Oklahoma § 36-6530.2 - Definitions

§ 36-6530.2. Definitions

As used in the Oklahoma Individual Health Insurance Market

Stabilization Act:

1. "Agent" means any person who is licensed to sell health

insurance in this state;

2. "Board" means the Board of Directors of the Oklahoma

Individual Health Insurance Market Stabilization Program;

3. "Health insurance" means any individual or group hospital or

medical-expense-incurred policy or health care benefits plan or

contract providing insurance against loss through illness or injury

of the insured. The term does not include any policy governing

short-term accidents only, a fixed indemnity policy, a limited

benefit policy, a specified accident policy, a specified disease

policy, a Medicare supplement policy, a long-term care policy,

medical payment or personal injury coverage in a motor vehicle

policy, coverage issued as a supplement to liability insurance, a

disability policy or workers' compensation;

4. "High-risk pool" means specially designated health insurance

plans organized by federal or state entities, or a combination of

federal and state entities, to serve high-risk, high-cost or both

high-risk and high-cost individuals who meet enrollment criteria and

do not have access to group insurance. They are organized as

independent entities governed by their own boards and administrators

and supported by the state's department of insurance;

5. "Insurer" means any individual, corporation, association,

partnership, fraternal benefit society or any other entity engaged

in the health insurance business, except insurance agents and

brokers. This term shall also include not-for-profit hospital

service and medical indemnity plans, health maintenance

organizations, preferred provider organizations, prepaid health

plans, the State and Education Employees Group Health Insurance

Plan, stop-loss insurance plans and any reinsurer reinsuring health

insurance in this state, which shall be designated as engaged in the

business of insurance for the purposes of the Oklahoma Individual

Health Insurance Market Stabilization Act;

6. "Market" means the individual health insurance market in

Oklahoma, wherein income-eligible individuals may receive federal

financial assistance for the purchase of qualified health plans as

provided by Section 36B of Title 26 of the United States Code and

Section 1301 of the federal Patient Protection and Affordable Care

Act;

Oklahoma Statutes - Title 36. Insurance

7. "Market stabilization activities" means a high-risk pool,

reinsurance, hybrid programs or any combination thereof authorized

by this act;

8. "Plan" means any of the comprehensive health insurance

benefit plans as approved by the Board of Directors of the Oklahoma

Individual Health Insurance Market Stabilization Program or

qualified for participation in the market or by rule;

9. "Program" means the Oklahoma Individual Health Insurance

Market Stabilization Program;

10. "Reinsurer" means any insurer from whom any insurer

providing health insurance to Oklahomans procures insurance for

itself with respect to all or part of the health insurance risk of

the person; and

11. "Reinsurance" means the contract made between an entity

providing insurance coverage and a third party to protect the

insurer from losses. The contract provides for the third party to

pay for the loss sustained by the insurer when the insurer makes a

payment on the original contract. Reinsurance lets insurers cover a

portion of their financial risks by recovering some or all of the

claimed amounts they pay.

Added by Laws 2017, c. 383, § 2, emerg. eff. June 6, 2017.