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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1310 By: McCortney
AS INTRODUCED
An Act relating to state employee benefits; amending
74 O.S. 2021, Sections 1304.1, 1305.1, 1306.1,
1306.2, 1306.5, 1306.6, 1307.1, 1 308.1, 1309, 1310.1,
1310.2, 1312, 1314.3, 1314.5, 1315, 1315.1, 1316.1,
1316.2, 1316.3, 1317, 1318, 1321, 1323, 1371, and
1374, which relate to the Oklahoma Employees
Insurance and Benefits Act; transferring certain
powers and duties to the Oklahoma Emplo yees Insurance
and Benefits Board; directing implementation;
providing for certain state-offered plans to be
maintained within Of fice of Management and Enterprise
Services; modifying requirements of Board membership;
conforming language; modifying plan selection
requirements by Board; updating statutory language ;
updating statutory reference s; providing an effective
date; and declaring an emergency .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKL AHOMA:
SECTION 1. AMENDATORY 74 O.S. 2021, Section 1304.1, is
amended to read as follows:
Section 1304.1. A. The State and Education Employees Group
Insurance Board and the Oklahoma State Employ ees Benefits Council
are hereby abolished. Wherever the State and Education Employe es
Group Insurance Board and the Oklahoma State Employees Benefits
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Council are reference d in law, that reference shall be construed to
mean the Oklahoma Employees Insurance and Benefits Board.
B. 1. There is hereby created the Oklahoma Employees Insuranc e
and Benefits Board. The Board shall have authority to administer
and negotiate benefits plans pursuant to the Oklahoma Employees
Insurance and Benefits Act . On and after the effective date of this
act, all powers and dutie s existing within th e Office of Management
and Enterprise Services for the purpose s described herein shall be
transferred to the Board.
2. The provisions of this act sha ll apply to the plan year
beginning January 1, 2025 .
3. The Office shall provide staff and administrative support a s
needed to the Board. Any reference herein to staff members of the
Board shall be construed as staff of the Office provided to the
Board.
4. The Office shall continue to offer and maintain the state-
administered health insurance plan, life insurance plan, and dental
benefits plan and shall be subject to the requirements of this act .
C. The chair and vice-chair vice chair shall be elected by the
Board members at the first meeting of the Board and shall pr eside
over meetings of the Board and perform other duties as may be
required by the Board. Upon the resignation or expiration of the
term of the chair or vice-chair vice chair, the members shall elect
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a chair or vice-chair vice chair. The Board shall elect one of its
members to serve as secretary.
D. The Board shall consist of seven (7) members to be appointed
as follows:
1. The State Insurance Commissioner , or designee;
2. Four members shall be appointed by the Governor , one of whom
shall be presently insured by a plan administered by the Board;
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 State Senate.
E. The appointed members shall All appointed members of the
Board, except for the appointee who is presently insured as
referenced in paragraph 2 of su bsection D, shall:
1. Have demonstrated professional experience in investment or
funds management, public funds man agement, public or private group
health or pension fund ma nagement, or group health insurance
management;
2. Be licensed to practice law in this st ate 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 conform to the requirements of this
subsection, at least one but not more than three members shall be
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appointed each from parag raphs 2 and 3 of this subsection by the
combined appointing authorities.
F. Each member of the Board shall serve a term of four (4)
years from the date of appointment.
G. Members of the Board shall b e subject to the following:
1. The appointed members shall each receive compensation of
Five Hundred Dollars ($500.00) per month. Appointed members who
fail to attend a regularly scheduled 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 their duties, which shall be paid
from the Health and Dental 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 calendar year, the appointing authority may
remove the member;
4. A member may also be remove d for any other cause as provided
by law;
5. No Board member shall be individually or p ersonally liable
for any action of the Board; and
6. Participation on the Board is contingent upon maintaining
all necessary annual training as may be required through the Health
Insurance Portability and Accoun tability 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 conduct
business but shall meet no less 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 majorit y 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 member
of the Board shall be a lobbyist 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 Employees
Benefits Council, or the Oklahoma Employees Insurance and Benefits
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 subs ection.
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 Oklahoma 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 practice
law in this state and one state licensed state-licensed health care
professional or health c are administrator who has at least three (3)
years years’ practical experience, has had or has admitting
privileges to a hospital in this state, has a wor king knowledge of
prescription medication, or has worked in an administrative c apacity
at some point in their career. The state health care professional
shall be appointed by the Governor. At the Governor ’s discretion,
one or more qualified individuals m ay also be appointed as an
alternate 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 Board shall
have the following duties, responsibilities and aut hority with
respect to the administration of the f lexible 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 benefits which s hall be made available 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 f ollowed by participants in
making elections and filing cl aims 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 prod uct to eligible employees who are
eligible TRICARE beneficiaries. 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 D efense health care
program for active duty and retired se rvice members and their
families;
5. To prepare and distribute information communicating and
explaining the plan to participating employers and participants.
Health Maintenance Organizations maintenance organizations (HMOs) or
other third-party insurance vendors may be directly or indirectly
involved in the distribution of commu nicated information to
participating state agency e mployers and state employe e participants
subject to the following condition: the Board shall verify all
marketing and communicat ions information 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 a dministration
of the plan, and any of the benefi ts offered thereunder;
7. To furnish the participating employers and 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 u nder the plan;
9. To negotiate for best and final offer through competitive
negotiation with the assistance and through the purchasing
procedures adopted by the Office of Management and Enterprise
Services and contract with federally qualified hea lth maintenance
organizations under the provisions of 42 U.S.C., Section 300e et
seq., or with Health Maintenance Organizations health maintenance
organizations granted a certificate of authority by the Insur ance
Commissioner pursuant to the Health Maintenance Reform Organization
Act of 2003 for consideration by participants as an alter native to
the health plans offered by the Oklahoma Employees Insurance and
Benefits Board, and to transfer to the health maint enance
organizations such funds as may be approved for a part icipant
electing health maintenance organization alternative services. The
Board may also select a nd contract with a vendor to offer a poin t-
of-service plan. An HMO may offer coverage through a point-of-
service plan, subject to the guidelines established by the Boar d.
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However, if the Board cho oses to offer a point -of-service plan, then
a vendor that offers both an HMO plan and a point -of-service plan
may choose to offer only its point -of-service plan in lieu of
offering its HMO plan. The Board may, howe ver, renegotiate rates
with successful bidders after contracts have been awarded if there
is an extraordinary circumstance. An extraordinar y circumstance
shall be limited to insolvency of a part icipating health maint enance
organization or point -of-service plan, dissolution of a
participating health maintenance 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 unilaterally alter the terms of the contract;
10. To retain as confidential information t he initial Request
For Proposal request for proposal offers as well as any subsequent
bid offers made by the health plans prior to fin al contract awards
as a part of the best and final offer negotiations pr ocess for the
benefit plan;
11. To promulgate administrative rules for the competitive
negotiation process;
12. To require vendors offering coverage to provide such
enrollment and claim s data as is determined by the Board. The Board
shall be authorized to retain as confidential any proprietary
information submitted in response to the Board’s Request For
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Proposal request for proposal . Provided, however, that any such
information requested by the Board from the vendors shall only be
subject to the confidentiality provision of this paragraph if it is
clearly designated in the Request For Proposal request for proposal
as being protected under this provision. All requested information
lacking such a designation in the Request For Proposal request for
proposal shall be subject to Section 24A.1 et seq. of Title 51 of
the Oklahoma Statutes. From health maintenanc e organizations, data
provided shall include the current Health Plan Employer D ata and
Information Set (HEDIS);
13. To authorize the purchase of any insurance deemed necessary
for providing benefits under the plan including indemnity dental
plans, provided that the only indemnity 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 benefit plan offered by the Board. All
indemnity dental plans shall meet or exceed the following
requirements:
a. they shall have a stat ewide provider network,
b. they shall provide benefits which shall reimburse the
expense for the following types of dental procedures:
(1) diagnostic,
(2) preventative,
(3) restorative,
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(4) endodontic,
(5) periodontic,
(6) prosthodontics,
(7) oral surgery,
(8) dental implants,
(9) dental prosthetics, and
(10) orthodontics, and
c. they shall provide an annual benefit of not less than
One Thousand Five Hundred Dollars ($1,500.00) f or all
services other than or thodontic services, and a
lifetime benefit of not less than One Thousand Five
Hundred Dollars ($1,500.00) for orthodontic services;
14. To communicate defer red compensation programs as provided
in Section 1701 of Title 74 of t he Oklahoma Statutes;
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 State Em ployees Benefits Act and 26
U.S.C.A., Section 1 et seq.;
17. To promulgate e lection and claim forms to be used by
participants;
18. To adopt rules requirin g payment for medical and de ntal
services and treatment rendered by du ly licensed hospitals,
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physicians and dentists. Unless the Board has otherwise contracted
with the out-of-state health care provider, the Board shall
reimburse for medical services and treatment rendered a nd charged by
an out-of-state health care provider at least at the same percent age
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 the out-of-state health care
provider by a physician or it was an emergency situation 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 p aragraph, health care
providers shall include, but not be limited to, physician s,
dentists, hospitals and special care facil ities;
19. To enter into a cont ract with out-of-state providers in
connection with any PPO or hospital or medic al network plan which
shall include, but not be limited to, special ca re facilities and
hospitals outside the borders of the State of Oklahoma this state.
The contract for out -of-state providers shall be identical to the
in-state provider contracts. The Board may negotiate for discounts
from billed charges when the out -of-state provider is not a network
provider and the member sought services in an e mergency situation,
when the services were not otherwise available in the State of
Oklahoma or when the Administrator appointed by the Board appro ved
the service as an exceptional circumstance this state;
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20. To create the establishment of a grievance procedure by
which a three-member grievance panel shall act as an appeals body
for complaints by insured employees regarding the a llowance and
payment of claims, eligibility, and o ther matters. Except for
grievances settled to the satisfaction of both parties prior to a
hearing, any person who requests in w riting a hearing before the
grievance panel shall re ceive a hearing before the panel. The
grievance procedure provided by this paragraph shall be the
exclusive remedy available to insured employees having complaints
against the insurer. Such grievance procedure shall be subject to
the Oklahoma Administrative Procedures Act, inclu ding provisions
thereof for review of agency decis ions by the district court. The
grievance panel shall schedule a hearing regarding the allowance and
payment of claims, eligibi lity 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 contin uance for good cause
shown. Upon written request by the insured employee to the
grievance panel and received not less than ten (10) days before the
hearing date, the grievance pane l shall cause a full stenographic
record of the proceedings to be made by a competent court reporter
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 mo ney to the
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Office of Management and Enterprise Se rvices Board, and to ensure
that the participants are afforded due process of law.
N. Except for a breach of fiduciary obligation, a Board member
shall not be individua lly or personally responsible for any action
of the Board.
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. Th e provisions of this section shall
not be construed to prevent the members of the Board from attending
educational seminars, conferences, meetings or similar functions.
SECTION 2. AMENDATORY 74 O.S. 20 21, Section 1305.1, is
amended to read as follows:
Section 1305.1. (1) The Director of the Office of Management
and Enterprise Services and the Oklahoma Employees Insurance and
Benefits Board shall discharge their its duties with respect to the
Oklahoma Employees Insurance and Benefits Act, the State Employees
Flexible Benefits Act and the State Employee s Disability Program Act
solely in the interest of said Acts such acts and:
(a) for the exclusive purpose of:
(i) providing benefits to the participants and their
dependents, and
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(ii) defraying reasonable expenses of administering the
Oklahoma Employees Insurance and Benefits Act, the
State Employees Flexible Benefits Act and the State
Employees Disability Program Act;
(b) with the care, skill, prudence, and diligence u nder the
circumstances then prevailing that a prudent person acting in a like
capacity and familiar with such matters would use in the conduct of
an enterprise of a like character and with like aims;
(c) by diversifying investments so as to minimize the risk of
large losses, unless under t he circumstances it is clearly prudent
not to do so; and
(d) in accordance with the laws, documents and instruments
governing the Oklahoma Em ployees Insurance and Benefi ts Act, the
State Employees Flexible Benefits Act a nd the State Employees
Disability Program Act.
(2) The Office Board may procure insurance indemnifying the
members of the Board and the Director from personal loss or
accountability from liability resulting from action or inaction.
(3) The Director Board may establish an investment commit tee.
The investment committee shall be composed of not more tha n three
(3) members of the Board selected by the Director . The committee
shall make recommendations to th e full Board on all matters related
to the choice of custodians and managers of the assets of the Office
of Management and Enterprise Services relating to the Oklahoma
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Employees Insurance and Benefits Act, on the establishment of
investment and fund management guidelines, and in planning fut ure
investment policy. The committee shall have n o authority to act on
behalf of the Board or Director in any circumstances whatsoever. No
recommendation of the committee shall have effect a s an action of
the Board or Director nor take effect without the approval of th e
Board or Director.
(4) The Office of Management and Enterprise Service , based on
recommendation of the Board shall retain qualified investment
managers to provide for the investment of the monies received by the
Office Board. The investment managers shall be chosen by a
solicitation of proposals on a competitive bid basis pursuant to
standards set by the Board. Subject to the overall investment
guidelines set by the Board, t he investment managers shall have full
discretion in the management of those mo nies of the Office Board
allocated to the investment managers. The Board shall oversee the
management of those monies no t specifically allocated to the
investment managers. The monies of the Office Board allocated to
the investment manager s shall be actively managed by the investment
managers, which may include selling investments and realizing losses
if such action is considered advantageous to longer term return
maximization. Because of the total retur n objective, no distinction
shall be made for manag ement and performance evalua tion purposes
between realized and unrealized capital gains and losses.
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(5) Funds and revenues for investment by the investment
managers or the Office of Management and Enterprise Services shall
be placed with a custodian recommended by the Board. The custodian
shall be a bank or trust company offering pension fund master
trustee and master custodial services. The custodian shall be
chosen by a solicitation of proposals on a c ompetitive bid basis
pursuant to standards set by t he Board. In compliance wit h the
investment policy guidelines of the Board, the custodian bank or
trust company shall be contr actually responsible for ensur ing that
all monies of the Office Board are invested in income -producing
investment vehicles at all times. If a custodian bank or tru st
company has not received direction from the investment manage rs of
the Office Board as to the investment of the monies of the Office in
specific investment vehicles, t he custodian bank or trust company
shall be contractually responsible to the Office Board for investing
the monies in appropriately collateralized short -term interest-
bearing investment vehicles.
(6) Prior to August 1 of each year, the Board shall develop a
written investment plan for the m onies received by the Office.
(7) The Administrator A designated staff person of the Board
shall compile annual f inancial statements of all the activity of the
Office Board on a calendar year basis. The financial state ments
shall be compiled pursuant to accounting prin ciples generally
accepted in the United States. The report shall include several
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relevant measures of investment value, including acquisition cost
and current fair market value with appropr iate summaries of total
holdings and returns. The report shall contain combined and
individual rate of returns of the investment managers by category of
investment, over periods of time. The report shall be distributed
to the Board and the Director of the Office of Man agement and
Enterprise Services.
SECTION 3. AMENDATORY 74 O. S. 2021, Section 1306.1, is
amended to read as follows:
Section 1306.1. A. The Office of Management and Enterprise
Services Oklahoma Employees Insurance and B enefits Board shall have
the right of subrogat ion to recover any payments made for injury to
an employee or dependent caused by a third party ’s wrongful act or
negligence. The Office Board shall have the authority to waive or
reduce subrogation in individual cases when the exercise of the
right of subrogation would create an extreme financial hardsh ip on
the employee or depe ndent.
B. Subrogation will exist only to the extent of actual claims
paid.
C. If an employee o r dependent has prejudiced the Office’s
Board’s right of subrogation by releasing th e responsible party
prior to submitting claims to the Office Board, the claims may be
denied by the Office Board. If claims are submitted and paid after
the employee or dependent has release d the responsible party, the
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Office Board shall be entitled to bring an action against the
employee, dependent, or their assignees, for any such claims paid
and for additional costs incurred by the Office Board including, but
not limited to: interest, administrative and adjud icative costs,
and attorney fees.
SECTION 4. AMENDATORY 74 O.S. 2021 , Section 1306.2, is
amended to read as follows:
Section 1306.2. A. The Director of the Office of Management
and Enterprise Services Oklahoma Employees Insurance and B enefits
Board shall submit to the Insurance Commiss ioner the following
information regarding utilization review performed by employees of
the Office Board:
1. A utilization review plan that includes:
a. an adequate summary description of review standards,
protocol and procedures to be used i n evaluating
proposed or delivered hospital and me dical care,
b. assurances that the standards and criter ia to be
applied in review determinations are established with
input from health care provid ers representing major
areas of specialty and certified by the boards of the
various American medical special ties, and
c. the provisions by which patients or health care
providers may seek reconsideration or appeal of
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adverse decisions concerning requests for medical
evaluation, treatment or procedures;
2. The type and qualifications of the personnel either empl oyed
or under contract to perform t he utilization revie w;
3. The procedures and policies to ensure that an employee of
the Office Board is reasonably accessible to patie nts and health
care providers five (5) days a week durin g normal business hours,
such procedures and policies to include as a requirement a toll -free
telephone number to be available during said such business hours;
4. The policies and procedures to ensure that all applicable
state and federal laws to protect the confidentiality of individ ual
medical records are followed;
5. The policies and procedures to verif y the identity and
authority of personnel performing utilization re view by telephone;
6. A copy of the materials designed to inform applicable
patients and health care providers of the requirements of the
utilization review plan;
7. The procedures for receiving and handling complaints by
patients, hospitals and health care providers concerning utilization
review; and
8. Procedures to ensure that after a request for medical
evaluation, treatment, or procedures has been rejected in whole or
in part and in the event a copy of the report on said such rejection
is requested, a copy of the report of the personnel performing
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utilization review concerning the rejection s hall be mailed by the
insurer, postage prepaid, to the ill or injured person, the treating
health care provider, hospital or to the person financially
responsible for the patient ’s bill within fifteen (15) days after
receipt of the request for the report.
B. The Office Board shall pay an annual fee to the Insurance
Commissioner of Five Hundred Dollars ($500.00).
SECTION 5. AMENDATORY 74 O.S. 2021, Sect ion 1306.5, is
amended to read as follows:
Section 1306.5. A network provider facility or physician
contract, or any part or section of it, may be amended at any time
during the term of the contract only by mutual written consent of
duly authorized representatives of the Office of Management and
Enterprise Services Oklahoma Employees Insurance and B enefits Board
and the facility or physician.
SECTION 6. AMENDATORY 74 O.S. 2021, Section 1306.6, is
amended to read as follows:
Section 1306.6. The Director of the Office of Management and
Enterprise Services Oklahoma Employees Insurance and Benefits Board,
in accordance with administering the Medical Expense Liability
Revolving Fund pursuant to Section 746.1 of Title 19 of the Oklahoma
Statutes, shall employ, appoint, or otherwise des ignate the
necessary personnel to carry out the du ties of the fund.
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SECTION 7. AMENDATORY 74 O.S. 2021 , Section 1307.1, is
amended to read as follows:
Section 1307.1. No employee or dependent who participates in an
HMO a health maintenance organization (HMO) through the Oklahoma
Employees Insurance and Benefits Act shall be denied the right of
changing the primary care physician to any other primary care
physician within the HMO. The employee or dependent shall notify
the HMO in writing of any change in the choice of primary car e
physician forty-five (45) days in advance of the change by certified
mail with return receipt requested. Any such c hange in a primary
care physician shall not be su bject to the approval of the HMO, the
Office of Management and Enter prise Services Oklahoma Employees
Insurance and Benefits Board, or state agency.
SECTION 8. AMENDATORY 74 O.S. 2021, Section 1308.1, is
amended to read as follows:
Section 1308.1. (1) An educational entity may extend the
benefits of the health insur ance plan, the dental insurance plan,
and the life insurance plan to education employees employed by the
entity. The benefits of the plans for an education employee shall
be the same and shall in clude the same plan options as would be made
available to a state employee participating in the plan that resided
at the same location. Notwithstanding th e provisions of Section
1308.2 of this title, a period shall exist for enr olling education
entities from April 1, 1989, through October 1, 1991, whereby
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education employees of a participating education entity may be
enrolled, pursuant to this act Section 1308.2 of this tit le, during
the entities’ initial enrollment period, regardless of preexisting
conditions. The Office of Management and Enterprise Services
Oklahoma Employees Insurance and B enefits Board shall adopt rules
and regulations for enrollment by which education entities may apply
to participate in the insurance plans. On ce an education entity
becomes a participant in the health and dental insurance pla ns
offered through the Oklahoma Employees Insurance and Benefits Act,
the education entity may withdraw from parti cipation, in a manner
prescribed by the Office Board. If a school district is
participating in the health and dental i nsurance plans pursuant to
the Oklahoma Employees Insurance and Benefits Act, S ections 1301
through 1329.1 of this title, the employees of the school district
who are eligible to participate in the heal th and dental plans, at
such time as the school district may withdraw from su ch
participation, may require the board of education of the school
district to call an election to allow the emplo yees to vote as to
whether the school dis trict shall continue participation in the
health and dental insurance plans of fered through the Oklah oma
Employees Insurance and Benefits Act. Upon the fili ng with the
board of education of a petition calling for such an election which
is signed by no less than thirty percent (3 0%) of the eligible
employees of the school district, the board of education shall call
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an election for the purpose of determining whether the school
district shall continue participation in the health and dental
insurance plans offered through the Oklahoma Employees Insurance and
Benefits Act. The election shall be held within th irty (30) days of
the filing of the petition. If a majo rity of those eligible
employees voting at the election vote to continue participation in
the health and dental insurance p lans offered through the Ok lahoma
Employees Insurance and Benefits Act, the b oard of education shall
be prohibited from withdrawing the school district from such
participation. If a majority of those eligible employees voting at
the election vote against continued participation in the health and
dental insurance plans offered thro ugh the Oklahoma Employees
Insurance and Benefits Act, t he board of education of the school
district shall apply to discontinue such participation within thirty
(30) days of the election and within the time s the school district
is authorized to withdraw fr om participation in accordance with
rules established for withdrawal by the Office Board.
(2) Except as otherwise provided in this subsection, when an
education entity participates in the health and dental insurance
plans offered through the Oklahoma Empl oyees Insurance and Benefits
Act, all employees shall be advised of Health Maintenance
Organizations health management organizations prepaid plans
available as an alternative to the state self -insured health
insurance plan. Eligible part -time education employees, at the
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option of the employee, may enroll in the plans either at the t ime
the education entity begins participati on in the plans or, if later,
upon a showing of insurability to t he satisfaction of the Office
Board.
(3) Any employee of an educatio n entity participating in the
health and dental insurance plans offered through the Okla homa
Employees Insurance and Benefits Act wh o is employed after the
education entity began said such participation may be enrolled in
the health and dental insurance pl ans or HMO health maintenance
organization (HMO) plans approved by the Office Board on the first
day of the second month of employment.
(4) Upon initial enrollment of an institution of higher
education to participate in the healt h and dental insurance plans
offered through the Oklahoma Employees Insurance and Benefits Act,
all individuals presently insured by said the institution’s present
group health insurance plan shall become enrolled in said the state
plans for the remaining period of said the institution’s contractual
liabilities.
(5) Education employees who shall be absent fr om the teaching
service because of election or appointment as a local, state, or
national education association officer shall be allowed to retain
coverage pursuant to the Oklahoma Employees Insurance and Benefits
Act upon the payment of the full cost of the coverage at the rate
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and under such terms and conditions esta blished by the Office or
Board.
(6) Except as otherwise provided by law, an educational entity
may cease to participate in the Oklahoma Employees Ins urance and
Benefits Act but provide health insurance coverage throu gh another
insurance carrier. The subsequent carrier shall provide coverage to
the employees of the educational entity who terminated emp loyment
with a retirement benefit, with a vested benefit, or who have ten
(10) or more years of service with a participating educational
entity but did not h ave a vested benefit through t he retirement
system of the educational entity, if the election to retain h ealth
insurance coverage was made within thir ty (30) days of termination
of employment. Coverage shall also be provided to the eligible
dependents of the employees if an election to retain coverage is
made within thirty (30) days of termination of e mployment.
SECTION 9. AMENDATORY 74 O.S. 2021, Section 1309, is
amended to read as follows:
Section 1309. A. Any eligible employe e may elect to have a
dependent or dependents of the emp loyee covered by the Health
Insurance Plan health insurance plan and Dental Insurance Plan
dental insurance plan or by any available Health Maintenance
Organization health maintenance organization (HMO) approved by the
Office of Management and Enterprise Services Oklahoma Employees
Insurance and Benefits Board. The employee may elect to cover all
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dependent children and no t elect to cover the spouse of the
employee. Such election shall be made at the time the employee
becomes enrolled in the Plan plan, under such procedures as the
Office Board may establish. If dependent coverage is not elected or
if the employee elects to cover all depen dent children and not the
spouse of the employee at the time an employee becomes enrolled in
the Plan plan, dependent coverage or coverage for the spouse cannot
be elected until the next enrollment period or until a qualifying
event has occurred as established by the Office Board. Such
subsequent election of dependent coverage shall be made under such
conditions as the Office Board may impose. If elec ting not to cover
the spouse, the employee shall submit a statement signed by both the
employee and the spouse acknowledging their choice not to provide
insurance coverage for the spouse under the Health Insurance Plan
health insurance plan and Dental Insurance Plan dental insurance
plan or approved HMO plans.
B. Any employee with dependent coverage, as provided in this
section, who has a change in the number of dependents may at the
time of such change increase or decrease th e number of dependents
covered by the Health Insurance Plan health insurance plan and
Dental Insurance Plan dental insurance plan or approved HMO plans,
under procedures established by the Office Board.
C. Any employee who has no eligible dependents at the time the
employee becomes enrolled may elect dependent coverage at the time
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the dependency status of the employee changes under procedures
established by the Office Board.
SECTION 10. AMENDATORY 74 O.S. 2021, Section 1310.1, is
amended to read as follows:
Section 1310.1. A. If a certified employee elects health care
coverage under a plan offer ed by a school district, including a plan
offered by the Office of Management and Enterprise Services Oklahoma
Employees Insurance and Benefits Board or a self-insured plan
offered by the school district, then a school district shall pay no
less than one hundred percent (100%) of the premium amount for the
HealthChoice (HI) option plan for an individual offered by the
Office of Management and Enterprise Services.
The amount a school di strict is required to pay pursuant to this
subsection shall be reduced by the flexible benefit allowance
provided for in Section 26 -105 of Title 70 of the Oklahoma Statutes.
B. The premium for education entities that parti cipate in the
health and dental insurance pla ns offered through the Oklahoma
Employees Insurance and Benefits Act shall be the same as paid by
state agencies for said such plans.
C. All education entities that participate in the insurance
plans offered through the Oklahoma Employees Insurance and Benefits
Act shall forward the appropriate premiums for each employe e to the
Office no later than the tenth day of each month following the month
for which payment is due. Nothing shall prohibit a school district
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from forwarding appropriate premiums to the Office Board prior to
the month for which payment is due.
SECTION 11. AMENDATORY 74 O.S. 2021, Sectio n 1310.2, is
amended to read as follows :
Section 1310.2. A school district shall pay fifty percent (50%)
of the cost of the indiv idual health care premium amount for school
district employees who are not otherwise covered pursuant to Section
1310.1 of this title or Section 26 -105 of Title 70 of the Oklahoma
Statutes, if such employee elects health care coverage under a plan
offered by a school district, including a plan offered by the Office
of Management and Ente rprise Services Oklahoma Employees Insuranc e
and Benefits Board or a self-insured plan offered by the school
district.
SECTION 12. AMENDATORY 74 O.S . 2021, Section 1312, is
amended to read as follows:
Section 1312. (1) Except as otherwise provided by law, all
employee and employer contributions, appropriations and dividend
payments related to the health and dental plans administered by the
Director of the Office of Management and Enterprise Services
Oklahoma Employees Insurance and B enefits Board shall be deposited
in a fund in the State Treasury which is hereb y created and which
shall be known as the Health and Dental Insurance Reserve Fund
“Health and Dental Insurance Re serve Fund”. The money in such fund
shall be invested by the Oklahoma Employees Insurance and Benefits
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Board in the manner specified in Section 1305.1 of this title.
Investment income of the fund shall be added to the fund. Money
payable to the claims administrator and all expenses in connection
with the plans shall be paid from the fund. The Board shall have
responsibility for management of the fund.
(2) All monies in the Health and Dental Insurance Reserve Fund
that are reserves for the life insurance plan admi nistered by the
Office Board shall be transferred to the Life Insura nce Reserve Fund
on July 1, 1989.
SECTION 13. AMENDATORY 74 O.S. 2021, Section 1314.3, is
amended to read as follows:
Section 1314.3. (1) All otherwise eligible employees hired by
the Oklahoma Employment Security Commission after the effective date
of this act May 30, 1990, shall participate in the State Plan and
shall not be entitled to the supplementa l health insurance for which
provision is made in this act Section 1314.2 et seq. of this title
nor to any other Commission benefit plan not generally available to
state employees, and no other provisions of this act Section 1314.2
et seq. of this title shall apply to such future hir ees.
(2) All otherwise eligible Commission employees not
participating in the Agency Plan as of the effective date of this
act May 30, 1990, shall be enrolled in the State Plan on July 1,
1990. Said The nonparticipating Commission employees shall not be
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entitled to the supplemental health insurance for which provisio n is
made in this act Section 1314.2 et seq. of this title .
(3) All Commission employees, retirees and dependents
participating in the Agency Plan as of the effective date of this
act May 30, 1990, shall be permitted to transfer to the State Plan
and receive the supplemental insurance benefits for which provision
is made in Section 131 4.4 of this title at such time as the
supplemental insurance is available. If not sooner transferred, all
Agency Plan participants shall be transferred to the State Plan on
January 1, 1991. Such mandatory transfer shall occ ur simultaneously
with any cancellation by the insurance provider of the Agency Plan,
occurring prior to January 1, 1991.
(4) All Commission employees, retirees and dependents enrolling
in or transferring to the St ate Plan under the provisions of this
section shall be given the opportu nity to participate in all options
under the State Plan at the time of their enrollment or transfer.
(5) For active employees of the Commission, the Commission
shall pay the same monthly p remium toward employee -only coverage as
that set by the Office of Management and Enterprise Services
Oklahoma Employees Insurance and B enefits Board and paid by the
other state agencies participating in the state health insurance
program. For retirees of the Commission who retired pursuant to the
provisions of the Oklaho ma Public Employees Retirement System, the
Oklahoma Public Employees Retirement System shall pay the same
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monthly contribution towards premiums for regular or Medicare
supplement health ins urance coverage for those retirees a s the
amount paid towards the premiums for the Oklahoma Public Employees
Retirement System retirees from other ag encies. For retirees of the
Commission who retired under the pr ovisions of another retirement
plan, the Commission shall pay the same monthly contribution towards
premiums for regular or Medicare supplement health insurance
coverage for those retirees as the amount paid towards prem iums by
the Oklahoma Public Employees Retirement System for retirees of
other state agencies.
(6) Except as provid ed in this subsection, employees and
retirees of the Commission, and their dependents, shall be covered
under the dental and life insurance plans provided by the Office of
Management and Enterprise Services Board pursuant to the same
provisions and premiums as apply to the employees and retirees of
other state agencies. Employees and ret irees may elect to keep
their present agency offered life insurance, in addition to the
state life insurance. Any employee who elects t o keep their agency
offered life insurance shall pay the premium for the life insurance
provided pursuant to the Oklahoma Employees Insurance and Benefits
Act. Any Commission retiree who elects to participate in the li fe
insurance program provided pursuant to the Oklahoma Employees
Insurance and Benefits Act shall pay th e premium for such coverage.
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(7) In the event that t he agency offered life insurance plan is
canceled by the insurer offering it, the Commission shall contract
with the Office Board for replacement coverage equal to that los t by
said such cancellation. The Office Board is expressly authorized
and directed to enter into such a contract. The Commission and the
participants shall pay the full actuarial costs and all reaso nable
administrative costs for such coverage. Said The actuarial and
administrative costs shall be divided between the Commission and the
participants in the same ratio as premiums are now divided for the
agency offered life insurance. The Office Board shall maintain
separate reserves for said such coverage. On January 1, 2005, the
Commission shall convert the agency offered life insurance to the
life insurance plans provided by the Office Board pursuant to the
same provisions and premiums as apply to the employees and retir ees
of other state agencies. The Commission may offer eligible
employees an opportunity to voluntarily relinquish their agenc y life
insurance upon a payment to the eligible em ployee, provided funds
exist to do so.
SECTION 14. AMENDATORY 74 O.S. 2021, Sec tion 1314.5, is
amended to read as follows:
Section 1314.5. A. The Oklahoma Employment Security Commission
shall attempt to obtain the supplemental he alth insurance described
in Section 1314.4 of this title through competitive procurement
under The the Oklahoma Central Purchasing Act. If the Commission
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does not obtain such supplemental health insurance in this manner,
it shall contract with the Office of Management and Enterprise
Services Oklahoma Employees Insurance and B enefits Board for such
coverage or the Commission may provide the supp lemental health
insurance through a self -insurance program.
B. If the Commission decides to contract with the Office Board
for the supplemental health insur ance coverage, the Office Board is
expressly authorized and directed to enter into such a contract and
administer the supplemental benefit in such manner to cause the
least disruption to its systems and daily oper ations. The
supplemental benefit does not have to be offered as a supplemental
plan but can be combined with the state plan to be administere d and
actuarially rated as a single plan. If this option is chosen, all
dependents of employees or former employe es currently eligible for
the supplemental health insurance shall be inclu ded in the plan,
regardless of whethe r or not the dependents were previously included
in the plan, and this subsection will prevail over the provisions of
Section 1314.3 of this titl e. The Commission shall pay the full
actuarial cost to be determined by the Office Board and all
reasonable administrative costs for such cov erage, if provided by or
through the Office Board. The Office Board may consider the
utilization experience of th e group participating in the benefit
when calculating the rate for providing the benefit. The Office
Board shall maintain separate reserves for said such coverage.
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C. If the Commission decides to provide supplemental health
insurance through a self -insurance program, the Commission shall be
authorized to contract with a private com pany to provide claims
adjusting services for the supplemental healt h insurance claims
adjusting and processing .
SECTION 15. AMENDATORY 74 O.S. 2021, Section 1315, is
amended to read as follows:
Section 1315. A. Upon application in writing and subject to
any underwriting criteria that may be established by the Office of
Management and Enterprise Services Oklahoma Employees Insurance and
Benefits Board, the Office Board may extend the benefits of the
Oklahoma Employees Insurance an d Benefits Plans to emplo yees who are
employed in positions requirin g actual performance of duty during
not less than one thousand (1,000) hours per year and to all full -
time employees of:
1. Any of the following groups which participate in the
Oklahoma Public Employees Retirement System:
a. county,
b. city,
c. town,
d. public trust for which the state is the primary
beneficiary, or
e. conservation districts; and
2. Any of the following groups:
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a. county hospital,
b. rural water district, including employ ees and board
members,
c. sewer district,
d. gas district,
e. solid waste management district,
f. nonprofit water corporation employees and board
members,
g. conservancy district or master conservancy district
authorized by the provisions of Section 541 of Title
82 of the Oklahoma Statutes,
h. voluntary organization of Oklahoma l ocal government
jurisdictions listed in Section 2003 of Title 62 of
the Oklahoma Statutes including an y council created by
the voluntary organizations,
i. voluntary association desi gnated to administer the
County Government Council as authorized in Section 7
of Title 19 of the Oklahoma Statutes,
j. statewide nonprofit entities representing employees of
the state or employees of local political subd ivisions
who are eligible for insurance benefits authorized by
the provisions of the Oklahoma Employees Insuran ce and
Benefits Act, or
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k. statewide nonprofit entit ies receiving state funds to
provide no cost no-cost legal services to low income
and senior citizens.
B. Applications to partic ipate in the Oklahoma Employees
Insurance and Benefits Plans shall be approv ed by majority action of
the governing body of the groups listed in subsection A of this
section.
C. Groups listed in subsection A of this section part icipating
in the Oklahoma Employees Insurance and Benefits Plans shall pay all
costs attributable to their part icipation. The benefits of said
such plans for a participant provided coverage pursuant to th is
section shall be the same and shall include the same plan options as
would be made available to a state employee participating in the
plan that resided at th e same location. The premium for
participating groups listed in subsection A of this section shall be
the same as paid by state and education employees .
D. Participating groups listed in subsection A of this section
shall not be required to offer dental insurance as defined in
paragraph 11 12 of Section 1303 of this title, or other insurance as
defined in paragraph 12 13 of Section 1303 of this title. However,
if dental insurance or any other insurance is offered, it must be
provided to all eligible employees. If an employee retires and
begins to receive benefits from the Oklahoma Public Employees
Retirement System or terminates service and has a vested bene fit
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with the Oklahoma Public Employees Retirement System, the employee
may elect, in the manner provided in Section 1316.2 of this title,
to participate in the dental insurance plan offered thro ugh the
Oklahoma Employees Insurance and Benefits Act within thirty (30)
days from the date of termination of employment. The employee shall
pay the full cost of the dental insurance.
E. 1. Any employee of a group listed in subsection A of thi s
section who retires or who has a vested benefit pursuant to the
Oklahoma Public Employees Retirement System may begin the health
insurance coverage if the employer of the employee is not a
participant of the Oklaho ma Employees Insurance and Benefits Act and
does not offer health insuran ce to its employees. Such election by
the employee to begin coverage shall be made within thirty (30) days
from the date of termination of ser vice.
2. Any employee of a group listed in subsection A of this
section who retires or who has a vested benefit pursuant to the
Oklahoma Public Employe es Retirement System may begin or continue
the health insurance coverage if the employer of the employee is a
participant of the Oklahoma Employ ees Insurance and Benefits Act and
the election to begin or continue cove rage is made within thirty
(30) days from the date of te rmination of service.
F. Any county, city, town, county hospital, public trust,
conservation district, or rural water, sewer, gas or solid waste
management district, or nonprofit water corporation, any of which of
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the aforementioned group s is not a participating employer in the
Oklahoma Public Employees Retirement System, but which has employees
who are participating in the healt h, dental or life insurance plans
offered by or through the Oklahoma Empl oyees Insurance and Benefits
Act on July 1, 1997, may co ntinue to allow its current and future
employees to participate in such health, dental or life insurance
plans. Participation of such employees may also continue foll owing
termination of employment if the employee has completed at least
eight (8) years of service with a participating employer and such an
election to continue in force is made within thirty (30) days
following termination of employment. Any retiree or terminated
employee electing cover age pursuant to this section shall pay the
full cost of the insurance.
G. An employee of a group listed in paragraph 2 of subsection A
of this section may continue in force health, dental and life
insurance coverage follow ing termination of employment if the
employee has a minimum of eight (8) years of service with a
participating employer and the election to continue in force is made
within thirty (30) calendar days following termina tion of
employment.
H. Notwithstanding other prov isions in this section, an
employer listed in subsection A of this section may cease to
participate in the Oklahoma Employees Insurance and Benefits Act but
provide health insurance coverage for its current and former
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employees through another in surance carrier. The subsequent carrier
shall be responsible for provid ing coverage to the entity ’s
employees who terminated employment with a retirement benefit, with
a vested benefit, or who have eight (8) or more years of service
with a participating employer bu t did not have a vested benefit
through the Oklahoma Public Employees Retiremen t System, if the
election to retain health insurance coverage was made within thirty
(30) days of termination of employment. Coverage shall also be
provided to the eligible dependents of the employees if an election
to retain coverage is made within thirty (30) day s of termination of
employment. Employees who terminate employment from an employer
covered by this paragraph before December 31, 2001, and elect
coverage under the O klahoma Employees Insur ance and Benefits Act,
shall not be required to change i nsurance carriers in the event that
the employer changes its insurance carrier to a sub sequent carrier.
The provisions of this subsection shall become effective Janua ry 1,
2002.
I. Employers pursuant to subsection A of this section who
participate in the Oklahoma Public Employees Retirement System and
who offer health insurance coverage to their active employees, shall
offer health insurance coverage to those employees who reti re from
the employer and also to those employees who terminate employment
and are eligible to elect a vested benefit in the System. Such
employers shall begin offeri ng coverage to such employees on or
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before January 1, 2004. Such employees who wish to continue
coverage shall make an election to retain health insurance c overage
within thirty (30) days of termination of employment. However,
former employees of such employers who have already retired or who
have terminated and are eligible to elect a vested benefit under the
Oklahoma Public Employees Retirement System, during the peri od
beginning January 1, 2002, and ending December 31, 2003, may make an
election to begin participation in the plans offered by the Office
Board on or before December 31, 20 03, in the same manner as other
participating retired or vested members . The employer, assis ted by
the Oklahoma Public Employees Retirement System , shall notify by
October 1, 2003, all members who have either retired from the System
or who are eligible to ele ct a vested benefit in t he System between
January 1, 2002, through December 31, 2003, and who were employed by
an employer listed in subsection A of this section of th e member’s
potential eligibility to participate in such pl ans. Each employer
shall notify the Oklahoma Public Employees Retirement System when an
employee is retiring and makes the election pursuant to this
subsection to continue co verage under a plan offered by such
employer and when an emplo yee terminates employment and is eligible
to elect a vested benefit in the System and such employee elects to
continue coverage under a plan offered by such employer. Such
employer shall also notify the Oklahoma Publ ic Employees Retirement
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System if a retired employee or an employee who is eligible to elect
a vested benefit in the System terminates such continued coverag e.
J. Any group that begins participation in the Oklahoma
Employees Insurance and Benefits Plans after the effective date of
this act May 30, 1990, and that is not composed of state or
education employees must have one hundre d percent (100%)
participation in the hea lth plan offered pursuant to the Oklahoma
Employees Insurance and Benefits Act.
SECTION 16. AMENDATORY 74 O.S. 2021, Section 1315.1, is
amended to read as follows:
Section 1315.1. Upon election and application by the secretary
of a county election board and subject to any underwriting criteria
that may be established by the Office of Management and Enterp rise
Services Oklahoma Employees Insurance and B enefits Board, the Office
Board shall extend the benefits of the Oklahoma Employe es Insurance
and Benefits Plans to the secretary of each county election board,
if the county in which the secretary serves is not participating in
such plans.
SECTION 17. AMENDATORY 74 O.S. 2021, Section 1316.1, is
amended to read as follows:
Section 1316.1. A. Any person who retires or who has elected
to receive a vested benefit under the provisions of the State of
Oklahoma retirement systems or perso ns who are currently drawing
disability benefits under Section 1331 et seq. of this title or who
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meet each and every requirement of the State Employees Disability
Program or the spouse or dependent of any such employee may continue
in force the life insura nce benefits authorized by this act Section
1301 et seq. of this title in a face amount of not less than one -
fourth (1/4) of the basic life insurance amount, if such election to
continue in force is made wi thin thirty (30) days from the time of
severance. Persons electing to continue in force life insurance
benefits shall pay the full cost of the life insurance and under
such terms and conditions as established by the Office of Management
and Enterprise Services Oklahoma Employees Insurance and B enefits
Board. Further, any such retiree may continue in force any
additional life insurance that was purchased prior to ret irement at
an actuarially adjusted rate and under such terms and conditions as
established by the Office Board.
Effective January 1, 2002 , nonvested employees may also continue
their life insurance benefits as prov ided in this section following
termination of employment, if the employee has completed at least
eight (8) years of service with an employe r participating in the
Oklahoma Public Emplo yees Retirement System or at least ten (10)
years of service with an employer participating in the Teachers ’
Retirement System of Oklahoma. The election to continue the
employee’s life insurance in force m ust be made within th irty (30)
days after the date of termination.
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B. Any retired employee who is receiving a benefit or
terminates employment with a vested benefit from the Teachers ’
Retirement System of Oklahoma and who becomes enrolled in the health
insurance plan offered by the Oklahoma Employees Ins urance and
Benefits Act, pursuant to subsection E of Section 5 -117.5 of Title
70 of the Oklahoma Statutes, may elect to purchase life insurance
benefits in amounts and at a cost as provided for in this sect ion.
C. In lieu of subsection A of this secti on, any person who
retires or who has elected to receive a vested benefit und er the
provisions of the State of Oklahoma retirement systems and who is
participating in a health insurance plan, the dental insurance plan,
or the life insurance plan offered by the Office Oklahoma Employees
Insurance and Benefits Board, including such persons who are
currently drawing disability benefits under Section 1331 et seq. of
this title or who meet each and every requirement of the State
Employees Disability Program on or before July 1, 1999, or the
spouse of any such person may elect to purchase life insurance
benefits authorized by this subsection in a face amount not to
exceed Fifty Thousand Dollars ($50,000.00). Eligible persons
pursuant to this subsection shall make an election by January 1,
2000, to purchase the life ins urance coverage provided in this
subsection. Life insurance cov erage pursuant to this subsection
shall depend upon providing satisfactory evidence of in surability
for the person who is to be covered. Life insurance coverage,
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pursuant to this subsection, shall be purchased in bloc ks of Five
Thousand Dollars ($5,000.0 0). The premium for such life insurance
coverage shall be at a blended rate and shall be set by the Office
Board. The Office Board shall promulgate rules necessary for the
implementation of the provisions of this subsection.
SECTION 18. AMENDATORY 74 O.S. 2021, Section 1316.2, is
amended to read as follows:
Section 1316.2. A. Any employee, other than an education
employee, who retires pursuant to the provisions of the Oklahoma
Public Employees Retirement System or who has a vest ed benefit
pursuant to the provisions of the Oklahoma Public Employees
Retirement System may continu e in force the health and dental
insurance benefits authorized by the provisions of the Oklah oma
Employees Insurance and Benefits Act, or other employer insu rance
benefits if the employer does not participate in the plans offered
by the Office of Management and Enterprise Services Oklahoma
Employees Insurance and B enefits Board, if such election to continue
in force is made within thirty (30) days from the da te of
termination of service . Except as otherwise provided for in Section
840-2.27I of this title a nd subsection H of this section, health and
dental insurance coverage may not be rei nstated at a later time if
the election to continue in force is declined . Vested employees
other than education employees who have terminated service a nd are
not receiving benefits and effective July 1, 1996, nonvested persons
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who have terminated service with more than eight (8) years of
participating service with a participa ting employer, who within
thirty (30) days from the date of termination of service elect to
continue such coverage, shall pay the full cost of the insurance
premium at the rate and pur suant to the terms and conditions
established by the Office Board. Provided also, any employee other
than an education employee who commences employmen t with a
participating employer on or after September 1, 1991, who terminates
service with such employer on or after July 1, 1996, but who
otherwise has insufficient years of s ervice to retire or terminate
service with a vested benefit pursuant to the provisions of the
Oklahoma Public Employees Retirement System or to elect to continue
coverage as a nonvested empl oyee as provided in this section, but
who, immediately prio r to employment with the participating
employer, was covered as a dependent on the heal th and dental
insurance policy of a spouse who was an active employee other than
an education employee, may co unt as part of his or her cre dited
service for the purpose of dete rmining eligibility to elect to
continue coverage under this section, the time during which the
terminating employee was covered as such a d ependent.
B. 1. Health insurance benefit plans o ffered pursuant to this
section shall include:
a. indemnity plans offered through the Office Board,
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b. managed care plans offered as alternatives to the
indemnity plans offered through the Office Board,
c. Medicare supplements offer ed pursuant to the Oklahoma
Employees Insurance and Benefits Act,
d. Medicare risk-sharing contracts offered as
alternatives to the Medicare supplements offered
through the Office Board. All Medicare risk-sharing
contracts shall be subject to a risk adjustment
factor, based on gene rally accepted actuarial
principles for adverse selection which may occur, and
e. for the Oklahoma Publi c Employees Retirement System,
other employer-provided health insurance benefit pl ans
if the employer does not participate in the plans
offered pursuant to the Oklahom a Employees Insurance
and Benefits Act.
2. Health insurance benefit plans offered pursuant to this
section shall provide prescription drug ben efits, except for plans
designed pursuant to the Medicare Prescription Dru g, Improvement,
and Modernization Act of 2003, for which provision of prescription
drug benefits is optional, and except for plans offered pursuant to
subparagraph e of paragraph 1 of this subsection.
C. 1. Designated public retirement systems shall contr ibute a
monthly amount towards the healt h insurance premium of certain
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individuals receiving benefits from the public retirement system as
follows:
a. a retired employee, other than a n education employee
or an employee who par ticipates in the defined
contribution system administered by the Oklahoma
Public Employees Retirement System on or afte r
November 1, 2015, who is receiving benefits from the
Oklahoma Public Employee s Retirement System after
September 30, 1988, shall have One Hundred Five
Dollars ($105.00), or the premium rate of the health
insurance benefit plan, whichever is less, paid by the
Oklahoma Public Employees Retirement System to the
Board or to another insurance carrier or other
qualified benefits administrator of the employer if
the employer does not participate in the plans offered
by the Office Board in the manner specified in
subsection G of this section,
b. a retired employee or surviving spouse other than an
education employee who is receivi ng benefits from the
Oklahoma Law Enforcement Retir ement System after
September 30, 1988, is under sixty-five (65) years of
age and is not otherwise eligible for Medicare shall
have the premium rate for the health insurance benefit
plan or One Hundred Five Dollars ($105.00 ), whichever
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is less, paid by the Oklahoma Law Enforcement
Retirement System to the Office Board in the manner
specified in subsection G of this section,
c. a retired employee other than an educatio n employee
who is receiving benefits from the Oklahoma Law
Enforcement Retirement System after Se ptember 30,
1988, is sixty-five (65) years of age or older or who
is under sixty-five (65) years of age and is eligible
for Medicare shall have One Hundred Five Dollars
($105.00), or the premium rate of the health ins urance
benefit plan, whichever is less, paid by the Oklahoma
Law Enforcement Retir ement System to the Office Board
in the manner specified in subsection G of this
section, and
d. a retired employee other than an education employee
who is receiving benefits from the Uniform Retirement
System for Justices and Judges after September 30,
1988, shall have One Hundred Five Do llars ($105.00),
or the premium rate of the health insurance plan,
whichever is less, paid by the Unif orm Retirement
System for Justices and Judges to the Office Board in
the manner specified in subsection G of this section.
2. Premium payments made pursuant to this section shall be made
subject to the following conditions:
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a. the health plan shall be authorized by the provis ions
of the Oklahoma Employees Insurance and Benefits Act,
except that if an employer from which an employee
retired or with a vested benefit pursuant to the
provisions of the Oklahoma Public Employees Retirement
System does not partic ipate in the plans authorized by
the provisions of the Oklahoma E mployees Insurance and
Benefits Act, the health plan will be the he alth
insurance benefits o f the employer from which the
individual retired or vested,
b. for plans offered by the Oklahoma Employees Insurance
and Benefits Act, the amount to be paid shall be
determined pursuant to the provisions of this
subsection and shall first be applied in whole or in
part to the prescription drug coverage premium . Any
remaining amount shall be applied tow ard the medical
coverage premium,
c. for all plans, if the amount paid by the public
retirement system does not cover the full cost of the
elected coverage, the individual shall pay the
remaining premium amount, and
d. payment shall be made by the retirement systems in the
manner specified under subsection G of this section.
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D. For any member of the Oklahoma Law Enforce ment Retirement
System killed in the line of duty, whether the member was killed in
the line of duty prior to May 18, 2005, or on or after May 18, 2005,
or if the member was on a disability leave status a t the time of
death, the surviving spouse or dependents of such dec eased member of
the Oklahoma Law Enforcement Retirement System may elect to continue
or commence health and dental insurance benefits, provided t he
dependents pay the full cost of such insurance, and for de aths
occurring on or after July 1, 2002, such election is made within
thirty (30) days of the date of death . The eligibility for the
benefits shall terminate for the survivi ng children when the
children cease to qualify as dependents.
E. Effective July 1, 2004, a retired member of the Oklahoma Law
Enforcement Retirement System who retired from the System by means
of a personal and traumatic injury of a ca tastrophic nature and in
the line of duty and any surviving spouse of such retired member and
any surviving spouse of a member who was ki lled in the line of duty
shall have one hundred percent (100%) of the retired member ’s or
surviving spouse’s health care premium cost, whet her the member or
surviving spouse ele cts coverage under the Medi care supplement or
Medicare risk-sharing contract, paid by the Okla homa Law Enforcement
Retirement System to the Office Board in the manner specified in
subsection H of this secti on. For plans offered by the Office
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Board, such contributions will first be applied in whole or in part
to the prescription drug coverage premium, if any.
F. Dependents of a deceased employee who was on active work
status or on a disability leave at the time of deat h or of a
participating retardant retirant or of any person who has elected to
receive a vested benefit under the Oklahoma Public Employees
Retirement System, the Uniform Retirement System for Justices and
Judges or the Oklahoma Law Enforcement Retirement System may
continue the health and dental insurance benefits in force, provided
the dependents pay th e full cost of such insurance and they were
covered as eligible dependents at the time of such death and such
election is made withi n thirty (30) days of date of de ath. The
eligibility for the benefits shall terminate for the surviving
children when the children cease to qualify as dependents.
G. The amounts required to be paid by the Oklahoma Public
Employees Retirement System, the Uniform Ret irement System for
Justices and Judges and the Oklahoma Law Enforcement Retirement
System pursuant to this secti on shall be forwarded no later than the
tenth day of each month following the month for which payment is due
by the Oklahoma Public E mployees Retirement System Board of Trustees
or the Oklahoma Law Enforcement Retirement Board to the Office
Oklahoma Employees Insurance and Benefits Board for deposit in the
Health, Dental and Life Insurance Reserve Fund or to another
insurance carrier or other administrator of qualified benefits of
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the employer as provided for in subsecti on H of Section 1315 of this
title.
H. Upon retirement from employment of the Board of Regents of
the University of Oklahoma, any person who was or is employed at the
George Nigh Rehabilitation Institute and who transferred employment
pursuant to Section 3427 of Title 70 of t he Oklahoma Statutes, any
person who was employed at the Medical Technology and Research
Authority and who transferre d employment pursuant to Section 7068 of
this title and any person who is a member of the Okl ahoma Law
Enforcement Retirement System pursuant to the authority of Section
2-314 of Title 47 of the Oklahom a Statutes may participate in the
benefits authorized by the provisions of the Oklahoma Employees
Insurance and Benefits Act for retired participants including
health, dental and life insurance benefits, if such election to
participate is made within thirty (30) days from the date of
termination of service . Life insurance benefits for any such person
who transferred employment shall not exceed the c overage the person
had at the time of such transfer . Retirees who transferred
employment and who participate pursuant to this paragraph shall pay
the premium for elected benefits less any amounts paid by a state
retirement system pursua nt to this section.
SECTION 19. AMENDATORY 74 O.S. 2021, Section 1316.3, is
amended to read as follows:
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Section 1316.3. A. Any person who retires pursuant to the
provisions of the Teachers ’ Retirement System of Oklahoma with at
least ten (10) years of creditable service or who has a vested
benefit with at least ten (10) years of creditable service, pursuant
to the provisions of the Teachers ’ Retirement System of Oklahoma may
continue in force the h ealth and dental insurance benefits
authorized by the provisions of the Oklahoma Employees Insuran ce and
Benefits Act if such election to con tinue in force or begin is made
within thirty (30) days from the date of terminat ion of service.
Except as provided in subsection E of Sections 5 -117.5 and 14-108.1
of Title 70 of the Oklahom a Statutes and Section 840-2.27I of this
title and subsection K of this section, health and dental insurance
coverage may not be reinstated at a later time if the election to
continue in force or begin coverage is declined. Vested persons who
have terminated service and are not receiving benefits and effective
July 1, 1996, nonvested persons who have term inated service with
more than ten (10) year s of participating service with a qu alifying
employer, who within thirty (30) days fro m the date of termination
of service, elect to continue such coverage, shal l pay the full cost
of said such insurance premium at the rate and pursuant to the terms
and conditions established by the Office of Management and
Enterprise Services Oklahoma Employees Insurance and Benefits Board.
B. 1. Health insurance benefit plans offered pursua nt to this
section shall include:
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a. indemnity plans offered through the Office Board,
b. managed care plans offered as alternatives to the
indemnity plans,
c. Medicare supplements offered thr ough the Office Board,
d. Medicare risk-sharing contracts offered as
alternatives to the Medicare supplements offered
through the Office Board, and
e. any other employer-provided health insurance benefit
plans if the employer does not participate in the
plans offered pursuant to the Oklahoma Employees
Insurance and Benefits Act.
2. Health insurance benefit plans offered pursuant to this
section shall provide prescription drug benefi ts, except for plans
designed pursuant to the Medi care Prescription Drug , Improvement,
and Modernization Act of 2003, which may o r may not contain
prescription drug benefits, for which provision of presc ription drug
benefits is optional, and except for plans offered pursuant to
subparagraph e of paragraph 1 of this subsection.
C. A retired person who:
1. Is receiving benefits from the Teach ers’ Retirement System
of Oklahoma after September 30, 1988, is under sixty -five (65) years
of age and is not otherwi se eligible for Medicare and pursuant to
subsection A of this section elect s to begin or to continue the
health insurance plan;
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2. Is receiving benefits from the Teachers ’ Retirement System
of Oklahoma after June 30, 1 993, is under sixty-five (65) years of
age and is not otherwise eligible for Medicare a nd participates in a
health insurance plan provided by a participating education employer
of the Teachers’ Retirement System of Oklahoma other than a health
insurance plan offer ed pursuant to the Oklahoma E mployees Insurance
and Benefits Act or an alternat ive health plan offered p ursuant to
the Oklahoma State Employees Benefits Act;
3. Is receiving benefits from the Teachers ’ Retirement System
of Oklahoma after September 30, 1988, made contributions to the
system and is sixty-five (65) years of age or olde r, or who is under
sixty-five (65) years of age and is eligible for Medicare and is a
participant in the Oklahoma Employees Insurance and Benefits Act and
elects coverage under the Medicare supplement offer ed by the Office
Board; or
4. Is receiving benefi ts from the Teachers ’ Retirement System
of Oklahoma after June 30, 1993, made c ontributions to the system
and is sixty-five (65) years of age or older, or who is under sixty -
five (65) years of age and is eligible for Medicare and participates
in a health insurance plan provid ed by a participating education
employer of the Teachers ’ Retirement System of Oklahoma other than a
health insurance plan offered pursuant to the Oklahoma E mployees
Insurance and Benefi ts Act or an alternati ve health plan offered
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pursuant to the Oklahoma State Employees Benefits Act and elects
coverage under the Medicare supplement offered by the Office Board,
shall have the amount determined pursuant to subsection E of this
section, or the premium rate of the health insurance benefit p lan,
whichever is less, paid by the Teachers’ Retirement System of
Oklahoma. If the amou nt paid by the Teachers’ Retirement System of
Oklahoma does not cover the full cost of t he health insurance
premium, the retired person shall pay the remaining amount if the
retired person wants to continue the coverage.
D. The Teachers’ Retirement System shall pay the amount due
pursuant to the provisions of subsection C of this section as
follows:
1. For those individuals participating in plans provided
through the Oklahoma Employees I nsurance and Benefits Act, payment
shall be made to the Office Board pursuant to the provisions of
subsection I of this section; or
2. For those individuals participating in plans provi ded
through a participating education employer of the Teachers’
Retirement System of Oklahoma other than a health insurance plan
offered pursuant to the Oklahoma Employees Insurance and Benefits
Act, payment shall be made to the education employer.
E. Beginning July 1, 2000, the maximum benefit payable b y the
Teachers’ Retirement System of Oklahoma on behalf of a retired
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person toward said the person’s monthly premium for health insurance
shall be determined in accordance with the following schedule:
LESS THAN
25 YEARS BUT GREATER
LESS THAN GREATER THAN THAN 24.99
AVERAGE SALARY 15 YEARS OF 14.99 YEARS OF YEARS OF
USED FOR DETERMINING CREDITABLE CREDITABLE CREDITABLE
RETIREMENT ALLOWANCE SERVICE SERVICE SERVICE
Less than $20,000.00 $103.00 $104.00 $105.00
Less than $30,000.00 but
greater than $19,999.99 $102.00 $103.00 $104.00
Less than $40,000.00 but
greater than $29,999.99 $101.00 $102.00 $103.00
$40,000.00 or greater $100.00 $101.00 $102.00
For plans offered by the Office Board, the amount paid pu rsuant
to this subsection shall first be applied t o the prescription drug
coverage premium, if any. Any remaining amounts shall be applied
towards the medical coverage premium.
F. If a person retires and begins to receive benefits from the
Teachers’ Retirement System of Oklahoma or terminates service an d
has a vested benefit w ith the Teachers’ Retirement System of
Oklahoma, the person may e lect, in the manner provided in subsection
A of this section, to participate in the dental insurance plan
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offered through the Oklahoma Employees Insurance and Benefits Act.
The person shall pay the full cost of the dental insurance.
G. Those persons who are receiving benefits from the Teachers ’
Retirement System of Oklahoma and have health insurance coverage
which on the operative date of this section is being paid by the
education entity from which the person reti red shall make the
election required in s ubsection A of this section within thirty (30)
days of the termination of said the health insurance coverage. The
person making the election shall give the Office Board certified
documentation satisfactory to the Office Board of the termination
date of the other health insurance coverage.
H. Dependents of a deceased education employee who was on
active work status or on a disability leave at the time of death or
of a participating retirant or o f any person who has elected to
receive a vested benefit under the Teachers’ Retirement System of
Oklahoma may continue the health and dental in surance benefits in
force provided said the dependents pay the full cost of such
insurance and they were cove red as eligible dependents at the time
of such death and such election is made within thirty (30) days of
date of death. The eligibility for said such benefits shall
terminate for the surviving children when said the children cease to
qualify as dependents.
I. The amounts required to be paid by the Teacher s’ Retirement
System of Oklahoma pursuant to this section shall be forwarded no
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later than the tenth day of each month f ollowing the month for which
payment is due by the Board of Trustees of the Teacher s’ Retirement
System of Oklahoma to the Office Board for deposit in the Education
Employees Group Insurance Reserve Fund.
J. The Teachers’ Retirement System of Oklahoma shall provide
the Office Board information concerning the employers of retired and
vested members necessary to allow the Office Board to track
eligibility for continued coverage.
K. Upon retirement from employment with the Board of Regents of
the University of Oklahoma, any person who is or was employed at the
George Nigh Rehabilitation In stitute and who transferred employment
pursuant to Section 3427 of Title 70 of the Oklahoma Statutes, any
person who was employed at the Me dical Technology and Research
Authority and who transferred employment pursuan t to Section 7068 of
this title, and any person who is a member of the Oklahoma Law
Enforcement Retirement Sy stem pursuant to the authority of Section
2-314 of Title 47 of the Oklahoma S tatutes may participate in the
benefits authorized by the provisions of the Oklahoma Employees
Insurance and Benefits Act for retired participants, including
health, dental and life insurance benefits, if such election to
participate is made within thirty (30) days from the date of
termination of employment. Life insurance benefits for any such
person who transferred employment shall not exceed the coverage t he
person had at the time of such transfer. Retirees who are persons
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transferred employment and wh o participate pursuant to this
paragraph shall pay the premium for elected benefits l ess any
amounts paid by the retirement system pursuant to this section.
SECTION 20. AMENDATORY 74 O.S. 2021, Section 1317, is
amended to read as follows:
Section 1317. Any legally blind person who is licensed by the
State Department of Rehabilitation Services as a vending sta nd
operator or managing operator shall be eligib le for membership in
the Health Insurance Plan health insurance plan, Dental Insurance
Plan dental insurance pla n and Life Insurance Plan life insurance
plan referred to in the Oklahoma Employees Insurance and Benefits
Act. Enrollment in th e Plan plan shall be optional with each
operator pursuant to the rules prescribed by the Office of
Management and Enterprise Services Oklahoma Employees Insurance and
Benefits Board. Any payments required to be made for enrollees in
the Plan plan shall be payable by the operator in such manner a s may
be determined by the State Department of Rehabilitation Services;
provided, that the Department may, in its discretion, make all o r a
part of such payment s.
SECTION 21. AMENDATORY 74 O .S. 2021, Section 1318, is
amended to read as follows:
Section 1318. No former employee who is reemployed by a
participating entity within twenty -four (24) months after the dat e
of termination of previous employment shall be enrolled in the
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Oklahoma Employees Insurance and Benefits Plan authorized by
Sections 1301 through 1329 .1 of this title, for a greater amount of
life insurance or life benefit than the amount for which the l ife of
the former employee was insured under the plan at the date of
termination of employment, except upon the former employee
furnishing evidence of insurability, satisfactory to the Office of
Management and Enterprise Services Oklahoma Employees Insuran ce and
Benefits Board, and any greater amount of benefit or insurance
provided the employee sh all be at the former employee ’s cost.
SECTION 22. AMENDATORY 74 O.S. 2021, Section 1321 , is
amended to read as follows:
Section 1321. A. The Office of Manageme nt and Enterprise
Services shall have the authority to determine all rates and life,
dental and health benefits for state-sponsored plans. All rates
shall be compiled in a comprehensive Schedule of Benefits . The
Schedule of Benefits shall be submitted to and approved by the
Oklahoma Employees Insurance and Benefits Board for each plan year.
The Schedule of Benefits shall be avai lable for inspection during
regular business hours at the Office of Management and Enterprise
Services. The Office shall have t he authority to annually adjust
the rates and benefits based on claim experi ence.
B. The premiums for such insurance plans offered for the next
plan year shall be established as follows:
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1. For active employees and their dependent s, the Office’s
premium determination shall be made and submitted to the Oklahoma
Employees Insurance and Benefits Board no later than the bid
submission date for health maintenance organizations set by the
Oklahoma State Employees Benefits Council, which shall be set in
August no later than the third Friday of that month; and
2. For all other covered members and dependents, the Office ’s
and the health maintenance organi zations’ premium determinations
shall be no later than the fourth Friday of September.
C. The Office may approve a mid -year adjustment provided the
need for an adjustment is substa ntiated by an actuarial
determination or more current expe rience rating. The only
publication or notice require ments that shall apply to the Schedule
of Benefits shall be those requirem ents provided in the Oklahoma
Open Meeting Act and within this section. It is the intent of the
Legislature that the benefits provided not include cosme tic dental
procedures except for certain orthodontic procedures as adopted by
the Director of the Office of Management and Enterprise Services.
SECTION 23. AMENDATORY 74 O.S. 2021, Section 1323, is
amended to read as follows:
Section 1323. Any person who shall knowingly make any false
statement, or who shall falsify or permit to be falsified any record
necessary for carrying out the in tent of the Oklahoma Employees
Insurance and Benefits Act, Sections 1301 through 1329.1 of this
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title, for the purpose of committing fraud, shall be guilty of a
misdemeanor, and upon conviction shall be punished by a fine not
exceeding Five Thousand Dollars ($5,000.00) o r by imprisonment for
not exceeding one (1) year or b y both the fine and impr isonment.
The Office of Management and Enterprise Services Oklahoma Employees
Insurance and Benefits Board shall have the right to audit
participating employer gro ups to verify eligibility for any member
and/or dependent and may require proof of eligibility upon demand.
SECTION 24. AMENDATORY 74 O.S. 2021, Section 1371, is
amended to read as follows:
Section 1371. A. All participants must purchase at lea st the
basic plan unless, to the extent that it is consistent with federal
law, the participant is a person who has retired from a branch of
the United States mil itary and has been provi ded with health
coverage through a federal plan and tha t participant provides proof
of that coverage, or the participant has opted out of the state ’s
basic plan according to t he provisions in Section 1308.3 of this
title. On or before January 1 of the plan year beginning July 1,
2001, and July 1 of any plan year beginning a fter January 1, 2002,
the Oklahoma Employees Insurance and Benefits Board sha ll design the
basic plan for the ne xt plan year to ensure that the basic plan
provides adequate coverage to a ll participants. All benefit plans,
whether offered by the State and Education Employees Group Insurance
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Board, a health maintenance organization o r other vendors shall meet
the minimum requirements set by the Board for the basic p lan.
B. The Board shall offer health, disability, life and den tal
coverage to all participant s and their dependents. For health,
dental, disability and life coverage, th e Board shall offer plans at
the basic benefit level established by the Board, and in addition,
may offer benefit plans that provide an enhanced level of benefits.
The Board shall be responsible for determining the plan design and
the benefit price for the plans that they offer. Ef fective for the
plan year beginning January 1, 2017, and for each plan year
thereafter, in setting health insurance prem iums for active
employees and for retirees under sixty -five (65) years of age, the
Board shall set the month ly premium for active employees to be equal
to the monthly premium for retirees under sixty-five (65) years of
age; except that the Board may offer retirees under s ixty-five (65)
years of age the opportunity to voluntarily enroll in an alternative
plan of insurance at a rate that is between One Hundred Dollars
($100.00) less than the month ly premium for active employees and up
to One Hundred Dollars ( $100.00) more than the monthly premium for
active employees. Retirees under the age of sixty -five (65) who
enroll in an alternative plan of in surance shall retain the right to
enroll in any other health insurance pla n offered by the Board for
which they might be qualifie d during a subsequent open enrollment
period.
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Nothing in this subsection shall be construed a s prohibiting the
Board from offering additional medical plans, provided that any
medical plan offered to participants shall meet or exceed the
benefits provided in the medical p ortion of the basic plan.
C. In lieu of electing any of the preceding medica l benefit
plans, a participant may elect medical coverage by any health
maintenance organization made availab le to participants by the
Board. The benefit price of any health maintenance organization
shall be determined on a competitive bid basis. Contract s for said
such plans shall not be subject to the provisions of The the
Oklahoma Central Purchasing Act. The Board shall promulgate rules
establishing appropriate competitive bi dding criteria and procedures
for contracts awarded for flexible benefits pla ns. All plans
offered by health maintenance organizations meeting the bid
requirements as determined by the Board shall be accepted. The
Board shall have the auth ority to reject the bid or restrict
enrollment in any health maintenance organization for which the
Board determines the benefit price to be excessive. The Board s hall
have the authority to reject any plan that does not meet the bid
requirements. All bidders shall subm it along with their bid a
notarized, sworn statement as provided by Section 8 5.22 of this
title. Effective for the plan year beginning January 1, 2007, and
for each plan year thereafter , in setting health insu rance premiums
for active employees and for retirees under sixty -five (65) years of
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age, HMOs health maintenance organizations, self-insured
organizations and prepaid plans shall set the monthl y premium for
active employees to be equal to the monthly premium for retirees
under sixty-five (65) years of age.
D. Nothing in this section shall be construed as prohibiting
the Board from offering additional qualified benefit plans or
currently taxable benefit plans.
E. Each employee of a participating employer who meets the
eligibility requirements for participation in the flexible benefits
plan shall make an annual election of benefit s under the plan during
an enrollment period to be held prior to th e beginning of each plan
year. The enrollment period dates will be determined annually and
will be announced by the Board, providing; provided, the enrollment
period shall end no later than thirty (30) days before the beginning
of the plan year.
Each such employee shall make an irrevocable advance elec tion
for the plan year or the remainder thereo f pursuant to such
procedures as the Board shall prescribe. A ny such employee who
fails to make a proper election under the plan shall, neverthel ess,
be a participant in th e plan and shall be deemed to have purchased
the default benefits described in this section.
F. The Board shall prescribe the forms t hat participants will
be required to use in making their elections, and may prescribe
deadlines and other procedures for filin g the elections.
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G. Any participant who, in the first year for which he or she
is eligible to participate in the plan, fails to make a prope r
election under the plan in conformance wit h the procedures set forth
in this section or as prescribed by the Board shall be deemed
automatically to have purchased the default benefits. The default
benefits shall be the same as the basic plan benefits. Any
participant who, after having participated in the plan during the
previous plan year, fails to make a proper el ection under the plan
in conformance with the procedures set forth in this sect ion or
prescribed by the Board, shall be deemed automatically to have
purchased the same benefits which th e participant purchased in the
immediately preceding plan year, exc ept that the participant shall
not be deemed to have elected coverage under the health care
reimbursement account plan or the dependen t care reimbursement
account plan.
H. Benefit plan contracts with the Board, health maintenance
organizations, and other thir d party insurance vendors shall p rovide
for a risk adjustment factor for advers e selection that may occur,
as determined by the Board, based on generally accepted actuarial
principles.
I. 1. For the plan year ending Decembe r 31, 2004, employees
covered or eligible to be covered under the State and Education
Employees Group Insurance Act and the State Empl oyees Flexible
Benefits Act who are enrolled in a health maintenance organization
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offering a network in Oklahoma City, shall hav e the option of
continuing care with a primary care physic ian for the remainder of
the plan year if:
a. that primary care physician was part of a provider
group that was offered to the individual at enrollment
and later removed from the network of th e health
maintenance organization, for reasons other than for
cause, and
b. the individual submits a request in writing to the
health maintenance organization to continue to have
access to the primary care physician.
2. The primary care physician selected by th e individual shall
be required to accept reimbursement for such health care services on
a fee-for-service basis only. The fee-for-service shall be computed
by the health maintenance organization based on the a verage of the
other fee-for-service contracts of the health mainten ance
organization in the local community. The individual shall only be
required to pay the primary care ph ysician those co-payments,
coinsurance and any applicable deductibles in accordance with the
terms of the agreement between the employer and the health
maintenance organization and the p rovider shall not balance bill the
patient.
3. Any network offered in Oklahoma City that is terminated
prior to July 1, 2004, shall notify the health m aintenance
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organization, and Oklahoma Em ployees Insurance and Benef its Board by
June 11, 2004, of the network ’s intentions to continue providing
primary care services as desc ribed in paragraph 2 of thi s subsection
offered by the health maintenance organization to state and public
employees.
SECTION 25. AMENDATORY 74 O.S. 2021, Sectio n 1374, is
amended to read as follows:
Section 1374. A. For the plan year beginning January 1, 2017,
and for each year thereafter, it shall be the res ponsibility of the
Office of Management and Enterprise Services Oklahoma Employees
Insurance and Benefits Board to offer vision plans to participants
during the open enrollme nt period. Providers of pl ans eligible for
selection shall submit information requested by the Office of
Management and Enterprise Services Board. For the plan year
beginning January 1, 2022, and for each year thereafter, t he Office
of Management and Enterprise Serv ices Board shall have the authority
to renew vision plan contracts wit h plan providers for succeeding
one-year terms if the provider had a co ntract for the immediately
preceding year. The Office of Management and Enterprise Services
Board may, at its discretion, require the provider to submit
information including, but not limited to, ra te schedules, contact
information for the plan, policy li mits and applicable deductibles
and billing practices of the plan prior to the renewal. Plans
eligible for selection shall mee t or exceed the following criteria:
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1. Has in place a sta tewide network of at least one hundred
fifty providers. “Providers”, for purposes of this section, means
Optometrists optometrists (OD), Ophthalmologists ophthalmologists
(MD), and Ophthalmologists ophthalmologists (DO) which shall be
counted once regardless of the number of locations where they may
practice. Optical shops and retail optical locations shall not be
listed as providers. The company off ering the vision plan must have
a direct relationship with eac h provider on its panel, and may not
lease, borrow, or otherwise obta in use of a provider p anel from
another company. This would not prevent a company from of fering its
plan through one corporate entity and administering the plan or
provider panel through ano ther legal entity of the same organization
so long as the entity receiving premiums remains legally r esponsible
for the payment of benefits. Providers must be actively engaged in
providing the services offered under the vision plan they represent;
2. Has operated in Oklahoma for at least five (5) years;
provided, that an immediately prior operation in Oklahoma of a
nonsurviving corporation that merges into an affiliated corporation
shall be counted in determining whether the surviving corporation
has operated a plan in Oklahoma for five (5) years;
3. Is properly licensed, registered, certified or author ized to
operate its business in this state by the Insurance Department.
Vision plans must be offered by the company administering the plan,
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not by an agent or third party. A company shall offer only one
vision plan and rate schedule for eac h plan year;
4. Presents accurate product information in a reproduc ible
format not to exceed two pages; and
5. Vision plans must provide an examination, frames and len ses,
and/or contact lenses and some form of indemnified payment to the
contracted providers for each component of the benefits, i.e., the
exam, frames and lenses and/or contact lenses. This does not
eliminate discounted supplementary benefits under a qualified plan,
so long as such benefits pertain to vision care.
B. Any administrative fee s imposed by the Office of Management
and Enterprise Services Board shall be applied equally to all
qualified vision plans. There shall be no additional requirements
imposed on a vision plan other than the proper licensing,
certification or authorization to operate its business by the
Oklahoma Insurance Department.
C. No more than two Oklahoma -based vision care benefits
companies that meet the criteria as specified in subsection A of
this section and no more than two out-of-state vision care benefits
companies that meet the crit eria as specified in subsection A of
this section shall be offered as vendors for enrollment in any state
employee benefit offering. For purpose s of this subsection, an
“Oklahoma-based vision care benefits company ” shall be defined as
follows:
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1. A vision care benefits company that has a home office,
customer service and administra tion located within the State of
Oklahoma this state and is subject to Oklahoma state income taxes;
or
2. A vision care benefits company that has a majority of
ownership interest held either directly or indirectly by residents
of the State of Oklahoma this state and is subject to Oklahoma state
income taxes.
D. In the event the number of vision companies submitting
offerings exceeds the amount permitted under subsection C of this
section, the Office of Management and Enterprise Services Board
shall have the authority to reject excess offerings based upon
failures to meet bid requirements or for providing lesser value for
the State of Oklahoma.
SECTION 26. This act shall become effective July 1, 2024.
SECTION 27. It being immediately necessary for the preservation
of the public peace, healt h or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
59-2-2366 RD 12/13/2023 11:22:15 AM