Oklahoma § 36-6052 - Copayment requirements - Disclosure of calculations Penalty - Rules

§ 36-6052. Copayment requirements - Disclosure of calculations Penalty - Rules

A. Any policy, contract or agreement issued or renewed by an

insurer, as defined in Section 6054 of Title 36 of the Oklahoma

Statutes, or any contract or agreement issued or renewed for any

preferred provider or other provider arrangement or managed care

plan, which requires the insured or enrollee to make a copayment

when benefits are provided, shall disclose to the insured or

enrollee the calculation for the copayment. In no case shall the

copayment be based on a higher figure than either the amount billed

or the amount paid, whichever is less. This subsection shall apply

to any health insurance plan offered through the State and Education

Employees Group Insurance Act.

B. Any insurer, hospital or licensed health care provider

determined to be in violation of subsection A of this section by the

Insurance Commissioner, the State Board of Health or the appropriate

health care professional licensing entity, after notice, shall be

subject to an administrative fine of not less than One Thousand

Dollars ($1,000.00) or more than Five Thousand Dollars ($5,000.00)

for each violation. Notice under this section shall include a

statement of violations on which the fine is based and notice of the

opportunity for a hearing.

C. The Insurance Commissioner, the State Board of Health or the

appropriate health care professional licensing entity shall

promulgate rules providing for enforcement of the provisions of this

act. In addition, each entity may promulgate rules providing for

suspension or revocation of a license for substantial failure to

comply with the provisions of this act. Such rules shall provide

Oklahoma Statutes - Title 36. Insurance

for notice and a hearing prior to the suspension or revocation of a

license.

Added by Laws 1996, c. 335, § 1, eff. Nov. 1, 1996.