Oklahoma 2022 Regular Session

Oklahoma House Bill HB3040 Compare Versions

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Version 2 (New)

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	30	+	April 11, 2022
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3	34		BILL NO. 3040 By: Boles and Fugate of the
4	35		House
5	36
6	37		and
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8	39		Garvin of the Senate
9		-
10	40
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15	45		An Act relating to Medicare; amending 36 O.S. 2021,
16	46		Section 3611.1, which relates to Medicare supplement
17	47		policies; modifying provisions related to not ice of
18	48		premium rate increase; restricting frequency of
19	49		implementation; eliminating exemption from filing
20	50		requirements; and providing an effective date .
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24		-	SUBJECT: Medicare
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26	55		BE IT ENACTED BY THE PEOPLE O F THE STATE OF OKLAHOMA:
27		-
28	56		SECTION 1. AMENDATORY 36 O.S. 2021, Section 3611.1, is
29	57		amended to read as follows :
30		-
31	58		Section 3611.1 A. As used in this section:
32		-
33	59		1. "Commissioner" means the Commissioner of Insurance;
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35	60		2. "Medicare supplement policy" means a group or individual
36	61		policy of accident and health ins urance, or a subscriber contract of
37	62		a nonprofit hospital service and medical indemnity corporation or a
38	63		health maintenance organization which is advertised, marketed or
39	64		designed primarily as a supplement to reimbursements under Medicare
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40	92		for the hospital, medical or surgical expenses of persons eligible
41	93		for Medicare. Such term does not inclu de:
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43	94		a. a policy or contract of one or more employers or labor
44	95		organizations, or of the trustees of a fund
45	96		established by one or more employers or labor
46		-	organizations, or combination thereof, for employees ~~ENR. H. B. NO. 3040 Page 2~~
	97	+	organizations, or combination thereof, for employees
47	98		or former employees, or combination thereof, or for
48	99		members or former members, or combination thereof, of
49	100		the labor organizations, or
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51	101		b. a policy or contract of any professional, trade or
52	102		occupational association for its members or former or
53	103		retired members, or combination the reof, if such
54	104		association:
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56	105		(1) is composed of individuals all of whom are
57	106		actively engaged in the same profession, trade or
58	107		occupation,
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60	108		(2) has been maintained in good faith for purposes
61	109		other than obtaining insurance, and
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63	110		(3) has been in existence for at least two (2) years
64	111		prior to the date of its initial offering of such
65	112		policy or plan to its members, or
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67	113		c. individual policies o r contracts issued pursuant to a
68	114		conversion privilege under a policy or contract of
69	115		group or individual insurance; and
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71	143		3. "Direct response Medicare supplemen t policy" means a policy
72	144		of insurance which is advertised, marketed or designed primarily as
73	145		a supplement to reimbursements under Medicare for the hospital,
74	146		medical or surgical expenses of persons eligible for Medicare issued
75	147		as a result of solicitation of individual insureds by mail or by
76	148		mass media advertising.
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78	149		B. The Commissioner shall issue reason able regulations to
79	150		establish minimum standards for benefit claims paym ent, marketing
80	151		practices, compensation arrangements, and reporting practices for
81	152		Medicare supplement policies. The Commissioner shall issue
82	153		reasonable regulations to provide for an ope n enrollment period for
83	154		those persons who qualify as disabled pursuant to federal Medicare
84	155		guidelines.
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86	156		C. A Medicare supplement policy may not deny a claim f or losses
87	157		incurred more than six (6) months from the effective date of
88	158		coverage for a preexisting condition. The policy may not define a
89	159		preexisting condition more rest rictively than "a condition for which
90		-	medical advice was given or treatment was recomme nded by or received ~~ENR. H. B. NO. 3040 Page 3~~
	160	+	medical advice was given or treatment was recomme nded by or received
91	161		from a physician within six (6) months before the effective date of
92	162		coverage".
93		-
94	163		D. Any premium rate filing for a Medicare supplement policy
95	164		shall be filed with and approved by the Insurance Commissioner and
96	165		communicated to the policyhol der on or after September 1 but no
97	166		later than October 30 of each year at least forty-five (45) days
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98	194		prior to the effective date of a premium rate increase. Such
99	195		premium increases shall be effective January 1 of the following year
100	196		implemented no more than once per year. This subsection shall not
101	197		apply to insurers with five thousand or fewer policy holders.
102		-
103	198		E. A Medicare supplement policy shall be expected to return to
104	199		the policyholder benefits w hich are reasonable in relat ion to the
105	200		premium charged. The Commissioner shall issue regulations to
106	201		establish minimum standards for loss ratios of Medicare supplement
107	202		policies on the basis of incurred claims experience, or incurre d
108	203		health care expenses wh ere coverage is provided by a health
109	204		maintenance organization on a service rath er than reimbursement
110	205		basis, and earned premiums for the period of coverage f or which
111	206		rates are computed and in accordance with accepted actuarial
112	207		principles and practices.
113		-
114	208		F. 1. No Medicare supplement p olicy or certificate issued
115	209		pursuant to a group Med icare supplement policy shall be de livered or
116	210		issued for delivery in this sta te unless an outline of c overage is
117	211		provided to the applicant at the time a pplication is made.
118		-
119	212		2. The Commissioner shall prescr ibe by regulation the contents
120	213		and a standard form of an informational brochure for pe rsons
121	214		eligible for Medicare which is inten ded to improve the buyer 's
122	215		ability to select the most appropriate coverage and improve the
123	216		buyer's understanding of Medicare. T he Commissioner may require by
124	217		regulation that the informational brochure be provided with the
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125	245		outline of coverage to any prospe ctive insureds eligible f or
126	246		Medicare. With respect to direct response poli cies, the
127	247		Commissioner may require that the prescribe d brochure and outline of
128	248		coverage be provided upon request to any prospective insured s
129	249		eligible for Medicare, but in no event l ater than the time of pol icy
130	250		delivery.
131		-
132	251		3. The Commissioner may require not ice provisions, designed to
133	252		inform prospective insure ds that particular insurance coverages are
134		-	not Medicare supplement coverages, for all accident and health ~~ENR. H. B. NO. 3040 Page 4~~
	253	+	not Medicare supplement coverages, for all accident and health
135	254		insurance policies sol d to persons eligible for Medicare by reason
136	255		of age, other than:
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138	256		a. Medicare supplement policies,
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140	257		b. disability income policies,
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142	258		c. basic, catastrophic, or major medical expense
143	259		policies,
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145	260		d. single premium, nonrene wable policies, or
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147	261		e. other policies defin ed by regulation of the
148	262		Commissioner.
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150	263		4. The Commissioner may adopt from t ime to time, such
151	264		reasonable regulations as are neces sary to conform Medicare
152	265		supplement policies and ce rtificates to the requirements of f ederal
153	266		law and regulations promulgated the reunder, including but no t
154	267		limited to:
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156	295		a. requiring refunds or credits if t he policies or
157	296		certificates do not meet loss ratio re quirements,
158		-
159	297		b. establishing a uniform methodology f or calculating and
160	298		reporting loss ratios,
161		-
162	299		c. assuring public access to polici es, premiums and loss
163	300		ratio information of issuers of Medicare supplement
164	301		insurance, and
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166	302		d. establishing a policy for holding pu blic hearings
167	303		prior to approval of premium increase s.
168		-
169	304		G. Medicare supplement policies or certificates shall have a
170	305		notice prominently printed on the fir st page of the policy or
171	306		certificate, or attached thereto, stating that the applicant shall
172	307		have the right to return the policy or certificate within thir ty
173	308		(30) days of its delivery and to have the premium refunded if, after
174	309		examination of the policy or c ertificate, the applicant is not
175	310		satisfied for any reason. A direct respon se policy issued to
176	311		persons eligible for Medicare shall have a notice prominent ly
177	312		printed on the first page, or at tached thereto, stating that the
178	313		applicant shall have the right to return the policy or certificate
179		-	within thirty (30) days of its delivery an d to have the premium ~~ENR. H. B. NO. 3040 Page 5~~
	314	+	within thirty (30) days of its delivery an d to have the premium
180	315		refunded if, after examination, the applicant is not sati sfied for
181	316		any reason.
182		-
183	317		H. The Insurance Commissioner shall have the authority to
184	318		employ actuaries, sta tisticians, accountants, auditors,
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185	346		investigators, or any other technicians as the Insurance
186	347		Commissioner may deem necessary or beneficial to examine any
187	348		Medicare supplement filings made by insurers or rating organizations
188	349		and to examine such records of the insurers or rating organizations
189	350		as may be deemed appropriate in conjuncti on with the Medicare
190	351		supplement filing in order to determine that the rates or other
191	352		filings are consistent with t he terms, conditions, requirements and
192	353		purposes of the Insurance Co de, and to verify, validate and
193	354		investigate the information upon which the insurer or rating
194	355		organization relies to support such filing.
195		-
196	356		1. The Commissioner shall maintain a list of techni cians who
197	357		are proficient in the line of Me dicare supplement insuran ce. If the
198	358		Commissioner determines that it is nec essary to utilize the ser vices
199	359		of such a technician, the Commissioner shall employ the next
200	360		available technician in rotation on the list.
201		-
202	361		2. All reasonable expenses incurred in suc h filing review shall
203	362		be paid by the insurer or rating organization making the filing.
204		-
205	363		SECTION 2. This act shall become effective November 1, 2022.
206		-	ENR. H. B. NO. 3040 Page 6
207		-	Passed the House of Representatives the 14th day of March, 2022.
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211		-
212		-	Presiding Officer of the House
213		-	of Representatives
214		-
215		-
216		-	Passed the Senate the 25th day of April, 2022.
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221		-	Presiding Officer of the Senate
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225		-	OFFICE OF THE GOVERNOR
226		-	Received by the Office of the Governor this ____________________
227		-	day of ___________________, 20_______, at _______ o'clock _______ M.
228		-	By: _________________________________
229		-	Approved by the Governor of the State of Oklahoma this _____ ____
230		-	day of ___________________, 20_______, at _______ o'clock _______ M.
231		-
232		-
233		-	_________________________________
234		-	Governor of the State of Oklahoma
235		-
236		-	OFFICE OF THE SECRETARY OF STATE
237		-	Received by the Office of the Secretary of State this __________
238		-	day of ___________________, 20_______, at _______ o'clock _______ M.
239		-	By: _________________________________
240		-
	364	+	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
	365	+	April 11, 2022 - DO PASS