Okla. Stat. tit. 36, § 36-6519

transacting business - Filing with Commissioner - Required

compliance with certain provisions - Exceptions.

A. 1. As a condition of transacting business in this state

with small employers, every small employer carrier shall actively

offer to small employers the health benefit plans currently being

marketed by the small employer carrier.

2. a. A small employer carrier shall issue a health benefit

plan to any eligible small employer that applies for a

plan and agrees to make the required premium payments

and to satisfy the other reasonable provisions of the

Oklahoma Statutes - Title 36. Insurance Page 1284

health benefit plan not inconsistent with Section 6511

et seq. of this title.

b. In the case of a small employer carrier that

establishes more than one class of business pursuant

to Section 6514 of this title, the small employer

carrier shall maintain and issue to eligible small

employers all health benefit plans currently being

marketed in each class of business so established. A

small employer carrier may apply reasonable criteria

to determine the class of business applicable to any

small employer, provided that:

(1) the criteria are not intended to discourage or

prevent acceptance of small employers applying

for a health benefit plan,

(2) the criteria are not related to the health status

or claim experience of the small employer,

(3) the criteria are applied consistently to all

small employers applying for coverage in the

class of business, and

(4) the small employer carrier provides for the

acceptance of all eligible small employers into

one or more classes of business.

The provisions of this subparagraph shall not apply to

a class of business into which the small employer

carrier is no longer enrolling new small businesses.

3. A small employer is eligible under paragraph 2 of this

subsection if it employed at least two or more eligible employees

within this state on at least fifty percent (50%) of its working

days during the preceding calendar quarter. This also includes

family businesses where employees of the business may be related.

The fact that the employees are related shall have no effect on the

eligibility for coverage of the small employer.

4. A small employer carrier that offers a health benefit plan

in the small employer market only through one or more bona fide

association health plans is not required to offer that health

benefit plan to any small employer that is not a member of the bona

fide association sponsoring the bona fide association health plan.

B. 1. A small employer carrier shall file with the

Commissioner, in a format and manner prescribed by the Commissioner,

all health benefit plans to be used by the carrier. A health

benefit plan filed pursuant to this paragraph may be used by a small

employer carrier beginning sixty (60) days after it is filed unless

the Commissioner disapproves its use.

2. Except as otherwise set forth in this title, the

Commissioner at any time may, after providing notice and an

opportunity for a hearing to the small employer carrier, disapprove

the continued use by a small employer carrier of any health benefit

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plan on the grounds that the plan does not meet the requirements of

the Small Employer Health Insurance Reform Act.

C. Health benefit plans covering small employers shall comply

with the following provisions:

1. 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. A health benefit plan

shall not define a preexisting condition more restrictively than:

a. a condition that would have caused an ordinarily

prudent person to seek medical advice, diagnosis, care

or treatment during the six (6) months immediately

preceding the effective date of coverage, or
e (12) months following the effective date of the individual's

coverage due to a preexisting condition. A health benefit plan

shall not define a preexisting condition more restrictively than:

a. a condition that would have caused an ordinarily

prudent person to seek medical advice, diagnosis, care

or treatment during the six (6) months immediately

preceding the effective date of coverage, or

b. 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;

2. A health benefit plan may exclude coverage for late

enrollees for the greater of eighteen (18) months or for an

eighteen-month preexisting condition exclusion; provided that if

both a period of exclusion from coverage and a preexisting condition

exclusion are applicable to a late enrollee, the combined period

shall not exceed eighteen (18) months from the date the individual

enrolls for coverage under the health benefit plan;

3. a. Except as provided in subparagraph d of this

paragraph, requirements used by a small employer

carrier will be limited to requirements for minimum

participation of eligible employees and minimum

employer contributions. These requirements shall be

applied uniformly among all small employers with the

same number of eligible employees applying for

coverage or receiving coverage from the small employer

carrier.

b. A small employer carrier may vary application of

minimum participation requirements and minimum

employer contribution requirements only by the size of

the small employer group.

c. (1) Except as provided in division (2) of this

subparagraph, in applying minimum participation

requirements with respect to a small employer, a

small employer carrier shall not consider

employees or dependents who have qualifying

existing coverage in determining whether the

applicable percentage of participation is met.

(2) With respect to a small employer, a small

employer carrier may consider employees or

dependents who have coverage under another health

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benefit plan sponsored by a small employer in

applying minimum participation requirements.

d. A small employer carrier shall not increase any

requirement for minimum employee participation or any

requirement for minimum employer contribution

applicable to a small employer at any time after the

small employer has been accepted for coverage; and

4. a. If a small employer carrier offers coverage to a small

employer, the small employer carrier shall offer

coverage to all of the eligible employees of a small

employer and their dependents. A small employer

carrier shall not offer coverage to only certain

individuals in a small employer group or to only part

of the group, except in the case of late enrollees as

provided in paragraph 2 of this subsection.

b. Except as permitted under paragraphs 1 and 2 of this

subsection, a small employer carrier shall not modify

a health benefit plan with respect to a small employer

or any eligible employee or dependent, through riders,

endorsements or otherwise, to restrict or exclude

coverage or benefits for specific diseases, medical

conditions or services otherwise covered by the plan.

D. The Commissioner shall develop, by rule, a uniform health

questionnaire for use by small employers applying for health

insurance coverage under group health plans offered by small

employer carriers. Small employer carriers shall be required to

accept and use the uniform health questionnaire not more than six
specific diseases, medical

conditions or services otherwise covered by the plan.

D. The Commissioner shall develop, by rule, a uniform health

questionnaire for use by small employers applying for health

insurance coverage under group health plans offered by small

employer carriers. Small employer carriers shall be required to

accept and use the uniform health questionnaire not more than six

(6) months after the rules adopting the questionnaire become

effective.

E. 1. A small employer carrier shall not be required to offer

coverage or accept applications pursuant to subsection A of this

section in the case of the following:

a. to a small employer, where the small employer is not

physically located in the established geographic

service area of the carrier,

b. to an employee, when the employee does not work or

reside within the established geographic service area

of the carrier, or

c. within an area where the small employer carrier

reasonably anticipates, and demonstrates to the

satisfaction of the Commissioner, that it will not

have the capacity within its established geographic

service area to deliver service adequately to the

members of such groups because of its obligations to

existing group policyholders and enrollees.

2. A small employer carrier that cannot offer coverage pursuant

to subparagraph c of paragraph 1 of this subsection may not offer

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coverage in the applicable area to new cases of employer groups with

more than fifty (50) eligible employees or to any small employer

groups until the later of one hundred eighty (180) days following

each refusal or the date on which the carrier notifies the

Commissioner that it has regained capacity to deliver services to

small employer groups.

F. A bona fide association health plan established pursuant to

this title to provide benefits to a particular trade, business,

profession or industry or their subsidiaries shall not issue

coverage to a group or individual that is not in the same trade,

business, profession or industry as that covered by the bona fide

association health plan. The bona fide association health plan

shall accept all employer groups in the same trade, business,

profession or industry or their subsidiaries that apply for coverage

under the arrangement and that meet the requirements for membership

in the arrangement. For purposes of this subsection, the

requirements for membership in a bona fide association health plan

shall not include any requirements that relate to the actual or

expected health status of the prospective enrollee.