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53	53	STATE OF OKLAHOMA
54	54
55	55	2nd Session of the 59th Legislature (2024 )
56	56
57	57	HOUSE BILL 3375 By: Fugate
58	58
59	59
60	60
61	61
62	62
63	63	AS INTRODUCED
64	64
65	65	An Act relating to health insurance policies;
66	66	amending 36 O.S. 2021, Section 4502, which relates to
67	67	provisions of group accident and heal th policies;
68	68	adding pregnancy to the special enrollment period;
69	69	providing when coverage begins; and providing an
70	70	effective date.
71	71
72	72
73	73
74	74
75	75	BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
76	76	SECTION 1. AMENDATORY 36 O.S. 2021, Section 4502, is
77	77	amended to read as follows:
78	78	Section 4502. A. Each group accident and health policy shall
79	79	contain in substance the following provisions:
80	80	1. A provision that, in the absence of fraud, all statements
81	81	made by the policyholder or by any in sured person shall be deemed
82	82	representations and not warranties, and that no statement made for
83	83	the purpose of effecting insurance shall avoid such insurance or
84	84	reduce benefits unless contained in a written instrument signed by
85	85	the policyholder or the insu red person, a copy of which has been
86	86	furnished to such policyholder or to such person or his or her
87	87	beneficiary;
88	88
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139	139	2. A provision that the insurer will furnish to the
140	140	policyholder, for delivery to each employee or member of the insured
141	141	group, an individual certificate setting forth in summary form a
142	142	statement of the essential features of the insurance coverage of
143	143	such employee or member and to whom benefits are payable. If
144	144	dependents or family members are included in the coverage additional
145	145	certificates need not be issued for delivery to such dependents or
146	146	family members; and
147	147	3. A provision that to the group originally insured may be
148	148	added from time to time eligible new employees or members or
149	149	dependents, as the case may be, in accordance with the terms of the
150	150	policy.
151	151	B. Each group health policy certificate subject to the
152	152	provisions of the Federal Health Insurance Portability and
153	153	Accountability Act, Public Law 104 -191, (HIPAA) laws shall contain
154	154	in substance the following provisions, which shall be in addit ion to
155	155	the provisions required by subsection A of this section.
156	156	1. A provision that a health benefit plan shall not deny,
157	157	exclude or limit benefits for a covered individual for losses
158	158	incurred more than twelve (12) months following the effective date
159	159	of the individual's coverage due to a preexisting condition;
160	160	2. A provision that a health benefit plan shall not define a
161	161	preexisting condition more restrictively than:
162	162
163	163
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213	213	a. a condition for which medical advice, diagnosis, care
214	214	or treatment was recommended or r eceived during the
215	215	six (6) months immediately preceding the effective
216	216	date of coverage,
217	217	b. pregnancy and genetic information shall not be
218	218	considered preexisting conditions,
219	219	c. a health benefit plan may exclude a preexisting
220	220	condition for late enrollees for a period not to
221	221	exceed eighteen (18) months from the date the
222	222	individual enrolls for coverage,
223	223	d. the period of any such preexisting condition exclusion
224	224	shall be reduced by the aggregate of the periods of
225	225	creditable coverage as defined in the Federal HIPA A
226	226	laws,
227	227	e. a period of creditable coverage shall not be counted
228	228	if after such period and before the enrollment date,
229	229	there was a sixty-three-day period during all of which
230	230	the individual was not covered under any creditable
231	231	coverage,
232	232	f. "enrollment date" means the date of enrollment of the
233	233	individual in the plan or coverage or, if earlier, the
234	234	first day of the waiting period for such enrollment,
235	235	and
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287	287	g. "late enrollee" means a participant or beneficiary who
288	288	enrolls under the plan other than during the first
289	289	period in which the individual is eligible to enroll
290	290	under the plan or a special enrollment period;
291	291	3. A provision that individuals losing other coverage shall be
292	292	permitted to enroll for coverage under the terms of the plan if each
293	293	of the following condit ions is met:
294	294	a. the employee or dependent was covered under a group
295	295	health plan or had health insurance coverage at the
296	296	time coverage was previously offered to the employee
297	297	or dependent,
298	298	b. the employee stated in writing at such time that
299	299	coverage under a group health plan or health insurance
300	300	coverage was the reason for declining enrollment, but
301	301	only if the plan sponsor or issuer required such a
302	302	statement at such time and provided the employee with
303	303	notice of such requirement, and the consequences of
304	304	such requirement, at such time,
305	305	c. the employee's or dependent's coverage was under a
306	306	COBRA continuation provision and the coverage under
307	307	such provision was exhausted; or was not under such a
308	308	provision and either the coverage was terminated as a
309	309	result of loss of eligibility for the coverage,
310	310	including as a result of legal separation, divorce,
311	311
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362	362	death, termination of employment, or reduction in the
363	363	number of hours of employment, or employer
364	364	contributions toward such coverage were terminated,
365	365	and
366	366	d. under the terms of the plan, the employee requests
367	367	such enrollment not later than thirty (30) days after
368	368	the date of exhaustion of coverage;
369	369	4. A provision that for any period that an individual is in a
370	370	waiting period for any coverage under a group health plan or for
371	371	group health insurance coverage or is in an affiliation period, that
372	372	period shall not be taken into account in determining the continuous
373	373	period of creditable coverage. "Affiliation period" means a period
374	374	which, under the terms of the health insurance coverag e offered by a
375	375	health maintenance organization, must expire before the health
376	376	insurance coverage becomes effective. The organization is not
377	377	required to provide health care services or benefits during such
378	378	period and no premium shall be charged to the part icipant or
379	379	beneficiary for any coverage during the period;
380	380	5. A provision that preexisting condition exclusions will not
381	381	apply to newborns, who, as the last day of the thirty -day period
382	382	beginning with the date of birth, are covered under creditable
383	383	coverage;
384	384
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435	435	6. A provision that preexisting condition exclusions will not
436	436	apply to a child who is adopted or placed for adoption before
437	437	attaining eighteen (18) years of age;
438	438	7. A provision that dependents are eligible for a special
439	439	enrollment period if the group health plan makes coverage available
440	440	with respect to a dependent of an individual, and the individual is
441	441	a participant under the plan, or has met any waiting period
442	442	applicable to becoming a participant under the plan and is eligible
443	443	to be enrolled under t he plan but for a failure to enroll during a
444	444	previous enrollment period, and a person becomes such a dependent of
445	445	the individual through marriage, birth or, adoption or, placement
446	446	for adoption, or pregnancy. The special enrollment period shall
447	447	apply to that person or, if not otherwise enrolled, the individual,
448	448	the dependent of the individual, and in the case of the birth or,
449	449	adoption of a child, or pregnancy of the indivi dual or dependent of
450	450	the individual, the spouse of the individual may be enrolled as a
451	451	dependent of the individual if such spouse is otherwise eligible for
452	452	coverage.
453	453	a. The dependent special enrollment period shall be a
454	454	period of not less than thirty (30) days and shall
455	455	begin on the later of the date dependent coverage is
456	456	made available, or t he date of the marriage, birth, or
457	457	adoption or, placement for adoption . The dependent
458	458	special enrollment period, for pregnancy, shall be a
459	459
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510	510	period of not less t han ninety (90) days and shall
511	511	begin on the date of the pregnancy.
512	512	b. There is no waiting period if an individual seeks to
513	513	enroll a dependent during the first thirty (30) days
514	514	of such a dependent special enrollment period.
515	515	c. The coverage for the d ependent shall become effective
516	516	in the case of marriage, not later than the first day
517	517	of the first month beginning after the date the
518	518	completed request for enrollment is received, in the
519	519	case of a dependent's birth, as of the date of such
520	520	birth, in the case of a dependent's adoption or
521	521	placement for adoption, the date of such adoption o r
522	522	placement for adopti on, in the case of pregnancy of
523	523	either the individual or dependent of the individual ,
524	524	not later than the first day of the first month
525	525	beginning after the date the completed request for
526	526	enrollment is received ;
527	527	8. A provision that eligibility or continued e ligibility of any
528	528	individual will not be based on any of the following health -status-
529	529	related factors in relation to the individual or a dependent of the
530	530	individual: health status, medical condition, including both
531	531	physical and mental illnesses, claims exp erience, receipt of health
532	532	care, medical history, genetic information, evidence of
533	533
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584	584	insurability, including conditions arising out of acts of domestic
585	585	violence or disability.
586	586	a. Carriers are not required to provide particular
587	587	benefits other than those provi ded under the terms of
588	588	the plan or coverage.
589	589	b. Carriers may establish limitations or restrictions on
590	590	the amount, level, extent, and nature of the benef its
591	591	or coverage for similarly situated individuals
592	592	enrolled in the plan or coverage; and
593	593	9. A provision that the group health plan is guaranteed
594	594	renewable, except as provided pursuant to the federal provisions
595	595	found in HIPAA, which are as follows:
596	596	a. nonpayment of premium,
597	597	b. fraud,
598	598	c. violation of participation and/or contribution rules,
599	599	d. termination of coverage:
600	600	(1) in any case in which an issuer decides to
601	601	discontinue offering a particular type of group
602	602	health insurance coverage offered in the large o r
603	603	small group market, coverage of such type may be
604	604	discontinued by the issuer only if: the issuer
605	605	provides notice to each plan sponsor provided
606	606	coverage of this type in such market, and
607	607	participants and beneficiaries covered under such
608	608
609	609
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659	659	coverage, of such discontinuation at least ninety
660	660	(90) days prior to the date of the
661	661	discontinuation of such coverage and m akes
662	662	available the option to purchase all or, in the
663	663	case of the large group market, any other health
664	664	insurance coverage currently being offered by the
665	665	issuer to a group health plan in such market and
666	666	in exercising the option to discontinue coverage
667	667	of this type and in offering the option of
668	668	coverage pursuant to this provision, the issuer
669	669	acts uniformly without regard to the claims
670	670	experience of those spo nsors or any health-
671	671	status-related factor relating to any
672	672	participants or beneficiaries covered or new
673	673	participants or beneficiaries who may become
674	674	eligible for such coverage,
675	675	(2) in any case in which an issuer decides to
676	676	discontinue offering a particular type of group
677	677	health insurance coverage offered in the large or
678	678	small group market, coverage of such typ e may be
679	679	discontinued by the issuer only if: the issuer
680	680	provides notice to the Oklahoma Insurance
681	681	Department and to each plan sponsor and
682	682	participants and beneficiaries covered under such
683	683
684	684
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734	734	coverage of such discontinuation at least one
735	735	hundred eighty (180) days prior to the date of
736	736	the discontinuation of such coverage; and all
737	737	health insurance issued or delivered for issuance
738	738	in the state in such market or markets are
739	739	discontinued and coverage under such health
740	740	insurance coverage in such market or markets is
741	741	not renewed, and
742	742	(3) in the case of a discontinuation under division
743	743	(2) of this subparagraph in a market, the issuer
744	744	shall not provide for the issuanc e of any health
745	745	insurance coverage in the market and in this
746	746	state during the five -year period beginning on
747	747	the date of the discontinuation of the last
748	748	health insurance coverage not so renewed,
749	749	e. movement outside the service area, and
750	750	f. association membership ceases.
751	751	SECTION 2. This act shall become effective November 1, 2024.
752	752
753	753	59-2-9610 TJ 01/17/24

Oklahoma 2024 Regular Session

Oklahoma House Bill HB3375 Compare Versions