Posts by: Britney Han

Growing Oklahoma Captive Industry

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For Immediate Release:
June 29, 2022

Growing Oklahoma Captive Industry

By Oklahoma Insurance Commissioner Glen Mulready   

 

Oklahoma is a great place to do business. As one of the fastest-growing domiciles for captives in the country, the Oklahoma Insurance Department (OID) is attracting more and more companies to do business here. A captive insurance company provides great flexibility to business owners who want to take control of their insurance programs. Captives exist to underwrite the risk of their owner(s) and affiliates. Between 2017 and 2021, Oklahoma’s captive premium volume increased significantly, rising to $214.4 million in 2021, up from $147.3 million in 2017.

Oklahoma now has 40 licensed captives—more than one-third of these were issued during my first two years in office. In 2019 and 2020, captives domiciled in Oklahoma generated over $1 million in premium taxes to help fund public safety pensions and the state’s general revenue fund. With OID’s supportive, efficient regulatory platform, companies of various industries around the country recognize Oklahoma as a highly competitive jurisdiction.

To help Oklahoma continue to be the hub of innovation and technology, OID is hosting its first Oklahoma Captive & Insurance Business Transfer (IBT) Conference on August 24-25 at the Omni Oklahoma City Hotel. This two-day conference will address new and emerging risks facing companies and organizations worldwide. We’ll bring together subject matter experts to share insights on captive insurance and IBTs and educate stakeholders on the benefits of these cutting-edge mechanisms. This conference will demonstrate how captives can offer solutions that may not be available in the traditional insurance marketplace.

It’s the first in-person conference we are hosting since the COVID-19 pandemic. And I’m excited to showcase Oklahoma’s endless possibilities to risk managers, business owners, regulators, financial executives and insurance professionals. Registration is required to attend the event and limited seats are available. For more information about the event, visit www.oid.ok.gov/CIBTC/ and follow OID on Facebook, Twitter, Instagram and LinkedIn

If you have questions about other insurance issues, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov

 

Questions or comments should be directed to
Communications Director, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Bulletin No. 6-1-2022

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BULLETIN NO. 6-1-2022

To: All Health Insurance Companies, Health Maintenance Organizations, PBMs and Other Interested Parties
Re: Unfair Claims Settlement Practice: Pharmacy Benefit Calculations
From: Glen Mulready, Insurance Commissioner
Date: June 13, 2022

 

The Oklahoma Insurance Department (“Department”) is releasing this bulletin with the purpose of providing information to issuers of health benefit plans as defined by 36 O.S. § 1250.2(5) regarding HB 3495, a bill enacted during the 2022 Regular Session of the Oklahoma Legislature amending 36 O.S. § 1250.5. HB 3495 took effect on May 16, 2022.

Prior to the enactment of HB 3495, the Department released guidance in Bulletin No. LH 2021-05 regarding a conflict between federal requirements governing health savings account (“HSA”) eligibility and the language in 36 O.S. § 1250.5(18) requiring a health benefit plan issuer to combine all payments made toward a prescription when calculating an enrollee’s total contribution.

Section 1(18) of HB 3495, now codified as 36 O.S. § 1250.5(18), addresses the previous conflict and provides the following clarification:

However, if, under federal law, application of this paragraph would result in health savings account ineligibility under Section 223 of the federal Internal Revenue Code, as amended, this requirement shall apply only for health savings accounts with qualified high-deductible health plans with respect to the deductible of such plan after the enrollee has satisfied the minimum deductible, except with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C) of the federal Internal Revenue Code, as amended, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible has been satisfied.

The Department understands this clarification to mean that in the case of an enrollee with a qualified high-deductible health plan (“HDHP”) and correlating HSA, the requirement to calculate any third-party payment toward a prescription as part of the enrollee’s total contribution will apply only after the enrollee’s deductible under their HDHP is satisfied. This understanding is subject to change if differing guidance is issued by the Internal Revenue Service.

As previously advised in Bulletin No. LH 2021-05, health benefit plan issuers are strongly encouraged to continue to communicate the effects of applying funds from third parties when making payments for prescriptions to members enrolled in an HDHP with an associated HSA.

 

Questions applicable to this bulletin should be directed to:

Kim Hunter, General Counsel, at kim.hunter@oid.ok.gov or Molly Clinkscales, Assistant General Counsel at molly.clinkscales@oid.ok.gov.

Bulletin No. 6-2-2022

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BULLETIN NO. 6-2-2022

To: All Health Insurance Companies, Health Maintenance Organizations, PBMs and Other Interested Parties
Re: Unfair Claims Settlement Practice: Claim Refunds
From: Glen Mulready, Insurance Commissioner
Date: June 13, 2022

 

The Oklahoma Insurance Department (“Department”) is releasing this bulletin with the purpose of providing information to issuers of health benefit plans as defined by 36 O.S. § 1250.2(5) regarding HB 3495, a bill enacted during the 2022 Regular Session of the Oklahoma Legislature amending 36 O.S. § 1250.5. HB 3495 took effect on May 16, 2022.

Section 1(15) of HB 3495, now codified as 36 O.S. § 1250.5(15), considers the following to be an unfair claims settlement practice:

Requesting a refund of all or a portion of a payment of a claim made to a claimant more than twelve (12) months or a health care provider more than eighteen (18) months after the payment is made. This paragraph shall not apply:

a. if the payment was made because of fraud committed by the claimant or health care provider, or

b. if the claimant or health care provider has otherwise agreed to make a refund to the insurer for overpayment of a claim[.]

Previously, 36 O.S. § 1250.5(15) prohibited an insurer from requesting refunds after twenty-four months. As of May 16, 2022, it is an unfair claims practice to request a refund from claimants more than twelve months after the claim was paid and from health care providers more than eighteen months after the claim was paid.

 

Questions applicable to this bulletin should be directed to:

Kim Hunter, General Counsel, at kim.hunter@oid.ok.gov or Molly Clinkscales, Assistant General Counsel at molly.clinkscales@oid.ok.gov.

Bulletin No. 5-2022 (Senate Bill 737)

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BULLETIN NO. 5-2022

 

To: ALL PHARMACY BENEFITS MANAGERS LICENSED IN OKLAHOMA
Re: SENATE BILL 737
From: GLEN MULREADY, INSURANCE COMMISSIONER
Date: June 8, 2022

 

PURPOSE OF THIS BULLETIN

            Oklahoma SB 737 was codified into Title 36 § 6962 of the Oklahoma Statutes and includes a declaration of emergency, thus taking effect immediately upon Governor Stitt’s signature on April 21, 2022.  This measure includes new requirements which will have a significant impact on the Pharmacy Benefits Management industry. The Department hopes that this bulletin will clarify what is required.

Overview

            SB 737 prohibits any pharmacy benefits manager (PBM) from engaging in the practice of spread pricing as defined in the measure and from charging a pharmacist or pharmacy certain fees as they relate to participation in a retail pharmacy network. Additionally, PBMs must disclose to insurers, self-funded employers, unions or other PBM clients the existence of the respective aggregate prescription drug discounts, rebates received from drug manufacturers, and pharmacy audit recoupments. PBMs must also provide the Insurance Commissioner with certain data pertaining to pharmaceutical manufacturer and provider contracts, plan utilization data, plan pricing data, pharmacy utilization data, and pharmacy pricing data. Such reports to the Commissioner will occur on a quarterly basis.

The measure empowers the Insurance Commissioner to suspend or revoke a PBM’s license and to censure such managers for any violation relating to the Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, or other relevant statutes. The Commissioner may assess an administrative fine on top of any other fines levied against a manager ranging from $100.00 to $10,000.00. Each day that a PBM operates without a license from the Insurance Department will be deemed a violation of the Patient’s Right to Pharmacy Choice Act.

Spread pricing prohibition: Oklahoma statutes define spread pricing as “a prescription drug pricing model utilized by a pharmacy benefits manager in which the PBM charges a health benefit plan a contracted price for prescription drugs that differs from the amount the PBM directly or indirectly pays the pharmacy or pharmacist for providing pharmacy services”. Oklahoma statute now prohibits spread pricing. PBMs must cease all spread pricing, even if it is permitted in their contract with an Oklahoma pharmacy. If a PBM does have a spread pricing provision in their contract, they must remove that language when the contract is renewed.

Participation fees: 36 O.S. § 6962 now prohibits PBMs from charging Oklahoma pharmacies fees related to: an application fee, an enrollment or participation fee, a credentialing or recredentialing fee, a change of ownership fee, or a fee for the development or management of claims processing services or claims payment services.

Disclosures:  SB 737 requires certain disclosures to organizations that the PBM conducts business with. A PBM must now “fully disclose to insurers, self-funded employers, unions or other PBM clients the existence of the respective aggregate prescription drug discounts, rebates received from drug manufacturers and pharmacy audit recoupments”

Every PBM must also Provide the Insurance Commissioner, insurers, self-funded employer plans and unions unrestricted audit rights of and access to the respective PBM pharmaceutical manufacturer and provider contracts, plan utilization data, plan pricing data, pharmacy utilization data and pharmacy pricing data;

Additionally, PBMs are also required to maintain, for no less than three (3) years, documentation of all network development activities including but not limited to contract negotiations and any denials to providers to join networks. This documentation shall be made available to the Commissioner upon request;

Reporting: Every Pharmacy Benefits Manager licensed in the State of Oklahoma must report to the Commissioner, on a quarterly basis for each health insurer payor, the following information:

a. the aggregate amount of rebates received by the PBM,
b. the aggregate amount of rebates distributed to the appropriate health insurer payor,
c. the aggregate amount of rebates passed on to the enrollees of each health insurer payor at the point of sale that reduced the applicable deductible, copayment, coinsure or other cost sharing amount of the enrollee,
d. the individual and aggregate amount paid by the health insurer payor to the PBM for pharmacy services itemized by pharmacy, drug product and service provided, and
e. the individual and aggregate amount a PBM paid a provider for pharmacy services itemized by pharmacy, drug product and service provided.

Each PBM licensed in the State of Oklahoma will be required to submit its “Oklahoma Pharmacy Benefits Manager Quarterly Data Report” to the Oklahoma Insurance Department (“Department”) beginning in October 2022.

Every Oklahoma Pharmacy Benefits Manager Quarterly Data Report submitted to the Department by a PBM must be in Excel software spreadsheet format that is searchable and in a manner which allows for the data to be arranged and organized.  All other file types will be rejected. Each report submitted by a PBM must also specify the time-period to which the data included in the report pertains.

For reporting purposes, please go to the following link to access an acceptable template as required by the Department: https://www.oid.ok.gov/regulated-entities/pbm/.  This is the only reporting format which will be accepted by the Department.  Each report submitted by a PBM should have a file name identifying the PBM’s license number, the year and the specific quarter (time-period) for which the report is being submitted.  For example, if XYZ Company (OK PBM License #999999) is submitting a report for the third (3rd) quarter of 2022, the ideal file name of the report would be as follows:  “999999-2022.3rd Qtr.OK PBM Data Report.xlsx” in Excel.

On or before the last day of each month in which it is due, each report submitted by a PBM should be delivered electronically to the Department at PBMReporting@oid.ok.gov in a manner that is without redaction and which is neither encrypted nor password protected.

Accompanying each report submission, a PBM must also provide the contact information for a specific representative of the PBM who may be contacted by the Department with regards to the report submitted should the need arise.  The PBM representative’s contact information provided should include their direct telephone number and email address. Additionally, each report submission must be accompanied by a general attestation of authenticity (see below) signed by the representative of the PBM who prepares the report.

Attestation Example:

“In compliance with Title 36 O.S. § 6962 (D)(5), the PBM Quarterly Aggregate Data Report herein attached is submitted to be filed with the Oklahoma Insurance Department and I hereby attest to the accuracy of the data and facts represented within this document as of [Date submitted].”

 

Questions applicable to this bulletin should be directed to:

the PBM Compliance and Enforcement Division, Oklahoma Insurance Department at PBMReporting@oid.ok.gov.

BULLETIN NO. 4-2022

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BULLETIN NO. 4-2022

 

To: ALL PROPERTY AND CASUALTY INSURERS LICENSED IN OKLAHOMA
Re: HOUSE BILL 3495 & 36 O.S. §1250.5
From: GLEN MULREADY, INSURANCE COMMISSIONER
Date: May 31, 2022

 

PURPOSE OF THIS BULLETIN

The purpose of this bulletin is to inform all property and casualty insurers of the changes made to the Unfair Claim Settlement Practices found at 36 O.S. 1250.5(7), effectuated by House Bill 3495.

Effective May 16, 2022, 36 O.S. §1250.5(7) has been amended to state “any policy that specifies a time limit covering damage to a roof due to wind or hail must allow the filing of claims after the first anniversary but no later than twenty-four (24) months after the date of the loss, if the damage is not evident without inspection.”

The Department also encourages consumers/insureds to have their roofs inspected by a reputable expert once a year or after a major hail or wind event.

The Oklahoma Insurance Department encourages readers of this bulletin to periodically check the Department’s website at  http://www.ok.gov/oid/  for news and updates to bulletins and other relevant material.

 

Questions applicable to this bulletin should be directed to:

Jason Johnston, Consumer Assistance Division, at Jason.Johnston@oid.ok.gov; or

Bo DeBose, Legal Division, at Bo.Debose@oid.ok.gov

2022 Emergency Rule Amendments

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Medicare Fraud Prevention Week: Join the Oklahoma Insurance Department for the Summer Senior Fraud Live Events This Summer

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For Immediate Release:
June 1, 2022

Medicare Fraud Prevention Week:
Join the Oklahoma Insurance Department for the Summer Senior Fraud Live Events This Summer

 

OKLAHOMA CITY – In conjunction with the first national Medicare Fraud Prevention Week, the Oklahoma Insurance Department’s (OID) Medicare Assistance Program (MAP) is inviting Medicare beneficiaries to the Summer Senior Fraud Live Events on June 23 and July 14. OID has partnered with MAP, the Oklahoma Social Security Administration, the Oklahoma Department of Securities, the Oklahoma Attorney General’s Office, AARP Oklahoma and the National Insurance Crime Bureau to educate and empower Oklahomans in the fight against fraud targeting senior citizens.

“We’re excited to bring back these in-person events and continue to work with our partners to help Oklahomans protect themselves from fraud,” Director of the MAP division Ray Walker said. “Educational events like this will help individuals stay safe and protect the Medicare program for generations to come.”

The Summer Senior Fraud Live Events, funded in part by the SMP grant through the Administration for Community Living, will be held at the OID’s Oklahoma City office. These in-person events will consist of two one-day sessions led by speakers with diverse areas of expertise such as state agency directors, Medicare professionals and fraud prevention professionals. The topics include Medicare and healthcare fraud, contractor fraud, cyber scams, investment fraud and securities fraud. These events are free for senior adults and include breakfast. Registration is required because of limited capacity. To register, visit oid.ok.gov/summerseniorfraud/.

The Medicare Fraud Prevention Week, held June 5-11, kicks off on June 5, or “6-5,” because most people become eligible for Medicare when they turn 65 years old. Learn more about Medicare Fraud Prevention Week at www.smpresource.org

If you have questions about other insurance issues, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov.

 

For more information, contact:

Liz Heigle
405-522-0683
Liz.Heigle@oid.ok.gov

Mulready Says Get Ready Part III: After the Storm

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For Immediate Release:
May 11, 2022

Mulready Says Get Ready Part III:
After the Storm 

By Oklahoma Insurance Commissioner Glen Mulready  

 

Recovering from a disaster can be challenging and stressful. Most natural disasters happen unexpectedly and can significantly impact your mental and physical health. Fortunately, the state of Oklahoma has excellent disaster assistance resources. Knowing how to access them makes the recovery process faster and less stressful. This Mulready Says Get Ready Part III: After the Storm offers some general advice on steps to take after disaster strikes. Here are three important post-disaster steps to remember: 

  1. Take care of yourself and your family.
  • Your first concern after a disaster is your family’s health and safety. Check for injuries and seek medical help for any injured family members. 
  • If the storm destroyed your home, business or personal property, know that cleaning up and repairing the damage can be physically, mentally and financially challenging. 
  • Let your local officials know of any damages you may have and what immediate assistance you may need such as food and shelter. You can report flooding and storm damages at damage.ok.gov.
  • For non-emergency disaster or health and human service information, please contact your local 2-1-1. Services are available 24 hours a day. 
  1. Contact your insurance agent as soon as possible.
  • Document all your damages before you clean up. Take photos or videos and make a list. Check out our free Home Inventory Checklist if you haven’t created a home inventory. 
  • Save all your receipts for post-damage repair and clean-up. 
  • Contact your insurance agent to start the claims process as soon as possible. 
  • Work with your adjuster and complete proof of loss to support your claim. 
  1. Be aware of post-disaster fraud and scams.
  • DO NOT give any personal information such as Social Security or bank account numbers unless you are sure it is safe. Local officials, state and federal workers like FEMA inspectors never need this information to provide services. 
  • Watch out for people going door-to-door or calling homeowners claiming to be building contractors. These could be scam artists, especially if they ask for financial information. 
  • Report suspicious activity to local authorities and the FEMA Disaster Fraud Hotline at 1-866-720-5721. You can also contact the Oklahoma Insurance Department’s Anti-Fraud Unit at fraudstoppers@oid.ok.gov or 1-800-522-0071. 

To help Oklahomans prepare for this storm season, I’ve released the three-part column series—Mulready Says Get Ready: Before, During and After the Storm. This comprehensive series will provide general preparedness tips for before, during and after disasters. Visit www.oid.ok.gov/news to check out Part I: Before the Storm and Part II: During the Storm columns. Also, be sure to listen to our Mulready Minutes Podcast Episode 10: the Preparedness Movement Part I & 2 at www.oid.ok.gov/podcast to learn how to Get Ready for severe weather. For more disaster preparedness resources: www.oid.ok.gov/getready

If you have questions about other insurance issues, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov

 

Questions or comments should be directed to
Communications Director, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Mulready Says Get Ready Part II: During the Storm

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For Immediate Release:
April 26, 2022

Mulready Says Get Ready Part II: During the Storm

By Oklahoma Insurance Commissioner Glen Mulready  

 

When it comes to severe weather, proper preparation and knowing what to do in certain situations can save you and your family’s lives. That’s why I’m encouraging Oklahomans to Get Ready for when—not if—the next disaster happens. Storms in Oklahoma often occur without warning, not leaving you enough time to prepare. Here are three important steps you can take to stay safe during the storm: 

  1. Take Shelter Immediately
  • Go to the basement or storm shelter. Put your family emergency plan into action and check your go-bag in case you must leave in a hurry. 
  • If you do not have a basement or storm shelter, go to the room at the lowest level in the home (i.e., hallway or bathroom), away from windows and corners where objects tend to collect. Cover yourself with a heavy object such as a mattress or sleeping bag to protect you from broken glass or flying debris. 
  • Stay in place until you are sure the storm has passed. 
  1. Stay Weather Informed
  • Stay informed on weather updates. Monitor the storm’s progress and listen for warnings from local officials. 
  • Power outages are highly possible in severe weather. Unplug appliances that are not necessary for obtaining weather updates. Use phones only in an emergency. 
  • Have multiple sources to stay informed of the evolving conditions—TV and radio, emergency notifications via mobile devices, NOAA Weather Radio, etc. Make sure to have at least one source that does not require electricity. 
  1. Plan to Evacuate If Necessary
  • Before leaving your home or driving anywhere, listen carefully to local weather experts and government officials who will be coordinating evacuation plans.
  • Go to higher ground if flash flooding or flooding is possible. 
  • DO NOT drive into high water. Six inches of water will wash away a person and two feet of water will wash away a car.  
  • Don’t forget the footwear. It is dangerous to walk outside barefoot because glass and other debris are everywhere during a storm.

To help Oklahomans prepare for this storm season, I’m releasing the three-part column series—Mulready Says Get Ready: Before, During and After the Storm. This comprehensive series will provide general preparedness tips for before, during and after disasters. Visit www.oid.ok.gov/news to check out Part I: Before the Storm. In the next series, I’ll share detailed information on the insurance claim process and how to recover quickly after disasters. Please stay tuned and visit www.oid.ok.gov/getready for more information on how to Get Ready

If you have questions about other insurance issues, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov

 

Questions or comments should be directed to
Communications Director, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

BULLETIN NO. 3-2022

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BULLETIN NO. 3-2022

 

To: ALL PROPERTY AND CASUALTY INSURERS LICENSED IN OKLAHOMA ALL RATING AND ADVISORY ORGANIZATIONS ATTENTION: STATE FILING DIVISION
Re: OKLAHOMA MARKET ASSISTANCE PROGRAM (OK-MAP) ANNUAL ASSESSMENT
From: GLEN MULREADY, INSURANCE COMMISSIONER
Date: April 25, 2022

 

PURPOSE OF THIS BULLETIN

The Oklahoma Market Assistance Program (OK-MAP) Plan of Operation and the Oklahoma Insurance Code allow the program to collect an assessment from all “member” insurers in the State of Oklahoma. The purpose of the assessment is to help fund the program so that it may continue its efforts in assisting Oklahoma consumers in finding homeowners insurance. The amount of the assessment is $150 and all member insurers will receive an invoice for that amount during the first week of May 2022.

“Member” means all property and casualty insurers licensed in the State of Oklahoma or writing homeowners’ or liability insurance in the state.

36 O.S. § 6422 requires OK-MAP members to participate in all assessments and writings of the program. The statute also allows for imposition of a penalty against members who fail to pay the assessment, including revocation of an insurer’s certificate of authority and a fine of up to $5,000.

The assessment is due on September 1, 2022. Please remit payment to the following address:

Oklahoma Market Assistance Program
PO Box 13488
Oklahoma City, OK 73113

Please do not send payment to the Oklahoma Insurance Department.

Additional information regarding OK-MAP is available online at www.mapsprogram.com.

 

Questions applicable to this bulletin should be directed to:

Marletta Bruner, Rate and Form Division, at Marletta.Bruner@oid.ok.gov;

Cuc Nguyen, Rate and Form Division, at Cuc.Nguyen@oid.ok.gov; or

Bo Debose, Legal Division, at Bo.Debose@oid.ok.gov