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Oklahoma House Bill HB3495

Oklahoma 2022 Regular Session

Oklahoma House Bill HB3495 Compare Versions

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28+ENGROSSED SENATE AMENDMENT
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30+ENGROSSED HOUSE
31+BILL NO. 3495 By: McEntire and Phillips of
32+the House
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34+ and
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36+ Montgomery of the Senate
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40+An Act relating to insurance; amending 36 O.S. 2021,
41+Section 1250.5, which relates to acts by an insurer
42+constituting unfair claim settlement practice;
43+modifying acts considered unfair claim settlement
44+practices; and providing an effective date.
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50+AMENDMENT NO. 1. Page 6, line 19, insert a new Section 2 to read
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54+“SECTION 2. It being immediately necessary for the pr eservation
55+of the public peace, health or safety, an emergency is hereby
56+declared to exist, by reason whereof this act shall take effect and
57+be in full force from and after its passage and approval. ”
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59+and amend the title to conform
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88+Passed the Senate the 27th day of April, 2022.
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92+ Presiding Officer of the Senate
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95+Passed the House of Representatives the ____ day of __________,
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100+ Presiding Officer of the House
101+ of Representatives
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128+ENGROSSED HOUSE
3129 BILL NO. 3495 By: McEntire and Phillips of
4130 the House
5131
6132 and
7133
8134 Montgomery of the Senate
9135
10136
11137
12138
13139
14140 An Act relating to insurance; amending 36 O.S. 2021,
15141 Section 1250.5, which relates to acts by an insurer
16142 constituting unfair claim settl ement practice;
17143 modifying acts considered unfair claim settlement
18-practices; and declaring an emergency .
144+practices; and providing an effective date.
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22-SUBJECT: Insurance
148+
23149
24150 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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26151 SECTION 1. AMENDATORY 36 O.S. 2021, Section 1250.5, is
27152 amended to read as follows:
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29153 Section 1250.5 Any of the following acts by an insure r, if
30154 committed in violation of Section 1250.3 of this title, constitutes
31155 an unfair claim settlement practice exclusive of paragraph 16 of
32156 this section which shall be applic able solely to health benefit
33157 plans:
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35158 1. Failing to fully disclose to first -party claimants,
36159 benefits, coverages, or other provisions of any insurance policy or
37160 insurance contract when the benefits, coverages or other provision s
38161 are pertinent to a claim;
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40188 2. Knowingly misrepresenting to claimants pertinent facts or
41189 policy provisions rela ting to coverages at i ssue;
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43190 3. Failing to adopt and implement reasonable standards for
44191 prompt investigations of claims arising under its insura nce policies
45192 or insurance contracts;
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47193 4. Not attempting in good faith to effectuate prompt, fair and
48194 equitable settlement of claims su bmitted in which liability has
49195 become reasonably clear;
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51196 5. Failing to comply with the provisions of Section 1219 of
52197 this title;
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54198 6. Denying a claim fo r failure to exhibit the property without
55199 proof of demand and unfounded refusal by a claimant to do so;
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57200 7. Except where there is a time limit specified in the policy,
58201 making statements, written or otherwise, which require a cl aimant to
59202 give written notice of loss or proof of loss within a specified time
60203 limit and which seek to relieve t he company of its obli gations if
61204 the time limit is not complied with unless the failure to comply
62205 with the time limit prejudices the rights of a n insurer. Any policy
63206 that specifies a time limit covering damage to a roof due to wind or
64207 hail must allow the filing of claims after the first anniversary but
65208 no later than twenty -four (24) months after the date of the loss, if
66209 the damage is not evident without inspection;
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68210 8. Requesting a claimant to sign a release that extends beyond
69211 the subject matter that gav e rise to the claim payment;
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71238 9. Issuing checks, drafts or electronic payment in partial
72239 settlement of a loss or claim under a specified coverage which
73240 contain language relea sing an insurer or its insured from its total
74241 liability;
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76242 10. Denying payment to a claimant on the grounds that services,
77243 procedures, or supplies provided by a treating physician or a
78244 hospital were not medically necessary unles s the health insurer or
79245 administrator, as defined in Section 1442 of this title, first
80246 obtains an opinion from any provider of health care licensed by law
81247 and preceded by a medical examination or claim review, to the effect
82248 that the services, procedures or supplies for which payment i s being
83249 denied were not medically necessary. Upon written request of a
84250 claimant, treating physician, or hospital, the opinion shall be set
85251 forth in a written report, prepared and signed by the reviewing
86252 physician. The report shall detail which specific s ervices,
87253 procedures, or supplies were not medically necessary, in the opinion
88254 of the reviewing physician, and an explanation of that conclusion.
89255 A copy of each report of a reviewing physician shall be mailed by
90256 the health insurer, or administrator, postag e prepaid, to the
91-claimant, treating physician or hospital requesting same within ENR. H. B. NO. 3495 Page 3
257+claimant, treating physician or hospital requesting same within
92258 fifteen (15) days after receipt of the written request. As used in
93259 this paragraph, "physician" means a person holding a valid license
94260 to practice medicine and surgery, osteo pathic medicine, podiatric
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95287 medicine, dentistry, chiropractic, or optometry, pursua nt to the
96288 state licensing provisions of Title 59 of the Oklahoma Statutes;
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98289 11. Compensating a reviewing physician, as defined in paragraph
99290 10 of this section, on the basis o f a percentage of the amount by
100291 which a claim is reduced for payment;
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102292 12. Violating the provisions of the Health Care Fraud
103293 Prevention Act;
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105294 13. Compelling, without just cause, policyholders to institute
106295 suits to recover amoun ts due under its insurance po licies or
107296 insurance contracts by offering substantially less than the amounts
108297 ultimately recovered in suits brought by them, when the
109298 policyholders have made claims for amounts reasonably similar to the
110299 amounts ultimately recov ered;
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112300 14. Failing to maintai n a complete record of all complaints
113301 which it has received during the preceding t hree (3) years or since
114302 the date of its last financial examination conducted or accepted by
115303 the Commissioner, whichever time is longer. This rec ord shall
116304 indicate the total number of complaints, their classification by
117305 line of insurance, the nature of eac h complaint, the disposition of
118306 each complaint, and the time it took to process each complaint. For
119307 the purposes of this paragraph, "complaint" means any written
120308 communication primarily expressing a grievance;
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122309 15. Requesting a refund of all or a portion of a payment of a
123310 claim made to a claimant more than twelve (12) months or a health
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124337 care provider more than twenty-four (24) eighteen (18) months after
125338 the payment is made. This paragraph shall not apply:
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127339 a. if the payment was made because of fraud committ ed by
128340 the claimant or health car e provider, or
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130341 b. if the claimant or health care provider has otherwise
131342 agreed to make a refund to the insurer f or overpayment
132343 of a claim;
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134344 16. Failing to pay, or requesting a refund of a payment, for
135345 health care services co vered under the policy if a heal th benefit
136-plan, or its agent, has provided a preauthorization or ENR. H. B. NO. 3495 Page 4
346+plan, or its agent, has provided a preauthorization or
137347 precertification and verification of eligibili ty for those health
138348 care services. This paragraph shall not apply if:
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140349 a. the claim or payment was made because of fraud
141350 committed by the claima nt or health care provider,
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143351 b. the subscriber had a preexisting exclusion under the
144352 policy related to the servic e provided, or
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146353 c. the subscriber or employer failed to pay the
147354 applicable premium and all grace periods and
148355 extensions of coverage have expired;
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150356 17. Denying or refusing to accept an application for life
151357 insurance, or refusing to renew, cancel, restrict or otherwise
152358 terminate a policy of life insurance, or charge a different rate
153359 based upon the lawful travel destina tion of an applicant or insured
154360 as provided in Section 4024 of this title; or
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156387 18. As a health insurer that provides pharmacy benefits or a
157388 pharmacy benefits manager that ad ministers pharmacy benefits for a
158389 health plan, failing to include any amount paid b y an enrollee or on
159390 behalf of an enrollee by anoth er person when calculating the
160391 enrollee's total contribution to an out -of-pocket maximum,
161392 deductible, copayment, coinsuranc e or other cost-sharing
162393 requirement.
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164394 However, if, under federal law, application of this paragraph
165395 would result in health savings account ineligibility under Sect ion
166396 223 of the federal Internal Revenue Code, as amended , this
167397 requirement shall apply only for health savings accounts with
168398 qualified high-deductible health plans with respect to the
169399 deductible of such a plan after t he enrollee has satisfied the
170400 minimum deductible, except with respect to items or services that
171401 are preventive care pursuant to Section 223(c)(2)(C) of the federal
172402 Internal Revenue Code, as amended, in which case the requirements of
173403 this paragraph shall apply regardless of whether the minimum
174404 deductible has been satisfied.
405+SECTION 2. This act shall become effective Novemb er 1, 2022.
175406
176-SECTION 2. It being immediately necessary for the preservation
177-of the public peace, health or saf ety, an emergency is hereby
178-declared to exist, by reason whereof this act shall take effect and
179-be in full force from and after its passage and approval .
180- ENR. H. B. NO. 3495 Page 5
181-Passed the House of Represent atives the 10th day of May, 2022.
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432+Passed the House of Representatives the 22nd day of March, 2022.
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186437 Presiding Officer of the House
187438 of Representatives
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190-Passed the Senate the 27th day of April, 2022.
441+Passed the Senate the ___ day of __________, 2022.
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195446 Presiding Officer of the Senate
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199-OFFICE OF THE GOVERNOR
200-Received by the Office of the Governor this _______ _____________
201-day of ___________________, 20_______, at _______ o'clock _______ M.
202-By: _________________________________
203-Approved by the Governor of the State of Oklahoma this _____ ____
204-day of ___________________, 20_______, at _______ o'clock _______ M.
205-
206-
207- _________________________________
208- Governor of the State of Oklahoma
209-
210-OFFICE OF THE SECRETARY OF STATE
211-Received by the Office of the Secretary of State this __________
212-day of ___________________, 20_______, at _______ o'clock _______ M.
213-By: _________________________________