A. On or after the effective date of this act, pursuant to the provisions of this section and any other applicable section of Title 36 of the Oklahoma Statutes, every health benefit plan shall file all group and individual initial rates and group and individual rate adjustments with the Insurance Commissioner. If the Commissioner determines that the initial rate or rate adjustment is unreasonable, excessive, unjustified or unfairly discriminatory, the Commissioner shall make a written decision stating the reason or reasons for the determination, and shall deliver a copy of the determination to the company within thirty (30) calendar days unless the Commissioner extends the determination period for an additional thirty (30) calendar days.

B. 1. For purposes of this section, "health benefit plan" means a plan that:

a.provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, and

b.is offered by any insurance company, group hospital service corporation, or health maintenance organization that delivers or issues for delivery an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service 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.

2. The term "health benefit plan" shall not include:

a.a plan that provides coverage:

(1)only for a specified disease or diseases or under an individual limited benefit policy,

(2)only for accidental death or dismemberment,

(3)for dental or vision care,

(4)a hospital confinement indemnity policy or other fixed indemnity insurance,

(5)disability income insurance or a combination of accident-only and disability income insurance, or

(6)as a supplement to liability insurance,

b.a Medicare supplemental policy as defined by Section 1882(g)(1) of the Social Security Act (42 U.S.C., Section 1395ss),

c. workers’ compensation insurance coverage,

d.medical payment insurance issued as part of a motor vehicle insurance policy,

e.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,

f.short-term health insurance issued on a nonrenewable basis with duration of six (6) months or less,

g.policy issued under Title XVIII, or

h.a plan issued to any person, firm, corporation, partnership, limited liability company or association that is actively engaged in business and that, on at least fifty percent (50%) of its working days during the preceding calendar quarter, employed more than fifty (50) eligible employees.

Added by Laws 2011, c. 278, § 29. Amended by Laws 2011, c. 360, § 24.