Oklahoma § 36-4415 - Definitions – Standard health benefit plans for

§ 36-4415. Definitions – Standard health benefit plans for

individuals under 40 years of age – Coverage disclosure statements

and acknowledgments – Rate filings - Rules.

A. As used in this section:

1. “Health carrier” means any entity or insurer authorized

under Title 36 of the Oklahoma Statutes to provide accident or

health insurance or health benefits in this state and any entity or

person engaged in the business of making contracts of accident or

health insurance;

2. “Standard health benefit plan” means an accident or health

insurance policy that does not offer or provide state-mandated

health benefits but that provides creditable coverage and is issued

to an individual under forty (40) years of age; and

3.

a.

“State-mandated health benefits” means coverage for

health care services or benefits, required by state

law or state regulations, requiring the reimbursement

or utilization related to a specific illness, injury,

or condition of the covered person, including those

Oklahoma Statutes - Title 36. Insurance

provisions listed in Sections 6060 through 6060.11 of

Title 36 of the Oklahoma Statutes.

b.

“State-mandated health benefits” does not mean those

benefits found in Sections 4401 through 4411 and 4501

through 4513 of Title 36 of the Oklahoma Statutes.

B. 1. A health carrier may offer one or more standard health

benefit plans to individuals under forty (40) years of age.

2. Each application and health benefit plan issued pursuant to

this section shall contain the following language at the beginning

of the document in bold type:

“This standard health benefit plan does not provide statemandated health benefits normally required in accident and health

insurance policies in the State of Oklahoma. This standard health

benefit plan may provide a more affordable health insurance policy

for you although, at the same time, it may provide you with fewer

health benefits than those normally included as state-mandated

health benefits in policies in the State of Oklahoma.”

C. An insurer providing a standard health benefit plan shall

provide a proposed policyholder or policyholder with a written

disclosure statement that:

1. Lists those state-mandated health benefits not included

under the standard health benefit plan and acknowledges that the

plan being purchased does not provide those benefits; and

2. Provides a notice that purchase of the plan may limit the

future coverage options of the policyholder in the event the health

of the policyholder changes and needed benefits are not available

under the standard health benefit plan.

D. Each applicant for initial coverage and each policyholder on

renewal of coverage shall sign the disclosure statement provided by

the insurer under subsection C of this section and return the

statement to the insurer. An insurer shall:

1. Retain the signed disclosure statement in the records of the

insurer; and

2. Upon request of the Insurance Commissioner, provide the

signed disclosure statement to the Oklahoma Insurance Department.

E. An insurer that offers one or more standard health benefit

plans as provided in this section shall also offer at least one

accident or health insurance policy with state-mandated health

benefits that is otherwise authorized by Title 36 of the Oklahoma

Statutes.

F. A health carrier shall file, for informational purposes

only, with the Oklahoma Insurance Department the rates to be used

with a standard health benefit plan.

G. The Insurance Commissioner shall adopt rules necessary to

implement the provisions of this section.

Added by Laws 2009, c. 128, § 4, eff. Nov. 1, 2009.

Oklahoma Statutes - Title 36. Insurance