Okla. Admin. Code § 365:10-5-162

Current through Vol. 42, No. 7, December 16, 2024

Section 365:10-5-162 - Status of carriers as small employer carriers

(a) Within thirty (30) days after the effective date of the Act, each carrier providing health benefit plans in this state shall make a filing with the Commissioner indicating whether the carrier intends to operate as a small employer carrier in this state under the terms of this regulation.

(b) Subject to 365:10-5-162(c), a carrier shall not offer health benefit plans to small employers, or continue to provide coverage under health benefit plans previously issued to small employers in this state, unless the filing provided pursuant to 365:10-5-162(a) indicates that the carrier intends to operate as a small employer carrier in this state.

(c)Continuing coverage.

(1) If the filing made pursuant to 365:10-5-162(a) indicates that a carrier does not intend to operate as a small employer carrier in this state, the carrier may continue to provide coverage under the health benefit plans previously issued to small employers in this state only if the carrier complies with the following provisions:

(A) The carrier complies with the requirements of the Act (other than 36 O.S.Supp.1994, §§6520, 6521 and 6522) with respect to each of the health benefit plans previously issued to small employers by the carrier.

(B) The carrier provides coverage to each new entrant to a health benefit plan previously issued to a small employer by the carrier. The provisions of the Act (other than 36 O.S.Supp.1994, §§6520, 6521 and 6522) and this Part shall apply to the coverage issued to such new entrant.

(C) The carrier complies with the requirements of 36 O.S.Supp.1994, §6528, and 365:10-5-160 and 365:10-5-163 as they apply to small employers whose coverage has been terminated by the carrier and to individuals and small employers whose coverage has been limited or restricted by the carrier.

(2) A carrier that continues to provide coverage pursuant to 365:10-5-162(c) shall not be eligible to participate in the reinsurance program established under 36 O.S.Supp.1994, §6522.

(d) If the filing made pursuant to 365:10-5-162(a) indicates that a carrier does not intend to operate as a small employer carrier in this state, the carrier shall be precluded from operating as a small employer carrier in this state (except as provided for in 365:10-5-162(c)) for a period of five (5) years from the date of the filing.

Okla. Admin. Code § 365:10-5-162

Added at 12 Ok Reg 3137, eff 7-31-95