§ 36-635. License eligibility requirements - Filing of contracts.

A.  To meet the requirements for issuance of a license and to maintain a MEWA, a MEWA either must be:

1.a.nonprofit,

b.(1)established by a trade association, industry association or professional association of employers or professionals that has a constitution or bylaws and that has been organized and maintained in good faith for a continuous period of five (5) years for purposes other than that of obtaining or providing insurance, or

(2)requires membership in an association described in division (1) of this subparagraph in order to obtain the insurance offered by the MEWA,

c.operated pursuant to a trust agreement by a board of trustees that has complete fiscal control over the MEWA and that is responsible for all operations of the MEWA.  Except as provided in this paragraph, the trustees must:

(1)be owners, shareholders, partners, officers, directors, or employees of one or more employers in the MEWA.  With the Insurance Commissioner's approval, a person who is not such an owner, shareholder, partner, officer, director, or employee may serve as a trustee if that person possesses the expertise required for such service.  A trustee may not be an owner, shareholder, partner, officer or employee of the administrator or service company of the MEWA,

(2)have the authority to approve applications of association members for participation in the MEWA, and

(3)have the authority to contract with an authorized administrator or service company to administer the operations of the MEWA,

d.neither offered nor advertised to the public generally,

e.operated in accordance with sound actuarial principles, and

f.offered only after Two Hundred Thousand Dollars ($200,000.00) of cash or federally guaranteed obligations of less than five-year maturity that have a fixed or recoverable principal amount or such other investments as the Commissioner may authorize by rule is titled in such a manner that it may not be traded, sold or otherwise expended without the consent of the Insurance Commissioner; provided, said funds shall be taken into account in determining whether the MEWA is actuarially sound, and evidence of said investment shall be filed with the State Treasurer; or

2.a.operated pursuant to a trust agreement for a trust which has its situs in this state, is operated pursuant to a trust agreement by a board of trustees that has complete fiscal control over the MEWA, is responsible for all operations of the MEWA, and which has as one of its trustees a financial institution which is independent of the entity which established the MEWA.  Except as provided in this paragraph, the board of trustees must have owners, shareholders, partners, officers, directors or employees of one or more employers in the MEWA.  With the Insurance Commissioner’s approval, a person who is not such an owner, shareholder, partner, officer, director or employee may serve as a trustee if that person possesses the expertise required for such service.  A trustee shall not be an owner, shareholder, partner, officer, director or employee of the administrator or service company of the MEWA,

b.operated and administered in a manner that causes all assets of the MEWA to be held in trust until paid either:

(1)for the benefit of individuals who receive medical, dental or similar benefits from the MEWA, or

(2)for the expenses of the MEWA, such as the fees of the trustee, licensed agents, administrator, service company, and all expenses of complying with the provisions of this act,

c.offered only to employers for the benefit of their employees,

d.operated in accordance with sound actuarial principles, and

e.offered only after Two Hundred Thousand Dollars ($200,000.00) of cash or federally guaranteed obligations of less than five-year maturity that have a fixed or recoverable principal amount or such other investments as the Commissioner may authorize by rule is titled in such a manner that it may not be traded, sold or otherwise expended without the consent of the Insurance Commissioner; provided, said funds shall be taken into account in determining whether the MEWA is actuarially sound, and evidence of said investment shall be filed with the State Treasurer.

B.  1.  The MEWA shall issue to each covered employee a policy, contract, certificate, summary plan description, or other evidence of the benefits and coverages provided.  The policy, contract, certificate, summary plan description, or other evidence of the benefits, coverages provided, premium rates to be charged and any contracts between the MEWA and any administrator or service company, including any changes to those documents, must be filed with the Oklahoma Insurance Department.  The evidence of benefits and coverages provided shall contain, in boldface type on the face page of the policy and the certificate, the following statement:  "THE BENEFITS AND COVERAGES DESCRIBED HEREIN ARE PROVIDED THROUGH A TRUST FUND ESTABLISHED BY A GROUP OF EMPLOYERS (name of MEWA).  THE TRUST FUND IS NOT SUBJECT TO ANY INSURANCE GUARANTY ASSOCIATION.  OTHER RELATED FINANCIAL INFORMATION IS AVAILABLE FROM YOUR EMPLOYER OR FROM THE (name of MEWA).  EXCESS INSURANCE IS PROVIDED BY A LICENSED INSURANCE COMPANY TO COVER CERTAIN CLAIMS WHICH EXCEED CERTAIN AMOUNTS.  THIS IS THE ONLY SOURCE OF FUNDING FOR THESE BENEFITS AND COVERAGES."

2.  If applicable, the same documents shall contain in boldface type on the face page of the policy and the certificate:  "THE BENEFITS AND COVERAGE DESCRIBED HEREIN ARE FUNDED BY CONTRIBUTIONS FROM EMPLOYERS, EMPLOYEES, AND OTHER INDIVIDUALS ELIGIBLE FOR COVERAGE."

3.  Any statement required by this subsection is not required on identification cards issued to covered employees or other insureds.

C.  The Commissioner shall not grant or continue a license to any MEWA if the Commissioner reasonably deems that:

1.  Any trust, manager or administrator is incompetent, untrustworthy, or so lacking in insurance expertise as to make the operations of the MEWA hazardous to the potential and existing insureds;

2.  Any trustee, manager or administrator has been found guilty of or has pled guilty or no contest to a felony, a crime involving moral turpitude, or a crime punishable by imprisonment of one (1) year or more under the law of any state or country, whether or not a judgment or conviction has been entered; or

3.  Any trustee, manager or administrator has had any type of insurance license justifiably revoked in this or any other state.

D.  To qualify for and retain a license, a MEWA shall file all contracts with administrators or service companies with the Insurance Commissioner, and report any changes in such contracts to the Commissioner in advance of their implementation.  The Commissioner shall have the authority to cause any contract with an administrator or service company to be renegotiated if the Commissioner reasonably determines that the charges under any such contract are excessively high in light of the services being delivered under the contract.

E.  An initial filing fee of One Thousand Dollars ($1,000.00) is required for licensure.  Each subsequent year the MEWA is in operation, an annual fee of Two Hundred Fifty Dollars ($250.00) shall be required.

F.  Failure to maintain compliance with the eligibility requirements established by this section is a ground for denial, suspension or revocation of the license of a MEWA.

Added by Laws 1992, c. 374, § 3, eff. Jan. 1, 1993.  Amended by Laws 2002, c. 129, § 1, eff. Nov. 1, 2002.