Okla. Stat. tit. 36, § 36-3611.1

Regulations - Issuance - Return and refund - Examination of

insurers.

A. As used in this section:

1. "Commissioner" means the Commissioner of Insurance;

2. "Medicare supplement policy" means a group or individual

policy of accident and health insurance, or a subscriber contract of

a nonprofit hospital service and medical indemnity corporation or a

health maintenance organization which is advertised, marketed or

designed primarily as a supplement to reimbursements under Medicare

Oklahoma Statutes - Title 36. Insurance Page 779

for the hospital, medical or surgical expenses of persons eligible

for Medicare. Such term does not include:

a. a policy or contract of one or more employers or labor

organizations, or of the trustees of a fund

established by one or more employers or labor

organizations, or combination thereof, for employees

or former employees, or combination thereof, or for

members or former members, or combination thereof, of

the labor organizations, or

b. a policy or contract of any professional, trade or

occupational association for its members or former or

retired members, or combination thereof, if such

association:

(1) is composed of individuals all of whom are

actively engaged in the same profession, trade or

occupation,

(2) has been maintained in good faith for purposes

other than obtaining insurance, and

(3) has been in existence for at least two (2) years

prior to the date of its initial offering of such

policy or plan to its members, or

c. individual policies or contracts issued pursuant to a

conversion privilege under a policy or contract of

group or individual insurance; and

3. "Direct response Medicare supplement policy" means a policy

of insurance which is advertised, marketed or designed primarily as

a supplement to reimbursements under Medicare for the hospital,

medical or surgical expenses of persons eligible for Medicare issued

as a result of solicitation of individual insureds by mail or by

mass media advertising.

B. The Commissioner shall issue reasonable regulations to

establish minimum standards for benefit claims payment, marketing

practices, compensation arrangements, and reporting practices for

Medicare supplement policies. The Commissioner shall issue

reasonable regulations to provide for an open enrollment period for

those persons who qualify as disabled pursuant to federal Medicare

guidelines.

C. A Medicare supplement policy may not deny a claim for losses

incurred more than six (6) months from the effective date of

coverage for a preexisting condition. The policy may not define a

preexisting condition more restrictively than "a condition for which

medical advice was given or treatment was recommended by or received

from a physician within six (6) months before the effective date of

coverage".

D. Any premium rate filing for a Medicare supplement policy

shall be filed with and approved by the Insurance Commissioner and

communicated to the policyholder at least forty-five (45) days prior

Oklahoma Statutes - Title 36. Insurance Page 780

to the effective date of a premium rate increase. Such premium

increases shall be implemented no more than once per year.

E. A Medicare supplement policy shall be expected to return to

the policyholder benefits which are reasonable in relation to the

premium charged. The Commissioner shall issue regulations to

establish minimum standards for loss ratios of Medicare supplement

policies on the basis of incurred claims experience, or incurred

health care expenses where coverage is provided by a health

maintenance organization on a service rather than reimbursement

basis, and earned premiums for the period of coverage for which

rates are computed and in accordance with accepted actuarial

principles and practices.

F. 1. No Medicare supplement policy or certificate issued

pursuant to a group Medicare supplement policy shall be delivered or
care expenses where coverage is provided by a health

maintenance organization on a service rather than reimbursement

basis, and earned premiums for the period of coverage for which

rates are computed and in accordance with accepted actuarial

principles and practices.

F. 1. No Medicare supplement policy or certificate issued

pursuant to a group Medicare supplement policy shall be delivered or

issued for delivery in this state unless an outline of coverage is

provided to the applicant at the time application is made.

2. The Commissioner shall prescribe by regulation the contents

and a standard form of an informational brochure for persons

eligible for Medicare which is intended to improve the buyer's

ability to select the most appropriate coverage and improve the

buyer's understanding of Medicare. The Commissioner may require by

regulation that the informational brochure be provided with the

outline of coverage to any prospective insureds eligible for

Medicare. With respect to direct response policies, the

Commissioner may require that the prescribed brochure and outline of

coverage be provided upon request to any prospective insureds

eligible for Medicare, but in no event later than the time of policy

delivery.

3. The Commissioner may require notice provisions, designed to

inform prospective insureds that particular insurance coverages are

not Medicare supplement coverages, for all accident and health

insurance policies sold to persons eligible for Medicare by reason

of age, other than:

a. Medicare supplement policies,

b. disability income policies,

c. basic, catastrophic, or major medical expense

policies,

d. single premium, nonrenewable policies, or

e. other policies defined by regulation of the

Commissioner.

4. The Commissioner may adopt from time to time, such

reasonable regulations as are necessary to conform Medicare

supplement policies and certificates to the requirements of federal

law and regulations promulgated thereunder, including but not

limited to:

a. requiring refunds or credits if the policies or

certificates do not meet loss ratio requirements,

Oklahoma Statutes - Title 36. Insurance Page 781

b. establishing a uniform methodology for calculating and

reporting loss ratios,

c. assuring public access to policies, premiums and loss

ratio information of issuers of Medicare supplement

insurance, and

d. establishing a policy for holding public hearings

prior to approval of premium increases.

G. Medicare supplement policies or certificates shall have a

notice prominently printed on the first page of the policy or

certificate, or attached thereto, stating that the applicant shall

have the right to return the policy or certificate within thirty

(30) days of its delivery and to have the premium refunded if, after

examination of the policy or certificate, the applicant is not

satisfied for any reason. A direct response policy issued to

persons eligible for Medicare shall have a notice prominently

printed on the first page, or attached thereto, stating that the

applicant shall have the right to return the policy or certificate

within thirty (30) days of its delivery and to have the premium

refunded if, after examination, the applicant is not satisfied for

any reason.

H. The Insurance Commissioner shall have the authority to

employ actuaries, statisticians, accountants, auditors,

investigators, or any other technicians as the Insurance

Commissioner may deem necessary or beneficial to examine any

Medicare supplement filings made by insurers or rating organizations

and to examine such records of the insurers or rating organizations

as may be deemed appropriate in conjunction with the Medicare

supplement filing in order to determine that the rates or other

filings are consistent with the terms, conditions, requirements and

purposes of the Insurance Code, and to verify, validate and

investigate the information upon which the insurer or rating
ganizations

and to examine such records of the insurers or rating organizations

as may be deemed appropriate in conjunction with the Medicare

supplement filing in order to determine that the rates or other

filings are consistent with the terms, conditions, requirements and

purposes of the Insurance Code, and to verify, validate and

investigate the information upon which the insurer or rating

organization relies to support such filing.

1. The Commissioner shall maintain a list of technicians who

are proficient in the line of Medicare supplement insurance. If the

Commissioner determines that it is necessary to utilize the services

of such a technician, the Commissioner shall employ the next

available technician in rotation on the list.

2. All reasonable expenses incurred in such filing review shall

be paid by the insurer or rating organization making the filing.