Discount Medical Plan Organizations (DMPO)
Disclaimer: The following is an overview of the laws pertaining to the licensing requirements for this entity type. Refer to the OSCN webpage to research all the statues.
Definitions 36 § 1219.4
“Direct contract” means a contractual arrangement tying the ultimate seller purporting to offer discounts through the discount card to the health care provider, which expressly states the intent of this agreement to be used for the purpose of offering discounts on health-related purchases to uninsured or noncovered persons.
“Discount card” means a card or any other purchasing mechanism or device, which is not insurance, that purports to offer discounts or access to discounts in health-related purchases from health care providers.
“Discount medical plan” means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount. The term discount medical plan does not include any product regulated as an insurance product, group health service product or health maintenance organization (HMO) product in the State of Oklahoma or discounts provided by an insurer, group health service, or health maintenance organizations (HMOs) where those discounts are provided at no cost to the insured or member and are offered due to coverage with a licensed insurer, group health service, or HMO.
“Discount medical plan organization” means a person or an entity which operates a discount medical plan.
“Health care provider” means any person or entity licensed by this state to provide health care services including, but not limited to, physicians, hospitals, home health agencies, pharmacies, and dentists.
“Health care provider network” means an entity which directly contracts with physicians and hospitals and has contractual rights to negotiate on behalf of those health care providers with a discount medical plan organization to provide medical services to members of the discount medical plan organization.
“Marketer” means a person or entity who markets, promotes, sells or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan but does not operate a discount medical plan.
“Medical services” means any care, service or treatment of illness or dysfunction of, or injury to, the human body including, but not limited to, physician care, inpatient care, hospital surgical services, emergency services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric care services, laboratory services, and medical equipment and supplies. The term does not include pharmaceutical supplies or prescriptions.
“Member” means any person who pays fees, dues, charges, or other consideration for the right to receive the purported benefits of a discount medical plan; and
“Person” means an individual, corporation, business trust, estate, trust, partnership, association, joint venture, limited liability company, or any other government or commercial entity.
$250.00 Annual registration fee
$100.00 Annual Affiliate Exempt DMPO registration fee
Cycle – Annual on the last day of the issue month
Requirements 36 § 1219.4
- Prior to registration each DMPO shall establish an Internet web site
- All forms used, including the written agreement per 36 § 1219.4(G) shall first be filed with the Insurance Department.
- Every form filed shall be identified by a unique form number placed in the lower left corner of each form.
- A filing fee of Twenty-five Dollars ($25.00) per form shall be payable electronically upon submission.
- Each registered DMPO (except an affiliate) is required to maintain a net worth of at least One Hundred Fifty Thousand Dollars ($150,000.00).
- Each DMPO is required to provide the OID at least thirty (30) days’ advance notice of any change in the DMPO’s name, address, principal business address, or mailing address.
- Each discount medical plan organization shall maintain an up-to-date list of the names and addresses of the providers with which it has contracted on an Internet web site page, the address of which shall be prominently displayed on all its advertisements, marketing materials, brochures, and discount cards. This section applies to those providers with whom the discount medical plan organization has contracted directly, as well as those who are members of a provider network with which the discount medical plan organization has contracted.
- All advertisements, marketing materials, brochures and discount cards used by marketers shall be approved in writing for such use by the discount medical plan organization.
Exempt DMPOs 36 § 1219.4(B)(9) and (10.a)
Prior to the sale, marketing or solicitation an exempt DMPO is required to register and submit the same requirements as mentioned above; however, the fees are reduced to $100.00.
Exempt DMPOs include:
- An affiliate of a licensed insurance company, HMO, group health service organization or motor service club.
NOTE: A provider who provides discounts to his or her own patients to obtain and maintain a registration as a discount medical plan organization is exempt from registration as a DMPO. The provider is not a DMPO
Quarterly filings 36 § 1219.4(G)(3)
A health care provider agreement with a health care provider network shall require that the health care provider network have written agreements with its health care providers that:
- contain the following terms
- a description of the services and products to be provided at a discount,
- the amount or amounts of the discounts or, alternatively, a fee schedule which reflects the health care provider’s discounted rates, and
- a provision that the health care provider will not charge members more than the discounted rates.
- authorize the health care provider network to contract with the discount medical plan organization on behalf of the provider, and
- require the network to maintain an up-to-date list of its contracted health care providers and to provide that list on a quarterly basis to the discount medical plan organization.
Refuse to renew, suspend, or revoke the registration 36 § 1219.4(B)(6) and 36 § 1219.4(J)
The Insurance Commissioner may deny a registration to an applicant or refuse to renew, suspend, or revoke the registration of a registrant if the applicant or registrant, or an officer, director, or employee of the applicant or registrant:
- makes a material misstatement or misrepresentation in an application for registration,
- fraudulently or deceptively obtains or attempts to obtain a registration for the applicant or registrant or for another,
- in connection with the administration of a health care discount program, commits fraud or engages in illegal or dishonest activities, or
- has violated any provisions of this section.
The Insurance Department may suspend the authority of a discount medical plan organization to enroll new members, revoke any registration issued to a discount medical plan organization, or order compliance if the Department finds that any of the following conditions exist:
- the organization is not operating in compliance with the provisions of 36 § 1219.4,
- the organization does not have the minimum net worth as required by 36 § 1219.4,
- the organization has advertised, merchandised or attempted to merchandise its services in such a manner as to misrepresent its services or capacity for service or has engaged in deceptive, misleading or unfair practices with respect to advertising or merchandising,
- the organization is not fulfilling its obligations as a discount medical plan organization, or
- the continued operation of the organization would be hazardous to its members.