{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6908","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6908","heading":"Group or individual contract - Delivery - Required","body":"provisions - Evidence of coverage - Filing and review of forms.\n\nA. 1. Every group and individual contract holder is entitled\n\nto a group or individual contract which may be delivered through\n\nelectronic means or methods; provided, a member may request a\n\nprinted copy from the health maintenance organization if the member\n\ncannot view and print such electronic copy.\n\n2. The contract shall not contain provisions or statements\n\nwhich are unjust, unfair, inequitable, misleading, deceptive, or\n\nwhich encourage misrepresentation as defined by Articles 12 and 12A-\n\n1 of the Insurance Code.\n\n3. The contract shall contain a clear statement of the\n\nfollowing:\n\na. the name and address of the health maintenance\n\norganization,\n\nb. eligibility requirements,\n\nc. benefits and services within the service area,\n\nd. emergency care benefits and services,\n\ne. out of area benefits and services, if any,\n\nf. copayments, deductibles or other out-of-pocket\n\nexpenses,\n\ng. limitations and exclusions,\n\nh. enrollee termination,\n\ni. enrollee reinstatement, if any,\n\nj. claims procedures,\n\nk. enrollee grievance procedures,\n\nl. continuation of coverage,\n\nm. conversion,\n\nn. extension of benefits, if any,\n\no. coordination of benefits, if applicable,\n\np. subrogation, if any,\n\nq. description of the service area,\n\nr. entire contract provision,\n\ns. term of coverage,\n\nt. cancellation of group or individual contract holder,\n\nu. renewal,\n\nv. reinstatement of group or individual contract holder,\n\nif any,\n\nw. grace period, and\n\nx. conformity with state law.\n\nAn evidence of coverage may be filed as part of the group\n\ncontract to describe the provisions required in this paragraph.\n\nB. In addition to those provisions required in paragraph 3 of\n\nsubsection A of this section, an individual contract shall provide\n\nfor a ten-day period to examine and return the contract and to\n\nrefund any premiums. If services were received during the ten-day\n\nperiod, and the subscriber returns the contract to receive a refund\n\nof the premium paid, he or she must pay for those services.\n\nC. 1. Every subscriber shall receive an evidence of coverage\n\nfrom the group contract holder or the health maintenance\n\norganization.\n\n2. The evidence of coverage shall not contain provisions or\n\nstatements that are unfair, unjust, inequitable, misleading,\n\ndeceptive, or that encourage misrepresentation as defined by\n\nArticles 12 and 12A-1 of the Insurance Code.\n\n3. The evidence of coverage shall contain a clear statement of\n\nthe provisions required in paragraph 3 of subsection A of this\n\nsection.\n\nD. Every health maintenance organization doing business in this\n\nstate shall comply with the provisions of Article 36A of the\n\nInsurance Code.\n\nE. No group or individual contract, evidence of coverage or\n\namendment thereto, shall be delivered or issued for delivery in this\n\nstate, unless its form has been filed with and approved by the\n\nInsurance Commissioner, subject to the provisions of subsections F\n\nand G of this section.\n\nF. If an evidence of coverage issued pursuant to and\n\nincorporated in a contract issued in this state is intended for\n\ndelivery in another state and the evidence of coverage has been\n\napproved for use in the state in which it is to be delivered, the\n\nevidence of coverage need not be submitted to the Insurance\n\nCommissioner of this state for approval.\n\nG. 1. Every form required by this section shall be filed with\n\nthe Insurance Commissioner not less than thirty (30) days prior to\n\ndelivery or issue for delivery in this state. At any time during\n\nthe initial thirty-day period, the Insurance Commissioner may extend\n\nthe period for review an additional thirty (30) days. Notice of an\n\nextension shall be in writing. At the end of the review period, the\n\nform is deemed approved if the Insurance Commissioner has taken no\n\naction. The filer must notify the Insurance Commissioner in writing\n\nprior to using a form that is deemed approved.\ne during\n\nthe initial thirty-day period, the Insurance Commissioner may extend\n\nthe period for review an additional thirty (30) days. Notice of an\n\nextension shall be in writing. At the end of the review period, the\n\nform is deemed approved if the Insurance Commissioner has taken no\n\naction. The filer must notify the Insurance Commissioner in writing\n\nprior to using a form that is deemed approved.\n\n2. At any time, after thirty (30) days' notice and for cause\n\nshown, the Insurance Commissioner may withdraw approval of a form,\n\neffective at the end of the thirty (30) days.\n\n3. When a filing is disapproved or approval of a form is\n\nwithdrawn, the Insurance Commissioner shall give the health\n\nmaintenance organization written notice of the reasons for\n\ndisapproval and in the notice shall inform the health maintenance\n\norganization that within thirty (30) days of receipt of the notice\n\nthe health maintenance organization may request a hearing. A\n\nhearing shall be conducted within thirty (30) days after the\n\nInsurance Commissioner has received the request for hearing.\n\nH. The Insurance Commissioner may require the submission of\n\nrelevant information he or she deems necessary in determining\n\nwhether to approve or disapprove a filing made pursuant to this\n\nsection.","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":"0ef6e776c22d8a9dd3ee33cc2421039720bf30fb875332b5d02e50460e10ac77","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6907","next":"us-ok/okla.-stat.-tit.-36-36-6909"},"notice":"GroundRules: Original legal text. Not legal advice."}