{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-1219.4","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-1219.4","heading":"Definitions - Requirements for discount medical plan","body":"organizations - Penalties.\n\nA. As used in this section:\n\n1. \"Direct contract\" means a contractual arrangement tying the\n\nultimate seller purporting to offer discounts through the discount\n\ncard to the health care provider, which expressly states the intent\n\nof this agreement to be used for the purpose of offering discounts\n\non health-related purchases to uninsured or noncovered persons;\n\n2. \"Discount card\" means a card or any other purchasing\n\nmechanism or device, which is not insurance, that purports to offer\n\ndiscounts or access to discounts in health-related purchases from\n\nhealth care providers;\n\n3. \"Discount medical plan\" means a business arrangement or\n\ncontract in which a person, in exchange for fees, dues, charges, or\n\nother consideration, provides access for plan members to providers\n\nof medical services and the right to receive medical services from\n\nthose providers at a discount. The term discount medical plan does\n\nnot include any product regulated as an insurance product, group\n\nhealth service product or health maintenance organization (HMO)\n\nproduct in the State of Oklahoma or discounts provided by an\n\ninsurer, group health service, or health maintenance organizations\n\n(HMOs) where those discounts are provided at no cost to the insured\n\nor member and are offered due to coverage with a licensed insurer,\n\ngroup health service, or HMO;\n\n4. \"Discount medical plan organization\" means a person or an\n\nentity which operates a discount medical plan;\n\n5. \"Health care provider\" means any person or entity licensed\n\nby this state to provide health care services including, but not\n\nlimited to, physicians, hospitals, home health agencies, pharmacies,\n\nand dentists;\n\n6. “Health care provider network” means an entity which\n\ndirectly contracts with physicians and hospitals and has contractual\n\nrights to negotiate on behalf of those health care providers with a\n\ndiscount medical plan organization to provide medical services to\n\nmembers of the discount medical plan organization;\n\n7. \"Marketer\" means a person or entity who markets, promotes,\n\nsells or distributes a discount medical plan, including a private\n\nlabel entity that places its name on and markets or distributes a\n\ndiscount medical plan but does not operate a discount medical plan;\n\n8. \"Medical services\" means any care, service or treatment of\n\nillness or dysfunction of, or injury to, the human body including,\n\nbut not limited to, physician care, inpatient care, hospital\n\nsurgical services, emergency services, ambulance services, dental\n\ncare services, vision care services, mental health services,\n\nsubstance abuse services, chiropractic services, podiatric care\n\nservices, laboratory services, and medical equipment and supplies.\n\nThe term does not include pharmaceutical supplies or prescriptions;\n\n9. \"Member\" means any person who pays fees, dues, charges, or\n\nother consideration for the right to receive the purported benefits\n\nof a discount medical plan; and\n\n10. \"Person\" means an individual, corporation, business trust,\n\nestate, trust, partnership, association, joint venture, limited\n\nliability company, or any other government or commercial entity.\n\nB. 1. Before doing business in this state as a discount\n\nmedical plan organization, an entity shall be a corporation, limited\n\nliability corporation, partnership, limited liability partnership or\n\nother legal entity, organized under the laws of this state or, if a\n\nforeign entity, authorized to transact business in this state, and\n\nshall be registered as a discount medical plan organization with the\n\nInsurance Department or be licensed by the Insurance Department as a\n\nlicensed insurance company, licensed HMO, licensed group health\n\nservice organization or motor service club.\n\n2. To register as a discount medical plan organization, an\n\napplicant shall:\n\na. file with the Insurance Department an application on\nmedical plan organization with the\n\nInsurance Department or be licensed by the Insurance Department as a\n\nlicensed insurance company, licensed HMO, licensed group health\n\nservice organization or motor service club.\n\n2. To register as a discount medical plan organization, an\n\napplicant shall:\n\na. file with the Insurance Department an application on\n\nthe form that the Insurance Commissioner requires, and\n\nb. pay to the Insurance Department an application fee of\n\nTwo Hundred Fifty Dollars ($250.00).\n\n3. A registration is valid for a one-year term.\n\n4. A registration expires one year following the registration\n\nunless it is renewed as provided in this subsection.\n\n5. Before it expires, a registrant may renew the registration\n\nfor an additional one-year term if the registrant:\n\na. otherwise is entitled to be registered,\n\nb. files with the Insurance Department a renewal\n\napplication on the form that the Insurance\n\nCommissioner requires, and\n\nc. pays to the Insurance Department a renewal fee of Two\n\nHundred Fifty Dollars ($250.00).\n\n6. The Insurance Commissioner may deny a registration to an\n\napplicant or refuse to renew, suspend, or revoke the registration of\n\na registrant if the applicant or registrant, or an officer,\n\ndirector, or employee of the applicant or registrant:\n\na. makes a material misstatement or misrepresentation in\n\nan application for registration,\n\nb. fraudulently or deceptively obtains or attempts to\n\nobtain a registration for the applicant or registrant\n\nor for another,\n\nc. in connection with the administration of a health care\n\ndiscount program, commits fraud or engages in illegal\n\nor dishonest activities, or\n\nd. has violated any provisions of this section.\n\n7. Prior to registration by the Insurance Department, each\n\ndiscount medical plan organization shall establish an Internet web\n\nsite.\n\n8. All amounts collected as registration or renewal fees shall\n\nbe deposited into the General Revenue Fund.\n\n9. Nothing in this subsection shall require a provider who\n\nprovides discounts to his or her own patients to obtain and maintain\n\na registration as a discount medical plan organization.\n\n10. a. Nothing in this subsection shall apply to an affiliate\n\nof a licensed insurance company, HMO, group health\n\nservice organization or motor service club, provided\n\nthat the affiliate registers with and maintains\n\nregistration in good standing with the Insurance\n\nDepartment in accordance with subparagraphs b and c of\n\nthis paragraph.\n\nb. An affiliate shall register as a discount medical plan\n\norganization on a form prescribed by the Insurance\n\nCommissioner prior to the sale, marketing or\n\nsolicitation of a discount medical plan and pay an\n\napplication fee of One Hundred Dollars ($100.00).\n\nc. A registration shall expire one (1) year after the\n\ndate of registration, and each year on that date\n\nthereafter. A registrant may renew the registration\n\nif the registrant pays an annual registration fee of\n\nOne Hundred Dollars ($100.00) and remains in good\n\nstanding with the Insurance Department.\n\nd. For purposes of this section, “affiliate” means a\n\nperson that, directly or indirectly through one or\n\nmore intermediaries, controls or is controlled by or\n\nis under common control with an insurance company,\n\nHMO, group health service organization or motor\n\nservice club licensed in this state.\n\nC. 1. The Insurance Department may examine or investigate the\n\nbusiness and affairs of any discount medical plan organization. The\n\nInsurance Department may require any discount medical plan\n\norganization or applicant to produce any records, books, files,\n\nadvertising and solicitation materials, or other information and may\n\ntake statements under oath to determine whether the discount medical\n\nplan organization or applicant is in violation of the law or is\n\nacting contrary to the public interest. The expenses incurred in\nThe\n\nInsurance Department may require any discount medical plan\n\norganization or applicant to produce any records, books, files,\n\nadvertising and solicitation materials, or other information and may\n\ntake statements under oath to determine whether the discount medical\n\nplan organization or applicant is in violation of the law or is\n\nacting contrary to the public interest. The expenses incurred in\n\nconducting any examination or investigation shall be paid by the\n\ndiscount medical plan organization or applicant. Examinations and\n\ninvestigations shall be conducted as provided in Sections 309.1 and\n\n309.3 through 309.7 of this title. Discount medical plan\n\norganizations shall be governed by the provisions of this section\n\nand shall not be subject to the provisions of the Insurance Code\n\nunless specifically referenced.\n\n2. All work papers, recorded information, documents, books,\n\nfiles, advertising and solicitation materials, copies or other\n\ninformation produced by, obtained by or disclosed to the\n\nCommissioner or any other person in the course of an examination or\n\ninvestigation made pursuant to this section or in the course of\n\nanalysis by the Commissioner or other person, shall be given\n\nconfidential treatment by the Commissioner and may not be made\n\npublic by the Commissioner or any other person who obtained the\n\ninformation in the course of the examination or investigation,\n\nexcept to the extent provided in this section. Access may be\n\ngranted to the National Association of Insurance Commissioners. The\n\nparties shall agree in writing prior to receiving the information to\n\nprovide to it the same confidential treatment as required by this\n\nsection, unless the prior written consent of the company to which it\n\npertains has been obtained. The confidentiality and protection from\n\ndiscovery by subpoena provided for in this paragraph shall not be\n\nconstrued to be extended to identical, similar or other related\n\ndocuments or information or to the work papers that are not deemed\n\nto be in the possession, custody or control of the Commissioner.\n\n3. Failure by the discount medical plan organization to pay the\n\nexpenses incurred under paragraph 1 of this subsection shall be\n\ngrounds for denial or revocation of the discount medical plan\n\norganization’s registration.\n\nD. 1. A discount medical plan organization may charge a\n\nreasonable one-time processing fee and a periodic charge.\n\n2. If the member cancels the membership within the first thirty\n\n(30) days after receipt of the discount card and other membership\n\nmaterials, the member shall receive a reimbursement of all periodic\n\ncharges paid. The return of all periodic charges shall be made\n\nwithin thirty (30) days of the date of the cancellation. If all of\n\nthe periodic charges have not been paid within thirty (30) days,\n\ninterest shall be assessed and paid on the proceeds at a rate of the\n\nTreasury Bill rate of the preceding calendar year, plus two (2)\n\npercentage points.\n\n3. The right of cancellation shall be set out in the contract\n\non the first page, in ten-point type or larger.\n\n4. If a discount medical plan charges for a time period in\n\nexcess of one (1) month, the plan shall, in the event of\n\ncancellation of the membership by either party, make a pro rata\n\nreimbursement of all periodic charges to the member.\n\nE. 1. A discount medical plan organization may not:\n\na. use in its advertisements, marketing material,\n\nbrochures, and discount cards the terms “insurance”,\n\n\"health plan\", \"coverage\", \"copay\", \"copayments\",\n\n\"preexisting conditions\", \"guaranteed issue\",\n\n\"premium\", \"PPO\", \"preferred provider organization”,\n\nor other terms in a manner that could reasonably\n\nmislead a person to believe that the discount medical\n\nplan is health insurance,\n\nb. except for hospital services, have restrictions on\n\nfree access to plan providers including waiting\n\nperiods and notification periods, or\n\nc. pay providers any fees for medical services.\ns\", \"guaranteed issue\",\n\n\"premium\", \"PPO\", \"preferred provider organization”,\n\nor other terms in a manner that could reasonably\n\nmislead a person to believe that the discount medical\n\nplan is health insurance,\n\nb. except for hospital services, have restrictions on\n\nfree access to plan providers including waiting\n\nperiods and notification periods, or\n\nc. pay providers any fees for medical services.\n\n2. A discount medical plan organization may not collect or\n\naccept money from a member for payment to a provider for specific\n\nmedical services furnished or to be furnished to the member unless\n\nthe organization has an active license from the Insurance Department\n\nto act as an administrator.\n\nF. 1. The following disclosures, to be printed in not less\n\nthan twelve-point type, shall be made in writing to any prospective\n\nmember and shall appear on the first page of any advertisements,\n\nmarketing materials or brochures relating to a discount medical\n\nplan:\n\na. that the plan is not insurance,\n\nb. that the plan provides discounts with certain health\n\ncare providers for medical services,\n\nc. that the plan does not make payments directly to the\n\nproviders of medical services,\n\nd. that the plan member is obligated to pay for all\n\nhealth care services but will receive a discount from\n\nthose health care providers who have contracted with\n\nthe discount plan organization, and\n\ne. the name and the location of the registered discount\n\nmedical plan organization, including the current\n\ntelephone number of the registered discount medical\n\nplan organization or other entity responsible for\n\ncustomer service for the plan, if different from the\n\nregistered discount medical plan organization.\n\n2. If the discount medical plan is sold, marketed, or solicited\n\nby telephone, the disclosures required by this section shall be made\n\norally and provided in the initial written materials that describe\n\nthe benefits under the discount medical plan provided to the\n\nprospective or new member.\n\n3. The discount card provided to members shall prominently\n\ndisplay the words “This is not insurance”.\n\nG. 1. All providers offering medical services to members under\n\na discount medical plan shall provide such services pursuant to a\n\nwritten agreement. The agreement may be entered into directly by\n\nthe health care provider or by a health care provider network to\n\nwhich the provider belongs if the provider network has contracts\n\nwith the health care provider that allow the provider network to\n\ncontract on behalf of the health care provider.\n\n2. A health care provider agreement shall provide the\n\nfollowing:\n\na. a description of the services and products to be\n\nprovided at a discount,\n\nb. the amount or amounts of the discounts or,\n\nalternatively, a fee schedule which reflects the\n\nhealth care provider's discounted rates, and\n\nc. a provision that the health care provider will not\n\ncharge members more than the discounted rates.\n\n3. A health care provider agreement with a health care provider\n\nnetwork shall require that the health care provider network have\n\nwritten agreements with its health care providers that:\n\na. contain the terms described in paragraph 2 of this\n\nsubsection,\n\nb. authorize the health care provider network to contract\n\nwith the discount medical plan organization on behalf\n\nof the provider, and\n\nc. require the network to maintain an up-to-date list of\n\nits contracted health care providers and to provide\n\nthat list on a quarterly basis to the discount medical\n\nplan organization.\n\n4. The discount medical plan organization shall maintain a copy\n\nof each active health care provider agreement into which it has\n\nentered.\n\nH. 1. There shall be a written agreement between the discount\n\nmedical plan organization and the member specifying the benefits\n\nunder the discount medical plan and complying with the disclosure\n\nrequirements of this section.\ncount medical\n\nplan organization.\n\n4. The discount medical plan organization shall maintain a copy\n\nof each active health care provider agreement into which it has\n\nentered.\n\nH. 1. There shall be a written agreement between the discount\n\nmedical plan organization and the member specifying the benefits\n\nunder the discount medical plan and complying with the disclosure\n\nrequirements of this section.\n\n2. All forms used, including the written agreement pursuant to\n\nthe provisions of subsection G of this section, shall first be filed\n\nwith the Insurance Department. Every form filed shall be identified\n\nby a unique form number placed in the lower left corner of each\n\nform. A filing fee of Twenty-five Dollars ($25.00) per form shall\n\nbe payable to the Insurance Department for deposit into the General\n\nRevenue Fund.\n\nI. 1. Each discount medical plan organization required to be\n\nregistered pursuant to this section except an affiliate shall, at\n\nall times, maintain a net worth of at least One Hundred Fifty\n\nThousand Dollars ($150,000.00).\n\n2. The Insurance Department may not allow a registration unless\n\nthe discount medical plan organization has a net worth of at least\n\nOne Hundred Fifty Thousand Dollars ($150,000.00).\n\nJ. 1. The Insurance Department may suspend the authority of a\n\ndiscount medical plan organization to enroll new members, revoke any\n\nregistration issued to a discount medical plan organization, or\n\norder compliance if the Department finds that any of the following\n\nconditions exist:\n\na. the organization is not operating in compliance with\n\nthe provisions of this section,\n\nb. the organization does not have the minimum net worth\n\nas required by this section,\n\nc. the organization has advertised, merchandised or\n\nattempted to merchandise its services in such a manner\n\nas to misrepresent its services or capacity for\n\nservice or has engaged in deceptive, misleading or\n\nunfair practices with respect to advertising or\n\nmerchandising,\n\nd. the organization is not fulfilling its obligations as\n\na discount medical plan organization, or\n\ne. the continued operation of the organization would be\n\nhazardous to its members.\n\n2. If the Insurance Department has cause to believe that\n\ngrounds for the suspension or revocation of a registration exist,\n\nthe Insurance Department shall notify the discount medical plan\n\norganization in writing, specifically stating the grounds for\n\nsuspension or revocation, and shall provide opportunity for a\n\nhearing on the matter in accordance with the Administrative\n\nProcedures Act and the Oklahoma Insurance Code.\n\n3. When the certificate of registration of a discount medical\n\nplan organization is nonrenewed, surrendered or revoked, such\n\norganization shall proceed, immediately following the effective date\n\nof the order of revocation, or in the case of nonrenewal, the date\n\nof expiration of the certificate of registration, to wind up its\n\naffairs transacted under the certificate of registration. The\n\norganization may not engage in any further advertising,\n\nsolicitation, collecting of fees, or renewal of contracts.\n\n4. The Insurance Department shall, in its order suspending the\n\nauthority of a discount medical plan organization to enroll new\n\nmembers, specify the period during which the suspension is to be in\n\neffect and the conditions, if any, which shall be met by the\n\ndiscount medical plan organization prior to reinstatement of its\n\nregistration to enroll new members. The order of suspension is\n\nsubject to rescission or modification by further order of the\n\nInsurance Department prior to the expiration of the suspension\n\nperiod. Reinstatement may not be made unless requested by the\n\ndiscount medical plan organization; however, the Insurance\n\nDepartment may not grant reinstatement if it finds that the\n\ncircumstances for which the suspension occurred still exist or are\n\nlikely to reoccur.\n\nK. Each discount medical plan organization required to be\nf the\n\nInsurance Department prior to the expiration of the suspension\n\nperiod. Reinstatement may not be made unless requested by the\n\ndiscount medical plan organization; however, the Insurance\n\nDepartment may not grant reinstatement if it finds that the\n\ncircumstances for which the suspension occurred still exist or are\n\nlikely to reoccur.\n\nK. Each discount medical plan organization required to be\n\nregistered pursuant to this section shall provide the Insurance\n\nDepartment at least thirty (30) days' advance notice of any change\n\nin the discount medical plan organization's name, address, principal\n\nbusiness address, or mailing address.\n\nL. Each discount medical plan organization shall maintain an\n\nup-to-date list of the names and addresses of the providers with\n\nwhich it has contracted on an Internet web site page, the address of\n\nwhich shall be prominently displayed on all its advertisements,\n\nmarketing materials, brochures, and discount cards. This section\n\napplies to those providers with whom the discount medical plan\n\norganization has contracted directly, as well as those who are\n\nmembers of a provider network with which the discount medical plan\n\norganization has contracted.\n\nM. 1. All advertisements, marketing materials, brochures and\n\ndiscount cards used by marketers shall be approved in writing for\n\nsuch use by the discount medical plan organization.\n\n2. The discount medical plan organization shall have an\n\nexecuted written agreement with a marketer prior to the marketer's\n\nmarketing, promoting, selling, or distributing the discount medical\n\nplan.\n\nN. The Insurance Commissioner may promulgate rules to\n\nadminister the provisions of this section.\n\nO. Regulation of discount medical plan organizations shall be\n\ndone pursuant to the Administrative Procedures Act.\n\nP. 1. A discount medical plan organization required to be\n\nregistered pursuant to this section except an affiliate shall\n\nmaintain a surety bond with the Insurance Department, having at all\n\ntimes a value of not less than Thirty-five Thousand Dollars\n\n($35,000.00), for use by the Insurance Department in protecting plan\n\nmembers.\n\n2. No judgment creditor or other claimant of a discount medical\n\nplan organization, other than the Insurance Department, shall have\n\nthe right to levy upon the surety bond held pursuant to the\n\nprovisions of paragraph 1 of this subsection.\n\nQ. 1. A person who knowingly and willfully operates as or aids\n\nand abets another operating as a discount medical plan organization\n\nin violation of subsection B of this section commits a felony,\n\npunishable as provided for in Oklahoma law, as if the discount\n\nmedical plan organization were an unauthorized insurer, and the\n\nfees, dues, charges, or other consideration collected from the\n\nmembers by the discount medical plan organization or marketer were\n\ninsurance premium.\n\n2. A person who collects fees for purported membership in a\n\ndiscount medical plan but fails to provide the promised benefits\n\ncommits a theft, punishable as provided in Oklahoma law.\n\nR. 1. In addition to the penalties and other enforcement\n\nprovisions of this section, the Insurance Department may seek both\n\ntemporary and permanent injunctive relief if:\n\na. a discount medical plan organization is being operated\n\nby any person or entity that is not registered\n\npursuant to this section, or\n\nb. any person, entity, or discount medical plan\n\norganization has engaged in any activity prohibited by\n\nthis section or any rule adopted pursuant to this\n\nsection.\n\n2. The venue for any proceeding brought pursuant to the\n\nprovisions of this section shall be in the district court of\n\nOklahoma County.\n\nS. 1. The provisions of this section apply to the activities\n\nof a discount medical plan organization that is not registered\n\npursuant to this section as if the discount medical plan\n\norganization were an unauthorized insurer.\n\n2. A discount medical plan organization being operated by any\neding brought pursuant to the\n\nprovisions of this section shall be in the district court of\n\nOklahoma County.\n\nS. 1. The provisions of this section apply to the activities\n\nof a discount medical plan organization that is not registered\n\npursuant to this section as if the discount medical plan\n\norganization were an unauthorized insurer.\n\n2. A discount medical plan organization being operated by any\n\nperson or entity that is not registered pursuant to this section, or\n\nany person, entity or discount medical plan organization that has\n\nengaged or is engaging in any activity prohibited by this section or\n\nany rules adopted pursuant to this section shall be subject to the\n\nUnauthorized Insurer Act as if the discount medical plan\n\norganization were an unauthorized insurer, and shall be subject to\n\nall the remedies available to the Insurance Commissioner under the\n\nUnauthorized Insurer Act.\n\nT. If the Insurance Commissioner finds that a discount medical\n\nplan organization has violated any provision of this section or that\n\ngrounds exist for the discretionary revocation or suspension of a\n\nregistration, the Commissioner, in lieu of such revocation or\n\nsuspension, may impose a fine upon the discount medical plan\n\norganization in an amount not to exceed One Thousand Dollars\n\n($1,000.00) per violation.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"173c4c052828fc8b5e5a16ff03ba14bc9550d5f8e9ffa6ce05fff8c816973a37","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-1219.3","next":"us-ok/okla.-stat.-tit.-36-36-1219.5"},"notice":"GroundRules: Original legal text. Not legal advice."}