{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6515","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6515","heading":"Premium rates","body":"A. Premium rates for health benefit plans subject to the Small\n\nEmployer Health Insurance Reform Act shall be subject to the\n\nfollowing provisions:\n\n1. The rate manual developed for use by a small employer\n\ncarrier shall be filed and approved by the Insurance Commissioner\n\nprior to use. Any changes to the rate manual shall be filed and\n\napproved by the Insurance Commissioner prior to use. Every filing\n\nshall be made not less than thirty (30) days prior to the date the\n\nsmall employer carrier intends to implement the rates. The rate\n\nmanual so filed shall be deemed approved upon expiration of the\n\nthirty-day waiting period unless, prior to the end of the period, it\n\nhas been affirmatively approved or disapproved by order of the\n\nCommissioner. Approval of a rate manual by the Commissioner shall\n\nconstitute a waiver of any unexpired portion of the thirty-day\n\nwaiting period. The Commissioner may extend the period to approve\n\nor disapprove a rate manual by not more than an additional thirty\n\n(30) days by giving notice of such extension before expiration of\n\nthe initial thirty-day period. At the expiration of an extended\n\nperiod, the rate filing shall be deemed approved unless otherwise\n\napproved or disapproved by the Commissioner. The Commissioner may\n\nat any time, after notice and for cause shown, withdraw approval of\n\na filed rate;\n\n2. A small employer health benefit plan shall not be delivered\n\nor issued for delivery unless the policy form or certificate form\n\ncan be expected to return to policyholders and certificate holders\n\nin the form of aggregate benefits provided under the policy form or\n\ncertificate form at least sixty percent (60%) of the aggregate\n\namount of premiums earned. The rate of return shall be estimated\n\nfor the entire period for which rates are computed to provide\n\ncoverage. The rate of return shall be calculated on the basis of\n\nincurred claims experience or incurred health care expenses where\n\ncoverage is provided by a health maintenance organization on a\n\nservice rather than reimbursement basis and earned premiums for the\n\nperiod in accordance with accepted actuarial principles and\n\npractices;\n\n3. The index rate for a rating period for any class of business\n\nshall not exceed the index rate for any other class of business by\n\nmore than twenty percent (20%);\n\n4. For a class of business, the premium rates charged during a\n\nrating period to small employers with similar case characteristics\n\nfor the same or similar coverage, or the rates that could be charged\n\nto such employers under the rating system for that class of\n\nbusiness, shall not vary from the index rate by more than twenty-\n\nfive percent (25%) of the index rate;\n\n5. The percentage increase in the premium rate charged to a\n\nsmall employer for a new rating period may not exceed the sum of the\n\nfollowing:\n\na. the percentage change in the new business premium rate\n\nmeasured from the first day of the prior rating period\n\nto the first day of the new rating period. In the\n\ncase of a health benefit plan into which the small\n\nemployer carrier is no longer enrolling new small\n\nemployers, the small employer carrier shall use the\n\npercentage change in the base premium rate, provided\n\nthat the change does not exceed, on a percentage\n\nbasis, the change in the new business premium rate for\n\nthe most similar health benefit plan into which the\n\nsmall employer carrier is actively enrolling new small\n\nemployers,\n\nb. any adjustment, not to exceed fifteen percent (15%)\n\nannually and adjusted pro rata for rating periods of\n\nless than one year, due to the claim experience,\n\nhealth status or duration of coverage of the employees\n\nor dependents of the small employer as determined from\n\nthe rate manual for the class of business of the small\n\nemployer carrier, and\n\nc. any adjustment due to change in coverage or change in\n\nthe case characteristics of the small employer, as\n\ndetermined from the rate manual for the class of\nless than one year, due to the claim experience,\n\nhealth status or duration of coverage of the employees\n\nor dependents of the small employer as determined from\n\nthe rate manual for the class of business of the small\n\nemployer carrier, and\n\nc. any adjustment due to change in coverage or change in\n\nthe case characteristics of the small employer, as\n\ndetermined from the rate manual for the class of\n\nbusiness of the small employer carrier;\n\n6. Adjustments in rates for claim experience, health status and\n\nduration of coverage shall not be charged to individual employees or\n\ndependents. Any adjustment shall be applied uniformly to the rates\n\ncharged for all employees and dependents of the small employer;\n\n7. A small employer carrier may utilize industry as a case\n\ncharacteristic in establishing premium rates; provided, the highest\n\nrate factor associated with any industry classification shall not\n\nexceed the lowest rate factor associated with any industry\n\nclassification by more than fifteen percent (15%);\n\n8. In the case of health benefit plans issued prior to the\n\neffective date of the Small Employer Health Insurance Reform Act, a\n\npremium rate for a rating period may exceed the ranges set forth in\n\nparagraphs 3 and 4 of this subsection for a period of three (3)\n\nyears following the effective date of the Small Employer Health\n\nInsurance Reform Act. In such case, the percentage increase in the\n\npremium rate charged to a small employer for a new rating period\n\nshall not exceed the sum of the following:\n\na. the percentage change in the new business premium rate\n\nmeasured from the first day of the prior rating period\n\nto the first day of the new rating period. In the\n\ncase of a health benefit plan into which the small\n\nemployer carrier is no longer enrolling new small\n\nemployers, the small employer carrier shall use the\n\npercentage change in the base premium rate, provided\n\nthat the change does not exceed, on a percentage\n\nbasis, the change in the new business premium rate for\n\nthe most similar health benefit plan into which the\n\nsmall employer carrier is actively enrolling new small\n\nemployers, and\n\nb. any adjustment due to change in coverage or change in\n\nthe case characteristics of the small employer, as\n\ndetermined from the rate manual of the carrier for the\n\nclass of business;\n\n9. Small employer carriers shall:\n\na. apply rating factors, including case characteristics,\n\nconsistently with respect to all small employers in a\n\nclass of business. Rating factors shall produce\n\npremiums for identical groups within the same class of\n\nbusiness which differ only by amounts attributable to\n\nplan design and do not reflect differences due to\n\nclaims experience, health status and duration of\n\ncoverage, and\n\nb. treat all health benefit plans issued or renewed in\n\nthe same calendar month as having the same rating\n\nperiod;\n\n10. For the purposes of this subsection, a health benefit plan\n\nthat utilizes a restricted provider network shall not be considered\n\nsimilar coverage to a health benefit plan that does not utilize such\n\na network, provided that utilization of the restricted provider\n\nnetwork results in substantial differences in claims costs;\n\n11. The Insurance Commissioner may establish rules to implement\n\nthe provisions of this section and to assure that rating practices\n\nused by small employer carriers are consistent with the purposes of\n\nthe Small Employer Health Insurance Reform Act, including:\n\na. assuring that differences in rates charged for health\n\nbenefit plans by small employer carriers are\n\nreasonable and reflect objective differences in plan\n\ndesign, not including differences due to claims\n\nexperience, health status or duration of coverage, and\n\nb. prescribing the manner in which case characteristics\n\nmay be used by small employer carriers.\n\nB. A small employer carrier shall not transfer a small employer\nsmall employer carriers are\n\nreasonable and reflect objective differences in plan\n\ndesign, not including differences due to claims\n\nexperience, health status or duration of coverage, and\n\nb. prescribing the manner in which case characteristics\n\nmay be used by small employer carriers.\n\nB. A small employer carrier shall not transfer a small employer\n\ninvoluntarily into or out of a class of business. A small employer\n\ncarrier shall not offer to transfer a small employer into or out of\n\na class of business unless the offer is made to transfer all small\n\nemployers in the class of business without regard to case\n\ncharacteristics, claim experience, health status or duration of\n\ncoverage.\n\nC. The Commissioner may suspend for a specified period the\n\napplication of paragraph 3 of subsection A of this section as to the\n\npremium rates applicable to one or more small employers included\n\nwithin a class of business of a small employer carrier for one or\n\nmore rating periods upon a filing by the small employer carrier and\n\na finding by the Commissioner either that the suspension is\n\nreasonably necessary in light of the financial condition of the\n\nsmall employer carrier or that the suspension would enhance the\n\nefficiency and fairness of the marketplace for small employer health\n\ninsurance.\n\nD. Nothing in the Small Employer Health Insurance Reform Act\n\nshall prohibit a small employer carrier from including in premium\n\nrate development an employer's bona fide wellness program for its\n\nemployees including, but not limited to, a tobacco cessation\n\nprogram.","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":"2014c468006b4f6b8d66412c1b2eb43f4f41099c269b319337b31b59e6c90a60","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6514","next":"us-ok/okla.-stat.-tit.-36-36-6516"},"notice":"GroundRules: Original legal text. Not legal advice."}