Okla. Stat. tit. 36, § 36-4424

Unless the context requires otherwise, the definitions in this

section apply throughout the Long-Term Care Insurance Act.

1. a. "Long-term care insurance" means any insurance policy,

certificate or rider, including qualified long-term

care insurance contracts and long-term care

partnership program contracts, which are advertised,

marketed, offered or designed primarily to provide

coverage for not less than twelve (12) consecutive

months for each covered person on an expense incurred,

indemnity, prepaid, or other basis, for one or more

necessary or medically necessary diagnostic,

preventive, therapeutic, rehabilitative, maintenance,

or personal care services, provided in a setting other

than an acute care unit of a hospital.

b. This term includes group and individual health

policies or riders or group and individual life

policies or annuities or riders which provide,

directly or as a supplement, coverage for long-term

care, whether issued by insurers, fraternal benefit

societies, nonprofit health, hospital, and medical

service corporations, prepaid health plans, health

maintenance organizations, life care communities, or

any similar organization.

c. This term also includes a policy or rider which

provides for payment of long-term care benefits based

upon cognitive impairment or the loss of functional

capacity.

d. Long-term care insurance shall not include any

insurance policy which is offered primarily to provide

basic Medicare supplement coverage, basic hospital

expense coverage, basic medical-surgical expense

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coverage, hospital confinement indemnity coverage,

major medical expense coverage, disability income

protection coverage or related asset-protection

coverage, catastrophic coverage, comprehensive

coverage, accident only coverage, specified disease or

specified accident coverage, or limited benefit health

coverage.

e. With regard to life insurance, this term does not

include life insurance policies which accelerate the

death benefit specifically for one or more of the

qualifying events of terminal illness, medical

conditions requiring extraordinary medical

intervention, or permanent institutional confinement,

and which provide the option of a lump-sum payment for

those benefits and in which neither the benefits nor

the eligibility for the benefits is conditioned upon

the receipt of long-term care.

f. Notwithstanding any other provision contained herein,

any product advertised, marketed or offered as long-

term care insurance shall be subject to the provisions

of the Long-Term Care Act.

2. "Applicant" means:

a. in the case of an individual long-term care insurance

policy, the person who seeks to contract for such

benefits, and

b. in the case of a group long-term care insurance

policy, the proposed certificate holder.

3. "Certificate" means any certificate issued under a group

long-term care insurance policy, which certificate has been

delivered, or issued for delivery, in this state.

4. "Group long-term care insurance" means a long-term care

insurance policy which is delivered, or issued for delivery, in this

state and issued to:

a. one or more employers or labor organizations, or to a

trust or to the trustees of a fund established by one

or more employers or labor organizations, or a

combination thereof, for employees or former

employees, or a combination thereof or for members or

former members, or a combination thereof, of the labor

organizations, or

b. 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 or

were actively engaged in the same profession,

trade or occupation, and

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r

former members, or a combination thereof, of the labor

organizations, or

b. 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 or

were actively engaged in the same profession,

trade or occupation, and

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(2) has been maintained in good faith for purposes

other than insurance, or

c. an association, a trust, or the trustee or trustees of

a fund established, created, or maintained for the

benefit of members of one or more associations. Prior

to advertising, marketing or offering such policy

within this state, the association or associations, or

the insurer of the association or associations, shall

file evidence with the Insurance Commissioner that the

association or associations shall have at the outset

of transacting long-term care insurance in this state

a minimum of one hundred (100) persons in the

association or associations and shall have been

organized and maintained in good faith for purposes

other than that of obtaining insurance; shall have

been in active existence for at least one (1) year;

and shall have a constitution and bylaws which provide

that (i) the association or associations hold regular

meetings not less than annually to further purposes of

the members, (ii) except for credit unions, the

association or associations collect dues or solicit

contributions from members, and (iii) the members have

voting privileges and representation on the governing

board and committees. Thirty (30) days after such

filing the association or associations shall be deemed

to satisfy such organizational requirements, unless

the Commissioner makes a finding that the association

or associations do not satisfy those organizational

requirements, or

d. a group other than as described in subparagraphs a, b

and c of this paragraph, subject to a finding by the

Commissioner that:

(1) the issuance of the group policy is not contrary

to the best interest of the public,

(2) the issuance of the group policy would result in

economies of acquisition or administration, and

(3) the benefits are reasonable in relation to the

premiums charged.

5. "Not-for-Profit Life care community" within the meaning of

Section 1-853.1 of Title 63 of the Oklahoma Statutes means any not-

for-profit organization that enters into an arrangement pursuant to

which a person contracts for a place of residence and personal care

services, including but not limited to services which progress from

independent living to semi-dependent nursing care to acute nursing

care, in consideration of an endowed prepayment, license or entry

fee which has been actuarially established to meet the cost of the

promised services and accommodations. For communities commencing

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operations after January 1, 2016, the amount of the endowed

prepayment must be independently, actuarially determined, in

compliance with the Actuarial Standards of Practice promulgated by

the Actuarial Standards Board of the American Academy of Actuaries,

prior to opening the community and annually thereafter to ensure

that sufficient payments are collected to meet the future services

of the residents. The actuarial study shall take into consideration

projected or actual project costs, resident fees and charges,

resident contract provisions and any other factors affecting the

operation of the facility. It shall contain mortality and morbidity

data and an actuary's signed opinion that the proposed is feasible

and that the study has been prepared in accordance with standards

adopted by the American Academy of Actuaries. A not-for-profit life

care community shall not include the following:

a. traditional landlord and tenant agreements utilizing

periodic rental and security deposit payments,
. It shall contain mortality and morbidity

data and an actuary's signed opinion that the proposed is feasible

and that the study has been prepared in accordance with standards

adopted by the American Academy of Actuaries. A not-for-profit life

care community shall not include the following:

a. traditional landlord and tenant agreements utilizing

periodic rental and security deposit payments,

b. residential care homes licensed pursuant to the

Oklahoma Residential Care Act,

c. assisted living centers and continuum of care

facilities licensed pursuant to the Oklahoma Continuum

of Care and Assisted Living Act,

d. facilities licensed pursuant to the Oklahoma Nursing

Home Care Act, or

e. any facility where the endowed prepayment, license or

entry fee is less than Fifty Thousand Dollars

($50,000.00).

6. "Policy" means any policy, contract, certificate, subscriber

agreement, rider or endorsement delivered, or issued for delivery,

in this state by an insurer, fraternal benefit society, nonprofit

health, hospital, or medical service corporation, prepaid health

plan, health maintenance organization, life care community, or any

similar organization.

7. "Qualified long-term care insurance contract" means any:

a. individual or group insurance contract if the contract

meets the requirements of Section 7702(B) of the

Internal Revenue Code, as amended, and if:

(1) the only insurance protection provided under the

contract is coverage of qualified long-term care

services,

(2) the contract does not pay or reimburse expenses

incurred for services or items to the extent that

such expenses are reimbursable under Title XVIII

of the Social Security Act as amended, or would

be so reimbursable but for the application of a

deductible or coinsurance amount. The

requirements of this subparagraph do not apply to

contracts where Medicare is a secondary payor, or

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where the contract makes per diem or other

periodic payments without regard to expenses,

(3) the contract is guaranteed renewable,

(4) the contract does not provide for a cash

surrender value or other money that can be paid,

assigned, pledged as collateral for a loan, or

borrowed. All refunds of premiums and all

policyholder dividends or similar amounts, under

such contract are to be applied as a reduction in

future premiums or to increase future benefits,

except that a refund of the aggregate premium

paid under the contract may be allowed in the

event of death of the insured or a complete

surrender or cancellation of the contract, and

(5) the contract contains the consumer protection

provisions set forth in Section 7702(B)(g) of the

Internal Revenue Code, or

b. life insurance contract which provides long-term care

coverage by rider or as part of the contract if the

contract complies with the applicable provisions of

Section 7702(B) of the Internal Revenue Code, as

amended.

8. "Qualified long-term care services" means necessary

diagnostic, preventive, therapeutic, curing, treating, mitigating,

and rehabilitative services, and maintenance for personal care

services for which an insured is eligible under a qualified long-

term care insurance contract, and which are provided pursuant to a

plan of care prescribed by a licensed health care practitioner.