2018 Oklahoma Statutes
Title 36. Insurance
§36-4415. Definitions – Standard health benefit plans for individuals under 40 years of age – Coverage disclosure statements and acknowledgments – Rate filings - Rules.
A. As used in this section:
1. “Health carrier” means any entity or insurer authorized under Title 36 of the Oklahoma Statutes to provide accident or health insurance or health benefits in this state and any entity or person engaged in the business of making contracts of accident or health insurance;
2. “Standard health benefit plan” means an accident or health insurance policy that does not offer or provide state-mandated health benefits but that provides creditable coverage and is issued to an individual under forty (40) years of age; and
3.a.“State-mandated health benefits” means coverage for health care services or benefits, required by state law or state regulations, requiring the reimbursement or utilization related to a specific illness, injury, or condition of the covered person, including those provisions listed in Sections 6060 through 6060.11 of Title 36 of the Oklahoma Statutes.
b.“State-mandated health benefits” does not mean those benefits found in Sections 4401 through 4411 and 4501 through 4513 of Title 36 of the Oklahoma Statutes.
B. 1. A health carrier may offer one or more standard health benefit plans to individuals under forty (40) years of age.
2. Each application and health benefit plan issued pursuant to this section shall contain the following language at the beginning of the document in bold type:
“This standard health benefit plan does not provide state-mandated health benefits normally required in accident and health insurance policies in the State of Oklahoma. This standard health benefit plan may provide a more affordable health insurance policy for you although, at the same time, it may provide you with fewer health benefits than those normally included as state-mandated health benefits in policies in the State of Oklahoma.”
C. An insurer providing a standard health benefit plan shall provide a proposed policyholder or policyholder with a written disclosure statement that:
1. Lists those state-mandated health benefits not included under the standard health benefit plan and acknowledges that the plan being purchased does not provide those benefits; and
2. Provides a notice that purchase of the plan may limit the future coverage options of the policyholder in the event the health of the policyholder changes and needed benefits are not available under the standard health benefit plan.
D. Each applicant for initial coverage and each policyholder on renewal of coverage shall sign the disclosure statement provided by the insurer under subsection C of this section and return the statement to the insurer. An insurer shall:
1. Retain the signed disclosure statement in the records of the insurer; and
2. Upon request of the Insurance Commissioner, provide the signed disclosure statement to the Oklahoma Insurance Department.
E. An insurer that offers one or more standard health benefit plans as provided in this section shall also offer at least one accident or health insurance policy with state-mandated health benefits that is otherwise authorized by Title 36 of the Oklahoma Statutes.
F. A health carrier shall file, for informational purposes only, with the Oklahoma Insurance Department the rates to be used with a standard health benefit plan.
G. The Insurance Commissioner shall adopt rules necessary to implement the provisions of this section.
Added by Laws 2009, c. 128, § 4, eff. Nov. 1, 2009.
