BULLETIN NO. 7-2022
|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.