SECTION 260:50-3-8. Refunds

(a)   Refunds. Any refund of payment for any premium overpayment shall be made only when EGID is notified in writing no later than sixty [60] days after the actual date of the overpayment, unless lack of notification is beyond control as determined by EGID.

(b)   Administrative Error. Refunds for overpayment due to administrative error, as limited and defined in the rules in this title, of the Insurance/Benefits Coordinator or the payroll clerk for EGID, shall be made at one hundred percent [100%].

(c)   Refunds on behalf of employees. Refunds on behalf of employees shall be paid to the appropriate party. For an entity to receive a refund, the entity must have a credit balance.

(d)   Inaccurate or erroneous information. If EGID finds that materially erroneous, false, inaccurate, or misleading information was intentionally submitted in order to obtain a specific coverage, then:

(1)   For optional or supplemental life insurance coverage in excess of any guaranteed amounts of coverage, EGID shall extinguish its liability by tendering a refund of premiums paid to the insured or the beneficiary;

(2)   Health or dental coverage would be canceled retroactive to the effective date of the

coverage obtained by the misrepresentation. Refunded premiums would be reduced by any claims paid by HealthChoice.

(e)   Medicare eligibility. There shall be no refund of premiums for prior months during which the member was eligible for Medicare, and written notice was not provided to EGID. An exception shall be made for individuals who are retroactively awarded Medicare coverage by the Social Security Administration, when written notice of the retroactive award is provided to EGID within thirty [30] days after the member's notification of the Social Security Administration award. A member's sixty-fifth [65^th] birthday is considered automatic notification of Medicare eligibility.

(f)   Deceased member. All refunds for overpayment resulting from the death of an employee or former employee will be capped at the overpayment amount received by EGID within twenty four [24] months of notification.

[Source: Added at 31 Ok Reg 1390, eff 9-12-14; Amended at 34 Ok Reg 1250, eff 1-1-18; Amended at 35 Ok Reg 1352, eff 1-1-19; Amended at 37 Ok Reg 1334, eff 9-11-20]