Oklahoma § 36-4524 - Rates – Choice of plans – Benefits not required to

§ 36-4524. Rates – Choice of plans – Benefits not required to

contain state-mandated benefits – Plan requirements – Premium

discounts and modification of copayments or deductibles.

Oklahoma Statutes - Title 36. Insurance

A. Each Health Insurance Purchasing Group (HIPG), in

conjunction with a HIPG health carrier, shall make available a

health benefits plan in the manner described in this section to all

eligible employers and eligible employees at rates, including

employers’ and employees’ shares, on a policy- or product-specific

basis which may vary only as permitted under law.

B. Subject to subsection C of this section, a HIPG shall not

offer a health benefit plan which unfairly discriminates against

eligible employees.

C. Nothing in this act shall be construed as requiring a HIPG

health carrier to provide coverage outside the service area of the

insurer or organization.

D. Each HIPG shall provide a health benefits plan only through

contracts with HIPG health carriers and shall not assume insurance

risk with respect to the coverage.

E. Except as provided in this act, the HIPG may develop or

offer a health benefits plan for its members, in whole or in part,

not subject to state-mandated health benefits.

F. The HIPG shall offer at least two types of plans to its

members, including one plan providing a choice of deductibles with

state-mandated health benefits.

G. The HIPG may also offer a health benefits plan not subject

to state-mandated health benefits which does not contain standard

provisions or rights required to be present in a health benefits

plan pursuant to law or regulations unrelated to a specific illness,

injury or condition of the insured, for the provisions as may be

determined by rules and regulations of the Commissioner.

H. Every health benefits plan offered through a HIPG shall:

1. Be underwritten by a HIPG health carrier that:

a.

is licensed or otherwise regulated under state

law,

b.

meets all applicable state standards relating to

consumer protection, including, but not limited

to, state solvency and market conduct, and

c.

offers the coverage under an approved contract

with the HIPG;

2. Be approved or otherwise permitted to be offered under law;

3. Provide full portability of creditable coverage for

individuals who remain members of the same HIPG notwithstanding that

they change the eligible employer through which they are members;

and

4. Comply with the provisions of the Oklahoma Insurance Code in

their sales and solicitation of insurance including, but not limited

to, the Trade Practices Act, and to the degree that an agent is

involved in the solicitation, sale or purchase of a health benefits

plan offered to a HIPG, that agent must be duly licensed by the

Oklahoma Statutes - Title 36. Insurance

State Insurance Department and hold a valid license to transact the

business of insurance.

I. A HIPG shall be subject to the requirements of the Small

Employer Health Insurance Reform Act.

J. Nothing in this act shall be construed as precluding a HIPG

health carrier from offering a health benefits plan through a HIPG

by establishing premium discounts for members, or from modifying

otherwise applicable copayments or deductibles in return for

adherence to programs of health promotion and disease prevention, so

long as the programs are agreed to in advance by the HIPG and comply

with all other provisions of this act and do not discriminate among

similarly situated members.

Added by Laws 2002, c. 276, § 4, eff. Nov. 1, 2002.