reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-12.1 - Required appointments [REVOKED]

Current through Vol. 41, No.
				20, July 1, 2024
Added at 15 Ok Reg 1207,
				  eff 1-30-98 (emergency); Added at 15 Ok Reg 3204, eff 7-13-98; Revoked at 24 Ok
				  Reg 2204, eff 7-14-07
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-12.2 - Company background checks

Current through Vol. 41, No. 20,
				July 1, 2024
All appointing companies shall conduct a background check to
				  verify the trustworthiness, financial responsibility, competence, reputation
				  and fitness of all appointed agents.
Added at 15 Ok Reg 1207,
				  eff 1-30-98 (emergency); Added at 15 Ok Reg 3204, eff
				  7-13-98
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-13 - Suggested language for producers bonds

Current through Vol. 41,
				No. 20, July 1, 2024
(a)
Insurance Bond.
The Insurance Bond form provides suggested
				language for preparing an insurance bond.
(b)
Surplus Lines Insurance Brokers
				Bond.
The Surplus Lines Insurance Brokers Bond form provides suggested
				language for preparing an insurance brokers bond.
(c)
Non-Resident Agents License
				Bond.
The Non-Resident Agents License Bond form provides suggested
				language for preparing a non-resident agents insurance bond.
(d)
Public Adjusters Bond.
The
				Public Adjusters Bond form provides suggested language for preparing a public
				adjusters bond.
(e)
Third
				Party Administrators Bond.
The Third Party Administrators Bond form
				provides suggested language for preparing a third party administrators
				bond.
Added at 10 Ok Reg 1457,
				  eff 5-1-93; Amended at 28 Ok Reg 1956, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-14 - Producer and adjuster continuing education forms [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 10 Ok Reg 1457,
				  eff 5-1-93; Amended at 15 Ok Reg 1207, eff 1-30-98 (emergency); Amended at 15
				  Ok Reg 3204, eff 7-13-98; Amended at 24 Ok Reg 2204, eff 7-14-07; Revoked at 28
				  Ok Reg 1956, eff 7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-15 - Forms regarding agents examinations

Current through Vol. 41,
				No. 20, July 1, 2024
(a)
Examination admission.
The examination authorization letter shall
				be sent out to applicants.
(b)
Pass/Fail Notice to Applicants.
After an applicant has taken an
				examination, the applicant receives a pass/fail notice indicating the outcome
				of the test taken.
Added at 10 Ok Reg 1457,
				  eff 5-1-93; Amended at 15 Ok Reg 1207, eff 1-30-98 (emergency); Amended at 15
				  Ok Reg 3204, eff 7-13-98; Amended at 19 Ok Reg 1292, eff
				  7-14-02
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-15.1 - License renewals and reinstatements

Current through Vol. 41,
				No. 20, July 1, 2024
(a)
Proof of courses.
As a prerequisite for submission of a renewal or
				reinstatement application, when requested by the Insurance Commissioner, each
				licensee shall have completed the total number of continuing education hours
				required.
(b)
Required
				submissions for reinstatement.
After the license expires and within one
				year after the license expiration date, a licensee shall be eligible for
				reinstatement by completing required Continuing Education and submitting a new
				application and double the license fee. A licensee shall not be eligible for
				reinstatement if previously the license was revoked, suspended or continuance
				was denied.
(c)
Insurance
				adjusters.
This section shall also apply to insurance adjusters as
				defined by the Insurance Code.
Added at 15 Ok Reg 1207,
				  eff 1-30-98 (emergency); Added at 15 Ok Reg 3204, eff 7-13-98; Amended at 19 Ok
				  Reg 1292, eff 7-14-02; Amended at 21 Ok Reg 1656, eff 7-14-04; Amended at 22 Ok
				  Reg 1953, eff 7-14-05; Amended at 24 Ok Reg 2204, eff 7-14-07; Amended at 28 Ok
				  Reg 1956, eff 7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-16 - Producer licensing forms

Current through Vol. 41, No. 20, July
				1, 2024
(a)
Licenses.
The license form is executed under the hand and seal of
				the Insurance Commissioner and delivered. This form is evidence of a producer's
				authority to transact business within Oklahoma.
(b)
Managing General Agent's
				License.
The Managing General Agent's License is executed under the hand
				and seal of the Insurance Commissioner and delivered. This form is evidence of
				an individual's authority to act as a managing general agent in the State of
				Oklahoma.
(c)
Temporary
				Insurance Producer's License.
The Temporary Insurance Producer's License
				is executed under the hand and seal of the Insurance Commissioner and
				delivered. This form is evidence of an individual's authority to act as a
				temporary insurance agent in the State of Oklahoma. The appointing company that
				requests the license may receive a temporary license after completion of a
				properly completed application and an affidavit as prescribed by the Insurance
				Commissioner. The temporary license shall be valid for up to one hundred eighty
				(180) days from the date of issuance, or until the applicant passes the license
				examination, whichever time is shorter.
(d)
Third Party Administrator License
				Certificate.
The Third Party Administrator License Certificate is
				executed under the hand and seal of the Insurance Commissioner and delivered.
				This form is evidence of an individual's authority to act as a third party
				administrator in the State of Oklahoma.
(e)
Renewal Notice.
The Producer
				Licensing Division of the Insurance Department may send a Renewal Notice to
				producers to remind them to comply with renewal requirements by either
				electronic or paper means.
Added at 10 Ok Reg 1457,
				  eff 5-1-93; Amended at 15 Ok Reg 1207, eff 1-30-98 (emergency); Amended at 15
				  Ok Reg 3204, eff 7-13-98; Amended at 28 Ok Reg 1956, eff
				  7-14-11
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-17 - Other agents forms

Current through Vol. 41, No. 20, July 1,
				2024
(a)
Letter of
				certification.
A letter of certification is provided to an agent at
				his/her request to provide license status for a non-resident license out of
				state.
(b)
Limited Power of
				Attorney.
The Limited Power of Attorney form is used for an individual
				to appoint and terminate agents.
(c)
TPA Plan Supplemental Information
				Sheet.
This form shall be submitted with each renewal and shall provide
				a summary of each plan administered.
Added at 10 Ok Reg 1457,
				  eff 5-1-93; Amended at 15 Ok Reg 1207, eff 1-30-98 (emergency); Amended at 15
				  Ok Reg 3204, eff 7-13-98
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-17.1 - Refund of fees

Current through Vol. 41, No. 20, July 1,
				2024
(a) Upon request by
				an applicant, the Insurance Commissioner may refund to the applicant all or a
				portion of any fees collected by the Commissioner pursuant to law, in
				accordance with this rule. Such fees may be refunded, if requested, prior to
				any official action being taken by the Commissioner or prior to the occurrence
				of the action for which the application was made.
(1) The request must be in written form and
				received in the office of the Commissioner within twenty days of the original
				submission.
(2) The Commissioner
				may consider the following factors in determining whether or not to grant a
				refund:
(A) whether an examination has been
				administered;
(B) whether a license
				has been printed;
(C) whether a
				legal file has been opened; or
(D)
				whether an analysis has been commenced.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-17.2 - Name change on an individual license

Current through Vol. 41, No.
				20, July 1, 2024
Name changes for an individual license, excluding legal
				  entities, require proper documentation at the time of the written request, such
				  as a copy of a court order, marriage license or divorce
				  decree.
Added at 15 Ok Reg 1207,
				  eff 1-30-98 (emergency); Added at 15 Ok Reg 3204, eff
				  7-13-98
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-19 - Request for Assistance and Prompt Pay Forms

Current through Vol.
				41, No. 20, July 1, 2024
The Request for Assistance Form and Prompt Pay Form are used
				  by the Consumer Assistance and Claims Division to gather information regarding
				  complaints and/or inquiries. This information is used to contact insurance
				  companies and other persons and/or entities to seek resolutions to complaints
				  and answers to inquiries. The Consumer Assistance and Claims Division will also
				  accept letters requesting assistance in lieu of the Request for Assistance
				  form.
Added at 10 Ok Reg 1457,
				  eff 5-1-93; Amended at 21 Ok Reg 1656, eff
				  7-14-04
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-20 - Real Estate Appraiser forms

Current through Vol. 41, No. 20, July
				1, 2024
(a)
Application.
The application for Real Estate Appraiser licensure
				or certification is to be completed by the person making the application and
				when completed, contains all the information required by statute.
(b)
Registration for real estate
				appraiser temporary practice.
The registration for Real Estate Appraiser
				temporary practice is to be completed by the person requesting a temporary
				practice permit, and when completed, contains all information required by
				statute.
(c)
Oklahoma
				Temporary Practice Permit.
The Oklahoma Temporary Practice Permit,
				executed under the hand and seal of the Insurance Commissioner and the Real
				Estate Appraisal Board members, and delivered, is evidence of a Real Estate
				Appraiser's authority to conduct appraisals in Oklahoma on a temporary basis,
				not to exceed ninety (90) days.
(d)
Designation of agent form.
The designation of agent form lists the
				Secretary of State for service of process and must be filed by all Real Estate
				Appraisers.
(e)
License.
The Real Estate Appraiser License is executed under the
				hand and seal of the Insurance Commissioner and the Real Estate Appraiser Board
				members, and delivered, is evidence of a Real Estate Appraiser's authority to
				conduct appraisals in Oklahoma.
(f)
Certificate.
The Real Estate Appraiser Certificate is executed
				under the hand and seal of the Insurance Commissioner and the Real Estate
				Appraiser Board members, and delivered, is evidence of a Real Estate
				Appraiser's authority to conduct appraisals in Oklahoma.
(g)
Annual fee application.
The
				annual fee application for Real Estate Appraiser licensure or certification is
				to be completed by the person making the application annually, and when
				completed, contains all the information required by statute.
(h)
Real Estate Appraiser Board Request
				for Assistance form.
The Real Estate Appraiser Board Request for
				Assistance form is used to gather information regarding real estate appraiser
				complaints and/or inquiries. This information is used to contact the appraisers
				to seek resolutions to complaints and answers to inquiries. Letters requesting
				assistance in lieu of this form may also be accepted.
Added at 10 Ok Reg 1457,
				  eff 5-1-93
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 9 - Description of Forms and Instructions › Section 365:1-9-21 - Utilization Review forms

Current through Vol. 41, No. 20, July 1,
				2024
(a)
Application.
The utilization review application is to be completed
				by the firm seeking a certificate of registration, should include all exhibits
				requested in the application, and when completed, contains all information
				required by statute.
(b)
Renewal application.
The utilization review renewal application is
				to be completed by firms previously issued a certificate of registration, and
				must be submitted to the Commissioner's office prior to the expiration of the
				certificate of registration. Along with the renewal application, the firm
				should submit any changes to the original application made during the
				year.
(c)
Utilization review
				certificate of registration.
The Certificate of Registration executed
				under the hand and seal of the Insurance Commissioner and delivered, is
				evidence of authority to perform utilization review in the State of
				Oklahoma.
Added at 10 Ok Reg 1457,
				  eff 5-1-93
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this subchapter is to set forth the internal
				  regulations and procedures of the Oklahoma Insurance Department's E.A.G.L.E.
				  (Ending Arguments Gently, Legally and Economically) Mediation
				  Program.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-2 - Office procedures

Current through Vol. 41, No. 20, July 1,
				2024
Mediation and settlement conference files will be maintained
				  in the Legal Division of the Department. The contents of such files shall not
				  be publicly available, in accordance with 12 O.S. §
									1805.
				  The details of any mediation, settlement conference, or resulting settlement
				  agreement shall not be revealed by Legal Division employees or volunteers
				  associated with the E.A.G.L.E. Mediation Program, except to notify the
				  Claims/Consumer Assistance Division whether a settlement was reached, or to
				  notify a hearing examiner of the issues that have been resolved or remain to be
				  tried after a settlement conference.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-3 - Referrals

Current through Vol. 41, No. 20, July 1, 2024
Referrals for mediation will mainly come from the Consumer
				  Assistance/Claims Division of the Oklahoma Insurance Department. Referrals may
				  also be accepted from outside sources. In no event shall the Insurance
				  Department accept the referral of a case for mediation that does not relate to
				  insurance. Referrals for settlement conferences may be initiated by the
				  Department, a respondent in an administrative disciplinary proceeding, or by
				  order of the hearing examiner assigned to the case.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-4 - Contact and interviews with parties

Current through Vol. 41, No.
				20, July 1, 2024
The Program Director or his/her designee shall endeavor to
				  make contact with each of the parties on the day the referral is received, or
				  as soon thereafter as reasonably practicable. A mediation session shall be
				  scheduled with the consent of all parties, at a time that is convenient for the
				  parties and the assigned mediator. A settlement conference shall be scheduled
				  at the time ordered by the hearing examiner who will conduct the settlement
				  conference.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-5 - Training of mediators

Current through Vol. 41, No. 20, July 1,
				2024
Mediators shall complete at least twenty hours of training
				  conducted by a state certified trainer, as required by Rule 11 of the Rules and
				  Procedures for the Dispute Resolution Act. The training shall include
				  instruction and role-playing on issues that are likely to arise in
				  insurance-related mediation. A mediator who has previously been certified by
				  the Administrative Director of the Courts shall be deemed approved as a
				  mediator for the E.A.G.L.E. Mediation Program if the Program Director is
				  satisfied that the mediator adequately understands the types of
				  insurance-related issues that would be included in training for new E.A.G.L.E.
				  Mediation Program mediators.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-6 - Assignment of mediators

Current through Vol. 41, No. 20, July 1,
				2024
A mediator generally will be assigned according to his/her
				  proximity to the location where the mediation will be held. If a number of
				  certified mediators reside or work within the same city or area in which a
				  mediation is scheduled, assignments will be made on a rotating basis. If a
				  mediator has specific knowledge or expertise that is expected to be helpful in
				  understanding the issues, that mediator may be assigned outside the normal
				  rotation. Hearing examiners will be chosen to conduct settlement conferences
				  based on their availability, knowledge of the applicable law and related
				  experience as a successful judge, hearing examiner, arbitrator or
				  mediator.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-7 - Other volunteer assignments and training

Current through
				Vol. 41, No. 20, July 1, 2024
The E.A.G.L.E. Mediation Program may employ interns or other
				  volunteers to assist Department employees in administering the program. Such
				  volunteers shall be trained by Department employees regarding office procedures
				  and confidentiality requirements.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-8 - Conducting the mediation session

Current through Vol. 41, No. 20,
				July 1, 2024
All mediation sessions shall be conducted in accordance with
				  the Dispute Resolution Act, 12 O.S. §
									1821, et
				  seq., and Rules and Procedures for the Dispute Resolution Act. Mediation
				  sessions shall be conducted by assigned mediators without interference or input
				  from Insurance Department employees. No Department employee shall attend a
				  mediation session unless all parties consent. A mediator shall reveal any
				  relationship with the parties or witnesses or other factors that could have a
				  bearing on the mediator's competence or impartiality. If one of the parties is
				  dissatisfied with the competence or impartiality of the assigned mediator, the
				  session may be rescheduled with a different assigned
				  mediator.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-9 - Reporting

Current through Vol. 41, No. 20, July 1, 2024
When a mediation session is adjourned, the mediator shall
				  forward the signed Agreement to Mediate a Dispute, Rules of Conduct for Outside
				  Parties Attending Mediation Hearing, Mediation Agreement and Record of
				  Termination forms to the Program Director at the Oklahoma Insurance Department.
				  The Program Director shall submit an annual report to the Administrative
				  Director of the Courts no later than July 30 of each year, in compliance with
				  Rule 13 of the Rules and Procedures for the Dispute Resolution
				  Act.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-10 - Follow-up

Current through Vol. 41, No. 20, July 1, 2024
The Department shall select a random sample from the parties
				  who have participated in mediation and interview them regarding their
				  satisfaction with the process.
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 11 - E.A.G.L.E. Mediation Program › Section 365:1-11-11 - Forms

Current through Vol. 41, No. 20, July 1, 2024
The E.A.G.L.E. Mediation Program shall use forms
				  substantially the same as those adopted or approved by the Administrative
				  Director of the Courts. If the Administrative Director of the Courts changes
				  the forms that are approved for use in programs that are certified pursuant to
				  the Dispute Resolution Act, the forms used by the E.A.G.L.E. Mediation Program
				  will be changed accordingly. Copies of the following forms are available from
				  the Oklahoma Insurance Department:
(1)
				Agreement to Mediate a Dispute
(2)
				Rules of Conduct for Outside Parties Attending Mediation Hearing
(3) Mediation Agreement
(4) Record of Termination
Added at 17 Ok Reg 1619,
				  eff 7-14-00
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 1 - Administrative Operations › Subchapter 13 - Electronic Filings › Section 365:1-13-1 - Electronic filings

Current through Vol. 41, No. 20, July 1,
				2024
(a) Effective
				January 1, 2009, the following filings, and fees relating thereto, shall be
				made with the Insurance Department by electronic means and format as approved
				by the Insurance Commissioner:
(1) Insurance
				agent/producer initial and renewal license applications;
(2) Insurance adjuster initial and renewal
				license applications;
(3) Limited
				lines producers initial and renewal license applications;
(4) Life, accident and health insurance
				brokers initial and renewal license applications;
(5) Motor service club agent's initial and
				renewal license applications;
(6)
				Appointments and terminations of appointments of those listed in Paragraphs 1
				through 5 of this section;
(7)
				Continuing education providers initial and renewal applications; and
(8) Continuing education course
				submissions;
(9) Continuing
				education course completion filings;
(10) Schedule of continuing education course
				offerings;
(11) Filings submitted
				to the Rate and Form Compliance Division of the Insurance
				Department.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-2 - Severability

Current through Vol. 41, No. 20, July 1, 2024
If any provision of this chapter or the application thereof
					 to any person or circumstance is for any reason held to be invalid, the
					 remainder of the section and the application of such provisions to the persons
					 or circumstances shall not be affected thereby.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-3 - Uniform health insurance claim form

Current through Vol. 41,
				  No. 20, July 1, 2024
(a)
Purpose.
The purpose of this section is to set forth a uniform
				  health insurance claim form which shall be accepted by all insurers
				  transmitting health insurance in the state, state agencies and insurance
				  trusts.
(b)
Uniform health
				  insurance claim form.
(1) The form in
				  Appendix A of this chapter shall be accepted by all insurers transmitting
				  health insurance in the state, all state agencies that require health insurance
				  claim forms for their records and all insurance trusts or derivatives
				  thereof.
(2) An insurer may
				  continue to request additional information from the claimant or hospital so
				  that the health insurance claim may be properly processed.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-4 - Blood transfusions

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Purpose.
The purpose of this section is to set forth required
				  policy provisions regarding blood transfusions.
(b)
Contract requirements regarding
				  blood transfusions.
Accident and Health contracts containing benefits
				  respecting blood transfusions shall clearly set forth whether or not the cost
				  of the blood is included in the benefit. If the cost of the blood is not
				  included, the contract shall so specify. Examples of acceptable wording shall
				  be as follows:
(1) Blood transfusion,
				  including materials, services and equipment (including blood cost).
(2) Blood transfusion, including materials,
				  services and equipment (excluding blood cost).
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-5 - Unfair discrimination on basis of blindness or partial blindness

Current through Vol. 41, No. 20, July 1, 2024
(a)
Purpose.
The purpose of this
				  section is to identify specific acts or practices which are prohibited by 36
				  O.S. §
										1204(7)
(b)
Acts of "unfair
				  discrimination" defined.
The following are hereby identified as acts or
				  practices which constitute
unfair discrimination between
				  individuals of the same class [36:1204(7)]:
(1) Refusing to insure, or
(2) Refusing to continue to insure,
				  or
(3) Limiting the amount, extent
				  or
(4) Kind of coverage available
				  to an individual, or
(5) Charging
				  an individual a different rate for the same coverage solely because of
				  blindness or partial blindness.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-6 - Oklahoma Life and Health Insurance Guaranty Association notice requirements

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Purpose.
The purpose of this section is to provide the contract or
				  policyholders with information concerning the coverage or non-coverage by the
				  Oklahoma Life and Health Insurance Guaranty Association Act.
(b)
Form of notice.
The notice
				  for policies or contracts covered or not covered by the Guaranty Association
				  shall be prepared as follows:
(1) The
				  information required by 36 O.S. Section
				  2043(C)
				  shall be included on the summary document required by 36 O.S. Section
				  2043(B).
				  The summary document shall:
(A) Prominently
				  warn the policy or contract holder that the Life and Health Insurance Guaranty
				  Association may not cover the policy or, if coverage is available, it will be
				  subject to substantial limitations, exclusions and conditioned on continued
				  residence in the state;
(B) State
				  that the insurer and its agents are prohibited by law from using the existence
				  of the Life and Health Insurance Guaranty Association for the purpose of sales,
				  solicitation or inducement to purchase any form of insurance;
(C) Emphasize that the policy or contract
				  holder should not rely on coverage under the Life and Health Insurance Guaranty
				  Association when selecting an insurer; and
(D) State the name and address of the Life
				  and Health Insurance Guaranty Association and Insurance Department.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-7 - Charitable services exclusions - applicability to state owned or controlled hospitals - penalty

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Purpose.
The purpose of this section is to provide that a policy
				  exclusion limiting benefits to the insured for services rendered by a state
				  hospital are not applicable to state owned and/or controlled hospitals which
				  admit paying patients.
(b)
Application of charitable service exclusions to state-owned or controlled
				  hospitals; penalties.
(1)
Applicability.
Any exclusion or limitation contained in policies
				  of accident and health, and/or hospitalization insurance heretofore or
				  hereafter issued by any insurer to residents of this state, which exclusion or
				  limitation purports to deny policy benefits to the insured for "any or all
				  hospital, surgical and/or medical services obtained from or at state hospitals,
				  which the insured is entitled to receive without charge", or any exclusion or
				  limitation of similar import, however worded, shall not be applicable to state
				  owned and/or controlled hospitals in this state, provided, and to the extent
				  that such state hospitals are duly authorized to admit "paying patients" for
				  hospital, surgical and/or medical services, or any of such services.
(2)
Penalties for noncompliance.
Any insurance company violating the provisions of this section in connection
				  with claims arising in this state shall be subject to the penalties provided
				  for by law, including, but not by way of limitation, the revocation of its
				  license to transact business in this state.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-8 - Proof of loss [REVOKED]

Current through Vol. 41, No. 20, July
				  1, 2024
Added at 9 Ok Reg
					 3307, eff 7-27-92
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-9 - Eliminating unfair discrimination

Current through Vol. 41, No. 20,
				  July 1, 2024
(a)
Purpose.
The purpose of this section is to eliminate the act of
				  denying benefits or coverage unfairly in the terms and conditions of insurance
				  contracts and in the underwriting criteria of insurance carriers. It is not
				  intended to prohibit reasonable and justifiable differences in premium rates
				  based upon sound actuarial principles or actual or reasonably anticipated
				  experience.
(b)
Definitions.
(1)
"Contract"
means any insurance policy, plan or binder, including
				  any rider or endorsement thereto offered by an insurer.
(2)
"Insurer"
includes:
(A) Every person engaged in the business of
				  making contracts of insurance or indemnity.
(B) A nonprofit hospital service and medical
				  indemnity corporation is an insurer within the meaning of the Code.
(C) Burial associations shall be deemed not
				  to be insurers.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-10 - Portability form

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Purpose.
The purpose of this section is to set forth a portability
				  form which may be accepted by insurers transacting health insurance in the
				  state, state agencies and insurance trusts.
(b)
Portability form.
The form
				  in Appendix U of this Chapter may be accepted by all insurers transacting
				  health insurance in the state, all employers that require proof of portability
				  of insurance benefits for their records and all insurance trusts or derivatives
				  thereof.
(c)
Form
				  availability.
The portability form is to be completed by the employer
				  and provided to the employee upon termination of employment. The form may be
				  included with information pertaining to continuation of group coverage through
				  COBRA.
(d)
Proof of
				  satisfaction of preexisting conditions.
A form properly completed and
				  signed by the previous employer may be accepted by the succeeding employer as
				  proof of satisfaction of preexisting condition limitations or exclusions under
				  the previous group coverage. Additional documentation should not be necessary
				  either from the employee, the previous employer or the prior carrier, provided
				  that the employee applies for the new coverage within 31 days of
				  eligibility.
(e)
COBRA
				  extension.
Electing COBRA continues group coverage and extends
				  eligibility for continuous group coverage for purposes of
				  portability.
(f)
Use of
				  form.
The use of the portability form by employers is strictly
				  voluntary. Failure to use this form will not result in civil or criminal
				  penalties under the Insurance Code. The Portability form is designed to promote
				  ease and uniformity of administration of health insurance benefits in
				  compliance with 36 O.S. §
										4509.2.
Added at 11 Ok Reg
					 1835, eff 5-15-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-11 - Insurance policy and claim form warning

Current through Vol. 41,
				  No. 20, July 1, 2024
(a)
Policies.
Every insurance policy issued or delivered in this State
				  shall specify on its face, or by endorsement, or rider attached to the policy,
				  printed in ten (10) point or larger type, a statement that clearly indicates in
				  substance, as required in 36 O.S. §
										3613.1,
				  the following:
WARNING: Any person who knowingly, and with intent to
				  injure, defraud or deceive and insurer, makes any claim for the proceeds of an
				  insurance policy containing any false, incomplete or misleading information is
				  guilty of a felony.
(b)
Claim forms.
Every insurance claim form shall contain a statement
				  that clearly indicates in substance, as required in 36 O.S. §
										3613.1,
				  the following:
WARNING: Any person who knowingly, and with intent to
				  injure, defraud or deceive and insurer, makes any claim for the proceeds of an
				  insurance policy containing any false, incomplete or misleading information is
				  guilty of a felony.
Added at 11 Ok Reg
					 1837, eff 5-15-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-12 - Policy of insurance shall include insurer's complete name and street address

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Purpose.
The purpose of this section is to set forth information
				  which must be included on an insurance policy.
(b)
Insurer's name and address required
				  on policy.
(1) 36 O.S. §
											3613(1981),
				  entitled "Contents of Policies in General," provides that each contract of
				  insurance shall set forth
the insurer's name and complete address
				  [36:3613(b) (2)].
(2)
				  Every policy of insurance issued or delivered in this State shall specify, on
				  its face, or by endorsement, or rider attached to the policy:
(A) The complete name of the
				  insurer;
(B) The complete street
				  address of the home or principal office of the insurer.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-13

Current
				  through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg
					 2955, eff 7-14-97; Amended at 14 Ok Reg 3688, eff 8-20-97 through 7-14-98
					 (emergency)1; Amended at 26 Ok Reg 1529, eff
					 7-14-09; Amended at 28 Ok Reg 1960, eff
					 7-14-11
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-98 (after the 7-14-98 expiration of the emergency action), the text of
					 365:10-1-13 reverted back to the permanent text that became effective 7-14-97,
					 as was last published in the 1997 OAC Supplement, and remained as such until
					 amended by permanent action on 7-14-09..
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-14 - Notice of withdrawal or discontinuance of writing

Current
				  through Vol. 41, No. 20, July 1, 2024
(a) Any insurer desiring to withdraw from the
				  state or discontinue the writing of a particular type or class of insurance in
				  this state shall give one hundred eighty (180) days notice in writing to the
				  Rate and Form Filing Compliance Division of the Insurance Department and shall
				  state in writing its reasons for such action. The insurer shall also provide
				  the following information:
(1) The number of
				  policyholders affected;
(2) The
				  number of insurance agents affected;
(3) The date the insurer will cease writing
				  new business;
(4) The date the
				  insurer will start non-renewing insurance policies;
(5) Whether the insurer has made arrangements
				  with another insurer to cover the renewals;
(6) The lines of insurance on which the
				  insurer plans to concentrate; and
(7) Whether the insurer anticipates
				  re-entering the market.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-15

Current
				  through Vol. 41, No. 20, July 1, 2024
Added at 28 Ok Reg
					 1960, eff 7-14-11; Amended at 29 Ok Reg 1254, eff
					 7-14-12
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 1 - GENERAL PROVISIONS › Section 365:10-1-16 - Providing insurance policy information

Current through Vol. 41,
				  No. 20, July 1, 2024
(a)
				  An insurer shall provide to any insurance producer authorized to sell life
				  insurance products, whose appointment has been terminated for any reason other
				  than the reasons set forth in 36 O.S. §
										1435.13
				  and who is still the agent of record or servicing agent and has not been
				  replaced by another servicing agent upon termination, information relating to
				  the policy of the person who purchased a product from such producer if the
				  insured has signed a form authorizing the release of the information.
(b) This requirement does not apply to any
				  policy sold or serviced by the insurance producer while associated with the
				  insurer's captive distribution system.
(c) Insurers shall use the "Policy Holder's
				  Authorization To Release Insurance Policy Information To Agent Of Record"
				  specified in Appendix UU or a substantially form to comply with this
				  requirement.
Added at 29 Ok Reg
					 1254, eff 7-14-12
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-30 - Applicability and scope

Current through Vol. 41, No. 20, July 1,
				  2024
As defined in
					 365:10-1-31, this
					 Part is applicable to all:
(1) third
				  party payors,
(2) health care
				  practitioners, and
(3)
				  hospitals.
Added at 11 Ok Reg
					 3295, eff 7-1-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-32 - Requirements for use of HCFA Form 1500 and HCFA Form 1491

Current
				  through Vol. 41, No. 20, July 1, 2024
(a) Health care practitioners shall use the
				  HCFA Form 1500 and instructions provided by HCFA for use of the HCFA Form 1500
				  when filing claims with third party payors for professional services. HCFA Form
				  1491 may be used instead of the HCFA Form 1500 when filing claims for
				  transportation and/or ambulance services.
(b) The requirement set forth in
				  365:10-1-32(a) does not apply to:
(1) dental
				  services which are billed by dentists using the ADA-1990 Dental Claim Form and
				  CDT-1 Codes, or
(2) pharmacists or
				  pharmacies which are filing claims for prescription drugs.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-33 - Requirements for use of ADA-1990 Dental Claim Form

Current through
				  Vol. 41, No. 20, July 1, 2024
(a) A dentist shall use the ADA-1990 Dental
				  Claim Form and instructions provided by the American Dental Association CDT-1
				  for use of the ADA-1990 Dental Claim Form for filing claims with third party
				  payors for professional services.
(b) A third party payor may not require a
				  dentist to use any code other than the CDT-1 codes for the initial filing of
				  claims for dental care services.
Added at 11 Ok Reg
					 3295, eff 7-1-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-34 - Requirements for use of HCFA Form UB-82 and UB-92

Current through
				  Vol. 41, No. 20, July 1, 2024
(a) For claims submitted before April 1,
				  1994, hospitals shall use either the HCFA Form UB-82 or UB-92 as mutually
				  agreed to by the hospital and third party payor.
(b) For claims submitted on or after April 1,
				  1994, hospitals shall use HCFA Form UB-92 and its successors when billing third
				  party payors for hospital services.
Added at 11 Ok Reg
					 3295, eff 7-1-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-35 - Requirements for use of Universal Prescription Drug Claim Form

Current through Vol. 41, No. 20, July 1, 2024
A pharmacist or pharmacy shall use the Universal
					 Prescription Drug Claim Form for billing third party payors for prescription
					 drugs.
Added at 11 Ok Reg
					 3295, eff 7-1-94
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-36 - Claims processing

Current through Vol. 41, No. 20, July 1,
				  2024
(a) A health care
				  practitioner or hospital shall file a claim in a manner consistent with the
				  requirements of this Part and in accordance with nationally recognized
				  standards.
(b) A third party payor
				  shall accept a form which is submitted in compliance with this Part for the
				  processing of the third party payor's claims.
(c) When the legitimacy or appropriateness of
				  the health care service is disputed, a third party payor may request additional
				  medical information that describes and summarizes the diagnosis, treatment, and
				  services rendered to the insured, member, or subscriber.
(d) All third party payors may obtain
				  additional claims information, when necessary to determine eligibility for
				  benefits or for determination of coverage, subject to the following:
(1) third insured, member or
				  subscriber,
(2) the employer of the
				  insured, member or subscriber, or
(3) any other non-provider third
				  party.
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 3 - Advertising › Part 1 - ACCIDENT AND HEALTH INSURANCE › Section 365:10-3-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Part is to assure truthful and complete
					 disclosure of all material and relevant information in the advertising and sale
					 of accident, disability and sickness insurance. This purpose is intended to be
					 accomplished by the establishment of, and adherence to, certain minimum
					 standards and guidelines of conduct in the advertising and sale of accident,
					 disability and sickness insurance in a manner which prevents unfair competition
					 among insurers and is conducive to the accurate presentation and description to
					 the insurance buying public of policies of insurance offered through various
					 advertising media.
Amended at 10 Ok Reg
					 1471, eff 5-1-93
Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 3 - Advertising › Part 1 - ACCIDENT AND HEALTH INSURANCE › Section 365:10-3-2 - Applicability; insurer responsibility

Current through Vol. 41, No.
				  20, July 1, 2024
(a)
				  This Part shall apply to any accident, disability and sickness insurance
				  "advertisement", as the term is defined in
				  365:10-3-3, intended
				  for presentation, distribution or dissemination in this state when such
				  presentation, distribution or dissemination is made or controlled either
				  directly or indirectly by or on behalf of an insurer, agent, person, broker or
				  solicitor as those terms are defined in the Insurance Code of this state and in
				  this Part.
(b) Every accident,
				  health, hospitalization or disability insurer shall establish and at all times
				  maintain a system of control over the content, form and method of dissemination
				  of all advertisements of its policies. All such advertisements, regardless of
				  by whom written, created, designed or presented, shall be the responsibility of
				  the insurer whose policies are so advertised.