Okla. Stat. tit. 36, § 36-6920

Payment of expenses.

A. A certificate of authority issued under the Health

Maintenance Organization Act of 2003 may be suspended or revoked,

and an application for a certificate of authority may be denied, if

the Insurance Commissioner finds that any of the following

conditions exist:

Oklahoma Statutes - Title 36. Insurance Page 1404

1. The health maintenance organization (HMO) is operating

significantly in contravention of its basic organizational document

or in a manner contrary to that described in any other information

submitted under Section 6903 of this title, unless amendments to

those submissions have been filed with and approved by the Insurance

Commissioner;

2. The health maintenance organization issues an evidence of

coverage or uses a schedule of charges for health care services that

does not comply with the requirements of Sections 6908 and 6916 of

this title;

3. The health maintenance organization does not provide or

arrange for basic health care services;

4. The Insurance Commissioner determines that:

a. the health maintenance organization does not meet the

requirements of Section 6907 of this title, or

b. the health maintenance organization is unable to

fulfill its obligations to furnish health care

services;

5. The health maintenance organization is no longer financially

responsible and may reasonably be expected to be unable to meet its

obligations to enrollees or prospective enrollees;

6. The health maintenance organization has failed to correct,

within the time frame prescribed by subsection C of this section,

any deficiency occurring due to the health maintenance

organization's prescribed minimum net worth being impaired;

7. The health maintenance organization has failed to implement

the grievance procedures required by Section 6911 of this title in a

reasonable manner to resolve valid complaints;

8. The health maintenance organization, or any person on its

behalf, has advertised or merchandised its services in an untrue,

misrepresentative, misleading, deceptive or unfair manner;

9. The continued operation of the health maintenance

organization would be hazardous to its enrollees or to the public;

or

10. The health maintenance organization has otherwise failed to

comply with the provisions of the Health Maintenance Organization

Act of 2003 or applicable rules promulgated by the Insurance

Commissioner pursuant thereto.

B. In addition to or in lieu of suspension or revocation of a

certificate of authority pursuant to the provisions of this section,

an applicant or health maintenance organization who knowingly

violates the provisions of this section may be subject to an

administrative penalty of Five Thousand Dollars ($5,000.00) for each

occurrence.

C. The following shall apply when insufficient net worth is

maintained:

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1. Whenever the Insurance Commissioner finds that the net worth

maintained by any health maintenance organization subject to the

provisions of this act is less than the minimum net worth required

to be maintained by Section 6913 of this title, the Insurance

Commissioner shall give written notice to the health maintenance

organization of the amount of the deficiency and require filing with

the Insurance Commissioner a plan for correction of the deficiency

that is acceptable to the Insurance Commissioner, and correction of

the deficiency within a reasonable time, not to exceed sixty (60)

days, unless an extension of time, not to exceed sixty (60)

additional days, is granted by the Insurance Commissioner. A

deficiency shall be deemed an impairment, and failure to correct the

impairment in the prescribed time shall be grounds for suspension or

revocation of the certificate of authority or for placing the health

maintenance organization in conservation, rehabilitation or

liquidation; or

2. Unless allowed by the Insurance Commissioner, no health
al days, is granted by the Insurance Commissioner. A

deficiency shall be deemed an impairment, and failure to correct the

impairment in the prescribed time shall be grounds for suspension or

revocation of the certificate of authority or for placing the health

maintenance organization in conservation, rehabilitation or

liquidation; or

2. Unless allowed by the Insurance Commissioner, no health

maintenance organization or person acting on its behalf may,

directly or indirectly, renew, issue or deliver any certificate,

agreement or contract of coverage in this state, for which a premium

is charged or collected, when the health maintenance organization

writing the coverage is impaired, and the fact of impairment is

known to the health maintenance organization or to the person;

provided, however, the existence of an impairment shall not prevent

the issuance or renewal of a certificate, agreement or contract when

the enrollee exercises an option granted under the plan to obtain a

new, renewed or converted coverage.

D. A certificate of authority shall be suspended or revoked or

an application or a certificate of authority denied or an

administrative penalty imposed only after compliance with the

requirements of this section.

1. Suspension or revocation of a certificate of authority,

denial of an application, or imposition of an administrative penalty

by the Insurance Commissioner, pursuant to the provisions of this

section, shall be by written order and shall be sent to the health

maintenance organization or applicant by certified or registered

mail. The written order shall state the grounds, charges or conduct

on which the suspension, revocation or denial or administrative

penalty is based. The health maintenance organization or applicant

may, in writing, request a hearing within thirty (30) days from the

date of mailing of the order. If no written request is made, the

order shall be final upon the expiration of thirty (30) days.

2. If the health maintenance organization or applicant requests

a hearing pursuant to the provisions of this section, the Insurance

Commissioner shall issue a written notice of hearing and send such

notice to the health maintenance organization or applicant by

certified or registered mail stating:

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a. a specific time for the hearing, which may not be less

than twenty (20) nor more than thirty (30) days after

mailing of the notice of hearing, and

b. that any hearing shall be held at the office of the

Insurance Commissioner.

After the hearing, or upon failure of the health maintenance

organization to appear at the hearing, the Insurance Commissioner

shall take whatever action is deemed necessary based on written

findings. The Insurance Commissioner shall mail the decision to the

health maintenance organization or applicant.

E. The provisions of the Administrative Procedures Act shall

apply to proceedings under this section to the extent they are not

in conflict with the provisions of Section 313 of this title.

F. If the certificate of authority of a health maintenance

organization is suspended, the health maintenance organization shall

not, during the period of suspension, enroll any additional

enrollees except newborn children or other newly acquired dependents

of existing enrollees, and shall not engage in any advertising or

solicitation whatsoever.

G. If the certificate of authority of a health maintenance

organization is revoked, the HMO shall proceed, immediately

following the effective date of the order of revocation, to wind up

its affairs and shall conduct no further business except as may be

essential to the orderly conclusion of the affairs of the

organization. The HMO shall engage in no further advertising or

solicitation whatsoever. The Insurance Commissioner may, by written

order, permit further operation of the HMO if found to be in the
tely

following the effective date of the order of revocation, to wind up

its affairs and shall conduct no further business except as may be

essential to the orderly conclusion of the affairs of the

organization. The HMO shall engage in no further advertising or

solicitation whatsoever. The Insurance Commissioner may, by written

order, permit further operation of the HMO if found to be in the

best interests of enrollees, to the end that enrollees will be

afforded the greatest practical opportunity to obtain continuing

health care coverage.