Oklahoma 2022 Regular Session

Oklahoma House Bill HB2678 Compare Versions

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	29	+	SENATE FLOOR VERSION
	30	+	March 29, 2021
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3	34		BILL NO. 2678 By: Marti, Mize, Munson,
4	35		McEntire, Echols, Roberts
5	36		(Dustin), Pfeiffer, Davis ,
6	37		Frix, Hardin (David),
7	38		Fugate and Waldron of the
8	39		House
9	40
10	41		and
11	42
12		-	McCortney, Rader, Jett,
13		-	Bullard and Bergstrom of
14		-	the Senate
15		-
	43	+	McCortney, Rader and Jett
	44	+	of the Senate
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20	49		An Act relating to insurance; amending 36 O.S. 2011,
21	50		Section 1250.5, as amended by Section 1, Chapter 105,
22	51		O.S.L. 2012 (36 O.S. Supp. 2020 , Section 1250.5),
23	52		which relates to the Unfair Claim s Settlement
24	53		Practices Act; expanding actions that constitute
25	54		unfair claims settlement practice s; and providing an
26	55		effective date.
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30		-	~~SUBJECT: Insurance~~
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32	61		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
33		-
34	62		SECTION 1. AMENDATORY 36 O.S. 2011, Section 1250.5, as
35	63		amended by Section 1, Chapter 105, O.S.L. 2012 (36 O.S. Supp. 2020,
36	64		Section 1250.5), is amended to read as follows:
37		-
38	65		Section 1250.5 Any of the following acts by an insurer, if
39	66		committed in violation of Section 1250.3 of this title, constitutes
40	67		an unfair claim settlement practice exclusive o f paragraph 16 of
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41	95		this section which shall be applicable solely to he alth benefit
42	96		plans:
43		-
44	97		1. Failing to fully disclose to first party claimants,
45		-	benefits, coverages, or other provisions of any insurance policy or ~~ENR. H. B. NO. 2678 Page 2~~
	98	+	benefits, coverages, or other provisions of any insurance policy or
46	99		insurance contract when the benefits, cover ages or other provisions
47	100		are pertinent to a claim;
48		-
49	101		2. Knowingly misrepresenting to claimants pertinent facts or
50	102		policy provisions relating to coverages at issue;
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52	103		3. Failing to adopt and implement reasonable standards for
53	104		prompt investigations of claims a rising under its insurance policies
54	105		or insurance contracts;
55		-
56	106		4. Not attempting in good faith to effectuate prompt, fair and
57	107		equitable settlement of claims submitted in which liability has
58	108		become reasonably clear;
59		-
60	109		5. Failing to comply with the provisions o f Section 1219 of
61	110		this title;
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63	111		6. Denying a claim for failure to exhi bit the property without
64	112		proof of demand and unfounded refusal by a claimant to do so;
65		-
66	113		7. Except where there is a time limit specified in the policy,
67	114		making statements, written or otherw ise, which require a claimant to
68	115		give written notice of loss or proof of loss within a specified time
69	116		limit and which seek to relieve the company of its obligations if
70	117		the time limit is not complied with unless the failure to comply
71	118		with the time limit pre judices the rights of an insurer;
72	119
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73	146		8. Requesting a claimant to sign a release that extends beyond
74	147		the subject matter that gave rise to the claim payment;
75		-
76	148		9. Issuing checks or drafts in partial settlement of a loss or
77	149		claim under a specified coverage which contain language releasing an
78	150		insurer or its insured from its total liability;
79		-
80	151		10. Denying payment to a claimant on the grounds that services,
81	152		procedures, or supplies provided by a treating physician or a
82	153		hospital were not medically necessary unless the health insurer or
83	154		administrator, as defined in Section 1442 of this t itle, first
84	155		obtains an opinion from any provider of health care licensed by law
85	156		and preceded by a medical examination or claim review, to the effect
86	157		that the services, procedures or suppl ies for which payment is being
87	158		denied were not medically necessary. Upon written request of a
88	159		claimant, treating physician, or hospital, the opinion shall be set
89	160		forth in a written report, prepared and signed by the reviewing
90		-	physician. The report shall ~~deta il~~ which specific services, ~~ENR. H. B. NO. 2678 Page 3~~
	161	+	physician. The report shall detail which specific services,
91	162		procedures, or supplies were not medi cally necessary, in the opinion
92	163		of the reviewing physician, and an explanation of that conclusion.
93	164		A copy of each report of a reviewing physician shall be mailed by
94	165		the health insurer, o r administrator, postage prepaid, to the
95	166		claimant, treating physician or hospital requesting same within
96	167		fifteen (15) days after receipt of the written request. As used in
97	168		this paragraph, "physician" means a person holding a valid license
98	169		to practice medicine and surgery, osteopathic medicine, podiatric
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99	197		medicine, dentistry, chiropractic, or optometry, pursuant to the
100	198		state licensing provisions of Title 59 of the Oklahoma Statutes;
101		-
102	199		11. Compensating a reviewing physician, as defined in paragraph
103	200		10 of this subsection section, on the basis of a percentage of the
104	201		amount by which a claim is reduced for payment;
105		-
106	202		12. Violating the provisions of the Health Care Fraud
107	203		Prevention Act;
108		-
109	204		13. Compelling, without just cause, policyholders to institute
110	205		suits to recover amounts due under its insurance policies or
111	206		insurance contracts by of fering substantially less than the amounts
112	207		ultimately recovered in suits brought by them, when the
113	208		policyholders have made claims for amounts reasonably similar to the
114	209		amounts ultimately recovered;
115		-
116	210		14. Failing to maintain a complete record of all complain ts
117	211		which it has received during the preceding three (3) years or since
118	212		the date of its last financial examination conducted or accepted by
119	213		the Commissioner, whichever time is longer. Thi s record shall
120	214		indicate the total number of complaints, their classif ication by
121	215		line of insurance, the nature of each complaint, the disposition of
122	216		each complaint, and the time it took to process each complaint. For
123	217		the purposes of this paragraph, "complaint" means any written
124	218		communication primarily expressing a grievance ;
125		-
126	219		15. Requesting a refund of all or a portion of a payment of a
127	220		claim made to a claimant or health care provider more than twenty -
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128	248		four (24) months after the payment is made. This paragr aph shall
129	249		not apply:
130		-
131	250		a. if the payment was made because of fraud comm itted by
132	251		the claimant or health care provider, or
133		-	ENR. H. B. NO. 2678 Page 4
134	252		b. if the claimant or health care provider has otherwise
135	253		agreed to make a refund to the insurer for overpayment
136	254		of a claim;
137		-
138	255		16. Failing to pay, or requesting a refund of a payment, for
139	256		health care services covered under the policy if a health benefit
140	257		plan, or its agent, has provided a preauthorization or
141	258		precertification and verification of eligibility for those health
142	259		care services. This paragraph shall not apply if:
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144	260		a. the claim or payment was made becau se of fraud
145	261		committed by the claimant or health care provider,
146		-
147	262		b. the subscriber had a preexisting exclusion under the
148	263		policy related to the service provided, or
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150	264		c. the subscriber or empl oyer failed to pay the
151	265		applicable premium and all grace periods and
152	266		extensions of coverage have expired; or
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154	267		17. Denying or refusing to accept an application for life
155	268		insurance, or refusing to renew, cancel, restrict or otherwise
156	269		terminate a policy of life insurance, or charge a different rate
157	270		based upon the lawful travel d estination of an applicant or insured
158	271		as provided in Section 4024 of this title ; or
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160	299		18. As a health insurer that provides pharmacy benefits or a
161	300		pharmacy benefits manager that administer s pharmacy benefits for a
162	301		health plan, failing to include any amount paid by an enrollee or on
163	302		behalf of an enrollee by another person when calculating the
164	303		enrollee's total contribution to an out -of-pocket maximum,
165	304		deductible, copayment, coinsurance or oth er cost-sharing
166	305		requirement.
167		-
168	306		SECTION 2. This act shall become effective November 1, 2021 .
169		-	ENR. H. B. NO. 2678 Page 5
170		-	Passed the House of Representatives the 8th day of March, 2021.
171		-
172		-
173		-
174		-
175		-	Presiding Officer of the House
176		-	of Representatives
177		-
178		-
179		-	Passed the Senate the 12th day of April, 2021.
180		-
181		-
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183		-
184		-	Presiding Officer of the Senate
185		-
186		-
187		-	OFFICE OF THE GOVERNOR
188		-	Received by the Office of the Governor this ____________________
189		-	day of ___________________, 20_______, at _______ o'clock _______ M.
190		-	By: ______________________ ___________
191		-	Approved by the Governor of the State of Oklahoma this _________
192		-	day of ___________________, 20_______, at _______ o'clock _______ M.
193		-
194		-
195		-	_________________________________
196		-	Governor of the State of Oklahoma
197		-
198		-	OFFICE OF THE SECRETARY OF STATE
199		-	Received by the Office of the Secretary of State this __________
200		-	day of ___________________, 20_______, at _______ o'clock _______ M.
201		-	By: _________________________________
202		-
	307	+	COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
	308	+	March 29, 2021 - DO PASS