Oklahoma § 36-4509.1 - Liability of prior carrier - Eligibility under

§ 36-4509.1. Liability of prior carrier - Eligibility under

succeeding carrier - Determination of benefits - Election of

coverage.

A. This section applies to determination of the liability of a

carrier pursuant to a group or blanket accident or health insurance

plan in those instances in which the contract of one carrier

replaces a plan of similar benefits of another carrier. As used in

this section, "carrier" means an insurer or other entity subject to

Oklahoma Statutes - Title 36. Insurance

the provisions of Title 36 of the Oklahoma Statutes, and includes

but is not limited to a not-for-profit hospital service and medical

indemnity corporation, a fraternal benefit society, a health

maintenance organization and a multiple employer welfare

arrangement.

B. The prior carrier shall be liable only to the extent of its

accrued liabilities and extensions of benefits. The position of the

prior carrier shall be the same whether the group policyholder or

other entity responsible for making payments or submitting

subscription charges to the carrier secures replacement coverage

from a new carrier, self-insures, or foregoes the provision of

coverage.

C. Each person who was covered by the plan of the prior carrier

shall be covered by the plan of benefits of the succeeding carrier

conditioned only upon the payment of the premium.

D. The succeeding carrier, in applying any deductibles or

waiting periods in its plan, including but not limited to waiting

periods for preexisting conditions, shall give credit for the

satisfaction or partial satisfaction of the same or similar

provisions under a prior plan providing similar benefits and shall

not impose any additional waiting periods for coverage for any

person who was covered by the plan of the prior carrier. In the

case of deductible provisions, the credit shall apply for the same

or overlapping benefit periods and shall be given for expenses

actually incurred and applied against the deductible provisions of

the prior plan during the ninety (90) days preceding the effective

date of the succeeding plan but only to the extent these expenses

are recognized under the terms of the plan of the succeeding carrier

and are subject to similar deductible provision.

E. If a determination of the benefits of the prior plan is

required and requested by the succeeding carrier, upon receiving

such request, the prior carrier shall furnish a statement of the

benefits available or pertinent information sufficient either to

permit verification of the benefits available under the prior plan

or to permit the determination of the benefits by the succeeding

carrier. For the purposes of this subsection, benefits of the prior

plan shall be determined in accordance with all of the definitions,

conditions, and covered expense provisions of the prior plan and

shall not be subject to the definitions, conditions, and covered

expense provisions of the succeeding plan. The benefit

determination shall be made as if coverage had not been replaced by

the succeeding carrier.

F. Nothing in this section shall prevent an individual from

electing not to be covered under the plan of benefits of the

succeeding carrier.

Added by Laws 1988, c. 123, § 1, eff. Nov. 1, 1988. Amended by Laws

1992, c. 304, § 2, eff. Jan. 1, 1993.

Oklahoma Statutes - Title 36. Insurance