reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-2 - Additional application requirements

Current through Vol. 41, No. 20, July 1, 2024
The Application for a new Group Self-Insurance Association
				  Permit provided for in
				  810:25-11-1 shall be
				  submitted in a manner prescribed by the Commission at least sixty (60) days
				  before the desired effective date and include all of the following:
(1) A One Thousand Dollar ($1,000.00)
				nonrefundable application fee, made payable to the Commission;
(2) A sample of the members' indemnity
				agreement and power of attorney, as required by
				810:25-11-15,
				binding the association and each member thereof, jointly and severally, to
				comply with the provisions of the AWCA;
(3) An executed copy of the application of
				each employer for membership in the association. The application must be on a
				form approved by the Commission and include the following:
(A) An indemnity agreement and power of
				attorney executed by the employer;
(B) A joint and several liability agreement
				executed by the employer;
(C) The
				employer's current audited financial statement for the two previous fiscal
				years, including a balance sheet, statement of income, statement of cash flows,
				and notes;
(D) If audited financial
				statements are not available, the employer should provide the employer's
				financial statement for the two previous years signed by two (2) company
				executives, including a balance sheet, statement of income, statement of cash
				flows and notes; and
(E) A balance
				sheet and income statement for the current fiscal year.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-3 - Approval of new members of the association

Current through Vol. 41, No. 20, July 1, 2024
(a) A new membership may not become effective
				without Permitting Services Division approval. All applications for membership,
				in a form approved by the Permitting Services Division, shall be filed with the
				Commission. New member applicants must be reported to the Permitting Services
				Division and NCCI no later than thirty (30) days after the effective date of
				each new member applicant. The date the application is received by the
				Commission will be the received date for purposes of this deadline.
(b) The application for membership shall
				include the following:
(1) An indemnity
				agreement and power of attorney executed by the applicant, as required by
				810:25-11-15;
(2) A joint and several liability agreement
				executed by the applicant, as required by
				810:25-11-15;
(3) Signed approval of the applicant by the
				association;
(4) A balance sheet
				and income statement, or if a new business, a pro forma financial statement
				signed by two (2) executive officers of the business entity, for the new
				applicant's current fiscal year; and
(5) The estimated standard and discounted
				premium the applicant will pay during the period between the application
				effective date and the association's renewal.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-4 - Investment and reserve requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) The members' supervisory board of an
				association may, in its discretion, invest its funds in either of the following
				investments:
(1) Savings accounts or
				certificates of deposit in a Federal Deposit Insurance Corporation (FDIC)
				insured institution; or
(2) Direct
				obligations of the United States Treasury, either as notes, bonds, or bills
				that are backed by the full faith and credit of the United States
				Government.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-5 - Financial and related reports

Current through Vol. 41, No. 20, July 1, 2024
(a) On or before the one hundred twentieth
				(120) day after the end of its fiscal year, every association shall file a
				certified audit of its annual financial condition prepared by a certified
				public accountant acceptable to the Commission. Audits must include a complete
				breakdown of all monies collected by the association, including the amount
				discounted and a complete breakdown of expenses. The audit should footnote and
				analyze completely all paid claims and claims reserved but not reported. A
				footnote must also be included to indicate if payments to contracted parties
				are in accordance with current contracts.
(b) An interim financial statement shall be
				filed sixty (60) days following the midyear fiscal anniversary of the
				association. This statement need not be audited, but should reflect pertinent
				data regarding income, claims reserves and IBNR, standard premium, discounts,
				interest earned, expense constant fees, as well as a breakdown of the
				association's expenses.
(c) An
				actuarial report of the association's estimated reserves must be filed with the
				certified financial audit required in Subsection (a) of this Section. The
				reserves recommended by the actuarial report must be used by the association.
				If the actuary gives a range of reserves, the association should use the
				midrange or higher. The actuary completing the report should be a member in
				good standing with the Casualty Actuarial Society.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-6 - Excess insurance

Current through Vol. 41, No. 20, July 1, 2024
(a) A
				group self-insurance association must obtain specific and aggregate excess
				insurance from an admitted or surplus lines insurer with an AM Best Rating of
				B+ or better. The self insured retention must be approved by the Commission and
				the excess carrier's limits of liability must be statutory. An amount less than
				statutory limits must be approved in advance by the Commission. The attachment
				point of the aggregate excess insurance should not exceed one hundred percent
				(100%) of an association's estimated standard premium, unless authorized by the
				Commission.
(b) The policy required
				in Subsection (a) of this Section must not be terminable for any reason except
				upon thirty (30) days' written notice by certified mail or overnight courier to
				the Commission and the association.
(c) Copies of the complete policy required by
				Subsection (a) of this Section must be filed with the Commission.
(d) Under certain conditions, an irrevocable
				letter of credit may be presented in lieu of aggregate excess insurance. The
				form and amount of the letter of credit must be approved by the
				Commission.
(e) Two or more group
				self-insurance associations may pool together to purchase aggregate excess
				insurance, upon application and approval of the Commission and the excess
				carrier.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-7 - Operating expenses

Current through Vol. 41, No. 20, July 1, 2024
The maximum operating expenses of the association should not
				  exceed thirty-three percent (33%) of the standard premium. These expenses
				  include the following:
(1)
				Administrator's fee;
(2) TPA
				fee;
(3) Marketing fees, billing
				and collection fees, and sales commissions;
(4) General operating expenses, including
				audits and actuarial reports;
(5)
				Cost of excess insurance; and
(6)
				Any other fees approved by the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-8 - Rates, experience modifications, and discounts

Current through Vol. 41, No. 20, July 1, 2024
(a) All workers' compensation rates to be
				charged to its members must be approved in advance by the Commission. The rates
				should be based on the latest advisory loss costs provided by the National
				Council on Compensation Insurance (NCCI), must be actuarially certified, and
				must be sufficient to cover the association's estimated losses and expenses for
				the upcoming year. The actuary's report must accompany the rate request to the
				Commission. The actuary must be a member in good standing with the Casualty
				Actuarial Society.
(b) Experience
				modifiers for the members must be promulgated by the NCCI on an annual
				basis.
(c) All premium discounts
				must be approved by the Commission. The aggregate of all discounts allowed to a
				member cannot exceed twenty-five percent (25%) of the member's standard
				premium. Types of acceptable discounts include:
(1) Prompt Pay;
(2) Safety program;
(3) Premium volume;
(4) Experience rated; and
(5) Other discounts approved by the
				Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-9 - Premium deposits

Current through Vol. 41, No. 20, July 1, 2024
On the association's effective date, the premium deposit of
				  at least twenty-five percent (25%) of the first year's discounted premium
				  payable by each member of the association, shall have been paid into a
				  designated depository, which shall certify receipt of same to the Commission.
				  The balance of the first year's premium shall be paid, either in quarterly or
				  monthly installments at the discretion of the board, no later than the end of
				  the ninth month of the association's fiscal year. For subsequent years, the
				  board of each association shall determine the amount of advance deposit
				  required, or if the deposit shall remain permanent, with distribution only
				  after termination of the membership and all premium audits and adjustments
				  completed, and all premiums due paid in full. The Commission may require an
				  association to make its deposits permanent.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-10 - Surplus distributions

Current through Vol. 41, No. 20, July 1, 2024
(a) Any
				surplus monies may be declared refundable by the board, and the amount of such
				declaration shall be a fixed liability of the association at the time of the
				declaration. The date and manner of the distribution shall be declared by the
				board. The manner of the distribution shall be in accordance with the
				association's bylaws. The board shall submit the distribution request to the
				Commission, with all supporting documents. The payment of any distribution
				shall not be made without Commission approval.
(b) The following distribution guidelines
				shall apply:
(1) Distributions from profitable
				years can be assigned to unprofitable years;
(2) Full and final distributions of all
				surplus remaining for a particular year cannot be made until all claims
				incurred during that year are permanently closed;
(3) Distributions will not be approved if the
				association has an overall deficit, or the distribution will place the
				association in an overall deficit; and
(4) Distributions shall be made in an
				equitable manner as provided in the association's bylaws.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-11 - Deficits and assessments

Current through Vol. 41, No. 20, July 1, 2024
(a) If
				the association incurs a deficit for a particular year, the board must address
				the issue with the Commission. If the loss is significant, the board may be
				required to increase rates or to reduce expenses and discounts to return the
				group to profitability. If the cumulative net worth of the association is in a
				deficit position, the board may be required to assess its membership to make up
				the deficit. If an assessment is made, it shall be done in an equitable manner
				in accordance with the association's bylaws.
(b) The following assessment guidelines shall
				apply:
(1) Assessments must be declared by the
				board, and approved by the Commission. On the date the declaration is made, the
				assessment can be recorded as a receivable on the association's financial
				statements;
(2) A member cannot be
				assessed for a deficit in a fiscal year it was not a member;
(3) The assessment can be payable over a
				thirty-six (36) month period, or shorter time frame, if desired by the board or
				required by the Commission; and
(4)
				Any member who does not pay its assessment when due, shall be cancelled from
				the group with ten (10) days' notice to the member and the
				Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-13 - Security deposit

Current through Vol. 41, No. 20, July 1, 2024
A group self-insurance association may be required to post an
				  irrevocable letter of credit with the Commission, in an amount determined by
				  the Commission. The actual amount of the letter of credit will be determined by
				  the Commission after evaluating the financial status of the association,
				  including the following:
(1) The
				association's available surplus;
(2) The gap between the amount of premium
				estimated to be collected and the attachment point of the aggregate excess
				insurance policy; and
(3) The
				financial strength of the collective membership.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-14 - Letter of credit requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) An irrevocable letter of credit
				authorized pursuant to
				810:25-11-6 or
				required pursuant to
				810:25-11-13
				must be issued by a state or national chartered bank, whose deposits are
				insured by the Federal Deposit Insurance Corporation (FDIC). The bank must be
				approved in advance by the Commission. The letter of credit must be on a form
				prescribed by the Commission, include an automatic renewal clause, and cannot
				be non-renewed without sixty (60) days' prior written notice to the Commission.
				The letter of credit shall be made payable to the Commission. The Commission
				may make demand and collect on the posted letter of credit in whole or in part,
				in the case of actual or imminent default of the association to pay
				compensation liabilities, or the cancellation of the letter of credit without
				an adequate replacement.
(b) All
				letters of credit referenced in Subsection (a) of this Section, and any
				proceeds thereof collected upon demand, including any interest thereon, shall
				be maintained by the Commission as provided in the AWCA until each claim for
				workers' compensation benefits is paid, settled or lapses under the AWCA, and
				costs of administration of those claims are paid, or until otherwise released
				by the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-15 - Indemnity agreements and power of attorney

Current through Vol. 41, No. 20, July 1, 2024
(a) Every member of a group self-insurance
				association shall execute an indemnity agreement and power of attorney which
				shall set forth the rights, privileges and obligations of the member and the
				association and the powers and duties of the administrator. Such indemnity
				agreement and power of attorney shall be subject to the approval of the
				Commission and shall contain in substance the following:
(1) An agreement on a form approved by the
				Commission, under which each member agrees to assume and discharge, jointly and
				severally, liability under the AWCA of any and all employers party to such
				agreement;
(2) Provisions requiring
				that the members' supervisory board designate and appoint an administrator
				empowered to accept service of process on behalf of the association and
				authorized to act for and bind the association and members in all transactions
				either relating to or arising out of the operation of the
				association;
(3) Provisions for the
				right of substitution of the administrator and revocation of the power of
				attorney and right hereunder; and
(4) Provisions that clearly state all of the
				coverages of the policy.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-16 - Administrator

Current through Vol. 41, No. 20, July 1, 2024
The members' supervisory board must designate an
				  administrator to administer the financial affairs of the association, who shall
				  furnish a fidelity bond with the association as obligee, in an amount
				  sufficient to protect the association against the misappropriation or misuse of
				  any monies or securities. The amount of the bond shall be determined by the
				  Commission and evidence of such shall be filed with the
				  Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-17 - Third-party administration

Current through Vol. 41, No. 20, July 1, 2024
(a)
				The association must contract with a third party to provide claims adjusting,
				underwriting, industrial safety engineering, marketing and accounting
				functions. More than one organization can be contracted with to provide these
				services. The company providing the claims adjusting and marketing must be a
				third-party administrator licensed by the Commission.
(b) All copies of contracts between the
				association and any organization providing services to association shall be
				filed with the Commission. Any change in contract must be filed with the
				Commission ten (10) days' before the effective date.
(c) Any contract with a TPA for claims
				adjusting must state the TPA agrees to handle all claims incurred to their
				conclusion, unless approval to transfer the claims is obtained from the
				Commission before such transfer.
(d) A company providing marketing services to
				a self-insurance program must be approved by the Commission's Permitting
				Services Division. The company requesting approval must submit to the
				Commission's Permitting Services Division all marketing material prior to being
				utilized by an association.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-18 - Termination of members

Current through Vol. 41, No. 20, July 1, 2024
A member of an association may not be terminated unless at
				  least ten (10) days' written notice has been given to the member and the
				  Commission if the termination is due to nonpayment of premium or assessment. If
				  the cancellation is for other reasons, then the member may not be terminated
				  unless at least thirty (30) days' written notice is given to the member and the
				  Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-19 - Revocation

Current through Vol. 41, No. 20, July 1, 2024
(a) The group
				self-insurance association permit may be revoked by the Commission at any time
				upon reasonable notice and hearing, for good cause shown, including, but not
				limited to: failure to comply with the rules of the Commission; failure to pay
				compensation when due; and financial impairment of the association which has or
				will make the association insolvent. The association will be given forty five
				(45) days to cancel its members and for the members to obtain alternative
				workers' compensation coverage authorized by law.
(b) The association's members are expected to
				secure their workers' compensation obligations at all times as provided by law,
				notwithstanding the revocation. Failure to do so may subject the member to
				sanctions pursuant to 85A O.S., § 40 and enforcement proceedings as
				provided in Subchapter 7 of this Chapter.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-20 - Examination of association

Current through Vol. 41, No. 20, July 1, 2024
Whenever the Commission deems it expedient for the protection
				  of the interests of the people of the State of Oklahoma, it may make or direct
				  to be made an examination into the affairs of any association, member,
				  marketing firm, or TPA approved in the State of Oklahoma.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-22 - Miscellaneous operating guidelines

Current through Vol. 41, No. 20, July 1, 2024
(a) The assets of a group self-insurance
				association and control thereof are property of the members under the direction
				of its supervisory board members.
(b) The association's standard premium by the
				end of its first fiscal year and for all subsequent fiscal years shall not be
				less than One Million Dollars ($1,000,000.00);
(c) Any change in the bylaws and/or contracts
				with the association must be filed promptly with the Commission.
(d) Any false or misleading solicitation of
				membership in the group self-insurance association may be cause for
				cancellation of approval of the TPA, marketing organization, and the group
				self-insurance association as a whole.
(e) Any recalculation of premium, due to
				experience modification, cannot be retroactive more than one hundred eighty
				(180) days.
(f) A cancellation
				short rate penalty may not be charged if the member has been a member of the
				association at least twelve (12) months before the cancellation.
(g) Any trade membership dues must be
				collected separate from the group self-insurance association. Services provided
				by the trade association must be fully explained to members joining the trade
				association.
(h) A separate safety
				program may not be sold to a member by a marketer of the association.
(i) At least ninety percent (90%) of all
				expense constant fees collected shall be deposited directly into the
				association's general revenues. No portion of these fees may be paid to any
				group or individual contracted with the association in an amount greater than
				that of the normal sales commission allowed.
(j) All billing and receiving will be
				supervised and reviewed by the TPA and the administrator of the association.
				All monies must be deposited promptly in the association's designated Oklahoma
				depository account.
(k) Wrongfully
				changing employee classification codes or rates are grounds for immediate
				revocation of the approval of the TPA, marketing organization, and the group
				self-insurance association as a whole.
(l) The members' supervisory board can be
				reimbursed its travel and incidental expenses incurred during its services as a
				member of the board. Board members may not be paid a salary. A group
				self-insurance association shall comply with Section 111 of the Medicare,
				Medicaid, and SCHIP Extension Act of 2007 (MMSEA), including all MMSEA workers'
				compensation reporting requirements, to the extent and as provided by Federal
				law.
(m) A group self-insurance
				association shall comply with Section 111 of the Medicare, Medicaid, and SCHIP
				Extension Act of 2007 (MMSEA), including all MMSEA workers' compensation
				reporting requirements, to the extent, and as provided by, federal
				law.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-23 - Winding down of association's affairs

Current through Vol. 41, No. 20, July 1, 2024
(a) The members' supervisory board, the
				administrator, and the TPA shall remain in place if the association
				relinquishes its approval, and shall wind down the affairs of the association.
				A change in board membership, administrator, or TPA, must be approved by the
				Commission.
(b) A loss portfolio
				transfer or equivalent may be obtained by the association to transfer its
				liability to a licensed insurance company. Any transfer or equivalent must be
				filed with the Commission.
(c)
				Annual financial statements, as required in
				810:25-11-5,
				will still be required once an association relinquishes its approval, unless
				otherwise approved by the Commission.
(d) Distributions of surplus, as referenced
				in
				810:25-11-10,
				may be made upon application to the Commission. A full and final release of all
				funds from the association will not be allowed absent compliance with the
				criteria specified in 85A O.S., § 102(B).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-24 - Effectiveness of previously authorized permits and security deposits

Current through Vol. 41, No. 20, July 1, 2024
(a) Group
				self-insurance association permits previously authorized by the Workers'
				Compensation Court Administrator pursuant to 85 O.S., § 351 and in effect
				on January 31, 2014 shall remain in full force and effect for the duration of
				the permit term thereafter, unless voluntarily terminated by the association or
				revoked by the Commission.
(b) All
				security deposits posted by a group self-insurance association with the
				Workers' Compensation Court Administrator pursuant to 85 O. S., § 351
				before February 1, 2014 as a condition for the association to self fund its
				workers' compensation obligations, which are maintained by the Court
				Administrator and in effect on January 31, 2014, shall remain in full force and
				effect, pursuant to their respective terms, on and after February 1, 2014,
				notwithstanding assumption by the Commission of the Court Administrator's
				regulatory responsibilities regarding group self-insurance associations
				beginning February 1, 2014. At that time, the Commission shall be considered
				the successor entity to the Workers' Compensation Court Administrator in all
				respects regarding the security deposit, with full power and authority in its
				own name to make demand and collect thereon in the same manner and to the same
				extent as and if the Commission were the Court Administrator. The Commission
				may require a group self-insurance association to post an adequate replacement
				security deposit, made payable to the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-25 - Designation of service agent

Current through Vol. 41, No. 20, July 1, 2024
A group self-insurance association must designate a service
				  agent to receive service of notice. The designation must be made in a manner
				  prescribed by the Commission and filed with the Commission as provided in
				  810:10-1-11.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 13 - Third-party Administrator Permit for Workers' Compensation Purposes › Section 810:25-13-1 - Application

Current through Vol. 41, No. 20, July 1, 2024
(a) Any person
				desiring authorization to act as a TPA for workers' compensation purposes shall
				make application in a manner prescribed by the Commission. The application must
				be completed in its entirety, including all attachments and supporting
				documents required in the application, and submitted at least thirty (30) days
				before the desired effective date of the permit. A One Thousand Dollar
				($1,000.00) nonrefund-able application fee, made payable to the Commission,
				must also be submitted. The applicant must receive approval from the Commission
				before contracting with any client to provide administrative services for
				Oklahoma workers' compensation self-insurers.
(b) The application shall be reviewed by the
				Commission's Permitting Services Division. If the application is determined to
				be sufficient, the Division will issue a permit licensing the applicant as a
				Third-Party Administrator, for a period of one year. If the application is
				determined to be deficient, the Division will notify the applicant thereof,
				stating the reasons for the deficiency. If the deficiency cannot be resolved
				within the stated time from the Division, the application will be
				denied.
(c) An applicant may
				withdraw its pending Application for approval as a TPA for workers'
				compensation purposes at any time. Once withdrawn, no further action regarding
				the application will be taken by the Commission and the Commission's file on
				the application request will be considered closed.
(d) The Commission's Permitting Services
				Division may extend or amend an existing permit, in its discretion, if
				necessary for the completion of a renewal application or a change in facts of
				the permit.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 13 - Third-party Administrator Permit for Workers' Compensation Purposes › Section 810:25-13-2 - Renewals

Current through Vol. 41, No. 20, July 1, 2024
The criteria for renewal of a TPA permit shall be the same as
				  that for a new applicant.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 13 - Third-party Administrator Permit for Workers' Compensation Purposes › Section 810:25-13-3 - Termination or revocation of authority

Current through Vol. 41, No. 20, July 1, 2024
(a) Any TPA may surrender its authority to
				act as a TPA for workers' compensation purposes by notifying the Commission in
				writing of the effective date of the surrender.
(b) The TPA permit may be revoked by the
				Commission at any time upon reasonable notice for good cause shown, including,
				but not limited to, failure to comply with the rules of the
				Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 13 - Third-party Administrator Permit for Workers' Compensation Purposes › Section 810:25-13-4 - Operating requirements

Current through Vol. 41, No. 20, July 1, 2024
The TPA must:
(1)
				Have adequate personnel on staff to handle the volume and type of work. The TPA
				may subcontract for services not provided by the TPA, but requested from the
				self-insurer;
(2) Be financially
				solvent, and must report its financial statements on an annual basis to the
				Commission in an approved form and manner;
(3) Maintain an adequate Errors and Omissions
				policy;
(4) Maintain an adequate
				Fidelity Bond;
(5) Establish claims
				reserves at the most likely outcome. Best case reserving is not
				allowed.
(6) Retain its
				independence when setting claim reserves. The TPA shall not let the
				self-insurer influence the amount of the reserve or the closing of a
				claim;
(7) Maintain an Oklahoma
				office, if handling a group self-insurance association program; and
(8) Maintain adequate computerized records
				and paper claims files on each claim. A copy of this information must be made
				available for the Commission's review at all times upon request.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 1 - PROCEDURAL RULES › Section 101-001-0000 - Notice of Proposed Rule Changes

Current through Register Vol. 63, No. 7, July 1, 2024
Prior to adoption, amendment, or repeal of any rule, the Public
				Employees' Benefit Board (PEBB), will give notice of the intended action to the
				following:
(1) The Secretary of
			 State's Bulletin, referred to in ORS
			 183.360, at least 21 days prior
			 to the effective date.
(2) To
			 persons on the PEBB mailing list established pursuant to ORS
			 183.335(8) at
			 least 28 days before the effective date of the rule.
(3) To the Legislative Counsel Committee and
			 Legislators specified in ORS
			 183.335(15), at
			 least 49 days before rule takes effect.
(4) Employee organizations certified by the
			 Employment Relations Board.
(5)
			 State agency and university personnel and payroll representatives.
(6) Insurance carriers.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS
				  183.310 -
				  183.550,
				  192.660,
				  243.061 -
				  243.302 &
				  292.05
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 1 - PROCEDURAL RULES › Section 101-001-0005 - Uniform and Model Rules of Procedure

Current through Register Vol. 63, No. 7, July 1, 2024
The Attorney General's Uniform and Model Rules of Procedure
				under the Administrative Procedure Act, effective January 1, 2004, are adopted
				as rules of procedure of the Public Employees' Benefit Board and are made a
				part of OAR chapter 101.
The full text of the Attorney General's Model Rules of
				  Procedures is available from the office of the Attorney General or the
				  Department of Administrative Services, Public Employees' Benefit
				  Board.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS
				  183.310 -
				  183.550,
				  192.660,
				  243.061 -
				  243.302,
				  292.05
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 1 - PROCEDURAL RULES › Section 101-001-0015 - Disbursement of PEBB Fund Monies

Current through Register Vol. 63, No. 7, July 1, 2024
The Public Employees' Benefit Board Fund was created for the
				purpose of maintaining insurance program stabilization reserves. PEBB may
				disburse any or all monies in the fund for any of the following
				purposes:
(1) To reimburse insurers
			 for monies due under the applicable contract (For example, when benefit plan
			 expenses exceed premium revenues);
(2) To minimize premium increases resulting
			 from random experience flux, inflationary variations or any other
			 cause;
(3) To minimize impact on
			 contributions to premiums due to benefit plan design changes;
(4) To pay for expenses critical to
			 administration of PEBB programs (For example, data processing, benefit plan
			 communications, etc.); and
(5) To
			 pay for services, programs, or studies that will reduce benefit plan
			 costs.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS
				  243.135
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 2 - POWERS OF THE BOARD › Section 101-002-0005 - Powers and Duties of the Board

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Pursuant to ORS
			 243.125, it will be within the
			 powers and duties of the Board to study all matters connected with providing
			 adequate benefit plan coverage for Eligible Employees on the best basis
			 possible with relation both to the welfare of the employees and to the
			 state.
(2) The Board will design
			 benefit plans, devise specifications, invite proposals, analyze responses to
			 requests for proposals, decide on the award of contracts for benefit plan
			 coverage of Eligible Employees.
(3)
			 The Board seeks optimal health for PEBB's members through a system of care that
			 is patient-centered, focused on wellness, coordinated, efficient, effective,
			 accessible, and affordable. The Board will place emphasis on:
(a) Employee choice among high quality
			 benefit plans;
(b) A competitive
			 marketplace;
(c) Benefit plan
			 performance and information;
(d)
			 Employer flexibility in benefit plan design and contracting;
(e) Quality customer services;
(f) Creativity and innovation;
(g) Benefit plans as part of total employee
			 compensation;
(h) The improvement
			 of employee health;
(i) An
			 innovative delivery system;
(j) A
			 focus on improving quality and outcomes;
(k) Promotion of health and
			 wellness;
(l) Appropriate provider,
			 health plan, and consumer incentives;
(m) Accessible and understandable information
			 about costs, outcomes, and other health data, and;
(n) Benefits that are affordable to the state
			 and employees.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 2 - POWERS OF THE BOARD › Section 101-002-0010 - Conduct of Meetings of the Board

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Board will select one of its
			 appointed voting members as chairperson and another voting member as vice
			 chairperson.
(2) Meetings will be
			 conducted by and will be under the control of the chairperson of the Board. In
			 the absence of the chairperson, the vice chairperson or other Board member
			 designated by the chairperson in the absence of the vice chairperson will
			 preside. All meetings of the Board will be conducted in the matter prescribed
			 by and in accordance with the Oregon Public Meetings Law, ORS
			 192.610 to
			 192.690.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS
				  183.310 - 550,
				  192.660,
				  243.061 - 302 &
				  292.051
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0010 - Renewal, Screening and Selection for Benefit, Vendor and Consultant Contracts

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The Board is charged with the obligation of obtaining Benefit Plans to provide
			 Benefits to Eligible Employees. OARs 101-005-0040  through 101-005-0140  set
			 forth the screening, selection and renewal process to be used for all such
			 Benefit Plan contracts. The Board has sole authority for procuring all benefits
			 and services contemplated by ORS
			 243.061 through
			 243.302.
(2) Except as provided in OAR 101-005-0040  through 101-005-0140, the Board adopts the DOJ model public contract rules in
			 OAR 137, division 46 (General Provisions Related to Public Contracting) and
			 division 47 (Public Procurements for Goods or Services), effective January 1,
			 2010, as the contracting rules that shall apply to its procurements for Benefit
			 Plan contracts.
(3) The Board
			 adopts the DOJ model public contract rules in OAR 137, division 46 (General
			 Provisions Related to Public Contracting) and division 47 (Public Procurements
			 for Goods or Services), effective January 1, 2010, as the contracting rules
			 that shall apply to its procurements for Vendor and consultant contracts within
			 the Board's contracting authority.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS
				  243.125
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0020 - Policy

Current through Register Vol. 63, No. 7, July 1, 2024
The policy of the Board is to select Contractors in an
				expeditious and efficient a manner that is consistent with the goal of
				delivering high quality Benefits and other services at a cost that is
				affordable to both the employees and the state, consistent with the
				requirements of ORS 242.135 and OAR 101-002-0005. The Board may enter into more
				than one contract for each type of Benefit Plan or other service
				sought.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS
				  243.125 &
				  243.135(2)
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0030 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purposes of OARs 101-005-0010  through 101-005-0140  the
				following terms have the meanings indicated below.
(1) "Benefit Plan" includes, but is not
			 limited to:
(a) Contracts for insurance or
			 other benefit based on life; supplemental medical, supplemental dental,
			 optical, accidental death or disability insurance; group medical, surgical,
			 hospital, flexible spending account, or any other remedial care recognized by
			 state law; and related services and supplies.
(b) Comparable benefits for employees who
			 rely on spiritual means of healing;
(c) Self insurance programs managed by the
			 Board, and;
(d) Employee assistance
			 programs.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0040 - Procurement and Renewal Processes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Formal Selection Procedure: This
			 procedure will be used for the procurement of Benefits Exceptions to this
			 procedure are specified in sections (2), (3), (4) and (5).
(a) Announcement: The Board will give notice
			 of intent to contract for Benefits via the Oregon Procurement Information
			 Network (ORPIN). The notice shall include a description of the Benefits or
			 services sought the scope of the services required, and a description of
			 special requirements, if any. The notice will invite qualified prospective
			 contractors to apply. The notice will specify when and where the application
			 may be obtained, to whom it must be returned, and the closing date.
(b) Proposal: The Proposal from the
			 prospective contractors will consist of a statement that describes the
			 prospective contractor's credentials, performance data and other information
			 sufficient to establish contractor's qualifications for providing the Benefits
			 or services sought, as well as any other information requested in the
			 announcement.
(c) Evaluation: The
			 Board or its designees will evaluate the qualifications of all applicants and
			 select prospective contractors as set forth in OAR 101-005-0110.
(d) Award of Contracts: The Board will make
			 final selections based on the criteria included in OAR 101-002-005(3) in
			 addition to criteria included in the Request for Proposal (RFP).
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0050 - Mistakes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Treatment of
			 Mistakes. If the Board discovers certain mistakes in a Proposal before award of
			 the Contract, and the mistakes are not identified as those qualifying as
			 non-responsive to the specifications of the procurement, the Board may take the
			 following action unless otherwise allowed under the procurement:
(a) The Board may waive a minor formaility,
			 or permit a Proposer to correct a minor informality. A minor informality is a
			 matter of form(s) rather than substance that is evident on the face of the
			 Proposal, or an insignificant mistake that can be waived or corrected without
			 prejudice to other Proposers. Mistakes including, but not limited to,
			 signatures not affixed to the proposal document, proposals sent to the
			 incorrect address, insufficient number of proposals submitted, incorrect
			 format, etc., will not be considered minor.
(b) The Board may correct a clerical error if
			 the intended Proposal and the error are evident on the face of the Proposal, or
			 other documents submitted with the Proposal, and the Proposer confirms the
			 Board's correction in writing. A clerical error is a Proposer's error in
			 transcribing its Proposal.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0070 - Contract Amendments

Current through Register Vol. 63, No. 7, July 1, 2024
PEBB may amend a contract without additional competition in any
				of the following circumstances:
(1)
			 The amendment is within the scope of the procurement as described in RFP, the
			 sole source determination, or special procurement (the "Procurement Document").
			 An amendment is not within the scope of the procurement if the Agency
			 determines that if it had described the changes to be made by the amendment in
			 the Procurement Document, it would likely have increased competition or
			 affected award of the contract.
(2)
			 These rules otherwise permit PEBB to award a contract without competition for
			 the goods or services to be procured under the amendment.
(3) The amendment is necessary to comply with
			 a change in law that affects performance of the contract.
(4) The amendment results from renegotiation
			 of the terms and conditions, including the contract price, of a contract and
			 the amendment is advantageous to PEBB, subject to all of the following
			 conditions:
(a) The Services to be provided
			 under the amended contract are the same as the Services to be provided under
			 the unamended contract.
(b) PEBB
			 determines that, with all things considered, the amended contract is at least
			 as favorable to PEBB as the unamended contract.
(c) The amended contract does not have a
			 total term greater than allowed in the Procurement Document after combining the
			 initial and extended terms.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0075 - Pre-Proposal Conference

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Unless identified in the procurement as required, the Pre-Proposal Conference
			 will:
(a) Include voluntary
			 attendance;
(b) Will be held in
			 Salem, Oregon or will be conducted via conference call or by other electronic
			 means; and
(c) Will identify
			 attendees by name and company represented;