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STATE OF OKLAHOMA
2nd Session of the 58th Legislature (2022)
SENATE BILL 1812 By: Pugh
AS INTRODUCED
An Act relating to insurance; creating the Okla homa
Right to Shop Act; defining terms; a uthorizing
insurance carriers to create certain program;
establishing requirements of program; providing for
calculation and method of distribution of incentives;
requiring insurer to provide certain notification an d
filings; requiring insurer to publish c ertain
information on website; providing methodology for
calculating minimum required savings incentive;
requiring insurer to make certain payments; requiring
certain report within specified time period; stating
contents of report; specifying participation in
program is optional; directing the I nsurance
Department to promulgate rules; requiring Office of
Management and Enterprise Services to conduct
analysis; requiring certain program be implemented;
requiring Office to provide certain report to
Legislature; providing for codification; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes a s Section 6060.40 of Title 36, unless
there is created a duplication in numbering, reads as follows:
This act shall be known and may be cited as the “Oklahoma Right
to Shop Act”.
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SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.41 of Title 36, unless
there is created a duplication in numbering, reads as follows:
As used in the Oklahoma Right to Shop Act:
1. “Allowed amount” means the contractually agreed-upon amount
paid by a carrier to a health care e ntity participating in the
network of the carrier;
2. “Comparable health care service ” means any covered
nonemergency health care service or bundle of services. The
Insurance Commissioner may limit what is considered a comparable
health care service if a n insurance carrier can demonstrate allowed
amount variation among network providers is less than Fifty Dollars
($50.00);
3. “Health benefit plan” means any plan as defined in
subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes;
4. “Insurance carrier” or “carrier” means an insurance compa ny
that issues policies of accident and health insurance and is
licensed to sell insurance in this state;
5. “Shared savings incentive ” means a voluntary and optional
financial incentive that an insurance carrier may provide to an
enrollee for choosing ce rtain health care services under a shared
savings incentive program; and
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6. “Shared savings incentive program ” means a voluntary and
optional incentive program established by an insurance carrier
pursuant to this act.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.42 of Title 36, unless
there is created a duplication in numbering, rea ds as follows:
A. An insurance carrier may offer a shared savings incentive
program to provide ince ntives to an enrollee when the enrollee
obtains a comparable health care service that is covered by the
carrier from providers that charge less than the ave rage allowed
amount paid by that carrier to networ k providers for that comparable
health care service.
B. Incentives may be calculated as a percentage of the
difference in allowed amounts to the average, as a flat dollar
amount, or by any other reasonabl e methodology approved by the
Insurance Department . The carrier shall provide the incentive as a
cash payment to the enrollee or credit toward the annual in -network
deductible and out-of-pocket limit of the enrollee. Carriers may
allow enrollees to selec t which method the enrollee prefers to
receive the incentive.
C. An insurance carrier that offers a shared savings incentive
program shall:
1. Establish the program as a component part of the policy or
certificate of insurance provided by the carrier and notify the
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enrollees and the Insurance Department at least thirty (30) days
before program terminati on;
2. File a description of the program on a form prescribed by
the Insurance Commissioner. The Insurance Department shall review
the filing and determi ne whether the program complies with the
provisions of this section;
3. Notify an enrollee annually or at the time of renewal of the
availability of the shared savings incentive program and the
procedures to participate in the program;
4. Publish on the website of the insurance carrier, easily
accessible to enrollees and applicants for insurance, a list of
comparable health care services and health care providers and the
shared savings incentive amount applicable for each service. A
shared savings incentive shall not be less than twenty -five percent
(25%) of the savings generated by the participation of the enrollee
in any shared savings incentive program offered by the insurance
carrier. The baseline for the savings calculation shall be the
average in-network amount paid for that service in the most recent
twelve-month period or any other methodology e stablished by the
insurance carrier and approved by the Insurance Department;
5. At least quarterly, credit, deposit , or make a cash payment
to an enrollee of the shared savings incentive amount pursuant to
participation in the shared savings incentive pr ogram; and
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6. Submit an annual report to the Insurance Department within
ninety (90) days after the close of each health benefit plan year.
At a minimum, the report shall include the following informati on:
a. the number of enrollees who participated in t he
program during the health benefit plan year and the
number of instances of participation,
b. the total cost of services provided as a part of the
program, and
c. the total value of the shared savings i ncentive
payments made to enrollees participating in the
program and the values distributed as cash or credit
toward the annual in -network deductible and out -of-
pocket limit of an enrollee.
D. An enrollee shall not be required to participate in a shared
savings incentive program.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.43 of Title 36, unless
there is created a duplication in numbering, reads as follows:
The Insurance Departme nt shall promulgate necessary rules for
the implementation of the Oklahoma Right to Shop Act.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.44 of Title 36, unless
there is created a duplication in numbering, reads as follows:
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The Office of Management and Enterprise Services shall conduct
an analysis no later than November 1, 202 3, of the cost-
effectiveness of implementing a shared savings incentive program, as
defined in paragraph 6 of Section 2 of this act, for current
enrollees of the Oklahoma Employees Insurance Plan created pursuant
to the Oklahoma Employees Insurance and Benefits Act. If a program
is found to be cost-effective, it shall be implemented as part of
the next open enrollment. The Office shall communicate the
rationale for its decision to the President Pro Tempore of the
Senate, the Speaker of the House of Representatives, and the chairs
of the relevant legislative committees in writing.
SECTION 6. This act shall become effective November 1, 202 2.
58-2-2861 RJ 1/20/2022 7:53:17 PM