Title 36 — Title 36 — Insurance
0 chapters · 2,025 sections in this title.
36 O.S. § 6908 Group or individual contract - Delivery - Required
4.9K chars
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
1.8K chars
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
1.0K chars
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
0.8K chars
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
0.3K chars
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
7.7K chars
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36 O.S. § 6914 Repealed by Laws 2019, c. 384, § 14, eff. Nov. 1, 2019
0.1K chars
36 O.S. § 6914 Repealed by Laws 2019, c. 384, § 14, eff. Nov. 1, 2019
36 O.S. § 6915 Insolvency - Replacement coverage - Reduction or
4.0K chars
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
2.2K chars
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
2.4K chars
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
1.6K chars
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 -
1.9K chars
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 -
7.5K chars
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. § 6921 Repealed by Laws 2019, c. 384, § 14, eff. Nov. 1, 2019
0.1K chars
36 O.S. § 6921 Repealed by Laws 2019, c. 384, § 14, eff. Nov. 1, 2019
36 O.S. § 6922 Order to rectify financial condition or violation -
2.3K chars
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
0.2K chars
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
0.3K chars
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
3.2K chars
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
1.3K chars
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
0.7K chars
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
3.1K chars
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
0.7K chars
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
0.9K chars
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
1.0K chars
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. § 6932 Repealed by Laws 2019, c. 384, § 14, eff. Nov. 1, 2019
0.1K chars
36 O.S. § 6932 Repealed by Laws 2019, c. 384, § 14, eff. Nov. 1, 2019
36 O.S. § 6933 Provision of basic health care services directly or by
3.6K chars
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
0.4K chars
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
0.8K chars
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
0.3K chars
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
0.3K chars
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
3.0K chars
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 -
1.9K chars
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 …
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…