§36-4250. Rate filing – Definitions.
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/ok/title-36-insurance/36-4250·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. On or after the effective date of this act, pursuant to the provisions of this section and any other applicable section of Title 36 of the Oklahoma Statutes, every health benefit plan shall file all group and individual initial rates and group and individual rate adjustments with the Insurance Commissioner. If the Commissioner determines that the initial rate or rate adjustment is unreasonable, excessive, unjustified or unfairly discriminatory, the Commissioner shall make a written decision stating the reason or reasons for the determination, and shall deliver a copy of the determination to the company within thirty
(30)calendar days unless the Commissioner extends the determination period for an additional thirty
calendar days.
B. 1. For purposes of this section, "health benefit plan" means a plan that:
a. provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident,
or sickness, and
b. is offered by any insurance company, group hospital
service corporation, or health maintenance
organization that delivers or issues for delivery an
individual, group, blanket, or franchise insurance
policy or insurance agreement, a group hospital
service contract, or an evidence of coverage, or, to
the extent permitted by the Employee Retirement Income
Security Act of 1974, 29 U.S.C., Section 1001 et seq.,
by a multiple employer welfare arrangement as defined
in Section 3 of the Employee Retirement Income
Security Act of 1974, or any other analogous benefit
arrangement, whether the payment is fixed or by
indemnity.
2. The term "health benefit plan" shall not include:
a. a plan that provides coverage:
(1)only for a specified disease or diseases or under
an individual limited benefit policy,
(2)only for accidental death or dismemberment,
(3)for dental or vision care,
(4)a hospital confinement indemnity policy or other
fixed indemnity insurance,
(5)disability income insurance or a combination of
accident-only and disability income insurance, or
(6)as a supplement to liability insurance,
b. a Medicare supplemental policy as defined by Section
1882(g)(1) of the Social Security Act (42 U.S.C.,
Section 1395ss),
c. workers’ compensation insurance coverage,
d. medical payment insurance issued as part of a motor
vehicle insurance policy,
e. a long-term care policy, including a nursing home
fixed indemnity policy, unless a determination is made
that the policy provides benefit coverage so
comprehensive that the policy meets the definition of
a health benefit plan,
f. short-term health insurance issued on a nonrenewable
basis with duration of six
(6)months or less,
g. policy issued under Title XVIII, or
h. a plan issued to any person, firm, corporation,
partnership, limited liability company or association
that is actively engaged in business and that, on at
least fifty percent (50%) of its working days during
the preceding calendar quarter, employed more than
fifty
(50)eligible employees. Added by Laws 2011, c. 278, § 29. Amended by Laws 2011, c. 360, § 24.