Okla. Stat. tit. 36, § 36-6515

A. Premium rates for health benefit plans subject to the Small

Employer Health Insurance Reform Act shall be subject to the

following provisions:

1. The rate manual developed for use by a small employer

carrier shall be filed and approved by the Insurance Commissioner

prior to use. Any changes to the rate manual shall be filed and

approved by the Insurance Commissioner prior to use. Every filing

shall be made not less than thirty (30) days prior to the date the

small employer carrier intends to implement the rates. The rate

manual so filed shall be deemed approved upon expiration of the

thirty-day waiting period unless, prior to the end of the period, it

has been affirmatively approved or disapproved by order of the

Commissioner. Approval of a rate manual by the Commissioner shall

constitute a waiver of any unexpired portion of the thirty-day

waiting period. The Commissioner may extend the period to approve

or disapprove a rate manual by not more than an additional thirty

(30) days by giving notice of such extension before expiration of

the initial thirty-day period. At the expiration of an extended

period, the rate filing shall be deemed approved unless otherwise

approved or disapproved by the Commissioner. The Commissioner may

at any time, after notice and for cause shown, withdraw approval of

a filed rate;

2. A small employer health benefit plan shall not be delivered

or issued for delivery unless the policy form or certificate form

can be expected to return to policyholders and certificate holders

in the form of aggregate benefits provided under the policy form or

certificate form at least sixty percent (60%) of the aggregate

amount of premiums earned. The rate of return shall be estimated

for the entire period for which rates are computed to provide

coverage. The rate of return shall be calculated 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

Oklahoma Statutes - Title 36. Insurance Page 1279

period in accordance with accepted actuarial principles and

practices;

3. The index rate for a rating period for any class of business

shall not exceed the index rate for any other class of business by

more than twenty percent (20%);

4. For a class of business, the premium rates charged during a

rating period to small employers with similar case characteristics

for the same or similar coverage, or the rates that could be charged

to such employers under the rating system for that class of

business, shall not vary from the index rate by more than twenty-

five percent (25%) of the index rate;

5. The percentage increase in the premium rate charged to a

small employer for a new rating period may not exceed the sum of the

following:

a. the percentage change in the new business premium rate

measured from the first day of the prior rating period

to the first day of the new rating period. In the

case of a health benefit plan into which the small

employer carrier is no longer enrolling new small

employers, the small employer carrier shall use the

percentage change in the base premium rate, provided

that the change does not exceed, on a percentage

basis, the change in the new business premium rate for

the most similar health benefit plan into which the

small employer carrier is actively enrolling new small

employers,

b. any adjustment, not to exceed fifteen percent (15%)

annually and adjusted pro rata for rating periods of

less than one year, due to the claim experience,

health status or duration of coverage of the employees

or dependents of the small employer as determined from

the rate manual for the class of business of the small

employer carrier, and

c. any adjustment due to change in coverage or change in

the case characteristics of the small employer, as

determined from the rate manual for the class of
less than one year, due to the claim experience,

health status or duration of coverage of the employees

or dependents of the small employer as determined from

the rate manual for the class of business of the small

employer carrier, and

c. any adjustment due to change in coverage or change in

the case characteristics of the small employer, as

determined from the rate manual for the class of

business of the small employer carrier;

6. Adjustments in rates for claim experience, health status and

duration of coverage shall not be charged to individual employees or

dependents. Any adjustment shall be applied uniformly to the rates

charged for all employees and dependents of the small employer;

7. A small employer carrier may utilize industry as a case

characteristic in establishing premium rates; provided, the highest

rate factor associated with any industry classification shall not

exceed the lowest rate factor associated with any industry

classification by more than fifteen percent (15%);

Oklahoma Statutes - Title 36. Insurance Page 1280

8. In the case of health benefit plans issued prior to the

effective date of the Small Employer Health Insurance Reform Act, a

premium rate for a rating period may exceed the ranges set forth in

paragraphs 3 and 4 of this subsection for a period of three (3)

years following the effective date of the Small Employer Health

Insurance Reform Act. In such case, the percentage increase in the

premium rate charged to a small employer for a new rating period

shall not exceed the sum of the following:

a. the percentage change in the new business premium rate

measured from the first day of the prior rating period

to the first day of the new rating period. In the

case of a health benefit plan into which the small

employer carrier is no longer enrolling new small

employers, the small employer carrier shall use the

percentage change in the base premium rate, provided

that the change does not exceed, on a percentage

basis, the change in the new business premium rate for

the most similar health benefit plan into which the

small employer carrier is actively enrolling new small

employers, and

b. any adjustment due to change in coverage or change in

the case characteristics of the small employer, as

determined from the rate manual of the carrier for the

class of business;

9. Small employer carriers shall:

a. apply rating factors, including case characteristics,

consistently with respect to all small employers in a

class of business. Rating factors shall produce

premiums for identical groups within the same class of

business which differ only by amounts attributable to

plan design and do not reflect differences due to

claims experience, health status and duration of

coverage, and

b. treat all health benefit plans issued or renewed in

the same calendar month as having the same rating

period;

10. For the purposes of this subsection, a health benefit plan

that utilizes a restricted provider network shall not be considered

similar coverage to a health benefit plan that does not utilize such

a network, provided that utilization of the restricted provider

network results in substantial differences in claims costs;

11. The Insurance Commissioner may establish rules to implement

the provisions of this section and to assure that rating practices

used by small employer carriers are consistent with the purposes of

the Small Employer Health Insurance Reform Act, including:

a. assuring that differences in rates charged for health

benefit plans by small employer carriers are

Oklahoma Statutes - Title 36. Insurance Page 1281

reasonable and reflect objective differences in plan

design, not including differences due to claims

experience, health status or duration of coverage, and

b. prescribing the manner in which case characteristics

may be used by small employer carriers.

B. A small employer carrier shall not transfer a small employer
small employer carriers are

Oklahoma Statutes - Title 36. Insurance Page 1281

reasonable and reflect objective differences in plan

design, not including differences due to claims

experience, health status or duration of coverage, and

b. prescribing the manner in which case characteristics

may be used by small employer carriers.

B. A small employer carrier shall not transfer a small employer

involuntarily into or out of a class of business. A small employer

carrier shall not offer to transfer a small employer into or out of

a class of business unless the offer is made to transfer all small

employers in the class of business without regard to case

characteristics, claim experience, health status or duration of

coverage.

C. The Commissioner may suspend for a specified period the

application of paragraph 3 of subsection A of this section as to the

premium rates applicable to one or more small employers included

within a class of business of a small employer carrier for one or

more rating periods upon a filing by the small employer carrier and

a finding by the Commissioner either that the suspension is

reasonably necessary in light of the financial condition of the

small employer carrier or that the suspension would enhance the

efficiency and fairness of the marketplace for small employer health

insurance.

D. Nothing in the Small Employer Health Insurance Reform Act

shall prohibit a small employer carrier from including in premium

rate development an employer's bona fide wellness program for its

employees including, but not limited to, a tobacco cessation

program.