2016 Oklahoma Statutes
Title 36. Insurance
§36-6914. Uncovered expenditures insolvency deposit - Withdrawals - Claims - Reports.

A. If at any time uncovered expenditures exceed ten percent (10%) of total health care expenditures, a health maintenance organization (HMO) shall place an uncovered expenditures insolvency deposit with the Insurance Commissioner or, at the discretion of the Insurance Commissioner, with an organization or trustee acceptable to the Insurance Commissioner and through which a custodial or controlled account is maintained, cash or securities that are acceptable to the Insurance Commissioner. The deposit shall at all times have a fair market value in an amount of one hundred twenty percent (120%) of the HMO’s outstanding liability for uncovered expenditures for enrollees in this state, including incurred but not reported claims, and shall be calculated as of the first day of the month and maintained for the remainder of the month. If a health maintenance organization is not otherwise required to file a quarterly report, it shall file a report within forty-five (45) days of the end of the calendar quarter with information sufficient to demonstrate compliance with the provisions of this section.

B. The deposit required under this section is in addition to the deposit required under subsection B of Section 13 of this act and is an admitted asset of the health maintenance organization in the determination of net worth. All income from deposits or trust accounts shall be assets of the health maintenance organization and may be withdrawn from the deposit or account quarterly with the approval of the Insurance Commissioner.

C. A health maintenance organization that has made a deposit may withdraw that deposit or any part of the deposit if:

1. A substitute deposit of cash or securities of equal amount and value is made;

2. The fair market value exceeds the amount of the required deposit; or

3. The required deposit under subsection A of this section is reduced or eliminated. Deposits, substitutions or withdrawals may be made only with the prior written approval of the Insurance Commissioner.

D. The deposit required under this section is in trust and may be used only as provided under the provisions of this section. The Insurance Commissioner may use the deposit of an insolvent health maintenance organization for administrative costs associated with administering the deposit and payment of claims of enrollees of this state for uncovered expenditures in this state. Claims for uncovered expenditures shall be paid on a pro rata basis based on assets available to pay the ultimate liability for incurred expenditures. Partial distribution may be made pending final distribution. Any amount of the deposit remaining shall be paid into the liquidation or receivership of the health maintenance organization.

E. The Insurance Commissioner may by rule prescribe the time, manner and form for filing claims under the provisions of subsection D of this section.

F. The Insurance Commissioner may by rule or order require health maintenance organizations to file annual, quarterly or more frequent reports deemed necessary to demonstrate compliance with the provisions of this section. The Insurance Commissioner may require that the reports include liability for uncovered expenditures as well as an audit opinion.

Added by Laws 2003, c. 197, § 14, eff. Nov. 1, 2003.