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ENGROSSED SENATE
BILL NO. 1918 By: Bullard and Jett of the
Senate
and
Sneed of the House
An Act relating to health insurance claims; defining
terms; prohibiting health benefit plans from
disallowing direct payment for covered services;
requiring certain discounted prices to be deemed full
payment; providing direct payment be applied to
deductible and out-of-pocket expense subject to
certain procedures; directing publi cation of certain
procedures on certain website; prohibiting certain
contract terms; providing for codification; and
providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.50 of Title 36, unless
there is created a duplication in numbering, reads as follows:
A. As used in this section:
1. “Health benefit plan” means a health benefit plan as defined
pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes; and
2. “Health care provider” means any physician, dentist,
pharmacist, optometrist, ps ychologist, registered optician, licensed
professional counselor, physical therapist, chiropractor, hospital ,
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or other entity or person that is licensed or otherwise authorized
in this state to furnish health care services.
B. 1. No health benefit plan may prohibit a health care
provider from accepting directly from an enrollee full payment for a
health care service in lieu of submitting a claim to the enrollee ’s
health benefit plan.
2. For purposes of this subsection, the discounted cash price
for services rendered from a health care provider is considered full
payment.
C. Payment for a health care service made pursuant to
subsection B of this section shall be applied toward the enrollee ’s
deductible and annual maximum out -of-pocket expense if the service
is a medically necessary covered service under the health plan.
D. 1. A health benefit plan that is offered, issued, or
renewed in this state shall establish a procedure for enrollees t o
claim credit for any direct payment made for a covered health ca re
service under this section and identify any necessary documentation
to be submitted with a claim for credit.
2. Information about the procedure and necessary documentation
described in paragraph 1 of this subsection shall be readily
available to the enrollee on the health benefit plan ’s website.
E. No requirement of this section may be waived, v oided, or
nullified by contract.
SECTION 2. This act shall become effective N ovember 1, 2024.
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Passed the Senate the 4th day of March, 2024.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2024.
Presiding Officer of the House
of Representatives