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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
ENGROSSED SENATE
BILL NO. 462 By: Taylor and Bullard of the
Senate
and
Frix of the House
An Act relating to insurance; creating the Oklahom a
Right to Shop Act; defining terms; authorizing
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 and
filings; requiring insurer to publish certain
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 Insurance
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:
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SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as 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”.
SECTION 2. NEW LAW A new section of law to b e 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 entity 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 an 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 Okla homa Statutes;
4. “Insurance carrier” or “carrier” means an insurance company
that issues policies of accident and health insurance and is
licensed to sell insurance in this state;
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5. “Shared savings incentive ” means a voluntary and optional
financial incentive that an insurance carrier may provide to an
enrollee for choosing certain health care services under a shared
savings incentive program; and
6. “Shared savings incentive program ” means a voluntary and
optional incentive program established by an i nsurance 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, reads as follows:
A. An insurance carrier may offer a shared savings incentive
program to provide incentives 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 average allowed
amount paid by that carrier to network 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 reasonable 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 select which method the enrolle e prefers to
receive the incentive.
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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
enrollees and the Insurance Department at least thirty (30) days
before program termination;
2. File a description of the program on a form prescribed by
the Insurance Commissioner. The Insurance Department shall review
the filing and determine whether the program com plies 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 th an 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 t hat service in the most recent
twelve-month period or any other methodology established by the
insurance carrier and approved by the Insurance Department;
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5. At least quarterly, credit, deposit or make a cash payment
to an enrollee of the shared savings i ncentive amount pursuant to
participation in the shared savings incentive program; and
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 information:
a. the number of enrollees who participated in the
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 incentive
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 p articipate 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 Department shall promulgate necessary rules for
the implementation of the Oklahoma Right to Shop Act.
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SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.44 of Title 36, unle ss
there is created a duplication in numbering, reads as follows:
The Office of Management and Enterprise Services shall conduct
an analysis no later than November 1, 2022, 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 State Employees Benefit 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, 2021.
COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS AND BUDGET , dated
04/08/2021 - DO PASS.