Oklahoma § 36-6905 - Powers of health maintenance organization - Notice of

§ 36-6905. Powers of health maintenance organization - Notice of

effect on financial soundness.

Oklahoma Statutes - Title 36. Insurance

A. The powers of a health maintenance organization (HMO)

include, but are not limited to, the following:

1. The purchase, lease, construction, renovation, operation or

maintenance of hospitals, medical facilities, or both, and their

ancillary equipment and property reasonably required for its

principal office or for purposes necessary to the transaction of the

business of the organization;

2. Transactions between affiliated entities, including loans

and the transfer of responsibility under all provider or subscriber

contracts between affiliates or between the health maintenance

organization and its parent;

3. The furnishing of health care services through providers,

provider associations or agents for providers which are under

contract with or employed by the health maintenance organization;

4. The contracting with a person for the performance on its

behalf of certain functions such as marketing, enrollment and

administration;

5. The contracting with an insurance company licensed in this

state, or with a hospital or medical service corporation authorized

to do business in this state, for the provision of insurance,

indemnity or reimbursement against the cost of health care services

provided by the health maintenance organization;

6. The offering of other health care services in addition to

basic health care services. Nonbasic health care services may be

offered by a health maintenance organization on a prepaid basis

without offering basic health care services to any group or

individual; and

7. The joint marketing of products with an insurance company

licensed in this state or with a hospital or medical service

corporation authorized to do business in this state as long as the

company that is offering each product is clearly identified.

B. 1. A health maintenance organization shall file notice,

with adequate supporting information, with the Insurance

Commissioner prior to the exercise of any power granted in

paragraphs 1, 2 or 4 of subsection A of this section that may affect

the financial soundness of the health maintenance organization. The

Insurance Commissioner shall disapprove the exercise of power only

if, in the Insurance Commissioner’s opinion, it would substantially

and adversely affect the financial soundness of the health

maintenance organization and endanger its ability to meet its

obligations. If the Insurance Commissioner does not disapprove such

exercise of power within sixty (60) days of the filing, it shall be

deemed approved.

2. The Insurance Commissioner may promulgate rules exempting

those activities having a de minimis effect from the filing

requirement of paragraph 1 of this subsection.

Added by Laws 2003, c. 197, § 5, eff. Nov. 1, 2003.

Oklahoma Statutes - Title 36. Insurance