§ 36-6532. Definitions.

As used in the Health Insurance High Risk Pool Act:

1.  "Agent" means any person who is licensed to sell health insurance in this state;

2.  "Primary plan" means the comprehensive health insurance benefit plan adopted by the Board of Directors of the Health Insurance High Risk Pool which meets all requirements of federal law as a plan required to be offered by the Pool;

3.  "Board" means the Board of Directors of the Health Insurance High Risk Pool;

4.  "Church plan" has the meaning given such term under Section 3(33) of the Employee Retirement Income Security Act of 1974;

5.  "Creditable coverage" means, with respect to an individual, coverage of the individual provided under any of the following:

a.a group health plan,

b.health insurance coverage,

c.Part A or B of Title XVIII of the Social Security Act,

d.Title XIX of the Social Security Act, other than coverage consisting solely of benefits under Section 1928 of such act,

e.Chapter 55 of Title 10, U.S. Code,

f.a medical care program of the Indian Health Service or of a tribal organization,

g.a state health benefits risk pool,

h.a health plan offered under Chapter 89 of Title 5, U.S. Code,

i.a public health plan as defined in federal regulations,

j.a health benefit plan under Section 5(e) of the Peace Corps Act, 22 U.S.C. 2504(e), or

k.a temporary high risk pool referred to as the Pre-Existing Condition Insurance Plan or PCIP program, offered pursuant to Section 1101(b) of the Patient Protection and Affordable Care Act (“Affordable Care Act”, Public Law 111-148);

6.  "Federally defined eligible individual" means an individual:

a.for whom, as of the date on which the individual seeks coverage under the Health Insurance High Risk Pool Act, the aggregate of the periods of creditable coverage, as defined in Section 1D of the Employee Retirement Income Security Act of 1974, is eighteen (18) or more months.  The eighteen-month period required in this paragraph shall not apply to an individual whose most recent creditable coverage was under a plan defined in paragraph k of subsection 5 of this section,

b.whose most recent prior creditable coverage was under a group health plan, governmental plan, church plan, a temporary high risk health insurance pool referred to as the Pre-Existing Condition Insurance Plan or PCIP program, offered pursuant to Section 1101(b) of the Patient Protection and Affordable Care Act (“Affordable Care Act”, Public Law 111-148) which has ceased to be available or health insurance coverage offered in conjunction with any such plan, and

c.who is not eligible for coverage under a group health plan, part A or B of Title XVIII of the Social Security Act, or a state plan under Title XIX of such Act or any successor program and who does not have other health insurance coverage, except that a person who has exhausted COBRA coverage shall be, for the purposes of the Health Insurance High Risk Pool Act, a federally defined individual;

7.  "Governmental plan" has the same meaning given such term under Section 3(32) of the Employee Retirement Income Security Act of 1974 and any federal governmental plan;

8.  "Group health benefit plan" means an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974 to the extent that the plan provides medical care as defined in Section 3N of the Employee Retirement Income Security Act of 1974 and including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement, or otherwise;

9.  "Health insurance" means any individual or group hospital or medical expense-incurred policy or health care benefits plan or contract.  The term does not include any policy governing short-term accidents only, a fixed-indemnity policy, a limited benefit policy, a specified accident policy, a specified disease policy, a Medicare supplement policy, a long-term care policy, medical payment or personal injury coverage in a motor vehicle policy, coverage issued as a supplement to liability insurance, a disability policy, or workers' compensation;

10.  "Insurer" means any individual, corporation, association, partnership, fraternal benefit society, or any other entity engaged in the health insurance business, except insurance agents and brokers.  This term shall also include not-for-profit hospital service and medical indemnity plans, health maintenance organizations, preferred provider organizations, prepaid health plans, the State and Education Employees Group Health Insurance Plan, and any reinsurer reinsuring health insurance in this state, which shall be designated as engaged in the business of insurance for the purposes of the Health Insurance High Risk Pool Act;

11.  "Medical care" means amounts paid for:

a.the diagnosis, care, mitigation, treatment or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body,

b.transportation primarily for and essential to medical care referred to in subparagraph a of this paragraph, and

c.insurance covering medical care referred to in subparagraphs a and b of this paragraph;

12.  "Medicare" means coverage under Parts A and B of Title XVIII of the Social Security Act (Public Law 74-271, 42 U.S.C., Section 1395 et seq., as amended);

13.  "Pool" means the Health Insurance High Risk Pool;

14.  "Physician" means a doctor of medicine and surgery, doctor of osteopathic medicine, doctor of chiropractic, doctor of podiatric medicine, doctor of optometry, and, for purposes of oral and  maxillofacial surgery only, a doctor of dentistry, each duly licensed by this state;

15.  "Plan" means any of the comprehensive health insurance benefit plans as adopted by the Board of Directors of the Health Insurance High Risk Pool, or by rule;

16.  "Alternative plan" means any of the comprehensive health insurance benefit plans adopted by the Board of Directors of the Health Insurance High Risk Pool other than the primary plan; and

17.  "Reinsurer" means any insurer as defined in Section 103 of this title from whom any person providing health insurance to Oklahoma insureds procures insurance for itself as the insurer, with respect to all or part of the health insurance risk of the person.

Added by Laws 1995, c. 250, § 2, eff. July 1, 1995.  Amended by Laws 1996, c. 249, § 2, emerg. eff. May 28, 1996; Laws 1997, c. 180, § 5, emerg. eff. May 12, 1997; Laws 2002, c. 439, § 1, eff. July 1, 2002; Laws 2004, c. 274, § 18, eff. July 1, 2004; Laws 2009, c. 207, § 2, emerg. eff. May 18, 2009; Laws 2011, c. 175, § 1.

Note

NOTE:  Laws 1996, c. 246, § 19 repealed by Laws 1996, c. 249, § 9, emerg. eff. May 28, 1996.