Oklahoma Administrative Code
Title 310 - Oklahoma State Department of Health
Chapter 657 - Certified Workplace Medical Plans
Subchapter 17 - Contracts and Service Explanations
Section 310:657-17-2 - Contents of the insurers' or insureds' contract
Current through Vol. 42, No. 1, September 16, 2024
Each contract shall contain a clear statement of the following:
(1) Plan's name and address;
(2) Eligibility requirements;
(3) Medical and health services in the area;
(4) Emergency care services and procedures for authorizing emergency services by non-Plan providers;
(5) Out of area services;
(6) Limits and excluded items;
(7) Employee termination;
(8) Employee reinstatement;
(9) Claims procedures, if any;
(10) Dispute resolution and grievance procedures;
(11) Continuing coverage;
(12) Extension of benefits;
(13) Substitution of creditors;
(14) Geographic service area;
(15) Entire contract provision;
(16) Term of coverage;
(17) Renewing contract;
(18) Canceling contract;
(19) Reinstatement of contract;
(20) Grace period; and
(21) Conformity with state law.
Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96; Amended at 23 Ok Reg 2404, eff 6-25-06