Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB92 Compare Versions

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Version 2 (New)

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	3	+	ENGR. S. B. NO. 92 Page 1 1
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29		-	HOUSE OF REPRESENTATIVES - FLOOR VERSION
30		-
31		-	STATE OF OKLAHOMA
32		-
33		-	1st Session of the 58th Legislature (2021)
34		-
35		-	COMMITTEE SUBSTITUTE
36		-	FOR ENGROSSED
37		-	SENATE BILL NO. 92 By: McCortney, Rader,
	28	+	ENGROSSED SENATE
	29	+	BILL NO. 92 By: McCortney, Rader,
38	30		Montgomery, Jett and
39	31		Stanley of the Senate
40	32
41	33		and
42	34
43	35		McEntire of the House
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48		-
49		-	COMMITTEE SUBSTITUTE
50		-
51		-	An Act relating to insurance; amending 36 O.S. 2011,
52		-	Section 1250.5, as amended by Section 1, Chapter 105,
53		-	O.S.L. 2012 (36 O.S. Supp. 2020, Section 1250.5),
54		-	which relates to the Unfair Claims Settlement
55		-	Practices Act; expanding actions that constitute
56		-	unfair claims settlement practices; updating
57		-	references; and providing an effective date.
58		-
	40	+	[ insurance - Unfair Claims Settlement Practices Act
	41	+	- effective date ]
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63	46		BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
64	47		SECTION 1. AMENDATORY 36 O.S. 2011, Section 1250.5, as
65	48		amended by Section 1, Chapter 105, O.S.L. 2012 (36 O.S. Supp. 2020,
66	49		Section 1250.5), is am ended to read as follows:
67		-	Section 1250.5 Any of the following acts by an insurer, if
	50	+	Section 1250.5. Any of the following acts by an insurer, if
68	51		committed in violation of Section 1250.3 of this title, constitutes
69	52		an unfair claim settle ment practice exclusive of paragraph 16 of
	53	+	this section which shall be applicable solely to he alth benefit
	54	+	plans:
	55	+	1. Failing to fully disclos e to first party claimants,
	56	+	benefits, coverages, or other provisions of any insurance policy or
	57	+	insurance contract when the benefits, coverages or other pro visions
	58	+	are pertinent to a claim;
	59	+	2. Knowingly misrepresenting to claimants pertinent facts or
	60	+	policy provisions relating to coverages at issue;
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71		-	SB92 HFLR Page 2
72		-	BOLD FACE denotes Committee Amendments. 1
	62	+	ENGR. S. B. NO. 92 Page 2 1
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97		-	this section which shall be applicable solely to health benefit
98		-	plans:
99		-	1. Failing to fully disclose to first party claimants,
100		-	benefits, coverages, or other provisions of any insurance policy or
101		-	insurance contract when the benefits, coverages or other provisions
102		-	are pertinent to a claim;
103		-	2. Knowingly misrepresenting to claimants pertinent facts or
104		-	policy provisions relating to coverages at issue;
105	87		3. Failing to adopt and implement reasonable s tandards for
106	88		prompt investigations of claims arising under its insurance policies
107	89		or insurance contracts;
108	90		4. Not attempting in good faith to effectuate prompt, fa ir and
109	91		equitable settlement of claims submitted in which liability has
110	92		become reasonably clea r;
111	93		5. Failing to comply with the provisions of Section 1219 of
112	94		this title;
113	95		6. Denying a claim for failure to exhi bit the property without
114	96		proof of demand and unf ounded refusal by a claimant to do so;
115	97		7. Except where there is a time limit specified in th e policy,
116	98		making statements, written or otherwise, which requir e a claimant to
117	99		give written notice of loss or proof of loss within a specified time
118	100		limit and which seek to relieve the company of its obligations if
119	101		the time limit is not complied with unless the failure to compl y
120	102		with the time limit prejudices the right s of an insurer;
	103	+	8. Requesting a claimant to sign a release that extends beyond
	104	+	the subject matter that gave rise to the claim payment;
	105	+	9. Issuing checks or drafts in partial settlement of a loss or
	106	+	claim under a specified coverage which contain language releasing an
	107	+	insurer or its insured from its total liability;
	108	+	10. Denying payment to a claimant on the grounds that services,
	109	+	procedures, or supplies provided by a treating physician or a
	110	+	hospital were not medica lly necessary unless the health insurer or
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122		-	SB92 HFLR Page 3
123		-	BOLD FACE denotes Committee Amendments. 1
	112	+	ENGR. S. B. NO. 92 Page 3 1
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148		-	8. Requesting a claimant to sign a release that extends beyond
149		-	the subject matter that gave rise to the claim payment;
150		-	9. Issuing checks or drafts in partial settlement of a loss or
151		-	claim under a specified coverage which contain language releasing an
152		-	insurer or its insured from its total liability;
153		-	10. Denying payment to a claimant on the grounds that services,
154		-	procedures, or supplies provided by a treating physician or a
155		-	hospital were not medically necessary unless the health insurer or
156	137		administrator, as defined in Section 1442 of this t itle, first
157	138		obtains an opinion from any provider of health care licensed by law
158	139		and preceded by a medical examination or claim review, to the effect
159	140		that the services, procedures or supplies for which pay ment is being
160	141		denied were not medically necessary. Upon written request of a
161	142		claimant, treating phy sician, or hospital, the opinion shall be set
162	143		forth in a written report, prepared and signed by the reviewing
163	144		physician. The report shall detail which spec ific services,
164	145		procedures, or supplies were not medi cally necessary, in the opinion
165	146		of the reviewing physician, and an explanation of that conclusion.
166	147		A copy of each report of a reviewing phys ician shall be mailed by
167	148		the health insurer, or administrator, postage prepaid, to the
168	149		claimant, treating physician or hospital requesting same within
169	150		fifteen (15) days after receipt of the written request. As used in
170	151		this paragraph, "physician" means a person holding a valid license
171	152		to practice medicine and surgery, osteopathic medicine, podiatric
	153	+	medicine, dentistry, chiropractic, or optometry, pursuant to the
	154	+	state licensing provisions of Title 59 of the Oklahoma Statutes;
	155	+	11. Compensating a reviewing physician, as defined in paragraph
	156	+	10 of this subsection section, on the basis of a percentage of the
	157	+	amount by which a claim is reduced for payment;
	158	+	12. Violating the provisions of the Health Care Fraud
	159	+	Prevention Act;
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173		-	SB92 HFLR Page 4
174		-	BOLD FACE denotes Committee Amendments. 1
	161	+	ENGR. S. B. NO. 92 Page 4 1
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199		-	medicine, dentistry, chiropractic, or optometry, pursuant to the
200		-	state licensing provisions of Title 59 of the Oklahoma Statutes;
201		-	11. Compensating a reviewing physician, as defined in paragraph
202		-	10 of this subsection section, on the basis of a percentage of the
203		-	amount by which a claim is reduced for payment;
204		-	12. Violating the provisions of the Health Care Fraud
205		-	Prevention Act;
206	186		13. Compelling, without just cause , policyholders to in stitute
207	187		suits to recover amounts due under its ins urance policies or
208	188		insurance contracts by of fering substantially less than the amounts
209	189		ultimately recovered in suits brought by them, when the
210	190		policyholders have made claims for amounts reasonably similar t o the
211	191		amounts ultimately recovered;
212	192		14. Failing to maintain a complete record of all complain ts
213	193		which it has received during the preceding th ree (3) years or since
214	194		the date of its last financial examination conducted or accepted by
215	195		the Commissioner, which ever time is longer. This record shall
216	196		indicate the total number of complaints, their classif ication by
217	197		line of insurance, the nature of each complaint, the disposition of
218	198		each complaint, and the time it took to process each complaint . For
219	199		the purposes of this paragraph, "complaint" means any written
220	200		communication primarily expressing a grievance ;
221	201		15. Requesting a refund of all or a portion o f a payment of a
222	202		claim made to a claimant or health care provider more than twenty -
	203	+	four (24) months after the paym ent is made. This paragraph shall
	204	+	not apply:
	205	+	a. if the payment was made because of fraud comm itted by
	206	+	the claimant or health care provider, o r
	207	+	b. if the claimant or health care provider has otherwise
	208	+	agreed to make a refund to the ins urer for overpayment
	209	+	of a claim;
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224		-	SB92 HFLR Page 5
225		-	BOLD FACE denotes Committee Amendments. 1
	211	+	ENGR. S. B. NO. 92 Page 5 1
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250		-	four (24) months after the payment is made. This paragraph shall
251		-	not apply:
252		-	a. if the payment was made because of fraud committed by
253		-	the claimant or health care provider, or
254		-	b. if the claimant or health care provider has otherwise
255		-	agreed to make a refund to the insurer for over payment
256		-	of a claim;
257	236		16. Failing to pay, or requesting a r efund of a payment, for
258	237		health care services covered under the policy if a health benefit
259	238		plan, or its agent, has provided a preauthorization or
260	239		precertification and verification of eli gibility for those he alth
261	240		care services. This paragraph shall not appl y if:
262	241		a. the claim or payment was made becau se of fraud
263	242		committed by the claimant or health care provider,
264	243		b. the subscriber had a preexisting exclusion under the
265	244		policy related to the service provided, or
266	245		c. the subscriber or employer failed to pay the
267	246		applicable premium and all grace periods and
268	247		extensions of coverage have expired; or
269	248		17. Denying or refusing to accept an application for life
270	249		insurance, or refusing to renew, cancel, re strict or otherwise
271	250		terminate a policy of life insurance, or charge a d ifferent rate
272	251		based upon the lawful travel d estination of an applicant or insured
273	252		as provided in Section 4024 of this title; or
	253	+	18. As a health insurer that provides pharmacy benefits or a
	254	+	pharmacy benefits manager that administers pharma cy benefits for a
	255	+	health plan, failing to include any amount paid by an enrollee or on
	256	+	behalf of an enrollee by another person, as defined in Section 104
	257	+	of this title, when calculating the total contribution to an out-of-
	258	+	pocket maximum of the enrollee, deductible, copayment, coinsurance
	259	+	or other cost-sharing requirement.
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275		-	SB92 HFLR Page 6
276		-	BOLD FACE denotes Committee Amendments. 1
	261	+	ENGR. S. B. NO. 92 Page 6 1
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301		-	18. As a health insurer that provides pharmacy benefits or a
302		-	pharmacy benefits manager that administers pharmacy benefits for a
303		-	health plan, failing to include any amount paid by an enrollee or on
304		-	behalf of an enrollee by another person, as defined in Section 104
305		-	of this title, when calculating the total contribution to an out-of-
306		-	pocket maximum of the enrollee, deductible, copayment, coinsurance
307		-	or other cost-sharing requirement.
308	286		SECTION 2. This act shall become effective November 1, 2021.
	287	+	Passed the Senate the 8th day of March, 2021.
309	288
310		-	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 04/01/2021 - DO
311		-	PASS, As Amended.
	289	+
	290	+
	291	+	Presiding Officer of the Senate
	292	+
	293	+
	294	+	Passed the House of Representatives the ____ day of __________,
	295	+	2021.
	296	+
	297	+
	298	+
	299	+	Presiding Officer of the House
	300	+	of Representatives
	301	+