{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6519","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6519","heading":"Basic and standard health benefit plans - Condition of","body":"transacting business - Filing with Commissioner - Required\n\ncompliance with certain provisions - Exceptions.\n\nA. 1. As a condition of transacting business in this state\n\nwith small employers, every small employer carrier shall actively\n\noffer to small employers the health benefit plans currently being\n\nmarketed by the small employer carrier.\n\n2. a. A small employer carrier shall issue a health benefit\n\nplan to any eligible small employer that applies for a\n\nplan and agrees to make the required premium payments\n\nand to satisfy the other reasonable provisions of the\n\nhealth benefit plan not inconsistent with Section 6511\n\net seq. of this title.\n\nb. In the case of a small employer carrier that\n\nestablishes more than one class of business pursuant\n\nto Section 6514 of this title, the small employer\n\ncarrier shall maintain and issue to eligible small\n\nemployers all health benefit plans currently being\n\nmarketed in each class of business so established. A\n\nsmall employer carrier may apply reasonable criteria\n\nto determine the class of business applicable to any\n\nsmall employer, provided that:\n\n(1) the criteria are not intended to discourage or\n\nprevent acceptance of small employers applying\n\nfor a health benefit plan,\n\n(2) the criteria are not related to the health status\n\nor claim experience of the small employer,\n\n(3) the criteria are applied consistently to all\n\nsmall employers applying for coverage in the\n\nclass of business, and\n\n(4) the small employer carrier provides for the\n\nacceptance of all eligible small employers into\n\none or more classes of business.\n\nThe provisions of this subparagraph shall not apply to\n\na class of business into which the small employer\n\ncarrier is no longer enrolling new small businesses.\n\n3. A small employer is eligible under paragraph 2 of this\n\nsubsection if it employed at least two or more eligible employees\n\nwithin this state on at least fifty percent (50%) of its working\n\ndays during the preceding calendar quarter. This also includes\n\nfamily businesses where employees of the business may be related.\n\nThe fact that the employees are related shall have no effect on the\n\neligibility for coverage of the small employer.\n\n4. A small employer carrier that offers a health benefit plan\n\nin the small employer market only through one or more bona fide\n\nassociation health plans is not required to offer that health\n\nbenefit plan to any small employer that is not a member of the bona\n\nfide association sponsoring the bona fide association health plan.\n\nB. 1. A small employer carrier shall file with the\n\nCommissioner, in a format and manner prescribed by the Commissioner,\n\nall health benefit plans to be used by the carrier. A health\n\nbenefit plan filed pursuant to this paragraph may be used by a small\n\nemployer carrier beginning sixty (60) days after it is filed unless\n\nthe Commissioner disapproves its use.\n\n2. Except as otherwise set forth in this title, the\n\nCommissioner at any time may, after providing notice and an\n\nopportunity for a hearing to the small employer carrier, disapprove\n\nthe continued use by a small employer carrier of any health benefit\n\nplan on the grounds that the plan does not meet the requirements of\n\nthe Small Employer Health Insurance Reform Act.\n\nC. Health benefit plans covering small employers shall comply\n\nwith the following provisions:\n\n1. A health benefit plan shall not deny, exclude or limit\n\nbenefits for a covered individual for losses incurred more than\n\ntwelve (12) months following the effective date of the individual's\n\ncoverage due to a preexisting condition. A health benefit plan\n\nshall not define a preexisting condition more restrictively than:\n\na. a condition that would have caused an ordinarily\n\nprudent person to seek medical advice, diagnosis, care\n\nor treatment during the six (6) months immediately\n\npreceding the effective date of coverage, or\ne (12) months following the effective date of the individual's\n\ncoverage due to a preexisting condition. A health benefit plan\n\nshall not define a preexisting condition more restrictively than:\n\na. a condition that would have caused an ordinarily\n\nprudent person to seek medical advice, diagnosis, care\n\nor treatment during the six (6) months immediately\n\npreceding the effective date of coverage, or\n\nb. a condition for which medical advice, diagnosis, care\n\nor treatment was recommended or received during the\n\nsix (6) months immediately preceding the effective\n\ndate of coverage;\n\n2. A health benefit plan may exclude coverage for late\n\nenrollees for the greater of eighteen (18) months or for an\n\neighteen-month preexisting condition exclusion; provided that if\n\nboth a period of exclusion from coverage and a preexisting condition\n\nexclusion are applicable to a late enrollee, the combined period\n\nshall not exceed eighteen (18) months from the date the individual\n\nenrolls for coverage under the health benefit plan;\n\n3. a. Except as provided in subparagraph d of this\n\nparagraph, requirements used by a small employer\n\ncarrier will be limited to requirements for minimum\n\nparticipation of eligible employees and minimum\n\nemployer contributions. These requirements shall be\n\napplied uniformly among all small employers with the\n\nsame number of eligible employees applying for\n\ncoverage or receiving coverage from the small employer\n\ncarrier.\n\nb. A small employer carrier may vary application of\n\nminimum participation requirements and minimum\n\nemployer contribution requirements only by the size of\n\nthe small employer group.\n\nc. (1) Except as provided in division (2) of this\n\nsubparagraph, in applying minimum participation\n\nrequirements with respect to a small employer, a\n\nsmall employer carrier shall not consider\n\nemployees or dependents who have qualifying\n\nexisting coverage in determining whether the\n\napplicable percentage of participation is met.\n\n(2) With respect to a small employer, a small\n\nemployer carrier may consider employees or\n\ndependents who have coverage under another health\n\nbenefit plan sponsored by a small employer in\n\napplying minimum participation requirements.\n\nd. A small employer carrier shall not increase any\n\nrequirement for minimum employee participation or any\n\nrequirement for minimum employer contribution\n\napplicable to a small employer at any time after the\n\nsmall employer has been accepted for coverage; and\n\n4. a. If a small employer carrier offers coverage to a small\n\nemployer, the small employer carrier shall offer\n\ncoverage to all of the eligible employees of a small\n\nemployer and their dependents. A small employer\n\ncarrier shall not offer coverage to only certain\n\nindividuals in a small employer group or to only part\n\nof the group, except in the case of late enrollees as\n\nprovided in paragraph 2 of this subsection.\n\nb. Except as permitted under paragraphs 1 and 2 of this\n\nsubsection, a small employer carrier shall not modify\n\na health benefit plan with respect to a small employer\n\nor any eligible employee or dependent, through riders,\n\nendorsements or otherwise, to restrict or exclude\n\ncoverage or benefits for specific diseases, medical\n\nconditions or services otherwise covered by the plan.\n\nD. The Commissioner shall develop, by rule, a uniform health\n\nquestionnaire for use by small employers applying for health\n\ninsurance coverage under group health plans offered by small\n\nemployer carriers. Small employer carriers shall be required to\n\naccept and use the uniform health questionnaire not more than six\nspecific diseases, medical\n\nconditions or services otherwise covered by the plan.\n\nD. The Commissioner shall develop, by rule, a uniform health\n\nquestionnaire for use by small employers applying for health\n\ninsurance coverage under group health plans offered by small\n\nemployer carriers. Small employer carriers shall be required to\n\naccept and use the uniform health questionnaire not more than six\n\n(6) months after the rules adopting the questionnaire become\n\neffective.\n\nE. 1. A small employer carrier shall not be required to offer\n\ncoverage or accept applications pursuant to subsection A of this\n\nsection in the case of the following:\n\na. to a small employer, where the small employer is not\n\nphysically located in the established geographic\n\nservice area of the carrier,\n\nb. to an employee, when the employee does not work or\n\nreside within the established geographic service area\n\nof the carrier, or\n\nc. within an area where the small employer carrier\n\nreasonably anticipates, and demonstrates to the\n\nsatisfaction of the Commissioner, that it will not\n\nhave the capacity within its established geographic\n\nservice area to deliver service adequately to the\n\nmembers of such groups because of its obligations to\n\nexisting group policyholders and enrollees.\n\n2. A small employer carrier that cannot offer coverage pursuant\n\nto subparagraph c of paragraph 1 of this subsection may not offer\n\ncoverage in the applicable area to new cases of employer groups with\n\nmore than fifty (50) eligible employees or to any small employer\n\ngroups until the later of one hundred eighty (180) days following\n\neach refusal or the date on which the carrier notifies the\n\nCommissioner that it has regained capacity to deliver services to\n\nsmall employer groups.\n\nF. A bona fide association health plan established pursuant to\n\nthis title to provide benefits to a particular trade, business,\n\nprofession or industry or their subsidiaries shall not issue\n\ncoverage to a group or individual that is not in the same trade,\n\nbusiness, profession or industry as that covered by the bona fide\n\nassociation health plan. The bona fide association health plan\n\nshall accept all employer groups in the same trade, business,\n\nprofession or industry or their subsidiaries that apply for coverage\n\nunder the arrangement and that meet the requirements for membership\n\nin the arrangement. For purposes of this subsection, the\n\nrequirements for membership in a bona fide association health plan\n\nshall not include any requirements that relate to the actual or\n\nexpected health status of the prospective enrollee.","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":"f112ad03882f083c15951f3018908cb38532c0214a59c06c8353b4be9f1c00cb","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6518","next":"us-ok/okla.-stat.-tit.-36-36-6526"},"notice":"GroundRules: Original legal text. Not legal advice."}