{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-1250.2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-1250.2","heading":"Definitions","body":"As used in the Unfair Claims Settlement Practices Act:\n\n1. \"Agent\" means any individual, corporation, association,\n\npartnership, or other legal entity authorized to represent an\n\ninsurer with respect to a claim;\n\n2. \"Claimant\" means either a first party claimant, a third\n\nparty claimant, or both, and includes such claimant's designated\n\nlegal representatives and includes a member of the claimant's\n\nimmediate family designated by the claimant;\n\n3. \"Commissioner\" means the Insurance Commissioner;\n\n4. \"First-party claimant\" means an individual, corporation,\n\nassociation, partnership, or other legal entity, including a\n\nsubscriber under any plan providing health services, asserting a\n\nright to payment pursuant to an insurance policy or insurance\n\ncontract for an occurrence of contingency or loss covered by such\n\npolicy or contract;\n\n5. \"Health benefit plan\" means group hospital or medical\n\ninsurance coverage, a not-for-profit hospital or medical service or\n\nindemnity plan, a prepaid health plan, a health maintenance\n\norganization plan, a preferred provider organization plan, the State\n\nand Education Employees Group Health Insurance Plan, and coverage\n\nprovided by a Multiple Employer Welfare Arrangement (MEWA) or\n\nemployee self-insured plan except as exempt under federal ERISA\n\nprovisions. The term shall not include short-term accident, fixed\n\nindemnity, or specified disease policies, disability income\n\ncontracts, limited benefit or credit disability insurance, workers'\n\ncompensation insurance coverage, automobile medical payment\n\ninsurance, or insurance under which benefits are payable with or\n\nwithout regard to fault and which is required by law to be contained\n\nin any liability insurance policy or equivalent self-insurance;\n\n6. \"Insurance policy or insurance contract\" means any contract\n\nof insurance, certificate, indemnity, medical or hospital service,\n\nsuretyship, annuity, subscriber certificate or any evidence of\n\ncoverage of a health maintenance organization issued, proposed for\n\nissuance, or intended for issuance by any entity subject to this\n\nCode;\n\n7. \"Insurer\" means a person licensed by the Commissioner to\n\nissue or who issues any insurance policy or insurance contract in\n\nthis state and also includes health maintenance organizations.\n\nProvided that, for the purposes of paragraphs 15 and 16 of Section\n\n1250.5 of this title, \"insurer\" shall include the State and\n\nEducation Employees Group Insurance Board;\n\n8. \"Investigation\" means all activities of an insurer directly\n\nor indirectly related to the determination of liabilities under\n\ncoverages afforded by an insurance policy or insurance contract;\n\n9. \"Notification of claim\" means any notification, whether in\n\nwriting or other means acceptable under the terms of an insurance\n\npolicy or insurance contract, to an insurer or its agent, by a\n\nclaimant, which reasonably apprises the insurer of the facts\n\npertinent to a claim;\n\n10. \"Preauthorization/precertification\" means a determination\n\nby a health benefit plan, based on the information presented at the\n\ntime by the health care provider, that health care services proposed\n\nby the health care provider are medically necessary. The term shall\n\ninclude \"authorization\", \"certification\" and any other term that\n\nwould be a reliable determination by a health benefit plan. A\n\npreauthorization/precertification from a previous health plan shall\n\nnot bind a succeeding health benefit plan;\n\n11. \"Third-party claimant\" means any individual, corporation,\n\nassociation, partnership, or other legal entity asserting a claim\n\nagainst any individual, corporation, association, partnership, or\n\nother legal entity insured under an insurance policy or insurance\n\ncontract; and\n\n12. \"Verification of eligibility\" means a representation by a\n\nhealth benefit plan to a health care provider that a claimant is\n\nentitled to covered benefits under the policy. Such verification of\npartnership, or other legal entity asserting a claim\n\nagainst any individual, corporation, association, partnership, or\n\nother legal entity insured under an insurance policy or insurance\n\ncontract; and\n\n12. \"Verification of eligibility\" means a representation by a\n\nhealth benefit plan to a health care provider that a claimant is\n\nentitled to covered benefits under the policy. Such verification of\n\neligibility shall be valid for four (4) business days from the date\n\ngiven by the health benefit plan.","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":"5338d5e5440f4cd5e871776d3e71fef7022414a8aeac7aabd022747884d0ddbf","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-1250.17","next":"us-ok/okla.-stat.-tit.-36-36-1250.3"},"notice":"GroundRules: Original legal text. Not legal advice."}