reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 9 - Annuities › Part 3 - PERTAINING TO SEPARATE ACCOUNTS IN CONNECTION WITH VARIABLE ANNUITY CONTRACTS › Section 365:10-9-16 - Required reports

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Annual
				  report of investments to contractholders.
Any company issuing individual
				  variable annuity contracts providing benefits in variable amount, shall mail to
				  the contractholder, at least once in each contract year, after the first, at
				  his last address known to the company, a statement or statements reporting the
				  investments held in the separate account and, in the case of contracts under
				  which payments have not yet commenced, a statement reporting as of a date not
				  more than four months previous to the date of mailing:
(1) the number of accumulation units credited
				  to such contracts and the dollar value of a unit, or
(2) the value of the contractholder's
				  account.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 9 - Annuities › Part 3 - PERTAINING TO SEPARATE ACCOUNTS IN CONNECTION WITH VARIABLE ANNUITY CONTRACTS › Section 365:10-9-17 - Reporting actions taken against variable annuity licenses

Current through Vol. 41, No. 20, July 1, 2024
Any person licensed in this state as a variable annuity
					 contract agent, and his appointing Company, shall immediately report to the
					 Commissioner:
(1) any suspension or
				  revocation of his variable annuity contract agent's license or life insurance
				  agent's license in any other state or territory of the United States,
(2) the imposition of any disciplinary
				  sanction (including suspension or expulsion from membership, suspension or
				  revocation or denial of registration) imposed upon him by any national
				  securities exchange, or national securities association, or any Federal, or
				  State or Territorial agency with jurisdiction over securities or contracts on a
				  variable basis,
(3) any judgment or
				  injunction entered against him on the basis of conduct deemed to have involved
				  fraud, deceit, misrepresentation, or violation of any insurance or securities
				  law or regulation.
Amended at 11 Ok Reg
					 1853, eff 5-15-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 9 - Annuities › Part 3 - PERTAINING TO SEPARATE ACCOUNTS IN CONNECTION WITH VARIABLE ANNUITY CONTRACTS › Section 365:10-9-18 - Severability provisions

Current through Vol. 41, No. 20, July 1,
				  2024
If any provision of this section or application thereof to
					 any person or circumstance is held invalid, the remainder of the provisions and
					 the application of such provision to other persons or circumstances shall not
					 be affected thereby.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this subchapter is to adopt the Model Group
				  Coordination of Benefits Regulation, as promulgated by the National Association
				  of Insurance Commissioners. This subchapter is intended to establish uniformity
				  in the permissive use of over insurance provisions and to avoid claim delays
				  and misunderstandings that could otherwise result from the use of inconsistent
				  or incompatible provisions amount Plans. It is contrary to the public policy of
				  this state for a Plan to declare its coverage to be "excess" to all others, or
				  always "secondary", or to reduce its benefits because of the existence of
				  duplicate coverage in a manner other than as permitted by this regulation; or
				  to reduce its benefits because a person covered by the Plan is eligible for any
				  other coverage. It is requested that courts give effect to this public policy
				  when they consider the interrelation of Plans with order of benefit
				  determination rules which comply with this subchapter and Plans with order of
				  benefit determination rules which differ from those set forth in this
				  subchapter.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-3 - Effect on benefits

Current through Vol. 41, No. 20, July 1,
				2024
(a)
Determining benefits.
This section shall apply in determining the
				benefits as to a person covered under the Plan for any claim determination
				period if, for the allowable expense incurred as to such person during such
				period, the sum of:
(1) the benefits that
				would be payable under this Plan in the absence of this provision,
				and
(2) the benefits that would be
				payable under all other Plans in the absence therein of provisions of similar
				purpose to this provision would exceed such Allowable Expenses.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-4 - Right to receive and release necessary information

Current
				through Vol. 41, No. 20, July 1, 2024
For the purpose of determining the applicability of and
				  implementing the terms of this section of this Plan or any provision of similar
				  purpose of any other Plan, the insurer or service plan may, without the consent
				  of or notice to any person, release to or obtain from any other insurance
				  company or other organization or person any information, with respect to any
				  person, which the insurer or service plan deems to be necessary for such
				  purposes. Any person claiming benefits under this plan shall furnish to the
				  insurer or service plan such information as may be necessary to implement this
				  section. Occasionally this will necessitate a carrier making payment as the
				  primary carrier with a right of recovery in the event that subsequent
				  investigation proves that payment as a secondary carrier should have been
				  made.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-5 - Benefit payments

Current through Vol. 41, No. 20, July 1,
				2024
Carriers shall use the following claims administration
				  procedures to expedite claim payments where COB is involved:
(1)
Improving exchange of benefit
				information.
(A) There should be
				continued and improved education of claim personnel stressing accurate and
				prompt completion of the HIC Duplicate Coverage Inquiry (DUP-1) Form by the
				inquiring carrier and the responding carrier. This education effort should also
				be encouraged through local claim associations.
(B) Claim personnel should be encouraged to
				make every effort, including use of the telephone, to speed up exchange of COB
				information. All carriers shall respond to inquiries at least thirty (30) days
				from receipt of such inquiries.
(C)
				Carriers should encourage building a local date file of other group plans in
				the area, with at least basic information on group health plans for major
				employers.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-6 - Subrogation

Current through Vol. 41, No. 20, July 1, 2024
The concept of coordination of benefits is clearly
				  distinguishable from that of subrogation. Provisions for either may be included
				  in a group health insurance policy without compelling the inclusion or
				  exclusion of the other.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-7 - Small claim waivers

Current through Vol. 41, No. 20, July 1,
				2024
Carriers shall waive the investigation of possible other
				  coverage for COB purposes on claims less than $50, but if additional liability
				  is incurred to raise the small claim above $50, the entire liability may be
				  included in the COB computation.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-8 - Public education

Current through Vol. 41, No. 20, July 1,
				2024
Each carrier has an affirmative obligation to urge its
				  respective group policyholder-clients to take reasonable steps to assure that
				  those insured by the group policy or subscriber contract have been exposed to
				  reasonably concise explanations, with as little technical terminology as is
				  commensurate with accuracy, as to the purpose and operation of COB. Such
				  educational effort may take the form of articles in the company magazines or
				  newspapers, speeches before the appropriate labor organization in the case of a
				  unionized company, brochures added to pay envelopes, notices on the company
				  bulletin board, material used by personnel department in counseling employees,
				  and the like.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-9 - Applicability

Current through Vol. 41, No. 20, July 1, 2024
(a) Group policies or contracts which are in
				force at the time of promulgation of this subchapter which contain an "excess"
				clause, "anti-duplication" provision, or any other provision by whatever name
				designated under which benefits would be reduced because of other existing
				coverages, other than the COB provisions established in this subchapter, shall
				be brought into compliance by the later of the next anniversary or renewal date
				of the group policy or contract or the expiration of the applicable
				collectively bargained contract, pursuant to which they are written, if
				any.
(b) The definition of "Plan"
				in
				365:10-11-2 applies
				to plans that are delivered, issued for delivery, or renewed on or after
				January 1, 2015. A contract that is in force on January 1, 2015, must be
				brought into compliance with the definition of "Plan" on the next anniversary
				date or renewal date of the contract, or the expiration of any applicable
				collective bargaining contract under which it was written.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-10 - Facility of payment

Current through Vol. 41, No. 20, July 1,
				2024
Whenever payments which should have been made under this Plan
				  in accordance with this section have been made under any other Plans, the
				  insurer or service plan shall have the right, exercisable alone and in its sole
				  discretion, to pay over to any organizations making such other payments any
				  amounts it shall determine to be warranted in order to satisfy the intent of
				  this section, and amounts so paid shall be deemed to be benefits paid under
				  this Plan and, to the extent of such payments, the insurer or service plan
				  shall be fully discharged from liability under this Plan.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 11 - Coordination of Benefit Guidelines › Section 365:10-11-11 - Right of recovery

Current through Vol. 41, No. 20, July 1,
				2024
Whenever payment has been made by the insurer with respect to
				  allowable expenses in a total amount, at any time, in excess of the maximum
				  amount of payment necessary at that time to satisfy the intent of this section,
				  the insurer or service plan shall have the right to recover such payments, to
				  the extent of such excess, from among one or more of the following, as the
				  insurer or service plan shall determine:
(1) any persons to or for or with respect to
				whom such payments were made;
(2)
				any other insurers; or
(3) service
				plans or any other organizations.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 13 - Industrial Insurance: Settlement of Claims - Payment by Cash Prohibited › Section 365:10-13-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this subchapter is to set forth rules
				  regarding payment of claims by insurers employing route agents for collection
				  of premiums and to set forth rules requiring maintenance of a policyholder's
				  premium payment book.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 13 - Industrial Insurance: Settlement of Claims - Payment by Cash Prohibited › Section 365:10-13-2 - Settlement of industrial insurance claims

Current through Vol.
				41, No. 20, July 1, 2024
(a)
Payment of claims by check or
				draft.
Every industrial insurer transacting business within this state
				and employing route agents for collections of premiums, payment of policy
				claims benefits and/or other servicing of its policies of insurance held by
				residents of this state shall, within forty five (45) days next succeeding the
				effective date of this section, establish and maintain a procedure whereby all
				claims for policy benefits are, upon approval thereof, paid to the parties in
				interest by company check or draft, which checks or drafts shall in every case
				set out the policy benefits for payment of which such check or draft is
				issued.
(b)
Payments of
				policyholder acknowledged by official company receipt.
No industrial
				insurer, its agents, employees or supervisors shall receive any advance or
				other payment of premium payment of policy loan, or other form of payment from
				a policyholder or for a policyholder's benefit without issuing there for an
				official company receipt acknowledging such payment to the payor or duly noting
				the fact of such payment in the policyholder's premium payment book. The
				"policyholder's premium payment book" shall be construed to mean, for the
				purpose of this section, the official premium payment record which is retained
				in the custody of the policyholder.
(c)
Penalties for noncompliance.
Any insurer who fails to comply with the requirements of this subchapter be
				subject to the penalties provided for by law, including, but not by way of
				limitation, the suspension or revocation of its certificate of authority to
				transact business in the State of Oklahoma.
(d)
Acknowledgment of receipt of
				rule.
Receipt of this section shall be acknowledged by one of the
				executive officers of the companies concerned.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this subchapter is to set forth rules
				  regarding utilization review regulation as authorized by the Hospital and
				  Medical Services Utilization Review Act, 36 O.S. §
									6551 et.
				  seq.
Added at 14 Ok Reg 2957,
				  eff 7-14-97; Amended at 19 Ok Reg 1294, eff
				  7-14-02
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-2 - Private review agents

Current through Vol. 41, No. 20, July 1,
				2024
(a) The following
				persons or entities shall be considered private review agent(s) for purposes of
				the Hospital and Medical Services Utilization Review Act, Sections
				6551
				through
				6581
				of Title 36 of the Oklahoma Statutes:
(1) Any
				person or entity who performs utilization review on behalf of an employer in
				this state. The term employer means any person or entity who employs any person
				in this state. No person or entity who performs utilization review on behalf of
				an employer in this state shall be exempt from the provisions of the Hospital
				and Medical Services Utilization Review Act on the basis that the employer is
				self-insured or participates in an ERISA exempt employee welfare benefit plan
				or multiple employer welfare arrangement;
(2) Any person or entity who performs
				utilization review on behalf of a health maintenance organization which has
				been issued a license pursuant to Sections
				6901
				through
				6936
				of Title 36 of the Oklahoma Statutes. However, any such person or entity
				performing utilization review on behalf of a health maintenance organization so
				licensed shall be exempt from the provisions of the Hospital and Medical
				Services Utilization Review Act if, prior to performing utilization review,
				such person or entity has obtained written documentation from the health
				maintenance organization that:
(A) the health
				maintenance organization is federally regulated; and
(B) the health maintenance organization has
				filed with the Commissioner of Health a plan of utilization review which is
				carried out by health care professionals and which has established complaint
				and appellate procedures for claims;
(3) Any person or entity who performs
				utilization review on behalf a third party providing or administering hospital
				and medical benefits to citizens of this state, including but not limited to a
				health insurer, not-for-profit hospital service or medical plan, health
				insurance service organization, preferred provider organization or other entity
				offering health insurance policies, contracts or benefits in this
				state;
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-3 - Private review agent certification and renewal

Current through
				Vol. 41, No. 20, July 1, 2024
(a) A private review agent shall not perform
				utilization review unless the Insurance Commissioner has granted the private
				review agent a certificate.
(b) A
				certificate to perform utilization review as a private agent expires on the
				anniversary of its effective date, unless renewed by the Insurance
				Commissioner. If the renewal application is received by the Oklahoma Insurance
				Department after 5:00 p.m. on the day of expiration it will not be accepted and
				the Five Hundred Dollar ($500.00) renewal fee shall not be returned. Once a
				private review agent's certificate has expired, the private review agent may
				not perform utilization review until such time as the private review agent has
				applied for and received a new certificate from the Insurance Commissioner. The
				application for a new certificate shall require submission of the $500.00
				certification fee as well as the filing of all exhibits which are required to
				be filed with an original certificate application.
(c) In order to prevent its certificate from
				automatically expiring, a private review agent must submit the following
				information to the Insurance Commissioner prior to the anniversary of the
				certificate's effective date: a $500.00 renewal fee; a renewal application; and
				satisfactory evidence of compliance with any specific requirement made by the
				Insurance Commissioner for renewal of such certificate.
(d) If the fees and documentation set forth
				in the prior paragraph are submitted to the Insurance Commissioner prior to the
				anniversary of the certificate's effective date, the Insurance Commissioner
				shall not refuse to renew the certificate without providing the certificate
				holder reasonable time to supply additional information demonstrating
				compliance with the Hospital and Medical Services Utilization Review Act and
				the opportunity to request a hearing.
Added at 14 Ok Reg 2957,
				  eff 7-14-97
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-4 - Transferability of Certificates

Current through Vol. 41, No. 20, July
				1, 2024
(a) A
				certificate issued pursuant to the Hospital and Medical Services Utilization
				Review Act is not transferable.
(b)
				If an entity which holds a certificate to perform utilization review merges
				with another entity, consolidates with another entity, or has a greater than
				10% of its ownership purchased by another person or entity, then the
				certificate holder must apply for a new certificate.
Added at 14 Ok Reg 2957,
				  eff 7-14-97
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-5 - Use of Oklahoma physician in utilization review

Current
				through Vol. 41, No. 20, July 1, 2024
(a) Every private review agent shall have an
				appropriate number of Oklahoma licensed physicians and/or Oklahoma licensed
				health care professionals who are involved in supervising the private review
				agent's utilization review activities. Such Oklahoma licensed physicians and
				Oklahoma licensed health care professionals shall actively participate in the
				private review agent's appeal process and complaint process.
(b) The term "appropriate number", as used in
				the preceding paragraph, shall mean a reasonable amount of Oklahoma licensed
				physicians and/or Oklahoma licensed health care professionals to adequately
				supervise the private review agent's utilization review activities, depending
				upon the utilization review activities undertaken by the private review agent,
				but shall in no event be construed to be less than one Oklahoma licensed
				physician or Oklahoma licensed health care professional.
Added at 14 Ok Reg 2957,
				  eff 7-14-97
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-6 - Third party payors

Current through Vol. 41, No. 20, July 1,
				2024
A private review agent shall disclose all persons or entities
				  for whom the private review agent is performing utilization review to the
				  Insurance Department. Disclosure shall include the name of the third party, the
				  business address of the third party, the telephone number of the third party,
				  and a reference contact of the third party. By providing a reference contact of
				  the third party, the private review agent authorizes the Insurance Commissioner
				  to discuss the nature of the private review agent's utilization review services
				  with such reference contact.
Added at 14 Ok Reg 2957,
				  eff 7-14-97
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 15 - Utilization Review Regulations › Section 365:10-15-7 - In-house utilization review by insurance companies

Current
				through Vol. 41, No. 20, July 1, 2024
(a) Insurance Companies, not-for-profit
				hospital service or indemnity plans, and not-for-profit medical or indemnity
				plans which hold certificates of authority from the State of Oklahoma and which
				perform in-house utilization review shall be registered pursuant to subsection
				B.
(b) Registration shall consist
				of completing the Insurance Commissioner's Utilization Review Certification
				and/or Registration Application Form and forwarding the same with all other
				information required by Okla. Stat. tit. 36, §6559 to the Insurance
				Commissioner for approval.
(c) A
				$500.00 fee shall accompany the Utilization Review Certification and/or
				Registration Application Form.
(d)
				Registration is complete upon approval by the Insurance Commissioner.
(e) Insurance Companies, not-for-profit
				hospital service or indemnity plans, and not-for-profit medical or indemnity
				plans registered to perform in-house utilization review shall complete the
				Insurance Commissioner's Utilization Review Certification and/or Registration
				Annual Renewal Application each year and forward the same with all information
				requested therein to the Insurance Commissioner prior to or on the anniversary
				date. A $500 renewal fee shall accompany the Annual Renewal
				Application.
Added at 14 Ok Reg 2957,
				  eff 7-14-97
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 17 - Valuation of Life Insurance Policies Regulation (Including the Introduction and Use of New Select Mortality Factors) › Section 365:10-17-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
(a) The purpose of this Subchapter is to
				provide:
(1) Tables of select mortality
				factors and rules for their use;
(2) Rules concerning a minimum standard for
				the valuation of plans with nonlevel premiums or benefits; and
(3) Rules concerning a minimum standard for
				the valuation of plans with secondary guarantees.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 17 - Valuation of Life Insurance Policies Regulation (Including the Introduction and Use of New Select Mortality Factors) › Section 365:10-17-2 - Applicability

Current through Vol. 41, No. 20, July 1, 2024
This Subchapter shall apply to all life insurance policies,
				  with or without nonforfeiture values, issued on or after the effective date of
				  this regulation, subject to the following exceptions and conditions.
(1)
Exceptions.
(A) This regulation shall not apply to any
				individual life insurance policy issued on or after the effective date of this
				regulation if the policy is issued in accordance with and as a result of the
				exercise of a reentry provision contained in the original life insurance policy
				of the same or greater face amount, issued before the effective date of this
				regulation, that guarantees the premium rates of the new policy. This
				regulation also shall not apply to subsequent policies issued as a result of
				the exercise of such a provision, or a derivation of the provision, in the new
				policy.
(B) This regulation shall
				not apply to any universal life policy that meets all the following
				requirements:
(i) Secondary guarantee period,
				if any, is five (5) years or less;
(ii) Specified premium for the secondary
				guarantee period is not less than the net level reserve premium for the
				secondary guarantee period based on the CSO valuation tables as defined in
				Section
				365:10-17-3(a)(6)
				and the applicable valuation interest rate; and
(iii) The initial surrender charge is not
				less than 100 percent of the first year annualized specified premium for the
				secondary guarantee period.
(C) This regulation shall not apply to any
				variable life insurance policy that provides for life insurance, the amount or
				duration of which varies according to the investment experience of any separate
				account or accounts.
(D) This
				regulation shall not apply to any variable universal life insurance policy that
				provides for life insurance, the amount or duration of which varies according
				to the investment experience of any separate account or accounts.
(E) This regulation shall not apply to a
				group life insurance certificate unless the certificate provides for a stated
				or implied schedule of maximum gross premiums required in order to continue
				coverage in force for a period in excess of one year.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 17 - Valuation of Life Insurance Policies Regulation (Including the Introduction and Use of New Select Mortality Factors) › Section 365:10-17-4 - General calculation requirements for basic reserves and premium deficiency reserves

Current through Vol. 41, No. 20, July 1,
				2024
(a) At the election
				of the company for any one or more specified plans of life insurance, the
				minimum mortality standard for basic reserves may be calculated using the 1980
				CSO valuation tables with select mortality factors (or any other valuation
				mortality table adopted by the NAIC after the effective date of this regulation
				and promulgated by regulation by the Insurance Commissioner for this purpose).
				If select mortality factors are elected, they may be:
(1) The ten-year select mortality factors
				incorporated into the 1980 amendments to the NAIC Standard Valuation
				Law;
(2) The select mortality
				factors in the Appendix BB of this chapter; or
(3) Any other table of select mortality
				factors adopted by the NAIC after the effective date of this regulation and
				promulgated by regulation by the Insurance Commissioner for the purpose of
				calculating basic reserves.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 17 - Valuation of Life Insurance Policies Regulation (Including the Introduction and Use of New Select Mortality Factors) › Section 365:10-17-5 - Calculation of minimum valuation standard for policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits (other than universal life policies)

Current through Vol. 41, No. 20, July 1,
				2024
(a)
Basic
				reserves.
Basic reserves shall be calculated as the greater of the
				segmented reserves and the unitary reserves. Both the segmented reserves and
				the unitary reserves for any policy shall use the same valuation mortality
				table and selection factors. At the option of the insurer, in calculating
				segmented reserves and net premiums, either of the adjustments described in
				Paragraph (1) or (2) below may be made:
(1)
				Treat the unitary reserve, if greater than zero, applicable at the end of each
				segment as a pure endowment and subtract the unitary reserve, if greater than
				zero, applicable at the beginning of each segment from the present value of
				guaranteed life insurance and endowment benefits for each segment.
(2) Treat the guaranteed cash surrender
				value, if greater than zero, applicable at the end of each segment as a pure
				endowment; and subtract the guaranteed cash surrender value, if greater than
				zero, applicable at the beginning of each segment from the present value of
				guaranteed life insurance and endowment benefits for each segment.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 17 - Valuation of Life Insurance Policies Regulation (Including the Introduction and Use of New Select Mortality Factors) › Section 365:10-17-6 - Calculation of minimum valuation standard for flexible premium and fixed premium universal life insurance policies that contain provisions resulting in the ability of a policyowner to keep a policy in force over a secondary guarantee period

Current through Vol. 41, No. 20, July 1,
				2024
(a)
General.
(1) Policies with a
				secondary guarantee include:
(A) A policy with
				a guarantee that the policy will remain in force at the original schedule of
				benefits, subject only to the payment of specified premiums;
(B) A policy in which the minimum premium at
				any duration is less than the corresponding one year valuation premium,
				calculated using the maximum valuation interest rate and the 1980 CSO valuation
				tables with or without ten-year select mortality factors, or any other table
				adopted after the effective date of this regulation by the NAIC and promulgated
				by regulation by the Insurance Commissioner for this purpose; or
(C) A policy with any combination of
				Subparagraph (a) and (b).
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 17 - Valuation of Life Insurance Policies Regulation (Including the Introduction and Use of New Select Mortality Factors) › Section 365:10-17-7 - Effective date [EXPIRED]

Current through Vol. 41, No. 20, July
				1, 2024
Added at 17 Ok Reg 726,
				  eff 1-3-00 through 7-14-00
				  (emergency)1
1This emergency action expired
				  without being superseded by a permanent action. Upon expiration of an emergency
				  action enacting a new Section, the Section is no longer effective. Therefore,
				  on 7-15-00 (after the 7-14-00 expiration of the emergency action), Section
				  365:10-17-7 was no longer effective. For the official text of the emergency
				  rule that was in effect from 1-3-00 through 7-14-00, see 17 Ok Reg
				  726.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-1 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following terms used in this Part, shall have the same
				  meaning as set out in 36 O.S. §
									4522 of
				  the Act, unless the context clearly indicates otherwise:
"Act"
means the Employer Health Insurance
				  Purchasing Group Act, 36 O.S. §
									4521, et
				  seq.
"Dependent"
means a spouse, newly born child,
				  adopted child, child placed for adoption from the moment of placement, child of
				  the insured under the age of majority who is a natural child of the insured,
				  and/or a step-child under the age of majority who is dependent upon the insured
				  for support or maintenance. Dependent shall also include any dependent child
				  who is incapable of self sustaining employment due to mental retardation or
				  physical handicap on the date that such child's coverage would otherwise
				  terminate under the policy due to the attainment of a specified age limit for
				  children, if the child is chiefly dependent on the insured for support and
				  maintenance.
"New entrant"
means an eligible employee or
				  individual who becomes an eligible employee after the initial period for
				  enrollment in a health benefit plan.
Added at 20 Ok Reg 224,
				  eff 11-25-02 (emergency); Added at 20 Ok Reg 1731, eff
				  7-14-03
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-2 - Applicability and scope

Current through Vol. 41, No. 20, July 1,
				2024
(a) This Part shall
				apply to any health benefit plan written for a Health Insurance Purchasing
				Group pursuant to the Act.
(b) This
				Part shall apply to any health benefit plan that issues or delivers a policy or
				certificate in this state pursuant to the Act.
(c) The provisions of the Act and this Part
				shall not apply to an individual health benefit plan delivered or issued for
				delivery in this state.
(d) The
				provisions of the Act and this Part shall apply to HIPGs formed for citizens in
				the State of Oklahoma.
(e) For the
				purpose of this act, a health insurer does not include a MEWA as defined in 36
				O.S. §
									634.
(f) If an eligible employer is issued a
				health benefit plan pursuant to the Act, the provisions of the Act and this
				Part shall continue to apply to the health benefit plan in the case that the
				employer subsequently employs more than one hundred (100) eligible employees. A
				HIPG health carrier providing coverage to such an employer shall, within sixty
				(60) days of becoming aware that the employer has more than one hundred (100)
				eligible employees but no later than the anniversary date of the employer's
				health benefit plan, notify the employer that the provisions of the Act and
				this Part shall cease to apply to the employer if such employer fails to renew
				its current health benefit plan or elects to enroll in a different health
				benefit plan.
(g) A HIPG health
				carrier providing coverage to an employer pursuant to the Act shall, within
				sixty (60) days of becoming aware that the employer has fifty (50) or fewer
				eligible employees, notify the employer of the options and protections
				available to the employer under the Small Employer Health Insurance Reform Act
				as set out pursuant to 36 O.S. §
									6511 et
				seq., including the employer's option to purchase a small employer health
				benefit plan from any small employer carrier.
(h) A carrier that is not operating as a
				Health Insurance Purchasing Group carrier in this state shall not become
				subject to the provisions of the Act and this Part solely because an employer
				that was issued a health insurance purchasing group plan in another state by
				that HIPG health carrier moves to this state and the coverage remains in
				force.
Added at 20 Ok Reg 224,
				  eff 11-25-02 (emergency); Added at 20 Ok Reg 1731, eff
				  7-14-03
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-3 - Establishment of business

Current through Vol. 41, No. 20, July 1,
				2024
(a) A health
				insurer that establishes a health benefit plan pursuant to 36 O.S. §
									4522,
				shall maintain on file for inspection by the Commissioner the following
				information with respect to each health benefit plan so established:
(1) A description of each criterion employed
				by the HIPG health carrier (or any of its agents) for determining membership in
				the health benefit plan;
(2) A
				statement disclosing which, if any, health benefit plans are currently
				available for purchase by Health Insurance Purchasing Groups.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-4 - Board of directors and plan of operations

Current through Vol.
				41, No. 20, July 1, 2024
(a) Individuals on the Board of Directors as
				required under 36 O.S. §
									4523
				shall be owners or employees of the participating employer groups.
(1) Be composed of Directors of the employers
				participating in the Health Insurance Purchasing Group;
(2) A vacancy on the board may be filled by a
				member of the employer group from which the vacancy occurred if that employer
				is still participating in the Health Insurance Purchasing Group plan or any
				other employer group which is participating in the Health Insurance Purchasing
				Group plan;
(3) A board member may
				be removed from the board for cause.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-5 - Requirement to insure all employees of the purchaser and new entrants

Current through Vol. 41, No. 20, July 1, 2024
(a)
Offer of coverage.
(1) A HIPG health carrier that offers
				coverage to a HIPG shall offer to provide coverage to each eligible employee
				and their dependents and to each new entrant to the plan and to each dependent
				of the new entrant. New entrants shall be covered upon the first day of the
				calendar month following any established waiting periods of the HIPG.
(2) A HIPG health carrier shall offer the
				eligible employees of a HIPG the option of choosing among one or more health
				benefit plans, one of which shall contain the mandated benefits pursuant to the
				entire Oklahoma Insurance Code, provided that each employee may choose any of
				the offered plans. The choice among benefit plans may not be limited,
				restricted or conditioned based upon the risk characteristics of the employees
				or their dependents.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-6 - Prohibited provisions and other requirements

Current through Vol.
				41, No. 20, July 1, 2024
(a) No HIPG or HIPG health carrier shall make
				provisions establishing a probationary or waiting period during which no
				coverage is available to eligible employees for a period of more than three
				months from the date of hire.
(b)
				No HIPG or HIPG health carrier shall enter into exclusive agreements between
				the HIPG and the HIPG health carrier. A HIPG health carrier shall not enter
				into any contract that would bind a HIPG health carrier to a specific
				HIPG.
(c) No HIPG shall have or use
				a name that tends to mislead, deceive, or confuse. The Oklahoma Insurance
				Department shall determine whether the name of the HIPG has a tendency to
				mislead, deceive or confuse.
(d) No
				HIPG shall use any documents of a HIPG health carrier after termination of the
				HIPG and shall return all documents produced and/or provided by the HIPG health
				carrier immediately upon termination of the HIPG.
(e) Employer eligibility requirements shall
				not be more restrictive than those found in the Small Employer Health Insurance
				Reform Act.
Added at 20 Ok Reg 224,
				  eff 11-25-02 (emergency); Added at 20 Ok Reg 1731, eff
				  7-14-03
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-7 - Filing requirements

Current through Vol. 41, No. 20, July 1,
				2024
(a) Prior to the
				formation on a HIPG the HIPG shall provide the following documents to the
				Oklahoma Insurance Department for review and approval:
(1) All HIPG documents.
(2) Contracts between the HIPG and HIPG
				health carrier.
(3) All
				administrative agreements.
(4) Plan
				of Operations.
(5) Marketing
				methods to be used.
(6)
				Constitutions and/or bylaws.
(7)
				Names of five representatives of eligible employers.
(8) Employer eligibility
				requirements
(9) Requirements for
				membership and disclosure requirements.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 19 - Health Insurance Purchasing Groups › Section 365:10-19-8 - Annual reporting requirements

Current through Vol. 41, No.
				20, July 1, 2024
(a) A
				HIPG health carrier shall file annually the following information with the
				Commissioner related to health benefit plans issued by the HIPG health carrier
				to HIPGs in this state:
(1) The number of
				Purchasers that were issued the limited benefit health benefit plans in the
				previous calendar year (separated as to newly issued plans and renewals and the
				number of covered lives);
(2) The
				number of Purchasers that were issued providing the state-mandated health
				benefits in the previous calendar year (separated as to newly issued plans and
				renewals and as to class of business and the number of covered
				lives);
(3) The number of Purchaser
				health benefit plans that were voluntarily not renewed by Purchasers in the
				previous calendar year;
(4) The
				number of HIPG health benefit plans that were terminated or nonrenewed (for
				reasons other than nonpayment of premium) by the HIPG health carrier in the
				previous calendar year; and
(5) The
				number of HIPG health benefit plans that were issued to Purchaser that were
				uninsured for at least the three (3) months prior to issue.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 21 - Recognition of the 2001 CSO Mortality Table for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits Regulation › Section 365:10-21-1 - Authority

Current through Vol. 41, No. 20, July 1, 2024
This regulation is promulgated by the Commissioner of
				  Insurance pursuant to 36 O.S. §
									1510(A)(4)(iii)
				  and 36 O.S. § 4029(H)(4)(h)(vi) of the Oklahoma Insurance Laws and O.A.C.
				  365:10-17-4(a)
				  and (b) of the Oklahoma Insurance Department
				  Regulations.
Added at 20 Ok Reg 1734,
				  eff 7-14-03
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 21 - Recognition of the 2001 CSO Mortality Table for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits Regulation › Section 365:10-21-2 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this regulation is to recognize, permit and
				  prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality
				  Table in accordance with 36 O.S. §
									1510(A)(4)(iii)
				  and 36 O.S. § 4029(H)(4)(h)(vi) of the Oklahoma Insurance Laws and O.A.C.
				  365:10-17-4(a)
				  and (b) of the Oklahoma Insurance Department
				  Regulations.
Added at 20 Ok Reg 1734,
				  eff 7-14-03
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 21 - Recognition of the 2001 CSO Mortality Table for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits Regulation › Section 365:10-21-3 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
(a) "2001 CSO Mortality Table" means that
				mortality table, consisting of separate rates of mortality for male and female
				lives, developed by the American Academy of Actuaries CSO Task Force from the
				Valuation Basic Mortality Table developed by the Society of Actuaries
				Individual Life Insurance Valuation Mortality Task Force, and adopted by the
				NAIC in December 2002. The 2001 CSO Mortality Table is included in the
Proceedings of the NAIC (2nd Quarter 2002)
. Unless the context
				indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate
				form of that table and the select and ultimate form of that table and includes
				both the smoker and nonsmoker mortality tables and the composite mortality
				tables. It also includes both the age-nearest-birthday and age-last-birthday
				bases of the mortality tables.
(b)
				"2001 CSO Mortality Table (F)" means that mortality table consisting of the
				rates of mortality for female lives from the 2001 CSO Mortality
				Table.
(c) "2001 CSO Mortality Table
				(M)" means that mortality table consisting of the rates of mortality for male
				lives from the 2001 CSO Mortality Table.
(d) "Composite mortality tables" means
				mortality tables with rates of mortality that do not distinguish between
				smokers and nonsmokers.
(e) "Smoker
				and nonsmoker mortality tables" means mortality tables with separate rates of
				mortality for smokers and nonsmokers.
Added at 20 Ok Reg 1734,
				  eff 7-14-03
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 21 - Recognition of the 2001 CSO Mortality Table for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits Regulation › Section 365:10-21-4 - 2001 CSO Mortality Table

Current through Vol. 41, No. 20, July
				1, 2024
(a) At the
				election of the company for any one or more specified plans of insurance and
				subject to the conditions stated in this regulation, the 2001 CSO Mortality
				Table may be used as the minimum standard for policies issued on or after July
				14, 2003 and before the date specified in Subsection (b) to which 36 O.S.
				§
									1510(A)(4)(iii)
				and 36 O.S. § 4029(H)(4)(h)(vi) of the Oklahoma Insurance Laws and O.A.C.
				365:10-17-4(a)
				and (b) of the Oklahoma Insurance Department
				Regulations are applicable. If the company elects to use the 2001 CSO Mortality
				Table, it shall do so for both valuation and nonforfeiture purposes.
(b) Subject to the conditions stated in this
				regulation, the 2001 CSO Mortality Table shall be used in determining minimum
				standards for policies issued on and after January 1, 2009, to which 36 O.S.
				§
									1510(A)(4)(iii)
				and 36 O.S. § 4029(H)(4)(h)(vi) of the Oklahoma Insurance Laws and O.A.C.
				365:10-17-4(a)
				and (b) of the Oklahoma Insurance Department
				Regulations are applicable.
Added at 20 Ok Reg 1734,
				  eff 7-14-03; Amended at 21 Ok Reg 1659, eff
				  7-14-04