§ 1250.2. Definitions
Oklahoma Statutes AnnotatedTitle 36. Insurance
36 Okl.St.Ann. § 1250.2
§ 1250.2. Definitions
As used in the Unfair Claims Settlement Practices Act:
4. “First-party claimant” means an individual, corporation, association, partnership, or other legal entity, including a subscriber under any plan providing health services, asserting a right to payment pursuant to an insurance policy or insurance contract for an occurrence of contingency or loss covered by such policy or contract;
5. “Health benefit plan” means group hospital or medical insurance coverage, a not-for-profit hospital or medical service or indemnity plan, a prepaid health plan, a health maintenance organization plan, a preferred provider organization plan, the State and Education Employees Group Health Insurance Plan, and coverage provided by a Multiple Employer Welfare Arrangement (MEWA) or employee self-insured plan except as exempt under federal ERISA provisions. The term shall not include short-term accident, fixed indemnity, or specified disease policies, disability income contracts, limited benefit or credit disability insurance, workers' compensation insurance coverage, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and which is required by law to be contained in any liability insurance policy or equivalent self-insurance;
6. “Insurance policy or insurance contract” means any contract of insurance, certificate, indemnity, medical or hospital service, suretyship, annuity, subscriber certificate or any evidence of coverage of a health maintenance organization issued, proposed for issuance, or intended for issuance by any entity subject to this Code;1
7. “Insurer” means a person licensed by the Commissioner to issue or who issues any insurance policy or insurance contract in this state and also includes health maintenance organizations. Provided that, for the purposes of paragraphs 15 and 16 of Section 1250.5 of this title, “insurer” shall include the State and Education Employees Group Insurance Board;
10. “Preauthorization/precertification” means a determination by a health benefit plan, based on the information presented at the time by the health care provider, that health care services proposed by the health care provider are medically necessary. The term shall include “authorization”, “certification” and any other term that would be a reliable determination by a health benefit plan. A preauthorization/precertification from a previous health plan shall not bind a succeeding health benefit plan;
Credits
Laws 1986, c. 251, § 14, eff. Nov. 1, 1986. Renumbered from Title 36, § 1252 and amended by Laws 1994, c. 342, §§ 2, 20, eff. Sept. 1, 1994. Laws 1994, 2nd Ex.Sess., c. 1, § 4, emerg. eff. Nov. 4, 1994; Laws 2003, c. 197, § 53, eff. Nov. 1, 2003; Laws 2004, c. 274, § 7, eff. July 1, 2004; Laws 2005, c. 170, § 1, eff. Nov. 1, 2005; Laws 2009, c. 323, § 1, eff. July 1, 2010; Laws 2013, c. 254, § 19, eff. Jan. 1, 2015.
Footnotes
Title 36, § 101 et seq.
36 Okl. St. Ann. § 1250.2, OK ST T. 36 § 1250.2
Current with emergency effective legislation through Chapter 257 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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