Okla. Admin. Code § 310:657-17-2

Current through Vol. 41, No. 19, June 17, 2024

Section 310:657-17-2 - Contents of the insurers' or insureds' contract

Each contract shall contain a clear statement of the following:

(1) Plan's name and address;

(2) Eligibility requirements;

(3) Medical and health services in the area;

(4) Emergency care services and procedures for authorizing emergency services by non-Plan providers;

(5) Out of area services;

(6) Limits and excluded items;

(7) Employee termination;

(8) Employee reinstatement;

(9) Claims procedures, if any;

(10) Dispute resolution and grievance procedures;

(11) Continuing coverage;

(12) Extension of benefits;

(13) Substitution of creditors;

(14) Geographic service area;

(15) Entire contract provision;

(16) Term of coverage;

(17) Renewing contract;

(18) Canceling contract;

(19) Reinstatement of contract;

(20) Grace period; and

(21) Conformity with state law.

Okla. Admin. Code § 310:657-17-2

Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96; Amended at 23 Ok Reg 2404, eff 6-25-06