§36-635. License eligibility requirements - Filing of contracts.
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/ok/title-36-insurance/36-635·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. To meet the requirements for issuance of a license and to maintain a MEWA, a MEWA must be nonprofit and either:
1. a. established by a trade association, industry
association or professional association of employers
or professionals that has a constitution or bylaws and
that has been organized and maintained in good faith
for a continuous period of five
(5)years for purposes
other than that of obtaining or providing insurance,
or
b. established by an association that has a current M-1
form filed with and accepted by the United States
Department of Labor showing Oklahoma as the state of
operation and:
(1)is formed in accordance with the applicable
provisions of 29 CFR 2510, or
(2)was previously established or is newly formed in
accordance with federal regulatory guidance
effective prior to August 20, 2018, or
c. operated pursuant to a trust agreement by a board of
trustees that has complete fiscal control over the
MEWA and that is responsible for all operations of the
MEWA. Except as provided in this paragraph, the
trustees must:
(1)be owners, shareholders, partners, officers,
directors, or employees of one or more employers
in the MEWA. With the Commissioner's approval, a
person who is not such an owner, shareholder,
partner, officer, director, or employee may serve
as a trustee if that person possesses the
expertise required for such service. A trustee
may not be an owner, shareholder, partner,
officer or employee of the administrator or
service company of the MEWA,
(2)have the authority to approve applications of
association members for participation in the
MEWA, and
(3)have the authority to contract with an authorized
administrator or service company to administer
the operations of the MEWA,
d. neither offered nor advertised to the public
generally,
e. operated in accordance with sound actuarial
principles, and
f. offered only after Two Hundred Thousand Dollars
($200,000.00) of cash or federally guaranteed
obligations of less than five-year maturity that have
a fixed or recoverable principal amount or such other
investments as the Commissioner may authorize by rule
is titled in such a manner that it may not be traded,
sold or otherwise expended without the consent of the
Commissioner; provided, the funds shall be taken into
account in determining whether the MEWA is actuarially
sound, and evidence of the investment shall be filed
with the Commissioner; or
2. a. operated pursuant to a trust agreement for a trust
which has its situs in this state, is operated
pursuant to a trust agreement by a board of trustees
that has complete fiscal control over the MEWA, is
responsible for all operations of the MEWA, and which
has as one of its trustees a financial institution
which is independent of the entity which established
the MEWA. Except as provided in this paragraph, the
board of trustees must have owners, shareholders,
partners, officers, directors or employees of one or
more employers in the MEWA. With the Commissioner's
approval, a person who is not such an owner,
shareholder, partner, officer, director or employee
may serve as a trustee if that person possesses the
expertise required for such service. A trustee shall
not be an owner, shareholder, partner, officer,
director or employee of the administrator or service
company of the MEWA,
b. operated and administered in a manner that causes all
assets of the MEWA to be held in trust until paid
either:
(1)for the benefit of individuals who receive
medical, dental or similar benefits from the
MEWA, or
(2)for the expenses of the MEWA, such as the fees of
the trustee, licensed agents, administrator,
service company, and all expenses of complying
with the provisions of this act,
c. offered only to employers for the benefit of their
employees,
d. operated in accordance with sound actuarial
principles, and
e. offered only after Two Hundred Thousand Dollars
($200,000.00) of cash or federally guaranteed
obligations of less than five-year maturity that have
a fixed or recoverable principal amount or such other
investments as the Commissioner may authorize by rule
is titled in such a manner that it may not be traded,
sold or otherwise expended without the consent of the
Insurance Commissioner; provided, the funds shall be
taken into account in determining whether the MEWA is
actuarially sound, and evidence of the investment
shall be filed with the Commissioner.
B. 1. The MEWA shall issue to each covered employee a policy, contract, certificate, summary plan description, or other evidence of the benefits and coverages provided. The policy, contract, certificate, summary plan description, or other evidence of the benefits, coverages provided, premium rates to be charged and any contracts between the MEWA and any administrator or service company, including any changes to those documents, must be filed with the Oklahoma Insurance Department.
The evidence of benefits and coverages provided shall contain, in boldface type on the face page of the policy and the certificate, the following statement: "THE BENEFITS AND COVERAGES DESCRIBED HEREIN ARE PROVIDED THROUGH A TRUST FUND ESTABLISHED BY A GROUP OF EMPLOYERS (name of MEWA). THE TRUST FUND IS NOT SUBJECT TO ANY INSURANCE GUARANTY ASSOCIATION. OTHER RELATED FINANCIAL INFORMATION IS AVAILABLE FROM YOUR EMPLOYER OR FROM THE (name of MEWA). EXCESS INSURANCE IS PROVIDED BY A LICENSED INSURANCE COMPANY TO COVER CERTAIN CLAIMS WHICH EXCEED CERTAIN
AMOUNTS. THIS IS THE ONLY SOURCE OF FUNDING FOR THESE BENEFITS AND COVERAGES."
2. If applicable, the same documents shall contain in boldface type on the face page of the policy and the certificate: "THE BENEFITS AND COVERAGE DESCRIBED HEREIN ARE FUNDED BY CONTRIBUTIONS FROM EMPLOYERS, EMPLOYEES, AND OTHER INDIVIDUALS ELIGIBLE FOR COVERAGE."
3. Any statement required by this subsection is not required on identification cards issued to covered employees or other insureds.
C. The Commissioner shall not grant or continue a license to any MEWA if the Commissioner reasonably deems that:
1. Any trust, manager or administrator is incompetent, untrustworthy, or so lacking in insurance expertise as to make the operations of the MEWA hazardous to the potential and existing insureds;
2. Any trustee, manager or administrator has been found guilty of or has pled guilty or no contest to a felony, a crime involving moral turpitude, or a crime punishable by imprisonment of one
(1)year or more under the law of any state or country, whether or not a judgment or conviction has been entered; or
3. Any trustee, manager or administrator has had any type of insurance license justifiably revoked in this or any other state.
D. To qualify for and retain a license, a MEWA shall file all contracts with administrators or service companies with the Commissioner, and report any changes in such contracts to the Commissioner in advance of their implementation. The Commissioner shall have the authority to cause any contract with an administrator or service company to be renegotiated if the Commissioner reasonably determines that the charges under any such contract are excessively high in light of the services being delivered under the contract.
E. An initial filing fee of One Thousand Dollars ($1,000.00) is required for licensure. Each subsequent year the MEWA is in operation, an annual fee of Two Hundred Fifty Dollars ($250.00) shall be required.
F. Failure to maintain compliance with the eligibility requirements established by this section is a ground for denial, suspension or revocation of the license of a MEWA. Added by Laws 1992, c. 374, § 3, eff. Jan. 1, 1993. Amended by Laws 2002, c. 129, § 1, eff. Nov. 1, 2002; Laws 2014, c. 275, § 6, eff. Nov. 1, 2014; Laws 2019, c. 425, § 2, eff. Nov. 1, 2019.