{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-4405","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-4405","heading":"Accident and health policy provisions","body":"A. Required Provisions. Except as provided in subsection D of\n\nthis section, each such policy delivered or issued for delivery to\n\nany person in this state shall contain the provisions specified in\n\nthis subsection in the words in which the same appear in this\n\nsection; provided, however, that the insurer may, at its option,\n\nsubstitute for one or more of such provisions corresponding\n\nprovisions of different wording approved by the Insurance\n\nCommissioner which are in each instance not less favorable in any\n\nrespect to the insured or the beneficiary. Such provisions shall be\n\npreceded individually by the caption appearing in this subsection\n\nor, at the option of the insurer, by such appropriate individual or\n\ngroup captions or subcaptions as the Insurance Commissioner may\n\napprove.\n\n1. A provision as follows: ENTIRE CONTRACT; CHANGES: This\n\npolicy, including the endorsements and the attached papers, if any,\n\nconstitutes the entire contract of insurance. No change in this\n\npolicy shall be valid until approved by an executive officer of the\n\ninsurer and unless such approval be endorsed hereon or attached\n\nhereto. No agent has authority to change this policy or to waive\n\nany of its provisions.\n\n2. A provision as follows: TIME LIMIT ON CERTAIN DEFENSES:\n\n(a) After two (2) years from the date of issue of this policy,\n\nno misstatements, except fraudulent misstatements, made by the\n\napplicant in the application for such policy shall be used to void\n\nthe policy or to deny a claim for loss incurred or disability (as\n\ndefined in the policy) commencing after the expiration of such two-\n\nyear period. The foregoing policy provision shall not be so\n\nconstrued as to affect any legal requirement for avoidance of a\n\npolicy or denial of a claim during such initial two-year period, nor\n\nlimit the application of paragraphs 1, 2, 3, 4 and 5 of subsection B\n\nof this section in the event of misstatement with respect to age or\n\noccupation or other insurance. A policy which the insured has the\n\nright to continue in force subject to its terms by the timely\n\npayment of premium (i) until at least fifty (50) years of age or,\n\n(ii) in the case of a policy issued to a person older than forty-\n\nfour (44) years of age, for at least five (5) years from its date of\n\nissue, may contain in lieu of the foregoing the following provisions\n\n(from which the clause in parentheses may be omitted at the\n\ninsurer's option) under the caption \"Incontestable\". After this\n\npolicy has been in force for a period of two (2) years during the\n\nlifetime of the insured (excluding any period during which the\n\ninsured is disabled), it shall become incontestable as to the\n\nstatements contained in the application.\n\n(b) No claim for loss incurred or disability (as defined in the\n\npolicy) commencing after two (2) years from the date of issue of\n\nthis policy shall be reduced or denied on the ground that a disease\n\nor physical condition not excluded from coverage by name or specific\n\ndescription effective on the date of loss had existed prior to the\n\neffective date of coverage of this policy.\n\n3. A provision as follows: GRACE PERIOD:\n\n(a) A grace period of ______ (insert a number not less than \"7\"\n\nfor weekly premium policies, \"10\" for monthly premium policies and\n\n\"31\" for all other policies) days will be granted for the payment of\n\neach premium falling due after the first premium, during which grace\n\nperiod the policy shall continue in force.\novision as follows: GRACE PERIOD:\n\n(a) A grace period of ______ (insert a number not less than \"7\"\n\nfor weekly premium policies, \"10\" for monthly premium policies and\n\n\"31\" for all other policies) days will be granted for the payment of\n\neach premium falling due after the first premium, during which grace\n\nperiod the policy shall continue in force.\n\n(b) A policy in which the insurer reserves the right to refuse\n\nrenewal shall have, at the beginning of the above provision, \"Unless\n\nnot less than thirty (30) days prior to the premium due date the\n\ninsurer has delivered to the insured or has mailed to his last\n\naddress as shown by the records of the insurer written notice of its\n\nintention not to renew this policy beyond the period for which the\n\npremium has been accepted.\"\n\n4. A provision as follows: REINSTATEMENT:\n\n(a) If any renewal premium be not paid within the time granted\n\nthe insured for payment, a subsequent acceptance of premium by the\n\ninsurer or by any agent duly authorized by the insurer to accept\n\nsuch premium, without requiring in connection therewith an\n\napplication for reinstatement, shall reinstate the policy; provided,\n\nhowever, that if the insurer or such agent requires an application\n\nfor reinstatement and issues a conditional receipt for the premium\n\ntendered, the policy will be reinstated upon approval of such\n\napplication by the insurer or, lacking such approval, upon the\n\nforty-fifth day following the date of such conditional receipt,\n\nunless the insurer has previously notified the insured in writing of\n\nits disapproval of such application. The reinstated policy shall\n\ncover only loss resulting from such accidental injury as may be\n\nsustained after the date of reinstatement and loss due to such\n\nsickness as may begin more than ten (10) days after such date. In\n\nall other respects the insured and insurer shall have the same\n\nrights thereunder as they had under the policy immediately before\n\nthe due date of the defaulted premium, subject to any provisions\n\nendorsed hereon or attached hereto in connection with the\n\nreinstatement. Any premium accepted in connection with a\n\nreinstatement shall be applied to a period for which premium has not\n\nbeen previously paid, but not to any period more than sixty (60)\n\ndays prior to the date of reinstatement.\n\n(b) The last sentence of the above provision may be omitted from\n\nany policy which the insured has the right to continue in force\n\nsubject to its terms by the timely payment of premiums (i) until at\n\nleast fifty (50) years of age or, (ii) in the case of a policy\n\nissued to a person older than forty-four (44) years of age, for at\n\nleast five (5) years from its date of issue.\n\n5. A provision as follows: NOTICE OF CLAIM:\n\n(a) Written notice of claim must be given to the insurer within\n\ntwenty (20) days after the occurrence or commencement of any loss\n\ncovered by the policy, or as soon thereafter as is reasonably\n\npossible. Notice given by or on behalf of the insured or the\n\nbeneficiary to the insurer at ______ (insert the location of such\n\noffice as the insurer may designate for the purpose), or to any\n\nauthorized agent of the insurer, with information sufficient to\n\nidentify the insured, shall be deemed notice to the insurer.\nn thereafter as is reasonably\n\npossible. Notice given by or on behalf of the insured or the\n\nbeneficiary to the insurer at ______ (insert the location of such\n\noffice as the insurer may designate for the purpose), or to any\n\nauthorized agent of the insurer, with information sufficient to\n\nidentify the insured, shall be deemed notice to the insurer.\n\n(b) In a policy providing a loss-of-time benefit which may be\n\npayable for at least two (2) years, an insurer may, at its option,\n\ninsert the following between the first and second sentences of the\n\nabove provision: Subject to the qualifications set forth below, if\n\nthe insured suffers loss of time on account of disability for which\n\nindemnity may be payable for at least two (2) years, he shall, at\n\nleast once in every six (6) months after having given notice of\n\nclaim, give to the insurer notice of continuance of said disability\n\nexcept in the event of legal incapacity. The period of six (6)\n\nmonths following any filing of proof by the insured or any payment\n\nby the insurer on account of such claim or any denial of liability\n\nin whole or in part by the insurer shall be excluded in applying\n\nthis provision. Delay in the giving of such notice shall not impair\n\nthe insured's right to any indemnity which would otherwise have\n\naccrued during the period of six (6) months preceding the date on\n\nwhich such notice is actually given.\n\n6. A provision as follows: CLAIM FORMS: The insurer, upon\n\nreceipt of a notice of claim, will furnish to the claimant such\n\nforms as are usually furnished by it for filing proofs of loss. If\n\nsuch forms are not furnished within fifteen (15) days after the\n\ngiving of such notice, the claimant shall be deemed to have complied\n\nwith the requirements of this policy as to proof of loss upon\n\nsubmitting, within the time fixed in the policy for filing proofs of\n\nloss, written proof covering the occurrence, the character and the\n\nextent of the loss for which claim is made.\n\n7. A provision as follows: PROOFS OF LOSS: Written proof of\n\nloss must be furnished to the insurer at its said office in case of\n\nclaim for loss for which the policy provides any periodic payment\n\ncontingent upon continuing loss within ninety (90) days after the\n\ntermination of the period for which the insurer is liable and in\n\ncase of claim for any other loss within ninety (90) days after the\n\ndate of such loss. Failure to furnish such proof within the time\n\nrequired shall not invalidate nor reduce any claim if it was not\n\nreasonably possible to give proof within such time, provided such\n\nproof is furnished as soon as reasonably possible and in no event,\n\nexcept in the absence of legal capacity, later than one (1) year\n\nfrom the time proof is otherwise required.\n\n8. A provision as follows: TIME OF PAYMENT OF CLAIMS:\n\nIndemnities payable under this policy for any loss other than loss\n\nfor which this policy provides any periodic payment will be paid\n\nimmediately upon receipt of due written proof of such loss. Subject\n\nto due written proof of loss, all accrued indemnities for loss for\n\nwhich this policy provides periodic payment will be paid______\n\n(insert period for payment which must not be less frequently than\n\nmonthly) and any balance remaining unpaid upon the termination of\n\nliability will be paid immediately upon receipt of due written\n\nproof.\n\n9. A provision as follows: PAYMENT OF CLAIMS:\naccrued indemnities for loss for\n\nwhich this policy provides periodic payment will be paid______\n\n(insert period for payment which must not be less frequently than\n\nmonthly) and any balance remaining unpaid upon the termination of\n\nliability will be paid immediately upon receipt of due written\n\nproof.\n\n9. A provision as follows: PAYMENT OF CLAIMS:\n\n(a) Indemnity for loss of life will be payable in accordance\n\nwith the beneficiary designation and the provisions respecting such\n\npayment which may be prescribed herein and effective at the time of\n\npayment. If no such designation or provision is then effective,\n\nsuch indemnity shall be payable to the estate of the insured. Any\n\nother accrued indemnities unpaid at the insured's death may, at the\n\noption of the insurer, be paid either to such beneficiary or to such\n\nestate. All other indemnities will be payable to the insured.\n\n(b) The following provisions, or either of them, may be included\n\nwith the foregoing provision at the option of the insurer: If any\n\nindemnity of this policy shall be payable to the estate of the\n\ninsured, or to an insured or beneficiary who is a minor or otherwise\n\nnot competent to give a valid release, the insurer may pay such\n\nindemnity, up to an amount not exceeding $______ (insert an amount\n\nwhich shall not exceed One Thousand Dollars ($1,000.00)), to any\n\nrelative by blood or connection by marriage of the insured or\n\nbeneficiary who is deemed by the insurer to be equitably entitled\n\nthereto. Any payment made by the insurer in good faith pursuant to\n\nthis provision shall fully discharge the insurer to the extent of\n\nsuch payment.\n\nSubject to any written direction of the insured in the\n\napplication or otherwise, all or a portion of any indemnities\n\nprovided by this policy on account of hospital, nursing, medical, or\n\nsurgical services may, at the insurer's option and unless the\n\ninsured requests otherwise in writing not later than the time of\n\nfiling proofs of such loss, be paid directly to the hospital or\n\nperson rendering such services; but it is not required that the\n\nservice be rendered by a particular hospital or person.\n\n10. A provision as follows: PHYSICAL EXAMINATION, AUTOPSY:\n\nThe insurer at its own expense shall have the right and\n\nopportunity to examine the person of the insured when and as often\n\nas it may reasonably require during the pendency of a claim\n\nhereunder and to make an autopsy in case of death where it is not\n\nforbidden by law.\n\n11. A provision as follows: LEGAL ACTIONS: No action at law\n\nor in equity shall be brought to recover on this policy prior to the\n\nexpiration of sixty (60) days after written proof of loss has been\n\nfurnished in accordance with the requirements of this policy. No\n\nsuch action shall be brought after the expiration of three (3) years\n\nafter the time written proof of loss is required to be furnished.\n\n12. A provision as follows: CHANGE OF BENEFICIARY: Unless the\n\ninsured makes an irrevocable designation of beneficiary, the right\n\nto change of beneficiary is reserved to the insured and the consent\n\nof the beneficiary or beneficiaries shall not be requisite to\n\nsurrender or assignment of this policy or to any change of\n\nbeneficiary or beneficiaries, or to any other changes in this\n\npolicy.\n\nThe first clause of this provision, relating to the irrevocable\n\ndesignation of beneficiary, may be omitted at the insurer's option.\n\nB. Other provisions. Except as provided in subsection D of\n\nthis section, no such policy delivered or issued for delivery to any\n\nperson in this state shall contain provisions respecting the matters\n\nset forth below unless such provisions are in the words in which the\n\nsame appear in this section; provided, however, that the insurer\n\nmay, at its option, use in lieu of any such provision a\n\ncorresponding provision of different wording approved by the\nD of\n\nthis section, no such policy delivered or issued for delivery to any\n\nperson in this state shall contain provisions respecting the matters\n\nset forth below unless such provisions are in the words in which the\n\nsame appear in this section; provided, however, that the insurer\n\nmay, at its option, use in lieu of any such provision a\n\ncorresponding provision of different wording approved by the\n\nInsurance Commissioner which is not less favorable in any respect to\n\nthe insured or the beneficiary. Any such provision contained in the\n\npolicy shall be preceded individually by the appropriate caption\n\nappearing in this subsection or, at the option of the insurer, by\n\nsuch appropriate individual or group captions or subcaptions as the\n\nInsurance Commissioner may approve.\n\n1. A provision as follows: CHANGE OF OCCUPATION: If the\n\ninsured be injured or contract sickness after having changed his\n\noccupation to one classified by the insurer as more hazardous than\n\nthat stated in this policy or while doing for compensation anything\n\npertaining to an occupation so classified, the insurer will pay only\n\nsuch portion of the indemnities provided in this policy as the\n\npremium paid would have purchased at the rates and within the limits\n\nfixed by the insurer for such more hazardous occupation. If the\n\ninsured changes his occupation to one classified by the insurer as\n\nless hazardous than that stated in this policy, the insurer, upon\n\nreceipt of proof of such change of occupation, will reduce the\n\npremium rate accordingly, and will return the excess pro rata\n\nunearned premium from the date of change of occupation or from the\n\npolicy anniversary date immediately preceding receipt of such proof,\n\nwhichever is the more recent. In applying this provision, the\n\nclassification of occupational risk and the premium rates shall be\n\nsuch as have been last filed by the insurer prior to the occurrence\n\nof the loss for which the insurer is liable or prior to date of\n\nproof of change in occupation with the state official having\n\nsupervision of insurance in the state where the insured resided at\n\nthe time this policy was issued; but if such filing was not\n\nrequired, then the classification of occupational risk and the\n\npremium rates shall be those last made effective by the insurer in\n\nsuch state prior to the occurrence of the loss or prior to the date\n\nof proof of change of occupation.\n\n2. A provision as follows: MISSTATEMENT OF AGE: If the age of\n\nthe insured has been misstated, all amounts payable under this\n\npolicy shall be such as the premium paid would have purchased at the\n\ncorrect age.\n\n3. A provision as follows: OTHER INSURANCE IN THIS INSURER:\n\nIf an accident or health or accident and health policy or\n\npolicies previously issued by the insurer to the insured be in force\n\nconcurrently herewith, making the aggregate indemnity for______\n\n(insert type of coverage or coverages) in excess of $______ (insert\n\nmaximum limit of indemnity or indemnities), the excess insurance\n\nshall be void and all premiums paid for such excess shall be\n\nreturned to the insured or to his estate; or, in lieu thereof:\n\nInsurance effective at any one time on the insured under a like\n\npolicy or policies in this insurer is limited to the one such policy\n\nelected by the insured, his beneficiary or his estate, as the case\n\nmay be, and the insurer will return all premiums paid for all other\n\nsuch policies.\n\n4. A provision as follows: INSURANCE WITH OTHER INSURERS:\nto the insured or to his estate; or, in lieu thereof:\n\nInsurance effective at any one time on the insured under a like\n\npolicy or policies in this insurer is limited to the one such policy\n\nelected by the insured, his beneficiary or his estate, as the case\n\nmay be, and the insurer will return all premiums paid for all other\n\nsuch policies.\n\n4. A provision as follows: INSURANCE WITH OTHER INSURERS:\n\n(a) If there be other valid coverage, not with this insurer,\n\nproviding benefits for the same loss on a provision of service basis\n\nor on an expense incurred basis and of which this insurer has not\n\nbeen given written notice prior to the occurrence or commencement of\n\nloss, the only liability under any expense incurred coverage of this\n\npolicy shall be for such proportion of the loss as the amount which\n\nwould otherwise have been payable hereunder plus the total of the\n\nlike amounts under all such other valid coverages for the same loss\n\nof which this insurer had notice bears to the total like amounts\n\nunder all valid coverages for such loss, and for the return of such\n\nportion of the premiums paid as shall exceed the pro rata portion\n\nfor the amount so determined. For the purpose of applying this\n\nprovision when other coverage is on a provision of service basis,\n\nthe \"like amount\" of such other coverage shall be taken as the\n\namount which the services rendered would have cost in the absence of\n\nsuch coverage.\n\n(b) If the foregoing policy provision is included in a policy\n\nwhich also contains the next following policy provision, there shall\n\nbe added to the caption of the foregoing provision the phrase\n\n\"Expense Incurred Benefits\". The insurer may, at its option,\n\ninclude in this provision a definition of \"other valid coverage\",\n\napproved as to form by the Insurance Commissioner, which definition\n\nshall be limited in subject matter to coverage provided by\n\norganizations subject to regulation by insurance law or by insurance\n\nauthorities of this or any other state of the United States or any\n\nprovince of Canada, and by hospital or medical service\n\norganizations, and to any other coverage the inclusion of which may\n\nbe approved by the Insurance Commissioner. In the absence of such\n\ndefinition such term shall not include group insurance, automobile\n\nmedical payments insurance, or coverage provided by hospital or\n\nmedical service organizations or by union welfare plans or employer\n\nor employee benefit organizations. For the purpose of applying the\n\nforegoing policy provision with respect to any insured, any amount\n\nof benefit provided for such insured pursuant to any compulsory\n\nbenefit statute (including any workers' compensation or employer's\n\nliability statute), whether provided by a governmental agency or\n\notherwise, shall in all cases be deemed to be \"other valid coverage\"\n\nof which the insurer has had notice. In applying the foregoing\n\npolicy provision no third party liability coverage shall be included\n\nas \"other valid coverage\".\n\n5. A provision as follows: INSURANCE WITH OTHER INSURERS:\n\n(a) If there be other valid coverage, not with this insurer,\n\nproviding benefits for the same loss on other than an expense\n\nincurred basis and of which this insurer has not been given written\n\nnotice prior to the occurrence or commencement of loss, the only\n\nliability for such benefits under this policy shall be for such\n\nportion of the indemnities otherwise provided hereunder for such\n\nloss as the like indemnities, of which the insurer had notice\n\n(including the indemnities under this policy), bear to the total\n\namount of all like indemnities for such loss, and for the return of\n\nsuch portion of the premium paid as shall exceed the pro rata\n\nportion for the indemnities thus determined.\nis policy shall be for such\n\nportion of the indemnities otherwise provided hereunder for such\n\nloss as the like indemnities, of which the insurer had notice\n\n(including the indemnities under this policy), bear to the total\n\namount of all like indemnities for such loss, and for the return of\n\nsuch portion of the premium paid as shall exceed the pro rata\n\nportion for the indemnities thus determined.\n\n(b) If the foregoing policy provision is included in a policy\n\nwhich also contains the next preceding policy provision, there shall\n\nbe added to the caption of the foregoing provision the phrase \"Other\n\nBenefits\". The insurer may, at its option, include in this\n\nprovision a definition of \"other valid coverage\", approved as to\n\nform by the Insurance Commissioner, which definition shall be\n\nlimited in subject matter to coverage provided by organizations\n\nsubject to regulation by insurance law or by insurance authorities\n\nof this or any other state of the United States or any province of\n\nCanada, and to any other coverage the inclusion of which may be\n\napproved by the Insurance Commissioner. In the absence of such\n\ndefinition, such term shall not include group insurance or benefits\n\nprovided by union welfare plans or by employer or employee benefit\n\norganizations. For the purpose of applying the foregoing policy\n\nprovision with respect to any insured, any amount of benefit\n\nprovided for such insured pursuant to any compulsory benefit statute\n\n(including any workers' compensation or employer's liability\n\nstatute) whether provided by a governmental agency or otherwise,\n\nshall in all cases be deemed to be \"other valid coverage\" of which\n\nthe insurer has had notice. In applying the foregoing policy\n\nprovision, no third party liability coverage shall be included as\n\n\"other valid coverage\".\n\n6. A provision as follows: RELATION OF EARNINGS TO INSURANCE:(a) If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether\n\npayable on a weekly or monthly basis, shall exceed the monthly\n\nearnings of the insured at the time disability commenced or his\n\naverage monthly earnings for the period of two (2) years immediately\n\npreceding a disability for which claim is made, whichever is the\n\ngreater, the insurer will be liable only for such proportionate\n\namount of such benefits under this policy as the amount of such\n\nmonthly earnings or such average monthly earnings of the insured\n\nbears to the total amount of monthly benefits for the same loss\n\nunder all such coverage upon the insured at the time such disability\n\ncommences and for the return of such part of the premiums paid\n\nduring such two (2) years as shall exceed the pro rata amount of the\n\npremiums for the benefits actually paid hereunder; but this shall\n\nnot operate to reduce the total monthly benefits payable under all\n\nsuch coverage upon the insured below the sum of Two Hundred Dollars\n\n($200.00) or the sum of the monthly benefits specified in such\n\ncoverages, whichever is the lesser, nor shall it operate to reduce\n\nbenefits other than those payable for loss of time.\nount of the\n\npremiums for the benefits actually paid hereunder; but this shall\n\nnot operate to reduce the total monthly benefits payable under all\n\nsuch coverage upon the insured below the sum of Two Hundred Dollars\n\n($200.00) or the sum of the monthly benefits specified in such\n\ncoverages, whichever is the lesser, nor shall it operate to reduce\n\nbenefits other than those payable for loss of time.\n\n(b) The foregoing policy provision may be inserted only in a\n\npolicy which the insured has the right to continue in force subject\n\nto its terms by the timely payment of premiums (i) until at least\n\nfifty (50) years of age or, (ii) in the case of a policy issued to a\n\nperson older than forty-four (44) years of age, for at least five\n\n(5) years from its date of issue. The insurer may, at its option,\n\ninclude in this provision a definition of \"valid loss of time\n\ncoverage\", approved as to form by the Insurance Commissioner, which\n\ndefinition shall be limited in subject matter to coverage provided\n\nby governmental agencies or by organizations subject to regulation\n\nby insurance law or by insurance authorities of this or any other\n\nstate of the United States or any province of Canada, or to any\n\nother coverage the inclusion of which may be approved by the\n\nInsurance Commissioner or any combination of such coverages. In the\n\nabsence of such definition, such term shall not include any coverage\n\nprovided for such insured pursuant to any compulsory benefit statute\n\n(including any workers' compensation or employer's liability\n\nstatute), or benefits provided by union welfare plans or by employer\n\nor employee benefit organizations.\n\n7. A provision as follows: UNPAID PREMIUM: Upon the payment\n\nof a claim under this policy, any premium then due and unpaid or\n\ncovered by any note or written order may be deducted therefrom.\n\n8. A provision as follows: CONFORMITY WITH STATE STATUTES: Any\n\nprovision of this policy which, on its effective date, is in\n\nconflict with the statutes of the state in which the insured resides\n\non such date is hereby amended to conform to the minimum\n\nrequirements of such states.\n\n9. A provision as follows: ILLEGAL OCCUPATION: The insurer\n\nshall not be liable for any loss to which a contributing cause was\n\nthe insured's commission of or attempt to commit a felony or to\n\nwhich a contributing cause was the insured's being engaged in an\n\nillegal occupation.\n\n10. A provision as follows: NARCOTICS: The insurer shall not\n\nbe liable for any loss sustained or contracted in consequence of the\n\ninsured's being under the influence of any narcotic unless\n\nadministered on the advice of a physician.\n\n11. A provision as follows: CONTINUITY OF COVERAGE: If\n\ncoverage otherwise terminates as to covered family members, other\n\nthan for nonpayment of premium, nonrenewal of the policy or the\n\nexpiration of the term for which the policy is issued, a covered\n\nperson (other than one eligible for Medicare or any other similar\n\nfederal program), including the spouse and any covered dependent\n\nchild of the last-named insured or the representative of such child,\n\nshall have the right to the continuation of coverage under\n\nprovisions which, at the option of the insurer, are consistent with\n\neither the continuation of the policy with the person exercising the\n\nright of continuation designated as the named insured; or the\n\nissuance of a converted policy with the person exercising the\n\nconversion right designated as the named insured. Where\n\ncontinuation of coverage or conversion is made in the name of the\n\nspouse of the named insured, such coverage may, at the option of\n\nsuch spouse, include covered dependent children for whom such spouse\n\nhas responsibility for care and support. The person who accepts the\n\nconversion policy shall become the insured and pay the premiums\n\ndirect to the insurer.\ndesignated as the named insured. Where\n\ncontinuation of coverage or conversion is made in the name of the\n\nspouse of the named insured, such coverage may, at the option of\n\nsuch spouse, include covered dependent children for whom such spouse\n\nhas responsibility for care and support. The person who accepts the\n\nconversion policy shall become the insured and pay the premiums\n\ndirect to the insurer.\n\n(a) Coverage continued through the issuance of a converted\n\npolicy shall consist of a form of coverage then being offered by the\n\ninsurer as a conversion policy in the jurisdiction where the person\n\nexercising the conversion right resides. Continued and converted\n\ncoverages, other than those provided through the exercise of\n\ncontinuation or conversion rights contained in optionally renewable\n\nor limited right of renewal contracts, shall contain provisions\n\nunder which the person exercising the continuation or conversion\n\nshall have the right to renew the coverage until the attainment of\n\nthe age of eligibility for Medicare or any other similar federal or\n\nstate health insurance program subject to the right of the insurer\n\nto nonrenew all such policies in this state as a class, or, other\n\nrenewal provisions that are not less favorable to the insured than\n\nthose contained in the policy from which conversion is exercised.\n\n(b) Coverage provided through continuation or conversion shall\n\nbe without additional evidence of insurability except as to\n\noverinsurance, and shall not impose any preexisting condition\n\nlimitations or other contractual time limitations other than those\n\nremaining unexpired under the policy or contract from which\n\ncontinuation or conversion is exercised.\n\n(c) Benefits otherwise payable under a converted policy may be\n\nreduced so they are not, during the first policy year of the\n\nconverted policy, in excess of those that would have been payable\n\nhad the coverage under the policy from which conversion is exercised\n\nnot terminated, and by the amount of benefits, if any, payable as to\n\nthe same loss under the policy from which conversion is exercised.\n\n(d) The insurer shall not be required to issue a converted\n\npolicy if at the time of application therefor other coverage exists\n\nunder other health insurance policies, hospital or medical service\n\nplan corporation contracts, health maintenance organization plans or\n\nself-insured health benefit plans providing similar benefits, or if\n\nthe applicant for the converted policy is eligible for coverage\n\nunder a group policy or contract providing similar benefits, or is\n\nprovided with similar benefits required by any statute, or is\n\ncovered under any national, state or governmental plan, which\n\ntogether with the converted policy would result in overinsurance\n\naccording to the insurer's underwriting standards.\n\nThe provisions of this paragraph shall apply to individual\n\nfamily health insurance policies providing hospital, surgical and\n\nmedical expense benefits or hospital confinement indemnity benefits,\n\nindividual family hospital and medical service plan corporation\n\ncontracts, and family health maintenance organization contracts,\n\ndelivered or issued for delivery in the State of Oklahoma but shall\n\nnot apply to disability income policies, accidental death or\n\ndismemberment policies nor to single-term, nonrenewable policies.\n\nC. 1. The terms \"noncancelable\" and \"guaranteed renewable\" may\n\nbe used only in a policy which the insured has the right to continue\n\nin force by the timely payment of premiums set forth in the policy\n\nuntil a person is at least fifty (50) years of age, or in the case\n\nof a policy issued to a person older than forty-four (44) years of\n\nage, for at least five (5) years from its date of issue, during\n\nwhich period the insurer has no right to make unilaterally any\n\nchange in any provision of the policy while the policy is in force.\n\n2. Except as provided in paragraph 1 of this subsection, the\nlicy\n\nuntil a person is at least fifty (50) years of age, or in the case\n\nof a policy issued to a person older than forty-four (44) years of\n\nage, for at least five (5) years from its date of issue, during\n\nwhich period the insurer has no right to make unilaterally any\n\nchange in any provision of the policy while the policy is in force.\n\n2. Except as provided in paragraph 1 of this subsection, the\n\nterm \"guaranteed renewable\" may be used only in a policy which the\n\ninsured has the right to continue in force by the timely payment of\n\npremiums by the insured until fifty (50) years of age, or in the\n\ncase of a policy issued to an insured who is older than forty-four\n\n(44) years of age, for at least five (5) years from its date of\n\nissue, during which period the insurer has no right to make\n\nunilaterally any change in any provision of the policy while the\n\npolicy is in force, except that the insurer may make changes in\n\npremium rates by classes.\n\nThe foregoing limitation on the use of the term \"noncancelable\"\n\nshall also apply to any synonymous term such as \"guaranteed\n\ncontinuable\".\n\nNothing contained in this subsection is intended to restrict the\n\ndevelopment of policies having other guarantees of renewability, or\n\nto prevent the accurate description of their terms of renewability\n\nor the classification of such policies as guaranteed renewable or\n\nnoncancelable for any period during which they may actually be such,\n\nprovided the terms used to describe them in policy contracts and\n\nadvertising are not such as may readily be confused with the above\n\nterms.\n\nD. Inapplicable or Inconsistent Provisions. If any provision\n\nof this section is in whole or in part inapplicable to or\n\ninconsistent with the coverage provided by a particular form of\n\npolicy, the insurer, with the approval of the Insurance\n\nCommissioner, shall omit from such policy any inapplicable provision\n\nor part of a provision, and shall modify any inconsistent provision\n\nor part of the provision in such manner as to make the provision as\n\ncontained in the policy consistent with the coverage provided by the\n\npolicy.\n\nE. Order of Certain Policy Provisions. The provisions which\n\nare the subject of subsections A and B of this section, or any\n\ncorresponding provisions which are used in lieu thereof in\n\naccordance with such subsections, shall be printed in the\n\nconsecutive order of the provisions in such subsections or, at the\n\noption of the insurer, any such provision may appear as a unit in\n\nany part of the policy, with other provisions to which it may be\n\nlogically related, provided the resulting policy shall not be in\n\nwhole or in part unintelligible, uncertain, ambiguous, abstruse, or\n\nlikely to mislead a person to whom the policy is offered, delivered\n\nor issued.\n\nF. Third Party Ownership. The word \"insured\", as used in this\n\narticle, shall not be construed as preventing a person other than\n\nthe insured with a proper insurable interest from making application\n\nfor and owning a policy covering the insured or from being entitled\n\nunder such a policy to any indemnities, benefits and rights provided\n\ntherein.\n\nG. Employer Designated as Beneficiary. No employer shall be\n\ndesignated or appointed as beneficiary of an employee or receive any\n\nbenefits under an individual or group accident and health policy\n\nsolely by reason of the employer-employee relationship; provided,\n\nhowever, this subsection shall not prevent the designation or\n\nappointment of an employer as beneficiary under a policy of accident\n\nand health insurance on any valuable or key employee of such\n\nemployer.\n\nH. Requirements of Other Jurisdictions. 1. Any policy of a\n\nforeign or alien insurer, when delivered or issued for delivery to\n\nany person in this state, may contain any provision which is not\n\nless favorable to the insured or the beneficiary than the provisions\n\nof this article and which is prescribed or required by the law of\nd health insurance on any valuable or key employee of such\n\nemployer.\n\nH. Requirements of Other Jurisdictions. 1. Any policy of a\n\nforeign or alien insurer, when delivered or issued for delivery to\n\nany person in this state, may contain any provision which is not\n\nless favorable to the insured or the beneficiary than the provisions\n\nof this article and which is prescribed or required by the law of\n\nthe state under which the insurer is organized.\n\n2. Any policy of a domestic insurer may, when issued for\n\ndelivery in any other state or country, contain any provision\n\npermitted or required by the laws of such other state or country.\n\nI. Filing Procedure. The Insurance Commissioner may make such\n\nreasonable rules and regulations concerning the procedure for the\n\nfiling or submission of policies subject to this article as are\n\nnecessary, proper or advisable to the administration of this\n\narticle. This provision shall not abridge any other authority\n\ngranted the Insurance Commissioner by law.","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":"30c71e4d7b64c55590b3c435275feff9c24127a5070858f7470e392d6a4271c1","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-4404","next":"us-ok/okla.-stat.-tit.-36-36-4405.1"},"notice":"GroundRules: Original legal text. Not legal advice."}