In conjunction with an application for a certificate, the private review agent shall submit information that the Insurance Commissioner requires, including, but not limited to:
1. A utilization review plan that includes:
2. The type and qualifications of the personnel either employed or under contract to perform the utilization review;
3. The procedures and policies to ensure that a representative of the private review agent is reasonably accessible, if domiciled in this state, to patients and health care providers five (5) days a week during normal business hours, such procedures and policies to include as a requirement a toll-free telephone number to be available during said business hours; provided, in the alternative, the out-of-state private review agent shall be available or make staff available by toll-free telephone for at least forty (40) hours per week during normal business hours and shall have a telephone system which is capable of accepting or recording incoming telephone calls during other than normal hours, and shall respond to such calls within two (2) working days, if sufficient information is provided to whomever accepts the call or on a recorded message;
4. The policies and procedures to ensure that all applicable state and federal laws to protect the confidentiality of individual medical records are followed;
5. The policies and procedures to verify the identity and authority of personnel performing utilization review by telephone;
6. A copy of the materials designed to inform applicable patients and health care providers of the requirements of the utilization review plan;
7. A list of the third party payors for which the private review agent is performing utilization review in this state. Said list may be deemed confidential by the Commissioner for the purpose of protecting competition between agents;
8. The procedures for receiving and handling complaints by patients and health care providers concerning utilization review; and
9. Procedures to ensure that after a request for medical evaluation, treatment, or procedures has been rejected in whole or in part and in the event a copy of the report on said rejection is requested, a copy of the report of a private review agent concerning the rejection shall be mailed by the insurer, postage prepaid, to the ill or injured person, the treating health care provider or to the person financially responsible for the patient's bill within fifteen (15) days after receipt of the request for the report.
Added by Laws 1991, c. 294, § 8, eff. Nov. 1, 1991.
Structure Oklahoma Statutes
§36-105. "Transacting" insurance.
§36-106. "Insurance Commissioner" defined.
§36-107.3. Pharmacy Choice Commission defined.
§36-108. "Insurance Department" defined.
§36-110. Application as to particular types of insurers.
§36-114. Existing actions, violations.
§36-115. Particular provisions prevail.
§36-121. Computation of time periods.
§36-122. Electronic filing of documents.
§36-123. Delivery and storage of electronic documents.
§36-124. Incorporation of new measures into benefit plans.
§36-301. Insurance Department.
§36-302. Insurance Commissioner.
§36-302.1. Insurance Department Oklahoma City office location.
§36-303. Official seal of Insurance Commissioner.
§36-304. Funds to be deposited weekly - Collection by nongovernmental entities.
§36-305. Commissioner may appoint assistants; legal counsel.
§36-305.1. Delinquency proceedings; appointment of personnel; exemptions.
§36-306. Records - Disclosure.
§36-307. Duties of Insurance Commissioner.
§36-307.1. Rules and regulations.
§36-307.2. Nonpublic personal information.
§36-307.3. State Insurance Commissioner Revolving Fund.
§36-307.4. Use of grant - Audited annually.
§36-307.5. Insurance Department Anti-Fraud Revolving Fund.
§36-307.6. Insurance Department Pharmacy Benefits Manager Revolving Fund.
§36-309.1. Examinations - Definitions.
§36-309.2. Nature and frequency of examinations - Reports in lieu of examinations.
§36-309.3. Appointment of examiner - Compliance with examiner's requests - Powers of Commissioner.
§36-309.4. Report of examination - Review by Commissioner - Investigatory hearing - Disclosure.
§36-309.5. Examiner's conflict of interest.
§36-309.6. Payment of charges.
§36-310A.2. Material acquisitions or dispositions defined - Information to be disclosed in report.
§36-311.1. Fraudulent or false statement - Failure to timely file statement - Penalty.
§36-311.2. Reports on financial condition.
§36-311.3. Financial reports regarding real property.
§36-311A.1. Short title - Oklahoma Annual Financial Report Act.
§36-311A.4. Annual audit - Extensions.
§36-311A.5. Contents of annual audited financial report.
§36-311A.7. Qualified independent certified public accountants.
§36-311A.8. Audited consolidated or combined financial statements.
§36-311A.9. Conduct of audit of financial statements.
§36-311A.12. Accountant letter to insurer - Contents.
§36-311A.13. Work papers - Availability for examiner review - Copies.
§36-311A.14. Audit committee - Membership - Duties.
§36-311A.14.1. Internal audit function requirements - Exemptions.
§36-311A.15. Unlawful misleading statements - Manipulating accountant.
§36-311A.16. Report of the insurer's internal control over financial reporting.
§36-311A.17. Exemptions from compliance - Effective dates.
§36-311A.18. Canadian and British insurers - Letter of conformity.
§36-312A. Enforcement and recording of penalties and fees.
§36-317. Witnesses or evidence.
§36-321. Fees and licenses - Deposits.
§36-321.1. Report fees - Information requests - Costs.
§36-332. General duties - Powers.
§36-334.1. Training of rate analysts and assistant rate analysts - Tuition and fees.
§36-335. Conflicts of interest - Exceptions.
§36-350. Electronic format filing requirement.
§36-352. Commissioner authorized to refund certain fees.
§36-361. Anti-Fraud Unit - Investigations - Confidentiality of records
§36-362. Fees – Transfer to Attorney General’s Insurance Fraud Unit Revolving Fund.
§36-363. Notification of suspected fraud - Immunity.
§36-364. Seizure of property used in insurance-related crimes.
§36-365. Insurance-related crime property - Forfeiture - Replevin.
§36-402. Persons prohibited from engaging in business of insurance - Exception - Penalty.
§36-403. Powers of Insurance Commissioner - Injunctive relief.
§36-404. Business of insurance.
§36-405. Emergency cease and desist order - Hearing - Judicial review - Attorneys fees.
§36-601. "Domestic" insurer defined.
§36-602. "Foreign" insurer defined.
§36-603. "Alien" insurer defined.
§36-604. "State," "United States" defined.
§36-606. Authority to transact insurance required.
§36-607. General qualifications to transact insurance.
§36-607.1. Certain entities considered insurers - Audited financial reports - Actuarial opinions.
§36-608. Workers' compensation insurance.
§36-608.2. Assigned risk plan for employers unable to procure coverage in the voluntary market.
§36-609. Kinds of insurance an insurer may transact.
§36-610. Capital funds or minimum surplus required.
§36-612. Additional kinds of insurance - Requirments.
§36-612.1. Kinds of insurance; requirements.
§36-612.2. Workers' compensation insurance - Required capital and surplus.
§36-613. Deposit requirements.
§36-613.1. Surety bond or other security arrangement required.
§36-615.1. Application to transact insurance - Application review.
§36-615.2. Biographical affidavit.
§36-616. Issuance or refusal of certificate.
§36-617. Renewal and amendment of certificate.
§36-618. Mandatory revocation or suspension.
§36-619. Discretionary revocation or suspension; civil fines.
§36-619.1. Availability of coverage without regard to geographic location.
§36-619.3. Motor vehicle liability insurer compliance.
§36-621. Service of legal process on foreign or alien insurers.
§36-622. Manner of service of process.
§36-624. Report of premiums, fees and taxes - Payment - Penalties.
§36-624.1. Tax credit for taxes paid by domestic insurer in foreign state.
§36-624.2. Refund of erroneously paid premium tax – Filing – Demand for hearing.
§36-624.3. Refund of adverse economically targeted and home office credit deductions.
§36-625. Credit against tax by investment in Oklahoma securities.
§36-625.1. Premium tax credit.
§36-625.2. Premium tax credit - Applicable insurers.
§36-625.3. Insurance companies - Home office - Tax credit.
§36-625.4. Credit against premium tax.
§36-626. Collection proceedings.
§36-629. Estimate and prepayment of premium tax - Crediting.
§36-630. Failure to make payments timely - Penalties.
§36-632.1. Home service contracts and home warranties not insurance.
§36-633. MEWA defined - Information relating to administrative services contracts.
§36-634. Valid license required - Exempt entities.
§36-635. License eligibility requirements - Filing of contracts.
§36-636. Use of words or descriptions causing beneficiaries to believe MEWA is insurance company.
§36-637. Application for license.
§36-641. Promulgation of rules relating to multiple employer welfare arrangements.
§36-650. Competition with Nine-One-One system prohibited.
§36-701. Definitions not mutually exclusive.
§36-702. "Life insurance" defined.
§36-703. "Accident and health insurance" defined.
§36-704. "Property insurance" defined.
§36-705. "Marine insurance" defined.
§36-706. "Vehicle insurance" defined.
§36-707. "Casualty insurance" defined.
§36-708. "Surety insurance" defined.
§36-709. "Title insurance" defined.
§36-711. Allowance for credit or increase in amount at risk – Contract requirements.
§36-712. Posting of standard policies and endorsements.
§36-901.3. Filing - Contents and procedure.
§36-902. Excessive, inadequate or unfairly discriminatory rates.
§36-902.2. Factors for review of filing - Weight - Prohibited expenses.
§36-903.2. Workplace safety plans - Expenses of implementation.
§36-907. General powers of the Insurance Commissioner.
§36-907.1. Monitoring and examination of rates.
§36-908. Administrative penalties.
§36-924.3. Appeals of rating classifications.
§36-932. Joint underwriting or joint reinsurance.
§36-940. Inquiry regarding making claim – Prohibited acts.
§36-944. Motor vehicle policies - Restriction on cancellation or increasing rates.
§36-953. Use of credit information - Prohibited acts.
§36-954. Reunderwriting and rerating of insured - Refund of overpayment.
§36-955. Disclosure statement.
§36-956. Adverse action based upon credit information - Notification to consumer.
§36-957. Filing of scoring models or other scoring processes.
§36-958. Indemnification of agents.
§36-959. Sale of data or lists by consumer reporting agencies.
§36-961. Premium discount or rate reduction for resistance to tornado or other wind events.
§36-963. Insurable property defined.
§36-965. Promulgation of rules to implement and administer the act.
§36-981. Short title and purposes of act.
§36-985. Ratemaking standards.
§36-985.1. Regulation of rates in market without competition.
§36-989. Improper rates – Disapproval - Hearing.
§36-990. Challenge and review of application of rating system.
§36-992. Insurers - Prohibited activity.
§36-994. Advisory organizations - Filing requirements.
§36-995. Joint underwriting, joint reinsurance pool and residual market activities.
§36-996.1. Assigned risk plans.
§36-997. Commercial special risks.
§36-998. Appeals from Commissioner.
§36-999.4. Subsidence coverage for residences, living units and commercial buildings - Exemption.
§36-999.5. Coverage for additional living expenses.
§36-999.6. Refusal to cover unrepaired damage.
§36-999.7. Right of subrogation.
§36-1100. Short title - Purpose and effect.
§36-1100.2. Authority to enter multistate agreements.
§36-1101. Representation of unauthorized insurers prohibited.
§36-1101.1. Domestic surplus line insurers.
§36-1102. Validity of contracts effectuated by a surplus lines insurer.
§36-1103. Service of process on a surplus lines insurer.
§36-1104. Exemptions from service of process provisions.
§36-1106. Surplus lines - Brokers.
§36-1106.1. Due diligence search.
§36-1106.2. Due diligence - Flood insurance with a nonadmitted insurer.
§36-1107. Multistate risk - Required application and informational filings - Fee payments.
§36-1108. Recognized surplus lines.
§36-1109. Validity of surplus line insurance - Notice of limitations of coverage.
§36-1111. Acceptance of surplus line business by brokers.
§36-1112. Solvent insurer required - License revocation - Penalties.
§36-1113. Records of surplus lines licensees or brokers.
§36-1114. Broker's annual statement.
§36-1115. Tax on surplus lines - Surplus lines insurer.
§36-1116. Penalty for failure to remit tax.
§36-1118. Legal process against surplus line insurer.
§36-1119. Exemptions from surplus lines provisions.
§36-1120. Records of insureds.
§36-1125. Filing requirements.
§36-1126. Public access to documents and reports - Confidentiality.
§36-1140. Definitions - Licensing - Application - Duration of license.
§36-1142. Permitted activities and services.
§36-1143. Review of advisory organization actions.
§36-1144. Examination by Insurance Commissioner - Scope - Report by official of another state.
§36-1145. Rules and statistical plans - Commissioner authority to promulgate - Scope.
§36-1146. Withholding or providing false or fraudulent information - Prohibition - Punishment.
§36-1147. Suspension or revocation of license - Commissioner authority - Procedure.
§36-1148. Adherence to loss cost filings - Application to workers' compensation insurance.
§36-1163. Exclusion from application for certain policies or coverage certificates.
§36-1164. Exclusion from application for certain unmet terms, conditions and limitations.
§36-1165. Participation in employer sponsored health plan - Retired military employees.
§36-1201. Declaration of purpose.
§36-1203. Unfair methods of competition or unfair and deceptive acts or practices prohibited.
§36-1204. Unfair methods of competition and unfair or deceptive acts or practices defined.
§36-1204.1. Availability of loss runs and claims histories.
§36-1205. Power of commissioner.
§36-1206. Statement of charges and notice of hearing - Opportunity to be heard.
§36-1207. Cease and desist orders and modifications thereof.
§36-1208. Judicial review of cease and desist orders.
§36-1210. Judicial review by intervenor.
§36-1212. Provisions of act additional.
§36-1213. Immunity from prosecution.
§36-1214. Fair disclosure - Protection against misleading sales methods.
§36-1219.3. Discounted reimbursement and disclosure of reimbursement terms prohibited.
§36-1219.4. Definitions - Requirements for discount medical plan organizations - Penalties.
§36-1219.5. Modification of existing or issuance of new coverage - Consent.
§36-1219.6. Methods of payments to providers – Prohibition on restricting methods – Notice of fees.
§36-1220. Exclusive agents - Restrictions.
§36-1241. Property and casualty insurer - Acceptance or denial of application.
§36-1250.4. Claim files - Examination - Response to inquiries.
§36-1250.5. Acts by an insurer constituting an unfair claim settlement practice.
§36-1250.7. Property and casualty insurer - Denial or acceptance of claim.
§36-1250.8. Motor vehicle total loss or damage claim.
§36-1250.10. Enforcement - Standards of performance - Complaints - Investigations.
§36-1250.11. Statement of charges - Notice of hearing.
§36-1250.13. Cease and desist order – Enforcement.
§36-1250.14. Violation of act - Penalty.
§36-1250.16. Rules and regulations.
§36-1250.17. Nonemergency patient form - Perjury.
§36-1415.3. Navigator registration – Application – Requirements - Violations.
§36-1415.4. Navigator limitations and prohibited actions.
§36-1415.5. Implementation of rules and regulations.
§36-1416. State Innovation Waiver
§36-1435.1. Short title - Application of act.
§36-1435.3. Agency of insurance producer - Authority - Commissions.
§36-1435.4. License required for selling, soliciting, or negotiating - Waiver of penalty.
§36-1435.5. When license not required.
§36-1435.9. Nonresident producer license.
§36-1435.10. Exemptions from examination requirement.
§36-1435.11. Use of assumed name.
§36-1435.12. Temporary license without examination – Protection of insureds and public.
§36-1435.13a. Property and casualty insurance producers - Fiduciary duties - Violation - Punishment.
§36-1435.20a. Sale of storage insurance by self-storage facility.
§36-1435.21. Licensure for purposes of writing controlled business prohibited.
§36-1435.22. Applicant to file bond prior to issuance of license.
§36-1435.23. License fees – Collection by Commissioner.
§36-1435.26. Unlawful acts and penalties.
§36-1435.27. Facsimile signature stamp as proof.
§36-1435.28. Ownership interest by producer in policy – Insurable interest.
§36-1435.29. Prelicensing and continuing education.
§36-1435.33. Maximum agent’s fees on renewals.
§36-1435.36. Certain information to be included on license - Term of license.
§36-1435.39. Refusal of license - Fees not refundable.
§36-1435.41. Providing insurance policy information - Exception.
§36-1441.1. Administrator of certain group self-insurance associations exempted from act.
§36-1443. Written agreement required - Examination, audit and inspection of records.
§36-1444. Payments to administrator - Rights against administrator.
§36-1445. Fiduciary capacity and duties of administrator.
§36-1449. Notice and information to be provided to insured individuals.
§36-1450. Licensing procedure - Violations.
§36-1452. Annual report - Penalties for failure to file - Waiver.
§36-1473. Agent license - Bond - Errors and omissions policy.
§36-1474. Written contract with insurer required - Minimum provisions.
§36-1476. Acts of managing general agent - Imputation to insurer.
§36-1477. Violations - Penalties - Judicial review - Rights affected.
§36-1478. Rules and regulations.
§36-1502. Assets as deductions from liabilities.
§36-1503. Assets not allowed as deductions from liabilities.
§36-1504. Reporting assets not allowed.
§36-1505. Liabilities - Mandatory securities valuation reserves.
§36-1506. Unearned premium reserve.
§36-1507. Unearned premium reserve for marine insurance.
§36-1508. Reserves for accident and health insurance.
§36-1509.1. Confidentiality of information.
§36-1510. Definitions - Valuation law - Life - Exemption - Conflict.
§36-1512. Valuation of other securities.
§36-1513. Valuation of real property - Improvements.
§36-1514. Valuation of purchase money mortgages.
§36-1515. Information for valuation of securities.
§36-1523. Annual risk-based capital report - Factors - Adjustment of inaccurate reports.
§36-1524. Company Action Level Event.
§36-1525. Regulatory Action Level Event.
§36-1526. Authorized Control Level Event.
§36-1527. Mandatory Control Level Event.
§36-1528. Confidential departmental hearing.
§36-1529. Confidentiality of RBC Reports and Plans.
§36-1530. Provisions of act supplemental – Promulgation of rules - Exemptions from act.
§36-1532. Immunity for Commissioner and employees.
§36-1533. Notices to insurers - When effective.
§36-1536. Corporate Governance Annual Disclosure (CGAD).
§36-1537. Discretion of insurer or insurance group over responses.
§36-1538. Confidentiality and privilege.
§36-1539. Third-party consultants to assist the Commissioner in reviewing documents.
§36-1540. Failure to timely file.
§36-1541. Promulgation of rules.
§36-1602. Eligible investments.
§36-1603. Qualification of securities or property as eligible investments.
§36-1604. Approval of investment.
§36-1605. Investments in any one person.
§36-1606. Required capital investments.
§36-1607. United States government obligations.
§36-1608. State, district or Canadian obligations.
§36-1609. County, district, city, school district or Canadian obligations.
§36-1610. Public structure or improvement obligations.
§36-1611. Obligations payable from public utility revenues.
§36-1613. Acceptances and bill of exchange.
§36-1614. Corporate obligations.
§36-1615. Preferred or guaranteed stock.
§36-1616. Limitations on investments in corporate securities.
§36-1617. Equipment trust certificates.
§36-1618. Obligations of receivers or trustees; investments not otherwise authorized; limitations.
§36-1620. Investment or deposit of funds.
§36-1622. Mortgages on real estate.
§36-1623. Purchase money mortgages.
§36-1624. Acquiring or holding real property.
§36-1625. Time limits for disposal of other ineligible property and securities; penalty.
§36-1626. Investments of foreign, alien insurers.
§36-1627. Investments in loans secured by certain securities.
§36-1628. Definitions - Deposit of securities - Custodial responsibilities.
§36-1629. Guaranteed or reinsured student loans.
§36-1632. Subsidiaries of domestic insurers - Permissible investments.
§36-1633. Acquisition of control of or merger with domestic insurer.
§36-1635. Registration of insurers.
§36-1636. Transactions within an insurance holding company - Standards.
§36-1637. Examination of registered insurers.
§36-1638. Commissioner power to participate in supervisory colleges.
§36-1639. Group-wide supervisor for any internationally active insurance group.
§36-1640. Confidentiality of documents and other information.
§36-1641. Authority to issue rules, regulations and orders.
§36-1642. Injunctions - Voting of securities prohibited - Sequestration of voting securities.
§36-1644. Violations threatening insolvency - Possession taken by Commissioner.
§36-1645. Recovery of distributions by receiver - Liability.
§36-1646. Authority to suspend, revoke or refuse to renew license or authority to do business.
§36-1647. Appeal to district court by aggrieved persons.
§36-1648. Powers, remedies, procedures and penalties as additional.
§36-1673. Applicability of Act.
§36-1676. Powers of Commissioner or receiver - Civil actions.
§36-1681. Short title - Insurance Business Transfer Act.