Home » Rights – Laws

Rights – Laws

As a policyholder of a health insurance plan, you are entitled to know what options are legally available to both you and your insurer. Laws for health insurance are regulated at both the state and federal levels, and becoming more federally based as we approach 2014, due to the Affordable Care Act. Current laws reflect the state of Oklahoma’s allowance of insurers to decline people with conditions more easily, and rate up more liberally for women and those with a sub-par medical history. Certain rights are also in place for the protection of the insured, including guaranteed renewability, and the freedom to file an appeal if your claim denial seems unjust.

In the future, Oklahoma laws on health insurance will change drastically from their present state. The process of applying for a health plan will be much more smooth for people with conditions, women, and others who find it difficult to get approved for health insurance. For the next year, however, insurers in the state can exercise their right to turn people away for health insurance if they seem too high a risk. Many states still regulate applicants int his way, but Oklahoma is particularly broad in defining conditions.

Use this section as an interim guide to pre-health reform Oklahoma, and find out what’s to come with the introduction of new laws. As the intention of health insurance is to protect yourself, you have the right to know how your state works in regard to coverage and laws.

 

Guaranteed Renewal

Oklahoma insurers must follow the guaranteed renewability provision, which enforces the need to keep policyholders insured continuously. This law requires insurers to offer to renew a member’s plan for another year before coverage runs out. More importantly, it also prohibits insurers from canceling a health plan on the grounds of anything other than fraud, misrepresenting yourself on an application, or nonpayment of premiums. In other words, if you applied for a health plan and were approved with a honest application verifying your true health status, then you become sick, the insurance company cannot decide you are suddenly too expensive and drop you from the plan.

 

Pre-Existing Conditions

Congruent with the majority of the South, Oklahoma is rather rigid when it comes to pre-existing condition laws. Oklahoma insurers judge a condition based on the prudent person standard, which allows insurers to consider something a condition in an applicant’s medical history even if it was never diagnosed or treated. Therefore, companies have the ability to decline or accept individuals they see as having a condition. If they accept an applicant with a condition, insurers can attach an elimination rider or a limitless exclusion period to their plan. The state’s look-back period is 60 months for pre-existing conditions.

Due to federal law, however, applicants in Oklahoma under age 19 cannot be declined, though they are still subject to rate increases for having a condition. Anyone who is rejected by an insurer for their medical history can bring their letter of rejection to the Pre-Existing Condition Insurance Plan (PCIP) and receive coverage until the end of 2013 if they qualify.

 

Mandatory Benefits

All private health plans in Oklahoma are required by law to offer certain benefits in some or all or their coverage options. Some of these include the required preventive care services each health insurer must include for free with in-network providers, following HHS guidelines. Other services are particular to the state, though commonly required in other states, as well. In 2014, the rule of essential health benefits requires every Oklahoma insurer to offer coverage in at least ten areas, including ones listed below in every health plan, not just a select few. The following rules apply to both the individual and group markets in Oklahoma.

 

  • Birth control
  • Bone density screening
  • Colorectal cancer screening
  • Continuous coverage for dependents on parent’s plan
  • Continuous coverage for employees
  • Conversion plans from group policies
  • Dental anesthesia
  • Diabetes management and supplies
  • Emergency care
  • Emergency medical transportation
  • Hair prostheses
  • Hearing aids
  • Mammograms
  • Mastectomy and hospitalization
  • Maternity care and hospitalization
  • Medical foods
  • Mental health care
  • Newborn coverage through parent’s plan
  • Newborn sickle cell testing
  • Prostate cancer screening
  • Reconstructive breast surgery
  • Well-child care
Top