Okla. Stat. tit. 36, § 36-6903

Submission to Insurance Commissioner - Rules.

A. Notwithstanding any law of this state to the contrary, any

person may apply to the Insurance Commissioner for a certificate of

authority to establish and operate a health maintenance organization

pursuant to the provisions of the Health Maintenance Organization

Act of 2003. No person shall establish or operate a health

maintenance organization in this state without obtaining a

certificate of authority pursuant to the provisions of this act. A

foreign corporation may qualify under this act, subject to its

registration to do business in this state as a foreign corporation

and compliance with all provisions of this act and other applicable

state laws. All certificates of authority shall be perpetual and

automatically renewed as of March 1 of each year, unless the health

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maintenance organization fails to qualify for renewal pursuant to

the provisions of this act and any other applicable provisions of

Title 36 of the Oklahoma Statutes.

B. Any health maintenance organization that has previously

received a certificate of authority from the State Commissioner of

Health, but has not received a certificate of authority from the

Insurance Commissioner to operate as a health maintenance

organization as of the effective date of this act shall submit an

application for a certificate of authority, as provided in

subsection C of this section, by March 1, 2004. Each applicant may

continue to operate until such time as the Insurance Commissioner

acts upon the application if the applicant continues to comply with

the provisions of Title 63 of the Oklahoma Statutes, the rules

promulgated pursuant thereto by the State Board of Health as they

existed immediately prior to the effective date of this act, and

administrative orders entered by the State Commissioner of Health

prior to the effective date of this act. In the event that an

application is denied under the provisions of Section 4 of this act,

the applicant shall thereafter be treated as a health maintenance

organization whose certificate of authority has been revoked.

C. Each application for a certificate of authority shall be

verified by an officer or authorized representative of the

applicant, shall be in a form prescribed by the National Association

of Insurance Commissioners (NAIC), and shall be accompanied by the

following:

1. A copy of the applicant’s organizational documents

including, but not limited to, the articles of incorporation,

articles of association, partnership agreement, trust agreement, or

other applicable documents, and all amendments thereto;

2. A copy of the bylaws, rules, regulations or similar

document, if any, regulating the conduct of the internal affairs of

the applicant;

3. A list of the names, addresses, official positions and

biographical information, on forms acceptable to the NAIC, of the

persons who are to be responsible for the conduct of the affairs and

day-to-day operations of the applicant, including all members of the

board of directors, board of trustees, executive committee or other

governing board or committee, and the principal officers in the case

of a corporation, or the partners or members in the case of a

partnership or association;

4. A copy of any contract form made or to be made between any

class of providers and the health maintenance organization, and a

copy of any contract made or to be made between third party

administrators, marketing consultants or persons listed in paragraph

3 of this subsection and the health maintenance organization;

5. A copy of the form of evidence of coverage to be issued to

enrollees;

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6. A copy of the form of group contract, if any, to be issued

to employers, unions, trustees or other organizations;

7. Financial statements showing the applicant’s assets,
ants or persons listed in paragraph

3 of this subsection and the health maintenance organization;

5. A copy of the form of evidence of coverage to be issued to

enrollees;

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6. A copy of the form of group contract, if any, to be issued

to employers, unions, trustees or other organizations;

7. Financial statements showing the applicant’s assets,

liabilities and sources of financial support including, but not

limited to:

a. a copy of the applicant’s most recent, regular

certified financial statement,

b. an unaudited current financial statement, and

c. fully audited financial information as to the earnings

and financial condition of each person controlling a

domestic health maintenance organization pursuant to

the provisions of subsection (c) of Section 1651 of

Title 36 of the Oklahoma Statutes for the preceding

five (5) fiscal years for each such acquiring party,

or for such lesser period as such acquiring party and

any predecessors thereof shall have been in existence,

and similar unaudited information as of a date not

earlier than ninety (90) days prior to the filing of

the statement; provided, however, the Insurance

Commissioner shall have the discretionary ability to

waive the audit requirement based upon review of

substantially similar financial disclosure statements

submitted by the acquiring party;

8. A financial feasibility plan that includes detailed

enrollment projections, the methodology for determining premium

rates to be charged during the first twelve (12) months of

operations as certified by an actuary or other qualified person

acceptable to the Insurance Commissioner, a projection of balance

sheets, cash flow statements showing any capital expenditures,

purchase and sale of investments and deposits with the state, and

income and expense statements anticipated from the start of

operations until the organization has had net income for at least

one year, and a statement as to the sources of working capital as

well as any other sources of funding;

9. A power of attorney duly executed by the applicant, if not

domiciled in this state, appointing the Insurance Commissioner, his

or her successors in office and duly authorized deputies, as the

true and lawful attorney of the applicant in and for this state upon

whom all lawful process in any legal action or proceeding against

the health maintenance organization on a cause of action arising in

this state may be served;

10. A statement or map reasonably describing the geographic

area or areas to be served;

11. A description of the internal grievance procedures to be

utilized for the investigation and resolution of enrollee complaints

and grievances;

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12. A description of the proposed quality assurance program,

including the formal organizational structure, methods for

developing criteria, procedures for comprehensive evaluation of the

quality of care rendered to enrollees, and processes to initiate

corrective action and reevaluation when deficiencies in provider or

organizational performance are identified;

13. A description of the procedures to be implemented to meet

the protection against insolvency provisions of Section 13 of this

act;

14. A list of the names, addresses, and license numbers of all

providers with which the health maintenance organization has

agreements;

15. Other information the Insurance Commissioner may require to

make the determinations required in Section 4 of this act; and

16. An original, along with copies, of all documents required

pursuant to the provisions of this subsection, with all required

fees.

D. 1. The Insurance Commissioner may promulgate rules for the

proper administration of this act and to require a health

maintenance organization, subsequent to receiving its certificate of

authority, to submit the information, modifications or amendments to
nd

16. An original, along with copies, of all documents required

pursuant to the provisions of this subsection, with all required

fees.

D. 1. The Insurance Commissioner may promulgate rules for the

proper administration of this act and to require a health

maintenance organization, subsequent to receiving its certificate of

authority, to submit the information, modifications or amendments to

the items described in subsection C of this section to the Insurance

Commissioner, either for approval or for information only, prior to

the effectuation of the modification or amendment, or to require the

health maintenance organization to indicate the modifications to

both the State Commissioner of Health and the Insurance Commissioner

at the time of the next succeeding site visit or examination.

2. Any modification or amendment for which the Insurance

Commissioner’s approval is required shall be deemed approved unless

disapproved within thirty (30) days, provided that the Insurance

Commissioner may postpone the action for such further time, not

exceeding an additional sixty (60) days, as necessary for proper

consideration.