™Your Policy Risk Impact Agent
0 chapters · 1,670 sections in this title.
36 O.S. § 6940 Company action level event - Definition - Submission of
6.0K chars
RBC plan - Insurance Commissioner's determination - Notice and hearing. A. “Company Action Level Event” means any of the following events: 1. The filing of an RBC report by a health maintenance organization that indicates that the health maintenance organization’s total adjusted …
36 O.S. § 6941 Regulatory action level event - Definition - Duties of
6.0K chars
Insurance Commissioner - Challenge to adjusted RBC report or revised RBC plan - Use of actuaries, investment experts and other consultants. A. “Regulatory Action Level Event” means, with respect to a health maintenance organization, any of the following events: 1. The filing of a…
36 O.S. § 6942 Authorized control level event - Definition - Duties of
2.8K chars
Insurance Commissioner. A. “Authorized Control Level Event” means any of the following events: 1. The filing of an RBC report by the health maintenance organization that indicates that the health maintenance organization’s total adjusted capital is greater than or equal to its Ma…
36 O.S. § 6943 Mandatory control level event - Definition - Duties of
1.9K chars
Insurance Commissioner. A. “Mandatory Control Level Event” means any of the following events: 1. The filing of an RBC report which indicates that the health maintenance organization’s total adjusted capital is less than its Mandatory Control Level RBC; 2. Notification by the Comm…
36 O.S. § 6944 Challenge of determination or action by Insurance
1.9K chars
Commissioner - Required events - Hearing. Upon the occurrence of any of the events specified in this section, the health maintenance organization shall have the right to a confidential departmental hearing, on the record, at which time the health maintenance organization may chal…
36 O.S. § 6945 Confidentiality of RBC reports and plans - Sharing and
5.8K chars
use of confidential information by Insurance Commissioner - Publication of RBC levels - Use of information in rate proceedings. A. All Risk-Based Capital (RBC) reports, to the extent the information is not required to be provided in a publicly available annual statement schedule,…
36 O.S. § 6946 Application of act - Rules for implementation of act
0.9K chars
A. The provisions of the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003 are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the Insurance Commissioner under such laws includin…
36 O.S. § 6947 Foreign health maintenance organizations
2.5K chars
A. 1. A foreign health maintenance organization shall, upon the written request of the Insurance Commissioner, submit to the Commissioner a Risk-Based Capital (RBC) report as of the end of the calendar year just ended the later of: a. the date an RBC report would be required to b…
36 O.S. § 6948 Immunity from liability on part of Insurance Commissioner
0.4K chars
or Insurance Department or its employees or agents. There shall be no liability on the part of, and no cause of action shall arise against, the Insurance Commissioner or the Insurance Department or its employees or agents for any action taken by them in the performance of their p…
36 O.S. § 6949 Severability
0.4K chars
If any provision of the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003 or its application to any person or circumstance is held invalid, such determination shall not affect the provisions or applications of this act that can be given effect without the …
36 O.S. § 6950 Effective date of notices by Insurance Commissioner
0.5K chars
All notices by the Insurance Commissioner to a health maintenance organization that may result in regulatory action under this act shall be effective upon the date the notice is postmarked by the United States Postal Service if transmitted by registered or certified mail or, in t…
36 O.S. § 6951 Requirements for RBC reports filed in 2003
1.1K chars
For Risk-based Capital (RBC) reports required to be filed by health maintenance organizations in 2003, the following requirements shall apply in lieu of the provisions of Sections 40, 41, 42 and 43 of this act: 1. In the event of a Company Action Level Event in a domestic health …
36 O.S. § 6952 Nonprofit health maintenance organizations
1.2K chars
A. Nonprofit charitable and benevolent health maintenance organization corporations may hereafter be organized under the laws of the State of Oklahoma for the purpose of establishing, maintaining and operating a nonprofit health maintenance organization by complying with the prov…
36 O.S. § 6953 Certificate of authority to issue contracts
0.6K chars
A nonprofit health maintenance organization corporation may issue contracts to its subscribers only when the Insurance Commissioner has, by certificate of authority, authorized it to do so. Application for such certificate of authority shall be made on forms supplied or approved …
36 O.S. § 6954 Application for certificate of authority - Requirements
1.2K chars
The Insurance Commissioner may certify nonprofit health maintenance organization corporations by issuing a certificate of authority, authorizing the applicant to issue contracts to its subscribers, when it is shown to the satisfaction of the Commissioner that: 1. The applicant is…
36 O.S. § 6955 Transfers for existing health maintenance organizations
0.4K chars
to nonprofit status. Any existing Oklahoma licensed domestic health maintenance organization that amends its Certificate of Incorporation and is approved as a nonprofit health maintenance organization corporation by the Insurance Commissioner may utilize its existing contracts, f…
36 O.S. § 6956 Private or publicly owned nonprofits – Application of
0.7K chars
Health Maintenance Organization Act of 2003 and rules to nonprofits. A nonprofit health maintenance organization corporation may be privately or publicly owned. All of the requirements of the Health Maintenance Organization Act of 2003, the risk-based capital for the Health Maint…
36 O.S. § 6957 Scope of act
0.3K chars
The provisions of this act shall govern and apply only to nonprofit health maintenance organization corporations. Such corporations shall comply with all other laws applicable to health maintenance organizations under Title 36 of the Oklahoma Statutes and any rules promulgated th…
36 O.S. § 6958 Short title - Patient's Right to Pharmacy Choice Act
0.1K chars
This act shall be known and may be cited as the "Patient's Right to Pharmacy Choice Act". Added by Laws 2019, c. 426, § 1, eff. Nov. 1, 2019.
36 O.S. § 6959 Purpose of act
0.3K chars
The purpose of the Patient's Right to Pharmacy Choice Act is to establish minimum and uniform access to a provider and standards and prohibitions on restrictions of a patient's right to choose a pharmacy provider. Added by Laws 2019, c. 426, § 2, eff. Nov. 1, 2019.
36 O.S. § 6960 Definitions
4.8K chars
A. For purposes of the Patient’s Right to Pharmacy Choice Act: 1. “340B drug pricing” means the pricing agreement established under Section 602 of the Veterans Health Care Act of 1992, Pub. L. No. 102-585; 2. “340B entity” means a covered entity as that term is defined in 42 U.S.…
36 O.S. § 6961 Retail pharmacy network access standards
2.1K chars
A. Pharmacy benefits managers (PBMs) shall comply with the following retail pharmacy network access standards: 1. At least ninety percent (90%) of covered individuals residing in an urban service area live within two (2) miles of a retail pharmacy participating in the PBM's retai…
36 O.S. § 6962 Compliance review
9.3K chars
A. The Attorney General shall review and approve retail pharmacy network access for all pharmacy benefits managers (PBMs) to ensure compliance with Section 6961 of this title. B. A PBM, or an agent of a PBM, shall not: 1. Cause or knowingly permit the use of advertisement, promot…
36 O.S. § 6963 Health insurer to monitor activities and ensure
1.6K chars
compliance. A. A health insurer shall be responsible for monitoring all activities carried out by, or on behalf of, the health insurer under the Patient's Right to Pharmacy Choice Act, and for ensuring that all requirements of this act are met. B. Whenever a health insurer contra…
36 O.S. § 6964 Formulary to identify drugs that offer greatest value
1.0K chars
A. A health insurer's pharmacy and therapeutics committee (P&T committee) shall establish a formulary, which shall be a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. B. A health insurer shal…
36 O.S. § 6965 Power and authority to investigate, examine, and enforce
4.2K chars
A. The Attorney General shall have power and authority to examine and investigate the affairs of every pharmacy benefits manager (PBM) engaged in pharmacy benefits management in this state in order to determine whether such entity is in compliance with the Patient’s Right to Phar…
36 O.S. § 6966.1 Violations – Penalties - Hearings
5.5K chars
A. The Insurance Commissioner may censure, suspend, revoke, or refuse to issue or renew a license of or levy a civil penalty against any person licensed under the insurance laws of this state for any violation of the Patient’s Right to Pharmacy Choice Act, Section 6958 et seq. of…
36 O.S. § 6966.2 Attorney General's Pharmacy Benefits Manager
1.1K chars
Enforcement Revolving Fund. There is hereby created in the State Treasury a revolving fund for the Office of the Attorney General, to be designated the “Attorney General’s Pharmacy Benefits Manager Enforcement Revolving Fund”. The fund shall be a continuing fund, not subject to f…
36 O.S. § 6967 Confidentiality and privilege of information
2.6K chars
A. Documents, evidence, materials, records, reports, complaints or other information in the possession or control of the Office of the Attorney General or Insurance Department that are obtained by, created by or disclosed to the Office of the Attorney General or Insurance Commiss…
36 O.S. § 6968 Severability
0.7K chars
If any one or more provision, section, subsection, sentence, clause, phrase or word of this act or the application hereof to any person or circumstance is found to be unconstitutional, the same is hereby declared to be severable and the balance of this act shall remain effective …
36 O.S. § 6969 Restrictions on health benefit plans and pharmacy benefit
2.7K chars
managers — White bagged drugs. A. As used in this section: 1. "Health benefit plan" means a health benefit plan as defined pursuant to Section 6060.4 in Title 36 of the Oklahoma Statutes; 2. "Pharmacy benefits manager" means a person that performs pharmacy benefits management and…
36 O.S. § 6971 Electronic provider directories for health benefit plans
7.5K chars
A. As used in this section: 1. “Health benefit plan” means a plan as defined pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes; 2. “Health care facility” means a facility as defined pursuant to Section 1-725.2 of Title 63 of the Oklahoma Statutes; 3. “Health care pr…
36 O.S. § 6972 Definitions
4.3K chars
As used in this act: 1. “Contractual discount” means a reduction from a provider’s usual and customary rate for covered services and materials required under a prepaid vision plan agreement with a provider; 2. “Covered materials” means materials for which reimbursement from the i…
36 O.S. § 6973 Reimbursements — Charges — Pricing — Incentivization
2.6K chars
A. No agreement between an insurer or prepaid vision plan and a vision care provider may require that a provider provide services or materials at a fee limited or set by the insurer or prepaid vision plan, unless the services or materials are reimbursed as covered services or cov…
36 O.S. § 6974 Credentials — Reimbursement and requirements for
1.8K chars
physicians and optometrists — Subcontracts. A. 1. No agreement between an insurer or a prepaid vision plan and a vision care provider shall require that a provider participate with or be credentialed by any specific prepaid vision plan as a condition for participation in the heal…
36 O.S. § 6975 Agreement between provider and insurer or organization —
1.4K chars
Changes to agreement. A. An insurer or prepaid vision plan organization shall not change or alter an agreement entered into with a vision care provider unless the insurer or organization: 1. Provides notice of any proposed change to the provider through a certified letter or an e…
36 O.S. § 6976 Restrictions on provider choice of sources and suppliers
0.5K chars
— Reimbursement. No agreement between an insurer or prepaid vision plan and a vision care provider shall restrict or limit, either directly or indirectly, the provider’s choice of sources and suppliers of services or materials or use of optical labs provided by the vision care pr…
36 O.S. § 6977 Certificate of authority to operate as prepaid vision
4.3K chars
plan organization. A. No person, organization, or entity, unless authorized pursuant to an approved certificate of authority under Section 7 of this act, shall establish or operate a prepaid vision plan organization in this state or sell, offer to sell, solicit offers to purchase…
36 O.S. § 6978 Conditions for issuance of certificate of authority
2.6K chars
A. Issuance of a certificate of authority for a prepaid vision plan organization shall be granted by the Insurance Commissioner if the Commissioner is satisfied that the following conditions are met: 1. The requirements of Section 6 of this act have been fulfilled; 2. The persons…
36 O.S. § 6979 Tangible net equity requirements — Trust deposit
3.0K chars
A. 1. Except as approved in accordance with subsection B of this section, each prepaid vision plan organization shall at all times have and maintain tangible net equity equal to the greater of: a. Fifty Thousand Dollars ($50,000.00), or b. two percent (2%) of the organization’s a…
36 O.S. § 6980 Authority to increase requirements
0.6K chars
The Insurance Commissioner may increase the amounts required under this act for tangible net equity, capital maintained, fidelity bond, and deposit to any amount the Commissioner determines to be appropriate if the Commissioner determines that such an increase is necessary to: 1.…
36 O.S. § 6981 Policy of coverage — Issuance to enrollees — Filing and
1.7K chars
approval — Requirements. A. Every enrollee of a prepaid vision plan shall be issued a coverage policy by the prepaid vision plan organization. No policy for coverage or amendment to the policy shall be issued or delivered to any person in this state until a copy of the policy for…
36 O.S. § 6982 Report of business activities — Annual filing
1.6K chars
A. On or before March 1 of each calendar year, every prepaid vision plan organization offering coverage in this state shall file with the Insurance Commissioner a report of the business activities of the organization for the preceding calendar year. The report shall contain a not…
36 O.S. § 6983 Certificate of authority — Suspension of revocation —
2.7K chars
Fines—Hearing. A. The Insurance Commissioner may suspend or revoke any certificate of authority issued pursuant to this act if the Commissioner finds that the prepaid vision plan organization: 1. Is operating contrary to the basic organizational documents of the organization or i…
36 O.S. § 6984 Advertising or sales materials required — Filing and
2.2K chars
approval. A. 1. No advertising or sales material relating to a prepaid vision plan organization shall be issued or delivered to any person in this state until a copy of the material has been filed with and approved by the Insurance Commissioner. 2. Within thirty (30) days after t…
36 O.S. § 6985 Examination of business affairs by Insurance
0.7K chars
Commissioner. A. The Insurance Commissioner may conduct an examination of the business affairs of any prepaid vision plan organization as often as the Commissioner deems necessary for the protection of the interests of the people of this state. B. Any receivership, rehabilitation…
36 O.S. § 6991 Prohibiting refusal of coverage for durable medical
2.6K chars
equipment. A. As used in this section: 1. “Durable medical equipment” means equipment as defined pursuant to Section 375.2 of Title 59 of the Oklahoma Statutes; 2. “Health benefit plan” means a health benefit plan as defined pursuant to Section 6060.4 of Title 36 of the Oklahoma …
36 O.S. § 7001 Short title - Purpose
0.5K chars
Sections 21 through 23 of this act shall constitute Article 70 of the Oklahoma Insurance Code and shall be known and may be cited as the “Health Savings Account Act”. The purpose of this act is to enable citizens of Oklahoma to establish health savings accounts as permitted by Se…
36 O.S. § 7002 Definitions
1.4K chars
As used in the Health Savings Account Act: 1. “High deductible health plan” means a health plan which meets the requirements of Section 223(c)(2) of the Internal Revenue Code as added by Section 1201 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P…
36 O.S. § 7003 State-mandated health benefits – Exclusion
0.5K chars
Any insurance company, health maintenance organization or group health service organization that files a high deductible health benefit plan pursuant to Section 223(c)(2) of the Internal Revenue Code as added by Section 1201 of the Medicare Prescription Drug, Improvement, and Mod…