Oklahoma's group health questions center on three statutes. 36 O.S. 4509 covers state continuation and extension of benefits. 36 O.S. 4502.1 covers spousal conversion. The Small Employer Health Insurance Reform Act (36 O.S. 6511 et seq.) covers small group rating and marketing. Group concepts in general (eligibility, contributory vs. noncontributory plans, COBRA, HIPAA, ERISA, coordination of benefits) are in the national Group Health Insurance guide.

State continuation (36 O.S. 4509)

Oklahoma's continuation law fills the gap for terminations that COBRA doesn't cover.

• Length: a terminated employee must be offered continuation of group health coverage for at least 63 days after termination.
• Exceptions: there is no continuation right after termination for gross misconduct or when the plan itself ends.
• Notice: the carrier tells the employee about the option within 30 days after the plan sponsor notifies it.
• Election: the employee elects continuation in writing no later than the 31st day after being notified.

Extension of benefits (4509(C))

• If the group plan ends while a covered person who has been insured for 6 months or more is totally disabled, benefits for that continuous loss must continue.
• The extension runs at least 3 months for basic coverage and 6 months for major medical, unless the maximum benefits are paid first.

Conversion for spouses (36 O.S. 4502.1)

If a group policy lets employees convert, a covered spouse must also get a conversion privilege when coverage would end because of:

• The insured's death.
• Divorce.
• The insured's termination of employment or membership for any reason, including retirement.

Small employer health insurance (36 O.S. 6511 et seq.)

Who is a small employer (6512)

• An employer with no more than 50 eligible employees, most of them in Oklahoma, on at least half its working days in the preceding quarter (6512(25)).
• Eligible employee means a full-time employee. At the employer's option, part-time employees who normally work at least 24 hours a week can also count (6512(13)).

Renewal rating (6515(A)(5))

• At renewal, the adjustment for the group's claim experience, health status or duration of coverage is capped at 15% a year.

Marketing rules (6527)

• Carriers and agents may not encourage a small employer not to apply, or to go to another carrier, because of:
  • Health status or claims experience.
  • Industry, occupation or location.
  • Size.
• Agent compensation may not vary with the group's health status or claims experience. A violation is an unfair trade practice (6527(C), (I)).
• A denial must be in writing, and the only reasons allowed are failure to meet minimum participation or contribution requirements (6527(G)).

Group life (for combined Life and Health candidates)

These group life rules are covered in the Oklahoma Life Policy Provisions guide (36 O.S. 4103):

• A 31-day grace period.
• A 31-day conversion window after employment ends.
• When the group policy itself ends, conversion only for people insured under it at least 5 years.

Common exam traps

• Oklahoma continuation is 63 days. COBRA is federal and runs much longer. The state law applies only where COBRA doesn't.
• Election deadline: the 31st day after notice. The carrier's notice is due within 30 days.
• Extension of benefits for total disability: 6 months for major medical, 3 months for basic.
• Small employer means up to 50 eligible employees. Part-timers count only at the employer's option, at 24 hours or more a week.
• Rate adjustments for health and claims are capped at 15% a year at renewal.