SECTION 365:10-19-5. Requirement to insure all employees of the purchaser and new entrants

(a)   Offer of coverage.

(1)   A HIPG health carrier that offers coverage to a HIPG shall offer to provide coverage to each eligible employee and their dependents and to each new entrant to the plan and to each dependent of the new entrant. New entrants shall be covered upon the first day of the calendar month following any established waiting periods of the HIPG.

(2)   A HIPG health carrier shall offer the eligible employees of a HIPG the option of choosing among one or more health benefit plans, one of which shall contain the mandated benefits pursuant to the entire Oklahoma Insurance Code, provided that each employee may choose any of the offered plans. The choice among benefit plans may not be limited, restricted or conditioned based upon the risk characteristics of the employees or their dependents.

(b)   List of eligible employees and waivers.

(1)   A HIPG health carrier shall require each employer of the HIPG that applies for coverage, as part of the application process, to provide a complete list of eligible employees and dependents of eligible employees as defined in 36 O.S. § 4522(2) & (4). The HIPG health carrier shall require the Purchaser to provide appropriate supporting documentation (such as the W-2 Summary Wage and Tax Form, or other proof of employment as may be determined by the Oklahoma Insurance Department) to verify the information required under this section.

(2)   A HIPG health carrier shall obtain a waiver with respect to each eligible employee and each dependent of such an eligible employee who declines an offer of coverage under a health benefit plan provided to a Purchaser. The waiver shall be signed by the eligible employee (on behalf of such employee or the dependent of such employee) and shall certify that the individual who declined coverage was informed of the availability of coverage under the health benefit plan. The waiver form shall require that the reason for declining coverage be stated on the form and shall include a written warning of the penalties imposed on late enrollees. Waivers shall be maintained by the HIPG health carrier for the period in which the coverage is in effect.

(c)   Inducement to decline coverage due to the individual's risk characteristics prohibited.

(1)   A HIPG health carrier shall not issue coverage to a Purchaser if the HIPG health carrier, or a producer for such HIPG health carrier, has reason to believe that the Purchaser has induced or pressured an eligible employee or dependent of an eligible employee to decline coverage due to the individual's risk characteristics.

(2)   A producer shall notify a HIPG health carrier, prior to submitting an application for coverage with the HIPG health carrier on behalf of a Purchaser, of any circumstances that would indicate that the Purchaser has induced or pressured an eligible employee or dependent of an eligible employee to decline coverage due to the individual's risk characteristics.

[Source: Added at 20 Ok Reg 224, eff 11-25-02 (emergency); Added at 20 Ok Reg 1731, eff 7-14-03]