{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6915","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6915","heading":"Insolvency - Replacement coverage - Reduction or","body":"exclusion of benefits.\n\nA. 1. In the event of an insolvency of a commercial health\n\nmaintenance organization, upon order of the Insurance Commissioner,\n\nall other carriers that participated in the enrollment process with\n\nthe insolvent health maintenance organization at a group’s last\n\nregular enrollment period shall offer the group’s enrollees of the\n\ninsolvent health maintenance organization a thirty-day enrollment\n\nperiod commencing upon the date of insolvency. Each carrier shall\n\noffer the enrollees of the insolvent health maintenance organization\n\nthe same coverages and rates offered to the enrollees of the group\n\nat its last regular enrollment period.\n\n2. If no other carrier had been offered to some groups enrolled\n\nin the insolvent health maintenance organization, or if the\n\nInsurance Commissioner determines that the other health benefit\n\nplans lack sufficient health care delivery resources to ensure that\n\nhealth care services will be available and accessible to all of the\n\ngroup enrollees of the insolvent health maintenance organization,\n\nthe Insurance Commissioner shall equitably allocate the insolvent\n\nhealth maintenance organization’s group contracts for these groups\n\namong all health maintenance organizations that operate within a\n\nportion of the insolvent health maintenance organization’s service\n\narea, taking into consideration the health care delivery resources\n\nof each health maintenance organization. Each health maintenance\n\norganization to which a group or groups are so allocated shall offer\n\nthe group or groups the health maintenance organization’s existing\n\ncoverage that is most similar to each group’s coverage with the\n\ninsolvent health maintenance organization, at rates determined in\n\naccordance with the successor health maintenance organization’s\n\nexisting rating methodology.\n\nB. 1. “Discontinuance” means the termination of the contract\n\nbetween the group contract holder and a health maintenance\n\norganization due to the insolvency of the health maintenance\n\norganization, and does not refer to the termination of any agreement\n\nbetween any individual enrollee and the health maintenance\n\norganization.\n\n2. Any carrier providing replacement coverage with respect to\n\ngroup hospital, medical or surgical expense or service benefits\n\nwithin a period of sixty-three (63) days from the date of\n\ndiscontinuance of a prior health maintenance organization contract\n\nor policy providing hospital, medical or surgical expense or service\n\nbenefits shall, as of the effective date of the replacement\n\ncoverage, cover all enrollees who were validly covered under the\n\nprevious health maintenance organization contract or policy at the\n\ndate of discontinuance and who would otherwise be eligible for\n\ncoverage under the succeeding carrier’s contract, regardless of any\n\nprovisions of the contract relating to active employment, hospital\n\nconfinement or pregnancy.\n\n3. Except to the extent benefits for the condition would have\n\nbeen reduced or excluded under the prior carrier’s contract or\n\npolicy, no provision in a succeeding carrier’s contract of\n\nreplacement coverage that would operate to reduce or exclude\n\nbenefits on the basis that the condition giving rise to benefits\n\npreexisted the effective date of the succeeding carrier’s contract\n\nshall be applied with respect to those enrollees validly covered\n\nunder the prior carrier’s contract or policy on the date of\n\ndiscontinuance.\n\n4. a. Upon being declared insolvent, a health maintenance\n\norganization shall provide to the Insurance\n\nCommissioner:\n\n(1) the names of all known enrollees who were validly\n\nenrolled under the insolvent HMO’s contract, or\nthe succeeding carrier’s contract\n\nshall be applied with respect to those enrollees validly covered\n\nunder the prior carrier’s contract or policy on the date of\n\ndiscontinuance.\n\n4. a. Upon being declared insolvent, a health maintenance\n\norganization shall provide to the Insurance\n\nCommissioner:\n\n(1) the names of all known enrollees who were validly\n\nenrolled under the insolvent HMO’s contract, or\n\n(2) policy information on validly enrolled enrollees\n\nwho are hospitalized or whose health conditions\n\nrequire continuity of care.\n\nb. The insolvent HMO shall continue to provide such\n\ninformation to the Insurance Commissioner throughout\n\nthe period of time required to provide replacement\n\ncoverage to the validly covered enrollees of the\n\ninsolvent HMO.","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":"b7703b84f590ec1fa4a6567c710dec6d692a68816dd9dbba9a4494698eba7e93","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6913","next":"us-ok/okla.-stat.-tit.-36-36-6916"},"notice":"GroundRules: Original legal text. Not legal advice."}