Oklahoma Individual Health Insurance Regulations

Oklahoma health insurance plans are not required to be guarantee issue, so insurance providers typically review health history in order to determine if they will accept or decline an application for coverage. Applications go through the medical underwriting process, which reviews health history and medical claims to identify any pre-existing conditions. Once looking over the applicant's history, the insurer may decline coverage or offer a plan with an elimination rider-an amendment to a policy that exempts them from having to pay claims for certain pre-existing conditions.

Even Oklahomans with prior creditable coverage are not exempt from exclusionary periods or elimination riders, unless the plan is an HMO. In Oklahoma, insurers are not allowed to impose exclusionary periods on individual health plans, but it is nearly impossible to find insurers who offer HMO insurance plans in Oklahoma. Regardless of the plan type, insurers do not have the right to cancel a policy based on an increase in claims or a medical diagnosis.

Small Group Oklahoma Health Insurance Regulations and Guarantee Issue

In the state of Oklahoma, an employee group with two to 50 people qualifies for small group health insurance. Kentucky law states that small groups must receive coverage on a guarantee issue basis, meaning a group cannot be declined coverage due to health history or current medical conditions for a single group member or the group as a whole.

It is the employer's discretion whether or not he/she wants to mandate a waiting period for new employees joining the employer-sponsored group health plan; however the waiting period must be the same for all employees.

When it comes to HMO policies, the health insurance provider may ask the employer to deny group acceptance to a new employee until he or she has been with the company for a minimum of two months. Known as the AMO affiliation period, this two month waiting period must apply to all new employees. Still, HMO plans are not allowed to place an exclusionary period on pre-existing medical conditions. Often an employer may impose the affiliation period on new hires in an effort to encourage them to choose a PPO policy instead, which can include exclusionary periods which may last no longer than 12 months. Any new group members with prior creditable coverage will have the time applied to the exclusionary period.

In Oklahoma, insurers may review a new applicant's health history up to 6 months prior to the first day on the plan to identify pre-existing conditions. Insurers have the right to charge inflated rates to businesses whose employee groups are deemed high-risk, but the maximum rate may not go above 125% of the standard rate of the time.

Understanding Oklahoma COBRA and Continuation Coverage Issues

Oklahoma employer groups with more than 20 employees fall under Federal COBRA regulations. COBRA ensures an employee can access continuous coverage on the group health insurance plan in Oklahoma for a maximum of 18 months following the termination date. The terminated employee's qualified dependents also have access to COBRA coverage and may have eligibility for as long as 36 months in some circumstances.

Unlike some states, Oklahoma does not provide mini-COBRA to companies having fewer than 20 employees. Instead, the state offers a benefits law providing an extension of benefits to the smaller company employees. Under this law, the employees can remain insured under the group plan for 30 days following the termination without making any payments for premiums. During the 30 day period, any medical claims will be paid by the insurer, except the insurer will deduct the premium amount from the amount it pays to the health care provider.

In some cases, employees in this situation may be able to have coverage for more than 30 days if pregnant or experiencing a disability. Additionally, some insurers in Oklahoma offer conversion plans, allowing a person exiting a group to covert the coverage into a private individual health policy. These health insurance plans typically come with high premium rates as well as fewer covered benefits.

Once an individual has used up the months of COBRA coverage, they qualify for coverage under the Oklahoma Health Insurance Risk Pool as long as they are ineligible for individual health insurance through a private insurer.

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