§36-6960. Definitions.
For purposes of the Patient’s Right to Pharmacy Choice Act: 1. “Health insurer” means any corporation, association, benefit society, exchange, partnership or individual licensed by the Oklahoma Insurance Code; 2. “Health insurer payor” means a health insurance company, health maintenance organization, union, hospital and medical services organization or any entity providing or administering a self-funded […]
§36-6928. Disclosure of diagnostic, treatment or health status information.
A. 1. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from that person or from a provider by a health maintenance organization shall be held in confidence and shall not be disclosed to any person except: a.to the extent that it may be necessary to carry […]
§36-6945. Confidentiality of RBC reports and plans – Sharing and use of confidential information by Insurance Commissioner – Publication of RBC levels – Use of information in rate proceedings.
A. All Risk-Based Capital (RBC) reports, to the extent the information is not required to be provided in a publicly available annual statement schedule, and RBC plans, including the work papers produced, obtained by or disclosed to the Commissioner or any other person in the course of any examination or analysis and the results or […]
§36-6961. Retail pharmacy network access standards.
A. Pharmacy benefits managers (PBMs) shall comply with the following retail pharmacy network access standards: 1. At least ninety percent (90%) of covered individuals residing in an urban service area live within two (2) miles of a retail pharmacy participating in the PBM’s retail pharmacy network; 2. At least ninety percent (90%) of covered individuals […]
§36-6929. Contracts by Health Commissioner with qualified persons.
The Insurance Commissioner, in carrying out his or her obligations under the Health Maintenance Organization Act of 2003, may contract with qualified persons to make recommendations concerning the determinations required to be made by the Insurance Commissioner. The recommendations may be accepted in full or in part by the Insurance Commissioner. The Insurance Commissioner shall […]
§36-6946. Application of act – Rules for implementation of act.
A. The provisions of the Risk-based Capital (RBC) for Health Maintenance Organizations Act of 2003 are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the Insurance Commissioner under such laws including, but not limited to, Articles 18 and 19 of […]
§36-6962. Compliance review.
A. The Oklahoma Insurance Department shall review and approve retail pharmacy network access for all pharmacy benefits managers (PBMs) to ensure compliance with Section 6961 of this title. B. A PBM, or an agent of a PBM, shall not: 1. Cause or knowingly permit the use of advertisement, promotion, solicitation, representation, proposal or offer that […]
§36-6930. Acquisition of control of health maintenance organization.
No person other than the issuer may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, […]
§36-6947. Foreign health maintenance organizations.
A. 1. A foreign health maintenance organization shall, upon the written request of the Insurance Commissioner, submit to the Commissioner a Risk-Based Capital (RBC) report as of the end of the calendar year just ended the later of: a.the date an RBC report would be required to be filed by a domestic health maintenance organization […]
§36-6963. Health insurer to monitor activities and ensure compliance.
A. A health insurer shall be responsible for monitoring all activities carried out by, or on behalf of, the health insurer under the Patient’s Right to Pharmacy Choice Act, and for ensuring that all requirements of this act are met. B. Whenever a health insurer contracts with another person to perform activities required under this […]