§36-6530.5. Board of Directors – Duties – Sunset of Program.
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/ok/title-36-insurance/36-6530-5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. The Board of Directors of the Oklahoma Individual Health Insurance Market Stabilization Program shall:
1. Develop, implement and administer the Program. Implementation of the Program shall be contingent upon Oklahoma's approval for and receipt of federal funds to implement and sustain the Program;
2. Apply for and utilize federal funding for the reinsurance program, as provided in subsection C of this section;
3. Make payments to provide for the market stabilization activities authorized by this act and for administrative expenses incurred or estimated to be incurred during the period for which assessment is made;
4. Establish administrative and accounting processes and procedures for the operation of the Program and create operating rules to effectuate the provisions of this act including but not limited to:
a. determine eligibility of individuals to receive
coverage under the Program,
b. establish standards for qualification based upon
health status, health conditions, prior or current
insurance coverage status, health costs as a result of
utilization of consuming health care,
c. establish the dollar amount of claims for eligible
individuals after which the Program will provide
payments to health insurance plans and the proportion
of such claims above such dollar amount that the
Program will pay,
d. establish the rate at which the Program will reimburse
a health insurance plan for claims incurred for an
enrolled individual's claims, above the attachment
point and below the reinsurance cap,
e. determine the threshold amount for claims costs
incurred by a health insurance plan for an enrolled
individual's claims, after which the claims costs for
benefits are no longer eligible for reinsurance
payments, and
f. determine the diagnosed health condition of an
eligible individual for which the Program will provide
payments to health insurance plans for claims incurred
after such diagnosis is made; and
5. Apply for, accept and receive federal funding for the operation of the Program, including the following:
a. approval of a waiver provided by Section 1332 of the
Patient Protection and Affordable Care Act, "1332
State Innovation Waiver", authorizing federal funding
to support market stabilization program payments,
b. Oklahoma's participation in any federal grant program
or programs, or
c. any combination of the above approaches.
B. In the event Oklahoma is unable to secure federal approval of a 1332 State Innovation Waiver or secure funding from federal grant programs within two
(2)years from the effective date of this act, the Oklahoma Individual Health Insurance Market Stabilization Program shall sunset, and any remaining monies shall be returned to insurers on a pro rata basis based on the amount each insurer has paid in assessments since the creation of the Program.
C. To the extent that federal funds become available under federal law, regulation or executive action, the Board may:
1. Apply for the funds; and
2. Use the funds to establish and administer a reinsurance program for the purposes of the Oklahoma Individual Health Insurance Market Stabilization Act.
D. The Board shall not have the authority to assess insurers, employers, policies or plans or any other entity to fund the program. The Board may accept funding from other sources for the purpose of the Oklahoma Individual Health Insurance Market Stabilization Act. Added by Laws 2017, c. 383, § 5, emerg. eff. June 6, 2017. Amended by Laws 2018, c. 267, § 1.