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0 chapters · 1,670 sections in this title.
36 O.S. § 6817 Designated statistical agent - Definition
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STATISTICAL DATA COLLECTION As used in Sections 19 and 20 of this act, “designated statistical agent” means an organization designated or contracted with by the Commissioner pursuant to Section 19 of this act. Added by Laws 2003, c. 390, § 18, eff. July 1, 2003.
36 O.S. § 6818 Designation of or contract with organization to serve as
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statistical agent. The Insurance Commissioner may designate or contract with a qualified organization to serve as the statistical agent for the Commissioner to analyze the information provided pursuant to Sections 12 and 13 of this act. Added by Laws 2003, c. 390, § 19, eff. July…
36 O.S. § 6819 Qualifications for statistical agent
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To qualify as a statistical agent, an organization must demonstrate at least five (5) years of experience in data collection, data maintenance, data quality control, accounting and other related areas. Added by Laws 2003, c. 390, § 20, eff. July 1, 2003.
36 O.S. § 6820 Provision of premium and loss cost data
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An insurer shall provide all premium and loss cost data to the Insurance Commissioner as the Commissioner requires. Added by Laws 2003, c. 390, § 21, eff. July 1, 2003.
36 O.S. § 6830 Insurance compliance audits - Confidentiality
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A. Except as provided in Sections 2 and 3 of this act, an insurance compliance self-evaluative audit is privileged information and is not discoverable, or admissible as evidence in any legal action in any civil, criminal, or administrative proceeding. The privilege created herein…
36 O.S. § 6831 Applicability of confidentiality privilege - Disclosure
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A. The privilege set forth in Section 1 of this act does not apply: 1. To the extent that it is expressly waived by the company that prepared or caused to be prepared the insurance compliance self-evaluative audit document; 2. If the company that prepared or caused to be prepared…
36 O.S. § 6832 Petition for in camera hearing - Contents
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A. Within thirty (30) days after the Insurance Commissioner, district attorney, Attorney General, or opposing party in a civil, criminal or administrative proceeding, serves on an insurer a written request by certified mail for disclosure of an insurance compliance self-evaluativ…
36 O.S. § 6833 Burden of proof
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A. A company asserting the insurance compliance self-evaluative privilege set forth in Section 1 of this act has the burden of demonstrating the applicability of the privilege. Once a company has established the applicability of the privilege, the party seeking disclosure under t…
36 O.S. § 6834 Non-privileged information
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The privilege set forth in Section 1 of this act shall not extend to any of the following: 1. Documents, communications, data, reports, or other information expressly required to be collected, developed, maintained, or reported to a regulatory agency pursuant to this act, or othe…
36 O.S. § 6835 Definitions
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As used in this act: 1. "Insurance compliance audit" means a voluntary internal evaluation, review, assessment, audit, or investigation for the purpose of identifying or preventing noncompliance with, or promoting compliance with, laws, regulations, orders, or industry or profess…
36 O.S. § 6836 Privilege effective date
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The insurance compliance self-evaluative privilege created by this act shall apply to all audits performed or commissioned after the effective date of this act, whether or not the litigation or administrative proceedings were pending on the effective date of this act. Added by La…
36 O.S. § 6837 Effect upon statutory or common law privileges
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Nothing in this act nor the release of any self-evaluative audit document hereunder shall limit, waive, or abrogate the scope or nature of any statutory or common law privilege including, but not limited to, the work product doctrine, the attorney-client privilege, or the subsequ…
36 O.S. § 6850.1 Notification of deletions in prescription coverage
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Any health benefit plan that provides prescription drug coverage or contracts with a third party for prescription drug services shall notify an enrollee presently taking a prescription drug of any deletions, other than generic substitutions, in the health benefit plan's prescript…
36 O.S. § 6901 Short title
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This act shall be known and may be cited as the "Health Maintenance Organization Act of 2003". Added by Laws 2003, c. 197, § 1, eff. Nov. 1, 2003.
36 O.S. § 6902 Definitions
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As used in the Health Maintenance Organization Act of 2003: 1. “Basic health care services” means the following medically necessary services: a. preventive care, b. emergency care, c. inpatient and outpatient hospital and physician care, d. diagnostic laboratory and diagnostic an…
36 O.S. § 6903 Certificate of authority - Application requirements -
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Submission to Insurance Commissioner - Rules. A. Notwithstanding any law of this state to the contrary, any person may apply to the Insurance Commissioner for a certificate of authority to establish and operate a health maintenance organization pursuant to the provisions of the H…
36 O.S. § 6903.1 Exemption of certain domestic health maintenance
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organizations from certain provisions of act. Notwithstanding any other provision of this title: 1. Domestic health maintenance organizations that contract with the Oklahoma Health Care Authority to provide basic health services to Medicaid recipients are only subject to the bene…
36 O.S. § 6904 Certification by Insurance Commissioner - Issuance of
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certificate. A. Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall within forty-five (45) days determine whether the applicant, with respect to health care services to be furnished, has complied with the provisions of Secti…
36 O.S. § 6905 Powers of health maintenance organization - Notice of
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effect on financial soundness. A. The powers of a health maintenance organization (HMO) include, but are not limited to, the following: 1. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipm…
36 O.S. § 6906 Receipt, collection, disbursement or investment of funds
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- Fiduciary relationship - Fidelity bond or insurance. A. A director, officer, employee or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of the organization shall be responsible for the funds in a…
36 O.S. § 6907 Reasonable standards of quality of care - Quality
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assurance plan and activities - Record of proceedings - Patient record system - Medical policy - Credentialing and recredentialing of health care providers - Termination or nonrenewal of contracts - Emergency services. A. Every health maintenance organization shall establish proc…
36 O.S. § 6908 Group or individual contract - Delivery - Required
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provisions - Evidence of coverage - Filing and review of forms. A. 1. Every group and individual contract holder is entitled to a group or individual contract which may be delivered through electronic means or methods; provided, a member may request a printed copy from the health…
36 O.S. § 6909 Reports and statements
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A. Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two principal officers with the Insurance Commissioner covering the preceding calendar year. The report shall be on forms and shall include all forms p…
36 O.S. § 6910 Information to be provided to subscribers
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Every health maintenance organization (HMO) shall: 1. Provide to its subscribers electronically or in paper copy a list of providers upon enrollment and make such list available electronically or in paper copy upon reenrollment; provided, a subscriber has submitted written assura…
36 O.S. § 6911 Grievance procedures
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A. Every health maintenance organization shall establish and maintain a grievance procedure that has been approved by the Insurance Commissioner to provide for the resolution of grievances initiated by enrollees. Such grievance procedure shall be approved by the Insurance Commiss…
36 O.S. § 6912 Investment of funds
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With the exception of investments made in accordance with the provisions of paragraph 1 of subsection A of Section 5 of this act, the funds of a health maintenance organization shall be invested only in accordance with the provisions of Article 16 of the Insurance Code. Added by …
36 O.S. § 6913 Minimum net worth required - Deposit with Insurance
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Commissioner - Determination of liabilities - Liability of subscriber for health maintenance organization's debts - Insolvency plan - Notice of termination of agreement. A. 1. Before issuing any certificate of authority, the Insurance Commissioner shall require that the health ma…
36 O.S. § 6915 Insolvency - Replacement coverage - Reduction or
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exclusion of benefits. A. 1. In the event of an insolvency of a commercial health maintenance organization, upon order of the Insurance Commissioner, all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a group’s las…
36 O.S. § 6916 Premium rates - Approval by Insurance Commissioner
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A. No premium rate may be used by a health maintenance organization until such time as a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the Insurance Commissioner. Such premium rates shall be confidential and not subject…
36 O.S. § 6917 Producer license - Exempted persons
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A. Health maintenance organization producers shall comply with all applicable statutes and provisions of Title 36 of the Oklahoma Statutes and rules relating to producer licensing, including the Oklahoma Producer Licensing Act. B. The following persons shall not be required to ho…
36 O.S. § 6918 Organizations permitted to organize and operate health
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maintenance organization - Contracts for insurance against cost of care provided. A. An insurance company licensed in this state or a hospital or medical service corporation authorized to do business in this state may either directly or through a subsidiary or affiliate organize …
36 O.S. § 6919 Examination of affairs, programs, books, and records -
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Payment of expenses. A. The Insurance Commissioner may make an examination of the affairs of any health maintenance organization, producers and providers with whom the organization has contracts, agreements or other arrangements pursuant to the provisions of Sections 309.1 throug…
36 O.S. § 6920 Examination of affairs, programs, books, and records -
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Payment of expenses. A. A certificate of authority issued under the Health Maintenance Organization Act of 2003 may be suspended or revoked, and an application for a certificate of authority may be denied, if the Insurance Commissioner finds that any of the following conditions e…
36 O.S. § 6922 Order to rectify financial condition or violation -
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Required actions - Remedies and measures available to Insurance Commissioner. A. Whenever the Insurance Commissioner determines that the financial condition of a health maintenance organization (HMO) is such that its continued operation might be hazardous to its enrollees, credit…
36 O.S. § 6923 Rules
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The Insurance Commissioner may promulgate rules necessary or proper to carry out the provisions of the Health Maintenance Organization Act of 2003. Added by Laws 2003, c. 197, § 23, eff. Nov. 1, 2003.
36 O.S. § 6924 Payment of fees
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Every health maintenance organization subject to the provisions of the Health Maintenance Organization Act of 2003 shall pay to the Insurance Commissioner the fees provided in Section 321 of Title 36 of the Oklahoma Statutes. Added by Laws 2003, c. 197, § 24, eff. Nov. 1, 2003.
36 O.S. § 6925 Administrative penalty in lieu of suspension or
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revocation of certificate - Suspected violation - Order to cease and desist - Injunction. A. The Insurance Commissioner may, in lieu of suspension or revocation of a certificate of authority under the provisions of Section 20 of this act, levy an administrative penalty against a …
36 O.S. § 6926 Provisions of laws not applicable to health maintenance
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organizations. A. Except as otherwise provided in the Health Maintenance Organization Act of 2003 or unless expressly made applicable to health maintenance organizations, provisions of the insurance law and provisions of hospital or medical service corporation laws shall not be a…
36 O.S. § 6927 Public records - Trade secrets - Privileged or
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confidential information. All applications, filings, provider contracts excluding any financial terms and/or reimbursement criteria contained in such contracts, and reports required under the Health Maintenance Organization Act of 2003 shall be treated as public records, except t…
36 O.S. § 6928 Disclosure of diagnostic, treatment or health status
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information. A. 1. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from that person or from a provider by a health maintenance organization shall be held in confidence and shall not be disclosed to any person except: …
36 O.S. § 6929 Contracts by Health Commissioner with qualified persons
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The Insurance Commissioner, in carrying out his or her obligations under the Health Maintenance Organization Act of 2003, may contract with qualified persons to make recommendations concerning the determinations required to be made by the Insurance Commissioner. The recommendatio…
36 O.S. § 6930 Acquisition of control of health maintenance
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organization. No person other than the issuer may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into …
36 O.S. § 6931 Coordination of benefits provisions
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A. A health maintenance organization is permitted, but not required, to adopt coordination of benefits provisions to avoid over insurance and to provide for the orderly payment of claims when an enrollee is covered by two or more group health insurance or health care plans. B. If…
36 O.S. § 6933 Provision of basic health care services directly or by
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contract or agreement - Standards and procedures for selection of providers - Chiropractic and vision care services - Referrals. A. A health maintenance organization shall provide basic health care services directly or by contract or agreement with other persons, corporations, in…
36 O.S. § 6934 Services permitted to be provided
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Health maintenance organizations may provide any services included in state or federal health care programs, such as state employee benefits, the state basic health benefits program, "Medicare", "Medicaid", "CHAMPUS" and Veterans Administrations and other health programs provided…
36 O.S. § 6935 Services provided to out-of-state enrollees
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Basic health care services as herein provided may be furnished to enrollees of health maintenance organizations outside this state only in accordance with the laws of the state or of the United States that govern the provision of such services in the state or place concerned; pro…
36 O.S. § 6936 Severability
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If any section, term or provision of this act shall be adjudged invalid for any reason, that judgment shall not affect, impair or invalidate any other section, term or provision of this act; but the remaining sections, terms and provisions shall be and remain in full force and ef…
36 O.S. § 6937 Short title - Risk-based Capital (RBC) for Health
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Maintenance Organizations Act of 2003. This act shall be known and may be cited as the "Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003". Added by Laws 2003, c. 197, § 37, eff. Nov. 1, 2003. Amended by Laws 2004, c. 146, § 2, eff. Nov. 1, 2004; Laws 2017…
36 O.S. § 6938 Definitions
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As used in the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003: 1. “Adjusted Risk-based Capital (RBC) report” means an RBC report which has been adjusted by the Insurance Commissioner in accordance with the provisions of subsection C of Section 39 of thi…
36 O.S. § 6939 Report of Risk-based Capital (RBC) levels - Formula -
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Adjustment by Commissioner. A. A domestic health maintenance organization shall, on or prior to each March 1 filing date, prepare and submit to the Insurance Commissioner a report of its Risk-based Capital (RBC) levels as of the end of the calendar year just ended, in a form and …