Health Insurance Laws for Oklahoma

Consumer Rights Laws

There are two key policy provisions by which all insurers operating in the State of Oklahoma must legally abide. The first is that a pre-existing condition can only be excluded from an individual's coverage for 12 months at most. This is great for Oklahoma residents, considering the majority of states allow companies to exclude individuals with pre-existing conditions indefinitely. The second provision states that insurers are prohibited from canceling a policy based on the physical health of the individual, which offers a bit of good news for those with deteriorating health conditions. However, companies can cancel policies for other reasons, such as lack of payment or violation of the insurance agreement.

An Oklahoma-based insurance company is free to turn down an applicant if he or she does not meet certain health condition requirements. The company is also able to set rates at any level it believes reasonable, and may impose cost increases during renewal periods. Additionally, those with pre-existing conditions may be subject to certain elimination policy riders, meaning the insurance company will not be held liable for treatment of a pre-existing medical condition, and unfortunately, the state does not have any specific definition of what constitutes a pre-existing condition. As such, pregnancy can be considered a pre-existing condition in some circumstances. Lastly, exclusion periods can be set with no time limitation and no creditable coverage. Creditable coverage is the health insurance coverage held by an individual before enrolling in a new plan, so long as that coverage was not interrupted by a period of 63 days or longer.

Under Oklahoma law, individuals who are eligible for any type of group health insurance plan cannot be refused due to a medical problem, nor can they be charged more because of it. However, if the applicant is deemed to have a pre-existing health condition within the previous six months, he or she can be excluded from receiving coverage for that particular medical problem for up to a year from the start of the policy. It is also important to note that exclusion periods in Oklahoma are only applicable to preferred provider organizations (PPO's), not health management organizations (HMO's). Residents should be aware that changes in marital status, occupation, or children may alter one's ability to enroll in group coverage.

Oklahoma mandates that any small business with between two and 50 employees cannot be refused medical coverage under a small business health insurance plan. Also, insurance companies have limits as to how high they can set their premiums, and they cannot cancel the policy due to the medical conditions of the employees. Unfortunately however, self-employed individuals are not eligible for small business health insurance plans.

There are a number of insurance plans in Oklahoma that are tailored toward individuals with unique needs. Those who are found to be eligible under the Health Insurance Portability and Accountability Act (HIPAA), for example--including individuals who have exhausted all private purchasing options--can buy insurance from the Oklahoma Health Insurance High Risk Pool. Medicaid is available for both individuals and families who need financial assistance, while the Take Charge program provides certain free screening services for women. In addition, Oklahoma's Children's Health Insurance Program and Soonercare offer medical coverage to needy children who are 19 years old or younger.