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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 7. POINT OF SERVICE OPTION |
SECTION 365:40-5-32. Responsibilities of the HMO
Latest version.
- (a) Each HMO that offers a point of service option shall collect and report to the Department the number of enrollees who access the benefit, the types and volumes of services received, and the costs to enrollees and the HMO.(b) Each HMO shall inform enrollees about the following:(1) Any premium and cost-sharing charges;(2) Annual out-of-pocket limits;(3) Annual and maximum benefit limits for out-of-plan services; and,(4) Potential financial liability for services for which payment could be denied because the service is not a covered benefit, or the dollar limit is exceeded.(c) Each HMO shall file with the Department all marketing and educational material for the point of service option prior to use of that material.