{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6913","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6913","heading":"Minimum net worth required - Deposit with Insurance","body":"Commissioner - Determination of liabilities - Liability of\n\nsubscriber for health maintenance organization's debts - Insolvency\n\nplan - Notice of termination of agreement.\n\nA. 1. Before issuing any certificate of authority, the\n\nInsurance Commissioner shall require that the health maintenance\n\norganization have an initial net worth of One Million Five Hundred\n\nThousand Dollars ($1,500,000.00) and that the HMO shall thereafter\n\nmaintain the minimum net worth required under paragraph 2 of this\n\nsubsection.\n\n2. Except as provided in paragraphs 3 and 4 of this subsection,\n\nevery health maintenance organization shall maintain a minimum net\n\nworth equal to the greater of:\n\na. One Million Five Hundred Thousand Dollars\n\n($1,500,000.00),\n\nb. two percent (2%) of annual premium revenues as\n\nreported on the most recent annual financial statement\n\nfiled with the Commissioner on the first One Hundred\n\nFifty Million Dollars ($150,000,000.00) of premium and\n\none percent (1%) of annual premium on the premium in\n\nexcess of One Hundred Fifty Million Dollars\n\n($150,000,000.00),\n\nc. an amount equal to the sum of three (3) months of\n\nuncovered health care expenditures as reported on the\n\nmost recent financial statement filed with the\n\nCommissioner, or\n\nd. an amount equal to the sum of:\n\n(1) eight percent (8%) of annual health care\n\nexpenditures, except those paid on a capitated\n\nbasis or managed hospital payment basis, as\n\nreported on the most recent financial statement\n\nfiled with the Commissioner, and\n\n(2) four percent (4%) of annual hospital expenditures\n\npaid on a managed hospital payment basis, as\n\nreported on the most recent financial statement\n\nfiled with the Commissioner.\n\n3. Every health maintenance organization licensed before\n\nNovember 1, 2003, shall maintain a minimum net worth of the greater\n\nof Seven Hundred Fifty Thousand Dollars ($750,000.00) or:\n\na. twenty-five percent (25%) of the amount required by\n\nparagraph 2 of this subsection by December 31, 2003,\n\nb. fifty percent (50%) of the amount required by\n\nparagraph 2 of this subsection by December 31, 2004,\n\nc. seventy-five percent (75%) of the amount required by\n\nparagraph 2 of this subsection by December 31, 2005,\n\nand\n\nd. one hundred percent (100%) of the amount required by\n\nparagraph 2 of this subsection by December 31, 2006.\n\n4. a. In determining net worth, no debt shall be considered\n\nfully subordinated unless the subordination clause is\n\nin a form acceptable to the Commissioner. An interest\n\nobligation relating to the repayment of any\n\nsubordinated debt shall be similarly subordinated.\n\nb. The interest expenses relating to the repayment of a\n\nfully subordinated debt shall be considered covered\n\nexpenses.\n\nc. A debt incurred by a note meeting the requirements of\n\nthis section, and otherwise acceptable to the\n\nInsurance Commissioner, shall not be considered a\n\nliability and shall be recorded as equity.\n\nB. 1. Unless otherwise provided below, each health maintenance\n\norganization shall deposit with the Commissioner or, at the\n\ndiscretion of the Commissioner, with any organization or trustee\n\nacceptable to the Commissioner through which a custodial or\n\ncontrolled account is utilized, cash, securities, or any combination\n\nof these or other measures that are acceptable to the Commissioner,\n\nwhich at all times shall have a value of not less than Five Hundred\n\nThousand Dollars ($500,000.00).\n\n2. The deposit shall be an admitted asset of the health\n\nmaintenance organization in the determination of net worth.\n\n3. All income from deposits shall be an asset of the\n\norganization. A health maintenance organization that has made a\n\nsecurities deposit may withdraw that deposit or any part thereof\n\nafter making a substitute deposit of cash, securities, or any\n\ncombination of these or other measures of equal amount and value.\n\nAny securities shall be approved by the Commissioner before being\n\ndeposited or substituted.\nincome from deposits shall be an asset of the\n\norganization. A health maintenance organization that has made a\n\nsecurities deposit may withdraw that deposit or any part thereof\n\nafter making a substitute deposit of cash, securities, or any\n\ncombination of these or other measures of equal amount and value.\n\nAny securities shall be approved by the Commissioner before being\n\ndeposited or substituted.\n\n4. The deposit shall be used to protect the interests of the\n\nhealth maintenance organization's enrollees and to ensure\n\ncontinuation of health care services to enrollees. If a health\n\nmaintenance organization is placed in receivership or liquidation,\n\nthe deposit shall be an asset subject to the provisions of the\n\nUniform Insurers Liquidation Act.\n\n5. The Insurance Commissioner may reduce or eliminate the\n\ndeposit requirement if a health maintenance organization deposits\n\nwith the Commissioner or other official body of the state or\n\njurisdiction of domicile for the protection of all subscribers and\n\nenrollees of the health maintenance organization, wherever located,\n\ncash, acceptable securities or surety, and delivers to the\n\nCommissioner a certificate to that effect, duly authenticated by the\n\nappropriate state official holding the deposit.\n\nC. 1. Every health maintenance organization shall, when\n\ndetermining liabilities, include an amount estimated in the\n\naggregate to provide for:\n\na. any unearned premium,\n\nb. the payment of all claims for incurred health care\n\nexpenditures, whether reported or unreported, that are\n\nunpaid and for which the organization is or may be\n\nliable, and\n\nc. the expense of adjustment or settlement of those\n\nclaims.\n\n2. The liabilities shall be computed in accordance with rules\n\npromulgated by the Commissioner upon reasonable consideration of the\n\nascertained experience and character of the health maintenance\n\norganization.\n\nD. 1. Every contract between a health maintenance organization\n\nand a participating provider of health care services shall be in\n\nwriting and shall provide that, in the event the health maintenance\n\norganization fails to pay for health care services as set forth in\n\nthe contract, a subscriber or an enrollee shall not be liable to the\n\nprovider for any sums owed by the health maintenance organization.\n\n2. In the event that the participating provider contract has\n\nnot been reduced to writing as required by this subsection or that\n\nthe contract fails to contain the required prohibition, the\n\nparticipating provider shall not collect or attempt to collect from\n\na subscriber or an enrollee sums owed by the health maintenance\n\norganization.\n\n3. No participating provider or the provider's agent, trustee\n\nor assignee may maintain an action at law against a subscriber or\n\nenrollee to collect sums owed by the health maintenance\n\norganization.\n\nE. The Commissioner shall require that each health maintenance\n\norganization have a plan for handling insolvency that allows for\n\ncontinuation of benefits for the duration of the contract period for\n\nwhich premiums have been paid and continuation of benefits to\n\nsubscribers or enrollees who are confined on the date of insolvency\n\nin an inpatient facility until their discharge or expiration of\n\nbenefits. In considering such a plan, the Commissioner may require:\n\n1. Insurance to cover the expenses to be paid for continued\n\nbenefits after an insolvency;\n\n2. Provisions in provider contracts that obligate the provider\n\nto provide services for the duration of the period after the health\n\nmaintenance organization's insolvency for which premium payment has\n\nbeen made and until the enrollees' discharge from inpatient\n\nfacilities;\n\n3. Insolvency reserves;\n\n4. Acceptable letters of credit; or\n\n5. Any other arrangements to ensure continuation of benefits as\n\nspecified above.\n\nF. An agreement to provide health care services between a\nth\n\nmaintenance organization's insolvency for which premium payment has\n\nbeen made and until the enrollees' discharge from inpatient\n\nfacilities;\n\n3. Insolvency reserves;\n\n4. Acceptable letters of credit; or\n\n5. Any other arrangements to ensure continuation of benefits as\n\nspecified above.\n\nF. An agreement to provide health care services between a\n\nprovider and a health maintenance organization shall require that if\n\nthe provider terminates the agreement, the provider shall give the\n\norganization at least ninety (90) days' advance notice of such\n\ntermination.","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":"381cf16531b583b3b9433ea286a3f3d2c047c13bf6531a6f6777bae5e32985eb","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6912","next":"us-ok/okla.-stat.-tit.-36-36-6915"},"notice":"GroundRules: Original legal text. Not legal advice."}