Oklahoma § 63-313A - Definitions

§ 63-313A. Definitions

A. As used in this section:

1.

a.

"Health benefit plan" means a plan that:

(1) provides benefits for medical or surgical

expenses incurred as a result of a health

condition, accident, or sickness, and

(2) is offered by any insurance company, group

hospital service corporation, the State and

Education Employees Group Insurance Board, or a

health maintenance organization that delivers or

issues for delivery an individual, group,

blanket, or franchise insurance policy or

insurance agreement, a group hospital service

Oklahoma Statutes - Title 63. Public Health and Safety

contract, or an evidence of coverage, or, to the

extent permitted by the Employee Retirement

Income Security Act of 1974, 29 U.S.C., Section

1001 et seq., by a multiple employer welfare

arrangement as defined in Section 3 of the

Employee Retirement Income Security Act of 1974,

or any other analogous benefit arrangement,

whether the payment is fixed or by indemnity.

b.

"Health benefit plan" shall not include:

(1) a plan that provides coverage:

(a) only for a specified disease or diseases or

under an individual limited benefit policy,

(b) only for accidental death or dismemberment,

(c) for dental or vision care,

(d) a hospital confinement indemnity policy,

(e) disability income insurance or a combination

of accident-only and disability income

insurance, or

(f) as a supplement to liability insurance,

(2) a Medicare supplemental policy as defined by

Section 1882(g)(1) of the Social Security Act (42

U.S.C., Section 1395ss),

(3) worker's compensation insurance coverage,

(4) medical payment insurance issued as part of a

motor vehicle insurance policy,

(5) a long-term care policy, including a nursing home

fixed indemnity policy, unless a determination is

made that the policy provides benefit coverage so

comprehensive that the policy meets the

definition of a health benefit plan, or

(6) short-term health insurance issued on a

nonrenewable basis with a duration of six (6)

months or less; and

2. "Prior authorization" means a utilization management

criterion utilized to seek permission or waiver of a drug to be

covered under a health prior authorization.

B. Notwithstanding any other provision of law to the contrary,

in order to establish uniformity in the submission of prior

authorization forms, on or after January 1, 2014, a health benefit

plan shall utilize prior authorization forms for obtaining any prior

authorization for prescription drug benefits. A form shall not

exceed three pages in length, excluding any instructions or guiding

documentation and a health benefit plan may customize the content of

the form specific to the prescription drug for which the prior

authorization is being requested. A health benefit plan may make

the form accessible through multiple computer operating systems.

Oklahoma Statutes - Title 63. Public Health and Safety

Additionally, upon request, the health benefit plan shall make a

copy of the form available to the Insurance Commissioner.

Added by Laws 2013, c. 362, § 1.