1 STATE OF OKLAHOMA
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2 2nd Session of the 59th Legislature (2024)
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3 HOUSE BILL 3375 By: Fugate
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6 AS INTRODUCED
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7 An Act relating to health insurance policies;
7 amending 36 O.S. 2021, Section 4502, which relates to
8 provisions of group accident and health policies;
8 adding pregnancy to the special enrollment period;
9 providing when coverage begins; and providing an
9 effective date.
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12 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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13 SECTION 1. AMENDATORY 36 O.S. 2021, Section 4502, is
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14 amended to read as follows:
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15 Section 4502. A. Each group accident and health policy shall
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16 contain in substance the following provisions:
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17 1. A provision that, in the absence of fraud, all statements
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18 made by the policyholder or by any insured person shall be deemed
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19 representations and not warranties, and that no statement made for
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20 the purpose of effecting insurance shall avoid such insurance or
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21 reduce benefits unless contained in a written instrument signed by
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22 the policyholder or the insured person, a copy of which has been
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23 furnished to such policyholder or to such person or his or her
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24 beneficiary;
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 1 2. A provision that the insurer will furnish to the
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2 policyholder, for delivery to each employee or member of the insured
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3 group, an individual certificate setting forth in summary form a
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4 statement of the essential features of the insurance coverage of
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5 such employee or member and to whom benefits are payable. If
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6 dependents or family members are included in the coverage additional
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7 certificates need not be issued for delivery to such dependents or
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8 family members; and
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9 3. A provision that to the group originally insured may be
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10 added from time to time eligible new employees or members or
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11 dependents, as the case may be, in accordance with the terms of the
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12 policy.
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13 B. Each group health policy certificate subject to the
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14 provisions of the Federal Health Insurance Portability and
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15 Accountability Act, Public Law 104-191, (HIPAA) laws shall contain
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16 in substance the following provisions, which shall be in addition to
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17 the provisions required by subsection A of this section.
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18 1. A provision that a health benefit plan shall not deny,
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19 exclude or limit benefits for a covered individual for losses
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20 incurred more than twelve (12) months following the effective date
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21 of the individual's coverage due to a preexisting condition;
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22 2. A provision that a health benefit plan shall not define a
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23 preexisting condition more restrictively than:
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 1 a. a condition for which medical advice, diagnosis, care
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2 or treatment was recommended or received during the
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3 six (6) months immediately preceding the effective
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4 date of coverage,
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5 b. pregnancy and genetic information shall not be
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6 considered preexisting conditions,
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7 c. a health benefit plan may exclude a preexisting
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8 condition for late enrollees for a period not to
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9 exceed eighteen (18) months from the date the
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10 individual enrolls for coverage,
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11 d. the period of any such preexisting condition exclusion
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12 shall be reduced by the aggregate of the periods of
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13 creditable coverage as defined in the Federal HIPAA
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14 laws,
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15 e. a period of creditable coverage shall not be counted
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16 if after such period and before the enrollment date,
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17 there was a sixty-three-day period during all of which
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18 the individual was not covered under any creditable
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19 coverage,
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20 f. "enrollment date" means the date of enrollment of the
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21 individual in the plan or coverage or, if earlier, the
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22 first day of the waiting period for such enrollment,
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23 and
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 1 g. "late enrollee" means a participant or beneficiary who
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2 enrolls under the plan other than during the first
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3 period in which the individual is eligible to enroll
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4 under the plan or a special enrollment period;
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5 3. A provision that individuals losing other coverage shall be
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6 permitted to enroll for coverage under the terms of the plan if each
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7 of the following conditions is met:
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8 a. the employee or dependent was covered under a group
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9 health plan or had health insurance coverage at the
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10 time coverage was previously offered to the employee
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11 or dependent,
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12 b. the employee stated in writing at such time that
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13 coverage under a group health plan or health insurance
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14 coverage was the reason for declining enrollment, but
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15 only if the plan sponsor or issuer required such a
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16 statement at such time and provided the employee with
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17 notice of such requirement, and the consequences of
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18 such requirement, at such time,
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19 c. the employee's or dependent's coverage was under a
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20 COBRA continuation provision and the coverage under
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21 such provision was exhausted; or was not under such a
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22 provision and either the coverage was terminated as a
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23 result of loss of eligibility for the coverage,
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24 including as a result of legal separation, divorce,
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 1 death, termination of employment, or reduction in the
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2 number of hours of employment, or employer
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3 contributions toward such coverage were terminated,
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4 and
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5 d. under the terms of the plan, the employee requests
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6 such enrollment not later than thirty (30) days after
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7 the date of exhaustion of coverage;
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8 4. A provision that for any period that an individual is in a
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9 waiting period for any coverage under a group health plan or for
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10 group health insurance coverage or is in an affiliation period, that
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11 period shall not be taken into account in determining the continuous
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12 period of creditable coverage. "Affiliation period" means a period
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13 which, under the terms of the health insurance coverage offered by a
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14 health maintenance organization, must expire before the health
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15 insurance coverage becomes effective. The organization is not
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16 required to provide health care services or benefits during such
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17 period and no premium shall be charged to the participant or
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18 beneficiary for any coverage during the period;
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19 5. A provision that preexisting condition exclusions will not
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20 apply to newborns, who, as the last day of the thirty-day period
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21 beginning with the date of birth, are covered under creditable
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22 coverage;
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 1 6. A provision that preexisting condition exclusions will not
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2 apply to a child who is adopted or placed for adoption before
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3 attaining eighteen (18) years of age;
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4 7. A provision that dependents are eligible for a special
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5 enrollment period if the group health plan makes coverage available
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6 with respect to a dependent of an individual, and the individual is
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7 a participant under the plan, or has met any waiting period
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8 applicable to becoming a participant under the plan and is eligible
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9 to be enrolled under the plan but for a failure to enroll during a
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10 previous enrollment period, and a person becomes such a dependent of
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11 the individual through marriage, birth or, adoption or, placement
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12 for adoption, or pregnancy. The special enrollment period shall
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13 apply to that person or, if not otherwise enrolled, the individual,
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14 the dependent of the individual, and in the case of the birth or,
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15 adoption of a child, or pregnancy of the individual or dependent of
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16 the individual, the spouse of the individual may be enrolled as a
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17 dependent of the individual if such spouse is otherwise eligible for
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18 coverage.
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19 a. The dependent special enrollment period shall be a
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20 period of not less than thirty (30) days and shall
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21 begin on the later of the date dependent coverage is
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22 made available, or the date of the marriage, birth, or
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23 adoption or, placement for adoption. The dependent
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24 special enrollment period, for pregnancy, shall be a
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 1 period of not less than ninety (90) days and shall
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2 begin on the date of the pregnancy.
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3 b. There is no waiting period if an individual seeks to
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4 enroll a dependent during the first thirty (30) days
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5 of such a dependent special enrollment period.
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6 c. The coverage for the dependent shall become effective
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7 in the case of marriage, not later than the first day
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8 of the first month beginning after the date the
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9 completed request for enrollment is received, in the
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10 case of a dependent's birth, as of the date of such
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11 birth, in the case of a dependent's adoption or
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12 placement for adoption, the date of such adoption or
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13 placement for adoption, in the case of pregnancy of
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14 either the individual or dependent of the individual,
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15 not later than the first day of the first month
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16 beginning after the date the completed request for
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17 enrollment is received;
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18 8. A provision that eligibility or continued eligibility of any
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19 individual will not be based on any of the following health-status-
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20 related factors in relation to the individual or a dependent of the
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21 individual: health status, medical condition, including both
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22 physical and mental illnesses, claims experience, receipt of health
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23 care, medical history, genetic information, evidence of
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 1 insurability, including conditions arising out of acts of domestic
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2 violence or disability.
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3 a. Carriers are not required to provide particular
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4 benefits other than those provided under the terms of
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5 the plan or coverage.
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6 b. Carriers may establish limitations or restrictions on
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7 the amount, level, extent, and nature of the benefits
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8 or coverage for similarly situated individuals
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9 enrolled in the plan or coverage; and
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10 9. A provision that the group health plan is guaranteed
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11 renewable, except as provided pursuant to the federal provisions
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12 found in HIPAA, which are as follows:
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13 a. nonpayment of premium,
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14 b. fraud,
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15 c. violation of participation and/or contribution rules,
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16 d. termination of coverage:
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17 (1) in any case in which an issuer decides to
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18 discontinue offering a particular type of group
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19 health insurance coverage offered in the large or
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20 small group market, coverage of such type may be
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21 discontinued by the issuer only if: the issuer
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22 provides notice to each plan sponsor provided
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23 coverage of this type in such market, and
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24 participants and beneficiaries covered under such
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 1 coverage, of such discontinuation at least ninety
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2 (90) days prior to the date of the
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3 discontinuation of such coverage and makes
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4 available the option to purchase all or, in the
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5 case of the large group market, any other health
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6 insurance coverage currently being offered by the
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7 issuer to a group health plan in such market and
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8 in exercising the option to discontinue coverage
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9 of this type and in offering the option of
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10 coverage pursuant to this provision, the issuer
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11 acts uniformly without regard to the claims
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12 experience of those sponsors or any health-
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13 status-related factor relating to any
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14 participants or beneficiaries covered or new
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15 participants or beneficiaries who may become
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16 eligible for such coverage,
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17 (2) in any case in which an issuer decides to
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18 discontinue offering a particular type of group
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19 health insurance coverage offered in the large or
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20 small group market, coverage of such type may be
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21 discontinued by the issuer only if: the issuer
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22 provides notice to the Oklahoma Insurance
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23 Department and to each plan sponsor and
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24 participants and beneficiaries covered under such
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 1 coverage of such discontinuation at least one
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2 hundred eighty (180) days prior to the date of
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3 the discontinuation of such coverage; and all
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4 health insurance issued or delivered for issuance
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5 in the state in such market or markets are
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6 discontinued and coverage under such health
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7 insurance coverage in such market or markets is
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8 not renewed, and
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9 (3) in the case of a discontinuation under division
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10 (2) of this subparagraph in a market, the issuer
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11 shall not provide for the issuance of any health
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12 insurance coverage in the market and in this
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13 state during the five-year period beginning on
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14 the date of the discontinuation of the last
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15 health insurance coverage not so renewed,
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16 e. movement outside the service area, and
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17 f. association membership ceases.
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18 SECTION 2. This act shall become effective November 1, 2024.
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20 59-2-9610 TJ 01/17/24
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