{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6920","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6920","heading":"Examination of affairs, programs, books, and records -","body":"Payment of expenses.\n\nA. A certificate of authority issued under the Health\n\nMaintenance Organization Act of 2003 may be suspended or revoked,\n\nand an application for a certificate of authority may be denied, if\n\nthe Insurance Commissioner finds that any of the following\n\nconditions exist:\n\n1. The health maintenance organization (HMO) is operating\n\nsignificantly in contravention of its basic organizational document\n\nor in a manner contrary to that described in any other information\n\nsubmitted under Section 6903 of this title, unless amendments to\n\nthose submissions have been filed with and approved by the Insurance\n\nCommissioner;\n\n2. The health maintenance organization issues an evidence of\n\ncoverage or uses a schedule of charges for health care services that\n\ndoes not comply with the requirements of Sections 6908 and 6916 of\n\nthis title;\n\n3. The health maintenance organization does not provide or\n\narrange for basic health care services;\n\n4. The Insurance Commissioner determines that:\n\na. the health maintenance organization does not meet the\n\nrequirements of Section 6907 of this title, or\n\nb. the health maintenance organization is unable to\n\nfulfill its obligations to furnish health care\n\nservices;\n\n5. The health maintenance organization is no longer financially\n\nresponsible and may reasonably be expected to be unable to meet its\n\nobligations to enrollees or prospective enrollees;\n\n6. The health maintenance organization has failed to correct,\n\nwithin the time frame prescribed by subsection C of this section,\n\nany deficiency occurring due to the health maintenance\n\norganization's prescribed minimum net worth being impaired;\n\n7. The health maintenance organization has failed to implement\n\nthe grievance procedures required by Section 6911 of this title in a\n\nreasonable manner to resolve valid complaints;\n\n8. The health maintenance organization, or any person on its\n\nbehalf, has advertised or merchandised its services in an untrue,\n\nmisrepresentative, misleading, deceptive or unfair manner;\n\n9. The continued operation of the health maintenance\n\norganization would be hazardous to its enrollees or to the public;\n\nor\n\n10. The health maintenance organization has otherwise failed to\n\ncomply with the provisions of the Health Maintenance Organization\n\nAct of 2003 or applicable rules promulgated by the Insurance\n\nCommissioner pursuant thereto.\n\nB. In addition to or in lieu of suspension or revocation of a\n\ncertificate of authority pursuant to the provisions of this section,\n\nan applicant or health maintenance organization who knowingly\n\nviolates the provisions of this section may be subject to an\n\nadministrative penalty of Five Thousand Dollars ($5,000.00) for each\n\noccurrence.\n\nC. The following shall apply when insufficient net worth is\n\nmaintained:\n\n1. Whenever the Insurance Commissioner finds that the net worth\n\nmaintained by any health maintenance organization subject to the\n\nprovisions of this act is less than the minimum net worth required\n\nto be maintained by Section 6913 of this title, the Insurance\n\nCommissioner shall give written notice to the health maintenance\n\norganization of the amount of the deficiency and require filing with\n\nthe Insurance Commissioner a plan for correction of the deficiency\n\nthat is acceptable to the Insurance Commissioner, and correction of\n\nthe deficiency within a reasonable time, not to exceed sixty (60)\n\ndays, unless an extension of time, not to exceed sixty (60)\n\nadditional days, is granted by the Insurance Commissioner. A\n\ndeficiency shall be deemed an impairment, and failure to correct the\n\nimpairment in the prescribed time shall be grounds for suspension or\n\nrevocation of the certificate of authority or for placing the health\n\nmaintenance organization in conservation, rehabilitation or\n\nliquidation; or\n\n2. Unless allowed by the Insurance Commissioner, no health\nal days, is granted by the Insurance Commissioner. A\n\ndeficiency shall be deemed an impairment, and failure to correct the\n\nimpairment in the prescribed time shall be grounds for suspension or\n\nrevocation of the certificate of authority or for placing the health\n\nmaintenance organization in conservation, rehabilitation or\n\nliquidation; or\n\n2. Unless allowed by the Insurance Commissioner, no health\n\nmaintenance organization or person acting on its behalf may,\n\ndirectly or indirectly, renew, issue or deliver any certificate,\n\nagreement or contract of coverage in this state, for which a premium\n\nis charged or collected, when the health maintenance organization\n\nwriting the coverage is impaired, and the fact of impairment is\n\nknown to the health maintenance organization or to the person;\n\nprovided, however, the existence of an impairment shall not prevent\n\nthe issuance or renewal of a certificate, agreement or contract when\n\nthe enrollee exercises an option granted under the plan to obtain a\n\nnew, renewed or converted coverage.\n\nD. A certificate of authority shall be suspended or revoked or\n\nan application or a certificate of authority denied or an\n\nadministrative penalty imposed only after compliance with the\n\nrequirements of this section.\n\n1. Suspension or revocation of a certificate of authority,\n\ndenial of an application, or imposition of an administrative penalty\n\nby the Insurance Commissioner, pursuant to the provisions of this\n\nsection, shall be by written order and shall be sent to the health\n\nmaintenance organization or applicant by certified or registered\n\nmail. The written order shall state the grounds, charges or conduct\n\non which the suspension, revocation or denial or administrative\n\npenalty is based. The health maintenance organization or applicant\n\nmay, in writing, request a hearing within thirty (30) days from the\n\ndate of mailing of the order. If no written request is made, the\n\norder shall be final upon the expiration of thirty (30) days.\n\n2. If the health maintenance organization or applicant requests\n\na hearing pursuant to the provisions of this section, the Insurance\n\nCommissioner shall issue a written notice of hearing and send such\n\nnotice to the health maintenance organization or applicant by\n\ncertified or registered mail stating:\n\na. a specific time for the hearing, which may not be less\n\nthan twenty (20) nor more than thirty (30) days after\n\nmailing of the notice of hearing, and\n\nb. that any hearing shall be held at the office of the\n\nInsurance Commissioner.\n\nAfter the hearing, or upon failure of the health maintenance\n\norganization to appear at the hearing, the Insurance Commissioner\n\nshall take whatever action is deemed necessary based on written\n\nfindings. The Insurance Commissioner shall mail the decision to the\n\nhealth maintenance organization or applicant.\n\nE. The provisions of the Administrative Procedures Act shall\n\napply to proceedings under this section to the extent they are not\n\nin conflict with the provisions of Section 313 of this title.\n\nF. If the certificate of authority of a health maintenance\n\norganization is suspended, the health maintenance organization shall\n\nnot, during the period of suspension, enroll any additional\n\nenrollees except newborn children or other newly acquired dependents\n\nof existing enrollees, and shall not engage in any advertising or\n\nsolicitation whatsoever.\n\nG. If the certificate of authority of a health maintenance\n\norganization is revoked, the HMO shall proceed, immediately\n\nfollowing the effective date of the order of revocation, to wind up\n\nits affairs and shall conduct no further business except as may be\n\nessential to the orderly conclusion of the affairs of the\n\norganization. The HMO shall engage in no further advertising or\n\nsolicitation whatsoever. The Insurance Commissioner may, by written\n\norder, permit further operation of the HMO if found to be in the\ntely\n\nfollowing the effective date of the order of revocation, to wind up\n\nits affairs and shall conduct no further business except as may be\n\nessential to the orderly conclusion of the affairs of the\n\norganization. The HMO shall engage in no further advertising or\n\nsolicitation whatsoever. The Insurance Commissioner may, by written\n\norder, permit further operation of the HMO if found to be in the\n\nbest interests of enrollees, to the end that enrollees will be\n\nafforded the greatest practical opportunity to obtain continuing\n\nhealth care coverage.","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":"34daeca065108c74f0e23083ae81cd5d4c36e55c796b82603f1bb3dd6e5db991","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6919","next":"us-ok/okla.-stat.-tit.-36-36-6922"},"notice":"GroundRules: Original legal text. Not legal advice."}