{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-3611.1","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-3611.1","heading":"Medicare supplement policies - Definitions -","body":"Regulations - Issuance - Return and refund - Examination of\n\ninsurers.\n\nA. As used in this section:\n\n1. \"Commissioner\" means the Commissioner of Insurance;\n\n2. \"Medicare supplement policy\" means a group or individual\n\npolicy of accident and health insurance, or a subscriber contract of\n\na nonprofit hospital service and medical indemnity corporation or a\n\nhealth maintenance organization which is advertised, marketed or\n\ndesigned primarily as a supplement to reimbursements under Medicare\n\nfor the hospital, medical or surgical expenses of persons eligible\n\nfor Medicare. Such term does not include:\n\na. a policy or contract of one or more employers or labor\n\norganizations, or of the trustees of a fund\n\nestablished by one or more employers or labor\n\norganizations, or combination thereof, for employees\n\nor former employees, or combination thereof, or for\n\nmembers or former members, or combination thereof, of\n\nthe labor organizations, or\n\nb. a policy or contract of any professional, trade or\n\noccupational association for its members or former or\n\nretired members, or combination thereof, if such\n\nassociation:\n\n(1) is composed of individuals all of whom are\n\nactively engaged in the same profession, trade or\n\noccupation,\n\n(2) has been maintained in good faith for purposes\n\nother than obtaining insurance, and\n\n(3) has been in existence for at least two (2) years\n\nprior to the date of its initial offering of such\n\npolicy or plan to its members, or\n\nc. individual policies or contracts issued pursuant to a\n\nconversion privilege under a policy or contract of\n\ngroup or individual insurance; and\n\n3. \"Direct response Medicare supplement policy\" means a policy\n\nof insurance which is advertised, marketed or designed primarily as\n\na supplement to reimbursements under Medicare for the hospital,\n\nmedical or surgical expenses of persons eligible for Medicare issued\n\nas a result of solicitation of individual insureds by mail or by\n\nmass media advertising.\n\nB. The Commissioner shall issue reasonable regulations to\n\nestablish minimum standards for benefit claims payment, marketing\n\npractices, compensation arrangements, and reporting practices for\n\nMedicare supplement policies. The Commissioner shall issue\n\nreasonable regulations to provide for an open enrollment period for\n\nthose persons who qualify as disabled pursuant to federal Medicare\n\nguidelines.\n\nC. A Medicare supplement policy may not deny a claim for losses\n\nincurred more than six (6) months from the effective date of\n\ncoverage for a preexisting condition. The policy may not define a\n\npreexisting condition more restrictively than \"a condition for which\n\nmedical advice was given or treatment was recommended by or received\n\nfrom a physician within six (6) months before the effective date of\n\ncoverage\".\n\nD. Any premium rate filing for a Medicare supplement policy\n\nshall be filed with and approved by the Insurance Commissioner and\n\ncommunicated to the policyholder at least forty-five (45) days prior\n\nto the effective date of a premium rate increase. Such premium\n\nincreases shall be implemented no more than once per year.\n\nE. A Medicare supplement policy shall be expected to return to\n\nthe policyholder benefits which are reasonable in relation to the\n\npremium charged. The Commissioner shall issue regulations to\n\nestablish minimum standards for loss ratios of Medicare supplement\n\npolicies on the basis of incurred claims experience, or incurred\n\nhealth care expenses where coverage is provided by a health\n\nmaintenance organization on a service rather than reimbursement\n\nbasis, and earned premiums for the period of coverage for which\n\nrates are computed and in accordance with accepted actuarial\n\nprinciples and practices.\n\nF. 1. No Medicare supplement policy or certificate issued\n\npursuant to a group Medicare supplement policy shall be delivered or\ncare expenses where coverage is provided by a health\n\nmaintenance organization on a service rather than reimbursement\n\nbasis, and earned premiums for the period of coverage for which\n\nrates are computed and in accordance with accepted actuarial\n\nprinciples and practices.\n\nF. 1. No Medicare supplement policy or certificate issued\n\npursuant to a group Medicare supplement policy shall be delivered or\n\nissued for delivery in this state unless an outline of coverage is\n\nprovided to the applicant at the time application is made.\n\n2. The Commissioner shall prescribe by regulation the contents\n\nand a standard form of an informational brochure for persons\n\neligible for Medicare which is intended to improve the buyer's\n\nability to select the most appropriate coverage and improve the\n\nbuyer's understanding of Medicare. The Commissioner may require by\n\nregulation that the informational brochure be provided with the\n\noutline of coverage to any prospective insureds eligible for\n\nMedicare. With respect to direct response policies, the\n\nCommissioner may require that the prescribed brochure and outline of\n\ncoverage be provided upon request to any prospective insureds\n\neligible for Medicare, but in no event later than the time of policy\n\ndelivery.\n\n3. The Commissioner may require notice provisions, designed to\n\ninform prospective insureds that particular insurance coverages are\n\nnot Medicare supplement coverages, for all accident and health\n\ninsurance policies sold to persons eligible for Medicare by reason\n\nof age, other than:\n\na. Medicare supplement policies,\n\nb. disability income policies,\n\nc. basic, catastrophic, or major medical expense\n\npolicies,\n\nd. single premium, nonrenewable policies, or\n\ne. other policies defined by regulation of the\n\nCommissioner.\n\n4. The Commissioner may adopt from time to time, such\n\nreasonable regulations as are necessary to conform Medicare\n\nsupplement policies and certificates to the requirements of federal\n\nlaw and regulations promulgated thereunder, including but not\n\nlimited to:\n\na. requiring refunds or credits if the policies or\n\ncertificates do not meet loss ratio requirements,\n\nb. establishing a uniform methodology for calculating and\n\nreporting loss ratios,\n\nc. assuring public access to policies, premiums and loss\n\nratio information of issuers of Medicare supplement\n\ninsurance, and\n\nd. establishing a policy for holding public hearings\n\nprior to approval of premium increases.\n\nG. Medicare supplement policies or certificates shall have a\n\nnotice prominently printed on the first page of the policy or\n\ncertificate, or attached thereto, stating that the applicant shall\n\nhave the right to return the policy or certificate within thirty\n\n(30) days of its delivery and to have the premium refunded if, after\n\nexamination of the policy or certificate, the applicant is not\n\nsatisfied for any reason. A direct response policy issued to\n\npersons eligible for Medicare shall have a notice prominently\n\nprinted on the first page, or attached thereto, stating that the\n\napplicant shall have the right to return the policy or certificate\n\nwithin thirty (30) days of its delivery and to have the premium\n\nrefunded if, after examination, the applicant is not satisfied for\n\nany reason.\n\nH. The Insurance Commissioner shall have the authority to\n\nemploy actuaries, statisticians, accountants, auditors,\n\ninvestigators, or any other technicians as the Insurance\n\nCommissioner may deem necessary or beneficial to examine any\n\nMedicare supplement filings made by insurers or rating organizations\n\nand to examine such records of the insurers or rating organizations\n\nas may be deemed appropriate in conjunction with the Medicare\n\nsupplement filing in order to determine that the rates or other\n\nfilings are consistent with the terms, conditions, requirements and\n\npurposes of the Insurance Code, and to verify, validate and\n\ninvestigate the information upon which the insurer or rating\nganizations\n\nand to examine such records of the insurers or rating organizations\n\nas may be deemed appropriate in conjunction with the Medicare\n\nsupplement filing in order to determine that the rates or other\n\nfilings are consistent with the terms, conditions, requirements and\n\npurposes of the Insurance Code, and to verify, validate and\n\ninvestigate the information upon which the insurer or rating\n\norganization relies to support such filing.\n\n1. The Commissioner shall maintain a list of technicians who\n\nare proficient in the line of Medicare supplement insurance. If the\n\nCommissioner determines that it is necessary to utilize the services\n\nof such a technician, the Commissioner shall employ the next\n\navailable technician in rotation on the list.\n\n2. All reasonable expenses incurred in such filing review shall\n\nbe paid by the insurer or rating organization making the filing.","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":"814957985318427ef655c02006d64900e261a90d4b7d60fd1058051e1f1d6364","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-3611","next":"us-ok/okla.-stat.-tit.-36-36-3612"},"notice":"GroundRules: Original legal text. Not legal advice."}