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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 365. Insurance Department |
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Chapter 40. Health Maintenance Organizations (HMO) |
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Subchapter 5. Life, Accident & Health Division and Consumer Assistance and Claims Division Rules |
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Part 21. GEOGRAPHIC SERVICE AREA VARIATIONS |
SECTION 365:40-5-110. Accessibility of providers
Latest version.
- (a) The Department shall presume a proposed service area to be reasonable if the mean travel time is thirty (30) minutes or less from six equidistant points on the area boundary to the nearest primary and emergency care delivery sites within that area.(b) The Department shall consider approving service areas with distances of greater than thirty (30) minutes to primary and emergency care providers, based on the following.(1) Primary or emergency care providers are not available in the area;(2) Primary or emergency care providers are available but do not meet the HMO's reasonable credentialing requirements;(3) Primary or emergency care providers are unwilling or unable to enter a reasonable health services contract with the HMO; or(4) Residents of the area customarily travel longer than 30 minutes to reach primary or emergency care providers.