Insurance & Managed Care

 

SB 1206(1) (Henry/Toure): Creates the Managed Health Care Reform and Accountability Act in furtherance of the regulation of the business of insurance. Requires health care entities to exercise duty of ordinary care in treatment decisions and provides for liability for damages proximately caused by breach of duty. The act creates no obligation on the health care entities to provide the enrollee treatment not covered by the health care plan. Creates no liability on the part of an employer or an employer group purchasing organization. Prohibits a health care entity from removing a health care provider from its plan or refusing to renew the health care provider with the plan for advocating on the enrollee's behalf for appropriate health care. Prohibits a health care entity from seeking indemnification from a health care provider and deems contrary contract provisions void and unenforceable. Prohibits a health care entity from asserting certain defenses. States that the act does not apply to insurance agents licensed by the Insurance Department or workers' compensation insurance. Requires affected enrollee to comply with certain procedures before filing a civil action. Prohibits cause of action from being certified as a class action. Excludes specific method for determining exemplary damages. Deletes rebuttable presumption created in any subsequent action at law that the plan's coverage determination was appropriate by a determination in favor of the health benefit plan. Effective 7-1-00.

SB 1278(1) (Brown/Eddins): Prohibits the Insurance Commissioner from appointing as supervisor, conservator, or attorney for the insurer any person who is related to the Commissioner within the third degree of consanguinity or affinity. Prohibits the Commissioner from appointing as attorney for the insurer any current or former officer, director, or employee of the insurer. This act also prohibits the Commissioner, as receiver, from appointing persons or contracting with persons related to the Commissioner in the third degree. Effective 11-1-00.

SB 1472(1) (Shurden/Erwin): Prescribes procedures for the reimbursement of clean claims. Prohibits the lapse in certain life insurance policies without notice. Effective 11-1-00.

HB 2343(1) (Adkins/Price): Makes some changes to the Credit for Reinsurance Act, having the stated intent of ensuring adequate regulation of insurers and reinsurers and adequate protection for those parties to whom insurers and reinsurers owe obligations. Effective 11-1-00.

HB 2428(1) (Braddock/Coffee): Requires the Council on Law Enforcement Education and Training to keep specified records confidential. Excepts confidentiality requirements under certain circumstances. Authorizes an intergovernmental self-insurance pool to keep certain information confidential. Effective date 11-1-2000.

HB 2559(1) (Ervin/Smith): Requires health care insurers to provide a timely explanation of benefits to practitioners, hospitals, home care agencies, and ambulatory surgical centers. Effective 11-1-00.

HB 2582(1) (Frame/Shurden): Provides criteria for coverage of emergency services by an insurer or preferred provider organization (PPO). Prohibits denial of coverage by insurer or PPO for covered emergency services based solely on lack of notification to the insurer or PPO. Requires the insurer or PPO to compensate a medical provider for services rendered in determining whether the condition requires medical services. Provides for coverage for subsequent services after a determination that emergency services are not required. Effective 11-1-2000.

HB 2725(1) (Thornbrugh/Smith): Probably best known for requiring health benefit plans, effective 7-1-00, to cover wigs or other scalp prostheses for persons treated for cancer and other conditions by chemotherapy or radiation therapy. The bill also exempts licensed residential care homes, assisted living centers, continuum of care facilities, and facilities licensed under the Oklahoma Nursing Home Care Act from requirements of the Long-Term Care Insurance Act. Additionally, the bill eliminates prohibition against certain ceding arrangements under the Small Employer Health Insurance Reform Act. Effective 5-2-00.


(1) Passed, signed by Governor (2) Passed, pending Governor's approval/disapproval (3) Vetoed by Governor
(4) Pending in Legislature (5) Failed in Legislature (6) Enrolled with the Sec. of State

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