Oklahoma § 36-4528 Areas served – Services and plans permitted to be offered

Oklahoma Statutes

§ 36-4528 — Areas served – Services and plans permitted to be offered

Oklahoma·Title 36 Insurance

by single administrative organization – Rating characteristics.

A.Nothing in this act shall be construed as preventing one or more Health Insurance Purchasing Groups (HIPG) from serving different areas, whether or not contiguous, by providing for some or all of the following through a single administrative organization or otherwise: 1. Coordinating the offering of the same or similar health benefits coverage in different areas served by the different HIPG; or 2. Providing for crediting of deductibles and other cost- sharing for individuals who are provided a health benefits plan through the HIPG or affiliated HIPG after: a. a change of eligible employers through which the coverage is provided, or b. a change in place of employment to an area not served by the previous HIPG.

B.No HIPG hea

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by single administrative organization – Rating characteristics. A. Nothing in this act shall be construed as preventing one or more Health Insurance Purchasing Groups (HIPG) from serving different areas, whether or not contiguous, by providing for some or all of the following through a single administrative organization or otherwise: 1. Coordinating the offering of the same or similar health benefits coverage in different areas served by the different HIPG; or 2. Providing for crediting of deductibles and other cost- sharing for individuals who are provided a health benefits plan through the HIPG or affiliated HIPG after: a. a change of eligible employers through which the coverage is provided, or b. a change in place of employment to an area not served by the previous HIPG. B. No HIPG health carrier shall be required to offer HIPG health benefits plans, or health benefits plans not subject to state-mandated health benefits, to non-HIPG organizations, associations, or employer groups, including but not limited to the small employer health insurance group marketplace in this state. C. Nothing in this act shall be construed as precluding a HIPG from providing for adjustments in amounts distributed among the HIPG health carriers offering a health benefits plan through the HIPG, based on factors such as the relative health care risk of members enrolled under the coverage offered by the different issuers. D. Nothing in this act shall be construed as precluding a HIPG from establishing minimum participation and contribution rules for eligible employers that apply to become purchasers in the HIPG, so long as the rules are applied uniformly for all HIPG health carriers. E. The HIPG may determine what rating characteristics it will allow in the health benefit plan including, but not limited to, age, sex, industry, geography, or health. F. If health is used as a rating characteristic, then the rates for the groups having two through fifty members will be subject to the small employer group rating law as required in the Small Employer Health Insurance Reform Act but may be considered separate from any small groups sold outside the HIPG.

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