2014 Oklahoma Statutes
Title 36. Insurance
§36-6534. Eligibility for coverage - Enrollment cap.

This section is due to be repealed effective Jan. 1, 2017, by Laws 2014, c. 389, § 3.

A. Except as otherwise provided in this section, any person who maintains a primary residence in this state for at least one (1) year, or who is legally domiciled in this state on the date of application and who is eligible for the credit for health insurance costs under Section 35 of the Internal Revenue Code of 1986, or is a federally defined eligible individual shall be eligible for coverage under any of the plans of the Health Insurance High Risk Pool including:

1. The spouse of the insured; and

2. Any dependent unmarried child of the insured, from the moment of birth. Such coverage shall terminate at the end of the premium period in which the child marries, ceases to be a dependent of the insured, or attains the age of nineteen (19) years, whichever occurs first. However, if the child is a full-time student at an accredited institution of higher learning, the coverage may continue while the child remains unmarried and a full-time student, but not beyond the premium period in which the child reaches the age of twenty-three (23) years.

B. 1. Except as provided in this paragraph, no person is eligible for coverage under any of the Pool plans unless such person has been rejected by at least two insurers for coverage substantially similar to the primary plan coverage. As used in this paragraph, rejection includes an offer of coverage with a material underwriting restriction or an offer of coverage at a rate equal to or greater than the primary Pool plan rates. No person is eligible for coverage under any of the plans if such person has, on the date of issue of coverage under any of the plans, coverage equivalent to the primary plan under another health insurance contract or policy. This paragraph shall not apply to federally defined eligible individuals or an individual who is eligible for the credit for health insurance costs under Section 35 of the Internal Revenue Code of 1986 except for a person who has exhausted COBRA coverage as provided for in subparagraph c of paragraph 6 of Section 6532 of this title.

2. No person who is currently receiving, or is entitled to receive, health care benefits under any federal or state program providing financial assistance or preventive and rehabilitative social services is eligible for coverage under any of the plans.

3. No person who is covered under any of the plans and who terminates coverage is again eligible for coverage unless twelve (12) months has elapsed since the coverage was terminated; provided, however, this provision shall not apply to an applicant who is a federally defined eligible individual. The Board of Directors of the Health Insurance High Risk Pool may waive the twelve-month waiting period under circumstances to be determined by the Board.

4. No person on whose behalf any of the plans have paid out an aggregate from any or all offered plans of One Million Dollars ($1,000,000.00) in covered benefits is eligible for coverage under any of the plans.

5. No inmate incarcerated in any state penal institution or confined to any narcotic detention, treatment, and rehabilitation facility shall be eligible for coverage under any of the plans; provided, however, this provision shall not apply with respect to an applicant who is a federally defined eligible individual.

C. The Board may establish an annual enrollment cap if the Board determines it is necessary to limit costs to the plans. However, federally defined eligible individuals shall be guaranteed access to the Pool without regard to any enrollment caps that are set for nonfederally defined eligible individuals.

D. The coverage of any person who ceases to meet the eligibility requirements of this section may be terminated at the end of the month in which an individual no longer meets the eligibility requirements.

E. Nothing in this section shall be construed to deny eligibility to a person who has exhausted COBRA coverage. Any person who has exhausted COBRA coverage must apply for coverage under any of the Pool plans within sixty-three (63) days after exhausting such COBRA coverage in order to have a preexisting condition covered.

Added by Laws 1995, c. 250, § 4, eff. July 1, 1995. Amended by Laws 1996, c. 249, § 3, emerg. eff. May 28, 1996; Laws 1997, c. 180, § 6, emerg. eff. May 12, 1997; Laws 2002, c. 439, § 2, eff. July 1, 2002; Laws 2004, c. 274, § 19, eff. July 1, 2004; Laws 2008, c. 404, § 2, eff. July 1, 2009; Laws 2009, c. 207, § 3, emerg. eff. May 18, 2009.

NOTE: Laws 1996, c. 246, § 20 repealed by Laws 1996, c. 249, § 9, emerg. eff. May 28, 1996.