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.