Okla. Stat. tit. 36, § 36-4502

A. Each group accident and health policy shall contain in

substance the following provisions:

1. A provision that, in the absence of fraud, all statements

made by the policyholder or by any insured person shall be deemed

representations and not warranties, and that no statement made for

the purpose of effecting insurance shall avoid such insurance or

reduce benefits unless contained in a written instrument signed by

the policyholder or the insured person, a copy of which has been

furnished to such policyholder or to such person or his or her

beneficiary;

2. A provision that the insurer will furnish to the

policyholder, for delivery to each employee or member of the insured

group, an individual certificate setting forth in summary form a

statement of the essential features of the insurance coverage of

such employee or member and to whom benefits are payable. If

dependents or family members are included in the coverage additional

certificates need not be issued for delivery to such dependents or

family members; and

3. A provision that to the group originally insured may be

added from time to time eligible new employees or members or

dependents, as the case may be, in accordance with the terms of the

policy.

B. Each group health policy certificate subject to the

provisions of the Federal Health Insurance Portability and

Oklahoma Statutes - Title 36. Insurance Page 979

Accountability Act, Public Law 104-191, (HIPAA) laws shall contain

in substance the following provisions, which shall be in addition to

the provisions required by subsection A of this section.

1. A provision that a health benefit plan shall not deny,

exclude or limit benefits for a covered individual for losses

incurred more than twelve (12) months following the effective date

of the individual's coverage due to a preexisting condition;

2. A provision that a health benefit plan shall not define a

preexisting condition more restrictively than:

a. a condition for which medical advice, diagnosis, care

or treatment was recommended or received during the

six (6) months immediately preceding the effective

date of coverage,

b. pregnancy and genetic information shall not be

considered preexisting conditions,

c. a health benefit plan may exclude a preexisting

condition for late enrollees for a period not to

exceed eighteen (18) months from the date the

individual enrolls for coverage,

d. the period of any such preexisting condition exclusion

shall be reduced by the aggregate of the periods of

creditable coverage as defined in the Federal HIPAA

laws,

e. a period of creditable coverage shall not be counted

if after such period and before the enrollment date,

there was a sixty-three-day period during all of which

the individual was not covered under any creditable

coverage,

f. "enrollment date" means the date of enrollment of the

individual in the plan or coverage or, if earlier, the

first day of the waiting period for such enrollment,

and

g. "late enrollee" means a participant or beneficiary who

enrolls under the plan other than during the first

period in which the individual is eligible to enroll

under the plan or a special enrollment period;

3. A provision that individuals losing other coverage shall be

permitted to enroll for coverage under the terms of the plan if each

of the following conditions is met:

a. the employee or dependent was covered under a group

health plan or had health insurance coverage at the

time coverage was previously offered to the employee

or dependent,

b. the employee stated in writing at such time that

coverage under a group health plan or health insurance

coverage was the reason for declining enrollment, but

only if the plan sponsor or issuer required such a

Oklahoma Statutes - Title 36. Insurance Page 980

statement at such time and provided the employee with

notice of such requirement, and the consequences of

such requirement, at such time,
e employee stated in writing at such time that

coverage under a group health plan or health insurance

coverage was the reason for declining enrollment, but

only if the plan sponsor or issuer required such a

Oklahoma Statutes - Title 36. Insurance Page 980

statement at such time and provided the employee with

notice of such requirement, and the consequences of

such requirement, at such time,

c. the employee's or dependent's coverage was under a

COBRA continuation provision and the coverage under

such provision was exhausted; or was not under such a

provision and either the coverage was terminated as a

result of loss of eligibility for the coverage,

including as a result of legal separation, divorce,

death, termination of employment, or reduction in the

number of hours of employment, or employer

contributions toward such coverage were terminated,

and

d. under the terms of the plan, the employee requests

such enrollment not later than thirty (30) days after

the date of exhaustion of coverage;

4. A provision that for any period that an individual is in a

waiting period for any coverage under a group health plan or for

group health insurance coverage or is in an affiliation period, that

period shall not be taken into account in determining the continuous

period of creditable coverage. "Affiliation period" means a period

which, under the terms of the health insurance coverage offered by a

health maintenance organization, must expire before the health

insurance coverage becomes effective. The organization is not

required to provide health care services or benefits during such

period and no premium shall be charged to the participant or

beneficiary for any coverage during the period;

5. A provision that preexisting condition exclusions will not

apply to newborns, who, as the last day of the thirty-day period

beginning with the date of birth, are covered under creditable

coverage;

6. A provision that preexisting condition exclusions will not

apply to a child who is adopted or placed for adoption before

attaining eighteen (18) years of age;

7. A provision that dependents are eligible for a special

enrollment period if the group health plan makes coverage available

with respect to a dependent of an individual, and the individual is

a participant under the plan, or has met any waiting period

applicable to becoming a participant under the plan and is eligible

to be enrolled under the plan but for a failure to enroll during a

previous enrollment period, and a person becomes such a dependent of

the individual through marriage, birth or adoption or placement for

adoption. The special enrollment period shall apply to that person

or, if not otherwise enrolled, the individual, the dependent of the

individual, and in the case of the birth or adoption of a child, the

spouse of the individual may be enrolled as a dependent of the

individual if such spouse is otherwise eligible for coverage.

Oklahoma Statutes - Title 36. Insurance Page 981

a. The dependent special enrollment period shall be a

period of not less than thirty (30) days and shall

begin on the later of the date dependent coverage is

made available, or the date of the marriage, birth, or

adoption or placement for adoption.

b. There is no waiting period if an individual seeks to

enroll a dependent during the first thirty (30) days

of such a dependent special enrollment period.

c. The coverage for the dependent shall become effective

in the case of marriage, not later than the first day

of the first month beginning after the date the

completed request for enrollment is received, in the

case of a dependent's birth, as of the date of such

birth, in the case of a dependent's adoption or

placement for adoption, the date of such adoption or

placement for adoption;

8. A provision that eligibility or continued eligibility of any

individual will not be based on any of the following health-status-
th beginning after the date the

completed request for enrollment is received, in the

case of a dependent's birth, as of the date of such

birth, in the case of a dependent's adoption or

placement for adoption, the date of such adoption or

placement for adoption;

8. A provision that eligibility or continued eligibility of any

individual will not be based on any of the following health-status-

related factors in relation to the individual or a dependent of the

individual: health status, medical condition, including both

physical and mental illnesses, claims experience, receipt of health

care, medical history, genetic information, evidence of

insurability, including conditions arising out of acts of domestic

violence or disability.

a. Carriers are not required to provide particular

benefits other than those provided under the terms of

the plan or coverage.

b. Carriers may establish limitations or restrictions on

the amount, level, extent, and nature of the benefits

or coverage for similarly situated individuals

enrolled in the plan or coverage; and

9. A provision that the group health plan is guaranteed

renewable, except as provided pursuant to the federal provisions

found in HIPAA, which are as follows:

a. nonpayment of premium,

b. fraud,

c. violation of participation and/or contribution rules,

d. termination of coverage:

(1) in any case in which an issuer decides to

discontinue offering a particular type of group

health insurance coverage offered in the large or

small group market, coverage of such type may be

discontinued by the issuer only if: the issuer

provides notice to each plan sponsor provided

coverage of this type in such market, and

participants and beneficiaries covered under such

coverage, of such discontinuation at least ninety

Oklahoma Statutes - Title 36. Insurance Page 982

(90) days prior to the date of the

discontinuation of such coverage and makes

available the option to purchase all or, in the

case of the large group market, any other health

insurance coverage currently being offered by the

issuer to a group health plan in such market and

in exercising the option to discontinue coverage

of this type and in offering the option of

coverage pursuant to this provision, the issuer

acts uniformly without regard to the claims

experience of those sponsors or any health-

status-related factor relating to any

participants or beneficiaries covered or new

participants or beneficiaries who may become

eligible for such coverage,

(2) in any case in which an issuer decides to

discontinue offering a particular type of group

health insurance coverage offered in the large or

small group market, coverage of such type may be

discontinued by the issuer only if: the issuer

provides notice to the Oklahoma Insurance

Department and to each plan sponsor and

participants and beneficiaries covered under such

coverage of such discontinuation at least one

hundred eighty (180) days prior to the date of

the discontinuation of such coverage; and all

health insurance issued or delivered for issuance

in the state in such market or markets are

discontinued and coverage under such health

insurance coverage in such market or markets is

not renewed, and

(3) in the case of a discontinuation under division

(2) of this subparagraph in a market, the issuer

shall not provide for the issuance of any health

insurance coverage in the market and in this

state during the five-year period beginning on

the date of the discontinuation of the last

health insurance coverage not so renewed,

e. movement outside the service area, and

f. association membership ceases.