Oklahoma § 36-6931 - Coordination of benefits provisions

§ 36-6931. Coordination of benefits provisions

A. A health maintenance organization is permitted, but not

required, to adopt coordination of benefits provisions to avoid over

insurance and to provide for the orderly payment of claims when an

enrollee is covered by two or more group health insurance or health

care plans.

Oklahoma Statutes - Title 36. Insurance

B. If a health maintenance organization adopts coordination of

benefits, the provisions thereof shall be consistent with the

coordination of benefits provisions that are in general use in the

state for coordinating coverage between two or more group health

insurance or health care plans.

C. To the extent necessary for a health maintenance

organization to meet its obligations as a secondary carrier under

the rules for coordination, a health maintenance organization may

make payments for services that are:

1. Received from nonparticipating providers;

2. Provided outside its service areas; or

3. Not covered under the terms of its group contract or

evidence of coverage.

Added by Laws 2003, c. 197, § 31, eff. Nov. 1, 2003.