{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-4424","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-4424","heading":"Definitions","body":"Unless the context requires otherwise, the definitions in this\n\nsection apply throughout the Long-Term Care Insurance Act.\n\n1. a. \"Long-term care insurance\" means any insurance policy,\n\ncertificate or rider, including qualified long-term\n\ncare insurance contracts and long-term care\n\npartnership program contracts, which are advertised,\n\nmarketed, offered or designed primarily to provide\n\ncoverage for not less than twelve (12) consecutive\n\nmonths for each covered person on an expense incurred,\n\nindemnity, prepaid, or other basis, for one or more\n\nnecessary or medically necessary diagnostic,\n\npreventive, therapeutic, rehabilitative, maintenance,\n\nor personal care services, provided in a setting other\n\nthan an acute care unit of a hospital.\n\nb. This term includes group and individual health\n\npolicies or riders or group and individual life\n\npolicies or annuities or riders which provide,\n\ndirectly or as a supplement, coverage for long-term\n\ncare, whether issued by insurers, fraternal benefit\n\nsocieties, nonprofit health, hospital, and medical\n\nservice corporations, prepaid health plans, health\n\nmaintenance organizations, life care communities, or\n\nany similar organization.\n\nc. This term also includes a policy or rider which\n\nprovides for payment of long-term care benefits based\n\nupon cognitive impairment or the loss of functional\n\ncapacity.\n\nd. Long-term care insurance shall not include any\n\ninsurance policy which is offered primarily to provide\n\nbasic Medicare supplement coverage, basic hospital\n\nexpense coverage, basic medical-surgical expense\n\ncoverage, hospital confinement indemnity coverage,\n\nmajor medical expense coverage, disability income\n\nprotection coverage or related asset-protection\n\ncoverage, catastrophic coverage, comprehensive\n\ncoverage, accident only coverage, specified disease or\n\nspecified accident coverage, or limited benefit health\n\ncoverage.\n\ne. With regard to life insurance, this term does not\n\ninclude life insurance policies which accelerate the\n\ndeath benefit specifically for one or more of the\n\nqualifying events of terminal illness, medical\n\nconditions requiring extraordinary medical\n\nintervention, or permanent institutional confinement,\n\nand which provide the option of a lump-sum payment for\n\nthose benefits and in which neither the benefits nor\n\nthe eligibility for the benefits is conditioned upon\n\nthe receipt of long-term care.\n\nf. Notwithstanding any other provision contained herein,\n\nany product advertised, marketed or offered as long-\n\nterm care insurance shall be subject to the provisions\n\nof the Long-Term Care Act.\n\n2. \"Applicant\" means:\n\na. in the case of an individual long-term care insurance\n\npolicy, the person who seeks to contract for such\n\nbenefits, and\n\nb. in the case of a group long-term care insurance\n\npolicy, the proposed certificate holder.\n\n3. \"Certificate\" means any certificate issued under a group\n\nlong-term care insurance policy, which certificate has been\n\ndelivered, or issued for delivery, in this state.\n\n4. \"Group long-term care insurance\" means a long-term care\n\ninsurance policy which is delivered, or issued for delivery, in this\n\nstate and issued to:\n\na. one or more employers or labor organizations, or to a\n\ntrust or to the trustees of a fund established by one\n\nor more employers or labor organizations, or a\n\ncombination thereof, for employees or former\n\nemployees, or a combination thereof or for members or\n\nformer members, or a combination thereof, of the labor\n\norganizations, or\n\nb. any professional, trade or occupational association\n\nfor its members or former or retired members, or\n\ncombination thereof, if such association:\n\n(1) is composed of individuals, all of whom are or\n\nwere actively engaged in the same profession,\n\ntrade or occupation, and\n\nr\n\nformer members, or a combination thereof, of the labor\n\norganizations, or\n\nb. any professional, trade or occupational association\n\nfor its members or former or retired members, or\n\ncombination thereof, if such association:\n\n(1) is composed of individuals, all of whom are or\n\nwere actively engaged in the same profession,\n\ntrade or occupation, and\n\n(2) has been maintained in good faith for purposes\n\nother than insurance, or\n\nc. an association, a trust, or the trustee or trustees of\n\na fund established, created, or maintained for the\n\nbenefit of members of one or more associations. Prior\n\nto advertising, marketing or offering such policy\n\nwithin this state, the association or associations, or\n\nthe insurer of the association or associations, shall\n\nfile evidence with the Insurance Commissioner that the\n\nassociation or associations shall have at the outset\n\nof transacting long-term care insurance in this state\n\na minimum of one hundred (100) persons in the\n\nassociation or associations and shall have been\n\norganized and maintained in good faith for purposes\n\nother than that of obtaining insurance; shall have\n\nbeen in active existence for at least one (1) year;\n\nand shall have a constitution and bylaws which provide\n\nthat (i) the association or associations hold regular\n\nmeetings not less than annually to further purposes of\n\nthe members, (ii) except for credit unions, the\n\nassociation or associations collect dues or solicit\n\ncontributions from members, and (iii) the members have\n\nvoting privileges and representation on the governing\n\nboard and committees. Thirty (30) days after such\n\nfiling the association or associations shall be deemed\n\nto satisfy such organizational requirements, unless\n\nthe Commissioner makes a finding that the association\n\nor associations do not satisfy those organizational\n\nrequirements, or\n\nd. a group other than as described in subparagraphs a, b\n\nand c of this paragraph, subject to a finding by the\n\nCommissioner that:\n\n(1) the issuance of the group policy is not contrary\n\nto the best interest of the public,\n\n(2) the issuance of the group policy would result in\n\neconomies of acquisition or administration, and\n\n(3) the benefits are reasonable in relation to the\n\npremiums charged.\n\n5. \"Not-for-Profit Life care community\" within the meaning of\n\nSection 1-853.1 of Title 63 of the Oklahoma Statutes means any not-\n\nfor-profit organization that enters into an arrangement pursuant to\n\nwhich a person contracts for a place of residence and personal care\n\nservices, including but not limited to services which progress from\n\nindependent living to semi-dependent nursing care to acute nursing\n\ncare, in consideration of an endowed prepayment, license or entry\n\nfee which has been actuarially established to meet the cost of the\n\npromised services and accommodations. For communities commencing\n\noperations after January 1, 2016, the amount of the endowed\n\nprepayment must be independently, actuarially determined, in\n\ncompliance with the Actuarial Standards of Practice promulgated by\n\nthe Actuarial Standards Board of the American Academy of Actuaries,\n\nprior to opening the community and annually thereafter to ensure\n\nthat sufficient payments are collected to meet the future services\n\nof the residents. The actuarial study shall take into consideration\n\nprojected or actual project costs, resident fees and charges,\n\nresident contract provisions and any other factors affecting the\n\noperation of the facility. It shall contain mortality and morbidity\n\ndata and an actuary's signed opinion that the proposed is feasible\n\nand that the study has been prepared in accordance with standards\n\nadopted by the American Academy of Actuaries. A not-for-profit life\n\ncare community shall not include the following:\n\na. traditional landlord and tenant agreements utilizing\n\nperiodic rental and security deposit payments,\n. It shall contain mortality and morbidity\n\ndata and an actuary's signed opinion that the proposed is feasible\n\nand that the study has been prepared in accordance with standards\n\nadopted by the American Academy of Actuaries. A not-for-profit life\n\ncare community shall not include the following:\n\na. traditional landlord and tenant agreements utilizing\n\nperiodic rental and security deposit payments,\n\nb. residential care homes licensed pursuant to the\n\nOklahoma Residential Care Act,\n\nc. assisted living centers and continuum of care\n\nfacilities licensed pursuant to the Oklahoma Continuum\n\nof Care and Assisted Living Act,\n\nd. facilities licensed pursuant to the Oklahoma Nursing\n\nHome Care Act, or\n\ne. any facility where the endowed prepayment, license or\n\nentry fee is less than Fifty Thousand Dollars\n\n($50,000.00).\n\n6. \"Policy\" means any policy, contract, certificate, subscriber\n\nagreement, rider or endorsement delivered, or issued for delivery,\n\nin this state by an insurer, fraternal benefit society, nonprofit\n\nhealth, hospital, or medical service corporation, prepaid health\n\nplan, health maintenance organization, life care community, or any\n\nsimilar organization.\n\n7. \"Qualified long-term care insurance contract\" means any:\n\na. individual or group insurance contract if the contract\n\nmeets the requirements of Section 7702(B) of the\n\nInternal Revenue Code, as amended, and if:\n\n(1) the only insurance protection provided under the\n\ncontract is coverage of qualified long-term care\n\nservices,\n\n(2) the contract does not pay or reimburse expenses\n\nincurred for services or items to the extent that\n\nsuch expenses are reimbursable under Title XVIII\n\nof the Social Security Act as amended, or would\n\nbe so reimbursable but for the application of a\n\ndeductible or coinsurance amount. The\n\nrequirements of this subparagraph do not apply to\n\ncontracts where Medicare is a secondary payor, or\n\nwhere the contract makes per diem or other\n\nperiodic payments without regard to expenses,\n\n(3) the contract is guaranteed renewable,\n\n(4) the contract does not provide for a cash\n\nsurrender value or other money that can be paid,\n\nassigned, pledged as collateral for a loan, or\n\nborrowed. All refunds of premiums and all\n\npolicyholder dividends or similar amounts, under\n\nsuch contract are to be applied as a reduction in\n\nfuture premiums or to increase future benefits,\n\nexcept that a refund of the aggregate premium\n\npaid under the contract may be allowed in the\n\nevent of death of the insured or a complete\n\nsurrender or cancellation of the contract, and\n\n(5) the contract contains the consumer protection\n\nprovisions set forth in Section 7702(B)(g) of the\n\nInternal Revenue Code, or\n\nb. life insurance contract which provides long-term care\n\ncoverage by rider or as part of the contract if the\n\ncontract complies with the applicable provisions of\n\nSection 7702(B) of the Internal Revenue Code, as\n\namended.\n\n8. \"Qualified long-term care services\" means necessary\n\ndiagnostic, preventive, therapeutic, curing, treating, mitigating,\n\nand rehabilitative services, and maintenance for personal care\n\nservices for which an insured is eligible under a qualified long-\n\nterm care insurance contract, and which are provided pursuant to a\n\nplan of care prescribed by a licensed health care practitioner.","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":"af00d16ad007381e1970f26e23a1138c8821e78440e9981e8b0001064904b2b1","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-4423","next":"us-ok/okla.-stat.-tit.-36-36-4426"},"notice":"GroundRules: Original legal text. Not legal advice."}