An Act
ENROLLED HOUSE
BILL NO. 3040 By: Boles and Fugate of the
House
and
Garvin of the Senate
An Act relating to Medicare; amending 36 O.S. 2021,
Section 3611.1, which relates to Medicare supplement
policies; modifying provisions related to not ice of
premium rate increase; restricting frequency of
implementation; eliminating exemption from filing
requirements; and providing an effective date .
SUBJECT: Medicare
BE IT ENACTED BY THE PEOPLE O F THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 3611.1, is
amended to read as follows :
Section 3611.1 A. As used in this section:
1. "Commissioner" means the Commissioner of Insurance;
2. "Medicare supplement policy" means a group or individual
policy of accident and health ins urance, or a subscriber contract of
a nonprofit hospital service and medical indemnity corporation or a
health maintenance organization which is advertised, marketed or
designed primarily as a supplement to reimbursements under Medica re
for the hospital, medical or surgical expenses of persons eligible
for Medicare. Such term does not inclu de:
a. a policy or contract of one or more employers or labor
organizations, or of the trustees of a fund
established by one or more employers or labor
organizations, or combination thereof, for employees ENR. H. B. NO. 3040 Page 2
or former employees, or combination thereof, or for
members or former members, or combination thereof, of
the labor organizations, or
b. a policy or contract of any professional, trade or
occupational association for its members or former or
retired members, or combination the reof, if such
association:
(1) is composed of individuals all of whom are
actively engaged in the same profession, trade or
occupation,
(2) has been maintained in good faith for purposes
other than obtaining insurance, and
(3) has been in existence for at least two (2) years
prior to the date of its initial offering of such
policy or plan to its members, or
c. individual policies o r contracts issued pursuant to a
conversion privilege under a policy or contract of
group or individual insurance; and
3. "Direct response Medicare supplemen t policy" means a policy
of insurance which is advertised, marketed or designed primarily as
a supplement to reimbursements under Medicare f or the hospital,
medical or surgical expenses of persons eligible for Medicare issued
as a result of solicitation of individual insureds by mail or by
mass media advertising.
B. The Commissioner shall issue reason able regulations to
establish minimum sta ndards for benefit claims paym ent, marketing
practices, compensation arrangements, and reporting practices for
Medicare supplement policies. The Commissioner shall issue
reasonable regulations to provide for an ope n enrollment period for
those persons who qualify as disabled pursuant to federal Medicare
guidelines.
C. A Medicare supplement policy may not deny a claim f or losses
incurred more than six (6) months from the effective date of
coverage for a preexisting condition. The policy may not define a
preexisting condition more rest rictively than "a condition for which
medical advice was given or treatment was recomme nded by or received ENR. H. B. NO. 3040 Page 3
from a physician within six (6) months before the effective date of
coverage".
D. Any premium rate filing for a Medi care supplement policy
shall be filed with and approved by the Insurance Commissioner and
communicated to the policyhol der on or after September 1 but no
later than October 30 of each year at least forty-five (45) days
prior to the effective date of a premium rate increase. Such
premium increases shall be effective January 1 of the following year
implemented no more than once per year. This subsection shall not
apply to insurers with five thousand or fewer policy holders.
E. A Medicare supple ment policy shall be expected to return to
the policyholder benefits w hich are reasonable in relat ion to the
premium charged. The Commissioner shall issue regulations to
establish minimum standards for loss ratios of Medicare supplement
policies on the basis of incurred claims experience, or incurre d
health care expenses wh ere coverage is provided by a health
maintenance organization on a service rath er than reimbursement
basis, and earned premiums for the period of coverage f or which
rates are computed an d in accordance with accepted actuarial
principles and practices.
F. 1. No Medicare supplement p olicy or certificate issued
pursuant to a group Med icare supplement policy shall be de livered or
issued for delivery in this sta te unless an outline of covera ge is
provided to the applicant at the time a pplication is made.
2. The Commissioner shall prescr ibe by regulation the contents
and a standard form of an informational brochure for pe rsons
eligible for Medicare which is inten ded to improve the buyer 's
ability to select the most appropriate coverage and improve the
buyer's understanding of Medicare. T he Commissioner may require by
regulation that the informational brochure be provided with the
outline of coverage to any prospe ctive insureds eligible for
Medicare. With respect to direct response poli cies, the
Commissioner may require that the prescribe d brochure and outline of
coverage be provided upon request to any prospective insured s
eligible for Medicare, but in no event l ater than the time of policy
delivery.
3. The Commissioner may require not ice provisions, designed to
inform prospective insure ds that particular insurance coverages are
not Medicare supplement coverages, for all accident and health ENR. H. B. NO. 3040 Page 4
insurance policies sol d to persons eligible for Medi care by reason
of age, other than:
a. Medicare supplement policies,
b. disability income policies,
c. basic, catastrophic, or major medical expense
policies,
d. single premium, nonrene wable policies, or
e. other policies defin ed by regulation of the
Commissioner.
4. The Commissioner may adopt from t ime to time, such
reasonable regulations as are neces sary to conform Medicare
supplement policies and ce rtificates to the requirements of f ederal
law and regulations promulgated the reunder, including but not
limited to:
a. requiring refunds or credits if t he policies or
certificates do not meet loss ratio re quirements,
b. establishing a uniform methodology f or calculating and
reporting loss ratios,
c. assuring public access to polici es, premiums and loss
ratio information of issuers of Medicare supplement
insurance, and
d. establishing a policy for holding pu blic hearings
prior to approval of premium increase s.
G. Medicare supplement policies or certificates shall have a
notice prominently printed on the first page of the policy or
certificate, or attached thereto, stating that the applicant shall
have the right to return the policy or certificate within thir ty
(30) days of its delivery and to have the premium refunded if, after
examination of the policy or cert ificate, the applicant is not
satisfied for any reason. A direct respon se policy issued to
persons eligible for Medicare shall have a notice prominent ly
printed on the first page, or at tached thereto, stating that the
applicant shall have the right to ret urn the policy or certificate
within thirty (30) days of its delivery an d to have the premium ENR. H. B. NO. 3040 Page 5
refunded if, after examination, the applicant is not sati sfied for
any reason.
H. The Insurance Commissioner shall have the authority to
employ actuaries, stati sticians, accountants, auditors,
investigators, or any other technicians as the Insurance
Commissioner may deem necessary or beneficial to examine any
Medicare supplement filings made by insurers or rating organizations
and to examine such records of the i nsurers or rating organizations
as may be deemed appropriate in conjuncti on with the Medicare
supplement filing in order to determine that the rates or other
filings are consistent with t he terms, conditions, requirements and
purposes of the Insurance Code , and to verify, validate and
investigate the information upon which the insurer or rating
organization relies to support such filing.
1. The Commissioner shall maintain a list of techni cians who
are proficient in the line of Me dicare supplement insuranc e. If the
Commissioner determines that it is nec essary to utilize the ser vices
of such a technician, the Commissioner shall employ the next
available technician in rotation on the list.
2. All reasonable expenses incurred in suc h filing review shall
be paid by the insurer or rating organization making the filing.
SECTION 2. This act shall become effective November 1, 2022.
ENR. H. B. NO. 3040 Page 6
Passed the House of Representatives the 14th day of March, 2022.
Presiding Officer of the House
of Representatives
Passed the Senate the 25th day of April, 2022.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _____ ____
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________