reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 19 - Annuity Disclosure Regulation › Section 365:25-19-8 - Separability

Current through Vol. 41, No. 20, July 1, 2024
If any provision of this regulation or its application to any
				  person or circumstance is for any reason held to be invalid by any court of
				  law, the remainder of the regulation and its application to other persons or
				  circumstances shall not be affected.
Added at 23 Ok Reg 2738,
				  eff 7-14-06
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 19 - Annuity Disclosure Regulation › Section 365:25-19-9 - Effective Date

Current through Vol. 41, No. 20, July 1,
				2024
This regulation shall become effective January 1, 2007, and
				  shall apply to contracts sold on or after the effective date.
Added at 23 Ok Reg 2738,
				  eff 7-14-06
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 21 - Regulation on the Use of Senior-Specific Certifications and Professional Designations in the Sale of Life Insurance and Annuities › Section 365:25-21-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this regulation is to set forth standards to
				  protect consumers from misleading and fraudulent marketing practices with
				  respect to the use of senior-specific certifications and professional
				  designations in the solicitation, sale or purchase of, or advice made in
				  connection with, life insurance, annuity products or other senior-specific
				  products such as Medicare Supplement plans, Medicare Advantage plans, and
				  Medicare Part D Prescription Drug plans.
Added at 26 Ok Reg 1654,
				  eff 7-14-09
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 21 - Regulation on the Use of Senior-Specific Certifications and Professional Designations in the Sale of Life Insurance and Annuities › Section 365:25-21-2 - Scope

Current through Vol. 41, No. 20, July 1, 2024
This regulation shall apply to any solicitation, sale or
				  purchase of, or advice made in connection with, life insurance, annuity
				  products, or other senior-specific products such as Medicare Supplement plans,
				  Medicare Advantage plans, and Medicare Part D Prescription Drug plans by an
				  insurance producer.
Added at 26 Ok Reg 1654,
				  eff 7-14-09
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 21 - Regulation on the Use of Senior-Specific Certifications and Professional Designations in the Sale of Life Insurance and Annuities › Section 365:25-21-3 - Authority

Current through Vol. 41, No. 20, July 1, 2024
(a) This regulation is issued under the
				authority of Article 12 of Title 36 of the laws of this State.
(b) Nothing in this regulation shall limit
				the commissioner's authority to enforce existing provisions of law.
Added at 26 Ok Reg 1654,
				  eff 7-14-09
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 21 - Regulation on the Use of Senior-Specific Certifications and Professional Designations in the Sale of Life Insurance and Annuities › Section 365:25-21-4 - Definition

Current through Vol. 41, No. 20, July 1, 2024
For purposes of this regulation, "insurance producer" means a
				  person required to be licensed under the laws of this State to sell, solicit or
				  negotiate insurance, including annuities.
Added at 26 Ok Reg 1654,
				  eff 7-14-09
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 21 - Regulation on the Use of Senior-Specific Certifications and Professional Designations in the Sale of Life Insurance and Annuities › Section 365:25-21-5 - Prohibited uses of senior-specific certifications and professional designations

Current through Vol. 41, No. 20, July 1,
				2024
(a)
Unfair
				and deceptive acts or practices.
(1)
				It is an unfair and deceptive act or practice in the business of insurance
				within the meaning of Article 12 of Title 36 of the laws of this State for an
				insurance producer to use a senior-specific certification or professional
				designation that indicates or implies in such a way as to mislead a purchaser
				or prospective purchaser that the insurance producer has special certification
				or training in advising or servicing seniors in connection with the
				solicitation, sale or purchase of a life insurance or annuity product or in the
				provision of advice as to the value of or the advisability of purchasing or
				selling life insurance, annuity products, or other senior-specific products
				such as Medicare Supplement plans, Medicare Advantage plans, and Medicare Part
				D Prescription Drug plans, either directly or indirectly through publications
				or writings, or by issuing or promulgating analyses or reports related to a
				life insurance, or annuity product, or other senior-specific products such as
				Medicare Supplement plans, Medicare Advantage plans, and Medicare Part D
				Prescription Drug plans.
(2) The
				prohibited use of senior-specific certifications or professional designations
				includes, but is not limited to, the following:
(A) Use of a certification or professional
				designation by an insurance producer who has not actually earned or is
				otherwise ineligible to use such certification or designation;
(B) Use of a nonexistent or self-conferred
				certification or professional designation;
(C) Use of a certification or professional
				designation that indicates or implies a level of occupational qualifications
				obtained through education, training or experience that the insurance producer
				using the certification or designation does not have; and
(D) Use of a certification or professional
				designation that was obtained from a certifying or designating organization
				that:
(i) Is primarily engaged in the
				business of instruction in sales or marketing;
(ii) Does not have reasonable standards or
				procedures for assuring the competency of its certificants or designees;
(iii) Does not have reasonable
				standards or procedures for monitoring and disciplining its certificants or
				designees for improper or unethical conduct; or
(iv) Does not have reasonable continuing
				education requirements for its certificants or designees in order to maintain
				the certificate or designation.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 21 - Regulation on the Use of Senior-Specific Certifications and Professional Designations in the Sale of Life Insurance and Annuities › Section 365:25-21-6 - Effective Date

Current through Vol. 41, No. 20, July 1,
				2024
This regulation shall become effective July 14,
				  2009.
Added at 26 Ok Reg 1654,
				  eff 7-14-09
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this subchapter is to set forth rules and
				  procedural requirements which the Commissioner deems necessary to carry out the
				  provisions of the Cemetery Merchandise Trust Act. The information called for by
				  the regulations of this subchapter is hereby declared to be necessary and
				  appropriate in the public interest.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-2 - Permit required

Current through Vol. 41, No. 20, July 1,
				2024
(a) Pursuant to the
				Cemetery Merchandise Trust Act, any organization which shall accept money or
				anything of value for prepaid cemetery merchandise pursuant to a prepaid
				cemetery merchandise contract shall obtain a permit from the Oklahoma Insurance
				Department authorizing the transaction of this type of business prior to the
				commencement of this type of business. The Commissioner may deny the issuance
				of a permit if the organization or any of its owners or officers:
(1) Makes a material misstatement or
				misrepresentation in an application or permit;
(2) Has been sentenced, convicted, pled
				guilty or nolo contendre to a crime involving fraud, dishonesty or moral
				turpitude; or
(3) Fraudulently or
				deceptively obtains or attempts to obtain a permit for another.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-3 - Contract approval

Current through Vol. 41, No. 20, July 1,
				2024
No organization shall use in any way any sales contract
				  without having received prior written approval from the Insurance Commissioner
				  to do so. The original and two (2) copies of any such contract, including any
				  amendments thereto, shall be submitted to the Insurance Commissioner for
				  approval.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-4 - Forms

Current through Vol. 41, No. 20, July 1, 2024
(a)
Application for Cemetery
				Merchandise Permit.
An application for Cemetery Merchandise Permit shall
				be made by filing an Application for Cemetery Merchandise Permit Original
				Application on a form approved by the Commissioner. The application shall be
				filed with and approved by the Insurance Commissioner before any contracts
				covered by this act may be marketed.
(b)
Surety bond.
Organizations
				purchasing a surety bond shall use the Surety Bond Form as approved by the
				Commissioner. Any variation from this form must have the prior written approval
				of the Insurance Commissioner.
(c)
Renewal of Cemetery Merchandise Permit.
A renewal of a Cemetery
				Merchandise Permit shall be made by filing the Renewal of Cemetery Merchandise
				Permit form as approved by the Commissioner no later than March 15 of each
				year. Renewals made after March 15 of the year following the year the permit is
				first issued shall be made by filing the Application for Cemetery Merchandise
				Permit and paying any fines that may have been imposed with respect to an
				expired permit in addition to double the renewal fee.
(d)
Cemetery Merchandise Annual
				Report.
Every holder of a Cemetery Merchandise Permit shall file a
				Cemetery Merchandise Annual Report on a form approved by the Commissioner on or
				before March 15 of each year.
(e)
Oklahoma Quarterly Report of Cemetery Merchandise.
Every holder of
				a Cemetery Merchandise Permit that maintains a surety bond shall submit an
				Oklahoma Quarterly Report of Cemetery Merchandise on a form approved by the
				Commissioner.
(f)
Notice of
				Sale.
Prior to the sale of a cemetery with a cemetery merchandise
				permit, a permit holder shall first file a Notice of Sale on a form approved by
				the Commissioner.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-5 - Trust fund and trustee

Current through Vol. 41, No. 20, July 1,
				2024
A holder of a Cemetery Merchandise Permit with funds in
				  trust shall keep the Insurance Department informed of the identity of the
				  trustee at all times and at all times shall comply with the provisions of 36
				  O.S. § 7126. Prior to changing the trustee, trust agreement or trust
				  location, a permit holder shall notify the Commissioner at least thirty (30)
				  days prior to any transfer or change stating the reason for the proposed
				  change.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-6 - Surety bond

Current through Vol. 41, No. 20, July 1,
				2024
(a) A permit holder
				posting a surety bond in lieu of making remittances to a trust fund, shall file
				a quarterly report no later than the thirtieth day after the close of each
				quarter. The bond shall be in an amount not less than the minimum funding
				requirement for cemetery merchandise trusts pursuant to the provisions of 36
				O.S. § 7126. If at any time the Quarterly Report shows that the bond
				posted does not meet the minimum funding requirements, the permit holder shall
				be notified by the Insurance Department and shall post an additional or amended
				bond within ten (10) days following notification. The additional or amended
				bond shall be sufficient in size to satisfy the provisions of 36 O.S.
				§§ 7126 and 7127.
(b) A
				bond posted in connection with Cemetery Merchandise Trust Act shall be filed in
				the form and manner prescribed by the Insurance Commissioner. Any variance from
				this form must have the prior written approval of the Insurance Commissioner.
				An insurer shall provide thirty (30) day's written notice to the Insurance
				Commissioner prior to cancelling any bond required by the Cemetery Merchandise
				Trust Act.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-7 - Reports to trustee

Current through Vol. 41, No. 20, July 1,
				2024
The Cemetery Merchandise Trust Act provides that each permit
				  holder provide either a copy of each contract to its trustee or may, in lieu
				  thereof, submit a summary of the relevant information from the contracts. If a
				  permit holder chooses to provide a summary, the information shall be submitted
				  on a monthly basis to the trustee on a form provided by the Oklahoma Insurance
				  Department. The report shall contain the following information:
(1) Name of the cemetery;
(2) Town where the cemetery is
				located;
(3) Period of time covered
				by the report;
(4) Account numbers
				assigned to each contract;
(5) Name
				of the contract beneficiary;
(6)
				Description of the merchandise purchased;
(7) Cost breakdown on each piece of
				merchandise sold which is covered by the Cemetery Merchandise Trust
				Act;
(8) Amount of deposit made on
				each account;
(9) Beginning and
				ending balances; and
(10) A current
				original manufacturer's price list from any and all cemetery merchandise
				suppliers used by the permit holder.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-8 - Annual report

Current through Vol. 41, No. 20, July 1,
				2024
On or before March 15 of each year, each permit holder shall
				  file an Annual Report with the Oklahoma Insurance Department which shall
				  include the following information:
(1)
				Name of the cemetery;
(2) Town
				where the cemetery is located;
(3)
				Name and address of person to contact with questions about the
				report;
(4) Period of time covered
				by the report;
(5) Trust account
				numbers;
(6) Merchandise covered by
				each account;
(7) Amount deposited
				on each account to the trust fund;
(8) Beginning and ending balance;
(9) Method of determination of wholesale
				cost;
(10) A current original
				manufacturer's price list from any and all cemetery merchandise suppliers used
				by the permit holder; and
(11) Name
				of the vault company with whom the permit holder deals.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 23 - Cemetery Merchandise Trusts › Section 365:25-23-9 - Notice of sale

Current through Vol. 41, No. 20, July 1,
				2024
The seller of a cemetery with a cemetery merchandise trust
				  permit, shall make application forty-five (45) days prior to the transfer of
				  ownership using a form approved by the Commissioner. A transfer may only be
				  made to a permit holder in good standing with the Department. In addition to
				  the notice, the seller shall also submit a copy of the proposed Seller's
				  Agreement and a listing of all undelivered prepaid cemetery merchandise
				  contracts. The listing shall provide the contract holder's name; the
				  beneficiary's name or names, contract number, contract value, and the trust
				  value at the time of notice. No transfer may be made without the Commissioner's
				  prior written approval.
Added at 28 Ok Reg 214,
				  eff 10-19-10 (emergency); Added at 28 Ok Reg 1964, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 27 - Military Sales Practices Regulation › Section 365:25-27-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
(a) The purpose of this regulation is to set
				forth standards to protect active duty service members of the United States
				Armed Forces from dishonest and predatory insurance sales practices by
				declaring certain identified practices to be false, misleading, deceptive or
				unfair.
(b) Nothing herein shall be
				construed to create or imply a private cause of action for a violation of this
				regulation.
Added at 25 Ok Reg 58,
				  eff 8-13-07 (emergency); Added at 25 Ok Reg 1660, eff
				  7-14-08
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 27 - Military Sales Practices Regulation › Section 365:25-27-2 - Scope

Current through Vol. 41, No. 20, July 1, 2024
This regulation shall apply only to the solicitation or sale
				  of any life insurance or annuity product by an insurer or insurance producer to
				  an active duty service member of the United States Armed
				  Forces.
Added at 25 Ok Reg 58,
				  eff 8-13-07 (emergency); Added at 25 Ok Reg 1660, eff
				  7-14-08
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 27 - Military Sales Practices Regulation › Section 365:25-27-3 - Authority

Current through Vol. 41, No. 20, July 1, 2024
This regulation is issued under the authority of the Oklahoma
				  Unfair Trade Practices Act, 36 O.S. §
									1201, et
				  seq.
Added at 25 Ok Reg 58,
				  eff 8-13-07 (emergency); Added at 25 Ok Reg 1660, eff
				  7-14-08
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 27 - Military Sales Practices Regulation › Section 365:25-27-4 - Exemptions

Current through Vol. 41, No. 20, July 1, 2024
(a) This regulation shall not apply to
				solicitations or sales involving:
(1) Credit
				insurance;
(2) Group life insurance
				or group annuities where there is no in-person, face-to-face solicitation of
				individuals by an insurance producer or where the contract or certificate does
				not include a side fund;
(3) An
				application to the existing insurer that issued the existing policy or contract
				when a contractual change or a conversion privilege is being exercised; or,
				when the existing policy or contract is being replaced by the same insurer
				pursuant to a program filed with and approved by the commissioner; or, when a
				term conversion privilege is exercised among corporate affiliates;
(4) Individual stand-alone health policies,
				including disability income policies;
(5) Contracts offered by Service members'
				Group Life Insurance (SGLI) or Veterans' Group Life Insurance (VGLI), as
				authorized by
				38
				U.S.C. Section 1965, et seq.;
(6) State Sponsored Life Insurance (SSLI)
				provided by a State or through a State National Guard Association pursuant to
				37 U.S.C. Section
				707(a);
(7) Life insurance contracts offered through
				or by a non-profit military association, qualifying under Section 501(c)(23) of
				the Internal Revenue Code (IRC), and which are not underwritten by an insurer;
				or
(8) Contracts used to fund:
(A) An employee pension or welfare benefit
				plan that is covered by the Employee Retirement and Income Security Act
				(ERISA);
(B) A plan described by
				Sections 401(a), 401(k), 403(b), 408(k) or 408(p) of the IRC, as amended, if
				established or maintained by an employer;
(C) A government or church plan defined in
				Section 414 of the IRC, a government or church welfare benefit plan, or a
				deferred compensation plan of a state or local government or tax exempt
				organization under Section 457 of the IRC;
(D) A nonqualified deferred compensation
				arrangement established or maintained by an employer or plan sponsor;
(E) Settlements of or assumptions of
				liabilities associated with personal injury litigation or any dispute or claim
				resolution process; or
(F)
				Prearranged funeral contracts.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 27 - Military Sales Practices Regulation › Section 365:25-27-6 - Practices declared false, misleading, deceptive or unfair on a military installation

Current through Vol. 41, No. 20, July 1,
				2024
(a) The following
				acts or practices when committed on a military installation by an insurer or
				insurance producer with respect to the in-person, face-to-face solicitation of
				life insurance are declared to be false, misleading, deceptive or unfair:
(1) Knowingly soliciting the purchase of any
				life insurance product "door to door" or without first establishing a specific
				appointment for each meeting with the prospective purchaser.
(2) Soliciting service members in a group or
				"mass" audience or in a "captive" audience where attendance is not
				voluntary.
(3) Knowingly making
				appointments with or soliciting service members during their normally scheduled
				duty hours.
(4) Making appointments
				with or soliciting service members in barracks, day rooms, unit areas, or
				transient personnel housing or other areas where the installation commander has
				prohibited solicitation.
(5)
				Soliciting the sale of life insurance without first obtaining permission from
				the installation commander or the commander's designee.
(6) Posting unauthorized bulletins, notices
				or advertisements.
(7) Failing to
				present DD Form 2885, Personal Commercial Solicitation Evaluation, to service
				members solicited or encouraging service members solicited not to complete or
				submit a DD Form 2885.
(8)
				Knowingly accepting an application for life insurance or issuing a policy of
				life insurance on the life of an enlisted member of the United States Armed
				Forces without first obtaining for the insurer's files a completed copy of any
				required form which confirms that the applicant has received counseling or
				fulfilled any other similar requirement for the sale of life insurance
				established by regulations, directives or rules of the DoD or any branch of the
				Armed Forces.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 27 - Military Sales Practices Regulation › Section 365:25-27-8 - Severability

Current through Vol. 41, No. 20, July 1, 2024
If any provision of these sections or the application thereof
				  to any person or circumstance is held invalid for any reason, the invalidity
				  shall not affect the other provisions or any other application of these
				  sections which can be given effect without the invalid provisions or
				  application. To this end all provisions of these sections are declared to be
				  severable.
Added at 25 Ok Reg 58,
				  eff 8-13-07 (emergency); Added at 25 Ok Reg 1660, eff
				  7-14-08
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Subchapter is to:
(1) Set forth the regulations and procedures
				relating to the licensing and oversight of pharmacy benefits managers under 59
				O.S. §§ 357-360, and
(2)
				Set forth the regulations and procedures relating to the Patient's Right to
				Pharmacy Choice Act, 36 O.S. §§ 6958-6968.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-2 - Scope

Current through Vol. 41, No. 20, July 1, 2024
This Subchapter shall apply to all pharmacy benefits
				  managers, which must be licensed pursuant to 59 O.S. § 358(A), and to all
				  health insurers subject to compliance with 36 O.S. § 6958 et
				  seq.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-3 - Authority

Current through Vol. 41, No. 20, July 1, 2024
This Subchapter is promulgated under the authority granted
				  to the Insurance Commissioner in 59 O.S. § 358(B)and 36 O.S. §§
				  6958-6968.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-4 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
All definitions contained in 59 O.S. §§ 357-360
				  and 36 O.S. §§ 6958-6968 are applicable to this Subchapter and in
				  addition:
(1)
"Day"
means
				a calendar day, unless otherwise defined or limited.
(2) The
"act"
means 59 O.S.
				§§ 357-360 and 36 O.S. §§ 6858-6968.
(3) Pharmacy benefits manager and PBM may be
				used interchangeably in this Subchapter.
(4)
"Preferred participating
				pharmacy"
means a pharmacy that is designated as a preferred
				participating pharmacy in a PBM's retail pharmacy network.
(5)
"Provider"
means an Oklahoma
				licensed retail pharmacy.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-5 - Forms and contents of application for PBM license

Current
				through Vol. 41, No. 20, July 1, 2024
An application for PBM License shall be on a form provided
				  by the Commissioner and shall include:
(1) The identity of the PBM and any company
				or organization controlling the operation of the PBM, including the name,
				business address, and contact person for the PBM and the controlling entity.
				For purposes of this subsection, "control" or "controlling" means the
				possession, direct or indirect, of the power to direct or cause the direction
				of the management and policies of the PBM, whether through the ownership of
				voting securities, by contract or otherwise, unless, for an individual, the
				power is the result of an official position with or corporate office held by
				the person;
(2) The name and
				address of the corporate officers and directors, members and managers (if an
				LLC), or names of all partners (if a partnership) of the applicant
				PBM;
(3) A license fee in the
				amount of One Thousand Dollars ($1,000.00);
(4) A "Certificate of Incorporation" or
				comparable organizational document from the domiciliary state of the PBM;
(5) In the case of a PBM domiciled
				outside the State of Oklahoma, a certificate that the PBM is in good standing
				in the state of domicile or organization;
(6) A report of the details of any
				suspension, sanction, penalty or other disciplinary action relating to the PBM
				and its officers and directors;
(7)
				The name and address of the agent of record for services of process in
				Oklahoma;
(8) The number of total
				covered individuals or lives served under all of the PBM's contracts or
				agreements in Oklahoma;
(9) The
				most recently concluded fiscal year-end financial statements for the PBM and
				its controlling entity, which statements have been audited by an independent
				certified public accountant (CPA) under U.S. generally accepted accounting
				principles (GAAP); and
(10) A
				certificate signed by an Executive Officer of the PBM attesting to the accuracy
				of the information contained in the filing.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-6 - Surety bond

Current through Vol. 41, No. 20, July 1,
				2024
(a) Prior to the
				issuance of a pharmacy benefits manager license, the PBM applicant shall file
				with the Commissioner and thereafter keep in effect, as long as the license
				remains in effect, a surety bond in an amount determined to be sufficient by
				the Commissioner. The bond shall be in a form acceptable to the Commissioner
				and for the purpose of securing conformity with the laws and regulations
				governing pharmacy benefits managers. The bond shall be for the benefit of
				parties protected by the provisions of 59 O.S. §§ 357-360 and 36 O.S.
				§§ 6958-6968.
(b) The
				surety bond must provide that no party may cancel the bond without first giving
				thirty (30) days written notice to the principal and the
				Commissioner.
(c) Absent a finding
				otherwise, a bond, shall be deemed to be sufficient if it meets the following
				requirements:
(1) For a PBM with not more
				than five thousand (5,000) annual Oklahoma covered lives, the bond shall have a
				minimum penal sum of fifty thousand dollars ($50,000.00);
(2) For a PBM with more than five thousand
				(5,000) but not more than ten thousand (10,000) annual Oklahoma covered lives,
				the bond shall have a minimum penal sum of one hundred thousand dollars
				($100,000.00);
(3) For a PBM with
				more than ten thousand (10,000) but not more than twenty-five (25,000) annual
				Oklahoma covered lives, the bond shall have a minimum penal sum of two hundred
				fifty thousand dollars ($250,000.00);
(4) For a PBM with more than twenty-five
				thousand (25,000) but not more than fifty thousand (50,000) annual Oklahoma
				lives covered, the bond shall have a minimum penal sum of five hundred thousand
				dollars ($500,000.00);
(5) For a
				PBM with more than fifty thousand (50,000) but not more than one hundred
				thousand (100,000) annual Oklahoma lives covered, the bond shall have a minimum
				penal sum of seven hundred fifty thousand dollars ($750,000.00); and
(6) For a PBM with more than one hundred
				thousand (100,000) annual Oklahoma covered lives, the bond shall have a minimum
				penal sum of one million dollars ($1,000,000.00).
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-7 - License term, renewals, fees

Current through Vol. 41, No. 20,
				July 1, 2024
(a) An
				application fee shall not be refundable if the application is denied,
				withdrawn, cancelled, or refused for any reason by either the applicant or the
				Commissioner.
(b) The PBM license
				shall continue in force no longer than twelve (12) months from the original
				month of issuance. Upon filing a PBM license renewal application on a form
				provided by the Commissioner, a renewal license may be issued by the
				Commissioner to a PBM licensee which is in compliance with the act, has
				continuously maintained such license, and has paid a renewal fee of Five
				Hundred Dollars ($500.00).
(c) If
				the PBM fails to timely apply for renewal of its license or fails to pay any
				applicable fees or outstanding fines by the last day of the month in which the
				license was originally issued, the license shall expire automatically. After
				expiration, the PBM license may be reinstated for up to one (1) year following
				the expiration date upon filing a PBM license renewal application on a form
				provided by the Commissioner and the payment of a reinstatement fee of One
				Thousand Dollars ($1,000.00). If after the one-year date the license has not
				been reinstated, the licensee shall be required to apply for a license as a new
				PBM licensee applicant.
(d) In the
				event that the Commissioner declines to issue or renew a PBM license, the
				Commissioner shall notify the applicant or licensee of such declination and
				advise the applicant or licensee, in writing, of the reason for the
				declination. The applicant or licensee may make written demand upon the
				Commissioner within thirty (30) days of the date of notification by the
				Commissioner, for a hearing before the Commissioner or an independent hearing
				examiner appointed by the Commissioner to determine the existence of the
				grounds for the Commissioner's action. The hearing shall be held within a
				reasonable time period pursuant to the Oklahoma Administrative Procedures
				Act.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-7.1 - Retail pharmacy network access - audit

Current through Vol.
				41, No. 20, July 1, 2024
(a) Standards:
(1) Section 6960 of the act defines "member
				of a retail pharmacy network" as meaning retail pharmacy providers contracted
				with a PBM on behalf of a payor in which the pharmacy primarily fills and sells
				prescription medicine via retail storefront location.
(2) The act draws no distinction between
				regular or specialty drugs, both being prescription medications, therefore,
				specialty drugs fall within the contemplation of the act.
(3) Pharmacy benefits managers shall not in
				any manner on any material, including but not limited to mail and ID cards,
				include the name of any pharmacy, hospital or other providers unless it
				specifically lists all pharmacies, hospitals and providers.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-8 - PBM to file certain financial statements with the Commissioner

Current through Vol. 41, No. 20, July 1, 2024
(a) Before May 1 of each year, every PBM
				providing pharmacy benefits management shall submit to the Insurance
				Commissioner a report, which includes the most recently concluded fiscal
				year-end financial statements for the PBM and report of covered lives, signed
				by an Executive Officer of the PBM attesting to the accuracy of the information
				contained in the report form prescribed by the Commissioner. The report shall
				be audited by an independent certified public accountant (CPA) and prepared
				using generally accepted accounting principles (GAAP). The report may be
				supplemented by any additional information required by the Insurance
				Commissioner.
(b) The Commissioner
				may extend the time prescribed for filing annual or other reports or exhibits
				of any kind for good cause shown. However, the Commissioner shall not extend
				the time for filing annual statements beyond ninety (90) days after the time
				prescribed by this Section.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-9 - Contractual requirements

Current through Vol. 41, No. 20, July 1,
				2024
(a) Maximum
				Allowable Cost.
(1) Contracts between a PBM
				and a provider shall conform to the following requirements:
(A) Identify sources of information utilized
				by the PBM to create and modify the PBM's maximum allowable cost price specific
				to the pharmacy;
(B) The PBM shall
				provide an electronic process, including but not limited to e-mail, for its
				pharmacy providers to readily access the MAC list specific to that provider.
				Upon a provider's written request, a PBM shall furnish its MAC list to the
				provider in paper form or other agreed format;
(C) If a provider is unable to obtain a drug
				from a regional or national wholesaler at a price equal to or less than the
				PBM's multisource drug product reimbursement, the PBM shall provide a
				reasonable appeals procedure to contest the multisource drug product
				reimbursement amount ;
(D) A
				"reasonable appeals procedure" means a process which permits a provider or a
				provider's representative to contest a multisource drug product reimbursement
				amount based on the provider's contention that the drug is not generally
				available for purchase by Oklahoma pharmacies in the state at or below the
				PBM's multisource drug product reimbursement;
(E) A provider's appeal shall contain
				information including but not limited to the date of claim, National Drug Code
				number, and the identity of the national or regional wholesalers from which the
				drug was found to be unavailable for purchase by the provider, at or below the
				PBM's multisource drug product reimbursement;
(F) Appeals filed under this subsection shall
				be presented to the PBM within ten (10) business days following the final
				adjusted payment date. The PBM must respond to a provider within ten (10)
				business days following the receipt by the PBM of the notice that the provider
				is contesting the multisource drug product reimbursement amount;
(G) If a provider's appeal is denied, the PBM
				shall provide the reason for the denial, including the National Drug Code
				number and the identity of the national or regional wholesalers from whom the
				drug was generally available for purchase by providers in the state at or below
				the PBM's multisource drug product reimbursement;
(H) If a provider's appeal is found to be
				justified, the PBM shall make a change in the multisource drug product
				reimbursement amount, permit the provider to reverse and re-bill the claim in
				question, and make the multisource drug product reimbursement amount change
				applicable prospectively for all similarly contracted Oklahoma
				providers.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-10 - Penalty for noncompliance

Current through Vol. 41, No. 20, July 1,
				2024
(a) After notice and
				opportunity for hearing, and upon determining that the PBM has violated any of
				the provisions of 59 O.S. §§ 357-360 of the Oklahoma Statutes, or
				this Subchapter as it relates to 59 O.S. §§ 357-360, or upon finding
				the existence of grounds to refuse the issuance or renewal of such license, the
				Commissioner may suspend or revoke a PBM's license or assess a civil penalty of
				not less than Five Hundred Dollars ($500.00) nor more than Five Thousand
				Dollars ($5,000.00) for each instance of violation, or both. Each day that a
				pharmacy benefits manager conducts business in the State of Oklahoma without a
				license shall be deemed to be an instance of violation. The payment of the
				penalty may be enforced in the same manner as civil judgments may be enforced.
(b) After notice and opportunity
				for hearing, and upon determining that the PBM has violated any of the
				provisions of 36 O.S. §§ 6958-6968 of the Oklahoma Statutes, or this
				Subchapter as it relates to 36 O.S. §§ 6958-6968, the Commissioner
				may suspend or revoke a PBM's license and/or levy fines not to exceed Ten
				Thousand Dollars ($10,000.00) for each count for which any PBM has violated the
				provisions of 36 O.S. §§ 6958-6968. The payment of the penalty may be
				enforced in the same manner as civil judgments may be enforced.
(c) After notice and opportunity for hearing,
				and upon determining that the health insurer has violated any of the provisions
				of 36 O.S. §§ 6958-6968 of the Oklahoma Statutes, the Commissioner
				may suspend or revoke a health insurer's certificate of authority license or
				assess a civil penalty of not less than Five Hundred Dollars ($500.00) nor more
				than Five Thousand Dollars ($5,000.00) for each instance of violation, or both.
				The payment of the penalty may be enforced in the same manner as civil
				judgments may be enforced.
(d)
				Every health insurer and PBM upon receipt of any inquiry from the Commissioner
				or the Commissioner's representative shall, within twenty (20) days from the
				date of inquiry, furnish the Commissioner or the Commissioner's representative
				with an adequate response to the inquiry.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-11 - "Doing pharmacy benefits management business in this state" defined-venue-exceptions

Current through Vol. 41, No.
				20, July 1, 2024
(a) The
				venue of any act listed in this Section shall be Oklahoma County.
(b) Any one of the following acts, in this
				state, effected by mail or otherwise, is defined to be doing pharmacy benefits
				management business in this state:
(1) The
				making of or proposing to make, as a PBM, a contract with a covered entity for
				the provision of pharmacy benefits management services to covered individuals
				residing in Oklahoma;
(2) The
				provision of pharmacy benefit management services to covered individuals
				residing in Oklahoma;
(3) Directly
				or indirectly acting as an agent for, or otherwise representing or aiding on
				behalf of another, any person or PBM in:
(A)
				the solicitation, negotiation, procurement, or effectuation of pharmacy
				benefits management contracts or services to citizens of this state;
(B) the transaction of matters subsequent to
				effectuation of a contract providing pharmacy benefits management services and
				arising out of it; or
(C) any
				other manner representing or assisting a person in the transaction of the
				business of pharmacy benefits management to residents in this state.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29.12 - Commissioner's authority - advisory committee

Current through Vol.
				41, No. 20, July 1, 2024
(a) Pursuant to 36 O.S. § 6966, the
				Insurance Commissioner shall establish an advisory committee composed of
				representatives from the following constituent groups:
(1) Oklahoma Pharmacists Association;
(2) Office of the Oklahoma
				Attorney General;
(3) Consumers;
				and,
(4) Insurers or
				PBMs.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-13 - Claims payment

Current through Vol. 41, No. 20, July 1,
				2024
Payment of claims arising under the terms and conditions of
				  any policy of a medical insurance health benefit plan is the obligation of the
				  insurer that issues such policy. Failure to properly handle such claims is
				  addressed by other provisions of Title 36.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-14 - Inquiry/complaint handling process

Current through Vol. 41, No. 20, July
				1, 2024
(a) Complaints
				alleging failure by the PBM to comply with the act, shall be made in writing to
				the Commissioner, supported by evidentiary materials. All complaints must
				include a completed "PBM Complaint Form" as promulgated by the Commissioner.
(b) All audits of PBMs by health
				insurers shall include a review of complaints against the PBM to determine
				compliance with the terms of the contract between the PBM and the
				complainant.
(c) PBMs must provide
				the complainant with a written notice as to the final disposition of the
				complaint.
(d) As part of its
				response to the Department in connection with every complaint, the PBM must
				provide a statement to the Department that the complaint was carefully reviewed
				and could not be resolved under the terms and conditions of the
				contract.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 29 - Pharmacy Benefit Managers › Section 365:25-29-15 - Examinations of PBMs and health insurers

Current through Vol. 41,
				No. 20, July 1, 2024
(a)
				Pursuant to 36 O.S. § 6965, the Commissioner may examine PBMs for
				compliance with the 59 O.S §§ 357-360 and 36 O.S. §§
				6958-6968.
(b) Pursuant to 36 O.S.
				§ 309.1 through 309.7, the Commissioner may examine health insurers for
				compliance with 36 O.S. §§ 6958-6968.
(c) Any examination permitted under 36
				O.S.§ 6965 will follow the examination procedures and requirements
				applicable to insurers under 36 O.S. §§309.1 through 309.7.
(d) The Commissioner shall not be required to
				regularly examine a PBM under the same time constraints, as required under 36
				O.S. §§ 309.1 through 309.7, applicable to insurers, however, the
				Commissioner may examine the PBM, pursuant to 36 O.S. § 6965, at any time,
				in which he or she believes it reasonably necessary to ensure compliance with
				59 O.S §§ 357-360 and 36 O.S. §§ 6958-6968 or provisions of
				this subchapter.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 30 - Professional Employer Organizations › Section 365:25-30-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Subchapter is to set forth the
				  regulations and procedures relating to the registration and oversight of
				  professional employer organizations under the Oklahoma Professional Employer
				  Organization Recognition and Registration Act, 40 O.S. §§
				  600.1-600.9.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 30 - Professional Employer Organizations › Section 365:25-30-2 - Scope

Current through Vol. 41, No. 20, July 1, 2024
This Subchapter shall apply to all professional employer
				  organizations which must be registered pursuant to 40 O.S. § 600.4.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 30 - Professional Employer Organizations › Section 365:25-30-3 - Authority

Current through Vol. 41, No. 20, July 1, 2024
This Subchapter is promulgated under the authority granted to
				  the Insurance Commissioner in 40 O.S. § 600.4(J).
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 30 - Professional Employer Organizations › Section 365:25-30-4 - Refusal to register

Current through Vol. 41, No. 20, July 1,
				2024
The Insurance Commissioner may refuse to register any person,
				  suspend or revoke the registration of any professional employer organization in
				  accordance with 40 O.S. § 600.9. In addition to or in lieu of any
				  applicable denial, suspension or revocation, the applicant or professional
				  employer organization may be subject to an administrative fine of not less than
				  One-Hundred Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00)
				  for each violation of the Oklahoma Professional Employer Organization
				  Recognition and Registration Act.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 25 - Other Licensees › Subchapter 31 - Reduced Premium Tax Rate for Key Person › Section 365:25-31-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Subchapter is to set forth standards and
				  requirements for a reduced premium tax rate for "Key Person" life insurance
				  policies purchased by an employer on the life of an owner, top executive or
				  other employee in accordance with 36 O.S. § 624(A)(2)(a) and
				  (b).