Okla. Admin. Code § 365:40-5-45

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

Section 365:40-5-45 - Guaranteed renewal

(a) Except as otherwise provided in this section, an HMO that issues a group contract must renew or continue in force such coverage at the option of the contractholder.

(b) An HMO may nonrenew or discontinue a group contract based only on one or more of the following conditions:

(1) The contractholder has failed to pay premiums or contributions in accordance with the terms of the contract or the HMO has not received timely premium payments.

(2) The contractholder has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the contract.

(3) The contractholder has failed to comply with a material provision of their group contract with the HMO that relates to rules for employer contributions or group participation.

(4) The HMO is ceasing to offer a particular type of coverage in a market.

(5) There are no longer enrollees who live or work in the service area.

(6) In the case of group health coverage that is made available only through a bona fide association, the membership of an employer in the association, on the basis of which the coverage is provided, ceases, but only if such coverage is terminated uniformly without regard to any health-status-related factors that relate to any covered individuals.

(c) An HMO shall not impose pre-existing condition limitations.

(d) An HMO may apply an affiliation period not to exceed two (2) months (or three (3) months for late enrollees). Affiliation periods shall be applied uniformly without regard to any health status-related factors. No premium shall be charged for the affiliation period. The HMO is not required to provide health care services or benefits during such period.

Okla. Admin. Code § 365:40-5-45

Added at 21 Ok Reg 77, eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff 7-14-04