Each contract shall contain a clear statement of the following:
- (1) Plan's name and address;
- (2) Eligibility requirements;
- (3) Medical and health services in the area;
- (4) Emergency care services and procedures for authorizing emergency services by non-Plan providers;
- (5) Out of area services;
- (6) Limits and excluded items;
- (7) Employee termination;
- (8) Employee reinstatement;
- (9) Claims procedures, if any;
- (10) Dispute resolution and grievance procedures;
- (11) Continuing coverage;
- (12) Extension of benefits;
- (13) Substitution of creditors;
- (14) Geographic service area;
- (15) Entire contract provision;
- (16) Term of coverage;
- (17) Renewing contract;
- (18) Canceling contract;
- (19) Reinstatement of contract;
- (20) Grace period; and
- (21) Conformity with state law.
Added at 12 Ok Reg 2977, eff 6-16-95 (emergency)
Added at 13 Ok Reg 2127, eff 6-13-96
Amended at 23 Ok Reg 2404, eff 6-25-06