Okla. Stat. tit. 36, § 36-6908: Group or individual contract - Delivery - Required

provisions - Evidence of coverage - Filing and review of forms.

A. 1. Every group and individual contract holder is entitled

to a group or individual contract which may be delivered through

electronic means or methods; provided, a member may request a

printed copy from the health maintenance organization if the member

cannot view and print such electronic copy.

2. The contract shall not contain provisions or statements

which are unjust, unfair, inequitable, misleading, deceptive, or

which encourage misrepresentation as defined by Articles 12 and 12A-

1 of the Insurance Code.

3. The contract shall contain a clear statement of the

following:

a. the name and address of the health maintenance

organization,

b. eligibility requirements,

c. benefits and services within the service area,

d. emergency care benefits and services,

e. out of area benefits and services, if any,

f. copayments, deductibles or other out-of-pocket

expenses,

g. limitations and exclusions,

h. enrollee termination,

i. enrollee reinstatement, if any,

j. claims procedures,

k. enrollee grievance procedures,

l. continuation of coverage,

m. conversion,

n. extension of benefits, if any,

o. coordination of benefits, if applicable,

p. subrogation, if any,

q. description of the service area,

r. entire contract provision,

s. term of coverage,

t. cancellation of group or individual contract holder,

u. renewal,

v. reinstatement of group or individual contract holder,

if any,

w. grace period, and

x. conformity with state law.

An evidence of coverage may be filed as part of the group

contract to describe the provisions required in this paragraph.

B. In addition to those provisions required in paragraph 3 of

subsection A of this section, an individual contract shall provide

for a ten-day period to examine and return the contract and to

refund any premiums. If services were received during the ten-day

period, and the subscriber returns the contract to receive a refund

of the premium paid, he or she must pay for those services.

C. 1. Every subscriber shall receive an evidence of coverage

from the group contract holder or the health maintenance

organization.

2. The evidence of coverage shall not contain provisions or

statements that are unfair, unjust, inequitable, misleading,

deceptive, or that encourage misrepresentation as defined by

Articles 12 and 12A-1 of the Insurance Code.

3. The evidence of coverage shall contain a clear statement of

the provisions required in paragraph 3 of subsection A of this

section.

D. Every health maintenance organization doing business in this

state shall comply with the provisions of Article 36A of the

Insurance Code.

E. No group or individual contract, evidence of coverage or

amendment thereto, shall be delivered or issued for delivery in this

state, unless its form has been filed with and approved by the

Insurance Commissioner, subject to the provisions of subsections F

and G of this section.

F. If an evidence of coverage issued pursuant to and

incorporated in a contract issued in this state is intended for

delivery in another state and the evidence of coverage has been

approved for use in the state in which it is to be delivered, the

evidence of coverage need not be submitted to the Insurance

Commissioner of this state for approval.

G. 1. Every form required by this section shall be filed with

the Insurance Commissioner not less than thirty (30) days prior to

delivery or issue for delivery in this state. At any time during

the initial thirty-day period, the Insurance Commissioner may extend

the period for review an additional thirty (30) days. Notice of an

extension shall be in writing. At the end of the review period, the

form is deemed approved if the Insurance Commissioner has taken no

action. The filer must notify the Insurance Commissioner in writing

prior to using a form that is deemed approved.

e during

the initial thirty-day period, the Insurance Commissioner may extend

the period for review an additional thirty (30) days. Notice of an

extension shall be in writing. At the end of the review period, the

form is deemed approved if the Insurance Commissioner has taken no

action. The filer must notify the Insurance Commissioner in writing

prior to using a form that is deemed approved.

2. At any time, after thirty (30) days' notice and for cause

shown, the Insurance Commissioner may withdraw approval of a form,

effective at the end of the thirty (30) days.

3. When a filing is disapproved or approval of a form is

withdrawn, the Insurance Commissioner shall give the health

maintenance organization written notice of the reasons for

disapproval and in the notice shall inform the health maintenance

organization that within thirty (30) days of receipt of the notice

the health maintenance organization may request a hearing. A

hearing shall be conducted within thirty (30) days after the

Insurance Commissioner has received the request for hearing.

H. The Insurance Commissioner may require the submission of

relevant information he or she deems necessary in determining

whether to approve or disapprove a filing made pursuant to this

section.