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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
HOUSE BILL 3369 By: McEntire
AS INTRODUCED
An Act relating to state government; amending 74 O.S.
2021, Section 1304.1, which relates to the Oklahoma
Employees Insurance and Benef its Act; modifying
certain duties and responsibilities ; adding external
review requirements; and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 74 O.S. 2021, Se ction 1304.1, is
amended to read as follows:
Section 74-1304.1 A. The State and Education Employees Group
Insurance Board and the Oklahoma State Employees Benefits Council
are hereby abolished. Wherever the State and E ducation Employees
Group Insurance Board and the Oklahoma State Employees Benefits
Council are referenced in law, that reference shall be construed to
mean the Oklahoma Employees Insurance and Benefits Board.
B. There is hereby created the Oklahoma Employ ees Insurance and
Benefits Board.
C. The chair and vice-chair shall be elected by the Board
members at the first meeting of the Board and shall preside over
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meetings of the Board and perform other duties as may be required by
the Board. Upon the resignat ion or expiration of the term of th e
chair or vice-chair, the members shall elect a chair or vice -chair.
The Board shall elect one of its members to serve as secretary.
D. The Board shall consist of seven (7) mem bers to be appointed
as follows:
1. The State Insurance Commissioner, or des ignee;
2. Four members shall be appointed by the Governor;
3. One member shall be appointed by the Speaker of the Oklahoma
House of Representatives; and
4. One member shall be appointed by the President Pro Tempore
of the Oklahoma State Senate.
E. The appointed members shall:
1. Have demonstrated professional experience in investment or
funds management, public funds management, public or private group
health or pension fund management , or group health insurance
management;
2. Be licensed to practice law in this state and have
demonstrated professional experience in commercial matters; or
3. Be licensed by the Oklahoma Accountancy Board to practice in
this state as a public accountant or a certified public accountant .
In making appointments that confo rm to the requirements of this
subsection, at least one but not more than three members shall be
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appointed each from paragraphs 2 and 3 of this subsection by the
combined appointing author ities.
F. Each member of the Boa rd shall serve a term of four (4)
years from the date of appointment.
G. Members of the Board shall be subject to the following:
1. The appointed members shall each receive compensation of
Five Hundred Dollars ($500.00) p er month. Appointed members who
fail to attend a regularly schedule d meeting of the Board shall not
receive the related compensation;
2. The appointed members shall be reimbursed for their
expenses, according to the State Travel Reimbursement Act, as are
incurred in the performance of t heir duties, which shall be paid
from the Health Insurance Reserve Fund;
3. In the event an appointed member does not attend at least
seventy-five percent (75%) of the regularly scheduled meetings of
the Board during a cal endar year, the appointing author ity may
remove the member;
4. A member may also be removed for any other cause as provided
by law;
5. No Board member shall be individually or personally liable
for any action of the Board; and
6. Participation on the Bo ard is contingent upon maintainin g
all necessary annual training as may be required through the Health
Insurance Portability and Accountability Act of 1996, Medicare
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contracting requirements or other statutory or regulatory
guidelines.
H. The Board shall meet as often as necessary to con duct
business but shall meet no les s than four times a year, with an
organizational meeting to be held prior to December 1, 2012. The
organizational meeting shall be called by the Insurance
Commissioner. A majority of the members of the Board shall
constitute a quorum for the transaction of business, and any
official action of the Board must have a favorable vote by a
majority of the members of the Board present.
I. Except as otherwise provided in this subsection, no memb er
of the Board shall be a lobbyi st registered in this state as
provided by law, or be employed directly or indirectly by any firm
or health care provider under contract to the State and Education
Employees Group Insurance Board, the Oklahoma State Employe es
Benefits Council, or the Oklah oma Employees Insurance and Benefit s
Board, or any benefit program under its jurisdiction, for any goods
or services whatsoever. Any physician member of the Board shall not
be subject to the provisions of this subsection.
J. Any vacancy occurring on the Board shall be filled for the
unexpired term of office in the same manner as provided for in
subsection D of this section.
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K. The Board shall act in accordance with the provisions of the
Oklahoma Open Meeting Act, the Okla homa Open Records Act and the
Administrative Procedures Act.
L. The Administrative Director of the Courts shall designate
grievance panel members as shall be necessary. The members of the
grievance panel shall consist of two attorneys licensed to practic e
law in this state and one state -licensed health care professional or
health care administrator who has at least three (3) years practical
experience, has had or has admitting privileges to a hospital in
this state, has a working knowledge of prescription medication, or
has worked in an administrative capacity at some poi nt in their his
or her career. The state health care professional shall be
appointed by the Governor. At the Governor 's discretion, one or
more qualified individuals may also be appointed as an alt ernate to
serve on the grievance panel in the event the Governor's primary
appointee becomes unable to serve.
M. The Office of Management and Enterprise Services shall have
the following duties, responsibilities and authority with respect to
the administration of the flexible benefits plan authorized pursuant
to the State Employees Flexible Benefits Act:
1. To construe and interpret the plan, and decide all questions
of eligibility in accordance with the Oklahoma State Employees
Benefits Act and 26 U.S.C. A., Section 1 et seq.;
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2. To select those ben efits which shall be made availa ble to
participants under the plan, according to the Oklahoma State
Employees Benefits Act, and other applicable laws and rules;
3. To prescribe procedures to be followed by par ticipants in
making elections and filing claim s under the plan;
4. Beginning with the plan year which begins on January 1,
2013, to select and contract with one or more providers to offer a
group TRICARE Supplement product to eligible employees who are
eligible TRICARE benefic iaries. Any membership dues required to
participate in a group TRICARE Supplement product offered pursuant
to this paragraph shall be paid by the employee. As used in this
paragraph, "TRICARE" means the Department of Defense health care
program for active duty and retired servi ce members and their
families;
5. To prepare and distribute information communicating and
explaining the plan to participating employers and participants.
Health Maintenance Organizations or other third -party insurance
vendors may be directly or indirectl y involved in the distribution
of communicated information to participating state agency employers
and state employee participants subject to the following condition:
the Board shall verify all marketing and c ommunications informat ion
for factual accuracy prior to distribution;
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6. To receive from participating employers and participants
such information as shall be necessary for the proper administration
of the plan, and any of the benefits offered thereunder;
7. To furnish the pa rticipating employers an d participants such
annual reports with respect to the administration of the plan as are
reasonable and appropriate;
8. To keep reports of benefit elections, claims and
disbursements for claims under the plan;
9. To negotiate for best and final offer thr ough competitive
negotiation with the assistance and through the purchasing
procedures adopted by the Office of Management and Enterprise
Services and contract with federally qualified health maintenance
organizations under the prov isions of 42 U.S.C., Sec tion 300e et
seq., or with Health Maintenance Organizations granted a certificate
of authority by the Insurance Commissioner pursuant to the Health
Maintenance Reform Act of 2003 for consideration by participan ts as
an alternative to the health plans offer ed by the Oklahoma Employees
Insurance and Benefits Board, and to transfer to the health
maintenance organizations such funds as may be approved for a
participant electing health maintenance organization altern ative
services. The Board may also select and contract with a vendor to
offer a point-of-service plan. An HMO may offer coverage through a
point-of-service plan, subject to the guidelines established by the
Board. However, if the Board chooses to offer a point-of-service
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plan, then a vendor that of fers both an HMO plan and a poin t-of-
service plan may choose to offer only its point -of-service plan in
lieu of offering its HMO plan. The Board may, however, renegotiate
rates with successful bidders after co ntracts have been awar ded if
there is an extraordinary circumstance. An extra ordinary
circumstance shall be limited to insolvency of a participating
health maintenance organization or point -of-service plan,
dissolution of a participating health maintenanc e organization or
point-of-service plan or withdrawal of another participating health
maintenance organization or point -of-service plan at any time during
the calendar year. Nothing in this section of law shall be
construed to permit either party to unila terally alter the term s of
the contract;
10. To retain as confidential inform ation the initial Request
For Proposal offers as well as any subsequent bid offers made by the
health plans prior to final contract awards as a part of the best
and final offer negotiations process fo r the benefit plan;
11. To promulgate administrative ru les for the competitive
negotiation process;
12. To require vendors offering coverage to provide such
enrollment and claims data as is determined by the Board. The Board
shall be authorized to retai n as confidential any pr oprietary
information submitted in response to the Board 's Request For
Proposal. Provided, however, that any such information requested by
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the Board from the vendors shall only be subject to the
confidentiality provision of this pa ragraph if it is clearly
designated in the Request For P roposal as being protected under this
provision. All requested information lacking such a designation in
the Request For Proposal shall be subject to Section 24A.1 et seq.
of Title 51 of the Oklahoma Statutes. From health maintenance
organizations, data provided shall include the current Health Plan
Employer Data and Information Set (HEDIS);
13. To authorize the purchase of any insurance deemed necessary
for providing benefits under the plan includi ng indemnity dental
plans, provided that the only indemn ity health plan selected by the
Board shall be the indemnity plan offered by the Board, and to
transfer to the Board such funds as may be approved for a
participant electing a be nefit plan offered by the Board. All
indemnity dental plans shall meet or exc eed the following
requirements:
a. they shall have a statewide provider network,
b. they shall provide benefits which shall reimburse the
expense for the following types of denta l procedures:
(1) diagnostic,
(2) preventative,
(3) restorative,
(4) endodontic,
(5) periodontic,
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(6) prosthodontics,
(7) oral surgery,
(8) dental implants,
(9) dental prosthetics, and
(10) orthodontics, and
c. they shall provide an annual benefit of not l ess than
One Thousand Five Hundred Dollars ($1 ,500.00) for all
services other than orthodontic services, and a
lifetime benefit of not less than One Thousand Five
Hundred Dollars ($1,500.00) for orthodontic services;
14. To communicate deferred compensati on programs as provide d
in Section 1701 of Title 74 of the Oklahoma Statutes this title;
15. To assess and collect reasonable fees from contracted
health maintenance organizations and third -party insurance vendors
to offset the costs of administration;
16. To accept, modify or reject elections under the plan in
accordance with the Oklahoma S tate Employees Benefits Act and 26
U.S.C.A., Section 1 et seq.;
17. To promulgate election and claim forms to be used by
participants;
18. To adopt rules requiring payment for medical and dental
services and treatment rendered by duly licensed hospitals,
physicians and dentists. Unless the Board has otherwise contracted
with the out-of-state health care provider, the Board shall
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reimburse for medical services and treatment rend ered and charged by
an out-of-state health care provider at least at the same percentage
level as the network percentage level of the fee schedule
established by the Oklahoma Employees Insurance and Benefits Board
if the insured employee was referred to th e out-of-state health care
provider by a physician or it was an emergency situ ation and the
out-of-state provider was the closest in proximity to the place of
residence of the employee which offers the type of health care
services needed. For purposes of this paragraph, health care
providers shall include, but not be limited to, ph ysicians,
dentists, hospitals and special care facilities;
19. To enter into a contract with out -of-state providers in
connection with any PPO or hospital or medical network pla n which
shall include, but not be l imited to, special care facilities and
hospitals outside the borders of the State of Oklahoma. The
contract for out-of-state providers shall be identical to the in -
state provider contracts. The Board may negotiate for d iscounts
from billed charges when t he out-of-state provider is not a network
provider and the member sought services in an emergency situation,
when the services were not otherwise available in the State of
Oklahoma or when the Administrator appointed by t he Board approved
the service as an exceptional circumstance;
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20. To create the establishment of a grievance procedure by
which a three-member grievance panel external appeals procedures for
complaints by insured employees in the two following manners:
a. independent review organizations, accredited by a
national accrediting body, shall act as an appeals
body bodies for complaints by insured employees
regarding the allowance and payment of claims,
eligibility, and other matters. Except for grievances
settled to the satisfaction of both pa rties prior to a
hearing, any person who requests in writing a hearing
before the grievance panel shall receive a hearing
before the panel. adverse benefit determinations based
on:
(1) medical judgment,
(2) whether the insurer is com plying with the
surprise billing and cost-sharing protections set
forth in Sections 2799A-1 and 2799A-2 of the
Public Health Services Act, 42 U.S.C. 201 et
seq., and
(3) a recission in coverage,
b. a three-member grievance panel, which shall act as an
appeals body for complaints by ins ured employees
regarding all other issues.
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The grievance procedure appeals procedures provided by this
paragraph shall be the exclusive remedy remedies available to
insured employees having complaints against the insurer. Such
grievance procedure The appeals procedures of the three-member
grievance panel shall be subject to the Oklahoma Administrative
Procedures Act, including provisions thereof for review of agency
decisions by the district court. The grievance p anel shall schedule
a hearing regarding the allowance and payment of claims,
eligibility and other matters within sixty (60) days from the date
the grievance panel receives a written request for a hearing unless
the panel orders a continuance for good cau se shown. Upon written
request by the insured employee to the grievance panel and rec eived
not less than ten (10) days before the hearing date, the grievance
panel shall cause a full stenographic record of the proceedings to
be made by a competent court r eporter at the insured employee's
expense; and
21. To intercept monies owing to plan participants from other
state agencies, when those participants in turn owe money to the
Office of Management and Enterprise Services, and to ensure that the
participants are afforded due process of law.
N. Except for a breach of fiduciary obligation, a B oard member
shall not be individually or personally responsible for any action
of the Board.
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O. The Board shall operate in an advisory capacity to the
Office of Management and Enterprise Services.
P. The members of the Board shall not accept gifts or
gratuities from an individual organization with a value in excess of
Ten Dollars ($10.00) per year. The provisions of this section shall
not be construed to prevent the mem bers of the Board from attending
educational seminars, conferences, meetings or simila r functions.
SECTION 2. This act shall become effective November 1, 2024.
59-2-9189 TJ 12/28/23