Okla. Stat. tit. 36, § 36-1250.2

As used in the Unfair Claims Settlement Practices Act:

1. "Agent" means any individual, corporation, association,

partnership, or other legal entity authorized to represent an

insurer with respect to a claim;

2. "Claimant" means either a first party claimant, a third

party claimant, or both, and includes such claimant's designated

legal representatives and includes a member of the claimant's

immediate family designated by the claimant;

3. "Commissioner" means the Insurance Commissioner;

4. "First-party claimant" means an individual, corporation,

association, partnership, or other legal entity, including a

subscriber under any plan providing health services, asserting a

right to payment pursuant to an insurance policy or insurance

contract for an occurrence of contingency or loss covered by such

policy or contract;

5. "Health benefit plan" means group hospital or medical

insurance coverage, a not-for-profit hospital or medical service or

indemnity plan, a prepaid health plan, a health maintenance

organization plan, a preferred provider organization plan, the State

and Education Employees Group Health Insurance Plan, and coverage

provided by a Multiple Employer Welfare Arrangement (MEWA) or

employee self-insured plan except as exempt under federal ERISA

provisions. The term shall not include short-term accident, fixed

indemnity, or specified disease policies, disability income

contracts, limited benefit or credit disability insurance, workers'

compensation insurance coverage, automobile medical payment

insurance, or insurance under which benefits are payable with or

without regard to fault and which is required by law to be contained

in any liability insurance policy or equivalent self-insurance;

6. "Insurance policy or insurance contract" means any contract

of insurance, certificate, indemnity, medical or hospital service,

suretyship, annuity, subscriber certificate or any evidence of

coverage of a health maintenance organization issued, proposed for

issuance, or intended for issuance by any entity subject to this

Code;

7. "Insurer" means a person licensed by the Commissioner to

issue or who issues any insurance policy or insurance contract in

this state and also includes health maintenance organizations.

Provided that, for the purposes of paragraphs 15 and 16 of Section

1250.5 of this title, "insurer" shall include the State and

Education Employees Group Insurance Board;

Oklahoma Statutes - Title 36. Insurance Page 306

8. "Investigation" means all activities of an insurer directly

or indirectly related to the determination of liabilities under

coverages afforded by an insurance policy or insurance contract;

9. "Notification of claim" means any notification, whether in

writing or other means acceptable under the terms of an insurance

policy or insurance contract, to an insurer or its agent, by a

claimant, which reasonably apprises the insurer of the facts

pertinent to a claim;

10. "Preauthorization/precertification" means a determination

by a health benefit plan, based on the information presented at the

time by the health care provider, that health care services proposed

by the health care provider are medically necessary. The term shall

include "authorization", "certification" and any other term that

would be a reliable determination by a health benefit plan. A

preauthorization/precertification from a previous health plan shall

not bind a succeeding health benefit plan;

11. "Third-party claimant" means any individual, corporation,

association, partnership, or other legal entity asserting a claim

against any individual, corporation, association, partnership, or

other legal entity insured under an insurance policy or insurance

contract; and

12. "Verification of eligibility" means a representation by a

health benefit plan to a health care provider that a claimant is

entitled to covered benefits under the policy. Such verification of
partnership, or other legal entity asserting a claim

against any individual, corporation, association, partnership, or

other legal entity insured under an insurance policy or insurance

contract; and

12. "Verification of eligibility" means a representation by a

health benefit plan to a health care provider that a claimant is

entitled to covered benefits under the policy. Such verification of

eligibility shall be valid for four (4) business days from the date

given by the health benefit plan.