{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-4512","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-4512","heading":"Insured employer health benefit plans - 20 or more","body":"employees.\n\nA. This section applies to an insured employer health benefit\n\nplan providing health insurance to employees of employers employing\n\ntwenty (20) or more full-time or full-time-equivalent employees.\n\nB. An employer carrier, on written request from an insured\n\nemployer covered by that carrier, shall report to the employer\n\ninformation from the twelve (12) months preceding the date of the\n\nreport regarding:\n\n1. The total amount of charges submitted to the carrier for\n\npersons covered under the employer health benefit plan;\n\n2. The total amount of premium payments made by the\n\npolicyholder to the insured carrier;\n\n3. The total amount of payments made by the carrier to health\n\ncare providers for persons covered under the plan, including the\n\ntotal hospital charges, physician charges, and pharmaceutical\n\ncharges; and\n\n4. For any claims for an individual paid in excess of Ten\n\nThousand Dollars ($10,000.00), information on claims paid, including\n\ndiagnostic evaluations.\n\nC. An employer shall have to make a written request for\n\ninformation. The employer may make one request per year prior to\n\nthe anniversary or renewal date. In addition, prior to the date of\n\na rate change, an employer may make additional written requests for\n\nthe information, provided the employer shall not make more than one\n\nadditional request in any one (1) year.\n\nD. Except as otherwise provided in this subsection, an employer\n\ncarrier shall provide the information provided for in this section\n\nnot later than sixty (60) days before the anniversary or annual\n\nrenewal date, or thirty (30) days before the date of any rate change\n\naction of the employer's benefit plan. Provided, if the carrier\n\nreceives the request from the employer less than sixty (60) days\n\nbefore the anniversary or renewal date or less than thirty (30) days\n\nbefore the date of a rate change, the carrier shall have sixty (60)\n\ndays from the date of receiving the request to provide the\n\ninformation. Provided further, if the carrier requires the employer\n\nto submit any changes to the benefit plan prior to the anniversary\n\nor annual renewal date, the carrier shall provide the information\n\nnot later than sixty (60) days before the date the employer is\n\nrequired to submit any changes.\n\nE. An employer carrier shall not report any information\n\nrequired under this section if the release of such information is\n\nprohibited by federal law or regulation.\n\nF. Claim information provided by an employer carrier under this\n\nsection shall be provided in the aggregate, without information\n\nthrough which a specific individual covered by the health insurance\n\nor evidence or coverage may be identified. Claim information shall\n\ninclude the total claims made, the total claims paid, the total plan\n\ncharges and the head count by coverage.\n\nG. 1. If an employer carrier fails to provide the information\n\nin the time required by subsection D of this section, the Insurance\n\nCommissioner may, after notice and hearing, subject an insurer to a\n\ncivil penalty of One Hundred Dollars ($100.00) for each day that the\n\ninformation is delinquent.\n\n2. If an employer carrier has a risk-bearing contract with a\n\nmedical group, independent practice association (IPA), or management\n\nservices organization (MSO) that stipulates the delegation of claims\n\npayment, and the carrier satisfies the Insurance Commissioner that\n\nthe medical group, IPA, or MSO has failed to provide the information\n\nto the employer carrier in a sufficient time for the carrier to\n\ncomply with subsection D of this section, the Commissioner may waive\n\nthe penalty provided for in paragraph 1 of this subsection.\n\n3. The civil penalty may be enforced in the same manner in\n\nwhich civil judgments may be enforced, as provided in Section 312A\n\nof this title. Such penalties shall be placed in the State\n\nInsurance Commissioner Revolving Fund. Any person aggrieved by the\nhe carrier to\n\ncomply with subsection D of this section, the Commissioner may waive\n\nthe penalty provided for in paragraph 1 of this subsection.\n\n3. The civil penalty may be enforced in the same manner in\n\nwhich civil judgments may be enforced, as provided in Section 312A\n\nof this title. Such penalties shall be placed in the State\n\nInsurance Commissioner Revolving Fund. Any person aggrieved by the\n\ndetermination of the Insurance Commissioner may seek judicial review\n\npursuant to Section 320 of this title.\n\nH. The Insurance Commissioner shall promulgate rules for the\n\nimplementation and administration of this section.\n\nI. As used in this section, \"employer carrier\" means any entity\n\nwhich provides health insurance in this state. For the purposes of\n\nthis section, employer carrier includes a licensed insurance\n\ncompany, not-for-profit hospital service or medical indemnity\n\ncorporation, a fraternal benefit society, a health maintenance\n\norganization, a multiple employer welfare arrangement or any other\n\nentity providing a plan of health insurance or health benefits\n\nsubject to state insurance regulation.","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":"29cb28d2c88406f1a2e8eb538f6e43516651e6eac370507653a6d7d3069bd29d","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-4511","next":"us-ok/okla.-stat.-tit.-36-36-4513"},"notice":"GroundRules: Original legal text. Not legal advice."}