 |
Oklahoma Administrative Code (Last Updated: March 11, 2021) |
 |
TITLE 310. Oklahoma State Department of Health |
|
|
Chapter 655. Health Maintenance Organizations and Prepaid Health Plans [revoked] |
| Subchapter 1. General Provisions [revoked] |
| SECTION 310:655-1-1. Purpose [revoked] |
| SECTION 310:655-1-2. Definitions [revoked] |
| SECTION 310:655-1-3. Severability [revoked] |
| Subchapter 3. Rating System [revoked] |
| SECTION 310:655-3-1. Definitions [revoked] |
| SECTION 310:655-3-2. Community rating [revoked] |
| SECTION 310:655-3-3. Community rating by class [revoked] |
| SECTION 310:655-3-4. Adjusted community rating [revoked] |
| SECTION 310:655-3-5. Rates to reflect risk-sharing arrangements [revoked] |
| SECTION 310:655-3-6. Filing requirements for rating information [revoked] |
| Subchapter 5. Comprehensive and Supplemental Health Services [revoked] |
| SECTION 310:655-5-1. Comprehensive services [revoked] |
| SECTION 310:655-5-2. Supplemental services [revoked] |
| Subchapter 7. Point of Service Option [revoked] |
| SECTION 310:655-7-1. Definitions [revoked] |
| SECTION 310:655-7-2. Purpose/scope [revoked] |
| SECTION 310:655-7-3. Responsibilities of the HMO [revoked] |
| Subchapter 9. License Applications [revoked] |
| SECTION 310:655-9-1. Purpose [revoked] |
| SECTION 310:655-9-2. Description [revoked] |
| Subchapter 11. Review of Applications [revoked] |
| SECTION 310:655-11-1. Description [revoked] |
| SECTION 310:655-11-2. Filings [revoked] |
| SECTION 310:655-11-3. Initial license review [revoked] |
| SECTION 310:655-11-4. License renewal review [revoked] |
| SECTION 310:655-11-5. Appeals [revoked] |
| Subchapter 13. Public Hearings on Initial License Applications [revoked] |
| SECTION 310:655-13-1. Procedures [revoked] |
| Subchapter 15. Requirements for a License [revoked] |
| SECTION 310:655-15-1. License required [revoked] |
| SECTION 310:655-15-2. Description [revoked] |
| SECTION 310:655-15-3. Services to members [revoked] |
| SECTION 310:655-15-4. Membership [revoked] |
| SECTION 310:655-15-5. Individual conversion contracts [revoked] |
| SECTION 310:655-15-6. Premiums/co-payments [revoked] |
| SECTION 310:655-15-7. Grievance system [revoked] |
| SECTION 310:655-15-8. Guaranteed renewal [revoked] |
| SECTION 310:655-15-9. Small group offering [revoked] |
| SECTION 310:655-15-10. Special enrollment periods [revoked] |
| Subchapter 17. Utilization and Quality Review Systems [revoked] |
| SECTION 310:655-17-1. Requirement [revoked] |
| SECTION 310:655-17-2. Quality review system [revoked] |
| SECTION 310:655-17-3. Utilization review [revoked] |
| SECTION 310:655-17-4. First and subsequent years [revoked] |
| SECTION 310:655-17-4.1. Peer review [revoked] |
| SECTION 310:655-17-5. Second and subsequent years [revoked] |
| SECTION 310:655-17-6. Third and subsequent years [revoked] |
| SECTION 310:655-17-7. Fourth and subsequent years [revoked] |
| SECTION 310:655-17-8. Disclosure requirements [revoked] |
| SECTION 310:655-17-9. Governing body oversight [revoked] |
| SECTION 310:655-17-10. Independent medical judgment [revoked] |
| SECTION 310:655-17-11. Quality of care examinations [revoked] |
| Subchapter 19. Ownership/Control of HMO [revoked] |
| SECTION 310:655-19-1. Ownership [revoked] |
| SECTION 310:655-19-2. Removal or transfer of property [revoked] |
| SECTION 310:655-19-3. Accounts, books and records [revoked] |
| Subchapter 21. Issuance of a License [revoked] |
| SECTION 310:655-21-1. Description [revoked] |
| SECTION 310:655-21-2. Duration of license [revoked] |
| Subchapter 23. Withdrawal of a License [revoked] |
| SECTION 310:655-23-1. Conditions for revocation/suspension [revoked] |
| SECTION 310:655-23-2. Suspension [revoked] |
| SECTION 310:655-23-3. Revocation [revoked] |
| Subchapter 25. Protection Against Insolvency [revoked] |
| SECTION 310:655-25-1. Net worth requirement [revoked] |
| SECTION 310:655-25-2. Minimum deposit requirements [revoked] |
| SECTION 310:655-25-3. Purpose of deposits [revoked] |
| SECTION 310:655-25-4. Reduction of deposit [revoked] |
| SECTION 310:655-25-5. Liability insurance [revoked] |
| SECTION 310:655-25-6. Provider contracts [revoked] |
| SECTION 310:655-25-7. Covered and uncovered expenses [revoked] |
| SECTION 310:655-25-8. Projections [revoked] |
| SECTION 310:655-25-9. Impairment [revoked] |
| SECTION 310:655-25-10. Deposit of funds [revoked] |
| SECTION 310:655-25-11. Financial examination [revoked] |
| SECTION 310:655-25-12. Claims against deposit [revoked] |
| Subchapter 27. Termination of Members, Providers and Continuation of Benefits [revoked] |
| SECTION 310:655-27-1. Termination of group or individual contracts [revoked] |
| SECTION 310:655-27-2. Termination of providers [revoked] |
| SECTION 310:655-27-3. Continuation of benefits [revoked] |
| SECTION 310:655-27-4. Disenrollment for cause [revoked] |
| SECTION 310:655-27-5. Certification of creditable coverage [revoked] |
| Subchapter 29. Discontinuation of HMO [revoked] |
| SECTION 310:655-29-1. Notice [revoked] |
| SECTION 310:655-29-2. Replacement coverage [revoked] |
| SECTION 310:655-29-3. Individual market [revoked] |
| SECTION 310:655-29-4. Group market [revoked] |
| SECTION 310:655-29-5. Market reentry [revoked] |
| Subchapter 31. Failure to Obtain License [revoked] |
| SECTION 310:655-31-1. Restrictions [revoked] |
| SECTION 310:655-31-2. Prohibitions [revoked] |
| SECTION 310:655-31-3. Enforcement [revoked] |
| Subchapter 33. Reports and Periodic Filings [revoked] |
| SECTION 310:655-33-1. Annual survey [revoked] |
| SECTION 310:655-33-2. Application changes [revoked] |
| SECTION 310:655-33-3. Periodic filings [revoked] |
| SECTION 310:655-33-4. Department review [revoked] |
| Subchapter 35. Requirements for Group Contract, Individual Contract and Evidence of Coverage [revoked] |
| SECTION 310:655-35-1. Purpose [revoked] |
| SECTION 310:655-35-2. Contents of contract [revoked] |
| SECTION 310:655-35-3. Evidence of coverage [revoked] |
| SECTION 310:655-35-4. Examination period [revoked] |
| SECTION 310:655-35-5. Department review [revoked] |
| SECTION 310:655-35-6. Benefit changes [revoked] |
| SECTION 310:655-35-7. Identification cards [revoked] |
| Subchapter 37. Confidentiality of Medical Information and Liability [revoked] |
| SECTION 310:655-37-1. Responsibility of HMO [revoked] |
| SECTION 310:655-37-2. Responsibility of the Department [revoked] |
| Subchapter 39. Powers of Health Maintenance Organizations [revoked] |
| SECTION 310:655-39-1. Powers of an HMO [revoked] |
| SECTION 310:655-39-2. Transactions between affiliates [revoked] |
| Subchapter 41. Miscellaneous Provisions [revoked] |
| SECTION 310:655-41-1. Examinations [revoked] |
| SECTION 310:655-41-2. Request for assistance [revoked] |
| SECTION 310:655-41-3. Coordination of benefits [revoked] |
| SECTION 310:655-41-4. Other requirements [revoked] |
| Subchapter 43. Ex Parte Contacts [revoked] |
| SECTION 310:655-43-1. Purpose [revoked] |
| Subchapter 45. Geographic Service Area Variations [revoked] |
| SECTION 310:655-45-1. Accessibility of providers [revoked] |
| SECTION 310:655-45-2. Marketing and enrolling [revoked] |
| SECTION 310:655-45-3. Required filings [revoked] |
| Subchapter 47. Reimbursement of Claims [revoked] |
| SECTION 310:655-47-1. Purpose [revoked] |
| SECTION 310:655-47-2. Requirement to reimburse claims for point of service [revoked] |
| SECTION 310:655-47-3. Responsibilities [revoked] |
| SECTION 310:655-47-4. Reimbursement criteria [revoked] |
| SECTION 310:655-47-5. Deadline for claim payment [revoked] |
| SECTION 310:655-47-6. Claims payment report [revoked] |
| SECTION 310:655-47-7. Elements of a clean claim [revoked] |
| SECTION 310:655-47-8. Disclosure requirements [revoked] |
| SECTION 310:655-47-9. Disclosure of processing procedures [revoked] |
| SECTION 310:655-47-10. Failure to promptly pay [revoked] |
| SECTION 310:655-47-11. Date of claim receipt [revoked] |
| SECTION 310:655-47-12. Terms of contracts [revoked] |
| Subchapter 49. Administrative Penalties [revoked] |
| SECTION 310:655-49-1. Purpose [revoked] |
| SECTION 310:655-49-2. Determining seriousness of violation [revoked] |
| SECTION 310:655-49-3. Available remedies [revoked] |
| SECTION 310:655-49-4. Categories of remedies [revoked] |
| SECTION 310:655-49-5. Notice of penalty or other remedy [revoked] |
| SECTION 310:655-49-6. Effective date and duration of penalty or other remedy [revoked] |
| Subchapter 51. Coordination With State Insurance Commissioner [revoked] |
| SECTION 310:655-51-1. Purpose [revoked] |
| SECTION 310:655-51-2. Exchange of information [revoked] |
| SECTION 310:655-51-3. Complaints [revoked] |
| SECTION 310:655-51-4. Recommendations [revoked] |
| SECTION 310:655-51-5. Review and analysis functions [revoked] |
| Subchapter 53. Examinations [revoked] |
| SECTION 310:655-53-1. Definitions [revoked] |
| SECTION 310:655-53-2. Nature and frequency of examinations [revoked] |
| SECTION 310:655-53-3. Appointment of examiner [revoked] |
| SECTION 310:655-53-4. Payment of charges [revoked] |
| SECTION 310:655-53-5. Report of examination [revoked] |
| Subchapter 55. [revoked] |
| Subchapter 57. Risk Based Capital [revoked] |
| SECTION 310:655-57-1. Purpose [revoked] |
| SECTION 310:655-57-2. Phase in of risk-based capital [revoked] |
| SECTION 310:655-57-3. Adoption by reference [revoked] |
| SECTION 310:655-57-4. [Reserved] |
| SECTION 310:655-57-5. Actions of department [revoked] |
| SECTION 310:655-57-6. Limitations [revoked] |
Note
[Authority: 63 O.S., §§ 1-104 and 2501 et seq.; OK Laws 2003, c.197]
[Source: Codified 12-31-91]