Req. No. 1067 Page 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
SENATE BILL 651 By: David
AS INTRODUCED
An Act relating to health insurance; amending 36 O.S.
2011, Section 4512, as amended by Section 1, Chapter
34, O.S.L. 2017 (36 O.S. Supp. 2020, Section 4512),
which relates to insured employer health benefit
plans; prohibiting insurer from canceling accident
and health policy without notice; requiring insurer
to explain reason for cancellation; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2011, Section 4512, as
amended by Section 1, Chapter 34, O.S .L. 2017 (36 O.S. Supp. 2020,
Section 4512), is amended to read as follows:
Section 4512. A. This section applies to an insured employer
health benefit plan providing health insuran ce to employees of
employers employing twenty (20) or more full -time or full-time-
equivalent employees.
B. An employer carrier, on written request from an insur ed
employer covered by that carrier, shall report to the employer
information from the twelve ( 12) months preceding the date of the
report regarding:
Req. No. 1067 Page 2 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1. The total amount of charges sub mitted to the carrie r for
persons covered under the employer health ben efit plan;
2. The total amount of premium payments made by the
policyholder to the insured car rier;
3. The total amount of payments made by the carrier to health
care providers for pe rsons covered under the plan, including the
total hospital charges, phy sician charges, and pharmaceutical
charges; and
4. For any claims for an individual paid in ex cess of Ten
Thousand Dollars ($10,000.00), information on claims paid, including
diagnostic evaluations.
C. An employer shall have to make a written request for
information. The employer may make one request per year prior to
the anniversary or renewal d ate. In addition, prior to the date of
a rate change, an employer may make additional wri tten requests for
the information, provided the employer shall not make more than one
additional request in any one (1) year.
D. Except as otherwise provided in this subsection, an employer
carrier shall provide the information provided for in this sectio n
not later than sixty (60) days before the anniversary or annual
renewal date, or thirty (30) days before the date of any rate change
action of the employer ’s benefit plan. Provided, if the carrier
receives the request from the employer less than sixty ( 60) days
before the anniversary or renewal date or less than thirty (30 ) days
Req. No. 1067 Page 3 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
before the date of a rate change, the carrier shall have sixty (60)
days from the date o f receiving the request to provide the
information. Provided further, if the carrier requ ires the employer
to submit any changes to the benefit plan prior to th e anniversary
or annual renewal date, the carrier shall provide the information
not later than sixty (60) days before the date the employer is
required to submit any changes.
E. An employer carrier shall not report any information
required under this sect ion if the release of such information is
prohibited by federal law or regulation.
F. Claim information provided by an employer carrier under this
section shall be provided in the aggr egate, without infor mation
through which a specific individual covered by the health insurance
or evidence or coverage may be identified. Claim information shall
include the total claims made, the total claims paid, the total plan
charges and the head cou nt by coverage.
G. 1. If an employer carrier fails to provide the inf ormation
in the time required by subsection D of this section, the Insurance
Commissioner may, after notice and hearing, subject an insurer to a
civil penalty of One Hundred Dollars ($1 00.00) for each day that the
information is delinquent.
2. If an employer carrier has a risk -bearing contract with a
medical group, independent practice association (IPA), or management
services organization (MSO) that stipulates the delegation of claims
Req. No. 1067 Page 4 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
payment, and the car rier satisfies the Insurance Commissioner that
the medical group, IPA, or MSO has failed to provide the information
to the employer carrier in a s ufficient time for the carrier to
comply with subsection D of this section, the Commission er may waive
the penalty provided for in paragraph 1 of this subsection .
3. The civil penalty may be enforced in the same manner in
which civil judgments may be enfo rced, as provided in Section 312A
of this title. Such penalties shall be placed in the St ate
Insurance Commissioner Revolving Fund. Any person aggrieved by the
determination of the Insurance Commissioner may seek judicial review
pursuant to Section 320 o f this title.
H. An employer carrier shall not cancel a group or individual
policy of existing coverage under an accident and health insurance
policy without providing notice to the policyholder at least thirty
(30) days prior to the cancellation. The notification shall explain
in sufficient detail the reason for the cancellation of the policy.
I. The Insurance Commissioner shall promulgate rules for the
implementation and administration of this section.
I. J. As used in this section, “employer carrier” means any
entity which provides health insurance in this state. For the
purposes of this section, employer c arrier includes a licensed
insurance company, not -for-profit hospital service or medical
indemnity corporation, a fraternal benefit society, a health
maintenance organization, a multiple employer welfare arrangement or
Req. No. 1067 Page 5 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
any other entity providing a plan of health insurance or health
benefits subject to stat e insurance regulation.
SECTION 2. This act shall become effective Novemb er 1, 2021.
58-1-1067 CB 1/21/2021 9:57:55 AM