{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6903","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6903","heading":"Certificate of authority - Application requirements -","body":"Submission to Insurance Commissioner - Rules.\n\nA. Notwithstanding any law of this state to the contrary, any\n\nperson may apply to the Insurance Commissioner for a certificate of\n\nauthority to establish and operate a health maintenance organization\n\npursuant to the provisions of the Health Maintenance Organization\n\nAct of 2003. No person shall establish or operate a health\n\nmaintenance organization in this state without obtaining a\n\ncertificate of authority pursuant to the provisions of this act. A\n\nforeign corporation may qualify under this act, subject to its\n\nregistration to do business in this state as a foreign corporation\n\nand compliance with all provisions of this act and other applicable\n\nstate laws. All certificates of authority shall be perpetual and\n\nautomatically renewed as of March 1 of each year, unless the health\n\nmaintenance organization fails to qualify for renewal pursuant to\n\nthe provisions of this act and any other applicable provisions of\n\nTitle 36 of the Oklahoma Statutes.\n\nB. Any health maintenance organization that has previously\n\nreceived a certificate of authority from the State Commissioner of\n\nHealth, but has not received a certificate of authority from the\n\nInsurance Commissioner to operate as a health maintenance\n\norganization as of the effective date of this act shall submit an\n\napplication for a certificate of authority, as provided in\n\nsubsection C of this section, by March 1, 2004. Each applicant may\n\ncontinue to operate until such time as the Insurance Commissioner\n\nacts upon the application if the applicant continues to comply with\n\nthe provisions of Title 63 of the Oklahoma Statutes, the rules\n\npromulgated pursuant thereto by the State Board of Health as they\n\nexisted immediately prior to the effective date of this act, and\n\nadministrative orders entered by the State Commissioner of Health\n\nprior to the effective date of this act. In the event that an\n\napplication is denied under the provisions of Section 4 of this act,\n\nthe applicant shall thereafter be treated as a health maintenance\n\norganization whose certificate of authority has been revoked.\n\nC. Each application for a certificate of authority shall be\n\nverified by an officer or authorized representative of the\n\napplicant, shall be in a form prescribed by the National Association\n\nof Insurance Commissioners (NAIC), and shall be accompanied by the\n\nfollowing:\n\n1. A copy of the applicant’s organizational documents\n\nincluding, but not limited to, the articles of incorporation,\n\narticles of association, partnership agreement, trust agreement, or\n\nother applicable documents, and all amendments thereto;\n\n2. A copy of the bylaws, rules, regulations or similar\n\ndocument, if any, regulating the conduct of the internal affairs of\n\nthe applicant;\n\n3. A list of the names, addresses, official positions and\n\nbiographical information, on forms acceptable to the NAIC, of the\n\npersons who are to be responsible for the conduct of the affairs and\n\nday-to-day operations of the applicant, including all members of the\n\nboard of directors, board of trustees, executive committee or other\n\ngoverning board or committee, and the principal officers in the case\n\nof a corporation, or the partners or members in the case of a\n\npartnership or association;\n\n4. A copy of any contract form made or to be made between any\n\nclass of providers and the health maintenance organization, and a\n\ncopy of any contract made or to be made between third party\n\nadministrators, marketing consultants or persons listed in paragraph\n\n3 of this subsection and the health maintenance organization;\n\n5. A copy of the form of evidence of coverage to be issued to\n\nenrollees;\n\n6. A copy of the form of group contract, if any, to be issued\n\nto employers, unions, trustees or other organizations;\n\n7. Financial statements showing the applicant’s assets,\nants or persons listed in paragraph\n\n3 of this subsection and the health maintenance organization;\n\n5. A copy of the form of evidence of coverage to be issued to\n\nenrollees;\n\n6. A copy of the form of group contract, if any, to be issued\n\nto employers, unions, trustees or other organizations;\n\n7. Financial statements showing the applicant’s assets,\n\nliabilities and sources of financial support including, but not\n\nlimited to:\n\na. a copy of the applicant’s most recent, regular\n\ncertified financial statement,\n\nb. an unaudited current financial statement, and\n\nc. fully audited financial information as to the earnings\n\nand financial condition of each person controlling a\n\ndomestic health maintenance organization pursuant to\n\nthe provisions of subsection (c) of Section 1651 of\n\nTitle 36 of the Oklahoma Statutes for the preceding\n\nfive (5) fiscal years for each such acquiring party,\n\nor for such lesser period as such acquiring party and\n\nany predecessors thereof shall have been in existence,\n\nand similar unaudited information as of a date not\n\nearlier than ninety (90) days prior to the filing of\n\nthe statement; provided, however, the Insurance\n\nCommissioner shall have the discretionary ability to\n\nwaive the audit requirement based upon review of\n\nsubstantially similar financial disclosure statements\n\nsubmitted by the acquiring party;\n\n8. A financial feasibility plan that includes detailed\n\nenrollment projections, the methodology for determining premium\n\nrates to be charged during the first twelve (12) months of\n\noperations as certified by an actuary or other qualified person\n\nacceptable to the Insurance Commissioner, a projection of balance\n\nsheets, cash flow statements showing any capital expenditures,\n\npurchase and sale of investments and deposits with the state, and\n\nincome and expense statements anticipated from the start of\n\noperations until the organization has had net income for at least\n\none year, and a statement as to the sources of working capital as\n\nwell as any other sources of funding;\n\n9. A power of attorney duly executed by the applicant, if not\n\ndomiciled in this state, appointing the Insurance Commissioner, his\n\nor her successors in office and duly authorized deputies, as the\n\ntrue and lawful attorney of the applicant in and for this state upon\n\nwhom all lawful process in any legal action or proceeding against\n\nthe health maintenance organization on a cause of action arising in\n\nthis state may be served;\n\n10. A statement or map reasonably describing the geographic\n\narea or areas to be served;\n\n11. A description of the internal grievance procedures to be\n\nutilized for the investigation and resolution of enrollee complaints\n\nand grievances;\n\n12. A description of the proposed quality assurance program,\n\nincluding the formal organizational structure, methods for\n\ndeveloping criteria, procedures for comprehensive evaluation of the\n\nquality of care rendered to enrollees, and processes to initiate\n\ncorrective action and reevaluation when deficiencies in provider or\n\norganizational performance are identified;\n\n13. A description of the procedures to be implemented to meet\n\nthe protection against insolvency provisions of Section 13 of this\n\nact;\n\n14. A list of the names, addresses, and license numbers of all\n\nproviders with which the health maintenance organization has\n\nagreements;\n\n15. Other information the Insurance Commissioner may require to\n\nmake the determinations required in Section 4 of this act; and\n\n16. An original, along with copies, of all documents required\n\npursuant to the provisions of this subsection, with all required\n\nfees.\n\nD. 1. The Insurance Commissioner may promulgate rules for the\n\nproper administration of this act and to require a health\n\nmaintenance organization, subsequent to receiving its certificate of\n\nauthority, to submit the information, modifications or amendments to\nnd\n\n16. An original, along with copies, of all documents required\n\npursuant to the provisions of this subsection, with all required\n\nfees.\n\nD. 1. The Insurance Commissioner may promulgate rules for the\n\nproper administration of this act and to require a health\n\nmaintenance organization, subsequent to receiving its certificate of\n\nauthority, to submit the information, modifications or amendments to\n\nthe items described in subsection C of this section to the Insurance\n\nCommissioner, either for approval or for information only, prior to\n\nthe effectuation of the modification or amendment, or to require the\n\nhealth maintenance organization to indicate the modifications to\n\nboth the State Commissioner of Health and the Insurance Commissioner\n\nat the time of the next succeeding site visit or examination.\n\n2. Any modification or amendment for which the Insurance\n\nCommissioner’s approval is required shall be deemed approved unless\n\ndisapproved within thirty (30) days, provided that the Insurance\n\nCommissioner may postpone the action for such further time, not\n\nexceeding an additional sixty (60) days, as necessary for proper\n\nconsideration.","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":"a5277c31ad7a5e1357647d413f0121646263d1fe60bb72b236f26a0c309771d3","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6902","next":"us-ok/okla.-stat.-tit.-36-36-6903.1"},"notice":"GroundRules: Original legal text. Not legal advice."}