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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.
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