this state
				  and shall be subject to the authority and jurisdiction of this state.
(1) The Insurance Commissioner shall approve
				  an HMO's application to redomesticate unless he finds that:
(A) the HMO cannot comply with all the
				  requirements of law relative to the organization and licensing of a domestic
				  HMO,
(B) after redomestication, the
				  HMO would not be able to satisfy the requirements for the issuance of a license
				  to conduct business as an HMO in this State,
(C) the effect of the redomestication would
				  be substantially to lessen competition in this state or tend to create a
				  monopoly therein,
(D) the financial
				  condition of the HMO is such as might jeopardize or prejudice the interest of
				  its enrollees, members or subscribers or this state and is not in the public
				  interest, or
(E) the competence,
				  experience and integrity of those persons who control the operation of the HMO
				  are such that it would not be in the interest of the enrollees, members,
				  subscribers, the public or the state to permit the domestication.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-17 - Forms: general requirements

Current through Vol. 41, No. 20,
				  July 1, 2024
(a)
Forms A, B, C, D, E and R.
HMO Forms A, B, C, D, E and R, as set
				  forth in Appendices A, B, C, D, E, and F of this Chapter, are intended to be
				  guides in the preparation of the statements required by Article 16A of Title
				  36, Section
				  6930 of Title 36 and O.A.C.
				  365:40-3-12, 13 and 16. They are
				  not intended to be blank forms that are to be filled in. The statements filed
				  shall contain the numbers and captions of all items, but the text of the items
				  may be omitted provided the answers thereto are prepared in such a manner as to
				  indicate clearly the scope and coverage of the items. All instructions, whether
				  appearing under the items of the form or elsewhere therein, are to be omitted.
				  Unless expressly provided otherwise, if any item is inapplicable, or the answer
				  thereto is in the negative, an appropriate statement to that effect shall be
				  made.
(b)
Filing
				  statements.
Statements shall be filed electronically. Third-party
				  verifications sent by the third party may be filed electronically. A copy of an
				  HMO Form B and C shall be filed in each state in which an HMO is authorized to
				  do business, if the HMO authority of that state has notified the HMO of its
				  request in writing, in which case the HMO has thirty (30) days from receipt of
				  the notice to file such form. Appropriate electronic signatures are permitted.
				  The Commissioner may request a wet signature at his or her discretion. If the
				  signature of any person is affixed pursuant to a power of attorney or other
				  similar authority, a copy of such power of attorney or other authority shall
				  also be filed with the statement.
(c)
Format of statements.
Electronic statements shall meet all technical requirements of the
				  Commissioner. All copies of any statement, financial statements, or exhibits
				  shall be clear, easily readable and suitable for reproduction. Debits in credit
				  categories and credits in debit categories shall be designated so as to be
				  clearly distinguishable as such on copies. Statements shall be in the English
				  language, and monetary values shall be stated in United States Currency. If any
				  exhibit or other paper or document filed with the statement is in a foreign
				  language, it shall be accompanied by a translation into the English language
				  and any monetary value shown in a foreign currency shall be converted into
				  United States Currency.
Added at 21 Ok Reg 77, eff 11-1-03 (emergency) ; Added
						at 21 Ok Reg 1672, eff 7-14-04 ; Amended at 30 Ok Reg 1801, eff
						7-14-13
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-19 - Acquisition of control; statement filing (HMO Form A)

Current
				  through Vol. 41, No. 20, July 1, 2024
(a)
HMO Form A.
A person
				  required to file a statement pursuant to Section 6930 of the HMO Act and
				  Section 1653 of the Holding Company Act shall furnish the required information
				  on HMO Form A, hereby made a part of this section, as set forth in Appendix A
				  of this Chapter. Such person shall also furnish the required information on HMO
				  Form E, as set forth in Appendix E of this Chapter.
(b)
Amendments to applications.
The applicant shall promptly advise the Commissioner of any changes in the
				  information so furnished on HMO Form A arising subsequent to the date upon
				  which such information was furnished, but prior to the Commissioner's
				  disposition of the application.
(c)
Identification of Section 6930/Section 1653(a) Health Maintenance
				  Organizations.
(1)
Domestic HMO
				  name.
The name of the domestic HMO on the cover page of an HMO Form A
				  should be indicated as follows: "ABC HMO, a subsidiary of XYZ Holding
				  Company."
(2)
Reference to
				  subsidiary HMO and person being acquired.
Where an HMO is being
				  acquired, references to "the HMO" contained in HMO Form A (Appendix A of this
				  Chapter) shall refer to both the domestic subsidiary HMO and the person being
				  acquired.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-20 - Pre-acquisition notification

Current through Vol. 41, No. 20, July 1,
				  2024
If a domestic HMO, including any person controlling a
					 domestic HMO, is proposing a merger or acquisition pursuant to Section 6930 of
					 the HMO Act and Section 1653(a) of the Holding Company Act, that person shall
					 file a preacquisition notification form, HMO Form E, as set forth in Appendix E
					 of this Chapter. In addition to the information required by HMO Form E, the
					 Commissioner may require an expert opinion as to the competitive impact of the
					 proposed acquisition.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-21 - Annual registration of HMOs; statement filing (HMO Form B)

Current through Vol. 41, No. 20, July 1, 2024
(a)
HMO Form B.
An HMO filing an
				  annual registration statement pursuant to O.A.C.
				  365:40-3-12
				  shall furnish the required information on HMO Form B as set forth in Appendix B
				  of this Chapter.
(b)
Summary
				  registration.
An HMO filing an annual registration statement pursuant to
				  O.A.C.
				  365:40-3-12
				  is also required to furnish information required on HMO Form C, as set forth in
				  Appendix C of this Chapter. An HMO shall file a copy of HMO Form C in each
				  state in which the HMO is authorized to do business, if requested by the HMO
				  authority/agency of that state.
(c)
Amendments to HMO Form B.
(1)
15 day amendments.
An amendment to HMO Form B (Appendix B of this
				  Chapter) shall be filed within 15 days after the end of any month in which
				  there is a material change to the information provided in the annual
				  registration statement.
(2)
Filing date amendments.
Amendments shall be filed in the HMO Form
				  B format, as set forth in Appendix B of this Chapter, with only those items
				  which are being amended and reported. Each amendment shall include at the top
				  of the cover page "Amendment No. [insert number] to HMO Form B for [insert
				  year]" and shall indicate the date of the change and not the date of the
				  original filing.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-22 - Dividend to stockholders

Current through Vol. 41, No. 20, July
				  1, 2024
(a) A domestic
				  HMO shall not pay any ordinary cash dividend to stockholders except out of that
				  part of its available surplus funds which is derived from realized net profits
				  on its business (positive unassigned funds). The restriction shall also apply
				  to extraordinary dividends as defined in O.A.C.
				  365:40-3-13.
(b) A dividend otherwise proper may be
				  payable out of the HMO's earned surplus even though its total surplus is then
				  less than the aggregate of its past contributed surplus resulting from issuance
				  of its capital stock at a price in excess of the par value thereof.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-23 - Extraordinary dividends and other distributions

Current through Vol.
				  41, No. 20, July 1, 2024
(a)
Request for approval of
				  extraordinary dividends.
Requests for approval of extraordinary
				  dividends or any other extraordinary distribution to shareholders shall include
				  the following:
(1) the amount of the proposed
				  dividend;
(2) the date established
				  for payment of the dividend;
(3) a
				  statement as to whether the dividend is to be in cash or other property and, if
				  in property, a description thereof, its cost, and its fair market value
				  together with an explanation of the basis for valuation;
(4) a copy of the calculations determining
				  that the proposed dividend is extraordinary. The work paper shall include the
				  following information:
(A) the amounts, dates
				  and form of payment of all dividends or distributions (including regular
				  dividends but excluding distributions of the HMOs own securities) paid within
				  the period of twelve (12) consecutive months ending on the date fixed for
				  payment of the proposed dividend for which approval is sought and commencing on
				  the day after the same day of the same month in the last preceding
				  year;
(B) total capital and surplus
				  as of the 31st day of the December next preceding;
(C) the net income less realized capital
				  gains for the 12-month period ending the 31st day of December next preceding
				  and the two preceding 12-months periods; and
(D) the dividends paid to stockholders
				  excluding distributions of the HMO's own securities in the preceding two (2)
				  calendar years.
(5) a
				  balance sheet and statement of income for the period intervening from the last
				  annual statement filed with the Insurance Commissioner and the end of the month
				  preceding the month in which the request for dividend approval is submitted;
				  and
(6) a brief statement as to the
				  effect of the proposed dividend upon the HMO's surplus and the reasonableness
				  of surplus in relation to the HMO's outstanding liabilities and the adequacy of
				  surplus relative to the HMO's financial needs.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-24 - Adequacy of surplus

Current through Vol. 41, No. 20, July 1,
				  2024
The factors set forth in Section
					 365:40-3-13(d)
					 are not intended to be an exhaustive list. In determining the adequacy and
					 reasonableness of an HMO's surplus, no single factor is necessarily
					 controlling. The Commissioner, instead, will consider the net effect of all of
					 these factors plus other factors bearing on the financial condition of the HMO.
					 In comparing the surplus maintained by other HMOs, the Commissioner will
					 consider the extent to which each of these factors varies from company to
					 company and in determining the quality and liquidity of investments in
					 subsidiaries, the Commissioner will consider the individual subsidiary and may
					 discount or disallow its valuation to the extent that the individual
					 investments so warrant.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 3 - HOLDING COMPANY SYSTEM › Section 365:40-3-25 - Failure to file

Current through Vol. 41, No. 20, July 1,
				  2024
Any failure of an HMO, without just cause, to timely file
					 any registration statement, summary or other information as required by the HMO
					 Act or this Part is a violation of this regulation.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 5 - MISCELLANEOUS › Section 365:40-3-30 - Liabilities

Current through Vol. 41, No. 20, July 1, 2024
Liabilities shall be computed in accordance with the
					 provisions of the NAIC Accounting Practices and Procedures Manual of the
					 NAIC.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 5 - MISCELLANEOUS › Section 365:40-3-31 - Name of HMO

Current through Vol. 41, No. 20, July 1,
				  2024
(a) No HMO shall be
				  authorized to transact the business of an HMO in Oklahoma which has or uses a
				  name so similar to that of any HMO already so authorized as to cause
				  uncertainty or confusion; except, that in case of conflict of names between two
				  HMOs, the Insurance Commissioner may permit or require the newly-authorized
				  insurer to use in Oklahoma such supplementation or modification of its name as
				  may reasonably be necessary to avoid such conflict.
(b) No insurer shall be authorized to
				  transact the business of an HMO in Oklahoma which has or uses a name which
				  tends to deceive or mislead as to the type of organization of the
				  HMO.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 5 - MISCELLANEOUS › Section 365:40-3-32 - Standards for determining hazardous financial condition

Current
				  through Vol. 41, No. 20, July 1, 2024
The following may be considered by the Insurance
					 Commissioner to determine whether the continued operation of any HMO might be
					 deemed to be hazardous to the enrollees, members, subscribers, creditors or the
					 general public. The Commissioner may consider:
(1) financial condition and market conduct
				  examination reports;
(2) the
				  National Association of Insurance Commissioners Insurance Regulatory
				  Information System and its related reports;
(3) the ratios of commission expense, general
				  business expense, group and individual contract benefits and reserve increases
				  as to annual premium and net investment income;
(4) the HMO's assets;
(5) the HMO's reinsurance program;
(6) the HMO's operating results for the last
				  twelve month period or any shorter period of time;
(7) the financial condition of the HMO's
				  affiliates, subsidiaries, or reinsurers;
(8) contingent liabilities, pledges or
				  guaranties;
(9) whether any
				  "controlling person" of an HMO is delinquent in the transmitting to, or payment
				  of, net premiums to such HMO;
(10)
				  the age and collectibility of receivables;
(11) competence and fitness of the management
				  of the HMO, including officers, directors, or any other person who directly or
				  indirectly controls the operation of such HMO;
(12) whether the HMO has failed to respond to
				  the Insurance Commissioner's inquiries relative to the condition of the HMO or
				  has furnished false and misleading information in response to such
				  inquiries;
(13) whether the HMO
				  either has filed any false or misleading sworn financial statements, or has
				  released false or misleading financial statements to lending institutions or to
				  the general public;
(14) whether
				  the HMO lacks adequate financial and administrative capacity to meet its
				  obligations in a timely manner;
(15) whether the HMO has experienced or will
				  experience in the foreseeable future cash flow and/or liquidity
				  problems.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 3 - Financial › Part 5 - MISCELLANEOUS › Section 365:40-3-33 - Commissioner's authority

Current through Vol. 41, No. 20, July 1,
				  2024
(a) For the
				  purposes of making a determination of an HMO's financial condition under the
				  Act, the Insurance Commissioner may, if consistent with the facts and existing
				  law:
(1) Disregard any credit or amount
				  receivable resulting from transactions with a reinsurer which is insolvent,
				  impaired or otherwise subject to a delinquency proceedings;
(2) Make appropriate adjustments to asset
				  values attributable to investments in or transactions with parents,
				  subsidiaries, or affiliates;
(3)
				  Refuse to recognize the stated value of accounts receivable if the ability to
				  collect receivables is highly speculative in view of the age of the account or
				  the financial condition of the debtor;
(4) Increase the HMO's liability in an amount
				  equal to any contingent liability, pledge, or guarantee not otherwise included
				  if there is a substantial likelihood that the HMO will be called upon to meet
				  the obligation undertaken within the next 12-month period.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 1 - GENERAL PROVISIONS › Section 365:40-5-2 - Form filings

Current through Vol. 41, No. 20, July 1,
				  2024
All group and individual contract forms, evidence of
					 coverage or amendments thereto, shall be filed for approval before use pursuant
					 to 36 O.S. §§
										6903(C)(5)
					 and (6) and
					 6908(E),(F)
					 and (G). The appropriate filing fee, as
					 provided in 36 O.S. §
										321,
					 shall accompany each filing. All filings submitted pursuant to this section
					 shall be submitted electronically to the Rate and Form Compliance Division of
					 the Oklahoma Insurance Department.
Added at 27 Ok Reg
					 1565, eff 7-14-10
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 3 - RATING SYSTEM › Section 365:40-5-10 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
When used in this Part the term "Rating System" means the
					 method or combination of methods which the HMO uses to calculate enrollee
					 premiums, and is limited to community rating, community rating by class,
					 adjusted community rating or a combination of all. An HMO may fix rates of
					 payment under either a system of community rating, community rating by class,
					 adjusted community rating or under all three systems. However, the HMO may use
					 only one such system for setting rates for any group at any one
					 time.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 3 - RATING SYSTEM › Section 365:40-5-11 - Community rating

Current through Vol. 41, No. 20, July 1,
				  2024
Under community rating, rates of payments may be determined
					 on a per-person or per-family basis and may vary with the number of persons in
					 a family, but except as otherwise authorized in this paragraph, such rates must
					 be equivalent for all individuals and for all families of similar composition.
					 This does not preclude changes in the rates of payments for health services
					 based on a community rating system which are established for new enrollments or
					 re-enrollments and which changes do not apply to existing contracts until the
					 renewal of such contracts. Only the following differentials in rates of
					 payments may be established under such system:
(1) Nominal differentials in such rates may
				  be established to reflect differences in marketing costs and the different
				  administrative costs of collecting payments from the following categories of
				  subscribers:
(A) Individual (non-group)
				  subscribers (including their families).
(B) Small groups of subscribers.
(C) Large groups of subscribers.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 3 - RATING SYSTEM › Section 365:40-5-12 - Community rating by class

Current through Vol. 41, No. 20, July
				  1, 2024
Under "community rating by class," rates are fixed by
					 groups for individuals and families, and must be equivalent for all individuals
					 or for all families in the same group. A class is actuarially derived or
					 developed based on factors which reasonably predict differences in the use of
					 HMO services. Age, sex, family size and marital status factors need not be
					 justified.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 3 - RATING SYSTEM › Section 365:40-5-13 - Adjusted community rating

Current through Vol. 41, No. 20, July
				  1, 2024
Under "adjusted community rating" rates are fixed on the
					 basis of revenue requirements for providing services to the group, except that
					 rates for a group of less than 50 persons may not be fixed at rates greater
					 than 115 percent of the rate that would be fixed under community rating or
					 community rating by class.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 3 - RATING SYSTEM › Section 365:40-5-14 - Rates to reflect risk-sharing arrangements

Current through Vol.
				  41, No. 20, July 1, 2024
An HMO may establish differentials based on financial
					 risk-sharing arrangements with organizations or entities which have contracted
					 with the HMO to provide selected basic health care services to members of said
					 organizations or entities, as permitted by 36 O.S. §
										6902(1)
					 and otherwise permitted by the HMO Act or this Chapter.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 5 - BASIC AND SUPPLEMENTAL HEALTH CARE SERVICES › Section 365:40-5-22 - Benefit changes

Current through Vol. 41, No. 20, July 1,
				  2024
Each HMO shall provide to each group and individual
					 enrollee a written statement of benefit changes for the upcoming benefit year.
					 The statement shall identify clearly and concisely those aspects of the
					 proposed benefits plan which differ from the current benefits plan. Such notice
					 should be provided as soon as available, but at least thirty (30) days prior to
					 the date by which the group or individual enrollees must choose coverage. When
					 an employer, rather than an HMO, requests changes for the upcoming benefit year
					 that does not allow for a notification of at least thirty (30) days, the HMO
					 shall provide notice as soon as reasonably possible.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 5 - BASIC AND SUPPLEMENTAL HEALTH CARE SERVICES › Section 365:40-5-23 - Identification cards

Current through Vol. 41, No. 20, July 1,
				  2024
The subscriber and enrollee identification card issued by
					 an HMO shall clearly indicate the name, mailing address, and phone number for
					 submission of requests for payment or reimbursement of claims. If the HMO
					 requires claims to be submitted to an entity other than the licensed HMO, then
					 the identification card shall disclose that requirement. The HMO shall not
					 distribute a subscriber and enrollee identification card until its form has
					 been approved by the Department.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 7 - POINT OF SERVICE OPTION › Section 365:40-5-30 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
When used in this Part, "point of service option" means a
					 benefit that allows a member to submit claims for payment or reimbursement of
					 nonemergency health services obtained from noncontracting providers. It also
					 may mean a benefit for non-emergency services obtained from a contracting
					 provider without a referral or authorization.
Added at 21 Ok Reg 77,
					 eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff
					 7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 7 - POINT OF SERVICE OPTION › Section 365:40-5-31 - Purpose/scope

Current through Vol. 41, No. 20, July 1, 2024
(a) The provisions of this Part do not apply
				  to emergency care.
(b) Each HMO
				  shall submit this benefit for the Department's approval before offering the
				  benefit to members.
(c) This
				  benefit is optional, and the HMO has the following flexibility:
(1) The HMO is not required to offer this
				  benefit;
(2) The HMO may decide
				  which services will be offered or excluded;
(3) The HMO may limit the groups to whom this
				  benefit is offered, but the benefit must be offered to all persons within the
				  group;
(4) If individual contracts
				  are offered, the HMO may limit the individuals to whom this benefit is
				  offered;
(5) The HMO may set annual
				  dollar limits on services provided through this benefit;
(6) The HMO may use enrollee cost-sharing for
				  this benefit. This cost-sharing may be accomplished through premium, copayment
				  or deductible; and,
(7) The HMO may
				  require precertification of services provided through this benefit.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 7 - POINT OF SERVICE OPTION › Section 365:40-5-32 - Responsibilities of the HMO

Current through Vol. 41, No. 20, July 1,
				  2024
(a) Each HMO that
				  offers a point of service option shall collect and report to the Department the
				  number of enrollees who access the benefit, the types and volumes of services
				  received, and the costs to enrollees and the HMO.
(b) Each HMO shall inform enrollees about the
				  following:
(1) Any premium and cost-sharing
				  charges;
(2) Annual out-of-pocket
				  limits;
(3) Annual and maximum
				  benefit limits for out-of-plan services; and,
(4) Potential financial liability for
				  services for which payment could be denied because the service is not a covered
				  benefit, or the dollar limit is exceeded.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 40 - Health Maintenance Organization (HMO) › Subchapter 5 - Life, Accident & Health Division and Consumer Assistance and Claims Division Rules › Part 9 - HMO REQUIREMENTS AND PROHIBITIONS › Section 365:40-5-40 - Services to members

Current through Vol. 41, No. 20, July 1,
				  2024
Within the HMO's service area, basic health care services
					 and those supplemental health care services for which enrollees have contracted
					 to be provided by the HMO shall be:
(1) Provided or arranged by the HMO, except
				  as described in Parts 7, 13 and 19 of this Subchapter. Basic health care
				  services shall be provided for HMO members as needed and without limitations as
				  to time and cost.
(2) Available and
				  accessible to each of the HMO's enrollees with reasonable promptness with
				  respect to:
(A) Geographic location, hours of
				  operation, and provisions for after-hours services (medically necessary
				  emergency services shall be available and accessible twenty-four (24) hours a
				  day, seven (7) days a week). An HMO that has a service area located in a
				  non-metropolitan area may make a basic health care service available outside
				  its service area if that basic health care service is not a primary care or
				  emergency care service and if there is an insufficient number of providers of
				  that basic health care service within the service area who will provide that
				  service to enrollees of the HMO.
(B) Staffing patterns within generally
				  accepted norms for meeting the projected enrollment needs.
(C) The type of health professional so that
				  availability of health professionals is adequate to meet the enrollees'
				  needs.