Oklahoma § 36-6530.5 - Board of Directors – Duties – Sunset of Program

§ 36-6530.5. Board of Directors – Duties – Sunset of Program

A. The Board of Directors of the Oklahoma Individual Health

Insurance Market Stabilization Program shall:

1. Develop, implement and administer the Program.

Implementation of the Program shall be contingent upon Oklahoma's

approval for and receipt of federal funds to implement and sustain

the Program;

2. Apply for and utilize federal funding for the reinsurance

program, as provided in subsection C of this section;

3. Make payments to provide for the market stabilization

activities authorized by this act and for administrative expenses

incurred or estimated to be incurred during the period for which

assessment is made;

4. Establish administrative and accounting processes and

procedures for the operation of the Program and create operating

rules to effectuate the provisions of this act including but not

limited to:

a.

determine eligibility of individuals to receive

coverage under the Program,

b.

establish standards for qualification based upon

health status, health conditions, prior or current

insurance coverage status, health costs as a result of

utilization of consuming health care,

c.

establish the dollar amount of claims for eligible

individuals after which the Program will provide

payments to health insurance plans and the proportion

of such claims above such dollar amount that the

Program will pay,

d.

establish the rate at which the Program will reimburse

a health insurance plan for claims incurred for an

enrolled individual's claims, above the attachment

point and below the reinsurance cap,

e.

determine the threshold amount for claims costs

incurred by a health insurance plan for an enrolled

individual's claims, after which the claims costs for

Oklahoma Statutes - Title 36. Insurance

benefits are no longer eligible for reinsurance

payments, and

f.

determine the diagnosed health condition of an

eligible individual for which the Program will provide

payments to health insurance plans for claims incurred

after such diagnosis is made; and

5. Apply for, accept and receive federal funding for the

operation of the Program, including the following:

a.

approval of a waiver provided by Section 1332 of the

Patient Protection and Affordable Care Act, "1332

State Innovation Waiver", authorizing federal funding

to support market stabilization program payments,

b.

Oklahoma's participation in any federal grant program

or programs, or

c.

any combination of the above approaches.

B. In the event Oklahoma is unable to secure federal approval

of a 1332 State Innovation Waiver or secure funding from federal

grant programs within two (2) years from the effective date of this

act, the Oklahoma Individual Health Insurance Market Stabilization

Program shall sunset, and any remaining monies shall be returned to

insurers on a pro rata basis based on the amount each insurer has

paid in assessments since the creation of the Program.

C. To the extent that federal funds become available under

federal law, regulation or executive action, the Board may:

1. Apply for the funds; and

2. Use the funds to establish and administer a reinsurance

program for the purposes of the Oklahoma Individual Health Insurance

Market Stabilization Act.

D. The Board shall not have the authority to assess insurers,

employers, policies or plans or any other entity to fund the

program. The Board may accept funding from other sources for the

purpose of the Oklahoma Individual Health Insurance Market

Stabilization Act.

Added by Laws 2017, c. 383, § 5, emerg. eff. June 6, 2017. Amended

by Laws 2018, c. 267, § 1.