Okla. Stat. tit. 36 § 6530.5

Current through Laws 2024, c. 453.

Section 6530.5 - Board of Directors - Duties - Sunset of Program

A. The Board of Directors of the Oklahoma Individual Health Insurance Market Stabilization Program shall:

1. Develop, implement and administer the Program. Implementation of the Program shall be contingent upon Oklahoma's approval for and receipt of federal funds to implement and sustain the Program;

2. Apply for and utilize federal funding for the reinsurance program, as provided in subsection C of this section;

3. Make payments to provide for the market stabilization activities authorized by this act and for administrative expenses incurred or estimated to be incurred during the period for which assessment is made;

4. Establish administrative and accounting processes and procedures for the operation of the Program and create operating rules to effectuate the provisions of this act including but not limited to:

a. determine eligibility of individuals to receive coverage under the Program,

b. establish standards for qualification based upon health status, health conditions, prior or current insurance coverage status, health costs as a result of utilization of consuming health care,

c. establish the dollar amount of claims for eligible individuals after which the Program will provide payments to health insurance plans and the proportion of such claims above such dollar amount that the Program will pay,

d. establish the rate at which the Program will reimburse a health insurance plan for claims incurred for an enrolled individual's claims, above the attachment point and below the reinsurance cap,

e. determine the threshold amount for claims costs incurred by a health insurance plan for an enrolled individual's claims, after which the claims costs for benefits are no longer eligible for reinsurance payments, and

f. determine the diagnosed health condition of an eligible individual for which the Program will provide payments to health insurance plans for claims incurred after such diagnosis is made; and

5. Apply for, accept and receive federal funding for the operation of the Program, including the following:

a. approval of a waiver provided by Section 1332 of the Patient Protection and Affordable Care Act, "1332 State Innovation Waiver", authorizing federal funding to support market stabilization program payments,

b. Oklahoma's participation in any federal grant program or programs, or

c. any combination of the above approaches.

B. In the event Oklahoma is unable to secure federal approval of a 1332 State Innovation Waiver or secure funding from federal grant programs within two (2) years from the effective date of this act, the Oklahoma Individual Health Insurance Market Stabilization Program shall sunset, and any remaining monies shall be returned to insurers on a pro rata basis based on the amount each insurer has paid in assessments since the creation of the Program.

C. To the extent that federal funds become available under federal law, regulation or executive action, the Board may:

1. Apply for the funds; and

2. Use the funds to establish and administer a reinsurance program for the purposes of the Oklahoma Individual Health Insurance Market Stabilization Act.

D. The Board shall not have the authority to assess insurers, employers, policies or plans or any other entity to fund the program. The Board may accept funding from other sources for the purpose of the Oklahoma Individual Health Insurance Market Stabilization Act.

Okla. Stat. tit. 36, § 6530.5

Amended by Laws 2018 , c. 267, s. 1, eff. 8/24/2018.

Added by Laws 2017 , c. 383, s. 5, eff. 6/6/2017.