Okla. Admin. Code § 365:10-1-9

Current through Vol. 42, No. 8, January 2, 2025

Section 365:10-1-9 - Eliminating unfair discrimination

(a)Purpose. The purpose of this section is to eliminate the act of denying benefits or coverage unfairly in the terms and conditions of insurance contracts and in the underwriting criteria of insurance carriers. It is not intended to prohibit reasonable and justifiable differences in premium rates based upon sound actuarial principles or actual or reasonably anticipated experience.

(b)Definitions.

(1)"Contract" means any insurance policy, plan or binder, including any rider or endorsement thereto offered by an insurer.

(2)"Insurer" includes:

(A) Every person engaged in the business of making contracts of insurance or indemnity.

(B) A nonprofit hospital service and medical indemnity corporation is an insurer within the meaning of the Code.

(C) Burial associations shall be deemed not to be insurers.

(c)Applicability and scope.

(1) This section shall apply to all contracts delivered or issued for delivery in this state by an insurer on or after July 1, 1993, to all existing group, franchise or blanket contracts which are amended or renewed on or after July 1, 1993 and to all policy forms submitted for approval on or after July 1, 1993, provided however that in the case of contracts issued pursuant to all collective bargaining agreements this section shall apply on the first date after July 1, 1993 upon which any new bargaining agreement first becomes effective.

(2) This section does not apply to or affect the right of fraternal benefit societies to determine eligibility requirements for membership. If a fraternal benefit society does, however, admit members of both sexes, this section is applicable to the insurance benefits available to members thereof.

(d)Availability requirements.

(1) Availability of any insurance contract shall not be denied to an insured or prospective insured solely on the basis of sex or marital status of the insured or prospective insured. The amount of benefits payable, or any term, conditions or type of coverage shall not be restricted, modified, excluded, or reduced solely on the basis of the sex or marital status of the insured or prospective insured except to the extent that amount of benefits, term, conditions or type of coverage vary as a result of the application of rate differentials permitted under the Oklahoma Insurance Code. However, nothing in this section shall prohibit an insurer from taking marital status into account for the purpose of defining persons eligible for dependents benefits. Specific examples of practices prohibited by this section include but are not limited to the following:

(A) Denying coverage to females gainfully employed at home, employed part-time or employed by relatives when coverage is offered to males similarly employed.

(B) Denying policy riders to females when the riders are available to males.

(C) Denying maternity benefits to unmarried females covered under a contract if maternity coverage is available to married females under such contract, provided that this shall not be construed to require that benefits must be payable for normal pregnancies under either group or individual insurance contracts.

(D) Denying, under group contracts, dependant coverage to husbands of female employees, when dependant coverage is available to wives of male employees.

(E) Denying disability income contracts to employed women when coverage is offered to men similarly employed.

(F) Treating complications of pregnancy differently from any other illness or sickness under the contract. Complications of pregnancy means:

(i) conditions, requiring hospital confinement (when the pregnancy is not terminated), whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity, but shall not include false labor, occasional spotting, physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, and similar conditions associated with the management of a difficult pregnancy not constituting a nosological distinct complication of pregnancy; and

(ii) non-elective cesarean section, ectopic pregnancy which is terminated and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.

(G) Restricting, reducing, modifying, or excluding benefits payable for disorders of the genital organs of only one sex.

(H) Offering lower maximum monthly benefits to women that to men who are in the same classification under a disability income contract.

(I) Offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same classification under a disability income contract.

(J) Establishing different conditions by sex under which the policyholder may renew a contract or exercise benefit options contained in the contract.

(K) Limiting the amount of coverage an insured or prospective insured may purchase based upon the insured's or prospective insured's marital status unless such limitation is for the purpose of defining persons eligible for dependents benefits.

Okla. Admin. Code § 365:10-1-9

Added at 10 Ok Reg 1469, eff 5-1-93