Okla. Stat. tit. 63, § 63-313A
This is the official text of Okla. Stat. tit. 63, § 63-313A, part of Oklahoma’s Stat. tit. 63, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 63,." Browse the sections below, each linked to its official government source.
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Definitions
Official statutory text
A. As used in this section:
1. a. "Health benefit plan" means a plan that:
(1) provides benefits for medical or surgical
expenses incurred as a result of a health
condition, accident, or sickness, and
(2) is offered by any insurance company, group
hospital service corporation, the State and
Education Employees Group Insurance Board, or a
health maintenance organization that delivers or
issues for delivery an individual, group,
blanket, or franchise insurance policy or
insurance agreement, a group hospital service
Oklahoma Statutes - Title 63. Public Health and Safety Page 1091
contract, or an evidence of coverage, or, to the
extent permitted by the Employee Retirement
Income Security Act of 1974, 29 U.S.C., Section
1001 et seq., by a multiple employer welfare
arrangement as defined in Section 3 of the
Employee Retirement Income Security Act of 1974,
or any other analogous benefit arrangement,
whether the payment is fixed or by indemnity.
b. "Health benefit plan" shall not include:
(1) a plan that provides coverage:
(a) only for a specified disease or diseases or
under an individual limited benefit policy,
(b) only for accidental death or dismemberment,
(c) for dental or vision care,
(d) a hospital confinement indemnity policy,
(e) disability income insurance or a combination
of accident-only and disability income
insurance, or
(f) as a supplement to liability insurance,
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1) of the Social Security Act (42
U.S.C., Section 1395ss),
(3) worker's compensation insurance coverage,
(4) medical payment insurance issued as part of a
motor vehicle insurance policy,
(5) a long-term care policy, including a nursing home
fixed indemnity policy, unless a determination is
made that the policy provides benefit coverage so
comprehensive that the policy meets the
definition of a health benefit plan, or
(6) short-term health insurance issued on a
nonrenewable basis with a duration of six (6)
months or less; and
2. "Prior authorization" means a utilization management
criterion utilized to seek permission or waiver of a drug to be
covered under a health prior authorization.
B. Notwithstanding any other provision of law to the contrary,
in order to establish uniformity in the submission of prior
authorization forms, on or after January 1, 2014, a health benefit
plan shall utilize prior authorization forms for obtaining any prior
authorization for prescription drug benefits. A form shall not
exceed three pages in length, excluding any instructions or guiding
documentation and a health benefit plan may customize the content of
the form specific to the prescription drug for which the prior
authorization is being requested. A health benefit plan may make
the form accessible through multiple computer operating systems.
Oklahoma Statutes - Title 63. Public Health and Safety Page 1092
Additionally, upon request, the health benefit plan shall make a
copy of the form available to the Insurance Commissioner.
1. a. "Health benefit plan" means a plan that:
(1) provides benefits for medical or surgical
expenses incurred as a result of a health
condition, accident, or sickness, and
(2) is offered by any insurance company, group
hospital service corporation, the State and
Education Employees Group Insurance Board, or a
health maintenance organization that delivers or
issues for delivery an individual, group,
blanket, or franchise insurance policy or
insurance agreement, a group hospital service
Oklahoma Statutes - Title 63. Public Health and Safety Page 1091
contract, or an evidence of coverage, or, to the
extent permitted by the Employee Retirement
Income Security Act of 1974, 29 U.S.C., Section
1001 et seq., by a multiple employer welfare
arrangement as defined in Section 3 of the
Employee Retirement Income Security Act of 1974,
or any other analogous benefit arrangement,
whether the payment is fixed or by indemnity.
b. "Health benefit plan" shall not include:
(1) a plan that provides coverage:
(a) only for a specified disease or diseases or
under an individual limited benefit policy,
(b) only for accidental death or dismemberment,
(c) for dental or vision care,
(d) a hospital confinement indemnity policy,
(e) disability income insurance or a combination
of accident-only and disability income
insurance, or
(f) as a supplement to liability insurance,
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1) of the Social Security Act (42
U.S.C., Section 1395ss),
(3) worker's compensation insurance coverage,
(4) medical payment insurance issued as part of a
motor vehicle insurance policy,
(5) a long-term care policy, including a nursing home
fixed indemnity policy, unless a determination is
made that the policy provides benefit coverage so
comprehensive that the policy meets the
definition of a health benefit plan, or
(6) short-term health insurance issued on a
nonrenewable basis with a duration of six (6)
months or less; and
2. "Prior authorization" means a utilization management
criterion utilized to seek permission or waiver of a drug to be
covered under a health prior authorization.
B. Notwithstanding any other provision of law to the contrary,
in order to establish uniformity in the submission of prior
authorization forms, on or after January 1, 2014, a health benefit
plan shall utilize prior authorization forms for obtaining any prior
authorization for prescription drug benefits. A form shall not
exceed three pages in length, excluding any instructions or guiding
documentation and a health benefit plan may customize the content of
the form specific to the prescription drug for which the prior
authorization is being requested. A health benefit plan may make
the form accessible through multiple computer operating systems.
Oklahoma Statutes - Title 63. Public Health and Safety Page 1092
Additionally, upon request, the health benefit plan shall make a
copy of the form available to the Insurance Commissioner.
Status: in_force · Read it on the official government site
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