{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-2025","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-2025","heading":"Oklahoma Life and Health Insurance Guaranty Association","body":"Act - Coverage - Liability.\n\nA. For the policies and contracts specified in subsection B of\n\nthis section, the Oklahoma Life and Health Insurance Guaranty\n\nAssociation Act shall provide coverage:\n\n1. a. To persons, who regardless of where they reside,\n\nexcept for nonresident certificate holders under group\n\npolicies or contracts, are the beneficiaries,\n\nassignees or payees, including health care providers\n\nrendering services covered under health insurance\n\npolicies or certificates, of the persons covered under\n\nsubparagraph b of this paragraph,\n\nb. To persons who are owners of or certificate holders or\n\nenrollees under the policies or contracts, other than\n\nstructured settlement annuities, and in each case who:\n\n(1) are residents, or\n\n(2) are not residents, but only under all of the\n\nfollowing conditions:\n\n(a) the member insurer that issued the policies\n\nor contracts are domiciled in this state,\n\n(b) the states in which the persons reside have\n\nassociations similar to the Oklahoma Life\n\nand Health Insurance Guaranty Association\n\ncreated by this act, and the persons are not\n\neligible for coverage by an association in\n\nany other state due to the fact that the\n\ninsurer or health maintenance organization\n\nwas not licensed in the state at the time\n\nspecified in the guaranty association law of\n\nthe state;\n\n2. Subparagraphs a and b of paragraph 1 of this subsection\n\nshall not apply to structured settlement annuities specified in\n\nsubsection B of this section and in the Oklahoma Life and Health\n\nInsurance Guaranty Association Act shall, except as provided in\n\nparagraphs 3 and 4 of this subsection, provide coverage to a person\n\nwho is a payee under a structured settlement annuity or a\n\nbeneficiary of a payee if the payee is deceased, if the payee:\n\na. is a resident, regardless of where the contract owner\n\nresides, or\n\nb. is not a resident, but only under both of the\n\nfollowing conditions:\n\n(1) (a) the contract owner of the structured\n\nsettlement annuity is a resident, or\n\n(b) the contract owner of the structured\n\nsettlement annuity is not a resident but:\n\ni. the insurer that issued the structured\n\nsettlement annuity is domiciled in this\n\nstate, and\n\nii. the state in which the contract owner\n\nresides has an association similar to\n\nthe association created by the Oklahoma\n\nLife and Health Insurance Guaranty\n\nAssociation Act, and\n\n(2) neither the payee nor beneficiary nor the\n\ncontract owner is eligible for coverage by the\n\nassociation of the state in which the payee or\n\ncontract owner resides;\n\n3. The Oklahoma Life and Health Insurance Guaranty Association\n\nAct shall not provide coverage to a person who is a payee or\n\nbeneficiary of a contract owner resident of this state, if the payee\n\nor beneficiary is afforded coverage by the association of another\n\nstate; and\n\n4. The Oklahoma Life and Health Insurance Guaranty Association\n\nAct is intended to provide coverage to a person who is a resident of\n\nthis state and in special circumstances, to a nonresident. In order\n\nto avoid duplicate coverage, if a person who would otherwise receive\n\ncoverage under the Oklahoma Life and Health Insurance Guaranty\n\nAssociation Act is provided coverage under the laws of any other\n\nstate, the person shall not be provided coverage under the Oklahoma\n\nLife and Health Insurance Guaranty Association Act. In determining\n\nthe application of the provisions of this paragraph to situations\n\nwhere a person could be covered by the association of more than one\n\nstate, whether as an owner, payee, enrollee, beneficiary or\n\nassignee, the Oklahoma Life and Health Insurance Association Act\n\nshall be construed in conjunction with the laws of other states to\n\nresult in coverage by only one association.\n\nB. 1. The Oklahoma Life and Health Insurance Guaranty\n\nAssociation Act shall provide coverage to the persons specified in\nher as an owner, payee, enrollee, beneficiary or\n\nassignee, the Oklahoma Life and Health Insurance Association Act\n\nshall be construed in conjunction with the laws of other states to\n\nresult in coverage by only one association.\n\nB. 1. The Oklahoma Life and Health Insurance Guaranty\n\nAssociation Act shall provide coverage to the persons specified in\n\nsubsection A of this section for policies or contracts of direct,\n\nnon-group life insurance, health insurance, which for the purposes\n\nof this act includes health maintenance organization subscriber\n\ncontracts and certificates, or annuities and supplemental policies\n\nor contracts to any of these, and for certificates under direct\n\ngroup policies and contracts, except as limited by the Oklahoma Life\n\nand Health Insurance Guaranty Association Act. Annuity contracts\n\nand certificates under group annuity contracts include allocated\n\nfunding agreements, structured settlement annuities and any\n\nimmediate or deferred annuity contracts.\n\n2. Except as provided in paragraph 3 of this subsection, the\n\nOklahoma Life and Health Insurance Guaranty Association Act shall\n\nnot provide coverage for:\n\na. a portion of a policy or contract not guaranteed by\n\nthe insurer, or under which the risk is borne by the\n\npolicy or contract owner,\n\nb. a policy or contract of reinsurance, unless assumption\n\ncertificates have been issued pursuant to the\n\nreinsurance policy or contract,\n\nc. a portion of a policy or contract to the extent that\n\nthe rate of interest on which it is based, or the\n\ninterest rate, crediting rate or similar factor\n\ndetermined by use of an index or other external\n\nreference stated in the policy or contract employed in\n\ncalculating returns or changes in value:\n\n(1) averaged over the period of four (4) years prior\n\nto the date on which the Association becomes\n\nobligated with respect to the policy or contract,\n\nexceeds a rate of interest determined by\n\nsubtracting two (2) percentage points from\n\nMoody's Corporate Bond Yield Average averaged for\n\nthat same four-year period or for such lesser\n\nperiod if the policy or contract was issued less\n\nthan four (4) years before the Association became\n\nobligated, and\n\n(2) on and after the date on which the Association\n\nbecomes obligated with respect to the policy or\n\ncontract, exceeds the rate of interest determined\n\nby subtracting three (3) percentage points from\n\nMoody's Corporate Bond Yield Average as most\n\nrecently available,\n\nd. a portion of a policy or contract issued to a plan or\n\nprogram of an employer, association or other person to\n\nprovide life, health or annuity benefits to its\n\nemployees, members or others, to the extent that the\n\nplan or program is self-funded or uninsured, including\n\nbut not limited to benefits payable by an employer,\n\nassociation or other person under:\n\n(1) a Multiple Employer Welfare Arrangement as\n\ndefined in 29 U.S.C. Section 1144,\n\n(2) a minimum premium group insurance plan,\n\n(3) a stop-loss group insurance plan, or\n\n(4) an administrative services only contract,\n\ne. a portion of a policy or contract to the extent that\n\nit provides for:\n\n(1) dividends or experience rating credits,\n\n(2) voting rights, or\ner,\n\nassociation or other person under:\n\n(1) a Multiple Employer Welfare Arrangement as\n\ndefined in 29 U.S.C. Section 1144,\n\n(2) a minimum premium group insurance plan,\n\n(3) a stop-loss group insurance plan, or\n\n(4) an administrative services only contract,\n\ne. a portion of a policy or contract to the extent that\n\nit provides for:\n\n(1) dividends or experience rating credits,\n\n(2) voting rights, or\n\n(3) payment of any fees or allowances to any person,\n\nincluding the policy or contract owner, in\n\nconnection with the service to or administration\n\nof the policy or contract,\n\nf. a policy or contract issued in this state by a member\n\ninsurer at a time when it was not licensed or did not\n\nhave a certificate of authority to issue the policy or\n\ncontract in this state,\n\ng. a portion of a policy or contract to the extent that\n\nthe assessments required by Section 2030 of this title\n\nwith respect to the policy or contract are preempted\n\nby federal or state law,\n\nh. an obligation that does not arise under the express\n\nwritten terms of the policy or contract issued by the\n\nmember insurer to the enrollee, certificate holder or\n\ncontract or policy owner, including without\n\nlimitation:\n\n(1) claims based on marketing materials,\n\n(2) claims based on side letters, riders or other\n\ndocuments that were issued by the member insurer\n\nwithout meeting applicable policy or contract\n\nform filing or approval requirements,\n\n(3) misrepresentations of or regarding policy or\n\ncontract benefits,\n\n(4) extra-contractual claims, or\n\n(5) a claim for penalties or consequential or\n\nincidental damages,\n\ni. a contractual agreement that establishes the\n\nobligations of the member insurer to provide a book\n\nvalue accounting guaranty for defined contribution\n\nbenefit plan participants by reference to a portfolio\n\nof assets that is owned by the benefit plan or its\n\ntrustee, which in each case is not an affiliate of the\n\nmember insurer,\n\nj. an unallocated annuity contract,\n\nk. a portion of a policy or contract to the extent it\n\nprovides for interest or other changes in value to be\n\ndetermined by the use of an index or other external\n\nreference stated in the policy or contract, but which\n\nhave not been credited to the policy or contract, or\n\nas to which the policy or contract owner's rights are\n\nsubject to forfeiture, as of the date the member\n\ninsurer becomes an impaired or insolvent insurer under\n\nthe Oklahoma Life and Health Insurance Guaranty\n\nAssociation Act, whichever is earlier. If a policy's\n\nor contract's interest or changes in value are\n\ncredited less frequently than annually, then for\n\npurposes of determining the values that have been\n\ncredited and are not subject to forfeiture under this\n\nsubparagraph, the interest or change in value\n\ndetermined by using the procedures defined in the\n\npolicy or contract will be credited as if the\n\ncontractual date of crediting interest or changing\n\nvalues was the date of impairment or insolvency,\n\nwhichever is earlier, and will not be subject to\n\nforfeiture, or\n\nl. a policy or contract providing any hospital, medical,\n\nprescription drug or other health care benefits\n\npursuant to Part C or Part D of Subchapter XVIII,\n\nChapter 7 of Title 42 of the United States Code,\n\ncommonly known as Medicare Part C or Part D, or\n\nSubchapter XIX, Chapter 7 of Title 42 of the United\n\nStates Code or any regulations issued pursuant\n\nthereto.\n\n3. The exclusion from coverage in this section shall not apply\n\nto any portion of a policy or contract, including a rider that\n\nprovides long-term care or any other health insurance benefits.\n\nC. The benefits that the Association may become obligated to\n\ncover shall in no event exceed the lesser of:\n\n1. The contractual obligations for which the member insurer is\n\nliable or would have been liable if it were not an impaired or\n\ninsolvent insurer; or\n\n2. a. with respect to any one life, regardless of the number\n\nof policies or contracts:\ng-term care or any other health insurance benefits.\n\nC. The benefits that the Association may become obligated to\n\ncover shall in no event exceed the lesser of:\n\n1. The contractual obligations for which the member insurer is\n\nliable or would have been liable if it were not an impaired or\n\ninsolvent insurer; or\n\n2. a. with respect to any one life, regardless of the number\n\nof policies or contracts:\n\n(1) Three Hundred Thousand Dollars ($300,000.00) in\n\nlife insurance death benefits, but not more than\n\nOne Hundred Thousand Dollars ($100,000.00) in net\n\ncash surrender and net cash withdrawal values for\n\nlife insurance,\n\n(2) for health insurance benefits:\n\n(a) One Hundred Thousand Dollars ($100,000.00)\n\nfor coverages not defined as disability\n\nincome insurance or health benefit plans or\n\nlong-term care insurance as defined in\n\nSection 4424 of this title, including any\n\nnet cash surrender and net cash withdrawal\n\nvalues,\n\n(b) Three Hundred Thousand Dollars ($300,000.00)\n\nfor insurance providing income payments to\n\nan insured wage earner when income is\n\ninterrupted or terminated because of\n\nillness, sickness or accident, commonly\n\nknown as disability income insurance and\n\nThree Hundred Thousand Dollars ($300,000.00)\n\nfor long-term care insurance as defined in\n\nSection 4424 of this title, and\n\n(c) Five Hundred Thousand Dollars ($500,000.00)\n\nfor health benefit plans, or\n\n(3) Three Hundred Thousand Dollars ($300,000.00) in\n\nthe present value of annuity benefits, including\n\nnet cash surrender and net cash withdrawal\n\nvalues, or\n\nb. with respect to each payee of a structured settlement\n\nannuity or beneficiary or beneficiaries of the payee\n\nif the payee is deceased, Three Hundred Thousand\n\nDollars ($300,000.00) in present value annuity\n\nbenefits, in the aggregate, including net cash\n\nsurrender and net cash withdrawal values,\n\nc. however, in no event shall the Association be\n\nobligated to cover more than:\n\n(1) an aggregate of Three Hundred Thousand Dollars\n\n($300,000.00) in benefits with respect to any one\n\nlife under this subparagraph and subparagraphs a\n\nand b of this paragraph except with respect to\n\nhealth benefit plans under division (2) of\n\nsubparagraph a of this paragraph, in which case\n\nthe aggregate liability of the Association shall\n\nnot exceed Five Hundred Thousand Dollars\n\n($500,000.00) with respect to any one individual,\n\nor\n\n(2) with respect to one owner of multiple non-group\n\npolicies of life insurance, whether the policy or\n\ncontract owner is an individual, firm,\n\ncorporation or other person, and whether the\n\npersons insured are officers, managers, employees\n\nor other persons, more than Five Million Dollars\n\n($5,000,000.00) in benefits, regardless of the\n\nnumber of policies and contracts held by the\n\nowner,\n\nd. the limitations set forth in this subsection are\n\nlimitations on benefits for which the Association is\n\nobligated before taking into account either its\n\nsubrogation and assignment rights or the extent to\n\nwhich those benefits could be provided out of the\n\nassets of the impaired or insolvent insurer\n\nattributable to covered policies. The costs of the\n\nobligations of the Association under the Oklahoma Life\n\nand Health Insurance Guaranty Association Act may be\n\nmet by the use of assets attributable to covered\n\npolicies or reimbursed to the Association pursuant to\n\nits subrogation and assignment rights,\n\ne. for purposes of the Oklahoma Life and Health Insurance\n\nGuaranty Association Act, benefits provided by a long-\n\nterm care rider to a life insurance policy or annuity\n\ncontract shall be considered the same type of benefits\n\nas the base life insurance policy or annuity contract\n\nto which it relates.\n\nD. In performing its obligations to provide coverage under\n\nSection 2028 of this title, the Association shall not be required to\n\nguarantee, assume, reinsure, reissue or perform, or cause to be\novided by a long-\n\nterm care rider to a life insurance policy or annuity\n\ncontract shall be considered the same type of benefits\n\nas the base life insurance policy or annuity contract\n\nto which it relates.\n\nD. In performing its obligations to provide coverage under\n\nSection 2028 of this title, the Association shall not be required to\n\nguarantee, assume, reinsure, reissue or perform, or cause to be\n\nguaranteed, assumed, reinsured, reissued or performed, the\n\ncontractual obligations of the insolvent or impaired insurer under a\n\ncovered policy or contract that do not materially affect the\n\neconomic values or economic benefits of the covered policy or\n\ncontract.","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":"68cc7ff695967792ee28113f7e209b48f41697b762cea82605697b4f04a79961","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-2024","next":"us-ok/okla.-stat.-tit.-36-36-2026"},"notice":"GroundRules: Original legal text. Not legal advice."}