Oklahoma § 36-6916 - Premium rates - Approval by Insurance Commissioner

§ 36-6916. Premium rates - Approval by Insurance Commissioner

A. No premium rate may be used by a health maintenance

organization until such time as a schedule of premium rates or

methodology for determining premium rates has been filed with and

approved by the Insurance Commissioner. Such premium rates shall be

confidential and not subject to public disclosure.

B. Either a specific schedule of premium rates or a methodology

for determining premium rates shall be established in accordance

with actuarial principles for various categories of enrollees;

Oklahoma Statutes - Title 36. Insurance

provided, that the premium applicable to an enrollee shall not be

individually determined based on the status of the enrollee’s

health. Provided further, that the premium rates shall not be

excessive, inadequate, unfair or discriminatory. A certification by

a qualified actuary or other qualified person acceptable to the

Insurance Commissioner as to the appropriateness of the use of the

methodology, based on reasonable assumptions, shall accompany the

filing along with adequate supporting information.

C. The Insurance Commissioner shall approve the schedule of

premium rates or methodology for determining premium rates if the

requirements of subsection B of this section are met. If the

Insurance Commissioner disapproves the filing, the Insurance

Commissioner shall notify the health maintenance organization. In

the notice, the Insurance Commissioner shall specify the reasons for

disapproval. A hearing will be conducted within thirty (30) days

after a request in writing by the person filing. If the Insurance

Commissioner does not take action on the schedule or methodology

within thirty (30) days of the filing of the schedule or

methodology, it shall be deemed approved.

D. When contracting with educational entities within the

meaning of Section 1306 of Title 74 of the Oklahoma Statutes, in

setting health insurance premiums for active employees and for

retirees under sixty-five (65) years of age, health maintenance

organizations shall set the monthly premium for active employees at

a maximum of Ninety Dollars ($90.00) less than the monthly premium

for retirees under sixty-five (65) years of age.

Added by Laws 2003, c. 197, § 16, eff. Nov. 1, 2003.