Oklahoma § 36-4250 - Rate filing – Definitions

§ 36-4250. Rate filing – Definitions

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 (30)

Oklahoma Statutes - Title 36. Insurance

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

Oklahoma Statutes - Title 36. Insurance

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.