Oklahoma § 36-4523 - Each group to be nonprofit corporation – Size

§ 36-4523. Each group to be nonprofit corporation – Size

requirements – Purchase contracts – Enrollment by eligible employees

– Filing of reports.

A. Each Health Insurance Purchasing Group (HIPG) shall be a

nonprofit corporation operated under the direction of a board of

directors, which is composed of five (5) representatives of eligible

employers.

B. Each HIPG shall be composed of at least two hundred eligible

employees from one or more eligible employers.

1. A HIPG shall have twelve (12) months from the time of

formation to reach the level of two hundred eligible employees.

Oklahoma Statutes - Title 36. Insurance

2. At the time of formation, the HIPG shall have at least

fifty-one eligible employees.

C. Upon the failure of a HIPG to maintain the required size

restrictions described in subsection B of this section, the HIPG

shall notify the Commissioner in writing that the HIPG does not

comply with the size requirements. The HIPG may then continue to

operate the health benefit plan for its members but shall within

sixty (60) calendar days comply with the size requirements of this

section, or within a time period as determined by the Commissioner.

D. Upon the failure of the HIPG to maintain size requirements

as required under subsection C of this section, after sixty (60)

calendar days, or after the time period determined by the

Commissioner, the HIPG may then be terminated following notice and

hearing before the Commissioner.

E. 1. Subject to the provisions of this act, a HIPG shall

permit any eligible employer, which meets the membership

requirements of the HIPG, to contract with the HIPG for the purchase

of a health benefits plan for its eligible employees and dependents

of those eligible employees.

2. The HIPG may not vary conditions of eligibility, including

premium rates and membership fees, for any employer meeting the

membership requirements of the HIPG, nor may it vary conditions of

eligibility for any employee to qualify for a HIPG health benefits

plan offered to the eligible employer by the HIPG.

3. A HIPG may not require a contract under this subsection

between a HIPG and a purchaser to be effective for a period of

longer than twelve (12) months.

4. This shall not be construed to prevent a contract from being

extended for additional twelve-month periods or preventing the

purchaser from voluntarily electing a contract period of longer than

twelve (12) months.

5. A contract shall provide that the purchaser agrees not to

obtain or sponsor a health benefits plan, on behalf of any eligible

employees and their dependents, other than through the HIPG. This

shall not be construed to apply to an eligible individual who

resides in an area for which no coverage is offered by a HIPG health

carrier.

F. 1. Under rules established to carry out this act, with

respect to an eligible employer that has a purchaser contract with a

HIPG, individuals who are eligible employees of an eligible employer

may enroll for a health benefits plan offered by a HIPG health

carrier.

2. The health benefits plan may include coverage for dependents

of the enrolling employees, if this coverage is offered.

3. The employees may enroll for health benefits provided

through their employer’s contract with a HIPG.

Oklahoma Statutes - Title 36. Insurance

G. A HIPG shall not deny enrollment as a member to an

individual who is an eligible employee, or dependent of an employee

qualified to be enrolled based on health-status-related factors,

except as may be permitted by law.

H. In the case of members enrolled in a health benefits plan

offered by a HIPG health carrier, the HIPG shall provide for an

annual open enrollment period of thirty (30) calendar days during

which the members may change the coverage option in which the

members are enrolled.

I. 1. Nothing in this section shall preclude a HIPG from

establishing rules of employee eligibility for enrollment and

reenrollment of members during the annual open enrollment period

under subsection H of this section.

2. The rules shall be applied consistently to all purchasers

and members within the HIPG and shall not be based in any manner on

health-status-related factors and shall not conflict with sections

of this act.

J. 1. Each HIPG shall annually file a report with the

Commissioner to be reviewed for approval. The report shall include:

a.

a description of its plan of operation including each

of the products it intends to sell,

b.

a description of its marketing methods and materials,

and

c.

a description of its membership and disclosure

requirements, or other information as required by the

Commissioner through rules and regulations.

2. The annual filing required shall be deemed approved upon

expiration of a sixty-day waiting period unless, prior to the end of

the period, it has been affirmatively approved or disapproved by the

Commissioner. The Commissioner may extend the period to approve or

disapprove the annual filing by not more than an additional thirty

(30) days by giving notice of such extension before expiration of

the initial sixty-day period. At the expiration of an extended

period, the annual filing shall be deemed approved unless otherwise

approved or disapproved by the Commissioner. The Commissioner may

at any time, after notice and for cause shown, withdraw approval of

an annual report.

K. Each HIPG shall be considered a large group for purposes of

application of the Oklahoma Insurance Code to the activities and

health benefit plans of the HIPG, unless stated otherwise in this

act.

Added by Laws 2002, c. 276, § 3, eff. Nov. 1, 2002.